Adolescent girls, school, HIV, and pregnancy: evidence from Kenya Michael Kremer, Harvard University Esther Duflo, Pascaline Dupas, Samuel Sinei; Edward Miguel and Rebecca Thornton

Context  Poor, rural region in Western Kenya  Most children start primary school, but drop out before secondary school  Free primary education  Teen childbearing (DHS) 16% of 17-year old women have begun childbearing 46% of 19-year old women  Two randomized evaluations

Reproductive health programs  Teacher training on HIV/AIDS curriculum Government curriculum Limited discussion of condoms  Debate on condoms and essay on protecting self against HIV/AIDS  Information about HIV age profile (Dupas)  Reducing cost of education

Teacher training in HIV/AIDS curriculum No significant/limited impact on knowledge, self-reported sexual behavior, childbearing Increases marriage conditional on childbearing by 6 %

Debate on condoms/ Essay on protecting self  No increase in self-reported sexual activity  Increases knowledge of and self- reported use of condoms  Waiting for childbearing outcomes

Information about age-profile of infection Large gender differences in age profile imply cross-generational sex is key route of infection Girls not aware Information on age profile of infection by gender (delivered by NGO workers) Video

Outcomes  Reduces girls’ childbearing by 32%  Reduces childbearing with adult men by 65%

Reducing cost of education Primary education is free, but de facto costs (uniforms) School vs. childbearing tradeoff Reduces dropout by 13.5% Increases confidence in girls for saying “No” if partner wants to have sex by 5% Reduces probability of reporting ever having had sex by 13% Reduces teen childbearing by 10%

Targeted merit scholarships Policy challenge: secondary education – how allocate funds Prior to FPE; merit scholarships for girls scoring well in 6 th grade exams Girl Scholarship Program (GSP) in two districts in Western Kenya

Girls Scholarship Program  Overall incentive effect: test-score gains of 0.14 sd (~6 percentage points)  Teacher attendance up  Girls with low pre-test scores gain  No evidence of weakened intrinsic motivation/gaming Effects persist  Heterogeneous program effect by district In successful district: test scores increase 0.25 s.d., gains for boys too, student attendance up In other district: cannot reject zero program impact

Conclusion  Cost effective programs exist Informing girls about risks of relationships with older men Reducing cost of education Secondary school scholarships?  Jury out? HIV/AIDS education training for new teachers Debates on condoms and essays on protecting self  How to expand access to secondary education?

Outcomes of interest  HIV education in schools Knowledge and attitudes Condom use Teenage childbearing Marriage Drop-out

HIV education: Improvement in students’ knowledge?

HIV education: Improvement in students’ attitudes?

HIV education: Self-reported sexual behavior

HIV education: Childbearing rates

HIV education: Dropout

HIV education: Relative risk information