Deepening context in realist evaluation : exploring adolescent agency in sexual and reproductive health in urban India

Background: Although accountability interventions to strengthen adolescent sexual and reproductive health (ASRH) service delivery in marginalized urban neighbourhoods are on the rise, evidence on the underlying mechanisms and context conditions is scarce. We analysed the strategies of two grassroots organizations in India that support adolescent agency in sexual and reproductive health (SRHR) to identify the mechanisms and context conditions in which they work. Methods: We used realist evaluation (RE) and a case study design with two sites in Delhi and Mumbai. We used Margaret Archer's structure-agency-culture (SAC) framework to deepen the analysis of context and of the temporal dynamics of the intervention. Results: We found that the organizations used five strategies: (1) mobilization of girls and young women, (2) raising critical consciousness, (3) supporting self-organization and emergent collective action, (4) documenting lived realities and engagement with local governance actors. Organizational and relational mechanisms triggered include trust-building in the community and with parents, which enables support, fosters a group identity, and provides a safe space for peer exchange. Enhancing reflexivity, self-efficacy and a sense of place among adolescent girls, the intervention stimulates emergent collective action within the neighbourhood, which in turn contributes to build consensus and enforce accountabilitywith local and sub-national governance actors. We considered causal mechanisms to be historically grounded in practices preceding current ones, and we adopted a view on "context" that includes a longer-term temporal dimension. Conclusion: The refined programme theory confirms that organizations will simultaneously engage in consensus-oriented and agonistic strategies with state actors in their efforts to achieve social change.