Working with men to prevent intimate partner violence in a conflict-affected setting: a pilot cluster randomized controlled trial in rural Côte d'Ivoire

Mazeda Hossain, Cathy Zimmerman, Ligia Kiss, Tanya Abramsky, Drissa Kone, Monika Bakayoko-Topolska, Jeannie Annan, Heidi Lehmann, Charlotte Watts, Mazeda Hossain, Cathy Zimmerman, Ligia Kiss, Tanya Abramsky, Drissa Kone, Monika Bakayoko-Topolska, Jeannie Annan, Heidi Lehmann, Charlotte Watts

Abstract

Background: Evidence from armed conflict settings points to high levels of intimate partner violence (IPV) against women. Current knowledge on how to prevent IPV is limited-especially within war-affected settings. To inform prevention programming on gender-based violence in settings affected by conflict, we evaluated the impact of adding a targeted men's intervention to a community-based prevention programme in Côte d'Ivoire.

Methods: We conducted a two-armed, non-blinded cluster randomized trial in Côte d'Ivoire among 12 pair-matched communities spanning government-controlled, UN buffer, and rebel-controlled zones. The intervention communities received a 16-week IPV prevention intervention using a men's discussion group format. All communities received community-based prevention programmes. Baseline data were collected from couples in September 2010 (pre-intervention) and follow-up in March 2012 (one year post-intervention). The primary trial outcome was women's reported experiences of physical and/or sexual IPV in the last 12 months. We also assessed men's reported intention to use physical IPV, attitudes towards sexual IPV, use of hostility and conflict management skills, and participation in gendered household tasks. An adjusted cluster-level intention to treat analysis was used to compare outcomes between intervention and control communities at follow-up.

Results: At follow-up, reported levels of physical and/or sexual IPV in the intervention arm had decreased compared to the control arm (ARR 0.52, 95% CI 0.18-1.51, not significant). Men participating in the intervention reported decreased intentions to use physical IPV (ARR 0.83, 95% CI 0.66-1.06) and improved attitudes toward sexual IPV (ARR 1.21, 95% CI 0.77-1.91). Significant differences were found between men in the intervention and control arms' reported ability to control their hostility and manage conflict (ARR 1.3, 95% CI 1.06-1.58), and participation in gendered household tasks (ARR 2.47, 95% CI 1.24-4.90).

Conclusions: This trial points to the value of adding interventions working with men alongside community activities to reduce levels of IPV in conflict-affected settings. The intervention significantly influenced men's reported behaviours related to hostility and conflict management and gender equitable behaviours. The decreased mean level of IPV and the differences between intervention and control arms, while not statistically significant, suggest that IPV in conflict-affected areas can be reduced through concerted efforts to include men directly in violence prevention programming. A larger-scale trial is needed to replicate these findings and further understand the mechanisms of change.

Trial registration: clinicaltrials.gov NCT01803932.

Figures

Figure 1
Figure 1
Overview of Men’s Discussion Groups curriculum and underlying stages of change.
Figure 2
Figure 2
Flow diagram.

References

    1. Garcia-Moreno C, Jansen HA, Ellsberg M, Heise L, Watts CH. Prevalence of intimate partner violence: findings from the WHO multi-country study on women’s health and domestic violence. Lancet. 2006;368(9543):1260–1269. doi: 10.1016/S0140-6736(06)69523-8.
    1. Garcia-Moreno C, Heise L, Jansen HA, Ellsberg M, Watts C. Public health. Violence against women. Science. 2005;310(5752):1282–1283. doi: 10.1126/science.1121400.
    1. Stark L, Ager A. A systematic review of prevalence studies of gender-based violence in complex emergencies. Trauma Violence Abuse. 2011;12(3):127–134. doi: 10.1177/1524838011404252.
    1. Devries KM, Mak JY, Garcia-Moreno C, Petzold M, Child JC, Falder G, Lim S, Bacchus LJ, Engell RE, Rosenfeld L, Pallitto C, Vos T, Abrahams N, Watts CH. Global health. The global prevalence of intimate partner violence against women. Science. 2013;340(6140):1527–1528. doi: 10.1126/science.1240937.
    1. Zimmerman C, Hossain M, Kiss L, Mak J, Hoey J, Weneden K, Bhatti S, Christie G, Baillot H, Watts C. Asylum-Seeking Women, Violence & Health: Results from a Pilot Study in Scotland and Belgium. London and Glasgow: London School of Hygiene & Tropical Medicine (LSHTM) and Scottish Refugee Council (SRC); 2009.
    1. Zimmerman C, Hossain M, Yun K, Gajdadziev V, Guzun N, Tchomarova M, Ciarrocchi RA, Johansson A, Kefurtova A, Scodanibbio S, Motus MN, Roche B, Morison L, Watts C. The health of trafficked women: a survey of women entering posttrafficking services in Europe. Am J Public Health. 2008;98(1):55–59. doi: 10.2105/AJPH.2006.108357.
    1. Stockl H, Devries K, Rotstein A, Abrahams N, Campbell J, Watts C, Moreno CG. The global prevalence of intimate partner homicide: a systematic review. Lancet. 2013;382(9895):859–865. doi: 10.1016/S0140-6736(13)61030-2.
    1. Devries KM, Mak JY, Bacchus LJ, Child JC, Falder G, Petzold M, Astbury J, Watts CH. Intimate partner violence and incident depressive symptoms and suicide attempts: a systematic review of longitudinal studies. PLoS Med. 2013;10(5):e1001439. doi: 10.1371/journal.pmed.1001439.
    1. Dube SR, Anda RF, Felitti VJ, Edwards VJ, Williamson DF. Exposure to abuse, neglect, and household dysfunction among adults who witnessed intimate partner violence as children: implications for health and social services. Violence Vict. 2002;17(1):3–17. doi: 10.1891/vivi.17.1.3.33635.
    1. Gil-González D, Vives-Cases C, Ruiz MT, Carrasco-Portiño M, Álvarez-Dardet C. Childhood experiences of violence in perpetrators as a risk factor of intimate partner violence: a systematic review. J Public Health. 2008;30(1):14–22. doi: 10.1093/pubmed/fdm071.
    1. Coker AL. Does physical intimate partner violence affect sexual health? A systematic review. Trauma Violence Abuse. 2007;8(2):149–177. doi: 10.1177/1524838007301162.
    1. Ministère du Plan, Macro International Inc. Enquête Démographique et de Santé, République Démocratique du Congo 2007. Calverton, Maryland, USA: Ministère du Plan, Macro International; 2008.
    1. Abramsky T, Watts CH, Garcia-Moreno C, Devries K, Kiss L, Ellsberg M, Jansen HA, Heise L. What factors are associated with recent intimate partner violence? findings from the WHO multi-country study on women’s health and domestic violence. BMC Public Health. 2011;11:109. doi: 10.1186/1471-2458-11-109.
    1. Heise L. What Works to Prevent Partner Violence? An Evidence Overview. London, UK: STRIVE Research Consortium, London School of Hygiene and Tropical Medicine; 2011.
    1. International Rescue Committee (IRC) Je ne veux pas mourir avant mon heure: La violence domestique en Afrique de l'Ouest [I do not want to die before my time: Domestic Violence in West Africa] New York, NY: IRC; 2012.
    1. Men’s Resources International (MRI) Engaging Men in Ending Gender-Based Violence in Liberia Case Study and Promising Practices: Male Involvement Project - Year One. Pelham, MA, USA: MRI; 2010.
    1. Promundo I. Engaging men to Prevent Gender-Based Violence: A Multi-Country Intervention and Impact Evaluation Study. Report for the UN Trust Fund. Washington, DC: Promundo; 2012.
    1. Network SGJ. Study on Involving Men and Boys in Preventing and Responding to Gender-Based Violence in Conflict, Post-Conflict and Humanitarian Settings. Cape Town, South Africa: Sonke Gender Justice Network and UNFPA; 2012.
    1. Barker G, Ricardo C, Nascimento M, Olukoya A, Santos C. Questioning gender norms with men to improve health outcomes: evidence of impact. Glob Public Health. 2010;5(5):539–553. doi: 10.1080/17441690902942464.
    1. Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Khuzwayo N, Koss M, Puren A, Wood K, Duvvury N. A cluster randomized-controlled trial to determine the effectiveness of Stepping Stones in preventing HIV infections and promoting safer sexual behaviour amongst youth in the rural Eastern Cape, South Africa: trial design, methods and baseline findings. Trop Med Int Health. 2006;11(1):3–16. doi: 10.1111/j.1365-3156.2005.01530.x.
    1. Pronyk PM, Hargreaves JR, Kim JC, Morison LA, Phetla G, Watts C, Busza J, Porter JD. 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(9551):1973–1983. doi: 10.1016/S0140-6736(06)69744-4.
    1. Kim JC, Watts CH, Hargreaves JR, Ndhlovu LX, Phetla G, Morison LA, Busza J, Porter JD, Pronyk P. Understanding the impact of a microfinance-based intervention on women’s empowerment and the reduction of intimate partner violence in South Africa. Am J Public Health. 2007;97(10):1794–1802. doi: 10.2105/AJPH.2006.095521.
    1. Ditlopo P, Mullick S, Askew I, Vernon R, Maroga E, Sibeko S, Tshabalala M, Raletsemo R, Peacock D, Levack A. Testing the Effectiveness of the Men as Partners Program (MAP) in Soweto, South Africa. Washington, DC: USAID; 2007.
    1. Peacock D, Levack A. The Men as Partners Program in South Africa:Reaching Men to End Gender-Based Violence and Promote Sexual and Reproductive Health. Int J Mens Health. 2004;3(3):173–188. doi: 10.3149/jmh.0303.173.
    1. Pulerwitz J, Michaelis A, Verma R, Weiss E. Addressing gender dynamics and engaging men in HIV programs: lessons learned from Horizons research. Public Health Rep. 2010;125(2):282–292.
    1. Michau L. Approaching old problems in new ways: community mobilisation as a primary prevention strategy to combat violence against women. Gend Dev. 2007;15(1):95–109. doi: 10.1080/13552070601179144.
    1. Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Puren A, Duvvury N. Impact of stepping stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial. BMJ. 2008;337:a506. doi: 10.1136/bmj.a506.
    1. John-Kall J, Roberts B. Exploring the involvement of men in gender-based violence prevention programmes in settings affected by armed conflict. Divers Health Care. 2010;7(3):169–176.
    1. Hossain M, Zimmerman C, Kiss L, Kone D, Bakayoko-Topolska M, Manan KAD, Lehmann H, Watts C. Men’s and women’s experiences of violence and traumatic events in rural Côte d’Ivoire before, during and after a period of armed conflict. BMJ Open. 2014;4(2):e003644. doi: 10.1136/bmjopen-2013-003644.
    1. Hossain M, Zimmerman C, Kiss L, Watts C. Violence Against Women and men in Côte d’Ivoire: A Cluster Randomized Controlled Trial to Assess the Impact of the ‘Men and Women in Partnership’ Intervention on the Reduction of Violence Against Women in Rural Côte d’Ivoire - Formative Results from a Community Survey. London: London School of Hygiene & Tropical Medicine; 2010.
    1. Gibbs A, Willan S, Misselhorn A, Mangoma J. Combined structural interventions for gender equality and livelihood security: a critical review of the evidence from southern and eastern Africa and the implications for young people. J Int AIDS Soc. 2012;15(Suppl 1):1–10. doi:10.7448/IAS.7415.7443.17362.
    1. Koffi T. Côte d’Ivoire - l’agonie du jardin. Abidjan: CEDA/NEI; 2006.
    1. Hellweg J. Hunting the Ethical State: The Benkadi Movement of Côte d’Ivoire. Chicago: University of Chicago Press; 2011.
    1. McGovern M. Making War in Côte d’Ivoire. Chicago: University of Chicago Press; 2011.
    1. Langer A. Occasional Paper, Vol. Oxford: Human Development Report Office - Centre for Research on Inequality, Human Security and Ethnicity (CRISE), UNDP; 2005. Horizontal inequalities and violent conflict. Côte d'Ivoire Country Paper.
    1. United Nations Development Programme (UNDP) The Conflict in Côte d’Ivoire and its Effect on West African Countries: A Perspective from the Ground. New York, NY: UNDP, Regional Bureau for Africa; 2011.
    1. Brammuci G, editor. International Rescue Committee (IRC) Men & Women in Partnership - Facilitators Guide. Abidjan, Côte d’Ivoire: IRC; 2010.
    1. Abramsky T, Francisco L, Kiss L, Michau L, Musuya T, Kaye D, Watts C. SASA! Baseline Report. London and Kampala: London School of Hygiene & Tropical Medicine (LSHTM) and Raising Voices; 2010.
    1. Ellsberg M, Heise L, Pena R, Agurto S, Winkvist A. Researching domestic violence against women: methodological and ethical considerations. Stud Fam Plann. 2001;32(1):1–16. doi: 10.1111/j.1728-4465.2001.00001.x.
    1. Babcock JC, Costa DM, Green CE, Eckhardt CI. What situations induce intimate partner violence? A reliability and validity study of the Proximal Antecedents to Violent Episodes (PAVE) scale. J Fam Psychol. 2004;18(3):433–442.
    1. Allden K, Ceric I, Kapetanovic A, Lavelle J, Loga S, Mathias M, McInnes K, Mollica R, Puratic V, Sarajlic N, Merhamet Medical Team-Rijeka. Harvard Trauma Manual: Bosnia-Herzegovina Version. Cambridge: Harvard Program in Refugee Trauma; 1998.
    1. Shoeb M, Weinstein H, Mollica R. The Harvard trauma questionnaire: adapting a cross-cultural instrument for measuring torture, trauma and posttraumatic stress disorder in Iraqi refugees. Int J Soc Psychiatry. 2007;53(5):447–463. doi: 10.1177/0020764007078362.
    1. Hossain M, Zimmerman C, Kiss L, Watts C. LSHTM Gender Violence & Health Survey Instrument for Post-Conflict Settings. London: London School of Hygiene & Tropical Medicine; 2010.
    1. Ford N, Mills EJ, Zachariah R, Upshur R. Ethics of conducting research in conflict settings. Confl Health. 2009;3:7. doi: 10.1186/1752-1505-3-7.
    1. Watts C, Heise L, Ellsberg M, Moreno CG. Putting Women’s Safety First: Ethical and Safety Recommendations for Research on Domestic Violence Against Women. Geneva: World Health Organization (WHO); 1999.
    1. Donner A, Klar N. Design and Analysis of Cluster Randomised Trials in Health Research. London: Wiley; 2000.
    1. Grosskurth H, Mosha F, Todd J, Mwijarubi E, Klokke A, Senkoro K, Mayaud P, Changalucha J, Nicoll A, ka-Gina G, Newell J, Mugeye K, Mabey D, Hayes R. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial. Lancet. 1995;346(8974):530–536. doi: 10.1016/S0140-6736(95)91380-7.
    1. Abramsky T, Devries K, Kiss L, Francisco L, Nakuti J, Musuya T, Kyegombe N, Starmann E, Kaye D, Michau L, Watts C. 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. doi: 10.1186/1745-6215-13-96.
    1. Stith SM, Smith DB, Penn CE, Ward DB, Tritt D. Intimate partner physical abuse perpetration and victimization risk factors: a meta-analytic review. Aggress Violent Behav. 2004;10(1):65–98. doi: 10.1016/j.avb.2003.09.001.
    1. Flynn A, Graham K. “Why did it happen?” A review and conceptual framework for research on perpetrators’ and victims’ explanations for intimate partner violence. Aggress Violent Behav. 2010;15(3):239–251. doi: 10.1016/j.avb.2010.01.002.
    1. Human Security Report Project. Human Security Report 2012: Sexual Violence, Education, and War: Beyond the Mainstream Narrative. Vancouver: Human Security Press; 2012.

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