Effect of Sexuality and Procreation Education on Health and Poverty Reduction of Girls in Rural China -- The Case study in Gansu Province, China Selection meeting for PEP-AusAID, Policy Impact Evaluation Research Initiative (PIERI) June 9-13, 2008 Québec, Canada Wei QUGansu Academy of Social Sciences

Outlines 1.Aim of the proposed research 2.Background and policy relevance 3.Methods 4.Consultation and dissemination strategy 5.The study team 6.Timeline and budget

1. Aim of the proposed research Study overview Research questions and objectives

1.1 Study overview (1) More and more young girls from poor rural areas working in cities now, because (of): –rapid economic growth; –nine-year compulsory education system in China, but high school is not free, most of girls drop-out after 9 years, parents don’t like to send girls to high school in poor rural area, traditionally they pay more attention on sons than daughters; – redundant labor, difficult to find a job in rural area; –huge income gap between big cities and poor rural area (in 2007, urban/rural income per capita is 4.3 in Gansu, national 3.3), life in city has attraction. A special vulnerable group, they are: –young, starting work in cities at years old; –less-educated, unskilled labor, difficult to find a decent job; –lack of knowledge (access) on sexuality and procreation issues; –living alone in cities, lonely; –without control from parents and traditional culture

1.1 Study overview (2) Those girls have high risk on abortion, sexually transmitted diseases (STDs), which will hurt their health/human capital. –2001 Almanac of China's Health, 10 million induced abortions annually, 20-30% is provided to unmarried young women; –Wang et al. (2005): the suburban Shanghai, unmarried youth aged 15-24, 26% of female had unexpected pregnancy during the 20-month intervention period. Training/good knowledge on sexuality and procreation issues → reduce abortion and STDs → improving health and human capital → high salary and poverty reduction

1.2 Research questions and objectives (1) Main research questions: Does training/education on sexuality and procreation help girls to have appropriate attitudes towards relevant issues, and have less abortion and venereal diseases? What kinds of knowledge and service do they need most? Does training/education on sexuality and procreation improve health and human capital of girls, helping them to have a better career and high income?

1.2 Research questions and objectives (2) Core research objectives: Better understanding on the relationships between knowledge on sexuality and procreation, attitude towards relevant issues, probability of abortion and venereal diseases, health, human capital and poverty problem of those young girls; Find an appropriate policy intervention to improve their knowledge on sexuality and procreation, improving their life quality.

2. Background and policy relevance Literature review directly relevant to main research questions Explanation of what are the gaps in this literature Explanation of how filling these gaps is relevant to specific country policy issues

2.1 Literature review directly relevant to main research questions (1) Sex education programs for adolescent in developed countries: –Hoff et al. (2000): insufficient sexuality education for U.S. high school students; –Constantine et al. (2007), Landry et al. (2003): CSE supported in the U.S., rarely experienced; –Lewis and Knijn (2003): sex education in the Netherlands and UK; –Smylie et al. (2008): Canadian sex education programme, 240 Grade 9 students.

2.1 Literature review directly relevant to main research questions (2) Sex education programs in developing countries: –Rashid (2000): Adolescent Reproductive Health Education programme in Bangladesh –Holzner and Oetomo (2004) Sex education in China: –Wang et al. (2005): the suburban Shanghai, 2,227 unmarried youth aged 15-24, decreasing of unwanted pregnancy, community-based intervention; –Li et al. (2004): 400 college students. Economics literature: Oettinger (1999), sex education in the 1970s had some causal impact on teen sexual behavior.

2.2 Explanation of what are the gaps in this literature Very limited economics literature on sex education, and its socioeconomic effect. No study investigates the effects of sexuality and procreation education on the health/human capital of young girls from poor rural area in China.

2.3 Explanation of how filling these gaps is relevant to specific country policy issues China has more than ten millions of young girls working in the cities who come from poor rural area. If an appropriate education on sexuality and procreation could help young girls to reduce unexpected pregnancy rates and relevant diseases, and improve their health/human capital, then the Central Government should focus on this vulnerable group, providing sufficient information /education and services on relevant issues.

3. Methods General description of the intervention, population to be studied, outcomes of interest, timing of effects, existing data and/or data to be collected, methods to be used to analyze data The experiment/intervention Data collection methods Modeling and testing Human subjects concerns

3.1 General description (1) General description of the intervention: a comprehensive one-week training (education) on sexuality and procreation issues Population to be studied: girls from poor rural area, years old, working in cities < 2 years. Outcomes of interest: knowledge on sexuality and procreation → better ability to deal with related affairs, protect themselves in cities (less abortion and diseases) → better health and human capital → better career, higher income and less poverty

3.1 General description (2) Timing of effects (expected outcomes): Reduction of abortion and diseases >= 1 year: –do the first medical examination and baseline survey a.s.a.p. (end of September 2008); –do the second medical examination and survey as late as possible, in December 2009 (15 months for intervention period); –do the potential third medical examination and survey in October 2010 (25 months) Income effects (health, human capital) >2 years, needs 5-10 years to fully materialize: –do the third survey in October 2010, may partly observe income effects; –add some girls (20-22 years old, working in cities > 5 years) in our samples, test whether knowledge (and the way to get) on sexuality and procreation issues has effect on their health, human capital and income.

3.1 General description (3) Existing data and/or data to be collected: –no existing data; –data to be collected: basic information include family background, score in school, job information, earning, and information about health situation, attitude to sexuality and procreation, experience of sex life; –get basic information with questionnaire, health data by medical examinations. Methods to be used to analyze data: quantitative and parametric –linear regression –discrete choice models, e.g. binary/multinomial Probit model –sample selection model

3.2 The experiment/intervention (1) Experiment/intervention: a comprehensive training/education on sexuality and procreation issues in order to help half of our samples (150 girls) to get relevant knowledge. It may include contents on abstinence, HIV/AIDS, sexually transmitted diseases, birth control and contraceptive services, female anatomy/physiology, etc. Consult with Bureau of Public Health and organize an group of experts (4-5). The exact contents should consult with experts, discuss with local officials, and girls in intervention group.

3.2 The experiment/intervention (2) The beneficiaries: –in the short term, young girls (17-19 years old) who get training in our experiment; –in the long term, all girls for rural area to cities for off- farming job will become beneficiaries if the government spent money on this kind of training. How will they benefit? –training on sexuality and procreation issues → more knowledge → good health/human capital → better job → get rid of poverty (themselves and their families)

3.2 The experiment/intervention (3) Way to draw the control group/treated group: stratified sampling –5 districts of Lanzhou, 60 girls in each district, who are 17 to 19 years old, and have been working in city less than two years; –randomly choose 30 girls to be the control group, and the other 30 girls to be the treated group; –300 respondents in total, half in the control group, and half in the treated group. Who will do it? Our research team + some medical experts + local officials in relevant institutions

3.2 The experiment/intervention (4) There are three potential problems we foresee: –questions about sexuality and procreation are quite sensitive in China, especially in rural area; –many information of privacy; –mobility of those girls, data attrition.

3.2 The experiment/intervention (5) An example of our previous research to collect sensitive data: how individual farmers evaluated the village leaders: good explanation, pure research purpose; experienced team; good reputation of GASS; formal agreement with each of them.

3.2 The experiment/intervention (6) Ways to solve those problems after discussed with experts and 4 girls (targeted population): experienced female surveyors; explain research purpose carefully, reputation of GASS; formal agreement to protect the privacy; all surveyors/team remembers sign an agreement to protect the privacy; a professional lawyer in our research group in charge of protecting privacy; free medical examination each year for all respondents; 500 yuan bonus at the end if staying in our sample; small database, cell phone to trace them; a group of experts, including obstetrics, gynecology and psychology, to provide free service to respondents.

3.3 Data collection methods (1) Will a baseline data be collected or will you use existing data for the baseline? We will collect the baseline data: questionnaire survey + result of medical examinations What population will be studied girls from rural area, years old, <2 years working experience in Lanzhou

3.3 Data collection methods (2) Sampling design, sample size and statistical power – two groups of random samples: the control group, without training; the treated group, with training –Duflo et al. (2006), the power of experiment: 90%, “medium” effect of 0.5 s.d., one sided at 5% level, the sample size: 140. –the potential attrition rate: 40-50%, sample size: 300, each group has 150 girls.

3.3 Data collection methods (3) Key data to be collected (and how this will be done) –information include family background, score in school, job information, earning, knowledge of sex issues and information about health situation –Questionnaire + medical examinations Additional data to be collected –attitude to marriage, sexuality and family life, first time to have sex, time of abortion, and procreation health, experience of sex life, etc.

3.4 Modeling and testing (1) What model/idea will you test with these methods? –Does training/knowledge on sexuality and procreation help girls better to protect themselves, and thus improve their health status or even human capital? –Does improvement of health and human capital help those girls find better job with high income and help themselves and their families get rid of poverty?

3.4 Modeling and testing (2) What empirical methods will you use to do this testing –linear regression –discrete choice models, ordered or binary Probit model –multinomial Probit/Logit model –sample selection model What empirical problems do you foresee –date quality and sample attrition; –some complicated models, like Multinomial Probit and sample selection may need programming; –only one team member has good training on econometrics.

4. Consultation and dissemination strategy (1) How, in the elaboration and execution of your project, will you consult with policy makers, civil society representatives and other parties interested in the research issues you examine? Policy makers: Office of Poverty Alleviation and Development, Bureau of Public Health, Bureau of Education (provincial, county) Civil society representatives: Women’s Federation, representatives of teachers, young girls (targeted), their parents and other parties Already discussed with deputy director of Gansu Bureau of Public Health, and one from Gansu Women’s Federation, and officials from Jingning County during the proposal designing period; Policy makers, civil society representatives and other parties: go to their office discuss/consult with them (personal contact), have meeting and small workshops

4. Consultation and dissemination strategy (2) How and where research results will be disseminated: for academics –one working paper in English (international journal) –2-3 papers in Chinese (top journals in China) –1-2 small seminars –submit paper to international conferences for policy-makers –already discussed with some of them; all interested in; –involve them during research: personal contact (call, , meeting), consulting, writing report, seminar; –GASS can submit short, policy oriented report to Provincial Governor, Chinese Academy of Social Sciences - national level; for the public –1-2 articles in Chinese newspapers; –invite representatives to attend seminar, send reports to them

4. Consultation and dissemination strategy (3) Examples of our previous research: We did a research on rural poverty and movement of “building new socialist rural area” in 2007, we submitted our report to Deputy Governor of Gansu, and it had some influence on policy-making.

5. The study team Principal investigator Other key research staff and their roles Past, current or pending projects in related areas

5.1 Principal investigator Principal investigator; brief bio and explanation as to why they are well suited to lead this project. Wei QU, PhD (June 2008) in human geography, Lanzhou University, China. Research on rural development like poverty reduction, education, gender issue, off-farming labor, self-governance of rural society in Gansu Province. Qin Tu, PhD (2005) in economics, Tilburg University, the Netherlands. Good training on econometrics, did field experiments and many researches on sustainable resources use and poverty in rural China. both are senior researchers in development economics have good relationship with local governments experiences on leading research projects and doing field surveys Wei Qu has very good knowledge on the situation in rural Gansu, Qin Tu has a strong background on econometric analysis.

5.2 Other key research staff and their roles (1) Other key research staff Jing WANGage: 39, female, bachelor in law, senior research fellow, social security in rural area and rural labor protection. Qijun LIUage: 29, male, master in agricultural economics, junior researcher, poverty, public services in rural area. Miao HUage: 25, female, master in human geography, junior researcher, poverty, women issues, rural development. Qiong JIAage: 28, female, bachelor in agricultural economics, junior researcher, off-farming labor. Huijuan ZHENGage: 35, female, master in agricultural economics, junior researcher, poverty, land tenure, agricultural economics.

5.2 Other key research staff and their roles (2) Capacity building: Gansu is in the north-west China, less developed. No expert on econometrics at GASS. GASS expects the research team members can learn more about quantitative analysis: –how to use Stata; –discrete choice models: ordered and multinomial Porbit model; –data selection model young members can get chance to attend conferences (mainly national/international conferences in China, but may be also international conference aboard) and present a paper. basic knowledge on health economics, hope can learn more literature and theories on health economics. health + poverty background on economics or agricultural economics → multi- disciplines: sociology on poverty alleviation, gender issues, sex education and HIV.

5.2 Other key research staff and their roles (3) All young researchers will contribute substantively to all analytical components of the research: questionnaire design experiment design sampling and field survey data analysis report/paper writing present a paper in conferences

5.3 Past, current or pending projects (1) Asian Development Bank, “Lanzhou Transportation Project”, Wei QU, Qin TU, Jing WANG, Qijun LIU, Qiong JIA, Miao HU. National Social Science Foundation, “Investigation of Some National Minority Poverty Counties”. Wei QU National Social Science Foundation, “Patterns of Rural Poverty Alleviation”. Wei QU, Qijun LIU, Qiong JIA, Miao HU World Bank, “Research on Management Mechanism of Poverty Reduction in Western Region of China - Rural Publicizing and Educating”. Wei QU, Qijun LIU, Jing WANG Bureau of Finance, Gansu Province, “Comparative Analysis and Countermeasure Research of Educational Investment in Gansu”. Wei QU, Qijun LIU, Jing WANG, Qiong JIA Ford Foundation, “Current Condition and Research on Villager Autonomy in Less-Development Region in China”. Wei QU, Jing WANG

5.3 Past, current or pending projects (2) Bureau of Science and Technology, Gansu Province, “Approaches and Countermeasures of Transferring the Rural Labor”. Wei QU Newman Foundation, Germany, “Families Managed by Women: Labor Transfer and Land Right”. Wei QU, Jing WANG KNAW and MOST, “Water Scarcity and Poverty in Heihe Watershed Area”. Qin TU, Wei QU, Jing WANG, Qijun LIU, Qiong JIA, Miao HU. KNAW and MOST, “Grassland Degradation and Poverty of Herd Household in Qinghai Lake Area”. Qin TU Ministry of Finance, “Effects of National Forest Projects on Poverty Reduction”. Qin TU

6. Timeline and budget (1) Timelines Aug 1 – Sep 1, 2008: First interim report (survey/experiment design and/or pilot study results) Sep 15, 2008: Comments on first interim report Sep 20 – Oct 31, 2008: Baseline survey and medical examination Nov 1 – Nov 30, 2008: Experiment Dec 2008: Presentation of survey/experiment implementation at PEP general meeting Jan 1 – May 31, 2009: Analysis of baseline data Jun 2009: Second interim report (results of analyzing baseline data) Jul 2009: Comments on second interim report Nov 20 – Dec 31, 2009: Follow-up survey and medical exam

6. Timeline and budget (2) Timelines Jan 1 – Jan 31, 2010: Data analysis Feb 15, 2010: Draft final report Mar 2010: Study visit May 2010: Final report Jun 2010: Presentation of final report at PEP general meeting Sep 20 – Oct 31, 2010: Potential the third round survey. Because results of our experiment may need more time to discover, we may do the third round survey and a simple medical examination. Jun-Dec 2010: Working paper

6. Timeline and budget (3) Budget 1. Material costs: CAN $ 6, Small workshop in Lanzhou: twice, CAN $3000 eachCAN $ 6, Data input/analysis: CAN $ 6, Field work:CAN $ 80, Cost of experiment: 1500*300= 450,000 yuan 3.2 Training: 400 * 150= 60,000 yuan 3.3 Survey cost: 60*2*300= 36,000 yuan Total: 546,000 yuan 1 CAN $ = yuan RMB 4. Other cost: CAN $ 4, Management fee (10%): CAN $ 10,200 Total :CAN $112,200