Addressing Intimate Partner Violence in South Asia: Evidence for Interventions in the Health Sector, Women's Collectives and Local Governance Mechanisms

Based on a systemic review of literature, this International Center for Research on Women (ICRW) report seeks to understand how best to design responsive intimate partner violence (IPV) interventions by examining relevant programmes that were or are being implemented in South Asia. These interventions use(d) one or more of the following three platforms: the public health system, local governance systems, or women's collectives. The report also gathers, synthesises, and analyses existing evidence from these programmes to identify key implementation challenges and understand how to design more responsive programmes, especially in India. The three aforementioned community-based platforms were selected because they are easily and frequently accessed by women, cover the range of interaction that women have with their communities, and are relevant to the Indian context.

As ICRW explains, IPV is defined as sexual, physical, or psychological violence inflicted by a partner or ex-partner. In India, IPV is rooted in the historical, social, and cultural practices that reinforce rigid patriarchal norms that generate and maintain spousal power relations sanctioning husbands' almost unlimited control and power over their wives. Meanwhile, a "good woman" is considered one who submits to and obeys her husband. These norms contribute to high levels of acceptance of IPV by men and women alike. They also contribute to a lack of openness to acknowledge and address IPV as a problem, due to stigma against those who have experienced violence and the fact that women are socialised to accept and tolerate the practice. Programmes do exist across the sub-continent to address multiple forms of violence against women. Yet a lack of rigorous evaluations makes it difficult to identify promising approaches. This report seeks to address that gap.

The document devotes a separate section to each of the three platforms of interest, with many specific strategies explored; communication-centred highlights follow:

The public health system (at the service institutions level): This might include, at the primary health centre (PHC) and block level, training of primary health workers to screen community health workers (CHWs) to screen IPV survivors or engaging CHWs to address IPV. An example of the latter is the Mitanin Program, Chattisgarh, India, whereby local women volunteers (mitanins) undertake family outreach, community mobilisation, and social mobilisation (e.g., using folk media) on health and its determinants, including gender-based violence (GBV). The researchers found a much larger number of health-platform-based interventions to address GBV that were centred at a district- or higher-level hospital. The analysis of these centres is divided by governmental versus non-governmental organisation (NGO) initiative. On the whole, the latter appear to have been more successful than the one-stop crisis centre (government-initiated) programmes in expanding a centre to encompass several platforms beyond the health system and in engaging a range of stakeholders.

A number of challenges and gaps in these health-sector-platform-based approaches are outlined. These are related to: documentation and evaluation; provider challenges (e.g., gender-insensitive norms and beliefs on their own part); challenges in operationalisation (e.g., due to poor communication and coordination among the different ministries); populations served; engaging men (few of the programmes reviewed do); focus on GBV versus IPV; and challenges related to scope of activities and reach. The report also identifies elements contributing to effectiveness of health platform approaches, including the tenure and quality of training and the engagement of other stakeholders and groups in the community.

Women's collectives (at the immediate community level): The collectives reviewed here are grouped into: (i) women's groups created as alternate dispute resolution mechanisms; (ii) women's groups structured around finances (microfinance, microcredit, and self-help groups, or SHGs); and (iii) community-based women's groups of all other kinds (depicted in Table 3). The report first describes examples and basic evaluation results for the efforts to address IPV via these collectives. To cite only one: The International NGOs Partnership Agreement Program (IPAP), India sets up women's dispute resolution collectives to operationalise five of its larger programme strategies: provision of support services to survivors; sensitising a range of governmental and non-governmental providers; community mobilisation against violence against women (VAW); creating and strengthening village-level structures to provide support mechanisms for women facing violence; and lobbying and advocating with policymakers. IPAP-India's evaluation found that, compared to control areas, the programme was effective in: raising awareness of domestic violence, especially among men; contributing to a gendered understanding of the causes of domestic violence; using police and legal mechanisms; and observing a higher reporting of domestic violence.

Despite the lack of rigorous evaluations for the most part, there are some clear repeated patterns across programmes that suggest certain critical elements for success. In brief: Break the culture of silence; create a safe space and "sisterhood" of support for women; fill gaps in access for the economically poorest; facilitate engagement with other service providers and institutions; engage with men; engage with community structures; function through transparent processes and clear protocols; and adopt a community-driven process to identify intended populations. This section then moves to a discussion of challenges for women's collectives and thoughts in moving forward. For instance, the IPAP-India programme found that it is a challenge to ensure that economically poorer, lower caste women have the opportunity to assume group leadership. The participatory, community-based strategies used to identify the "poorest of the poor" by the Mahalir Thitam and Velugu programmes illustrate how the least empowered, most disadvantaged can be engaged from the start.

The local governance system (at the political level of a community): In South Asia, there are - broadly speaking - two systems of local governance. One is the formal system that is part of the national government and to which members and leadership is often elected. In India this is the panchayat system, in Bangladesh the Union Parishad, and in Pakistan the Union Councils, for example. The second is the non-formal, religious systems of local governance, such as caste panchayats, shalish, jirga, or shura. These are typically led by older men in the community who are considered religious leaders and/or scholars. The analysis of addressing IPV through local governance is divided accordingly. On the whole, interventions use a range of strategies and activities to engage not just with male and female elected representatives, but also with men and boys, communities, and government institutions. One finding: In Bangladesh, Nepal, and Pakistan, having more women representatives on local governance councils encouraged more women to come forward with their concerns, and forums were active in adjudicating cases of domestic violence. However, in the NU-shalish programme initiated by Nagrik Uddyog (NU) in Bangladesh, women Shalishkars (consisting one-third of the members) did not typically intervene from concerns of gender equality but from concerns of legality and logic. In fact, in cases of spousal dispute resolution, including domestic violence, all efforts were made to reconcile the spouses, since this was the pragmatic approach in that context.

Some enabling strategies for using local governance as a platform to address IPV include: working across and with a range of institutions, and working with men (and women) in local governance institutions as members of an institution (to change their public actions) but also as individuals (to change their private beliefs and behaviour). Challenges include: backlash from traditional local governance organisations that perceive a challenge to their power; the structure of the local governance mechanism which may, for example, create or support politicisation; weak links with other institutions, and with levels of and services in the system; inadequate policy support; and logistics and finances.

Several programmes reviewed in the report have been scaled up or replicated, and the report examines these, also highlighting common concerns with such a process. Next, the researchers summarise some common enablers and challenges or obstacles to success that were mentioned repeatedly across programmes, as these are likely to be critical to address no matter what platform is chosen.

• Common enabling factors: clear protocols, procedures, and responsibilities; intensive, high-quality, gendered training; strategic engagement with other sectors and stakeholders; fostering community engagement; and including men and boys in addressing domestic violence.
• Common challenges and obstacles: lack of evaluation and documentation; time and availability of those addressing IPV; lack of clarity about mandate; dommunity or peer hostility; engaging with men and boys in ways that maintain interest, attention, and participation; limitations in reaching the most vulnerable women; consent and confidentiality; and logistical challenges.

The report concludes with a checklist of essential elements for future pilot programmes based on lessons learned. "Going forward, programmers and donors must discuss, delineate and arrive at a clearly documented understanding of what are the elements of 'success' they expect the programming to achieve. Equally important, the envisaged success must align with the goals, strengths and constraints of the platform(s) chosen as the base of IPV interventions."