Final Report: Perceptions of Psychosocial Well-being Among Conflict Affected Women in Burundi
Kumererwa-neza: To Be Well in Your Heart
Understanding Conflict-Affected Women’s Perceptions of
Psychosocial Well-Being in Burundi
Prepared by Martha Bragin PhD Silberman School of Social Work at Hunter College City University of New York May 2013
Understanding psychosocial well-being among women in Burundi: A participatory study
Imprint:
To cite this study: Bragin, M., Nzeyimana, G., Ntacobakinvuna, D. & Eibs, T. (2013). Kumererwa-neza: To Be Well in Your Heart. Understanding Conflict-Affected Women’s Perceptions of Psychosocial Well-being in Burundi. Vienna and Bujumbura: CARE Österreich
For further information refer to [email protected] Online download under: http://care.at/expert/coe-resources/psychosocial
May 2013
1 Understanding psychosocial well-being among women in Burundi: A participatory study
ACKNOWLEDGEMENTS
The PIs express their gratitude to the leadership of CARE International in Burundi, especially Ms Ida Ntawundora, Program Director, Women’s Empowerment, and Laurent Uwumuremyi, Program Quality and Learning Director, without whose support and generosity the work would not have been possible. In addition, gratitude is owed to the entire office staff for their collaboration. Michelle Carter, Country Director, Yawo Douvon, Assistant Country Director facilitated the implementation of the pilot study, making the entire project possible. Josée Ntabahungu facilitated the entire pilot study, working weekends and holidays to ensure that the work went forward.
The PIs also express their gratitude to the Transcultural Psychosocial Organization under the direction of Herman Ndayisaba for their role in facilitation and to Consolata Mayondo, Project Director, for arranging and organizing the entire second round.
Immeasurable thanks are due to the following CARE and TPO officers who went far beyond what could have been expected in any way to support the study.
List of Persons Supporting the Study
Study Support
Tonka Eibs Psychosocial Advisor CARE Austria Alexis Macumi M & E Director, Women’s Empowerment Programs, CARE, Burundi Consolata Mayondo Project Coordinator HealthNet TPO Ida Ntawundora Program Director, Women’s Empowerment Laurent Uwumuremyi Program Quality and Learning Director
Research Team
Martha Bragin International PI Silberman School of Social Work, CUNY Generose Nzeyimana Burundi Co-PI Program Director, Kirumara Project, CARE, Burundi Domitille Ntacobakinvuna Burundi Co-PI Advisor for Gender and Learning, CARE Burundi Justine Nkurunziza Translator Jean Pierre Driver
Research Assistants
Kelsey Adolphs Research Assistant Sarnaz Lofti Research Assistant Anneija Hyatt Research Assistant Veronica Mollere Research Assistant
2 Understanding psychosocial well-being among women in Burundi: A participatory study
Participating CARE Officers for Each Region:
Louise Nzosaba Bujumbura, Capacity Building Officer Godelieve Nininahazwe Gitega Capacity Building Officer Sylvie Ndantishumiye Gitega, Field Coordinator Epogémine Sindakira Gitera, Gitega Field Coordinator Adèle Hakizimanda Makebuko, Gitega Faustine Nkwirikiye Mutimbizi Bujumbura Rurale Judith Nzéyimbana Field Coordinator CARE Gridjambo
Participating Psychosocial Assistants from HealthNet TPO:
Nadège Kwizera Psychosocial Assistant, Gitera, Gitega Matthias Nzohabonimanza: Psychosocial Assistant Makebuko, Gitega Félix Ndikumanzi Psychosocial Assistant Mpanda, Bujumbura
We express our deep gratitude to the following National Experts who contributed their valuable time to help us to understand the context of Burundi:
Ndayisaba, Herman Deputy Head of Mission, HealthNet TPO in Burundi Nkurunziza, Deo Project Manager, HealthNet –TPO Burundi Ndayisaba, Gorethe Founder and Director Dushirahamwe Nsabiyua, Christine Chief of Police, Community Development Force OPC2 Mworoha, Emile Professor Emeritus, University of Burundi Department of History Ndatayinzingo, Marceline Deputy Minister, Ministry of Gender Mayondo, Consolata Project Coordinator, HealthNet-TPO Ntabona, Abbé Adrien Professor and Department Chair of African Language and Literature Director: Center for Research for Inculturation and Development (CRID) Member: National Bashingantahe Organization Abbé: Catholic Church University Parish
3 Understanding psychosocial well-being among women in Burundi: A participatory study
CONTENTS
Acknowledgements ...... 1
Introduction ...... 10
Background ...... 10
Purpose of the study ...... 11
Goals of the study ...... 11
Rationale and Significance ...... 11
Organization of this document ...... 13
Critical Review of the Literature ...... 16
Psychosocial work with children ...... 17
Evaluating psychosocial programs for children ...... 18
Evaluating Psychosocial Programs During and After Armed Conflict ...... 19
Psychosocial Well-being and “Subjective Well-being:” Integrating Literature from Economics ...... 22
What about Women and Psychosocial Well-being in Areas of Armed Conflict? ...... 25
Summarizing the Literature on Evaluating Psychosocial Interventions for Conflict-affected Women .. 26
Studying Women’s Well-being in Burundi ...... 28
Background ...... 28
History of Burundi ...... 29
Women in Burundi ...... 31
Women during the conflict and immediate post-conflict period ...... 33
4 Understanding psychosocial well-being among women in Burundi: A participatory study
Women and HIV/AIDS ...... 34
Burundian women in peace and reconciliation ...... 35
Current situation of women in Burundi ...... 36
Current studies of women in Burundi ...... 37
Studying Psychosocial Well-being with Burundian Women ...... 37
CARE’s studies on women’s empowerment in Burundi ...... 37
Next steps ...... 38
Methodology ...... 39
The study design ...... 39
Study hypothesis ...... 39
The study objectives ...... 39
The main study questions ...... 40
Figure 1: The study design ...... 41
Methods Used in This Study ...... 42
Figure 2: Stepwise Ethnographic Exploration ...... 43
Participatory Ranking Method ...... 44
Site Selection ...... 44
Recruitment and sampling ...... 45
Special populations: young unmarried mothers and women associated with fighting forces ...... 45
Sample Size ...... 46
5 Understanding psychosocial well-being among women in Burundi: A participatory study
Figure 3: Total numbers: participants, focus groups and key informants Rounds One and Two ...... 47
Figure 4: Focus Group Sample: Round One ...... 47
Figure 5: Focus Group Sample Round Two ...... 47
Study Procedures for Round One ...... 47
Study procedures for data analysis and interpretation: Round One ...... 48
Results from Round One ...... 50
Questions asked for concept identification and clarification ...... 50
Language and terminology ...... 50
The right questions to ask ...... 50
Domains of Well Being for War Affected Women in the Study Districts in Burundi ...... 52
Psychosocial Well-Being as an Integrated Concept ...... 58
Figure 6: Constellation of Domains Comprising Psychosocial Well-being for all Groups ...... 58
Study Procedures: Round Two ...... 59
Qualitative Concept Validation: Workshop with the Research Team and Institutional Collaborators .. 60
Comments on the domains ...... 60
Qualitative Concept Validation: Focus Group Discussions for Round Two ...... 60
Added domains and outliers: how these were noted in the field ...... 61
Participatory Ranking Method ...... 61
Rationale for the method...... 61
Implementation of the method ...... 61
6 Understanding psychosocial well-being among women in Burundi: A participatory study
Key Informant Interviews...... 62
Qualitative analysis of the key informant interviews ...... 62
Nightly group meetings (Peer De-briefing) ...... 63
Results From Round Two ...... 64
Results from the Qualitative Concept Validation Exercise ...... 64
New domains added from among outliers ...... 64
New Sub-categories: Operationalizing the Domains ...... 65
Results of Discussions with Women Associated with Fighting Forces ...... 66
Reasons for joining the fighting forces ...... 67
Special problems affecting women associated with fighting forces ...... 68
Women associated with fighting forces’ perceptions of the effectiveness of their role ...... 69
Special skills women associated with the fighting forces bring to the community ...... 70
Summary: Women associated with fighting forces ...... 70
Results from the Participatory Ranking Method (PRM) ...... 70
Procedures used to organize the results of the participatory ranking exercise ...... 70
Results of the Ranking Exercises ...... 72
Figure 7: Consolidated Ranking of Domains of Well-being...... 72
Figure 8: Ranking of Domains in Gitega ...... 73
Figure 9: Ranking of Domains in Bujumbura Rurale ...... 74
Figure 10: Ranking of Domains in Bubanza: Mpanda ...... 75
7 Understanding psychosocial well-being among women in Burundi: A participatory study
Special Populations: Bujumbura Mairie: Unmarried Mothers’ Group ISHAKA ...... 76
Figure 11: Ishaka: Young unmarried mothers’ group: Bujumbura ...... 76
Special Populations: Women Associated with Fighting Forces ...... 77
Figure 12: Ex-combatants Group: Gridjambo ...... 77
Results of the Inquiry on Traditions that Support Women’s Well-being ...... 78
Summary of positive traditions identified by focus groups and key informants ...... 79
From the Spiritual Traditions of the Monarchy (from focus groups in Gitega and the key informants)
...... 79
From the political traditions of the monarchy (from the key informant interviews) ...... 80
Community Traditions (from key informant interviews, literature, and focus groups) ...... 80
Alternative Medicine and Traditional Healing for Women’s Psychological Well-being (from the key
informants) ...... 81
Societal Traditions Continuing to the Present ...... 81
Positive Cultural Traditions in Community Context ...... 83
Women as negotiators and educators ...... 84
Kuganira, to dialogue ...... 84
Women as educators ...... 88
Limitations of the Study ...... 90
Sampling Limitations ...... 90
Limitations of language and translation ...... 91
Limitations of scope ...... 91
8 Understanding psychosocial well-being among women in Burundi: A participatory study
Discussion: Organizing Themes ...... 92
The Psychosocial Working Group ...... 92
Figure 13: Domains of Well-being in the Context of Psychosocial Working Group...... 95
Amartya Sen and the Capabilities Approach ...... 95
Figure 14: Domains of Well-being in the Context of Sen’s Capabilities Approach ...... 97
Hobfoll and Colleagues’ Five Essential Elements for Psychosocial Support Programs ...... 97
Figure 15: Domains of Well-being in the Context of Hobfoll et. al’s Five Essential Elements ...... 100
Establishing a Baseline for Psychosocial Well-Being: Utilizing What We Learned From the Study ...... 101
Sample Questions for the Implementation of a Baseline Study on Psychosocial Well-being among
Conflict Affected Women in Burundi...... 101
Replication of the Methodology for future use through Participatory Monitoring and Evaluation .... 104
Using this study for replicable design monitoring and evaluation ...... 104
Conclusion ...... 105
References ...... 106
Annex A: List of Acronyms Used in This Document ...... 118
Annex B. Key Informants Interviewed ...... 119
Annex C. Protocol for Second Round of Research: Burundi ...... 120
Annex D: Round 1: Focus Groups with Demographic and Geographic Detail ...... 123
Annex D: Round Two Focus Groups with Demographic and Geographic Detail ...... 124
9 Understanding psychosocial well-being among women in Burundi: A participatory study
INTRODUCTION
Background
The negative impact of war on women grew exponentially during the second half of the 20th century, when casualties shifted from the battlefield to the civilian population (Machel, 1996; UNFP,
2010). United Nations Security Council Resolution 1325 was among the United Nations resolutions intended to address this issue as part of the overall search for peace. UNSCR 1325 proposes to combat this disproportionate effect through empowering women to participate in the negotiations that put an end to conflict and to give them the opportunity to benefit from them (UNSCR 1325, 2000). However, in order to make this ideal a reality, programs were needed to support the capacity of women in conflict and post-conflict countries to realize their rights (Stummer, 2009; UNFPA, 2010).
Among the effects of armed conflict on those who survive are emotional and social sequelae that have been shown to prevent them from taking action in their own behalf (van Ommeren and
Wessells, 2007; Becker and Weyermann, 2006). In light of these findings, CARE Austria, and the Austrian
Development Agency (ADA), have hypothesized that the inclusion of psychosocial interventions in the package of assistance provided to women affected by armed conflict, along with support for their economic and social empowerment, would be essential to enable them to claim their rights as participants in the peace process as stipulated in UNSCR 1325 (Stummer, 2009).
The Kirumara project, located in Bujumbura Rurale, Mpanda and Gitega districts of Burundi is one such program. It combines political empowerment, economic empowerment and family empowerment components with community-based psychosocial supports, in order to enable the participation of poor women survivors of armed conflict to participate fully in the ongoing peace process. The Kirumara project regularly evaluates the effectiveness of the components that support economic well-being and progress toward empowerment. In each of these evaluations, the project began a process of appreciative inquiry to ensure that the indicators were sensitive to the specific 10 Understanding psychosocial well-being among women in Burundi: A participatory study context of Burundi. This study represents the continuing effort to complete this process for the psychosocial component.
Purpose of the Study
The purpose of this study is to develop an understanding of psychosocial well-being among conflict affected women in Burundi as defined by the women themselves, in their own language and on their own terms, in order to establish indicators by which to measure the effectiveness of psychosocial programs developed for their benefit.
Goals of the study.
To understand the precise meaning of “psychosocial well-being” for conflict-affected women in
Burundi.
Based on this understanding, to develop culture-sensitive indicators for use in measuring the
concept of psychosocial well-being for women in the defined areas.
To contribute to the development of a replicable, rapid and practical method to develop
indicators for psychosocial well-being to be utilized in the design, monitoring and evaluation of
future programs for war-affected adult women.
The long-term goal of the study is to insure that programmatic supports for psychosocial well- being are appropriate and effective in context, and enable the testing of the program hypothesis that psychosocial interventions are an essential element in facilitating women’s participation in the political and social processes that affect their future.
Rationale and significance. In recent years, international standards have been developed indicating that the best way to provide sub-clinical support to people affected by armed conflict is through psychosocial programs, that is, programs that improve psychological well-being through social activities (IASC, 2007). In 2007, the Interagency Standing Committee (IASC) of the United Nations Office of Humanitarian Coordination Assistance (UNOCHA) launched official guidelines to be followed in the
11 Understanding psychosocial well-being among women in Burundi: A participatory study development of mental health and psychosocial support in emergency settings, including those of armed conflict. These best practice standards are based on those findings available from extensive consultation and field research (Bragin, 2010; van Ommeren & Wessells 2007). However, the evidentiary base for the effectiveness of psychosocial programs in general and the best practices recommended by international guidelines remains thin (Wessells, 2009). This is because the conditions in the field often make it difficult to carry on proper empirical studies as the need to provide care to all must take precedence over learning (Hobfoll, et al, 2007).
The time has come to strengthen the evidence for effective psychosocial interventions in order to ensure that they are replicated, that ineffective practices are discarded, and that program participants receive the highest quality of service possible (Wessells, et al 2009; Ager, Stark, Akeeson &
Boothby, 2011; Stummer, 2009).
Researchers have recommended that in order to evaluate the effectiveness of psychosocial programs, we need to evaluate on three domains: 1) skills and knowledge 2) emotional well-being and
3) psychological well-being as perceived by program participants and their communities (Ager, Stark,
Akeeson, & Boothby, 2010). UNICEF has completed a full set of guidelines for understanding these domains when establishing psychosocial programs for children and adolescents (Ager, Ager, Stavrou &
Boothby, 2011). However, there is almost no research that defines women’s psychological and social well-being in their own voice and on their own terms (Stark, Ager, Boothby &Wessells, 2008; Ager, Ager
& Boothby, 2010).
CARE has taken leadership on participatory research and evaluation in all of its programs for women and in particular those in Burundi. These studies include sex, the implications of sex, gender and power in HIV and AIDS transmission (Iredale and Ntacobakinvuna, 2009), baseline and evaluation studies for the Kirumara project itself (deBoodt, 2007; 2009), the evaluation of a men’s engagement program
(de Boodt, 2009a) and most important for this study, a set of women’s empowerment indicators for
12 Understanding psychosocial well-being among women in Burundi: A participatory study northern Burundi (CARE Burundi: UMWIZWERO Team, 2011). These studies indicated that participatory methods are effective in learning from conflict-affected women in Burundi (de Boodt, 2007a) and that such methods could be used to establish indicators of empowerment (CARE Burundi: UMWIZERO Team,
2011).
The next step is to help women to sort and define what psychological and social well-being mean to them, what mechanisms they use to maintain it and what is needed, materially, psychologically, and socially to make it possible. The results of this study will be used to foster a participatory process wherein women will define well-being and help to design and evaluate the effectiveness of psychosocial programs created for their benefit, as they already do with the economic and empowerment components of the program.
Organization of this Document
This document is designed to fulfill two interrelated yet distinct objectives: First, to tell us how poor, marginalized and conflict-affected women in the three provinces of Burundi where this study took place understand and operationalize indicators of psychosocial well-being; and second, to elaborate a practical and effective method for obtaining such indicators in any location where a psychosocial program for these women is planned/intended. Having both levels of information available will make it possible for CARE to evaluate the psychosocial component of its programs through measurement against baseline indicators as effectively as it does indicators of empowerment and economic well- being. Therefore, this document not only gives us results, but also a transparent and replicable way to trace all the steps taken to obtain those results for use in other situations.
To accomplish this, the document is divided into ten sections: introduction, review of the literature, methodology, study procedures, results, limitations, discussion, establishing a baseline, conclusion. References and annexes are included at the end of the document. The following paragraphs should guide readers on the documents’ use.
13 Understanding psychosocial well-being among women in Burundi: A participatory study
Introduction. This section, above, introduces the study, including its background, purpose, goals, rationale and significance, and addresses the organization of the document itself.
Review of the literature. The review of the literature is divided in two parts. The first part chronicles the history of attempts to measure psychosocial well-being. It includes the major theories and ideas, what is known and what is yet to be discovered. It contextualizes the present study within that literature.
The second part reviews the literature specifically related to women in Burundi, from historical times to the present with emphasis on the effects of conflict and their historical role. It also contextualizes the present study within the current state of written literature specifically related to
Burundian women.
One key finding of the literature review was that there were no existing studies on concepts of psychosocial well-being among conflict-affected women. Another was a controversy regarding the role of traditional culture in women’s lives. Most sources describe it as specifically detrimental to women’s well-being (ACAT& OMCT, 2008; deBoodt 2009; Ntacobakinvuna & Iredale, 2009; Rackley, 2005; Somers,
2006; Stummer, 2009; Uvin, 2009), while others suggest that positive traditions existed prior to the colonial period that may support women’s psychosocial well-being today (Daley, 2007, Ntahobari &
Ndayiziga, 3003).
Methodology. This section provides the overall design of the study, as well as the methods employed and the information regarding site selection and sampling. The study utilized Stepwise
Ethnographic Exploration (Nagpal & Sell, 1985; 1992) as one of its methods and the Participatory
Ranking Method [PRM] (Stark, et.al, 2009) as a second method to verify the accuracy of the findings in the first round.
Procedures and results. The study was conducted in two rounds, the first to identify concepts, questions, terminologies and domains and the second to verify the results of the first. The study
14 Understanding psychosocial well-being among women in Burundi: A participatory study procedures include a discussion of how the results were coded and the various strategies employed to increase rigor.
The procedures from round two include two methods of qualitative concept validation1 from the stakeholders, focus group discussion and the Participatory Ranking Method. The results from round two are presented in narrative, chart and diagram form following the procedures from round one that explain how we arrived at our findings.
The results sections also include information on special populations and the results of an additional question related to women’s perceptions of positive sources of well-being in the context of
Burundi.
Limitations. The limitations section outlines the limitations of the study as well as the specific challenges the research team encountered in the course of the study.
Discussion: Organizing themes. This section compares the domains of well-being listed in the results sections of the study to three theoretical frameworks for the study of psychosocial well-being derived from the empirical literature. The purpose of this section is to contextualize the data into specific psychosocial frameworks that can be studied further.
Establishing a baseline for psychosocial well-being. This section is divided in two parts. The first uses the theoretical frameworks elaborated in the discussion section to create a set of locality-specific
1 The word “validation” is contested among some researchers. Qualitative Concept Validation is the name given to Step 4 and 5 of Stepwise Ethnographic Exploration, which this research team modified to make it more participant and practitioner inclusive. Padgett (2008 p. 180) uses the term “member checking” to refer to the process of checking with respondents to ensure that they agree that the research report reflects what they have meant. Barbour writing in the British Medical Journal (2001p.1117) uses the term “respondent validation” to refer to member checking specifically, and the word validation, to refer to efforts at rigor that involve attempts to ensure that respondents and practitioners agree that language used to code their responses accurately reflects their thinking. This paper will use the term Qualitative Concept Validation from Stepwise Ethnographic Exploration and in this instance “validation” when discussing efforts at rigor in the definition of the concept that is being studied.
15 Understanding psychosocial well-being among women in Burundi: A participatory study questions that might be used to establish a baseline for future psychosocial programs among a comparable population in Burundi. This is not a validated instrument, but a practical device for future use based on the Stepwise Ethnographic Exploration method.
The second part of this section points the way toward adapting the study methods to develop criteria by which to establish a psychosocial baseline for future use in the design, monitoring and evaluation of psychosocial programs.
Conclusion. This provides a brief summary of how the research study answered the questions it posed and points the way forward for future studies.
CRITICAL REVIEW OF THE LITERATURE
There is a small but significant literature that defines psychosocial programs. The Cape Town
Principles and Best Practices on the Prevention of Recruitment of Children into Armed Forces and on the
Demobilization and Social Reintegration of Child Soldiers in Africa (UNICEF, 1997), provided a widely used definition, reiterated and emphasized ten years later in the Paris Principle (The Paris Principles,
2007). The prefix “psycho” refers to the psychological dimension of the individual, and has to do with the inner world of thoughts, feelings desires, beliefs, values, cognition and ways in which people perceive themselves and others. The suffix “social” refers to the relationships and environment of the individual. It includes the material world as well as the social and cultural context in which people live, ranging from the network of their relationships to cultural manifestations, to the community and the state. It is also used to refer to the socio-economic resources and material conditions of life. The term
‘psychosocial’ is used to explain the way these aspects of the person are inseparable, with each continuously influencing the other so that it is impossible to tease them apart (The Paris Principles,
2007; UNICEF, 1997).
16 Understanding psychosocial well-being among women in Burundi: A participatory study
Psychosocial interventions are those that enhance and influence human development by addressing the negative impact of social factors on people’s thoughts and behaviors (Loughry & Eyber,
2003). According to the consensus found in the authors’ review, they do this by instituting social programs that support the positive interaction of behaviors within the social context (Loughry & Eyber,
2003). Thus, psychosocial supports are social interventions intended to affect the psychological well- being as well as the social situation of the participants, imbedding principles of psychological intervention within them (Loughry & Eyber, 2003; Wurzer & Bragin, 2009).
The Psychosocial Working Group (PWG), a consortium comprising international humanitarian agencies and university partners who specialized in community-based psychosocial work with children, defined psychosocial as the interplay between human capacity, social ecology and culture/values (A.
Ager, W. Ager & Boothby, 2010). The Psychosocial Working Group has developed a conceptual framework that identifies three domains representative of a person’s resilience and ability to adjust after having experienced a traumatic life event. This framework includes: human capacity (i.e. mental health and well-being), social ecology (one’s interpersonal relationships and interdependency within social structures), culture and values. The availability of physical, material, and cultural resources further promote one’s sense of adjustment (Psychosocial Working Group, 2003).
Psychosocial Work with Children
All of these definitions had their origins in psychosocial work with children, since it was the recognition of the psychological and social consequences of armed conflict on children’s dynamic development that first caused humanitarian actors to recognize the importance of intervening in both psychological and social realms (Bragin, 2005; Loughry & Eyber, 2003).
Studies of psychosocial work with children have identified lessons learned working with children affected by war (Boothby, Crawford, & Halperin, 2006; Stark, Ager, Wessells & Boothby, 2009). The studies indicate that many former child soldiers were able to reintegrate into society because of the
17 Understanding psychosocial well-being among women in Burundi: A participatory study support and acceptance of the community. Similar outcomes were also reported in research studies with former child soldiers and children affected by armed conflict throughout the world (Stark et al.,
2009; Karki, Kohrt & Jordans, 2009; Amone-P’Olak, 2005; MacMullin & Loughry, 2004). However, none of these studies directly defined or addressed what well-being meant to the children or how they found it within their families, community or society, until the 2011 study on the impact of the school-based
Psychosocial Structured Activities (PSSA) program on conflict-affected children in Northern Uganda
(Ager, Akesson et al., 2011). This study reflects on and begins the process of defining psychosocial well- being of youth as indicated by teachers, parents and the youth themselves, representing an important predecessor to the current study (Ager, Akesson et al., 2011).
Evaluating psychosocial programs for children. Researchers in humanitarian work have conducted a number of studies examining extant programs that address the needs of children in crisis- affected areas (Ager, Stark, Akesson, & Boothby, 2010). The studies found that the empirical evidence thus far appears thin as to which interventions work best, and which do not work at all. Participants in these studies identified that interested agencies need to establish a “culture of learning,” which allows for consistent and culturally competent research and evaluation. In addition, the studies conclude that further research is essential to understanding how to ensure that psychosocial interventions, in conflict settings, are integrated into overall programming and evaluated for effectiveness (Jordans, Tol,
Komproe, & de Jong, 2009; Ager, Stark, et al., 2010).
UNICEF developed a country implementation guide to monitoring and evaluating psychosocial programs. The guide stresses the need to define, operationalize and measure emotional and social well- being before beginning any psychosocial intervention with children (A. Ager, W. Ager, & Boothby, 2010).
While there is a difference between women’s and children’s needs and rights in understanding well- being, UNFPA and UNICEF (2011) have begun to address this issue together.
18 Understanding psychosocial well-being among women in Burundi: A participatory study
A positive approach to defining well-being in cultural context is through various forms of case studies, including qualitative and quantitative data collection. The methodology of the school-based
Psychosocial Structured Activities (PSSA) program was developed as a collaborative effort between Save the Children Uganda and Ugandan authorities. This study successfully engaged conflict–affected students in evaluating the effects of a structured curriculum on their own perceived psychosocial well- being (Ager, Akesson, et al., 2011).
Evaluating Psychosocial Programs During and After Armed Conflict
However, the work with children is not the only psychosocial work that suffers from a limited evidence base for effectiveness. The very nature of the emergencies that create the need to develop psychosocial programs has made it difficult to develop clinical trials that would yield satisfactory information regarding whether, how and to what degree they are effective (Hobfoll et al., 2007; Bragin,
2010). Among the difficulties in doing this is to ensure that measurement is relevant to the program participants. Bracken (1998), points out that measurement of effectiveness must take into account the constructs that are meaningful to the society in which they are being measured in order to evaluate effectiveness (Bracken, 1998). He warns against mistaking the reliability of measures for validity.
Culture, environment, gender, age, and socio-economic factors all impact how individuals and societies understand well-being, and cannot be understood through lenses that do not take local culture and values into account (Bracken, 1998; Honwana, 1999; Summerfield, 1999, 2001; Wessells, 1998). Current inter-agency guidelines on mental health and psychosocial support in humanitarian emergencies specifically preclude the use of measures validated in western terms to be utilized in other contexts, much as non-western measures would not be used to evaluate the psychological and social state of those in the west (IASC, 2007).
One attempt to develop some sort of cross-cultural model was that of Hobfoll and his colleagues
(2007). They include war as one of many situations they discuss in their study of interventions to effect
19 Understanding psychosocial well-being among women in Burundi: A participatory study well-being in the face of “mass trauma.” The study’s authors explain that in emergency situations controlled trials are not possible, so they utilize a panel of international experts (from Europe, the
United States and Israel) to develop a consensus on essential elements of programming. While they do not specifically mention “psychosocial” programs by name, nor do they speak specifically about well- being, this first attempt at an empirical standard for intervention with an adult population is an important one. The study isolates five essential elements required for successful psychosocial intervention following what the authors call “mass trauma.” The five elements are 1) a sense of safety,
2) calming, 3) a sense of self– and community efficacy, 4) connectedness, and 5) hope (Hobfoll et al.,
2007, p. 284).
Organizations engaged in psychosocial work have noted the importance of developing tools to study its effectiveness in numerous reports (Duncan & Arntson, 2004; Ager, 2008; Williams, Mikus Kos,
Ajdukovic, van der Veer & Feldman, 2008; Ajdukovic, 2008; A. Ager, W. Ager & Boothby, 2010).
Inconsistencies in programming and differing viewpoints on how to realize such evaluations of psychosocial programs led to the North Atlantic Treaty Organization (NATO) sponsoring a workshop on the subject: evaluating community-based psychosocial programs in areas affected by war and terrorism
(Williams et al., 2008). Workshop participants developed specific recommendations for evaluation, and for the design and implementation of psychosocial interventions. Most important, they noted that such definitions must be meaningful to the people who are involved, and that such definitions and the ways in which they are operationalized must be consistent with the understanding of program participants if such programs are to be evaluated for meaningful definitions of success (Bragin, 2005; Ager, Boothby,
Wessells, 2007; van der Veer, 2008; Williams et al., 2008; Jordans, Tol, Komproe & de Jong, 2009; Ager,
Stark, Akesson, & Boothby, 2010).
Participatory methods in measuring children’s well-being during and after armed conflict. To support such a role for program participants, the conference recommended using consensus and
20 Understanding psychosocial well-being among women in Burundi: A participatory study participatory methodologies to understand concepts relevant to psychosocial interventions. They cited many other authors who advocated for these methods as a way to begin to understand psychosocial well-being in cultural context (Bragin, 2005; Ager, Boothby, Wessells, 2007; van der Veer, 2008; Williams et al., 2008; Ager, Stark, et al., 2010; Jordans et al., 2009). One participatory approach to evaluating programs for children and youth is the Community Participatory Evaluation Tool (CPET) (Bragin, 2005), which engages community members including elders, parents, children and youth to define children’s successful development, detail the effects of war on both development and coping, and provide a template for design, monitoring and evaluating psychosocial programs against it. The underlying concept of well-being in this model is successful achievement of developmental milestones appropriate to being a respected member of the community, as defined by participants.
Another example is the Participatory Ranking Method (PRM) used in Sierra Leone to assist girls associated with armed groups define and explain how they could successfully reintegrate into society
(Stark, Ager, Wessells & Boothby, 2009). The approach places the girls as experts in their own lives and allows for participants to address issues in a culturally relevant and meaningful way. The issue of well- being is defined through the aggregation of the girls’ priorities.
In the 2011 Northern Uganda PSSA study, the intervention program included all children who were raised in the stress-ridden conflict-zone, not solely children who had formerly been abducted. This allowed for a more comprehensive perspective on well-being. In addition, the classroom component of the program was implemented by the children’s regular schoolteachers, so as not to affect the outcome of the research by introducing new educators with this change in curriculum. Throughout this study, depicted by Ager and Akesson et al. (2011), activities focused on issues of “safety and control, self- esteem, thoughts and reactions during danger, resource identification, and coping skills” (p. 3) through instructive presentations, reflective exercises, drama and games. Parental engagement was made possible through meetings with the teachers and the Save the Children organization. This approach gave
21 Understanding psychosocial well-being among women in Burundi: A participatory study the parents insight into their children’s personal experiences with the new program activities. A combination of teacher-, parental- and self-evaluations allowed the youth to have a say in their own experience, interest, perception of change, and idea of well-being (Ager, Akesson et al., 2011).
The Inter-Agency Guide to the Evaluation of Psychosocial Programming in Humanitarian Settings
(A. Ager, W. Ager, et al., 2011) significantly advances this process by standardizing the domains by which the impact of the programs (that is, their actual success in creating change) could be measured. The domains are skills and knowledge, emotional well-being, and social well-being. They have de-coupled the elements of psychosocial well-being, after the efforts a decade earlier to link them. The document, sponsored by UNICEF, focuses almost exclusively on evaluating programs for children, leaving space to follow up with similar efforts focused on programs for adults.
In summary, literature related to increasing the effectiveness of psychosocial programs through empirical evaluation consistently calls for studies to define and operationalize psychosocial well-being as the critical next step (Bragin, 2005; Ager, Boothby & Wessells, 2007; van der Veer, 2008; Williams et al.,
2008; Ager, Stark, et al., 2010; Jordans et al., 2009). Some significant strides have been made in regard to children and adolescents. In the area of women’s well-being it appears that such definitions and measures are yet to appear in the literature on humanitarian intervention, leaving these as needed next steps moving forward.
Psychosocial Well-being and “Subjective Well-being:” Integrating Literature from Economics
Well-being has been studied extensively in economics, although citations of these studies are often absent from the psychosocial literature. Sen (1985) defines well-being and agency within the context of one’s perceived sense of freedom. An individual’s autonomy and personal liberty are inextricably linked to his or her agency. Agency is then correlated to the inherent ability to consciously choose happiness and fulfillment through actions and interactions. Sen proposes that the main feature of a person’s well-being is the individual’s functioning vector, which exemplifies the urgent pursuit of a
22 Understanding psychosocial well-being among women in Burundi: A participatory study specific outcome, such as escaping morbidity or undernourishment (Sen, 1985). With regards to the empowerment of women as promoting economic growth and viability within families and communities,
Sen articulates the importance of women’s agency, in correlation with educational attainment, as securing positive economic and social outcomes for both her and her children (Sen, 1999). This aforementioned development then positively impacts the progression of the community in which women live (Sen, 1999). On the other hand, Sen is careful to differentiate women’s agency and empowerment from subjective well-being as two distinct concepts (Sen, 1985, p. 169).
CARE international has used this concept to develop indicators of economic well-being through strategic impact indicator studies (SIIS) in Nepal, Uganda and Burundi. This was followed by the development of guidelines from the implementation of baseline studies for women’s empowerment
(CARE Norway, 2009). These guidelines address the issue of women’s empowerment and suggest the means of studying agency in a meaningful way, while at the same time remaining as two distinct sets of indicators.
An outgrowth of Sen’s work has been the division of the study of well-being into two categories,
“objective,” involving measurable economic and social assets, and “subjective,” involving thoughts, feelings, attitudes, and social relationships (Conceicao & Bandura, 2008). This may well correlate to psychosocial well-being, and is therefore the subject of our more extended study here.
Most of the economic literature on subjective well-being uses the proxy “happiness” (Conceicao
& Bandura, 2008; McGillivray, 2007). This substitution, while popular among economists, has been widely criticized as a limiting and inappropriate proxy (Ryff, 1989; Nagpal & Sell, 1985, 1992; Kashdan,
2004; Conciecao & Bandura, 2008; McGillivray, 2010). Happiness, they argue, has been defined as how one feels at a specific time, and can quickly change, while well-being is more about how one defines their overall life, over the long term (Ryff, 1989; Nagpal & Sell, 1985, 1992; Kashdan, 2004; Conciecao &
Bandura, 2008; McGillivray, 2010). It has been suggested that happiness may be an innate capacity,
23 Understanding psychosocial well-being among women in Burundi: A participatory study related more to biology and temperament than to experience and far removed from Sen’s ideas regarding agency and freedom of action (Conceicao & Bandura, 2008; McGillivray, 2010).
The capabilities approach to the study of subjective well-being. Sen’s critique of the proxy
“happiness” led to a positive definition of subjective well-being as “living a good life” (Anand et al.,
2005, p.10). He argues that subject well-being can be studied in terms of “capabilities,” that is “what people are able to do or able to be” (Anand et al., 2005, p.11). These capabilities are to be differentiated from activities of daily living and represent potential and aspirational states as well as actual experiences. Sen’s approach is context-dependent, requiring that people define for themselves the conditions for a good life (Robeyns, 2003). Feminist authors have debated whether there is actually a need to create a fixed number of capabilities, representing a universal standard, or whether, in fact, participatory methods are the more important factor (Nussbaum, 2003; White & Petit, 2007; Klasen,
2007).
Measures of subjective well-being. Two tools have been located that specifically attempt to measure subjective well-being as a complex psychological phenomenon: the Ryff scale, created by the
American psychologist Carol D. Ryff (1989), and the Subjective Well-being Inventory, developed for the
World Health Organization’s regional office in India by Nagpal and Sell (1992).
Ryff (1989) draws from a combination of psychological constructs that include Maslow’s hierarchy of needs, and Erikson’s psychosocial stage model to define, measure and understand well- being (Ryff, 1989). Her measurement tool includes several components of self-acceptance, positive relations with others, autonomy, environmental mastery, purpose in life and personal growth as necessary to understanding well-being (Ryff, 1989). This tool was validated for use in the United States and lacks validation for other contexts.
The Assessment of Subjective Well-being Scale (SUBI) by Nagpal and Sell (1992) was developed among educated populations in India and has been validated for use with non-western populations of
24 Understanding psychosocial well-being among women in Burundi: A participatory study men and women. The authors consider the methodology that they used, rather than the inventory itself, to be a significant breakthrough in measuring subjective well-being as it is participatory, and was developed with the professional community as well as the community at large. Borrowing from anthropology, they coined the phrase “stepwise ethnographic exploration” (1992) to establish the domains of inquiry to be included in the inventory. Stepwise ethnographic exploration is an iterative consensus methodology that brings together a wide range of key informants and ordinary people to develop consensus regarding a list of concepts that should be utilized. The consensus led to eight areas of concern that were elaborated into specific inventory items. These eight areas were the following: mental mastery over self and environment; rootedness and belongingness; structural and cohesive aspects of family life; density of social network; security in adversity (relating to health and economics); and harmony between expectations and achievement. As the interviews became increasingly structured, inventory questions were elaborated and posed to a sample population for validation.
This methodology parallels the one used in consensus methodologies developed for children and adolescents in armed conflict, and may have significance for defining women’s well-being in areas of armed conflict. It also runs parallel to Sen’s suggestion that subjective well-being is always context dependent (Robeyns, 2003).
What about Women and Psychosocial Well-being in Areas of Armed Conflict?
Extensive searches on EBSCO, JSTOR, Project Muse, and relevant journals, on variations of the key words “women” and “well-being” in areas affected by conflict yielded surprisingly few results. Some literature exists on psychosocial well-being of women and war, but this largely consists of reports or manuals for care. Becker and Weyermann’s manual (2006) is among those that illustrate the psychosocial effects of war on women in some detail. The 2010 UNFPA report on conflict and change affirms the importance of UN Resolution 1325, stating that women are not only adversely affected by conflict, but that they are also crucial to the peace-building process and the rebuilding of communities
25 Understanding psychosocial well-being among women in Burundi: A participatory study and nations. While it also documents the progress made on UN Resolution 1325, it does not address concepts of women and psychosocial well-being. Wurzer and Bragin (2009) discuss the importance of integrating psychosocial interventions into women’s empowerment programs, and explore a resilience- based approach to programming. However, a systematic study of the concept of psychosocial well- being, as defined by women in conflict-affected areas, has not yet been accomplished.
Summarizing the Literature on Evaluating Psychosocial Interventions for Conflict-Affected Women
The literature indicates that while psychosocial interventions in areas of armed conflict has been seen as a “best practice” intervention, evidence of the precise effectiveness of such interventions remains thin (Ager, Boothby & Wessells, 2007; van der Veer, 2008; Williams et al., 2008; Jordans et al.,
2009). In order to develop that body of evidence, researchers have recommended that it will be necessary to define and operationalize standards of psychological and social well-being for affected people in cultural and social context (Bragin, 2005; Ager, Boothby & Wessells, 2007; Hobfoll et al., 2007; van der Veer, 2008; Williams et al., 2008; Ager, Stark, et al., 2010; Jordans et al., 2009).
To address this issue, a number of studies have been conducted leading to the elaboration of methods to evaluate the effectiveness of psychosocial programs for children and adolescents in emergency situations (Ager, et al, 2011; A. Ager, W. Ager & Boothby, 2010; A. Ager, W. Ager, Stavrou &
Boothby, 2011; Stark, Ager, Wessells & Boothby, 2009).
There has also been a beginning group of studies of adult women’s well-being in areas of armed conflict that have focused on establishing the negative effects of the conflict on women’s overall well- being as predecessors to further developing methods to evaluate psychosocial program effectiveness
(Horn, 2009; TPO Nepal, 2007; UNFPA, 2010; Becker & Weyermann , 2006).
In addition, studies of well-being in adults that allow for positive psychosocial outcomes to be explored also exist in a variety of different literatures including the resilience literature and that of economics (Conciecao & Bandura, 2008; Sen, 1999, Hobfoll et al., 2007, Reich, Zautra, & Hall, 2010;
26 Understanding psychosocial well-being among women in Burundi: A participatory study
Ungar, 2010). These approaches have yielded conceptual support but have fallen short in the area of methodology.
However, a particularly promising approach, grounded in the economic literature is the
Subjective Well-being Index which uses “Stepwise Ethnographic Exploration” as a method of choice for understanding the well-being of adult women (Nagpal & Sell, 1992).
Next steps are to explore the literature on psychosocial well-being among women in the specific areas of armed conflict where CARE’s psychosocial programs for women’s empowerment and participation take place – Nepal, Burundi and Uganda – in order to learn about specific advances there in the study of women’s well-being. The purpose will be to help to refine what is known about the subjective well-being among women in the conflict zones of these three countries.
27 Understanding psychosocial well-being among women in Burundi: A participatory study
STUDYING WOMEN’S WELL-BEING IN BURUNDI
Background
Burundi is located within the great lakes region of Central Africa. A small, hilly, landlocked country, at 340 persons per square kilometer, it is the most densely populated in Sub-Saharan Africa
(Youngblood-Coleman, 2012).
Burundi is currently at the end of a forty-year, multi-party civil war, that included two separate instances of genocidal killing – over one third of the population was killed in each instance – and the displacement of over 400,000 thousand others throughout the world (Barltrop, 2008; Daley 2007; Uvin
2009). There are three academic books that contain relevant information about women in Burundi: one focuses on gender and genocide (Daly, 2007), one focuses on life in the post-genocide era and contains a chapter on changing gender roles (Uvin, 2009), and one focuses on the traditional institution of the
Bashingantahe and contains a short chapter specifically on women (Ntahombaye, et al, 1999). A thorough search of the EBSCO, Social Science Full Text, Project Muse, Africa Watch, and Sage Journals, using the terms “women” “gender” and “Burundi” failed to yield any academic papers published on women and Burundi, and only two that related to gender at all in the context of studies of culture and the history of Burundi (Haken, et al, 2011; Ntahombaye & Nduwayo, 2007). In the “gray literature,” however, numerous reports were found that concentrate on the sexual and gender based violence that occurred during the years of conflict (Rackley 2005; 2005b), women’s role in peace and reconciliation
(Falch, 2010; Ntahobari& Ndayiziga, 2003) as well as the realities of HIV/AIDS as a threat to women and national security itself (Iredale & Ntacobakinvuna, 2009; Nsabimana, 2006; Seckinelgin, Bigirumwami &
Morris, 2006). The specific situation of women in post-conflict Burundi is documented in literature from
United Nations and NGO sources (ACAT & OMCAT, 2008; ONUB, 2006).
CARE International in Burundi has engaged in an extensive program of participatory research to insure that women’s voices and contributions are documented in the context of post-conflict Burundi 28 Understanding psychosocial well-being among women in Burundi: A participatory study
(deBoodt, 2007a, 2007b, 2009a, 2009b). The methodology used – appreciative inquiry – allowed women to discuss their positive points of view on a number of subjects (2007a). Included in these studies is one that includes economic well-being (Iredale & Ntacobakinvuna 2009) and a beginning look at components related to psychosocial well-being (deBoodt 2007a, 2007b).
History of Burundi
Prior to colonization in the 19th century, Burundi was an agrarian monarchy, ruled by a king who was “an embodiment of the nation” rather than associated with the any of the principal social groupings, batutsi, bahutu, or batwa (Uvin 2009, p.7). Since all Burundians shared language and citizenship, the distinctions among them were not considered ethnic, but social/occupational, with the
Batutsi as cattle keepers, the Bahutu engaged in agriculture, and a small number of Batwa, engaging in tool production and craftsmanship, (Ntahobari & Ndayiziga, 2003; Ntahombaye & Nduwayo 2007; Uvin,
2009). All three groups were linked by clans, family ties, and their place within the kingdom, although batwa were known to live apart theoretically by choice and the nature of their occupations (Ntahobari &
Ndayiziga, 2003; Ntahombaye & Nduwayo (2007; Uvin, 2009). All male Burundians could hold positions related to court and administration within this hierarchical structure. Under the king were baganwa or princes, banyamabanga or custodians of ritual, the batware or sub-chiefs, the ivyariho, delegated women’s leaders, and the bashingantahe, elders (Ntahombaye & Nduwayo 2007; Uvin, 2009). The bashingantahe was comprised of well-known local leaders who were accessible to all members of the population and their function has been revived today (Hakem, et al, 2011; Ntahombaye & Nduwayo
2007; Uvin, 2009). This finely tuned political and social structure was needed to govern daily life in a small and densely populated region, and was widely accepted by the population as a whole (Daley,
2007; Hakem, et al, 2011; Ntahombaye & Nduwayo 2007; Uvin, 200).
The political and social structure radically changed with establishment of German colonial rule imposing a European style class system to enable extraction of colonial wealth (Daley, 2007; Uvin, 2009).
29 Understanding psychosocial well-being among women in Burundi: A participatory study
That system was changed and further rigidified after Belgium gained control of Burundi in 1916 (Daley,
2007; Uvin, 2009). Animosity and power struggles between the social groups (now designated as ethnicities) were widely believed to have been created by the colonial powers in order to maintain control of the population (Hakem et al, 2011; Daley, 2007; Ntahombaye & Nduwayo, 2007; Uvin, 2009).
This was further exacerbated in 1926 when the colonial government began an economic, political and social attack on the Bahutu, categorizing them as separate and inferior to the Batutsi. Bahutu lost power and rights in important areas, including their ability to own land, and obtain an education (Uvin, 2009, p.
8).
The end of colonial rule in 1962 brought little positive change to the new nation of Burundi
(Daley, 2007; Uvin 2009). Burundi was left an unstable nation with six different governments between
1962 and 1966 (Daley, 2007). The animosity between Batutsi and Bahutu continued into the post- colonial period, as a result of the policies that left Bahutu without land, education or access to positions of power (Hakem et al, 2011; Daley, 2007; Ntahombaye & Nduwayo, 2007; Uvin, 2009). However, these cannot be seen as simply “interethnic” rivalries, but as reflective of the interplay of competing ideological and economic views of the way forward for an impoverished country with many divisions
(Hakem et al, 2011; Daley, 2007; Ntahombaye & Nduwayo, 2007). The 1972 mass killing of over 150,000
(mainly) Bahutu followed by the assassination of a Hutu president, which also brought forth a wave of anti-Tutsi violence, mark the first “genocidal” conflict (Barltrop 2008). Thousands of Hutus fled to neighboring Tanzania and remain in refugee camps to this day. Many scholars mark the 1970’s as the beginning of the Burundian civil war, while others mark 1993, when the first democratically elected
(Hutu) president, Melchior Ndadaye, was assassinated, as the actual beginning of the war (Barltrop
2008).
As noted earlier, reasons for the war and genocide are complex, and not simply due to “ethnic conflict.” Patricia Daley writes, “concentration on the problem of ethnicity helped to deflect serious
30 Understanding psychosocial well-being among women in Burundi: A participatory study analysis of the specific character of the modern Burundi state both in the colonial and post-colonial era”
(2007, p.67). Colonialism, neo-colonialism, militarization, globalization, international trade, and humanitarian aid are all implicated in the conflict/genocide and widely viewed as collectively responsible for current day difficulties in Burundian society (Hakem et al, 2011; Daley, 2007;
Ntahombaye & Nduwayo, 2007).
The Arusha peace accord in 2000 failed to produce an effective solution to Burundi’s civil war
(Barltrop, 2008). However, a deliberate process of talks leading to sequential progress continued
(Barltrop 2008). By 2004, an interim constitution was agreed upon and elections were held in 2005, beginning a process of peace that was consolidated in 2006 (Barltrop, 2008; Uvin, 2009). The presidential election of 2010, though marred by some instances of violence, continued to institutionalize the stabilization process (Falch, 2010; Haken, et al, 2011).
Women in Burundi
Traditionally, Burundi was an agrarian society in which both men and women were judged by their performance of specific roles in the life of the family. Women’s role was primarily that of the guardian of the home and the children, while men were charged with all responsibilities that took place outside (Ntahobari & Ndayiziga, 2003; Ntahombaye et al 1999). A woman’s role in her parents’ home, her marriage, and the achievements of her children were sources of her power and authority (Ntahobari
& Ndayiziga, 2003; Ntahombaye et al 1999; Uvin, 2009).
Within that tradition, a man’s value to society and community lay in his ability to provide the conditions that made the women’s role possible. A family would support its sons in new marriages by providing bridewealth, building a house, and supporting each young couple for two years (Ntahombaye et al, 1999; Uvin, 2009). The son would inherit the land that the couple worked and provide for the family in all ways external to the home, including the provision of peace and security (Ntahobari &
Ndayiziga, 2003; Ntahombaye et al 1999; Uvin, 2009).
31 Understanding psychosocial well-being among women in Burundi: A participatory study
Daley argues that the effects of colonial domination on masculinities and the capacity of families to care for one another is another negative effect that continues to affect the lives of all Burundians today, especially women. She maintains that these effects are implicated in the militarization of
Burundian society at all levels (Daley, 2007).
However, other literature attributes the situation of Burundian women to historical and cultural discrimination predating the colonial period (de Boodt, 2007, 2009a; Iredale and Ntacobakinvuna, 2009).
The literature universally notes that Burundian proverbs have a profound connection to the realities of everyday life. “Women and girls were created to provide pleasure to men,” is but one of the many
Burundian proverbs noted in the literature, which explains some cultural attitudes (de Boodt, 2007,
2009a; Iredale and Ntacobakinvuna, 2009; Rackley, 2005; Iredale & Ntacobakinvuna, 2009; Seckinelgin,
Bigirumwami, & Morris, 2006; Uvin, 2009). However other proverbs suggest an important advisory role for women (Haken et al., 2011) “When you bring the woman, you bring wealth.”
Both women’s and men’s roles were traditionally defined within the context of marriage, and being a “married” person, rather than an individual person, was the only way a woman or man could receive respect within Burundian society (Uvin, 2009). This can have discriminatory aspects. Men in contemporary society may not be able to raise the money for bridewealth, a home, or a proper marriage and may offer instead only an informal liaison, in which the woman becomes known as a concubine or a prostitute (Rackley, 2005; Uvin, 2009). The unmarried man is seen as inadequate as well, and not respected in society.
When bridewealth is available and a proper marriage can be achieved, traditional arrangements can affect women negatively. Men often see bridewealth as a purchase price for a bride, and therefore both members of the couple believe that her obligation is to serve her husband without question in all areas of life. If she questions or disobeys, a wife can be subject to domestic violence (de Boodt, 2007,
2009a; Iredale and Ntacobakinvuna, 2009; Rackley, 2005; Iredale & Ntacobakinvuna, 2009; Seckinelgin,
32 Understanding psychosocial well-being among women in Burundi: A participatory study
Bigirumwami, & Morris, 2006; Uvin, 2009). Widows, although once married, are considered single and lose their status. Worse, they can be viewed as sexual predators, attracting men who are travelling away from home (Rackley, 2005; Uvin, 2009). Widows, according to Uvin, “… are the most disadvantaged group in Burundian society… often abused by family members, losing access to land, and living in destitution (Uvin, 2009, p. 131).”
However, culture is fluid and ever changing, and today’s young men see women through different eyes, in many ways due to the process of women’s political empowerment (de Boodt, 2009a;
Falch, 2010; Uvin, 2009). CARE’s research has consistently revealed that women’s empowerment will be improved by working with both women and men, as the roles assigned by culture and society cannot be changed by working solely with women (de Boodt, 2007; 2009; Ntacobakinvuna & Iredale, 2009).
Women during the conflict and immediate post-conflict period. When the armed conflicts began, women remained the main guardians of the home, where they stayed, caring for crops and family members (Seckinelgin, Bigirumwami & Morris, 2006). This made them more vulnerable to rape and sexually based violence, which has affected not only individual women, but has become an epidemic throughout the society (Iredale and Ntacobakinvuna, 2009; Rackley, 2005; Seckinelgin,
Bigirumwami & Morris, 2006). Rape was introduced as a weapon of control during the colonial period and was widely used as weapon by all parties to the civil war that followed (Daley, 2007; Iredale and
Ntacobakinvuna, 2009; Rackley, 2005; Seckinelgin, Bigirumwami & Morris, 2006). This was perpetuated in the immediate post-war period by a proliferation of small arms, ubiquitous in both city and countryside (Rackley; 2005).
As in most countries, rape, like sex, is not easily talked about within Burundian society (Iredale &
Ntacobakinvuna, 2009; Rackley, 2005; Uvin; 2009). This attitude produces a culture of silence, which makes it difficult for women to verbalize the abuse they have endured, and there is little support for victims of violence, within the familial or governmental structures. Women are abandoned, banished
33 Understanding psychosocial well-being among women in Burundi: A participatory study and chastised upon disclosure (Iredale & Ntacobakinvuna, 2009; Rackley, 2005; Uvin, 2009). To avoid the danger of isolation, they contribute to the culture of impunity by denying the rape at all costs (ACAT
& OMCAT, 2008; Iredale & Ntacobakinvuna, 2009; Rackley, 2005; Seckinelgin, Bigirumwami & Morris,
2006; Uvin, 2009).
Both colonial domination and armed conflict also separated men from their traditional roles
(Iredale & Ntacobakinvuna, 2009; Daley, 2007; Rackley, 2005). At the same time, the economy provided young men with little access to employment (Uvin, 2009). These factors were among those that allowed for the suffering of war to be enacted with in the family itself, as it is in many conflict-affected countries
(Uvin, 2007; Iredale & Ntacobakinvuna 2009; Wurzer and Bragin, 2009).
The result has been a disaster for Burundian women. They ended the civil war with no legal right to the fruit of their daily labor in the fields, to decide on how funds would be spent, and faced potential violence at home (de Boodt, 2007; Iredale & Ntacobakinvuna, 2009; Rackley, 2005; Uvin, 2009).
Women and HIV/AIDS.
Between the impunity associated with rape and the diminution of stable formal marriage created by the loss of income for young men, HIV/AIDS has hit the female population hard. By the end of 2005, the number of people living with HIV/ AIDS) in Burundi was estimated to be 150,000, of which 60% were women (Nsabimana, 2006).
Women are limited in their options and methods of preventing contraction of HIV by customs and traditions. Married women often do not feel comfortable discussing sex or negotiating condom usage with their husbands, as they believe they will be accused of cheating or being infected with HIV, and will then be beaten or abandoned (Iredale & Ntacobakinvuna, 2009; Rackley, 2005; Seckinelgin,
Bigirumwami & Morris, 2006; Uvin, 2009). Research shows that most women and men in both urban and rural areas have the necessary education regarding HIV transmission, and it is not a lack of information, but rather fear and a lack of power, which deters women from protecting themselves from
34 Understanding psychosocial well-being among women in Burundi: A participatory study
HIV (Iredale & Ntacobakinvuna, 2009; Seckinelgin, Bigirumwami & Morris, 2006). Bigirumwami & Morris
(2006) argue that this situation is not only a tragedy for the women and their families, but also a significant factor in the demobilization and integration of ex-combatants. They point out that for there to be real peace and reconciliation the mythologies about sex and gender in Burundi will have to be addressed, and a gender-sensitive approach to the ending of the conflict will be needed. Further, they posit that like everything else in Burundi, a simplistic duality contrasting armed men and powerless women doesn’t really get at the heart of the problem or what is needed going forward. Rather they argue for a more complex look at gender norms and relations for both men and women, as they are constructed and defined in the post-conflict period.
Burundian women in peace and reconciliation.
While the traditional task of securing peace and reconciliation in traditional (pre-colonial) society was the province of the Bashingantahe, women nonetheless had a number of roles to play (Ntahobari &
Ndayiziga, 2003). Among those roles were those of peacekeeper in the family, and facilitating the resolution of conflicts among women. This later role was the province of the Inararibonye or “those who have seen many things” (Ntahobari & Ndayiziga, 2003, p. 20). They mediated conflicts among women and also could pass judgment on women seen to be behaving improperly. Their role in armed conflict in those times was secondary, although there were apparent instances when women took over a husband’s political or administrative responsibilities when the man was away at war. Some were given chieftainships of their own.
This tradition had largely been lost during the colonial period. However, decades of conflict and accompanying social breakdown led women to organize themselves and demand a role in the peace process. Beginning in 1994, women came together on a multi-ethnic basis and to organize for peace at the grassroots, community and national levels (Falch, 2010, p. 15). Initially not included in international peace negotiations, their success led to their achieving permanent observer status. Women continued
35 Understanding psychosocial well-being among women in Burundi: A participatory study to apply pressure to be heard, and the 2005 constitution allowed for their entry into the political system
(Falch, 2010). As the women’s organizations proliferate they go beyond peace and agitate for the full integration of women and men within the society (Falch, 2010).
Current situation of women in Burundi. This consistent, organized pressure for a role in the peace process in particular and as full members of society as a whole led to changes in the legal status of women (Falch, 2010). The Family Code, instituted in 1980, provided the legislative basis for the rights of women and girls in the post-colonial period. The Code granted women the same rights to household resources as men and makes the right to make decisions regarding the management and utilization of household resources law. It also made underage marriage illegal along with bride price and the purchase of women and girls in payment for debt (CARE Burundi, 2007). The current (2005) constitution went further, granting women full citizenship and equal rights under the law. Today, women can vote, hold office and own property, including land (Falch, 2010). Land may be deeded to them by their parents if there is no surviving male heir and if they are unmarried. Single women and widows have the legal right to their own property. Physical violence against women, including rape, both in and out of marriage is against the law. All children are citizens regardless of proof of paternity (Falch, 2010; ACAT & OMCAT,
2008).
However, legislation does not make rights a reality in women’s daily lives. Women’s advocates and rights organizations have consistently denounced the inadequacy of implementing legislation that purports to ensure the enforcement of constitutional provisions (ACAT & OMCAT, 2008). Women’s and men’s organizations have worked actively to make a change in these realities both in the individual lives of women and in the legislative process (Nsabimana, 2006; de Boodt 2009, 2009a). Special attention must be given to Abatangamuco an indigenous men’s movement supporting women’s empowerment that has been working on a family-by-family basis, and also on a community and political level to make women’s rights a reality in everyday life (deBoodt, 2009, 2009a; Uvin, 2009).
36 Understanding psychosocial well-being among women in Burundi: A participatory study
Current studies of women in Burundi. The studies cited in this section have focused on the many difficulties facing women in Burundi, from colonial times through the conflict and post-conflict periods (ACAT& OMCAT, 2008; Daley, 2007; de Boodt, 2007; Iredale and Ntacobakinvuna, 2009; Rackley
2005, 2005a; Seckinelgin, Bigirumwami & Morris, 2006; Uvin 2009). However, the strength of their advocacy efforts has ensured that they are recorded in the literature not solely as victims but also as actors (de Boodt 2007, 2007a, 2009; Falch, 2010; Iredale and Ntacobakinvuna, 2009; Nsabimana, 2006;
Ntahobari & Ndayiziga, 2003).
The overwhelmingly problem-focused view of women in Burundi, coupled with the lack of published scientific research, led CARE Burundi to take a unique approach to the study of Burundian women in context, in order to be sure that their voices were heard and reflected in research going forward (de Boodt, 2007a). Called “dialogue valorisant” the approach is adapted from the appreciative inquiry method, a form of Participatory Action Research (Padgett, 2008), that specifically enables members of the community to focus on any existing positive practices as well as those that they can envision in the future.
Studying Psychosocial Well-being with Burundian Women
The Kirumara program baseline (de Boodt, 2007) located psychosocial well-being within the domains of empowerment. The definition given for psychosocial well-being was, “a happy woman who is not beaten/ a woman whose husband is respectful” (de Boodt, 2007, p. 80). Psychosocial well-being was described largely in terms of access to counseling and community support for those who had been abused (de Boodt, 2007 p. 81).
CARE’s studies on women’s empowerment in Burundi.
The Kirumara baseline has been followed by a rigorous study of empowerment that is both phenomenological and empirical to determine the indicators of empowerment in the Burundian context
(CARE Burundi UMWIZERO Team, 2011). Especially important to understanding empowerment in
37 Understanding psychosocial well-being among women in Burundi: A participatory study
Burundi is the ability for researchers to understand the diversity of opinions across the country and across the lifespan (de Boodt, 2007; 2007a). Understandings of what it means to become empowered were influenced by region, class, ethnicity, and age. For example, women in the plains region share more power with their husbands than women in the hills region (De Boodt, 2007). All of the above indicators also changed over time as women’s aspirations, community engagement, or education changed. As noted earlier, while psychosocial well-being is intimately related to empowerment, it is in fact a separate phenomenon that must be studied separately (Anand, Hunter & Smith, 2005; Sen, 1985,
1999; Petit and White, 2007).
Next Steps
The rigorous empowerment studies completed in Burundi form an important basis for the phenomenological study, expanding women’s views of psychosocial well-being, and elaborating culturally specific and appropriate indicators that can accompany and be correlated to indicators of empowerment. This correlation should point the way to addressing the program hypothesis that psychosocial well-being supports empowerment and political participation amongst war-affected women in Burundi. Further, the study can elaborate which aspects of psychosocial well-being contribute to coping and resilience, in order to take these factors into account when building new programs.
As part of a three-country study including concepts and domains developed by conflict-affected women in Burundi, Nepal and Northern Uganda, this may contribute to filling the gap in knowledge as to how women in post-conflict countries define their psychosocial well-being, so that attempts to support them can take their ideas and thinking into account for program planning and evaluation of impact and effectiveness. Lessons learned from the sophisticated methodological field in Burundi may strengthen and inform the research taking place in the other two countries, as well among other war-affected women. By identifying culturally sensitive indicators for assessing women’s psychosocial well-being in the three localities, this study may pave the way for the identification of a replicable process that can be
38 Understanding psychosocial well-being among women in Burundi: A participatory study used to identify indicators for women’s psychosocial well-being in other localities. It is hoped that this study will also contribute to developing an evidentiary base for the effectiveness of psychosocial programming.
The experience of Burundi has already provided a valuable lesson for generalized learning about how war-affected women and men understand empowerment, and it shows promise to contribute further understanding to what it means for a woman to experience psychological and social well-being.
METHODOLOGY
The Study Design
The present study is part of a larger three-country study in the operational areas of CARE
Austria’s Women’s Empowerment Programs – Burundi, Uganda and Nepal. The study is designed to contribute to program effectiveness by addressing the capacity to measure the psychosocial component of the program, through an operational definition of psychosocial well-being in cultural context. The study also addresses the gap in the literature on conflict-affected populations by including the voices of conflict-affected adult women, and presenting for the first time their positive views of an end state of psychosocial well-being and the means needed to arrive at that state.
Study hypothesis. The hypothesis of this study is that poor, vulnerable and socially excluded
(PVSE) women affected by the armed conflict in Burundi will be able to utilize participatory methodologies to develop an operational definition of psychosocial well-being in cultural context, and to elaborate the indicators needed to measure it.
Study objectives.
To learn from PVSE conflict-affected women in the study areas how they describe
psychosocial well-being and the factors necessary to attain it.
39 Understanding psychosocial well-being among women in Burundi: A participatory study
To contribute to the development an operational definition of psychosocial well-being
among PVSE conflict-affected women in Burundi.
To establish culturally sensitive indicators of psychosocial well-being to be used in the
design, monitoring and evaluation of psychosocial programs.
To develop a practical, reliable and valid method for developing culture sensitive indicators
of psychosocial well-being to include in any design, monitoring and evaluation.
To place the study of PVSE war-affected women from the three districts’ perceptions of
psychosocial well-being in the context of the literature on war-affected women in Burundi.
To enable future testing of the main program hypothesis, namely that improved
psychosocial well-being is associated with successful empowerment and participation in
peace building as stipulated in UNSCR 1325.
Main study questions.
How do conflict-affected women in Burundi understand psychosocial well-being?
What are the conditions that these women believe are necessary to achieve psychosocial
well-being?
What questions could be added to future program assessments and evaluations that would
help evaluators to know if the war-affected women in Burundi experienced psychosocial
programs designed for their benefit to be effective?
40 Understanding psychosocial well-being among women in Burundi: A participatory study
Figure 1: The study design
41 Understanding psychosocial well-being among women in Burundi: A participatory study
Methods Used in This Study
This is a qualitative, phenomenological study of women’s subjective views of psychosocial well- being in Burundi. It is intended to address a gap in the literature on the effectiveness of psychosocial programs for war-affected women by filling in several needed elements: to develop an operational definition of psychosocial well-being in cultural context that can be used to make psychosocial programs more effective; to test the program hypotheses objectively; and to contribute to the overall goal of studying the effectiveness of the psychosocial method in humanitarian work. The study will also address a practical need, namely, to suggest an approach to obtaining such definitions rapidly in the field, in order to ensure that psychosocial programs meant to support the well-being of conflict-affected women are informed by participants’ understanding and can be measured against their views. The indicators developed by women for their psychosocial well-being can then be used alongside the currently validated indicators used to measure empowerment and economic well-being.
To address these complex issues twin methodological approaches were employed:
Stepwise Ethnographic Exploration, to insure construct validity in cultural context
The Participatory Ranking Method of Columbia University to facilitate reliability,
transparency and replicability.
“Stepwise Ethnographic Exploration” (Sell & Nagpal, 1992) is a method that has been validated for studying psychological well-being related to health in India, as noted in the literature review. The
Participatory Ranking Method (PRM) (Stark, et al, 2009) was used successfully by Columbia University for learning about perceptions of psychosocial well-being among adolescent girls in Sub-Saharan Africa.
We adapted it slightly to use with adults. Both of the above named methodologies rely upon systematically arranged focus group discussions to develop culture sensitive indicators of well-being.
Participatory methods such as these have demonstrated effectiveness in developing valid instruments in
42 Understanding psychosocial well-being among women in Burundi: A participatory study cultural context (Ager, Boothby, Wessells, 2007; van der Veer, 2008; Williams, Mikus Kos, Ajdukovic, van der Veer & Feldman, 2008).
Figure 2. Stepwise Ethnographic Exploration
•Unstructured Interviews with Interviewers •Concept Identification •Concept Identification •Unstructured Interviews with Key Informants •Semi Structured Focus Group Discussions •Concept Clarification •Semi Structured Interviews with Key Informants in the field next step •Concept Clarification •Interviewers meetings next step •Consensus on concepts/ development of domains of inquiry
•Focus Group discussion: structured •Qualitative concept validation
•Semi Structured Interviews with Key Informant •Qualitative concept validation
•Development of interview guide for psychosocial well-being of women in cultural context
Preliminary data analysis was done concurrently with fieldwork in a reflexive and iterative process, followed by a retrospective analysis. Following field data collection, handwritten notes were assembled and typed in Microsoft Word. The notes were reviewed thoroughly and coded manually to discern emerging issues, unique quotations and crosscutting experiences across districts. The qualitative data was then analyzed using Atlas-ti software, which was then compared with the hand-coded data.
The study was conducted in two rounds, in two separate research visits. The first round defined the concept in social and cultural context and determined which words and questions should be used to ensure that we were in fact studying the construct “psychosocial well-being” and not something else.
This is particularly important when working with adults who may see the world in a more complex way than the children and adolescents. Retrospective analysis utilized Atlas-ti software for the second round
43 Understanding psychosocial well-being among women in Burundi: A participatory study of interviews. The results of the Atlas-ti codes were then compared to results of hand coding. To avoid the danger of “cherry-picking” data, codes were counted within focus groups, within districts and across focus groups. Domains of inquiry, and the subcategories by which they were operationalized were developed from among those that occurred across focus groups. Those that occurred only in specific focus groups or communes were treated as “outliers” but were accounted for in the discussion.
Participatory ranking method. Following participants’ agreement that the questions reflected their ideas regarding well-being, participants were asked to rank responses in each domain as to their importance. Once again, detailed notes were taken from each group and the process continued until there was saturation. The ranked questions were used to develop a pattern of responses to be used as indicators in a future baseline studies to measure the effectiveness of psychosocial programs.
Retrospective analysis utilized SPSS software to ensure objective results for the frequency and ranking of domains and sub-categories. Atlas-ti was used to review themes against themes contributed by key informants.
Site Selection
The Kirumara program is situated in the study districts: five communes in Gitega, Bujumbura
Rurale and Bubanza. In addition, the study included interviews with a group of informally displaced young single mothers in Bujumbura City (Mairie). It should be noted that Gitega was the seat of both the monarchy and the colonial administrators, while Bujumbura Mairie is the current capital city.
Previous studies have indicated that women from the five communes selected had been negatively affected by extreme and recent violence during the conflict and post conflict period, including massacres, formal battles, and forced evacuations. In the current study period they are sites of mutual suspicion and ongoing tension. Bubanza and Gitega are also sites of high levels of maternal death and high numbers of displaced persons (Youngblood-Coleman, 2012).
44 Understanding psychosocial well-being among women in Burundi: A participatory study
Recruitment and Sampling
Subjects were recruited from among program participants who are between 18 and 65 years of age and have been ongoing participants in a local women’s support program for at least two years. An equal number of women were recruited from Kirumara groups and from other NGO organizations or from other CARE-sponsored women’s groups in the area, including one for young single mothers (CARE’s group called Ishaka or “we have zeal”), and one for ex-combatants CARE-sponsored group called
Gridjambo or “we have a voice”). The second round added additional women who shared characteristics but had not participated in the original meetings. The solidarity groups participating in the focus group discussions (FGDs) were recruited purposively based on the following:
Those where the partner organizations have capacity to support any woman reporting
distress through ongoing psychosocial activity and referral to the designated expert service
for the treatment of psychosocial distress.
Women members included those with the following characteristics:
o Widows
o Women who were injured or are disabled
o Women’s whose husbands had disappeared or been injured
o Women who are ex-combatants
Special Populations: Young Unmarried Mothers and Women Associated with Fighting Forces
Among the populations most exemplary of the effects of conflict were women who had children out of wedlock and women who had participated in the fighting forces.
Ishaka: young unmarried women’s group. Young women who become pregnant out of wedlock are often forced to leave their villages due to the property laws that allow no place for them in their agricultural communities. With rape and sexual abuse endemic to conflict, this is a frequent problem.
45 Understanding psychosocial well-being among women in Burundi: A participatory study
The precise number of these women is not known, but the literature is clear that their plight is serious and widespread (Daley, 2007; Haken, et. al, 2011; Nsamimana, 2006; Ntahombaye & Nduwayo, 2003;
Ntacobakinvuna& Iredale, 2009; Rackley, 2005; Seckinelgin, Bigirumwami, & Morris, 2006).
We were able to include a small number of these young women through a CARE-sponsored program known as Ishaka. We included eight members of the group in Bujumbura Mairie in the first round and 15 in the second; that is, seven who had participated in round one and eight newcomers.
Women associated with fighting forces. Due to the difficult conditions for women in the country, a number joined the fighting forces. Those who were not integrated into the armed forces and had to return to the local communities, where land and resources were scarce, often with one or more children, were among those most marginalized in the post-conflict period. We were able to interview one member of the government forces who remained integrated after the conflict to get an overview of why women joined and how participation supported their well-being.
In addition, we had integrated seven women ex-combatants from the non-governmental forces into the first round of interviews in Bujumbura Rurale, which had proved ineffective as the members of the group barely spoke. Therefore, in the second we met with a complete solidarity group from the
CARE program Giridjambo, a support program for women ex-combatants. They were seen in Bujumbura rurale.
Sample Size
The study was conducted and repeated in focus groups until saturation was reached in the first round. The second round included those women plus other similar women for comparison. That included a separate focus group of ex-combatants including seven who participated in the first round but did not speak very much and eight new additions for a total of 15. A total of 203 persons participated in the study, including 195 women in focus group discussions and 12 key informants of whom five were women and seven were men. The breakdown is shown below in figures 3-5.
46 Understanding psychosocial well-being among women in Burundi: A participatory study
Figure 3. Total numbers: participants, focus groups and key informants Rounds One and Two
Districts Total # Total #FG Total FG Total # FG # Key Total # study Focus Participants Participants Participants Informants participants Groups See X2 Seen X 1
Gitega 5 22 61 83 1(M) 84 Bujumbura 1 8 7 15 6(F) 6(M) 27 Bujumbura 4 47 3 50 50 Rurale Mpanda 2 37 10 47 47 Totals 12 114 81 195 6 7 208
Figure 4. Participant Sample: Round One
Districts # Focus # Key Total Groups Participants Informant Interviews
Gitega 2 9, 13 1 1(M) 23 Bujumbura 1 8 5 2(M) 3(F) 11 Bujumbura Rurale 2 20, 27 47 Bubanza 1 37 37 Total 6 114 6 119
Figure 5. Participant Sample: Round Two
Districts # FGDs # Participants KIIS Total Gitega 3 28,28,27 83 Bujumbura 1 15 5 (3F) (2 M) 20 Bujumbura Rurale 2 15, 35 50 Bubanza 1 47 47 Total 7 195 5 200
Study Procedures for Round One
The first round addresses steps 1 – 5 of the Stepwise Methodology. One research team was established comprising members of CARE’s Kirumara staff, the International Principal Investigator, and
47 Understanding psychosocial well-being among women in Burundi: A participatory study the International Psychosocial Advisor. The CARE staff members translated during the focus groups. The interviews including translation were recorded electronically and transcribed each evening by the international team members.
The first round proceeded as follows:
Initial concept identification was accomplished by individual interviews with the heads of each
individual CARE-Burundi program and leadership.
The research team identified key informants and held open discussions for concept
identification.
Semi-structured interviews were conducted with the selected focus groups, which included
discussion about the concept and free listing to establish which questions were most useful to
help women to discuss the issue of psychosocial well-being. This is a process of concept
clarification.
After each day of discussions the two research teams reviewed the notes and again clarified
concepts in an iterative process. This is continued concept clarification.
The days’ notes were then transcribed and reviewed by both teams for agreement, continuing
concept clarification.
Study procedures for data analysis and interpretation: Round one.
Interviewers meeting, in which the interviewers shared their perceptions of the accumulated
results of the meetings.
The typed notes from the key informant interviews and focus group discussion were coded by
two research assistants, who hand-coded them, counting the number of focus groups in which
the codes occurred.
Domains that recurred were color coded and reviewed for context.
48 Understanding psychosocial well-being among women in Burundi: A participatory study
The typed notes from the interviews were coded by a different research assistant using Atlas-ti
software, which also segregated terms by frequency and context.
The results were disaggregated by colline and district.
The results of the three methods (interviewers meeting, hand-coding, and Atlas-ti) were
combined and synthesized in a weekend workshop with the International Principal Investigator
and the research assistants.
49 Understanding psychosocial well-being among women in Burundi: A participatory study
RESULTS FROM ROUND ONE
The purpose of round one was to identify the concept in cultural context through conversations with CARE project managers in Bujumbura and Gitega, as well as the leaders of CARE’s partner organizations, Dushirahamwe and HealthNet-TPO. The next step was to clarify the concept through focus group discussions and to identify domains that could be used to build culturally sensitive indicators of psychosocial well-being in the local context.
Questions Asked for Concept Identification and Clarification
The following questions were asked of CARE and partner staff to facilitate the identification of the concept of psychosocial well-being in the Burundi context.
o How do you define psychosocial well-being for yourself?
o How do you define psychosocial well-being for program participants?
o What questions do you think are important to ask?
. How would you ask those questions?
Language and terminology. Psychosocial well-being is a concept imported for use by the international community and in practice is mostly associated with responses to adversity. The studies that have been done in Burundi focused on that adversity. Defining what it really meant to be well both psychologically and socially was quite new for the participants. However, in Kirundi there is actually a word which means to feel well in your heart: Kumererwa-neza. Another word that came from the field with great frequency was: kuganira, to negotiate, to discuss.
The right questions to ask. Four questions were asked in the field; the last yielded the largest number of responses.
What does it mean to feel well in your heart?
How do you relieve pressure in your heart? What helps you to cope?
Are their positive traditions that will help you to cope?
50 Understanding psychosocial well-being among women in Burundi: A participatory study
Is there something that has given you joy for more than a moment, during the last month?
If you have a small daughter and she will be grown and she will be well in her heart, what will
her life like? How will she be well?
The group sat quietly, answering specific questions, with little to say. They were adjusting the babies
on their laps, attentively. We asked, ”If this little baby on your lap will be grown and she will be well in
her heart, what will her life be like?” The answers flowed quickly with members interrupting one
another.
If my daughter will be grown and she will be well in her heart, then I will come to her house in the
morning and I will sweep for her, as she will be going out to her work.
Oh no, says another, if my daughter is grown and she is well, she will bring a girl from the village and
educate her, and that girl will also sweep and clean for her. I will come to visit my daughter, and I will
make tea. When my daughter comes home from her work, we will sit together and drink the tea and
wait for the grandchildren to come from school, to study and to have their supper.
My daughter who is well will be a teacher and respected everywhere. Everyone will seek her advice.
Her children will bring great happiness to everyone.
-Young Unmarried Women in Bujumbura
51 Understanding psychosocial well-being among women in Burundi: A participatory study
Domains of Well Being for War Affected Women in the Study Districts in Burundi
1. Have control over the resources that she needs to have the basic necessities of life for herself and her children If her daughter is not married, then through the capacity to earn through education, a job, training, commerce or the ability to save with an organization If she is married through the ability to discuss, dialogue and influence the decisions of her husband o To have own incomes o To be educated (literacy)/access to information o To be able to share the fruits of her cultivation o To be able to determine how funds are spent o To be able to have the help of her husband in earning and cultivating
What makes me feel well in my heart? My goat. Every morning when I wake up the first thing that I
see is my goat, tied up to the tree. Then I smile. I bought that goat with my savings in the solidarity
group. Someone could come and kill that goat. Someone could steal her. But it would not matter. I
could get another goat, because I bought the goat myself, with my savings. And now I have the
power to solve my problems and take care of my daughter. I never have to be afraid anymore!
-Woman in Bujumbura Rurale
We used to suffer, because sometimes a woman would come every week to the solidarity group but
she would cry because she did not have her coin. So we decided we should talk to the man and to
dialogue with him. We joined with the men and encouraged them to organize themselves, to
dialogue with their families. This dialogue changes everything… now she can choose with her
husband how to spend the fruits of her labor, and she can save for school fees for the children. Even
he will come to work with her to accomplish the task…
-Woman in Gitega
52 Understanding psychosocial well-being among women in Burundi: A participatory study
2. Love and support from your family To have a husband with whom one can dialogue To be loved by your husband’s family To be loved Continued support and contact from your parents and family To have a loving husband To have a loving relationship with your children
It is not only important to be loved. It is important that you yourself should feel love.
-Women in Mutimbisi
Loving your children and having them love you is the best way.
-Women in Bubanza
To have love like this, it would be heaven of happiness.
-Ex-combatant woman in Bujumbura Rurale
Our daughter should love her husband and be loved by him. She will be loved also by his family. She
and her husband will solve their conflicts by discussion, by negotiation, so that there will not be
violence.
-Women in Gitega Round One
53 Understanding psychosocial well-being among women in Burundi: A participatory study
3. Love and support from outside of the family From friends o Be attended in childbirth o Visited in sickness o Be respected in the community o Be regarded as useful to others o To sing and to dance together2 o Have someone listen to your troubles
I was sick and the members of the association visited me.
It is important to be attended in childbirth, not only by your family but by your friends.
If you belong to an association you will not be alone; you will be attended in childbirth, and you will
be visited in sickness.
We listen to our members’ troubles and we try to find solutions for her.
Yes we sing and to dance together.
-Women in Gitera Round One
2 References to singing and dancing together refer to a specific tradition, akazehe, in which women who greet one another after a long time or a hardship, use song and dance to tell their story and give support to one another. See page 82 for further discussion. 54 Understanding psychosocial well-being among women in Burundi: A participatory study
As part of an organization that can bring about change o To have her children be part of an organization o Be able to save together o Be able to do advocacy together o Be able to share together
Now, because of our associations we know that girls should study: we pay their school fees. In the
past women were harassed if they were too ill to work… now we support one another….
-Women in Gitera Round One
To be well you must have good relations with others in your community, you must be seen as useful
to others and then they will respect you. Then you can change things together….
-Women in Matebuko Round One
4. Be educated Be educated herself Be able to educate her children Have access to information
If my daughter will be educated her life will be like a dream. It will be like the life of the women in
Europe. She will help others, she will care for others. She will be truly free. All will respect her….
-Women in Gitera
We have done a great deal without education. With education, with the quality and education, we
should bring light to the other parts of the world.
-Women in Bubanza
I have no education and still I was elected to a local office. Imagine what we could do if we had a bit
of education? This does not mean literacy class, although we want that. This means high quality
education that changes you into another person.
-Ex-combatants in Mutimbisi
55 Understanding psychosocial well-being among women in Burundi: A participatory study
5. Be healthy Her children should be healthy Have access to health care To be well in mind and body To be able to control the number of children she has Access to reproductive health information
6. Live in peace, safety and security, through dialogue and understanding In her home o To not be beaten or abused by her husband o To not need a husband or boyfriend, be able to leave if she is mistreated
We want to solve our problems now with dialogue, with discussion, so that we are not mistreated.
But if we are mistreated then we want to have the power to be alone.
-Women in Bujumbura Rurale
In her community o To be free of discrimination (widows, ethnic, disabled) o To “feel safe in my country and community” o To not fear for the future, especially the return of violence
Every human person should be able to walk without fear.
-Woman in Gitera Round One
56 Understanding psychosocial well-being among women in Burundi: A participatory study
7. Have a voice in non-economic issues Inside of the family o To be able to say what is in my mind at home o To be able to discuss without fear o To have my ideas respected by my husband
Outside of the family o To be able to speak and to be heard in the community o To be able to decide laws and influence the rights of my children o To be able to participate in elections o To be able to hold positions of leadership and run for public office
Our associations give us the right to vote and stand for office… they give us the power to insist on our
rights. We should all become parliamentarians.
-Women in Bubanza
8. Have moments of joy To be able to see my children healthy, to laugh with them and play To be able to laugh with my husband To have tea and time to sit and to drink it To participate in religious ceremonies and festivals To sing and to dance together with others
Seeing my children happy and able to play makes me smile. I can be happy when I am seen as useful
to others.
-Woman in Bujumbura Rurale
I was happy when I was able to come together with others and to sing and dance.
-Woman in Bubanza Round One
57 Understanding psychosocial well-being among women in Burundi: A participatory study
Psychosocial Well-Being as an Integrated Concept
When we heard the women’s voices, we heard how all their dreams of being well in their hearts are interrelated. They described political power, love and being loved, safety and security, access to resources, education, and solidarity as each necessary to the other, integral to the other and not easily pulled apart.
Figure 6: Constellation of Domains Comprising Psychosocial Well-being for all Groups
58 Understanding psychosocial well-being among women in Burundi: A participatory study
STUDY PROCEDURES: ROUND TWO
While Round One served as a pilot for the study as a whole, Round Two provided the opportunity to learn from experience and improve the quality of the investigation. CARE International in
Burundi appointed two experienced researchers to serve as CO-PI’s, and also engaged an outside interpreter. CARE’s partner organizations had a staff member on site with each focus group. The CO-PIs conducted the interviews in Kirundi, while the International PI took notes, which were reviewed during the nightly meetings.
Round Two combined the last steps of Stepwise Ethnographic Exploration with the introduction of the Participatory Ranking Method. In addition, the team added a variant of “negative case analysis”
(Padgett, 2004, p. 167) to increase rigor, by asking specific questions about information that did not appear in the first round. We specifically interviewed women who had served in the fighting forces since they did not speak during the first round, and the Burundi team was concerned that this population had been hidden and silenced in Burundi. Specific attention was also directed to the question of positive cultural traditions that supported women’s psychosocial well-being. The literature is divided on this subject, and all reference to traditions that appeared in the transcripts was negative.
We considered the possibility of an organizational bias, negatively affecting the reliability of our findings.
Therefore, we added a specific question in the second round to address the issue.
First we completed the Stepwise Ethnographic Exploration including a) qualitative concept validation of the domains above with the Burundi team; b) validation of the domains with focus group discussions and c) key informant Interviews. The Participatory Ranking Method was then added to further strengthen this process through active participation. These procedures were designed to further enhance the rigor of the study’s method in order to address the first two study questions, namely:
How do conflict-affected women in Burundi understand psychosocial well-being?
59 Understanding psychosocial well-being among women in Burundi: A participatory study
What are the conditions that these women believe are necessary to achieve psychosocial
well-being?
We added an additional question:
Are there any old Burundian traditions, that you learned from you grandparents, perhaps,
from the days of the kingdom, that can help a woman to survive and to be well? Can you
tell us what they are? Have you yourself used any of them?
Qualitative Concept Validation: Workshop with the Research Team and Institutional Collaborators
Comments on the domains. The coded findings were presented in a meeting to the complete research team including knowledgeable staff from CARE as well as the local partner organizations. The purpose was to obtain comments, feedback and revisions to the results of Round One. Corrections and changes were made on a slide projector; repetitions were removed from the original subcategories; and decisions were made as to where to place each subcategory. (See also Annex C for the domains and subcategories as presented in the field).
Workgroups on positive cultural traditions. The group was divided into three working groups to discuss and present ideas regarding cultural traditions that might specifically be used to support women’s psychosocial well-being. The names were given in Kirundi and then used to compare or attach to those cultural traditions that were mentioned by the women in the focus group discussions.
Qualitative Concept Validation: Focus Group Discussions for Round Two
The domains and subcategories above were presented to focus groups consisting of the same women who had participated in round one, plus additional women who had not participated. These women were selected from other NGOs in the region, and, in the case of the ex-combatants and urban young women’s group, Ishaka, an equal number of women who had not participated in the first round.
60 Understanding psychosocial well-being among women in Burundi: A participatory study
The purpose was to see whether the domains “held up” with women who had not participated in the process (see Annex D for location of the focus groups and the number of participants in each group).
The focus groups took 1.5 hours each. Each domain and subcategory was read and the participants were asked to add or subtract any domains or subcategories. The additions are presented in the results section.
Added domains and outliers: How these were noted in the field. Outliers in qualitative research are exceptions to emerging patterns (Barbour, 2001). In this study, the team defined outliers as those ideas that appear only once in only one focus group or region and were not repeated. These additions were presented to each group for ranking. The group had a choice: to rank separately or to include in one of the domains. Many groups ranked the “outliers” separately and found that they did not actually rank; that is, the women were not really interested enough to rank them at all. Most of the outliers were included within existing domains or sub-categories as modifiers. We then re-ranked with the outliers included within the sub-categories. These are noted specifically in the result. A future study may look more specifically at the outliers to see what more can be learned about the subject.
Participatory Ranking Method
Rationale for the method. The Participatory Ranking Method was used to support the concept validation process beyond the use of coding and focus group consensus validation. The ranking method ensured that each woman in the group would participate in some way. When the group members were asked to formally rank the domains, each group member was seen taking time, asking questions and being engaged in the inclusion or exclusion of categories and in the elements of each. This led to a review of whether low ranking domains should be included, and if so why. This also gave the opportunity to rank separately or to include within the domains any items that were added.
Implementation of the method. After each focus group reviewed the individual domain and subcategories, the group leaders held up an illustrative poster for each domain, and again repeated the
61 Understanding psychosocial well-being among women in Burundi: A participatory study subcategories that operationalized the domain. The participants were asked which they would choose if only one domain were possible and then to line up behind the poster that represented that domain. The domain with the most votes for number one was given the rank of 1. Then that poster was removed and the same procedure was followed until all were ranked. The participants were asked to choose the one that they would want if they had one additional domain and they were told that they could subtract any domain if they wished to do so.
Key Informant Interviews
The key informants from round two consisted of three experts on culture and traditions and one female ex-combatant from the government side. All were national figures interviewed in Bujumbura.
The purpose of the interviews was to provide an additional layer of validation for the domains that were established by the focus group, correlating them to cultural ideas of psychosocial well-being, especially to any positive traditions supporting the well-being of women. This was intended as a partial protection against the ideas being those of CARE or the NGO partners. The four key informants for round two were not presented with the domains that the women had developed, but rather were asked the open-ended questions, “What does it mean for a woman to be well psychologically and socially? Are there any positive Burundian traditions that help women to feel well in their hearts or contribute to their understanding of well-being?”
Qualitative analysis of the key informant interviews. The content of the key informant interviews was coded using Atlas-ti using the original domains established for the study. The content was then coded again for additional domains that were then added with quotations and supportive documentation created for those domains. The key informant who was an ex-combatant was asked about her role in the military and about making a space for women in the military. Her discussion was coded along with the results from the ex-combatant focus group.
62 Understanding psychosocial well-being among women in Burundi: A participatory study
Nightly group meetings (peer debriefing). Each evening following the focus group discussions and local key informant interviews the research team members met to discuss the day’s results and to consider any issues that might have arisen. The team members checked the ranking methods, compared translation notes and gathered the needed information from the days’ discussions for recording, which was completed by the International Principal Investigator (PI) overnight, for the team members to read and approve the next day.3
3 This process corresponds to “peer support/ debriefing,” a strategy for rigor utilized in qualitative research (Padgett, 2008, p. 189). 63 Understanding psychosocial well-being among women in Burundi: A participatory study
RESULTS FROM ROUND TWO
Results from the Qualitative Concept Validation Exercise
The focus group members were told that they were free to add or subtract from the domains that were listed, based on their view of what it would mean for their daughter to be truly well in her heart (see Annex C for the protocol). This inquiry did not result in the removal of any domains; however, there were three outliers that were added as new domains during the process.
New domains added from among outliers. The new domains were:
Travel, mentioned by Ishaka women in Bujumbura and ranked last in Bujumbura Rurale
and Bubanza; (These groups comprised a total of 112 women or 57 % of respondents).
International exchange should be possible, our daughter should go abroad from time to time, study,
learn, contribute to international decision making even in the United Nations and then return home.
We have heard about these things: you do them and our daughters shall do them too.
-Woman elected leader in Bubanza
Our daughter should get on an airplane and go anywhere she wants to at any time! She should have
every opportunity.
-Woman in Bujumbura Rurale
Praising God was mentioned only in Bubanza, where the women insisted that it be a
domain of its own. They ranked it as number 4. Bubanza focus groups comprised 47
women or 24% of the respondents.
64 Understanding psychosocial well-being among women in Burundi: A participatory study
Praising God gives us joy! It will give joy to our daughters who come after it. When we have nothing
else, still we can praise God.
-Woman in Mutimbisi
I have joy in my heart because it is Easter, and I remember the resurrection of Jesus. When I think
about the resurrection I feel great joy!
-Woman in Bubanza Round One
Gender Equality was also emphasized in Bubanza and then ranked as number 6 during
the participatory ranking exercise. The Bubanza focus groups were comprised of 47
women or 24% of the participants in focus group discussions.
Aren’t we really talking about gender equity? Shall we say that gender equality will give our daughter
Kumererwa-neza? Let us add that one!
-Woman Leader in Bubanza
New sub-categories: Operationalizing the domains. Many focus group participants added to the sub-categories operationalizing the existing domains.
Under Education
. Quality Education (raised in five focus groups, two in Gitega, the ex-combatant group,
and Bubanza. (These groups comprised 118 women or 60% of all respondents).
. Higher Education (same as above plus one more group in Gitega, These groups
comprised 145 women or 74% of the focus group participants).
Under Access to Resources
. Land ownership (raised in all 12 groups, made a specific point by 100% of the focus groups.)
65 Understanding psychosocial well-being among women in Burundi: A participatory study
Under Health
. Access to reproductive health information (raised in all 12 groups).
. Access to information on contraception. This was raised in two groups in Gitega, in Bubanza
and by the ex-combatant women (These groups comprised 118 participants or 60% of the
total number of respondents).
Results of Discussions with Women Associated with Fighting Forces
We went through many hardships in the military. We fought for democracy and for rights. We fought
so that there would be justice in the future. We were separated from our friends and family, we
fought some of us for many years… we had little education… some of us were not even literate, yet
we have done a great deal. If we could do this much with so little, imagine what will be possible in
the future! Imagine what we could have accomplished if we were all educated!
-Woman Ex-Combatant
We included women associated with the fighting forces among the key informants in the second round, and held one focus group discussion exclusively with ex-combatant women who were participants in a distinct women’s organization called Gridjambo, or “we have a voice.” According to the focus groups and key informants in this study, adult women associated with the fighting forces were largely volunteers, who joined to fight for a cause or to obtain educational benefits denied to them in civilian life. The research team coded the responses of key informants and members of the Gridjambo group together as one in order to protect respondent identities. The following categories describe the responses of these respondents. Due to the small sample and lack of literature specific to women associated with fighting forces in Burundi, a further study on this issue alone would be needed to generalize beyond the sample. Their responses to the domains of well-being were included in the
66 Understanding psychosocial well-being among women in Burundi: A participatory study results section from pages 53-55. Their responses to the participatory ranking exercise are included in the graph on page 73 and the individual graph on page 78.
Reasons for joining the fighting forces.
Government offered educational benefits to those who signed up. We girls were struggling to get our
education… why not sign up and get that benefit for ourselves…it was difficult, but we did it.
-Woman Ex-combatant integrated as an Officer
We wanted to fight for a cause, for justice, for a future for ourselves and our children; the children of
our collines were starving, uneducated.
-Woman Ex-combatant in Bujumbura Rurale
Too many of us were in exile… We wanted to push the international community to enforce the
Arusha accord or intervene to create a new one.
-Woman ex-combatant in Bujumbura Rurale
We wanted a voice for women of all the ethnic groups to be heard.
-Young woman ex-combatant in Bujumbura Rurale
Our children had gone and joined, saying that they needed to fight for the future, and so we went to
help them, first we provided food, but we were tormented… then at last we had to flee to join them.
-Older woman ex-combatant in Bujumbura Rurale
67
Understanding psychosocial well-being among women in Burundi: A participatory study
Special problems affecting women associated with fighting forces.
The world is not perfect: there was favoritism in the giving of packages and in the demobilization.
-Ex-combatant from Bujumbura Rurale
In the forces we were not provided education but rather only training to shoot, we should now be
entitled to free education - not literacy classes, we got those- quality education.
-Ex-combatant in Bujumbura Rurale
There is suspicion in the community; especially toward women whose children came by rape, who
are widows, and those who were abandoned. People believe we will make demands of them
because we are on our own with our children, and we have carried the gun.
-Ex-combatant in Bujumbura Rurale
We miss being together with friends. Many of us were abandoned by our babies’ fathers. Now we
are alone. We miss our school friends. We need groups to bring us together.
-Ex-combatant in Bujumbura Rurale
We were denied everything. We had to fight for everything. The men did not want to accept us. We
had to work hard for this.
-Ex-combatant reintegrated into the fighting forces.
68 Understanding psychosocial well-being among women in Burundi: A participatory study
Women associated with fighting forces’ perceptions of the effectiveness of their role.
We succeeded beyond our dreams! The international forces did get involved and get a real peace for
us!
-Younger woman ex-combatant
Now there are rights for people with all ethnicities. Some of us are elected leaders now!
-Ex-combatant in Bujumbura Rurale
We suffered a lot in the forces. But now, every woman or man in this country has the right to
education!
-Ex-combatant in Bujumbura Rurale
Do you see this small child? His father abandoned me and I despaired. But he is in class 2 now! He is
studying and that is my reward. I am happy every day.
-Ex-combatant with two children in Bujumbura Rurale
Women are being integrated in the armed forces, now there is no going back; we even have our own
uniforms!
-Ex-combatant integrated in government forces
69 Understanding psychosocial well-being among women in Burundi: A participatory study
Special skills women associated with the fighting forces bring to the community.
We are expert at negotiation (kuganira) because we were forced to live among very different people
and to manage somehow.
-Ex-combatant in Bujumbura Rurale
We know how to strategize, and how to endure… that was the only way to survive in the forces.
-Ex-combatant integrated as an officer
We know what it means to succeed in spite of odds… if you need it done, we can do it.
-Ex-combatant in Bujumbura Rurale
Summary: Women associated with fighting forces. The women who participated had a mixed view of their situation. They described hardships during the fighting, but retained a positive view of themselves as having succeeded in their aims. They emphasized a constellation of well-being that included the elements outlined by the women in the other groups.
Results from the Participatory Ranking Method (PRM)
Procedures used to organize the results of the participatory ranking exercise.
1. Construct a table consisting of all the domains that each focus group ranked during the second
visit.
2. Include the outliers in the table and as they appear within the subcategories of the domains,
and any new domains that were added.
3. Read through the rankings from each focus group and tally the number of times each theme
was ranked first, second, third, etc. (frequency). For example, eight focus groups ranked
education first, so education received eight tally marks in the "Frequency ranked at 1" column. 70 Understanding psychosocial well-being among women in Burundi: A participatory study
Similarly, 2 focus groups ranked education second, so two tally marks were placed in the
"Frequency ranked at 2" column. We continued in this fashion until all frequencies for each
theme were recorded.
4. Assign values to each of the rankings. So, tally marks in the first ranking were each assigned a
value of 1, tally marks in the second ranking were each assigned a value of 2, and tally marks in
the third ranking were each assigned a value of 3, and so on.
5. Sum values of each of the tallies for each theme and divide by the total number of tallies to
derive an average ranking value. After calculating the average ranking of each of the domains,
order them from lowest to highest (lower averages would signify a higher overall raking) to
create an average composite ranking (see the tables).
6. Construct tables that consist of all of the domains which each focus group ranked during the
second visit.
7. Next, review the rankings from each focus group. Tally the number of times each theme was
ranked first, second, third, etc.
8. Then, assign values to each of the rankings. So, tally marks in the first ranking were each
assigned a value of 1, tally marks in the second ranking were each assigned a value of 2, and
tally marks in the third ranking were each assigned a value of 3, and so on. Those that did not
rank were given a number equivalent to 1+ the highest number tallied.
9. Finally, add up and divide values of each of the tallies by the total number of tallies to derive an
average ranking value. After calculating the average ranking of each of the domains, order them
from lowest to highest (lower averages would signify a higher overall ranking) to create an
average composite.
71 Understanding psychosocial well-being among women in Burundi: A participatory study
Results of the Ranking Exercises
Figure 7. Consolidated Ranking of Domains of Well-being
1. Education (2.29)4 2. Peace, Safety and Security (through negotiation) (2.71) 3. Love and Support in the Family (3.71) 4. Independent Voice (3.86) 5. Access to resources (4.43) 6. Access to healthcare (4.71) 7. Belonging to an organization (5.14) 8. Moments of joy (7.86)
4 The numerical means in this graph and all of those on subsequent pages were derived by the procedures detailed on p. 72 above.
72 Understanding psychosocial well-being among women in Burundi: A participatory study
Figure 8. Ranking of Domains in Gitega
1. Love and Support tied with Peace, Safety and Security (negotiation) (1.66) 2. Education (3.66) 3. Access to Health Care (4.33) 4. Independent Voice (4.66) 5. Belonging to an Organization tied with Access to Resources (including Land) (5) 6. Moments of Joy (7.66)
This area was a rebel base during the conflict with many of the groups based in the hills firing on the area. This forced many people into internally displaced persons camps, where some are still living and going to cultivate their lands that are infertile and over farmed. Since 2004 CARE has been in the region, which now has many women decision leaders. The school and health committees of the collines are very strong. There is a lot of commerce and migration to the town.
We had focus groups in three collines: Matebuko, Gitera, and Bwoga. We had seen the women in Matebuko and Gitera in round one, Bwoga was a new group. Additional women were also present in Matebuko.
73 Understanding psychosocial well-being among women in Burundi: A participatory study
Figure 9. Ranking of Domains in Bujumbura Rurale
1. Quality Education (1) 2. Independent voice (3) 3. Peace, Safety and Security (through negotiation) tied with Access to Resources (3.5) 4. Access to healthcare (including family planning) tied with Belonging to an Organization (5) 5. Love and Support in the Family (5.5) 6. Moments of Joy (6.5) 7. Travel (9)
This area was often raided by government for hiding rebel fighters who since fled to the nearby Democratic Republic of the Congo (DRC).The area suffered a massacre in 2011 of the supporters of a former rebel force. No one talks about this at all.
This chart combines two focus groups, one of ex-combatants comprising 15 women, and one of women between 18 and 65, the majority widowed due to the violence and fighting. Both groups included some women who were interviewed twice and an equal number interviewed for the first time.
74 Understanding psychosocial well-being among women in Burundi: A participatory study
Figure 10. Ranking of Domains in Bubanza: Mpanda
1. Peace, Safety and Security (through negotiation) 2. Quality Education 3. Access to Healthcare 4. Independent Voice tied with Praising God 5. Love in the family 6. Gender Equality 7. Access to resources (including land ownership) 8. Belonging to an organization 9. Travel, for learning and exchange 10. Moments of joy
This area was hotly contested and subject to violence, which is still believed to be common, although difficult to verify. According to our key informants, there were “tit for tat” massacres in successive years noted for their extreme brutality. Strong international support for rebuilding was apparent in the town, which included a new Chinese-financed hospital. Many of the residents have returned from long years in exile and internally displaced persons camps. The local Administrator is a woman.
The groups were combined due to practical concerns related to timing for the meetings. The women who came to the meeting represented leadership of NGOs and solidarity groups from five collines in the surrounding area.
75 Understanding psychosocial well-being among women in Burundi: A participatory study
Special Populations: Bujumbura Mairie: Unmarried Mothers’ Group ISHAKA
Figure 11. Ishaka: Young unmarried mothers’ group: Bujumbura
1. Education 2. Access to resources 3. Belonging to an organization for support and for change 4. Independent voice 5. Love and support in the family 6. Access to healthcare 7. Travel to learn and to teach and to do business 8. Moments of joy
Forced to leave their villages, the participants in this group had fled to Bujumbura Mairie where they live in marginal communities. Their responses should be seen as situation rather than locality based.
76 Understanding psychosocial well-being among women in Burundi: A participatory study
Special Populations: Women Associated with Fighting Forces
Figure 12. Ex-combatants Group: Gridjambo
1. Quality Education for All tied with Independent Voice 2. Belonging to an organization that includes women from all ethnicities together 3. Access to healthcare 4. Access to resources 5. Peace, safety and security 6. Love in the family 7. Moments of joy
77 Understanding psychosocial well-being among women in Burundi: A participatory study
RESULTS OF THE INQUIRY ON TRADITIONS THAT SUPPORT WOMEN’S WELL-BEING
This small inquiry was undertaken in response to the paucity of information in the literature and the lack of information gathered in the first round, leading to questions raised by both key informants, partner organizations, and CARE International in Burundi: are there any Burundian cultural traditions that women perceive as supporting their psychological and social well-being. The literature on women is replete with references to harmful traditional practices (ACAT& OMCT, 2008; deBoodt
2009; Ntacobakinvuna & Iredale, 2009; Rackley, 2005; Somers, 2006; Stummer, 2009; Uvin, 2009).
However, Daley (2007) indicates that positive traditions existed prior to the colonial period, but were obscured by the colonizers. Further, the strong role played by women in the development of the peace- building process indicates that strengths were there to be understood and explored (Falch, 2010;
Ntahobari & Ndayiziga, 2003). To explore this further, we added key informants who were experts in issues related to gender and the traditions of Burundi. We also added one related question to all focus groups and key informants in the second round:
Are there any old Burundian traditions, that you learned from your grandparents, perhaps, from
the days of the kingdom, that can help a woman to survive and to be well, psychologically and
socially?
Can you describe them?
We then grouped and coded the information in order to have a beginning picture of the most salient areas in women’s current lives and locate them in historical context.
These are complex issues that would require further study in their own right. However, they do help to create a more balanced picture of Burundian traditions than that which was available in the literature, and begin to connect current thinking to traditional practice.
78 Understanding psychosocial well-being among women in Burundi: A participatory study
Summary of Positive Traditions Identified by Focus Groups and Key Informants
Women were able to identify clearly the positive traditions that supported them in community life. They involved psychological support and friendship, material support, and support for their lives as wives and mothers. These traditions are listed below in their historical context.
From the spiritual traditions of the monarchy (from focus groups in Gitega and the key informants).
Cubandwa refers to the traditional spiritual culture of Burundi. It reveres the ancestral spirits and ascribes a spiritual life to living beings, animals and inanimate objects as they are imbued with the ancestral spirits. Kiranda refers to the spiritual mediator between God and the earth, not a visible human person but a spiritual entity. Kiryenda is the drum that is the symbolic repository of the power of the kingdom.
In the Cubandwa tradition, women held power through their spiritual relationship to the
Kiranda and Kiryenda as follows:
Mukakiranda
o The Mukakiranda is married to Kiranda. In that role she mediates with the world of the
ancestral spirits.
o Her presence at court invests the Mwana (king) with his power.
o Some elder women carry this power today and can mediate troubles such as infertility
(mentioned in two focus groups).
Mukakiryenda:
o She is the wife of the drum that symbolically holds the power of the kingdom.
o She is required for all important court rituals and procedures.
o The last of these women died in the 1970s.
79 Understanding psychosocial well-being among women in Burundi: A participatory study
From the political traditions of the monarchy (from the key informant interviews).
Unutumbuzi (Umugabekozi) refers to the mother of the crown prince. The mother of the crown prince frequently became regent on the death of the king, and had great influence at court. She could also rule if the king was away at war or for other business. This set the stage for acknowledgement of the role of exceptional women in political life. There were several well-known Unutumbuzi in Burundi’s history, among the most recent, Ririkumutima, who was said to have played a critical part in conflict resolution during the colonial period.
Community traditions (from key informant interviews, literature, and focus groups).
Inararibonye is the term for wise and senior female community leaders, tasked with solving problems of women within the society. (These were not mentioned by the women in the focus groups, although they were mentioned by the key informants and the literature. There have been calls for the restoration of this institution.)
In addition there were traditions without ceremonial names that were described as important to women and girls, and which continued through the colonial period:
Preparation for marriage: your father’s sisters (aunties) and your father’s mother prepare you
for marriage, both sexually and also in terms of behavior
Evening fireside education for children, directed by the mother, attended by the whole family,
leads to an honored place for women in the role of education and a reverence for the educated
woman
80 Understanding psychosocial well-being among women in Burundi: A participatory study
Alternative medicine and traditional healing for women’s psychological well-being (from the key informants).
Sage femme: traditional birth attendants who are able to solve many problems of women, through
herbal medicines and other means. These women had a significant role in supporting mothers’
aspirations at court. Their counseling role still needs to be studied.
Upfumu: Their role has yet to be understood and studied. Some men abuse this, but some women
may play important roles in mental-health treatment. Further study is being undertaken at the
University of Burundi, CRID.
Societal Traditions Continuing to the Present. These traditions were highlighted by women in the focus groups and re-affirmed by key informants:
Friendship.
Akazehe: Singing together when friends meet; composed as ballads, the songs are composed
describe current worries and troubles
Gathering of firewood, water or grass is a time for women to meet together and share secrets,
worries, troubles and joys
Childbirth.
Ibiriyazagu: Supporting the mother at the birth of the child, both families bring food, water and
firewood.
Allowing the mother to rest after the birth of the child
In celebrating the birth of the first child, the mother is treated like a queen.
Quarama: Celebrations and supports for the birth of twins.
81 Understanding psychosocial well-being among women in Burundi: A participatory study
Marriage and marital harmony.
Kurinda umukogba umwuho advice to the husband to treat the wife well
Gutanga igiseke portion of land for the bride
Gukwa bridewealth, particularly the gift of a goat or cattle, as a positive expression of the value
of the bride.
Kugemurira umukogba: Greeting the bride to make her welcome in her husband’s family
“Aunties” will come and train you, teach you about marriage, also sex and human relations
If a woman is mistreated by her husband, she can stay with her family who will care for her until
he is repentant and they are assured that she will be safe.
Death/ sickness.
Cugandaza or Kugandor: Support at the time of death of a child or a husband. Both families
come with baskets of firewood and food so that the young women need not gather nor cook
Ibiryagaza: The mourning period is one of support for the bereaved in which both the families
come together
Access to resources.
Gutanga igiseke portion of land for the bride.
Support for times of trouble.
Inkiri or Iciveri refers to the practice of community members joining together to cultivate the
land in order to support the vulnerable
Family of origin giving land to a woman who is divorced.
82 Understanding psychosocial well-being among women in Burundi: A participatory study
Ceremony to treat infertility is still practiced in the countryside related to Cubandwa. This
ceremony should be officiated by the Mukakiranda and involves both families working for the
couple, along with symbolic items and use of the family
Positive Cultural Traditions in Community Context
The smallest administrative unit in Burundi is called the colline (or hillside). It consists of families who may be living in separate compounds. The basic family unit in the compound is the husband, wife and children, a nuclear family. Land is inherited by male children in a system of primogeniture. Key features of the Burundian community are the private (as opposed to communal) ownership of land, and the hierarchical structure of the community, as opposed to a collective one. Women own no property, but work the private land of their parents and then of their husbands. The two in-law families come together to support their children’s households when they are needed. The young bride earns respect of her husband’s family through her work and her behavior. In general a colline may be populated by an extended family or two living in 5 or 10 homesteads of nuclear families visited by the elders (Uvin, 2009;
Watt, 2008; Émile Mworoha, personal communication, 23 August, 2012). If she is able to succeed in winning the approval of her in-laws and bringing the two families together to support her nuclear family she must:
Produce many children
Have a successful farm
Have a clean home
Be universally liked through excellent diplomacy
Be seen as the peacemaker between different points of view among the family
Educate her children well at home, and provide quality formal education for them.
83 Understanding psychosocial well-being among women in Burundi: A participatory study
According to the key informants, this brings her to the following knowledge that will influence her view of well-being:
Negotiation and dialogue are the most critical capacities for survival as they are the link
between the two families who can support her marriage
She will be judged by the quality of her work in the home and with the family, which supports
self-efficacy
Hard work and self-sacrifice lead to a better future for her and her children
The highest status activity she can achieve is providing or arranging quality education for her
children
Women as Negotiators and Educators
Two concepts that correlated to the indicators of well-being established by the women in focus groups were dialogue (kuganira) and education. They are discussed below.
Kuganira, to dialogue.
You are not secure in your community if you have won rights with force. People may come in the
night to kill you, or to drive you out. If you are in dialogue with the neighbors, then you will learn
about their concerns and you will have the means to reach an understanding in time of trouble.
-Formerly displaced widow in Gitera
Kuganira, dialogue, is an art that requires knowing what each person wants and being able to use that connection to keep both parties talking and arrive at a conclusion. The important thing however, is not that a conflict be well mediated, although that is the bi-product, but rather that a process is developed by which problems are solved by discussion.
84 Understanding psychosocial well-being among women in Burundi: A participatory study
That process involves being able to understand and empathize with the position of the other, even when it is difficult. In a hierarchical society in which the majority of women had little power and no possessions outside of the marriage, this was the means by which women could manage to gain love, acceptance, protection and care from her husband, his family, the community and the power structure.
The degree to which a woman uses kuganira is the degree to which she will have a good life now and in the future.
The word Kuganira was used all 12 focus groups, that is, all of the focus groups in each round in each location. The word was used 10 times in each of three domains:
1. Have control over the resources that she needs to have the basic necessities of life for herself
and her children
My husband and I resolve our conflicts by means of dialogue, discussion. When I want to save money
for something, I ask him to sit down and I tell him about it and get his inputs. Now we discuss
everything.
-Woman whose husband is part of the abatangamuco movement
2. Love and support in the family
In our family even the children dialogue. We all sit together and talk about our problems and even
our dreams. We dialogue about what we shall tackle, who shall tackle it and how. We are all at the
fireside at night and it is a very warm relationship.
When things are well at home we can even dialogue about sex…
-Women in Matebuko
The children do not cry and fear their father… they run to him with embraces…
-Woman in Gitera
85 Understanding psychosocial well-being among women in Burundi: A participatory study
3. Peace and Security
The women divided this category between the situation inside, and outside of their homes, in their community and their country.
Inside the family. Abatangamuco or “bringers of light when there is darkness” is a movement of men who have renounced violence in their homes and make a commitment to dialogue in the family as a way of resolving problems. To be admitted the wife must agree that the man is adhering to the principles, and in fact the couple participate in the program together. Abatangamuco flourishes in
Burundi based on the principle of kuganira. Husbands and wives are expected to practice “kuganira” to solve their own problems. Women discussed the fact that they also taught kuganira to their children.
A woman’s happiness depends on her ability to get the two families to cooperate, hers and her
husband’s so that she will be supported in her difficulties. For that she must learn to dialogue with
everyone, to engage them in listening and making decisions together.
-Key informant Bujumbura
My husband does not beat me or steal the money for the cash box… we take the time for dialogue to
resolve these issues.
-Woman in Giheta
86 Understanding psychosocial well-being among women in Burundi: A participatory study
Outside the family.
When we returned from the bush people were afraid of us; they thought that we would demand that
they share with us, and perhaps force them because we had learned to take up arms. But instead, we
began to dialogue with the people in the community, ask about their experiences and sympathize
with them. Now we are quite accepted and I have even been elected to be a local leader...
-Woman ex-combatant in Mutimbisi
In 1986 when we started Dushirihamwe, it was clear that the family was being destroyed by the war
by the violence, and there had to be a way to address it. We women had experience in dialogue, in
taking the space to talk things out. So we went very far with this dialogue, even to the United Nations
to persuade others that there was some help for us.
-Leader of Dushirahamwe, a national women’s peace organization
Dushirihamwe, or Let us Reconcile, is a women’s peace building organization, comprising women from all three “ethnic” groups, credited with organizing the first effective international campaigns for peace in Burundi (Falch, 2010). Among the testimonies to the power of kuganira among women is the capacity of Dushirahamwe to include women from a range of political parties, poor, rural, urban, internally displaced people (IDP) and refugee women and uneducated and educated women into one umbrella organization that was able to dialogue together to agree on platform and create a space to begin the discussion of peace.
87 Understanding psychosocial well-being among women in Burundi: A participatory study
Women as educators.
“It was important for women to enter the government army because it was a means of free
education. Women were leaving school for lack of support, and if they could be allowed to become
army officers this would be a way forward for them. For that reason we did everything possible to
make sure that they persevered and were incorporated into the armed forces.”
-Woman Police Chief
“If my daughter will be educated, I shall go in the morning to visit her house and I shall sweep for her.
Then I shall wait at home for her to return and we shall drink tea. She will teach and help others in
the neighborhood where all will respect her. Even her children shall be educated and go to very fine
schools.”
-Woman from Ishaka
Education appeared as a distinct entity that was a necessary component of well-being in all twelve focus groups in both rounds of the study. It ranked highest overall among the domains and was also emphasized in the discussions. However, its importance was understood more completely in light of the positive traditions study that placed women’s role as family educator in the spotlight. This is not a role much discussed in the literature, except to be listed among the responsibilities of women (Daley,
2007; Ntahobari & Ndayiziga 2003; Ntahombaye and Nduwayo, 2007; Watt, 2008). Therefore, we are amplifying it here to emphasize its importance beyond its practical implications.
During the colonial period, formal education was forbidden bahutu and education for batutsi was strictly limited by the Belgian authorities (Watt, 2008). Those who managed to leave the country and obtain education returned with a changed worldview and the capacity to transcend the rigid social
88 Understanding psychosocial well-being among women in Burundi: A participatory study system which characterized the colonial period. The formally educated person served as the interlocutor between the past and the outside world (Watt, 2008). On the other hand, non-formal education and traditional teachings was the province of the mother at the fireside. This education was carried out through stories, proverbs and parables, and included aspects of practical knowledge of mathematical values as well agricultural methods along with traditions and moral beliefs. The quality of this education was in the hands of the mother, and one of the ways that a young woman could obtain both praise and recognition from her in-laws and her community.
A woman must have access to all levels of education, so that she makes good decisions for herself
and her family, so that she has influence beyond the borders of her home and her community.
-Woman community leader in Mpanda
The role of the woman in the fireplace education cannot be over-emphasized. This is the only
education that our children received and if the children managed well it was entirely to the credit of
the woman for the quality of the education that she provided.
-Key Informant in Bujumbura
I volunteered to join the movement because I wanted to fight for justice. But the father of my child
denied me, and then I was demobilized with a child and no one to support me. But now my son, that
child is in primary school. He will be educated, so I am now well…
-Woman from Gridjambo
89 Understanding psychosocial well-being among women in Burundi: A participatory study
LIMITATIONS OF THE STUDY
Sampling Limitations
The study is based on qualitative data collection through focus group discussions, key informant interviews, free listing and participatory ranking, supported by an extensive review of the literature. By their very nature, qualitative, phenomenological studies such as this are limited by the statistically small number of participants, the purposive sampling and the specificity of the responses. Therefore, the results are not generalizable beyond the specific region in which the study is conducted.
Due to the need to provide for the protection of the subjects, all of the women who were interviewed were members of some form of solidarity group. The groups were run by local organizations most of whom were also partners of CARE. That is because in an area of great poverty and psychosocial need such as this one, it was important not to raise expectations among women who could not be provided with protection and care should any need be expressed, whether a result of the study, or a previous need that was yet uncovered. All of the women who participated had access to ongoing service.
The study was subject to numerous logistical challenges based on the conditions at the time.
There was a long gap between the pilot study and the second round. There were also limitations on the days and hours that the team could go to the field. That meant that the focus group discussions in
Bubanza were consolidated into one big group that ranked together. It also meant that when that group raised the possibility of additional domains, we could not continue holding focus groups in other locations until saturation was reached. Also, there was no time for investigations in the north of the country where a different perspective might have been found.
90 Understanding psychosocial well-being among women in Burundi: A participatory study
Limitations of Language and Translation
The Burundian PIs are native speakers of both French and Kirundi, with many years of solid research experience. They conducted the groups in the second round and the information was translated by an experienced professional translator. Every effort was taken to ensure fidelity and consistency of translation, through daily team meetings, discussions, concept clarification and back- translation. However, the Atlas-ti, SPSS and hand coding were done by English speakers so that all content needed translation. Therefore, the coding by English speakers may have left some open questions about the meaning of specific words and constructs. The team used its expertise to compensate for this. Efforts included using a call-and-response method of translation and clarification during the concept clarification and concept validation phases. As back-up, the Burundi team approved all interpretations made by the English-speaking analysis team on a line-by-line basis.
Limitations of Scope
Because the subject of this study was the definition of the factors comprising psychosocial well- being in cultural context, issues regarding the cultural traditions of Burundi were raised in the course of the study. These issues were hidden from view and complicated by the combined effects of colonialism and the post-colonial history of conflict. Our beginning -level questions indicate a need for a contemporary and advanced study of the relationship between Burundian traditions and the well-being of women. In particular, the role of the sage femmes in the lives of women’s well-being and the use of traditional healers in mental health might be explored. Partnership with TPO and the University of
Burundi’s Center for Research in Enculturation and Development (CRID) could produce a great deal of light on this subject and help to enrich the understanding of well-being in cultural context that this study has begun. Similarly, there were only a small number of ex-combatant women and urban single women, who were displaced following the conflict. These groups would warrant a more complete study of their circumstances and views of well-being.
91 Understanding psychosocial well-being among women in Burundi: A participatory study
DISCUSSION: ORGANIZING THEMES
The purpose of this study was to learn from conflict-affected women in Burundi how they understand psychosocial well-being in order to operationalize the concept, develop indicators against which to measure program success, and to elaborate a replicable method for use as part of the design, monitoring, and evaluation of future psychosocial programs. In order to ensure/safeguard the cultural construction of the domains, we did not impose any theoretical framework on what we learned, but employed Stepwise Ethnographic Exploration to establish the indicators from the ground up, and established domains of inquiry through open coding. However, with results analyzed and pending the development of indicators for practical use, it is important to discuss the meaning of what we have learned in the context of prevalent theoretical frames in the literature on psychosocial well-being. This section discusses the results in the light of three of them; namely the ecological frame of the
Psychosocial Working Group; the resilience frame of Hobfoll and colleagues’ five essential elements for successful psychosocial programs following mass trauma; and Amartya Sen’s capabilities framework for understanding subjective well-being.
The Psychosocial Working Group
The psychosocial working group, a partnership between academics and international NGOs who developed programs to support the psychosocial well-being of children in adversity, developed three basic domains as most useful for understanding psychosocial well-being for children in the context of their families and communities. These domains were: skills and knowledge, emotional well-being, and social well-being. These were developed in a framework reflecting three inter-related issues; human capacity, social ecology and culture and values.
In order to organize our thinking about the results of this study, it is possible to group the domains that the women provided under the headings provided by the Psychosocial Working Group. 92 Understanding psychosocial well-being among women in Burundi: A participatory study
1. Skills and knowledge To be educated To be able to provide my children with high quality education To be able to access to higher education To have access to information To know how to dialogue To have a marketable skill To have own incomes To be able to share the fruits of her cultivation To be able to determine how funds are spent To be able to have the help of her husband in earning and cultivating To know about how to space her children and control the total number she will conceive
2. Emotional Well-being Love and support from your family o To have a husband with whom one can dialogue o To be loved by your husband’s family o To be loved o Continued support and contact from your parents and family o To have children a loving relationship with the children o To have children who are well Love and support from outside of the family From friends o Be attended in childbirth o Visited in sickness o To sing, to dance and together o Have a someone to listen to troubles Have moments of joy o To be able to see my children healthy, to laugh with them and play o To be able to laugh with husband o To have tea and time to sit and to drink it o To participate in religious ceremonies and festivals o To sing and to dance together with others (Akazehe)
Be healthy o To be well in mind and body
3. Social Well-being Have a voice in non-economic issues Inside of the family o To be able to say what is in my mind at home Outside of the family o To be able to speak and to be heard in the community o To be able to decide laws and influence the rights of my children
93 Understanding psychosocial well-being among women in Burundi: A participatory study
o To be able to participate in elections o To be able to hold positions of leadership and run for public office Have control over the resources that she needs to have the basic necessities of life for herself and her children o If her daughter is not married, then through the capacity to earn through education, a job, training, commerce or the ability to save with an organization o To own her own land, to own the land that she cultivates As part of an organization that can bring about change o To have her children be part of an organization o Be able to save together o Be able to do advocacy together o Be able to share together Be healthy o Her children should be healthy o Have access to health care o To be well in mind and body
This organization of domains and subcategories indicates that they can fall within the three general categories developed by the Psychosocial Working Group. However, the division does not give us a simple way to take into account the definition of a good life that takes into account all of what a person is or might be in the future.
94 Understanding psychosocial well-being among women in Burundi: A participatory study
Figure 13. Domains of Well-being in the Context of Psychosocial Working Group
Amartya Sen and the Capabilities Approach
Amartya Sen’s view of what economists call “subjective well-being” is defined as “living a good life” (Anand, et al, 2005). Sen’s capabilities approach requires that well-being be described in terms of
“what human beings are able to do or be,” not only in the present but in their view of future possibilities and aspirations (Anand et al., 2005). This approach is always context dependent, although Sen himself
(1985, 1999) did emphasize the importance of both agency and freedom of action as key parts of the
95 Understanding psychosocial well-being among women in Burundi: A participatory study definition. This concept resonates with what we heard from the women in Burundi. This approach is differentiated from the idea (used in Bhutan) that subjective well-being is the same as happiness, which
Sen describes as fleeting; unlike subjective well-being which he describes as long lasting, stretching toward the future.
1) Capabilities Kuganira, that is, to be able to negotiate, with family and in community To be able to educate oneself and one’s children To have the capacities necessary to earn what one needs
2) Agency To be able to access material resources To be able to access information on family planning To be able to access information on all subjects To have a voice in the home, the family and the community
3) Living a (self-defined) “good life “now and in the future To live in safety and security in the home and community A loving relationship with family To have friends who care To have moments of joy To have hope for the future for myself and my children To be able to have healthy mind and body To resolve problems at home and the community through the use of kuganira To sing and dance together with friends (Akazehe) To have tea and time to drink it
This version does not explicitly account for the connection between the psychological and the social, making it useful to look at the connection to Hobfoll and colleagues’ empirical view.
96 Understanding psychosocial well-being among women in Burundi: A participatory study
Figure 14. Domains of Well-being in the Context of Sen’s Capabilities Approach
Hobfoll and Colleagues’ Five Essential Elements for Psychosocial Support Programs
Hobfoll, et al. (2007) list the following five essential elements that should be provided by psychosocial programs to support survivors of “mass trauma,” such as the kind of armed conflict and mass violence that occurred in Burundi. Unlike the Psychosocial Working Group, this schema is designed to look at the situation of adults. The elements that support well-being, according to this study are: a) sense of safety, b) calming; c) sense of self and community efficacy; d) connectedness; e) hope. 97 Understanding psychosocial well-being among women in Burundi: A participatory study
The domains and sub-categories actually fit neatly into these categories, and they help us to understand the psychological implications of social experiences.
The issue of safety was one that was often discussed and came up in two of the domains, one directly related to safety in the home and community, the other in regard to access to needed resources. Calming was related to the sense of safety and security.
1) Safety, security, calming
Live in safety and security though dialogue and understanding In her home . To not be beaten or abused by her husband, . To not need a husband or boyfriend, be able to leave if she is mistreated In her community . To be free of discrimination (widows, ethnic, disabled) . To “feel safe in my country and community” . To not fear for the future, especially the return of violence . To know one is safe from a return of conflict or persecution
Have control over the resources that she needs to have the basic necessities of life for herself and her children . To own her own land, to own the land that she cultivates . If she is married through the ability to discuss, dialogue and influence the decisions of her husband To have own incomes To be educated (literacy)/access to information To be able to share the fruits of her cultivation To be able to determine how funds are spent To be able to have the help of her husband in earning and cultivating Be healthy . Her children should be healthy . Have access to health care . To be well in mind and body . To be able to control the number of children she has . Access to reproductive health information
98 Understanding psychosocial well-being among women in Burundi: A participatory study
2) Self and community efficacy
Have a voice in non-economic issues a) Inside of the family . To be able to say what is in my mind at home . To be able to discuss without fear . To have my ideas respected by my husband b) Outside of the family . To be able to speak and to be heard in the community . To be able to decide laws and influence the rights of my children . To be able to participate in elections . To be able to hold positions of leadership and run for public office . Have access to information Domains that fell into this category while belonging to others as well . The capacities to access and allocate resources . To have the knowledge skills and education . To be a part of an organization that can bring about change
3) Human Connectedness
Love and support from your family . To have a husband with whom one can dialogue . To be loved by your husband’s family . To be loved . Continued support and contact from your parents and family . To have children and a loving relationship with them . To have children who are well Love and support from outside of the family . Be attended in childbirth . Visited in sickness . Be respected in the community Be regarded as useful to others . To sing, to dance and together (Akazehe) . Have a someone to listen to troubles
4) Hope
Education . Be educated herself . Be able to educate her children . High quality education . Access to higher education To be part of an organization that can bring about change . To have her children be part of an organization . Be able to save together . Be able to do advocacy together . Be able to share together
99 Understanding psychosocial well-being among women in Burundi: A participatory study
Have moments of joy . To be able to see my children healthy, to laugh with them and play . To be able to laugh with husband . To have tea and time to sit and to drink it . To participate in religious ceremonies and festivals . To sing and to dance together with others (Akazehe)
In reviewing the ways in which the women in the study operationalized the indicators of kumererwa-neza we can see that the domains and subcategories align with the three theoretical approaches. However, in all of the theories, as in the women’s own description, kumererwa-neza is a constellation of factors, each enabling the other and each imbued with psychic effects.
Figure 15. Domains of Well-being in the Context of Hobfoll et.al’s Five Essential Elements
100 Understanding psychosocial well-being among women in Burundi: A participatory study
ESTABLISHING A BASELINE FOR PSYCHOSOCIAL WELL-BEING: UTILIZING WHAT WE LEARNED FROM THE STUDY
This section is designed to answer the third main study question, namely:
What questions could be added to future program assessments and evaluations that would help
evaluators to know if the conflict-affected women experienced psychosocial programs to be
effective?
Our first goal for this study was to understand the precise meaning of “psychosocial well-being” in the context of Burundi. These meanings have been detailed in the results sections of this study. In this section we turn our attention to the next two goals of the study:
Based on our understanding, to develop culture-sensitive indicators for use in measuring the
concept of psychosocial well-being for women in the defined areas
To contribute to the development of a replicable, rapid and practical method to develop
indicators for psychosocial well-being to be utilized in the design monitoring and evaluation of
future programs for conflict –affected adult women.
Each of these requirements will be addressed in turn.
Sample Questions for the Implementation of a Baseline Study on Psychosocial Well-being among
Conflict Affected Women in Burundi
To obtain the sample questions we have applied the domains elaborated by the women to the essential elements for the survival of mass trauma as explained by the women themselves, as compared to the essential elements established by Hobfoll et al (2007). We then applied Sen’s capabilities approach as it also reflected what the women said, namely “all that one is capable of being and doing now and in the future” (Anand, Hunter & Smith, 2005). We then created questions that can be added to
101 Understanding psychosocial well-being among women in Burundi: A participatory study a baseline study along with the indicators CARE has developed for empowerment and economic well- being.5
The questions should be answered using a likert scale in which 0= not applicable. 1= not at all, 2
= some of the time 3=most of the time 4 =all of the time. The not-applicable answer should be used for questions that refer to husbands when women are widows, to children for women without children, etc.
Freedom from Anxiety, Worry and Fear
1. Peace and security, in my home, in my community and my country, based on kuganira, . Do you feel safe in your home? . Do you feel safe in your community? . Do you feel safe in your country? . Do you feel accepted by others, as part of the community? . Do you suffer from violence? At home? In your community? . Are you excluded? When you are excluded, do you feel that there are remedies that you can use?
2. Access the resources needed to be able to provide for myself and my children . Do you have a reliable means to feed your family? . Can you negotiate about the use of the crops that you cultivate or your savings? . Do you have a way to get financial help if you need it? . Do you have a means to earn money? Do you have control over the money that you earn? . Do you have a voice in how resources are distributed in your household? . If you cultivate, do you own the land that you cultivate? . If you do business do you own or control the essential resources that you need to do that business . Do you have a skill, knowledge or education that allows you to earn? Can you get education or training to obtain this ability?
3. Access to health care . Are you able to get care if you are sick? . Are you able to get health care for your children? . Do you have the opportunity to sleep when you are tired? . Are you able to eat enough food? Nutritious food?
5 This set of questions is an heuristic device, aimed at facilitating the process of evaluating the effectiveness of the psychosocial aspects of existing women’s empowerment programs in the specific area where this study was carried out. A questionnaire such as this one only becomes an actual instrument if it is pilot tested and validated according to international standards. Instead we recommend using this as a guide and working with the women themselves in each psychosocial program to establish the indicators of psychosocial well-being and integrating them into project design monitoring and evaluation schemes. This concept is elaborated in the final section. 102 Understanding psychosocial well-being among women in Burundi: A participatory study
. Do you have the opportunity to rest? . Do you have access to prenatal care? . Do you have access to information about when to have children?
Sustaining Human Connections
1. Love within my family from and for my husband, children, extended family and in-laws . Are you able to dialogue with your husband? . Are you able to dialogue with your family members? . Are you visited to your family of origin? . Are you able to dialogue with your in-laws?
2. Friendship and support in the community . Are you attended in childbirth? . Visited in sickness? . Invited to celebrations? . Do you have at least one person with whom you can talk when you are worried? . Can you share your worries and fears with at least one other person? . Can you share your joys with at least one person? . Do you have occasion to participate in Akazehe?
3. Membership in women’s organization . Are you a member of an organization? . How often do you go to meetings? . Do you share your problems and joys with members of the association?
Self and Community Efficacy
1. Voice in the family . Are you able to speak your mind at home? . Does your husband listen to what you say? . Does your extended family hear what you say? . Can you have a voice in the family decisions affecting you and your family?
2. Voice in the community . Are you able to speak in community meetings? . Do you vote in elections? . Do you have a means to propose changes to laws . Have you stood for election?
Hope for the Future
1. Ability to educate myself and my children . Can you pay the children’s school fees? . Are you able to get access to information? . Do you envision a positive future for all of your children? . Are you able to get access to skills training? . Do you have the skills that you need to negotiate for what you want? 103 Understanding psychosocial well-being among women in Burundi: A participatory study
2. Ability to have joy in living . Are you able to sing and dance together with others (Akazehe) . Do you participate in community and religious festivals? . Do you have time to sit and laugh with your husband, children, mother, friends? . Do you have tea and time to drink it?
3. Children’s future life . Are your children able to dialogue with others? . Are you able to educate your children? . Can you obtain higher education for your children? . Are there organizations that your children can join when they are old enough?
Replication of the Methodology for Future Use through Participatory Monitoring and Evaluation
This study has shown that poor women in Burundi can define the indicators of their own psychosocial well-being effectively and elaborate the domains and subcategories that comprise this concept through participatory processes, just as they have elaborated indicators for empowerment.
Using this study for replicable design monitoring and evaluation. To develop a baseline for future programs in other areas, one can easily follow the study procedures in this study, during the baseline assessment process. Using the language and major domains established by the women (i.e. freedom from worry, anxiety and fear, human connections, hope for the future and moments of joy), one can ask the women to define indicators in each area and then to rank them. They could then tick off where they were in achieving these results on a chart.
The women would then be asked to elaborate actions to take in the group that would promote or improve each domain and subcategory. The women could then be asked on a regular basis for their report on improvement. The chart could be marked off as progress is made by the group members, or the women could create their own questionnaire, like the one above, that pertains to women in their regional solidarity groups. This could facilitate especially sensitive measures for single women, ex- combatants, and other marginalized groups. A modified version of this methodology, known as the
SEE_PET for Women is available separately as an individual document, for use in future assessments.
104 Understanding psychosocial well-being among women in Burundi: A participatory study
CONCLUSION
The hypothesis of this study, namely that conflict-affected women are able to utilize participatory methodologies to develop an operational definition of psychosocial well-being in cultural context, as well as to elaborate the indicators needed to measure it, was demonstrated to be correct.
The women participated in the process and were able to define psychosocial well-being, for themselves and for their daughters. They were able to elaborate both operational definitions and the indicators that could be used to create a means for measurement.
Further the first four study objectives were met as follows:
The study learned from the conflict-affected women of three provinces of Burundi how they
describe psychosocial well-being, and the factors necessary to attain it.
This learning contributes to the development of an operational definition of psychosocial well-
being among conflict-affected women in Burundi.
The study established culturally sensitive indicators of psychosocial well-being that can be used
in the design, monitoring and evaluation of psychosocial programs in the specific region.
The study elaborated a practical, reliable and valid method for developing culture-sensitive
indicators of psychosocial well-being that can be replicated in any future exercise to design,
monitor and evaluate programs for women’s psychosocial well-being.
With the publication of this study, the perceptions of psychosocial well-being will be placed in the context of the literature on conflict-affected women in Burundi. It will represent a considerable advance as the literature on Burundi to date has little to say about aspirations of Burundi’s women.
It is hoped that this evolving and growing literature will be part of the evolving and growing movement for greater human capacity and well-being for all people of Burundi.
105 Understanding psychosocial well-being among women in Burundi: A participatory study
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117 Understanding psychosocial well-being among women in Burundi: A participatory study
ANNEX A: LIST OF ACRONYMS USED IN THIS DOCUMENT
ADA Austrian Development Agency
ACAT L’ Action des Chrétiens pour l ’Abolition de la Torture (Christian Action to
Abolish Torture, Burundi)
CUNY City University of New York
IASC Interagency Standing Committee
IRB Internal Review Board
OMCT World Organization against Torture
TPO Transcultural Psychosocial Organization
UNDP United Nations Development Program
UNFPA United Nations Population Fund
UNICEF United Nations Children’s Fund
UNSCR United Nations Security Council Resolution
WHO World Health Organization
118 Understanding psychosocial well-being among women in Burundi: A participatory study
ANNEX B. KEY INFORMANTS INTERVIEWED
Name Title Organization
1 Aline Newuzimana Project Coordinator CARE Ishaka (Courage for the future)
2 Jimmy Mategeko Project Coordinator CARE GEZAHO (Stop!)
3 Chartier Niyungeko Conflict Advisor CARE Gitega
4 Herman Ndayisaba Country Director HealthNet-TPO Burundi
5 Déo Nkuruziza, Project Manager HealthNet-TPO Burundi
6 Gorethi Ndacayisaba Founder and Director Dushirahamwe
7 Christine Nsengiyumva: Chief of Police Community Development Force OPC2
8 Consolata Mayondo Program Director HealthNet-TPO Burundi
9 Marceline Ndatayinzingo Coordinator of 11 Ministry of National Solidarity and Gender communes Center of Family Development Bujumbura Rurale 10 Ėmile Mworoha Professor Emeritus University of Burundi Department of History
11 Abbé Adrien Ntabona Professor and Chair University of Burundi. Department of African Member Language and Literature/ Center for Parish Priest Research, Inculturation and Development(CRID) National Bashingantahe Organization
119 Understanding psychosocial well-being among women in Burundi: A participatory study
ANNEX C. PROTOCOL FOR SECOND ROUND OF RESEARCH: BURUNDI
I. Greetings: introduction of team members, introduction of focus group members, by name, location, group to which they belong
II. Introduction of the study: we work together with women in Burundi who have suffered from many things; colonialism, inequality, discrimination, violence in the home and community, decades of war. You have told us about that suffering and we have worked together to try to make a change, in the home, the community, and in the nation.
Today we come to you to try to learn the answer to an important question, when our programs have succeeded, when things are good, what does it mean for a woman to be well in her heart? Kumererwa-neza
III. Procedure for the group meeting, informed consent: We came here before to ask this question, at the mid point in our projects. We took your answers and mixed them with answers from other women. Today we will tell you the answers that we got and ask you do we have it right? We will ask you to rank the answers. Then we will ask you one last question We think that this will take about 1 hour and half. You are free to leave if you wish, but we really hope that you will stay and help us to learn Is it okay?
IV. First Question: If your small daughter is the age that you are today, and she is well in her heart, what would her life be like? We have created a list based on the answer that you and other women gave us during our first visit. Would the items on that list define it? Are their some that you would add? Some that you would want to take away?
V. Ranking Exercise Show a picture that represents each of the Domains. Ask the women: If your daughter can have only 1 of these, which would you choose? Count and announce the number If your daughter can have that one and can have 1 more, which would you choose? Count and announce the vote Continue to the end
VI. Question on Traditions Right now, you survive many things every day, isn’t it? Are there any old Burundian traditions, that you learned from you grandparents, perhaps, from the days of the kingdom, that can help a woman to survive and to be well? Can you tell us what they are?
VII. Closing Questions Is there anything that we did not ask you that we should have? Is there anything that you would like to ask us Murakoze cane!
120 Understanding psychosocial well-being among women in Burundi: A participatory study
Domains of Well-Being for Women in Burundi
1. Have control over the resources that she needs to have the basic necessities of life for herself and her children (mentioned by all groups, and agreed by all members) . If her daughter is not married, then through the capacity to earn through education, a job, training, commerce or the ability to save with an organization . If she is married through the ability to discuss, dialogue and influence the decisions of her husband To have own incomes To be educated (literacy)/access to information To be able to share the fruits of her cultivation To be able to determine how funds are spent To be able to have the help of her husband in earning and cultivating
2. Love and support from your family . To have a husband with whom one can dialogue . To be loved by your husband’s family . To be loved . Continued support and contact from your parents and family . To have children
3. Be part of an organization that can bring about change, such as a solidarity group 1) From friends . Be attended in childbirth . Visited in sickness . Be respected in the community Be regarded as useful to others . To sing, to dance and together . Have a someone to listen to troubles
2) As part of an organization . To have her children be part of an organization . Be able to save together . Be able to do advocacy together . Be able to share together
4. Be educated . Be educated herself . Be able to educate her children . Have access to information
5. Be healthy . Her children should be healthy . Have access to health care . To be well in mind and body
121 Understanding psychosocial well-being among women in Burundi: A participatory study
6. Live in safety and security, through dialogue and understanding In her home . To not be beaten or abused by her husband . To not need a husband or boyfriend In her community . To be free of discrimination (widows, ethnic, disabled) . To “feel safe in my country and community” . To not fear for the future, especially the return of violence
7. Have a voice in non-economic issues Inside of the family . To be able to say what is in my mind at home . To be able to discuss without fear . To have my ideas respected by my husband Outside of the family . To be able to speak and to be heard in the community . To be able to decide laws and influence the rights of my children . To be able to participate in elections . To be able to hold positions of leadership and run for public office
8. Have moments of joy . To be able to see my children healthy, to laugh with them and play . To be able to laugh with husband . To have tea and time to sit and to drink it . To participate in religious ceremonies and festivals . To sing and to dance together with others
122 Understanding psychosocial well-being among women in Burundi: A participatory study
ANNEX D: ROUND ONE FOCUS GROUPS WITH DEMOGRAPHIC AND GEOGRAPHIC DETAIL
Province Commune Colline Partners/ Type of # of Key # of solidarity group Focus Informants Participants Groups Gitega Giheta Massasah TPO, Kirumara 1 9
Gitega Gitera Makebuko TPO, Kirumara, 1 1 M 13
Bujumbura Bujumbura ISHAKA young 1 3 8 Mairie Unmarried mothers 2 M 1 F Bujumbura Mutimbisi Kirumara and 1 20 Rurale Gridjambo together
Bujumbura Mutimbisi Kirumara/ 1 27 Rurale TPO/Gezaho /Gridjambo together
Bubanza Mpanda Kirumara, TPO 1 37 Representatives 5 (3groups collines seen together) Total 6 4 114
123 Understanding psychosocial well-being among women in Burundi: A participatory study
ANNEX E: ROUND TWO FOCUS GROUPS WITH DEMOGRAPHIC AND GEOGRAPHIC DETAIL
Province Commune Colline Partners/ Type of # Focus # of # Key group Groups Participants Informants
Gitega Giheta Massasah TPO, Kirumara 1 28
Gitega Giheta Bwoga, Representatives of 1 28 5 NGOs of 5 Collines Gitega Giheta Makebuko TPO, Kirumara, 1 27 mixed Bujumbura Bujumbura ISHAKA young 1 15 4 Mairie Unmarried (2 M 3 W) mothers Bujumbura Mutimbisi Ex-combatants 1 15 Rurale Gridjambo
Bujumbura Mutimbisi Kirumara/ TPO 1 35 Rurale Representatives 5 collines
Bubanza Mpanda Kirumara, TPO 1 47 Representatives 5 collines
TOTAL 7 195 4
124