A Comparative Case Study of Couples Programming to Support Relationship Quality in Nepal and Rwanda

"There is...emerging interest in couples-based violence prevention programming, and an urgent need for rigorous evidence to inform such approaches...in the Global South..."

Many couples who experience violence in their relationships may want to stay together and need support and skills to manage their interactions more positively. However, there have been valid concerns raised around the appropriateness of working with couples as part of violence prevention programming. More commonly implemented in the Global South, such approaches tend to use group or community-based formats rather than trained therapists or counsellors. This paper offers a comparative case study on programmes in Nepal and Rwanda that teach and support couples who are working to create and maintain equitable, nonviolent relationships. Both programmes were funded by the United Kingdom (UK) Department for International Development (DFID) under their What Works to Prevent Violence Against Women initiative, which is managed by the South African Medical Research Council.

More information about the two programmes is provided in this paper and other resources available at Related Summaries, below, but, in brief:

• Change Starts at Home (Change) was launched in 2015 and designed by Equal Access International (EAI) with the aim of shifting attitudes, norms, and behaviors that underpin intimate partner violence (IPV) among couples in Nepal. The intervention was a 9-month, curriculum-based, social and behaviour change communication (SBCC) strategy, combining media and community mobilisation. The radio drama programme and weekly facilitated meetings followed a participatory B.I.G (B: Begin to Question, I: Impart Life Skills and G: Go!) Change Curriculum, which drew on theories such as the Integrative Model of Behavior Prediction.
• The Indashyikirwa programme, implemented by CARE International in Rwanda, the Rwanda Women's Network (RWN), and Rwanda Men's Resource Centre (RWAMREC), implemented a 5-month curriculum with couples to support equitable, nonviolent relationships. Approximately 25% of individuals who completed the curriculum were further trained and mentored by RWAMREC staff to serve as community activists, using creative materials and outreach activities to engage community members for an additional 19 months. Also, RWN trained approximately 40 opinion leaders (e.g., local leaders, religious leaders, service providers, legal professionals) per intervention sector to encourage self-reflection on gender and power and promote more effective action on IPV prevention and response in their locales.

For the comparative study, qualitative interviews were conducted separately with 28 couples before, immediately after, and then one year following the intervention in Rwanda, and with 36 couples before, six months into, and again at the end of the intervention in Nepal. The process of comparative secondary analysis was conducted collaboratively through discussions among both study teams to identify and describe themes and discuss interpretations.

Despite the very different interventions and settings, the cross-comparative analysis suggests that both programmes helped achieve positive changes among the couples, including enhanced quality of their own relationships and improved skills as mediators to prevent IPV among others. Both programmes supported greater communication and conflict resolution skills. Furthermore, "[l]earning about rights through the curriculum, including women's rights to property, encouraged shared power and decision-making in Rwanda." The curriculum led several of the Rwandan couples to critically reflect on male-dominant decision-making power as a socialised behaviour. Along those lines, a few couples in Nepal "expressed that decisions were still predominantly determined by the husbands but that the process had become increasingly mutual." Several partners in both countries cited a greater sense of unity and interdependence as one of the most impactful aspects of the programme.

According to the researchers: "The skills building emphasis including communication and conflict resolution skills, combined with take home activities, appeared to be critical to support behavior change among couples in both settings. The accountability of both couples completing the programs together was important, as couples could reflect and remind each other of the curricula learning. In this way, couples approach to violence prevention may be less risky than working with women only to support their empowerment."

Furthermore: "Both programs used a community-based approach that emphasized outreach and behavior changes among couples as activists, for wider social norms change. This was intended to ensure an enabling and safer environment for couples to enact changes and could also support accountability of change among couples. Both programs supported couples to not only develop skills for their own relationships but take action in their communities, including responding to IPV survivors in empowering ways, and safely intervening in conflict. This is a markedly different approach than focusing on one relationship and speaks to the value of couples group and community-based approaches."

The studies suggest that concerns about working with couples can be mitigated through ensuring careful group facilitation, monitoring for social harm, and establishing support strategies for IPV survivors. For example

• In Rwanda, "the curriculum facilitators were equipped with psycho-social support skills; sessions were jointly facilitated by a man and woman so that single-sex sessions and responses could be offered; facilitators were encouraged to monitor for adverse consequences and intervene if necessary; and the program had strong referrals in place for further support, including to the Indashyikirwa women’s safe spaces."
• In Nepal, sensitive topics were addressed in sex-segregated sessions, with couple sessions occurring once a month. There was also an explicit plan for referrals, as well as monitoring around violence.
• The programmes were not framed as solely IPV response but, rather, as efforts to develop and support healthy families and relationships. Likewise, they did not provide individual couples' therapy but instead supported the building of key relationship skills among couples in a group format.

In conclusion, this comparative case study suggests that couples programming, in an enabling environment with highly trained facilitators and strong referral networks, can be a highly valuable approach to IPV prevention and support.