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Study Overview

Impact Evaluation of CARE’s Inspiring Married Adolescent Girls to Imagine New Empowered Futures (IMAGINE) Project
Study is 3ie funded:
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Pregnancy and childbirth are leading causes of mortality among adolescent girls under the age of 20 in low-income countries. Moreover, young mothers and their children face social disadvantages such as low educational attainment, low labor participation and perpetuation or deepening of socioeconomic hardship in both the short and long term. The risk of early childbearing is so great, that delaying birth by even one to two years is associated with improved socioeconomic and health benefits for mothers and their children. To understand how best to address the issue of early pregnancy among married adolescent girls (MAGs), CARE is testing the effectiveness of a holistic intervention package in Bangladesh and Niger designed to support adolescent girls to delay the timing of first birth after marriage.

Registration Citation:

Grant, C. and Laterra, A., 2019. Impact Evaluation of CARE’s Inspiring Married Adolescent Girls to Imagine New Empowered Futures (IMAGINE) Project. Registry for International Development for Impact Evaluations (RIDIE). Available at: 10.23846/ridie176

Health, Nutrition, and Population
Additional Keywords:
Longitudinal, Adolescents, Sexual Health, Reproductive Health
Secondary ID Number(s):
OPP1158727 2018

Principal Investigator(s)

Name of First PI:
Carolyn Grant
CARE International
Name of Second PI:
Anne Laterra
CARE International

Study Sponsor

The Bill and Melinda Gates Foundation
Study Sponsor Location:
United States

Research Partner

Name of Partner Institution:
Mitra and Associates in Bangladesh, The OASIS Initiative in Niger, Far Harbor in United States
Type of Organization:

Intervention Overview


CARE has launched a project to design and test interventions that hold promise for delaying the timing of first birth among married adolescents in Niger and Bangladesh. The foundational approach of this intervention consists of Girls’ Collective groups that serve as platforms to share information, create social support and build skills. Participants in these Girls’ Collectives will also be linked to vocational training and income generating opportunities in adolescent-friendly sectors identified during the formative research and design phase. In both countries the intervention also includes transformative work with health workers designed to build their counseling skills and challenge harmful norms, values and beliefs. In Niger these components are complemented by men’s social groups (Fada groups), participatory community dialogues. Couples Counseling is an additional component in Bangladesh.

Theory of Change:

The underlying theory of change suggests that for adolescent girls to successfully delay their first birth they must be equipped at an individual level with the skills, capabilities and assets needed to envision alternative futures to early motherhood and act on that vision. Girls also need the families, communities and systems (economic, and health) that surround them to supportive of their ability to exercise their rights and make decisions about their lives. At the individual level, activities (girls’ collectives and training) will serve to enhance girls’ social support and access to information and build skills in decision-making, goal setting, planning, communication and negotiation. Vocational training opportunities build financial literacy and entrepreneurship skills. At the community level CARE will engage those that play a pivotal role through couples counseling activities and community dialogues, these opportunities to come together to identify and interrogate norms and beliefs that limit girls’ agency and perpetuate early first births are necessary in order to create more support family and community environments. IMAGINE also aims to effect system-level change by ensuring health systems are better able to respond to the family planning needs of adolescents and that economic systems over feasible income generating opportunities.

Multiple Treatment Arms Evaluated?

Implementing Agency

Name of Organization:
CARE International
Type of Organization:
NGO (International)

Program Funder

Name of Organization:
The Bill and Melinda Gates Foundation
Type of Organization:

Intervention Timing

Intervention or Program Started at time of Registration?
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Evaluation Method

Evaluation Method Overview

Primary (or First) Evaluation Method:
Other (specify)
Other (not Listed) Method:
Survival Analysis with time-to-first birth as the outcome event
Additional Evaluation Method (If Any):
Other (not Listed) Method:

Method Details

Details of Evaluation Approach:

The study employs a prospective cohort design with longitudinal follow-up. Following purposive assignment of villages to intervention or treatment condition based on operational and geographic constraints, a household sample of nulliparious female adolescents between 15 and 19 years of age will be selected from both treatment and control communities. Through a household survey, baseline data will be collected to confirm eligibility and allow for matching of treatment and control samples at the time of analysis on characteristics such as religion, ethnicity, literacy, or distance from health facility, observed prior to exposure to the intervention. The two samples will then be re-surveyed three years post-baseline to assess birth outcome.

Outcomes (Endpoints):

Primary outcome: Time from marriage to first birth. Secondary outcomes: contraceptive use, unmet need for family planning, satisfaction with SRHR / FP services, receipt of FP counseling services, knowledge of pregnancy risk, knowledge of fertile period, knowledge of key SRHR topics, self-efficacy, self-esteem, social capital, mobility, decision making authority, income, financial savings, financial decision making authority.

Unit of Analysis:
Unit of analysis will be individual adolescent aged 15-19; nulliparous at time of baseline data collection in intervention and comparison villages

The implementation of the IMAGINE intervention extends the interval between marriage and first birth by a minimum of 6 months in the intervention villages as compared to the comparison villages. 2. The implementation of the IMAGINE intervention increases use of FP methods among adolescent girls and their partners in the intervention villages 3. The implementation of the IMAGINE project increases key skills, assets, and capabilities (ex: self-confidence, self-efficacy, negotiation, budget, financial resources, decision making) among adolescent girls in the intervention villages.

Unit of Intervention or Assignment:
Number of Clusters in Sample:
With villages as the cluster, there are 85 in Niger and 90 in Bangladesh.
Number of Individuals in Sample:
3250 individuals in Bangladesh. 2750 individuals in Niger.
Size of Treatment, Control, or Comparison Subsamples:
Bangladesh: 35 clusters in treatment with 1623 observations (obs.), 55 clusters in control with 1627 obs. Niger: 41 clusters in treatment with 1370 obs., 44 clusters in control with 1380 obs.

Supplementary Files

Analysis Plan:
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Outcomes Data

Data will be collected through a household survey of sampled nulliparious female adolescents between 15 and 19 years of age in both treatment and control villages at baseline. These two samples will be re-surveyed three years post-baseline to assess changes in outcomes.
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Treatment Assignment Data

Participation or Assignment Information:
Data Obtained by the Study Researchers?
Data Previously Used?
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Data Obtained by the Study Researchers?
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Data Analysis

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Study Materials

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Registration Category

Registration Category:
Prospective, Category 1: Data for measuring impacts have not been collected

Completion Overview

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Preliminary Report:
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Summary of Findings:
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Data Availability

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Other Materials

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Description of Changes:

Study Stopped