Results from a randomized controlled trial (RCT) released in PLOS ONE journal reveal powerful impacts of targeted, gender-transformative programming on health and violence in Rwanda
28 August 2018, Kigali, Rwanda - Almost two years after participating in the Bandebereho fathers and couples program in Rwanda, men are nearly half as likely to use violence against their female partners, and spend almost one hour more per day doing household chores, reveals a randomized controlled trial (RCT). This evaluation, released in PLOS ONE journal is led by Promundo, together with the Rwanda Ministry of Health, Rwanda Biomedical Center, and the Rwanda Men’s Resource Center. It is one of a handful of rigorous studies, which show that engaging men as they become fathers and focusing on improving couple relationships can be an effective strategy to reduce men’s use of violence against women and improve relationships within the household.
“Our roles are equal; there is nothing she can do that I can’t do. Similarly, there is nothing I can do that she can’t do.” – Male participant
Working with men as allies to overcome such barriers is a relatively new approach, and so far there has been little rigorous evidence about the impact and long-term effects of such programs. This new study finds that such programs can work by helping couples build the skills needed to have stronger, more equal and nonviolent relationships. Particularly when they focus on power and on gender roles, such programs can transform ideas and norms about who does what and who has power in the household as well as in intimate relations.
This RCT assessed the impact of the fathers and couples program known as Program P globally and Bandebereho in Rwanda. The program was conducted with expectant fathers and fathers of young children (ages 21-35), and included their spouses or partners, across four districts in Rwanda. Twenty-one months after the Bandebereho fathers and couples program started, 575 randomly selected male-female couples participating in the discussions were compared with 624 similar couples who were randomly selected not to participate. The results include:
- Lower rates of physical and sexual violence: rates of violence experienced by women in the Bandebereho program by their husband or partner were nearly half of the those in the comparison group: 33% of female participants having experienced physical violence from a husband or partner in the past year vs. 57% in the comparison group. This means women in the Bandebereho program were 58% more likely to be living free from physical violence than women in the comparison group. In addition, 35% of female participants reported having experienced sexual violence from their husband or partner vs. 60% in the comparison group. This means women in the Bandebereho program were 55% more likely to be living free from sexual violence than women in the comparison group.
“He used to be away and to come back too late at night and he could not have time to discuss with me. This was a hindrance to the development in the family and led to conflict. After trainings […] he understood about violence. He evaluated himself and realized he was threatening violence against me.” – Female participant
- Greater modern contraceptive use: 70% of women in the Bandebereho program vs. 61% in the comparison group report currently using modern contraception. This means that the probability of couples in the Bandebereho program using modern contraception is 16% higher than the comparison group.
- Lower rates of violence against children by both men and women in the Bandebereho program than in the comparison group, among those couples who already have children.
- Greater sharing of child care and domestic tasks between partners and men spending more time doing unpaid care work. Men who participated in the Bandebereho program spent about 2 and a quarter hours per day on unpaid care – compared to men in the comparison group who spent about 1 hour and 24 minutes doing similar work. This is an increase of 52 minutes per day, or over 60%.
“I felt that anyone who would see me carrying a child on my back taking him/her to health facility would laugh at me. I felt that it was a big problem for me. I was uncomfortable bathing a child at my home, too. But as they trained us, so those perceptions faded away gradually.”
– Male participant
- Greater involvement of women in decision-making in the household: this includes around the decision to have children and the spacing of children as well as financial decision-making: 56% of women in the Bandebereho program say the man has the final say about the use of weekly/monthly income and expenses vs. 79% who say so in the comparison group.
“I am no longer afraid. We are now discussing about what is needed […] school fees for our children, about family planning, and about spending money.” – Female participant
- This is the first study of a program to engage men that has shown at least some impact on women’s coming for antenatal care visits: women in the Bandebereho program typically attended 3 to 4 visits vs. those in the comparison group, who typically attended 2 to 3 ANC visits. In addition, men in the Bandebereho program accompanied their partners to more ANC visits, with couples typically attended 2 visits together, while couples in the comparison group typically attended only 1 visit together.
The study affirms that targeting the transition into fatherhood, and supporting couples with skills to make their relationships stronger and more equal, can lead to more equitable and less violent relationships, additionally leading to less violence against children.
The program was implemented by the Rwanda Men’s Resource Center as part of MenCare+, a four-country initiative led by Rutgers and Promundo and funded by the Dutch Ministry of Foreign Affairs. The program used a 15-session curriculum adapted to the Rwandan context from Program P. The curriculum sessions on gender and power; fatherhood; couple communication and decision-making; violence; caregiving; child development; and engaging men in reproductive and maternal health.
Men met weekly with the same peer groups, from their own communities, over a period of 4-5 months; women joined their partners for approximately half of the sessions. The sessions provided the opportunity, often for the first time, for men and women to talk about their hopes and fears as they become parents, to discuss specific topics like pregnancy, contraception, and violence, and to learn and improve their relationship with their partners, including communication, conflict resolution, and sharing caregiving responsibilities.
Read the full article here: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192756
Access a version of the release online:https://promundoglobal.org/2018/04/04/fathers-rwanda-use-less-violence-reveals-new-study/
For more information contact:
Shamsi Kazimbay, Program Officer, Promundo |firstname.lastname@example.org |
Telephone number +250 788301299
About the study authors
The article was authored by Kate Doyle, Ruti G. Levtov, and Gary Barker of Promundo-US; Gautam G. Bastian of Africa Gender Innovation Lab, World Bank; Jeffrey B. Bingenheimer of Milken Institute School of Public Health, The George Washington University; Shamsi Kazimbaya of Rwanda Men’s Resource Center; Anicet Nzabonimpa and Felix Sayinzoga of Maternal, Child and Community Health Division, Rwanda Ministry of Health, Rwanda Biomedical Center; Julie Pulerwitz of HIV and AIDS Program, Population Council; Vandana Sharma of Harvard T.H. Chan School of Public Health, Harvard University; and Dominick Shattuck of Institute for Reproductive Health, Georgetown University.
About the RCT methodology
The multi-site randomized controlled trial was conducted in four Rwandan districts with expectant/current fathers and their partners, who were randomized to the intervention (n=575 couples) or control group (n=624 couples). At 21-months post-baseline, 1123 men and 1162 partners were included in intention to treat analysis. Generalized estimating equations with robust standard errors were used to fit the models.
About Bandebereho fathers and couples programming in Rwanda
The Bandebereho couples’ intervention engaged men and their partners in participatory, small group sessions of critical reflection and dialogue. The Rwanda Men’s Resource Center (RWAMREC), a local Rwanda non-governmental organization, implemented the intervention as part of MenCare+, a four-country initiative to engage men in sexual, reproductive, and maternal health. The MenCare+ program was coordinated by Rutgers and Promundo, and financed by the Dutch Ministry of Foreign Affairs. In Rwanda, the MenCare+ program was known as Bandebereho, or “role model”, as it aimed to transform norms around masculinity by demonstrating positive models of fatherhood.
The intervention used a structured 15-session curriculum adapted from Program P, an open source manual for engaging men in maternal and child health, created by Promundo, CulturaSalud, and REDMAS (2013) which includes a curriculum for fathers/couples, resources for designing health provider training and community campaigns . Men participating in the Bandebereho intervention were invited to 15 sessions (maximum 45 hours) and their partners to 8 (maximum 24 hours). Sessions addressed: gender and power; fatherhood; couple communication and decision-making; IPV; caregiving; child development; and male engagement in reproductive and maternal health.
MenCare is a global fatherhood campaign active in more than 45 countries on 5 continents. Its mission is to promote men’s involvement as equitable, nonviolent fathers and caregivers in order to achieve family well-being, gender equality, and better health for mothers, fathers, and children. MenCare works at multiple levels to engage individuals, communities, institutions, and policymakers. Through innovative programming, community-driven and global campaigns, and targeted advocacy, the campaign has reached millions of individuals and changed the lives of people around the world. MenCare believes that true equality will only be reached when men are taking on 50% of the childcare and domestic work around the world. MenCare is coordinated globally by Promundo and Sonke Gender Justice in collaboration with steering committee members Save the Children, Oxfam GB, and the MenEngage Alliance. For more information, see: www.men-care.org