Building caregivers’ emotional, parental and social support skills to prevent violence against adolescent girls: findings from a cluster randomised controlled trial in Democratic Republic of Congo

Lindsay Stark, Ilana Seff, Khudejha Asghar, Danielle Roth, Theresita Bakamore, Mairi MacRae, Cecile Fanton D’Andon, Kathryn L Falb - BMJ Global Health


Introduction Parenting programmes are increasingly popular for reducing children’s exposure to interpersonal violence in low/middle-income countries, but there is limited evidence on their effectiveness. We investigated the incremental impact of adding a caregiver component to a life skills programme for adolescent girls, assessing girls’ exposure to violence (sexual and others) and caregivers’ gender attitudes and parenting behaviours.

Methods In this two-arm, single-blinded, cluster randomised controlled trial, we recruited 869 adolescent girls aged 10–14 and 764 caregivers in South Kivu, Democratic Republic of Congo. Following a baseline survey, participants were divided into 35 clusters based on age, language and location. Eighteen clusters were randomised to the treatment arm and 17 clusters to the wait-list control arm. Adolescent girls in both arms received 32 life skills sessions; caregivers in the treatment arm received 13 complementary caregiver sessions. The primary outcome was girls’ self-reported exposure to sexual violence in the last 12 months; secondary outcomes included self-reports of specific forms of sexual violence, physical and emotional violence, transactional sex, child marriage for girls and parenting behaviours for caregivers. Intent-to-treat and per-protocol analyses were conducted.

Results At 12 months of follow-up, the intervention showed no impact on sexual violence (adjusted OR=0.95; 95% CI 0.65 to 1.37) or any secondary outcomes for girls. The intervention was associated with improved supportive parenting behaviours. Protocol adherence was also associated with improvements in these outcomes.

Conclusion While the caregiver curriculum improved some parenting outcomes, additional programmatic adaptations may be needed to reduce adolescent girls’ violence exposure in humanitarian settings.