Community-Based Intervention to Prevent Domestic Violence against Women in the Reproductive Age in Northwestern Ethiopia: A Quasi-Experimental Implementation Research

Abstract

Background: Violence against women is a devastating public health challenge and a pervasive human rights abuse. Worldwide, a third of women experience domestic violence from either intimate or non-intimate partner in their lifetime. In sub-Saharan Africa region, the prevalence of domestic violence against women is similar with the global picture (36.6%). In Ethiopia, domestic violence against women is a common phenomenon and forms part of women’s life experiences ranging from 19% to 78%. However, there is paucity of translation of existing evidence into community-based intervention, and piloting its implementation applicability and effectiveness in preventing domestic violence against women in Ethiopia. Objective: Assessed the implementation and outcome of a community-based intervention on the prevention of domestic violence against women and its associated factors in Awi Zone, Northwestern Ethiopia. Methods: A community-based quasi-experimental study was conducted using mixed methods to assess domestic violence against women in the Northwestern Ethiopia. Complex probability sampling design and purposive methods were used to recruit study participants for quantitative and qualitative study, respectively. Study participants were assigned into three groups; Intervention, Active comparator, and Control and given the intervention packages. The women in the intervention group received all the intervention packages. These consisted of stakeholder advocacy workshop, community mobilization, training of community agents, house-to-house women’s awareness-creation and participating partners. In the active comparator group, only partners’ participating component was not implemented. The control group were sustained on standard services. A sequential explanatory data collection method was applied for both pre and post intervention surveys. Gathered data were entered into EpiData software and exported into SPSS version 23.0 for analysis. Descriptive, Generalized Linear Models and Difference in Differences (DID) statistical analysis methods were carried out. Statistical associations were reported using adjusted prevalence ratio at 95% confidence interval (CI) and p-value less than 0.05. The qualitative data were transcribed, coded, and thematically analyzed using Nvivo 11. The study protocol was registered on trial registry platform (ClinicalTrials.gov: NCT03265626). Results: The level of domestic violence against women reduced from pre-intervention 48.3% to 40.1% at post-intervention survey. Women’s receptive attitudes towards justified wife-beating reduced from 69.9% to 59.0%. Likewise, women’s receptive attitudes towards inequitable gender-norms between wives and partners declined from 67.6% to 55.9%. In the DID analysis, women’s experience of sexual violence declined by 10% among women in the active comparator group than the control group (DID, -0.10; 95% CI: -0.19, -0.02). Women’s receptive attitude towards justified wife-beating reduced by 17% in the active comparator group compared to the control group (DID, -0.17; 95% CI: -0.26, -0.08). Likewise, women’s receptive attitude towards inequitable gender-norms reduced by 17% in the intervention as compared with the control group (DID, -0.17, 95% CI: -0.26, -0.08). Furthermore, budget constraints, lack of commitment, having community-traditional gender-norms, poor planning, lack of integration and inter-sectoral collaboration were barriers to existing policy implementation to prevent domestic violence against women. The existing community health extension program, women development ‘army’ group, existing policy frameworks, government’s political willingness, presence of school-based gender clubs and development partners were some of the enabling conditions for ensuring the sustainable implementation of domestic violence prevention programs in the study area. Conclusions: The community-based piloted intervention was effective in preventing domestic violence, receptive attitudes towards justified wife-beating and inequity-norms. However, the prevalence of the different forms of domestic VAW were still high. Both women’s receptive attitude towards justified wife-beating and inequitable gender-norms were interlinked factors associated with persistently high domestic violence against women. The community’s receptive attitude is also exhibited by local politicians and or implementers. Community-based intervention was found to be effective, feasible and applicable in reducing domestic violence and its receptive attitudes. The implementation of existing policies to prevent domestic violence against women was poor due to lack of inter-sectoral collaboration, poor integration and stakeholders having competing priorities among others. It is suggested that programs focus on intersectoral collaboration and service integration with existing programs to sustain and synergize domestic violence prevention intervention.