Transforming Masculinities/Masculinité, Famille, et Foi Intervention: Endline Quantitative Research Report

"MFF contributes to global evidence on gender transformative approaches within faith-based settings seeking not only to bring about changes in attitudes and behaviors, but also to shift the social norms identified as influencing those attitudes and behaviors."

This report presents the results of an endline quantitative study conducted from November 2018 - February 2019 to evaluate the effect of an adapted Transforming Masculinities (TM) approach in Kinshasa, Democratic Republic of Congo (DRC), known locally as Masculinité, Famille, et Foi (MFF). The intervention focuses on social norms and centres on religious leaders and faith communities in an effort to increase voluntary family planning (FP) use and reduce intimate partner violence (IPV) among newly married couples (NMC) and first-time parents (FTP). This study is the result of a partnership between Tearfund, Église de Christ au Congo (ECC), and the Institute for Reproductive Health (IRH) as part of the United States Agency for International Development (USAID)-funded Passages Project.

MFF's multi-level, norms-shifting approach with focuses on improving individual, relationship, and normative influences on IPV and voluntary use of modern contraception. As shown in the programme's theory of change (see also Related Summaries, below), the premise of the intervention was that MFF's main components - mobilising faith leaders, transforming masculinities with gender champions, holding community dialogues with young couples (18-35 years of age), shifting norms with broader congregation members, and creating an enabling service environment - would work together to diffuse new ideas that change the underlying social norms and ultimately impact reproductive health (RH) and well-being in Kinshasa.

This report focuses on data from two quantitative surveys conducted among congregations allocated to either receive the MFF intervention or act as a comparison population at baseline and endline (a two-group, pre-test/post-test design). Surveys were conducted at baseline in late 2016 and again at endline, after the completion of approximately 18 months of intervention, in late 2018. These surveys included:

1. A couple survey conducted amongst NMC and FTP: The sample at baseline included 425 individuals in the comparison population and 476 individuals in the intervention population; at endline, there were 384 individuals in the comparison and 407 individuals in the intervention population.
2. A diffusion survey among the wider congregation: The sample at baseline included 634 individuals in the comparison population and 623 individuals in the intervention population; at endline, there were 590 individuals in the comparison and 667 individuals in the intervention population.

Selected findings from the surveys include:

• What effect did MFF have on intermediate outcomes for FP?
  • There were large, significant differences in individual attitudes at endline, with respondents in intervention congregations significantly (p0.01) more likely to agree that both NMC and FTP can voluntarily use modern contraception compared to comparison congregations.
  • There were significant differences in self-efficacy, with respondents in intervention congregations significantly (p0.01) more likely to report that they could suggest voluntarily using modern contraception to their partner and that they could voluntarily use modern contraception if they desired.
  • There were improvements in communication within a partnership around FP, with respondents in intervention congregations significantly (p0.01) more likely to report speaking with their partner about RH topics in the previous one year compared to respondents in comparison congregations at endline.
  • However, there was no difference in the involvement of women in FP decision-making comparing respondents in intervention and comparison congregations at baseline.
• Did MFF lead to changes in social norms and reference groups (i.e., different types of people thought to influence the social norm) for voluntary use of modern contraception?
  • There are slight indications that norms around FP are more amenable to voluntary use of modern contraception in intervention congregations compared to comparison congregations. By sex, women in intervention congregations were significantly (p0.05) more likely to perceive that voluntary use of modern contraception was typical and acceptable behaviour compared to women in comparison congregations. However, men in intervention congregations were unexpectedly less likely to perceive that voluntary modern contraception use was approved behaviour by people in their reference group.
  • In both intervention and comparison congregations, more participants at endline considered their partner and/or a health worker as important reference groups and fewer listed their faith leaders, mothers/in-law, or fathers/in-law.
• Did MFF lead to improved voluntary use of modern contraception?
  • A significantly (p0.05) higher proportion of non-pregnant respondents in intervention congregations reported voluntarily currently using a modern method of contraception (53.4%) compared to comparison congregations (45.3%). This is also an increase compared to 40.1% of respondents in intervention congregations at baseline.
  • At endline, 82.8% of respondents in intervention congregations reported they were likely to voluntarily use modern contraception in the future, which was a significantly (p0.05) higher proportion than the 74.7% of respondents in comparison congregations who reported this.
  • Among women at endline, 54.8% of women in intervention congregations reported voluntarily using modern contraception compared to 42.6% of women in comparison congregations, a significant difference.
  • Among FTP at endline, 62.1% in intervention congregations reported voluntarily using modern contraception compared to 48.8% of FTP in comparison congregations, which was statistically significant at the p0.05 level.
  • However, there were no significant differences comparing men or NMC in intervention and comparison congregations at endline.
• What effect did MFF have on intermediate outomes for IPV? There were improvements in several attitudinal statements, but similar shifts were observed in comparison congregations.
• Did MFF lead to changes in social norms and reference groups for IPV?
  • The researchers write: "Findings on social norms related to IPV were unexpected...[and] raise important questions about the study and possibly the intervention." For example:
    • There was an increase in the perception that IPV was typical behaviour by both male and female respondents in intervention congregations from baseline to endline.
    • Respondents in intervention congregations were statistically significantly (p0.05) more likely to perceive that their reference groups would approve of a husband's use of IPV against his wife.
    • By sex and life stage, women and FTP in intervention congregations at endline were significantly (p0.05) more likely to perceive that IPV as acceptable behaviour at endline compared to women and FTP in comparison congregations.
  • Further, fewer respondents listed their faith leaders and their mothers/in-law or fathers/in-law as key reference group members for IPV.
• Did MFF contribute to reduced IPV?
  • At endline, significantly fewer (55.7%) respondents in intervention congregations reported emotional IPV compared to men and women in comparison congregations (63.1%).
  • Fewer, though not significantly less, respondents in intervention congregations reported physical and sexual IPV at endline.
  • 6.1% of respondents in intervention congregations at endline reported IPV related to woman's use or expressed desire to voluntarily use modern contraception. This is a lower, but not statistically significant, proportion of those reporting IPV in comparison congregations (8.3%).
  • Slightly higher proportions of NMC in intervention congregations reported experiencing all forms of IPV except emotional IPV compared to respondents in comparison congregations, though these differences were not statistically significant.
• Did MFF contribute to changes in social norms for positive masculinities? Respondents in intervention congregations significantly (p0.01) supported equality among sexes compared to those in comparison congregations at endline. With regard to household roles and expectations, similar improvement in perceptions that husbands were involved in these activities and that this involvement was acceptable from baseline to endline was seen in comparison congregations.
• Did MFF messaging diffuse through congregations?
  • In intervention congregations, 30.1% of congregants reported speaking to another individual about FP in the previous three months, 38.0% about IPV, and 41.5% about gender roles. This was higher compared to baseline levels (17.2%, 26.5%, and 26.0%, respectively) in intervention congregations. However, differences were only statistically significant comparing intervention and comparison congregations for speaking about gender roles in the previous three months (41.5% vs. 33.2%).
  • Perceptions of IPV as typical and/or accepted behaviour did not differ between the wider congregations of intervention and comparison samples. However, respondents in intervention congregations were significantly (p0.01) more likely to perceive that married couples voluntarily used modern contraception in their congregations (66.7% vs. 60.3%), that fellow congregants (68.1% vs. 63.2%) and faith leaders (67.8% vs. 60.3%) approved of married couples voluntarily using modern contraception, and that Scripture supports married couples voluntarily using modern contraception (52.9% vs. 45.9%) compared to respondents in comparison congregations.
  • Despite this increased perceived support in congregations and by faith leaders, at endline participants reported that faith leaders' opinions mattered less than the opinion of a respondent's partner or health workers.

Thus, the results indicate that the MFF change strategies led to improvements in voluntary use of modern contraception and intermediate outcomes related to FP and modern contraceptive use among NMC and FTP. However, findings related to IPV, gender, and diffusion are more mixed.

Reflecting on the findings, the researchers note that, "[t]hough the theory of change indicated that changing social norms was important for behavior change, this study indicated that MFF may have contributed only marginally at this point to shifting norms related to voluntary use of FP and intention to use FP generally and, for women, perceiving voluntary FP use as typical....This does not mean that the normative environment is not important for voluntary FP use. It is possible that couples shift in voluntary use of FP changes norms in the congregation opening space for norms shift in the wider congregation and allowing others not directly implicated in the program to their follow their intentions related to FP."

With regard to the finding that reference groups actually shifted away from faith leaders, despite this being a faith-centred intervention, the researchers suggest that this shift "may actually indicate an openness of trusting health workers (given linkages and strengthened health environments) or in the focus of the intervention on improved couple communication and negotiation around FP. The finding that an intervention may shift reference groups for a particular behavior is intriguing and carries important implications for norms shifting initiatives."

Programming recommendations highlighted in the report include the need to attend to norms-shifting pathways and their associations with attitudes and beliefs, "especially as contextual influences may shift even when the faith congregation is an important influence. Longer intervention time periods, with additional research touchpoints or a longitudinal design may have helped elucidate those factors."

Editor's note: In addition to the Related Summaries, below, you may be interested in the Masculinite, Famille, et Foi End of Project Report.