Conclusions
In sum, the RMA social behavioral intervention, inclusive of household visits from health workers and gender synchronized small groups for husbands and wives, demonstrated effectiveness in improving modern contraceptive use and reducing victimization from IPV among married adolescent girls in the Dosso region of Niger. Our four-arm design suggests that household visits may be more important for contraceptive use and small groups may be more important for reduction of IPV in this setting, but that a combined intervention approach was optimal for concurrently addressing both contraceptive use and IPV. This pattern suggests that changes in contraceptive use may be reliant on knowledge transmitted by a community expert in a more private setting, while changes in IPV may be reliant on the social norms changes achieved via a group process that allows for shifts in shared expectations among peers. Social norms and stigma may well affect delivery and impact of social behavioral interventions such as RMA, as those married adolescents receiving the program who did not have children, individuals for whom the use of contraceptives is least acceptable, did not increase their contraceptive use. Identifying the modes of social and behavior change programming able to most synergistically and effectively improve contraceptive use and reduce IPV in a setting with the world’s highest fertility and low levels of gender equity is a key step towards improving the health and well-being of these very young adolescent wives.