Objectives. We assessed the effects of a community-based project in Ethiopia that worked with young men to promote gender-equitable norms and reductions in intimate partner violence (IPV).
Methods. A quasi-experimental design was used to assign young Ethiopian men 15 to 24 years of age (809 participants were surveyed at baseline in 2008) to an intervention involving community engagement (CE) activities in combination with interactive group education (GE) sessions promoting gender-equitable norms and violence prevention, an intervention involving CE activities alone, or a comparison group.
Results. Participants in the GE + CE intervention were twice as likely (
P < .01) as those in the comparison group to show increased support for gender-equitable norms between the baseline and end-line points. Also, the percentage of GE + CE participants who reported IPV toward their partner in the preceding 6 months decreased from 53% to 38% between baseline and end line, and the percentage in the CE-only group decreased from 60% to 37%; changes were negligible in the comparison group.
Conclusions. Promoting gender equity is an important strategy to reduce IPV.In addition to being a human rights violation, gender-based violence (GBV) is a widespread public health issue with numerous negative health consequences. GBV, including intimate partner violence (IPV), causes injury and death and decreases survivors’ use of health services.
1,2 For example, violence and fear of violence can be barriers to effective HIV prevention, care, and treatment programs. IPV has also been associated with a lack of contraception use and HIV acquisition.
3,4 Consequently, addressing and reducing GBV is an explicit component of the President’s Emergency Plan for AIDS Relief.
5The number of women and girls affected by IPV is enormous. A seminal study conducted in 10 different countries demonstrated that between 15% and 71% of women of reproductive age had experienced physical or sexual IPV (and estimated that 30 % of women globally had experienced IPV).
6,7 The highest rates of IPV were those among Ethiopian women: 53.7% had experienced IPV within the 12 months preceding the interview and 70.9 % over their lifetime. In addition, HIV prevalence in Ethiopia is higher among women (1.9 %) than men (1.0 %).
8Certain gender norms—or social expectations about men’s and women’s appropriate roles, rights, and responsibilities—have been shown to be associated with the risk of IPV as well as the risk of HIV and other sexually transmitted infections (STIs).
9–12 For example, 45% of men and 68% of women taking part in the 2011 Ethiopia Demographic and Health Survey reported that wife beating is justified for at least 1 reason.
8Over the past decade, a series of programs attempting to address inequitable gender norms have been implemented across the globe; many have emphasized the importance of engaging boys and men in this process.
13,14 A growing body of work has demonstrated that these gender-focused interventions can lead to reductions in violence and to other positive health outcomes (e.g., increased contraception or condom use).
9,15–19 However, rigorous evaluations of only a small number of these programs have been documented in the scientific literature, and recent literature reviews have revealed that existing evaluations have various limitations, including a lack of comparison groups and standardized or validated measures, no exploration of effects across types of IPV, inadequate follow-up rates, and limited use of theoretical frameworks.
16,17To help address these gaps, we describe the results of a theoretically grounded, quasi-experimental intervention study of a community-based project in Ethiopia, the Male Norms Initiative, that worked with young men to promote gender-equitable norms and reductions in IPV. Our goal was to assess the effects of the intervention using standardized measures of violence and gender norms.The 2 main intervention components were interactive group education and community mobilization and engagement activities aimed at raising awareness and promoting community dialogue. The interventions focused on promoting critical reflection regarding common gender norms that might increase the risk of violence or HIV and other STIs (e.g., support for multiple sexual partners and acceptance of partner violence). Through this reflection, the participants were able to identify the potential negative outcomes of enacting these norms and the potential positive aspects of more gender-equitable behavior.In addition, the activities engaged the wider community in supporting a shift in specific harmful norms.
Engaging Boys and Men in Gender Transformation, a manual based on EngenderHealth and Promundo’s gender-transformative programming, was used to facilitate this process.
20 Hiwot Ethiopia, a nongovernmental organization, led the implementation of the project with technical support from EngenderHealth. PATH led the evaluation in collaboration with Miz-Hasab, an Ethiopia-based research institute.Both intervention groups participated in community engagement (CE) activities, which took place over a 6-month period from June to November 2008. Beginning with a march on International Father’s Day, these activities involved entire communities and included distribution of monthly newsletters and leaflets (approximately 15 000 in total), music and drama skits reaching 8700 people, monthly community workshop meetings, and distribution of more than 1000 condoms.A second component of the intervention—group education (GE) activities—took place over 4 months at youth centers during regularly scheduled youth group hours, usually on weekends. The activities included role plays, group discussions, and personal reflection. Sessions enrolling about 20 participants were facilitated by 2 or 3 peer educators each, with oversight from a master trainer. In total, 8 sessions 2 or 3 hours in duration were conducted, drawing on 19 activities from the manual.This intervention and evaluation design was informed by the theory of gender and power, a social structural theory that addresses environmental and social issues relating to gender dynamics, particularly sexual division of labor, sexual division of power, and the structure of cathexis (which is similar to the concept of gender norms).
21 According to this theory, various negative health and other outcomes stem from the socialization of women to be sexually passive, women’s economic reliance on men, and abusive partnerships. The theory affirms—as does the empirical evidence provided in the introduction—that addressing gender norms is a core factor in reducing both IPV and related health risks such as HIV and other STIs.
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