Improved Relationship Quality, Equitable Gender Attitudes, and Reduced Alcohol Abuse as Key Mechanisms to Reduce Intimate Partner Violence in the Bandebereho Couples' Randomized Trial in Rwanda.

Over the past decade, there has been rapid growth in the evidence for programs to prevent or reduce intimate partner violence (IPV)-the most common form of men's violence against women. IPV interventions targeting heterosexual couples have shown significant impact. However, our understanding of how these interventions achieve their impacts on violence-the mechanisms through which change occurs-remains limited. Using data from two follow-up rounds of a randomized controlled trial of the Bandebereho intervention in Rwanda, we constructed conceptually driven structural equation models to represent the processes by which hypothesized mediating variables linked treatment assignment to IPV. We found significant differences in the expected direction between the intervention and control participants on all mediating variables, including men's alcohol use, communication frequency, emotional closeness, frequency of quarreling, and men's attitudes related to gender and violence. Several mechanisms-more positive couple dynamics including emotional closeness and communication frequency; men's gender-equitable attitudes; men's alcohol use-accounted for the largest proportions of the effect of assignment to the Bandebereho intervention on IPV. Overall, our findings highlight that no one particular component is driving the reductions in violence; instead, the multiple components and pathways account for the intervention's effects, suggesting that the holistic nature of the intervention may be integral to its positive impact. The Bandebereho trial from which data was used in this analysis was registered on ClinicalTrials.gov prior to completion ( NCT02694627 ).

Long-term impacts of the Bandebereho programme on violence against women and children, maternal health-seeking, and couple relations in Rwanda: a six-year follow-up of a randomised controlled trial.

Background: Programmes that work with parents to build couple relationship and parenting skills and include critical reflection on gender norms are a promising approach for reducing violence against women and children. However, there is limited evidence of their longer-term impact. In Rwanda, the Bandebereho programme engaged expectant and current parents of children under five years. At 21-months, Bandebereho demonstrated positive impacts on intimate partner violence (IPV), child physical punishment, maternal health-seeking, and couple relations. This study seeks to explore whether those outcomes are sustained six years later. Methods: A six-year follow-up to a two-arm, multi-site randomised controlled trial was conducted in four districts of Rwanda between May and September 2021. At baseline, couples were randomly assigned to either the 15-session intervention (n = 575) or a control group (n = 624). At this follow-up, 1003 men and 1021 women were included in intention to treat analysis. Generalised estimating equations with robust standard errors were used to fit the models. This study was registered with Clinicaltrials.gov (NCT04861870). Findings: Bandebereho has lasting effects on IPV and physical punishment of children, alongside multiple health and relationship outcomes. Compared to the control group: intervention women report less past-year physical (OR = 0.45, 95% CI 0.34-0.60 p < 0.001), sexual (OR = 0.50, 95% CI 0.37-0.67, p < 0.001), economic (OR = 0.47 95% CI 0.34-0.64, p < 0.001), and moderate or severe emotional (OR = 0.40 95% CI 0.29-0.56, p < 0.001) IPV. Intervention couples report less child physical punishment (OR = 0.72, p = 0.009 for men; OR = 0.68, p = 0.017 for women), fewer depressive symptoms (OR = 0.52, p < 0.001 for men; OR = 0.50, p < 0.001 for women), less harmful alcohol use, and improved maternal health-seeking, father engagement, and division of household labour and decision-making. Interpretation: Our study expands the evidence, demonstrating that programmes engaging men and women to promote collaborative and non-violent couple relations can result in sustained reductions in family violence six years later. Funding: The Echidna Giving Fund, Grand Challenges Canada, the Oak Foundation, and Wellspring Philanthropic Fund supported this study.