Do Community-based Livelihood Interventions Affect Sexual and Reproductive Health and Rights of Young People in Slum Areas of Uganda: a Difference-in-difference with Kernel Propensity Score Matching Analysis.

ABSTRACT

Slum dwellers across Africa have been targeted in interventions whose impacts remain unclear. We evaluated the impact of a livelihood intervention on the sexual and reproductive health and rights (SRHR) of young people in the slum areas of Kampala, Uganda. We carried out a repeated cross-sectional survey in 2014 and 2017 to examine the impact of community-based livelihood interventions on the SRHR of young people in the slum areas of Kampala, Uganda. Impacts were observed such as reduced sexual activity, reduction in aspects of gender-based violence attitudes and beliefs, increased access to and decision-making about contraceptive and family-planning services, increased availability and affordability of SRHR services, reduced need to seek further knowledge on SRHR, reduced barriers to HIV testing, and increased knowledge of health responsibilities. Unexpected results included increased proportion of young people who had ever had sex, decreased mean age of sexual debut, unaffordability of contraceptives, and increased culturally shaped attitudes and social norms related to gender-based violence. We observed no impact on condom use, consensual sex and sexual assault, the number of sexual partners, knowledge about HIV/AIDS, stigma and discrimination against people living with HIV/AIDS, affordability of male and female condoms, and uptake of HIV testing services. Rights-based interventions are crucial to how we understand the SRHR of young people in complex sociocultural environments. While the livelihood interventions made significant impacts on the SRHR of young people, there are questions about how such interventions address deeply rooted sociocultural practices to maximise outcomes.