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Mayra K, Matthews Z, Sandall J, Padmadas SS. "I have to listen to them or they might harm me" and other narratives of why women endure obstetric violence in Bihar, India. Birth 2024. [PMID: 38840384 DOI: 10.1111/birt.12828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 03/28/2024] [Accepted: 05/01/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Evidence suggests that obstetric violence has been prevalent globally and is finally getting some attention through research. This human rights violation takes several forms and is best understood through the narratives of embodied experiences of disrespect and abuse from women and other people who give birth, which is of utmost importance to make efforts in implementing respectful maternity care for a positive birthing experience. This study focused on the drivers of obstetric violence during labor and birth in Bihar, India. METHODS Participatory qualitative visual arts-based method of data collection-body mapping-assisted interviews (adapted as birth mapping)-was conducted to understand women's perception of why they are denied respectful maternity care and what makes them vulnerable to obstetric violence during labor and childbirth. This study is embedded in feminist and critical theories that ensure women's narratives are at the center, which was further ensured by the feminist relational discourse analysis. Eight women participated from urban slums and rural villages in Bihar, for 2-4 interactions each, within a week. The data included transcripts, audio files, body maps, birthing stories, and body key, which were analyzed with the help of NVivo 12. FINDINGS Women's narratives suggested drivers that determine how they will be treated during labor and birth, or any form of sexual, reproductive, and maternal healthcare seeking presented through the four themes: (1) "I am admitted under your care, so, I will have to do what you say"-Influence of power on care during childbirth; (2) "I was blindfolded … because there were men"-Influence of gender on care during childbirth; (3) "The more money we give the more convenience we get"-Influence of structure on care during childbirth; and (4) "How could I ask him, how it will come out?"-Influence of culture on care during childbirth. How women will be treated in the society and in the obstetric environment is determined by their identity at the intersections of age, class, caste, marital status, religion, education, and many other sociodemographic factors. The issues related to each of these are intertwined and cross-cutting, which made it difficult to draw clear categorizations because the four themes influenced and overlapped with each other. Son preference, for example, is a gender-based issue that is part of certain cultures in a patriarchal structure as a result of power-based imbalance, which makes the women vulnerable to disrespect and abuse when their baby is assigned female at birth. DISCUSSION Sensitive unique feminist methods are important to explore and understand women's embodied experiences of trauma and are essential to understand their perspectives of what drives obstetric violence during childbirth. Sensitive methods of research are crucial for the health systems to learn from and embed women's wants, to address this structural challenge with urgency, and to ensure a positive experience of care.
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Affiliation(s)
- Kaveri Mayra
- Birth Place Lab, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zoë Matthews
- Department of Social Statistics and Demography, Faculty of Social Sciences, University of Southampton, Southampton, UK
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course Sciences, Kings College London, London, UK
| | - Sabu S Padmadas
- Department of Social Statistics and Demography, Faculty of Social Sciences, University of Southampton, Southampton, UK
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Sinha D, Srivastava S, T M, Kumar P. Predictors for the change in intimate partner violence among adolescent married girls aged 15-19 years: Estimates from random effect model. BMC Womens Health 2023; 23:108. [PMID: 36918886 PMCID: PMC10015729 DOI: 10.1186/s12905-023-02252-z] [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: 07/25/2021] [Accepted: 03/01/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Intimate Partner Violence (IPV) is one of the most common forms of violence against women. IPV against adolescents and young adult married women (15-19 years only) is poorly understood and not much researched as compared to their adult counterparts. The present study investigates the changes in multiple forms of IPV and tries to understand its association with different individual factors. METHODS The study used longitudinal data from Understanding the lives of Adolescent and Young Adults study (UDAYA), conducted in 2015-16 (wave 1) and 2018-19 (wave 2). The survey was done in two Indian states namely, Uttar Pradesh and Bihar. The sample size of the present study was 4,254 married adolescent girls aged 15-19 years. Multiple forms of IPV were the outcome variables of this study. A random effect regression analysis was used to estimate the association of changes in physical, sexual, and emotional violence with decision-making power and mobility restrictions along with other covariates. RESULTS Findings show that physical and emotional violence have increased from wave 1 to wave 2. Furthermore, married adolescent girls who took decisions alone/with others were less likely to suffer from IPV (β=-0.02; p < 0.05). Adolescent girls who agreed with the perception about wife-beating were more likely to report physical (β = 0.07; p < 0.05), sexual (β = 0.13; p < 0.05), and emotional violence (β = 0.14; p < 0.05). The risk of IPV was significantly more among adolescent girls whose family paid dowry compared to those who did not pay it (β = 0.04; p < 0.05). CONCLUSION Interventions against those social norms that harm any female adolescents' status in society and negatively impact their educational attainment should be adopted, simultaneously, with programs that promote gender equality in all aspects of their life.
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Affiliation(s)
- Debashree Sinha
- Department of Population & Development, International Institute for Population Sciences, Mumbai, 400088, Maharashtra, India
| | - Shobhit Srivastava
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, 400088, Maharashtra, India
| | - Muhammad T
- Department of Population Policies and Programs, International Institute for Population Sciences, Mumbai, 400088, Maharashtra, India
| | - Pradeep Kumar
- Specialist-Monitoring & Evaluation, Health Action Trust, Lucknow, Uttar Pradesh, India.
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Mayra K, Sandall J, Matthews Z, Padmadas SS. Breaking the silence about obstetric violence: Body mapping women’s narratives of respect, disrespect and abuse during childbirth in Bihar, India. BMC Pregnancy Childbirth 2022; 22:318. [PMID: 35421943 PMCID: PMC9009281 DOI: 10.1186/s12884-022-04503-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 02/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background Evidence on obstetric violence is reported globally. In India, research shows that almost every woman goes through some level of disrespect and abuse during childbirth, more so in states such as Bihar where over 70% of women give birth in hospitals. Objective 1) To understand how women experience and attach meaning to respect, disrespect and abuse during childbirth; and 2) document women’s expectations of respectful care. Methods ‘Body mapping’, an arts-based participatory method, was applied. The analysis is based on in-depth interviews with eight women who participated in the body mapping exercise at their homes in urban slums and rural villages. Analysis was guided by feminist relational discourse analysis. Findings Women reported their experiences of birthing at home, public facilities, and private hospitals in simple terms of what they felt ‘good’ and ‘bad’. Good experiences included being spoken to nicely, respecting privacy, companion of choice, a bed to rest, timely care, lesser interventions, obtaining consent for vaginal examination and cesarean section, and better communication. Bad experiences included unconsented interventions including multiple vaginal examinations by different care providers, unanesthetized episiotomy, repairs and uterine exploration, verbal, physical, sexual abuse, extortion, detention and lack of privacy. Discussion The body maps capturing birth experiences, created through a participatory method, accurately portray women’s respectful and disrespectful births and are useful to understand women’s experience of a sensitive issue in a patriarchal culture. An in-depth understanding of women’s choices, experiences and expectations can inform changes practices in and policies and help to develop a culture of sharing birth experiences. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04503-7.
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Santhya KG, Francis Zavier AJ. Long-Term Impact of Exposure to a Gender-Transformative Program Among Young Men: Findings From a Longitudinal Study in Bihar, India. J Adolesc Health 2022; 70:634-642. [PMID: 34952780 DOI: 10.1016/j.jadohealth.2021.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/21/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Gender-transformative programs with men and boys are recognized as a promising strategy for reducing violence against women and girls (VAWG). Reviews of such programs have underscored the need for investments in high-quality studies that measure effects on bio-behavioral outcomes and downstream effects. This article extends the limited evidence on long-term effects of gender-transformative programs with men and boys in India. METHODS We used data from a cluster randomized trial of a gender-transformative life-skills education cum sports coaching program that sought to promote gender egalitarian attitudes and rejection of VAWG among boys and men aged 13-21 and a follow-up study. Young men were interviewed thrice-before the launch, after the completion, and 5 years after the completion of the trial (N = 853). We used generalized estimating equations models to estimate the short- and long-term effects of the intervention and effect modification by participation level and intervention exposure in early/late adolescence. RESULTS The intervention succeeded in promoting gender equitable attitudes and notions of positive masculinity (β = 0.319; p = .012), and attitudes rejecting men's controlling behaviors (β = 0.428; p = .068) and VAWG (β = 0.673; p = .051) among young men in the long- erm. It reduced their perpetration of intimate partner violence (odds ratio 0.639; p = .062). The long-term positive effects were observed for regular participants only, and greater effects were observed among those exposed to the intervention in early than late adolescence. DISCUSSION Exposing boys to gender-transformative programs early on and ensuring their regular intervention participation can have sustained impact on promoting gender egalitarian attitudes and reducing their perpetration of VAWG.
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Affiliation(s)
- K G Santhya
- Population Council, Poverty, Gender and Youth, New Delhi, India.
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Gram L, Chakraborty P, Daruwalla N, Osrin D. Social and Psychological Readiness to Take Collective Action Against Violence Against Women: A Mixed Methods Study of Informal Settlements in Mumbai, India. Violence Against Women 2021; 27:3176-3196. [PMID: 33227227 PMCID: PMC8521371 DOI: 10.1177/1077801220971360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Past failures to mobilize communities in collective action against violence against women (VAW) have been ascribed to contextual challenges, but researchers have not systematically mapped community capacity for collective action against VAW. We conducted a mixed methods study in Mumbai, India using quantitative data from a household survey (n = 2,642) and qualitative data from 264 community meetings. We found attitudes supporting gender inequality and violence coexisted with significant enthusiasm and support for collective action against VAW. These findings open up avenues for policymakers to treat communities as less vulnerable and more capable of changing situations and problems that affect them.
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Affiliation(s)
- Lu Gram
- University College London, UK
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6
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Vollmer N, Singh M, Harshe N, Valadez JJ. Does interviewer gender influence a mother's response to household surveys about maternal and child health in traditional settings? A qualitative study in Bihar, India. PLoS One 2021; 16:e0252120. [PMID: 34133433 PMCID: PMC8208568 DOI: 10.1371/journal.pone.0252120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/11/2021] [Indexed: 12/16/2022] Open
Abstract
Background Two probability surveys, conducted in the same districts of Bihar, India (Aurangabad and Gopalganj) at approximately the same time in 2016 using identical questionnaires and similar survey methods, produced significantly different responses for 37.2% (58/156) of the indicator comparisons. Interviewers for one survey were men while for the other they were women. Respondents were mothers of children aged 0–59 months living in a traditional rural setting. We examined the influence of interviewer gender on mothers’ survey responses and their implications for interpreting survey results. Methods We used qualitative methods including 10 focus group discussions (FGDs) and 33 in-depth interviews (IDIs) in the same locations as the 2016 surveys. FGD participants were purposefully selected mothers with children 0–59 months, husbands and other in-law family members. IDIs were carried out with frontline health-workers, enumerators and supervisors from the two previous household surveys. Results Findings revealed a preference for female interviewers for household surveys in study districts as they facilitated access to mothers and reduced their discomfort as survey participants. However, this gender preference was related to the survey question. Regardless of age, caste and educational level, most mothers were not permitted to communicate with men (aside from husbands) about female-specific health topics, including birth preparedness, delivery, menstrual cycles, contraception, breastfeeding, sexual behaviour, sexually transmitted disease, and domestic violence. Mothers in higher castes perceived these social restrictions more acutely than mothers in lower castes. There was no systematic direction of the resulting error. Mothers were willing to discuss child health issues with interviewers of either gender. Conclusions Interviewer gender is an important consideration when designing survey protocols for maternal and reproductive health studies and when selecting and training enumerators. Female interviewers are optimal for traditional settings in Bihar as they are more likely to obtain accurate data on sensitive topics and reduce the potential for non-sampling error due to their reduced social distance with maternal respondents.
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Affiliation(s)
- Nancy Vollmer
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Mansha Singh
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Navika Harshe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Joseph J. Valadez
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
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Desai S, Misra M, Das A, Singh RJ, Sehgal M, Gram L, Kumar N, Prost A. Community interventions with women's groups to improve women's and children's health in India: a mixed-methods systematic review of effects, enablers and barriers. BMJ Glob Health 2021; 5:bmjgh-2020-003304. [PMID: 33328199 PMCID: PMC7745316 DOI: 10.1136/bmjgh-2020-003304] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION India is home to over 6 million women's groups, including self-help groups. There has been no evidence synthesis on whether and how such groups improve women's and children's health. METHODS We did a mixed-methods systematic review of quantitative and qualitative studies on women's groups in India to examine effects on women and children's health and to identify enablers and barriers to achieving outcomes. We searched 10 databases and included studies published in English from 2000 to 2019 measuring health knowledge, behaviours or outcomes. Our study population included adult women and children under 5 years. We appraised studies using standard risk of bias assessments. We compared intervention effects by level of community participation, scope of capability strengthening (individual, group or community), type of women's group and social and behaviour change techniques employed. We synthesised quantitative and qualitative studies to identify barriers and enablers related to context, intervention design and implementation, and outcome characteristics. FINDINGS We screened 21 380 studies and included 99: 19 randomised controlled trial reports, 25 quasi-experimental study reports and 55 non-experimental studies (27 quantitative and 28 qualitative). Experimental studies provided moderate-quality evidence that health interventions with women's groups can improve perinatal practices, neonatal survival, immunisation rates and women's and children's dietary diversity, and help control vector-borne diseases. Evidence of positive effects was strongest for community mobilisation interventions that built communities' capabilities and went beyond sharing information. Key enablers were inclusion of vulnerable community members, outcomes that could be reasonably expected to change through community interventions and intensity proportionate to ambition. Barriers included limited time or focus on health, outcomes not relevant to group members and health system constraints. CONCLUSION Interventions with women's groups can improve women's and children's health in India. The most effective interventions go beyond using groups to disseminate health information and seek to build communities' capabilities. TRIAL REGISTRATION NUMBER The review was registered with PROSPERO: CRD42019130633.
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Affiliation(s)
- Sapna Desai
- Population Council India, New Delhi, Delhi, India
| | | | | | | | | | - Lu Gram
- Institute for Global Health, University College London, London, UK
| | - Neha Kumar
- International Food Policy Research Institute, Washington, DC, USA
| | - Audrey Prost
- University College London Institute of Child Health, London, UK
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Patel R, Gupte SS, Srivastava S, Kumar P, Chauhan S, Govindu MD, Dhillon P. Experience of gender-based violence and its effect on depressive symptoms among Indian adolescent girls: Evidence from UDAYA survey. PLoS One 2021; 16:e0248396. [PMID: 33765009 PMCID: PMC7993765 DOI: 10.1371/journal.pone.0248396] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/26/2021] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Violence against women has been one of the most prominent issue and a major public health concern. It is a principle violation of basic human rights and has both physical and mental effect on the victim. This study focuses on married and unmarried girls aged 15 to 19 years, belonging to Uttar Pradesh and Bihar, India. This study attempts to examine depression level among married and unmarried girls who have faced violence against them. With the unprecedented growth in social networking, online digital platform and its accessibility, the study also brings out the pertinent aspect of internet based violence and its psychological outcome on adolescent girls. Hence, the study can be seen as an important and needed value addition to the existing pool of knowledge on the subject. METHODS The study uses Understanding the lives of adolescents and young adults (UDAYA) project data for Uttar Pradesh and Bihar. Depressive symptoms among adolescent girl is the outcome variable of the study. Descriptive statistic and bivariate analysis has been used to get to preliminary results. Chi-squared test is used to test the significant of variables. Further, multi-variate analysis (logistic regression) was used. RESULTS Almost 29, 23 and 26 percent of married adolescent girls had faced emotional, physical and sexual violence respectively. It was found that about five per cent of unmarried and eight per cent of married girls had high depressive symptoms. It was found that unmarried adolescent girls who had witnessed their father beating mother were 71 percent more likely to suffer from higher depressive symptoms [OR: 1.71, 1.09-2.69]. Adolescents who faced perpetrated bullying had 90 per cent [OR: 1.90, 1.32-2.72] and 86 per cent [OR: 1.86, 0.98-3.52] higher likelihood to suffer from higher depressive symptoms. CONCLUSION The study goes beyond intimate partner violence and includes various covariates to explain the association between violence and depressive symptoms among married and unmarried adolescents. Hence, more inclusive policies are needed to address the issue of violence against women as the spectrum of the violence is expanding with time.
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Affiliation(s)
- Ratna Patel
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | | | - Shobhit Srivastava
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, India
| | - Pradeep Kumar
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, India
| | - Shekhar Chauhan
- Department of Population Policies and Programmes, International Institute for Population Sciences, Mumbai, India
- * E-mail:
| | - Mani Deep Govindu
- Karnataka Health Promotion Trust (KHPT), Bengaluru, Karnataka, India
| | - Preeti Dhillon
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, India
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Mayra K, Matthews Z, Padmadas SS. Why do some health care providers disrespect and abuse women during childbirth in India? Women Birth 2021; 35:e49-e59. [PMID: 33678563 DOI: 10.1016/j.wombi.2021.02.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 02/19/2021] [Accepted: 02/19/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Disrespect and abuse during childbirth can result in fear of childbirth. Consequently, women may be discouraged to seek care, increasing the likelihood for women to choose elective cesarean section in order to avoid humiliation, postnatal depression and even maternal mortality. This study investigates the causes underlying mistreatment of women during childbirth by health care providers in India, where evidence of disrespect and abuse has been reported. METHODS Qualitative research was undertaken involving 34 in-depth interviews with midwifery and nursing leaders from India who represent administration, advocacy, education, regulation, research and service provision at state and national levels. Data are analysed thematically with NVivo12. The analysis added value by bringing an international perspective from interviews with midwifery leaders from Switzerland and the United Kingdom. FINDINGS The factors leading to disrespect and abuse of women relate to characteristics of both women and their midwives. Relevant woman-related attributes include her age, gender, physical appearance and education, extending to the social environment including her social status, family support, culture of abuse, myths around childbirth and sex-based discrimination. Midwife-related factors include gender, workload, medical hierarchy, bullying and powerlessness. DISCUSSION The intersectionality of factors associated with mistreatment during childbirth operate at individual, infrastructural, social and policy levels for both the women and nurse-midwives, and these factors could exacerbate existing gender-based inequalities. Maternal health policies should address the complex interplay of these factors to ensure a positive birthing experience for women in India. CONCLUSION Maternal health interventions could improve by integrating women-centred protocols and monitoring measures to ensure respectful and dignified care during childbirth.
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Affiliation(s)
- Kaveri Mayra
- Global Health Research Institute, Faculty of Social Sciences, University of Southampton, United Kingdom. https://www.twitter.com/myheroistrane
| | - Zoë Matthews
- Global Health Research Institute, Faculty of Social Sciences, University of Southampton, United Kingdom.
| | - Sabu S Padmadas
- Global Health Research Institute, Faculty of Social Sciences, University of Southampton, United Kingdom.
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Gram L, Granados R, Krockow EM, Daruwalla N, Osrin D. Modelling collective action to change social norms around domestic violence: social dilemmas and the role of altruism. HUMANITIES & SOCIAL SCIENCES COMMUNICATIONS 2021; 8:53. [PMID: 34553143 PMCID: PMC7611687 DOI: 10.1057/s41599-021-00730-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/05/2021] [Indexed: 06/03/2023]
Abstract
Interventions promoting collective action have been used to prevent domestic violence in a range of settings, but their mechanisms of operation remain unclear. We formalise and combine feminist theoretical approaches to domestic violence into a game-theoretic model of women's collective action to change gendered social norms and outcomes. We show that social norms create a social dilemma in which it is individually rational for women to abstain from action to prevent domestic violence among neighbours, but all women suffer negative consequences if none take action. Promoting altruism among women can overcome the social dilemma. Discouraging women from tolerating domestic violence, imposing additional external punishment on men for perpetrating violence, or lowering costs to women of taking action against violence may not work or even backfire. We invite researchers on community mobilisation to use our framework to frame their understandings of collective action to prevent domestic violence.
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Affiliation(s)
- Lu Gram
- Institute for Global Health, University College London, London, UK
| | - Rolando Granados
- Institute for Global Health, University College London, London, UK
| | - Eva M Krockow
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Nayreen Daruwalla
- Prevention of Violence against Women and Children, Society for Nutrition, Education and Health Action (SNEHA), Mumbai, India
| | - David Osrin
- Institute for Global Health, University College London, London, UK
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Nair N, Daruwalla N, Osrin D, Rath S, Gagrai S, Sahu R, Pradhan H, De M, Ambavkar G, Das N, Dungdung GP, Mohan D, Munda B, Singh V, Tripathy P, Prost A. Community mobilisation to prevent violence against women and girls in eastern India through participatory learning and action with women's groups facilitated by accredited social health activists: a before-and-after pilot study. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2020; 20:6. [PMID: 32213182 PMCID: PMC7093987 DOI: 10.1186/s12914-020-00224-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/25/2020] [Indexed: 11/26/2022]
Abstract
Background Almost one in three married Indian women have ever experienced physical, sexual, or emotional violence from husbands in their lifetime. We aimed to investigate the preliminary effects of community mobilisation through participatory learning and action groups facilitated by Accredited Social Health Activists (ASHAs), coupled with access to counselling, to prevent violence against women and girls in Jharkhand, eastern India. Methods We piloted a cycle of 16 participatory learning and action meetings with women’s groups facilitated by ASHAs in rural Jharkhand. Participants identified common forms of violence against women and girls, prioritised the ones they wanted to address, developed locally feasible strategies to address them, implemented the strategies, and evaluated the process. We also trained two counsellors and two ASHA supervisors to support survivors, and gave ASHAs information about legal, health, and police services. We did a before-and-after pilot study involving baseline and endline surveys with group members to estimate preliminary effects of these activities on the acceptability of violence, prevalence of past year emotional and physical violence, and help-seeking. Results ASHAs successfully conducted monthly participatory learning and action meetings with 39 women’s groups in 22 villages of West Singhbhum district, Jharkhand, between June 2016 and September 2017. We interviewed 59% (679/1149) of women registered with groups at baseline, and 63% (861/1371) at endline. More women reported that violence was unacceptable in all seven scenarios presented to them at endline compared to baseline (adjusted Odds Ratio [aOR]: 1.87, 95%: 1.39–2.52). Fewer women reported experiencing emotional violence from their husbands in the last 12 months (aOR: 0.55, 95% CI: 0.43–0.71), and more sought help if it occurred (aOR: 2.19, 95% CI: 1.51–3.17). In addition, fewer women reported experiencing emotional or physical violence from family members other than their husbands in the last 12 months (aOR: 0.41, 95% CI: 0.32–0.53, and aOR: 0.36, 95% CI: 0.26–0.50, respectively). Conclusion Combining participatory learning and action meetings facilitated by ASHAs with access to counselling was an acceptable strategy to address violence against women and girls in rural communities of Jharkhand. The approach warrants further implementation and evaluation as part of a comprehensive response to violence.
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Affiliation(s)
| | - Nayreen Daruwalla
- Society for Nutrition, Education and Health Action, Mumbai, Maharashtra, India
| | - David Osrin
- Institute for Global Health, University College London, London, UK
| | | | | | | | | | - Megha De
- Ekjut, Chakradharpur, Jharkhand, India
| | - Gauri Ambavkar
- Society for Nutrition, Education and Health Action, Mumbai, Maharashtra, India
| | - Nibha Das
- Ekjut, Chakradharpur, Jharkhand, India
| | | | - Damini Mohan
- Society for Nutrition, Education and Health Action, Mumbai, Maharashtra, India
| | | | | | | | - Audrey Prost
- Institute for Global Health, University College London, London, UK.
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Gupta AK, Santhya KG. Promoting Gender Egalitarian Norms and Practices Among Boys in Rural India: The Relative Effect of Intervening in Early and Late Adolescence. J Adolesc Health 2020; 66:157-165. [PMID: 31227386 DOI: 10.1016/j.jadohealth.2019.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 03/11/2019] [Accepted: 03/11/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Although the importance of exposing adolescent boys to gender transformative programs has been recognized, such programs are limited in India. Studies that assessed the relative effect of intervening in early compared with late adolescence are even more limited. This article examines the differential effect of exposing boys to a gender transformative program in early and late adolescence on their gender role attitudes and practices. METHODS We used data from a cluster randomized trial of a gender transformative life-skills education cum sports-coaching program for younger boys (aged 13-14 years) and older boys (aged 15-19 years) (N = 962) and used generalized estimating equation model to examine the differential effect. RESULTS The intervention had a greater effect in helping younger than older boys to espouse gender-egalitarian attitudes (β = .669; p < .001 vs. β = .344; p < .001) and attitudes rejecting men's controlling behaviors (β = .973; p < .003 vs. β = .453; p < .088), men's perpetration of wife beating (β = .423; p < .002 vs. β = .282; p < .035), and violence on unmarried girls (β = .332; p < .038 vs. β = .306; p < .045). Younger boys had higher odds of reporting that their peers would respect them for acting in gender-equitable ways (odds ratio [OR] = 2.15; p < .003) compared with older boys (OR = 1.78; p < .014). However, younger boys had lower odds of intervening to stop incidents of violence that they had witnessed, compared with older boys (OR = 2.17; p < .03 vs. OR = 2.56; p < .002). These differences remained significant even when difference in regular exposure to the intervention was adjusted. CONCLUSIONS Gender transformative programs are likely to be more effective in changing traditional attitudes and practices among boys if they target them during early adolescence compared with late adolescence.
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Affiliation(s)
| | - K G Santhya
- Population Council, India Habitat Centre, New Delhi, India
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13
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Hatcher AM, McBride RS, Rebombo D, Munshi S, Khumalo M, Christofides N. Process evaluation of a community mobilization intervention for preventing men's partner violence use in peri-urban South Africa. EVALUATION AND PROGRAM PLANNING 2020; 78:101727. [PMID: 31639542 PMCID: PMC7264430 DOI: 10.1016/j.evalprogplan.2019.101727] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/29/2019] [Accepted: 10/02/2019] [Indexed: 05/05/2023]
Abstract
Intimate partner violence (IPV) is experienced by one-third of women globally, yet few programs attempt to shift men's IPV perpetration. Community mobilization is a potential strategy for reducing men's IPV perpetration, but this has rarely been examined globally. We conducted a mixed-methods process evaluation alongside a trial testing community mobilization in peri-urban South Africa. We used in-depth interviews (n=114), participant observation (160 h), and monitoring and evaluation data to assess program delivery. Qualitative data (verbatim transcripts and observation notes) were managed in Dedoose using thematic coding and quantitative data were descriptively analyzed using Stata13. We learned that outreach elements of community mobilization were implemented with high fidelity, but that critical reflection and local advocacy were difficult to achieve. The context of a peri-urban settlement (characterized by poor infrastructure, migrancy, low education, social marginalization, and high levels of violence) severely limited intervention delivery, as did lack of institutional support for staff and activist volunteers. That community mobilization was poorly implemented may explain null trial findings; in the larger trial, the intervention failed to measurably reduce men's IPV perpetration. Designing community mobilization for resource-constrained settings may require additional financial, infrastructural, organizational, or political support to effectively engage community members and reduce IPV.
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Affiliation(s)
- Abigail M Hatcher
- School of Public Health, Faculty of Health Sciences, Unviersity of the Witwatersrand, Johannesburg, South Africa; Department of Medicine, University of California, San Francisco, United States.
| | - Ruari-Santiago McBride
- School of Public Health, Faculty of Health Sciences, Unviersity of the Witwatersrand, Johannesburg, South Africa
| | | | - Shehnaz Munshi
- School of Public Health, Faculty of Health Sciences, Unviersity of the Witwatersrand, Johannesburg, South Africa
| | | | - Nicola Christofides
- School of Public Health, Faculty of Health Sciences, Unviersity of the Witwatersrand, Johannesburg, South Africa
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14
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Santhya KG, Jejeebhoy SJ, Acharya R, Pandey N, Gogoi A, Joshi M, Singh SK, Saxena K, Ojha SK. Transforming the attitudes of young men about gender roles and the acceptability of violence against women, Bihar. CULTURE, HEALTH & SEXUALITY 2019; 21:1409-1424. [PMID: 30730251 DOI: 10.1080/13691058.2019.1568574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 01/08/2019] [Indexed: 06/09/2023]
Abstract
Although the importance of working with young men to transform traditional gender norms has been widely acknowledged, programmes for young men remain sparse in highly gender stratified settings such as India, and those that have been implemented have not reached those in rural areas and those out-of-school. Drawing on data from a cluster randomised controlled trial with panel surveys, of a gender-transformative life skills education and sports-coaching programme conducted among young men aged 13-21 who were members of youth clubs, this paper examines the extent to which it transformed the gender role attitudes of young men and instilled in them attitudes rejecting violence against women and girls. The intervention succeeded in changing gender role attitudes and notions of masculinity, attitudes about men's controlling behaviours over women/girls, attitudes about men's perpetration of violence on a woman/girl and perceptions about peer reactions to young men acting in gender-equitable ways. Effects were particularly significant among young men who attended regularly, underscoring the importance of regular attendance in such programmes.
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