Design and Implementation of the Amenah Early Marriage Pilot Intervention Among Syrian Refugees in Lebanon

Maia Sieverding; Dima Bteddini; Rima Mourtada; Lama Al Ayoubi; Ola Hassan; Aya Ahmad; Jocelyn DeJong; Sawsan Abdulrahim

doi:10.9745/GHSP-D-21-00079

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FIGURE
School Enrollment and Marriage Rates by Age Among Syrian Refugee Girls in Bekaa, Lebanon
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Adolescent girls attending an Amenah session in Lebanon. ©2019 Catalina Martin-Chico

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TABLE 1.

The Main Drivers of and Points of Intervention for Early Marriage According to the Marcus and Page²² Conceptual Framework

Driver (Marcus and Page)	Intervention Approaches (Marcus and Page)	Amenah Intervention Component
Sociocultural norms that favor early marriage	Provide information to girls and community members on consequences of early marriage through community-level dialogue and awareness campaigns	Girls’ sessions Mothers’ and fathers’ sessions
	Life-skills education including on legal rights and risks of early marriage provided in girl-only safe spaces
Lack of knowledge of the law and consequences of early marriage	Provide information; life-skills education (as above)	Girls’ sessions Mothers’ and fathers’ sessions
Girls’ relative powerlessness	Support girls through income earning capacity and skills training; life-skills education	Girls’ sessions (for life skills education only)
Poverty and vulnerability	Strengthen family livelihoods; cash incentives for educational attendance	Not addressed
Lack of educational opportunities	Provide formal and nonformal education opportunities; cash incentives for educational attendance	English support
Weak law enforcement	Strengthen law enforcement	Not addressed

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TABLE 2.

Summary of Data Collection Instruments and Procedures for Amenah Early Marriage Pilot Intervention Among Syrian Refugees in Lebanon

	Instrument	Key Topics Covered	Administered By	Timing of Data Collection	Location of Data Collection
Outcome Evaluation	Household questionnaire	Sociodemographics of household members; asset index	Community workers	Baseline/endline	Family home
	Girls’ questionnaire	School experiences and attitudes; gender role attitudes; attitudes toward education and early marriage; experience of puberty; mother-daughter communication; experience and satisfaction with Amenah (endline only)	Female university students	Baseline/endline	Partner NGO (MAPs)
	Mothers’ questionnaire	Gender role attitudes; attitudes toward education and early marriage; mother-daughter communication; experience and satisfaction with Amenah (endline only)	Community workers	Baseline/endline	Family home
	Fathers’ questionnaire	Gender role attitudes; attitudes toward education and early marriage	Community workers	Baseline/endline	Family home
Process Evaluation	Session observation form	Objectives achieved; activities implemented as planned; notes on session delivery	Community workers; external evaluators	Directly after each session	Partner NGO (MAPs)
	Attendance records	Session attendance of mothers and girls	Community workers	During each session	Partner NGO (MAPs)
	Mothers’ focus group discussion	Perceptions of Amenah; effect of Amenah on relationship with daughter	Study team	7 months after intervention	Partner NGO (MAPs)

Abbreviations: MAPs, Multi-Aid Programs; NGO, nongovernmental organization.

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TABLE 3.

Steps Taken to Recruit Participants in Amenah Early Marriage Pilot Intervention

Step	Conducted by	Location
Obtain lists of the names and birthdates of Syrian female students from the 4 partner schools	Research team in coordination with schools	Schools
Send letter about the study to parents of all girls aged 11–14 years, informing them about the study and inviting them to attend a meeting on school premises	Research team in coordination with schools	Schools
Hold a meeting in each school to describe the study and obtain preliminary consent from attending parents to be visited at home; record parents’ contact information	Research team and community workers, in coordination with schools	Schools
Conduct home visits to obtain the consent of parents to enroll their daughter in the pilot intervention	Community workers	Home visits
Obtain assent from girls to participate in Amenah	Research team	Community partner (MAPs) premises

Abbreviation: MAPs, Multi-Aid Programs.

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TABLE 4.

Characteristics of Amenah Early Marriage Pilot Intervention Participants and Their Households

	No. (%)
Household characteristics
Residence in ITS
No	143 (80)
Yes	35 (20)
Mothers' characteristics
Mother age, years
25–29	6 (3)
30–34	47 (26)
35–39	56 (31)
40–44	34 (19)
45+	24 (13)
Missing	11 (6)
Mother education
Primary or less	75 (42)
Preparatory or higher	92 (52)
Missing	11 (6)
Mother's age at marriage, years
<16	31 (17)
16–17	51 (29)
18–19	37 (21)
20–24	42 (24)
25+	14 (8)
Missing	3 (2)
Fathers' characteristics
Father education
Primary or less	57 (32)
Preparatory or higher	95 (53)
Missing	26 (15)
Father employment
Not employed	32 (18)
Working but not regularly	76 (43)
Working regularly	44 (25)
Missing	26 (15)
Father UNHCR registration status
Registered	133 (75)
Not registered	19 (11)
Missing	26 (15)
Girls' characteristics
Age at baseline, years
11	28 (16)
12	63 (35)
13	54 (30)
14	33 (19)
School attended at baseline
Public elementary school	43 (24)
Public middle school	44 (25)
NGO school 1	33 (19)
NGO school 2	58 (33)
Grade level at baseline
3	6 (3)
4	32 (18)
5	33 (19)
6	63 (35)
7	31 (17)
8	13 (7)
Grade level compared to age
In expected grade level or higher	75 (42)
1–2 grade levels below expected	93 (52)
3 or more grade levels below expected	10 (6)
Total	178 (100)

Abbreviations: NGO, nongovernmental organization; UNHCR, United Nations High Commissioner for Refugees.
^aN=150 due to missing data on fathers’ age.

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TABLE 5.

Mothers’ and Girls’ Satisfaction With the Amenah Program

	No. (%)
Mothers' satisfaction (N=172)
In general, how would you rate Amenah?
Neutral to good	69 (40)
Very good	102 (60)
How would you rate your relationship with the community worker?
Neutral to good	42 (24)
Very good	130 (76)
How would you rate your relationship with the other mothers?^a
Neutral	25 (21)
Very good/good	92 (79)
Girls' satisfaction (N=175)
In general, how would you rate Amenah?
Neutral to good	24 (14)
Very good	151 (86)
The Amenah facilitator gave me important information.
Agree somewhat	9 (5)
Strongly agree	166 (95)
I can share my private feelings and problems with the Amenah facilitator.
I do not agree at all	31 (18)
Agree somewhat	70 (40)
Strongly agree	74 (42)
Did you make friends during Amenah?
No	36 (21)
Yes	138 (79)
How would you rate your relationship with the other girls in Amenah?
Neutral/bad	44 (25)
Good	50 (29)
Very good	81 (46)

↵a N=117 due to missing data.

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TABLE 6.

Bivariate Predictors of Higher Attendance Among Mothers and Girls

	Unadjusted Odds Ratio (Standard Error)
	Mother Attendance (1+ sessions)	Girl Attendance (>66% of sessions)
Residence (Ref =outside ITS)
Inside ITS	1.30 (0.579-2.938)	1.41 (0.656-3.012)
Mother education^a (Ref =primary or less)
Preparatory or higher	0.57 (0.297-1.084)	1.07 (0.560-2.031)
Missing	—	0.75 (0.183-3.075)
Mother age	1.09^b (1.024-1.161)	1.00 (0.947-1.062)
Father education (Ref =primary or less)
Preparatory or higher	1.20 (0.597-2.397)	1.31 (0.648-2.656)
Missing	0.50 (0.179-1.397)	1.25 (0.464-3.343)
Father employment^b (Ref =not working)
Work but not regularly	1.78 (0.703-4.495)	0.95 (0.391-2.333)
Work regularly	0.34 (0.132-0.895)	1.52 (0.584-3.974)
Missing	0.42 (0.133-1.310)	1.16 (0.387-3.501)
Father age	1.09^b (1.016-1.165)	1.00 (0.947-1.066)
Girl age, years (Ref =11)
12	1.14 (0.431-3.026)	0.67 (0.267-1.662)
13	0.73 (0.281-1.907)	0.67 (0.261-1.704)
14	1.09 (0.368-3.229)	0.50 (0.171-1.459)
Girl current school (Ref =public primary)
Public middle school	0.54 (0.205-1.435)	1.57 (0.657-3.770)
NGO school 1	0.89 (0.306-2.603)	0.90 (0.338-2.397)
NGO school 2	0.50 (0.199-1.231)	0.86 (0.366-2.014)
Girl attended more than 66% of sessions (Ref =no)	1.71 (0.835-3.518)
Very good overall rating of Amenah^a (Ref =neutral to good)	1.02 (0.531-1.975)	1.05 (0.422-2.617)
Very good relationship with CW (Ref =neutral to good)	1.05 (0.500-2.194)
Made friends during Amenah (Ref =no)		1.07 (0.491-2.319)
Relationship with other girls in Amenah^a (Ref =very good)
Good		0.39 (0.175-0.869)
Neutral/bad		0.72 (0.333-1.535)
CW provided important information (Ref =agree a little)		1.05 (0.252-4.338)
Agree a lot
Can share private feelings with CW (Ref =do not agree)
Agree a little		1.24 (0.507-3.039)
Agree a lot		1.01 (0.411-2.471)
Observations	175	178

Abbreviations: CW, community worker; ITS, informal tented settlement; NGO, nongovernmental organization.
↵a P<.1.
↵b P<.01.

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TABLE 7.

Baseline-Endline Comparison of Age at Marriage Outcomes

	Baseline	Endline
Ideal age at marriage
Total	20.1	20.4
School status at endline
Enrolled	20.2	20.5
Not enrolled^a	19.1	18.8
Age at endline, years
13	20.0	20.1
14	20.2	20.8
15–16	19.5	20.4
Own expected age at marriage (girls aged 13+ years at endline)
Total	20.2	20.8^b
School status at endline
Enrolled	20.3	20.9^b
Not enrolled^a	19.0	18.5
Age at endline, years
13	20.3	20.6
14	20.6	21.4
15–16	19.1	20.1^c

↵a Only 6 girls were not enrolled in school at endline and had complete data on the outcome.
↵b P<.05, based on paired t-test.
↵c P<.1, based on paired t-test.