Creating social norm change to prevent VAW and HIV: a programmatic perspective from Uganda

Abstract

Abstract

There has been an increased emphasis on evidence based programming for violence prevention in recent years, although research on what works to prevent violence is still an emerging field. There are also important lessons emerging from practice. The experience of Raising Voices in Uganda is that using community mobilization programming can help to shift entrenched norms, attitudes and behaviours. A recent randomised control trial evidenced some of these changes and whilst this research has been key to developing the approach, it is also essential that we continue to be informed by the voices of community members and activists. As we continue to build the evidence base on what works to prevent violence, the field needs to ensure that we place the experiences and ideas of the community at the center of our interventions.

Keywords:

• violence prevention
• social norm change
• community mobilisation
• Uganda
• SASA!

The last few years have seen an increased emphasis on evidence-based programming to prevent violence against women (VAW) and girls, but research on what works to prevent violence against women and girls is still an emerging field. A series on violence prevention in the Lancet (2014) included a “review of reviews” of prevention programs, including 84 rigorously evaluated interventions. Of these only 32 focused on prevention at a community level, and only 18 of these were interventions in low- or middle-income countries.¹ Similarly, Lori Heise’s evidence review highlights that the field of partner-violence prevention is still in its infancy, and that demonstrating impact within the typical two to three year timeframes of projects is challenging. ²

Nevertheless important insights and some evidence are emerging from practice, and key lessons are being applied in a number of contexts. The Lancet series highlighted that complex programming, working with community and group interventions can shift entrenched social norms,³ and in Uganda, our experience at Raising Voices shows that using community mobilization can change attitudes, beliefs, norms and behaviours around VAW and HIV.

SASA! is a community mobilization methodology that focuses on challenging the power imbalance between women and men, girls and boys to reduce VAW and HIV. The methodology draws upon two theoretical frameworks: the ecological model, and Prochaska and Velicer’s stages of change theory. ⁴ SASA! uses a phased-in approach to guide communities through a structured process of change. Through community-led activism, community members think through how power imbalances can lead to VAW and HIV, and then use a benefits-based approach to imagine – and strive towards – positive, non-violent alternatives. SASA! was developed by Raising Voices and implemented in Uganda by the Center for Domestic Violence Prevention. It has brought about encouraging changes within programmatic timeframes. These impacts were evidenced by a cluster randomised controlled trial (RCT),⁵ conducted in partnership with the London School of Hygiene and Tropical Medicine, the Center for Domestic Violence Prevention, and Makerere University. The RCT explored SASA!’s impact at the community level, irrespective of direct exposure to SASA! activities. It was the first study in sub-Saharan Africa to demonstrate population level impact on violence prevention, with women in SASA! communities 52% less likely than control communities to report experiencing past-year physical violence from an intimate partner. Further, 76% of women and men in SASA! communities reported believing that physical violence against a partner is not acceptable, compared to 26% in control communities.⁵ This change occurred within 2.8 years of programming (with research taking place from May 2008 to December 2012 due to periods of political unrest).

Whilst this research has been key to developing our approach to preventing violence against women, we also continue to be informed by the voices of the community members and activists that sustain, and innovate, this work every day. SASA! activists, everyday women and men living in communities, use activities such as poster discussions, community chats and dramas, to engage others in discussions about power. These activities are not one-off events; activists meet community members where they are – in the market place, at the mechanics shop – and work intensively to spark repeated dialogue and reflection in their communities. For example, one woman speaks about the changes she has seen occurring across her community since SASA! was introduced:

“You know when we go to the activities … you will hear people give testimonies of how their husbands have changed into good people. You will hear women say that my husband used to beat me but now he no longer does…. I think SASA! has brought a big change.” (Female community member)⁶

Another community member highlighted how SASA! activists are approachable and able to intervene in violent situations:

“I always felt ashamed to speak out, that he was beating me but I told her [SASA! activist]… now this lady summoned him and we sat, even my brother was there. They counselled him and the nabakyala [women’s representative] told him about the SASA! activities and that you are supposed to talk to your fellow adult and not beat them … then my husband started changing.” (Female community member)⁶

There is still much to learn about what works to prevent violence, but the SASA! experience shows that the prevention of violence is possible, and can be achieved within a programmatic timeframe. As we continue to build the evidence base for what works to prevent violence we need to remember that sustained and coordinated programming, working with both men and women, is critical to changing social norms at the community level and fostering individual behavior change, and that social norm change work that places the experiences and ideas of communities at the center of our interventions must be at the forefront of our continued investigations.