The Impact of a Combination Intervention on Intention to Migrate Among Adolescent Girls: Results from a Pilot Study in Ghana

Background and purpose: Sub-Saharan Africa (SSA) has the highest rates of child labor (24%) in the world. Within SSA, 22% of children engage in child labor in Ghana. Adolescent girls living in poverty increasingly make up the majority of the North-South unaccompanied migrants in Ghana, mainly working as head-load carriers (Kayayei), a hazardous but attractive job for poor girls who have discontinued their education. Girls list push factors, including poverty and education-related expenses, as well as family factors, as key drivers for their unaccompanied migration to big cities. While kayayei are identified as a high-risk population, there is limited effort to prevent its occurrence. In this study, we examined the preliminary impact of a combination intervention comprised of a family economic empowerment and strengthening component on intention to migrate among adolescent girls at risk of dropping out of school in the northern region of Ghana.

Methods: We analyzed data from a longitudinal two-arm pilot randomized clinical trial among adolescent girls and their caregivers in Ghana (n=97 adolescent girl-caregiver dyads). Participants were recruited from 10 junior high schools in the northern region. The inclusion criteria for adolescent girls were: (1) enrolled in school and living within a family; (2) ages 11 to 14; (3) capable of giving assent; and (4) skipping school in the past academic term (with at least 10% of unexcused absences). Participants were randomized at the school level to two study conditions: Bolstered usual care and ANZANSI combination intervention. The intervention was provided for 9 months. Data were collected at baseline, 9 and 15-month post-intervention initiation. We employed a mixed-effects linear regression to examine the impact of the intervention on the intention to migrate. The model also included time as a continuous variable in the random part of the model, enabling us to explore the trajectory of intent to migrate over time.

Results: The average age of adolescents at baseline was approximately 13.69 (SD=0.58) years, with a mean household size of 14 people (SD=7.96) and an average of 6 (SD=4.40) children below 18 years per household. Family assets averaged at 8.14 (SD=3.23). Additionally, 84% of adolescents had biological parents as primary caregivers. We found no statistically significant differences between the two study groups at baseline. While there was no significant impact of the intervention on intention to migrate scores at 9 months (b =-0.18, 95% CIs: -0.53, 0.17, p = 0.31), a significant effect was observed at 15 months post-intervention (b =-0.61, 95% CIs: -1.18, -0.04, p = 0.04), showing a decrease in the intention to migrate in the intervention compared to the control group.

Conclusion: Adolescent girls living in poverty and at risk of dropping out of school are at high risk of unaccompanied migration to work as kayayei. The results from this pilot study contribute to our understanding of the potential of the ANZANSI intervention to reduce the intention to migrate among adolescent girls. The results also provide compelling evidence to support testing the efficacy of the ANZANSI intervention in a larger trial.