Guidance for evaluations of interventions to prevent violence against women in conflict-affected settings: Lessons from a trial in Cote d'Ivoire

Lead Research Organisation: London Sch of Hygiene and Trop Medicine
Department Name: Public Health and Policy

Abstract

Violence against women and girls (VAWG) includes intimate partner violence (IPV), child sexual abuse, forced marriage, sexual harassment, and rape. Although 'rape in war' has become a priority in the nascent area of programming to prevent VAWG, emerging evidence from conflict settings suggests that IPV occurs more frequently than 'wartime rapes'.

The past decade has seen an unprecedented recognition of the scale of VAWG in conflict, with the UN Security Council alone issuing nine resolutions focused on sexual violence in conflict and fragile state settings since 2000. While innovative interventions are being implemented, to date there has been no published evaluation research on the impact of VAWG prevention activities in conflict-affected settings, and only two published trials in sub-Saharan Africa have demonstrated how different prevention programming may influence levels of intimate partner violence. Without evidence on the impact and process of prevention activities, many agencies are struggling to determine how to target their resources most effectively. Programmers and donors recognise the need for rigorous evaluations of VAWG prevention strategies to determine how to measure the impact of programming and learn from ongoing and new large scale investments.

This project aims to advance the field of VAWG intervention evaluation by developing a first generation of Evaluation Guidance for VAWG prevention interventions in conflict-affected settings.

Our project will build on our evaluation work in Cote d'Ivoire, a West African conflict-affected setting, as well as our other IPV prevention evaluations, and the field experience of the International Rescue Committee (IRC) (our project partner) and the needs of donors, such as the UK Department for International Development (DfID) to: 1) raise the profile of different forms of violence beyond 'rape in war' in conflict-affected settings; and 2) develop evaluation guidance to measure the impact of VAWG interventions.

Questions we will consider include: What are effective ways to measure the influence of VAWG prevention activities? How can we evaluate VAWG prevention interventions with different levels of resources and technical capacity? What are realistic outcome and pathway indicators for different settings and time periods? How might the interaction between programme and research staff affect the evaluation? In developing the Evaluation Guidance, we will prioritise the needs of practitioners and donors by incorporating options for adaptation and flexibility so that this guidance can be modified for different settings and available financial and technical resources.

To develop the proposed guidance, LSHTM and IRC will convene a Strategic Planning meeting with practitioners, donors and researchers to assess the state of VAWG prevention research, determine strategic measurement priorities and develop a framework to guide a desk-based analysis of prevention evaluation models. We will analyse data from our Cote d'Ivoire study to explore causal pathways for IPV and review methodological features for adaptation in future evaluation research. This information will be summarised for a Final Round Table Discussion with programme organisations, donors and researchers to refine the conclusions and the guidance. We will develop and implement a strategic dissemination plan that takes advantage of our group's leadership and participation in global and local fora on the subjects of violence against women and conflict-affected settings. Most importantly, this project will encourage programmes to address a wider range of VAWG in conflict settings and improve our understanding of what prevents and reduced violence.

Planned Impact

With increasing global commitment to the prevention of violence against women and girls (VAWG) or gender based violence (GBV), particularly intimate partner violence (IPV) and sexual violence in conflict settings, now is a strategic moment to contribute evidence to guide the growing inter-agency dialogue among practitioners, donors and researchers. We have assembled a project team that includes leading intervention researchers (Gender Violence & Health Centre at LSHTM), VAWG programme specialists in conflict settings (IRC's Women's Protection & Empowerment Technical Team) and major donors in this field (DfID's Security & Justice Adviser, Conflict Cadre and VAWG research team). Relying on our joint contacts in the field of VAWG, we will also assemble an advisory committee composed of other leaders in this field (e.g., Irish Aid, Human Rights Watch, World Health Organization, UN Action Against Sexual Violence in Conflict, Centers for Disease Control & Prevention).

We will use results from LSHTM's cluster randomised controlled trial of IRC's complex social intervention to prevent IPV, including identifying priority indicators for measurement, variables along the violence causal pathway and indicators of health and well-being, and the lessons we have learned about impact evaluation methods in a conflict-affected settings and other evaluation research, combined with IRC's applied programming knowledge and input from DfID staff about donor needs to inform the nascent field of GBV prevention and evaluation.

For dissemination of the VAWG Evaluation Guidance we will target: (1) international organisations and decision-making bodies involved with GBV response and prevention; (2) donors, private and bilateral; (3) national-level decision-makers; and (4) researchers working on complex intervention evaluations.

At the most basic dissemination level, our project team will ensure that the Evaluation Guidance is made available via our respective websites and relevant on-line networks. We will also consider the option of disseminating and advancing the discussion on VAWG prevention and evaluation via webinars, seminars and incorporation of results and the main messages into relevant publications by each of our groups. As we often participate in many of the same discussions and forums, our proposed project team will work together to promote two main areas of results from this project:

1. Increase recognition about the need to address the full range of violence against women and girls in conflict settings, rather than focussing exclusively on rape and other forms of sexual violence.

2. Provide guidance on VAWG prevention evaluation indicators, evaluation methods, required resources, evaluation priorities and differing project and donor measurement needs, especially for conflict-affected settings.

Each of the respective project partners (LSHTM, IRC, DfID) will use the project output within their own networks. Other strategic stakeholders will be invited to participate to ensure that the project has a high impact. We are confident that we have an extremely strong and well-coordinated team to ensure that we can take advantage of many international and local opportunities to influence programming, policy and research on VAWG.
 
Description International awareness of violence against women and girls (VAWG) and its impact on health and development has received increasing recognition. Most recently, sexual violence in conflict-affected settings has been a focus of international attention. However, emerging prevalence data suggest that attention to intimate partner violence (IPV) may warrant as much or greater attention-even in conflict-affected communities. Yet, there has been limited evidence on how to prevent IPV in general populations and in conflict-affected settings, in particular. To ensure that findings from our cluster randomised controlled trial (RCT), 'Working with Men to Prevent Violence Against Women' in Côte d'Ivoire, and other related evidence would inform future violence prevention research, we completed a complementary set of activities to raise the profile of different forms of violence, not solely non-partner sexual violence, in conflict-affected settings. We further aimed to use our knowledge and experience to build the evidence base on preventing violence against women and girls. The programme of activities and outcomes resulting from this grant included:

• Identification of violence outcomes for IPV prevention research in a conflict setting: We conducted secondary analysis of data arising from our research in Côte d'Ivoire. Using data from a community survey, we assessed men's and women's experiences of gender based violence and other traumatic events in Côte d'Ivoire, a West African conflict-affected setting. The data was collected during a cross-sectional household survey conducted in 2008 among 12 rural communities directly impacted by the Crisis in Côte d'Ivoire, spanning regions controlled by government forces, rebels and UN peacekeepers. The dataset included responses from a total of 2,678 men and women aged 15-49 years old who were interviewed to assess violence exposures since age 15 years old. Questions included intimate partner physical and sexual violence; physical and sexual violence by others (including combatants) and exposure to traumatic events before, during and after the Crisis period (2000-2007). This analysis resulted in the publication of some of the first epidemiological evidence on the levels and range of gender based violence occurring in Côte d'Ivoire following a period of active conflict. Our findings suggest that while sexual violence in conflict remains a critical international policy concern, men and women experience different types of violence before, during and after conflict and intimate partner violence, may be more widespread than conflict-related sexual violence. After a period of active conflict, physical violence from an intimate partner was the most frequently reported form of violence and highest among women (20.9% women, 9.9% men). Alongside service provision for survivors of sexual violence, our findings underscored the need for post-conflict reconstruction efforts (policy and programming) to invest in the prevention and response of intimate partner violence and trauma.

• Methodological lessons from the evaluation of an IPV prevention programme in a conflict setting: Evidence on how to prevent intimate partner violence is extremely limited especially within conflict-affected settings. We conducted secondary data analysis on our cluster RCT dataset to assess the impact of adding a targeted men's intervention to a community-based violence prevention program in an armed conflict-affected setting. Our analysis of an intervention working with men to prevent IPV in Côte d'Ivoire suggest violence levels in conflict-affected areas can be reduced and point to the added value of including violence prevention interventions that work with men alongside community-based programming.

• Mapping of VAWG prevention and evaluation models in conflict settings: Our systematic global review of programmes and evaluations of VAWG prevention programming in armed conflict-affected settings found that the majority of prevention programmes occurred in post-conflict settings and no rigorous evaluations existed of programming in emergency settings. Of the few evaluations reviewed, few were conducted using rigorous methodologies (i.e., limited number of RCTs, few using comparison groups) and most focused on awareness raising efforts. Our Côte d'Ivoire research was found to be one of the few evaluations using a rigorous design conducted in a conflict-affected setting.

• Scope of evaluation needs for VAWG prevention: An expert group meeting for specialists working on the prevention of violence against women and girls in humanitarian crisis settings was held in London (July 2013). The meeting brought together an expert group of practitioners, policy makers, donors and researchers in order to determine prevention priorities and methodologies in conflict-affected settings. The meeting led to a review of prevention programming and evaluation methodologies within conflict-affected settings. The lack and difficulty of conducting rigorous evaluation within acute and emergency settings was highlighted by all stakeholders along with the need for improved evidence from crisis settings in the chronic and post-conflict stages. The difficulty of conducting research, limited resources and research technical capacity among programming staff along with a lack of standardized approaches for the measurement and sampling for representative populations were also highlighted. As a result of the meeting, a collaboration was formed between the London School of Hygiene & Tropical Medicine and the University of Ghent to pursue the development of a research consortium to field test approaches to measure gender based violence outcomes in humanitarian crisis settings among women, men and children. Funding proposals are under development.
Exploitation Route Methodological limitations are one important factor that has limited the wide-spread implementation of rigorous evaluation of violence prevention work in conflict-affected settings. This work provides quantitative measures and practical methodological and ethical lessons that can be used for the evaluation of programmes that work with men to prevent violence within conflict-affected settings. This programme of work intends to strengthen the ways that research is conducted on violence against women prevention programming in conflict settings, thereby improving our evidence base to inform policies and programming. We have disseminated our findings in various fora including the presentation of results at the United Nations headquarters at the 57th session of the Commission on the Status of Women, the UK Foreign & Commonwealth Office, at the Sexual Violence Research Initiative (SVRI) Forum which is an international conference for researchers working on sexual and intimate partner violence, and at multiple events for research and programming audiences within London. In addition, several peer-review publications have been written in collaboration with non-academics and published under an open-access license to ensure the information is made available to a wide audience. This audience includes researchers, policymakers, donors and organisations working on the development of violence prevention and response programming and policies within humanitarian crisis settings.
Sectors Communities and Social Services/Policy,Security and Diplomacy,Other

 
Description International awareness of violence against women and girls and its impact on health and development has received increasing global recognition, especially within humanitarian crisis and post-conflict settings. We used the results and lessons from LSHTM's pilot cluster randomised controlled trial of the International Rescue Committee's (IRC) Engaging Men in Accountable Practise (EMAP) to engage with policy debates about how best to respond to violence against women in conflict, as well as to inform the nascent field of gender based violence (GBV) prevention and evaluation in humanitarian contexts. Our analysis of women's patterns of exposures to violence show that combatant perpetrated violence is a relatively small portion of the violence that women experience. The intervention trial findings suggest that the intervention has economic and societal impacts, which include improving social welfare and social cohesion and enhancing quality of life among its beneficiaries. The findings have also contributed to evidence-based policy-making and increased public engagement with research through presentations at various local and international fora. The broader review of evidence on violence prevention in conflict settings highlights the many gaps in current evidence, and the need to support the evaluation of prevention and response initiatives. The findings were promoted at various fora including the Global Summit to End Sexual Violence in Conflict (London), the United Nation's Fifty-eighth session of the Commission on the Status of Women (New York), and the Sexual Violence Research Initiative Conference (Bangkok). The research was disseminated on expert panels to advance the discussions on violence prevention and evaluation. These activities were able to: • Increase recognition of the need to address the full spectrum of violence against women and girls in conflict settings, rather than focus too narrowly on sexual violence by state actors. • Provide methodological guidance to others evaluating violence programming or setting policies for programming and evaluation in conflict settings. • Illustrate that it is possible to evaluate violence prevention programmes in post-conflict settings, and to address the multiple potential benefits of effective programming with men. • Use the findings to inform future programming by IRC in the 17 humanitarian crisis settings where they deliver violence programming. These activities built on the work of LSHTM's research team and the IRC programming team and their strong networks and active participation in the global dialogues on violence prevention. This network includes UN organisations, government ministries, bi-lateral and private donors and other international and local organisations working on violence prevention and response. The direct impact included: 1. Presentations on expert panels at high-level meetings including the United Nations and to parliamentarians at the Global Summit to End Sexual Violence in Conflict, influenced policymakers in charge of gender based violence programming in their own countries. Practitioners in attendance were also influenced to pursue rigorous evaluation approaches. 2. Through sharing methodological lessons with other researchers through formal and informal networks, other researchers have implemented similar approaches in their studies. 3. The findings also influenced the evolution of the intervention approach, particularly the importance of keeping women's priorities at the centre of any intervention, while working directly with men. (Hossain et al 2014) As a result, a women's group component was added to tailor the intervention to the context at the community level by using direct feedback from women living in the same community. The men's group intervention was ultimately been renamed to 'Engaging Men in Accountable Practice' (EMAP) to reflect its development since the pilot trial in Cote d'Ivoire. 4. As of December 2014, two international trainings have been organised for the next iteration of EMAP. Two had already been held in Nairobi (2013) and Bangkok (2014) and an additional training is planned in Bangkok in 2015. The eight-day trainings are intended to reach professionals who are responsible for gender based violence (GBV) programming and prevention activities in humanitarian and post-conflict settings. The trainings are able to reach a global cohort of professionals who are then able to use the EMAP intervention within their own work. The trainings will eventually certify trainers in the EMAP approach who can then train others. 5. The EMAP intervention will be rolled out on a larger scale in the Democratic Republic of Congo in 2015. A second phase impact evaluation is planned for 2015 in the DRC to assess the influence of the next iteration of the intervention in a different conflict-affected setting. The EMAP intervention has also been rolled-out to other sites in Cote d'Ivoire and has started in Liberia.
First Year Of Impact 2013
Sector Communities and Social Services/Policy,Security and Diplomacy,Other
Impact Types Societal,Policy & public services

 
Description Standardizing the measurement of gender based violence in humanitarian crisis settings 
Organisation International Center for Reproductive Health (ICRH)
Country Belgium 
Sector Charity/Non Profit 
PI Contribution Building on the priorities and needs identified during this grant [LSHTM Expert Group Meeting-London in July 2013, evidence and lessons from research conducted in Cote d'Ivoire, and a LSHTM-led systematic review of violence prevention programming and evaluations], a research collaboration was formed with the LSHTM and the University of Ghent in order develop a funding proposal and consortium to validate and standardize research methodologies for measuring gender based violence in humanitarian crises. The research consortium currently consists of academic, operational and research organisations, as well as epidemiologists, social scientists and health professionals that work in humanitarian crisis settings. Members include individuals from the following institutions: World Health Organization-Geneva, Harvard Humanitarian Initiative-USA, Columbia University-USA, John Hopkins University-USA, UNESCWA-Lebanon, Uganda Protestant Medical Bureau, University of Amsterdam, Bioethics Institute Ghent, Center for Women?s Resources-Philippines, Citizen?s Disaster Response-Philippines, Centre for Children in Vulnerable Situations-Belgium, University of Denver-USA, Try Center-Jordan, HarrassMap-Egypt.
Collaborator Contribution Building on the priorities and needs identified during this grant [LSHTM Expert Group Meeting-London in July 2013, evidence and lessons from research conducted in Cote d'Ivoire, and a LSHTM-led systematic review of violence prevention programming and evaluations], a research collaboration was formed with the LSHTM and the University of Ghent in order develop a funding proposal and consortium to validate and standardize research methodologies for measuring gender based violence in humanitarian crises. The research consortium currently consists of academic, operational and research organisations, as well as epidemiologists, social scientists and health professionals that work in humanitarian crisis settings. Members include individuals from the following institutions: World Health Organization-Geneva, Harvard Humanitarian Initiative-USA, Columbia University-USA, John Hopkins University-USA, UNESCWA-Lebanon, Uganda Protestant Medical Bureau, University of Amsterdam, Bioethics Institute Ghent, Center for Women?s Resources-Philippines, Citizen?s Disaster Response-Philippines, Centre for Children in Vulnerable Situations-Belgium, University of Denver-USA, Try Center-Jordan, HarrassMap-Egypt.
Impact Funding not received.
Start Year 2012
 
Description 57th session of the UN Commission on the Status of Women: Violence prevention in a conflict-affected setting: Results from a cluster randomised controlled trial in Côte d'Ivoire 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Mazeda Hossain and Charlotte Watts presented on an expert panel for violence against women prevention programming at the 57th session of the UN Commission on the Status of Women (CSW), United Nations Headquarters (NY, USA). The 57th Commission on the Status of Women focused on the elimination and prevention of all forms of violence against women and girls. The results from the Cote d'Ivoire cluster RCT were used to highlight potential outcomes, indicators and lessons learned from a violence prevention programme in a conflict-affected setting. The expert panel on violence prevention programming and evaluation was facilitated by Irish Aid- Department of Foreign Affairs and Trade. The 57th Commission on the Status of Women focused on the elimination and prevention of all forms of violence against women and girls. The results from the Cote d'Ivoire cluster RCT were used to highlight potential outcomes, indicators and lessons learned from a violence prevention programme in a conflict-affected setting. The expert panel on violence prevention programming and evaluation was facilitated by Irish Aid- Department of Foreign Affairs and Trade.

The 57th Commission on the Status of Women focused on the elimination and prevention of all forms of violence against women and girls. The results from the Cote d'Ivoire cluster RCT were used to highlight potential outcomes, indicators and lessons learned
Year(s) Of Engagement Activity 2013
 
Description Ethical and safety considerations when conducting epidemiological research on vulnerable populations 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact Presentation on the ethical and safety challenges faced when conducting research on violence among vulnerable populations using examples from research on asylum seeking women, women trafficked for sex and a violence prevention trial in a conflict-affected setting. Presented as part of a Ethics in Public Health Research seminar series at the London School of Hygiene & Tropical Medicine.

After the talk, attendees asked for additional information and also reported increased understanding the context of working with vulnerable populations.
Year(s) Of Engagement Activity 2013
 
Description Evaluation of a complex intervention to prevent intimate partner violence in a conflict-affected setting: Lessons from a cluster RCT in Côte d'Ivoire 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact Panel presentation at the New Directions in Public Health Evaluation Conference (2012) at the LSHTM. The presentation provided an overview of methods and lessons learned while conducting a cluster randomized controlled trial of a violence prevention intervention in a conflict-affected setting among a population with a high-level of exposure to violent & traumatic acts.

Inquiries for additional information were received following the presentation.
Year(s) Of Engagement Activity 2012
 
Description Gender based violence in conflict-affected settings: Measurement, prevention and evaluation 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Schools
Results and Impact Presentation for LSHTM Short Course: Researching Gender Based Violence: Methods and Meaning. Talk sparked discussion and questions. Participants were able to relate findings and lessons to their own related research.

After talk, participants asked questions, inquired about future collaboration and were able to apply lessons to their own related research.
Year(s) Of Engagement Activity 2013
 
Description Researching gender based violence in a conflict-affected setting: Lessons from Côte d'Ivoire 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Overview of methodological considerations when conducting research on violence in a conflict-affected setting. Presented at the LSHTM Short Course - Researching Gender Based Violence: Methods & Meaning.

Following the presentation, course participants asked additional methodological questions in order to understand how they could apply it to their own evaluation research. Requests to remain in contact for future collaborations also occurred.
Year(s) Of Engagement Activity 2013
 
Description Standardizing the measurement of gender based violence in humanitarian crisis setting (Technical Workshop) 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Building on the priorities identified during the LSHTM Expert Group Meeting (London, July 2013), a research collaboration was formed by the LSHTM (led by M Hossain) and the University of Ghent (led by O Degomme). The research collaboration aims to obtain further funding to validate and standardize research methodologies and ethical guidelines in three different humanitarian crisis contexts. We held an expert technical workshop (Dec 2013) focused on methodologies to measure the prevalence of gender based violence (GBV) in humanitarian crisis settings among women, girls, men and boys.

Funding proposal developed following the meeting for future research collaboration.
Year(s) Of Engagement Activity 2013
 
Description UK Foreign & Commonwealth Office Round Table: Preventing violence against women & girls in conflict: an evidence-informed perspective 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact The findings influenced discussions on priority setting on the UK government's funding for the prevention of violence against women and girls.
Year(s) Of Engagement Activity 2013