Mediating Role of Gender Norms on IPV and Contraceptive Use in Niger RCT

Overview

This cluster randomized controlled trial in Niger evaluated how changes in inequitable gender norms mediate the effects of the Reaching Married Adolescents (RMA) intervention on intimate partner violence (IPV) and modern contraceptive use. Findings indicate that reductions in IPV and increases in contraceptive use are partially mediated by shifts in gender norms, with direct and indirect effects varying by intervention component.

Background

Gender norms are culturally embedded rules influencing behaviors related to IPV and reproductive health. Gender transformative interventions aim to modify these norms to improve health outcomes, but evidence on their mechanistic effects remains limited, especially in low- and middle-income countries. The RMA intervention in Niger targeted married adolescents and their husbands using household visits and small group discussions to address inequitable gender norms, IPV, and contraceptive use. This study investigates whether changes in gender norms mediate the intervention’s impact on IPV and contraceptive behaviors.

Data Highlights

Key Findings

• The RMA small group intervention reduced IPV prevalence by 8%, with 2% of this reduction mediated through changes in inequitable gender norms.
• Household visits increased modern contraceptive use by 20%, with a substantial direct effect (32% increase) and an indirect effect via gender norms accounting for an 11% decrease.
• The combination arm showed similar effects on contraceptive use as household visits alone.
• Changes in inequitable gender norms partially mediate the intervention’s effects on IPV and contraceptive use, supporting the role of gender norms as a mechanism of change.
• The intervention was delivered via gender-synchronized household visits and single-sex small group discussions facilitated by trained community health workers.

Clinical Implications

These findings highlight the importance of addressing inequitable gender norms to reduce IPV and improve contraceptive uptake among married adolescents in resource-limited settings. Gender transformative interventions incorporating both household visits and group discussions can effectively shift norms and behaviors. Clinicians and public health practitioners should consider integrating norm-focused strategies into reproductive health and IPV prevention programs.

Conclusion

The RMA intervention’s impact on reducing IPV and increasing contraceptive use is partially mediated by changes in inequitable gender norms, providing experimental evidence that modifying social norms is a viable pathway to improve health outcomes in Niger.

References

1. Reaching Married Adolescents Study, Niger (2016-2019) -- ClinicalTrials.gov NCT03226730
2. World Health Organization -- Gender transformative interventions and health
3. Gupta et al -- Gender norms and health outcomes