Gender norms and economic empowerment intervention to reduce intimate partner violence against women in rural Côte d’Ivoire: a randomized controlled pilot study

Abstract

BackgroundGender-based violence against women, including intimate partner violence (IPV), is a pervasive health and human rights concern. However, relatively little intervention research has been conducted on how to reduce IPV in settings impacted by conflict. The current study reports on the evaluation of the incremental impact of adding “gender dialogue groups” to an economic empowerment group savings program on levels of IPV. This study took place in north and northwestern rural Côte d’Ivoire.MethodsBetween 2010 and 2012, we conducted a two-armed, non-blinded randomized-controlled trial (RCT) comparing group savings only (control) to “gender dialogue groups” added to group savings (treatment). The gender dialogue group consisted of eight sessions that targeted women and their male partner. Eligible Ivorian women (18+ years, no prior experience with group savings) were invited to participate. 934 out of 981 (95.2%) partnered women completed baseline and endline data collection. The primary trial outcome measure was an overall measure of past-year physical and/or sexual IPV. Past year physical IPV, sexual IPV, and economic abuse were also separately assessed, as were attitudes towards justification of wife beating and a woman’s ability to refuse sex with her husband.ResultsIntent to treat analyses revealed that compared to groups savings alone, the addition of gender dialogue groups resulted in a slightly lower odds of reporting past year physical and/or sexual IPV (OR: 0.92; 95% CI: 0.58, 1.47; not statistically significant). Reductions in reporting of physical IPV and sexual IPV were also observed (not statistically significant). Women in the treatment group were significantly less likely to report economic abuse than control group counterparts (OR = 0.39; 95% CI: 0.25, 0.60, p < .0001). Acceptance of wife beating was significantly reduced among the treatment group (β = -0.97; 95% CI: -1.67, -0.28, p = 0.006), while attitudes towards refusal of sex did not significantly change Per protocol analysis suggests that compared to control women, treatment women attending more than 75% of intervention sessions with their male partner were less likely to report physical IPV (a OR: 0.45; 95% CI: 0.21, 0.94; p = .04) and report fewer justifications for wife beating (adjusted β = -1.14; 95% CI: -2.01, -0.28, p = 0.01) ; and both low and high adherent women reported significantly decreased economic abuse (a OR: 0.31; 95% CI: 0.18, 0.52, p < 0.0001; a OR: 0.47; 95% CI: 0.27, 0.81, p = 01, respectively). No significant reductions were observed for physical and/or sexual IPV, or sexual IPV alone.ConclusionsResults from this pilot RCT suggest the importance of addressing household gender inequities alongside economic programming, because this type of combined intervention has potential to reduce levels of IPV. Additional large-scale intervention research is needed to replicate these findings.Trial registrationRegistration Number: NCT01629472.

A global comprehensive review of economic interventions to prevent intimate partner violence and HIV risk behaviours

“…age 418 clusters randomly allocated into intervention or control; main group-matched control of women 860* Young women [14–34,37] less likely to have unprotected sex with non-spousal partner (a.R.R. 0.76)* Reduction of IPV by 55% (a.R.R 0.45 [signif] amongst those directly involved)Gupta et al [55]VSLA for women; 8 couples dialogue sessionsIvory CoastWomen; av. age 37.7934 women; 24 intervention clusters, 23 control clusters, randomly allocated; 12–18-month follow-up * Reduced sexual and physical IPV (not signif)* Reduced economic abuse (O.R = 0.39, p  < 0.0001)* Reduced acceptability of wife-beating ( p  = 0.006)Spielberg et al [56]Existing self-help groups; 10 sessions around gender and life skillsIndiaWomen participating in self-help groups; adolescents identified by womenCluster randomised trial; 55 villages assigned to intervention (n = 32) or control (n = 23); 6- and 12-month follow-upWomen saw:* No impact on condom use IRC [57]VSLA for women; 8 couples dialogue sessionsBurundiWomen members of VSLA483 women; randomised into intervention and control; 15-month follow-up * Women in the high or moderate risk category at baseline reported a 22% significant reduction in the incidence of violence in the last two weeks and a 46% reduction in physical harm (no significance reported)Rosenberg et al [58]Microfinance; max 5 training sessions; health bookHaitiWomen; age: mean 36.1; range 18–49192 participants; cross-sectional* Improved condom use in last year: O.R 0.63 (95% C.I 0.26–1.54)* Improved condom use among those with an unfaithful partner: O.R 3.95 (95% C.I 0.93–16.85) Dunbar et al [59]SHAZ!…”

“…The additional gender transformative components varied widely. Two used couples discussion groups [55,57], while another study was embedded in a wider community mobilisation intervention for sex workers [62]. The others all worked with women in group settings, such as VSLAs.…”

“…Four studies reported IPV-related outcomes [54,55,57,60]. Three reported significant reductions on IPV [23,57,60] and one a non-significant but positive outcome [55].…”

“…Three reported significant reductions on IPV [23,57,60] and one a non-significant but positive outcome [55]. One study also reported a reduction in economic abuse from their partner ( p  < 0.0001) in female participants [55].

Savings and gender transformative

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“…For instance some studies pointed to the potential of economic-based interventions to either increase or decrease male controlling behaviours [35,36,68], an important factor for HIV acquisition and IPV [89], but this measure was not common across many studies. In addition, economic violence was only measured in a limited number of studies [55], yet given the underlying aim of some economic interventions is to increase women’s economic autonomy in relation to male partners, this is similarly a missed opportunity.…”