Male Partners, Power, and Access to Care: Integrating Gendered Power Dynamics into the Adaptation of IPV and Mental Health Interventions In Informal Settlements In Kenya

Background and Purpose

Globally, one billion people live in informal settlements, a number projected to double by 2050. In Kenya, intimate partner violence (IPV) is highly prevalent in these settlements, with studies indicating that up to 85% of women report lifetime exposure. IPV and poor mental health outcomes are closely tied to household power relations, gender norms, and economic precarity. While evidence-based interventions exist, they are often developed outside of informal settlement contexts and may not adequately reflect the social and relational dynamics shaping women’s experiences of IPV and access to care. This study describes a community-engaged adaptation process to tailor an integrated IPV and mental health intervention for implementation in Kibera and Mathare, with particular attention to how male authority and household power dynamics influence intervention relevance and delivery.

Methods

We conducted a series of seven participatory workshops with 24 community members, including IPV survivors, community health volunteers, and health facility staff from clinics in Kibera and Mathare. Workshops were designed to iteratively adapt intervention content for a combined IPV and mental health intervention (WINGS+PM+). Activities included structured discussions, case development, and collaborative review of intervention materials to ensure contextual relevance, safety, and feasibility. Detailed notes and transcripts from workshop sessions were synthesized to identify key contextual factors and inform modifications to intervention content, framing, and delivery strategies.

Results

The adaptation process highlighted male authority as a central contextual factor shaping women’s experiences of IPV and their ability to engage with IPV and mental health services. Participants emphasized that financial dependence, fear of retaliation, and social norms surrounding male control constrain women’s help-seeking and disclosure. In response, adaptations included: integrating content that explicitly addresses economic dependence and safety planning within constrained choices; reframing intervention language to align with locally acceptable ways of discussing violence and mental health; and incorporating guidance for safely navigating partner dynamics, including when and how to involve—or avoid involving—male partners. Participants also identified the dual role of men in the community as both potential sources of harm and informal mediators, informing the cautious consideration of male engagement strategies within the intervention.

Conclusion and Implications

Adapting IPV and mental health interventions for informal settlements requires explicit attention to gendered power relations that shape IPV experiences and access to care. This community-engaged process demonstrates how integrating local knowledge can strengthen the relevance, safety, and feasibility of interventions. Rather than treating male partners solely as external barriers, adaptation efforts should account for their complex roles within households and communities. These findings underscore the importance of participatory approaches in developing contextually grounded, equity-oriented interventions that are responsive to the lived realities of women in informal settlements.