A Qualitative Analysis of the Link Between Violence Against Women and Children And Quality of RMNCAH Outcomes in 8 African Countries: Tom Muyunga-Mukasa, Gonzaga Kelly Kyagaba & Charles Lwande.

Domestic Violence is a barrier for quality maternal nutrition and RMNCAH outcomes and subverts efforts to achieve SDG 2, 3 & 5. Violence manifests in: structural, political and cultural systems; bodily injuries and physical assault. At individual level this presents as: pregnancy before 18 years; malnourishment in utero, obstructed labour; Fistula; Unplanned pregnancies; Sexually Transmitted Infections.

Background:

RMNCAH outcomes such as ensuring safer, optimal birth outcomes, maternal well-being, nutrition and autonomy for women to have opportunities for self-care are linked to reduced risk to Violence. This study explored negative stereotypes of hegemonic masculinity and the social structures linked to it. An exploration of 8 Sub-Saharan African countries found 3 country specific definitive social structures impacting the stereotypes, i.e., Enabling; Restrictive; and Hindering structures. 

Methods:

A meta-analysis of data and research findings from 2015-2019 of the relationship between violence against women and violence against children  is  reflected  in:  Trauma  Informed  Care  (TIC);  comprehensive  RMNCAH strategies such  as IMNI, A/PNC, KMC, perinatal death review, and/or integrated maternal and perinatal death surveillance and response (MPDSR) processes; enforcement of legal gender equality; religious and traditional support for respect and dignity of women; uptake of gender specific prevention services; Domestic Violence (DV) reports and HIV Prevention. 170 articles and reports were identified but 80 met inclusion criteria.

Results:
  

Partners  who  are  not  emancipated  about  maternal  nutrition  and  health  don’t  contribute  to women well-being and safer, optimal birth outcomes. Stereotypes of hegemonic masculinity exist in all 8 countries studied. Politics, religion and tradition influence risk reduction, e.g., enforcement of legal gender equality, political commitment and accountable judiciary ensure women can report abuses. Male dominance beliefs; traditions e.g.  Female genital cutting, rape, precarious toxic masculinity, indifference to expectant mother health by males, stigmatization of frequent clinic visits; and gender of breadwinner are linked to violence-related risks.

Compared to all 8 countries, Rwanda, Ethiopia and Kenya have a hindering structure promoting significant risk reduction with institutions fostering increased rule of law, political commitment to RMNCAH outcomes, enforcement and risk-reduction consciousness. Uganda and Tanzania have a restrictive structure characterized with legal loopholes, irregular enforcement and ambivalent political commitment to address acts of violence against women and children. In Senegal, South Africa and Nigeria political, religious and traditional factors blatantly backing traditional negative stereotypes of hegemonic  masculinity  foster  violence  enabling  structures  entrenching  repressive  acts  and  hate  crimes against women and children. In all countries however, Delivery room reception; level of Health information Management skills; HIV criminalization; affinity and sensitivity to quality health by all people; stigma around attending clinics by males; negotiating for safer sex by women which is circumscribed as a threat to male dominance, subvert or support optimal RMNCAH goals.

Conclusions:

Safer and optimal birth outcomes and achievement of the Sustainable Development Goals (SDGs) are connected. These in turn are dependent on over-arching social, political and economic dispensation. These manifest as: economic autonomy, religion and traditional backing which contribute effectively to overall risk-reduction as far as maternal nutrition and health are concerned. Contexts hindering violence prevail where state-led commitment thrives and these have far reaching benefits e.g., more people demand, access and benefit from RMNCAH outcomes.  Effective and quality RMNCAH programming in the countries studied will be effective if it is designed to involve males and addresses hegemonic masculinity practices too. Mortality implementation audits need to be dis-aggregated to reflect causes of and contributing factors to deaths such as assault to women and lack of male involvement in practices promoting optimal birth outcomes.

At SAI we are committed to continuous engagement in social impact research in order to promote RMNCAH, SGBV/VAC, and SRHR Including HIV prevention continuum. We believe this will contribute to accomplishment of our organization mission of mobilizing men to participate in mechanisms that promote free, healthy and quality living for themselves, spouses and children within their domicile communities in order to achieve positive sustainable social, economic and health outcomes and the Sustainable Development Goals 2, 3 & 5. 

We pride in raising the next generation of men to engage in building a safe and prosperous family, community and the nation at large!