Clinical Scorecard: Examining the Mediating Role of Unfair Gender Norms on Intimate Partner Violence and Contraceptive Practices in a Cluster Randomized Controlled Trial in Niger

At a Glance

Key Highlights

• The Reaching Married Adolescents (RMA) intervention reduced IPV prevalence and increased modern contraceptive use.
• Inequitable gender norms partially mediated the effects of the intervention on IPV and contraceptive use.
• Gender-synchronized community health worker interventions can effectively address gender norms, IPV, and reproductive health in low-resource settings.

Guideline-Based Recommendations

Diagnosis

• Assess inequitable gender norms as upstream determinants influencing IPV and contraceptive behaviors.

Management

• Implement gender-transformative interventions targeting both husbands and wives through household visits and small group discussions.
• Provide information and access to family planning methods focusing on healthy birth spacing.

Monitoring & Follow-up

• Evaluate changes in gender norms, IPV prevalence, and contraceptive use longitudinally to assess intervention impact.

Risks

• High rates of IPV and low contraceptive use linked to entrenched inequitable gender norms in resource-limited settings.

Patient & Prescribing Data

Married adolescent girls and their husbands in rural Niger

Household visits increased contraceptive use by 20%, with 11% mediated by changes in gender norms; small group discussions reduced IPV by 8%, with 2% mediated by gender norms.

Clinical Best Practices

• Use gender-synchronized interventions addressing both partners to modify inequitable gender norms.
• Combine individual household visits with group discussions for maximal impact on IPV and contraceptive uptake.
• Engage trained male and female community health workers to deliver culturally appropriate content.
• Prioritize interventions in high-need, low-resource settings with high gender inequality and adolescent marriage rates.

References

• Clinical trial registration NCT03226730