Qualitative endline results of the tipping point project to prevent child, early and forced marriage in Nepal.

Currently, Nepal is not on track to meet Sustainable Development Goal 5.3 - the elimination of harmful practices, including child, early and forced marriage by the year 2030. Evidence on what works to prevent child, early and forced marriage often is inattentive to contextual factors that influence intervention effectiveness. This study presents qualitative results of a mixed-methods evaluation of CARE's Tipping Point Program to prevent child, early and forced marriage in Nepal, interrogating the perceived benefits of the programme and elucidating contextual features that enhance or detract from programme benefit. Baseline data included interviews with adolescent girls (N = 20), boys (N = 10), adult community leaders (N = 8) and focus group discussions (FGDs) with girls (N = 8 groups; 48 individuals), boys (N = 8 groups; 47 individuals) and parents (N = 16 groups; 95 individuals). Using thematic analysis and structured comparisons by time, gender, district, caste/community, stakeholder type and arm, we found diverse programme participation, but widespread improvements in knowledge across several domains, with behavioural changes concentrated among participants with stronger participation and pre-programme characteristics suggestive of low risk of child marriage. Findings underscore the need to address structural barriers to prevent child marriage and the challenges of attributing programme benefit amidst a dynamic social context.

Impact of the CARE Tipping Point Program in Nepal on adolescent girls' agency and risk of child, early, or forced marriage: Results from a cluster-randomized controlled trial.

Background: Girl child, early, and forced marriage (CEFM) persists in South Asia, with long-term effects on well-being. CARE's Tipping Point Initiative (TPI) sought to address the gender norms and inequalities underlying CEFM by engaging participant groups on programmatic topics and supporting community dialogue to build girls' agency, shift power relations, and change norms. We assessed impacts of the CARE TPI on girls' multifaceted agency and risk of CEFM in Nepal. Methods: The quantitative evaluation was a three-arm, cluster-randomized controlled trial (control; Tipping Point Program [TPP]; Tipping Point Plus Program [TPP+] with emphasized social-norms change). Fifty-four clusters of ∼200 households each were selected from two districts (27:27) with probability proportional to size and randomized evenly to study arms. A pre-baseline census identified unmarried girls 12-16 years (1,242) and adults 25 years or older (540). Questionnaires covered marriage; agency; social networks/norms; and discrimination/violence. Baseline participation was 1,140 girls and 540 adults. Retention was 1,124 girls and 531 adults. Regression-based difference-in-difference models assessed program effects on 15 agency-related secondary outcomes. Cox-proportional hazard models assessed program effects on time to marriage. Sensitivity analyses assessed the robustness of findings. Results: At follow-up, marriage was rare for girls (<6.05%), and 10 secondary outcomes had increased. Except for sexual/reproductive health knowledge (coef.=.71, p=.036) and group membership (coef.=.48, p=.026) for TPP + versus control, adjusted difference-in-difference models showed no program effects on secondary outcomes. Results were mostly unmoderated by community mean: gender norms, household poverty, or women's schooling attainment. Cox proportional hazard models showed no program effect on time-to-marriage. Findings were robust. Discussion: Null findings of the Nepal TPI may be attributable to low CEFM rates at follow-up, poor socio-economic conditions, COVID-19-related disruptions, and concurrent programming in control areas. As COVID-19 abates, impacts of TPP/TPP + on girls' agency and marriage, alone and with complementary programming, should be assessed. Trial registration number: NCT04015856.