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Violence against women (VAW) and violence against children (VAC) are both global epidemics with prolonged impact on the health, well-being, and safety of both individuals and communities. The epidemics are also intimately interconnected, as VAW and VAC tend to co-occur within the same homes and exposure to VAC predicts VAW in adulthood. Yet despite a growing body of evidence indicating alarming levels of both VAW and VAC in emergencies, most interventions to address these issues have been fragmented across the gender-based violence (GBV) and child protection (CP) sectors. The goal of this review was to use a holistic lens to examine the landscape of interventions that have been used in humanitarian contexts and that may have applicability to primary prevention of any form of interpersonal household violence, including VAW, VAC or both. A combination of electronic database searches, published or publicly available reviews of violence prevention interventions, and communication with practitioners in the field was employed to identify interventions that met this criteria.
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... This evidence review builds on previous reviews that identified a few rigorously evaluated programmes with positive impacts on both children and women (7,(12)(13)(14). It focuses exclusively on identifying programmes that: i) Intentionally sought to reduce VAC and IPV; or found promising results in terms of violence reduction for women and/or children; and ...
... These interventions were mostly implemented in the Global South (11 out of 14) or had a substantial body of evidence from the Global North (Nurse-Family Partnership and Triple P). Some were implemented in the Global South without rigorous evaluations to date (Triple P, Safe at Home, Parenting for Respectability). ...
... Moreover, programmes that do include standard indicators to measure IPV or VAC generally rely on self-reported behaviour, increasing the likelihood of social desirability bias. For example, in most of the case studies in this review, women are not asked about their experiences to compare with male reports of IPV perpetration (12)(13)(14)37,61). ...
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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, it finds that despite growing attention to the potential to address family violence through parenting interventions, few programmes intentionally seek to reduce VAC, and even fewer attempt to prevent IPV. This review then summarises the current evidence of the impacts of parenting programmes on VAC and IPV. Almost all the rigorous evaluations included in our review found significant reductions in VAC, including decreased use of physical punishment and, in some cases, reductions in the use of emotional violence. A few found reductions in IPV, and others had more mixed results. The review then offers insights into promising approaches and components of parenting programmes including on curriculum content for learning parenting and relationship skills as well as programme approaches, delivery methods and format. It then identifies gaps in the existing evidence and provides emerging guidance and recommendations on programming and for future research.
... Broadly defined, protective assets are human, social, economic, or cognitive capital that are protective against violence, and support girls in navigating various risks as they progress through adolescence into adulthood [29]. Protective asset programs try to bolster known protective factors against violence, which may include individual-level factors such as building girls' self-esteem, household-level factors such as augmenting caregiver coping strategies and strengthening the gender equity and functioning within girls' immediate households, or community-level factors such as increasing the number of safe spaces or quality of response services [30][31][32][33][34]. Gender transformative family support programs are one such example, as they offer promising opportunities to build the protective assets of girls by targeting immediate cycles of household violence, while simultaneously reducing longer-term cognitive effects of trauma that fuel future violence victimization and perpetration [35][36][37]. ...
... This research explores the impact of a gender transformative, whole-family support program on attitudes and behaviours related to violence against adolescent girls at the household level. While family support programs typically focus on strengthening caregiver practices [35,40], the SSAGE program expands the scope to include the promotion of gender equitable attitudes and nonviolent interactions for the whole family, including male siblings. By engaging whole family units in synchronized, gender transformative curricula, the program addressed the unique ways in which attitudes and behaviours related to masculinities, femininities, and age shape individuals' acceptance, perpetration, or experience of violence within households. ...
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Background Household violence is one of the most prevalent forms of gender-based violence faced by adolescent girls in humanitarian settings. A growing evidence base demonstrates the extent to which multiple forms of familial violence, including intimate partner violence, violence against children, and sibling violence overlap in the same households. However, existing evidence of family support programming that effectively reduces violence against girls by addressing intersecting forms of household violence are limited, particularly in the Global South. Through a qualitative implementation evaluation informed by a grounded theoretical approach, we explored the perceived impact of a gender transformative, whole-family support intervention aimed at building adolescent girls’ protective assets against violence, among program participants in two communities of internally displaced people Maiduguri, Borno State, Northeast Nigeria. Methods We conducted six in-depth interviews and six focus group discussions with adult caregivers; six participatory activities and four paired interviews with adolescent girls and boys; and 12 key informant interviews with program staff. Criterion sampling was used to recruit 21 male caregivers, 21 female caregivers, 23 adolescent boys, and 21 adolescent girls; purposive sampling was used to recruit 12 program staff to participate in qualitative research activities. We audio recorded, translated, and transcribed all interviews. In a collaborative coding process, a multi-stakeholder team used applied thematic analysis in Dedoose to identify emergent themes in the data. Results Participants reported a decreased tolerance for and perpetration of violence against girls at the household level, and endorsed their right to protection from violence at the community level. However, alongside these self-reported changes in attitude and behavior, aspects of normative, patriarchal norms governing the treatment of adolescent girls were maintained by participants. Conclusions This study builds the evidence base for gender transformative, whole-family support programming and its impact on preventing violence against adolescent girls in humanitarian emergencies. Situating our findings in a feminist analysis of violence, this study calls attention to the complexity of gender norms change programming amongst families in conflict-affected settings, and highlights the need for programming which holistically addresses the relational, community, and structural drivers of violence against girls in emergencies.
... When we talk about violence against women and violence against children, the emphasis is often on some forms of violence, those related to the emergency situation, in particular physical and sexual violence and abuse by armed groups. Domestic violence, in particular by close partners or caregivers, is often neglected, although it is clear that the family seems to be the place in which most of the acts of violence take place [287]. Women in low-and middle-income and conflict-affected countries who reported being victims of sexual violence and other social stressors were significantly more likely to have suicidal thoughts and experience depression, anxiety, and PTSD symptoms [288]. ...
... Although female economic empowerment programmes have shown positive effects on safety and wellbeing, evaluations in humanitarian settings typically focus on programmes geared towards women, as opposed to adolescent girls specifically. 100 Further research is needed to assess the appropriateness and effectiveness of these programmes for adolescent girls in emergency settings, particularly given any legal barriers to employment for refugees and norms about children's financial empowerment. ...
Article
Adolescent girls face elevated risks of gender-based violence in humanitarian settings because of the intersectionality of age and gender, and the additional and exacerbated risk factors relevant to emergencies. Because there is no clear division of labour between the gender-based violence and child protection sectors, adolescent girls are often neglected by both groups, and violence against this subpopulation goes unaddressed. This Review presents an adapted ecological framework for gender-based violence risks facing adolescent girls in emergencies, synthesises the scant evidence for gender-based violence prevention and response, and identifies barriers to effective and ethical measurement and evaluation of programme effectiveness. Although nascent evidence highlights promising interventions for transforming girls' attitudes about violence and gender inequity and improving psychosocial and mental wellbeing, little evidence supports the ability of existing approaches to reduce gender-based violence incidence. A more explicit focus on adolescent girls is needed when designing and evaluating interventions to ensure global efforts to end gender-based violence are inclusive of this population. Translations For the Arabic, French and Spanish translations of the abstract see Supplementary Materials section.
... It is also common to address sexualisation of children in displacement settings in terms of child trafficking for prostitution, and sexual abuse by other people outside their immediate families (Pittaway, 2008), without giving attention to how displaced persons' housing and adult sexuality contribute to the sexualisation of children. A systematic review of interventions aimed at preventing Violence Against Women (VAW) and Violence Against Children (VAC) in humanitarian settings (Asghar, Rubenstein, & Stark, 2017) shows that while several interventions have focused on changing social norms regarding gender, few have given attention to strengthening the household economy and improving livelihoods of affected families. Only one of the reviewed interventions considered the importance of the built environment in preventing household violence. ...
Article
Sexual and Reproductive Health Rights are fundamental human rights. Previous studies on gender and sexuality in displacement settings have often focused on sexual and gender-based violence and the reproductive health problems of women while underplaying their needs for sexual expression, pleasure and procreation. This paper examines the influence of conflict and displacement on gender relations, sexuality and natality of internally displaced women in Nigeria. It draws on data from a larger study in which focus group discussions and in-depth interviews were used to explore 52 women's gendered experiences with Boko Haram insurgency and displacement. A critical thematic analysis of data revealed that the women's relationships with their men were complex and ambiguous, characterised by both tensions and solidarity. The women saw their men as partners in their struggle against multi-level oppression, including the structural barriers that undermine their mutual sexual expressions and pleasure, as well as their desire to procreate and repopulate their decimated ancestral communities. We recommend collaborative efforts to promote and protect the Sexual and Reproductive Health Rights of displaced women which includes building physical structures and living conditions that promote healthy, safe and pleasurable sexual expressions, and socio-political structures that create access to the long term social security.
... Although the body of evidence is small, violence prevention interventions that incorporate gender transformative norms tend to be more impactful (Jewkes et al., 2015). Furthermore, using an ecological approach to apply multiple interventions across several systems may contribute to sustainable changes in normative behaviors (Asghar, Rubenstein, & Stark, 2017;Heise, 2011;Jewkes et al., 2015). ...
Article
Increasingly, researchers and practitioners are examining connections between public and private cycles of violence. In complex emergency settings, these cycles of violence often intersect with conflicting norms and values as societies work toward sustainable peace. Gender norms, particularly norms of masculinity, are not often highlighted in transdisciplinary violence studies. Furthermore, few studies on either subject capture the perspectives and experiences of adolescent boys. This study seeks to explore adolescent boys’ (13-17 years) experiences with violence at home and in the community in “post-conflict” Colombia. Thematic qualitative analysis of 20 interview transcripts from 14 Colombian boys in Cundinamarca ( n = 5) and Córdoba ( n = 9) revealed themes of conflict avoidance, hegemonic masculinity, and opportunities for change in the form of positive coping habits. Further research into social and emotional coping behaviors and linkages to perpetuating violence between adolescence and adulthood is needed.
... Household violence-defined as "power and/or control perpetrated by one person in the household, with the intention or effect of causing harm to another person in the household's physical, sexual, or emotional health or well-being" [14][15][16]-has intergenerational effects [9]. ...
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Background: Research examining the interrelated drivers of household violence against women and violence against children is nascent, particularly in humanitarian settings. Gaps remain in understanding how relocation, displacement and ongoing insecurity affect families and may exacerbate household violence. Methods: Employing purposive sampling, we used photo elicitation methods to facilitate semi-structured, in-depth interviews with female and male adolescents and adults aged 13-75 (n = 73) in two districts in Colombia from May to August of 2017. Participants were displaced and/or residing in neighborhoods characterized by high levels of insecurity from armed groups. Results: Using inductive thematic analysis and situating the analysis within a feminist socioecological framework, we found several shared drivers of household violence. Intersections among drivers at all socioecological levels occurred among societal gender norms, substance use, attempts to regulate women's and children's behavior with violence, and daily stressors associated with numerous community problems. A central theme of relocation was of family compositions that were in continual flux and of family members confronted by economic insecurity and increased access to substances. Conclusions: Findings suggest interventions that systemically consider families' struggles with relocation and violence with multifaceted attention to socioecological intersections.
... Some violence interventions in humanitarian settings do already address a few of the predictors associated with VAW and VAC in this review. For example, a recent landscaping review of strategies to prevent household violence in humanitarian settings highlighted several programs that have successfully leveraged economic strengthening mechanisms (e.g., cash transfers) to reduce violence exposure (Asghar, Rubenstein, & Stark, 2017;Hidrobo, Peterman, & Heise, 2016;Ismayilova & Sanson, 2016). The landscaping review also highlighted several programs that have reduced violence by cultivating social support networks for adolescent girls (among other program elements) (Erulkar & Tamrat, 2014;Sarnquist et al., 2014;Sinclair et al., 2013). ...
Article
Interpersonal violence against women and children has increasingly been recognized as a public health priority in humanitarian emergencies. However, because the household is generally considered a private sphere, violence between family members remains neglected. A systematic literature review was conducted to identify predictors of household violence in humanitarian emergencies. PubMed, Web of Science, and Scopus were searched from January 1, 1998, to February 16, 2016. A predictor was defined as any individual, household, or community-level exposure that increases or decreases the risk associated with physical, sexual, or emotional interpersonal violence between two or more people living together. All studies reporting on quantitative research were eligible for inclusion. Results were analyzed using qualitative synthesis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed as applicable. The search strategy resulted in 2,587 original records, of which 33 studies met inclusion criteria. Thirty-two of the 33 studies used a cross-sectional design. This was the first known systematic review of predictors of household violence in humanitarian settings. The household framework drew attention to several factors that are associated with violence against both women and children, including conflict exposure, alcohol and drug use, income/economic status, mental health/coping strategies, and limited social support. There is a need for longitudinal research and experimental designs that can better establish temporality between exposures and household violence outcomes, control for confounding, and inform practice. In the interim, programmers and policy makers should try to leverage the predictors identified by this review for integrated violence prevention and response strategies, with the important caveat that ongoing evaluation of such strategies is needed.
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The international community recognises violence against women (VAW) and violence against children (VAC) as global human rights and public health problems. Historically, research, programmes, and policies on these forms of violence followed parallel but distinct trajectories. Some have called for efforts to bridge these gaps, based in part on evidence that individuals and families often experience multiple forms of violence that may be difficult to address in isolation, and that violence in childhood elevates the risk of violence against women. This article presents a narrative review of evidence on intersections between VAC and VAW - including sexual violence by non-partners, with an emphasis on low- and middle-income countries. We identify and review evidence for six intersections: 1) VAC and VAW have many shared risk factors. 2) Social norms often support VAW and VAC and discourage help-seeking. 3) Child maltreatment and partner violence often co-occur within the same household. 4) Both VAC and VAW can produce intergenerational effects. 5) Many forms of VAC and VAW have common and compounding consequences across the lifespan. 6) VAC and VAW intersect during adolescence, a time of heightened vulnerability to certain kinds of violence. Evidence of common correlates suggests that consolidating efforts to address shared risk factors may help prevent both forms of violence. Common consequences and intergenerational effects suggest a need for more integrated early intervention. Adolescence falls between and within traditional domains of both fields and deserves greater attention. Opportunities for greater collaboration include preparing service providers to address multiple forms of violence, better coordination between services for women and for children, school-based strategies, parenting programmes, and programming for adolescent health and development. There is also a need for more coordination among researchers working on VAC and VAW as countries prepare to measure progress towards 2030 Sustainable Development Goals.
Research
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This is a short summary of the Stepping Stones and Creating Futures Trial, explaining the rationale, process and timelines for the study. It also provides a list of team members.
Research
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This is a short summary of the Stepping Stones and Creating Futures Trial, explaining the rationale, process and timelines for the study. It also provides a list of team members.
Article
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Lori Heise reviews the empirical evidence of what works in low- and middle-income countries to prevent violence against women by their husbands and other male partners. The review focuses on prevention programmes rather than responses or services, and on research-based evaluations rather than insights from practice. Individual chapters cover: changing gender norms, childhood exposure to violence, excessive alcohol use, women’s economic empowerment, law and justice system reform. Heise summarises the evidence that links each factor with the risk of partner violence as well as the effectiveness of prevention programmes.
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Intimate partner violence (IPV) and child maltreatment often co-occur in households and lead to negative outcomes for children. This article explores the extent to which SASA!, an intervention to prevent violence against women, impacted children's exposure to violence. Between 2007 and 2012 a cluster randomized controlled trial was conducted in Kampala, Uganda. An adjusted cluster-level intention to treat analysis, compares secondary outcomes in intervention and control communities at follow-up. Under the qualitative evaluation, 82 in-depth interviews were audio recorded at follow-up, transcribed verbatim, and analyzed using thematic analysis complemented by constant comparative methods. This mixed-methods article draws mainly on the qualitative data. The findings suggest that SASA! impacted on children's experience of violence in three main ways. First, quantitative data suggest that children's exposure to IPV was reduced. We estimate that reductions in IPV combined with reduced witnessing by children when IPV did occur, led to a 64% reduction in prevalence of children witnessing IPV in their home (aRR 0.36, 95% CI 0.06-2.20). Second, among couples who experienced reduced IPV, qualitative data suggests parenting and discipline practices sometimes also changed-improving parent-child relationships and for a few parents, resulting in the complete rejection of corporal punishment as a disciplinary method. Third, some participants reported intervening to prevent violence against children. The findings suggest that interventions to prevent IPV may also impact on children's exposure to violence, and improve parent-child relationships. They also point to potential synergies for violence prevention, an area meriting further exploration.
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Intimate partner violence (IPV) is associated with HIV infection. We aimed to assess whether provision of a combination of IPV prevention and HIV services would reduce IPV and HIV incidence in individuals enrolled in the Rakai Community Cohort Study (RCCS), Rakai, Uganda. We used pre-existing clusters of communities randomised as part of a previous family planning trial in this cohort. Four intervention group clusters from the previous trial were provided standard of care HIV services plus a community-level mobilisation intervention to change attitudes, social norms, and behaviours related to IPV, and a screening and brief intervention to promote safe HIV disclosure and risk reduction in women seeking HIV counselling and testing services (the Safe Homes and Respect for Everyone [SHARE] Project). Seven control group clusters (including two intervention groups from the original trial) received only standard of care HIV services. Investigators for the RCCS did a baseline survey between February, 2005, and June, 2006, and two follow-up surveys between August, 2006, and April, 2008, and June, 2008, and December, 2009. Our primary endpoints were self-reported experience and perpetration of past year IPV (emotional, physical, and sexual) and laboratory-based diagnosis of HIV incidence in the study population. We used Poisson multivariable regression to estimate adjusted prevalence risk ratios (aPRR) of IPV, and adjusted incidence rate ratios (aIRR) of HIV acquisition. This study was registered with ClinicalTrials.gov, number NCT02050763. Between Feb 15, 2005, and June 30, 2006, we enrolled 11 448 individuals aged 15-49 years. 5337 individuals (in four intervention clusters) were allocated into the SHARE plus HIV services group and 6111 individuals (in seven control clusters) were allocated into the HIV services only group. Compared with control groups, individuals in the SHARE intervention groups had fewer self-reports of past-year physical IPV (346 [16%] of 2127 responders in control groups vs 217 [12%] of 1812 responders in intervention groups; aPRR 0·79, 95% CI 0·67-0·92) and sexual IPV (261 [13%] of 2038 vs 167 [10%] of 1737; 0·80, 0·67-0·97). Incidence of emotional IPV did not differ (409 [20%] of 2039 vs 311 [18%] of 1737; 0·91, 0·79-1·04). SHARE had no effect on male-reported IPV perpetration. At follow-up 2 (after about 35 months) the intervention was associated with a reduction in HIV incidence (1·15 cases per 100 person-years in control vs 0·87 cases per 100 person-years in intervention group; aIRR 0·67, 95% CI 0·46-0·97, p=0·0362). SHARE could reduce some forms of IPV towards women and overall HIV incidence, possibly through a reduction in forced sex and increased disclosure of HIV results. Findings from this study should inform future work toward HIV prevention, treatment, and care, and SHARE's ecological approach could be adopted, at least partly, as a standard of care for other HIV programmes in sub-Saharan Africa. Bill & Melinda Gates Foundation, US National Institutes of Health, WHO, President's Emergency Plan for AIDS Relief, Fogarty International Center. Copyright © 2015 Wagman et al. Open Access article distributed under the terms of CC BY-NC-ND. Published by .. All rights reserved.
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Intimate partner violence (IPV) and HIV are important and interconnected public health concerns. While it is recognized that they share common social drivers, there is limited evidence surrounding the potential of community interventions to reduce violence and HIV risk at the community level. The SASA! study assessed the community-level impact of SASA!, a community mobilization intervention to prevent violence and reduce HIV-risk behaviors. From 2007 to 2012 a pair-matched cluster randomized controlled trial (CRT) was conducted in eight communities (four intervention and four control) in Kampala, Uganda. Cross-sectional surveys of a random sample of community members, 18- to 49-years old, were undertaken at baseline (n = 1,583) and four years post intervention implementation (n = 2,532). Six violence and HIV-related primary outcomes were defined a priori. An adjusted cluster-level intention-to-treat analysis compared outcomes in intervention and control communities at follow-up. The intervention was associated with significantly lower social acceptance of IPV among women (adjusted risk ratio 0.54, 95% confidence interval (CI) 0.38 to 0.79) and lower acceptance among men (0.13, 95% CI 0.01 to 1.15); significantly greater acceptance that a woman can refuse sex among women (1.28, 95% CI 1.07 to 1.52) and men (1.31, 95% CI 1.00 to 1.70); 52% lower past year experience of physical IPV among women (0.48, 95% CI 0.16 to 1.39); and lower levels of past year experience of sexual IPV (0.76, 95% CI 0.33 to 1.72). Women experiencing violence in intervention communities were more likely to receive supportive community responses. Reported past year sexual concurrency by men was significantly lower in intervention compared to control communities (0.57, 95% CI 0.36 to 0.91). This is the first CRT in sub-Saharan Africa to assess the community impact of a mobilization program on the social acceptability of IPV, the past year prevalence of IPV and levels of sexual concurrency. SASA! achieved important community impacts, and is now being delivered in control communities and replicated in 15 countries. Trial registration ClinicalTrials.gov #NCT00790959, Study protocol available at http://www.trialsjournal.com/content/13/1/96
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This operations research project evaluated the effect and impact of a basic education program, developed by TOSTAN, a non-governmental organization based at Thiès, Senegal. The basic education program consists of four modules: hygiene, problem solving, women's health, and human rights. Through these four themes, emphasis was placed on enabling the participants, who were mostly women, to analyze their own situation more effectively and thus find the best solutions for themselves. The Supra Regional Project for the Elimination of Female Genital Cutting of GTZ funded implementation of the program in 90 villages in Kolda Region, and the Population Council's Frontiers in Reproductive Health Program, with funding from USAID, used this opportunity to evaluate the program in 20 villages.
Article
Few reproductive health programs are targeted to married adolescent girls. This study measures changes associated with a program for married adolescent girls and a parallel husbands' program, in rural Ethiopia. The married girls' program provided information on communication, self-esteem, reproductive health and gender through girls' groups. The husbands' program focused on non-violence, support to families, and reproductive health. Population-based surveys were undertaken among married girls, at midterm and end line. Outcomes of interest were husbands' assistance with domestic work, accompaniment to the clinic, family planning use, voluntary counseling and testing (VCT), and domestic violence. Overall, 1,010 married girls were interviewed. Participation in the girls' groups was associated with improvements in help with domestic work, accompaniment to the clinic, family planning and VCT. Further improvements were recorded when both partners participated. For example, participating girls were nearly 8 times more likely to receive VCT (OR 7.7) than nonparticipants, and more than 18 times more likely if both partners participated (OR 18.3). While these results are promising, there were indications of selectivity bias that could have contributed to the positive results. Programs engaging both wives and husbands can result in incremental improvements to the health and well-being of girls married early.