"I got courage from knowing that even a daughter-in-law can earn her living": Mixed methods evaluation of a family-centred intervention to prevent violence against women and girls in Nepal

BACKGROUND

We developed, and pilot tested a family focused intervention Sammanit Jeevan "Living with Dignity" to reduce gender-based violence by husbands, change harmful social and gender norms and improve the economic conditions of women through young married women-led income generating activities (IGAs).

METHODS

We conducted a modified interrupted time series study and qualitative research to evaluate the intervention in two migrant communities in Baglung district, Nepal. We enrolled young married women, their husbands and in-laws from 100 families. 200 women and 157 men completed questionnaires before the programme, and 6, 12 and 18 months afterwards. 18 in-depth interviews were conducted before the programme and 6 and 12 months later. We analysed the data for trends.

RESULTS

The intervention positively impacted young married women's economic conditions, exposure to violence and changed inequitable gender attitudes. Some positive outcomes were observed among older women and men. Young women's past month earnings (35.0% - 81.3%, β = 0.11, p-value<0.001) and savings (29.0% - 80.2%, β = 0.14, p-value<0.001) more than doubled over time. Young women experienced much less past year physical IPV over time (10% - 4.4%, β = -0.08, p-value = 0.077). They also perceived that their mothers-in-law were less cruel (mean 9.0-8.6, β = -0.03, p-value = 0.035). Improvements were observed in young women's individual (mean 44.4-43.3, β = -0.04, p-value = 0.297) and perceived community gender attitudes (mean 54.4-51.4, β = -0.19, p-value<0.001) and they reported that their husbands were less controlling (mean 17.5-16.1, β = -007, p-value<0.001). These changes were supported by qualitative findings.

CONCLUSIONS

Whilst caution is needed in attributing the effect due to lack of control arm, the results suggest that with adequate time and seed funding, Sammanit Jeevan enabled considerable income generation, a strengthened the position of young women in the households and it reduced their exposure to violence in this community. It warrants further research to optimise its impact.

Factors associated with IPV victimisation of women and perpetration by men in migrant communities of Nepal

This paper aims to describe the prevalent forms of intimate partner violence (IPV), and the factors associated with IPV among women and men living in the two migrant communities of Baglung district, Nepal. 357 adult women and men were enrolled following a family model, interviewing young married women with daughter-in-law status in the home, their husbands, and mothers-in-law and fathers-in-laws using an electronic questionnaire. Random effects regression modelling compared men and women, as well as young married women with daughter-in-law status and older women with mothers-in-law with status. 28.6% of women had ever experienced physical and/or sexual violence by an intimate partner compared to 18.2% of men ever perpetrated these forms of violence against their wives. Being older, male controlling behaviour and poor relations with husband increased women’s IPV in their lifetime while perceptions that the mother-in-law is kind were protective. Being ashamed of being unemployed and childhood trauma were associated with men perpetrating IPV in their lifetime. Borrowing money or food increased young married women’s lifetime IPV risk while mother-in-law cruelty and male control increased older married women’s lifetime IPV exposure. Factors associated with IPV in the past year among men were being younger, job seeking, experiences of childhood trauma and depression exposure among men while difficulty accessing money for emergencies, holding inequitable gender attitudes, and depression was associated with women’s increased IPV exposure. Unemployment stress, holding inequitable gender attitudes and mother-in-law kindness were associated with young women’s increased IPV risk and hunger, mother-in-law cruelty and depression with older women’s IPV risk. There is a need to critically challenge harmful social and gender norms by using approaches that are sensitive to young married women’s position and unequal gender relations in the family. IPV prevention interventions need to employ a holistic approach that combines changing social and gender norms and improving socioeconomic conditions of women living in migrant communities.

A survey of Anopheles gambiae (species A) and An. arabiensis (species B) of the An. gambiae Giles complex in the Kisumu area of Kenya following insecticidal spraying with OMS-43 (Fenitrothion)

After village huts in the Kisumu area of Kenya had been sprayed with a nominal 2 g/m2 of OMS-43 (fenitrothion) as part of an insecticidal evaluation programme 964 adults of the Anopheles gambiae complex collected from huts were identified cytogenetically as either An. gambiae (species A) or An. arabiensis (species B). Similarly, cytogenetic methods were used to identify 349 adults collected from granaries and artificial pit-shelters. In addition, 2203 larvae of the gambiae complex collected from different types of habitats were specifically identified cytogenetically. As in a previous survey made prior to insecticidal spraying, adults of An. arabiensis predominated in outdoor collections while An. gambiae was highly endophilic. However, it appeared that spraying with fenitrothion had resulted in an increase in both the degree of exophily in An. arabiensis and also its relative numbers in respect to An. gambiae, although the overall pooulation of both species was greatly reduced by spraying. Insecticidal spraying may have diverted both species from feeding on man to cattle. Except for one village, where larvae of An. arabiensis were commoner than expected in cattle hoof-prints, there was little difference between the selection of different types of larval habitats by the two sibling species. Chromosomal inversions were more common in adults of An. arabiensis than in An. gambiae.

Evaluation of fenitrothion for the control of malaria

Fenitrothion was evaluated for residual spraying in antimalaria programmes in a large-scale field trial near Kisumu, Kenya from 1972 to 1976. The insecticide was applied in a hyper/holoendemic malarious area of 200 km(2) inhabited by about 50 000 people. All houses and animal shelters were sprayed at a target dosage rate of 2 g/m(2) at 3-month intervals for a total of 8 consecutive spray rounds in 2 years. The malaria vectors Anopheles gambiae species A and B and A. funestus were reduced to negligible densities indoors and outdoors immediately after initiation of spraying and for 10 months after the last spray round. However, A. gambiae reappeared during the main wet season at densities high enough to reestablish low-level transmission for short periods. Spraying produced a marked and rapid decrease in both the incidence and prevalence of malaria. The daily probability of acquiring malaria infection was reduced from 0.009 before spraying to 0.0003 under spray protection, a reduction of 96%. Data collected on a longitudinal basis indicated that sustained spray protection would reduce malaria prevalence to an asymptotic limit of 6.9% under the assumption that the inoculation and recovery rates remain stable. However, to attain malaria eradication in this type of epidemiological situation, complementary measures such as mass drug administration appear to be necessary.

A survey of species A and B of the Anopheles gambiae Giles complex in the Kisumu area of Kenya prior to insecticidal spraying with OMS-43 (fenitrothion)

Throughout 1972 surveys were made in Kenya on the Anopheles gambiae Giles complex in an area near Kisumu, part of which was to have all houses sprayed with OMS-43 (fenitrothion) the following year. Pre-spray data was collected on monthly hut densities, man-biting rates, parity and the human blood indices and sporozoite rates of A. gambiae caught in both an area designated for spraying (evaluation zone) and a comparison zone which was to remain unsprayed. The sporozoite rates, host preferences, and population size of the A. gambiae comples in relation to the human population were similar in the two zones. Few adults were collected from artificial pit-shelters in either zone. Cytotaxonomic identifications showed that although species A of the A. gambiae comples predominated throughout the year, the population of species B decreased relatively less in the drier months than that of species A. No marked differences were found between the host preferences or sporozoite rates of the two species.