Shifting Norms in Faith Communities to Reduce Intimate Partner Violence: Results from a Cluster Randomized Controlled Trial in Nigeria.

Programs aiming to reduce intimate partner violence (IPV) increasingly seek to shift social norms. Few interventions have been rigorously evaluated for their impact on norms and incidence of IPV, particularly in sub-Saharan Africa. Shifting norms at the community level and subsequent pathways to behavior change remain poorly understood. We assessed shifts in individual- and couple-level factors, social norms, and IPV from an 18-month community-based trial of the Masculinity, Faith, and Peace (MFP) program-a faith-based, norms-shifting approach-in Plateau state, Nigeria. This study was part of a community-based, mixed-methods, two-arm cluster randomized control trial (cRCT) to evaluate the MFP program. Quantitative surveys were conducted with women 18 to 35 years old (n = 350) and their male partners (n = 281). Respondents came from 10 Muslim and 10 Christian congregations. Social norms were measured based on results from factor analysis. Intent-to-treat analyses assessed intervention effects. Qualitative research in MFP congregations explored pathways of change. All forms of IPV reduced over time among MFP participants. Regression analyses showed a significant 61% reduction in odds of reporting experiencing any IPV among women, a 64% reduction among Christians, and a 44% reduction in MFP congregations compared to their respective controls. In addition to improvement in norms, we found significant intervention effects on individual attitudes toward IPV and gender roles, relationship quality, and community cohesion. Qualitative findings reinforce these pathways, suggesting that critical reflection and dialogue on existing norms and the focus on faith and religious texts were valued by participants and supported IPV reductions. This study demonstrates that a faith-based, norms-shifting intervention can significantly reduce IPV in a short time. There are several pathways through which MFP reduced IPV, including shifts in norms, attitudes, relationship quality, and community cohesion.

Applying a Power and Gender Lens to Understanding Health Care Provider Experience and Behavior: A Multicountry Qualitative Study.

A limited but growing body of literature shows that health care providers (HCPs) in reproductive, maternal, and newborn health face challenges that affect how they provide services. Our study investigates provider perspectives and behaviors using 4 interrelated power domains-beliefs and perceptions; practices and participation; access to assets; and structures-to explore how these constructs are differentially experienced based on one's gender, position, and function within the health system. We conducted a framework-based secondary analysis of qualitative in-depth interview data gathered with different cadres of HCPs across Kenya, Malawi, Madagascar, and Togo (n=123). We find across countries that power dynamics manifest in and are affected by all 4 domains, with some variation by HCP cadre and gender. At the service interface, HCPs' power derives from the nature and quality of their relationships with clients and the community. Providers' power within working relationships stems from unequal decision-making autonomy among HCP cadres. Limited and sometimes gendered access to remuneration, development opportunities, material resources, supervision quality, and emotional support affect HCPs' power to care for clients effectively. Power manifests variably among community and facility-based providers because of differences in prevailing hierarchical norms in routine and acute settings, community linkages, and type of collaboration required in their work. Our findings suggest that applying power-and secondarily, gender lenses-can elucidate consistencies in how providers perceive, internalize, and react to a range of relational and environmental stressors. The findings also have implications on how to improve the design of social behavior change interventions aimed at better supporting HCPs.

Men and COVID-19: Adding a gender lens.

In this commentary, the authors point out that there are important gender determinants to both men's and women's vulnerabilities to COVID-19, and call on the global health community to unpack and address these early in the COVID-19 pandemic response. They point to best practices and tools from two decades of engaging men in research and programming in the sexual and reproductive health field.