“If you want to have sex you can, if you don’t, you don’t have to”: a qualitative evaluation of the Unite for a Better Life couples program to prevent intimate partner violence in rural Ethiopia

Abstract

Gender-transformative programing targeting couples is an important strategy to reduce intimate partner violence (IPV), but questions around efficacy and safety remain. This qualitative study explores indications of change and unintended consequences of the gender-transformative Unite for a Better Life (UBL) intervention, using data from the couples’ and control arms of a cluster randomized controlled trial (cRCT) in Ethiopia. The cRCT found no impact on physical and psychological IPV and weak evidence of reductions in sexual IPV in the couples’ arm. We analyzed 33 facilitator feedback questionnaires and 29 in-depth interviews (IDIs) among couples conducted approximately 30-months post intervention; 14 participated in UBL delivered to couples, and 15 were from the control arm. IDIs were conducted separately with each member of the couple and analyzed thematically in Dedoose to explore indications of change attributed to UBL. UBL couples attributed improved household task-sharing, communication, and joint decision-making to the program. Men and women developed more gender-equitable attitudes, leading to more fulfilling relationships. Additionally, most participants in violent relationships reported that UBL led to a reduction or cessation of physical and psychological IPV, and a complete cessation of sexual IPV. These effects were largely attributed to shifts at the individual level for men. Men developed better anger management skills, reduced their alcohol consumption, and increased their knowledge around the consequences of IPV. At the relational level, couples reported increased communication, particularly around sexual desire, and reduced conflict. Additionally, participants reported normative shifts, including decreased acceptance of IPV. There were no reports of changes in control participants nor of major unintended consequences. When delivered to couples, UBL shows promise in shifting individual-level male factors and relational dynamics and reducing conflict and IPV. This suggests that engaging men in couples can be an effective and safe strategy for IPV prevention.