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Donkoh IE, Aboagye RG, Okyere J, Seidu AA, Ahinkorah BO, Yaya S. Association between the survey-based women's empowerment index (SWPER) and intimate partner violence in sub-Saharan Africa. Reprod Health 2024; 21:63. [PMID: 38730477 PMCID: PMC11088024 DOI: 10.1186/s12978-024-01755-8] [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: 09/03/2023] [Accepted: 02/12/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is high among women of reproductive age in sub-Saharan Africa (SSA). However, empowering women enables them to confront and mitigate IPV. In this study, we examined the association between the survey-based women's empowerment index (SWPER) and IPV in SSA. METHODS We used data from the Demographic and Health Surveys of 19 countries conducted from 2015 to 2021. Our study was restricted to a weighted sample of 82,203 women of reproductive age who were married or cohabiting. We used spatial maps to show the proportions of women who experienced past-year IPV. A five-modelled multilevel binary logistic regression analysis was adopted to examine the association between SWPER and IPV. The results were presented using the adjusted odds ratio (AOR) with their respective 95% confidence interval (CI). Statistical significance was set at p < 0.05. RESULTS With physical and emotional violence, the country with the highest prevalence was Sierra Leone, with a prevalence of 39.00% and 38.97% respectively. Rwanda (10.34%), Zambia (11.09%), Malawi (15.00%), Uganda (16.88%), and Burundi (20.32%) were the hotspot countries for sexual violence. Angola (34.54%), Uganda (41.55%), Liberia (47.94%), and Sierra Leone (59.98%) were the hotspot countries for IPV. A high SWPER score in attitudes to violence significantly decreased the odds of IPV [AOR = 0.70; 95% CI = 0.66, 0.75]. Also, women with medium score in decision-making were less likely to experience IPV compared to those with lower scores [AOR = 0.89; 95% CI = 0.83, 0.95]. However, higher odds of experiencing IPV was found among women with medium score in autonomy compared to those with low scores [AOR = 1.07; 95% CI = 1.01, 1.14]. CONCLUSIONS Our study has shown that the three dimensions of SWPER significantly predict IPV among women. Consequently, it is crucial that sub-Saharan African countries implement various initiatives, such as IPV advocacy programs and economic livelihood empowerment initiatives. These initiatives should not only aim to improve women's attitudes to domestic violence but also to enhance their social independence, autonomy, and decision-making capacity.
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Affiliation(s)
- Irene Esi Donkoh
- Department of Medical Laboratory Science, University of Cape Coast, Cape Coast, Ghana
| | - Richard Gyan Aboagye
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- School of Nursing and Midwifery, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Abdul-Aziz Seidu
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
- REMS Consultancy Services Limited, Sekondi-Takoradi, Western region, Ghana
| | - Bright Opoku Ahinkorah
- REMS Consultancy Services Limited, Sekondi-Takoradi, Western region, Ghana
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada.
- The George Institute for Global Health, Imperial College London, London, UK.
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Mootz JJ, Spencer CM, Ettelbrick J, Kann B, Fortunato dos Santos P, Palmer M, Stith SM. Risk Markers for Victimization and Perpetration of Male-to-Female Physical Intimate Partner Violence in Sub-Saharan Africa: A Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2023; 24:3433-3444. [PMID: 36373646 PMCID: PMC10583092 DOI: 10.1177/15248380221129589] [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] [Indexed: 06/16/2023]
Abstract
Exposure to intimate partner violence (IPV) incurs significant public health consequences. Understanding risk markers can accelerate prevention and response efforts, important in settings like Sub-Saharan Africa (SSA) where resources are scarce. In this study, four databases were searched to identify studies that examined risk markers for male-to-female physical IPV. With application of the socioecological model, we analyzed 11 risk markers for male physical IPV perpetration (with 71 effect sizes) and 16 risk markers for female physical IPV victimization (with 131 effect sizes) in SSA from 51 studies. For male IPV perpetration, we found medium-to-large effect sizes for six risk markers: perpetrating emotional abuse and sexual IPV, witnessing parental IPV, being abused as a child, cohabitating (not married), and exhibiting controlling behaviors. We found small effect sizes for substance use. Employment, age, marital status, and education were not significant risk markers. For female IPV victimization, a medium effect size was found for post-traumatic stress symptoms. Small effect sizes were found for reporting depressive symptoms, being abused as a child, witnessing parental IPV, and reporting drug and alcohol use. Rural residence, approval of violence, length of relationship, income, education, employment, age, marital status, and religiosity were not significant risk markers. Findings highlight opportunities for screening and intervention at the couple level, show the need to test and incorporate interventions for IPV in mental health treatment, and emphasize the importance of further research on sociodemographic risk markers and the interventions that target them.
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Affiliation(s)
- Jennifer J. Mootz
- Columbia University, New York, NY, USA
- New York State Psychiatric Institute, USA
| | | | | | - Bianca Kann
- Columbia University, New York, NY, USA
- New York State Psychiatric Institute, USA
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Bloom BE, Hamilton K, Adeke B, Tuhebwe D, Atuyambe LM, Kiene SM. 'Endure and excuse': a mixed-methods study to understand disclosure of intimate partner violence among women living with HIV in Uganda. CULTURE, HEALTH & SEXUALITY 2022; 24:499-516. [PMID: 33530887 DOI: 10.1080/13691058.2020.1861328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 12/03/2020] [Indexed: 06/12/2023]
Abstract
Intimate partner violence and HIV remain significant health challenges among women living with HIV. Intimate partner violence has been linked to negative health outcomes and poorer HIV care engagement. This study examined intimate partner violence among Ugandan women living with HIV, their experiences disclosing such violence and how culturally normative factors affected disclosure-related outcomes. In a mixed-methods study conducted in Uganda in 2018, 168 women participated in interviewer-administered surveys; a sub-set who reported experiencing intimate partner violence participated in in-depth interviews (IDIs). Intimate partner violence was prevalent among women in the sample (68.0%); almost half experienced emotional violence (45.2%), while a smaller proportion had experienced physical (32.1%) and/or sexual violence (19.6%). Most women living with HIV (61.8%) had disclosed their experience of intimate partner violence to someone. Women who experienced intimate partner violence had higher odds of disclosure if they feared their partner and perpetrated violence against their partner. Thematic analysis of IDIs revealed enduring violence and blaming alcohol for men's perpetration of violence. Traditional cultural and gender norms, especially concerning motherhood and partnership, influenced women's experiences of intimate partner violence and disclosure. Multi-sectoral responses to challenge and reform cultural norms that perpetuate violence are needed, including mobilising key stakeholders (e.g. family, community, policy-makers) to serve as catalysts for change and encourage resource- and safety-seeking for women living with HIV to escape violence.
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Affiliation(s)
- Brittnie E Bloom
- School of Public Health, San Diego State University, San Diego, CA, USA
- School of Medicine, University of California San Diego, San Diego, CA, USA
| | | | - Barbra Adeke
- School of Public Health, Makerere University, Kampala, Uganda
| | - Doreen Tuhebwe
- School of Public Health, Makerere University, Kampala, Uganda
| | - Lynn M Atuyambe
- School of Public Health, Makerere University, Kampala, Uganda
| | - Susan M Kiene
- School of Public Health, San Diego State University, San Diego, CA, USA
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4
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Aboagye RG, Dadzie LK, Arthur-Holmes F, Okyere J, Agbaglo E, Ahinkorah BO, Seidu AA. Intimate partner violence against married and cohabiting women in sub-Saharan Africa: does sexual autonomy matter? Reprod Health 2022; 19:79. [PMID: 35346246 PMCID: PMC8962047 DOI: 10.1186/s12978-022-01382-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 03/11/2022] [Indexed: 11/15/2022] Open
Abstract
Background Literature shows that women’s sexual autonomy, which refers to women’s capacity to refuse sex and ask a partner to use condom, has significant implications on the sexual and reproductive health outcomes and sexual-and-gender based violence. Nevertheless, there is scarcity of empirical evidence to support the association between women’s sexual autonomy and intimate partner violence (IPV) in sub-Saharan Africa. Methods Data for the study were extracted from the recent Demographic and Health Surveys in 24 countries in sub-Saharan Africa between 2010 and 2019. Bivariable and multivariable binary logistic regression analyses were performed to examine the association between sexual autonomy and IPV in all the studied countries. Statistical significance was set at p < 0.05. Results The pooled prevalence of IPV and sexual autonomy in the 24 countries were 38.5% and 73.0% respectively. Overall, the odds of exposure to IPV were higher among women with sexual autonomy, compared to those without sexual autonomy even after controlling for covariates (age, level of education, marital status, current working status, place of residence, wealth quintile and media exposure). At the country-level, women from Angola, Cameroon, Chad, Gabon, Cote d’lvoire, Gambia, Mali, Nigeria, Kenya, Comoros, Zambia, and South Africa who had sexual autonomy were more likely to experience IPV whilst those in Burundi were less likely to experience IPV. The study showed that sexual autonomy increases women’s exposure to IPV and this occurred in many countries except Burundi where women with sexual autonomy were less likely to experience IPV. Conclusion The findings highlight the need for serious programs and policies to fight against IPV in the sub-region. Additionally, laws need to be passed and implemented, with law enforcement agencies provided with the necessary resources to reduce intimate partner violence among women with sexual autonomy. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-022-01382-1. Globally, intimate partner violence is regarded as a public health concern due to its devastating effects on the physical, emotional, and reproductive health of women. This study sought to determine how women’s capacity to refuse sex, negotiate for safe sex practices such as insisting on partner to use condom, and feeling justified in asking a partner to use condom is associated with the potential of experiencing violence from an intimate partner. Using data from the demographic and health survey conducted between 2010 and 2019, we found that women who had more capacity to refuse sex, negotiate for safe sex practices such as insisting on partner to use condom, and feeling justified in asking a partner to use condom were more likely to experience violence from their intimate partners after controlling for other factors such as the age of the woman, level of education, marital status, place of residence, economic status, and media exposure. The results highlight the need for sub-Saharan African countries to step up programs that ease up intimate partner violence reporting and access to legal support for those who experience it. Additionally, laws need to be passed and implemented, with law enforcement agencies provided with the necessary resources to reduce intimate partner violence among women with sexual autonomy.
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Affiliation(s)
- Richard Gyan Aboagye
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana.
| | - Louis Kobina Dadzie
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Francis Arthur-Holmes
- Department of Sociology and Social Policy, Lingnan University, 8 Castle Peak Road, Tuen Mun, Hong Kong
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.,Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
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Ireland H, Tran NT, Dawson A. The role of social capital in women's sexual and reproductive health and rights in humanitarian settings: a systematic review of qualitative studies. Confl Health 2021; 15:87. [PMID: 34819110 PMCID: PMC8611620 DOI: 10.1186/s13031-021-00421-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/09/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Social capital is an important social determinant of women's sexual and reproductive health and rights. Little research has been conducted to understand the role of social capital in women's sexual and reproductive health and how this can be harnessed to improve health in humanitarian settings. We synthesised the evidence to examine the nexus of women's sexual and reproductive health and rights and social capital in humanitarian contexts. METHODS We undertook a systematic review of qualitative studies. The preferred reporting items for systematic review and meta-analysis guidelines were used to identify peer-reviewed, qualitative studies conducted in humanitarian settings published since 1999. We searched CINAHL, MEDLINE, ProQuest Health & Medicine, PubMed, Embase and Web of science core collection and assessed quality using the Critical Appraisal Skills Programme tool. We used a meta-ethnographic approach to synthesise and analyse the data. FINDINGS Of 6749 initially identified studies, we included 19 studies, of which 18 were in conflict-related humanitarian settings and one in a natural disaster setting. The analysis revealed that the main form of social capital available to women was bonding social capital or strong links between people within groups of similar characteristics. There was limited use of bridging social capital, consisting of weaker connections between people of approximately equal status and power but with different characteristics. The primary social capital mechanisms that played a role in women's sexual and reproductive health and rights were social support, informal social control and collective action. Depending on the nature of the values, norms and traditions shared by network members, these social capital mechanisms had the potential to both facilitate and hinder positive health outcomes for women. CONCLUSIONS These findings demonstrate the importance of understanding social capital in planning sexual and reproductive health responses in humanitarian settings. The analysis highlights the need to investigate social capital from an individual perspective to expose the intra-network dynamics that shape women's experiences. Insights could help inform community-based preparedness and response programs aimed at improving the demand for and access to quality sexual and reproductive health services in humanitarian settings.
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Affiliation(s)
- Hannah Ireland
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia.
| | - Nguyen Toan Tran
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia
- Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland
| | - Angela Dawson
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia
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Wood SN, Kennedy SR, Hameeduddin Z, Asira B, Tallam C, Akumu I, Wanjiru I, Glass N, Decker MR. "Being Married Doesn't Mean You Have to Reach the End of the World": Safety Planning With Intimate Partner Violence Survivors and Service Providers in Three Urban Informal Settlements in Nairobi, Kenya. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP10979-NP11005. [PMID: 31587653 DOI: 10.1177/0886260519879237] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Intimate partner violence (IPV) harms women physically, sexually, and psychologically. Safety strategies, or harm reduction techniques implemented by women undergoing recurrent violence, may help mitigate the negative health, economic, and social consequences of IPV. This study aimed to understand recommended and utilized safety strategies among three urban informal settlements in Nairobi, Kenya. Semi-structured key informant discussions (KIDs; n = 18) with community-based service providers and focus group discussions (FGDs; n = 49) with IPV survivors were conducted. All interviews were audio-recorded, transcribed, and translated verbatim from Swahili to English. Inductive thematic analysis was used to structure codes. Convergence matrices were used to analyze emergent strategies by data source (service providers vs. IPV survivors). Women preferred safety strategies that they could implement unassisted as first line of harm reduction. Strategies included removing stressors, proactive communication, avoidance behaviors, sexual and reproductive health (SRH), economic, leaving partner for safety, child safety, and securing personal property. Strategies recommended by service providers and utilized by IPV survivors differed, with clear divergence indicated for leaving the abusive relationship, SRH, and personal property strategies. Innovative strategies emerged from IPV survivors for safeguarding property. Similar to upper-income and other low and middle-income contexts, women experiencing IPV in urban informal settlements of Nairobi actively engage in behaviors to maximize safety and reduce harm to themselves and their families. Integration of strategies known to be helpful to women in these communities into community-based prevention and response is strongly encouraged. Increased synergy between recommended and implemented safety strategies can enhance programming and response efforts.
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Affiliation(s)
- Shannon N Wood
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Zaynab Hameeduddin
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | - Nancy Glass
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Center for Global Health, Johns Hopkins University, Baltimore, MD, USA
| | - Michele R Decker
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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7
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Brown LL, Perkins JM, Hargrove JL, Pahl KE, Mogoba P, van Zyl MA. Correlates of Safety Strategy Use Among South African Women Living With HIV and at Risk of Intimate Partner Violence. Violence Against Women 2021; 28:1505-1522. [PMID: 34157908 PMCID: PMC8692488 DOI: 10.1177/10778012211021108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intimate partner violence (IPV) and HIV are correlated and endemic in South Africa. However, safety strategy use to prevent IPV among HIV-positive women is understudied. This study assesses correlates of specific safety strategy use among 166 Black South African women recently experiencing IPV and testing positive for HIV. Associations were observed between consultation with formal (i.e., counselors, clergy, IPV specialists) and informal networks (i.e., friends/family) and participant language (isiZulu, isiXhosa, Sesotho, and English), past year IPV, and engaging in HIV care. Future HIV-IPV programs should consider how characteristics of different IPV safety strategies may influence strategy uptake and ultimately HIV care.
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Affiliation(s)
- Leslie Lauren Brown
- Meharry Medical College, School of Medicine, Nashville, TN, USA.,Nashville CARES, Nashville, TN, USA
| | - Jessica Mayson Perkins
- Vanderbilt University, Nashville, TN, USA.,Vanderbilt Institute of Global HealthUniversity, Nashville, TN, USA
| | | | | | - Phepo Mogoba
- University of Cape Town, Western Cape, South Africa
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Horn R, Arakelyan S, Wurie H, Ager A. Factors contributing to emotional distress in Sierra Leone: a socio-ecological analysis. Int J Ment Health Syst 2021; 15:58. [PMID: 34116686 PMCID: PMC8193165 DOI: 10.1186/s13033-021-00474-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/19/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is increasing global evidence that mental health is strongly determined by social, economic and environmental factors, and that strategic action in these areas has considerable potential for improving mental health and preventing and alleviating mental disorders. Prevention and promotion activities in mental health must address the needs prioritised by local actors. The aim of this study was to identify stressors with the potential to influence emotional wellbeing and distress within the general population of Sierra Leone, in order to contribute to an inter-sectoral public mental health approach to improving mental health within the country. METHODOLOGY Respondents were a convenience sample of 153 respondents (60 women, 93 men) from five districts of Sierra Leone. Using freelisting methodology, respondents were asked to respond to the open question 'What kind of problems do women/men have in your community?'. Data analysis involved consolidation of elicited problems into a single list. These were then organised thematically using an adaptation of the socio-ecological model, facilitating exploration of the interactions between problems at individual, family, community and societal levels RESULTS: Overall, respondents located problems predominantly at community and societal levels. Although few respondents identified individual-level issues, they frequently described how problems at other levels contributed to physical health difficulties and emotional distress. Women identified significantly more problems at the family level than men, particularly related to relationships with an intimate partner. Men identified significantly more problems at the societal level than women, primarily related to lack of infrastructure. Men and women were equally focused on problems related to poverty and lack of income generating opportunities. CONCLUSION Poverty and inability to earn an income underpinned many of the problems described at individual, family and community level. Actions to address livelihoods, together with improving infrastructure and addressing gender norms which are harmful to both men and women, are likely key to improving the wellbeing of the Sierra Leone population.
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Affiliation(s)
- Rebecca Horn
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
- NIHR Global Health Research Unit on Health in Situations of Fragility, Queen Margaret University, Edinburgh, UK
| | - Stella Arakelyan
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
- NIHR Global Health Research Unit on Health in Situations of Fragility, Queen Margaret University, Edinburgh, UK
| | - Haja Wurie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- NIHR Global Health Research Unit on Health in Situations of Fragility, Queen Margaret University, Edinburgh, UK
| | - Alastair Ager
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
- NIHR Global Health Research Unit on Health in Situations of Fragility, Queen Margaret University, Edinburgh, UK
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Wood SN, Glass N, Decker MR. An Integrative Review of Safety Strategies for Women Experiencing Intimate Partner Violence in Low- and Middle-Income Countries. TRAUMA, VIOLENCE & ABUSE 2021; 22:68-82. [PMID: 30669943 DOI: 10.1177/1524838018823270] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Intimate partner violence (IPV) is prevalent and a leading source of morbidity and mortality to women worldwide. Safety planning is a cornerstone of harm reduction and violence support in many upper income countries. Far less is known about safety strategies used by women in low- and middle-income countries (LMICs) where the IPV support service infrastructure may be more limited. This study aimed to review the literature regarding safety strategies in LMICs. A PubMed search was conducted using search terms "safety," "coping," "harm reduction," and "intimate partner violence." Inclusion criteria comprised IPV studies mentioning characterization and utilization of safety strategies that were written in English and conducted in an LMIC. Our search yielded 16 studies (in-depth interviews, n = 5; focus group discussions, n = 2; case study, n = 2; mixed qualitative methods, n = 4; mixed methods, n = 1; and semi-structured quantitative survey, n = 2). Four distinct themes of strategies emerged: engaging informal networks, removing the stressor/avoidance, minimizing the damage to self and family through enduring violence, and building personal resources. IPV-related safety strategies literature primarily emerged from site-specific qualitative work. No studies provided effectiveness data for utilized strategies. Across geoculturally diverse studies, results indicate that women are engaging in strategic planning to minimize abuse and maximize safety. Women highlighted that safety planning strategies were feasible and acceptable within their communities. Further research is needed to test the effectiveness of these strategies in decreasing revictimization and increasing health and well-being. Further adoption of safety strategies into violence programming could increase monitoring and evaluation efforts.
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Affiliation(s)
- Shannon N Wood
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nancy Glass
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Center for Global Health, Johns Hopkins University, Baltimore, MD, USA
| | - Michele R Decker
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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10
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Sprague C, Woollett N, Hatcher AM. Enhancing agency for health providers and pregnant women experiencing intimate partner violence in South Africa. Glob Public Health 2020; 15:1820-1835. [PMID: 32552366 PMCID: PMC7641912 DOI: 10.1080/17441692.2020.1780290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 06/01/2020] [Indexed: 10/24/2022]
Abstract
Global policy frameworks call for strengthening the role of health systems to address intimate partner violence (IPV) and support women's agency, yet the evidence of health system responses remains slender in low- and middle-income countries (LMICs). In South Africa, 25-35% of pregnant women experience IPV, posing long-term health risks. We utilised agency as a theoretical construct, applying qualitative methods to investigate health professionals' experiences of a randomised controlled trial intervention to address IPV in pregnant women in five antenatal clinics (ANC) in Johannesburg (2011-2016). In-depth interviews (n = 16) were supplemented by participant observation, debriefing and field notes. Health providers viewed the intervention as enhancing health promotion agency and advancing help-seeking agency for IPV-exposed patients. Intervention nurses reported their own self-efficacy improved, and their relational and collective agency expanded. On-going supervision, mentorship and feedback were essential to establish the knowledge and skill-building necessary for providers to improve self-efficacy in intervention delivery. Integrating mental health services into primary ANC services is recommended. Findings offer insight into the untapped potential for LMIC health settings to become transformative, gender-responsive social systems, for patients and health professionals, in ways that advance women's agency, health, human rights and SDGs.
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Affiliation(s)
- Courtenay Sprague
- Department of Conflict Resolution, Human Security &
Global Governance, McCormack Graduate School of Policy and Global Studies,
University of Massachusetts Boston, Boston, MA, USA
- Department of Nursing, College of Nursing and Health
Sciences, University of Massachusetts Boston, Boston, MA, USA
- Wits Reproductive Health and HIV Institute, Faculty of
Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nataly Woollett
- School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
| | - Abigail M. Hatcher
- School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
- Department of Health Behavior, Gillings School of Global
Health, University of North Carolina, Chapel Hill, North Carolina, USA
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11
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Ali P, Watson R. Spousal Violence: A Mokken Scaling Analysis of Attitudes of South Asian Men and Women. VIOLENCE AND VICTIMS 2020; 35:656-673. [PMID: 33060249 DOI: 10.1891/vv-d-18-00043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Attitudes toward intimate partner violence (IPV) are usually explored by asking participants to respond to some statements describing various instances or situations. Currently, we do not know if responses to such questions or statements are random, leading to a total score which is hard to compare between respondents, or in a hierarchical manner which makes such comparison much more meaningful. The study was conducted to explore the structure of an "attitudes to intimate partner" violence scale used in the Demographic and Health Surveys Program (DHS), for a hierarchy of items according to the criteria of Mokken scaling. Secondary analyses of the data related to attitudes to IPV of South Asian men and women, collected by the DHS from Pakistan, India, Bangladesh, Maldives, and Nepal between 2006 and 2014. A strong Mokken scale was apparent in the data with IPV by men being most justified in cases where the wife neglected the children and least endorsed in the case of refusing to have sex. Men and women endorsed the items in the same order, but some inter country differences were apparent.
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Affiliation(s)
- Parveen Ali
- Health Sciences School, University of Sheffield, Sheffield, United Kingdom
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Strang A, O'Brien O, Sandilands M, Horn R. Help-seeking, trust and intimate partner violence: social connections amongst displaced and non-displaced Yezidi women and men in the Kurdistan region of northern Iraq. Confl Health 2020; 14:61. [PMID: 32874200 PMCID: PMC7456008 DOI: 10.1186/s13031-020-00305-w] [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] [Received: 01/24/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022] Open
Abstract
Background Conflict and displacement impact the social fabric of communities through the disruption of social connections and the erosion of trust. Effective humanitarian assistance requires understanding the social capital that shapes patterns of help-seeking in these circumstances - especially with stigmatised issues such as violence against women (VAW) and intimate partner violence (IPV). Methods A novel social mapping methodology was adopted amongst a Yezidi population displaced by ISIS (ISIS: Islamic State of Iraq and Syria, locally known as Da’esh) occupation and a neighbouring settled Yezidi population in the Kurdistan region of northern Iraq in late 2016. Six participatory workshops were conducted to identify available resources with respect to: meeting basic needs, dispute resolution and VAW. Subsequently, 51 individual interviews were conducted (segmented by gender and settlement status) to identify connectedness to, and trust in, the resources identified, with a focus on IPV against women. Results 90% of participants reported God as a key source of help in the previous 6 months, representing the most widely cited resource. Following God, the most accessed and trusted resources were family and community, with NGO (non-governmental organisation) provision being the least. Women drew more strongly upon familial resources than men (Χ2 = 5.73, df = 1, p = 0.017). There was reduced trust in resources in relation to seeking help with IPV. A distinction between trust to provide emotional support and trust to resolve issues was identified. Settled women were 1.6 times more likely to trust community members and government services and 3.7 times more likely to trust NGOs than displaced women. Conclusions Mapping social connections and trust provides valuable insight into the social capital available to support help-seeking in populations of humanitarian concern. For these Yezidi populations, family, religious and community resources were the most widely utilised and trusted. Trust was mostly reserved for family and their main religious leader regarding IPV against women. Lack of trust appeared to be a major barrier to stronger engagement with available NGO provision, particularly amongst displaced women. The role of faith and religious resources for this population is clearly significant, and warrants an explicitly faith-sensitive approach to humanitarian assistance.
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Affiliation(s)
- Alison Strang
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Oonagh O'Brien
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Maggie Sandilands
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Rebecca Horn
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
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Mannell J, Grewal G, Ahmad L, Ahmad A. A Qualitative Study of Women's Lived Experiences of Conflict and Domestic Violence in Afghanistan. Violence Against Women 2020; 27:1862-1878. [PMID: 32627712 PMCID: PMC8343200 DOI: 10.1177/1077801220935191] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This article empirically explores women’s lived experiences of domestic violence and conflict in Afghanistan. A thematic analysis of 20 semistructured interviews with women living in safe houses produced three main themes about the relationship between conflict and domestic violence: (a) violence from loss of patriarchal support, (b) violence from the drug trade as an economic driver, and (c) violence from conflict-related poverty. We discuss the bidirectional nature of this relationship: Not only does conflict contribute to domestic violence, but domestic violence contributes to conflict through justifying armed intervention, separating women from economic and public life, and perpetuating patriarchy.
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Affiliation(s)
| | | | - Lida Ahmad
- Independent Consultant, Kabul, Afghanistan
| | - Ayesha Ahmad
- UCL Institute for Global Health, London, UK.,St George's, University of London, UK
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Baragatti DY, Rolim ACA, de Castro CP, de Melo MC, Silva EM. [Critical pathway of women facing violence: an integrative reviewLa ruta crítica que recorren las mujeres en situación de violencia: revisión integradora]. Rev Panam Salud Publica 2019; 43:e34. [PMID: 31093258 PMCID: PMC6438411 DOI: 10.26633/rpsp.2019.34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 12/06/2018] [Indexed: 11/24/2022] Open
Abstract
Objective To identify the critical pathway taken by women facing domestic violence in the world in their search for help. Method An integrative review was performed. LILACS, MEDLINE/ PubMed, EMBASE, Scopus, and Web of Science databases were searched until year 2017. The following were inclusion criteria: full text available online, Portuguese, Spanish, or English as language of publication, focus on the theme of interest, and answering the guiding question (Which critical path is taken by women facing domestic violence?). Results Thirty-eight articles published from 2001 to 2017 were included. Factors driving the search for help included economic empowerment and increased schooling, severity of the violence, and presence of structured and qualified support services. Factors inhibiting the search for help were immigrant status, cultural gender norms, feelings of guilt, fear, and shame, lack of confidence and little knowledge and/or limited availability of formal support services. Children as well as family and community support may function as both inhibitors or drivers of the search for help. The types of formal help most often sought are police and health care services, whereas family, community, and religious leadership provide informal support. Conclusion The critical pathway of women facing domestic violence in the world includes both formal and informal elements. Therefore, it is necessary to address sociocultural, community, and family issues so as to encourage women to break free from the violent environment and seek qualified formal support networks.
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Affiliation(s)
- Daniella Yamada Baragatti
- Faculdade de Enfermagem (FENF/UNICAMP) Faculdade de Enfermagem (FENF/UNICAMP) Universidade Estadual de Campinas CampinasSP Brasil Universidade Estadual de Campinas, Faculdade de Enfermagem (FENF/UNICAMP), Campinas (SP), Brasil
| | - Ana Carine Arruda Rolim
- Escola Multicampi de Ciências Médicas (EMCM/UFRN) Escola Multicampi de Ciências Médicas (EMCM/UFRN) Universidade Federal do Rio Grande do Norte CaicóRN Brasil Universidade Federal do Rio Grande do Norte, Escola Multicampi de Ciências Médicas (EMCM/UFRN), Caicó (RN), Brasil
| | - Cristiane Pereira de Castro
- Faculdade de Saúde Pública (FSP/USP) Faculdade de Saúde Pública (FSP/USP) Universidade de São Paulo São PauloSP Brasil Universidade de São Paulo, Faculdade de Saúde Pública (FSP/USP), São Paulo (SP), Brasil
| | - Márcio Cristiano de Melo
- Faculdade de Ciências Médicas (FCM/UNICAMP) Faculdade de Ciências Médicas (FCM/UNICAMP) Universidade Estadual de Campinas CampinasSP Brasil Universidade Estadual de Campinas, Faculdade de Ciências Médicas (FCM/UNICAMP), Campinas (SP), Brasil
| | - Eliete Maria Silva
- Faculdade de Enfermagem (FENF/UNICAMP) Faculdade de Enfermagem (FENF/UNICAMP) Universidade Estadual de Campinas CampinasSP Brasil Universidade Estadual de Campinas, Faculdade de Enfermagem (FENF/UNICAMP), Campinas (SP), Brasil
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Baragatti DY, Carlos DM, Leitão MNDC, Ferriani MDGC, Silva EM. Critical path of women in situations of intimate partner violence. Rev Lat Am Enfermagem 2018; 26:e3025. [PMID: 30110101 PMCID: PMC6091378 DOI: 10.1590/1518-8345.2414.3025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 05/06/2018] [Indexed: 11/22/2022] Open
Abstract
Objective: To know and analyze the critical path followed by women subjected to intimate
partner violence until reaching a Reference Center of a Brazilian city, from
the perspective of these women. Method: Qualitative research, based on the concept of critical path. Participant
observations of the support group of the Reference Center and interviews
with ten women in situations of violence who were followed up in this
service. Results: the motivating factors for women to seek help were the increase in the
severity of the aggressions, the impact of the violence on their children
and support from their family. They go to several sectors and services
before reaching the Reference Center, such as the police and legal counsel,
health and social services. They find little effective responses from the
services, and care is indicated as the most relevant response factor to face
the situation. Conclusion: the assistance is fragmented and dependent on the posture of the
professional. The Reference Center is recognized as an important place of
support for women. In addition to governmental efforts to maintain the
network structured, the permanent education of the working professionals is
also fundamental.
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Affiliation(s)
| | - Diene Monique Carlos
- Post-doctoral fellow, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | | | - Maria das Graças Carvalho Ferriani
- PhD, Full Professor, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Eliete Maria Silva
- PhD, Associate Professor, Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Mannell J, Guta A. The ethics of researching intimate partner violence in global health: A case study from global health research. Glob Public Health 2017; 13:1035-1049. [PMID: 28278750 DOI: 10.1080/17441692.2017.1293126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
There has been an increase in attention to intimate partner violence (IPV) as a health issue that contributes to the spread of HIV, physical and emotional stress, depression, substance use, serious injuries, and higher rates of mortality in low-income settings. This paper explores the ethical implications raised by research on IPV by global health scholars. Drawing on Hedgecoe's work on critical bioethics to analyse a qualitative study of IPV in Rwanda, this paper discusses the risks and benefits of conducting research on IPV as part of the global health agenda. We discuss ethical issues that have become evident through our work in this area, including: raising IPV as an issue of concern in women's lives in settings where economic support for women experiencing IPV may not exist; recording interviews and focus group discussions in contexts with significant government surveillance; ethical tensions in appropriating local voices in ways that position women as 'victims' of violence; and the risks associated with framing IPV as a global health issue separate from feminist advocacy. We recommend more tailored approaches to ethics in IPV research, which considers the specificity of the social, cultural and economic context.
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Affiliation(s)
- Jenevieve Mannell
- a Institute for Global Health , University College London , London , UK
| | - Adrian Guta
- b School of Social Work , University of Windsor , Windsor , ON , Canada
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Campbell C, Mannell J. Conceptualising the agency of highly marginalised women: Intimate partner violence in extreme settings. Glob Public Health 2015; 11:1-16. [DOI: 10.1080/17441692.2015.1109694] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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