“Being Married Doesn’t Mean You Have to Reach the End of the World”: Safety Planning With Intimate Partner Violence Survivors and Service Providers in Three Urban Informal Settlements in Nairobi,Kenya

Setting

This study was conducted in three informal settlements Kariobangi/Korogocho, Dandora, and Huruma/Mathare in Nairobi, Kenya. All research activities were conducted in close collaboration with the Ujamaa-Africa Mashinani, a Nairobi-based non-governmental organization whose work focuses on gender-based violence prevention and response through microfinance and psychosocial support for women experiencing IPV. The Mashinani team led sampling, recruitment, and data collection activities following training by the Johns Hopkins University (JHU) research team. Study sites were selected based on perceived need and established relationships with the Mashinani team.

Sample and Recruitment

Recruitment was conducted via purposive, community-based sampling, and continued until saturation was achieved in each of the three informal settlements. KID inclusion criteria required informants to have experience working directly with female IPV survivors through their positions in violence prevention and response organizations. Informants included community health volunteers (CHVs), chiefs, and other violence service providers in each of the sites. Informal settlement section chiefs were selected given their responsibility over domestic affairs, including partner mediation of IPV, per recommendation of the Mashinani team and based on previous literature (Odero et al., 2014).

Eligible FGD participants had experienced physical, sexual, or emotional violence by a current or former partner in the past 12 months, were female, aged 18 and over, and resided within the targeted informal settlements in Nairobi. FGD participants were recruited via flyers, presentations by the Mashinani team at local organizations, and by word-of-mouth.

Data Collection Procedures

The Mashinani team confirmed the interest and eligibility of participants before scheduling the KID or FGD. Upon arrival at interview, eligibility was confirmed, and verbal consent was conducted individually and privately with trained team members. KID and FGD sessions were scheduled at a time and place convenient to the majority of eligible and consenting participants and lasted approximately 90 min. At the end of the session, each participant was asked to complete a brief, confidential demographic survey. KID and FGD sessions followed a semi-structured guide and centered on community women’s experiences of IPV, recommended and utilized formal and informal safety strategies, availability of community resources to support safety, and feedback on the myPlan app using mock-ups to inform adaption. The guides asked broadly what women did to keep themselves and their families safe and were further supplemented by mock-ups to elicit thoughts on safety strategies for children, health, and personal property to explore these lesser known areas. FGDs were deemed appropriate to solicit group feedback on experiences of women within the community and feedback on the proposed safety decision aid; guides did not ask directly about women’s own experiences. Snacks were provided during the session for all participants. Upon conclusion, referrals to local resources (medical, economic, counseling, and justice) were offered to all participants to confidentially access.

KIDs occurred with service providers through seven semi-structured discussions with three to four participants each (total n = 18) and conducted in a private room at the main Mashinani office. Two key informants were interviewed individually due to logistical challenges.

Six semi-structured FGDs were held with approximately eight female survivors per group (total n = 49) in secure office locations in three informal settlements of Nairobi (Kariobangi/Korogocho, Dandora, and Huruma/Mathare) to maximize participant convenience and safety. Given community-based sampling, some women opted to come with a friend or neighbor. All women were given the choice to opt for individual interview if there were confidentiality concerns; one IPV survivor opted for individual interview rather than FGD due to privacy concerns.

Data collection was conducted by a team of three female Kenyan interviewers in English and Swahili. Interviewers received 2 weeks of qualitative research training by the JHU team prior to study implementation, including facilitation of mock FGDs. On-site support from a seasoned qualitative researcher was available throughout data collection.

Ethics

All procedures were conducted in accordance with ethical best practices for violence-related research (World Health Organization, 2016). Relationships with IPV support services were established prior to study initiation to ensure connection with care and to minimize risk associated with participation. The facilitators were trained to identify participants who become upset during participation and remind all participants that their participation was voluntary and that they may refuse to answer a question or end participation without negative consequences. Furthermore, on conclusion of the KIDs and FGDs, all participants were confidentially provided with a list of local support resources.

To maintain confidentiality, minimal personal identifiers, such as name and phone number, were used only for recruitment purposes and not required during the consent process, discussions, or demographic survey. Identifiers were stored separately from audio and written data and destroyed immediately after completion of data collection.

All study team members were experienced in research pertaining to sensitive topics in this population and understood necessary human subjects’ protections. All team members underwent additional human subjects, informed consent, and confidentiality protection training. All procedures were approved by Institutional Review Boards (IRB) at Johns Hopkins University Bloomberg School of Public Health (JHSPH) and the National Committee on Science and Technology Innovation (NCOSTI) in Kenya.

Analysis

All KID and FGD sessions were audio-recorded, transcribed, and translated verbatim from Swahili to English by a team of six transcribers. The facilitators were either the direct transcriber or a consultant on the transcript being transcribed by other Mashinani team members. All transcripts were reviewed for clarity and potential errors by a member of the JHU research team, assisted by a Mashinani team member fluent in both English and Swahili.

Three master’s-level research assistants coded all KID and FGD transcripts in Atlas.ti.1.6 using inductive thematic analysis. Member checks to identify inconsistencies and biases in interpretation were used to improve internal consistency.

Qualitative analysis used matrices to organize emergent themes and sub-themes identified from the transcripts. These themes and sub-themes identified the multitude of strategies employed individually by women to ensure safety to themselves and their families. Service provider feedback was cross-referenced to identify areas of convergence and divergence with IPV survivor themes and sub-themes; results were summarized and triangulated through convergence matrixes (Farmer, Robinson, Elliott, & Eyles, 2006). Results regarding engagement with formal services and service providers are presented elsewhere. Given the substantial overlap between findings and to maximize the voices of survivors, these results focus on the safety strategies discussed by IPV survivors, for example, what to do with their children or personal property during conflict. Areas of divergence from service providers are highlighted throughout.

Removing Stressors

Women described active strategies they employed to remove or minimize behaviors they believed contributed to relationship conflict. Stress-inducing behaviors often related to the woman’s own behavior and included not being home when the husband returned, friendships with other men, dressing inappropriately, and heightened tones during arguments. Women identified that removing stressors required a critical thinking component to first identify the source of conflict and then work to mitigate the issue:

Ask yourself, “What always makes us to have conflict?” You rectify yourself, so if he’s someone who thinks, he will come to realize “We’ve been having problems because of this, and now that she’s rectified it, let me also change.” (IPV survivor, FGD02, Korogocho, age 30)

Partner alcohol use was commonly described as a driver of IPV. Women described harm reduction strategies of having conversations about reducing alcohol consumption when partners were sober and strategic engagement with inebriated partners. For example, one woman ensured preparation of specific food for her husband when he came home drunk: “I would sacrifice and eat kale instead of him and make him a nice meal. And he’ll sleep off. But when you serve him kale, he won’t like it, he will beat you up” (IPV survivor, FGD04, Mathare, age 21).

Service providers echoed stress removing behaviors, and additionally discussed failure to provide for children or use of drugs as actions that could exacerbate household stress and result in IPV. Both IPV survivors and service providers discussed women’s self-respect and critical thinking at the forefront of identifying and using safety strategies. When stressors could not be removed, women moved to either proactive communication or avoidance strategies.

Proactive Communication

Women suggested that communication with partners may be useful for conflict resolution, particularly naming harmful behaviors and their impact on the family. Furthermore, women discussed the need to talk about relationship issues and explain that violence could increase if current issues were not resolved. Continued discourse was deemed helpful, as lack of progress may serve as a point of embarrassment for men:

You place him in your shoes. When it reaches the point where he becomes a drunkard, as long as you had talked earlier on . . . as long as you had informed him, you are safe. He will even feel embarrassed, because you already talked to him. (IPV survivor, FGD06, Dandora, age 22)

Women discussed being “fierce” in negotiating time for sex as a strategy for preventing sexual violence. One woman suggested negotiating sex today to allow for a break tomorrow. Another woman explained the importance of standing her ground: “It is not good to accept to be pressured. You should stand firm, ‘I have periods, I won’t be having sex’” (IPV survivor, FGD06, Dandora, age 25).

Women rarely discussed physically confronting their abusive partner. One woman reported that she sought revenge and hit her husband back, but did not discuss the outcome of this confrontation. Another woman discussed threatening police involvement, indicating that the threat in itself was effective in reducing violence.

Service providers’ remarks closely aligned with those of women. In addition, they noted the importance of loving body language during discussions with partners. Conversations further delved into the importance of women “knowing their rights,” and setting their level of tolerance for abusive behaviors, as parameters to govern proactive communication:

We believe that information is power . . . We also need to tell them that as a human being, you’ve got your own rights: right of space, right of participation, economical right . . . You need to overcome cultural barriers that put men on top of everything. You need to know your legal rights. You need to be assertive. You need to have self-esteem. (NGO health promotion officer, KID05, Male)

Avoidance Behaviors

Women identified avoidance behaviors to circumvent potentially unsafe situations with an abusive partner. These strategies often involved not reacting to his verbal abuse or threats to prevent escalation of conflict: “When you keep silent, as he talks he will realize that he’s talking to himself. And since no one would be responding to him, what can he do?” (IPV survivor, FGD06, Dandora, age 35).

Women also took the opportunity to calm down before reacting to verbal abuse if they felt their reaction could escalate to physical violence. Women who utilized avoidance strategies discussed how obedience, respect, and perseverance helped keep women safe.

Women also described selectively removing themselves from volatile situations altogether. In particular, women discussed not returning home or hiding if they suspected that their husband would come home drunk:

When he gets home drunk, his lady always hides. When the man loudly shouts her name, she’ll just stay silent. With no response, the man will just eat and go to sleep. When the man gets to sleep, the lady will come out of her hiding place and sleep on the couch. (IPV survivor, FGD02, Korogocho, age 24)

Service providers echoed these strategies.

Sexual/Reproductive Health Strategies

SRH safety strategies were discussed less frequently. Seeking support or resources from health providers related to sexual and reproductive violence was considered stigmatizing, shameful, and often unhelpful. Women stated that use of verbal resistance to forced sex was ineffective and could contribute to neighborhood gossip about failed marital responsibilities.

Several women discussed family planning as an SRH strategy, given its utility in removing financial stress within the household and ensuring better child care by limiting births. The female condom, however, was the only family planning method singled out by IPV survivors to be effectively utilized without partner knowledge:

For women who are bright, they take this female condom. If you insert it early enough, it will feel like your body. When you want to have sex, you have to be the one inserting the penis. And the man won’t know if you have the female condom, if you are bright. (IPV survivor, FGD03, Huruma, age 43)

Service providers additionally suggested covert use of family planning as a potential strategy. Covert use was highlighted when previous contraceptive negotiation had failed and resulted in subsequent pregnancy:

She said to her husband that they get cannot support the entire family, and that they should do family planning. The husband refused. So, she added two more kids . . . then she made her own decision and decided to go for the contraceptives. (Gender defender, KID02, Female)

A few women discussed HIV pre-exposure prophylaxis (PrEP) as a sexual safety strategy, with the caveat that PrEP may not be easily utilized covertly within marriages or stable partnerships: “Remember you are living in the same house. You cannot be using those drugs forever, those are usually just for a short period of time” (IPV survivor, FGD04, Mathare, age 21). PrEP usage was also encouraged during service provider interviews.

Although family planning and PrEP were focused at the individual level, few strategies were implemented at the partner dyad level. One woman discussed the importance of confronting her partner about the physical harms incurred through his use of forceful sex, but emphasized this conversation must occur when things were going well in the relationship:

That moment when you are in good spirits, it’s the best time to tell him how you have always felt about forceful sexual intercourse. You tell him in a way so that he gets to understand how he gets you hurt. He may as well start to change. (IPV survivor, FGD01, Korogocho, age 22)

Other methods to prevent sexual violence were limited. Resisting sexual demands made by partners was seen as an affront to relationship stability and gender norms dictating that husbands have the right to demand sex from his wife. However, one woman discussed the possibility of living on her own to afford more respect from her partner. There were no conversations surrounding women’s use of physical resistance during sexual violence.

Economic Strategies

A variety of economic strategies were deemed helpful in decreasing violence. Foremost, women found that working and contributing to the family’s finances could remove economic burden and improve the well-being of the household. This first sub-theme focused on decreasing financial stress within the relationship. Sources of income discussed comprised table banking and merry-go-round groups, in which group members gave small loans to support personal businesses, starting own businesses by selling goods, and formal jobs as cooks or maids. Successful utilization of this strategy involved partners who were supportive of women’s contribution to household expenses:

And if she starts that business, sometimes abuses reduce. Even if a child is sent away from school because he lacks a book, one woman will not wait for the husband to get back and buy it. The children will have this feeling that, even if the father cannot take care of it, the mother can as well take care of it. And life goes on. (IPV survivor, FGD03, Huruma, age 54)

A second economic strategy sub-theme focused on achieving financial independence. For some women, the goal of this strategy was to leverage employment as a means to leave their abusive partners. Other women who utilized this strategy did not want to leave the relationship, and instead wanted to prove that they were “not in need of his money.” These women indicated that earning money in itself was enough to decrease IPV because of its associated independence from the abusive partner:

Women should be empowered. As long as a woman is empowered and you have something, this man cannot come to abuse you in the house. But that time that you have nothing, you are, like give me more money for this, like it’s the man providing you with everything. He feels as if he has power over you. (IPV survivor, FGD06, Kariobangi, age 22)

Even if the partners knew about their employment, some women preferred to hide their earnings. Women felt that IPV decreased because their earnings were being used as leverage within their relationship and could be used to quickly leave the home during heightened abuse:

If now you get empowered, when you get abused, the husbands already know that you have something monetary somewhere. So at times, the abuse reduces because he is aware that even if I do this to this woman, she has something hidden somewhere. (IPV survivor, FGD03, Huruma, age 38)

Women explained that working could bring additional challenges that could occur as a result of shifting the power dynamic in the relationship. For example, two women mentioned that holding a job could increase IPV. In one instance, the abusive partner went to her employer, which resulted in her dismissal from work. In the other situation, the husband disproved of her working as he believed it would give her the opportunity to have affairs: “He thinks that when the wife goes to work, she will use this opportunity to go see other men. So it’s not easy, women go to work secretly” (IPV survivor, FGD04, Mathare, age 19).

Women also frequently mentioned the need to keep their children safe from physical or sexual abuse by the husband/partner or from neighbors while she worked outside the home. These women noted that earnings were invested in child care to ensure their children’s safety.

Service provider strategies closely aligned with those mentioned by IPV survivors; however, providers were more likely to emphasize strategies that ensured financial independence. Strategies discussed were similar to those mentioned by survivors (i.e., table-banking), but an emphasis was placed on keeping earnings secret to limit potential adverse reactions by an abusive partner if he learned the woman was working outside the home.

Leaving Strategies

Leaving strategies varied substantially by tribe, longevity of relationship, and strength of formal/informal support networks. Women were hesitant to fully support separation approaches as they felt it was more complex, within their cultural or contextual situation. When leaving was seen as feasible, women identified three potential leaving strategies: temporary leaving to natal family, temporary leaving to in-laws, or permanently separating.

Temporary leaving strategies could last from days to years, with women most comfortable first approaching their own families for a safe place to stay. This strategy was preferred by most women, given that natal families were often seen as more supportive and welcoming. For some this was temporary, whereas others sought a more permanent solution:

At 3am, he tells me to get out and go to my family. I start walking past the railway. The last time he came for me, I refused to go back with him and so did my family. (IPV survivor, FGD02, Korogocho, age 26)

Safety and well-being of one’s children were the primary considerations when deciding whether to stay or seek alternate accommodation. Specifically, women were most concerned with their ability to bring children with them. Women indicated that the ideal scenario was to take the children and raise them at her family’s home with the financial support of their father:

I would request my husband to allow me stay with my children. They should be at home, and if he feels like supporting me, he may do it while I am at home in the upcountry. (IPV survivor, FGD04, Mathare, age 57)

Tribal and cultural norms, however, often led children to remain with the husband and his family in the event of separation from their mother. Some women leveraged this as a means to reform their husband’s behavior by making him become the primary caregiver: “They should be left with the husband so that he feels the pain women experience in taking care of children” (IPV survivor, IDI01, Korogocho, 18 years).

Fewer women described leaving to go to the in-laws’ home. Successful use of this strategy required the woman’s family to work with the in-laws in reconciling issues. More often, however, this approach was deemed unhelpful, as in-laws were often seen as biased:

I had problems in my marriage and I took time and went to tell my mother-in-law. . . She told me that she knows her son more than I do, from the time she gave birth to him to the point where he married me. . . there is nothing I can tell her concerning her son. From there, things got worse. The violence increased until it reached a point we separated. (IPV survivor, FGD03, Huruma, age 48)

Separation did not always involve dissolution of the relationship but was often used to increase respect and privacy through separate living accommodation. Separation was a last resort after trying other strategies with little success or “growing tired” of continued IPV. Women often preferred more permanent separation when violence became too severe, continued longer than they could tolerate, or exacerbated financial strain:

I will just raise my children on my own, even if they catch up with their dad later on in life. Suppose I am in such a situation, I will let go of the man, raise my children until they reach 18 years. Because I can’t feed a man and as well feed the children. (IPV survivor, FGD06, Dandora, age 41)

The dissonance between service providers and IPV survivors was most clearly seen in leaving strategies. Service providers were keen for women to permanently separate and “escape” their situations before the IPV was frequent or severe, as opposed to the “last resort” employed by many IPV survivors. However, there was a joint emphasis on cultural constraints, including money, husband’s payment of dowry to the wife’s family, and husband’s child custody rights as reasons for relationship preservation:

So, it’s better to preserve the family as a single unit. [When] we see this is going to be very fatal, that is when we can separate. So, we should still try to bring the children together, we should try to increase safety measures, and family counseling. (NGO staff, KID06, Male)

Child Safety

Children’s safety was linked to mother’s safety. Mothers reported advising children on how to stay safe before, during, and after a violent conflict, particularly to ensure that children did not confront or disrespect their fathers. Furthermore, women wanted their children to feel loved by their fathers, regardless of the IPV witnessed in the home. Participants conceded that achieving this goal sometimes required lying to children and blaming the violence on alcohol:

I bring the children and tell them, “Now you see, whatever we did last night, daddy was drunk. But we’ve talked with daddy, he’ll never do something like that again.” So, with that, you give the children some comfort. (IPV survivor, FGD03, Huruma, age 46)

Women indicated that older children were upset by the IPV against their mother and tried to fight their father. These confrontations were highly discouraged as women saw them as ineffective and dangerous for the child. In contrast, women sometimes used the presence of younger children to encourage peace or prevent IPV:

Plan with the kids so that they remain awake. That will make him fear. . . when he wants to abuse you. Instead, he will keep quiet first. Though he may fight you by the way he looks at you with harsh eyes, he will not fight you physically. So it’s a must that you ensure the kids are awake for the sake of your safety. (IPV survivor, FGD05, Dandora, age 60)

If a woman knew her husband was likely to come home drunk, she would advise her children to stay awake and alert so they could leave quickly if necessary. Other mothers, when feasible, arranged for the children to sleep in a safe location away from the house for the night.

Women raised concerns for physical and psychological repercussions of their children witnessing IPV. As a result, extensive measures were taken to prevent children from being exposed to IPV. For instance, one woman described going with her partner to the roof or getting a hotel room when conflict arose to ensure her children in the house would be unaffected. Others sought to remove the children from the house entirely by sending their children to neighbors’ or family members’ houses for a short period of time:

If you know that your husband normally comes home drunk, within that time you know you may clash on conversation and probably fight. Make sure the children go to sleep early enough. If not, if you are staying in a single room with your children, look for somewhere else where your children can go to sleep. Such that, when two of you are engaging in fights, it doesn’t affect the children psychologically. (IPV survivor, FGD04, Mathare, age 21)

Child safety strategies were closely intertwined with leaving strategies, particularly around returning to the natal home and ensuring children’s education. Preventing long-term exposure to IPV and protecting the children was perceived by IPV survivors as the primary responsibility of the mother. Women were further concerned that parental failure to effectively ensure child safety in the home could lead to interference by formal legal services. Concerns for child safety and the role of the mother in protecting the child were closely echoed by providers.

Securing Personal Property

Damage to personal property, such as furniture or electronics, was generally viewed as extremely violent and often a trigger for help-seeking or separation. The primary approach to these situations was prevention and de-escalation:

Any time that you fight, you try to avoid anything that can put that property in destruction. For example, when I see my husband has got that anger that makes him break property, I will calm down so that violence does not break out. Because I know, if it happens to break out, everything in the house would be destroyed. (IPV survivor, FGD04, Mathare, age 21)

Women utilized several strategies to ensure safekeeping of their documents, particularly identification cards, children’s school records, and financial records. Foremost, women discussed the need to keep documents in a location that was unknown or inaccessible to their partners. Messages varied regarding the best place for safekeeping, with several women suggesting a neighbor or close friend; others felt possession of documents could inflict undue harm on neighbors if the abusive partner came to their home to search for the documents:

I will personally have them close. And somewhere I can easily access them. I cannot hide them at my neighbor’s place. And again, neighbors are not always secretive.

But even if they are not secretive, if things get out of hand, your husband would not be in a position of going at your neighbors to take them. He will know that they are there, but he wouldn’t be able to access them. (IPV survivors, FGD04, Mathare)

Additional suggestions to protect documents from being destroyed or stolen, included lamination, storage in a secure file cabinet, and making digital copies, saved either within a password protected phone or within email:

So if you have that phone, that one that can download, you can have your things there. Even if they burn your item, they will always remain in your phone. (IPV survivor, FGD03, Huruma, age 38)

Women relayed mixed messages of claiming ownership over goods and property to minimize those items being targeted for destruction during conflicts. Some women said that receipts should be kept to claim items upon separation. Conversely, others said that items should never be bought or claimed, as the partner was more likely to damage items that did not belong to him. Securing personal property was rarely mentioned by service providers.