Bandebereho Evidence of Impact: Findings from a six-year randomized controlled trial

Background The Bandebereho intervention is a gender-transformative intervention for couples who are expecting or current parents (ages 21-35) of children under five years that promotes men’s engagement to prevent violence against women & children, promote reproductive, maternal, and child health, caregiving and healthier couple relations. The intervention uses fatherhood as an entry-point to promote men’s participation as caring, non-violent and supportive fathers and partners. The Bandebereho Pilot Bandebereho was first piloted in 4 Districts of Rwanda from 2013- 2015 and sessions were facilitated by local fathers trained to recruit and implement the sessions with men and couples in their community. A randomized controlled trial conducted from 2015-2016 that assessed the impact of Bandebereho implementation found that the intervention had a significant impact on increasing men’s engagement in their children’s and partners lives as well as a range of outcomes influencing the health and well-being of women, children and men themselves. Transition-to-Scale Based on the positive findings from the pilot, RWAMREC and Equimundo, in collaboration with RBC/MCCH division sought to scale-up Bandebereho to reach more families and communities. A multi-sectoral technical advisory group, led by RBC and including MIGEPROF, NCDA identified the health system using the community health workers as the strongest and most sustainable option for scaling-up across Rwanda. Since 2019, RWAMREC, (RBC/ MCCH) and Equimundo with support from the technical advisory group have been collaborating with Musanze district to adapt, and testing the delivery of Bandebereho through the health system as part of the transition to scale. A process evaluation of the transition-to-scale found that it is feasible for community health workers to implement Bandebereho with a high degree of quality and fidelity to the original intervention. EVALUATING THE IMPACT OF BANDEBEREHO A randomized controlled trial (RCT) considered by some as the gold standard of evaluation was conducted to assess the impact of Bandebereho on participating couples. In this study one group receives the intervention (treatment) and another does not receive the intervention (comparison or control group). A total of 1,199 couples was recruited into the study and then randomly assigned to either the treatment group, which received the Bandebereho intervention in 2015, or a control group, which received no intervention. Data were most recently collected at 76-month follow-up in 2021 more than six years after the baseline and nearly six years after the intervention ended. This long-term follow-up sought to understand: · The longer-term impacts of Bandebereho intervention on men’s and women’s behaviors; · Whether previous impacts (at 21 months) have been sustained over time; and · Any impacts on young children’s development. The Bandebereho RCT is unique for several reasons. First, when it began it was one of relatively few trials to assess the impact of an intervention designed to engage men in gender equality, reproductive and maternal health, or violence prevention. Second, it evaluates the impact of Bandebereho across multiple outcomes such as reproductive and maternal health, couple relations, and parenting practices and it sought to understand the impact on gender and power dynamics. Third, it evaluates impact across a nearly six-year timeframe, a much longer timeframe than most existing studies which allows us to understand whether the intervention’s earlier impacts have been sustained over time. Research permissions The data collection was approved by the Rwanda National Ethics Committee and the National Institute of Statistics of Rwanda. The 76-month follow-up was also approved by the Rwanda National Council for Science and Technology. KEY FINDINGS OF BANDEBEREHO IMPACT The Bandebereho RCT demonstrates that the intervention has led to multiple improved outcomes for women, children and men themselves that contribute to happier and healthier families. Encouragingly, the new data collected at 76-months indicates that many of these positive changes seen at 21 months have been sustained nearly six years later much longer than most programs have either been evaluated or shown lasting impacts. Below we summarize some (but not all) of the key findings from the RCT at both 21- and 76-months. All findings presented are statistically significant. 1. Men’s engagement and improved reproductive and maternal health outcomes Bandebereho successfully transformed men’s perceptions of their roles in reproductive and maternal health and increased their engagement and support for their partners’ care-seeking. In the period after the intervention, men who participated in Bandebereho were more likely to accompany their partners to antenatal care (ANC) visits than men in the control group. Women in Bandebereho also attended more ANC visits. At six-year follow-up, we find that Bandebereho couples continue to report greater rates of men’s antenatal accompaniment and women’s ANC attendance compared to the control group. The intervention also increased the level of support men provided their partners during pregnancy whether emotional, financial, or spiritual support, doing household tasks, cooking, or supporting his partner’s nutrition as reported by women (this outcome was not measured at 76 months) and reported greater communication about and use of family planning after participating in Bandebereho. Six years later, men in Bandebereho continue to report greater use of modern contraceptives compared to the control group. Yet, women in Bandebereho do continue to report greater communication about family planning and a feeling that their input was valued in making contraceptive decisions, compared to women in the control group. 2. More equitable and less violent couple relations The Bandebereho intervention also supported men and their partners to adopt more equitable relationship behaviours, allowing them to build stronger, less violent, and more equitable and caring relationships. Most notably, the intervention has led to significant reductions in men’s use of intimate partner violence (IPV). Couples who participated in Bandebereho also report higher rates of emotional closeness and better relationship quality compared to control couples. In addition, men and women in Bandebereho report greater levels of couple communication about household decisions and greater involvement of women in making household financial decisions findings that are sustained six years later. Bandebereho couples report that these tasks are shared more equally between partners. Both of these findings are sustained at six-year follow-up, suggesting the intervention has led to lasting changes within the home. 3. Improved parenting practices are contributing to better child outcomes The Bandebereho intervention not only increased men’s engagement in caring for their children, but also increased both parents’ participation in responsive caregiving time spent in stimulating interactions which help their children’s minds to develop. Bandebereho also led to reductions in both men’s and women’s use of physical punishment of their children in the period immediately after the intervention. Encouragingly, we find that six-years later Bandebereho couples continue to report lower rates of physical punishment of children than the control group. Indeed, the six-year follow-up suggests that Bandebereho’s impacts on parenting practices and the home environments in which children are raised is having a direct impact on children themselves. This suggests that the intervention’s impact extends beyond just the men and women who participate directly in it, but also influences the development and well-being of their children. It’s also worth noting that Bandebereho has led to reductions in intimate partner violence, therefore limiting children’s exposure to such violence, which may help to break the intergenerational transmission of violence as witnessing IPV in childhood increases men’s risk of growing up to perpetrate IPV and women’s risk of experiencing IPV

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Bandebereho Evidence of Impact: Findings from a six-year randomized controlled trial