Effects of a participatory learning and action programme in women's groups on adolescent girls: a cluster-randomized controlled trial in Bihar, India

Background Adolescence is a critical development period where young people acquire health behaviours, making this a crucial time for interventions targeting health. Participatory learning and action programmes aimed at improving maternal and child health are usually delivered through women's groups but could potentially impact adolescent girls as well, either through their direct participation or through information sharing in the community. Methods We used a cluster-randomized controlled trial to evaluate the impact of a large-scale participatory learning and action programme called Gram Varta on attitudes and health-related knowledge of adolescent girls in rural Bihar. The programme was implemented between 2015 and 2016 by state-supported agencies in women's self-help groups and additionally targeted adolescent girls for programme participation. Using household survey data on almost 700 girls aged 13–19 years, we estimated the community-level intention-to-treat effect of Gram Varta on adolescent girls. Outcomes included female empowerment, outlook on the future, preferences regarding marriage and childbearing, care given by parents, and knowledge and practices regarding reproductive health and contraception. Findings Out of 53 indicators, only one was statistically significantly affected by Gram Varta across specifications, suggesting an increase in the share of girls engaging in unpaid housework by about 12 percentage points. Conclusion Our findings suggest that Gram Varta did not change attitudes and knowledge of adolescent girls on the community-level. This could be due to low participation of girls in programme meetings as well as low levels of information sharing between adults who took part in this programme and adolescent girls.