Effective prevention of intimate partner violence through couples training: a randomised controlled trial ofIndashyikirwain Rwanda

Abstract

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.

Elements of the Design and Implementation of Interventions to Prevent Violence against Women and Girls Associated with Success: Reflections from the What Works to Prevent Violence against Women and Girls? Global Programme

“…The literature on violence prevention emphasises the importance of multiple component interventions (e.g., [19,20]); however, our findings have clarified that what is critically important is addressing multiple drivers of violence, including the most important drivers in the participants' lives [21]. This can be done with one component, as in the case of Stepping Stones and the Indashyikirwa couples' interventions, which both challenged gender inequity and the use of violence, while building stronger, more harmonious relationships, empowered with better communication [22,23]. Our conclusion in respect of multiple drivers is supported by the recent comprehensive review of what works in VAWG prevention [10].…”

“…The ratio was 1 activist to 1229 adults in Ghana, and 1 activist to 302 adults in DRC. The successful Indashyikirwa couples programme in Rwanda lasted 5 months and had an additional element of community activism to the extent that 25% of 1680 intervention participants undertook activism for an additional 22 months [23]. Interventions with community activists that were unsuccessful all experienced challenges with delivery intensity.…”

Sharing Responsibility through Joint Decision Making and Implications for Intimate-Partner Violence: Evidence from 12 Sub-Saharan African Countries

“…If one considers that women's agency is the capacity to make decisions about one's own life and act on them to achieve a desired outcome, free from the threat of violence and retribution (Klugman et al 2014), then making joint decisions clearly has a role to play in furthering agency. Second, our results underscore the promise of interventions seeking to reduce intimate partner violence by fostering shared accountability and cooperation within couples (Dunkle et al 2020, Sharma et al 2020.…”

Women’s economic status, male authority patterns and intimate partner violence: a qualitative study in rural North West Province, South Africa

“…To address rigidly entrenched gender norms, especially within short time-spans, it is therefore important that men be involved to harness their support of women's empowerment. A trial in Rwanda (Dunkle et al 2020) and research in the Democratic Republic of Congo (Vaillant et al 2020), alongside other evidence (Armenti and Babcock 2016;Stern, McGhee, et al 2020) have shown that when men and women are involved as couples, there is a significant reduction of intimate partner violence, including sexual intimate partner violence, as well as economic and psychological empowerment of women. There needs to be recognition however that some men may not be interested in participating in such programmes or that there may be a 'backlash' towards them, if men do not view the intervention as helpful.…”