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

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