Pedalling progress? Assessing the long-term impact of a bicycle intervention on adolescent maternal and child health in Zambia

This study evaluates the long-term impact of a gender-transformative intervention that provided bicycles to adolescent girls in rural Zambia to enhance school attendance and empowerment. Implemented in 2017 across 100 schools, the intervention aimed to reduce travel barriers and improve educational access. Using an experimental design with a final sample of 1615 adolescent girls (676 treatment, 939 control) in 92 school clusters, we estimate the causal impact of bicycle ownership on sexual, reproductive, maternal and child health indicators five years post-intervention. Our findings indicate a statistically significant 11.5 percentage point increase in adolescent motherhood among the treatment group compared to the control group. However, the intervention did not significantly affect antenatal care visits, iron and folic acid use, institutional deliveries, birth weight, or exclusive breastfeeding (n = 382). For sexual reproductive health outcomes, girls in the treatment group were 11 percentage points more likely to report sexual debut and eight percentage points more likely to report wanting the pregnancy. Causal mediation analysis suggests increased empowerment partially mediated the observed rise in adolescent motherhood. Complier analysis indicates a higher likelihood of adolescent childbearing for girls who use the bicycle for school as intended by the programme. These findings highlight the complexities of gender-transformative interventions in low-resource settings. While aiming to empower adolescent girls, increased mobility and decision-making power may intersect with unintended reproductive health consequences. This underscores the need for integrated program designs that complement empowerment initiatives with comprehensive sexual health education and services to mitigate adverse outcomes.