Maja Gavrilovic, UNICEF Office of Research - Innocenti, and Tia Palermo, University at Buffalo
Disclaimer: The views expressed within this Think Piece are those of the author(s)and do not necessarily represent the views of UNICEF. This Think Piece has not been edited to official publication standards and UNICEF accepts no responsibility for errors.
Adolescence is a period of considerable physiological, cognitive, and brain development. It is also a time when key decisions are made related to schooling, skills’ acquisition, partnerships, sexual debut, pregnancy, and marriage, all of which have lasting effects on an individual’s well-being and that of their future children. These decisions and transitions often occur in a context of limited individual autonomy and multidimensional risks that adolescents face, which are often gendered. Adverse coping strategies in response to poverty and other social vulnerabilities may increase boys’ risk of hazardous child labour, or girls’ pressures to engage in transactional sex, or drop out of school to engage in caregiving and domestic activities. These gendered responses to poverty and vulnerability are processes through which gender unequal outcomes occur. For example, adolescent girls face increased risk of HIV infection, early marriage, rates of intimate partner violence (IPV) and sexual violence, and early pregnancy, among others. Many of these adverse outcomes are related to girls’ sexual and reproductive health vulnerability, often compounded by structural barriers to their accessing appropriate healthcare due to social norms, which do not always reflect the reality of girls’ daily situation, autonomy, and capabilities.
In light of these risks, the potential for enhancing adolescents’ capabilities across multiple domains (including economic empowerment, physical capabilities, psycho-social wellbeing, bodily integrity, violence and agency, and education and learning) and therefore facilitating safer, healthier, and more productive transitions to adulthood, has important implications for reducing the inter-generational transmission of poverty, increasing realization of individual rights, and stimulating economic growth. A promising tool in reducing gender vulnerabilities faced by adolescents and facilitating their safe transitions to adulthood is social protection (SP), and cash transfers (CTs) in particular.
What does the evidence say: How do cash transfers contribute to positive gender outcomes for adolescents?
There is an increasing body of evidence examining how social protection, including CTs, improves the broader well-being of adolescents. Any impacts on adolescents of household-targeted transfers must first work at the household level. There is strong evidence on the positive impacts of CTs on household consumption, food security, and productive activities. Through these pathways, impacts on individual well-being across broader domains can occur.
Indeed, the evidence demonstrates positive impacts on school enrolment and reduction in child labour among children and adolescents, while health seeking and related outcomes have largely been studied among young children, with very little evidence on adolescents. Studies also examine whether CTs can improve broader dimensions of well-being, such as protecting against early sexual debut, marriage, pregnancy, violence, and HIV/STI risk, with promising but mixed evidence, often varying by gender and context. For example, there is evidence that Ethiopia’s Productive Safety Net Programme (PSNP) may have delayed early marriage among adolescent girls, as did a non-governmental CT in Malawi. However, studies of government CTs in Kenya, Malawi and Zambia failed to find protective effects on early marriage. In India, a government conditional CT to delay marriage had the unintentional effect of increasing marriage rates upon girls’ turning 18, given the increased availability of resources for dowries. The evidence on social transfers and violence against children and adolescents globally is limited but suggests the potential for protective effects, particularly around exploitation and sexual abuse among adolescent girls.
Turning to sexual debut and risky behaviours, there is evidence that government CTs delayed sexual debut and pregnancy in Kenya and South Africa (among girls but not boys), but not in Malawi or Zambia. There is also evidence that the South African programme reduced transactional sex and age-disparate sex (also among girls but not boys). The evidence on HIV and STI incidence and prevalence comes mainly from behavioural experiments and non-governmental programmes, with target populations that often vary significantly from government social protection programmes, and generally find no reductions in HIV prevalence or incidence (with one exception from Malawi), but some protective effects on other STIs.
Studies from Malawi and Kenya find that CTs improved mental health among adolescents, but there were no impacts in Tanzania, Zambia or Zimbabwe. Furthermore, impacts are often gendered: in Malawi government programming, there were protective impacts on both genders but impacts were stronger among females. However, in Kenya, findings were driven by the male sample. In a non-governmental programme in Malawi, unconditional CTs reduced psychological distress but conditional CTs increased distress among adolescents girls.
Given the differential impacts by gender and context described above, it is likely that gender dynamics--including gender norms, roles, and expectations--moderate the impacts of CTs, however, studies have generally not empirically examined their influence on impacts. Other moderating contextual factors that likely play an important role in the magnitude of effects include quality and accessibility of schools and health facilities, and access to markets, among others.
How can cash transfer design features be used to improve gender outcomes for adolescents?
Overall, the evidence base shows that CTs promote healthy, safe, and productive transitions to adulthood for adolescents, under some circumstances. Programming that intentionally considers adolescent and gender vulnerabilities in their design can help further leverage benefits for stronger and potentially gender transformative effects. However, more research on the effectiveness of different design features is still needed. A brief review of existing programme design characteristics, examining the extent to which they are adolescent- or gender-responsive, can help identify future research priorities. We discuss the following design features of CT programmes, including: targeting; transfer recipient; size; frequency and duration; conditions and messaging; and complementary interventions and linkages (also referred to as ‘Cash Plus’).
1. Targeting criteria and payment recipient
Consideration of adolescent populations and gender in eligibility criteria has important implications on uptake of benefits and potential gender impacts. Numerous CT programmes target poor households with adolescents living in them. While adolescents may not be the primary focus of targeting, such household-targeted programmes may still have important spillover benefits.
A smaller number of programmes directly target households with adolescents and can adopt gender- specific objectives (government programming still generally provides transfers to the head of the household or caregiver). For example, programmes can target households with boys or girls on the basis of their perceived greater vulnerability to specific risks related to gender (e.g., risk of dropout from school, early pregnancy, early marriage, violence prevention, etc.). These programmes can provide an important opportunity to meet adolescents’ practical needs for food, schooling, clothes, and healthcare, as well as boost their strategic position in families, provided that resources are shared equitably and reach adolescent members in the household Programmes which have adolescent-focused objectives may need substantial messaging and communication targeted at community members and caregivers, to ensure households understand programme intent.
Some non-governmental CT programmes have provided transfers directly to school-aged adolescent girls, however this has not yet been implemented in government programming and is likely not a politically feasible, scalable option, except in select settings. This approach aims to recognize adolescents as ‘rights holders’ and increase agency for girls who generally have more limited bargaining power in households compared to boys. Nevertheless, research on the links between cash and women’s empowerment highlights that explicit targeting and/or direct payments to females may not be sufficient to ensure their control over this income. Effects may be moderated by other programme design features, such as transfer size and payment delivery mechanisms, as well as contextual factors, including existing social and gender norms, the nature of family decision-making processes around resource allocations, and girls’ relationship with other members in the household. For example, mobile and/or electronic payments of transfers to clients can be used to improve clients’ control over income, enhance their financial inclusion and access to banking services, and provide greater privacy and discretion over how money is being used compared to plain cash delivery.
Giving cash directly to girls, may also potentially lead to unintended effects, such as risk of economic coercion by other household members, and intra-household conflict resulting from disputes over spending decisions. There is very limited evidence on these dynamics in the households resulting from transfers directed to adolescent girls, due to the limited number of programmes which have done so. Yet, it is important to note that there has been similar speculation that CTs to adult women would create a backlash and put them at increased risk of IPV. However, a global review found that in fact CTs generally reduce women’s exposure to IPV.
Overall, further research is needed to better understand how targeting (both household and individual-level approaches) can be designed to improve gender-equitable outcomes for adolescents, as well as the role that complementary design elements (e.g., electronic payments, messaging and safety provisions) can have in enhancing positive outcomes and minimizing unintended gender effects.
2. Transfer size and payment predictability
Setting benefits at the right levels and maintaining their real value are critical not only for achieving poverty-related outcomes, but also for achieving impacts on broader domains of well-being. Evidence from the Transfer Project generally shows that transfers equivalent to roughly 20% or more of baseline households monthly expenditures are required to improve broader outcomes beyond food security and consumption. Larger transfers can have positive spillover effects on girls, who are often more marginalised in household resource allocations. Recognising the potential benefits of increased transfer amounts to address gendered vulnerabilities among adolescents, some CTs provide top-up payments for households with adolescents enrolled in secondary school grades to promote gender parity in education. For example, a conditional CT in Mexico provides higher transfers for girls, while another in Jamaica provides higher payments for boys to compensate for the higher opportunity costs of their schooling as compared with girls. For older adolescents engaged in economic activities, larger transfers can help offset opportunity costs of engagement in wage labour, allowing them to increase their investments in education and training, as well as build their assets and savings, and strengthen their livelihood potential. These potential effects are particularly significant for girls who often face greater systemic barriers in access to, and control over productive resources, and more limited ability to accumulate assets compared to boys. Finally, predictable and well-timed payments can help households manage shocks and avoid harmful (and typically gendered) coping strategies to which adolescents are vulnerable in times of shocks and stresses, including reduced food intake, child marriage, being hired as domestic help, transactional sex, and hazardous child labour.
3. Conditionalities and messaging
CT programmes often use conditions to encourage participants to increase their investments in health and education. Conditions may also be used to address discriminatory gender roles and harmful practices, such as early marriage. However, there is limited evidence on whether conditions improve outcomes, and with regards to school enrolment, a large review failed to demonstrate significant differences in impacts between conditional and unconditional CTs.
Some studies highlight how ‘soft conditionalities’ and messaging can be just as effective in influencing positive behaviours and incentivizing families to invest in adolescents. For example, CTs in Morocco and Lesotho have used labeling to influence parents’ perceptions about the value of education and/or increase investments in education, leading to positive changes in the perceived returns of education for girls and investments in their education, as well as reductions in time spent on domestic work (in Lesotho). However, messaging which is too broad or gender-neutral may signal the wrong message, inadvertently reinforcing gender stereotypes or encouraging harmful behaviours. For example, this was demonstrated in the Indian conditional CT to delay child marriage, where households misunderstood the cash benefits as a way to supplement girls’ marriage costs rather than as a means for parents to value their daughter. Thus, it is important to consider the limited evidence on the effectiveness of conditions, ethical debates around paternalism, and the administrative burdens of enforcing conditions before promoting them in programming. Likewise, “labeling” and “messaging” efforts need to be well designed and staff need to be properly trained to effectively implement these measures in order to achieve intended results.
4. Complementary ‘Cash Plus’ interventions
Despite broad-ranging benefits, there is increasing recognition that cash alone is not enough to address the multifaceted challenges faced by adolescents to transition to a safe, healthy, and productive adulthood. Some governments are now innovating with integrated programming to leverage impacts for adolescents. Depending on programme objectives, adolescents may be provided direct access to existing complementary health services, such as sexual and reproductive health information and services, treatment and testing for HIV (examples include Tanzania and Zambia) to improve their health capacities, and/or vocational training to improve their employment opportunities and livelihoods (Tanzania provides one example). Case management and the engagement of social welfare workers is also increasingly being used as a mechanism to identify needs and vulnerabilities of adolescents, such as violence or early marriage, and to facilitate referrals to corresponding services (examples can be found in Ethiopia and Mozambique).
A key factor for the success of these complementary components and services is supply-side availability and quality, including schools and health facilities, and livelihood opportunities/access to markets. Other factors, which can influence CT effectiveness, include structural gender barriers (i.e. discriminatory norms and customs), which may be addressed through anti-discrimination legislation and behaviour change communication and media campaigns. To date, evidence on the effectiveness of the cash plus programming is very limited, and more research is needed.
Conclusion and areas for future research
CTs and integrated social protection programming can play an important role in shaping gender outcomes for adolescents, and subsequently facilitating safe, healthy and productive transitions to adulthood. However, in order to leverage the full potential of SP for these ends, more research is needed to understand the most effective programme design components and combinations of integrated programming. Some specific research questions for future consideration include the following:
- How do current SP programmes address gender-related vulnerabilities and facilitate safe transitions to adulthood, including impacts over the long-term and after programme support ends?
- What contextual factors moderate the impacts for adolescents of SP programming (e.g., gender norms, access to training, access to markets, financial inclusion)?
- How can programme design features (including transfer size and frequency, predictability and payment methods, and social accountability mechanisms, such as grievance mechanisms, among others) and additional measures and linkages be designed in a gender-transformative way to boost positive results for adolescent girls and boys?
- What are the trade-offs and unintended consequences of using conditions to influence behaviours through CT programming? Can the same positive effects be achieved through more rights-based measures, such as messaging or sensitization?
- What are the innovative evaluation methods that can be used to capture and measure the wellbeing and empowerment outcomes (including mental health, psychological wellbeing, autonomy, self-efficacy, confidence, life satisfaction, cognitive capacity) of adolescent girls and boys?
- To what extent can social protection address discriminatory gender norms, and through what pathways? Is social protection really the best (and cost effective) mechanism to address discriminatory norms and practices?
Efforts to answer these questions could move policy initiatives towards increased gender- and adolescent-responsive programming.