In the slums of Nairobi, where sexual assault is as commonplace as it is taboo to discuss, a team of Kenyan counselors is teaching kids that no means no.

The girls learn to shout — “Hands off my body!” — and throw an elbow jab or good kick to the groin. The boys are encouraged to stand up for the girls and fight against the social traditions that have normalized rape.

Perhaps most effectively, the children learn how to talk themselves out of precarious situations, use clever diversions and speak loudly when faced with potential attackers, through a series of role-playing exercises that promote healthy gender norms.

The behavioral intervention appears to be working. Observational studies have inferred that the incidence of rape has dropped dramatically — perhaps even by half.

But how do those who are devoted to protecting these girls from sexual violence prove to themselves and their donors that their efforts and dollars are making a difference?

This is where Mike Baiocchi comes in. The Stanford statistician and his team of researchers and students are conducting the largest-ever randomized trial of its kind in an effort to place rare, high-quality quantitative proof alongside the more common observational evidence.

“That’s what I specialize in: messy, real-world data where you try and prove the cause-and-effect relationship,” said Baiocchi, PhD, an assistant professor of medicine at the Stanford Prevention Research Center in the School of Medicine.

Rosenkranz Prize 2017 winner Mike Baiocchi and his partner, Clea Sarnquist, both of Stanford Medicine, conduct research on the ground in Nairobi, Kenya, to determine whether a rape prevention program is truly making a difference.

Rosenkranz Prize 2017 winner Mike Baiocchi and his partner, Clea Sarnquist, both of Stanford Medicine, conduct research on the ground in Nairobi, Kenya, to determine whether a rape prevention program is truly making a difference.

Baiocchi and his team have designed a closed-cohort study that will track the behavior of about 5,000 girls and 1,000 boys enrolled in the No Means No Worldwide project, which is training 300,000 girls and boys in Kenya and Malawi to prevent rape and teen pregnancy.

This innovative approach to applying math to a real-world problem won him this year’s Rosenkranz Prize for Health Care Research in Developing Countries.

“The entire Rosenkranz selection committee was highly impressed both with the rigor of Mike’s work — which he publishes in top journals in the field of statistics — as well as his unconventional and potentially very impactful work on the prevention of gender-based violence in illegal settlements around Nairobi,” said Grant Miller, PhD, an associate professor of medicine and core faculty member at Stanford Health Policy.

Miller chairs the committee that selects the winners of Stanford Health Policy’s annual $100,000 prize, which goes to promising young Stanford researchers who are investigating ways to improve health care and health policy in developing countries.

Overwhelming Prevalence of Sexual Violence

In the United States, according to the Centers for Disease Control and Prevention, nearly one in five women are raped. The World Health Organization estimates that globally, one in three women experience sexual or physical violence.

In Kenya, national surveys reveal that as many as 46 percent of Kenyan women experience sexual assault as children.

“In the roughest part of the Nairobi slums, 20 to 25 percent of high school girls will be raped this year,” said Baiocchi. “This program, however, looks like it is having the ability to cut that in about half. Our job is to tease out the evidence through careful measurement and design of experiment.”

To do this, Baiocchi and other members of the Stanford Gender-Based Violence Collaborative have traveled to Nairobi to collect baseline data. His partner is Clea Sarnquist, DrPH, a senior research scholar for the Global Child Health Program in the Stanford Department of Pediatrics.

Several pilot evaluations of the program, published in 2014 in Pediatrics, found that more than half of 2,000 high school girls who had completed the self-defense course had used their newfound skills to fend off sexual harassment or rape.

But Lee Paiva, the San Francisco-based founder of No Means No Worldwide, wanted proof. She told Stanford Medicine magazine last year that since establishing training in 2010, she often wondered about the true effectiveness of the program.

“A little voice inside me said, `What did you teach them?’” she said. “What did those kids actually get? What is that money really going to do?”

She determined that she wasn’t going to move forward on the program until she could answer those questions. That is when she turned to Stanford.

Expanding on their initial work, Baiocchi and Sarnquist spent several months last year, working with their Kenyan partners, Ujamaa-Africa and the African Institute for Health and Development, in 90 schools in the poorest parts of Nairobi to establish the largest randomized trial of its kind.

They interviewed the girls who have taken part in the six-week empowerment and self-defense program taught by Kenyans who grew up in the same neighborhoods and are familiar with the local culture.

“It’s hard not to be extraordinarily excited when you watch these girls; they’re play-acting and just being kids, but you are also watching them evolving and creating new ways to deal with these situations,” said Baiocchi.The team is now tracking a fixed group of  5,000 girls and 1,000 boys, ages 10 to 16, over two years. This will give the researchers a better understanding of just how the girls are adopting the training and readapting to societal demands.

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“Doing a randomized trial is slow, expensive, and — if I’m being totally honest — anxiety-inducing because everything is laid so bare and you put things in motion today that won’t be resolved for another two years,” Baiocchi said. “But the reward is extraordinarily high-quality data that helps you understand what’s really going on. We need this level of evidence if we’re going to take on such a difficult problem.”

Since using math to measure the benefits of gender-based violence prevention interventions is a relatively new science, Baiocchi said the team is adopting the highest level of rigor, equivalent to what it would take to get their results through the FDA.

The randomized controlled trial is being funded by the UK Department of International Development as part of its What Works to Prevent Violence initiative, with the goal of determining whether the behavioral intervention is effective in preventing sexual assault.

A Need to Do Good

Baiocchi notes both his parents are nurses, his brother is a nurse who is married to a nurse. Public health and service runs through the family DNA.

“So, when I came out as being a math person, I knew that I also had to do good.”

Since receiving his PhD in statistics from The Wharton School at the University of Pennsylvania in 2011, Baiocchi has worked on ways to improve high-risk infant deliveries, school-based earthquake risk reduction in Nepal, bail reform in the United States, improving cardiothoracic surgical care, as well as cancer and cardiovascular disease prevention in China.

The Kenya project team, which includes eight Stanford undergraduate and graduate students, intends to share their results, putting out open-source tutorials that will explain their statistical methods and provide sample code and data.

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“We want to make it really easy for people in this area to start having a similar language so we can better communicate and build on this science,” he said.

The Rosenkranz funding will help to build this open-source site and support the Stanford team in their research and travel to Kenya and other countries.

The award’s namesake, George Rosenkranz, who holds a doctorate in chemistry, first synthesized cortisone in 1951, and later progestin, the active ingredient in oral birth control pills. He went on to establish the Mexican National Institute for Genomic Medicine, and his family created the Rosenkranz Prize in 2009.The award embodies Rosenkranz’s belief that young scientists hold the curiosity and drive necessary to find alternative solutions to longstanding health-care dilemmas.

Baiocchi called Rosenkranz’s work to help women take control of their reproductive health “revolutionary,” and is humbled to now be on the list of the other prizewinners, Eran Bendavid, Sanjay Basu, Marcella Alsan, Jason Andrews and Ami Bhatt.

“Our work is a continuation of the powerful changes Dr. Rosenkranz set in motion,” he said.

And what really matters, Baiocchi said, are the end results.

“There are a number of girls who are not going to get raped this year because of what we are doing,” he said. “And we know that if someone doesn’t get assaulted, that leads them to having a better life — it’s an extraordinarily virtuous cycle.”

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The Center on Democracy, Development, and the Rule of Law (CDDRL) at Stanford University announced today that it has launched the Global Digital Policy Incubator (GDPi). GDPi’s mission is to help develop governance norms for the global digital ecosystem that reinforce democratic values, universal human rights and the rule of law. It will serve as a multi-stakeholder collaboration hub at Stanford for technologists, governments, civil society and the private sector actors. GDPi will identify and incubate global policy and governance innovations that enhance freedom, security and trust in the digital realm. 

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Fellows will arrive at Stanford in July to begin the three-week academic training program taught by Stanford faculty, policymakers and thought-leaders in the technology sector.

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Stanford's Center on Democracy, Development, and the Rule of Law is proud to announce the 2017 class of Draper Hills Summer Fellows, which is composed of 28 leaders – selected from among hundreds of applications – advancing democratic development in some of the most challenging corners of the world.

In Bahrain, Burma, Rwanda and Sudan our fellows are working on peace-building initiatives to create more tolerant and inclusive societies. Judges and lawyers are holding government and criminals accountable and reforming the rule of law in Argentina, Guatemala and the Philippines. Gender rights activists are creating new tools and programs to protect the safety and freedom of women and girls in India, Kuwait and Papua New Guinea.

In Egypt, Morocco, Pakistan, Serbia and Ukraine, our fellows are serving inside the government as members of Parliament and senior civil servants to advance reform and new policy agendas. Business leaders in Jordan and India launched initiatives to support more inclusive economic growth and social development.

CDDRL is excited to launch another powerful network of leaders determined to advance change in their communities. They will emerge with new tools, frameworks and connections to enhance their work and deepen their impact on democratic reform.

The 2017 class will mark the 13th cohort of the Draper Hills Summer Fellows Program and the fellows will join the Omidyar Network Leadership Forum, an alumni community of over 300 alumni in 75 countries worldwide.

When one thinks of the casualties of war, it is easy to imagine severed limbs, bullet holes, shrapnel, perhaps even sarin gas or Agent Orange. But in a recent Daedalus essay, Paul Wise argues that the most damaging health impacts of war are often indirect. Losing access to food supplies, medication and electricity can kill more people than battle itself. In this video by the American Academy of Arts and Sciences, Wise, a professor of pediatrics and Stanford Health Policy core faculty member, explains how fatal the indirect costs of war can be.

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While the United States has no peers in conventional military power, it is especially vulnerable – as a free and democratic society – to cyber misinformation campaigns, a Stanford scholar says.

Herbert Lin, a senior research scholar for cyberpolicy and security at Stanford’s Center for International Security and Cooperation (CISAC), is the co-author of a new draft working paper that spells out the perilous risks facing democratic, wired-up countries around the world.

America’s adversaries are seeking “asymmetric” methods for social disruption, rather than direct military conflict, Lin said.

“Cyber warfare is one asymmetric counter to Western (and especially U.S.) military advantages that depend on the use of cyberspace,” wrote Lin and his co-author Jackie Kerr, a research fellow at the Lawrence Livermore National Laboratory.

This new type of cyber aggression is aimed at winning – and confusing – hearts and minds, the very control centers of human existence, Lin said.

As a result, “information/influence warfare and manipulation,” or IIWAM as Lin describes it, poses profound implications for Western democracies, even though much of it may not be illegal under international law. This approach is based on the deliberate use of information by one party on an adversary to confuse, mislead, and ultimately to influence the choices and decisions that the adversary makes.

A recent example in point would be the 2016 Russian hacking of the U.S. presidential election and the surge of so-called “fake news.”

Lin points out that while misinformation campaigns are not new, the technology to spread it far and wide globally is. He noted that the patron saint of distorting reality for war-like purposes is Sun Tzu, who wrote that, “The supreme art of war is to subdue the enemy without fighting.”

While traditional cyber attacks typically hit hard targets like computer systems, cyber “influence” campaigns are conducted over longer periods of time and rely on soft power – propaganda, persuasion, culture, social forces, confusion and deception, Lin said. 

Words and images

How does it work? Lin explains:

“Victory is achieved by A when A succeeds changing B’s political goals so that they are aligned with those of A.  But such alignment is not the result of B’s 'capitulation' or B’s loss of the ability to resist – on the contrary, B (the losing side) is openly willing.”  That is, such victory shares the focus on subverting the opponent’s will, though not on destroying his military forces.

The ammunition in these cyberspace battles are “words and images,” the kind that persuade, inform, mislead, and deceive so that the adversary cannot respond militarily. In the example of a “fake news” story, they often take place below legal thresholds of “use of force” or “armed attack,” and at least in an international legal sense, do not trigger a military response.

The target is the “adversary’s perceptions,” which reside in the “cognitive dimension of the information environment.” In other words, such cyber warfare focuses on “damaging knowledge, truth, and confidence, rather than physical or digital artifacts,” according to Lin. It is the “brain-space.”

Additionally, IIWAM injects fear, anger, anxiety, uncertainty, and doubt into the adversary’s decision making processes, he added.  Success is defined as altering such perceptions so the target makes choices favoring the aggressor.

“Sowing chaos and confusion is thus essentially operational preparation of the information battlefield – shaping actions that make the information environment more favorable for actual operations should they become necessary,” the researchers wrote.

These cyber manipulations often prey upon cognitive and emotional biases present in the psychological and mental makeup of human beings, Lin said. 

For example, media channels such as Fox News play to “confirmation bias” for individuals with a right-of-center orientation, and similarly for MSNBC for those with a left-of-center, orientation, he wrote. Confirmation bias is the tendency to interpret new evidence as confirmation of one's existing beliefs or theories.

Countering misinformation

“Naming and shaming” is probably ineffective against many nation states conducting cyber disinformation campaigns, Lin said. And the idea that a government like the U.S. can quickly respond to misinformation created in the private sphere is unlikely to be effective as well.

What, then, might work? Lin suggests new tactics are needed, as no existing approach seems adequate. For example, Facebook is deploying a new protocol for its users to flag questionable news sites.  Google has banned fake news web sites from using its online advertising service. Twitter, YouTube, and Facebook shut down accounts that they determine are promoting terrorist content.  He noted that a recent Facebook letter from CEO Mark Zuckerberg states that, “Our approach will focus less on banning misinformation and more on surfacing additional perspectives and information, including that fact checkers dispute an item's accuracy.”

But such measures are unlikely to stem the “rising tide of misinformation conveyed” through cyber warfare, Lin said, because they mostly require users to do additional mental work.  

Wired world riskier

Today’s Internet-driven Western world offers countless opportunities for cyber influence mischief, Lin wrote.

“Democracy has rested on an underlying foundation of an enlightened, informed populace engaging in rational debate and argument to sort out truth from fiction and half-truth in an attempt to produce the best possible policy and political outcomes,” Lin wrote.

Cyber manipulators have exploited an arguable gap between ideals and reality in democratic systems – “rendered it much more questionable” – through the tremendous reach and speed of misinformation, he said. Many countries cannot deal with the onslaught of such focused efforts. This serves to make the democratic process look weak and unstable in the eyes of its citizens. The same dynamic does not apply equally around the world.

“Cyber weapons pose a greater threat to nations that are more advanced users of information technology than to less-developed nations,” Lin wrote.

He said that less developed or authoritarian countries do not have much Internet infrastructure or that wield control over expression – North Korea is an example.

MEDIA CONTACTS

Herbert Lin, Center for International Security and Cooperation: (650) 497-8600, herbert.s.lin@stanford.edu

Clifton B. Parker, Center for International Security and Cooperation: (650) 725-0224, cbparker@stanford.edu