Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa.
Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa.
BMJ Glob Health. 2020 Mar 16;5(3):e001946. doi: 10.1136/bmjgh-2019-001946. eCollection 2020.
We assessed whether the Women for Women International (WfWI) economic and social empowerment programme could reduce women's experiences of intimate partner violence (IPV) and depression in Afghanistan.
We conducted a two-arm individually randomised controlled trial in six urban and peri-urban communities. Communities were selected by WfWI for being conflict affected and showing signs of economic vulnerability (eg, little or no education, living in extreme poverty). Individual eligibility were female, aged 18-49, able to consent to participate and one woman per household. At 22 months, three primary outcomes were assessed: past year physical IPV experience; past year severe IPV experience; depressive symptoms. There was no blinding to arms. We conducted an intention-to-treat analysis, controlling for age. We also conducted qualitative interviews at endline, analysed using thematic analysis.
1461 women (n=933 married) were recruited and randomised. Retention at endline was n=1210 (82%). Primary outcomes were in the hypothesised direction, but showed no significant impacts: physical IPV (adjusted OR (aOR) 0.88 (0.62 to 1.23)), severe IPV (aOR 0.75 (0.50 to 1.11)) and depressive symptoms (β -0.35 (-1.19 to 0.48)). Women reported reduced food insecurity (β -0.48 (-0.85 to -0.12)), higher earnings (β 3.79 (0.96 to 6.61)) and savings (β 11.79 (9.95 to 13.64)). Women reported less gender-inequitable attitudes (β -0.89 (-1.15 to -0.62)), more household decision-making (β 0.35 (-0.04 to 0.74)) and increased mobility (aOR 1.78 (1.27 to 2.50)). Twenty-eight in-depth interviews were conducted.
The intervention did not impact IPV or depression. The intervention did improve livelihoods, create more gender-equitable relationships and increase women's mobility. Translating these gains into IPV and depression reduction is critical.
NCT03236948, registered 2 August 2017.
我们评估了女性国际（WfWI）经济和社会赋权计划是否可以减少阿富汗妇女遭受亲密伴侣暴力（IPV）和抑郁的经历。
我们在六个城市和城郊社区进行了一项双臂个体随机对照试验。社区是由 WfWI 选择的，因为它们受到冲突的影响，并显示出经济脆弱性的迹象（例如，几乎没有或没有教育，生活在极端贫困中）。个体资格为女性，年龄在 18-49 岁之间，能够同意参与，每个家庭有一名女性。在 22 个月时，评估了三个主要结果：过去一年的身体 IPV 经历；过去一年的严重 IPV 经历；抑郁症状。对武器没有盲目性。我们进行了意向治疗分析，控制了年龄。我们还在终点进行了定性访谈，使用主题分析进行了分析。
1461 名女性（n=933 名已婚）被招募并随机分组。终点保留率为 n=1210（82%）。主要结果与假设方向一致，但没有显著影响：身体 IPV（调整后的 OR（aOR）0.88（0.62 至 1.23）），严重 IPV（aOR 0.75（0.50 至 1.11））和抑郁症状（β-0.35（-1.19 至 0.48））。女性报告食物不安全程度降低（β-0.48（-0.85 至-0.12）），收入增加（β3.79（0.96 至 6.61））和储蓄增加（β11.79（9.95 至 13.64））。女性报告性别不平等态度减少（β-0.89（-1.15 至-0.62）），家庭决策增加（β0.35（-0.04 至 0.74））和流动性增加（aOR 1.78（1.27 至 2.50））。进行了 28 次深入访谈。
该干预措施并未影响 IPV 或抑郁。该干预措施确实改善了生计，建立了更公平的性别关系，并增加了妇女的流动性。将这些收益转化为减少 IPV 和抑郁至关重要。
NCT03236948，2017 年 8 月 2 日注册。
