Presentation (CTI)

OBJECTIVES: Human-centered, community-embedded service delivery models have been proposed to address restrictive gender norms in low and middle income countries like Nigeria, yet evidence on their comparative effectiveness in conservative settings remains limited. The Adolescent 360 (A360) Project, implemented by Society for Family Health was designed to align contraceptive decision-making with married adolescent girls’ (MAGs) life aspirations through mentorship, spousal engagement, and adolescent-responsive services. This study evaluated A360 effectiveness on ASRH knowledge, attitudes, modern contraceptive uptake, self-efficacy, and reproductive agency.
METHODS: A quasi-experimental pre-post evaluation using repeated cross-sectional surveys was conducted. Baseline data were collected in November-December 2022 and endline data in 2024 across 182 clusters in intervention and comparison local government areas in Kaduna and Nasarawa States. Structured computer-assisted interviews were administered to 2,184 MAGs at baseline and 2,160 at endline (aged 15-19 years). Outcomes included ASRH knowledge, contraceptive attitudes and intentions, current modern contraceptive use, self-efficacy in spousal communication, and perceived reproductive agency. Difference-in-difference analyses using mixed-effects regression with propensity score weighting adjusted for confounding and clustering. Ethical approvals were obtained, and informed consent was secured.
RESULTS: Post-implementation, intervention areas exhibited significantly greater improvements across all primary outcomes compared with pre-implementation levels and comparison areas. Knowledge of modern contraception exceeded 97% at endline among intervention participants. Modern contraceptive use increased to over 80%, compared with less than one-quarter at baseline. Measures of self-efficacy, spousal communication, and perceived decision-making agency also improved significantly. Difference-in-difference estimates indicated that observed changes were attributable to the intervention rather than secular trends.
CONCLUSIONS: The A360 intervention was associated with improved ASRH knowledge, contraceptive uptake, and agency-related outcomes among married adolescent girls. Findings provide decision-relevant evidence on how human-centered service delivery models can influence behavioral and intermediate outcomes in adolescent health. These results support consideration of such approaches in the design and scale-up of equitable, adolescent-responsive health services.