The Link Between Violence Against Women and Children And Quality of RMNCAH Outcomes In 8 African Countries

Background: Effective and quality RMNCAH outcomes are linked to reduced risk to violence. This study explored negative stereotypes of hegemonic masculinity and the social structures linked to it. An exploration of 8 Sub-Saharan African countries found 3 country-specific definitive social structures impacting the stereotypes, i.e., Enabling; Restrictive; and Hindering structures.

Methods: A meta-analysis of data from 2015-2019 of relationship between violence against women and children, is reflected in: Trauma Informed Care (TIC); comprehensive RMNCAH strategies such as IMNI, A/PNC, KMC, perinatal death review, and/or integrated maternal and perinatal death surveillance and response (MPDSR) processes; enforcement of legal gender equality; religious and traditional support for respect and dignity of women; uptake of gender-specific prevention services; Domestic Violence (DV) reports and HIV Prevention. 170 articles and reports were identified but 80 met inclusion criteria.

Results: Stereotypes of hegemonic masculinity exist in all 8 countries studied. Politics, religion and tradition influence risk reduction, e.g., enforcement of legal gender equality, political commitment and accountable judiciary ensure women can report abuses. Male dominance beliefs; traditions e.g. precarious toxic masculinity, indifference to expectant mother health by males, stigmatization of frequent clinic visits; and gender of breadwinner are linked to violence-related risks. Compared to all 8 countries, Rwanda, Ethiopia and Kenya have a hindering structure promoting significant risk reduction with institutions fostering increased rule of law, political commitment to RMNCAH outcomes, enforcement and risk-reduction consciousness. Uganda and Tanzania have a restrictive structure characterised with legal loopholes, irregular enforcement and ambivalent political commitment to address acts of violence against women and children. In Senegal, South Africa and Nigeria political, religious and traditional factors blatantly backing traditional negative stereotypes of hegemonic masculinity foster violence enabling structures entrenching repressive acts and hate crimes against women and children. In all countries however, Delivery room reception; level of Health Information Management skills; HIV criminalization; affinity and sensitivity to quality health by all people; stigma around attending clinics by males; negotiating for safer sex by women which is circumscribed as a threat to male dominance, subvert or support optimal RMNCAH goals.

Conclusions: Justice dispensation, economic autonomy, religion and traditional backing contribute effectively to risk-reduction. Contexts hindering violence prevail where state-led commitment thrives and these have far reaching benefits e.g., more people benefit from RMNCAH outcomes. Effective and quality RMNCAH programming in the countries studied will be effective if it is designed to address hegemonic masculinity practices too. Mortality implementation audits need to be disaggregated to reflect causes of and contributing factors to deaths.