Experiences of domestic violence prevention interventions and gender equality promotion work: a qualitative study of Nirdhar Groups in rural India

Gender inequality in India

Many Indian women face domestic violence and abuse (DVA) from their male partner (Jejeebhoy & Santhya, 2018; Borah et al., 2017). The causes of gender inequality and violence varies with local culture and norms, meaning local, community driven interventions play an important role (Desai et al., 2017) to reduce sufferings and promote change. In India, many rural communities face problems around women and girls’ safety (Ghosh & Choudhuri, 2011). Cultural pressures and norms often lead men into gender discriminatory practices (Ram et al., 2019). This may result in financial, emotional, or physical gender-based violence and discrimination (Anitha, 2019). As such, gender inequality severely hampers progress towards the Sustainable Development Goals (SDGs), particularly towards the fifth SDG, Gender Equality, and it is also important to achieve several others SDGs where girls/women involvement in health, economic and sustainable progress are imperative (United Nations Statistics Division, 2017). Rural and remote areas across India have inadequate resources such as limited judicial infrastructure, poor policing and environmental problems like frequent drought affecting agricultural yield which is the primary source of livelihood for many (Mahapatro et al., 2012; Showalter et al., 2020; Stephenson et al., 2013). Alcoholism and poverty are prevalent in these communities (Ram et al., 2019; Mshweshwe, 2020; Gunjal et al., 2020), fuelling men to dominate and engage in DVA (Daruwalla et al., 2019). Top down (governmental or socially led) strategies lack the capacity to address such issues faced in rural areas, which have their own social structures, community cultures, and related challenges.

Community based gender equality interventions

There is evidence that the most effective gender equality work can be done within and with the cooperation of the community itself (Daruwalla et al., 2019). Policies and laws are only effective when enacted in the community setting (Freudberg et al., 2018). Furthermore, engaging influential community members and ensuring that both women and men are actively involved in community-based gender equality interventions are markers for impact (Mahapatro et al., 2012). Targeted and localised approaches are deemed effective means for change (Kalokhe et al., 2017). With engagement from local communities, NGOs and community, volunteers are more readily accepted and recognised by those who need it most (Nair et al., 2020).

In partnership with and support from the SWISSAID India, the Halo Medical Foundation (HMF) initiated the ‘Responsible Couples’ project. The project involved developing local community level groups called Nirdhar Groups to address and reduce gender inequality, DVA and provide village-based support structures for women affected by gender inequality. Nirdhar in a local language, Marathi, means determination. Nirdhar Groups consisted of male and female community health workers, village police representatives, teachers, and elders. The NGO (HMF) convened, trained, and empowered such Nirdhar Groups with information, support, and resources so that they could support women’s rights within their own communities. The ‘Responsible Couples’ project involved the following key activities: (a) establishing village level gender equality groups known as Nirdhar Groups; (b) conducting training, education and media campaigns to educate people across project areas on the importance of gender equality; (c) motivating men (men’s involvement & engagement) to participate in household chores which are often shouldered by women, helping them understand the importance of gender equality and improving relationships at family levels; (d) advocating and working towards equal rights for women, such as joint bank accounts, joint property registrations for house and agricultural land (including ownership rights & decision making); (e) providing access to gender equality and domestic violence counselling services through HMF’s registered counselling centre (known as SAVALI Kendra, registered with the government authorities to provide support services & justice to victims of violence). The SAVALI Kendra receives referrals from village level Nirdhar Groups where specific support and expert advice are required to address DVA cases. Nirdhar Groups have now been in existence in 37 villages located in the Osmanabad district of the Maharashtra State of India since 2017. The overall project scope and objectives were focused on reducing any violence against women/girls and improve gender equality in rural communities, which is informed by SWISSAID and HMF’s strategies and work priorities to improve wellbeing of marginalised groups, children, and women in local communities. HMF has been working in community health and development sectors since 1990’s in rural areas of Maharashtra, particularly in Osmanabad district, which is one of the marginalised regions in the country.

All outlined project activities were designed and delivered by a dedicated team at HMF, through financial support from the SWISSAID. Team members had a range of backgrounds, primarily in social work with experience and interest to work on community development initiatives. The project structure offered each staff member an opportunity to work with a specific set of villages over time to conduct field-based meetings, training, educational tours, and also help communities develop village level groups (Nirdhar Groups) to improve gender equality and reduce domestic violence in communities. SWISSAID provided technical support through consultants and subject experts to train staff and village groups along with an intensive monitoring approach to track project progress. The support was also extended to design project activities such as initiatives to involve men in household activities, develop training manuals, and village/community level activities. Village groups were involved on a voluntary basis, and all project staff were full-time (~10 members) or part-time (~37 members) employed by the HMF (funded by the SWISSAID).

Purpose of the study

The purpose of this research was to explore the experiences of village level ‘gender equality’ Nirdhar Groups and to: (a) reveal how they developed processes and structures which impacted gender discriminatory practices and domestic violence & abuse (DVA) prevention across their local communities; (b) identify the issues and challenges they faced; (c) identify interventions which they used to combat gender inequalities in rural communities. The paper is presented in line with the COREQ guidelines (Tong et al., 2007).

Ethics

The study has been approved by the Faculty of Health Sciences Ethics Committee, University of Hull, UK (approval reference number- FHS125), and also by the ethics committee of the Ashwini Rural Medical College, Hospital and Research Centre, Solapur, Maharashtra, India (approval reference number- ARMCH/IECHR/03/2019).

Participants

The study involved 12 focus group discussions (FGDs) in 12 villages, which were part of the ‘Responsible Couples’ project. The groups were selected from a pool of 37 villages, where village groups were actively working in the ‘Responsible Couples’ project at the time of data collection. Each village had one group and each group had 15 and 20 members. The outlined 12 groups/villages were randomly selected from project area by members of the UK research team, Professor Mark Hayter and Dr Anand Ahankari, who were not aware about individual group level performance, to avoid any selection biases. All 12 village groups were provided information about the study in advance and once they agreed to participate in the study, then FGD (data collection) date and timings were confirmed. Based on our series of consultations with partners, field visits, interactions with beneficiaries, and literature evidence, the proposed 12 FGDs were deemed sufficient to achieve data saturation.

Study setting

A semi-structured discussion guide comprised of open-ended questions was used to collect qualitative data (see Extended data (Ahankari et al., 2019). FGDs explored the following topics having several sub-questions; how the village level group was formed, what trainings the group attend, what they understand by gender equality, what work they undertake as a group in their communities, impact of their work and what should be done more to ensure replication and success of such work elsewhere in Maharashtra/India. FGDs were deemed suitable for this work considering village level issues related to gender inequalities and domestic violence were identified by one or more group members, who then discussed those within the group during monthly meetings, and then they decided on their strategy to address identified issues. As a result, identification, intervention, and delivery was agreed through group discussions involving several members along with necessary support and advice provided by project staff. Thus, the proposed FGD method was appropriate to capture relevant data to achieve study objectives. The interview guide (see Extended data (Ahankari et al., 2019)) was prepared and reviewed several times by research team, partner agencies, and relevant staff to ensure its relevance and application.

Data collection

All 12 FGDs were conducted in community spaces such as a village/community hall, school, health centre, or other appropriate community location to ensure necessary meeting arrangements, where accessibility, confidentiality, and privacy were in place. Willing participants were requested to arrive at an agreed time to avoid disturbances or interruptions during the discussion. The village groups worked together to deliver ‘Responsible Couples’ project activities, thus members were aware of roles and work undertaken by others. While as a group participants knew each other, confidentiality was maintained about discussions undertaken during data collection session, where participants were requested not to discuss any sensitive topic(s) outside their Nirdhar Group. Participants were informed about research procedures to obtain a written group consent prior to the data collection session. The FGDs were conducted in local language (Marathi), audio recorded, transcribed, and translated into English for analysis. Time duration for FGDs varied between 90 and 120 minutes. Participants varied in each FGDs from eight to 12 and included both men and women members. The interviews were conducted by two qualitative researchers (Mrs Anuprita Dixit and Mr Sandeep Rasalpurkar), who were not involved in any capacity in the ‘Responsible Couples’ project in the past, and did not work previously in any capacity/role for organisations involved in delivering the ‘Responsible Couples’ project. Both qualitative researchers were bilingual (Marathi and English), and were native speakers of Marathi language with over 20 years of work experience in research and development sectors. They had backgrounds in health sciences (MSc), recruited as data collection consultants, and were given necessary resources to conduct in-depth FGDs. The combination of one male and one female data collector (gender balanced approach) was preferred considering the research topic, scope, and study participants background to create a suitable environment for all participants to engage in data collection sessions. Both data collection team and participants were aware about the study aims and objectives. Two key members of the UK research team, Professor Mark Hayter and Dr Anand Ahankari, provided in-person trainings to these qualitative researchers in India to inform about study procedures and ethics (Ahankari et al., 2019). Staff members of the ‘Responsible Couples’ project, funding agency (SWISSAID) did not attend FGDs to ensure that participants and research team members will have necessary autonomy and privacy to conduct in-depth data collection. FGDs data files (in Marathi/English) were accessible to research team members only, and were not shared with study participants. Each FGD was conducted only once, and study findings were communicated with village and project representatives through three dissemination events, where participants had opportunities to provide verbal feedback. All field based research work was completed between January 2019 and July 2019. Further details on the study procedures are available online (Ahankari et al., 2019).

Analysis

Analysis was informed by Braun and Clarke’s (2006) six phase deductive reasoning methodology, which was felt to reflect the linearity of this project. All FGDs data files were stored using Microsoft Office Word Software for analysis purposes. No other software tools were used. The thematic approach started with researchers identifying individual coded elements within the data and then iteratively developing explanatory themes to generate a final thematic overview of the phenomenon under investigation. Themes, therefore, were separated into: (1) how groups identified problems and worked together to prioritise interventions; (2) short-term interventions to inform and engage communities; and (3) long-term interventions which reflected an embedded transformation across communities. Table 1 lists major themes and sub-themes. No field notes were taken/used in the analysis. Data analysis was conducted by two researchers (Ms Heidi Fewings and Dr Amanda Lee), and was supervised by senior qualitative researcher (Prof Mark Hayter).

Theme 1 - Understanding gender equality and identifying priorities

This theme captures how Nirdhar Groups identified and defined their boundaries – using the norms and customs within their communities to assert the discourse of gender equality, and set the social transformation priorities within their communities. Group members highlighted several priorities, including addressing unequal access to education and healthcare, male dominated legislation (used as means to financial oppression and control), misogynistic rituals (dowry, child marriage), and family power dynamics with potential to increase ‘burden’ and disempower women. Nirdhar Groups highlighted confounding factors towards DVA and gender inequalities, such as substance misuse and the practice of hysterectomy to improve work productivity.

Discourse of gender equality

All groups began by discussing what they meant by ‘equality’ and then identified common practices, which impacted women’s rights and social status within communities. On defining gender equality, many of the groups acknowledged that men and women should be treated equally.

Some groups identified physical burden on women running households, and culture-based lack of knowledge on their rights as women.

Safe access to education and healthcare

Access to basic healthcare was identified as ‘unequal’ between men and women, where decision making power to access services remains with men. In our study area, women are known to neglect their personal healthcare issues and prioritise their children, husband, and family, especially in-laws.

Local cultures appeared to prevent women from accessing education. In particular, FGDs uncovered some practices that made women feel ‘unsafe’ when travelling to access education. These were mainly due to verbal harassments by young boys/men.

Legislation and home ownership

Gender equality in legislation was raised, with a focus on home, or land ownership and after being widowed or divorced. In the past, home ownership and finances were registered in the husbands’ name. New legislation has meant that women can now be placed on deeds for home ownership, financial institutes such as bank accounts, and such registration is also required to access government schemes and funding.

Misogynistic rituals – power, community, and family dynamics

Misogynistic rituals and cultures were highlighted as critical reminders of the oppression of women in local communities. Thus, certain behaviours and practices were identified as priorities for intervention. These included addressing child marriage, gynaecological health, and female foeticide.

The tradition of dowry was identified as problematic but noted to be reducing across societies.

One priority for Nirdhar Groups was identified as family planning. Smaller families were seen to decrease the burdens on women.

Domestic Violence and Abuse (DVA – formerly known as ‘intimate partner violence’)

Reducing DVA and aggression was a priority across most Nirdhar Groups. Many groups identified a need to address DVA and offer interventions to reduce addiction amongst ‘violent men’, educate men about these issues and impacts on women, which may help improve equality and wellbeing of women. These were primary project objectives set by SWISSAID and HMF.

There were many examples of incidences of DVA.

Substance misuse

In some communities, substance misuse with alcohol and betel nut were often identified as a causative factor. Betel nut, also known as areca nut, is the seed of areca palm tree. It is widely cultivated in South Asian countries. It contains psychoactive ingredients, and has many harmful effects on humans due to its carcinogenic nature (Arora & Squier, 2019). In our study area, it is known as ‘supari’ in the local language.

Theme 2 - Short term interventions to inform and engage communities

This theme contains examples of how Nirdhar Groups interacted with specific families and groups, to instil personal-level change in culture and behaviours. Through regular communication and involvement with their community citizens, the Nirdhar Groups were able to anchor themselves as agents of change. Their work involved a range of initiatives in line with priorities identified in their communities as explained in the theme 1.

Ensuring safe and equitable access to education and healthcare

Many Nirdhar Groups implemented strategies for equal access to education and healthcare for both daughters and daughter in-laws/wives. Education opportunities are limited in our study region due to school structure, where most of the villages have schools until 10 or 13 years of age, and for middle school many need to travel to nearby towns. Due to preference given to male children, females often drop out from the education system (Psaki et al., 2022), therefore, access to education is important for young girls in our study area. Furthermore, such inequalities prevent women/girls from accessing healthcare where females/women do not prioritise their health and are often neglected by their families due to gender based discrimination.

Creation and establishment of ‘safe spaces’

Girls and young women often discussed concerns about access to public transport facilities, so that they felt safe to attend education. The number of college-going girls increased over time in these communities. Women and girls received a platform and also a support system through Nirdhar Groups initiative to share their concerns with policy makers and influential people in their communities. This provided opportunities to voice their concerns/problems during village meetings and demand for necessary actions to improve safety and transport facilities. Females were present at village meetings, which used to be traditionally attended by men in the past. Village government office then formally requested district authorities to re-start public transport services, which will benefit young girls and women to access education institutes. This also improves their safety during travel.

Facilitating equal access to finance, grants, and home ownership

Nirdhar Groups used a variety of means to inform women of their rights and responsibilities and offered education sessions on legislation, so women could work towards a financial freedom. Groups were trained and equipped with resource by project staff, who also provide support during such activities. Previously, finances were in the male domain, with accounts held in the husband’s name, however women are now participating in financial activities.

Addressing and challenging misogynistic rituals through family communication

Nirdhar Groups used a ‘community presence’ to access homes and communicate across family groups to instil change.

Acts to reduce DVA

Community pressure and communication also facilitated issues with gender-based violence and oppression. Nirdhar Groups played crucial role while working as a team to intervene and provide support to victims. Capacity building trainings and continuous support by project staff (HMF) was offered considering a range of project activities and varying requirements and complexity of issues across project areas.

Theme 3 - Long-term interventions - creating a sustained environment of gender equality

This theme identifies how Nirdhar Groups worked towards a sustained, cultural agenda for change. It presents how people worked together, celebrating their successful outcomes, and ingraining the culture of gender equality across their communities. Thus, this theme presents higher level examples of cultural transformation, such as role modelling, empowerment, instilling kindness, care, and compassion, with a sustained power to change the next generation.

Role modelling

Groups modelled their work through a “willingness” and “responsibility” to have to work for the village (FGD7). Men took more responsibility for preparing meals and hosting visitors. Nirdhar members acknowledged that to present change, they had to act as role models. They acknowledged that, to instil change, they had to be a part of that change. Some Nirdhar members identified significant changes they had experienced, driven by a desire to be a social transformer, an activist in the ‘Prabhodhan’ ethos (Prabhodhankar was an ‘enlightened good citizen, working for the good of communities).

Role modelling was achieved through dissemination of knowledge received from education and training provided by the HMF. A Nirdhar member spoke of the impact of training on their motivation to disseminate the new knowledge.

Empowerment (through access to information)

Several Nirdhar Groups facilitated health related information exchange – empowering adolescent girls with health and vaccine related information through social media. Nirdhar Groups helped to organise ‘health clinics’ for women in their communities. These were used as fora and means to instigate vaccination strategies and engagement in health literacy activities, as adjuncts to basic medical and maternity care.

Empowering communities (by instilling kindness, care, and compassion)

Some Nirdhar Groups used their forums to assert kindness, care, and compassion towards all members of the communities. This also shows a sense of responsibility group members developed towards individuals in their communities who needed help. The ability to provide help as well as intervene in such situations as a group is much more feasible in our study area rather than working individually.

A sustained change for future generations

The underlying ethos of any sustained cultural change is to offer guidance and support to the next generation. Many Nirdhar Groups highlighted exemplars of ‘good citizenship’ which also helped in building confidence in girls and women in their communities.