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      Community-based empowerment program to delay marriage: Results from the More Than Brides Alliance intervention in India, Malawi, Mali and Niger

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          Abstract

          The More Than Brides Alliance (MTBA) implemented an intervention in India, Malawi, Mali and Niger from 2017 to 2020. The holistic community-based program included girls’ clubs focused on empowerment and sexual and reproductive health knowledge; work with parents and educators; community edutainment events; and local-, regional-, and national-level advocacy efforts related to child marriage. Using a cluster randomized trial design (India and Malawi), and a matched comparison design (Niger and Mali), we evaluated the effectiveness of the program on age at marriage among girls ages 12–19 in intervention communities. Repeat cross sectional surveys were collected at baseline (2016/7), midline after approximately 18 months of intervention (2018), and endline (2020). Impact was assessed using difference-in-difference (DID) analysis, adjusted for the cluster design. We find that the intervention was successful at reducing the proportion of girls ages 12–19 married in India (-0.126, p < .001). Findings in the other countries did not show impact of the intervention on delaying marriage. Our findings suggest that the MTBA program was optimized to succeed in India, in part because it was built on an evidence base that relies heavily on data from South Asia. The drivers of child marriage in India may be substantially different from those in Malawi, Mali, and Niger and require alternate intervention approaches. These findings have implications for those designing programs outside of South Asia and suggest that programs need to consider context-specific drivers and whether and how evidence-based programs operate in relation to those drivers.

          Trial registration: This work is part of an RCT registered August 4, 2016 in the AEA RCT registry identified as: AEAR CTR-0001463. See: https://www.socialscienceregistry.org/trials/1463.

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          Barriers to the utilization of maternal health care in rural Mali.

          This study used data from the 2001 Demographic and Health Survey and multilevel logistic regression models to examine area- and individual-level barriers to the utilization of maternal health services in rural Mali. The analysis highlights a range of area-level influences on the use made of maternal health services. While the dearth of health facilities was a barrier to receipt of prenatal care in the first trimester, transportation barriers were more important for four or more prenatal visits, and distance barriers for delivery assistance by trained medical personnel and institutional delivery. Women's odds of utilizing maternal health services were strongly influenced by the practices of others in their areas of residence and by living in close proximity to people with secondary or higher education. Household poverty and personal problems were negatively related to all outcomes considered. The results highlight the importance of antenatal care and counseling about pregnancy complications for increasing the likelihood of appropriate delivery care, particularly among women living 15-29 km from a health facility. Area-level factors explained a greater proportion of the variation in delivery care than in prenatal care However, significant area variation in the utilization of maternal health services remained unexplained.
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            What works to prevent child marriage: a review of the evidence.

            This article reviews 23 child marriage prevention programs carried out in low-income countries and employing a range of programmatic approaches and evaluation strategies. We document the types of child marriage programs that have been implemented, assess how they have been evaluated, describe the main limitations of these evaluations, summarize the evaluation results, and make recommendations to improve future prevention efforts. The evidence suggests that programs offering incentives and attempting to empower girls can be effective in preventing child marriage and can foster change relatively quickly. Methodological limitations of the reviewed studies, however, underscore that more needs to be learned about how the programs prevent child marriage and whether impact is sustained beyond program implementation. © 2012 The Population Council, Inc.
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              Interventions to Prevent Child Marriage Among Young People in Low- and Middle-Income Countries: A Systematic Review of the Published and Gray Literature.

              Child marriage, defined as marriage before the age of 18 years, is a human rights violation that can have lasting adverse educational and economic impacts. The objective of this review was to identify high-quality interventions and evaluations to decease child marriage in low- and middle-income countries. PubMed, Embase, PsycInfo, CINAHL Plus, Popline, and the Cochrane Databases were searched without language limitations for articles published through November 2015. Gray literature was searched by hand. Reference tracing was used, as well as the unpacking of systematic reviews. Retained articles were those that were evaluated as having high-quality interventions and evaluations using standardized scoring. Eleven high-quality interventions and evaluations were abstracted. Six found positive results in decreasing the proportion married or increasing age at marriage, one had both positive and negative findings, and four had no statistical impact on the proportion married or age at marriage. There is wide range of high-quality, impactful interventions included in this review which can inform researchers, donors, and policy makers about where to make strategic investments to eradicate marriage, a current target of the Sustainable Development Goals. Despite the cultural factors that promote child marriage, the diversity of interventions can allow decision makers to tailor interventions to the cultural context of the target population.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: Data curationRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                14 April 2023
                2023
                : 18
                : 4
                : e0281413
                Affiliations
                [1 ] Population Council, New York City, NY, United States of America
                [2 ] Independent Consultant, New York City, NY, United States of America
                [3 ] Population Council India, New Delhi, India
                [4 ] Centre d’Études et de Recherche sur l’Information en Population et Santé, Bamako, Mali
                [5 ] Invest in Knowledge Initiative, Zomba, Malawi
                [6 ] Laboratoire d’Études et de Recherche sur les Dynamiques Sociales et le Développement Local, Niamey, Niger
                IIPS: International Institute for Population Sciences, INDIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                ‡ These authors also contributed equally to this work

                Author information
                https://orcid.org/0000-0002-8271-858X
                https://orcid.org/0000-0003-1073-5951
                Article
                PONE-D-22-13808
                10.1371/journal.pone.0281413
                10104334
                37058509
                56925593-459d-439b-912d-6a72e5dc5575
                © 2023 Melnikas et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 11 May 2022
                : 24 January 2023
                Page count
                Figures: 5, Tables: 3, Pages: 16
                Funding
                Funded by: The Ministry of Foreign Affairs of the Netherlands
                Award ID: MINBUZA − 2016.55195
                Award Recipient :
                Funded by: The Ministry of Foreign Affairs of the Netherlands
                Award ID: MINBUZA − 2016.55195
                Award Recipient :
                Funded by: The Ministry of Foreign Affairs of the Netherlands
                Award ID: MINBUZA − 2016.55195
                Award Recipient :
                Funded by: The Ministry of Foreign Affairs of the Netherlands
                Award ID: MINBUZA − 2016.55195
                Award Recipient :
                The Ministry of Foreign Affairs of the Netherlands ( https://www.rijksoverheid.nl/) provided a grant to Save the Children Netherlands, the lead intervention partner (MINBUZA − 2016.55195); Population Council was the research partner and received funds to support this work (SA, AM, NP, GS). The funders has no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                People and Places
                Geographical Locations
                Asia
                India
                People and Places
                Geographical Locations
                Africa
                Mali
                People and Places
                Geographical Locations
                Africa
                Niger
                People and Places
                Geographical Locations
                Africa
                Malawi
                People and Places
                Population Groupings
                Age Groups
                Children
                Adolescents
                People and Places
                Population Groupings
                Families
                Children
                Adolescents
                Research and Analysis Methods
                Research Design
                Survey Research
                Surveys
                Social Sciences
                Sociology
                Education
                Schools
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
                Custom metadata
                The dataset is publicly available via the Population Council Dataverse, at the following link: https://dataverse.harvard.edu/dataset.xhtml?persistentId=doi:10.7910/DVN/ZOCVAD.

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