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�Training Care Groups on Sexual and Gender-Based Violence in Rural Niger

By:

Julie Tanaka and Bruce Larkin

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Niger

Least developed country in the world according to UN Development Index
48% of the population has access to healthcare
6% of Nigerien children 6-23 months of age receive a minimum acceptable diet
Among U5 children, 42.5% suffer from chronic malnutrition and 10.3% suffer from acute malnutrition
Fertility rate of 7.6 live childbirths per woman (World Bank, 2015)

https://wikitravel.org/en/Niger

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Banibangou

40 kilometers from Mali border
Insecurity due to AQIM
Chronic drought and food insecurity
Among children aged 6-23 months in 11 select villages

GAM = 26.5% (95% CI = 20.5%-32.6%)
SAM = 17.4 % (95% CI = 12.23%-22.66%)

https://www.africaguide.com/country/niger/

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Background

Major gender inequalities
Physical violence against women is ubiquitous

70% of women believe men may justifiably beat their wives (INS, 2017)

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Project Description

Bridging Gaps in Community Health (BGCH) funded by Samaritan’s Purse
Male and Female Care Groups

302 Leader Mothers (LM)
217 Leader Fathers (LF)

Trained on IYCF, MCH practices, birth spacing

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Project Description (cont.)

LMs and LFs were trained by “Health Promoters”

Literate community volunteers

LMs and LFs relay messages to 10-12 of their neighbors of the same gender through Neighborhood Groups (NGs)
Cascaded to 3,000 women and 2,000 men

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Project Description: Other Activities

Helping Babies Breathe training with MoH staff
CHW trainings on malnutrition screening
Capacity building of local health committees
Trainings with local imams on the Healthy Timing and Spacing of Pregnancy

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Photo: Saley Inoussa

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Imam Trainings on SGBV

Local Imams trained on the compatibility of birth spacing and SGBV prevention with the Koran

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Formative Research

Focus Groups—one set of 10 LMs, 10 NW, 10 LMs and 10 NM were included
Findings

Lack of protection services in the community
Speaking out on SGBV is taboo
Local authorities have been known to prohibit victims from voicing their complaints to police
Patient confidentiality issues

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Curriculum Design

Adapted from Phase 1 of Sasa Faith! (Michau and Siebert, 2016)
Designed for illiterate adults
Laminated images
6 one-hour sessions

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Samaritan’s Purse Nutrition Sector

Training Care Groups on SGBV in Rural Niger

Results from Focus Groups informed the curriculum design

The use of a modified version of Sasa! Faith proved to be an effective curriculum for the rural Muslim audience. The curriculum aims to promote gender equality by encouraging participants to reflect on how power dynamics affect interpersonal relationships. Subsequent lessons guide participants to apply the concept of power to gender equity and violence against women. This varies drastically from programmes that rely on dogmatic instructional messaging against SGBV (Michau et al, 2015). This subtle approach was apt for the audience, who may have been resistant to a more overt form of messaging.

--Sasa Faith, talks more about power dynamics, rather than a black and white perspective, which is easier for people to digest. It is important to note that he failed to find any other intervention that used uneducated adults to bring forth the intervention. First protection project that relied on uneducated LMs to transmit these complicated and nuanced topics. Had to adapt it to use for illerate adults.. Happened over 8 weeks, 6 one hour sessions, almost every week, short and simple, lot of repetition—general rule for Care Groups esp because of illiteracy and uneducated—trying to make it less complicated.

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Curriculum Design (cont.)

Key Messages Included:

Types of social power and power dynamics
“Equality’, defined as all individuals having the same rights, opportunities and life chances, regardless of gender or age
The types of violence commonly enacted against women

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Curriculum Design (cont.)

Key Messages (cont.):

The need for victims of sexual violence to be referred to a health center within 72 hours of any incident
The different ways in which violence impacts groups of people within society.

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Implementation of SGBV Module

Pilot

2 month duration from September to November 2017
302 LMs and 3,113 NW and 217 LFs and 2,391 NM trained
Health Promoters with little to no education

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Findings

6 female CGs and 5 male CGs were randomly selected to participate in the knowledge and attitude surveys
Each of these LMs and LFs surveyed each member of their NG
Surveyed 1,374 participants
Percentage of correct responses increased from 43% to 71.9%

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Findings (cont.)

Similar improvement between men and women
Improvements in attitudes towards:

Physical violence
Forced sexual intercourse
Roles of wives in financial decision-making

Misinterpretation of 2 knowledge areas

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Table 1. Distribution of correct responses to SGBV attitude questions in pilot pre-test (September 2017) and post-test (November 2017) among BGCH II CG beneficiaries.

Question	Correct Response	Pretest		Post-test		Statistically Significant? (p>=0.05)
Question	Correct Response	n	% (95% CI)	n	% (95% CI)	Statistically Significant? (p>=0.05)
Husbands have the right to force their wives to engage in sexual intercourse.	FALSE	1036	39.5% (35.27% - 43.7%)	1365	90.8% (88.60% - 92.9%)	Yes
Men have the right to beat their wives.	FALSE	1036	38.7% (34.51% - 42.9%)	1363	92.3% (90.29% - 94.3%)	Yes
It is acceptable for a man to force his wife to give him the money she has saved.	FALSE	1036	33.6% (29.52% - 37.7%)	1372	90.7% (88.49% - 92.8%)	Yes
Using one’s power over someone else is abuse of that person’s rights.	TRUE	1036	44.2% (39.93% - 48.5%)	1364	92.3% (90.30% - 94.3%)	Yes
I have the power to promote change in my community.	TRUE	1036	53.3% (48.99% - 57.6%)	1363	91.6% (89.48% - 93.6%)	Yes
I have the power to promote change in my community. (Women only)	TRUE	756	52.5% (47.48% - 57.5%)	748	90.8% (87.84% - 93.7%)	Yes
Who is the decision maker on major purchases in your household?*	Both Husbands and Wives	1040	21.2% (17.64% - 24.7%)	1363	83.9% (81.18% - 86.7%)	Yes
*Participants were given the option of responding, "Husband," "Wife," or "Both Husband and Wife." "Both Husband and Wife" was considered the correct response.

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Table 2. Distribution of correct responses to SGBV knowledge questions in pilot pre-test (September 2017) and post-test (November 2017) among BGCH II CG beneficiaries

Question	Correct Response	Pretest		Post-test		Statistically Significant? (p>=0.05)
Question	Correct Response	n	% (95% CI)	n	% (95% CI)	Statistically Significant? (p>=0.05)
Men are just as frequently victims of rape as women.	FALSE	1036	69.7% (65.73% - 73.6%)	1365	6.6% (4.73% - 8.5%)	No
Men, women, boys, and girls are all usually affected similarly by emergency situations.	FALSE	1036	56.7% (52.39% - 60.9%)	1364	90.4% (88.18% - 92.6%)	Yes
Violence against women is any act directed at a girl or woman that causes harm and is meant to keep a girl or woman under the control of others.	TRUE	1036	30.6% (26.63% - 34.6%)	1364	8.8% (6.67% - 10.9%)	No

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Discussion

SGBV messaging can be successfully integrated into CG interventions

Meaningful given that many LMs and LFs were illiterate

The modified version of Sasa! Faith was effective in reaching the rural Muslim audience.
Sensitization of Key Influencers—Imams—was crucial

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Samaritan’s Purse Nutrition Sector

Training Care Groups on SGBV in Rural Niger

--Sensitization of Imams gave more authority to what was being promoted

--donors really want interventions to be gender sensitive. If you could create a system to integrate SGBV into health and nutrition care groups—opens the door for funding. Empowering women in terms of protection but also tools to take care of their health and health of their kids—those 2 sectors will synergistically affect each other

--talking about very sensitive issues—it well well. Sasa Faith was developed for Christian and Muslim audience and it proved to be effective and it applied very well to the Nigerian context. Would have applied well to a Christian context.

--Sensitization of key influencers--philosophy in health and nutrition interventions is to target every key influencer group in the community—first training with the men—some of the men were very resistant to the training—when the trainers said “the imam received the same training and were ok with it”--that caused them to relax and accept the training.

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Recommendations

Community health actors incorporate SGBV messaging in their behavior-change programming.
Future Research on:

How knowledge and attitude change can lead to behavior change
How to measure SGBV behavior change in a systematic way when the topic is taboo
More extensive SGBV curriculum that can be adapted to multiple contexts, tested by multiple partners
Effects of promoting women’s empowerment and SGBV on IYCF and nutritional status indicators over an extended period of time

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Samaritan’s Purse Nutrition Sector

Training Care Groups on SGBV in Rural Niger

--Even with uneducated instructors, certain SGBV messages can be effectively transmitted using the CG model. As SGBV is a pertinent issue, it is suggested that nutrition actors incorporate SGBV messaging in their behaviour-change programming. Nutrition insecurity is linked to gender inequality and improved women’s empowerment, and gender equity can affect intra-household food distribution; women’s decision-making power over income, time and childcare practices; and household division of labour. All these things can affect a woman’s ability to practice the kinds of IYCF behaviours that lead to improved nutri- tional status for children during their most vulnerable years. These educational sessions, however, should be closely monitored to ensure that nuanced topics are clearly understood.

--Nutrition insecurity is linked to gender inequality and improved women’s empowerment, and gender equity can affect intra-household food distribution; women’s decision-making power over income, time and childcare practices; and household division of labour. All these things can affect a woman’s ability to practice the kinds of IYCF behaviours that lead to improved nutritional status for children during their most vulnerable years.

--Limitations—concerns that 2 of the questions were interpreted incorrectly. Wondered whether the recipients what they believed or what they knew we wanted them to say. They are reporting attitudes which may be their knowledge and not their genuine attitude. We have wondered about that.

--

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Any Questions?

https://photo.samaritanspurse.org/nurturing-niger/photos/3589507

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Bibliography

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Bibliography

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