Introduction
Globally, one in three women worldwide report experiencing intimate partner violence (IPV) in their lifetime.1 In conflict-affected settings, the prevalence of such violence may be higher as a recent population-based survey from South Sudan reports that over 60% of women report physical IPV from their male partners2 and nearly 70% of women in Democratic Republic of Congo (DRC) experienced at least one form of lifetime physical, sexual or emotional IPV within the 2013–2014 Demographic and Health Survey.3 Increased risk of men’s use of violence against women may occur in these settings due to a range of factors including normalisation of violence, increased traumatic experiences within families and economic instability.4 Recent evidence also indicates that violence against women and girls occurs early and over the life course in eastern DRC—with as many as half of all girls as young as age 13 reporting some form of violence in the past 12 months.5 Engaging men may be one strategy to reduce these levels of violence. In the vast majority of cases of violence, men and boys are the perpetrators, and it is recognised that working with men to change gender-unequal attitudes, beliefs and behaviours is an important component in reducing the incidence of IPV.6 However, evidence of effective interventions that work with men to reduce their likelihood of perpetration of IPV, particularly in low and middle-income countries that grapple with armed conflict is sparse. Additionally, the available evidence points to self-reported attitudinal changes, but not meaningful changes in violence perpetration.6 7 It is also worth noting that programmatic approaches to engaging men vary widely in intensity and target populations as well as content of the intervention, including the extent to which power dynamics, violence and gender equity are addressed in the programme.
This study evaluates the impact of Engaging Men through Accountable Practice (EMAP), a 16-week men-only discussion group intervention aiming to prevent IPV and transform attitudes and behaviours around gender and power in the couple. A study in Rwanda evaluating the effect of gender-transformative couple’s discussion groups found a significant impact both on reducing IPV and increasing women’s decision-making and men’s participation in housework.8 Another impact evaluation of a violence prevention programme at the community level in Uganda (SASA!, which means ‘now’ in Kiswahili) found decreases in acceptability of violence and non-significant, yet clear downward reductions in violence.9 However, in a conflict-affected setting, working with couples and multilevel, long-term, community intervention such as SASA! may present some safety and implementation challenges. A programme that worked with men in a humanitarian setting to reduce IPV through information, skills and behaviour change in a conflict-affected setting was the International Rescue Committee’s (IRC) ‘Men in Partnership’ intervention piloted in conflict-affected communities in Côte d’Ivoire. The programme comprised male discussion groups that sought to change men’s behaviour and promote gender equitable norms.10 Results of a cluster randomised controlled trial of the programme showed improvement in attitudes and participation in household tasks and conflict management skills. Suggestive evidence of reduction in IPV was found but was not statistically significant. Building on lessons from ‘Men in Partnership’, the IRC developed the ‘Preventing Violence Against Women and Girls: Engaging Men through Accountable Practice’ (EMAP) programme which aimed to maximise potential reductions in IPV through refining the gender equity approach and incorporating in the discussions women’s expressions of desired changes to their intimate relationships in order to keep women’s voices at the forefront of violence prevention work.
This study contributes to the evidence base on the effectiveness of engaging men to reduce violence against women and girls in three main ways. First, previous studies have suffered from a lack of statistical power, due to small sample sizes. In this study, we use a large sample of men and women. With a sample size of approximately 1300 men and 1200 women in a total of 28 study sites, it ensures that power to detect changes in primary and secondary outcomes is high. Second, a wide set of outcomes is examined, including IPV and attitudes around gender, but also women’s decision-making power and intrahousehold cooperation indicators. There is little evidence to date on how gender-transformative interventions change women’s economic empowerment and intrahousehold dynamics. Increasing women’s agency is important in its own right but it may also be instrumental in reducing violence against women in the longer term.11 In addition, increasing the communication and cooperation within a household may enhance its efficiency, which could in turn relax economic stress, a recognised correlate of violence.11 Third, the study is set in the North and South Kivu provinces in DRC which have been grappling with vacillating levels of conflict for over two decades. Over the years, the DRC received significant international attention and news coverage for its high rates of sexual violence,12 with particular attention placed on sexual violence perpetrated by armed groups. However, IRC’s long-term engagement in conflict-affected communities in DRC has shown that women experience gender-based violence (GBV) more often at the hands of someone they know, notably an intimate partner, which is consistent with other conflict-affected settings.13 Indeed, IPV may be exacerbated by the disruption of men’s social role as economic providers in contexts of instability and insecurity and high levels of psychological stress.14 The need for a transformation of gender norms, behaviours and relations associated with violence in this context is evident. The study aims to provide much needed rigorous evidence of the effectiveness of such approaches in humanitarian settings.15