School-Based Interventions for Preventing, Mitigating and Reducing Gender-Based Violence in Sub-Saharan Africa: A Systematic Review

Background and Purpose:Gender Based Violence (GBV) is a significant public health problem in sub-Saharan Africa (SSA), with deleterious effects on survivors, including physical and mental health problems, low academic performance, and high prevalence of Sexually Transmitted Infections. Although school settings are a natural entry point for GBV interventions, scant evidence exists on the effectiveness of school-based GBV interventions (SB-GBVIs) among adolescents in SSA. This review addresses the identified knowledge gap by assessing the quality and effectiveness of school-based interventions in preventing/mitigating/reducing GBV among adolescents in SSA. Specifically, this review describes common types of SB-GBVIs in SSA, evaluates the use of theory, and highlights study outcomes.

Methods: A systematic search of six databases (e.g., MEDLINE, CINAHL, EMBASE, PsychINFO—2005-to-May 2 2020) identified peer-reviewed articles focusing on SB-GBVI in SSA. Included studies were: 1) conducted in SSA, 2) quantitatively evaluated SB-GBVIs and/or included school-going adolescents 10-24 years, and 3) reported attitudes on, and incidence of GBV. Data extracted from eligible studies included study design, the host country, sample description, intervention theoretical underpinning/approach, intervention type, intervention setting, intervention components, intervention outcomes, effect size, and results. We used the Methodological Quality Rating Scale (MQRS) to establish the level of rigor of the studies (high, medium, and low)—ranging from 0 to 23.

Results: Of the 12 studies included, eight were Randomized Control Trials, and four were Quasi-experimental. Most studies (n=11) were implemented in schools, while one evaluated the indirect effect of an education policy on GBV outcomes of school-going students. For the methodological quality, most studies (n=8) scored equal or above the median (high rigor), while four scored below the median (medium rigor). Most interventions (n=8) focused on the reduction of GBV, while 4 combined prevention and mitigation. Five studies explicitly stated the theoretical perspective that informed their intervention. Half of the studies (n=6) had a follow-up period (post-intervention: >12 months)—only three studies had a longer follow-up period (<24 months). GBV intervention outcomes included: reduction in sexual violence (n=6), and physical violence (n=5) and changes in norms and behaviors (n=1). Only two studies evaluated norm change—attitudes toward women, physical threats, and prosocial behaviors (response to physical threats, sexual or physical violence). Most of the SB-GBVIs (n=11) were effective in reducing sexual violence, physical violence, and changes in norms. Intervention components included cash incentives, empowerment, gender-equitable attitudes, and behavior, and gender equity-related social action that reduced the risk and prevalence of GBV.

Conclusions and Implications: Findings of this systematic review suggest that SB-GBVIs focusing on individual and interpersonal level risk factors are effective in reducing GBV among adolescents. Additionally, GBV prevention methods such as empowerment, community engagement, social support, and movements towards gender equity are acceptable in educational settings. Social workers need to use an ecological perspective to comprehensively address risk and protective factors across all levels (student, classroom, school, community, and structural). SB-GBVIs need to be theory-driven, address cultural norms, and track outcomes for a longer duration (e.g., >24 months) to assess for sustained intervention effectiveness.