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Um MY, Lee JO, Kim HJ, Rice E, Palinkas LA. Testing the pathway from pre-migration sexual violence to suicide-related risk among North Korean refugee women living in South Korea: do social networks matter? Soc Psychiatry Psychiatr Epidemiol 2021; 56:485-495. [PMID: 33211123 DOI: 10.1007/s00127-020-01977-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 10/24/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To examine the pathways from pre-migration sexual violence to suicide-related risk via the lack of important social networks among North Korean refugee women living in South Korea. METHODS As part of a larger study, cross-sectional social network data from 273 North Korean refugee women aged 19 or older (M = 41 years; range = 19-69) were collected by self-reported surveys from April to May 2014 in South Korea. Snowball sampling was used for participant recruitment. We analyzed whether lack of network diversity and lack of kin ties mediated the association between pre-migration sexual violence and suicide-related risk in two multivariable mediation analyses. RESULTS The prevalence of past-year suicide-related risk was 34.4% in our study sample, and 31.1% of the participants reported at least one type of pre-migration sexual violence. Pre-migration sexual violence was associated with increased suicide-related risk. Lack of network diversity (b = 0.03, 95% CI 0.01-0.07) and lack of kin ties (b = 0.03, 95% CI 0.01-0.08) partially mediated this association. CONCLUSION Assessment of pre-migration sexual violence victimization needs to begin at an early stage of resettlement. Study findings highlight the urgent need to create suicide prevention programs that incorporate social network interventions, especially for North Korean refugee women who have experienced sexual violence during migration.
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Affiliation(s)
- Mee Young Um
- Arizona State University, Watts College of Public Service and Community Solutions, School of Social Work, Phoenix, AZ, USA
| | - Jungeun Olivia Lee
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Los Angeles, CA, USA
| | - Hee Jin Kim
- Myongji University, Bangmok College of General Education, 116 Myongji-ro, Cheoin-gu, Yongin-si, Gyeonggi-do, 449-728, South Korea.
| | - Eric Rice
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Los Angeles, CA, USA
| | - Lawrence A Palinkas
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Los Angeles, CA, USA
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Wen K, McGrath M, Acarturk C, Ilkkursun Z, Fuhr DC, Sondorp E, Cuijpers P, Sijbrandij M, Roberts B. Post-traumatic growth and its predictors among Syrian refugees in Istanbul: A mental health population survey. J Migr Health 2020; 1-2:100010. [PMID: 34405165 PMCID: PMC8352006 DOI: 10.1016/j.jmh.2020.100010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 11/26/2020] [Accepted: 11/26/2020] [Indexed: 01/19/2023] Open
Abstract
AIMS The negative mental health effects of exposure to trauma are well-documented. However, some individuals are theorized to undergo post-traumatic growth (PTG) after exposure to trauma, potentially experiencing positive psychological change across five domains: appreciation for life, relationships with others, new possibilities in life, personal strength, and spiritual change. PTG is less studied in forcibly displaced populations in low- and middle-income countries. This study aimed to explore levels of PTG and associated factors among Syrian refugee adults living in Istanbul, Turkey. METHODS A cross-sectional survey was conducted with 1678 respondents. This study analyzed PTG data from 768 individuals as measured by the Post-Traumatic Growth Inventory (PTGI). Descriptive analysis and univariate and multivariate least squares linear regression modeling were used. Factor analysis and Cronbach's alpha tests assessed the psychometric properties of the PTGI. RESULTS The sample exhibited a moderate level of PTG at 55.94 (SD=22.91, range 0-105). Factor analysis of PTGI revealed only four factors instead of five, and the PTGI yielded high internal reliability (Cronbach's α=0.90). PTG and post-traumatic stress disorder (PTSD) had a curvilinear relationship, with the highest PTG levels experienced by those with moderate PTSD levels. Five other variables were significantly associated with PTG: older age, less education, somatic distress, and history of an overnight stay at a health facility for mental health care were associated with lower PTG, while more years of education were associated with higher PTG. CONCLUSIONS This study identified the role of the sociodemographic and psychological determinants that influence post-traumatic growth among Syrian refugees in Istanbul. These findings could be used to inform future research and programs seeking to understand PTG in refugees.
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Affiliation(s)
- Karen Wen
- London School of Hygiene and Tropical Medicine, Department of Health Services Research and Policy, Public Health and Policy, 15-17 Tavistock Place, London, UK
| | | | - Ceren Acarturk
- Department of Psychology, Koç University, Istanbul, Turkey
| | | | - Daniela C. Fuhr
- London School of Hygiene and Tropical Medicine, Department of Health Services Research and Policy, Public Health and Policy, 15-17 Tavistock Place, London, UK
| | - Egbert Sondorp
- KIT Royal Tropical Institute, Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, the Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, the Netherlands
| | - Bayard Roberts
- London School of Hygiene and Tropical Medicine, Department of Health Services Research and Policy, Public Health and Policy, 15-17 Tavistock Place, London, UK
| | - STRENGTHS consortium
- London School of Hygiene and Tropical Medicine, Department of Health Services Research and Policy, Public Health and Policy, 15-17 Tavistock Place, London, UK
- KIT Royal Tropical Institute, Amsterdam, the Netherlands
- Department of Psychology, Koç University, Istanbul, Turkey
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, the Netherlands
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Hossain M, Pearson RJ, McAlpine A, Bacchus LJ, Spangaro J, Muthuri S, Muuo S, Franchi G, Hess T, Bangha M, Izugbara C. Gender-based violence and its association with mental health among Somali women in a Kenyan refugee camp: a latent class analysis. J Epidemiol Community Health 2020; 75:jech-2020-214086. [PMID: 33148683 PMCID: PMC7958090 DOI: 10.1136/jech-2020-214086] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/16/2020] [Accepted: 10/11/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND In conflict-affected settings, women and girls are vulnerable to gender-based violence (GBV). GBV is associated with poor long-term mental health such as anxiety, depression and post-traumatic stress disorder (PTSD). Understanding the interaction between current violence and past conflict-related violence with ongoing mental health is essential for improving mental health service provision in refugee camps. METHODS Using data collected from 209 women attending GBV case management centres in the Dadaab refugee camps, Kenya, we grouped women by recent experience of GBV using latent class analysis and modelled the relationship between the groups and symptomatic scores for anxiety, depression and PTSD using linear regression. RESULTS Women with past-year experience of intimate partner violence alone may have a higher risk of depression than women with past-year experience of non-partner violence alone (Coef. 1.68, 95% CI 0.25 to 3.11). Conflict-related violence was an important risk factor for poor mental health among women who accessed GBV services, despite time since occurrence (average time in camp was 11.5 years) and even for those with a past-year experience of GBV (Anxiety: 3.48, 1.85-5.10; Depression: 2.26, 0.51-4.02; PTSD: 6.83, 4.21-9.44). CONCLUSION Refugee women who experienced past-year intimate partner violence or conflict-related violence may be at increased risk of depression, anxiety or PTSD. Service providers should be aware that compared to the general refugee population, women who have experienced violence may require additional psychological support and recognise the enduring impact of violence that occurred before, during and after periods of conflict and tailor outreach and treatment services accordingly.
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Affiliation(s)
- Mazeda Hossain
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Women, Peace & Security, London School of Economics and Political Science, London, UK
| | - Rachel Jane Pearson
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Alys McAlpine
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Loraine J Bacchus
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Jo Spangaro
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Stella Muthuri
- African Population and Health Research Center, Nairobi, Kenya
| | - Sheru Muuo
- African Population and Health Research Center, Nairobi, Kenya
| | - Giorgia Franchi
- Violence Prevention and Response Unit, International Rescue Committee UK, London, UK
| | - Tim Hess
- Violence Prevention and Response Unit, International Rescue Committee UK, London, UK
| | - Martin Bangha
- African Population and Health Research Center, Nairobi, Kenya
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Ellsberg M, Ovince J, Murphy M, Blackwell A, Reddy D, Stennes J, Hess T, Contreras M. No safe place: Prevalence and correlates of violence against conflict-affected women and girls in South Sudan. PLoS One 2020; 15:e0237965. [PMID: 33044980 PMCID: PMC7549805 DOI: 10.1371/journal.pone.0237965] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 08/06/2020] [Indexed: 11/24/2022] Open
Abstract
Background Conflict and humanitarian crises increase the risk of both intimate partner violence and non-partner sexual violence against women and girls. We measured the prevalence and risk factors of different forms of violence against women and girls in South Sudan, which has suffered decades of conflict, most recently in 2013. Methods A population-based survey was conducted among women aged 15–64 in three conflict-affected sites in South Sudan: Juba, Rumbek, and the Protection of Civilian Sites (PoCs) in Juba between 2015 and 2016. Findings A total of 2,244 women between the ages of 15–64 were interviewed. Fifty percent (in the Juba PoCs) to 65% (in Juba and Rumbek) of all female respondents experienced either physical or sexual violence from a partner or non-partner in the course of their lifetimes. Approximately 35% of respondents have experienced rape, attempted rape or other forms of sexual violence by a non-partner during their lifetime. For ever-partnered women, lifetime prevalence of physical and/or sexual partner violence ranged between 54% in the Juba PoCs and 73% in Rumbek. Restrictive marital practices and gender norms, and experiences of conflict were major drivers of both partner and non-partner violence. Conclusion Women and girls in South Sudan suffer among the highest levels of physical and sexual violence in the world. Although the prevalence of sexual assault by non-partners is four times the global average, women are still at greatest risk of physical and sexual assault from intimate partners. Conflict-related and intimate partner violence reinforce each other and are upheld by restrictive gender norms and marital practices. Expansion of comprehensive services, including health and psycho-social support for survivors is urgently needed. Moreover, policies and laws to prevent violence against women and provide survivors with access to justice should be given high priority within the ongoing peacebuilding process in South Sudan.
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Affiliation(s)
- Mary Ellsberg
- Global Women’s Institute, George Washington University, Washington, D.C., United States of America
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, D.C., United States of America
- * E-mail:
| | - Junior Ovince
- Global Women’s Institute, George Washington University, Washington, D.C., United States of America
| | - Maureen Murphy
- Global Women’s Institute, George Washington University, Washington, D.C., United States of America
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, D.C., United States of America
| | - Alexandra Blackwell
- Global Women’s Institute, George Washington University, Washington, D.C., United States of America
| | | | - Julianne Stennes
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, D.C., United States of America
| | - Tim Hess
- International Rescue Committee, London, United Kingdom
| | - Manuel Contreras
- Global Women’s Institute, George Washington University, Washington, D.C., United States of America
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Njie-Carr VPS, Sabri B, Messing JT, Suarez C, Ward-Lasher A, Wachter K, Marea CX, Campbell J. Understanding Intimate Partner Violence among Immigrant and Refugee Women: A Grounded Theory Analysis. JOURNAL OF AGGRESSION, MALTREATMENT & TRAUMA 2020; 30:792-810. [PMID: 34483645 PMCID: PMC8412032 DOI: 10.1080/10926771.2020.1796870] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 03/05/2020] [Accepted: 05/29/2020] [Indexed: 05/28/2023]
Abstract
Immigrant and refugee women may experience considerable multifaceted and interrelated barriers that place them at heightened risk for intimate partner violence (IPV). The objective of this analysis was to increase our understanding of immigrant and refugee women's responses to abuse. We conducted in-depth interviews with 84 women who immigrated from Africa, Asia, and Latin America. Engendering Resilience to Survive emerged as the core category explaining women's strength to stay safe and survive IPV experiences. In the face of the violence they experienced, women in this sample demonstrated remarkable resilience and the ability to harness their strength to survive. Resilience as a process and outcome could facilitate empowerment, and self-directedness to access health services and resources to stay safe. The developed Engendering Resilience to Survive Model can be utilized as a framework to inform research, policy, and practice to support abused women.
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Affiliation(s)
- Veronica P S Njie-Carr
- Department of Organizational Systems and Adult Health School of Nursing, University of Maryland, Baltimore, MD
| | - Bushra Sabri
- School of Nursing, Johns Hopkins University, Baltimore, MD
| | - Jill T Messing
- School of Social Work, Arizona State University, Phoenix, AZ
| | - Cecelia Suarez
- Department of Behavioral and Community Health, School of Public Health University of Maryland, College Park, College Park, MD
| | | | - Karin Wachter
- School of Social Work, Arizona State University, Phoenix, AZ
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Blackmore R, Boyle JA, Fazel M, Ranasinha S, Gray KM, Fitzgerald G, Misso M, Gibson-Helm M. The prevalence of mental illness in refugees and asylum seekers: A systematic review and meta-analysis. PLoS Med 2020; 17:e1003337. [PMID: 32956381 PMCID: PMC7505461 DOI: 10.1371/journal.pmed.1003337] [Citation(s) in RCA: 266] [Impact Index Per Article: 66.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/14/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Globally, the number of refugees and asylum seekers has reached record highs. Past research in refugee mental health has reported wide variation in mental illness prevalence data, partially attributable to methodological limitations. This systematic review aims to summarise the current body of evidence for the prevalence of mental illness in global refugee populations and overcome methodological limitations of individual studies. METHODS AND FINDINGS A comprehensive search of electronic databases was undertaken from 1 January 2003 to 4 February 2020 (MEDLINE, MEDLINE In-Process, EBM Reviews, Embase, PsycINFO, CINAHL, PILOTS, Web of Science). Quantitative studies were included if diagnosis of mental illness involved a clinical interview and use of a validated assessment measure and reported at least 50 participants. Study quality was assessed using a descriptive approach based on a template according to study design (modified Newcastle-Ottawa Scale). Random-effects models, based on inverse variance weights, were conducted. Subgroup analyses were performed for sex, sample size, displacement duration, visa status, country of origin, current residence, type of interview (interpreter-assisted or native language), and diagnostic measure. The systematic review was registered with PROSPERO (CRD) 42016046349. The search yielded a result of 21,842 records. Twenty-six studies, which included one randomised controlled trial and 25 observational studies, provided results for 5,143 adult refugees and asylum seekers. Studies were undertaken across 15 countries: Australia (652 refugees), Austria (150), China (65), Germany (1,104), Italy (297), Lebanon (646), Nepal (574), Norway (64), South Korea (200), Sweden (86), Switzerland (164), Turkey (238), Uganda (77), United Kingdom (420), and the United States of America (406). The prevalence of posttraumatic stress disorder (PTSD) was 31.46% (95% CI 24.43-38.5), the prevalence of depression was 31.5% (95% CI 22.64-40.38), the prevalence of anxiety disorders was 11% (95% CI 6.75-15.43), and the prevalence of psychosis was 1.51% (95% CI 0.63-2.40). A limitation of the study is that substantial heterogeneity was present in the prevalence estimates of PTSD, depression, and anxiety, and limited covariates were reported in the included studies. CONCLUSIONS This comprehensive review generates current prevalence estimates for not only PTSD but also depression, anxiety, and psychosis. Refugees and asylum seekers have high and persistent rates of PTSD and depression, and the results of this review highlight the need for ongoing, long-term mental health care beyond the initial period of resettlement.
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Affiliation(s)
- Rebecca Blackmore
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jacqueline A. Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mina Fazel
- Department of Psychiatry, Oxford University, Oxford, United Kingdom
| | - Sanjeeva Ranasinha
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kylie M. Gray
- Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, Australia
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, United Kingdom
| | - Grace Fitzgerald
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Marie Misso
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Melanie Gibson-Helm
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- * E-mail:
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Understanding Violence against Women Irregular Migrants Who Arrive in Spain in Small Boats. Healthcare (Basel) 2020; 8:healthcare8030299. [PMID: 32858816 PMCID: PMC7551312 DOI: 10.3390/healthcare8030299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 11/24/2022] Open
Abstract
African irregular migrants risk their lives crossing the Mediterranean Sea in small boats hoping to reach Europe. Women irregular migrants (WIMs) are an especially vulnerable group that suffer from violence and sexual aggression, but little is known about their actual experiences. The objective of our study is to describe and understand the violence against WIMs who arrive in Spain in small boats. A qualitative study based on Gadamer’s phenomenology was used. The data collection included twenty-six in-depth interviews with WIMs. Three main themes arose: “Poverty and discrimination push WIMs into migrating”; “WIMs as a paradigm of extreme vulnerability”, and “WIMs in small boats should raise the alarm”. WIMs who arrive to Europe in small boats have a history of violence, rape, prostitution, forced pregnancy, and human trafficking. Emergency care must include gynecological examinations and must make detecting sexual violence and human trafficking of WIMs part of their care protocols.
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Patil SS, Chaukimath SP. COVID-19: Mass exodus of migrant workers in India, are we staring at a mental health crisis? Ind Psychiatry J 2020; 29:360-361. [PMID: 34158730 PMCID: PMC8188920 DOI: 10.4103/ipj.ipj_102_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/19/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Shailaja S Patil
- Department of Community Medicine, BLDE (Deemed to be University), Shri B M Patil Medical College Hospital and Research Center, Vijayapur, Karnataka, India
| | - Shivakumar P Chaukimath
- Department of Psychiatry, BLDE (Deemed to be University), Shri B M Patil Medical College Hospital and Research Center, Vijayapur, Karnataka, India
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Papadimos TJ. What's New in Critical Illness and Injury Science? Mental health and COVID-19: Self-inflicted and interpersonal violence amid a pandemic. Int J Crit Illn Inj Sci 2020; 10:45-48. [PMID: 32904505 PMCID: PMC7456292 DOI: 10.4103/ijciis.ijciis_66_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/11/2020] [Accepted: 08/15/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Thomas J Papadimos
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Nara R, Banura A, Foster AM. Exploring Congolese refugees' experiences with abortion care in Uganda: a multi-methods qualitative study. Sex Reprod Health Matters 2020; 27:1681091. [PMID: 31738122 PMCID: PMC7888001 DOI: 10.1080/26410397.2019.1681091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Uganda hosts 1.4 million refugees and conflict-affected people. Widely regarded as the best place in Africa to be a refugee, Uganda’s policies encourage self-sufficiency and local integration. However, abortion is legally restricted and recent studies suggest that displaced women and girls have persistent unmet sexual and reproductive health needs. In 2017, we conducted a multi-methods study to assess the reproductive health needs of displaced Congolese women in camp- and urban-based settings in Uganda. Our project focused on maternal health and delivery care, contraception, and abortion/post-abortion services and the intersection of these issues with sexual and gender-based violence. We interviewed 11 key informants, facilitated 4 focus group discussions with refugee women, and conducted 21 in-depth interviews with Congolese women of reproductive age to understand better knowledge, attitudes, practices, and services. Using both inductive and deductive techniques, we employed a multi-phased analytic plan to identify content and themes and triangulate and interpret findings. Our results suggest that Congolese refugees in Uganda are unable to navigate the legal restrictions on abortion and are engaging in unsafe abortion practices. This appears to be the case for those living in both camps and urban areas. The legal restrictions on induced abortion pose a barrier to the provision of post-abortion care. Efforts to ensure access to comprehensive abortion care should be prioritised and providing information and support to women in need of post-abortion care is imperative.
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Affiliation(s)
- Ruth Nara
- Former student, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Amanda Banura
- Student, Faculty of Science, Uganda Martyrs University, Kampala, Uganda
| | - Angel M Foster
- Professor, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.,Principal Scientist, Institute of Population Health, University of Ottawa, Ottawa, Canada
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Heidari S, Onyango MA, Chynoweth S. Sexual and reproductive health and rights in humanitarian crises at ICPD25+ and beyond: consolidating gains to ensure access to services for all. Sex Reprod Health Matters 2020; 27:1676513. [PMID: 31699014 PMCID: PMC7888011 DOI: 10.1080/26410397.2019.1676513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Shirin Heidari
- Senior Researcher, Global Health Center, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Monica A Onyango
- Clinical Associate Professor, Department of Global Health, Boston University, School of Public Health, Boston, MA, USA
| | - Sarah Chynoweth
- Sexual Violence Project Director/Consultant, Women's Refugee Commission, New York, NY, USA
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Sharma V, Amobi A, Tewolde S, Deyessa N, Scott J. Displacement-related factors influencing marital practices and associated intimate partner violence risk among Somali refugees in Dollo Ado, Ethiopia: a qualitative study. Confl Health 2020; 14:17. [PMID: 32280368 PMCID: PMC7137193 DOI: 10.1186/s13031-020-00267-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 03/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Child and forced marriage have negative health consequences including increased risk of intimate partner violence (IPV) for women and girls. War and humanitarian crises may impact decision-making around marriage and risks of IPV for displaced populations. A qualitative study was conducted among Somali refugees in Dollo Ado, Ethiopia to understand the interplay of factors that contribute to IPV and to inform an intervention. This secondary analysis aims to explore the influence of displacement on marital practices and associated IPV risk. Methods Interviews and focus group discussions were conducted in 2016 in Dollo Ado, Ethiopia, among Somali women and men living in Bokolmayo refugee camp, host community members, non-governmental staff and service providers, stakeholders, and community and religious leaders (N = 110). Data were transcribed, translated to English, and coded and analyzed thematically using Dedoose software and a codebook developed a priori. Results Findings reveal numerous displacement-related factors that led to perceived shifts in marital practices among refugees, including reductions in child and forced marriages. NGO awareness-raising programs and Ethiopian laws prohibiting child marriage as well as increased access to education for girls were reported to have contributed to these changes, despite continued economic hardship and high perceived risk of non-partner sexual violence within the camp and host community. Polygamy was also perceived to have decreased, primarily due to worsening economic conditions. Forced marriage, polygamy and dowry were reported to contribute to physical IPV, and sexual IPV was reported as common in all types of marital unions. However, there was no evidence that changes in these marital practices contributed to any perceived declines in IPV within this context. Conclusion Safe access to education for girls should be prioritized in humanitarian settings. Interventions to address child and forced marriage should address gender and social norms. Intimate partner violence prevention programming should include specialized content taking into account marital practices including child and forced marriage and polygamy. Laws recognizing sexual IPV within marital relationships are needed to reduce sexual IPV.
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Affiliation(s)
- Vandana Sharma
- 1Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
| | - Adaugo Amobi
- 2Harvard Medical School, Boston, USA.,3Massachusetts General Hospital, Boston, USA
| | - Samuel Tewolde
- Women and Health Alliance International, Addis Ababa, Ethiopia and Paris, France
| | - Negussie Deyessa
- 5Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | - Jennifer Scott
- 2Harvard Medical School, Boston, USA.,Women and Health Alliance International, Addis Ababa, Ethiopia and Paris, France.,6Beth Israel Deaconess Medical Center, Boston, USA
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Traumatic Experiences and Mental Health Risk for Refugees. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061943. [PMID: 32188119 PMCID: PMC7143439 DOI: 10.3390/ijerph17061943] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 02/06/2023]
Abstract
Refugees who settle in Western countries exhibit a high rate of mental health issues, which are often related to experiences throughout the pre-displacement, displacement, and post-displacement processes. Early detection of mental health symptoms could increase positive outcomes in this vulnerable population. The rates and predictors of positive screenings for mental health symptoms were examined among a large sample of refugees, individuals with special immigrant visas, and parolees/entrants (N = 8149) from diverse nationalities. Logistic regression analyses were used to determine if demographic factors and witnessing/experiencing violence predicted positive screenings. On a smaller subset of the sample, we calculated referral acceptance rate by country of origin. Refugees from Syria, Iraq, and Afghanistan were most likely to exhibit a positive screening for mental health symptoms. Refugees from Sudan, Iraq, and Syria reported the highest rate of experiencing violence, whereas those from Iraq, Sudan, and the Democratic Republic of Congo reported the highest rate of witnessing violence. Both witnessing and experiencing violence predicted positive Refugee Health Screener-15 (RHS-15) scores. Further, higher age and female gender predicted positive RHS-15 scores, though neither demographic variable was correlated with accepting a referral for mental health services. The findings from this study can help to identify characteristics that may be associated with risk for mental health symptoms among a refugee population.
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Reques L, Aranda-Fernandez E, Rolland C, Grippon A, Fallet N, Reboul C, Godard N, Luhmann N. Episodes of violence suffered by migrants transiting through Libya: a cross-sectional study in "Médecins du Monde's" reception and healthcare centre in Seine-Saint-Denis, France. Confl Health 2020; 14:12. [PMID: 32140175 PMCID: PMC7048045 DOI: 10.1186/s13031-020-0256-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/29/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction The Central Mediterranean Route, passing through Libya, is one of the most dangerous for migrants. Episodes of violence have been documented but have not been accurately quantified. The objective of the study was to estimate the prevalence of episodes of violence suffered in Libya by migrants consulting the Médecins du Monde reception and healthcare centre in Seine-Saint-Denis (Ile-de-France). Methodology A monocentric cross-sectional study was conducted from February to May 2019 including migrants over the age of 18 years who had passed through Libya and arrived in Europe from 2017. The presence of emotional distress was considered as exclusion criterion. The proportion, frequency and factors associated to physical, deprivation and sexual violence in Libya were estimated through a bespoke questionnaire, as well as healthcare access in Libya and psychosocial support needs. Results Ninety eight people were recruited and 72 were interviewed (17 refused to participate and 9 were excluded). 76.4% were men, with a mean age of 31.9 years, 76.4% had low educational level, 66.7% came from Ivory Coast and 59.7% had left their country for security reasons. The median length of stay in Libya was 180 days. The overall proportion of participants having suffered from violence was 96.4% among men and 88.2% among women. The prevalence of physical, deprivation and sexual violence for men and women were 94.2, 81.7 and 18% and 80.0, 86.7 and 53.3%, respectively. Access to healthcare in Libya was 2.8 and 63.9% of participants were oriented to psychosocial support after the interview. Conclusions The vast majority of migrants reported having been victims of violence during their transit through Libya. Women were at particular risk of sexual violence. Access to health care in Libya was almost non-existent. Psychosocial support for this population is urgent.
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Affiliation(s)
- L Reques
- Médecins du Monde, 62 rue Marcadet, 75018 Paris, France
| | | | - C Rolland
- Médecins du Monde, 62 rue Marcadet, 75018 Paris, France
| | - A Grippon
- Médecins du Monde, 62 rue Marcadet, 75018 Paris, France
| | - N Fallet
- Médecins du Monde, 62 rue Marcadet, 75018 Paris, France
| | - C Reboul
- Médecins du Monde, 62 rue Marcadet, 75018 Paris, France
| | - N Godard
- Médecins du Monde, 62 rue Marcadet, 75018 Paris, France
| | - N Luhmann
- Médecins du Monde, 62 rue Marcadet, 75018 Paris, France
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Murphy M, Bingenheimer JB, Ovince J, Ellsberg M, Contreras-Urbina M. The effects of conflict and displacement on violence against adolescent girls in South Sudan: the case of adolescent girls in the Protection of Civilian sites in Juba. Sex Reprod Health Matters 2020; 27:1601965. [PMID: 31533572 PMCID: PMC7888044 DOI: 10.1080/26410397.2019.1601965] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
There is a paucity of data on violence against women and girls (VAWG) during times of conflict in general and even less information specifically on violence against adolescent girls. Based on secondary analysis of a larger study on VAWG in South Sudan, this article highlights the specific experience of conflict-affected adolescent girls resident in the Juba Protection of Civilian sites. Quantitative data from a cross-sectional household survey shows that the prevalence of non-partner sexual violence (NPSV) (26.5%) and intimate partner violence (IPV) (43.1% of partnered respondents) was high among a cohort of girls who were of adolescent age during the 2013 crisis. Direct exposure to armed conflict increased the odds of respondents experiencing NPSV (AOR: 7.21; 95%CI: 3.94–13.17) and IPV (AOR: 2.37; 95%CI: 1.07–5.29). Quantitative and qualitative data also showed that patriarchal practices, compounded by poverty and unequal power relationships within the home, remain some of the primary drivers of VAWG even in conflict-affected settings. Prevention activities need to consider these wider underlying drivers of VAWG during times of armed conflict, as they remain key factors affecting violence against adolescent girls.
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Affiliation(s)
- Maureen Murphy
- Research Scientist, The Global Women's Institute, The George Washington University , Washington , DC , USA
| | - Jeffrey B Bingenheimer
- Associate Professor, Department of Prevention and Community Health , Milken Institute School of Public Health , Washington , DC , USA
| | - Junior Ovince
- Senior Research Associate, The Global Women's Institute, The George Washington University , Washington , DC , USA
| | - Mary Ellsberg
- Director, The Global Women's Institute, The George Washington University , Washington, DC, USA; Professor, Department of Global Health, Milken Institute School of Public Health, Washington , DC , USA
| | - Manuel Contreras-Urbina
- Director of Research, The Global Women's Institute, The George Washington University , Washington , DC , USA
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Murphy M, Ellsberg M, Contreras-Urbina M. Nowhere to go: disclosure and help-seeking behaviors for survivors of violence against women and girls in South Sudan. Confl Health 2020; 14:6. [PMID: 32082415 PMCID: PMC7017609 DOI: 10.1186/s13031-020-0257-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/04/2020] [Indexed: 11/12/2022] Open
Abstract
Background Despite high rates of violence against women and girls (VAWG) in conflict and humanitarian contexts, many survivors do not tell anyone about their experience or seek help from support r services (e.g. health, legal, psychosocial support, police). Methods This paper examines disclosure and help seeking behaviours of survivors of non-partner sexual violence (NPSV) and intimate partner violence (IPV) among women and girls aged 15–64 from three sites in South Sudan. It seeks to understand how exposure to armed conflict is associated with disclosure and help seeking practices. Results For NPSV, respondents for whom an incident of sexual violence occurred during conflict had twice the odds of telling someone about their experience (aOR: 2.2; 95%CI: 1.3–3.7; p < 0.01) and three times the odds of seeking help (aOR: 3.1; 95%CI: 1.7–5.9, p < .001), compared to respondents for whom the incident of violence did not occur during conflict. Age, the identity of the perpetrator, working status of the woman, poverty and location also affected disclosure and help seeking behaviours for survivors of NPSV. For IPV, exposure to conflict increased the odds a respondent would tell someone about her experience (aOR 1.7; 95%CI 1.2–2.5; p < .01), but was not associated with seeking support services. The severity of IPV affected both disclosure and help seeking behaviours, with the odds of disclosing IPV increasing if the respondent experienced both physical and sexual IPV (compared to only sexual violence), had been injured, thought their well-being was affected, was afraid of their partner, or was controlled by their partner. However, not all these factors were subsequently associated with help seeking behaviours for survivors of IPV and respondents who reported they were sometimes afraid of their partner had reduced odds of seeking help, compared to those who were never afraid of their partners. Conclusions These findings are important as, prior to this analysis, it was unclear how experiencing conflict-related VAWG would influence disclosure and help seeking. Given the findings of this paper, it is important that the international community consider how to reduce barriers to reporting and help seeking for non-conflict-related forms of violence in these settings.
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Affiliation(s)
- Maureen Murphy
- The Global Women's Institute at the George Washington University, 2140 G Street NW, Washington DC, 20052 USA
| | - Mary Ellsberg
- The Global Women's Institute at the George Washington University, 2140 G Street NW, Washington DC, 20052 USA
| | - Manuel Contreras-Urbina
- The Global Women's Institute at the George Washington University, 2140 G Street NW, Washington DC, 20052 USA
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Rubenstein BL, Lu LZN, MacFarlane M, Stark L. Predictors of Interpersonal Violence in the Household in Humanitarian Settings: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2020; 21:31-44. [PMID: 29334000 DOI: 10.1177/1524838017738724] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Interpersonal violence against women and children has increasingly been recognized as a public health priority in humanitarian emergencies. However, because the household is generally considered a private sphere, violence between family members remains neglected. A systematic literature review was conducted to identify predictors of household violence in humanitarian emergencies. PubMed, Web of Science, and Scopus were searched from January 1, 1998, to February 16, 2016. A predictor was defined as any individual, household, or community-level exposure that increases or decreases the risk associated with physical, sexual, or emotional interpersonal violence between two or more people living together. All studies reporting on quantitative research were eligible for inclusion. Results were analyzed using qualitative synthesis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed as applicable. The search strategy resulted in 2,587 original records, of which 33 studies met inclusion criteria. Thirty-two of the 33 studies used a cross-sectional design. This was the first known systematic review of predictors of household violence in humanitarian settings. The household framework drew attention to several factors that are associated with violence against both women and children, including conflict exposure, alcohol and drug use, income/economic status, mental health/coping strategies, and limited social support. There is a need for longitudinal research and experimental designs that can better establish temporality between exposures and household violence outcomes, control for confounding, and inform practice. In the interim, programmers and policy makers should try to leverage the predictors identified by this review for integrated violence prevention and response strategies, with the important caveat that ongoing evaluation of such strategies is needed.
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Affiliation(s)
- Beth L Rubenstein
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lily Zhi Ning Lu
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Matthew MacFarlane
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lindsay Stark
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
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Logie CH, Okumu M, Mwima S, Hakiza R, Irungi KP, Kyambadde P, Kironde E, Narasimhan M. Social ecological factors associated with experiencing violence among urban refugee and displaced adolescent girls and young women in informal settlements in Kampala, Uganda: a cross-sectional study. Confl Health 2019; 13:60. [PMID: 31867053 PMCID: PMC6918605 DOI: 10.1186/s13031-019-0242-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/27/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Research on violence targeting urban forcibly displaced adolescent girls and young women (AGYW) is limited, particularly regarding polyvictimization (exposure to multiple forms of violence). Yet there is a global trend of refugee urbanization, and urban AGYW are at the nexus of violence disparities among adolescents, forcibly displaced persons, and slum dwellers. This study explored factors associated with young adulthood violence (> 16 years) (YAV) and intimate partner violence (IPV) among forcibly displaced AGYW in Kampala, Uganda. METHODS We conducted a cross-sectional survey with forcibly displaced AGYW aged 16-24 from five informal settlement (slum) communities across Kampala (Kabalagala, Rubaga, Kansanga, Katwe, Nsambya) using peer network sampling. We assessed YAV (experienced at age 16 or above) (sexual, physical, emotional violence) and recent (past 12-month) IPV (physical, sexual, control violence). We conducted descriptive statistics, followed by multinomial logistic regression analyses to explore social ecological factors (e.g., intrapersonal: depression; interpersonal: sexual relationship power, community: food insecurity) associated with experiencing YAV and YAV polyvictimization, and IPV and IPV polyvictimization. RESULTS Over half of participants (n = 333; mean age = 19.31; SD = 2.56, range = 16-24) reported YAV (n = 179; 53.7%) and 9.3% (n = 41) reported YAV polyvictimization. Most participants that were in an intimate relationship in the last 12 months (n = 200; 85.8%) reported IPV, among these, 45.5% reported one form of IPV and 54.5% reported IPV polyvictimization. In adjusted analyses, experiencing any YAV was significantly associated with: adolescent sexual and reproductive health (SRH) stigma; sexual relationship power; mobile app usage; depressive symptoms; childhood abuse; and childhood polyvictimization. In adjusted analyses YAV polyvictimization was associated with: depressive symptoms; childhood polyvictimization; sexual relationship power; and food insecurity. Recent IPV polyvictimization in adjusted analyses was associated with owning/using a mobile phone and depressive symptoms. Participants with higher sexual relationship power had lower odds of recent IPV polyvictimization. CONCLUSION Findings suggest that YAV and IPV polyvictimization require urgent attention among forcibly displaced AGYW in Kampala. Multi-level strategies are required to address intrapersonal e.g. (depression), interpersonal (e.g. childhood abuse, sexual relationship power) and community (e.g. adolescent SRH stigma, food insecurity) factors associated with experiencing violence. Future research can tailor approaches to advance health, agency and human rights among urban forcibly displaced AGYW.
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Affiliation(s)
- Carmen H. Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4 Canada
- Women’s College Research Institute, Women’s College Hospital, 76 Grenville St, Toronto, ON M5G 1N8 Canada
| | - Moses Okumu
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4 Canada
- School of Social Work, University of North Carolina-Chapel Hill, 325 Pittsboro ST CB#3550, Chapel Hill, NC 27599 USA
- National STI Control Unit, Mulago Hospital, Kampala, Uganda
| | - Simon Mwima
- AIDS Control Program, Ministry of Health, Plot 6, Lourdel Road, Nakasero, Kampala, Uganda
- Most At Risk Population Initiative, Kampala, Uganda
| | - Robert Hakiza
- Most At Risk Population Initiative, Kampala, Uganda
- Young African Refugees for Integral Development (YARID), Nsambya Gogonya, Kampala, Uganda
| | | | - Peter Kyambadde
- National STI Control Unit, Mulago Hospital, Kampala, Uganda
- AIDS Control Program, Ministry of Health, Plot 6, Lourdel Road, Nakasero, Kampala, Uganda
- Most At Risk Population Initiative, Kampala, Uganda
| | | | - Manjulaa Narasimhan
- Department of Reproductive Health and Research, World Health Organization, 20 Avenue Appia, CH-1211, 27 Geneva, Switzerland
- World Health Organization, Department of Reproductive Health and Research, including the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme (HRP), Geneva, Switzerland
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Winzer L, Krahé B, Guest P. The Scale of Sexual Aggression in Southeast Asia: A Review. TRAUMA, VIOLENCE & ABUSE 2019; 20:595-612. [PMID: 29333964 DOI: 10.1177/1524838017725312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Southeast Asia is one of the most dynamic regions in the world. It is experiencing rapid socioeconomic change that may influence the level of sexual aggression, but data on the scale of sexual aggression in the region remain sparse. The aim of the present article was to systematically review the findings of studies available in English on the prevalence of self-reported sexual aggression and victimization among women and men above the age of 12 years in the 11 countries of Southeast Asia (Brunei, Cambodia, East Timor, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand, and Vietnam). Based on four scientific databases, the search engine Google, Opengrey database, and reference checking, 49 studies were found on sexual victimization. Of those, 32 included only women. Self-reported perpetration was assessed by only three studies and included all-male samples. Prevalence rates varied widely across studies but showed that sexual victimization was widespread among different social groups, irrespective of sex and sexual orientation. Methodological heterogeneity, lack of representativeness of samples, imbalance of information available by country, missing information within studies, and cultural differences hampered the comparability between and within countries. There is a need for operationalizations that specifically address sexual aggression occurring after the age of consent, based on detailed behavioral descriptions of unwanted sexual experiences and allied to a qualitative approach with cultural sensitivity. Data on sexual aggression in conflict settings and in human trafficking are also limited. Recommendations for future research are presented in the discussion.
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Affiliation(s)
- Lylla Winzer
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom, Thailand
| | - Barbara Krahé
- Department of Psychology, University of Potsdam, Potsdam, Germany
| | - Philip Guest
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom, Thailand
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Araujo JDO, de Souza FM, Proença R, Bastos ML, Trajman A, Faerstein E. Prevalence of sexual violence among refugees: a systematic review. Rev Saude Publica 2019; 53:78. [PMID: 31553381 PMCID: PMC6752644 DOI: 10.11606/s1518-8787.2019053001081] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 12/04/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To synthesize data about the prevalence of sexual violence (SV) among refugees around the world. METHODS A systematic review was conducted from the search in seven bibliographic databases. Studies on the prevalence of SV among refugees and asylum seekers of any country, sex or age, whether in English, French, Spanish and Portuguese, were eligible. RESULTS Of the 2,906 titles found, 60 articles were selected. The reported prevalence of SV was largely variable (0% to 99.8%). Reports of SV were collected in all continents, with 42% of the articles mentioning it in refugees from Africa (prevalence from 1.3% to 100%). The rape was the most reported SV in 65% of the studies (prevalence from 0% to 90.9%). The main victims were women in 89% of the studies, all the way, especially when still in the countries of origin. The SV was perpetrated particularly by intimate partners, but also by agents of supposed protection. Few studies have reported SV in men and children; the prevalence reached up to 39.3% and 90.9%, respectively. Approximately one-third of the studies (32%) were carried out in refugee camps and more than half (52%) in health services using mental health assessment tools. No study has addressed the most recent migratory crisis. Meta-analysis was not performed due to the methodological heterogeneity of the studies. CONCLUSIONS SV is a prevalent problem affecting refugees of both sexes, of all ages, throughout the migratory journey, particularly those from Africa. Protection measures are urgently needed, and further studies, with more appropriate tools, may better measure the current magnitude of the problem.
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Affiliation(s)
- Juliana de Oliveira Araujo
- Universidade do Estado do Rio de Janeiro
Instituto de Medicina Social
Programa de Pós-Graduação em Saúde Coletiva
Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Programa de Pós-Graduação em Saúde Coletiva. Rio de Janeiro, RJ, Brasil
| | - Fernanda Mattos de Souza
- Universidade do Estado do Rio de Janeiro
Instituto de Medicina Social
Programa de Pós-Graduação em Saúde Coletiva
Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Programa de Pós-Graduação em Saúde Coletiva. Rio de Janeiro, RJ, Brasil
| | - Raquel Proença
- Universidade do Estado do Rio de Janeiro
Instituto de Medicina Social
Programa de Pós-Graduação em Saúde Coletiva
Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Programa de Pós-Graduação em Saúde Coletiva. Rio de Janeiro, RJ, Brasil
| | - Mayara Lisboa Bastos
- Universidade do Estado do Rio de Janeiro
Instituto de Medicina Social
Programa de Pós-Graduação em Saúde Coletiva
Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Programa de Pós-Graduação em Saúde Coletiva. Rio de Janeiro, RJ, Brasil
| | - Anete Trajman
- Universidade Federal do Rio de Janeiro. Faculdade de Medicina. Programa de pós-Graduação em Clínica médica. Rio de Janeiro, RJ, Brasil
- McGill University. Montreal, QC, Canadá
| | - Eduardo Faerstein
- Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil
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López-Domene E, Granero-Molina J, Fernández-Sola C, Hernández-Padilla JM, López-Rodríguez MDM, Fernández-Medina IM, Guerra-Martín MD, Del Mar Jiménez-Lasserrrotte M. Emergency Care for Women Irregular Migrants Who Arrive in Spain by Small Boat: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183287. [PMID: 31500213 PMCID: PMC6765787 DOI: 10.3390/ijerph16183287] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/31/2019] [Accepted: 09/05/2019] [Indexed: 02/06/2023]
Abstract
Background: this study aimed to describe and understand the experiences and health needs of women irregular migrants during emergency care provision upon arrival in Spain by small boat. Methods: a qualitative study based on Gadamer’s phenomenology was used. The data collection included 13 in-depth interviews with women irregular migrants and 10 in-depth interviews with key informants. The study took place in the Spanish Red Cross’ facilities between February 2017 and April 2018. Results: two main themes emerged from the data analysis: the need for emergency care focused on women irregular migrants with the sub-themes ‘Women irregular migrants as objects of sexual exploitation’ and ‘The mother-child dyad as the axis in human trafficking’; and developing an emergency care gender policy for women irregular migrants, with the subthemes ‘Healthcare in a police-controlled setting: detecting weaknesses’ and ‘Promoting screening and safety protocols focused on women irregular migrants’. Conclusions: women irregular migrants who arrive in Spain by small boat have specific needs and healthcare problems. Due to strict safety conditions during emergency care provision, rape and human trafficking can go unnoticed. Implications: interdisciplinary care protocols and new health policies that have a gender perspective are needed to improve the emergency care provided to women irregular migrants.
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Affiliation(s)
| | - José Granero-Molina
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almería, Spain.
- Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco 4780000, Chile.
| | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almería, Spain.
- Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco 4780000, Chile.
| | - José Manuel Hernández-Padilla
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almería, Spain.
- School of Health and Education, Middlesex University, London, NW4 4BT, UK.
| | | | | | | | - María Del Mar Jiménez-Lasserrrotte
- Cruz Roja Española, 04002 Almería, Spain.
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almería, Spain.
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Glass N, Perrin N, Marsh M, Clough A, Desgroppes A, Kaburu F, Ross B, Read-Hamilton S. Effectiveness of the Communities Care programme on change in social norms associated with gender-based violence (GBV) with residents in intervention compared with control districts in Mogadishu, Somalia. BMJ Open 2019; 9:e023819. [PMID: 30872541 PMCID: PMC6429733 DOI: 10.1136/bmjopen-2018-023819] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Determine the effectiveness of the Communities Care programme (CCP) on change in harmful social norms associated with gender-based violence (GBV) and confidence in provision of services with residents in intervention compared with control district. We hypothesised that residents in the intervention district would report a decrease in support for harmful social norms and increase in confidence in services in comparison with control district. SETTING The study was conducted in Mogadishu, Somalia. PARTICIPANTS In the intervention district, 192 community members (50% women) completed baseline surveys with 163 (84.9%) retained at endline. In the control district, 195 community members (50% women) completed baseline surveys with 167 (85.6%) retained at endline. INTERVENTION CCP uses facilitated dialogues with community members to catalyse GBV prevention actions and provides training to diverse sectors to strengthen response services for GBV survivors. RESULTS Residents in the intervention district had significantly greater improvement in change in social norms: (1) response to sexual violence (b=-0.214, p=0.041); (2) protecting family honour (b=-0.558, p<0.001); and (3) husband's right to use violence (b=-0.309, p=0.003) compared with control district participants. The greatest change was seen in the norm of 'protecting family honour' with a Cohen's d effect size (ES) of 0.70, followed by the norm 'husband's right to use violence' (ES=0.38), and then the norm of 'response to sexual violence' (ES=0.28). Residents in intervention district had a significantly greater increase in confidence in provision of GBV services across diverse sectors than the control district (b=0.318, p<0.001) with an associated effect size of 0.67. There were no significant differences between residents in intervention and control districts on change in personal beliefs on the norms. CONCLUSION The evaluation showed the promise of CCP in changing harmful social norms associated with GBV and increasing confidence in provision of services in a complex humanitarian setting.
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Affiliation(s)
- Nancy Glass
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nancy Perrin
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Amber Clough
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Amelie Desgroppes
- Comitato Internazionale per lo Sviluppo dei Popoli (CISP) Somalia, Nairobi, Kenya
| | - Francesco Kaburu
- Comitato Internazionale per lo Sviluppo dei Popoli (CISP) Somalia, Nairobi, Kenya
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Perrin N, Marsh M, Clough A, Desgroppes A, Yope Phanuel C, Abdi A, Kaburu F, Heitmann S, Yamashina M, Ross B, Read-Hamilton S, Turner R, Heise L, Glass N. Social norms and beliefs about gender based violence scale: a measure for use with gender based violence prevention programs in low-resource and humanitarian settings. Confl Health 2019; 13:6. [PMID: 30899324 PMCID: PMC6408811 DOI: 10.1186/s13031-019-0189-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 02/20/2019] [Indexed: 11/22/2022] Open
Abstract
Background Gender-based violence (GBV) primary prevention programs seek to facilitate change by addressing the underlying causes and drivers of violence against women and girls at a population level. Social norms are contextually and socially derived collective expectations of appropriate behaviors. Harmful social norms that sustain GBV include women’s sexual purity, protecting family honor over women’s safety, and men’s authority to discipline women and children. To evaluate the impact of GBV prevention programs, our team sought to develop a brief, valid, and reliable measure to examine change over time in harmful social norms and personal beliefs that maintain and tolerate sexual violence and other forms of GBV against women and girls in low resource and complex humanitarian settings. Methods The development and testing of the scale was conducted in two phases: 1) formative phase of qualitative inquiry to identify social norms and personal beliefs that sustain and justify GBV perpetration against women and girls; and 2) testing phase using quantitative methods to conduct a psychometric evaluation of the new scale in targeted areas of Somalia and South Sudan. Results The Social Norms and Beliefs about GBV Scale was administered to 602 randomly selected men (N = 301) and women (N = 301) community members age 15 years and older across Mogadishu, Somalia and Yei and Warrup, South Sudan. The psychometric properties of the 30-item scale are strong. Each of the three subscales, “Response to Sexual Violence,” “Protecting Family Honor,” and “Husband’s Right to Use Violence” within the two domains, personal beliefs and injunctive social norms, illustrate good factor structure, acceptable internal consistency, reliability, and are supported by the significance of the hypothesized group differences. Conclusions We encourage and recommend that researchers and practitioners apply the Social Norms and Beliefs about GBV Scale in different humanitarian and global LMIC settings and collect parallel data on a range of GBV outcomes. This will allow us to further validate the scale by triangulating its findings with GBV experiences and perpetration and assess its generalizability across diverse settings. Electronic supplementary material The online version of this article (10.1186/s13031-019-0189-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nancy Perrin
- Johns Hopkins School of Nursing, 525 North Wolfe Street, Baltimore, MD 21205 USA
| | | | - Amber Clough
- Johns Hopkins School of Nursing, 525 North Wolfe Street, Baltimore, MD 21205 USA
| | - Amelie Desgroppes
- Comitato Internazionale per lo Sviluppo dei Popoli (CISP) Somalia, Nairobi, Kenya
| | | | - Ali Abdi
- Comitato Internazionale per lo Sviluppo dei Popoli (CISP) Somalia, Nairobi, Kenya
| | - Francesco Kaburu
- Comitato Internazionale per lo Sviluppo dei Popoli (CISP) Somalia, Nairobi, Kenya
| | | | | | | | | | - Rachael Turner
- Johns Hopkins School of Nursing, 525 North Wolfe Street, Baltimore, MD 21205 USA
| | - Lori Heise
- Johns Hopkins School of Nursing, 525 North Wolfe Street, Baltimore, MD 21205 USA.,9Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Nancy Glass
- Johns Hopkins School of Nursing, 525 North Wolfe Street, Baltimore, MD 21205 USA
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Beek K, McFadden A, Dawson A. The role and scope of practice of midwives in humanitarian settings: a systematic review and content analysis. HUMAN RESOURCES FOR HEALTH 2019; 17:5. [PMID: 30642335 PMCID: PMC6333021 DOI: 10.1186/s12960-018-0341-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 12/20/2018] [Indexed: 05/15/2023]
Abstract
BACKGROUND Midwives have an essential role to play in preparing for and providing sexual and reproductive health (SRH) services in humanitarian settings due to their unique knowledge and skills, position as frontline providers and geographic and social proximity to the communities they serve. There are considerable gaps in the international guidance that defines the scope of practice of midwives in crises, particularly for the mitigation and preparedness, and recovery phases. We undertook a systematic review to provide further clarification of this scope of practice and insights to optimise midwifery performance. The review aimed to determine what SRH services midwives are involved in delivering across the emergency management cycle in humanitarian contexts, and how they are working with other professionals to deliver health care. METHODS Four electronic databases and the websites of 33 organisations were searched between January and March 2017. Papers were eligible for inclusion if they were published in English between 2007 and 2017 and reported primary research pertaining to the role of midwives in delivering and performing any component of sexual and/or reproductive health in humanitarian settings. Content analysis was used to map the study findings to the Minimum Initial Service Package (MISP) for SRH across the three phases of the disaster management cycle and identify how midwives work with other members of the health care team. RESULTS Fourteen studies from ten countries were included. Twelve studies were undertaken in conflict settings, and two were conducted in the context of the aftermath of natural disasters. We found a paucity of evidence from the research literature that examines the activities and roles undertaken by midwives across the disaster management cycle. This lack of evidence was more apparent during the mitigation and preparedness, and recovery phases than the response phase of the disaster management cycle. CONCLUSION Research-informed guidelines and strategies are required to better align the scope of practice of midwives with the objectives of multi-agency guidelines and agreements, as well as the activities of the MISP, to ensure that the potential of midwives can be acknowledged and optimised across the disaster management cycle.
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Affiliation(s)
- Kristen Beek
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Alison McFadden
- Mother and Infant Research Unit, School of Nursing & Health Sciences, University of Dundee, Scotland, UK
| | - Angela Dawson
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Wringe A, Yankah E, Parks T, Mohamed O, Saleh M, Speed O, Hémono R, Relyea B, Ibrahim M, Sandhu JS, Scott J. Altered social trajectories and risks of violence among young Syrian women seeking refuge in Turkey: a qualitative study. BMC WOMENS HEALTH 2019; 19:9. [PMID: 30630476 PMCID: PMC6329126 DOI: 10.1186/s12905-019-0710-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/02/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND There is limited evidence regarding the ways in which displacement disrupts social norms, expectations and trajectories for adolescent girls and young women and the resulting impacts on their risks of violence. This knowledge gap is especially marked with regards to Syrian adolescent girls and young women seeking refuge in Turkey. We explored risks of gender-based violence against Syrian adolescent girls and young women in Turkey and examined how these risks were shaped by their displacement. METHODS Data were collected in August 2016 in Izmir, Turkey through five sex-specific focus group discussions with Syrian adolescents and young people (aged 15-25 years) and two mixed gender focus group discussions with Syrian adults (18 years and older). Group discussions covered the issues facing Syrian adolescents and young women in Turkey, and how these were influenced by their displacement. Discussions in Arabic were audio-recorded, transcribed and translated into English. Data were coded inductively, and analysed thematically. RESULTS Syrian adolescent girls and young women expressed an increased sense of vulnerability to violence since their displacement. Due to financial strains and limited educational opportunities, they were often encouraged by parents to work or marry, both of which they perceived to increase the risks of violence. In contrast, some adults suggested that marriage could protect adolescent girls and young women from risks of violence associated with working. Being alone outside the home was viewed as risky by all participants due to pervasive sexual, verbal and physical harassment, aggression, and even kidnapping attempts. To limit these risks, many parents reported keeping adolescent girls and young women at home, or ensuring that they were accompanied by male relatives when in public. CONCLUSIONS Syrian adolescent girls and young women face multiple risks of violence following displacement related to altered social trajectories. Some family-based strategies to protect young women from violence could reinforce restrictive gender norms and increase risks of violence. Interventions to address violence should include providing safe spaces, access to education and safe transport for young women, and financial support for families as well as community-based interventions to address the daily risks of sexual harassment in public spaces.
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Affiliation(s)
- Alison Wringe
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, UK.
| | - Ekua Yankah
- Women and Health Alliance International (WAHA), Paris, France.,University of New South Wales, Sydney, Australia
| | - Tania Parks
- Women and Health Alliance International (WAHA), Paris, France.,Institut d'études politiques de Paris, Paris, France
| | - Omar Mohamed
- University of California Berkeley, Berkeley, California, USA.,Gobee Group, Oakland, California, USA
| | | | - Olivia Speed
- Women and Health Alliance International (WAHA), Paris, France
| | - Rebecca Hémono
- Women and Health Alliance International (WAHA), Paris, France
| | - Bridget Relyea
- Women and Health Alliance International (WAHA), Paris, France
| | | | - Jaspal S Sandhu
- University of California Berkeley, Berkeley, California, USA.,Gobee Group, Oakland, California, USA
| | - Jennifer Scott
- Women and Health Alliance International (WAHA), Paris, France.,Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Vojdik VK. Sexual Abuse and Exploitation by UN Peacekeepers as Conflict-Related Gender Violence. INTERNATIONAL HUMAN RIGHTS OF WOMEN 2019. [DOI: 10.1007/978-981-10-8905-3_28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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77
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De Schrijver L, Vander Beken T, Krahé B, Keygnaert I. Prevalence of Sexual Violence in Migrants, Applicants for International Protection, and Refugees in Europe: A Critical Interpretive Synthesis of the Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1979. [PMID: 30208610 PMCID: PMC6165364 DOI: 10.3390/ijerph15091979] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 09/07/2018] [Indexed: 11/21/2022]
Abstract
(1) Background: Sexual violence (SV) is a major public health problem, with negative socio-economic, physical, mental, sexual, and reproductive health consequences. Migrants, applicants for international protection, and refugees (MARs) are vulnerable to SV. Since many European countries are seeing high migratory pressure, the development of prevention strategies and care paths focusing on victimised MARs is highly needed. To this end, this study reviews evidence on the prevalence of SV among MAR groups in Europe and the challenges encountered in research on this topic. (2) Methods: A critical interpretive synthesis of 25 peer-reviewed academic studies and 22 relevant grey literature documents was conducted based on a socio-ecological model. (3) Results: Evidence shows that SV is highly frequent in MARs in Europe, yet comparison with other groups is still difficult. Methodologically and ethically sound representative studies comparing between populations are still lacking. Challenges in researching SV in MARs are located at the intrapersonal, interpersonal, community, societal, and policy levels. (4) Conclusions: Future research should start with a clear definition of the concerned population and acts of SV to generate comparable data. Participatory qualitative research approaches could be applied to better grasp the complexity of interplaying determinants of SV in MARs.
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Affiliation(s)
- Lotte De Schrijver
- UGent-International Centre for Reproductive Health, 9000 Ghent, Belgium.
| | - Tom Vander Beken
- UGent-Institute for International Research on Criminal Policy, 9000 Ghent, Belgium.
| | - Barbara Krahé
- Department of Psychology, University of Potsdam, 14476 Potsdam, Germany.
| | - Ines Keygnaert
- UGent-International Centre for Reproductive Health, 9000 Ghent, Belgium.
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Wirtz AL, Perrin NA, Desgroppes A, Phipps V, Abdi AA, Ross B, Kaburu F, Kajue I, Kutto E, Taniguchi E, Glass N. Lifetime prevalence, correlates and health consequences of gender-based violence victimisation and perpetration among men and women in Somalia. BMJ Glob Health 2018; 3:e000773. [PMID: 30105094 PMCID: PMC6074632 DOI: 10.1136/bmjgh-2018-000773] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/14/2018] [Accepted: 05/17/2018] [Indexed: 11/07/2022] Open
Abstract
Background Humanitarian emergencies increase the risk of gender-based violence (GBV). We estimated the prevalence of GBV victimisation and perpetration among women and men in urban settings across Somalia, which has faced decades of war and natural disasters that have resulted in massive population displacements. Methods A population-based survey was conducted in 14 urban areas across Somalia between December 2014 and November 2015. Results A total of 2376 women and 2257 men participated in the survey. One in five men (22.2%, 95% CI 20.5 to 23.9) and one in seven (15.5%; 95% CI 14.1 to 17.0) women reported physical or sexual violence victimisation during childhood. Among women, 35.6% (95% CI 33.4 to 37.9) reported adult lifetime experiences of physical or sexual intimate partner violence (IPV) and 16.5% (95% CI 15.1 to 18.1) reported adult lifetime experience of physical or sexual non-partner violence (NPV). Almost one-third of men (31.2%; 95% CI 29.4 to 33.1) reported victimisation as an adult, the majority of which was physical violence. Twenty-two per cent (21.7%; 95% CI 19.5 to 24.1) of men reported lifetime sexual or physical IPV perpetration and 8.1% (95% CI 7.1 to 9.3) reported lifetime sexual or physical NPV perpetration. Minority clan membership, displacement, exposure to parental violence and violence during childhood were common correlates of IPV and NPV victimisation and perpetration among women and men. Victimisation and perpetration were also strongly associated with recent depression and experiences of miscarriage or stillbirth. Conclusion GBV is prevalent and spans all regions of Somalia. Programmes that support nurturing environments for children and provide health and psychosocial support for women and men are critical to prevent and respond to GBV.
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Affiliation(s)
- Andrea L Wirtz
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nancy A Perrin
- Community Public Health Nursing, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | | | - Verena Phipps
- The World Bank, Washington, District of Columbia, USA
| | - Ali A Abdi
- Community Public Health Nursing, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Brendan Ross
- United Nations Children's Emergency Fund (Unicef), Mogadishu, Somalia
| | - Francesco Kaburu
- Comitato Internazionale per lo Sviluppo dei Popoli, Nairobi, Kenya
| | - Isatu Kajue
- United Nations Population Fund (UNFPA), New York City, New York, USA
| | - Ezekiel Kutto
- United Nations Population Fund (UNFPA), New York City, New York, USA
| | - Eri Taniguchi
- United Nations Population Fund (UNFPA), New York City, New York, USA
| | - Nancy Glass
- Community Public Health Nursing, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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Sweileh WM. Global research output in the health of international Arab migrants (1988-2017). BMC Public Health 2018; 18:755. [PMID: 29914447 PMCID: PMC6006754 DOI: 10.1186/s12889-018-5690-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/11/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In the past few decades Arab countries had witnessed several intra-regional conflicts and civil wars that led to the creation of millions of refugees and migrants. Assessment of research activity is an indicator of national and international efforts to improve the health of those millions of war victims. Therefore, the aim of this study was to analyze published literature in international Arab migrants. METHODS Literature in international Arab migrants published during the past three decades (1988-2017) was retrieved using Scopus database. A bibliometric analysis methodology was implemented on the retrieved data. Author keywords were mapped using VOSviewer program. RESULTS In total, 1186 documents were retrieved. More than half (658; 55.5%) were published in the last five years (2013-2017). Retrieved documents received an average of 8.6 citations per document and an h-index of 45. The most frequently encountered author keywords were refugees and mental health-related terms. Three countries in the Middle East; Jordan, Lebanon, and Turkey, were among the most active countries. In total, 765 (63.7%) documents were about refugees, 421 (35.5%) were about migrant workers, 30 (2.5%) were about asylum seekers, and 7 (0.6%) were about trafficked and smuggled people. When data were analyzed for the nationality of migrants being investigated, 288 (24.3%) documents were about Syrians, 214 (18.0%) were about Somali, 222 (18.7%) were about Arab or Middle Eastern in general, and 147 (12.4%) were about Palestinians. The American University of Beirut ranked first with 45 (2.4%) publications. The most active journal in publishing research in this field was Journal of Immigrant and Minority Health (35; 3.0%) followed by Journal of Refugee Studies (23, 1.9%), The Lancet (19, 1.6%) and BMC Public Health (16, 1.3%). Publications from Jordan and Lebanon had the highest percentage of international research collaboration. CONCLUSION Research in international Arab migrants showed a dramatic increase in the last few years mostly due to the Syrian war. Both mental health and Syrian refugees dominated the literature of international Arab migrants. Research in infectious diseases was relatively low. Research on non-refugee migrants such as workers, trafficked victims, and asylum seekers was also relatively low.
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Affiliation(s)
- Waleed M Sweileh
- Department of Physiology and Pharmacology/Toxicology, College of Medicine and Health Sciences, Nablus, Palestine.
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80
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Koegler E, Kennedy C, Mrindi J, Bachunguye R, Winch P, Ramazani P, Makambo MT, Glass N. Understanding How Solidarity Groups-A Community-Based Economic and Psychosocial Support Intervention-Can Affect Mental Health for Survivors of Conflict-Related Sexual Violence in Democratic Republic of the Congo. Violence Against Women 2018; 25:359-374. [PMID: 29911487 DOI: 10.1177/1077801218778378] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Solidarity groups were established in eastern Democratic Republic of Congo to provide female survivors of conflict-related sexual violence an opportunity to generate income, establish networks of support, and cope with atrocities. Qualitative data were collected from 12 members of solidarity groups to explore factors that contributed to members' mental health. All women identified some improvement (physiological, psychological, economic, or social) since joining the solidarity group, but none of the women were free from ailments. Our findings suggest that a multifaceted intervention in women's own communities has the potential to improve multiple aspects of women's lives, including mental health.
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Affiliation(s)
- Erica Koegler
- 1 Johns Hopkins University, Baltimore, MD, USA.,2 University of Missouri, Columbia, USA
| | | | - Janvier Mrindi
- 3 Foundation RamaLevina, Bukavu, Democratic Republic of the Congo
| | | | - Peter Winch
- 1 Johns Hopkins University, Baltimore, MD, USA
| | - Paul Ramazani
- 3 Foundation RamaLevina, Bukavu, Democratic Republic of the Congo
| | | | - Nancy Glass
- 1 Johns Hopkins University, Baltimore, MD, USA
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81
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Mhlongo MD, Tomita A, Thela L, Maharaj V, Burns JK. Sexual trauma and post-traumatic stress among African female refugees and migrants in South Africa. S Afr J Psychiatr 2018; 24. [PMID: 29930492 DOI: 10.4102/sajpsychiatry.v24i0.1208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background While there is considerable research in developed countries on the nature and extent of post-traumatic stress among refugees and migrants, few report on female Africans migrating within Africa. Aim The aim of this study was to investigate the association between exposure to traumatic life events and post-traumatic stress disorder risk in refugees and migrants in Durban, South Africa, with specific focus on sexual trauma events among women. Methods Interviews were conducted on 157 consenting non-South African adults using a sociodemographic questionnaire, Life Events Checklist (documenting traumatic events experienced) and the Harvard Trauma Questionnaire (measuring post-traumatic symptomatology). Associations between total number of traumatic events and post-traumatic stress were explored using adjusted regression models. Results The results of one model indicated that greater numbers of traumatic life events experienced by women were associated with raised odds of post-traumatic stress disorder risk (β = 1.48; p < 0.001). Another model indicated that exposure to sexual trauma events were associated with greater odds of post-traumatic stress disorder risk (β = 4.09; p = 0.02). Conclusion Our findings highlight the critical importance of mental health service for females with history of sexual traumatic events for this vulnerable population.
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Affiliation(s)
- Mpho D Mhlongo
- Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
| | - Andrew Tomita
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Lindokuhle Thela
- Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
| | - Varsha Maharaj
- Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
| | - Jonathan K Burns
- Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa.,Institute of Health Research, University of Exeter, United Kingdom
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Sommer M, Muñoz-Laboy M, Williams A, Mayevskaya Y, Falb K, Abdella G, Stark L. How gender norms are reinforced through violence against adolescent girls in two conflict-affected populations. CHILD ABUSE & NEGLECT 2018; 79:154-163. [PMID: 29471217 DOI: 10.1016/j.chiabu.2018.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 01/07/2018] [Accepted: 02/05/2018] [Indexed: 06/08/2023]
Abstract
Violence against women and girls is a global concern, and particularly salient in humanitarian settings. Successful efforts to prevent gender-based violence in humanitarian settings must address a wide range of issues, from discriminatory laws to explicit community support for violence, and yet, at the core of these efforts is reducing oppressive gender and social norms. This study examined local attitudes towards and social norms around responding to physical and sexual abuse of girls through interviews conducted with adolescent girls (n = 66) and with caregivers (n = 58) among two conflict-affected populations: villages in South Kivu in the Democratic Republic of the Congo and Sudanese and South Sudanese refugees in Ethiopian camps. The findings suggest how communities use violence as a tool to enforce the importance of girls practicing community-defined "good" adolescent girl behavior, and have implications for gender-based violence programming among other conflict-affected populations.
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Affiliation(s)
- Marni Sommer
- Mailman School of Public Health, Columbia University, Department of Sociomedical Sciences, 722 W. 168th Street, Room 537, New York, NY, 10032, United States.
| | - Miguel Muñoz-Laboy
- School of Social Work, College of Public Health, Temple University, Ritter Annex, 5th Floor, 1301 W. Cecil B. Moore Avenue, Philadelphia, PA, 10122, United States.
| | - Anaise Williams
- Mailman School of Public Health, Columbia University, Department of Population and Family Health, 60 Haven Avenue, B-4, Suite 432, New York, NY, 10032, United States.
| | - Yana Mayevskaya
- Mailman School of Public Health, Columbia University, Department of Population and Family Health, 60 Haven Avenue, B-4, Suite 432, New York, NY, 10032, United States.
| | - Kathryn Falb
- International Rescue Committee, 122 E. 42nd Street, New York, NY, 10168, United States.
| | - Gizman Abdella
- International Rescue Committee, TK International Bldg. 6th Floor, Bole Rd, Addis Ababa, Ethiopia.
| | - Lindsay Stark
- Mailman School of Public Health, Columbia University, Department of Population and Family Health, 60 Haven Avenue, B-4, Suite 432, New York, NY, 10032, United States.
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Odwe G, Undie CC, Obare F. Attitudes towards help-seeking for sexual and gender-based violence in humanitarian settings: the case of Rwamwanja refugee settlement scheme in Uganda. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018. [PMID: 29530031 PMCID: PMC5848542 DOI: 10.1186/s12914-018-0154-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Sexual and gender-based violence (SGBV) remains a silent epidemic in many humanitarian settings with many survivors concealing their experiences. Attitudes towards help-seeking for SGBV is an important determinant of SGBV service use. This paper examined the association between attitudes towards seeking care and knowledge and perceptions about SGBV among men and women in a humanitarian setting in Uganda. METHODS A cross-sectional survey was conducted from May to June 2015 among 601 heads of refugee households (261 females and 340 males) in Rwamwanja Refugees Settlement Scheme, South West Uganda. Analysis entails cross-tabulation with chi-square test and estimation of a multivariate logistic regression model. RESULTS Results showed increased odds of having a favorable attitude toward seeking help for SGBV among women with progressive attitudes towards SGBV (OR = 2.78, 95% CI: 1.56-4.95); who felt that SBGV was not tolerated in the community (OR = 2.03, 95% CI: 1.03-4.00); those who had not experienced violence (OR = 2.08, 95% CI: 1.06-4.07); and those who were aware of the timing for post-exposure prophylaxis (OR = 3.08, 95% CI: 1.57-6.04). In contrast, results for men sample showed lack of variations in attitude toward seeking help for SGBV for all independent variables except timing for PEP (OR = 2.57, 95% CI: 1.30-5.10). Among individuals who had experienced SGBV, the odds of seeking help was more likely among those with favorable attitude towards seeking help (OR = 4.22, 95% CI: 1.47-12.06) than among those with unfavorable help-seeking attitudes. CONCLUSION The findings of the paper suggest that targeted interventions aimed at promoting awareness and progressive attitudes towards SGBV are likely to encourage positive help-seeking attitudes and behaviors in humanitarian contexts.
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Affiliation(s)
- George Odwe
- Population Council, P. O. Box 17643 -00500, Nairobi, Kenya.
| | - Chi-Chi Undie
- Population Council, P. O. Box 17643 -00500, Nairobi, Kenya
| | - Francis Obare
- Population Council, P. O. Box 17643 -00500, Nairobi, Kenya
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Glass N, Perrin N, Clough A, Desgroppes A, Kaburu FN, Melton J, Rink A, Read-Hamilton S, Marsh M. Evaluating the communities care program: best practice for rigorous research to evaluate gender based violence prevention and response programs in humanitarian settings. Confl Health 2018; 12:5. [PMID: 29422946 PMCID: PMC5791214 DOI: 10.1186/s13031-018-0138-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 01/12/2018] [Indexed: 11/10/2022] Open
Abstract
Background Gender-based violence (GBV) is a significant issue for women and girls in humanitarian settings. Innovative primary prevention programs are being developed and implemented with existing response programs to change harmful social norms that sustain GBV in humanitarian settings. Social norms are expectations of how women, men, girls and boys should behave, who should have power and control over behavior, and how families and communities value women and girls and support their rights and opportunities. Methods The United Nations Children’s Fund (UNICEF) led Communities Care program is a primary prevention and response program designed from the understanding that within the context of conflict and displacement, there is an opportunity for positive change in social norms that support gender equity, and decrease GBV. The goal is to support communities in humanitarian settings to create healthy, safe and peaceful environments with quality response services for women and girls by transforming harmful social norms that uphold violence into norms that promote dignity, equity, and non-violence. Conclusion This manuscript will highlight the use of best practices in GBV research to rigorously evaluate the Communities Care program in two diverse in humanitarian settings, Somalia and South Sudan.
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Affiliation(s)
- N Glass
- 1Johns Hopkins University School of Nursing, 525 North Wolfe Street, Unit 435, Baltimore, MD 21205 USA
| | - N Perrin
- 1Johns Hopkins University School of Nursing, 525 North Wolfe Street, Unit 435, Baltimore, MD 21205 USA
| | - A Clough
- 1Johns Hopkins University School of Nursing, 525 North Wolfe Street, Unit 435, Baltimore, MD 21205 USA
| | - A Desgroppes
- Comitato Internazionale per lo Sviluppo dei Popoli (CISP) Somalia, Nairobi, Kenya
| | - F N Kaburu
- Comitato Internazionale per lo Sviluppo dei Popoli (CISP) Somalia, Nairobi, Kenya
| | | | - A Rink
- UNICEF, Juba, South Sudan
| | - S Read-Hamilton
- Consultant, Gender based violence in Emergencies, Sydney, Australia
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Delkhosh M, Ardalan A, Rahimiforoushani A, Keshtkar A, Amiri Farahani L, Merghati Khoei E. Interventions for Prevention of Intimate Partner Violence Against Women in Humanitarian Settings: A Protocol for a Systematic Review. PLOS CURRENTS 2017; 9:ecurrents.dis.f41d45fbdca13babe4ae5be0f9732e75. [PMID: 28856064 PMCID: PMC5553713 DOI: 10.1371/currents.dis.f41d45fbdca13babe4ae5be0f9732e75] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Humanitarian emergencies and the number of people who are adversely affected are increasing. In such emergencies, the vulnerability of women and girls to gender-based violence increases signifi-cantly and they often experience high levels of intimate partner violence (IPV). There are a limited number of interventions to reduce gender-based violence (GBV) and IPV in the contexts of humanitarian emergencies, and there is uncertainty about the effectiveness of these preventive interventions. This is the protocol for a systematic review that will synthesize the evidence on interventions for primary or secondary prevention of IPV in humanitarian settings, and assess the effect of existing types of IPV-related interventions in these settings. METHODS AND DESIGN The PRISMA-P 2015 statement has been used to prepare this report. Studies published from January 2000 to January 2017 will be reviewed with no language limits. Any experimental, quasi-experimental, or controlled trials will be included. A combination of four key concepts, including "IPV" AND "population" AND "humanitarian setting" AND "intervention" will be used in the search and a variety of information sources will be used: (1) bibliographic databases; (2) special databases and grey literature; (3) and the reference lists of eligible studies. Two reviewers will independently screen articles, extract relevant data and assess study quality. Discrepancies will be resolved through consensus. Risk of bias will be assessed using the Cochrane Risk of Bias tool and the quality of evidence will be assessed using the CONSORT checklist. A narrative synthesis will be provided. If a sufficient number of studies are found, their results will be pooled using a random-effects meta-analysis. For dichotomous outcomes, summaries of intervention effects for each study will be provided by calculating risk ratios with 95% confidence interval. Standardized mean differences will be used for continuous outcomes. DISCUSSION The review will be useful for IPV management policy and related planning. It will help researchers, policymakers and guideline developers with an interest in reducing violence against women among refugees, internally displaced persons (IDPs), and conflict-affected population.
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Affiliation(s)
- Marjan Delkhosh
- Department of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Department of Disaster & Emergency Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ardalan
- Department of Disaster & Emergency Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran; Department of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Harvard Humanitarian Initiative, Harvard University, Cambridge, MA, USA
| | | | - Abbas Keshtkar
- Department of Health Sciences Education Development, School of Public Health, Tehran University of Medical Sciences, Tehran, IRANTehran University of Medical Sciences
| | - Leila Amiri Farahani
- Department of Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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Feasibility and acceptability of a universal screening and referral protocol for gender-based violence with women seeking care in health clinics in Dadaab refugee camps in Kenya. Glob Ment Health (Camb) 2017; 4:e21. [PMID: 29230317 PMCID: PMC5719473 DOI: 10.1017/gmh.2017.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Gender-based violence (GBV) is both a global public health problem and violation of human rights. Refugees and internally displaced persons experience an increased risk of GBV and health outcomes associated with GBV are often exacerbated in conflict settings. METHODS A mixed methods study to examine the feasibility and acceptability of universal screening for GBV in a refugee population in the Dadaab refugee camp of Kenya, using the ASIST-GBV from January to July 2015. RESULTS Of 9366 women offered screening at International Rescue Committee health clinics, about 89% (n = 8369) female refugees consented to participate. Only 15% of the potentially eligible population could participate in GBV screening because of the ongoing struggle to identify private space in the clinics. Over 85% of women reported being 'willing' or 'very willing' to participate in GBV screening; 96% felt they had a good or very good experience with the screening protocol. Qualitative findings stressed the importance of securing a room/space in the busy clinic is critical to universal screening with referral to safe and confidential services for survivors. CONCLUSIONS The findings suggest that the evidence-based ASIST-GBV is both feasible to implement and acceptable to both providers and women seeking care. Universal GBV screening and referral is an effective way for health care and service providers in humanitarian settings to assist survivors of GBV.
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Lolk M, Byberg S, Carlsson J, Norredam M. Somatic comorbidity among migrants with posttraumatic stress disorder and depression - a prospective cohort study. BMC Psychiatry 2016; 16:447. [PMID: 27964720 PMCID: PMC5153678 DOI: 10.1186/s12888-016-1149-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 11/29/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In a cohort of migrants in Denmark, we compared somatic disease incidence among migrants diagnosed with posttraumatic stress disorder (PTSD) and depression with migrants without a diagnosed psychiatric disorder. METHODS The study builds on a unique cohort of migrants who obtained residence permit in Denmark from 1993 to 2010 (N = 92,104). The association with somatic disease was explored via register linkage. We used Poisson regression to model incidence rate ratios (IRR) adjusted for age, sex, income and region of origin. The Danish Data Protection Agency granted authorisation for the implementation of the project (No 2012-41-0065). RESULTS Our results showed that migrants diagnosed with PTSD and depression had significantly higher rates of somatic diseases compared with migrants without diagnosed psychiatric disorders - especially, infectious disease (IRR, 1.89; 95% CI, 1.45-2.48; p < 0.01), neurological disease (IRR, 2.35; 95% CI, 1.91-2.91; p < 0.01) and pulmonary disease (IRR, 1.69; 95% CI, 1.37-2.00; p < 0.01). We further saw differences in the IRRs according to region of origin. CONCLUSION Migrants with PTSD and depression had a significantly higher rates of somatic comorbidity compared with migrants without a diagnosed psychiatric disorder. The rates were especially high for infectious, neurological and pulmonary diseases. Our results further suggest difference in the rates of somatic comorbidity according to region of. Preventive and treatment services should pay special attention to improve the overall health of migrants with PTSD and depression.
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Affiliation(s)
- Mette Lolk
- Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5A, Copenhagen, Denmark. .,Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Maglevaenget 2, 2750, Ballerup, Denmark.
| | - Stine Byberg
- Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5A, Copenhagen, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Maglevaenget 2, 2750 Ballerup, Denmark
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5A, Copenhagen, Denmark ,Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Kettegård Allé 30, Copenhagen, Denmark
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88
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Kim JY, Kim HJ, Choi K, Nam B. Mental Health Conditions Among North Korean Female Refugee Victims of Sexual Violence. INTERNATIONAL MIGRATION 2016. [DOI: 10.1111/imig.12300] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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89
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Challenges Facing Mental Health in the 21st Century: A Summary of Scientific Evidences. Nurs Midwifery Stud 2016. [DOI: 10.5812/nmsjournal.41515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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90
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Matthew O. Challenges Facing Mental Health in the 21st Century: A Summary of Scientific Evidences. Nurs Midwifery Stud 2016. [DOI: 10.17795/nmsjournal41515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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91
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Wanigaratne S, Cole DC, Bassil K, Hyman I, Moineddin R, Shakya Y, Urquia ML. Severe Neonatal Morbidity Among Births to Refugee Women. Matern Child Health J 2016; 20:2189-98. [DOI: 10.1007/s10995-016-2047-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wirtz AL, Glass N, Pham K, Perrin N, Rubenstein LS, Singh S, Vu A. Comprehensive development and testing of the ASIST-GBV, a screening tool for responding to gender-based violence among women in humanitarian settings. Confl Health 2016; 10:7. [PMID: 27099617 PMCID: PMC4837612 DOI: 10.1186/s13031-016-0071-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 02/08/2016] [Indexed: 11/10/2022] Open
Abstract
Background Conflict affected refugees and internally displaced persons (IDPs) are at increased vulnerability to gender-based violence (GBV). Health, psychosocial, and protection services have been implemented in humanitarian settings, but GBV remains under-reported and available services under-utilized. To improve access to existing GBV services and facilitate reporting, the ASIST-GBV screening tool was developed and tested for use in humanitarian settings. This process was completed in four phases: 1) systematic literature review, 2) qualitative research that included individual interviews and focus groups with GBV survivors and service providers, respectively, 3) pilot testing of the developed screening tool, and 4) 3-month implementation testing of the screening tool. Research was conducted among female refugees, aged ≥15 years in Ethiopia, and female IDPs, aged ≥18 years in Colombia. Results The systematic review and meta-analysis identified a range of GBV experiences and estimated a 21.4 % prevalence of sexual violence (95 % CI:14.9-28.7) among conflict-affected populations. No existing screening tools for GBV in humanitarian settings were identified. Qualitative research with GBV survivors in Ethiopia and Colombia found multiple forms of GBV experienced by refugees and IDPs that occurred during conflict, in transit, and in displaced settings. Identified forms of violence were combined into seven key items on the screening tool: threats of violence, physical violence, forced sex, sexual exploitation, forced pregnancy, forced abortion, and early or forced marriage. Cognitive testing further refined the tool. Pilot testing in both sites demonstrated preliminary feasibility where 64.8 % of participants in Ethiopia and 44.9 % of participants in Colombia were identified with recent (last 12 months) cases of GBV. Implementation testing of the screening tool, conducted as a routine service in camp/district hospitals, allowed for identification of GBV cases and referrals to services. In this phase, 50.6 % of participants in Ethiopia and 63.4 % in Colombia screened positive for recent experiences of GBV. Psychometric testing demonstrated appropriate internal consistency of the tool (Cronbach’s α = 0.77) and item response theory demonstrated appropriate discrimination and difficulty of the tool. Conclusion The ASIST-GBV screening tool has demonstrated utility and validity for use in confidential identification and referral of refugees and IDPs who experience GBV.
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Affiliation(s)
- A L Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, USA
| | - N Glass
- Johns Hopkins School of Nursing, Baltimore, USA
| | - K Pham
- Department of Emergency Medicine, Johns Hopkins Medical Institute, Baltimore, USA ; Department of International Health, Johns Hopkins School of Public Health, Baltimore, USA
| | - N Perrin
- Johns Hopkins School of Nursing, Baltimore, USA ; Center for Health Research, Kaiser Permanente Northwest, Portland, USA
| | - L S Rubenstein
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, USA
| | - S Singh
- Department of Internal Medicine, Johns Hopkins Medical Institute, Baltimore, USA
| | - A Vu
- Department of Emergency Medicine, Johns Hopkins Medical Institute, Baltimore, USA ; Department of International Health, Johns Hopkins School of Public Health, Baltimore, USA
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Tappis H, Freeman J, Glass N, Doocy S. Effectiveness of Interventions, Programs and Strategies for Gender-based Violence Prevention in Refugee Populations: An Integrative Review. PLOS CURRENTS 2016; 8. [PMID: 27226926 PMCID: PMC4865365 DOI: 10.1371/currents.dis.3a465b66f9327676d61eb8120eaa5499] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Gender based violence (GBV) remains one of the most serious threats to the health and safety of women and girls worldwide. The problem is even more pronounced in refugee populations where women and girls are at increased risk of violence. In 2015, UNHCR reported the highest number of forcibly displaced people in recorded history. Despite growing need, there have been few rigorous evaluations of interventions aimed at primary GBV prevention and no systematic reviews of GBV prevention efforts specifically focused on refugee populations; reviews to date have primarily examined prevention of conflict related sexual violence, with very limited focus on other forms of GBV such as intimate partner violence Methods: This study reviewed the scientific literature addressing strategies for primary prevention of GBV and their effectiveness among refugee populations over the past ten years (2006 to 2015). Narrative content analysis methods were used to extract findings related to prevention activities/programs recommended by the global humanitarian community, such as sociocultural norms change, rebuilding family and community support structures, improving accountability systems, designing effective services and facilities, working with formal and traditional legal systems, monitoring and documenting GBV, and/or engaging men and boys in GBV prevention and response. RESULTS Study findings indicate that a range of GBV prevention activities recommended by the global humanitarian community are currently being applied in a variety of settings. However, there remains a limited body of evidence on the effectiveness of GBV prevention programs, interventions, and strategies, especially among refugee populations. CONCLUSION Commonly agreed upon standards or guidelines for evaluation of GBV prevention programming, and publication of evaluations conducted using these guidelines, could assist humanitarian stakeholders to build and disseminate an evidence base of effective GBV prevention interventions, programs and strategies. Evaluation of GBV prevention efforts, especially among refugee populations, must be given higher priority to justify continuation or revision of recommended GBV activities/programs being implemented in diverse humanitarian settings.
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Affiliation(s)
| | | | | | - Shannon Doocy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Falb KL, Tanner S, Ward L, Erksine D, Noble E, Assazenew A, Bakomere T, Graybill E, Lowry C, Mallinga P, Neiman A, Poulton C, Robinette K, Sommer M, Stark L. Creating opportunities through mentorship, parental involvement, and safe spaces (COMPASS) program: multi-country study protocol to protect girls from violence in humanitarian settings. BMC Public Health 2016; 16:231. [PMID: 26945586 PMCID: PMC4779562 DOI: 10.1186/s12889-016-2894-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/19/2016] [Indexed: 11/16/2022] Open
Abstract
Background Violence against adolescent girls in humanitarian settings is of urgent concern given their additional vulnerabilities to violence and unique health and well-being needs that have largely been overlooked by the humanitarian community. In order to understand what works to prevent violence against adolescent girls, a multi-component curriculum-based safe spaces program (Creating Opportunities through Mentorship, Parental involvement and Safe Spaces – COMPASS) will be implemented and evaluated. The objectives of this multi-country study are to understand the feasibility, acceptability and effectiveness of COMPASS programming to prevent violence against adolescent girls in diverse humanitarian settings. Methods/design Two wait-listed cluster-randomized controlled trials are being implemented in conflict-affected communities in eastern Democratic Republic of Congo (N = 886 girls aged 10–14 years) and in refugee camps in western Ethiopia (N = 919 girls aged 13–19 years). The intervention consists of structured facilitated sessions delivered in safe spaces by young female mentors, caregiver discussion groups, capacity-building activities with service providers, and community engagement. In Ethiopia, the research centers on the overall impact of COMPASS compared to a wait-list group. In DRC, the research objective is to understand the incremental effectiveness of the caregiver component in addition to the other COMPASS activities as compared to a wait-list group. The primary outcome is change in sexual violence. Secondary outcomes include decreased physical and emotional abuse, reduced early marriage, improved gender norms, and positive interpersonal relationships, among others. Qualitative methodologies seek to understand girls’ perceptions of safety within their communities, key challenges they face, and to identify potential pathways of change. Discussion These trials will add much needed evidence for the humanitarian community to meet the unique needs of adolescent girls and to promote their safety and well-being, as well as contributing to how multi-component empowerment programming for adolescent girls could be adapted across humanitarian settings. Trial registration Clinical Trials NCT02384642 (Registered: 2/24/15) & NCT02506543 (Registered: 7/19/15).
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Affiliation(s)
- Kathryn L Falb
- International Rescue Committee, 122 E 42nd St, New York City, NY, 10168, USA.
| | - Sophie Tanner
- International Rescue Committee, 3 Bloomsbury Place, London, WC1A 2QL, UK.
| | - Leora Ward
- International Rescue Committee, 1730 M Street, NW - Suite 505, Washington DC, 20036, USA.
| | - Dorcas Erksine
- International Rescue Committee, 3 Bloomsbury Place, London, WC1A 2QL, UK.
| | - Eva Noble
- International Rescue Committee, 122 E 42nd St, New York City, NY, 10168, USA.
| | - Asham Assazenew
- International Rescue Committee, TK International Bldg. 6th Floor, Bole Rd, Addis Ababa, Ethiopia.
| | | | | | - Carmen Lowry
- International Rescue Committee, Nairobi i-HUB, Galana Plaza, Wing B, 4th Floor, Kilimani, Nairobi, Kenya.
| | - Pamela Mallinga
- International Rescue Committee, Bukavu, Democratic Republic of Congo.
| | - Amy Neiman
- International Rescue Committee, TK International Bldg. 6th Floor, Bole Rd, Addis Ababa, Ethiopia.
| | - Catherine Poulton
- International Rescue Committee, Place de la Vieille Halle aux Blés 16, 1000, Bruxelles, Belgium.
| | - Katie Robinette
- International Rescue Committee, Bukavu, Democratic Republic of Congo.
| | - Marni Sommer
- Columbia University Mailman School of Public Health, 722 W. 168th Street, Room 537, New York, NY, 10032, USA.
| | - Lindsay Stark
- Columbia University Mailman School of Public Health, 60 Haven Avenue, B-4, Suite 432, New York, NY, 10032, USA.
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Vu A, Wirtz A, Pham K, Singh S, Rubenstein L, Glass N, Perrin N. Psychometric properties and reliability of the Assessment Screen to Identify Survivors Toolkit for Gender Based Violence (ASIST-GBV): results from humanitarian settings in Ethiopia and Colombia. Confl Health 2016; 10:1. [PMID: 26865857 PMCID: PMC4748528 DOI: 10.1186/s13031-016-0068-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 02/01/2016] [Indexed: 11/10/2022] Open
Abstract
Background Refugees and internally displaced persons who are affected by armed-conflict are at increased vulnerability to some forms of sexual violence or other types of gender-based violence. A validated, brief and easy-to-administer screening tool will help service providers identify GBV survivors and refer them to appropriate GBV services. To date, no such GBV screening tool exists. We developed the 7-item ASIST-GBV screening tool from qualitative research that included individual interviews and focus groups with GBV refugee and IDP survivors. This study presents the psychometric properties of the ASIST-GBV with female refugees living in Ethiopia and IDPs in Colombia. Methods Several strategies were used to validate ASIST-GBV, including a 3 month implementation to validate the brief screening tool with women/girls seeking health services, aged ≥15 years in Ethiopia (N = 487) and female IDPs aged ≥ 18 years in Colombia (N = 511). Results High proportions of women screened positive for past-year GBV according to the ASIST-GBV: 50.6 % in Ethiopia and 63.4 % in Colombia. The factor analysis identified a single dimension, meaning that all items loaded on the single factor. Cronbach’s α = 0.77. A 2-parameter logistic IRT model was used for estimating the precision and discriminating power of each item. Item difficulty varied across the continuum of GBV experiences in the following order (lowest to highest): threats of violence (0.690), physical violence (1.28), forced sex (2.49), coercive sex for survival (2.25), forced marriage (3.51), and forced pregnancy (6.33). Discrimination results showed that forced pregnancy was the item with the strongest ability to discriminate between different levels of GBV. Physical violence and forced sex also have higher levels of discrimination with threats of violence discriminating among women at the low end of the GBV continuum and coercive sex for survival among women at the mid-range of the continuum. Conclusion The findings demonstrate that the ASIST-GBV has strong psychometric properties and good reliability. The tool can be used to screen and identify female GBV survivors confidentially and efficiently among IDPs in Colombia and refugees in Ethiopia. Early identification of GBV survivors can enable safety planning, early referral for treatment, and psychosocial support to prevent long-term harmful consequence of GBV.
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Affiliation(s)
- Alexander Vu
- Department of Emergency Medicine, Johns Hopkins University, School of Medicine, Baltimore, USA ; Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA
| | - Andrea Wirtz
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA
| | - Kiemanh Pham
- Department of Emergency Medicine, Johns Hopkins University, School of Medicine, Baltimore, USA
| | - Sonal Singh
- Department of Medicine, Johns Hopkins University, Johns Hopkins Medical Institutions, Baltimore, USA
| | - Leonard Rubenstein
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA
| | - Nancy Glass
- Johns Hopkins University, School of Nursing , Baltimore, USA
| | - Nancy Perrin
- Johns Hopkins University, School of Nursing , Baltimore, USA ; Center for Health Research Kaiser Permanente Northwest, Portland, OR USA
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Violence against children in humanitarian settings: A literature review of population-based approaches. Soc Sci Med 2016; 152:125-37. [PMID: 26854623 DOI: 10.1016/j.socscimed.2016.01.052] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 01/27/2016] [Accepted: 01/29/2016] [Indexed: 11/22/2022]
Abstract
Children in humanitarian settings are thought to experience increased exposure to violence, which can impair their physical, emotional, and social development. Violence against children has important economic and social consequences for nations as a whole. The purpose of this review is to examine population-based approaches measuring violence against children in humanitarian settings. The authors reviewed prevalence studies of violence against children in humanitarian contexts appearing in peer-reviewed journals within the past twenty years. A Boolean search procedure was conducted in October 2014 of the electronic databases PubMed/Medline and PsychInfo. If abstracts contained evidence of the study's four primary themes--violence, children, humanitarian contexts and population-based measurement--a full document review was undertaken to confirm relevance. Out of 2634 identified articles, 22 met the final inclusion criteria. Across studies, there was varying quality and no standardization in measurement approach. Nine out of 22 studies demonstrated a relationship between conflict exposure and adverse health or mental health outcomes. Among studies that compared rates of violence between boys and girls, boys reported higher rates of physical violence, while girls reported higher rates of sexual violence. Children in infancy and early childhood were found to be among the most under-researched. Ultimately, the body of evidence in this review offers an incomplete picture regarding the prevalence, nature and impact of violence against children in emergencies, demonstrating a weak evidence base for some of the basic assumptions underpinning humanitarian practice. The development of standardized approaches to more rigorously measure violence against children is urgently needed in order to understand trends of violence against children in humanitarian contexts, and to promote children's healthy development and well-being.
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Spangaro J, Adogu C, Zwi AB, Ranmuthugala G, Davies GP. Mechanisms underpinning interventions to reduce sexual violence in armed conflict: A realist-informed systematic review. Confl Health 2015; 9:19. [PMID: 26170898 PMCID: PMC4499895 DOI: 10.1186/s13031-015-0047-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 05/29/2015] [Indexed: 11/10/2022] Open
Abstract
Sexual violence is recognised as a widespread consequence of armed conflict and other humanitarian crises. The limited evidence in literature on interventions in this field suggests a need for alternatives to traditional review methods, particularly given the challenges of undertaking research in conflict and crisis settings. This study employed a realist review of the literature on interventions with the aim of identifying the mechanisms at work across the range of types of intervention. The realist approach is an exploratory and theory-driven review method. It is well suited to complex interventions as it takes into account contextual factors to identify mechanisms that contribute to outcomes. The limited data available indicate that there are few deterrents to sexual violence in crises. Four main mechanisms appear to contribute to effective interventions: increasing the risk to offenders of being detected; building community engagement; ensuring community members are aware of available help for and responses to sexual violence; and safe and anonymous systems for reporting and seeking help. These mechanisms appeared to contribute to outcomes in multiple-component interventions, as well as those relating to gathering firewood, codes of conduct for personnel and legal interventions. Drawing on pre-existing capacity or culture in communities is an additional mechanism which should be explored. Though increasing the risk to offenders of being detected was assumed to be a central mechanism in deterring sexual violence, the evidence suggests that this mechanism operated only in interventions focused on gathering firewood and providing alternative fuels. The other three mechanisms appeared important to the likelihood of an intervention being successful, particularly when operating simultaneously. In a field where robust outcome research remains likely to be limited, realist methods provide opportunities to understand existing evidence. Our analysis identifies the important potential of building in mechanisms involving community engagement, awareness of responses and safe reporting provisions into the range of types of intervention for sexual violence in crises.
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Affiliation(s)
- Jo Spangaro
- />School of Social Sciences, University of New South Wales, Ground Floor Morven Brown Building, Sydney, 2052 NSW Australia
| | - Chinelo Adogu
- />School of Social Sciences, University of New South Wales, Ground Floor Morven Brown Building, Sydney, 2052 NSW Australia
| | - Anthony B. Zwi
- />School of Social Sciences, University of New South Wales, Ground Floor Morven Brown Building, Sydney, 2052 NSW Australia
| | - Geetha Ranmuthugala
- />School of Rural Medicine, The University of New England, Armidale, Australia
| | - Gawaine Powell Davies
- />Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
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Sipsma HL, Falb KL, Willie T, Bradley EH, Bienkowski L, Meerdink N, Gupta J. Violence against Congolese refugee women in Rwanda and mental health: a cross-sectional study using latent class analysis. BMJ Open 2015; 5:e006299. [PMID: 25908672 PMCID: PMC4410130 DOI: 10.1136/bmjopen-2014-006299] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 03/11/2015] [Accepted: 03/12/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To examine patterns of conflict-related violence and intimate partner violence (IPV) and their associations with emotional distress among Congolese refugee women living in Rwanda. DESIGN Cross-sectional study. SETTING Two Congolese refugee camps in Rwanda. PARTICIPANTS 548 ever-married Congolese refugee women of reproductive age (15-49 years) residing in Rwanda. PRIMARY OUTCOME MEASURE Our primary outcome was emotional distress as measured using the Self-Report Questionnaire-20 (SRQ-20). For analysis, we considered participants with scores greater than 10 to be experiencing emotional distress and participants with scores of 10 or less not to be experiencing emotional distress. RESULTS Almost half of women (49%) reported experiencing physical, emotional or sexual violence during the conflict, and less than 10% of women reported experiencing of any type of violence after fleeing the conflict. Lifetime IPV was reported by approximately 22% of women. Latent class analysis derived four distinct classes of violence experiences, including the Low All Violence class, the High Violence During Conflict class, the High IPV class and the High Violence During and After Conflict class. In multivariate regression models, latent class was strongly associated with emotional distress. Compared with women in the Low All Violence class, women in the High Violence During and After Conflict class and women in the High Violence During Conflict had 2.7 times (95% CI 1.11 to 6.74) and 2.3 times (95% CI 1.30 to 4.07) the odds of experiencing emotional distress in the past 4 weeks, respectively. Furthermore, women in the High IPV class had a 4.7 times (95% CI 2.53 to 8.59) greater odds of experiencing emotional distress compared with women in the Low All Violence class. CONCLUSIONS Experiences of IPV do not consistently correlate with experiences of conflict-related violence, and women who experience high levels of IPV may have the greatest likelihood for poor mental health in conflict-affected settings.
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Affiliation(s)
- Heather L Sipsma
- Department of Women, Children and Family Health Science, University of Illinois at Chicago College of Nursing, Chicago, Illinois, USA
| | - Kathryn L Falb
- Department of Chronic Disease Epidemiology and Division of Social and Behavioural Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Tiara Willie
- Department of Chronic Disease Epidemiology and Division of Social and Behavioural Sciences, Yale School of Public Health, New Haven, Connecticut, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA
| | - Elizabeth H Bradley
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | | | - Ned Meerdink
- American Refugee Committee, Minneapolis, Minnesota, USA
| | - Jhumka Gupta
- Department of Chronic Disease Epidemiology and Division of Social and Behavioural Sciences, Yale School of Public Health, New Haven, Connecticut, USA
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Wirtz AL, Pham K, Glass N, Loochkartt S, Kidane T, Cuspoca D, Rubenstein LS, Singh S, Vu A. Gender-based violence in conflict and displacement: qualitative findings from displaced women in Colombia. Confl Health 2014; 8:10. [PMID: 25076981 PMCID: PMC4115473 DOI: 10.1186/1752-1505-8-10] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 07/03/2014] [Indexed: 11/10/2022] Open
Abstract
Introduction Gender-based violence (GBV) is prevalent among, though not specific to, conflict affected populations and related to multifarious levels of vulnerability of conflict and displacement. Colombia has been marked with decades of conflict, with an estimated 5.2 million internally displaced persons (IDPs) and ongoing violence. We conducted qualitative research to understand the contexts of conflict, displacement and dynamics with GBV. This as part of a multi-phase, mixed method study, in collaboration with UNHCR, to develop a screening tool to confidentially identify cases of GBV for referral among IDP women who were survivors of GBV. Methods Qualitative research was used to identify the range of GBV, perpetrators, contexts in conflict and displacement, barriers to reporting and service uptake, as well as to understand experiences of service providers. Thirty-five female IDPs, aged 18 years and older, who self-identified as survivors of GBV were enrolled for in-depth interviews in San Jose de Guaviare and Quibdo, Colombia in June 2012. Thirty-one service providers participated in six focus group discussions and four interviews across these sites. Results Survivors described a range of GBV across conflict and displacement settings. Armed actors in conflict settings perpetrated threats of violence and harm to family members, child recruitment, and, to a lesser degree, rape and forced abortion. Opportunistic violence, including abduction, rape, and few accounts of trafficking were more commonly reported to occur in the displacement setting, often perpetrated by unknown individuals. Intrafamilial violence, intimate partner violence, including physical and sexual violence and reproductive control were salient across settings and may be exacerbated by conflict and displacement. Barriers to reporting and services seeking were reported by survivors and providers alike. Conclusions Findings highlight the need for early identification of GBV cases, with emphasis on confidential approaches and active engagement of survivors in available, quality services. Such efforts may facilitate achievement of the goals of new Colombian laws, which seek to prevent and respond to GBV, including in conflict settings. Ongoing conflict and generalized GBV in displacement, as well as among the wider population, suggests a need to create sustainable solutions that are accessible to both IDPs and general populations.
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Affiliation(s)
- Andrea L Wirtz
- Department of Emergency Medicine, Johns Hopkins Medical Institute, Baltimore, USA ; Center for Public Health and Human Rights, Department of Epidemiology, Johns School of Public Health, Baltimore, USA
| | - Kiemanh Pham
- Department of Emergency Medicine, Johns Hopkins Medical Institute, Baltimore, USA ; Department of International Health, Johns Hopkins School of Public Health, Baltimore, USA
| | - Nancy Glass
- Johns Hopkins School of Nursing, Baltimore, USA
| | | | - Teemar Kidane
- United Nations High Commissioner for Refugees, Bogota, Colombia
| | - Decssy Cuspoca
- Departamento de Antropología de la Universidad de los Andes, Bogota, Colombia
| | - Leonard S Rubenstein
- Center for Public Health and Human Rights, Department of Epidemiology, Johns School of Public Health, Baltimore, USA
| | - Sonal Singh
- Center for Public Health and Human Rights, Department of Epidemiology, Johns School of Public Health, Baltimore, USA ; Department of General Internal Medicine, Johns Hopkins Medical Institute, Baltimore, USA
| | - Alexander Vu
- Department of Emergency Medicine, Johns Hopkins Medical Institute, Baltimore, USA ; Department of International Health, Johns Hopkins School of Public Health, Baltimore, USA
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Affiliation(s)
- Mazeda Hossain
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK.
| | - Cathy Zimmerman
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Charlotte Watts
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
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