Preventing violence against women and girls - what works: effective investments summary

4. What works to prevent honour-based violence?

4.1 Honour-based violence interventions: Inconclusive

There are various definitions of honour-based violence, and its parameters can be unclear. SafeLives (no date:15) use the following definition of honour-based violence (HBV):

normally a collective and planned crime or incident, mainly perpetrated against women and girls, by their family or their community, who act to defend their perceived honour, because they believe that the victim(s) have done something to bring shame to the family or the community. It can take many forms including: 'honour' killing, forced marriage, rape, forced suicide, acid attacks, mutilation, imprisonment, beatings, death threats, blackmail, emotional abuse, surveillance, harassment, forced abortion and abduction.

Equally Safe defines HBV as: "dowry related violence, female genital mutilation, forced and child marriages, and 'honour' crimes". HBV is understood as distinct from domestic abuse, defined instead in relation to the "motive of the abuse (to defend perceived 'honour') and unlike domestic abuse the perpetrators of HBV can involve community members who may be extended family or strangers to the victim".

Currently there is limited available evidence (e.g. robust evaluations) on specific honour-based violence (HBV) interventions. Consequently these interventions have been classified as inconclusive due to insufficient evidence.

For context, according to Gill et al. (2017:2): "while HBV/A and FM^[48] share features in common with domestic abuse and gender-based violence more broadly, our victim engagement project highlights the critical and distinctive role that perceived 'honour' plays in shaping the context of this abuse". There are cultural norms that result in this being seen as a 'family problem', and that "speaking to the authorities was in itself considered a violation of community norms of honour".

According to Gillespie et al. (2011:44): "Most practitioners felt that more training on HBV and its effects on family members and local communities was needed, both within their own organisations and in partner agencies". Responding to this context, multi-agency working was understood as overall effective in both raising awareness of and responding to HBV (Gillespie et al., 2011).

Gill et al.'s (2017) review of services for victims-survivors of HBV and FM identifies the following factors that contributed to supportive practitioner responses:

• rapid response
• listening
• establishing trust
• being accessible and available
• offering clear guidance to victims as well as to perpetrators and extended families
• an awareness that personal experiences of HBV/A and (attempted) FM can vary greatly
• the consequent use of discretion and professional judgement in developing a tailored, client-centred approach whilst operating within statutory remits".

However, there were also criticisms of a limited victim focus and support within some services.

SafeLives (no date: 35) present the following recommendations for interventions to prevent (and reduce) HBV:

• domestic abuse services and local specialist services should work together, for instance arranging reciprocal training, to understand the links between these forms of abuse and ensure appropriate referral pathways between services
• all agencies making MARAC^[49] referrals should seek special advice before risk assessing cases in which there is a risk or presence of HBV, this may be from local specialist services or a national helpline
• domestic abuse services should review their risk assessment guidance to ensure it reflects the high levels of coercive control that can be achieved without obvious threats or violence, including how this may present in HBV cases
• information to be provided to victims and survivors in "formats and languages that are accessible and that they can identify with" within agencies delivering training on HBV, government literature, domestic abuse services.

Likewise, Idriss (2018:334) notes that victim/survivors valued organisations that spoke the same language and understood their cultural needs; these approaches made victim/survivors feel more comfortable to disclose their experiences and seek intervention.

Idriss (2018:335) also identified a number of key barriers to successful honour-based violence interventions in the UK:

• lack of communication and availability of interpreters in accessing services
• feeling 'uncomfortable' with public agency responses
• difficulties disclosing abuse for women informed by cultural expectation

Moreover, in Hester et al.'s (2015:39) participatory qualitative study they found that "participants wanted police to understand better the dynamics of 'honour', in particular how it exerts psychological and physical control over the victim, how the wider family and community may be implicated in the abuse, the multiple barriers to reporting, and the high level of risk facing victims who decide to approach the police".

Key findings for service delivery and practice:

• Honour-based violence raises unique challenges around family, community and privacy that can make it difficult to identify and be a barrier to women seeking help. Collaboration between different general and specialist services through referral pathways and reciprocal training are useful tools.
• Practitioners that believe a person they are working with may be at risk of honour based violence should seek specialist advice and support.

Interventions should be developed with relevant communities and delivered in ways that are culturally comfortable and provide

4.2 Female Genital Mutilation Interventions: Inconclusive

Interventions for Female Genital Mutilation FGM refers to "all proceduresinvolving partial or total removal of the female externalgenitalia or other injury to the female genital organs fornon-medical reasons" (WHO, 2018). Waiga et al. (2018:62) describe FGM as: "performed on young girls and causes short-term and life–long consequences for women as well as extended consequences for families and the community at large"

While available evidence remains relatively limited, Njue et al. (2019) highlight the following prevention-focused interventions:

• availability of healthcare services
• training health care professionals; on cultural competence, legal regulations, legal provisions pertaining to FGM and FGM related laws
• awareness raising and culturally appropriate education; capacity building workshops with professionals from various sectors, targeted training and information campaigns (about FGM issues, legislation, child protection procedures)
• community-based interventions; community education to promote a rights-based approach to tackling FGM, community 'champions' and advocates, resource and information development and dissemination, media campaigns, networking with community organisations
• engagement with students at schools
• support and information provided to men and local or religious leaders

This pilot evaluation also suggests that the following must also be taken into account for FGM interventions:

• engagement with girls and women from FGM-practicing countries
• cultural sensitivity
• a victim-centred approach
• clinical engagement with women from FGM-practicing countries (prevention and protection)
• engagement beyond the clinical setting

In addition to those listed above, Baillot et al. (2014) advocate for a gendered approach to tackling and responding to FGM to understand the root causes of the practice. They also suggest that developing strong relationships and trust with communities around the issue of FGM is important. For example, as Heise (2011:28)^[50] notes:

The most successful programmes engaged respected community members, including religious and local leaders, to provide information to help reframe views of the practice. To reduce the social costs of behaviour change (in terms of future prospects for marriage), they encouraged communities and marriage networks to abandon the practice en masse, and supported those families willing to make early public commitments to not cut their daughters.

Based on their early intervention model evaluation, McCracken et al. (2017:7) highlight potential barriers for FGM interventions as:

insensitive, unreflexive and heavy handed professional practice; negative perceptions of social services and mental health services; and inappropriate forms of engagement with members of potentially-affected communities.

Waigwa et al.'s (2011:1) systematic review of health education as an intervention to prevent FGM also highlights potential barriers in utilising health education interventions to prevent FGM:

Four main factors emerged and were associated with facilitating or hindering the effectiveness of health education interventions: sociodemographic factors; socioeconomic factors; traditions and beliefs; and intervention strategy, structure and delivery.

These barriers are also identified as potential facilitators if taken into account in the development and use of FGM-focused interventions.

Key findings for service delivery and practice:

• There is limited evidence on interventions to reduce female genital cutting, but any approach should involve relevant communities at all stages, as disavowing the practice can have problematic social consequences for individuals otherwise.
• Interventions should be sensitive to the specific cultural backgrounds the people they work with come from, be accessible in different languages, and be informed by the fact that past trauma is likely, either from the person's past or from prior negative experiences with services.

For the full reference list visit the main reportWhat Works to Prevent Violence Against Women and Girls: A Summary of the Evidence here.