IPV Clinical Trial
Official title:
Measuring the Effect of HERrespect: An Intervention Addressing Violence Against Female Garment Workers in Four Factories of Bangladesh
This study evaluates whether a factory wide intervention, HERrespect, can reduce female garment workers' experiences of intimate partner violence, and experience and/or witnessing of violence in the workplace. This is a quasi-experimental study involving four intervention and four control factories.
Background Violence against women (VAW) is an important public health, human rights and
development issue worldwide. Intimate partner violence (IPV) is the most common type of VAW
ranging between 15% and 71% worldwide. IPV in South Asian countries is as high as 42%.
Adverse consequences of spousal violence on women's health and well-being are well
documented. This violence is also known to affect women's work and productivity. IPV affects
not only the women, but also their children, families and the nation.
In Bangladesh, 53% of the ever-married reproductive aged women reported lifetime physical
and/or sexual abuse and about a quarter of the currently married women reported exposure to
this violence during the last 12 months. Common correlates of IPV in Bangladesh include young
age, poverty, low education, history of wife abuse in the family, childhood experience of
violence, dowry, and low spousal communication. The literature on correlates of IPV shows
that, particularly in patriarchal contexts, working women are more vulnerable to IPV.
Although research on IPV has gained great momentum over the last few decades, literature on
IPV against working women in low income settings is still scanty. Unpublished data from
icddr,b show that 70% of the garment workers aged 15 to 29 were physically and/or sexually
abused by their spouses during the last 12 months, while according to the Bangladesh
component of the WHO multi-country study on Women's Health and Domestic Violence against 53%
of urban and 62% of rural peers of them reported such violence. Studies show economic IPV
against female garment workers in Bangladesh. Thus, young female garment workers are highly
vulnerable to violence demanding attention of the researchers, programme implementers and
policy makers.
Approximately 80% of the workforce in the garment manufacturing industry in Bangladesh is
female. According to a report, about 60% of female workers experience harassment at work.
Qualitative research suggests that severe emotional and economic violence is universal in
this sector, while physical and sexual violence is not uncommon. Most common perpetrators of
violence are mid-and low-level factory management staff.
In general, evidence on what works in addressing IPV and workplace violence against women is
thin worldwide. A few sporadic interventions implemented for addressing workplace violence
against female garment workers over the last few years in Bangladesh have not been rigorously
studied. Although there is evidence that a combination of economic empowerment and gender
interventions reduces IPV effectively there has been no attempt at measuring effect of gender
interventions among female garment workers, who are relatively much more economically
empowered compared to their peers. The current research proposes to evaluate HERrespect, a
pilot intervention for preventing and responding to spousal and workplace violence against
female garment workers by providing interactive sessions to the management and the workers on
gender and violence against women and girls (VAWG).
Objectives of the study The primary objective of this study is to measure whether HERrespect
intervention reduces female garment workers' experiences of: (1) Spousal physical and sexual
violence and (2) Workplace violence over a period of 24 months between baseline and end-line
during which the intervention is delivered in the factories.
The secondary objectives are to assess whether HERrespect:
1. Increases gender equitable attitudes among female garment workers
2. Reduces acceptance of VAWG among female garment workers
3. Increases self-esteem of the female garment workers
4. Reduces rate of depression among female garment workers
5. Increases knowledge and uptake of service for addressing spousal violence
6. Increases gender equitable attitudes among garment management staff
7. Improves management skills of management staff
8. Increases knowledge of policies addressing gender discrimination and violence among
management staff
The intervention HERrespect is a workplace programme developed by Business for Socail
Responsibilities (BSR) and South African Medical Research Council (SAMRC), with inputs from
Change Associates Limited. Design of HERrespect is guided by the Theory of Change (TOC) and
the formative research conducted by icddr,b.
Theory of Change The base of the TOC begins with a core problem that female workers in the
RMG industry in Bangladesh experience high levels of violence, both in the workplace and
their intimate relationships. Such violence is not only a violation to their rights, but at
the same time constrain them from contributing to their personal growth, household, community
and the economy at large.
The barriers are based on BSR's experiences in implementing HERproject, a women empowerment
initiative in the supply chain, in Bangladesh, as well as the formative research conducted by
icddr,b. At an individual level, there is a lack of critical awareness about gender and
rights among workers, both male and female, and VAW is normalized and generally accepted in
the workplace. Outside the workplace, workers also do not have sufficient information on
available resources and initiatives in the community targeting IPV victims. Management does
not possess essential skills to manage the workforce, and perceives violence as the most
accessible and effective way to achieve production targets. The dominant social norms of
femininity and masculinity in Bangladesh and the disciplinary nature of operating a factory
reinforce the submissive identity of female workers and the unequal relationship between
managers and workers. Moreover, there are institutional barriers in the workplaces,
particularly on the gender-blind policies and organizational structure to prevent and address
violence; the lack or misuse of such may even incentivize VAW in workplace.
To overcome the barriers, a combination of intervention strategies will be adopted to: (1)
raise awareness on gender, rights and VAW among workers and management; (2) enhance the
skills of workers to prevent and address sexual harassment and IPV; (3) build capacity of
management to promote gender equitable environment; (4) create an enabling environment
through development of gender-sensitive policy and organizational structure, and (5) bridge
the information gap on community services and initiatives on IPV.
Together, the interventions will lead to five outputs. First of all, female workers will have
enhanced awareness and knowledge on gender, rights and VAW; their skills will also be
enhanced to respond to violence in workplace and family. In case they suffer from IPV, they
would have more knowledge on the services available in the community and know where to avail
them. For management and male workers, their awareness and skills will be enhanced to
motivate and support colleagues in preventing and addressing VAW at workplace.
Institutionally, the policies and structures of factory will be improved to address grievance
in more equitable and effective manner, and management will be supported to design and
implement policies to promote positive gender relations.
The outputs will lead to certain empowerment outcomes. Female workers will be empowered from
within through improved self-esteem, confidence and assertiveness; communications and
negotiations around IPV are also expected to improve through the training. The quality of
interactions between management and workers would improve, contributing to a more supportive
social network within the workplace. That will be further augmented by the improved
implementation of policies and mechanism on VAW. Finally, with heightened awareness of
community resources, it is expected that more women in need would avail services for VAW in
the community.
The goal (or impact) of HERrespect is to cultivate more gender equitable attitudes and
relationships among women and men in RMG industry in Bangladesh, which ultimately will
contribute to preventing VAW at workplace and family.
Intervention components
The main intervention components in the workplace, will be implemented by Change Associates,
are:
1. Separate gender transformative training for workers (single sex groups for female and
male workers) and management staff of 18 hours (six 3-hour modules), held over 9 months
and delivered to groups of 25. The session topics include communication skills (e.g.
listening, body language, etc.); assertive responses; reflection and discussion of
gender roles and norms, and relationships; power; violence in relationships (causes,
consequences and support system); stress and conflict management; factory policy; and
goal setting and being a change Maker. The curriculum is participatory, taking reference
from Stepping Stones and Freirean reflective pedagogy.
2. Joint session between workers (15 female and male) and middle-management staff (10),
held after third, fifth and sixth group sessions.
3. Factory-wide activities/campaigns using factories public address systems, skit play and
other behaviour change communication materials
4. Awareness raising among top management (e.g., general manager, HR&A director, etc.; 2
hours)
5. Factory policy review and development. Its activities include at least one meeting in
every two months with the Factory Well-being Committee. The topics include review
existing and develop new gender policies and mechanisms to prevent and address sexual
harassment; design and implement factory-wide promotional activities/campaigns; report
progress and challenges to top management on a regular basis; and design and implement
sustainability plan (initially support, and subsequently run, the joint sessions between
managers and workers).
In addition to the workplace interventions, HERrespect will have an community engagement
component, working with Awaj Foundation in their workers' café to develop a training module
on IPV based on their existing programmatic framework, build capacity of cafés' staff to
facilitate gender transformative curriculum, and develop training materials for use in the
workers' café's network.
Research Design and Methods This is a quasi-experimental study involving four intervention
and four matched control factories recruited by the buyers purposively. Factory matching
criteria include size, location, and type of product. Care will be taken to select control
factories at a distance from the intervention factories to prevent potential contamination.
In the intervention factories a randomly selected cohort of married female workers and all
management staff will receive group sessions. In addition, factory-wide campaigns will also
be carried out. The control factories will be waitlisted for intervention once the evaluation
is over.
All the workers receiving group intervention (n=400) and a cohort of randomly selected
married female workers from the control factories (n=400) will be included in the baseline
and endline worker surveys. The management survey will include 50 randomly selected
management staff from each factory. The endline surveys will be conducted 24 months
post-baseline.
Sample Size Calculation and Outcome The sample size for the worker survey was calculated
considering the primary outcome, physical and/or sexual IPV against female garment workers.
Considering 56% baseline prevalence, 20% effect size, 80% power, 5% level of significance and
20% lost to follow up the required sample size was 330 workers for both intervention and
control groups. Accounting for a 20% lost to follow up and rounding up the sample size became
800 workers (400 in intervention and 400 in control), making 100 workers per factory.
Sample size for the management survey was calculated based on high or moderate gender
inequitable attitudes of the management staff. Considering 50% baseline prevalence, 30%
effect size, 80% power and 5% level of significance a sample size of 183 was derived both for
intervention and control factories. Accounting for a 10% loss to follow up the final sample
size for each group of factories was 200, giving a total of 400 (50 per factory).
Translation of data collection tools The worker and management survey questionnaires will be
developed in English. Once the English version is finalized the questionnaire will be
translated into Bengali. The Bengali questionnaire will be finalized based on feedback from
pre-testing and piloting. Blinded back translation will be carried out by a third party once
the Bengali questionnaire is finalized. Where needed, revisions will be made in the Bengali
version based after comparison between the Bengali version and the back translation.
Recruitment of survey participants
In order to achieve the required sample size of 100 per factory, assuming that 40% of the
female workers will be married and that 80% of them will finally join the groups a list of
315 workers containing information on ID and name will be obtained from each factory. An
enumeration of these selected 315 workers will be carried out within the factory to collect
some socio-demographic information mainly for the purpose of screening eligibility and
obtaining residential addresses and other contact information for conducting the interviews
and for tracking the cohort. The eligibility criteria include:
- Minimum one year of work experience in the current factory
- Currently married and living with husband. We will randomly select 100 female garment
workers from the list of eligible workers. The selected workers from the intervention
factories will be assigned for group sessions and will be interviewed both at baseline
and endline. The selected workers from the control factories will be interviewed both at
baseline and endline. If more than one worker belongs to the same household, one will be
chosen randomly for participating in the study.
The management staff from mid-level factory management will be eligible for participating in
the study. A list of 50 management staff will be obtained from the factories for inclusion in
the study.
Pre-testing and piloting The Bengali version of the worker and management survey
questionnaires will be pre-tested on 20 female workers and 10 management staff respectively
using paper questionnaire. Cognitive pre-testing will be carried for sections that have not
been previously used in Bangladesh. The pre-test will help us identify sections and questions
that women find difficult to understand and answer and the cognitive pre-testing will help us
find solutions. Training will be conducted using the revised questionnaire. About 50
interviews will be conducted by the worker and 30 by the management survey team members
during piloting. The questionnaire will be finalized based on feedback from pre-testing and
piloting.
Cohort tracking This will be a closed cohort study. Therefore, it is important to carefully
track the study participants for successfully interviewing them both at baseline and endline.
In case of loss to follow up such tracking will help us understand the reasons for dropout.
One staff will be assigned to follow up the study participants over phone every two months
for ensuring retention. The tracking form will include the following information (the last
three are applicable only after the baseline): allocated ID, name; name of factory; name and
cell phone number of husband; name and cell phone number of a guardian other than the
husband; residential address and cell phone number, name, relationship, address and phone
numbers of other relatives or friends or co-workers or neighbours in close to her; whether
she is still working at the same factory; if not, what is the reason for leaving the factory;
current employment; current residential address
Tracking loss to follow up If a woman is unavailable or untraceable for follow up interview
we need to find out the reason. If she is traced and refuses to be interviewed the reason
will be recorded. If she cannot be found in her previous address, we will try to track her
through additional contact information.
Data collection and management Three teams, each will consisting of four female data
collectors, one female supervisor, and one male field assistant will be employed for the
worker survey. One quality control officer (QCO) will be responsible for rechecking all
questionnaires and providing feedback to the interviewers and the supervisors. A survey
coordinator will be responsible for coordinating survey implementation in the field. In order
to recruit the necessary number of survey team members we will train a greater number of the
candidates shortlisted based on written and verbal tests. The team will receive a 15-day
participatory training on gender, violence against women, ethics, survey methods, the
questionnaire, and use of tablets. Final selection of the survey team members will be based
on performance during the training and pilot. The data will be collected using Personalized
Digital Assistants (PDAs) to address ethical (privacy) issues and to maximize disclosure. An
offline-based survey software will be developed. The interviews of the workers will be
conducted in private in a location convenient for the participants outside the factory.
During working days most interviews are likely to take place in the evening after work.
Female workers are likely to give interviews at home commonly located in slums. If the study
participant is unavailable a maximum of three attempts will be made to complete the
interview. We anticipate two months of fieldwork for workers survey per round of interviews.
Two teams, each consisting of four male data collectors and one male supervisor will conduct
the management survey. The QCO will be responsible for rechecking questionnaires and
providing feedback. In order to recruit the required number of management survey team members
we will invite a greater number of shortlisted candidates to a 8-day training on gender,
violence against women, ethics in research VAWG and questionnaire modules. The final
selection will be done in the way similar to the workers survey. The interviews will be
conducted in private within the factory. An offline-based software will be developed for
collecting data using PDA.
One programmer will be available during the survey period for necessary trouble shooting and
data uploading. Confidentiality will be maintained by keeping the identification information
in separate files.
Data quality monitoring Worker survey Fieldwork for the worker survey will be distributed in
such a way that each interviewer is accompanied to the interview venue either by a supervisor
or by a field assistant. Before moving ahead with the next assignment the supervisor and the
field assistant will make sure the interview can be started in private. Once all the
interviews are started the supervisor and the field assistant will make rounds to check
whether the interview is going on uninterrupted. They will help, if intervention is needed,
to handle gatekeepers. The supervisor will also observe the quality of the interviews, keep
notes and discuss problems at review sessions. The survey coordinator will randomly choose
survey teams for spot checks.
The QCO will recheck all the questionnaires and will provide feedback. The data will be
uploaded to the server every day after the data collection has been completed for that day,
and uploaded data will be checked by the Research Officer using a computer -based data
checking routine. Due to the efficiency of this system, inconsistencies in the data can be
identified within a short period of time. Problems identified in the data will be
communicated to the survey team. The supervisor will resolve the problems through discussion
with the interviewer if possible. If necessary, the interviewer would revisit the respondent
and solve the issues consulting her. If the problems cannot be resolved using this strategy
the researchers will be informed. They will suggest ways of resolving the issue depending on
the nature of the problems. Five percent of the study participants will be revisited by the
supervisors and the coordinator for administering a short questionnaire mainly focused on
identifying problems in adhering to ethical guidelines and administering questions on
particular topics.
Management survey Supervisors will assign interviews to the team members, observe the quality
of the interviews, keep notes and discuss problems at review sessions. Supervisors both in
worker and management survey will report to the coordinator and will communicate directly to
the researchers if needed. The role of the QCO will be in line with the worker survey.
Data Analysis Intention to treat (ITT) analysis will be used for assessing the impact of
HERrespect. Thus, all the workers selected for the study will be included in the analysis.
The primary analysis will be a comparison between intervention and control factories will
enable us to determine the impact of full HERrespect intervention (group sessions and
factory-wide mobilization over control). Chi-square (for categorical variables) and t-tests
(for continuous variables) will be performed to test whether there are differences in
background characteristics between intervention and control groups. If differences between
intervention and control factories are evident, the pre-existing differences will be
controlled in subsequent analyses. The impact of HERrespect intervention on main outcomes of
interest will be assessed using risk ratios derived from binary regression analyses adjusting
for baseline rates. All analyses will be adjusted for the baseline prevalence and age. The
same approach will be followed for assessing the secondary outcomes.
Ethical considerations This study will be guided by the WHO recommendations for ethical
considerations in researching violence against women. The participation of the intervention
and control factories will be based on the factories' consent to be a part of the study.
Attention will be paid when designing the questionnaire to carefully and sensitively
introduce and enquire about workers' experiences of violence and to ensure that questions are
framed in a manner that is non-judgmental. There is evidence in the literature that the
factory management is opposed to disclosure of workplace violence and workers disclosing it
or attempting to address it are victimized. They may be harassed, threatened and dismissed.
The questions on workplace violence will be included in a style which was as far as possible
non-threatening to the factory management. Individual verbal consent will be sought prior to
the interview with each female garment workers and management staff. The participants will be
informed orally of the purpose and nature of the study, its expected benefits, and voluntary
nature of participation. As part of the consent procedure, the participant will be informed
that the data collected will be held in strict confidence. To ensure that the participant is
aware that the survey includes questions on highly personal and sensitive topics, the
interviewer will forewarn the participant that some of the topics are difficult to talk
about. The respondent will be free to terminate the interview at any point, and to skip any
questions that she does not wish to respond to. Because of the low levels of literacy and
concerns regarding confidentiality the interviewer will request verbal consent of the
participant to conduct the interview.
Participation in the study will be entirely voluntary. Interviews will only be conducted in a
private setting outside the factory. The participant will be free to reschedule (or relocate)
the interview to a time (or place) that may be more safe or convenient for her. The physical
safety of interviewees and interviewers from potential retaliatory violence by the
perpetrator will be of prime importance. If the focus of the research becomes widely known
either within the factory or household or among the wider community it may risk the safety
and security of both. Thus, at the factory level the intervention and the study will be thus
introduced as activities focused on addressing IPV and improving management and in the family
and community it will be framed as a survey of factory work management and female workers
life experiences. Even where a researcher or field worker has not herself experienced
violence, listening to stories of violence and abuse may be draining and even overwhelming
for her. During the research regular debriefing meetings will be scheduled to enable the
research team to discuss what they are hearing, their feelings about the situation, and how
it is affecting them. These meetings will aim to reduce the stress of the field work, and
avert any negative consequences. This strategy proved effective in the Bangladesh component
of the WHO multi-country study conducted by icddr,b. Despite these measures, some field
workers may need to be given less emotionally taxing tasks, be given a break from the study
or to withdraw from the research altogether. To account for these possibilities, sufficient
numbers of field workers will be recruited to allow for a 10% attrition rate of interviewers
over the study. All the study participants will be given a unique a code and all the
identifying information will be kept in a separate file exclusively accessed by the research
team and will be used for tracking the individuals over the intervention period and to
contact them during the endline survey. Care will be taken to present the research findings
in sufficiently aggregated form to ensure that no participating factories and workers can be
identified.
;
| Status | Clinical Trial | Phase | |
|---|---|---|---|
| Recruiting |
NCT05599581 -
Tu'Washindi RCT: Adolescent Girls in Kenya Taking Control of Their Health
|
N/A | |
| Completed |
NCT02769923 -
ID Administration of fIPV Using Intradermal Adapters vs. BCG Syringe
|
N/A | |
| Completed |
NCT03022370 -
Stepping Stones and Creating Futures Intervention Trial
|
Phase 3 | |
| Active, not recruiting |
NCT05374798 -
Wearable Technology and Alcohol-Facilitated Intimate Partner Violence
|
N/A | |
| Active, not recruiting |
NCT04218864 -
Strength for U in Relationship Empowerment
|
N/A | |
| Completed |
NCT05105373 -
Implementation Science and Impact Evaluation of PfR Programme: A Hybrid cRCT Design
|
N/A |