Adolescent girls, school, hiv, and pregnancy: evidence from Kenya



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Adolescent girls, school, HIV, and pregnancy: evidence from Kenya

  • Michael Kremer, Harvard University
  • Esther Duflo, Pascaline Dupas, Samuel Sinei;
  • Edward Miguel and Rebecca Thornton

Context

  • Poor, rural region in Western Kenya
  • Most children start primary school, but drop out before secondary school
  • Free primary education
  • Teen childbearing (DHS)
    • 16% of 17-year old women have begun childbearing
    • 46% of 19-year old women
  • Two randomized evaluations

Reproductive health programs

  • Teacher training on HIV/AIDS curriculum
    • Government curriculum
    • Limited discussion of condoms
  • Debate on condoms and essay on protecting self against HIV/AIDS
  • Information about HIV age profile (Dupas)
  • Reducing cost of education

Teacher training in HIV/AIDS curriculum

    • No significant/limited impact on knowledge, self-reported sexual behavior, childbearing
    • Increases marriage conditional on childbearing by 6 %

Debate on condoms/ Essay on protecting self

  • No increase in self-reported sexual activity
  • Increases knowledge of and self-reported use of condoms
  • Waiting for childbearing outcomes

Information about age-profile of infection

  • Large gender differences in age profile imply cross-generational sex is key route of infection
  • Girls not aware
  • Information on age profile of infection by gender (delivered by NGO workers)
  • Video

Outcomes

  • Reduces girls’ childbearing by 32%
  • Reduces childbearing with adult men by 65%

Reducing cost of education

    • Primary education is free, but de facto costs (uniforms)
    • School vs. childbearing tradeoff
    • Reduces dropout by 13.5%
    • Increases confidence in girls for saying “No” if partner wants to have sex by 5%
    • Reduces probability of reporting ever having had sex by 13%
    • Reduces teen childbearing by 10%

Targeted merit scholarships

    • Policy challenge: secondary education – how allocate funds
    • Prior to FPE; merit scholarships for girls scoring well in 6th grade exams
    • Girl Scholarship Program (GSP) in two districts in Western Kenya

Girls Scholarship Program

  • Overall incentive effect: test-score gains of 0.14 sd (~6 percentage points)
  • Teacher attendance up
  • Girls with low pre-test scores gain
  • No evidence of weakened intrinsic motivation/gaming
    • Effects persist
  • Heterogeneous program effect by district
    • In successful district: test scores increase 0.25 s.d., gains for boys too, student attendance up
    • In other district: cannot reject zero program impact

Conclusion

  • Cost effective programs exist
  • Jury out?
    • HIV/AIDS education training for new teachers
    • Debates on condoms and essays on protecting self
  • How to expand access to secondary education?

Outcomes of interest

  • HIV education in schools
    • Knowledge and attitudes
    • Condom use
    • Teenage childbearing
    • Marriage
    • Drop-out

HIV education: Improvement in students’ knowledge?

HIV education: Improvement in students’ attitudes?

HIV education: Self-reported sexual behavior

  • HIV education: Childbearing rates

HIV education: Dropout

HIV education: Relative risk information



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