THE NIA PROJECT: HIGHLIGHTS
FROM THE BASELINE REPORT
Eunice Muthengi, PhD
Emily Farris
Karen Austrian, PhD
August, 31st, 2017
The
Population Council conducts biomedical,
social science, and public
health research. We
deliver solutions that lead
to more effective policies,
programs, and
technologies that improve
lives around the world.
Poverty, Gender, and Youth Program
Policy-orientedresearch and programs that improve the lives of
vulnerable populations,
especially
disadvantaged girls
Background
• The onset of puberty and menarche is a vulnerable time for girls
• According to qualitative studies in Africa, these pressures are exacerbated by:
– girls’ lack of knowledge of their bodies and their rights
– inability to manage puberty and adolescence comfortably due to lack of access to menstrual products
Review of Literature
• No rigorous studies examining combined
interventions as compared to software or
hardware only
• Lack of studies comprehensively
examining impact on both educational
and reproductive health outcomes
Evaluation of The Nia Project
• Evaluation of ZanaAfrica’s Nia Teen interventions implemented by Plan International
• Randomized controlled trial conducted by Population Council
• Funding from Bill and Melinda Gates Foundation through Grand Challenges: Women and Girls at the Center of Development
+
Our business arm develops
feminine hygiene products
and brands designed for women,
by women, creating safe
spaces to learn about health.
Our foundation develops
innovative reproductive health
education solutions designed to
deliver comprehensive support
alongside pads to keep girls
healthy and in school.
ZanaAfrica takes a hybrid social enterprise approach to
adolescent reproductive health support
ZanaAfrica believes the onset of menstruation is the most natural and opportune time to engage girls in sexual and reproductive health and rights (SRHR) education to inform a
range of personal decisions.
Research Questions
• What is the effect of an MHM intervention combining software (reproductive health education) and hardware (sanitary pads) approaches on girls’ well-being and education, versus software or hardware alone?
• What is cost-effectiveness of the combined approach, as compared to either software or hardware approaches alone?
Study Design
• Cluster-randomized controlled trial
• 140 schools in Ganze, Magarini and
Kaloleni
Arm 135 schools 35 schools 35 schools 35 schools
Arm 2 Arm 3 Arm 4
Sanitary Pads
Reproductive Health Ed
Reproductive Health Ed
Control (No intervention)
Sanitary Pads
• Magarini = 44
• Kaloleni = 50
• Ganze = 46
Schools by Sub-
County
Theory of Change
Intervention: Sanitary Pads
• One pack of Nia
Teen pads
distributed monthly
• Underwear
distributed once
per term
Intervention: Reproductive Health
Education
• Reproductive Health Education
– Bi-monthly girls-only sessions conducted in school, led by trained facilitator
– Nia Teen magazine distributed once per term
Timeline
MAY 2017 Baseline survey completed
JUN 2017 Start of intervention
AUG 2017 Baseline report
JUN 2018 Qualitative study
DEC 2018 End of intervention
MAR 2019 Endline survey completed
AUG 2019 Final evaluation report
Baseline Survey
• Baseline survey conducted between January
and April, 2017 in the three sub-counties
• Girls survey with 3,489 girls conducted using
tablets: Ganze (1,149); Kaloleni (1,247);
Magarini (1,093)
• School quality survey to collect information
on school characteristics
Baseline Findings:
Demographic Characteristics
Age and Religion
• The average age of the participants was 14
years
– 5% between the ages of 10 and 11
– 10% between the ages of 19 and 20
• The majority of participants were Christians
(84%), one in eight were Muslims (13%), and
a few reported no religion/other (2.6%)
Parent Survival and Co-Residence
• The majority (82%) of girls reported that both
parents were alive, while 13% had lost a
father, 2% had lost a mother, and 1.4% were
double orphans
• Slightly more than half of girls (56%) were
residing with both parents, a quarter (26%)
with their mother only, 3% with a father only,
and 15% with neither parent
Parents’ Education
17%
23%29%
13%17%
49%
25%
15%
3%7%
0%
10%
20%
30%
40%
50%
60%
No Education Some
Primary
Completed
Primary
Completed
Secondary
Don't Know
Fathers Mothers
Baseline Findings:
Schooling
Mean KCPE Scores by Sub-county
257.5266.6
211.3222.7
205.7222.5
Girls Boys
Ganze Kaloleni Magarini
School Characteristics
• On average, schools have 44 girls and 42
boys enrolled in Class 7, with an average of
46 students per teacher
• The majority of schools report that they
distribute pads to girls (Ganze 89%; Kaloleni
74%; Magarini 93%).
• However, only 57% of schools had pads in
stock on the day of the survey
• On average, schools had 7 functional toilets
for all girls in the school,
• Number of girls per toilet: Ganze=38;
Kaloleni=59; Magarini 57
• About 23% report providing soap but only
9% were observed providing soap for
handwashing on the day of the survey
School Characteristics (cont.)
Schooling Aspirations
• Girls have high educational aspirations:
− 80% aspire to complete college/university, while
− 19% aspire to complete secondary school
• Of those who aspire to complete secondary
school or higher, only 14% did not actually
expect to be able to do so, mainly due to
inability to pay school fees
Schooling Participation
• On average, girls started school at age 7
(range = 4 to 14)
• Average travel time to school was 37 minutes
(range = 0 to 240 minutes)
• Two-thirds had repeated a class (Ganze 74%;
Kaloleni 58%; Magarini 67%)
− Class 7 = 39%; Class 6 = 25%; Class 4 or 5
= 20%
Schooling Participation (cont.)
• About 41% of girls
reported missing school
during the previous term
• Percent missing for each
reason:
− Illness: 73%
− Lack of fees: 11%
− Menstruation: 3%
73%
11%
4%3%
6%
Reasons for Missing School
Illness
Lack of School Fees
Bereavement
Menstruation
Other
Schooling Engagement
98%
91%
85%
96%
39%
It is as important for girls to
complete secondary school as it is for
boys
There is a female teacher who
encourages you to do well in school
Your father approves of you going to
school
Your mother approves of you going to
school
At times , you have so much work at
home you cannot complete
homework
Schooling Engagement (cont.)
95%
35%
18%
93%
97%
You feel comfortable participating in
class
You do not feel confident answering
questions in class
It is difficult for you to pay attention
in class
You always complete your school
work
You believe you are capable of
doing well in school
Key Findings: Schooling
• High educational aspirations despite anticipated
challenges
• Substantial parental approval for education despite
low levels of parental education
Baseline Findings:
Gender Norms and Violence
Gender Norms
41%
51%
26%
59%
Girls should be as independent as
boys
Girls should have the same
opportunities as boys
Girls should be able to move freely
as boys
Boys and girls should be equally
responsible for household chores
Violence• About one-fifth experienced emotional, physical or
sexual violence in the previous year (Ganze 21%;
Kaloleni 21%, Magarini 29%)
• Justification of wife-beating for one of the following
reasons was highest in Magarini (76%) compared to
Ganze 70% and Kaloleni 69%
41%
56%
49%
25%
21%
Goes out without telling him
Neglects the children
Argues with him
Refuses to have sex
Burns the food
Baseline Findings:
Menstruation
Menstruation Experiences• Four out of five participants had begun
menstruating (Ganze 84%, Kaloleni 77%);
Magarini 81%)
• The average age of first menstruation was
13 years, ranging from 9 years to 17 years
• More than a third (38%) of participants had
experienced leaking of blood onto their body
or clothes while at school
First Sources of Information
• The most common
sources of information
regarding
menstruation were:
– Mothers
– Sisters
– Friends
– Teachers
Source
Mother 33%
Sister 31%
Friend 38%
Teacher 39%
Other
Relatives
15%
Other 4%
Menstruation Management
• The main method used to manage
menstruation was disposable sanitary pads
(at school: 98% and at home: 94%)
• Of those who used other methods, 99%
preferred using disposable sanitary pads
• Aside from the main method, other methods
used were old cloths (20%), new cloths (4%),
cotton wool (3%) and others (2%).
55%
22%
71%
17%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Girl buys them Mother School Other
Sources of Materials/Products
Menstruation Management (cont.)
• About 79% of participants reported they do not have enough pads/materials to manage their period comfortably
• Frequency of changing pads/materials:
• None (0.4%)
• Once a day (8%)
• Twice a day (41%)
• Three times a day (42%)
• More than three times a day (8%)
18% 19%
27%
Ganze Kaloleni Magarini
Have enough material
to manage comfortably
Pad Distribution at School• During the first school term of 2017, only half
of participants received sanitary pads at
school (Ganze 60%; Kaloleni 42%; Magarini
60%)
• In the three-month school term, only 19%
received at least three packets:
– One in four received two packets (25%),
– Half received one packet (55%),
– One percent received less than a packet
Menstruation Attitudes/Perceptions
26%
73%
70%
67%
43%
A girl should not feel embarassed if she stains
her dress at school when on her period
It is easy to concentrate in class while on my
period
I feel proud that I have my period
I am uncomfortable in my body when I have
my period
I feel ashamed of my body when I have my
period
Activities Avoided during Menstruation
32%
18%21%
2%
10%
27%
19%
0.4%0%
5%
10%
15%
20%
25%
30%
35%
Playing
games/sports
Interact with
men/boys
Cooking for
family
Going to school
Chooses to Avoid Forbidden
Key Findings: Menstruation• A significant need for products to manage
menstruation still exists, demonstrated by the
large proportion of the girls who report that
they do not have enough pads, and those who
did not receive pads in school in the previous
term
• Girls shared feelings of shame and discomfort
regarding their period that can potentially be
improved by the group meetings and
magazine
Baseline Findings:
Reproductive Health
Reproductive Health Knowledge
• About half of girls know that there is a fertile
period between the menstruation cycle
(Ganze 50%; Kaloleni 46%; Magarini 49%),
• Only 10% correctly identified this time as
halfway between two periods.
Life Skills/ Family Life Education
• More than half of girls (60%) reported that a teacher
covered a topic related to life skills/family life
education in the previous year.
• About 18% received similar education from NGOs or
CBOs
• A third of students received this education once or
twice a month (35%), another third received it less
often (36%), and 29% received it more often
Sexual Behavior• About one out of every eight girls reported
ever having sex (Ganze 10%; Kaloleni 13%;
Magarini 15%) and the average age at first
sex is 12 (range = 7 to 19)
• Of those, about half (52%) did not want to
have sex the first time, and 41% were unsure
• Only 2% of respondent had given birth
• About 19% have engaged in transactional sex
in the past 6 months
Key Findings: Reproductive Health• Substantial room for improvement exists through
the Nia reproductive health education component
to positively affect the girls.
• About a tenth were sexually-experienced, and half
of those reported their first sex as unwanted, so
there is need for content addressing power in
relationships
• Girls who had already initiated sex are in need of
comprehensive education to increase their self-
efficacy on how to prevent exposure to STIs and
unwanted pregnancies
Conclusion
• Findings describe a cohort of school-going
adolescent girls, with high educational
aspirations, but a gap in their competencies
to aid in completion of educational goals
• The Nia Project has the potential to bridge
that gap, providing rigorous evidence to
guide education and health policy in this
area in Kenya and in the region
Acknowledgements
• ZanaAfrica and Plan International
• Kilifi County Department of Education & TSC
• Kilifi County Department of Health
• Ministry of Interior and Coordination of the
National Government
– County Commissioner and Assistant County
Commissioners
– Chiefs and Assistant Chiefs
The Population Council conducts research
and delivers solutions that improve lives
around the world. Big ideas supported by
evidence: It’s our model for global change.
Ideas. Evidence. Impact.