Browsing by Author "Chirwa, E.D."

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Evaluation of the rural response system intervention to prevent violence against women: findings from a community-randomised controlled trial in the Central Region of Ghana
(Global Health Action, 2020-01-14) Alangea, D.O.; Addo-Lartey, A.A.; Chirwa, E.D.; Sikweyiya, Y.; Coker-Appiah, D.; Jewkes, R.; Adanu, R.M.K.
Background: Intimate partner violence (IPV) affects one in three women globally and undermines women’s human rights, social and economic development, and health, hence the need for integrated interventions involving communities in its prevention. Objective: This community-randomised controlled trial evaluated the Rural Response System (RRS) intervention, which uses Community Based Action Teams to prevent IPV by raising awareness and supporting survivors, compared to no intervention. Methods: Two districts of the Central Region of Ghana were randomly allocated to each arm. Data were collected by repeated, randomly sampled, household surveys, conducted at baseline (2000 women, 2126 men) and 24 months later (2198 women, 2328 men). The analysis used a difference in difference (DID) approach, adjusted for age and exposure to violence in childhood. Results: In intervention communities, women’s past year experience of sexual IPV reduced from 17.1% to 7.7% versus 9.3% to 8.0% in the control communities (DID = −9.3(95%CI; −17.5,−1.0), p = 0.030). The prevalence of past-year physical IPV among women in the intervention communities reduced from 16.5% to 8.3% versus 14.6% to 10.9% in the controls (DID = −4.2(−12,3.6), p = 0.289). The prevalence of severe IPV experienced by women reduced from 21.2% to 11.6% in intervention versus 17.3% to 11.4% in controls (DID = −3.7(−12.5,5.1), p = 0.408). The direction of impact of the intervention on violence perpetrated by men was more towards a reduction but changes were not statistically significant. Emotional IPV perpetration was significantly lower (DID = −15.0(−28.5, −1.7), p = 0.031). Women’s depression scores and reports of male partner controlling behaviour significantly also reduced in the intervention arm compared to those in the control arm (DID = −4.8(−8.0,−1.5), p = 0.005; DID = −2.7(−3.3,−1.0), p = 0.002, respectively). Conclusion: Our findings indicate that the RRS intervention reduced women’s experiences of IPV, depression, and partner controlling behaviour and some evidence of men’s reported reductions in the perpetration of IPV. The RRS intervention warrants careful scale-up in Ghana and further research.
Patriarchy and gender-inequitable attitudes as drivers of intimate partner violence against women in the central region of Ghana
(BMC Public Health, 2020-05-13) Addo-Lartey, A.A.; Sikweyiya, Y.; Alangea, D.O.; Dako-Gyeke, P.; Chirwa, E.D.; Coker-Appiah, D.; Adanu, R.M.K.; Jewkes, R.
Background: In order to reduce women’s exposure to violence and develop culturally appropriate interventions, it is important to gain an understanding of how men who use violence rationalize it. The present study sought to explore the perspectives of men who had used violence on their female partners, specifically their views on intimate partner violence (IPV), gender norms, manhood, their gender attitudes and to understand how these may drive male perpetrated IPV against women in the Central Region of Ghana. Methods: This was a qualitative study involving purposively sampled adult men who had participated in a household-based survey in selected districts in the Central Region of Ghana and who had self-reported perpetration of IPV in the past 12 months. In-depth interviews were conducted with 17 men. Results: Data revealed how a range of social, cultural, and religious factors ̶stemming from patriarchy ̶combined to inform the construction of a traditional masculinity. These factors included the notion that decision-making in the home is a man’s prerogative, there should be rigid and distinct gender roles, men’s perceptions of owning female partners and having the right to have sex with them whenever they desire, and the notion that wife beating is legitimate discipline. Findings suggest that it was through performing, or aspiring to achieve, this form of masculinity that men used varying forms of violence against their female partners. Moreover, data show that the men’s use of violence was a tactic for controlling women and emphasizing their authority and power over them.Conclusions: Developers of interventions to prevent IPV need to recognize that there is a coherent configuration of aspirations, social norms and behaviours that is drawn on by some men to justify their use of IPV. Understanding the perspectives of men who have perpetrated IPV against women and their motivations for perpetration is essential for interventions to prevent IPV. This is discussed as drawing authority from ‘tradition’ and so engaging traditional and religious leaders, as well as men and women throughout the community, in activities to challenge this is likely to be particularly fruitful.
Prevalence and risk factors of intimate partner violence among women in four districts of the central region of Ghana: Baseline findings from a cluster randomised controlled trial
(PLoS ONE, 2018-07) Alangea, D.O.; Addo-Lartey, A.A.; Sikweyiya, Y.; Chirwa, E.D.; Coker-Appiah, D.; Jewkes, R.; Adanu, R.M.K.
Intimate partner violence (IPV) is a significant global public health problem. Understanding risk factors is crucial for developing prevention programmes. Yet, little evidence exists on population-based prevalence and risk factors for IPV in West Africa. Our objective was to measure both lifetime and past year prevalence of IPV and to determine factors associated with past year physical or sexual IPV experience. This population-based survey involved 2000 randomly selected women aged 18 to 49 years living in 40 localities within four districts of the Central Region of Ghana. Questionnaires were interviewer-administered from February to May 2016. Respondents were currently or ever-partnered, and resident in study area ≥12months preceding the survey. Data collected included: socio-demographics; sexual behavior; mental health and substance use; employment status; 12-month and lifetime experience of violence; household food insecurity; gender norms/attitudes; partner characteristics and childhood trauma. Logistic regression modelling was used to determine factors associated with sexual or physical IPV, adjusting for age and survey design. About 34% of respondents had experienced IPV in the past year, with 21.4% reporting sexual and or physical forms. Past year experience of emotional and economic IPV were 24.6% and 7.4% respectively. Senior high school education or higher was protective of IPV (AOR = 0.51[0.30–0.86]). Depression (AOR = 1.06[1.04–1.08], disability (AOR = 2.30[1.57–3.35]), witnessing abuse of mother (AOR = 2.1.98[1.44–2.72]), experience of childhood sexual abuse (AOR = 1.46[1.07–1.99]), having had multiple sexual partners in past year (AOR = 2.60[1.49–4.53]), control by male partner (AOR = 1.03[1.00–1.06]), male partner alcohol use in past year (AOR = 2.65[2.12–3.31]) and male partner infidelity (AOR = 2.31[1.72–3.09]) were significantly associated with increased odds of past year physical or sexual IPV experience. Male perpetrated IPV remains a significant public health issue in Ghana. Evidence-based interventions targeting women’s mental health, disabilities, exposure to violence in childhood, risky sexual behavior and unequal power in relationships will be critical in reducing IPV in this setting.
Prevalence and risk factors of physical or sexual intimate violence perpetration amongst men in four districts in the central region of Ghana: Baseline findings from a cluster randomised controlled trial
(PLoS ONE, 2018-03) Chirwa, E.D.; Sikweyiya, Y.; Addo-Lartey, A.A.; Alangea, D.O.; Coker-Appiah, D.; Adanu, R.M.K.; Jewkes, R.
Background Evidence-based interventions are essential in the prevention of violence against women (VAW). An understanding of risk factors for Male perpetration of VAW using population-based research is crucial for developing such interventions. This study is a baseline assessment of a two-arm unmatched cluster randomised controlled trial (C-RCT), set up to assess the impact of a Rural Response System (RRS) intervention for preventing violence against women and girls in Ghana. This study aims at assessing past year prevalence and risk factors for sexual or physical intimate partner violence (IPV) perpetration among men. Methods The population-based survey involved 2126 men aged 18 and above living in selected communities in 4 districts in the central region of Ghana. Logistic regression techniques were used to determine risk factors for sexual or physical IPV perpetration. All models adjusted for age of respondent and took into account the study design. Results Half of the men had perpetrated at least one form of violence against their intimate partners in their lifetime while 41% had perpetrated sexual or physical IPV. Majority (93%) of the men had been in relationships in the 12 months preceding the survey, and of these, 23% had perpetrated sexual or physical IPV. Childhood factors associated with sexual or physical IPV included witnessing abuse of mother (aOR:1.40(1.06–1.86)), and neglect (aOR:1.81(1.30–2.50)). Other major risk factors for IPV perpetration were: having multiple partners (aOR:1.76(1.36–2.26)), (involvement in transactional sex (aOR:1.76(1.36–2.26)), substance use (aOR:1.74(1.25–2.43)) and gender inequitable attitudes (aOR:0.94(0.91–0.97)). Conclusion Childhood violence experience and witnessing, risky behaviour (multiple partners, transactional sex, substance use) and gender inequitable attitudes are major risk factors for sexual or physical IPV perpetration. Perpetration of sexual or physical IPV tend to co-occur with non-partner violence and emotional IPV perpetration. Interventions targeting these factors are critical in reducing IPV. © 2018 Chirwa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Rural response system to prevent violence against women: methodology for a community randomised controlled trial in the central region of Ghana
(Global Health Action, 2019-05-28) Addo-Lartey, A.A.; Alangea, D.O.; Sikweyiya, Y.; Chirwa, E.D.; Coker-Appiah, D.; Jewkes, R.; Adanu, R.M.K.
Violence against women (VAW) is common in Ghana, with nation-wide surveys reporting high prevalence of intimate partner violence (IPV) (physical, sexual and/or emotional violence). Our trial assesses the community level impact of the Rural Response System which uses Community-Based Action Teams ‘COMBAT’ for preventing VAW in Ghana. This study is a mixed method unmatched cluster randomised controlled trial and includes rural (n = 23), peri-urban (n = 7) and urban (n = 10) communities in four districts of the Central Region, Ghana. The trial will last three years with one baseline survey, one impact assessment and a qualitative baseline, midpoint and endline evaluation. A total of 40 localities were selected to serve as clusters (20 per trial arm) with about 82 households per cluster recruited at baseline. The same number will be recruited post-intervention. Adult women (18 to 49 years) and men (≥ 18 years) were drawn from different localities. Sampling of households within a community was random and done using a computerised system. In each selected household, one female or male resident was invited to participate. Individuals are eligible for inclusion in the study if they usually live (sleep and eat) in the household, have lived in the community for at least a year, and are between the ages of 18-to-49 years old. Our impact assessment component will compare past 12 months incidence of IPV (i.e. IPV experiences for women and perpetration of physical and/or sexual IPV for men) between arms in the trial. The implementation of this community trial comes at an opportune time when evidence on the effectiveness of a targeted VAW intervention in the Ghanaian society is needed to inform the development of national policies for preventing VAW. Our progressive research approach using a mixed method design will further extend knowledge globally on a multifaceted intervention to reduce the incidence of intimate partner violence in a developing country.
’Small small quarrels bring about happiness or love in the relationships’: Exploring community perceptions and gendered norms contributing to male perpetrated intimate partner violence in the Central Region of Ghana
(Plos One, 2019-11-21) Dako-Gyeke, P.; Addo-Lartey, A.A.; Alangea, D.O.; Sikweyiya, Y.; Chirwa, E.D.; Coker-Appiah, D.; Jewkes, R.; Adanu, R.M.K.
In this paper, we explore gender norms held by men and women that might contribute to male perpetration of intimate partner violence (IPV) in Ghana. This qualitative research was conducted at the pre-intervention stage of a cluster randomized controlled trial. Our intervention uses community-based action teams to change social norms on gender and violence. Focus group discussions and in-depth interviews were conducted within communities. We found that male perpetrated IPV is a common phenomenon within the study communities, yet it is complex and experienced differently depending on the context. A woman’s non-compliance with gender norms provided context for the male partner to enforce societal conformity through IPV. Also, male partners’ misbehavior (e.g. alcohol abuse) may exacerbate IPV. Whereas the former is socially acceptable, the latter may be contested. Victims may challenge/counteract IPV using varying tactics (e.g. threats), which were mainly directed toward male partners’ immoral behavior. We conclude that there is a need to assess IPV with key considerations for female agency, as some victims may respond with violence. Moreover, some communities have the tendency to demonstrate more gender-equitable attitudes regarding male perpetration of IPV, as indicated by laws instituted by some traditional leaders to deter perpetrators. These are key learnings that can inform the design and delivery of various interventions that seek to address IPV.