Lori Heise

Johns Hopkins Bloomberg School of Public Health | JHSPH ·  Department of Population, Family and Reproductive Health

Background Women’s economic empowerment (WEE) is believed to reduce the risk of intimate partner violence (IPV), yet the relationship between WEE and IPV has proven to be highly variable. Little attention has been given to how the normative WEE environment may influence this relationship across different settings. This study tests whether IPV is as...

This brief considers how women's economic empowerment (WEE) interventions influence intimate partner violence (IPV) among heterosexual women who are cohabiting or living with their male partners. It focuses exclusively on the range of WEE strategies listed in Figure 1 and does not address how WEE affects other types of violence, such as non-partner...

Webtable: Sampling strategies adopted in the various sites in the WHO Violence Against Women study. (with: Prevalence of intimate partner violence: findings from the WHO multi-country study on women’s health and domestic violence. Lancet. 2006)

Prevention Collaborative

Girls' education has for many decades been central to the global development agenda, due to its positive impact on girls' health and wellbeing. In this paper, the authors revisit boys' attitudes, behaviours and norms related to girls' education, following the Samata intervention to prevent girls' school dropouts in Northern-Karnataka, South India....

Introduction Under Sustainable Development Goal 5, prevalence of intimate partner violence (IPV) is a globally reportable indicator. There is a lack of consensus on how to measure and report psychological IPV, affecting prevalence estimates and cross-country comparability. We examine similarities and differences in the patterning of women's experie...

Most impact evaluations of intimate partner violence (IPV) prevention interventions use binary measures of “any” versus “no” physical and/or sexual IPV as their primary outcome measure, missing opportunities to capture nuance. In this study, we reanalyzed secondary data from six randomized controlled trials conducted in low- and middle-income count...

Most impact evaluations of IPV prevention interventions use binary measures of any versus no physical and/or sexual IPV as their primary outcome measure, missing opportunities to capture nuance. In this study, we reanalysed secondary data from six randomised controlled trials conducted in low and middle-income countries- Bandebereho (Rwanda), Becom...

This is a social norms mentorship guide for organizations planning to implement norms change programs.

This brief introduces the Prevention Triad, a tool developed by the Prevention Collaborative, to encourage a more holistic understanding of what it takes to make violence against women and girls (VAWG) prevention programmes work. It provides a simple way to consider how multiple elements combine to determine the impact of different programme strate...

Although partner alcohol use and acceptance of intimate partner violence against women (IPVAW) are critical determinants of IPVAW, little is known about their interaction. We explored how partner alcohol use and attitudes toward IPVAW act independently and jointly at the individual and community levels to influence women's reports of experiencing I...

Intergenerational differences in inequitable gender attitudes may influence developmental outcomes, including education. In rural Karnataka, India, we examined the extent of intergenerational (adolescent girls [AGs] vs. older generation family members) dis/agreement to attitudes around gendered power inequities, including gender roles and violence...

Violence committed by men against women in intimate relationships is a pervasive problem around the world. Patriarchal norms that place men as the head of household are often to blame. Previous research suggests that trusted authorities can shift perceptions of norms and create behavior change. In many settings, a compelling authority on behavior i...

Over the last decade, the number of randomized trials of programs to reduce intimate partner violence (IPV) has grown precipitously. However, most trials continue to measure and code violence using standards originally designed for global prevalence surveys. This choice may have consequences in terms of bias, power, and efficiency of trial estimate...

Background Violence against women and girls (VAWG) is a human rights violation with social, economic, and health consequences for survivors, perpetrators, and society. Robust evidence on economic, social, and health impact, plus the cost of delivery of VAWG prevention, is critical to making the case for investment, particularly in low- and middle-i...

Introduction Adolescent girls and young women (AGYW) disproportionately experience gender-based violence (GBV), which can increase during emergencies like the COVID-19 pandemic. Methods A cohort of youth ages 15–24 in Nairobi, Kenya was surveyed at three time points over an 18-month period prior to and during the COVID-19 pandemic: June–August 201...

There is increasing interest in working at the intersections of intimate partner violence (IPV) and violence against children (VAC), especially in the family, yet few programmatic strategies exist or have been evaluated to assess the combined impact of strategies on both types of violence. This paper addresses this gap by exploring the influence th...

Community mobilisation is recognised as an important strategy to shift inequitable gender norms and ensure an enabling environment to prevent gender-based violence (GBV). Yet there is a need to better understand the factors that facilitate effective community activism in particular contexts. Although fundamental to the success of mobilisation progr...

Intimate partner violence (IPV) has a large and sustained impact on women's mental health, and so effective prevention is critical. A review of 96 rigorous evaluations of interventions for their impact on violence against women and girls (mostly IPV) found that several intervention approaches were effective. However, not every evaluation of a 'succ...

Background Infectious disease outbreaks like COVID-19 and their mitigation measures can exacerbate underlying gender disparities, particularly among adolescents and young adults in densely populated urban settings. Methods An existing cohort of youth ages 16–26 in Nairobi, Kenya completed a phone-based survey in August-October 2020 (n = 1217), sup...

Several studies confirm that intimate partner violence (IPV) victimization is associated with symptoms of depression among women and men. Less recognized, is the potential role that depression symptoms may play in elevating the risk for IPV victimization and/or perpetration. While both phenomena deserve attention as global health issues in their ow...

Purpose: This study assesses the role of gender norms on the relationship between adverse childhood experiences (ACEs) and peer-violence perpetration among very young adolescents in three urban poor cities of Indonesia. Methods: A cross-sectional study was conducted in Bandar Lampung, Denpasar, and Semarang in Indonesia. A total of 2,974 partici...

This paper explores adolescent girls' and young women's (AGYW) aspirations, factors that influence aspirations, and how their aspirations inform their sexual decision-making and behaviour. This study employed a qualitative design involving six participatory focus group discussions and 17 in-depth interviews with AGYW in-and out-of-school. Fieldwork...

Research on intimate partner violence (IPV) has progressed in the last decade in the fields of public health and economics, with under-explored potential for cross-fertilisation. We examine the theoretical perspectives and methodological approaches that each discipline uses to conceptualise and study IPV and offer a perspective on their relative ad...

Young women in Uganda are at risk of negative sexual and reproductive health outcomes, in part because of sex with older men. Theoretically grounded in the concept of liminality, this paper examines perceived markers of adolescent girls' suitability for sexual activity. In 2014, we conducted 19 focus group discussions and 44 in-depth interviews in...

Adolescent girls and young women (AGYW) in Uganda are at risk of early sexual debut, unwanted pregnancy, violence, and disproportionally high HIV infection rates, driven in part by transactional sex. This paper examines the extent to which AGYW’s participation in transactional sex is perceived to be coerced. We conducted 19 focus group discussions...

Background Between 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. Methods Sectors (n=28) were purposively s...

Men’s role in transactional sex is relatively unexplored, limiting initiatives to prevent exploitative transactional sex and its negative health implications for girls and women. We addressed this literature gap by conducting eight focus group discussions and twenty in-depth-interviews with boys and men aged 14�49 years in 2015 in Tanzania. We empl...

A critical component of community-level efforts to reduce intimate partner violence (IPV) is the meaningful engagement of opinion leaders. This paper assesses the successes, challenges, and processes of change that Indashyikirwa-an IPV prevention programme in Rwanda-encountered while engaging opinion leaders to combat IPV. The paper draws on three...

Gender norms serve to normalise gender inequalities and constrain girls' agency. This paper examines how girls' agency, along a continuum, is influenced by the interplay between constraining and enabling influences in the girls' environments. We analyse data from a qualitative study nested within a cluster randomised evaluation of Samata, a multi-l...

Currently, most efforts to evaluate programmes designed to reduce intimate partner violence (IPV) assume that they affect all people similarly. Understanding whether interventions are more or less effective for different subgroups of individuals, however, can yield important insights for programming. In this study, we conducted subgroup analyses to...

We evaluated the impact of Samata, a 3-year multilayered intervention among scheduled caste/scheduled tribe (SC/ST) adolescent girls in rural northern Karnataka, on family-level (parents or guardian) attitudes and direct and indirect norms related to child marriage and girl’s education. Endline data from 1840 family members were used to assess the...

Background: Violence against women and girls (VAWG) is a human-rights violation with adverse long-term and inter-generational consequences. Redefining VAWG as legally unacceptable is one strategy for social change. The co-occurrence of national laws against VAWG is understudied, and tools to monitor the national legal environment are lacking. We d...

Background Alcohol use is a consistent correlate of intimate partner violence (IPV) in low-income and middle-income countries (LMICs). However, the magnitude of this association differs across studies, which may be due to contextual and methodological factors. This study aims to estimate and explore sources of heterogeneity in the association betwe...

Background Despite growing interest in the role of social norms in perpetuating the harmful practice of sexual exploitation of children and adolescents (SECA), little is known about the state of the literature on this issue. Objective This systematic review aims to summarize what associated norms, attitudes and factual beliefs have been identified...

Background: Definitions of child sexual exploitation vary. Sexual exploitation violates children's rights and exposes them to mental and physical harm. There exist differences in views of behaviour that is considered exploitative, including transactional sex. This paper explores community perspectives on the extent to which transactional sex is co...

Background We implemented a comprehensive intervention (Samata) to address school drop-out and child marriage among rural, marginalised adolescent girls in north Karnataka, south India. Here, we investigate (i) the impact of the intervention on factors hypothesised at baseline to be on the pathway to preventing school drop-out and child marriage, a...

Background There is considerable interest in community organising and ac- tivism as a strategy to shift patriarchal gender norms, attitudes and beliefs and thus reduce intimate partner violence (IPV). Yet there is limited insight into how activism actually translates into reduced violence, including how aspects of programme implementation or cultur...

This study examines the link between the loss of men’s status as breadwinners and their use of intimate partner violence (IPV) in Kirumba (Mwanza city, Tanzania), mediated by the entry of women into the cash work force. Using qualitative data from 20 in-depth interviews and eight focus groups with men ( n = 58) and women ( n = 58), this article exp...

Two streams of theory and practice on gender equity have begun to elide. The first is work conducted to change social norms, particularly using theory that emerged from studies in social psychology. The second is work done on gender norms, emerging historically from feminist scholars working to counter gender inequality. As these two streams of wor...

Parenting programmes are interventions or services aimed at improving interactions between parents and their children, as well as knowledge, beliefs, attitudes and practices that affect parent-child relationships and children's development. This review looks at parent and caregiver support programmes that seek to prevent both IPV and VAC. However,...

This paper explores the relationship between changes in individual beliefs and behaviours, couple relationship dynamics and gender norms-and how interventions can influence these. It draws on longitudinal qualitative research with heterosexual couples who participated in the Indashyikirwa programme in Rwanda. The couples followed a curriculum desig...

Introduction Samvedana Plus is a multilevel intervention working with sex workers, their intimate partners (IPs) and communities to reduce intimate partner violence (IPV) and to increase condom use within intimate relationships of sex workers in Northern Karnataka, India. Methods A cluster randomised controlled trial in 47 villages. Female sex wor...

Background: Secondary education and delayed marriage provide long-term socio-economic and health benefits to adolescent girls. We tested whether a structural and norms-based intervention, which worked with adolescent girls, their families, communities, and secondary schools to address poverty, schooling quality and gender norms, could reduce secon...

Women's Rights International works with rural women and girls who are living in countries at war or with ongoing political violence. In 2005, The Asia Foundation invited Women's Rights International to Sri Lanka to evaluate the feasibility of a random-sample survey of women to document the impact of the decades-long conflict. The significant imbala...

Evidence that gender inequalities and restrictive norms adversely affect health is extensive; however, far less research has focused on testing solutions. We first comprehensively reviewed the peer-reviewed and grey literature for rigorously evaluated programmes that aimed to reduce gender inequality and restrictive gender norms and improve health....

Gender is not accurately captured by the traditional male and female dichotomy of sex. Instead, it is a complex social system that structures the life experience of all human beings. This paper, the first in a Series of five papers, investigates the relationships between gender inequality, restrictive gender norms, and health and wellbeing. Buildin...

Despite global commitments to achieving gender equality and improving health and wellbeing for all, quantitative data and methods to precisely estimate the effect of gender norms on health inequities are underdeveloped. Nonetheless, existing global, national, and subnational data provide some key opportunities for testing associations between gende...

Restrictive gender norms and gender inequalities are replicated and reinforced in health systems, contributing to gender inequalities in health. In this Series paper, we explore how to address all three through recognition and then with disruptive solutions. We used intersectional feminist theory to guide our systematic reviews, qualitative case st...

The Sustainable Development Goals offer the global health community a strategic opportunity to promote human rights, advance gender equality, and achieve health for all. The inability of the health sector to accelerate progress on a range of health outcomes brings into sharp focus the substantial impact of gender inequalities and restrictive gender...

In 2016, the Gender, Violence and Health Centre (GVHC) at the London School of Hygiene and Tropical Medicine (LSHTM) launched a learning and reflection group on social norms and gender-related harmful practices (GHP). Donors and development practitioners have become increasingly interested in harnessing insights from social norms theory to catalyse...

Although transactional sex is common in many sexual relationships, there has been little research into the degree to which the practice is considered exploitative in the settings in which it is practiced. We describe the social norms that influence transactional sex in two sites in Mwanza, Tanzania, and explore local understandings of whether and u...

Background Like other women in India, female sex workers (FSWs) frequently experience violence from their intimate partners (IPs)-a reality that increases their risk of acquiring HIV or other sexually transmitted infections. Less is known about the nature of these intimate relationships or what aspect of the relationship increases the risk of IP vi...

Inequitable gender norms can be harmful to girls’ and boys’ health and sexuality. Programmatic approaches that help renegotiate gendered power relationships are sorely needed. This qualitative study reveals how Parivartan, a sport-based intervention in a Mumbai informal settlement, helped families resist inequitable gender norms that limited girls’...

Background Gender-based violence (GBV) primary prevention programs seek to facilitate change by addressing the underlying causes and drivers of violence against women and girls at a population level. Social norms are contextually and socially derived collective expectations of appropriate behaviors. Harmful social norms that sustain GBV include wom...

Background: Psychological abuse within intimate relationships is linked to negative health outcomes among women and is frequently identified as more wounding than physical or sexual violence. However, there is little agreement on how to conceptualize or measure the phenomenon, a necessary foundational step to estimate the prevalence and range of ps...

Background Mental health disorders among adolescents have emerged as a major public health issue in many low and middle-income countries, including India. There is a paucity of research on the determinants of psychological distress, particularly among the poorest girls in the poorest communities. The purpose of this study was to assess the prevalen...

Sexual coercion among married or cohabitating couples is a complex phenomenon with few effective strategies for prevention. This paper explores sexual coercion among couples from rural Rwanda who participated in Indashyikirwa, a 4-year intimate partner violence prevention programme that included a 5-month couples curriculum to promote equalitarian,...

Background Age-disparate sex is associated with increased HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. However, little has been done to understand the dynamics of such relationships from the perspectives of either AGYW or older men, and the communities in which these relationships are embedded. This article explores...

Parivartan Plus is a structured sports mentoring programme for girls, implemented in a Mumbai slum where social expectations around gender-appropriate behaviour and good parenting restricts girls’ mobility and visibility in public spaces. This article presents practice-based learning from developing and implementing programme theory to empower girl...

There is increasing evidence that cash transfer (CT) programs decrease intimate partner violence (IPV). However, little is known about how CTs achieve this impact. We conducted a mixed-method review of studies in low- and middle-income countries (LMICs). Fourteen quantitative and eight qualitative studies met our inclusion criteria, of which eleven...

Background Gender-related norms and poverty remain important structural barriers to secondary school attendance among adolescent girls in southern India. We analyse how gender norms interact with family deprivation and dynamics to result in girls dropping out of school; we identify the main facilitators of school retention and changes to gender soc...