Preventing violence against women and girls - what works: evidence summary

Introduction

Background

This report summarises available evidence of what works to prevent^[7] VAWG. Broadly, VAWG is understood as “the violent and abusive behaviour carried out predominantly by men directed at women and girls precisely because of their gender” ^[8] (Equally Safe strategy, 2016). This report provides important evidence to feed into the Scottish Government’s work on preventing VAWG as part of the Equally Safe strategy (2016:6):

Equally Safe is our country’s strategy to take action on all forms of violence against women and girls. By this we mean the violent and abusive behaviour carried out predominantly by men directed at women and girls precisely because of their gender. Behaviour that stems from systemic, deep-rooted women’s inequality, and which includes domestic abuse, rape, sexual assault, commercial sexual exploitation (like prostitution), and so called ‘honour based’ violence like female genital mutilation and forced marriage.

As the UN’s (2015:8) A Framework To Underpin Action to Prevent Violence Against Women emphasises, VAWG is both a public health issue and “one of the most pervasive human rights violations in the world, rooted in gender inequality, discrimination and harmful cultural and social norms”. Article 12 of the Istanbul Convention highlights prevention as a central part of ending VAWG, and is one of four core pillars underlying the Istanbul Convention to prevent and combat VAWG (see Hester and Lilley, 2014).

Preventing VAWG is an international concern, with extensive international work conducted by the United Nations (UN), World Health Organisation (WHO) and others. For example, recent work by the WHO (2019) entitled RESPECT women: Preventing violence against women draws together international approaches to preventing VAWG; considering the available evidence on the effectiveness of different interventions^[9]. This work, alongside other high-quality international publications have been drawn upon within this report.

This report looks in detail at the interventions used to prevent VAWG. In looking at this topic, this report broadly considers gender based violence (GBV), while paying attention to domestic abuse (DA), and sexual violence (SV) as specific, often overlapping, aspects of this form of violence. Where specific forms of violence are the focus of a particular intervention this is highlighted within the report.

The evidence summarised within this review is predominantly international, reflecting the wide geographical spread of available and robust evaluations on interventions to prevent VAWG. Scottish evidence has been presented where there is substantial and robust evidence to show that a particular intervention is effective or promising (see Annexes B, C and D on methodology and effectiveness classifications).

The interventions presented within this review should be considered within a broader life course perspective to help in identifying:

early risk factors and the best times to disrupt the developmental trajectories towards violent behaviour using a primary prevention approach. For successful primary prevention, early intervention is required that focuses on younger age groups (WHO, 2010:2).

A forthcoming Scottish Government report (written by the Scottish Violence Reduction Unit) on What Works to Prevent and Reduce Youth Violence will highlight interventions that can be used with younger people; acknowledging the importance of early interventions to prevent VAWG and other forms of violence. This report on preventing VAWG and the forthcoming report on preventing youth violence are part of a linked series of reports on violence as part of the Scottish Government’s violence research programme.

Accompanying this main report, there is a standalone key findings paper available here, alongside a summary document entitled Effective Investments: A Summary of What Works to Prevent Violence Against Women and Girls for Policy and Practitioners available here.

Aims of the report

This report aims to:

• synthesise existing international evidence regarding the effectiveness of interventions designed to prevent VAWG and signpost to further evidence to help inform decision making
• provide a clear indication of the effectiveness of an intervention based on a critical assessment of the available evidence base
• provide information around barriers and facilitators to the successful implementation of interventions

It is important to note that this report does not purport to provide an exhaustive and definitive account of the evidence in this area. Rather, it constitutes a collation of evidence that was identified and accessed during the time available. This report aims to be a foundation upon which new and existing research can be added as it becomes available or is identified in the future^[10].

Report structure

While there are several ways to present the evidence on what works to prevent VAWG for high income countries^[11], this report is informed by research conducted by the WHO (2019).The WHO (2019) framework RESPECT Women: Preventing Violence Against Women highlighted seven areas to be addressed to prevent (and reduce) violence against women. For the purposes of this report, the following areas have been identified^[12] as relevant to prevention^[13] within a high income country context (such as Scotland):

• environments made safe: efforts to create safe schools, public spaces and work environments, among others
• transformed attitudes, beliefs and norms: strategies that challenge harmful gender attitudes, beliefs, norms and stereotypes that uphold male privilege and female subordination, that justify violence against women and that stigmatise survivors. These may range from public campaigns to group education and more.

These two identified areas have informed the overarching structure of this report, asking the following questions:

1) What works to make environments safe?

2) What works to transform attitudes, beliefs and norms?

To acknowledge the overlaps between different forms of violence within certain interventions, this report has been structured by intervention-type, rather than violence-type. However, where an intervention relates explicitly to one form of VAWG (e.g. domestic abuse), this has been highlighted by: gender based violence (GBV) and/or domestic abuse (DA) and/or sexual violence (SV).

An exception to this is overall approach is the latter section of this report on honour-based Violence, asking:

3) What works to prevent honour-based violence (HBV), including female genital mutilation (FGM)?^[14]

In response to these questions, this review presents available evidence, and an effectiveness rating, for primary interventions to prevent VAWG. This discussion draws upon evidence and evaluations relating to the effectiveness of these WHO strategies aimed at preventing violence.

Within this report, we examine interventions that seek specifically to prevent different types of VAWG as an outcome, and those that target key risk factors for violence perpetration and experiences^[15]. As such, it is not an exhaustive list of interventions. Instead, it focuses on the most common interventions, assessing their effectiveness, and signposting to relevant evidence^[16].

Determining prevention levels

Following this focus on preventing VAWG, this report focuses on primary prevention, understood as “approaches that aim to prevent violence before it occurs” (WHO 2002:15) ^[17]. Equally Safe (2016:22) defines primary prevention in these terms, focusing upon:

changing behaviour, building the knowledge and skills of individuals, and ultimately delivering a progressive shift in the structural, cultural and societal contexts in which violence occurs.

The focus of this report upon primary interventions reflects the increasing emphasis upon preventive measures as key to reducing forms of VAWG such as domestic abuse (Cleaver et al., 2019). According to Crooks et al. (2019), primary prevention involves:

• universal approaches to reduce the likelihood of VAWG
• reducing risk factors associated with violence
• promoting protective factors to enhance women and girls’ safety

Employing primary interventions as part of early interventions aim to “tackle root causes of problems before they become entrenched” (Cleaver et al., 2019:141). To prevent VAWG from happening^[18], Hester and Westmarland (2005:15) identify primary prevention as “a long-term strategy” that involves “changing the attitudes, values and structures that sustain inequality and violence”.

There is some evidence that focusing on early intervention and primary prevention interventions for public health challenges is an effective use of resources over the long-term (see BMA, 2017).

Further information on what constitutes primary, secondary, and tertiary prevention can be found in Annex A (see also ScotPHN report, 2019:9). Moreover, Annex B provides detailed information about the methodological approach of this report.

Out of scope interventions

The interventions identified as out of scope of this report are detailed in Annex E. They include: legislative changes, interventions focused on reducing violence perpetration (rather than preventing it from happening), services to support and advocate for victims-survivors of various forms of VAWG, and interventions within the justice system aimed towards perpetrators, or victims-survivors.

As this report focuses on pre-criminal justice and prevention-focused interventions, perpetrator programmes such as the Caledonian System and domestic violence perpetrator programmes (DVPPs) are out of scope. However the What Works to Reduce Reoffending (2015) report, which is due to be updated in 2021, will review the international evidence on the extent to which domestic abuse perpetrator programmes reduce reoffending.

Moreover, due to limited available evidence, interventions that focus specifically on the prevention of commercial sexual exploitation, stalking, and harassment have not been addressed in detail within this report. However, early intervention and prevention-focused interventions discussed within this report may also have longer-term, wide-reaching impacts in changing both attitudes towards and perpetration of VAWG. Future research should focus on understanding prevention of commercial sexual exploitation as complex and varied forms of VAWG.

More broadly, Wilson et al. (2015:76) argue for:

• collaborations between research and practice in designing, evaluating, and modifying intervention programmes
• programmes to be culturally appropriate
• programmes to target the specific physical, psychological, financial, social and spiritual requirements of victims-survivors of commercial sexual exploitation

Assessment of effectiveness of interventions

Decision-making tools (effectiveness classification criteria and decision tree) were developed to inform the process undertaken in synthesising the available evidence (see Annex B, C and D). These tools have been used to ensure a consistent and transparent approach to classifying the effectiveness of interventions to prevent VAWG. In particular, the following aspects are considered in classifying the available evidence:

• the relevance of the evidence: must include outcomes related to violence prevention/reduction or risk factors or intermediate outcomes for violence
• what the evidence says about the effectiveness of the intervention
• the strength of the available evidence (see Annex B on methodology)

The following colour-coded categories of effectiveness^[19] have been developed for this report, and are used throughout:

Effective (Green)

Promising (Amber)

Mixed (Amber)

No effect (Red)

Negative effect/potentially harmful (Red)

Inconclusive (Grey)^[20]

It should be noted that the inconclusive category is:

• distinct from the no effect^[21] category
• is based on insufficient evidence to make a judgement on impact of an intervention (e.g. only pilot evaluations available)
• indicates the need for further research and evidence before conclusions can be drawn on the effectiveness of an intervention

Where a respected expert organisation such as, the WHO or UN, have assigned a particular level of effectiveness to an intervention, this review has used their effectiveness rating. Where this is the case, the decision making process outlined in Annex C and D is not used. Exceptions to this include where robust new evidence has been produced since the publication of ratings by these organisations, or where an effectiveness rating is not relevant to a high income country such as Scotland (e.g. if that rating was only applicable to low income countries in a WHO report).

Prior to presenting the interventions in detail, a brief overview of each form of VAWG (GBV, DA and SV) are now detailed.