Economic and social empowerment to reduce global intimate partner violence: disentangling the pathways
Authors: Jhumka Gupta, Elizabeth A Reed
Journal: The Lancet Global Health (2019)

The UN Sustainable Development Goal 5 calls for achieving gender equality and empowering all women and girls. However, a recent review notes insufficient progress on structural issues at the root of gender inequality.1UNSustainable Development Goal 5: achieve gender equality and empower all women and girls.https://sustainabledevelopment.un.org/sdg5Date accessed: August 23, 2019Google Scholar For this reason, Saidi Kapiga and colleagues' study,2Kapiga S Harvey S Mshana G et al.A social empowerment intervention to prevent intimate partner violence against women in a microfinance scheme in Tanzania: findings from the MAISHA cluster randomised controlled trial.Lancet Glob Health. 2019; 7: e1423-e1434Summary Full Text Full Text PDF PubMed Scopus (23) Google Scholar reported in The Lancet Global Health, marks an important contribution because of its focus on advancing current understanding on preventing intimate partner violence against women. Kapiga and colleagues did a randomised controlled trial in north-western Tanzania of a social empowerment programme for women participants. This intervention, called MAISHA, provided women with a participatory gender training curriculum aiming to develop their skills in preventing intimate partner violence and mitigating associated negative consequences. Microfinance groups were randomly assigned to either receive the gender training curriculum (ie, the intervention arm) or ongoing microfinance group participation only (ie, the control group). Findings showed that, after 24 months, women in the intervention arm were less likely than those in the control arm to report physical or sexual intimate partner violence, express attitudes accepting of intimate partner violence, and view intimate partner violence as a private matter. MAISHA was inspired by the 2006 Intervention with Microfinance for AIDS and Gender Equity (IMAGE) study in South Africa that showed a 55% reduction in past year intimate partner violence.3Pronyk PM Hargreaves JR Kim JC et al.Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial.Lancet. 2006; 368: 1973-1983Summary Full Text Full Text PDF PubMed Scopus (613) Google Scholar Although the findings from the IMAGE study were promising, key questions remained regarding which specific components contributed to intimate partner violence reductions, and whether IMAGE could be adapted in other settings experiencing both intimate partner violence and HIV epidemics.4Harvey S Lees S Mshana G et al.A cluster randomized controlled trial to assess the impact on intimate partner violence of a 10-session participatory gender training curriculum delivered to women taking part in a group-based microfinance loan scheme in Tanzania (MAISHA CRT01): study protocol.BMC Womens Health. 2018; 18: 55PubMed Google Scholar Kapiga and colleagues are to be congratulated for extending learning from the IMAGE study through adapting the intervention model to the Tanzanian context in partnership with the Tanzanian Government and local partners. Furthermore, they provide rigorous evidence to help clarify the incremental effect of a social empowerment component. However, important questions remain surrounding differential treatment effects on various forms of intimate partner violence and underlying pathways. Although MAISHA reduced overall physical or sexual intimate partner violence, or both, changes appear to be largely driven by physical intimate partner violence and not sexual intimate partner violence. This finding is broadly consistent with other intervention trials of economic strengthening and gender norms, in which sexual intimate partner violence experiences and acceptance were not reduced.5Gupta J Falb KL Lehmann H et al.Gender norms and economic empowerment intervention to reduce intimate partner violence against women in rural Côte d'Ivoire: a randomized controlled pilot study.BMC Int Health Hum Rights. 2013; 13: 46Crossref PubMed Scopus (115) Google Scholar Gender norms relating to sexual intimate partner violence are likely to be more difficult to change or discuss explicitly within curricula (as was the case in our work in Côte d'Ivoire5Gupta J Falb KL Lehmann H et al.Gender norms and economic empowerment intervention to reduce intimate partner violence against women in rural Côte d'Ivoire: a randomized controlled pilot study.BMC Int Health Hum Rights. 2013; 13: 46Crossref PubMed Scopus (115) Google Scholar) than physical intimate partner violence, and bystander approaches might not translate into sexual intimate partner violence disruptions. Sexual consequences of intimate partner violence (eg, unintended pregnancy, poor mental health) are dire and can also impede economic empowerment efforts. Thus, future prioritisation of how to explicitly address sexual intimate partner violence in a safe and acceptable manner is needed. Notably, economic intimate partner violence can also stymie economic empowerment goals and threaten women's ability to separate from an abusive partner, yet it is less studied in comparison with physical and sexual intimate partner violence.6Gibbs A Jessica J Alice KW A global comprehensive review of economic interventions to prevent intimate partner violence and HIV risk behaviours.Glob Health Action. 2017; 101290427Crossref PubMed Scopus (58) Google Scholar Thus, tremendous opportunity to learn more from MAISHA exists. Emotional intimate partner violence also was not reduced. This finding is broadly consistent with those of the IMAGE study, in which controlling behaviors were not reduced, although other intimate partner violence intervention studies using economic empowerment alone or in combination with gender transformation have shown reductions.3Pronyk PM Hargreaves JR Kim JC et al.Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial.Lancet. 2006; 368: 1973-1983Summary Full Text Full Text PDF PubMed Scopus (613) Google Scholar, 5Gupta J Falb KL Lehmann H et al.Gender norms and economic empowerment intervention to reduce intimate partner violence against women in rural Côte d'Ivoire: a randomized controlled pilot study.BMC Int Health Hum Rights. 2013; 13: 46Crossref PubMed Scopus (115) Google Scholar, 7Glass N Perrin NA Kohli A Campbell J Remy MM Randomised controlled trial of a livestock productive asset transfer programme to improve economic and health outcomes and reduce intimate partner violence in a postconflict setting.BMJ Glob Health. 2017; 2e000165Crossref PubMed Scopus (21) Google Scholar It might be that MAISHA enabled women to focus on what was perceived as more severe forms of intimate partner violence (ie, physical violence). Norms around acceptance of physical intimate partner violence might be more amenable to change, as such women might be more likely to leave a physically abusive relationship. Varied intervention outcomes surrounding emotional intimate partner violence underscore the importance for greater research attention. The study team is currently developing a male engagement component that might be important for yielding more reductions and offering greater insight on potential pathways. The MAISHA study team, despite noted challenges, was successful in doing their endpoint assessment at 24 months with minimal attrition. Additional time, however, might be needed to observe changes in these other forms of intimate partner violence. Moreover, little is known regarding the longer-term effects of these types of interventions on what factors promote sustained reductions in intimate partner violence, and what factors might relate to the erosion of positive intervention effects. Thus, research into interventions for intimate partner violence will benefit from funding that will support long follow-up periods. Context is also important. Microfinance is one type of economic intervention and might not always be effective or possible across diverse populations and contexts. Economic interventions must be tailored to the contexts and needs of populations served and address the multiple risks women might be facing to optimise their safety. Other economic intervention typologies implemented in low-income and middle-income countries with promising effects on intimate partner violence reduction include livelihood interventions, village savings and loan associations, and cash transfers.6Gibbs A Jessica J Alice KW A global comprehensive review of economic interventions to prevent intimate partner violence and HIV risk behaviours.Glob Health Action. 2017; 101290427Crossref PubMed Scopus (58) Google Scholar Furthermore, although intervention work for intimate partner violence is growing in these countries, including humanitarian crisis settings, research on reducing intimate partner violence among refugees and immigrants within high-income countries is lacking, despite rapid shifts in gender roles and economic opportunities and high intimate partner violence levels including femicide.8Sabri B Njie-Carr VPS Messing JT et al.The weWomen and ourCircle randomized controlled trial protocol: a web-based intervention for immigrant, refugee and indigenous women with intimate partner violence experiences.Contemp Clin Trials. 2019; 76: 79-84Summary Full Text Full Text PDF PubMed Scopus (16) Google Scholar Thus, we hope that knowledge gained from Kapiga and colleagues' study will continue to inspire future research on interventions and pathways, and acquired evidence will be used to ensure the safety of women and their communities globally. We declare no competing interests. A social empowerment intervention to prevent intimate partner violence against women in a microfinance scheme in Tanzania: findings from the MAISHA cluster randomised controlled trialReported physical or sexual intimate partner violence, or both, was reduced among women who participated in the intervention arm, although the effect was greater for physical intimate partner violence, suggesting that intimate partner violence is preventable in high-risk settings such as Tanzania. Full-Text PDF Open Access