Gender norms, poverty and armed conflict in Côte D'Ivoire: engaging men in women's social and economic empowerment programming

Engaging men in women's empowerment: impact of a complex gender transformative intervention on household socio-economic and health outcomes in the eastern democratic republic of the Congo using a longitudinal survey

BACKGROUND

In the Democratic Republic of the Congo, women in (peri-)urban areas are commonly engaged in small trade, which allows them to meet the basic needs of their families. Microsaving approaches are a low-risk option to obtain financing for economic activities. A project combining men's sensitization on gender equity and women's empowerment through village savings and loan associations were implemented in North and South Kivu to raise the household economic level.

OBJECTIVE

This study assessed how involving men in gender equity affects women's health and socio-economic outcomes, including food security.

METHODS

A cohort study was conducted with 1812 women at the baseline; out of them 1055 were retrieved at the follow-up. Baseline data collection took place from May to December 2017 and the follow-up from July 2018 to January 2019. To identify socio-economic changes and changes of gender relations, linear and logistic regressions were run.

RESULTS

Results showed that the household income improved with intervention (coefficient = 0.327; p = 0.002), while the capacity to pay high bills without contracting debts decreased (coefficient = 0.927; p = 0.001). We did not find enough statistically significant evidence of the influence of the intervention on skilled birth attendance (coefficient = 0.943; p = 0.135), or family planning use (coefficient = 0.216; p = 0.435) nor women's participation in the decision-making (coefficient = 0.033; p = 0.227) nor on couple's cohesion (coefficient = 0.024; p = 0.431). Food insecurity levels decreased over time regardless of being in the intervention or control area.

CONCLUSION

Empowering women while sensitizing men on gender aspects improves financial well-being (income). Time, security, and strong politics of government recognizing and framing the approach are still needed to maximize the benefit of such projects on social factors such as women's participation in decision-making and social cohesion.

Ea$ing into the USA: study protocol for adapting the Economic and Social Empowerment (EA$E) intervention for US-based, forcibly based populations

INTRODUCTION

Immigrant and forcibly displaced women and girls are disproportionately impacted by the harmful health consequences of intimate partner violence (IPV) in the USA. Economic and Social Empowerment (EA$E), a women's protection and empowerment intervention, has shown promising reductions in IPV and gender inequities among forcibly displaced populations (FDPs) in low-income and middle-income countries. However, research on the integration of gender equity interventions into economic empowerment programming for FDPs within the USA is lacking. Additionally, there is growing interest in integrating gender equity programmes among US-based refugee resettlement organisations, including the International Rescue Committee (IRC). We describe our study protocol for examining the feasibility, acceptability and appropriateness of EA$E for use with US-based FDPs, and recommendations for adaptation.

METHODS AND ANALYSIS

This is a convergent parallel study to guide the adaptation of EA$E for use with US-based FDPs. Mixed methods (quantitative and qualitative) will be used for the adaptation research. Quantitative data will consist of brief surveys, and qualitative data will consist of focus group discussions (FGDs). Our research will be guided by the 'administration' phase of the ADAPT-ITT framework, which entails pretesting the intervention with the new target audience and implementation context to examine acceptability, appropriateness and feasibility to receive feedback to inform modifications of the original intervention. This is done via theatre testing, an innovative approach to pretesting that allows the new target audience to experience the intervention and provide feedback. We will conduct FGDs with IRC staff (n=4, total of 24 participants) and refugee clients (n=8, total of 48 participants, women and men, French and English speaking).

ETHICS AND DISSEMINATION

The study has received approval from the George Mason University Human Subjects Committee (#1686712-7) and IRC (via reliance agreement). Results will be made available to refugee resettlement organisations, policymakers, funders and other researchers. This study has been registered in Open Science Framework (https://doi.org/10.17605/OSF.IO/SZDVY).

Intimate Partner Abuse Among Rohingya Women and Its Relationship With Their Abilities to Reject Husbands' Advances to Unwanted Sex

Currently, around a million Rohingya refugees live in Cox's Bazar, Bangladesh. Displacement from homelands and restrictions on movement in the refugee camps may exacerbate intimate partner abuse (IPA) against refugee women and their abilities to reject husbands' advances to unwanted sex. This study examines Rohingya refugee women's attitudes toward and experience of intimate partner abuse (IPA) and their impact on the abilities to reject husbands' advances to unwanted sex. A survey was conducted among Rohingya refugee women in Cox's Bazar, Bangladesh. Women's attitudes toward IPA, and experience of IPA were the exposure variables. Women's abilities to say "no" to husbands' advances to unwanted sexual intercourse was the outcome variable. Multivariable logistic regression models were used to examine the relationships. Participants' median age was 22 years (range: 13-41). Most women perceived hitting/beatings by their husbands in certain situations as justifiable, 72% had experienced such abuse and 56.5% had to engage in unwanted sexual intercourse with their husbands. Women with increasing leniency towards hitting/beatings and those who had experienced such abuse were less likely to be able to say "no" to husbands' advances to unwanted sexual intercourse. Rohingya women's attitudes toward and experience of IPA are associated with their abilities to say "no" to husbands' advances to unwanted sex. Intervention is needed to denormalize the current practice of IPA, create awareness against IPA, and ensure formal education for girls.

Masculinity, power and structural constraints: Men's conceptualization of emotional abuse in Mwanza, Tanzania

Intimate partner violence is a global problem with devastating social and health consequences to individuals and families. While some forms of intimate partner violence such as physical and sexual violence have been explored in depth, there is a lack of clarity on men's perspectives of emotional violence, particularly in low-income countries. Yet it is recognized that incorporating men's perspectives and participation is crucial for addressing intimate partner violence. We draw from in-depth interviews with 30 men and 1, 645 pictures collected through photo voice to explore men's conceptualization and experiences of emotional violence by female partners in Mwanza, Tanzania. A sub-sample of the men (n = 16) were interviewed for a second time about pictures showing different aspects of their lives. The fieldwork was conducted between April and December 2019, and the data were analyzed through a multistage inductive process. Participants described emotional violence through a narrative of ‘being hurt’ by some actions or words of their partners. These included: verbal complaints about failure to provide for family, partner's infidelity and flirting with other men, accusation of poor sexual performance, and perceived normative deviance characterized by coming home late and not carrying out domestic chores. Threatened masculinities drawing from negative communal normative ideals, and the underlying interpersonal power struggles with their partners for the control of economic provision, sexual intimacy and family matters framed men's definitions of emotional violence. Ongoing changes such as women's ownership and engagement in economic activities and the scarcity of employment opportunities for men challenges their household dominance. Multicomponent interventions should target men, couples and communal ideals reinforcing negative masculinity. Analysis of interpersonal power and structural dynamics influencing relationships must inform the design of interventions instead of the narrow focus on individual demographic attributes.

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Male perspectives and engagement crucial for addressing intimate partner violence.

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Lack of insight on female to male emotional violence in low-income contexts.

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Threatened masculinities underlie men's perspectives of emotional violence.

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Socio-economic and policy circumstances influencing power dynamics in relationships.

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Tackling both individual and structural factors key to addressing partner violence.

The impact of interventions to reduce risk and incidence of intimate partner violence and sexual violence in conflict and post-conflict states and other humanitarian crises in low and middle income countries: a systematic review

Sexual violence and intimate partner violence are exacerbated by armed conflict and other humanitarian crises. This narrative systematic review of evidence for interventions to reduce risk and incidence of sexual and intimate partner violence in conflict, post-conflict and other humanitarian crises, updates and expands our review published in 2013. A search of ten bibliographic databases for publications from January 2011 to May 2020 used database specific key words for sexual/intimate partner violence and conflict/humanitarian crisis. The 18 papers, describing 16 studies were undertaken in conflict/post-conflict settings in 12 countries. Six intervention types were reported: i) personnel; ii) community mobilisation; iii) social norms; iv) economic empowerment; v) empowerment; and vi) survivor responses, with the most common being economic empowerment (n = 7) and gendered social norms interventions (n = 6). Combined interventions were reported in nine papers. Four studies identified non-significant reductions in incidence of sexual/ intimate partner violence, showing an evident positive trend; all four evaluated gendered social norms or economic empowerment singly or in combination. Evidence for improved mental health outcomes was found for some economic empowerment, social norms and survivor interventions. Some evidence of reduced risk of sexual violence and intimate partner violence was identified for all intervention types. Qualitative studies suggest that experiences of social connection are important for women who participate in programming to address sexual and intimate partner violence. Interventions with multiple strategies appear to hold merit. Achieving and demonstrating reduced sexual and intimate partner violence remains challenging in this context. Future research should continue to explore how social norms interventions can be most effectively delivered, including the impact of including mixed and same sex groups. Work is needed with local partners to ensure programs are contextually adapted.

Engaging men to transform inequitable gender attitudes and prevent intimate partner violence: a cluster randomised controlled trial in North and South Kivu, Democratic Republic of Congo

Introduction

The study objective was to understand the effectiveness of Engaging Men through Accountable Practice (EMAP), a group-based discussion series which sought to transform gender relations in communities, on intimate partner violence (IPV), gender inequitable attitudes and related outcomes.

Methods

A two-armed, matched-pair, cluster randomised controlled trial was conducted between 2016 and 2018 in eastern Democratic Republic of Congo. Adult men (n=1387) and their female partners (n=1220) participated in the study. The primary outcomes of the study were female report of past year physical and/or sexual IPV and men’s intention to commit violence. Secondary outcomes included men’s gender attitudes, women’s economic and emotional IPV, women’s perception of negative male behaviours and perceived quality of the relationship.

Results

Men in EMAP reported significant reductions in intention to commit violence (β=−0.76; SE=0.23; p<0.01), decreased agreement with any reason that justifies wife beating (OR=0.59; SE=0.08; p<0.01) and increased agreement with the ability of a woman to refuse sex for all reasons (OR=1.47; SE=0.24; p<0.05), compared with men in the control group. We found no statistically significant differences in women’s experiences of IPV between treatment and control group at follow-up (physical or sexual IPV: adjusted OR=0.95; SE=0.14; p=0.71). However, female partners of men in EMAP reported significant improvements to the quality of relationship (β=0.28; p<0.05) and significant reductions in negative male behaviour (β=−0.32; p<0.01).

Conclusion

Interventions engaging men have the potential to change gender attitudes and behaviours in conflict-affected areas. However, while EMAP led to changes in gender attitudes and behaviours related to perpetration of IPV, the study showed no overall reduction of women’s experience of IPV. Further research is needed to understand how working with men may lead to long-term and meaningful changes in IPV and related gender equitable attitudes and behaviours in conflict areas.

Trial registration number

NCT02765139.

Impact of a complex gender-transformative intervention on maternal and child health outcomes in the eastern Democratic Republic of Congo: protocol of a longitudinal parallel mixed-methods study

Background

In the eastern part of the Democratic Republic of Congo (DRC) Village Savings and Loan Associations (VSLAs) programs targeting women are implemented. In the context of the ‘Mawe Tatu’ program more equitable intra-household decision-making is stipulated by accompanying women’s participation in VSLAs with efforts to engage men for more gender equality, expecting a positive effect of this combined intervention on the household economy, on child nutritional status, on the use of reproductive health services including family planning, and on reducing sexual and gender-based violence (SGBV).

Methods

A longitudinal parallel mixed method study is conducted among women participating in VSLAs in randomly selected project areas and among a control group matched for socioeconomic characteristics. Descriptive statistics will be calculated and differences between intervention and control groups will be assessed by Chi2 tests for different degrees of freedom for categorical data or by t-tests for continuous data. Structural equation modelling (SEM) will be conducted to investigate the complex and multidimensional pathways that will affect household economic status, child nutritional status and use of reproductive health services. Analysis will be conducted with STATA V.15.

Concomitantly, qualitative data collection will shed light on the intra-household processes related to gender power-relations that may be linked to women’s participation in economic activities and may lead to improvements of maternal and child health. Focus group discussions and in-depth interviews will be conducted. All narrative data will be coded (open coding) with the help of qualitative data analysis software (Atlas TI).

Discussion

Women’s empowerment has long been identified as being able to bring about progress in various areas, including health. It has been shown that men’s commitment to transforming gender norms is a sinequanone factor for greater equity and better health, especially in terms of reproductive health and child nutrition. This study is one of the first in this genre in DRC and results will serve as a guide for policies aimed at improving the involvement of men in changing attitudes towards gender norms for higher household productivity and better health.

Promoting women's and children's health through community groups in low-income and middle-income countries: a mixed-methods systematic review of mechanisms, enablers and barriers

INTRODUCTION

Community mobilisation through group activities has been used to improve women's and children's health in a range of low-income and middle-income contexts, but the mechanisms through which it works deserve greater consideration. We did a mixed-methods systematic review of mechanisms, enablers and barriers to the promotion of women's and children's health in community mobilisation interventions.

METHODS

We searched for theoretical and empirical peer-reviewed articles between January 2000 and November 2018. First, we extracted and collated proposed mechanisms, enablers and barriers into categories. Second, we extracted and synthesised evidence for them using narrative synthesis. We assessed risk of bias with adapted Downs and Black and Critical Appraisal Skills Programme checklists. We assigned confidence grades to each proposed mechanism, enabler and barrier.

RESULTS

78 articles met the inclusion criteria, of which 39 described interventions based on a participatory group education model, 19 described community-led structural interventions to promote sexual health in marginalised populations and 20 concerned other types of intervention or multiple interventions at once. We did not have high confidence in any mechanism, enabler or barrier. Two out of 15 proposed mechanisms and 10 out of 12 proposed enablers and barriers reached medium confidence. A few studies provided direct evidence relating proposed mechanisms, enablers or barriers to health behaviours or health outcomes. Only two studies presented mediation or interaction analysis for a proposed mechanism, enabler or barrier.

CONCLUSION

We uncovered multiple proposed mechanisms, enablers and barriers to health promotion through community groups, but much work remains to provide a robust evidence base for proposed mechanisms, enablers and barriers.

PROSPERO REGISTRATION NUMBER

CRD42018093695.

A theory of change for community interventions to prevent domestic violence against women and girls in Mumbai, India

Background: We describe the development of a theory of change for community mobilisation activities to prevent violence against women and girls. These activities are part of a broader program in urban India that works toward primary, secondary, and tertiary prevention of violence and includes crisis response and counselling and medical, police, and legal assistance. Methods: The theory of change was developed in five phases, via expert workshops, use of primary data, recurrent team meetings, adjustment at further meetings and workshops, and a review of published theories. Results: The theory summarises inputs for primary and secondary prevention, consequent changes (positive and negative), and outcomes. It is fully adapted to the program context, was designed through an extended consultative process, emphasises secondary prevention as a pathway to primary prevention, and integrates community activism with referral and counselling interventions. Conclusions: The theory specifies testable causal pathways to impact and will be evaluated in a controlled trial.

A theory of change for community interventions to prevent domestic violence against women and girls in Mumbai, India

Background: We describe the development of a theory of change for community mobilisation activities to prevent violence against women and girls. These activities are part of a broader program in urban India that works toward primary, secondary, and tertiary prevention of violence and includes crisis response and counselling and medical, police, and legal assistance. Methods: The theory of change was developed in five phases, via expert workshops, use of primary data, recurrent team meetings, adjustment at further meetings and workshops, and a review of published theories. Results: The theory summarises inputs for primary and secondary prevention, consequent changes (positive and negative), and outcomes. It is fully adapted to the program context, was designed through an extended consultative process, emphasises secondary prevention as a pathway to primary prevention, and integrates community activism with referral and counselling interventions. Conclusions: The theory specifies testable causal pathways to impact and will be evaluated in a controlled trial.

Attitudes towards domestic violence in 49 low- and middle-income countries: A gendered analysis of prevalence and country-level correlates

BACKGROUND

Violence against women by an intimate partner (DV) is a serious public health and human rights issue. Attitudes justifying DV strongly predict its perpetration and victimisation. This paper presents gendered ecological analyses of the societal acceptance of DV in 49 low- and middle-income countries (LMICs) across geographical regions.

METHODS AND FINDINGS

We utilised data from 49 Demographic and Health Surveys conducted between 2005 and 2017, United Nations Statistics and topic-specific meta-databases. DV acceptance was measured as the justification of 'wife-beating' in at least one of five circumstances, and by the summative scale. Stepwise multiple linear regression examined country-level social, economic and political empowerment predictors of societal acceptance of DV amongst women, men, and the aggregate gender difference. Women were more likely than men to justify DV in Sub-Saharan Africa and South (east) Asia with societal acceptance of DV being more widespread in these regions compared with Latin America, the Caribbean, Central/West Asia and Europe. Political conflict and limited economic rights for women were associated with higher levels of DV acceptance amongst women and men. Men in more democratic countries were less likely to justify DV. Amongst women, higher national female literacy rates predicted lower levels of justification. There were higher levels of DV acceptance amongst women and a wider aggregate gender difference in countries with a larger representation of women in national parliament.

CONCLUSION

Justification of DV is widespread amongst women and men in LMICs with acceptance rates varying across countries and regions. Gender differences in the impact of contextual factors on DV acceptance supports a gendered approach to national-level interventions. Our findings highlight the need for tailored interventions targeting DV acceptance in conflict-impacted societies. The emphasis of inter(national) policies on the 'empowerment' domains of widely-used gender (in)equality indices need to be coupled with strategies tackling discriminatory gender norms.

Understanding participation dilemmas in community mobilisation: can collective action theory help?

Community mobilisation interventions have been used to promote health in many low-income and middle-income settings. They frequently involve collective action to address shared determinants of ill-health, which often requires high levels of participation to be effective. However, the non-excludable nature of benefits produced often generates participation dilemmas: community members have an individual interest in abstaining from collective action and free riding on others’ contributions, but no benefit is produced if nobody participates. For example, marches, rallies or other awareness-raising activities to change entrenched social norms affect the social environment shared by community members whether they participate or not. This creates a temptation to let other community members invest time and effort. Collective action theory provides a rich, principled framework for analysing such participation dilemmas. Over the past 50 years, political scientists, economists, sociologists and psychologists have proposed a plethora of incentive mechanisms to solve participation dilemmas: selective incentives, intrinsic benefits, social incentives, outsize stakes, intermediate goals, interdependency and critical mass theory. We discuss how such incentive mechanisms might be used by global health researchers to produce new questions about how community mobilisation works and conclude with theoretical predictions to be explored in future quantitative or qualitative research.

Gender Transformative Approaches to Engaging Men in Gender-Based Violence Prevention: A Review and Conceptual Model

Engaging men and boys as participants and stakeholders in gender-based violence (GBV) prevention initiatives is an increasingly institutionalized component of global efforts to end GBV. Accordingly, evidence of the impact of men's engagement endeavors is beginning to emerge, particularly regarding interventions aimed at fostering gender equitable and nonviolent attitudes and behaviors among men. This developing evidence base suggests that prevention programs with a "gender transformative" approach, or an explicit focus on questioning gender norms and expectations, show particular promise in achieving GBV prevention outcomes. Interventions targeting attitude and behavior change, however, represent just one kind of approach within a heterogeneous collection of prevention efforts around the globe, which can also include community mobilization, policy change, and social activism. The degree to which gender transformative principles inform this broader spectrum of men's engagement work is unclear. The goals of this article are twofold. First, we offer a conceptual model that captures and organizes a broader array of men's antiviolence activities in three distinct but interrelated domains: (1) initial outreach and recruitment of previously unengaged males, (2) interventions intended to promote gender-equitable attitudes and behavior among men, and (3) gender equity-related social action aimed at eradicating GBV, inclusive of all genders' contributions. Second, we review empirical literature in each of these domains. Across these two goals, we critically assess the degree to which gender transformative principles inform efforts within each domain, and we offer implications for the continuing conceptualization and assessment of efforts to increase men's participation in ending GBV.

Drivers of Intimate Partner Violence Against Women in Three Refugee Camps

This qualitative study examined the “drivers” of intimate partner violence (IPV) against women in displacement to identify protective factors and patterns of risk. Qualitative data were collected in three refugee camps in South Sudan, Kenya, and Iraq ( N = 284). Findings revealed interrelated factors that triggered and perpetuated IPV: gendered social norms and roles, destabilization of gender norms and roles, men’s substance use, women’s separation from family, and rapid remarriages and forced marriages. These factors paint a picture of individual, family, community and societal processes that exacerbate women’s risk of IPV in extreme conditions created by displacement. Implications for policy and practice are indicated.

Reducing PTSD symptoms through a gender norms and economic empowerment intervention to reduce intimate partner violence: a randomized controlled pilot study in Côte D'Ivoire

BACKGROUND

Women living in war-affected contexts face high levels of gender-based violence, including intimate partner violence (Stark & Ager, 2011). Despite well-documented negative consequences, including posttraumatic stress disorder (PTSD) (Garcia-Moreno et al. 2006; Steel et al. 2009), evidence remains thin regarding intervention effectiveness to mitigate consequences in these settings.

METHODS

This study used a two-armed parallel pilot randomized controlled trial to compare the impact of a group savings only (control) to gender dialogue groups added to group savings (treatment) on women's symptoms of PTSD in northwestern Côte d'Ivoire. Eligible Ivorian women (18+ years, no prior experience with group savings) were invited to participate and 1198 were randomized into treatment groups.

RESULTS

In the ITT analyses, women in the treatment arm had significantly fewer PTSD symptoms relative to the control arm (β: -0.12; 95% CI: -0.20 to -0.03; p = 0.005). Partnered women in the treatment arm who had not experienced intimate partner violence (IPV) at baseline had significantly fewer PTSD symptoms than the control arm (β = -0.12; 95% CI: -0.21 to -0.03; p = 0.008), while those who had experienced IPV did not show significant differences between treatment and control arms (β = -0.09; 95% CI: -0.29 to 0.11; p = 0.40).

CONCLUSIONS

Adding a couples gender discussion group to a women's savings group significantly reduced women's PTSD symptoms overall. Different patterns emerge for women who experienced IPV at baseline v. those who did not. More research is needed on interventions to improve mental health symptoms for women with and without IPV experiences in settings affected by conflict.

Perceptions and Experiences of Intimate Partner Violence in Abidjan, Côte d'Ivoire

Background

Men and women’s perceptions of intimate partner violence (IPV) within crisis-affected populations are not well understood. This mixed-methods study examined the frequency of IPV against women in urban Cote d’Ivoire, and qualitatively explored how men and women perceive the impact of various forms of IPV on health, everyday activities, and feelings of shame.

Methods

A survey was administered to Ivorian women (N = 80) to measure the frequency of IPV, and ten focus group discussions were conducted with women (n = 46) and men (n = 45) to explore perceptions of different forms of IPV, including its impacts on disruptions to health, everyday activities, and experiences of shame.

Results

Half of all surveyed women (53.6%) reported past year exposure to physical, sexual, or emotional IPV. Of the multiple types of violence, emotional IPV was most common (46.4%), followed by sexual IPV (21.7%) and physical IPV (17.4%). Focus group participants identified additional forms of violence including economic IPV and community discrimination. Lack of financial resources and unemployment were common problems among crisis-affected women and were described as an underlying source of IPV. Both women and men reported that shame and stigma play a large role in how women experience the repercussions of IPV, regardless of the form of violence, with public episodes of IPV almost always seen as more detrimental than private episodes of IPV.

Conclusions

These results underscore the need for increased social support mechanisms for women to reduce the shame, stigma, and isolation associated with their experiences. The creation of safe and supportive spaces for women to talk about and challenge social norms may be an important first step in reducing community shaming and the secrecy that often surrounds IPV. Safe spaces along with broader societal outreach, including challenging men’s social positions and creating opportunities for increasing economic resources can, in turn potentially decrease the frequency of IPV and its deleterious impacts on a woman’s well-being

What Factors Contribute to Intimate Partner Violence Against Women in Urban, Conflict-Affected Settings? Qualitative Findings from Abidjan, Côte d'Ivoire

Rapid urbanization is a key driver of the unique set of health risks facing urban populations. One of the most critical health hazards facing urban women is intimate partner violence (IPV). In post-conflict urban areas, women may face an even greater risk of IPV. Yet, few studies have examined the IPV experiences of urban-dwelling, conflict-affected women, including those who have been internally displaced. This study qualitatively examined the social and structural characteristics of the urban environment that contributed to the IPV experiences of women residing in post-conflict Abidjan, Côte d'Ivoire. Ten focus groups were conducted with men and women, both internally displaced (IDPs) and non-displaced. Lack of support networks, changing gender roles, and tensions between traditional gender norms and those of the "modern" city were reported as key contributors to IPV. Urban poverty and with it unemployment, food insecurity, and housing instability also played a role. Finally, IDPs faced heightened vulnerability to IPV as a result of displacement and discrimination. The relationship between economic strains and IPV are similar to other conflict-affected settings, but Abidjan's urban environment presented other unique characteristics contributing to IPV. Understanding these factors is crucial to designing appropriate services for women and for implementing IPV reduction interventions in urban areas. Strengthening formal and informal mechanisms for help-seeking, utilizing multi-modal interventions that address economic stress and challenge inequitable gender norms, as well as tailoring programs specifically for IDPs, are some considerations for IPV program planning focused on conflict-affected women in urban areas.

Differential Impacts of an Intimate Partner Violence Prevention Program Based on Child Marriage Status in Rural Côte d'Ivoire

PURPOSE

Little is known about whether effectiveness of intimate partner violence prevention programming varies for women who were married as child brides, given their additional social vulnerabilities. This subanalysis sought to assess treatment heterogeneity based on child marriage status for an intervention seeking to reduce intimate partner violence.

METHODS

A randomized controlled trial assessing the incremental effectiveness of gender dialogue groups in addition to group savings on changing past-year intimate partner violence was conducted in Côte d'Ivoire (2010-2012). Stratified models were constructed based on child marriage status to assess for effect modification. Analysis was restricted to married women with data on age at marriage (n = 682).

RESULTS

For child brides (N = 202), there were no statistically or marginally significant decreases in physical and/or sexual violence, physical violence, or sexual violence. The odds of reporting economic abuse in the past year were lower in the intervention arm for child brides relative to control group child brides (odds ratio [OR] = .33; 95% confidence interval [CI] = .13-.85; p = .02). For nonchild brides (N = 480), women were less likely to report physical and/or sexual violence (OR = .54; 95% CI = .28-1.04; p = .06), emotional violence (OR = .44; 95% CI = .25-.77; p = .004), and economic abuse (OR = .36; 95% CI = .20-.66; p = .001) in the combined intervention arm than their group savings-only counterparts.

CONCLUSIONS

Findings suggest that intervention participants with a history of child marriage may have greater difficulty benefiting from interventions that seek to reduce intimate partner violence.