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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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2
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Mchome Z, Mshana G, Malibwa D, Aloyce D, Dwarumpudi A, Peter E, Kapiga S, Stöckl H. Men's Narratives of Sexual Intimate Partner Violence in Urban Mwanza, Northwestern Tanzania. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2024; 36:441-463. [PMID: 37941093 PMCID: PMC11010543 DOI: 10.1177/10790632231213831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/12/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023]
Abstract
Engaging men has been established as central in addressing intimate partner violence. Yet few studies on intimate partner violence explored men's perspectives on what constitutes sexual violence in relationships only. To explore how men conceptualize sexual violence, we engaged a qualitative approach to unpack men's narratives of sexual IPV. The study was conducted in Mwanza, Tanzania using in-depth interviews with 30 married men. Men shared a broad spectrum of unacceptable behaviors that clearly or potentially connote sexual violence. Some of the acts were deemed to constitute sexual violence when directed to both men and women, while some were perceived as sexual violence when directed to women or men only. Threatened manhood underpinned men's conceptualization of sexual violence against them by their partners. Although a large part of men's narratives of sexual violence towards women seemed to challenge the common sexual scripts existing in patriarchal societies, some of their accounts indicated the persistence of traditional presumptions of masculine sexual entitlement. Our findings uncover additional dimensions of sexual violence that go beyond what is included in the current global frameworks, underscoring the critical need of giving people a voice in their local contexts in defining what sexual intimate partner violence entails for them. This may increase the likelihood of interventions becoming more acceptable and effective when targeting sexual violence, thereby contributing to reduced levels of sexual intimate partner violence.
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Affiliation(s)
- Zaina Mchome
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| | - Gerry Mshana
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | | | - Diana Aloyce
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Annapoorna Dwarumpudi
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Esther Peter
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Heidi Stöckl
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilian University of Munich
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3
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Ellsberg M, Quintanilla M, Ugarte WJ. Pathways to change: Three decades of feminist research and activism to end violence against women in Nicaragua. Glob Public Health 2022; 17:3142-3159. [PMID: 35184690 DOI: 10.1080/17441692.2022.2038652] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This paper presents the results of nearly three decades of partnership between feminist researchers and activists to prevent violence against women and girls (VAWG) in Nicaragua. A household survey conducted in 1995 in León, the country's second-largest city, revealed that 55 per cent of women had experienced lifetime physical intimate partner violence (IPV), and 27 per cent had experienced IPV in the last 12 months. The study results were instrumental in changing domestic violence laws in Nicaragua. A follow-up study in 2016 found a decrease of 63 per cent in lifetime physical IPV and 70 per cent in 12-month physical IPV. This paper examines possible explanations for the reduction, including the policy reforms resulting from feminist advocacy. We compare risk and protective factors for physical IPV, such as changes in women's attitudes towards violence, their use of services, and knowledge of laws, using data from both the 1995 and 2016 surveys, as well as three waves of Demographic and Health Surveys. We conclude that the decline in IPV can be partially attributed to the efforts of the Nicaraguan women's movements to reform laws, provide services for survivors, transform gender norms, and increase women's knowledge of their human rights.
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Affiliation(s)
- Mary Ellsberg
- Global Women's Institute, George Washington University, Washington, DC, USA
| | | | - William J Ugarte
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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4
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Couple Efficacy and Communal Coping for HIV Prevention Among Kenyan Pregnant Couples. AIDS Behav 2022; 26:2135-2147. [PMID: 35122576 DOI: 10.1007/s10461-021-03559-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 11/01/2022]
Abstract
Involving both partners of a couple in HIV prevention can improve maternal and child health outcomes in sub-Saharan Africa. Using data from 96 couples, we explored the actor and partner effects of perceived relationship dynamics on a couple's confidence and ability to reduce HIV risk together. Perceived relationship quality altered perceived confidence and ability to reduce HIV threat. One's own ability to confidently act together with their spouse appeared to be stronger for husbands than wives with respect to relationship commitment. A partner's confidence to communicate with their spouse about HIV risk reduction appeared to be stronger from husbands to wives for relationship satisfaction and trust. Gender differences in perceived relationship quality and effects on communal coping may exist and requires further study for applicability in intervention development in this setting. Efficacious couple-oriented interventions for HIV prevention should incorporate evidence on how partners mutually influence each other's health beliefs and behaviors.
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5
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Ranganathan M, Stern E, Knight L, Muvhango L, Molebatsi M, Polzer-Ngwato T, Lees S, Stöckl H. Women's economic status, male authority patterns and intimate partner violence: a qualitative study in rural North West Province, South Africa. CULTURE, HEALTH & SEXUALITY 2022; 24:717-734. [PMID: 33535894 DOI: 10.1080/13691058.2021.1880639] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 01/20/2021] [Indexed: 06/12/2023]
Abstract
There are conflicting views on the impact of microfinance-only interventions on women's economic empowerment and intimate partner violence in low and middle-income countries. Evidence suggests however that when microfinance is combined with complementary programmes (microfinance plus) it may be effective for empowering women and addressing intimate partner violence. We conducted in-depth interviews with adult women in rural South Africa who had received microfinance loans for more than a year and had recently completed gender training. We explored women's perceptions on income generation; the effects on their relationships, including intimate partner violence; their notions of power; and perspectives on men's reactions to their empowerment. Findings reveal that the notion of 'power within the self' is supported by women's income generation, alongside a sense of financial independence and improved social support. Women reported increased happiness and reduced financial stress, although social norms and gender expectations about women subservience and male headship remain salient, particularly among older women. Furthermore, younger women appeared to tolerate abuse due to financial and caring responsibilities. These findings underpin the importance of complementary gender training programmes and of including men as participants for enhancing the effectiveness of economic strengthening interventions.
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Affiliation(s)
- Meghna Ranganathan
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Erin Stern
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Louise Knight
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Lufuno Muvhango
- Intervention with Microfinance and Gender Equity (IMAGE), Johannesburg, South Africa
| | | | | | - Shelley Lees
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Heidi Stöckl
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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6
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Singleton R, Obong'o C, Mbakwem BC, Sabben G, Winskell K. Conceptualizing Consent: Cross-national and Temporal Representations of Sexual Consent in Young Africans' Creative Narratives on HIV. JOURNAL OF SEX RESEARCH 2021; 58:1161-1172. [PMID: 34313178 PMCID: PMC8551005 DOI: 10.1080/00224499.2021.1952399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Sexual violence, comprising all non-consensual sexual acts, is an important driver of HIV infection in sub-Saharan Africa. Definitions of sexual violence rely on understandings of sexual consent, understood as a feeling of willingness that is communicated via shared indicators of consent. In this paper, through analysis of young authors' narrative-based social representations, we sought to provide insight into young Africans' sense-making around sexual consent in order to develop a conceptual framework that can guide future methodological and conceptual work. We analyzed representations of sexual consent in a sample of 291 creative narratives about HIV written for a scriptwriting competition by young Nigerians, Kenyans and Swazis in 2005, 2008, and 2014. We combined thematic data analysis and narrative-based approaches. Narratives represented consent as a feeling of wanting or being willing to have sex, or an intention to have sex, communicated via character actions, conversations, or circumstances. Some narratives depicted characters not wanting but consenting to sex to avoid negative repercussions. Representations of sexual consent were fairly consistent across contexts and over time, although certain representations were more prominent in some country/year samples than others. Results are translated into a conceptual framework that can guide future prevention efforts to reframe sexual consent.
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Affiliation(s)
| | | | | | - Gaelle Sabben
- Hubert Department of Global Health, Rollins School of Public Health at Emory University
| | - Kate Winskell
- Hubert Department of Global Health, Rollins School of Public Health at Emory University
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Dugal C, Brassard A, Claing A, Lefebvre AA, Audet A, Paradis-Lavallée R, Godbout N, Péloquin K. Attachment Insecurities and Sexual Coercion in Same- and Cross-Gender Couples: The Mediational Role of Couple Communication Patterns. JOURNAL OF SEX & MARITAL THERAPY 2021; 47:743-763. [PMID: 34296961 DOI: 10.1080/0092623x.2021.1944937] [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: 06/13/2023]
Abstract
The use of subtle strategies to have sex with an unwilling partner is harmful to a couple's sexual well-being but these strategies remain understudied. This research examined the mediating role of communication patterns in the associations between attachment insecurities and sustained sexual coercion in 145 same- and cross-gender couples, and the moderating role of partners' gender. In addition to actor and partner effects, results revealed significant indirect effects from attachment insecurities to sexual coercion via communication patterns, with moderating effects of gender. Results may help practitioners and researchers understand the ways attachment insecurities and dysfunctional communication patterns can manifest in the experience of subtle forms of sexual coercion within couples.
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Affiliation(s)
- Caroline Dugal
- Département de psychologie, Université de Sherbrooke, Sherbrooke, Canada
| | - Audrey Brassard
- Département de psychologie, Université de Sherbrooke, Sherbrooke, Canada
| | - Aurélie Claing
- Département de psychologie, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Ariane Audet
- Département de psychologie, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Natacha Godbout
- Département de sexologie, Université du Québec à Montréal, Montréal, Canada
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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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9
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Gibbs A, Dunkle K, Mhlongo S, Chirwa E, Hatcher A, Christofides NJ, Jewkes R. Which men change in intimate partner violence prevention interventions? A trajectory analysis in Rwanda and South Africa. BMJ Glob Health 2021; 5:bmjgh-2019-002199. [PMID: 32424011 PMCID: PMC7239517 DOI: 10.1136/bmjgh-2019-002199] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/21/2020] [Accepted: 03/07/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Emerging evidence suggests working with men to prevent intimate partner violence (IPV) perpetration can be effective. However, it is unknown whether all men benefit equally, or whether different groups of men respond differentially to interventions. METHODS We conducted trajectory modelling using longitudinal data from men enrolled in intervention arms of three IPV trials in South Africa and Rwanda to identify trajectories of IPV perpetration. We then use multinomial regression to describe baseline characteristics associated with group allocation. RESULTS In South Africa, the Stepping Stones and Creating Futures (SS-CF) trial had 289 men and the CHANGE trial had 803 men, and in Rwanda, Indashyikirwa had 821 men. We identified three trajectories of IPV perpetration: a low-flat (60%-67% of men), high with large reduction (19%-24%) and high with slight increase (10%-21%). Baseline factors associated men in high-start IPV trajectories, compared with low-flat trajectory, varied by study, but included higher poverty, poorer mental health, greater substance use, younger age and more childhood traumas. Attitudes supportive of IPV were consistently associated with high-start trajectories. In separate models comparing high-reducing to high-increasing trajectories, baseline factors associated with reduced IPV perpetration were depressive symptoms (relative risk ratio, RRR=3.06, p=0.01 SS-CF); living separately from their partner (RRR=2.14, p=0.01 CHANGE); recent employment (RRR=1.85, p=0.04 CHANGE) and lower acceptability of IPV (RRR=0.60, p=0.08 Indashyikirwa). Older aged men had a trend towards reducing IPV perpetration in CHANGE (p=0.06) and younger men in Indashyikirwa (p=0.07). CONCLUSIONS Three distinct groups of men differed in their response to IPV prevention interventions. Baseline characteristics of past traumas and current poverty, mental health and gender beliefs predicted trajectory group allocation. The analysis may inform targeting of interventions towards those who have propensity to change or guide how contextual factors may alter intervention effects. TRIAL REGISTRATION NUMBERS NCT03022370; NCT02823288; NCT03477877.
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Affiliation(s)
- Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa .,Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Kristin Dunkle
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
| | - Shibe Mhlongo
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
| | - Esnat Chirwa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Abigail Hatcher
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,University of North Carolina, Chapel Hill, United States
| | - Nicola J Christofides
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Office of the Excutive Scientist, South African Medical Research Council, Pretoria, South Africa
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10
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Wood SN, Karp C, Tsui A, Kibira SPS, Desta S, Galadanci H, Makumbi F, Omoluabi E, Shiferaw S, Seme A, Moreau C. A sexual and reproductive empowerment framework to explore volitional sex in sub-Saharan Africa. CULTURE, HEALTH & SEXUALITY 2021; 23:804-821. [PMID: 32242473 DOI: 10.1080/13691058.2020.1733667] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 02/19/2020] [Indexed: 06/11/2023]
Abstract
Volitional sex is central to the sexual health and well-being of women and girls globally. To date, few studies have examined women's empowerment and its application to sexual health outcomes, including volitional sex. The aim of this study was to explore the relevance of a sexual and reproductive empowerment framework to volitional sex across four geographically and culturally diverse contexts in sub-Saharan Africa. Qualitative data were collected between July and August 2017 in four sites: Ethiopia, Nigeria (Anambra and Kano states) and Uganda. A total of 352 women aged 15-49 and 88 men aged 18 and older were interviewed through 120 in-depth interviews and 38 focus group discussions (n = 440 total participants). Results describe the substantial barriers restraining women's sexual choices, particularly norms that stigmatise women's requests for sex, even within marriage. Results further highlight women's internal sexual motivations, particularly related to the enjoyment of sex and the role of sex in strengthening partner relationships. Future empowerment research and measurement should focus not only on sexual constraints, but also integrate internal motivations, in order to fully understand the factors that shape women's sexual health outcomes.
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Affiliation(s)
- Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA
| | - Celia Karp
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA
| | - Amy Tsui
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA
| | - Simon Peter Sebina Kibira
- Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Selamawit Desta
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA
| | - Hadiza Galadanci
- Center for Advanced Medical Research and Training, Bayero University, Kano, Nigeria
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Elizabeth Omoluabi
- Centre for Research Evaluation Resources and Development, Ile-Ife, Nigeria
| | - Solomon Shiferaw
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Assefa Seme
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA
- Gender, Sexual and Reproductive Health, CESP Centre for Research in Epidemiology and Population Health, Le Kremlin-Bicêtre, France
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11
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Dunkle K, Stern E, Chatterji S, Heise L. Effective prevention of intimate partner violence through couples training: a randomised controlled trial of Indashyikirwa in Rwanda. BMJ Glob Health 2021; 5:bmjgh-2020-002439. [PMID: 33355268 PMCID: PMC7757483 DOI: 10.1136/bmjgh-2020-002439] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/31/2020] [Accepted: 06/05/2020] [Indexed: 01/17/2023] Open
Abstract
Background Between 2015 and 2018, three civil society organisations in Rwanda implemented Indashyikirwa, a four-part intervention designed to reduce intimate partner violence (IPV) among couples and within communities. We assessed the impact of the programme’s gender transformative curriculum for couples. Methods Sectors (n=28) were purposively selected based on density of village savings and loan association (VLSA) groups and randomised (with stratification by district) to either the full community-level Indashyikirwa programme (n=14) or VSLA-only control (n=14). Within each sector, 60 couples recruited from VSLAs received either a 21-session curriculum or VSLA as usual. No blinding was attempted. Primary outcomes were perpetration (for men) or experience (for women) of past-year physical/sexual IPV at 24 months post-baseline, hypothesised to be reduced in intervention versus control (ClinicalTrials.gov: NCT03477877). Results We enrolled 828 women and 821 men in the intervention sectors and 832 women and 830 men in the control sectors; at endline, 815 women (98.4%) and 763 men (92.9%) in the intervention and 802 women (96.4%) and 773 men (93.1%) were available for intention-to-treat analysis. Women in the intervention compared with control were less likely to report physical and/or sexual IPV at 24 months (adjusted relative risk (aRR)=0.44, 95% CI 0.34 to 0.59). Men in the intervention compared with control were also significantly less likely to report perpetration of physical and/or sexual IPV at 24 months (aRR=0.54, 95% CI 0.38 to 0.75). Additional intervention benefits included reductions in acceptability of wife beating, conflict with partner, depression, and corporal punishment against children and improved conflict management, communication, trust, self-efficacy, self-rated health, household earnings, food security and actions to prevent IPV. There were no study-related harms. Conclusions The Indashyikirwa couples’ training curriculum was highly effective in reducing IPV among male/female couples in rural Rwanda. Scale-up and adaptation to similar settings should be considered.
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Affiliation(s)
- Kristin Dunkle
- Gender and Health Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
| | - Erin Stern
- Gender Violence and Health Centre, London School of Hygiene & Tropical Medicine, Locon, UK
| | - Sangeeta Chatterji
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lori Heise
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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12
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Mchome Z, Mshana G, Aloyce D, Peter E, Malibwa D, Dwarumpudi A, Kapiga S, Stöckl H. " Don't You Think It Is Violence Forcing Me to Have Sex While Not Happy?" Women's Conceptualization of Enjoyable Sex and Sexual Intimate Partner Violence in Mwanza, Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217937. [PMID: 33138073 PMCID: PMC7662311 DOI: 10.3390/ijerph17217937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/22/2020] [Accepted: 10/24/2020] [Indexed: 12/03/2022]
Abstract
Intimate partner violence is a recognized public health and development issue that is consistently and comparatively measured through women's experience of physical and/or sexual acts by their partner. While physical intimate partner violence is covered by a wide range of behaviors, sexual intimate partner violence (SIPV) is often only measured through attempted or completed forced sex, ignoring less obvious forms of sexual intimate partner violence. We explored women's conceptualizations of SIPV by conducting in-depth interviews with 18 Tanzanian women. Using a thematic approach, we identified key features of women's sexual intimate relationships and their perceptions of them. The women clearly defined acts of positive sexual relationships that occurred with mutual consent and seduction and SIPV that included acts of forced sex and sex under the threat of violence. They also identified several acts that were crossing the line, whereby a discrepancy of views existed whether they constituted SIPV, such as having sex when out of the mood, sex being the duty of the wife, sex during the menses, requests for anal sex, having sex to not lose the husband, husband refusing sex and husband having other partners. Women in this study felt violated by a far wider range of sexual acts in their relationships. Future studies need to improve the measurement of sexual intimate partner violence to allow the collection of encompassing, yet comparable, data on this harmful phenomenon.
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Affiliation(s)
- Zaina Mchome
- Mwanza Intervention Trials Unit, P.O. Box 11936 Mwanza, Tanzania; (Z.M.); (G.M.); (D.A.); (E.P.); (D.M.); (S.K.)
- National Institute for Medical Research, Mwanza Centre, P.O. Box 1462 Mwanza, Tanzania
| | - Gerry Mshana
- Mwanza Intervention Trials Unit, P.O. Box 11936 Mwanza, Tanzania; (Z.M.); (G.M.); (D.A.); (E.P.); (D.M.); (S.K.)
- National Institute for Medical Research, Mwanza Centre, P.O. Box 1462 Mwanza, Tanzania
| | - Diana Aloyce
- Mwanza Intervention Trials Unit, P.O. Box 11936 Mwanza, Tanzania; (Z.M.); (G.M.); (D.A.); (E.P.); (D.M.); (S.K.)
| | - Esther Peter
- Mwanza Intervention Trials Unit, P.O. Box 11936 Mwanza, Tanzania; (Z.M.); (G.M.); (D.A.); (E.P.); (D.M.); (S.K.)
| | - Donati Malibwa
- Mwanza Intervention Trials Unit, P.O. Box 11936 Mwanza, Tanzania; (Z.M.); (G.M.); (D.A.); (E.P.); (D.M.); (S.K.)
| | - Annapoorna Dwarumpudi
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK;
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, P.O. Box 11936 Mwanza, Tanzania; (Z.M.); (G.M.); (D.A.); (E.P.); (D.M.); (S.K.)
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Heidi Stöckl
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK;
- Correspondence: ; Tel.: +44-2079272506
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A Mixed-Methods Systematic Review: Infidelity, Romantic Jealousy and Intimate Partner Violence against Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165682. [PMID: 32781565 PMCID: PMC7459695 DOI: 10.3390/ijerph17165682] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 12/11/2022]
Abstract
Infidelity and romantic jealousy (RJ) are commonly cited relational level drivers of intimate partner violence (IPV) but remain undertheorized and underutilized in IPV research and prevention. This global systematic review aims to characterize the existing research on real or suspected infidelity and RJ in relation to IPV and inform future research and programming. We systematically searched 11 databases for peer-reviewed research, published between April 2009 and 2019, that provided data on the prevalence or a measure of association (quantitative), or pathway (qualitative), between real or suspected infidelity or RJ, and IPV. Fifty-one papers from 28 countries were included and the evidence showed a consistent association between real or suspected infidelity, RJ and IPV. Our findings identify three overarching mechanisms and six pathways between infidelity, RJ and IPV. These provide support for prominent theories in the field related to patriarchal culture, threatened masculinities and femininities and a lack of emotional regulation and conflict resolution skills, but not evolutionary theories. Our findings suggest that researchers should use standardized measurement tools that make the distinction between RJ and suspected, confirmed and accusations of infidelity. Policy and programming should aim to transform traditional gender roles, accounting for infidelity and RJ and improving couple’s communication and trust.
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Chatterji S, Heise L, Gibbs A, Dunkle K. Exploring differential impacts of interventions to reduce and prevent intimate partner violence (IPV) on sub-groups of women and men: A case study using impact evaluations from Rwanda and South Africa. SSM Popul Health 2020; 11:100635. [PMID: 32802931 PMCID: PMC7417950 DOI: 10.1016/j.ssmph.2020.100635] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/22/2020] [Accepted: 07/25/2020] [Indexed: 11/02/2022] Open
Abstract
Currently, most efforts to evaluate programmes designed to reduce intimate partner violence (IPV) assume that they affect all people similarly. Understanding whether interventions are more or less effective for different subgroups of individuals, however, can yield important insights for programming. In this study, we conducted subgroup analyses to assess whether treatment effects vary by baseline reporting of IPV experience among women or perpetration among men. Results indicated that for both men and women, the Indashyikirwa intervention in Rwanda was more successful at reducing or stopping ongoing IPV than it was at preventing its onset. The SS-CF intervention in South Africa, by contrast, was more successful at preventing men from starting to perpetrate IPV than it was in reducing the intensity of men's perpetration or stopping it entirely. These results indicate that the prevention field needs to better understand the extent to which IPV interventions may have differential impacts on primary versus secondary prevention. It also emphasizes the importance of distinguishing between intervention strategies that prevent the onset of IPV versus those that reduce or stop ongoing IPV.
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Affiliation(s)
| | - Lori Heise
- Johns Hopkins Bloomberg School of Public Health, USA
- Johns Hopkins School of Nursing, USA
| | - Andrew Gibbs
- South African Medical Research Council, South Africa
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Chatterji S, Stern E, Dunkle K, Heise L. Community activism as a strategy to reduce intimate partner violence (IPV) in rural Rwanda: Results of a community randomised trial. J Glob Health 2020; 10:010406. [PMID: 32257154 PMCID: PMC7125418 DOI: 10.7189/jogh.10.010406] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background There is considerable interest in community organising and activism as a strategy to shift patriarchal gender norms, attitudes and beliefs and thus reduce intimate partner violence (IPV). Yet there is limited insight into how activism actually translates into reduced violence, including how aspects of programme implementation or cultural context may affect impact. This study evaluates the community activism/mobilisation portion of Indashyikirwa, a multi-component, IPV prevention programme implemented in rural Rwanda. The activism part of Indashyikirwa was based on SASA!, a promising program model from Uganda with demonstrated effectiveness. Methods We implemented two separate cross-sectional surveys as part of a larger community randomised controlled trial to assess the impact of the community portion of Indashyikirwa on preventing physical and/or sexual IPV and other secondary outcomes at a community level. The survey consisted of a random household-based sample of 1400 women and 1400 men at both waves. Surveys were conducted before community-level activities commenced and were repeated 24 months later with a new cross-sectional sample. Longitudinal, qualitative data were collected as part of an embedded process evaluation. Results There was no evidence of an intervention effect at a community level on any of the trial's primary or secondary outcomes, most notably women's experience of physical and/or sexual IPV from a current male partner in the past 12 months (adjusted odds ratio (aOR) = 1.25; 95% confidence interval (CI) = 0.92-1.70, P = 0.16), or men's perpetration of male-to-female physical and/or sexual IPV (aOR = 1.02; 95% CI = 0.72-1.45, P = 0.89). Process evaluation data suggest that delays due to challenges in adapting and implementing SASA!-style activites in rural Rwanda may account for the trial's failure to measure an effect. Additionally, the intervention strategy of informal activism was not well suited to the Rwandan context and required considerable modification. Conclusions Failure to reduce violence when implementing an adaptation of SASA! in rural Rwanda highlights the importance of allowing sufficient time for adapting evidence-based programming (EBP) to ensure cultural appropriateness and fidelity. This evaluation held little chance of demonstrating impact since the project timeline forced endline evaluation only months after certain elements of the programme became operational. Donors must anticipate longer time horizons (5 to 7 years) when contemplating evaluations of novel or newly-adapted programmess for reducing IPV at a population level. These findings also reinforce the value of including embedded process evaluations when investing in rigorous trials of complex phenomena such as community activism. Trial registration ClinicalTrials.gov, NCT03477877.
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Affiliation(s)
- Sangeeta Chatterji
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Erin Stern
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Af.,London School of Hygiene and Tropical Medicine, London, UK (affiliation at start of project)
| | - Kristin Dunkle
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Af
| | - Lori Heise
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.,London School of Hygiene and Tropical Medicine, London, UK (affiliation at start of project)
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