The Challenge

Approximately 90% of all adolescent pregnancies in the global South occur among married females, where youth marriage is common. Early childbirth can constrain these girls’ future potential, and in some cases present risks to their health and that of their children. Reproductive health programs often fail to reach these married adolescents. For various cultural reasons, many health programs focus only on the adult female population, leaving out the youngest and most vulnerable.

The Program

To address this gap, CARE (sponsored by the Bill & Melinda Gates Foundation) partnered with Far Harbor to help design, implement, and evaluate the innovative IMAGINE program.

Within the populations of Niger and Bangladesh, the CARE team combined holistic education on reproductive health, business skills, and life skills for married and unmarried adolescent girls and their husbands. Field workers also delivered health provider training on adolescent and youth-friendly health services, facilitated community dialogue sessions to address harmful social norms impacting adolescent childbearing, and introduced income-generating opportunities so that motherhood was not the only option for a stable future.

Activities were designed to inform and equip girls while engaging families and communities, influencing systems that create a better environment for girls to exercise their rights and make decisions about their health and lives. The overarching goal was to help these married adolescents to better control the timing of their first birth, while empowering them to envision and shape their futures.

Our Approach

Far Harbor developed the IMAGINE sampling and data collection strategy, cleaned and weighted baseline and follow-up surveys, designed the analytic strategy, built statistical models, and summarized results for audiences including the Bill and Melinda Gates Foundation, the scientific community, and the in-country Ministries of Health. Far Harbor leveraged its 20+ years of survey research and program evaluation experience in reporting the findings of the IMAGINE program.

The Impact

Throughout the IMAGINE project, thousands of adolescent girls engaged with the program across both countries. These interventions provided young people with vocational training and income generating activities, improvement of family planning knowledge, couples counseling, and improvement of health services over the course of several years. Exposure to the program in Niger resulted in significant increases contraceptive access and contraceptive uptake. In Bangladesh, analysis revealed a positive impact on contraceptive attitudes and personal agency for obtaining contraception. Analysis of program impacts continue, as our team investigates research questions about program impact on birth spacing and working with CARE on additional scientific publications.