Mental Health

Are parenting programmes effective at scale? Associations with violence against adolescent girls, parenting and mental health in real-world delivery across eight African countries: a meta-analysis of pre-post surveys.

TL;DR

In eight African countries, including humanitarian and pandemic-affected contexts, an evidence-based parenting programme showed consistent associations with reduced violence against adolescent girls and improved parenting and mental health.

Key Findings

Physical abuse against adolescent girls was associated with a 65% reduction across all countries in meta-analysis.

  • All-country meta-analysis estimate: -65% (95% CI 51% to 74%)
  • Data collected through pre-post surveys integrated into service data collection between 2016 and 2022
  • Programme delivered across Botswana, DRC, Eswatini, South Africa, South Sudan, Tanzania, Zambia, and Zimbabwe
  • Individual country scores analyzed using generalised linear mixed-effects models, combined via random-effects meta-analytic model

Emotional abuse against adolescent girls was associated with a 59% reduction in the all-country meta-analysis.

  • All-country meta-analysis estimate: -59% (95% CI 48% to 68%)
  • Findings were consistent across both caregiver and adolescent reports
  • Programme is WHO-endorsed and UNICEF-endorsed (Parenting for Lifelong Health)
  • Delivered through non-governmental organisation and government channels

Caregiver approval of corporal punishment decreased by 55% across all countries.

  • All-country meta-analysis estimate: -55% (95% CI 48% to 60%)
  • Abbreviated standardised measures were used for all outcomes
  • Results were consistent across both humanitarian and development settings, though with some heterogeneity in pre-intervention scores and extent of change

Positive involved parenting increased by 52% in the all-country meta-analysis.

  • All-country meta-analysis estimate: +52% (95% CI 24% to 87%)
  • Poor supervision/monitoring also decreased by 48% (95% CI 34% to 58%)
  • 56,423 caregivers were included at follow-up
  • Overall sample retention rate was 93%

Caregiver depressive symptoms decreased by 25% and parenting stress decreased by 46% across all countries.

  • Caregiver depressive symptoms: -25% (95% CI 8% to 48%)
  • Parenting stress: -46% (95% CI 41% to 52%)
  • Abbreviated standardised measures were used to assess both outcomes
  • Results were consistent across caregiver and adolescent reports

Adolescent depressive symptoms decreased by 22% and adolescent externalising behaviour problems decreased by 43%.

  • Adolescent depressive symptoms: -22% (95% CI 1% to 38%)
  • Adolescent externalising behaviour problems: -43% (95% CI 29% to 54%)
  • 57,908 adolescents were included at follow-up (96% female)
  • Pre-post surveys for adolescents were integrated into service data collection

The study included 123,050 participants with a 93% retention rate across eight African countries.

  • Total participants: 123,050
  • Retention rate: 93%
  • 57,908 adolescents at follow-up (96% female); 56,423 caregivers at follow-up
  • Data collected between 2016 and 2022
  • Programme supported by PEPFAR, USAID, and the European Union

There was heterogeneity in pre-intervention scores and extent of change between humanitarian and development settings, but strong consistency across caregiver and adolescent reports.

  • Heterogeneity was observed between humanitarian settings (e.g., South Sudan) and development settings
  • Heterogeneity was also observed between different target groups
  • Despite this heterogeneity, results were described as showing 'strong consistency across caregiver and adolescent reports'
  • Cross-country data were combined using a random-effects meta-analytic model to account for heterogeneity

Despite hundreds of randomised trials supporting parenting programmes, little was previously known about their outcomes when delivered at scale within routine delivery.

  • The study addresses a gap between evidence from randomised trials and real-world, at-scale implementation
  • The Parenting for Lifelong Health programme was delivered through both NGO and government channels
  • The study spans pandemic-affected contexts as data collection ran through 2022
  • This is described as real-world delivery across eight African countries

What This Means

This research suggests that a structured parenting program called Parenting for Lifelong Health, endorsed by the WHO and UNICEF, can produce large reductions in violence against adolescent girls and improvements in family mental health even when delivered at a large scale through governments and community organizations in Africa. The study analyzed data from over 123,000 participants across eight African countries — including in conflict zones and during the COVID-19 pandemic — and found consistent improvements before and after the program. Physical abuse dropped by about 65%, emotional abuse by about 59%, and caregiver approval of physical punishment by about 55%. Positive parenting increased by about 52%, while caregiver depression fell by 25%, parenting stress by 46%, and adolescent depression and behavioral problems also declined substantially. The findings matter because most prior research on parenting programs has come from tightly controlled randomized trials, leaving open the question of whether the benefits hold up in messy, real-world conditions at large scale. This study found that they do, with high retention rates (93%) and consistent results reported by both caregivers and adolescents across very different settings, from stable development environments to active humanitarian crises. The fact that these results were seen in countries as varied as South Sudan and Botswana, delivered through diverse organizations with government support, suggests the program can be broadly implemented. This research also suggests that parenting programs may simultaneously address multiple problems — not only violence against children, but also caregiver mental health, parenting skills, and adolescent wellbeing — making them potentially efficient investments for governments and international organizations. The study was observational (pre-post design without a control group), so caution is warranted in attributing all change solely to the program, but the scale, consistency across countries, and the use of standardized measures strengthen confidence in the findings.

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Citation

Cluver L, Ward C, Little F, Vallance I, Haupt Ronnie G, Shenderovich Y, et al.. (2026). Are parenting programmes effective at scale? Associations with violence against adolescent girls, parenting and mental health in real-world delivery across eight African countries: a meta-analysis of pre-post surveys.. BMJ global health. https://doi.org/10.1136/bmjgh-2025-020422