# **_Expanding social services for women and children_**

In many countries, public and private institutions have worked to improve social services for women and children who experience violence. In some settings, NGOs and coalitions such as the Nicaraguan Network of Women against Violence have spearheaded these initiatives (Velzeboer et al., 2003). In other settings, governments have promoted institutional reforms by establishing ministries, departments or agencies devoted to the advancement of women, including Mexico, Jamaica, Guatemala, Bolivia, Peru (Center for Reproductive Laws and Policy, 2000); these agencies often work to strengthen comprehensive services for survivors of gender-based violence. For example, in El Salvador, the Salvadoran Institute for the Development of Women is a government agency that coordinates the “Program to Strengthen the Family” _(Programa de Saneamiento de la Relación Familiar)_ , a multi-sectoral effort among public and private institutions (Valdez, 1999). In some settings, such as Nicaragua and Costa Rica, coalitions of government agencies and NGOs develop National Plans to improve the network of services for women and children affected by violence (Velzeboer et al., 2003). Typically, these efforts aim to expand, improve and integrate services such as telephone hotlines, emergency shelters, police intervention, legal assistance, counseling services, psychological care, support groups, income generation programs, programs for batterers and child welfare services.

A large literature exists on caring for survivors of physical and sexual abuse within specific professional disciplines, but research on the effectiveness, quality and impact of social service programs is scarce in low and middle-income countries. Most evaluations document numbers of persons served, services provided, and types of cases reported (Inter-American Development Bank, 2002). Some conduct informal studies of quality, by gathering information on service quality, client satisfaction, or qualitative perspectives of survivors. For example, see the evaluation of health, counseling, legal aid and women’s support groups by health programs in Brazil, the Dominican Republic and Venezuela (Guedes et al., 2002). Ideally, researchers would conduct randomized, longitudinal studies, such as the study by Sullivan and Bybee (1999) that demonstrated the benefits and risks of shelter-based advocacy services in the United States. Their study measured outcomes such as levels of physical violence, psychological abuse, depression, quality of life, and social support. However, almost no such research has been done in developing countries. At a community level, social service initiatives accompanied by substantial outreach efforts have sometimes increased the proportion of women who know what services exist and where, as well as the numbers of women who seek help, but little scientific research has explored the impact of expanded social services on violence prevention **.**

# **_Batterer programs_**

Increasingly, NGOs and governments have attempted to reduce violence against women by organizing treatment programs for batterers, aimed at changing their attitudes and behaviors. Most are run by NGOs, but they often depend on court- mandated attendance as an alternative to criminal sanctions. Most batterer programs have been carried out in high-income countries, but increasingly they have been implemented by developing country NGOs, such as the Instituto Noos in Brazil (White, Greene, and Murphy, 2003) and CORIAC in Mexico (Morrison and Biehl, 1999). Many studies have evaluated these programs’ effectiveness in high-income countries, but most evaluations have been methodologically flawed. The only randomized controlled trial to date was carried out by the United States Navy, which found no reduction in abuse compared with controls (Dunford, 2000). Battered women often identify treatment or counseling for their husbands as a high priority (e.g. Ellsberg, 2001b), but it remains to be seen whether cost-effective strategies for changing batterer behavior can be found.

# **_Shelters_**

Many researchers and advocates have called on governments and donors to invest in shelters for women who experience gender-based violence. Typically, these facilities offer emergency refuge as well as counseling, medical and legal assistance, job training, telephone hotlines, and other services. Most rigorous evaluation studies on the effectiveness and quality of shelters come from settings such as the 38