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The implications of community responses to intimate partner violence in Rwanda.

ABSTRACT: Intimate partner violence (IPV) has significant impacts on mental health. Community-focused interventions have shown promising results for addressing IPV in low-income countries, however, little is known about the implications of these interventions for women's mental wellbeing. This paper analyses data from a community-focused policy intervention in Rwanda collected in 2013-14, including focus group discussions and in-depth interviews with community members (n = 59). Our findings point to three ways in which these community members responded to IPV: (1) reconciling couples experiencing violence, (2) engaging community support through raising cases of IPV during community discussions, (3) navigating resources for women experiencing IPV, including police, social services and legal support. These community responses support women experiencing violence by helping them access available resources and by engaging in community discussions. However, assistance is largely only offered to married women and responses tend to focus exclusively on physical rather than psychological or emotional forms of violence. Drawing on Campbell and Burgess's (2012) framework for 'community mental health competence', we interrogate the potential implications of these responses for the mental wellbeing of women affected by violence. We conclude by drawing attention to the gendered nature of community responses to IPV and the potential impacts this may have for the mental health of women experiencing IPV.

SUBMITTER: Mannell J

PROVIDER: S-EPMC5931791 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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The implications of community responses to intimate partner violence in Rwanda.

Mannell Jenevieve J Seyed-Raeisy Iran I Burgess Rochelle R Campbell Catherine C

PloS one 20180502 5

Intimate partner violence (IPV) has significant impacts on mental health. Community-focused interventions have shown promising results for addressing IPV in low-income countries, however, little is known about the implications of these interventions for women's mental wellbeing. This paper analyses data from a community-focused policy intervention in Rwanda collected in 2013-14, including focus group discussions and in-depth interviews with community members (n = 59). Our findings point to three ...[more]

PMID: 29718961

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Project description:BackgroundThere 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.MethodsWe 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.ResultsThere 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.ConclusionsFailure 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 registrationClinicalTrials.gov, NCT03477877.

Project description:BackgroundIntimate partner violence against women is a prevailing public health problem in Tanzania, where four of ten women have a lifetime exposure to physical or sexual violence by their male partners. To be able to suggest relevant and feasible community and health care based interventions, we explored community members' understanding and their responses to intimate partner violence.MethodsA qualitative study using focus group discussions with 75 men and women was conducted in a community setting of urban Tanzania. We analysed data using a grounded theory approach and relate our findings to the ecological framework of intimate partner violence.ResultsThe analysis resulted in one core category, "Moving from frustration to questioning traditional gender norms", that denoted a community in transition where the effects of intimate partner violence had started to fuel a wish for change. At the societal level, the category "Justified as part of male prestige" illustrates how masculinity prevails to justify violence. At the community level, the category "Viewed as discreditable and unfair" indicates community recognition of intimate partner violence as a human rights concern. At the relationship level, the category "Results in emotional entrapment" shows the shame and self-blame that is often the result of a violent relationship. At the individual level, the risk factors for intimate partner violence were primarily associated with male characteristics; the category "Fed up with passivity" emerged as an indication that community members also acknowledge their own responsibility for change in actions.ConclusionsPrevailing gender norms in Tanzania accept women's subordination and justify male violence towards women. At the individual level, an increasing openness makes it possible for women to report, ask for help, and become proactive in suggesting preventive measures. At the community level, there is an increased willingness to intervene but further consciousness-raising of the human rights perspective of violence, as well as actively engaging men. At the macro level, preventive efforts must be prioritized through re-enforcement of legal rights, and provision of adequate medical and social welfare services for both survivors and perpetrators.

Project description:BackgroundBetween 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.MethodsSectors (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).ResultsWe 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.ConclusionsThe 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.

Project description:ObjectiveThe association between intimate partner violence (IPV) and breastfeeding is unclear. We conducted a systematic review to summarise the evidence of breastfeeding outcomes following exposure to IPV.DesignSystematic review.MethodsWe searched for published studies without study design or language restrictions (up to July 2019) in the following databases: PubMed, Embase, SCOPUS and The Global Health Library. Studies assessing various breastfeeding outcomes (initiation, duration and exclusive breastfeeding) in women exposed to IPV in any form (physical, psychological or sexual) and at any stage (1 year pre-pregnancy, during or post-pregnancy) were included. Two authors independently selected the studies and conducted the quality appraisal by use of the Newcastle-Ottawa Scale. Results were summarised taking precision and quality into account.ResultsA total of 16 studies (participants n=414 393) were included and they adjusted for a total of 48 different confounders. The majority of studies were cross-sectional (n=11) and most studies were judged to be fair/low quality. Four out of seven studies found that IPV exposure shortened breastfeeding duration (adjusted ORs/aORs=0.22 (95% CI: 0.05-0.85), 1.18 (95% CI: 1.01-1.37), 5.92 (95% CI: 1.72-27.98), 1.28 (95% CI: 1.18-1.39)). Further, 5/10 studies found that IPV led to early termination of exclusive breastfeeding (aORs=1.53 (95% CI: 1.01-23.1), 0.83 (95% CI: 0.71-0.96), 1.35 (95% CI: 1.07-1.71), 0.17 (95% CI: 0.07-0.4), 1839 (95% CI: 1.61-2911)) and 2/6 studies found that IPV significantly reduced breastfeeding initiation (aORs=2.00 (95% CI: 1.2-3.3), 0.81 (95% CI: 0.7-0.93)).ConclusionIPV exposure appears to associate negatively with some breastfeeding outcomes. Individual patient data meta-analysis is required to quantify the magnitude of the association for specific IPV-outcome combinations. More high-quality studies and definition of core confounders are warranted.Prospero registration numberCRD42019129353.

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The implications of community responses to intimate partner violence in Rwanda.

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The implications of community responses to intimate partner violence in Rwanda.

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