title: Gender norms and economic empowerment intervention to reduce intimate partner violence against women in rural Côte d'Ivoire: a randomized controlled pilot study.
abstract: BACKGROUND
  Gender-based violence against women, including intimate partner violence (IPV), is a pervasive health and human rights concern. However, relatively little intervention research has been conducted on how to reduce IPV in settings impacted by conflict. The current study reports on the evaluation of the incremental impact of adding "gender dialogue groups" to an economic empowerment group savings program on levels of IPV. This study took place in north and northwestern rural Côte d'Ivoire.
  
  
  METHODS
  Between 2010 and 2012, we conducted a two-armed, non-blinded randomized-controlled trial (RCT) comparing group savings only (control) to "gender dialogue groups" added to group savings (treatment). The gender dialogue group consisted of eight sessions that targeted women and their male partner. Eligible Ivorian women (18+ years, no prior experience with group savings) were invited to participate. 934 out of 981 (95.2%) partnered women completed baseline and endline data collection. The primary trial outcome measure was an overall measure of past-year physical and/or sexual IPV. Past year physical IPV, sexual IPV, and economic abuse were also separately assessed, as were attitudes towards justification of wife beating and a woman's ability to refuse sex with her husband.
  
  
  RESULTS
  Intent to treat analyses revealed that compared to groups savings alone, the addition of gender dialogue groups resulted in a slightly lower odds of reporting past year physical and/or sexual IPV (OR: 0.92; 95% CI: 0.58, 1.47; not statistically significant). Reductions in reporting of physical IPV and sexual IPV were also observed (not statistically significant). Women in the treatment group were significantly less likely to report economic abuse than control group counterparts (OR = 0.39; 95% CI: 0.25, 0.60, p < .0001). Acceptance of wife beating was significantly reduced among the treatment group (β = -0.97; 95% CI: -1.67, -0.28, p = 0.006), while attitudes towards refusal of sex did not significantly change Per protocol analysis suggests that compared to control women, treatment women attending more than 75% of intervention sessions with their male partner were less likely to report physical IPV (a OR: 0.45; 95% CI: 0.21, 0.94; p = .04) and report fewer justifications for wife beating (adjusted β = -1.14; 95% CI: -2.01, -0.28, p = 0.01) ; and both low and high adherent women reported significantly decreased economic abuse (a OR: 0.31; 95% CI: 0.18, 0.52, p < 0.0001; a OR: 0.47; 95% CI: 0.27, 0.81, p = 01, respectively). No significant reductions were observed for physical and/or sexual IPV, or sexual IPV alone.
  
  
  CONCLUSIONS
  Results from this pilot RCT suggest the importance of addressing household gender inequities alongside economic programming, because this type of combined intervention has potential to reduce levels of IPV. Additional large-scale intervention research is needed to replicate these findings.
  
  
  BACKGROUND
  
  
  
  BACKGROUND
  NCT01629472.
authors.affiliation: Department of Chronic Disease Epidemiology, Division of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06520, USA. jhumka.gupta@yale.edu.
authors.forename: Jhumka
authors.initials: J
authors.lastname: Gupta
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Falb
authors.forename: Heidi
authors.initials: H
authors.lastname: Lehmann
authors.forename: Denise
authors.initials: D
authors.lastname: Kpebo
authors.forename: Ziming
authors.initials: Z
authors.lastname: Xuan
authors.forename: Mazeda
authors.initials: M
authors.lastname: Hossain
authors.forename: Cathy
authors.initials: C
authors.lastname: Zimmerman
authors.forename: Charlotte
authors.initials: C
authors.lastname: Watts
authors.forename: Jeannie
authors.initials: J
authors.lastname: Annan
mesh_terms: D000328:Adult; D001294:Attitude to Health; D007560:Cote d'Ivoire / Q000453:epidemiology; D017579:Domestic Violence / Q000517:prevention & control* / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011203:Poverty / Q000523:psychology*; D011209:Power, Psychological; D012747:Sexual Partners / Q000523:psychology; D014930:Women / Q000523:psychology