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Seidu AA, Malau-Aduli BS, McBain-Rigg K, Malau-Aduli AEO, Emeto TI. Sexual lives and reproductive health outcomes among persons with disabilities: a mixed-methods study in two districts of Ghana. Reprod Health 2024; 21:69. [PMID: 38783342 PMCID: PMC11112844 DOI: 10.1186/s12978-024-01810-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION People with disabilities (PwDs) constitute a large and diverse group within the global population, however, their sexual and reproductive health (SRH) needs are often neglected, particularly in low-and middle-income countries. This may result in adverse outcomes, such as sexually transmitted infections (STIs), unintended pregnancies, and experience of interpersonal violence (IV). This study aimed to assess the factors that influence the sexual lives of PwDs in two districts of Ghana. METHODS A sequential explanatory mixed-methods study design was used to collect data from PwDs. Quantitative data were obtained from 402 respondents using a pretested questionnaire, and qualitative data gathered from 37 participants using in-depth interviews. The quantitative data were analysed using descriptive and inferential statistics, while the qualitative data were analysed using inductive thematic analysis. RESULTS Most PwDs (91%) reported that they have ever had sex, which was associated with age, disability severity, and household size. The prevalence of poor SRH status, STIs, unintended pregnancy, pregnancy termination, and unsafe abortion were 10.5%, 5.7%, 6.4%, 21.6%, and 36.9% respectively. These outcomes were influenced by education, income, health insurance subscription, and proximity to a health facility. The prevalence of IV was 65%, which was related to disability type and severity. The qualitative data revealed five main themes: curiosity to engage in sexual activities, feelings of despair and insecurity with abled partners, preference for sexual relationships with other PwDs, IV and its perpetrators, and adverse SRH outcomes. CONCLUSION The study findings indicate that most adult PwDs have ever had sex and they face various challenges in their sexual lives. They experience multiple forms of abuse and neglect from different perpetrators at different levels of society, which have negative impacts on their well-being. There is a need for comprehensive and inclusive interventions that address the SRH needs of PwDs, as well as the underlying social and structural factors that contribute to their vulnerability. Further research is recommended to explore the perspectives of stakeholders on how to improve the SRH outcomes of PwDs.
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Affiliation(s)
- Abdul-Aziz Seidu
- Public Health & Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, 4811, Australia.
- Department of Population and Health, University of Cape Coast, P.O. Box UC 182, Cape Coast, Ghana.
| | - Bunmi S Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2308, Australia
| | - Kristin McBain-Rigg
- Public Health & Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, 4811, Australia
| | - Aduli E O Malau-Aduli
- School of Environmental and Life Sciences, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Theophilus I Emeto
- Public Health & Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, 4811, Australia.
- World Health Organization Collaborating Center for Vector-Borne and Neglected Tropical Diseases, James Cook University, Townsville, QLD, 4811, Australia.
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Kalra N, Habumugisha L, Shankar A. Impacts of an abbreviated personal agency training with refugee women and their male partners on economic empowerment, gender-based violence, and mental health: a randomized controlled trial in Rwanda. BMC Public Health 2024; 24:1306. [PMID: 38745312 PMCID: PMC11092213 DOI: 10.1186/s12889-024-18780-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/06/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION We assessed the impact of a personal agency-based training for refugee women and their male partners on their economic and social empowerment, rates of intimate partner violence (IPV), and non-partner violence (NPV). METHODS We conducted an individually randomized controlled trial with 1061 partnered women (aged 18-45) living in a refugee camp in Rwanda. Women received two days of training, and their partners received one day of training. The follow-up survey where all relevant outcomes were assessed was carried out at 6-9 months post-intervention. RESULTS At follow up, women in the intervention arm were more likely to report partaking in income generating activities (aIRR 1.27 (1.04-1.54), p < 0.05) and skill learning (aIRR 1.59 (1.39-1.82), p < 0.001) and reported a reduction in experience of physical or sexual NPV in the past six months (aIRR 0.65 (0.39-1.07), p < 0.09). While improved, no statistically significant impacts were seen on physical or sexual IPV (aIRR 0.80 (0.58-1.09), p = 0.16), food insecurity (β 0.98 (0.93 to 1.03), p = 0.396), or clean cookstove uptake (aIRR 0.95 (0.88 to 1.01), p = 0.113) in the past six months. We found statistically significant reduction in physical and sexual IPV amongst those experiencing IPV at baseline (aIRR 0.72 (0.50 to 1.02), p < 0.07). Small improvements in self-efficacy scores and our indicator of adapting to stress were seen in the intervention arm. Some challenges were also seen, such as higher prevalence of probable depression and/or anxiety (aIRR 1.79 (1.00-3.22), p = 0.05) and PTSD (aIRR 2.07 (1.10-3.91), p < 0.05) in the intervention arm compared to the control arm. CONCLUSION Our findings echo previous research showing personal agency training can support economic well-being of women. We also find potentially promising impacts on gender-based violence. However, there is some evidence that integration of evidence-based mental health support is important when enhancing agency amongst conflict-affected populations. TRIAL REGISTRATION NUMBER The trial was registered with ClinicalTrials.gov, Identifier: NCT04081441 on 09/09/2019.
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Affiliation(s)
- Naira Kalra
- Africa Region Gender Innovation Lab, Office of the Chief Economist, The World Bank Group, Washington D.C., USA
| | | | - Anita Shankar
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
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Adebayo CT, Olukotun OV, Olukotun M, Kirungi J, Gondwe KW, Crooks NK, Singer RB, Adams S, Alfaifi FY, Dressel A, Fahmy L, Kako P, Snethen J, Valhmu LM. Experiences of gender-based violence among Somali refugee women: a socio-ecological model approach. CULTURE, HEALTH & SEXUALITY 2024; 26:654-670. [PMID: 37516928 PMCID: PMC10825063 DOI: 10.1080/13691058.2023.2236163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 07/10/2023] [Indexed: 07/31/2023]
Abstract
Gender-based violence (GBV) is an all-encompassing term that speaks to acts or threats that may lead to physical, sexual or emotional harm to an individual based on their gender. This paper provides a scoping review of research on gender-based violence among Somali refugee women in different parts of the world. Using the socio-ecological model as a framework, we reviewed 30 empirical studies focusing on some form of GBV among Somali refugee women. We identified societal, community and individual factors contributing to the experience of GBV. We also discuss how these factors influence women's willingness to access care, especially healthcare and social services. The review reveals that oftentimes, institutions that work closely with this population have a limited understanding of how closely culture affects the willingness and ability to seek help about GBV. Based on our analysis, we suggest ways in which social institutions and healthcare providers can provide culturally-safe support to Somali refugee women who have experienced some form of GBV.
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Affiliation(s)
| | | | - Mary Olukotun
- Faculty of Nursing, University of Alberta-Edmonton, Edmonton, AB, Canada
| | - Jackline Kirungi
- Department of African & African Diaspora Studies, University of Wisconsin, Milwaukee, WI, USA
| | | | - Natasha K. Crooks
- Human Development Nursing Science, University of Illinois, Chicago, IL, USA
| | - Randi B. Singer
- Human Development Nursing Science, University of Illinois, Chicago, IL, USA
| | - Shukri Adams
- Ras Al Khaimah School of Nursing, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
| | | | - Anne Dressel
- College of Nursing, University of Wisconsin, Milwaukee, WI, USA
| | - Laila Fahmy
- Department of Psychology, Towson University, Towson, MD, USA
| | - Peninah Kako
- College of Nursing, University of Jazan, Gizan, Saudi Arabia
| | - Julia Snethen
- College of Nursing, University of Jazan, Gizan, Saudi Arabia
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Murphy M, Ellsberg M, Balogun A, García-Moreno C. Risk and Protective Factors for Violence Against Women and Girls Living in Conflict and Natural Disaster-Affected Settings: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:3328-3345. [PMID: 36259449 DOI: 10.1177/15248380221129303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
This systematic review provides an overview of existing research on risk and protective factors associated with violence against women and girls (VAWG) in conflict and natural disaster settings. PubMed (Medline); PsycINFO; Scopus; and Cochrane Center trials registrar were searched as well as relevant internet repositories for VAWG research. The inclusion criteria covered studies that were published between January 1995 and December 2020, documented risk and/or protective factors for VAWG in conflict or natural disaster-affected settings and included primary or secondary data analysis. A total of 1,413 records were initially identified and 86 articles (covering 77 studies) were included in the final analysis. The findings show that many preexisting risk factors for VAWG are exacerbated in armed conflict and natural disaster-affected settings. Poverty and economic stress, men's substance abuse, exposure to violence, changing gender roles in contexts of inequitable gender norms, and a lack of social support are some of the risk factors associated with male perpetration or female experience of violence. In addition, risk factors specific to experiences during armed conflict or in a natural disaster (e.g., displacement, insecurity or congestion in and around displacement camps, militarization of society, killing of family, destruction of property, etc.) are associated with higher prevalence of VAWG in these contexts.
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Affiliation(s)
- Maureen Murphy
- The Global Women's Institute, George Washington University, DC, USA
| | - Mary Ellsberg
- The Global Women's Institute, George Washington University, DC, USA
| | - Aminat Balogun
- The Global Women's Institute, George Washington University, DC, USA
| | - Claudia García-Moreno
- The Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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García-Cuéllar MM, Pastor-Moreno G, Ruiz-Pérez I, Henares-Montiel J. The prevalence of intimate partner violence against women with disabilities: a systematic review of the literature. Disabil Rehabil 2023; 45:1-8. [PMID: 35038281 DOI: 10.1080/09638288.2022.2025927] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Although systematic reviews have already been conducted on violence and disability, the evidence is not conclusive in Intimate Partner Violence (IPV). This study examined the prevalence of IPV in women with disabilities, taking account of the different types of violence and disability. METHODS We performed a search in five databases. We included observational studies that analysed the frequency of IPV in women with disabilities compared to women without. Two independent reviewers selected and assessed studies. We made a qualitative synthesis according to the type of IPV analysed in relation to disability. RESULTS We identified 26 articles. The frequency and risk of IPV were greater in women with disabilities than in those without. All of the articles that studied financial violence, 81.3% of those that studied physical violence, 78.5% of those that studied psychological violence, 75% of those that studied physical/sexual violence, 73.3% of those that studied sexual violence and 50% of those that studied any type of violence found a significant association whit disability. CONCLUSIONS Women with disabilities are at higher risk of IPV. Rehabilitation centers and its professionals must have a leading role in the identification of these situations and this should be considered in IPV prevention plans.Implications for rehabilitationPeople with disabilities are at higher risk of multiple types of violence.Violence against women with disabilities therefore involves two public health issues interacting simultaneously.Rehabilitation centers and its professionals should have a leading role in the identification of IPV in women with disabilities.IPV prevention plans should consider rehabilitation centers and its professionals as a main component of interventions in women with disabilities.
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Affiliation(s)
| | - Guadalupe Pastor-Moreno
- Escuela Andaluza de Salud Pública, Granada, Spain.,Consorcio de Investigación Biomédica y en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Instituto de Investigación Biosanitaria de Granada (ibs. GRANADA), Granada, Spain
| | - Isabel Ruiz-Pérez
- Escuela Andaluza de Salud Pública, Granada, Spain.,Consorcio de Investigación Biomédica y en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Instituto de Investigación Biosanitaria de Granada (ibs. GRANADA), Granada, Spain
| | - Jesús Henares-Montiel
- Escuela Andaluza de Salud Pública, Granada, Spain.,Consorcio de Investigación Biomédica y en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Instituto de Investigación Biosanitaria de Granada (ibs. GRANADA), Granada, Spain
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Gupta J, Kanselaar S, Zhang C, Zaidi J. Disability and intimate partner violence in fragile states: A multi-country analysis. Glob Public Health 2023; 18:2204339. [PMID: 37114452 DOI: 10.1080/17441692.2023.2204339] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The 2030 Sustainable Development Goals call for both the elimination of violence against women and girls and disability-disaggregated data. However, few population-based, multi-country studies have examined how disability impacts intimate partner violence (IPV) in fragile settings. Demographic and Health Survey data from five countries (Pakistan, Timor-Leste, Mali, Uganda, and Haiti) were pooled and analyzed to assess the relationship between disability and IPV (N = 22,984). Pooled analysis revealed an overall disability prevalence of 18.45%, with 42.35% lifetime IPV (physical, sexual and/or emotional), and 31.43% past-year IPV. Women with disabilities reported higher levels of past-year and lifetime IPV compared to those without disabilities (AOR 1.18; 95% CI 1.07, 1.30; AOR 1.31; 95% CI 1.19, 1.44, respectively). Women and girls with disabilities may be disproportionately impacted by IPV in fragile settings. More global attention is needed to address IPV and disability in these settings.
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Affiliation(s)
- Jhumka Gupta
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA, USA
| | - Samantha Kanselaar
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA, USA
| | - Cheyu Zhang
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA, USA
| | - Jaffer Zaidi
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA, USA
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Ngaruiya C, Bernstein R, Leff R, Wallace L, Agrawal P, Selvam A, Hersey D, Hayward A. Systematic review on chronic non-communicable disease in disaster settings. BMC Public Health 2022; 22:1234. [PMID: 35729507 PMCID: PMC9210736 DOI: 10.1186/s12889-022-13399-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 05/11/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) constitute the leading cause of mortality globally. Low and middle-income countries (LMICs) not only experience the largest burden of humanitarian emergencies but are also disproportionately affected by NCDs, yet primary focus on the topic is lagging. We conducted a systematic review on the effect of humanitarian disasters on NCDs in LMICs assessing epidemiology, interventions, and treatment. METHODS A systematic search in MEDLINE, MEDLINE (PubMed, for in-process and non-indexed citations), Social Science Citation Index, and Global Health (EBSCO) for indexed articles published before December 11, 2017 was conducted, and publications reporting on NCDs and humanitarian emergencies in LMICs were included. We extracted and synthesized results using a thematic analysis approach and present the results by disease type. The study is registered at PROSPERO (CRD42018088769). RESULTS Of the 85 included publications, most reported on observational research studies and almost half (48.9%) reported on studies in the Eastern Mediterranean Region (EMRO), with scant studies reporting on the African and Americas regions. NCDs represented a significant burden for populations affected by humanitarian crises in our findings, despite a dearth of data from particular regions and disease categories. The majority of studies included in our review presented epidemiologic evidence for the burden of disease, while few studies addressed clinical management or intervention delivery. Commonly cited barriers to healthcare access in all phases of disaster and major disease diagnoses studied included: low levels of education, financial difficulties, displacement, illiteracy, lack of access to medications, affordability of treatment and monitoring devices, and centralized healthcare infrastructure for NCDs. Screening and prevention for NCDs in disaster-prone settings was supported. Refugee status was independently identified both as a risk factor for diagnosis with an NCD and conferring worse morbidity. CONCLUSIONS An increased focus on the effects of, and mitigating factors for, NCDs occurring in disaster-afflicted LMICs is needed. While the majority of studies included in our review presented epidemiologic evidence for the burden of disease, research is needed to address contributing factors, interventions, and means of managing disease during humanitarian emergencies in LMICs.
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Affiliation(s)
- Christine Ngaruiya
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA.
| | - Robyn Bernstein
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Rebecca Leff
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lydia Wallace
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA
| | - Pooja Agrawal
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA
| | - Anand Selvam
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA
| | - Denise Hersey
- Director, Dana Medical Library, University of Vermont, Burlington, VT, USA
| | - Alison Hayward
- Division of Global Emergency Medicine, Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, USA
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Abstract
In this paper, I set out the challenges of care for refugees and suggest approaches to assessment and intervention. I discuss clinical interventions that can address the immediate concern of the clinician in a bio-psycho-social framework, and the value of considering eco-social and structural influences that can hinder recovery and perpetuate inequalities. Refugees face multiple adversities before, during and after escaping from life-threatening situations, political violence, torture and persecution. They present with complex health needs and encounter hostility from host countries and public services, which see their needs as an additional demand on the public purse. Regrettably, existing care practice and training of professionals do not often include skills for working across cultures, including cultural formulations and fair assessment, cultural adaptation of interventions, cultural competence and cultural consultation methods, including clinical ethnography and exploration of cultural identity and explanatory models. There are little data on effective and kind models of interpretation and translation. Care systems are rarely designed to fully address the needs of refugees. Health practitioners are not trained to address structural and institutional racism and discrimination, which leads to exclusion of the most marginalised, with little attention to social justice and fair processes as part of appropriate healthcare.
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Affiliation(s)
- Kamaldeep Bhui
- Department of Psychiatry and Nuffield Department of Primary Care Health Sciences, University of Oxford, UK; East London NHS Foundation Trust, UK; Oxford Health NHS Foundation Trust, UK; and World Psychiatric Association Collaborating Centre in Research, Training, Policy and Practice, UK
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Murray SM, Lasater ME, Guimond MF, Poku O, Musci R, Al-Fataftah M, Kasina L, Lwambi M, Salaimeh A, Falb K. Measuring sexual violence stigma in humanitarian contexts: assessment of scale psychometric properties and validity with female sexual violence survivors from Somalia and Syria. Confl Health 2021; 15:96. [PMID: 34952621 PMCID: PMC8709979 DOI: 10.1186/s13031-021-00431-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/09/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Valid measures of sexual violence stigma that can be readily incorporated into program monitoring and evaluation systems are needed to strengthen gender-based violence (GBV) services in humanitarian emergencies. This study sought to assess the psychometric properties, construct validity, and measurement invariance of sexual violence stigma scales among female Somali GBV survivors in Kenya and Syrian GBV survivors in Jordan to identify an abbreviated scale that could be used across humanitarian contexts. METHODS We administered measures of sexual violence stigma to 209 female survivors of sexual violence aged 15 and older in Kenya and Jordan. Exploratory factor analysis was used to assess the underlying latent structure, and Item Response Theory was used to estimate item difficulty and discrimination parameters to guide efforts to shorten the scales. Differential item functioning (DIF) by site was assessed using Multiple Indicators, Multiple Causes models. Construct validity of the sexual violence stigma scales was assessed by estimating correlations with functional impairment, depression, and disability. RESULTS The sexual violence stigma measure exhibited distinct factor structures among Somali and Syrian GBV survivors. Among Somali survivors, a two-factor model with separate felt (10 items) and enacted (4 items) stigma constructs was identified, with scales for both domains exhibiting good internal consistency (Cronbach's alpha = 0.93 and 0.88, respectively). In Jordan, a single factor solution was uncovered for a 15-item stigma scale with good internal consistency (alpha = 0.86). The shortened core sexual stigma scale consisting of the 4 items that did not exhibit DIF had a Cronbach's alpha of 0.82 in Kenya and 0.81 in Jordan. The felt stigma scale in Kenya, the full stigma scale in Jordan, and abbreviated core stigma scales in both countries were meaningfully correlated with depression, while correlations with functional impairment were weaker and inconsistent across scales. CONCLUSIONS An abbreviated core set of invariant perceived and internalized sexual violence stigma items demonstrated evidence of construct validity in two diverse settings. The ability of this measure to be efficiently administered as a part of routine program monitoring and evaluation activities, with the potential addition of items from a measurement bank to improve contextual relevance, can facilitate improvements in the delivery and quality of gender-based violence programs in humanitarian emergencies.
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Affiliation(s)
- Sarah M. Murray
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway Street, Baltimore, MD 21205 USA
| | - Molly E. Lasater
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway Street, Baltimore, MD 21205 USA
| | - Marie-France Guimond
- grid.420433.20000 0000 8728 7745Airbel Impact Lab, International Rescue Committee, New York, NY USA
| | - Ohemaa Poku
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway Street, Baltimore, MD 21205 USA
| | - Rashelle Musci
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway Street, Baltimore, MD 21205 USA
| | - Manal Al-Fataftah
- Women Protection and Empowerment Program, International Rescue Committee, Amman, Jordan
| | - Lilian Kasina
- Design Monitoring and Evaluation Unit, International Rescue Committee, Nairobi, Kenya
| | - Mercy Lwambi
- Women’s Protection and Empowerment Program, International Rescue Committee, Nairobi, Kenya
| | - Asma Salaimeh
- Monitoring, Evaluation, Accountability and Learning Unit, International Rescue Committee, Amman, Jordan
| | - Kathryn Falb
- grid.420433.20000 0000 8728 7745Airbel Impact Lab, International Rescue Committee, Washington, DC USA
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