MORE MAMaZ is funded by Comic Relief. The programme is implemented by Transaid, Health Partners International, Development Data and Disacare in partnership with the Ministry of Health and District Health Teams.

Integrating a focus on GBV into the work of SMAG volunteers

• GBV serious public health problem

• Wide-ranging and damaging mental and physical, social and economic impacts

Background and Context

Impact of gender-based violence

Women who are affected:

• Are more likely to report poor or very poor health, emotional distress and attempted suicide

• Have increased likelihood of abortion, miscarriage, stillbirth, pre-term delivery, low birth weight

• Have increased vulnerability to HIV

Children of women who are affected:

• Tend to have poorer health & educational outcomes

• Suffer behavioural and emotional disturbances associated with violence later in life

• 2011 Zambian Anti Gender Based Violence Act was major breakthrough

• Yet GBV rates remain obstinately high

• GBV statistics in 2014 DHS show little change from 2007

• Many women see GBV as normal

GBV in Zambia

GBV rates in Zambia

43%

Women and girls who have experienced violence at some point in their lives

37%

Women and girls who have experienced violence in previous 12 months

17%

Women and girls who have experienced sexual violence

10%

Women who have experienced violence when pregnant

• GBV was an issue and a symbol of women’s low status

• Often associated with heavy drinking

• Silent issue at household level

• Prevailing social norm was “whatever

happens in the household stays within the household”

• Reticence to intervene even where GBV known to be happening

GBV in Intervention Sites

“With my sister in marriage, her husband

used to beat her so much…When she

was pregnant, he beat her so much that it affected the baby. She went into labour and had difficulty giving birth. When the baby was born, it had an injury to its leg.”

Female community member, Mkushi

• Safe pregnancy and delivery used as non-confrontational entry point to approach GBV

• Community discussion groups provided space for men and women of all ages to reflect on how to support women

• Focus on ‘sad memories’ – instances where women or babies had been injured

• Reflection on steps communities could take to avoid these situations in future

Strategy

Community discussion groups

Facilitated by SMAGs, these provided space for men and women of all ages to reflect on:

• Steps men could take to lighten women’s work burden

• Take care of their health & nutrition

• Enhance their well-being

Many disagreements in household were linked to perceptions that women not working hard enough during pregnancy.

Led to discussions about GBV.

• Focus on peer education adopted as key programme strategy – very powerful

• Male SMAGs shared their own stories about GBV during discussion groups and door-to-door visits

• Men who were violent were not judged – they were friends, neighbours, family

• Constructive approach created space for men to change while retaining their pride and self-esteem

Strategy

“I used to be a very violent person

towards my wife. I beat my wife so many times when she was pregnant. My bad attitude made me like this. I drank beer. The problem was ignorance. I never used to know anything. Now I know that I can cause problems if I act in this way. I have stopped beating my wife because of what I learnt. I’ve got

friends who are following my steps. It’s

easy to convince them to change. I’m

now enjoying my marriage. My wife is very happy that I have changed.”

Male SMAG, Mkushi District

"

“Men are advised

that life is precious. You should not use your wife like a drum that you just beat.” Male community member, Mongu

• Songs composed and used as medium to spread anti-GBV messages

• Helped shift social norms about acceptability of GBV

• Community encouraged to report GBV

• SMAGs organised themselves so could intervene if necessary

• Support of traditional leaders sought to reinforce importance of campaign

• Front-line health providers given training on communication and social exclusion

• Built providers’ capacity to identify, counsel

and support least-supported women, including those affected by GBV

Strategy

• Zero Tolerance for Wife Beating Campaign adopted

• Songs composed and used as medium to spread anti-GBV messages

• Helped to shift social norms about acceptability of GBV

• Community members encouraged to report GBV

• SMAGs organised themselves so could intervene if necessary

• Support of traditional leaders sought to reinforce importance of campaign

• Front-line health providers given training on communication and social exclusion

• Providers’ capacity built to identify, counsel

and support least-supported women, including those affected by GBV

Strategy

We don’t want those who

beat their wives

We want men who have

respect

CHORUS

Have you understood

We don’t want men who

beat

their wives

We want those who have

respect

We don’t want those who

beat pregnant women

In Jembo, Sikalongo have

you understood

We don’t want abuse of

pregnant women, we

want men who have

respect

We don’t want those who beat their wives

We want men who have respect

CHORUS

Have you understood

We don’t want men who beat their wives

We want those who have respect

We don’t want those who beat pregnant women

In Jembo, Sikalongo have you understood

We don’t want abuse of pregnant women, we want men who have respect

Tatuyandi bauma bamakaintu babo

Tuyanda balilemeka

CHORUS

Sena mavwa

Tatuyandi bauma bamakaintu babo

Tuyanda balilemeka

Tatuyandi bauma batumbu

Mu Jembo mwavwa, Sikalongo mwavawa

Tatuyandi batundulula bamakaintu balabula tuyanda balilemeka

• GBV interventions resulted in transformative change

• Intervention communities reported very significant reduction in GBV

• 89% of men and 88% of women reported that GBV had declined (17% and 12% higher than in control sites)

Results

Figure 1: Perceived reduction in GBV by community members

• The decline far more likely to be attributed to the work of the SMAG volunteers in intervention sites

• Evidence of the added value of the SMAGs in addressing GBV

Figure 2: % attributing reduction in GBV to SMAGs

• Traditional leaders readily embraced the campaign

• Government legislation legitimised their efforts

• Their inputs ranged from cautioning or fining perpetrators and threatening or actually reporting men to the police

• Key message was that it could no longer be ‘business as usual’

Results

• Community members reported greater harmony in the home

• SMAG volunteers more willing to intervene to address / prevent cases

• Greater willingness on part of victims to report GBV and seek justice, including through traditional governance system

• Health providers reported that their increased probing encouraged female clients to talk about GBV

• Providers spent more time counselling these women, in some cases interviewing domestic partners, and suggesting different types of community support

Results

“The men learnt that the wife should not be beaten, that they should talk and discuss rather than fight. Men are starting to discuss more. If something annoyed them in the past, men would just come back and hit their wife. Now they sit down and talk.” Female community member, Mongu

Results

Feedback from a SMAG volunteer, Mkushi

Low cost intervention

• Feasible to integrate a focus on GBV into the work of SMAGs, at low cost.

• Once SMAGs have received basic training and understand their role as facilitators, new topics can be easily be added to their portfolio

Need for culturally / locally appropriate approaches

• Important to tackle GBV sensitively, in ways acceptable to affected communities

• Care during pregnancy provided non-confrontational entry point

• A non-judgemental approach provides space for change

Reaching adolescents

• In some sites SMAGs targeted young men in drinking places, focusing on links between heavy alcohol consumption and GBV

• Efforts to reach out to young people were not consistent in all sites: missed opportunities to intervene in order to prevent GBV.

Lessons Learned

Addressing all aspects of GBV:

• MORE MAMaZ did not explicitly address sexual violence

• Emphasis on addressing root causes of GBV, including links between alcohol consumption and violence, likely had positive knock-on effect

• In future, SMAGs should be trained to address all aspects of GBV.

Complementarity of supply- and demand-side interventions:

• Programme’s work with health providers complemented and

reinforced the demand-side GBV activities

Lessons Learned

• Allocate sufficient resources for GBV mainstreaming within health sector

• Strengthen capacity of DHMTs to

support GBV interventions as core part of safe motherhood response

• Invest in activities that promote

inter-sectoral collaboration. Promote linkages between communities, health workers, police, justice system, social welfare services

Policy Implications