Sexual violence among adolescent girls and young women in Malawi: a cluster-randomized controlled implementation trial of empowerment self-defense training

Abstract

BackgroundGlobally, sexual violence is prevalent, particularly for adolescent women. This cluster-randomized controlled implementation trial examines empowerment self-defense (ESD) for sexual assault risk reduction among school-age women in Malawi.MethodsThe unit of randomization and analysis was the school (n = 141). Intervention participants received a 12-h intervention over 6 weeks, with refreshers. Primary outcomes were past-year prevalence and incident rate of sexual violence. Secondary outcomes included confidence, self-defense knowledge, and, for those victimized, violence disclosure. Interaction effects on outcomes were evaluated with Poisson models with school-correlated robust variance estimates for risk ratios and incident rate ratios (baseline n = 6644, follow-up n = 4278).ResultsPast-year sexual assault prevalence was reduced among intervention students (risk ratio [RR] 0.68, 95% CI 0.56, 0.82), but not control students (interaction effect p < 0.001). Significant increases in self-defense knowledge were observed solely among intervention students (RR 3.33, 95% CI 2.76, 4.02; interaction effect p < 0.001). Significant changes in sexual violence prevalence and knowledge were observed for both primary and secondary students. Favorable reductions were also observed in sexual violence incident rate among students overall (interaction effect p = 0.01).ConclusionsThis intervention reduced sexual violence victimization in both primary and secondary school settings. Results support the effectiveness of ESD to address sexual violence, and approach the elimination of violence against women and girls set forth with Sustainable Development Goal #5. Implementation within the education system can enable sustainability and reach.Trial registrationPan African Clinical Trials Registry PACTR201702002028911. Registered 09 February 2017. Retrospectively registered.

Disclosure, reporting and help seeking among child survivors of violence: a cross-country analysis

“…For example, a behaviour change communication toolkit (the 'Good School Toolkit') aimed at reducing violence by school staff in primary schools was found to decrease past week physical violence in Uganda [37]. In addition, a short-term classroom-based empowerment and self-defence training was shown to reduce sexual violence and assault among adolescent girls in Malawi and Kenya [38,39]. At the same time, these results underscore the need to increase efforts to reach more marginalized children who are not in school and may not be able to access school-based services and help.…”

“We are responsible for the violence, and prevention is up to us”: a qualitative study of perceived risk factors for gender-based violence among Ethiopian university students

“…While upper class students were reportedly more likely to commit violence in this study, it may be more feasible to engage first-year males, with mandatory trainings included as part of the university orientation and mentorship programs with older classmates or faculty who model gender-equitable behaviors and positive masculinity. Despite the lack of examples of the use of such interventions in the university context, interventions adapted from other school-based efforts to engage males in GBV prevention [24, 25] could be developed and tested in these universities.…”

Young People’s Experiences With an Empowerment-Based Behavior Change Intervention to Prevent Sexual Violence in Nairobi Informal Settlements: A Qualitative Study

“…15 Empowerment selfdefense (ESD) is an interactive feminist training to prevent sexual violence by building verbal, emotional, and physical skills to recognize and resist different forms of GBV through heightened self-esteem and confidence. [16][17][18] Previous studies in high-income settings indicate that ESD is a promising strategy for reducing sexual assault and coercion against female students on college and university campuses. 17,19,20 In low-and middle-income countries, ESD has primarily been used in primary and secondary schools via an adapted curriculum called IMPower, developed by the U.S.-based nongovernmental organization No Means No Worldwide.…”