Leah Prencipe, Tia Palermo, and Yekaterina Chzhen and presented “Impacts of a Cash Plus Intervention on Gender Attitudes among Tanzanian Adolescents” as part of European Commission Joint Research Center's Seminar Series. (June 2020)

1. Impacts of a Cash Plus intervention on gender
attitudes among Tanzanian adolescents
European Commission Joint Research Centre seminar series, June 26, 2020
Yekaterina Chzhen (Trinity College Dublin), Leah Prencipe (Erasmus MC) and Tia Palermo (State University of New
York at Buffalo), on behalf of the Tanzania Cash Plus Evaluation Team

2. Tanzania Cash Plus Evaluation team
University at Buffalo: Tia Palermo (co-Principal Investigator)
UNICEF Office of Research: Lusajo Kajula, Jacobus de Hoop, Leah Prencipe, Valeria Groppo, Jennifer Waidler
Economic Development Initiatives: Johanna Choumert Nkolo (co-Principal Investigator), Respichius Mitti (co-Principal
Investigator), Nathan Sivewright, Koen Leuveld, Bhoke Munanka
Tanzania Social Action Fund: Paul Luchemba, Tumpe Lukongo
Tanzania Commission for Aids: Aroldia Mulokozi
UNICEF Tanzania: Ulrike Gilbert, Paul Quarles van Ufford, Rikke Le Kirkegaard, Frank Eetaama

3. “Societal expectations about men’s
and women’s roles, rights,
and responsibilities.”
- Vu et al, 2017
GENDER NORMS

4. SOCIAL PROTECTION & GENDER:
THE LINKAGES
• Poverty, vulnerability and well-being have inherent gender
dimensions; thus gender considerations have historically
motivated & driven certain design features of SP:
• These have mostly been instrumental (motivated by functional
& operational features)
• More recently, intrinsic value of improving women’s
wellbeing & gender equality has gained traction:
• Goal 5 of SDGs call for social protection as an avenue for
reducing unpaid care (2016)
• First gender SPIAC-B working group (formed 2018)
• 63rd Commission on the Status of Women with priority theme
of social protection systems (2019)

5. “Comprehensive social protection
systems need to be gender-responsive
to a) ensure they do not further
exacerbate gender inequality and that
they b) promote gender equality.”
~Africa Ministerial Pre-Commission
on the Status of Women (CSW) 2019

6. SOCIAL PROTECTION
Social services
Insurance schemes
Labor market policies
SOCIAL SAFETY
NETS
Public works,
Subsidies, School feeding,
Economic transfers
CASH
TRANSFERS
~45%
global
coverage
~2.5 billion
in LMICs
~11% coverage
in LMICs Sources: World Social Protection Report 2017-2019:
Universal social protection to achieve the SDGs, ILO,
Geneva, 2017; Ivaschenko et al. 2018. The state of
social safety nets 2018 (English). Washington, D.C. :
World Bank Group

7. Source: Beegle K, Coudouel, A & E Monsalve (Eds) (2018). Realizing the Full Potential of Social Safety Nets in Africa. World Bank.
• Average country has 15 SSNs
• 10% of the population covered
• CT represent 41% (growing)
share of spending
EXPANSION OF SSNs IN SSA
A core strategy for addressing poverty and vulnerability

8. The Transfer Project
Who: Community of research, donor and implementing partners – focus on
coordination in efforts and uptake of results
 UNICEF, FAO, University of North Carolina at Chapel Hill, National
Governments, National researchers
Mission: Provide rigorous evidence on government-run large-scale (largely
unconditional) social cash transfers (SCTs)
Motivation:
 Income poverty has highly damaging impacts on human development
 Cash empowers people living in poverty to make their own decisions
on how to improve their lives
Where: Ethiopia, Ghana, Kenya, Lesotho, Malawi, Mozambique,
South Africa, Tanzania, Zambia & Zimbabwe

9. Enhancing adolescents’ capabilities
 Social protection can contribute to a pipeline of investments in childhood &
adolescence necessary for enhancing individuals’ capabilities, along multiple
dimensions
 GAGE defines adolescent capabilities as follows:
Graphic source: Coast (2016). Gender and Adolescence: Capabilities, change strategies and contexts for well-being.
http://www.partners-popdev.org/docs/presentation/IntConf_2016/PPDIntConf2016_Dr_Ernestina_Coast.pdf

10. for every child, answers
Cash Plus: The Intervention
The Cash: cash transfer to the household - Tanzania’s
Productive Social Safety Net (PSSN)
The Plus:
• 12 weeks of training on livelihoods and life skills
(including gender equity)
• Mentoring (including referrals and productive grant)
• Linkages to adolescent-friendly services (e.g.
sexual and reproductive health; violence response)

11. for every child, answers
Training Topics
Livelihoods
• Dreams and goals
• Entrepreneurship skills
• Business plans and record keeping
• Savings
HIV/Sexual Reproductive Health (SRH)
• Coping with puberty
• Relationships
• HIV knowledge, prevention and protection
• Pregnancy and family planning
• Violence and gender-based violence
• Addressing negative gender attitudes and
norms
• Alcohol and drugs
• Healthy living and nutrition

13. Study Design: Cluster Randomized Control Trial
Cluster RCT design: 130 villages (clusters) in four districts in Tanzania randomized into:
• Treatment: Cash + adolescent-focused services (“plus”)
• Control: Cash only
Youth surveys administered to eligible youth
• Aged 14-19 at baseline
• Living in a PSSN household
Longitudinal design
Sample sizes at baseline:
• Community (n=130)
• Health facility (n=91)
• Household (n=1946)
• Youth surveys (n=2458)
for every child, answers

14. Data
Youth questionnaire
• Baseline: April – June 2017
• Midline: May – July 2018
• Endline: May – August 2019
• Follow-up: Planned March – May
2020; postponed due to COVID-19

15. for every child, answers
Estimation
Imperfect compliance with the intervention (47% uptake)  intent-to-treat (ITT) impacts
Low autocorrelation between outcomes at baseline and midline (ρ=0.13) and baseline and
endline (ρ= 0.14)  Analysis of Covariance (ANCOVA)
𝒀 𝟏𝒊𝒋 = 𝜶 𝟎 + 𝜶 𝟏 𝑻𝒋 + 𝜶 𝟐 𝒀 𝟎𝒊𝒋 + 𝜶 𝟑 𝑿𝒊𝒋 + 𝜺𝒊𝒋
𝑌0𝑖𝑗 - baseline value of the outcome for adolescent i living in village j
𝑌1𝑖𝑗 - follow-up value of the outcome for adolescent i living in village j
Tj – treatment dummy (1-lives in a treatment village; 0 otherwise)
Xij – controls (age at baseline, gender, district x village size fixed effects)

16. RESEARCH QUESTION 1:
What is the impact of the (cash
plus) training on attitudes towards
equitable gender norms among 14-
19-year-olds in rural Tanzania in
cash transfer recipient households?

17. RESEARCH QUESTION 2:
Whether and how does the impact
differ with personal characteristics
(e.g. gender, sexual debut)?

18. for every child, answers
Background
Gender norms influence behaviours (including
health and violence domains)
Adolescence is a key period when new social roles
and power relations manifest
Research on determinants of gender-norms
attitudes in adolescence is mostly from North
America and Western Europe (Kågesten et al,
2016)
A review of 31 evaluations of small-scale
programmes in LMICs documents short-term
impacts on adolescents’ attitudes (John et al, 2017)

19. Measures
Gender norms: Gender Equitable Men
(GEM) scale (Pulerwitz et al, 2008)
• 24 items validated in a study of
adolescents in Uganda (Vu et al, 2017)
• Four domains: violence, reproductive
health, sexual relationships; domestic
chores & daily life
• Females more likely to express
support for inequitable norms in 11 of
24 items; males in 1 of 24.
• Items recoded, dichotomized and
summed into a scale (Cronbach’s alpha
0.87 in our sample).
“It is alright for a man to beat his
wife if she is unfaithful.”
(F 57%; M 42%)
“Only when a woman has a child is
she a real woman.” (F 63%; M 50%)
“Men are always ready to have sex.”
(F 48%; M 38%)
“A woman should obey her
husband in all things.”
(F66%: M 54%)

20. Panel Sample
for every child, answers
Endline analytic sample
(after excluding DK for baseline and
endline)
GEM scale: 1,229
Violence: 1,760
Reproductive Health: 1,517
Sexual Relationships: 1,393
Domestic chores and daily
life: 1,866
2,458 interviewed at
baseline
2,104 re- interviewed at
midline
2,191 re- interviewed at
Wave 3
1,933 interviewed at all
three waves

21. Cash Plus Intervention Impacts on
Gender-Norms Attitudes
for every child, answers

22. Cash Plus Intervention Midline Impacts
on Gender-Norms Attitudes (by gender)
for every child, answers

23. Cash Plus Intervention Endline Impacts
on Gender-Norms Attitudes (by gender)
for every child, answers

24. Cash Plus Intervention Midline Impacts on Gender-
Norms Attitudes (males, by sexual debut at baseline)
for every child, answers

25. for every child, answers
Key findings
The Cash Plus intervention increased gender equitable attitudes among males (but not females),
particularly in the domains of violence and the domestic chores.
Some impacts disappeared one year after face-to-face trainings; sustained impacts in domestic
chores and violence (among males) sub-scales
Evidence of heterogeneous impacts even among males:
• Impacts were more pronounced among males who had not reported experiences of sexual debut at
baseline
• This is not driven by age differences: the intervention affected males (but not females) in both the
younger (14 -15) and older (16-19) cohorts, with or without controlling for sexual debut at baseline

26. for every child, answers
Implications
Gender-focused interventions need to take place early, before
personal experiences have led to the consolidation of attitudes to
gender norms
• Experience of sexual intercourse is correlated with less equitable
gender norms in adolescents (Uganda; Vu et al, 2017)
More efforts need to be made to demonstrate the value of
progressive gender norms to female adolescents
Broader social protection policy can affect gender attitudes via
impacts on drivers of gender attitudes
• Cash transfer programmes targeting mothers of young children
increase women’s empowerment (Zambia; Bonilla et al 2017)

27. The authors would like to acknowledge the support of the TASAF and TACAIDS, in
particular Ladislaus Mwamanga (TASAF), Amadeus Kamagenge (TASAF), and Mishael
Fariji (TASAF) for the implementation of this evaluation. In addition, the UNICEF
personnel instrumental to the initial planning stages of this pilot and study include:
Beatrice Targa, Patricia Lim Ah Ken, Victoria Chuwa, Naomi Neijhoft and Tulanoga
Matwimbi. We would also like to acknowledge the hard-working field teams of EDI
Group, who conducted the data collection for this study to the highest professional
standards.
Funding for this research has been provided by Oak Foundation (#OCAY-16-73) and
UNICEF Tanzania; as well as the Swedish Development Cooperation (G41102) and the
UK Department for International Development (203529-102) through grants to
UNICEF Office of Research—Innocenti supporting the Transfer Project. Additional
funding for implementation of program activities was provided by Irish Aid
THANK YOU.

28. ANNEX

29. Levels of inequitable
gender norms
attitudes at baseline
(% agreed)
Gender differences significant at p<0.05 are in bold. Standard
errors adjusted for clustering by village.
Female
(N=841)
Male
(N=1,039)
There are times a woman deserves to be beaten. 36 38
A woman should tolerate violence in order to keep her family together. 42 43
If someone insults a man he should defend his reputation with force if he
has to.
41 35
It is okay for a man to hit his wife if she will not have sex with him. 29 24
A man using violence against his wife is a private matter that should not
be discussed outside the couple.
44 34
It is alright for a man to beat his wife if she is unfaithful. 57 42
It is a woman's responsibility to avoid getting pregnant. 58 51
A man should be angered/shocked if his wife asks him to use a
condom.
40 40
Women who carry condoms on them are easy. 38 44
Only when a woman has a child is she a real woman. 63 50
A real man produces a male child. 38 36
It disgusts me when I see a man acting like a woman. 72 72
A woman should not initiate sex. 47 48
You do not talk about sex, you just do it. 36 40
A woman who has sex before she marries does not deserve respect. 51 53
Men need sex more than women do. 39 33
Men are always ready to have sex. 48 38
A man needs other women, even if things with his wife are fine. 38 30
It is the man who decides how he wants to have sex. 48 44
Giving the kids a bath and feeding the kids are the mother's
responsibility.
76 60
A woman's most important role is to take care of her home and cook for
her family.
80 68
A man should have the final word on decisions in his home. 69 64
The husband should decide what major household items to buy. 61 57
A woman should obey her husband in all things. 66 54
Violence
Reproductive
Health
Sexual
relationships
Domestic
chores and
daily life
for every child, answers
Highest support for inequitable gender
norms in domestic chores/daily life;
lowest in the violence domain.
Females more likely to express
support for inequitable norms in 11 of 24
items; males in 1 of 24.

30. Descriptive Statistics
Baseline means of background characteristics in the panel sample, by treatment status
for every child, answers
Control Treatment
Mean N Mean N
Background characteristics
Age 16.08 987 16.01 932
Female 0.46 987 0.43 932
Sexually debuted 0.17 987 0.15 932
Age of household head 58.65 985 58.34 932
Female-headed household 0.67 987 0.65 932
Household size 4.94 987 5.01 932
Mufindi/Mafinga PAAs 0.50 987 0.51 932
Large village 0.72 987 0.67 932
Gender-norms attitudes
GEM scale (0-24) 12.68 780 12.30 699
Violence sub-scale (0-6) 3.75 942 3.66 896
Reproductive health sub-scale (0-5) 2.78 876 2.75 797
Sexual relationships sub-scale (0-8) 4.35 836 4.28 756
Domestic chores sub-scale (0-5) 1.76 969 1.68 916

31. Attrition
for every child, answers
Non-interviewed at midline and/or
endline (‘attritors’)
Re-interviewed at both midline and
endline (panel)
Difference Difference
Control Treatment P-value Control Treatment P-value Col(1)-
Col(4)
P-value Col(2)-
Col(5)
P-value
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
GEM scale (0-24) 13.12 11.94 0.08 12.68 12.30 0.41 0.44 0.40 -0.37 0.21
Violence sub-scale
(0-6)
3.85 3.64 0.26 3.75 3.66 0.48 0.10 0.42 -0.01 0.65
Reproductive health
sub-scale (0-5)
2.71 2.52 0.27 2.78 2.75 0.72 -0.07 0.44 -0.23 0.07
Sexual relationships
sub-scale (0-8)
4.51 4.24 0.28 4.35 4.28 0.65 0.16 0.34 -0.04 0.68
Domestic chores sub-
scale (0-5)
1.76 1.54 0.15 1.76 1.68 0.45 -0.00 0.66 -0.13 0.12

33. PSSN Details