A cluster randomised controlled trial to evaluate the impact of a gender transformative intervention on intimate partner violence against women in newly formed neighbourhood groups in Tanzania

Sheila Harvey, Tanya Abramsky, Gerry Mshana, Christian Holm Hansen, Grace J Mtolela, Flora Madaha, Ramadhan Hashim, Imma Kapinga, Charlotte Watts, Shelley Lees, Saidi Kapiga, Sheila Harvey, Tanya Abramsky, Gerry Mshana, Christian Holm Hansen, Grace J Mtolela, Flora Madaha, Ramadhan Hashim, Imma Kapinga, Charlotte Watts, Shelley Lees, Saidi Kapiga

Abstract

Introduction: Violence against women is a global public health concern; around a quarter of women will experience intimate partner physical or sexual violence during their lifetime. We assessed the impact of a gender transformative intervention for women designed to prevent intimate partner violence (IPV).

Methods: We conducted a cluster randomised controlled trial in Mwanza city, Tanzania, among women in newly formed neighbourhood groups to evaluate a 10-session participatory intervention that aims to empower women, prevent IPV and promote healthy relationships. Following a baseline interview, groups were randomly assigned (1:1 ratio) to the intervention or control arm. An intention-to-treat analysis was conducted to assess the impact of the intervention on the main outcomes, assessed 24 months postintervention. These included past-year physical IPV and sexual IPV (primary); past-year emotional abuse; and acceptability and tolerance of IPV.

Results: Between September 2015 and February 2017, 1265 women were recruited in 66 neighbourhoods and randomly allocated to intervention (n=627 women in 33 neighbourhoods) or control (n=638 women in 33 neighbourhoods). Assessment of outcomes was completed for 551 (88%) intervention and 575 (90%) control women. Among intervention women, 113 (21%) reported physical IPV compared with 117 (20%) control women (adjusted OR (aOR) 0.98, 95% CI 0.72 to 1.33, p=0.892), and 109 (20%) intervention women reported sexual IPV compared with 121 (21%) control women (aOR 0.98, 95% CI 0.72 to 1.32, p=0.881). Intervention women reported less emotional abuse (aOR 0.74, 95% CI 0.56 to 0.98, p=0.035), and were less likely to express attitudes accepting of IPV (aOR 0.49, 95% CI 0.36 to 0.66, p<0.001), and beliefs that IPV is a private matter (aOR 0.54, 95% CI 0.38 to 0.78, p=0.001), or should be tolerated (aOR 0.48, 95% CI 0.34 to 0.66, p<0.001).

Conclusion: These results indicate that the intervention was effective in reducing emotional abuse and positively impacting attitudes and beliefs condoning IPV, but was not sufficient to reduce physical or sexual IPV.

Trial registration number: NCT02592252.

Keywords: cluster randomized trial; prevention strategies; public health.

Conflict of interest statement

Competing interests: Following initiation of the trial, CW was seconded to the UK Government Department for International Development as their chief scientific advisor. Her ongoing role in this trial is in her academic capacity at LSHTM.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Trial timeline.
Figure 2
Figure 2
MAISHA intervention—Wanawake Na Maisha curriculum.
Figure 3
Figure 3
Trial profile. ITT, intention-to-treat.

References

    1. World Health Organization . Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence, 2013. Available: [Accessed 29 Mar 2021].
    1. World Health Organization . Violence against women prevalence estimates, 2018, executive summary, 2021. Available: [Accessed 29 Mar 2021].
    1. Devries KM, Mak JY, Bacchus LJ, et al. . Intimate partner violence and incident depressive symptoms and suicide attempts: a systematic review of longitudinal studies. PLoS Med 2013;10:e1001439. 10.1371/journal.pmed.1001439
    1. Ellsberg M, Jansen HAFM, Heise L, et al. . Intimate partner violence and women's physical and mental health in the who multi-country study on women's health and domestic violence: an observational study. Lancet 2008;371:1165–72. 10.1016/S0140-6736(08)60522-X
    1. Bacchus LJ, Ranganathan M, Watts C, et al. . Recent intimate partner violence against women and health: a systematic review and meta-analysis of cohort studies. BMJ Open 2018;8:e019995. 10.1136/bmjopen-2017-019995
    1. Heise L. What works to prevent partner violence: an evidence overview, 2011. Available: [Accessed 29 Mar 2021].
    1. Kerr-Wilson A, Gibbs A, Fraser E. A rigorous global evidence review of interventions to prevent violence against women and girls, 2020. Available: [Accessed 29 Mar 2021].
    1. Ellsberg M, Arango DJ, Morton M, et al. . Prevention of violence against women and girls: what does the evidence say? Lancet 2015;385:1555–66. 10.1016/S0140-6736(14)61703-7
    1. Devries KM, Mak JYT, García-Moreno C, et al. . Global health. the global prevalence of intimate partner violence against women. Science 2013;340:1527–8. 10.1126/science.1240937
    1. Pronyk PM, Hargreaves JR, Kim JC, et al. . Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial. Lancet 2006;368:1973–83. 10.1016/S0140-6736(06)69744-4
    1. Garcia-Moreno C, Jansen HAFM, Ellsberg M, et al. . Prevalence of intimate partner violence: findings from the WHO multi-country study on women’s health and domestic violence. The Lancet 2006;368:1260–9. 10.1016/S0140-6736(06)69523-8
    1. Kapiga S, Harvey S, Mshana G, et al. . 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. Lancet Glob Health 2019;7:e1423–34. 10.1016/S2214-109X(19)30316-X
    1. Harvey S, Lees S, Mshana G. A cluster randomised controlled trial to assess the impact on intimate partner violence of a 10-session participatory social empowerment intervention for women in Tanzania (MAISHA CRT02): study protocol, 2019. Available: [Accessed 29 Mar 2021].
    1. Watts C, Heise L, Garcia-Moreno C. Putting women first: ethical and safety recommendations for research on domestic violence against women. Geneva, Switzerland, 2001.
    1. Abramsky T, Devries K, Kiss L, et al. . Findings from the Sasa! study: a cluster randomized controlled trial to assess the impact of a community mobilization intervention to prevent violence against women and reduce HIV risk in Kampala, Uganda. BMC Med 2014;12:122. 10.1186/s12916-014-0122-5
    1. Wagman JA, Gray RH, Campbell JC, et al. . Effectiveness of an integrated intimate partner violence and HIV prevention intervention in Rakai, Uganda: analysis of an intervention in an existing cluster randomised cohort. Lancet Glob Health 2015;3:e23–33. 10.1016/S2214-109X(14)70344-4
    1. Abramsky T, Devries K, Kiss L, et al. . A community mobilisation intervention to prevent violence against women and reduce HIV/AIDS risk in Kampala, Uganda (the Sasa! study): study protocol for a cluster randomised controlled trial. Trials 2012;13:96. 10.1186/1745-6215-13-96
    1. Heise L, Pallitto C, García-Moreno C, et al. . Measuring psychological abuse by intimate partners: constructing a cross-cultural indicator for the sustainable development goals. SSM Popul Health 2019;9:100377. 10.1016/j.ssmph.2019.100377
    1. Gibbs A, Jewkes R, Willan S, et al. . Associations between poverty, mental health and substance use, gender power, and intimate partner violence amongst young (18-30) women and men in urban informal settlements in South Africa: a cross-sectional study and structural equation model. PLoS One 2018;13:e0204956. 10.1371/journal.pone.0204956
    1. Benavides M, León J, Etesse M, et al. . Exploring the association between segregation and physical intimate partner violence in Lima, Peru: the mediating role of gender norms and social capital. SSM Popul Health 2019;7:100338. 10.1016/j.ssmph.2018.100338
    1. Lees S, Marchant M, Selestine V, et al. . The transformative effects of a participatory social empowerment intervention in the MAISHA intimate partner violence trial in Tanzania. Cult Health Sex 2020:1–16. 10.1080/13691058.2020.1779347
    1. Fulu E, Miedema S, Roselli T, et al. . Pathways between childhood trauma, intimate partner violence, and Harsh parenting: findings from the un Multi-country study on men and violence in Asia and the Pacific. Lancet Glob Health 2017;5:e512–22. 10.1016/S2214-109X(17)30103-1
    1. Jewkes R, Fulu E, Tabassam Naved R, et al. . Women's and men's reports of past-year prevalence of intimate partner violence and rape and women's risk factors for intimate partner violence: a multicountry cross-sectional study in Asia and the Pacific. PLoS Med 2017;14:e1002381. 10.1371/journal.pmed.1002381
    1. Buller AM, Hidrobo M, Peterman A, et al. . The way to a man's heart is through his stomach?: a mixed methods study on causal mechanisms through which cash and in-kind food transfers decreased intimate partner violence. BMC Public Health 2016;16:488. 10.1186/s12889-016-3129-3
    1. Buller AM, Peterman A, Ranganathan M. A mixed methods review of cash transfers and intimate partner in low and middle-income countries, 2018. Available: [Accessed 29 Mar 2021].
    1. Gibbs A, Dunkle K, Mhlongo S, et al. . Which men change in intimate partner violence prevention interventions? A trajectory analysis in Rwanda and South Africa. BMJ Glob Health 2020;5:e002199. 10.1136/bmjgh-2019-002199
    1. Gibbs A, Jacobson J, Kerr Wilson A. A global comprehensive review of economic interventions to prevent intimate partner violence and HIV risk behaviours. Glob Health Action 2017;10:1290427. 10.1080/16549716.2017.1290427
    1. Peterman A, Palermo TM, Ferrari G. Still a leap of faith: microfinance initiatives for reduction of violence against women and children in low-income and middle-income countries. BMJ Glob Health 2018;3:e001143. 10.1136/bmjgh-2018-001143
    1. Jina R, Jewkes R, Hoffman S, et al. . Adverse mental health outcomes associated with emotional abuse in young rural South African women: a cross-sectional study. J Interpers Violence 2012;27:862–80. 10.1177/0886260511423247

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