The impacts of combined social and economic empowerment training on intimate partner violence, depression, gender norms and livelihoods among women: an individually randomised controlled trial and qualitative study in Afghanistan
- PMID: 32201622
- PMCID: PMC7076232
- DOI: 10.1136/bmjgh-2019-001946
The impacts of combined social and economic empowerment training on intimate partner violence, depression, gender norms and livelihoods among women: an individually randomised controlled trial and qualitative study in Afghanistan
Abstract
Introduction: We assessed whether the Women for Women International (WfWI) economic and social empowerment programme could reduce women's experiences of intimate partner violence (IPV) and depression in Afghanistan.
Methods: We conducted a two-arm individually randomised controlled trial in six urban and peri-urban communities. Communities were selected by WfWI for being conflict affected and showing signs of economic vulnerability (eg, little or no education, living in extreme poverty). Individual eligibility were female, aged 18-49, able to consent to participate and one woman per household. At 22 months, three primary outcomes were assessed: past year physical IPV experience; past year severe IPV experience; depressive symptoms. There was no blinding to arms. We conducted an intention-to-treat analysis, controlling for age. We also conducted qualitative interviews at endline, analysed using thematic analysis.
Results: 1461 women (n=933 married) were recruited and randomised. Retention at endline was n=1210 (82%). Primary outcomes were in the hypothesised direction, but showed no significant impacts: physical IPV (adjusted OR (aOR) 0.88 (0.62 to 1.23)), severe IPV (aOR 0.75 (0.50 to 1.11)) and depressive symptoms (β -0.35 (-1.19 to 0.48)). Women reported reduced food insecurity (β -0.48 (-0.85 to -0.12)), higher earnings (β 3.79 (0.96 to 6.61)) and savings (β 11.79 (9.95 to 13.64)). Women reported less gender-inequitable attitudes (β -0.89 (-1.15 to -0.62)), more household decision-making (β 0.35 (-0.04 to 0.74)) and increased mobility (aOR 1.78 (1.27 to 2.50)). Twenty-eight in-depth interviews were conducted.
Conclusion: The intervention did not impact IPV or depression. The intervention did improve livelihoods, create more gender-equitable relationships and increase women's mobility. Translating these gains into IPV and depression reduction is critical.
Trial registration number: NCT03236948, registered 2 August 2017.
Keywords: Afghanistan; mixed-methods; trial; violence against women; women.
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Conflict of interest statement
Competing interests: None declared.
Figures
Similar articles
-
An individually randomized controlled trial to determine the effectiveness of the Women for Women International Programme in reducing intimate partner violence and strengthening livelihoods amongst women in Afghanistan: trial design, methods and baseline findings.BMC Public Health. 2018 Jan 22;18(1):164. doi: 10.1186/s12889-018-5029-1. BMC Public Health. 2018. PMID: 29357843 Free PMC article. Clinical Trial.
-
Effectiveness of a culturally appropriate intervention to prevent intimate partner violence and HIV transmission among men, women, and couples in rural Ethiopia: Findings from a cluster-randomized controlled trial.PLoS Med. 2020 Aug 18;17(8):e1003274. doi: 10.1371/journal.pmed.1003274. eCollection 2020 Aug. PLoS Med. 2020. PMID: 32810146 Free PMC article. Clinical Trial.
-
Factors associated with past year physical and sexual intimate partner violence against women in Zimbabwe: results from a national cluster-based cross-sectional survey.Glob Health Action. 2018;11(sup3):1625594. doi: 10.1080/16549716.2019.1625594. Glob Health Action. 2018. PMID: 31232228 Free PMC article.
-
The effect of a savings intervention on women's intimate partner violence victimization: heterogeneous findings from a randomized controlled trial in Colombia.BMC Womens Health. 2019 Jan 25;19(1):17. doi: 10.1186/s12905-019-0717-2. BMC Womens Health. 2019. PMID: 30683076 Free PMC article. Clinical Trial.
-
Elements of the Design and Implementation of Interventions to Prevent Violence against Women and Girls Associated with Success: Reflections from the What Works to Prevent Violence against Women and Girls? Global Programme.Int J Environ Res Public Health. 2021 Nov 19;18(22):12129. doi: 10.3390/ijerph182212129. Int J Environ Res Public Health. 2021. PMID: 34831885 Free PMC article. Review.
Cited by
-
Impacts of an abbreviated personal agency training with refugee women and their male partners on economic empowerment, gender-based violence, and mental health: a randomized controlled trial in Rwanda.BMC Public Health. 2024 May 14;24(1):1306. doi: 10.1186/s12889-024-18780-8. BMC Public Health. 2024. PMID: 38745312 Free PMC article. Clinical Trial.
-
Sexual and reproductive health implementation research in humanitarian contexts: a scoping review.Reprod Health. 2024 May 13;21(1):64. doi: 10.1186/s12978-024-01793-2. Reprod Health. 2024. PMID: 38741184 Free PMC article. Review.
-
Effectiveness of community mobilisation and group-based interventions for preventing intimate partner violence against women in low- and middle-income countries: A systematic review and meta-analysis.J Glob Health. 2023 Oct 20;13:04115. doi: 10.7189/jogh.13.04115. J Glob Health. 2023. PMID: 37861113 Free PMC article.
-
Measurement invariance of the Center for Epidemiologic Studies Scale-Depression within and across six diverse intervention trials.Psychol Assess. 2023 Oct;35(10):805-820. doi: 10.1037/pas0001262. Epub 2023 Aug 24. Psychol Assess. 2023. PMID: 37616094
-
Interventions to Prevent Intimate Partner Violence: A Systematic Review and Meta-Analysis.Violence Against Women. 2024 Mar;30(3-4):953-980. doi: 10.1177/10778012231183660. Epub 2023 Jul 20. Violence Against Women. 2024. PMID: 37475456 Free PMC article.
References
-
- Niaz U, Hassan S-un-nisa, Tariq Q. Situational analysis of intimate partner violence interventions in South Asian and middle Eastern countries. Partner Abuse 2017;8:47–88. 10.1891/1946-6560.8.1.47 - DOI
Publication types
MeSH terms
Associated data
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous