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Allen EM, Munala L, Ward-Rannow J. Do Gender-Based Violence Interventions Consider the Impacts of Climate Change? A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:2421-2435. [PMID: 38102819 DOI: 10.1177/15248380231214793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Climate change and extreme weather events have been shown to increase incidences of gender-based violence (GBV). Numerous organizations have devoted significant time, resources, and effort to the design and implementation of interventions aimed at reducing GBV in Africa. Some interventions effectively reduce violence, but GBV persists and remains pervasive. The United Nations has called for GBV interventions that consider the impact of climate change on violence. This review aims to determine whether public health interventions intended to reduce GBV in Africa take into account the effects of climate change on the region and the population. PubMed, PsychArticles, and CINAHL databases were searched systematically in February 2023 for interventions conducted in Africa published between 2010 and 2023. There were a total of 86 articles in the final review that described 40 distinct interventions. The intervention designs included empowerment and participatory approaches (microfinance, microfinance plus, community education, and community engagement), changing social and cultural norms (community education, community engagement, and media), and school-based programs. None of the 40 interventions mentioned climate, weather, or climate change as a component of the intervention. There are several opportunities to improve existing, successful GBV interventions in order to increase their efficacy. GBV interventions could incorporate economic independence programs that do not rely on agriculture and include climate change education. These findings could facilitate the integration of two previously distinct research disciplines-climate change and GBV prevention-to inform future research and develop more effective and cost-efficient interventions.
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Wambiya EOA, Gourlay AJ, Mulwa S, Magut F, Mthiyane N, Orindi B, Chimbindi N, Kwaro D, Shahmanesh M, Floyd S, Birdthistle I, Ziraba A. Impact of DREAMS interventions on experiences of violence among adolescent girls and young women: Findings from population-based cohort studies in Kenya and South Africa. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001818. [PMID: 37163514 PMCID: PMC10171651 DOI: 10.1371/journal.pgph.0001818] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/16/2023] [Indexed: 05/12/2023]
Abstract
DREAMS aims to reduce HIV incidence among adolescent girls and young women (AGYW) by tackling drivers of HIV risk including gender-based violence. We evaluate the impact of DREAMS on recent experiences of violence perpetuated by men against AGYW. AGYW cohorts were randomly selected from demographic platforms in South Africa (rural KwaZulu-Natal) and Kenya (Nairobi informal settlements and rural Gem sub-county). AGYW aged 13-22 years were enrolled in 2017 (Nairobi, KwaZulu-Natal) or 2018 (Gem), with annual follow-up to 2019. We described proportions of AGYW who self-reported experiences of violence perpetrated by males in the 12 months preceding the interview, overall and by form (physical, sexual, emotional). We investigated associations with DREAMS (invitation to participate during 2017-2018) through multivariable propensity score-adjusted logistic regression and estimated the causal effect of DREAMS on experiences of violence, under counter-factual scenarios in which all versus no AGYW were DREAMS beneficiaries. Among 852, 1018 and 1712 AGYW followed-up in 2019 in Nairobi, Gem and KZN, respectively, proportions reporting any violence in 2019 were higher in Nairobi (29%) than Gem (18%) and KwaZulu-Natal (19%). By sub-type, emotional and physical violence were more frequently reported than sexual violence. We found no evidence of an impact attributable to DREAMS on overall levels of violence, in any setting. Nor was there evidence of impact on sub-types of violence, with one exception: an increase in physical violence in Nairobi if all, versus no, AGYW were DREAMS beneficiaries (16% vs 11%; +5% difference [95% CI: +0.2%, +10.0%]). Experiences of gender-based violence were common among AGYW, especially in urban settings, and DREAMS had no measurable impact on reducing violence within three years of implementation. Violence prevention programming that reaches more men and the broader community, sustained for longer periods, may yield greater gains in violence reduction than AGYW-focused programming. Additionally, more investment in implementation research is needed to bridge trial-based study findings from efficacy to population-level effectiveness.
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Affiliation(s)
- Elvis Omondi Achach Wambiya
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
- Health and Systems for Health, African Population and Health Research Center, Nairobi, Kenya
| | - Annabelle J. Gourlay
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah Mulwa
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Faith Magut
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Nondumiso Mthiyane
- Clinical Research Department, Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, United Kingdom
| | - Benedict Orindi
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Center for Geographic Medicine Research, Kilifi, Kenya
| | - Natsayi Chimbindi
- Clinical Research Department, Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, United Kingdom
- University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Daniel Kwaro
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Maryam Shahmanesh
- Clinical Research Department, Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, United Kingdom
- University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Sian Floyd
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Isolde Birdthistle
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Abdhalah Ziraba
- Health and Systems for Health, African Population and Health Research Center, Nairobi, Kenya
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Gram L, Paradkar S, Osrin D, Daruwalla N, Cislaghi B. 'Our courage has grown': a grounded theory study of enablers and barriers to community action to address violence against women in urban India. BMJ Glob Health 2023; 8:e011304. [PMID: 36690379 PMCID: PMC9872482 DOI: 10.1136/bmjgh-2022-011304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/29/2022] [Indexed: 01/25/2023] Open
Abstract
Transforming communities into supportive environments for women facing risks of violence requires community members to play an active role in addressing violence against women (VAW). We did a grounded theory study of enablers and barriers to community response to ongoing violence, sampling from programme areas of a non-governmental organisation (NGO)-led community mobilisation intervention in informal settlements in Mumbai, India. We held 27 focus group discussions and 31 semistructured interviews with 113 community members and 9 NGO staff, along with over 170 hours of field observation. We found that residents responded to violence in diverse ways, ranging from suicide prevention to couple mediation to police and NGO referral. Enabling and constraining factors fit into a social ecological model containing intrapersonal, immediate social network, and wider societal levels. We identified four themes interlinking factors: legitimacy of action, collective power, protection against risk and informal leadership. Legitimacy of action was negotiated in the context of individual disputes, making community members question not only whether VAW was 'wrong', but who was 'wrong' in specific disputes. Collective power through neighbourhood solidarity was key to action but could be curtailed by violent gang crime. Interveners in incidents of VAW turned out to need significant physical, social and legal protection against reprisal. However, repeat interveners could become informal leaders wielding influential prosocial reputations that incentivised and facilitated action. Our model integrates multiple perspectives on community action into one analytical framework, which can be used by implementers to ensure that community members receive encouragement, support and protection to act.
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Affiliation(s)
- Lu Gram
- Faculty of Population Health Sciences, Institute for Global Health, University College London, London, UK
| | - Sukanya Paradkar
- Society for Nutrition, Education and Health Action (SNEHA), Mumbai, India
| | - David Osrin
- Faculty of Population Health Sciences, Institute for Global Health, University College London, London, UK
| | - Nayreen Daruwalla
- Society for Nutrition, Education and Health Action (SNEHA), Mumbai, India
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Gram L, Chakraborty P, Daruwalla N, Osrin D. Social and Psychological Readiness to Take Collective Action Against Violence Against Women: A Mixed Methods Study of Informal Settlements in Mumbai, India. Violence Against Women 2021; 27:3176-3196. [PMID: 33227227 PMCID: PMC8521371 DOI: 10.1177/1077801220971360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Past failures to mobilize communities in collective action against violence against women (VAW) have been ascribed to contextual challenges, but researchers have not systematically mapped community capacity for collective action against VAW. We conducted a mixed methods study in Mumbai, India using quantitative data from a household survey (n = 2,642) and qualitative data from 264 community meetings. We found attitudes supporting gender inequality and violence coexisted with significant enthusiasm and support for collective action against VAW. These findings open up avenues for policymakers to treat communities as less vulnerable and more capable of changing situations and problems that affect them.
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Affiliation(s)
- Lu Gram
- University College London, UK
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Jewkes R, Willan S, Heise L, Washington L, Shai N, Kerr-Wilson A, Gibbs A, Stern E, Christofides N. Elements of the Design and Implementation of Interventions to Prevent Violence against Women and Girls Associated with Success: Reflections from the What Works to Prevent Violence against Women and Girls? Global Programme. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12129. [PMID: 34831885 PMCID: PMC8621962 DOI: 10.3390/ijerph182212129] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022]
Abstract
Intimate partner violence (IPV) has a large and sustained impact on women's mental health, and so effective prevention is critical. A review of 96 rigorous evaluations of interventions for their impact on violence against women and girls (mostly IPV) found that several intervention approaches were effective. However, not every evaluation of a 'successful approach' showed success in reducing IPV. In order to understand what else impacts success, we analysed practitioners' accounts and documentation of the design and implementation of seventeen interventions evaluated as part of What Works to Prevent Violence against Women and Girls (VAWG). Six features were identified as characteristics of all successful interventions: a rigorously planned intervention with a robust theory of change (ToC), attuned to the local context; addressing multiple drivers of VAWG; support for survivors; working with women and men; implementing at optimal intensity and having sufficient, well-selected, trained and supported staff and volunteers. Four features were necessary for success when relevant for the intervention approach: gender and social empowerment group activities and promoting positive interpersonal relations; participatory learning methods, emphasising empowerment, critical reflection and communication skills; carefully designed user-friendly manuals systematically followed; and when working with children, having an age-appropriate design with time for learning and an engaging pedagogy. This analysis provides the IPV prevention field with critical information for enhancing the impact of group- and community-based interventions in IPV prevention and through this strengthening women's mental health.
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Affiliation(s)
- Rachel Jewkes
- Office of the Executive Scientist, South African Medical Research Council, Pretoria 0001, South Africa
- Gender & Health Research Unit, South African Medical Research Council, Pretoria 0001, South Africa; (S.W.); (N.S.); (A.G.)
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa;
| | - Samantha Willan
- Gender & Health Research Unit, South African Medical Research Council, Pretoria 0001, South Africa; (S.W.); (N.S.); (A.G.)
| | - Lori Heise
- John Hopkins Bloomberg School of Public Health, John Hopkins University, Baltimore, MA 21211, USA;
- School of Nursing, John Hopkins University, Baltimore, MA 21211, USA
| | - Laura Washington
- Project Empower, Diakonia Centre, 20 Diakonia Ave, Durban 4001, South Africa;
| | - Nwabisa Shai
- Gender & Health Research Unit, South African Medical Research Council, Pretoria 0001, South Africa; (S.W.); (N.S.); (A.G.)
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa;
| | - Alice Kerr-Wilson
- Social Development Direct, Finsgate, 5-7 Cranwood Street, London EC1V 9LH, UK;
| | - Andrew Gibbs
- Gender & Health Research Unit, South African Medical Research Council, Pretoria 0001, South Africa; (S.W.); (N.S.); (A.G.)
| | - Erin Stern
- Gender Violence and Health Centre, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
| | - Nicola Christofides
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa;
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Chronic high risk of intimate partner violence against women in disadvantaged neighborhoods: An eight-year space-time analysis. Prev Med 2021; 148:106550. [PMID: 33848525 DOI: 10.1016/j.ypmed.2021.106550] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 02/25/2021] [Accepted: 04/08/2021] [Indexed: 01/10/2023]
Abstract
We conducted a small-area ecological longitudinal study to analyze neighborhood contextual influences on the spatio-temporal variations in intimate partner violence against women (IPVAW) risk in a southern European city over an eight-year period. We used geocoded data of IPVAW cases with associated protection orders (n = 5867) in the city of Valencia, Spain (2011-2018). The city's 552 census block groups were used as the neighborhood units. Neighborhood-level covariates were: income, education, immigrant concentration, residential instability, alcohol outlet density, and criminality. We used a Bayesian autoregressive approach to spatio-temporal disease mapping. Neighborhoods with low levels of income and education and high levels of residential mobility and criminality had higher relative risk of IPVAW. Spatial patterns of high risk of IPVAW persisted over time during the eight-year period analyzed. Areas of stable low risk and with increasing or decreasing risk were also identified. Our findings link neighborhood disadvantage to the existence and persistence over time of spatial inequalities in IPVAW risk, showing that high risk of IPVAW can become chronic in disadvantaged neighborhoods. Our analytic approach provides specific risk estimates at the small-area level that are informative for intervention purposes, and can be useful to assess the effectiveness of prevention efforts in reducing IPVAW.
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Makleff S, Garduño J, Zavala RI, Valades J, Barindelli F, Cruz M, Marston C. Evaluating Complex Interventions Using Qualitative Longitudinal Research: A Case Study of Understanding Pathways to Violence Prevention. QUALITATIVE HEALTH RESEARCH 2021; 31:1724-1737. [PMID: 33980080 PMCID: PMC8438767 DOI: 10.1177/10497323211002146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Evaluating social change programs requires methods that account for changes in context, implementation, and participant experience. We present a case study of a school-based partner violence prevention program with young people, where we conducted 33 repeat interviews with nine participants during and after an intervention and analyzed participant trajectories. We show how repeat interviews conducted during and after a social change program were useful in helping us understand how the intervention worked by providing rich contextual information, elucidating gradual shifts among participants, and identifying aspects of the intervention that appear to influence change. Long-term effects of social change interventions are very hard to quantify or measure directly. We argue that a qualitative longitudinal approach provides a way to measure subtle changes that can serve as proxies for longer term impacts.
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Affiliation(s)
- Shelly Makleff
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Monash University, Melbourne, Victoria, Australia
| | - Jovita Garduño
- Fundación Mexicana para la Planeación Familiar, A.C., Mexico City, Mexico
| | - Rosa Icela Zavala
- Fundación Mexicana para la Planeación Familiar, A.C., Mexico City, Mexico
| | | | | | | | - Cicely Marston
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Gram L, Granados R, Krockow EM, Daruwalla N, Osrin D. Modelling collective action to change social norms around domestic violence: social dilemmas and the role of altruism. HUMANITIES & SOCIAL SCIENCES COMMUNICATIONS 2021; 8:53. [PMID: 34553143 PMCID: PMC7611687 DOI: 10.1057/s41599-021-00730-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/05/2021] [Indexed: 06/03/2023]
Abstract
Interventions promoting collective action have been used to prevent domestic violence in a range of settings, but their mechanisms of operation remain unclear. We formalise and combine feminist theoretical approaches to domestic violence into a game-theoretic model of women's collective action to change gendered social norms and outcomes. We show that social norms create a social dilemma in which it is individually rational for women to abstain from action to prevent domestic violence among neighbours, but all women suffer negative consequences if none take action. Promoting altruism among women can overcome the social dilemma. Discouraging women from tolerating domestic violence, imposing additional external punishment on men for perpetrating violence, or lowering costs to women of taking action against violence may not work or even backfire. We invite researchers on community mobilisation to use our framework to frame their understandings of collective action to prevent domestic violence.
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Affiliation(s)
- Lu Gram
- Institute for Global Health, University College London, London, UK
| | - Rolando Granados
- Institute for Global Health, University College London, London, UK
| | - Eva M Krockow
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Nayreen Daruwalla
- Prevention of Violence against Women and Children, Society for Nutrition, Education and Health Action (SNEHA), Mumbai, India
| | - David Osrin
- Institute for Global Health, University College London, London, UK
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Makleff S, Billowitz M, Garduño J, Cruz M, Silva Márquez VI, Marston C. Applying a complex adaptive systems approach to the evaluation of a school-based intervention for intimate partner violence prevention in Mexico. Health Policy Plan 2020; 35:993-1002. [PMID: 32761146 PMCID: PMC7553757 DOI: 10.1093/heapol/czaa067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2020] [Indexed: 11/13/2022] Open
Abstract
Despite calls for evaluation practice to take a complex systems approach, there are few examples of how to incorporate complexity into real-life evaluations. This article presents the case for using a complex systems approach to evaluate a school-based intimate partner violence-prevention intervention. We conducted a post hoc analysis of qualitative evaluation data to examine the intervention as a potential system disruptor. We analysed data in relation to complexity concepts particularly relevant to schools: 'diverse and dynamic agents', 'interaction', 'unpredictability', 'emergence' and 'context dependency'. The data-two focus groups with facilitators and 33 repeat interviews with 14-17-year-old students-came from an evaluation of a comprehensive sexuality education intervention in Mexico City, which serves as a case study for this analysis. The findings demonstrate an application of complex adaptive systems concepts to qualitative evaluation data. We provide examples of how this approach can shed light on the ways in which interpersonal interactions, group dynamics, the core messages of the course and context influenced the implementation and outcomes of this intervention. This gender-transformative intervention appeared to disrupt pervasive gender norms and reshape beliefs about how to engage in relationships. An intervention comprises multiple dynamic and interacting elements, all of which are unlikely to be consistent across implementation settings. Applying complexity concepts to our analysis added value by helping reframe implementation-related data to focus on how the 'social' aspects of complexity influenced the intervention. Without examining both individual and group processes, evaluations may miss key insights about how the intervention generates change, for whom, and how it interacts with its context. A social complex adaptive systems approach is well-suited to the evaluation of gender-transformative interventions and can help identify how such interventions disrupt the complex social systems in which they are implemented to address intractable societal problems.
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Affiliation(s)
- Shelly Makleff
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Marissa Billowitz
- Independent, Juárez 208, Col. Tlalpan Centro, 14000 Mexico City, Mexico
| | - Jovita Garduño
- Fundación Mexicana para la Planeación Familiar, A.C. (Mexfam), Juárez 208, Col. Tlalpan Centro, 14000 Mexico City, Mexico
| | - Mariana Cruz
- IPPF/WHR Mexico, Juárez 208, Col. Tlalpan Centro, 14000 Mexico City, Mexico
| | - Vanessa Ivon Silva Márquez
- Fundación Mexicana para la Planeación Familiar, A.C. (Mexfam), Juárez 208, Col. Tlalpan Centro, 14000 Mexico City, Mexico
| | - Cicely Marston
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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Christofides NJ, Hatcher AM, Rebombo D, McBride RS, Munshi S, Pino A, Abdelatif N, Peacock D, Levin J, Jewkes RK. Effectiveness of a multi-level intervention to reduce men's perpetration of intimate partner violence: a cluster randomised controlled trial. Trials 2020; 21:359. [PMID: 32334615 PMCID: PMC7183134 DOI: 10.1186/s13063-020-4185-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 02/19/2020] [Indexed: 11/20/2022] Open
Abstract
Background Men’s perpetration of intimate partner violence (IPV) limits gains in health and wellbeing for populations globally. Largely informal, rapidly expanding peri-urban settlements, with limited basic services such as electricity, have high prevalence rates of IPV. Evidence on how to reduce men’s perpetration, change social norms and patriarchal attitudes within these settings is limited. Our cluster randomised controlled trial aimed to determine the effectiveness of the Sonke CHANGE intervention in reducing use of sexual and/or physical IPV and severity of perpetration by men aged 18–40 years over 2 years. Methodology The theory-based intervention delivered activities to bolster community action, including door-to-door discussions, workshops, drawing on the CHANGE curriculum, and deploying community action teams over 18 months. In 2016 and 2018, we collected data from a cohort of men, recruited from 18 clusters; nine were randomised to receive the intervention, while the nine control clusters received no intervention. A self-administered questionnaire, using audio-computer assisted software, asked about sociodemographics, gender attitudes, mental health, and the use and severity of IPV. We conducted an intention-to-treat analysis at the cluster level comparing the expected risk to observed risk of using IPV while controlling for baseline characteristics. A secondary analysis used latent classes (LCA) of men to see whether there were differential effects of the intervention for subgroups of men. Results Of 2406 men recruited, 1458 (63%) were followed to 2 years. Overall, we saw a reduction in men’s reports of physical, sexual and severe IPV from baseline to endpoint (40.2% to 25.4%, 31.8% to 15.8%, and 33.4% to 18.2%, respectively). Intention-to-treat analysis showed no measurable differences between intervention and control clusters for primary IPV outcomes. Difference in the cluster-level proportion of physical IPV perpetration was 0.002 (95% confidence interval [CI] − 0.07 to 0.08). Similarly, differences between arms for sexual IPV was 0.01 (95% CI − 0.04 to 0.06), while severe IPV followed a similar pattern (Diff = 0.01; 95% CI − 0.05 to 0.07). A secondary analysis using LCA suggests that among the men living in intervention communities, there was a greater reduction in IPV among less violent and more law abiding men than among more highly violent men, although the differences did not reach statistical significance. Conclusion The intervention, when implemented in a peri-urban settlement, had limited effect in reducing IPV perpetrated by male residents. Further analysis showed it was unable to transform entrenched gender attitudes and use of IPV by those men who use the most violence, but the intervention showed promise for men who use violence less. Trial registration ClinicalTrials.gov, NCT02823288. Registered on 30 June 2016.
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Affiliation(s)
- Nicola J Christofides
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg, 2193, South Africa.
| | - Abigail M Hatcher
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg, 2193, South Africa.,Division of HIV, Infectious Disease, and Global Medicine, University of California, SanFrancisco, USA
| | - Dumisani Rebombo
- Sonke Gender Justice, Juta Street, Braamfontein, Johannesburg, South Africa
| | - Ruari-Santiago McBride
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg, 2193, South Africa
| | - Shehnaz Munshi
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg, 2193, South Africa
| | - Angelica Pino
- Sonke Gender Justice, Juta Street, Braamfontein, Johannesburg, South Africa
| | - Nada Abdelatif
- South African Medical Research Council, 1 Soutpansberg Road, Pretoria, South Africa
| | - Dean Peacock
- Sonke Gender Justice, Juta Street, Braamfontein, Johannesburg, South Africa
| | - Jonathan Levin
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg, 2193, South Africa
| | - Rachel K Jewkes
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg, 2193, South Africa.,South African Medical Research Council, 1 Soutpansberg Road, Pretoria, South Africa
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