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There is increasing interest in working at the intersections of intimate partner violence (IPV) and violence against children (VAC), especially in the family, yet few programmatic strategies exist or have been evaluated to assess the combined impact of strategies on both types of violence. This paper addresses this gap by exploring the influence that Indashyikirwa-a programme designed to reduce IPV in Rwanda- had on VAC in the families of couples participating in the programme. Indashyikirwa included a 21-session couples' curriculum, safe spaces for IPV survivors, and community activism against violence. In addition to reductions in IPV, a randomized control trial found significant reductions in parent's reports of children witnessing IPV, parents' attitudes condoning harsh physical punishment of children, and parents' use of corporal punishment as discipline. This paper uses qualitative data to better understand how and why the couples' curriculum influenced parenting and VAC. Twenty-eight participants (fourteen male-female couples) were individually interviewed at three time points, once before and twice after the couples' curriculum implementation. Six men and six women who completed the curriculum and subsequently carried out activism were also interviewed at two time points. The data were analyzed thematically. Pathways motivating couples' attitude and behavior changes towards children included reflecting on the consequences of IPV for children and appreciating the benefits for children of non-violent, gender equitable households. This analysis suggests that working with co-habiting couples presents a viable strategy for working to prevent IPV, VAC and promote more gender equitable family dynamics., Author(s): Erin Stern [sup.1] [sup.2] , Lori Heise [sup.1] , Kristin Dunkle [sup.3] , Sangeeta Chatterji [sup.1] Author Affiliations: (1) grid.21107.35, 0000 0001 2171 9311, Johns Hopkins Bloomberg School of [...]

Background Violence against women and girls (VAWG) is a human rights violation with social, economic, and health consequences for survivors, perpetrators, and society. Robust evidence on economic, social, and health impact, plus the cost of delivery of VAWG prevention, is critical to making the case for investment, particularly in low- and middle-income countries (LMICs) where health sector resources are highly constrained. We report on the costs and health impact of VAWG prevention in 6 countries. Methods and findings We conducted a trial-based cost-effectiveness analysis of VAWG prevention interventions using primary data from 5 randomised controlled trials (RCTs) in sub-Saharan Africa and 1 in South Asia. We evaluated 2 school-based interventions aimed at adolescents (11 to 14 years old) and 2 workshop-based (small group or one to one) interventions, 1 community-based intervention, and 1 combined small group and community-based programme all aimed at adult men and women (18+ years old). All interventions were delivered between 2015 and 2018 and were compared to a do-nothing scenario, except for one of the school-based interventions (government-mandated programme) and for the combined intervention (access to financial services in small groups). We computed the health burden from VAWG with disability-adjusted life year (DALY). We estimated per capita DALYs averted using statistical models that reflect each trial's design and any baseline imbalances. We report cost-effectiveness as cost per DALY averted and characterise uncertainty in the estimates with probabilistic sensitivity analysis (PSA) and cost-effectiveness acceptability curves (CEACs), which show the probability of cost-effectiveness at different thresholds. We report a subgroup analysis of the small group component of the combined intervention and no other subgroup analysis. We also report an impact inventory to illustrate interventions' socioeconomic impact beyond health. We use a 3% discount rate for investment costs and a 1-year time horizon, assuming no effects post the intervention period. From a health sector perspective, the cost per DALY averted varies between US$222 (2018), for an established gender attitudes and harmful social norms change community-based intervention in Ghana, to US$17,548 (2018) for a livelihoods intervention in South Africa. Taking a societal perspective and including wider economic impact improves the cost-effectiveness of some interventions but reduces others. For example, interventions with positive economic impacts, often those with explicit economic goals, offset implementation costs and achieve more favourable cost-effectiveness ratios. Results are robust to sensitivity analyses. Our DALYs include a subset of the health consequences of VAWG exposure; we assume no mortality impact from any of the health consequences included in the DALYs calculations. In both cases, we may be underestimating overall health impact. We also do not report on participants' health costs. Conclusions We demonstrate that investment in established community-based VAWG prevention interventions can improve population health in LMICs, even within highly constrained health budgets. However, several VAWG prevention interventions require further modification to achieve affordability and cost-effectiveness at scale. Broadening the range of social, health, and economic outcomes captured in future cost-effectiveness assessments remains critical to justifying the investment urgently required to prevent VAWG globally., Author(s): Giulia Ferrari 1,2,3,*, Sergio Torres-Rueda 2, Esnat Chirwa 4, Andrew Gibbs 4, Stacey Orangi 5, Edwine Barasa 5,6, Theresa Tawiah 7, Rebecca Kyerewaa Dwommoh Prah 7, Regis Hitimana 8, [...]

While much research has documented unsatisfactory sexual and reproductive health (SRH) awareness among young people in South Africa, understanding of gender differences in access to and evaluation of SRH information is limited. This paper concerned itself with men and women's informal sources and content of SRH, and gendered divergences around accessibility, evaluation, and impact of such information. Fifty sexual history narrative interviews and twenty-five narrative interviews with women were conducted with participants purposively sampled from a range of ages, cultural and racial backgrounds, and in urban and rural sites across five provinces in South Africa. Data were analysed using thematic analysis. While young women were more likely to learn about SRH information from family members, they also reported greater regulation concerning their sexuality. This could enhance stigma surrounding women's sexuality and hinder open communication. Men predominantly learned about sex through pornography and peers, which was reported to encourage sexual prowess to the neglect of practising safer sex. Lack of adequate SRH instruction for young people as revealed through the narratives had significant and often negative implications for men and women's early safer sex behaviours. In response to these insights, recommendations are offered to strengthen informal sources of SRH awareness.

Community mobilisation is recognised as an important strategy to shift inequitable gender norms and ensure an enabling environment to prevent gender-based violence (GBV). Yet there is a need to better understand the factors that facilitate effective community activism in particular contexts. Although fundamental to the success of mobilisation programmes, there is also limited appreciation of the experiences and agency of engaged community activists. This paper draws on qualitative evaluations from two community mobilisation GBV prevention programmes: the Gender Violence in the Amazon of Peru (GAP) Project and the Indashyikirwa programme in Rwanda. In Peru, participatory data was collected, in addition to baseline and endline interviews with 8 activists. In Rwanda, baseline and endline interviews and observations were conducted with 12 activists, and interviews were conducted with 8 staff members. The data was thematically analysed, and a comparative case study approach was applied to both data sets. The comparative study identified similar programmatic aspects that could hinder or enable activist's engagement and development, and how these are embedded within contextual social and structural factors. We discuss these insights in reference to the current emphasis in public health on individualistic programming, with insufficient attention to how wider environments influence violence prevention programming. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

A critical component of evaluations of the effectiveness of intimate partner violence prevention programmes involves understanding pathways of change among individuals who participate in such programmes, and the intervention or contextual elements that support or hinder these. This paper draws on qualitative evaluations of four intimate partner violence prevention programmes in Ghana, Rwanda, South Africa and Tajikistan conducted as part of the What Works to Prevent Violence against Women and Girls Programme. Using a comparative case study approach, a secondary analysis was applied to thematically analysed data to explore how and why men and women change in response to different types of programmes across diverse contexts. Similar pathways of change were identified including the value of learning and applying relationship skills to support equitable, non-violent relationships; the importance of participatory approaches to challenge harmful gender norms and allow for group rapport; and the integration of economic empowerment activities to reduce drivers of intimate partner violence and conflict, and promote participants' self-confidence and status. These findings provide insights regarding intervention design and implementation factors pertinent to bring about changes in intimate partner violence. [ABSTRACT FROM AUTHOR]

A critical component of community-level efforts to reduce intimate partner violence (IPV) is the meaningful engagement of opinion leaders. This paper assesses the successes, challenges, and processes of change that Indashyikirwa – an IPV prevention programme in Rwanda – encountered while engaging opinion leaders to combat IPV. The paper draws on three rounds of qualitative interviews with 13 opinion leaders, two rounds of interviews with 12 community activists, and two rounds of interviews with six staff members. Thematic analysis was conducted and the data triangulated. The paper offers lessons learnt regarding how to effectively engage opinion leaders for IPV prevention programming. [ABSTRACT FROM AUTHOR]

This paper explores the relationship between changes in individual beliefs and behaviours, couple relationship dynamics and gender norms – and how interventions can influence these. It draws on longitudinal qualitative research with heterosexual couples who participated in the Indashyikirwa programme in Rwanda. The couples followed a curriculum designed to improve relationship skills and reduce the gender-inequitable beliefs, behaviours and norms that underpin intimate partner violence. Qualitative findings show that the programme resulted in moderate, but significant, positive 'shifts' in individual beliefs and behaviours, couple relationship dynamics and levels of inequality - increasing men's engagement in domestic duties, women's participation in household decision making, and women's access to economic resources. They also suggest which parts of the couples' curriculum were most effective in catalysing these changes. However, the data also show that these 'shifts' occurred without fully transforming deeply-entrenched beliefs and norms around gender roles and male authority over economic resources. The paper suggests that the persistence of these beliefs and norms constrained the extent of changes among couples – and could potentially constrain their longevity and act as an obstacle to longer-term, larger-scale changes in gender inequalities and violence. [ABSTRACT FROM AUTHOR]

This paper explores the relationship between changes in individual beliefs and behaviours, couple relationship dynamics and gender norms - and how interventions can influence these. It draws on longitudinal qualitative research with heterosexual couples who participated in the Indashyikirwa programme in Rwanda. The couples followed a curriculum designed to improve relationship skills and reduce the gender-inequitable beliefs, behaviours and norms that underpin intimate partner violence. Qualitative findings show that the programme resulted in moderate, but significant, positive 'shifts' in individual beliefs and behaviours, couple relationship dynamics and levels of inequality - increasing men's engagement in domestic duties, women's participation in household decision making, and women's access to economic resources. They also suggest which parts of the couples' curriculum were most effective in catalysing these changes. However, the data also show that these 'shifts' occurred without fully transforming deeply-entrenched beliefs and norms around gender roles and male authority over economic resources. The paper suggests that the persistence of these beliefs and norms constrained the extent of changes among couples - and could potentially constrain their longevity and act as an obstacle to longer-term, larger-scale changes in gender inequalities and violence. [ABSTRACT FROM AUTHOR]

Although intimate partner violence (IPV) is the most common form of violence against women, there is limited understanding of best practices to prevent IPV through working directly with couples and supporting quality of relationships. There are valid concerns of safely conducting research and programming with couples. Yet couples programming responds to the fact that many couples may want to stay together but require support and skills to manage violence. This article compares evaluation data of two programs in Nepal and Rwanda that worked with couples to support relationship quality. The Indashyikirwa program in Rwanda implemented a 5-month curriculum with couples to support equitable, nonviolent relationships. Approximately 25% of trained partners of couples were further supported as community activists for an additional 2 years. Change Starts at Home in Nepal implemented a 9-month couples' curriculum to promote equitable and violence free relationships through fostering mutual respect and understanding, alongside a weekly radio program. The last 3 months of the curriculum focused on community outreach and awareness. This article draws on longitudinal qualitative interviews conducted separately with 28 partners of couples before, immediately after and 1 year following the couples' curriculum in Rwanda, and with 36 partners of couples before, 6 months into the curriculum, and at the end of the intervention in Nepal. Thematic analysis of couples' accounts was conducted and compared across the two studies. Despite the different interventions and settings, the cross-comparative analysis suggests similar pathways of change among couples, including enhanced relationship quality and skills as mediators to prevent IPV. This article considers how both programs supported greater communication and conflict resolution skills and a sense of unity and shared power among couples. The findings suggest the value of couples programming within the context of an enabling environment, highly trained facilitators, and strong referral networks. [ABSTRACT FROM AUTHOR]

Sexual coercion among married or cohabitating couples is a complex phenomenon with few effective strategies for prevention. This paper explores sexual coercion among couples from rural Rwanda who participated in Indashyikirwa, a 4-year intimate partner violence prevention programme that included a 5-month couples curriculum to promote equalitarian, non-violent relationships. Drawing on three rounds of longitudinal qualitative interviews with partners from 14 couples (28 individuals), this paper explores processes of change in experiences and conceptualisations of coerced sex over the course of the intervention and 1 year after. The data were analysed using thematic and dyadic analysis. Both partners of couples reported significant changes in their sexual relationship, including reduced experiences of coerced sex, greater communication about sex and increased acceptability for women to initiate sex. Men and women became more willing to disclose sexual coercion over the course of the interviews, both current and past experiences, and couples' accounts generally became more concordant. Findings yield insights to inform programming to prevent coerced sex among spouses. These include grounding discussion of sexual coercion in an analysis of gendered power and norms, reflecting on the consequences of broader forms of sexual coercion and employing a benefits-driven, skills-based approach. [ABSTRACT FROM AUTHOR]