Changing Community Norms Around Domestic Violence in The Gambia :

A public health approach.

Dr. Matthew Shaw MSc MRCGPPublic & Environmental Health Research Unit London School of Hygiene & Tropical MedicineMatthew.shaw@lshtm.ac.uk

St. Louis

Dakar

Banjul

Bissau#

Why the Jola ?

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SER SIB FAR BAS

1993-52000-1

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SER SIB FAR BAS

1993-52000-1

Relevant cultural factors••Gender inequality Gender inequality

••Extended family systemExtended family system

••Daughter exchange & arranged marriageDaughter exchange & arranged marriage

••IslamIslam

••ChildhoodChildhood

••Female and male Female and male genital mutilationgenital mutilation

••Male hostility to Male hostility to FP/condomsFP/condoms

••Small organised Small organised communitiescommunities

Social Science & Public Health:Exploring the cultural landscape

Evaluation Tools

Stepping Stones

Capability for change

Empowerment?

§ Group building, problem identification4 sessions§ Reproductive health information

STIs, Infertility, Fertile period (morning after pill), HIV, Condoms3 sessions§ Participatory analysis of determinants of risk

2 sessions § Assertiveness training – ‘I’ Statements

2 sessions § Community Mobilisation

Presentation of special request to the community –‘we’ statement 3 sessions

Timeline• 97/99 2 x 2 pilot study 1 (HIV risk reduction)

• KAP survey 140 interviews at baseline, 8 wks & 1 yr.

• (25% random sample of adults)

• Condom demand

• 86 In depth interviews at 8 weeks and 1 year

• Participatory evaluation at 1 yr

• 2003 PhD fieldwork (Domestic violence)

• 6 months participatory observation

• Background ethnography, Focus groups, Interviews

1 "Before we were sleeping, now we are awake": Preliminary evaluation of a community-based sexual health programme in The Gambia. Paine K, Hart G, Jawo M, et al African Journal of AIDS Research 2002;1:41-52.

Villages A & B

••adult population 315adult population 315••2/3 no education 2/3 no education ••1/3 women in arranged marriage1/3 women in arranged marriage••¾ in ¾ in polygynouspolygynous marriagemarriage••145 enrolled in the programme 145 enrolled in the programme

(46%)(46%)

Now, sooner, later……

TBHeadacheWormsBoils

InfertilityUnplanned familyStomach acheJoint pains

Unsafe sexSpread of STI AIDS

You

ng

Men

JealousySTIsSexual weaknessHigh blood pressure

Having casual sexHeadacheGeneral body pain

Too many wivesMalariaEpi-gastric problemsO

ld

Men

Pain during sexSex when tiredafter delivery

Sex during mensesHusband refuses

condomDeflowering of young

girls

Too many childrenSex by forceAIDSSTIsUnwanted pregnancyWife beatingY

oung

Wo

men

JealousyMenopause painsSex when unwell or

pregnantHeadaches

Husband looking for a new wife

Sex when tiredTiredness after deliveryNo money

Sex when grandchildren awake

Wife beatingSTIsAIDSUnwanted pregnancy

Old

W

om

enLATERSOONNOW

Special requests

Village BVillage AOM

Village A&BYM

Parents prevent premarital sex

(daughters)

Be faithful or use condoms

Village A&BOW

Village A&BVillage A&BYW

Stop beatingMore financial support to prevent infidelity

Individual themes••Improved risk awarenessImproved risk awareness

••Improved cooperation across the villagesImproved cooperation across the villages

••Increased condom knowledge/use Increased condom knowledge/use

••Premarital, during breastfeeding, Premarital, during breastfeeding, extramaritalextramarital

••Assertiveness skillsAssertiveness skills

••Dialogue about HIV risk between partnersDialogue about HIV risk between partners••Increased permission to travelIncreased permission to travel••Acceptance of sex refusalAcceptance of sex refusal

Community themes

•• Community surveillanceCommunity surveillance–– Financial support from husbandsFinancial support from husbands–– Domestic violence grapevineDomestic violence grapevine

•• SanctionsSanctions–– By lawBy law–– Women's solidarityWomen's solidarity

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Marabout# Dam

#Football f

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Teacher

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Jat

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Jar

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Thatch

#Shop

#Mann

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Mosque

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Ustas

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Thatch

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#Borehole

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Skills cen

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New Hse

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Alkalo

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Bantaba

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Bantaba

Village B

How – social norms

From the final request, we have assigned ourselves as watchmen to one another, so that we know who will first violate the promise on wife beating (old man, 1 year, participatory evaluation, village B).

Village BSince the programme only one person

doesn’t hear what has been said and is always quarrelling with his wife. It is in fact less than a week since he had a fight with his wife. He seriously beat her, and wounded her. We held a meeting and wanted to beat him but it was prevented by our fathers.

(Young male participant, shortly after)

One man used to beat his wife, but he has passed away now. The other man beat his wife without compromise…the villagers came to the alkaloand told him to try and send the man away otherwise there will be a big problem….but now the wife has gone back to her parents and there is no more marriage between them….It was the alkalo who did it, he advised her to go back to her parents in Guinea. She went with the husband to Guinea, and her parents asked her to stay as she was treated very badly, so she never came back.

Q What did the man do? Did he come back?A No he is still there – he never came back

Young woman village B

Circumcision forest

Football

Health Centre

Primary Sch.

Alkalo

Shop

Mosque

Marabout

Well

Well

BoreholeBantaba

Banta

Village A

Adult population 138

Wife beating - then

Before the programme I was beaten more than 5 times in a month. I used to say that I'm only here because of my children, but now I thank God because of the programme.

( first wife, old woman, participant, Village A, 1 year)

Q. Which villages have visited your village for Salibu?F. A village called (a village) came here twice, but at that

time we had not gone for our Salibu. Later (another village) came because they also had to pay for a celebration, but these women were not invited by our husbands and ourselves.

I. You know we went for Salibu at (a third village) without the permission of our husbands and when we came back there was a problem between us and our husbands. So this was why we did not entertain those women.

Q. So when the women of (1st village) came what did your husbands do?

FJ Those women were shared to each manVillage A Young Women’s focus group

Village A

I thought every woman would go to her mothers until no woman was left in the village

(young woman participant village A, 1 year)

M. If you sleep with a man or partner, whatever he gives you is yours, you can’t share out that money because you have sex for your personal feelings, not for the (women’s) group, maybe he will give you one hundred or even five hundred

Q So might it happen that that he doesn’t give you any money

B. That can not be possible, he must give you some money

Young women’s focus group village A

Village A - Sanctions

Q. How was married life then and now?A. In those days women were left to do all the

housework and farm work. If your husband was angry with you he would beat you severely and throw your belongings on the street, but you would not go home because of the children. But now a days the women would go away, it has been 4 years since I heard of a wife being beaten

(70yr old woman village A, 3 ½ yrs)

Relationship qualityThe marriage before was very difficult

because if you want to discuss with your husband even if it is a simple thing he takes it to be a big thing.

….. before I did not take my husband to be important because I was also thinking that he did not take me to be important. But now this is not the case. I have changed a lot

(kanyeling (member of female infertility society)-participant)

Q. It seems that the women are different here

A. Yes we might as well be honest about it, the women run everything here

Q. But aren’t you worried that they don’t show enough respect?

A. The truth is we own them, and everything they own, so if they do well – is it not also good for us?

Old man Village A interview

Key messages• Change is possible• Ethnographic knowledge is essential for effective

prevention eg– Marital systems– Gendered identities– Identification of an agenda which benefits both sexes

• There are gendered relationships between domestic violence, reproductive health and gender inequality (education, status)

• Quantitative evaluation problem: Interventions aimed at improving discussion of sensitive issues, may increase willingness to REPORT stigmatised behaviour, even if the true incidence is reduced.

AcknowledgmentsImpossible without:

• Researchers: Katie Paine, Michelle Jawo, Isatta Wurie, Nana Ofori Ata, Linda Morison, Alice Welbourn

• Steering Committee: Dr Gaye, Dr Gassama, Yankuba Dibba, Sylvia Wachuku-King, Prof McAdam, Gisela Schneider

• Project Management Committee • Fieldworkers: Famara Bojang, Bajen Drammeh, Lamin Gibba• Stepping Stones facilitators: Noel Sambou, Landing Bojang, MamaSirrah

Jarju, Kuleymata Badgie, Sirreh Baldeh, Kawsu Bojang, Saja Colley, Assan Jobarteh

• The MP of Foni Bintang: FaAnsu Sanneh• The people of the 4 villages involved• The alkali, the imams and Karamo Camara• CBDs, CHNs, WEC Sibanor, GFPA Bwiam• Drivers: Assan Jallow, Lamin Touray, Batch Ba

• Data entry staff , Kunle Okunoye

Special requests; Village A• OW - Husbands should help their wives with

difficult jobs. To prevent infidelity• YW - husbands should be responsible for the

household and not leave everything to their wives. They should stop wife beating and improve dialogue with their spouse

• YM - parents should take good care of their children and advice them against premaritalsex

• OM - wives and husbands should be faithfulto each other or use condoms.

Special requests – Village B• YW - Husbands should try to support their wives

financially, and help build good relationships so as to reduce infidelity. – (play showed bad relationship in which man was

unfaithful and beat his wife)

• OW -Husbands should assist their wives with money especially when they are sick – to reduce STIs and infidelity

• Men – Parents should be active in making them their daughters aware of the dangers ofpremarital sex. and discouraging them from going out.

Q So how do you think the children issue will be resolved?

A I don’t think it will be a problem now because he knows that I am old

Q Will it encourage him to look for another wife?A Sometimes I ask him to go for a second wife.

The work is too much for me and I am getting very old. He says he will go but then he does not do it.

Q Is that because he does not have the money?A Yes he does not have the money, during the last

rains there were no groundnuts - but he really wanted to do it

Older woman village B

Philosophy

Research establishment(Epidemiology)

Stepping Stones (Intervention research)

Community