Transfers, Behavior Change Communication, and Intimate Partner Violence: Postprogram Evidence from Rural Bangladesh

Transfer programmes have been shown to reduce intimate partner violence (IPV), but little evidence exists on how activities linked to transfers affect IPV or what happens when programmes end. The researchers assessed post-programme impacts on IPV of randomly assigning women in Bangladesh - a country where IPV is high and social norms are conservative - to receive cash or food, with or without nutrition behaviour change communication (BCC). Evidence on mechanisms suggests sustained effects of BCC on women's "threat points", men's social costs of violence, and household well-being.

The existing literature primarily discusses two mechanisms as driving the reductions in IPV from transfer programmes. First, transfers made to women may improve their bargaining position within the household. Seen through this lens, a male's utility increases in the violence he inflicts on his partner - for example, because he derives esteem from doing so or because it releases frustration. Constraining his behaviour is the female partner’s "threat point": her ability to leave the relationship. Her capacity to generate income, either from working or from public or private transfers, is a primary factor shaping this ability. A second mechanism is that transfers increase total household income and reduce poverty-related stress; this in turn may reduce the conflict within the household.

The analysis uses data from the Transfer Modality Research Initiative (TMRI), a programme implemented in a rural context where patriarchal gender norms persist. Purdah - the practice of female seclusion - is common, and restrictions remain on women's movements outside the home without accompaniment by a male family member. Traditionally, men dominate most major household decisions, including those related to expenses. An implication is that many economically poor rural Bangladeshi married women, including participants in the study, prior to intervention, may have low threat points within their marriages.

In this context, the TMRI was designed and evaluated by the International Food Policy Research Institute (IFPRI) and implemented by the United Nations' World Food Programme (WFP). WFP managed the procurement and delivery of transfers, as well as the nutrition BCC training, and routinely monitored the programme. A non-governmental organisation (NGO) contracted by WFP, the Eco-Social Development Organization (ESDO), was responsible for the field implementation of project activities.

The TMRI was based on two cluster randomised control trials in rural Bangladesh: one in the northwest region (the "North") and one in the coastal southern region (the "South"). All beneficiaries were economically poor households (defined as having consumption below the lower poverty line in Bangladesh) with a child zero to 24 months of age in March 2012. Transfer payments and BCC were undertaken for 24 months, from May 2012 to April 2014.

The beneficiaries of the Cash+BCC arm in the North and of the Food+BCC arm in the South received the same transfer as in the Cash-only and Food-only treatment groups, respectively, as well as a suite of intensive nutrition BCC interventions focused on education and behaviour change at the household and community level. The BCC strategy involved three different activities:

1. Weekly group BCC trainings - some with beneficiaries only (that is, the woman in the Food+BCC or Cash+BCC groups) and some that invited other family members to attend along with beneficiaries, with the intention of creating a supportive household atmosphere and behaviour change at the household level. Trainings covered the following topics: basic nutrition, control and prevention of micronutrient deficiencies, infant and young child feeding (IYCF) practices, healthcare, maternal nutrition, and hygiene. The BCC training was led by community nutrition workers (CNWs), engaged by ESDO. CNWs were all women from the same villages as TMRI beneficiaries. They were trained by WFP and ESDO to impart the BCC content using a variety of methods including question and answer, flashcards, real-life examples, discussions, practical demonstrations, and interactive exercises such as role-playing and songs during sessions. CNWs identified successful mothers and involved them in facilitating the group meetings;
2. Bimonthly visits by CNWs to the beneficiaries' homes, in addition to more as needed for individual counseling. Monitoring data showed that 83% of respondents reported that, if a session was missed, the CNW followed up with a home visit; and
3. Monthly group meetings with influential community leaders (such as village heads, religious leaders, school teachers, community elected persons, and local health and family planning staff) that were conducted by CNWs and EDSO staff, without the beneficiaries present, with the goal of facilitating women's participation and increasing uptake of messages through a supportive community environment.

Of note, there was no explicit focus on violence or gender issues in any of the BCC components. However, negotiating conflict within the household regarding the purchase and consumption of foods, particularly those not typically consumed by these households, did form part of the interactive exercises that were part of the BCC.

Drawing on the randomised design, the researchers assessed impacts on IPV at postendline, separately estimating the effect of receiving only transfers from the effect of receiving transfers linked to nutrition BCC. Six to 10 months post-programe, IPV did not differ between women receiving transfers and a control group; however, women receiving transfers with BCC experienced 26% less physical violence. (Effects were not seen on emotional IPV).

The authors explore three possible mechanisms to explain why Transfer+BCC plausibly led to decreases in IPV six to 10 months after the programme ended, while the transfer alone did not:

• The first mechanism, which supports household economic bargaining models, is that Transfer+BCC (more so than transfers alone) led to improvements in women's threat point that were sustained even after the programme ended (e.g., "BCC led women to experience greater interaction and public respect in the community by increasing their knowledge of nutrition"); this increased their bargaining power within the household and made them less willing to accept violent behaviour through postendline.
• The second mechanism, which supports social control theories, is that Transfer+BCC (more so than transfers alone) led to increased interactions with community members that were sustained even after the programme ended ; this increased the probability of detection and social cost of men of inflicting violence through postendline.
• The third mechanism, which supports poverty-related stress theory, is that Transfer+BCC (more so than transfers alone) led to decreases in poverty that were sustained even after the programme ended; this reduced stress and conflict within the household.

One implication of the findings is that, although transfers by themselves may cause a contemporaneous reduction in IPV, sustained reductions in IPV beyond the end of transfers may require additional programme activities that lead to sustained improvements in women's status in the household and community. The findings also prompt several questions. For example, one might wish to understand whether the results generalise to a different type of BCC - e.g., one that is less intensive, involves different activities or topics, or is differently designed to reach other members of the household and community.