Young People's Experiences With an Empowerment-Based Behavior Change Intervention to Prevent Sexual Violence in Nairobi Informal Settlements: A Qualitative Study

Programs to Prevent Violence Against Children in Sub-Saharan Africa: A Systematic Review

Violence against children-which includes maltreatment (including physical, sexual, psychological and emotional violence, and neglect), bullying (including cyberbullying), youth violence (including physical assault with or without weapons), intimate partner violence (including exposure to domestic violence and direct involvement in teen dating violence), and sexual violence-continues to present itself as a significant public health crisis in Sub-Saharan Africa (SSA) leading to numerous short- and long-term deleterious outcomes. As such, the prevention of violence against children in SSA is a critical public health priority. In this systematic literature review, we identified 45 articles that reported on results from 22 programs that seek to reduce violence against children in SSA. Results suggested that programs that focus on (1) economic strengthening, (2) teachers schools, (3) entire families, (4) caregivers only, and (5) children only are generally effective in reducing violence against children by promoting focused action on the mechanisms of change (e.g., parenting skills, enhanced parent-child relationships, resistance skills for children). To date, no research in SSA has examined the impact of policy interventions on childhood victimization or community-level interventions to change norms and values that support violence against children. Future research is needed to examine the impacts of comprehensive efforts to prevent violence against children in SSA as well as factors that predict uptake and sustainability of such prevention efforts in SSA.

"I Wouldn't Believe Her at First"-A Qualitative Study of Young People's Sexual Consent Perceptions and Negotiation in Nairobi Informal Settlements

Forced or coerced sexual experiences have serious consequences for young people's health and well-being. Healthy sexual consent communication can foster positive intimate relationships and help prevent unwanted sexual experiences. We aimed to explore how young people in Nairobi's informal settlements construct, communicate, and negotiate sexual consent within heterosexual partnerships, given the limited insight into such experiences from resource-poor, global-south contexts. A qualitative study with young men and women aged 15 to 21 years was conducted among former participants of a school-based sexual violence prevention intervention in four informal settlements (slums) of Nairobi. Twenty-one individual in-depth interviews (n = 10 females, n = 11 males) and 10 focus group discussions (five with n = 6-11 males vs. females, respectively), that is, n = 89 in total were conducted. Data were analysed using thematic network analysis and interpreted using the Sexual script theory. Participants' endorsement of incongruent sexual scripts shaped their perceptions and negotiations of sexual consent. Young men were committed to respecting sexual consent, but promoted male (sexual) dominance, and perceived women's refusals as token resistance. Per traditional scripts of sexual chastity, young women were largely bound by their use of a "soft no" to give consent, so as to not display direct sexual interest. Actual non-assertive refusals thus risked being interpreted as consent. Young women's "actual" refusals had to be more assertive (saying a "hard no") and were described as having been influenced by skills learned during the school-based intervention. Findings highlight the need for sexual consent education to address internalized gendered norms about female token resistance, destigmatize female sexuality, reduce male dominance norms, and encourage young people's respect for both assertive and non-assertive sexual consent communication.

Sexual violence and associated factors among women of reproductive age in Rwanda: a 2020 nationwide cross-sectional survey

BACKGROUND

Sexual violence against women is a global public health issue with both short- and long-term effects on the physical and mental health of women. This study aimed to determine the prevalence of sexual violence and its associated factors among women of reproductive age in Rwanda.

METHODS

We used secondary data from the 2020 Rwanda Demographic and Health Survey of 1,700 participants, who were selected using multistage stratified sampling. Multivariable logistic regression was conducted to explore factors associated with sexual violence using SPSS (version 25).

RESULTS

Of the 1,700 women of reproductive age, 12.4% (95%CI: 11.0-14.1) had experienced sexual violence. Justified beating (AOR = 1.34, 95%CI: 1.16-1.65), not having health insurance (AOR = 1.46, 95%CI: 1.26-2.40), not being involved in healthcare decision-making (AOR = 1.64, 95%CI: 1.99-2.70), having a husband/partner with primary (AOR = 1.70, 95%CI: 5.47-6.21) or no education (AOR = 1.84, 95%CI: 1.21-3.37), as well as having a husband/partner who sometimes (AOR = 3.37, 95%CI: 1.56-7.30) or often (AOR = 12.87, 95%CI: 5.64-29.38) gets drunk were positively associated with sexual violence. However, women from male-headed households (AOR = 0.52, 95%CI: 0.29-0.92) were less likely to experience sexual violence.

CONCLUSIONS

There is a need to demystify negative culturally-rooted beliefs favouring sexual violence, such as justified beating, as well as increase efforts to promote women's empowerment and healthcare access. Moreover, engaging men in anti-sexual violence strategies is paramount to addressing male-related issues that expose women to sexual violence.

Early Educational Interventions to Prevent Gender-Based Violence: A Systematic Review

BACKGROUND

Gender-based violence is a worldwide public health problem that is increasingly occurring at younger ages. This investigation aims to analyze effective interventions to prevent and to face gender-based violence beginning in early childhood in order to ensure quality education for all children through violence-free schools.

METHODS

This research has conducted a systematic review of interventions that have demonstrated a positive impact on the prevention and reduction of gender-based violence from early ages up to 12 years, inclusive, in schools. An extensive search in scientific databases (WoS, SCOPUS, ERIC, PsycINFO) was conducted from 2007 to 2022.

RESULTS

Thirteen articles were selected and analyzed in-depth to identify the success factors of these interventions, which (a) are integrated into the school curriculum; (b) promote active participation of students and community; (c) are based on scientific evidence; and (d) make relevant adaptations to a specific group and context.

CONCLUSIONS

The programs analyzed have had a positive impact on raising awareness of gender violence, overcoming stereotypes, improving relationships in the classroom and reducing violent behavior, as well as empowering the most vulnerable people.

“When I woke up I was so worried and ashamed, I thought it was a disease”: Adolescent boys’ transitions through puberty in Kenya

Growing evidence suggests a need for more focused attention on boys’ experiences of puberty in sub-Saharan Africa to assure healthy transitions into young adulthood. Existing research remains limited on the masculinity norms shaping boys’ maturation experiences in Kenya. To help fill this gap, we conducted a comparative case study using qualitative methodologies with 16–19-year-old male youth in rural and urban Kenya, and with adults interacting in boys’ daily lives. Findings suggest that Kenyan boys experience shame, confusion and silence around changes happening in their bodies; face pressures from new societal expectations as they become young men; and have adolescent lives shaped by minimal supervision, increased peer pressures and engagement in more risky health behaviors. Additional research and targeted interventions on boys transitioning through puberty and early adolescence are needed to better understand their vulnerabilities and prevent or reduce their engagement in unsafe behaviors.

Mechanisms for the prevention of adolescent intimate partner violence: A realist review of interventions in low- and middle-income countries

Adolescent girls are among those at the greatest risk of experiencing intimate partner violence (IPV). Despite adolescence being widely regarded as a window of opportunity to influence attitudes and behaviours related to gender equality, evidence on what works to prevent IPV at this critical stage is limited outside of high-income, school-based settings. Even less is understood about the mechanisms of change in these interventions. We conducted a realist review of primary prevention interventions for adolescent IPV in low- and middle-income countries (LMICs) to synthesise evidence on how they work, for whom, and under which circumstances. The review took place in four iterative stages: 1) exploratory scoping, 2) developing initial programme theory, 3) systematic database search, screening and extraction, and 4) purposive searching and refinement of programme theory. We identified eleven adolescent IPV prevention interventions in LMICs, most of which demonstrated a positive impact on IPV experience and/or perpetration (n = 10). Most interventions (n = 9) implemented school- or community-based interactive peer-group education to transform attitudes and norms around gender and relationships for behaviour change. The central mechanism of change related to gender transformative content prompting adolescents to critically reflect on their attitudes and relationships, leading to a reconceptualisation of their values and beliefs. This central mechanism was supported by two secondary implementation mechanisms: 1) the design and delivery of interventions: interactive, age-appropriate education delivered in peer-groups provided adolescents a safe space to engage with content and build communication skills, and 2) the target group: social norms interventions targeting the wider community created enabling environments supportive of individual change. This review highlights the immense potential of gender transformative interventions during the critical period of adolescence for IPV prevention. Future interventions should consider the broader drivers of adolescent IPV and ensure intersectionality informed approaches to maximise their potential to capitalise on this window of opportunity.