A social empowerment intervention to prevent intimate partner violence against women in a microfinance scheme in Tanzania: findings from the MAISHA cluster randomised controlled trial

Abstract

Background Globally, about 30% of women have experienced physical or sexual violence, or both, from an intimate partner during their lifetime. Associations between poverty and women's increased risk of intimate partner violence have been observed. We therefore aimed to assess the effect of a violence prevention intervention delivered to women participating in a group-based microfinance scheme in Tanzania. Methods We did a cluster randomised controlled trial among women taking part in a microfinance loan scheme in Mwanza city, Tanzania. A microfinance loan group was only enrolled if at least 70% of members consented. We randomly assigned the microfinance groups in blocks of six to receive either the intervention (ie, the intervention arm) or be wait-listed for the intervention after the trial (ie, the control arm). Women in both arms of the trial met weekly for loan repayments. Only those in the intervention arm participated in the ten-session MAISHA intervention that aims to empower women and prevent intimate partner violence. Given the nature of the intervention, it was not possible to mask participants or the research team. The primary outcome was a composite of reported past-year physical or sexual intimate partner violence, or both. Secondary outcome measures were past-year physical, sexual, and emotional intimate partner violence; acceptability and tolerance of intimate partner violence; and attitudes and beliefs related to intimate partner violence. These outcomes were assessed 24 months after the intervention. An intention-to-treat analysis was done, adjusting for age, education, and baseline measure of the respective outcome. The study is registered with ClinicalTrials.gov, number NCT02592252. Findings Between September, 2014, and June, 2015, 66 (65%) of 101 microfinance groups approached in the study area met the trial eligibility criteria and were enrolled, of which 33 (n=544 women) were allocated to the intervention arm and 33 (n=505 women) to the control arm. Overall, 485 (89%) of 544 women in the intervention arm and 434 (86%) of 505 in the control arm completed the outcomes assessment. Among the intervention arm, 112 (23%) of 485 women reported past-year physical or sexual intimate partner violence, or both, compared with 119 (27%) of 434 in the control arm (adjusted odds ratio [aOR] 0•69, 95% CI 0•47-1•01; p=0•056). Women in the intervention arm were less likely to report physical intimate partner violence (aOR 0•64, 95% CI 0•41-0•99; p=0•043) and were less likely to express attitudes accepting of intimate partner violence (0•45, 0•34-0•61; p<0•0001) or beliefs that intimate partner violence is a private matter (0•51, 0•32-0•81; p=0•005) or should be tolerated (0•68, 0•45-1•01; p=0•055). There was no evidence of an effect on reported sexual or emotional intimate partner violence. There were no reports that participation in the trial had led to new episodes of violence or worsening of ongoing violence and abuse. Interpretation Reported physical or sexual intimate partner violence, or both, was reduc...

Women’s income and risk of intimate partner violence: secondary findings from the MAISHA cluster randomised trial in North-Western Tanzania

“…They also reported greater levels of confidence to assert an opinion different to their partner's. These are all potential explanations for how the MAISHA intervention worked to reduce physical IPV (as reported in the primary analysis of intervention impact) [56]. No intervention/control differences were seen regarding communication within the relationship or frequency of separation.…”

“…Indeed, recent IPV research has shown differing risk profiles for physical and sexual IPV, with sexual IPV linked most strongly to norms of masculinity that emphasize sexual dominance over women, sexual entitlement within marriage, and toughness and dominance over other men [55]. The fact that prevention interventions (including MAISHA) sometimes have more success at reducing physical IPV than sexual IPV [56][57][58] is also supportive of the idea that risk factors for physical IPV may be more readily manipulated by, for example, women's economic participation and social empowerment.…”

Mental health problems among female sex workers in low- and middle-income countries: A systematic review and meta-analysis

“…Second, the strong associations between mental health disorders and key occupational risk factors such as violence and harmful alcohol and drug use support the need for upstream structural interventions as part of holistic HIV prevention programming for FSWs. Again, violence interventions have been shown to be effective in reducing violence among women in LMICs [92,93] as well as among FSWs [94]. Low-cost, brief psychological interventions to treat harmful alcohol use could also be adapted to FSW settings [95].…”

The impacts of combined social and economic empowerment training on intimate partner violence, depression, gender norms and livelihoods among women: an individually randomised controlled trial and qualitative study in Afghanistan

“…As such, combining economic empowerment with social empowerment interventions has the potential to reduce women’s experiences of IPV. Indeed, a number of well-designed studies in Africa have demonstrated such approaches can reduce women’s experiences of IPV by up to 55% 9 10…”