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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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Stark L, Meinhart M, Seff I, Gillespie A, Roa AH, Villaveces A. Associations between conflict violence, community violence, and household violence exposures among females in Colombia. CHILD ABUSE & NEGLECT 2023:106341. [PMID: 37481346 PMCID: PMC10896229 DOI: 10.1016/j.chiabu.2023.106341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 06/22/2023] [Accepted: 07/01/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Exposure to protracted public violence is increasingly referenced as a risk factor for domestic violence, but limited quantitative evidence has demonstrated this association to date. This study analyzes associations in Colombia between lifetime experiences of external violence, including the Colombia civil conflict and community interpersonal violence, and experiences of household violence, including intimate partner and caregiver violence. METHODS AND FINDINGS We use the 2018 Colombia Violence Against Children and Youth Survey, employing multi-variable logistic regressions to determine the association between exposure to external violence and household violence victimization for females aged 13-24 (n = 1406). Adjusted models controlled for age, ever married, currently in school, and past 12-mo work experience and standard errors were adjusted to account for the multi-stage sampling design. Females who had ever witnessed community violence (39.23 %) faced increased risks of experiencing both physical violence (aOR = 2.81; 95 % CIs: 1.54-5.14; p < 0.001) and emotional violence (aOR: 2.48; 95 % CIs: 1.29-4.75; p < 0.01) from caregivers. Females who had ever witnessed internal conflict (15.99 %) had a greater likelihood of experiencing emotional violence from caregivers (aOR: 5.24; 95 % CIs: 1.86-14.76; p < 0.01) as well as physical violence perpetrated by intimate partners (aOR: 3.31; 95 % CIs: 1.22-8.95; p < 0.05). CONCLUSIONS This study demonstrates the connection between exposure to community violence and internal conflict and household violence victimization among adolescent and young adult females in Colombia. Findings build the evidence base for more holistic and coordinated policy and programming efforts and foreground the need to identify and support vulnerable populations across socioecological domains in contexts of chronic violence.
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Affiliation(s)
- Lindsay Stark
- Brown School at Washington University in St. Louis, MO, USA.
| | | | - Ilana Seff
- Brown School at Washington University in St. Louis, MO, USA
| | - Alli Gillespie
- Brown School at Washington University in St. Louis, MO, USA
| | - Arturo Harker Roa
- School of Government at the Universidad de los Andes, Bogotá, Colombia
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Yount KM, Comeau D, Blake SC, Sales J, Sacks M, Nicol H, Bergenfeld I, Kalokhe AS, Stein AD, Whitaker DJ, Parrott D, Van HTH. Consortium for violence prevention research, leadership training, and implementation for excellence (CONVERGE): a protocol to train science leaders in gender-based-violence and violence-against-children research for impact. Front Public Health 2023; 11:1181543. [PMID: 37469691 PMCID: PMC10352114 DOI: 10.3389/fpubh.2023.1181543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/12/2023] [Indexed: 07/21/2023] Open
Abstract
Background Gender-based violence (GBV) and violence against children (VAC) are two prevalent and highly interconnected global health challenges, yet data and research capacities to study these forms of violence and to generate evidence-based policies and programs remain limited. To address critical shortages in research capacity in Vietnam and to establish a model for other Low- and Middle-Income Countries (LMICs), we are establishing CONVERGE-the Consortium for Violence Prevention Research, Implementation, and Leadership Training for Excellence. Methods Based on a needs assessment with partners in Vietnam, CONVERGE will provide a comprehensive research training program supporting 15 long-term, postdoctoral trainees with multi-disciplinary research training in GBV and VAC. We also will offer in-country trainings and short-courses to 40 short-term mid-career academic trainees and 60 short-term practitioner/stakeholder trainees over 5 years to build productive GBV and VAC academic, scientific, and practitioner networks. The CONVERGE training program has four components: (1) 14 h of virtual/in-person annual mentorship training to prepare research mentors and to create a pipeline of future mentors in Vietnam; (2) a one-month intensive research training for long-term postdoctoral fellows at Emory University; (3) a structured 17-month, in-country mentored research project for long-term trainees that results in a peer-reviewed manuscript and a subsequent grant submission; and, (4) week-long in-country intensive translational trainings on implementation science, advanced topics in leadership, and advanced topics in science dissemination. Opportunities for on-going virtual training and professional networking will be provided for CONVERGE trainees and mentors in Vietnam with other trainees and mentors of D43s focused on injury/violence prevention, D43s housed at Emory, and D43s with other institutions in Southeast Asia. To assess the reach, implementation, fidelity, and effectiveness of these four components, we will implement a rigorous, mixed-methods, multi-level evaluation strategy using process and outcome measures. Findings from the evaluation will be used to refine program components for future trainee and mentor cohorts and to assess long-term program impact. Discussion Led by Emory University in the US and Hanoi Medical University in Vietnam, CONVERGE represents leading institutions and experts from around the world, with a goal of providing mentorship opportunities for early-career scientists with an interest in violence prevention.
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Affiliation(s)
- Kathryn M. Yount
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Dawn Comeau
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Sarah C. Blake
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jessica Sales
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Michael Sacks
- Goizueta Business School, Emory University, Atlanta, GA, United States
| | - Hannah Nicol
- School of Medicine, Emory University, Atlanta, GA, United States
| | - Irina Bergenfeld
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | | | - Aryeh D. Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | | | - Dominic Parrott
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Miall N, Francis SC, Stöckl H, Tucker JD. Working from home and intimate partner violence among cis-women during the COVID-19 pandemic: evidence from a global, cross-sectional study. BMC Public Health 2023; 23:965. [PMID: 37237282 DOI: 10.1186/s12889-023-15785-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Intimate partner violence (IPV) may have been exacerbated during the COVID-19 pandemic. This analysis aimed to determine how employment disruption during COVID-19, including working from home, was associated with IPV experience among cis-gendered women. METHODS The International Sexual Health and Reproductive health (I-SHARE) study is a cross-sectional online survey implemented in 30 countries during the pandemic. Samples used convenience, online panel, and population-representative methods. IPV was a pre-specified primary outcome, measured using questions from a validated World Health Organisation instrument. Conditional logistic regression modelling was used to quantify the associations between IPV and changes to employment during COVID-19, adjusted for confounding. RESULTS 13,416 cis-gender women, aged 18-97, were analysed. One third were from low and middle income countries, and two thirds from high income countries. The majority were heterosexual (82.7%), educated beyond secondary-level (72.4%) and childless (62.7%). During COVID-19 33.9% women worked from home, 14.6% lost employment, and 33.1% continued to work on-site. 15.5% experienced some form of IPV. Women working from home experienced greater odds of IPV than those working on-site (adjusted OR 1.40, 95% CI 1.12-1.74, p = 0.003). This finding was robust independent of sampling strategy and country income. The association was primarily driven by an increase in psychological violence, which was more prevalent than sexual or physical violence. The association was stronger in countries with high gender inequality. CONCLUSIONS Working from home may increase IPV risk globally. Workplaces offering working from home should collaborate with support services and research interventions to strengthen resiliency against IPV.
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Affiliation(s)
- Naomi Miall
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, LSHTM, Keppel Street, London, WC1E 7HT, UK.
| | - Suzanna C Francis
- MRC International Statistics & Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, LSHTM, Keppel Street, London, WC1E 7HT, UK
| | - Heidi Stöckl
- Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Marchioninistr. 15, 81377, München, Germany
| | - Joseph D Tucker
- Department of Clinical Research, London School of Hygiene and Tropical Medicine Keppel Street, Keppel Street, London, WC1E 7HT, UK
- Institute for Global Health and Infectious Diseases, University North Carolina, 130 Mason Farm Rd, Chapel Hill, North Carolina, UK
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Buller AM, Pichon M, Chevalier C, Treves-Kagan S. The role of gender and romantic jealousy in intimate partner violence against women, a mixed-methods study in Northern Ecuador. CULTURE, HEALTH & SEXUALITY 2023; 25:223-240. [PMID: 35114886 PMCID: PMC9923437 DOI: 10.1080/13691058.2022.2031299] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 01/15/2022] [Indexed: 06/14/2023]
Abstract
Male romantic jealousy is a commonly cited driver of intimate partner violence against women. An in-depth, contextualised understanding of the pathways and mechanisms from jealousy to intimate partner violence is, however, needed to inform programmes and interventions. We triangulated data from 48 interviews, eight focus groups and 1216 survey findings from low-income married women and men in northern Ecuador. Male jealousy was associated with controlling behaviours (aOR: 14.47, 95% CI: 9.47, 22.12) and sexual intimate partner violence (aOR: 2.4, 95% CI: 1.12, 5.12). Controlling behaviours were associated with physical and sexual intimate partner violence (aOR: 2.16, 95% CI: 1.21, 3.84). Qualitatively we found that most respondents framed jealousy within a discourse of love, and three triggers of male jealousy leading to intimate partner violence were identified: (1) community gossip, which acted as a mechanism of community control over women's movements and sexuality; (2) women joining the labour force, which was quantitatively associated with intimate partner violence and partially mediated by jealousy; and (3) women's refusal to have sex, which could lead husbands to coerce sex through accusations of infidelity. Gender-transformative interventions at the individual, couple and community level providing models of alternative masculinities and femininities may offer promise in reducing intimate partner violence in Ecuador. Importantly, future economic empowerment interventions should address jealousy to mitigate potential intimate partner violence backlash.
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Affiliation(s)
- Ana Maria Buller
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Marjorie Pichon
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Cleo Chevalier
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Treves-Kagan
- Research and Evaluation Branch, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Padilla-Medina DM, Small E, Pavlova Nikolova S. Exploring Help-Seeking Predictors Among Colombian Victims of Intimate Partner Violence in Different Age Groups. Violence Against Women 2023; 29:202-228. [PMID: 35791515 DOI: 10.1177/10778012221088308] [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: 01/07/2023]
Abstract
This study examined the extent, source, and individual, microsystem, exosystem, and macrosystem-level (Heise's Ecological Model) predictors of help-seeking behaviors among women of different age groups in Colombia. Data on 12,915 married or cohabitating women who had experienced diverse forms of intimate partner violence (IPV) were obtained from the Colombia Demographic Health Survey 2015. More than half of the Colombian women who reported some form of IPV experience did not seek any help. Women aged 25-39 were less likely to seek help. Type of violence and experience of IPV and education were the strongest predictors of help-seeking among women in all age groups. Implications for research and programming are discussed.
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Affiliation(s)
- Diana M Padilla-Medina
- Graduate School of Social Work, 19878University of Puerto Rico, Rio Piedras Campus, San Juan, San Juan, Puerto Rico
| | - Eusebius Small
- School of Social Work, 12329University of Texas at Arlington, 211 S. Cooper St., Bldg. A, Arlington, Texas, United States
| | - Silviya Pavlova Nikolova
- Department of Social Medicine and Healthcare Organization, 317231Medical University of Varna, Varna, Varna, Bulgaria
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Seff I, Koris A, Giuffrida M, Ibala R, Anderson K, Shalouf H, Deitch J, Stark L. Exploring the Impact of a Family-Focused, Gender-Transformative Intervention on Adolescent Girls' Well-Being in a Humanitarian Context. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15357. [PMID: 36430075 PMCID: PMC9690627 DOI: 10.3390/ijerph192215357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
While family functioning interventions show promise for improving adolescent girls' well-being in humanitarian contexts, few programs employ a gender-transformative approach to maximize benefits for adolescent girls. This paper presents findings from a mixed-methods pilot evaluation of a whole-family, gender-transformative intervention conducted with Syrian refugee families in Jordan. The Siblings Support of Adolescent Girls in Emergencies program was implemented with 60 Syrian refugee households in Azraq and Za'atari camps in Jordan. A quantitative survey was administered to 18 households at baseline and endline, and researchers conducted qualitative interviews and focus group discussions with caregivers, paired interviews and participatory discussions with adolescents, and key informant interviews with program mentors. Paired t-tests revealed statistically significant improvements in mental distress, resilience, and gender equitable attitudes in the full sample and for girls only and marginally significant improvements in family functioning. Qualitative findings revealed improvements in four domains of girls' well-being-self-efficacy, self-confidence, pro-social behavior, and mental health-through three primary pathways: family members' increased gender equitable attitudes, healthier intrahousehold communication, and greater affective involvement. Findings from this mixed-methods evaluation point to the potential value in merging gender-transformative and whole-family approaches in humanitarian programming to maximize positive impacts for adolescent girls.
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Affiliation(s)
- Ilana Seff
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Andrea Koris
- Independent Researcher, Capetown 8001, South Africa
| | | | - Reine Ibala
- Weill Cornell Medical College, New York, NY 10065, USA
| | | | - Hana Shalouf
- Mercy Corps Jordan, Building No. 8, Tabasheer 3 Street, 7th Circle, Amman, Jordan
| | | | - Lindsay Stark
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63130, USA
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Bennouna C, Gillespie A, Stark L, Seff I. Norms, Repertoires, & Intersections: Towards an integrated theory of culture for health research and practice. Soc Sci Med 2022; 311:115351. [PMID: 36108563 DOI: 10.1016/j.socscimed.2022.115351] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/01/2022] [Accepted: 09/01/2022] [Indexed: 10/14/2022]
Abstract
Public health scholars and practitioners have increasingly distanced themselves from the term "culture," which has been used to essentialize and blame marginalized "others." However, leading health theories inevitably entail the study of culture; omitting the term may sever vital connections to useful social theory. Instead, we propose the Intersectional Theory of Cultural Repertoires in Health (RiH), integrating social norms and intersectionality with repertoire theory, which has been highly influential in cultural sociology. We outline an approach to investigating relationships between cultural resources and health behaviors and illustrate the theory's application with two qualitative case studies. The cases demonstrate how RiH theory can elucidate the roles of cultural resources in influencing health outcomes, such as gender-equitable behavior in Nigeria and coping strategies in Haiti. Building on conventional normative explanations of health, we theorize how schemas, narratives, boundaries, and other cultural resources shape behavior and demonstrate how norms constrain the use of repertoires. We detail how this theory can deepen our understanding of health phenomena and identify future research priorities.
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Affiliation(s)
| | | | - Lindsay Stark
- Brown School at Washington University in St. Louis, USA
| | - Ilana Seff
- Brown School at Washington University in St. Louis, USA.
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Treves-Kagan S, Peterman A, Gottfredson NC, Villaveces A, Moracco KE, Maman S. Love in the Time of War: Identifying Neighborhood-level Predictors of Intimate Partner Violence from a Longitudinal Study in Refugee-hosting Communities. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP10170-NP10195. [PMID: 33446026 DOI: 10.1177/0886260520986267] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A high prevalence of intimate partner violence (IPV) has been documented among women living in conflict-affected and refugee-hosting areas, but why this occurs is not well understood. Conflict and displacement deteriorate communities' social cohesion and community connectedness; these neighborhood social environments may influence individual IPV outcomes. We explored neighborhood-level social disorganization and cohesion as predictors of recent IPV in refugee-hosting communities in northern Ecuador by conducting multi-level logistic regression on a longitudinal sample of 1,312 women. Neighborhood social disorganization was marginally positively associated with emotional IPV (AOR: 1.17, 95% CI: .99, 1.38) and physical and/or sexual IPV (AOR: 1.20, 95% CI: .96, 1.51). This was partially mediated by neighborhood-level civic engagement in the case of emotional IPV. At the household level, perceived discrimination and experience of psychosocial stressors were risk factors for both types of IPV, whereas social support was protective. To our knowledge, this is one of the first studies to examine how neighborhood social factors influence IPV outcomes in refugee-hosting communities or in South America. As the world grapples with the largest number of displaced people in history, this research can inform prevention and response programming and reinforces the critical importance of promoting acceptance of refugees and immigrants and positively engaging all community members in civic life in refugee-hosting settings.
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Affiliation(s)
| | | | | | | | | | - Suzanne Maman
- University of North Carolina at Chapel Hill, NC, USA
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Mora Ladino M, Villaquirán JE, Arboleda Trujillo MA, Pacichana-Quinayáz SG, Fandiño-Losada A, Gutiérrez Martínez MI. Exposure to gender violence in a population of women consulting a Community Psychiatry service in Cali, Colombia. Rev Salud Publica (Bogota) 2022. [DOI: 10.15446/rsap.v24n2.100270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo Conocer las características sociales, sintomatología mental y exposiciones a hechos de violencia de mujeres consultantes a un servicio de salud mental comunitaria en una Institución de Atención Primaria.
Metodología Se realizó un estudio de corte trasversal descriptivo en el programa de Psiquiatría Comunitaria de dos centros asistenciales de la Red de Salud de Ladera E. S. E. en Cali, Colombia. Se analizó el contenido de 157 registros del año 2018, usando estadística descriptiva para las variables sociodemográficas, clínicas y relacionadas con su historial psiquiátrico.
Resultados El 43,59% del total de las mujeres consultó por trastornos afectivos, ninguna enunció situaciones relacionadas con violencia en el motivo de consulta. Sin embargo, cerca del 16% enunció situaciones de violencia en el apartado de “enfermedad actual”, mientras que el 39,49% lo señaló como parte de los “antecedentes personales”, y el 15,29% lo relacionó con los “antecedentes familiares”. tras comparar este grupo de mujeres expuestas a violencia con las no expuestas, se encontró que los trastornos depresivos eran más frecuentes en el grupo expuesto (58,53%; p=0,035). El manejo farmacológico fue más frecuente en mujeres no expuestas y de tipo psicosocial en mujeres expuestas (p<0,05).
Conclusiones Aunque se hubiese enunciado alguna forma de violencia dentro del contenido de las historias clínicas, menos del 2% de los reportes incluyó diagnósticos relacionados con violencia de género.
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Cislaghi B, Weber AM, Shakya HB, Abdalla S, Bhatia A, Domingue BW, Mejía-Guevara I, Stark L, Seff I, Richter LM, Baptista Menezes AM, Victora CG, Darmstadt GL. Innovative methods to analyse the impact of gender norms on adolescent health using global health survey data. Soc Sci Med 2021; 293:114652. [PMID: 34915243 PMCID: PMC8819155 DOI: 10.1016/j.socscimed.2021.114652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 11/30/2021] [Accepted: 12/09/2021] [Indexed: 12/05/2022]
Abstract
Background Understanding how gender norms affect health is an important entry point into designing programs and policies to change norms and improve gender equality and health. However, it is rare for global health datasets to include questions on gender norms, especially questions that go beyond measuring gender-related attitudes, thus limiting gender analysis. Methods We developed five case studies using health survey data from six countries to demonstrate approaches to defining and operationalising proxy measures and analytic approaches to investigating how gender norms can affect health. Key findings, strengths and limitations of our norms proxies and methodological choices are summarised. Findings Case studies revealed links between gender norms and multiple adolescent health outcomes. Proxys for norms were derived from data on attitudes, beliefs, and behaviours, as well as differences between attitudes and behaviours. Data were cross-sectional, longitudinal, census- and social network-based. Analytic methods were diverse. We found that gender norms affect: 1) Intimate partner violence in Nigeria; 2) Unhealthy weight control behaviours in Brazil and South Africa; 3) HIV status in Zambia; 4) Health and social mobility in the US; and 5) Childbirth in Honduras. Interpretation Researchers can use existing global health survey data to examine pathways through which gender norms affect health by generating proxies for gender norms. While direct measures of gender norms can greatly improve the understanding of how gender affects health, proxy measures for norms can be designed for the specific health-related outcome and normative context, for instance by either aggregating behaviours or attitudes or quantifying the difference (dissonance) between them. These norm proxies enable evaluations of the influence of gender norms on health and insights into possible reference groups and sanctions for non-compliers, thus informing programmes and policies to shape norms and improve health. This article presents effective methods to study gender norms in existing global health survey data. We devised conceptual pathways linking gender norms to gender-based health disparities. We identified gender norms proxies and reference groups enforcing the norm. We tested hypotheses linking gender norms to health. These methods can aid policy and programme design to advance gender equality and health.
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Affiliation(s)
- Beniamino Cislaghi
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, London, UK
| | - Ann M Weber
- School of Public Health, University of Nevada, Reno, NV, USA
| | - Holly B Shakya
- Department of Medicine, Center on Gender Equity and Health, University of California, San Diego, La Jolla, CA, USA
| | - Safa Abdalla
- Global Center for Gender Equality, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Amiya Bhatia
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, London, UK
| | | | - Iván Mejía-Guevara
- Center for Population Health Sciences, Stanford University School of Medicine, Stanford, CA, USA; Stanford Aging and Ethnogeriatrics (SAGE) Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Lindsay Stark
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Ilana Seff
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Linda M Richter
- Centre of Excellence in Human Development, University of Witwatersrand, Durban, South Africa
| | - Ana Maria Baptista Menezes
- International Center for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande de Sul, Brazil
| | - Cesar G Victora
- International Center for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande de Sul, Brazil
| | - Gary L Darmstadt
- Global Center for Gender Equality, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
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The impact of interventions to reduce risk and incidence of intimate partner violence and sexual violence in conflict and post-conflict states and other humanitarian crises in low and middle income countries: a systematic review. Confl Health 2021; 15:86. [PMID: 34819111 PMCID: PMC8611888 DOI: 10.1186/s13031-021-00417-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/21/2021] [Indexed: 01/16/2023] Open
Abstract
Sexual violence and intimate partner violence are exacerbated by armed conflict and other humanitarian crises. This narrative systematic review of evidence for interventions to reduce risk and incidence of sexual and intimate partner violence in conflict, post-conflict and other humanitarian crises, updates and expands our review published in 2013. A search of ten bibliographic databases for publications from January 2011 to May 2020 used database specific key words for sexual/intimate partner violence and conflict/humanitarian crisis. The 18 papers, describing 16 studies were undertaken in conflict/post-conflict settings in 12 countries. Six intervention types were reported: i) personnel; ii) community mobilisation; iii) social norms; iv) economic empowerment; v) empowerment; and vi) survivor responses, with the most common being economic empowerment (n = 7) and gendered social norms interventions (n = 6). Combined interventions were reported in nine papers. Four studies identified non-significant reductions in incidence of sexual/ intimate partner violence, showing an evident positive trend; all four evaluated gendered social norms or economic empowerment singly or in combination. Evidence for improved mental health outcomes was found for some economic empowerment, social norms and survivor interventions. Some evidence of reduced risk of sexual violence and intimate partner violence was identified for all intervention types. Qualitative studies suggest that experiences of social connection are important for women who participate in programming to address sexual and intimate partner violence. Interventions with multiple strategies appear to hold merit. Achieving and demonstrating reduced sexual and intimate partner violence remains challenging in this context. Future research should continue to explore how social norms interventions can be most effectively delivered, including the impact of including mixed and same sex groups. Work is needed with local partners to ensure programs are contextually adapted.
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Lennon SE, Aramburo AMR, Garzón EMM, Arboleda MA, Fandiño-Losada A, Pacichana-Quinayaz SG, Muñoz GIR, Gutiérrez-Martínez MI. A qualitative study on factors associated with intimate partner violence in Colombia. CIENCIA & SAUDE COLETIVA 2021; 26:4205-4216. [PMID: 34586272 DOI: 10.1590/1413-81232021269.21092020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 07/08/2020] [Indexed: 11/22/2022] Open
Abstract
Intimate partner violence (IPV) is a human rights violation and a serious global public health problem. This study investigated factors associated with IPV in female survivors in Colombia. Four focus group discussions with female survivors of IPV and 15 key informant interviews with professionals from psychological, social and legal services and community leaders were conducted in Cali and Tuluá. Participant recruitment was via purposive sampling. Transcripts were analysed manually taking a social constructivist standpoint and a content analysis approach. Factors associated with IPV were divided into four themes: cultural beliefs, jealousy, alcohol abuse, and personal history of IPV. The first theme was divided into: patriarchy, gender roles, normalisation of violence, and unawareness of rights, economic dependence, and 'men own women'. The sub-themes were all inter-related and underpinned by patriarchal values. IPV was described as a sociocultural construction formed by patriarchal values ingrained in community and societal norms and individual processes. Therefore, academia, governmental and non-governmental bodies and society are urged to together, create preventative, context specific strategies for individuals, communities and societies.
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Affiliation(s)
- Shirley Evelyn Lennon
- Cisalva Institute, Universidad del Valle. Calle 4B No. 36-00 Edificio 135, Barrio San Fernando Viejo. Cali. 760043 Cali Colombia.
| | | | | | - María Adelaida Arboleda
- Cisalva Institute, Universidad del Valle. Calle 4B No. 36-00 Edificio 135, Barrio San Fernando Viejo. Cali. 760043 Cali Colombia. .,Red de Salud de Ladera ESE. Cali Colombia
| | - Andrés Fandiño-Losada
- Cisalva Institute, Universidad del Valle. Calle 4B No. 36-00 Edificio 135, Barrio San Fernando Viejo. Cali. 760043 Cali Colombia.
| | - Sara Gabriela Pacichana-Quinayaz
- Cisalva Institute, Universidad del Valle. Calle 4B No. 36-00 Edificio 135, Barrio San Fernando Viejo. Cali. 760043 Cali Colombia.
| | | | - María Isabel Gutiérrez-Martínez
- Cisalva Institute, Universidad del Valle. Calle 4B No. 36-00 Edificio 135, Barrio San Fernando Viejo. Cali. 760043 Cali Colombia.
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Hicks MHR, Mohsin M, Silove D, Fisher J, Moussa B, Steel Z, Nancarrow H, Nadar N, Klein L, Hasoun F, Yousif M, Khalil B, Krishna Y, Rees SJ. Attitudes towards gender roles and prevalence of intimate partner violence perpetrated against pregnant and postnatal women: Differences between women immigrants from conflict-affected countries and women born in Australia. PLoS One 2021; 16:e0255105. [PMID: 34329321 PMCID: PMC8323950 DOI: 10.1371/journal.pone.0255105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 07/09/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aim was to compare, for the first time in a large systematic study, women born in conflict-affected countries who immigrated to Australia with women born in Australia for attitudes towards gender roles and men's use of IPV and the actual prevalence of IPV. The study also examined if any associations remained across the two timepoints of pregnancy and postpartum. METHODS Women were interviewed during their first visit to one of three Australian public hospital antenatal clinics and re-interviewed at home six months after giving birth. A total of 1111 women completed both interviews, 583 were born in conflict-affected countries and 528 born in Australia. Associations between attitudes towards gender roles and men's use of IPV, socio-demographic characteristics and reported actual experiences of IPV were examined using bivariate and multiple logistic regression analyses. RESULTS Attitudes toward inequitable gender roles including those that condone men's use of IPV, and prevalence of IPV, were significantly higher (p<0.001) among women born in conflict-affected countries compared to Australia-born women. Women born in conflict-affected countries with the strongest held attitudes towards gender roles and men's use of IPV had an adjusted odds ratio (aOR) of 3.18 for IPV at baseline (95% CI 1.85-5.47) and an aOR of 1.83 for IPV at follow-up (95% CI 1.11-3.01). Women born in Australia with the strongest held attitudes towards gender roles and IPV had an aOR of 7.12 for IPV at baseline (95% CI 2.12-23.92) and an aOR of 10.59 for IPV at follow-up (95% CI 2.21-50.75). CONCLUSIONS Our results underscore the need for IPV prevention strategies sensitively targeted to communities from conflict-affected countries, and for awareness among clinicians of gender role attitudes that may condone men's use of IPV, and the associated risk of IPV. The study supports the need for culturally informed national strategies to promote gender equality and to challenge practices and attitudes that condone men's violence in spousal relationships.
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Affiliation(s)
- Madelyn Hsiao-Rei Hicks
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Mohammed Mohsin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
- Mental Health Academic Unit, Liverpool Hospital, South Western Sydney Area Health Service, New South Wales, Australia
| | - Derrick Silove
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Jane Fisher
- Women and Global Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Batool Moussa
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Zachary Steel
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
- St John of God Health Care, Richmond Hospital, North Richmond, New South Wales, Australia
| | - Heather Nancarrow
- School of Social Sciences, Arts and Social Sciences, University of New South Wales, Kensington, New South Wales, Australia
| | - Nawal Nadar
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Louis Klein
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
- Mental Health Academic Unit, Liverpool Hospital, South Western Sydney Area Health Service, New South Wales, Australia
| | - Fatima Hasoun
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Mariam Yousif
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Batoul Khalil
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Yalini Krishna
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Susan J. Rees
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
- * E-mail:
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Ndungu J, Jewkes R, Ngcobo-Sithole M, Chirwa E, Gibbs A. Afghan Women's Use of Violence against Their Children and Associations with IPV, Adverse Childhood Experiences and Poverty: A Cross-Sectional and Structural Equation Modelling Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7923. [PMID: 34360216 PMCID: PMC8345444 DOI: 10.3390/ijerph18157923] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022]
Abstract
Children who experience violence from a parent are more likely to experience and perpetrate intimate partner violence (IPV) later in life. Drawing on cross-sectional data among married women enrolled in the baseline of a randomized control trial in Afghanistan, we assess risk factors for women's use of violence against their children, focused on women's own adverse childhood experiences and experiences of IPV, poverty, poor mental health and gender attitudes. Analysis uses logistic regression and structural equation modelling (SEM). In total 744 married women reported on their use of violence against a child, with 71.8% (n = 534) reporting this in the past month. In regression models, their own experiences of witnessing their mother being physically abused, poverty during childhood, current food insecurity, their husband using corporal punishment on their child, current IPV experience, and other violence in the home were all associated with increased likelihood of women reporting corporal punishment. In the SEM, three pathways emerged linking women's childhood trauma and poverty to use of corporal punishment. One pathway was mediated by poor mental health, a second was mediated by wider use of violence in the home and a third from food insecurity mediated by having more gender inequitable attitudes. Addressing the culture of violence in the home is critical to reducing violence against children, as well as enabling treatment of parental mental health problems and generally addressing gender equity.
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Affiliation(s)
- Jane Ndungu
- Office of Engagement and Transformation, Nelson Mandela University, Port Elizabeth 6001, South Africa
| | - Rachel Jewkes
- Office of the Executive Scientist, South African Medical Research Council, Pretoria 0001, South Africa;
| | | | - Esnat Chirwa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria 0001, South Africa; (E.C.); (A.G.)
| | - Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria 0001, South Africa; (E.C.); (A.G.)
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Evaluation of an integrated intervention to reduce psychological distress and intimate partner violence in refugees: Results from the Nguvu cluster randomized feasibility trial. PLoS One 2021; 16:e0252982. [PMID: 34143803 PMCID: PMC8213126 DOI: 10.1371/journal.pone.0252982] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/26/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction The complex relationship between intimate partner violence and psychological distress warrants an integrated intervention approach. In this study we examined the relevance, acceptability, and feasibility of evaluating a multi-sectoral integrated violence- and mental health-focused intervention (Nguvu). Methods We enrolled 311 Congolese refugee women from Nyarugusu refugee camp in Tanzania with past-year intimate partner violence and elevated psychological distress in a feasibility cluster randomized trial. Women were recruited from local women’s groups that were randomized to the Nguvu intervention or usual care. Participants from women’s groups randomized to Nguvu received 8 weekly sessions delivered by lay refugee incentive workers. Psychological distress, intimate partner violence, other wellbeing, and process indicators were assessed at baseline and 9-weeks post-enrollment to evaluate relevance, acceptability, and feasibility of implementing and evaluating Nguvu in refugee contexts. Results We found that Nguvu was relevant to the needs of refugee women affected by intimate partner violence. We found reductions in some indicators of psychological distress, but did not identify sizeable changes in partner violence over time. Overall, we found that Nguvu was acceptable and feasible. However, challenges to the research protocol included baseline imbalances between study conditions, differential intervention completion related to intimate partner violence histories, differences between Nguvu groups and facilitators, and some indication that Nguvu may be less beneficial for participants with more severe intimate partner violence profiles. Conclusions We found evidence supporting the relevance of Nguvu to refugee women affected by partner violence and psychological distress and moderate evidence supporting the acceptability and feasibility of evaluating and implementing this intervention in a complex refugee setting. A definitive cluster randomized trial requires further adaptations for recruitment and eligibility screening, randomization, and retention. Trial registration ISRCTN65771265, June 27, 2016.
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Keating C, Treves-Kagan S, Buller AM. Intimate partner violence against women on the Colombia Ecuador border: a mixed-methods analysis of the liminal migrant experience. Confl Health 2021; 15:24. [PMID: 33832514 PMCID: PMC8028576 DOI: 10.1186/s13031-021-00351-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 03/16/2021] [Indexed: 12/04/2022] Open
Abstract
Background Intimate partner violence (IPV) has serious long-term health and psychological consequences and is highly prevalent in Latin America and among displaced populations. Liminality - the ambiguous in-between state of individuals completing a migratory journey - represents a state of legal, economic, and physical insecurity. Through the framework of liminality, this analysis seeks to understand the unique challenges faced by displaced Colombian women in Ecuador including their experience of IPV. Methods We performed a secondary analysis of 15 in-depth interviews and 319 longitudinal surveys, conducted on the border of Ecuador and Colombia, following a sequential explanatory mixed-methods design. We analysed interviews thematically and mapped the main themes onto complementary quantitative variables. We conducted logistic regression with identified risk and protective factors (measured at time 1) and recent IPV (measured at time 2), controlling for demographic characteristics and IPV at time 1. Results Our mixed-methods analysis revealed four main mechanisms by which displacement influenced the social and economic realities of Colombian women years after crossing the border, compounding their risk of IPV and limiting their ability to escape it. Lack of legal residence and documentation, violence experienced along life course and migratory continuums which increased their risk for later revictimisation, social isolation including loss of support networks and restricted mobility and lastly, financial stress. Conclusions This research highlights the critical importance of supporting the economic and social integration of migrants and refugees in host communities, as well as the need to carefully consider migration-related vulnerabilities in IPV prevention and response interventions. As the regional refugee crisis grows, policy makers must consider how the long-term marginalisation of refugee women contributes to their victimisation. This research also supports the idea of incorporating gender synchronised, transformative IPV prevention and response programmes into migration-related and poverty alleviation international development efforts.
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Affiliation(s)
- Colleen Keating
- London School of Hygiene and Tropical Medicine, Keppel St, London, England
| | - Sarah Treves-Kagan
- Department of Health Behaviour, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Ana Maria Buller
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, England.
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18
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Grose RG, Chen JS, Roof KA, Rachel S, Yount KM. Sexual and Reproductive Health Outcomes of Violence Against Women and Girls in Lower-Income Countries: A Review of Reviews. JOURNAL OF SEX RESEARCH 2021; 58:1-20. [PMID: 31902238 DOI: 10.1080/00224499.2019.1707466] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Gender-based violence (GBV) against women and girls is pervasive and has negative consequences for sexual and reproductive health (SRH). In this systematic review of reviews, we aimed to synthesize research about the SRH outcomes of GBV for adolescent girls and young women in low- and middle-income countries (LMICs). GBV exposures were child abuse, female genital mutilation/cutting, child marriage, intimate partner violence (IPV), and non-partner sexual violence. PsycINFO, PubMed, and Scopus searches were supplemented with expert consultations, reference-list searches, and targeted organizational website searches. Reviews had to contain samples of girls and young women ages 10-24, although inclusion criteria were expanded post-hoc to capture adolescent-adult combined samples. Twenty-seven reviews were quality-rated. Study-level data were extracted from the 10 highest quality reviews (62 unique studies, 100 samples). Reviews were mostly from Africa and Asia and published between 2011 and 2015. We found consistent associations between GBV and number of sexual partners, gynecological conditions (e.g., sexually transmitted infections [STIs]), unwanted/unplanned pregnancy, and abortion. Some types of IPV also were associated with greater use of contraception/STI prevention. Addressing GBV is essential to improve SRH for girls and women in LMICs.
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Affiliation(s)
- Rose Grace Grose
- Department of Community Health Education, Colorado School of Public Health, University of Northern Colorado
| | - Julia S Chen
- Hubert Department of Global Health, Rollins School of Public Health, Emory University
| | - Katherine A Roof
- Hubert Department of Global Health, Rollins School of Public Health, Emory University
| | - Sharon Rachel
- Kennedy-Satcher Center for Mental Health Equity, Satcher Health Leadership Institute, Morehouse School of Medicine
| | - Kathryn M Yount
- Asa Griggs Candler Chair of Global Health | Professor of Global Health and Sociology, Hubert Department of Global Health and Department of Sociology, Emory University
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19
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Gray S, Foster J, Revilla M, Pantoja Manzanarez L, Medina CM, Rizzieri A, Binfa L. Midwives' experiences with screening for intimate partner violence in Santiago, Chile. Health Care Women Int 2020; 43:746-762. [PMID: 33316202 DOI: 10.1080/07399332.2020.1797033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Although intimate partner violence (IPV) is well-established as a highly prevalent global issue, research examining the experience of health providers who screen women at risk for IPV is scarce. We aimed to explore the experience of midwives in primary health care centers in Santiago, Chile, regarding identification of at-risk women and barriers to screening. We highlight the intersection of complex issues of global relevance, such as culture, language, provider-patient relationships, and allocation of time and resources. In our results, we illustrate the importance of providing midwives extended time, interpreter services, and cross-cultural education to address IPV in their transcultural context.
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Affiliation(s)
- Savannah Gray
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Jennifer Foster
- Clinical Professor Emerita, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Matthew Revilla
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Loreto Pantoja Manzanarez
- Department of Women's and Newborn's Health Promotion, School of Midwifery, University of Chile, Santiago, Chile
| | | | - Ashley Rizzieri
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lorena Binfa
- Department of Women's and Newborn's Health Promotion, School of Midwifery, University of Chile, Santiago, Chile
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Gender-based violence against adolescent girls in humanitarian settings: a review of the evidence. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 5:210-222. [PMID: 33220789 DOI: 10.1016/s2352-4642(20)30245-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/23/2020] [Accepted: 07/16/2020] [Indexed: 11/23/2022]
Abstract
Adolescent girls face elevated risks of gender-based violence in humanitarian settings because of the intersectionality of age and gender, and the additional and exacerbated risk factors relevant to emergencies. Because there is no clear division of labour between the gender-based violence and child protection sectors, adolescent girls are often neglected by both groups, and violence against this subpopulation goes unaddressed. This Review presents an adapted ecological framework for gender-based violence risks facing adolescent girls in emergencies, synthesises the scant evidence for gender-based violence prevention and response, and identifies barriers to effective and ethical measurement and evaluation of programme effectiveness. Although nascent evidence highlights promising interventions for transforming girls' attitudes about violence and gender inequity and improving psychosocial and mental wellbeing, little evidence supports the ability of existing approaches to reduce gender-based violence incidence. A more explicit focus on adolescent girls is needed when designing and evaluating interventions to ensure global efforts to end gender-based violence are inclusive of this population. TRANSLATIONS: For the Arabic, French and Spanish translations of the abstract see Supplementary Materials section.
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21
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Aham-Chiabuotu CB, Abel G, Thompson L. ‘Men don't have patience’: Sexuality, pleasure and danger in displacement settings in Northcentral Nigeria. Glob Public Health 2019; 16:801-813. [DOI: 10.1080/17441692.2019.1690539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
| | - Gillian Abel
- Department of Population Health, University of Otago, Christchurch, New Zealand
| | - Lee Thompson
- Department of Population Health, University of Otago, Christchurch, New Zealand
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Weber AM, Cislaghi B, Meausoone V, Abdalla S, Mejía-Guevara I, Loftus P, Hallgren E, Seff I, Stark L, Victora CG, Buffarini R, Barros AJD, Domingue BW, Bhushan D, Gupta R, Nagata JM, Shakya HB, Richter LM, Norris SA, Ngo TD, Chae S, Haberland N, McCarthy K, Cullen MR, Darmstadt GL. Gender norms and health: insights from global survey data. Lancet 2019; 393:2455-2468. [PMID: 31155273 DOI: 10.1016/s0140-6736(19)30765-2] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 03/17/2019] [Accepted: 03/22/2019] [Indexed: 12/30/2022]
Abstract
Despite global commitments to achieving gender equality and improving health and wellbeing for all, quantitative data and methods to precisely estimate the effect of gender norms on health inequities are underdeveloped. Nonetheless, existing global, national, and subnational data provide some key opportunities for testing associations between gender norms and health. Using innovative approaches to analysing proxies for gender norms, we generated evidence that gender norms impact the health of women and men across life stages, health sectors, and world regions. Six case studies showed that: (1) gender norms are complex and can intersect with other social factors to impact health over the life course; (2) early gender-normative influences by parents and peers can have multiple and differing health consequences for girls and boys; (3) non-conformity with, and transgression of, gender norms can be harmful to health, particularly when they trigger negative sanctions; and (4) the impact of gender norms on health can be context-specific, demanding care when designing effective gender-transformative health policies and programmes. Limitations of survey-based data are described that resulted in missed opportunities for investigating certain populations and domains. Recommendations for optimising and advancing research on the health impacts of gender norms are made.
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Affiliation(s)
- Ann M Weber
- Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, CA, USA.
| | | | - Valerie Meausoone
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Safa Abdalla
- Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Iván Mejía-Guevara
- Department of Biology, Stanford University, Stanford, CA, USA; Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Pooja Loftus
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Emma Hallgren
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ilana Seff
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lindsay Stark
- Brown School at Washington University in St Louis, St Louis, MO, USA
| | - Cesar G Victora
- Federal University of Pelotas, Postgraduate Program in Epidemiology, Pelotas, Brazil
| | - Romina Buffarini
- Federal University of Pelotas, Postgraduate Program in Epidemiology, Pelotas, Brazil
| | - Aluísio J D Barros
- Federal University of Pelotas, Postgraduate Program in Epidemiology, Pelotas, Brazil
| | | | - Devika Bhushan
- Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Ribhav Gupta
- Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Jason M Nagata
- University of California San Francisco, Department of Pediatrics, San Francisco, CA, USA
| | - Holly B Shakya
- Department of Medicine, Center on Gender Equity and Health, University of California San Diego, La Jolla, CA, USA
| | - Linda M Richter
- DST-NRF Centre of Excellence in Human Development, University of Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- Department of Paediatrics, SAMRC Developmental Pathways for Health Research Unit, University of Witwatersrand, Johannesburg, South Africa
| | - Thoai D Ngo
- GIRL Center, Population Council, New York, NY, USA
| | - Sophia Chae
- GIRL Center, Population Council, New York, NY, USA
| | | | | | - Mark R Cullen
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, CA, USA; Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
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23
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Wringe A, Yankah E, Parks T, Mohamed O, Saleh M, Speed O, Hémono R, Relyea B, Ibrahim M, Sandhu JS, Scott J. Altered social trajectories and risks of violence among young Syrian women seeking refuge in Turkey: a qualitative study. BMC WOMENS HEALTH 2019; 19:9. [PMID: 30630476 PMCID: PMC6329126 DOI: 10.1186/s12905-019-0710-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/02/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND There is limited evidence regarding the ways in which displacement disrupts social norms, expectations and trajectories for adolescent girls and young women and the resulting impacts on their risks of violence. This knowledge gap is especially marked with regards to Syrian adolescent girls and young women seeking refuge in Turkey. We explored risks of gender-based violence against Syrian adolescent girls and young women in Turkey and examined how these risks were shaped by their displacement. METHODS Data were collected in August 2016 in Izmir, Turkey through five sex-specific focus group discussions with Syrian adolescents and young people (aged 15-25 years) and two mixed gender focus group discussions with Syrian adults (18 years and older). Group discussions covered the issues facing Syrian adolescents and young women in Turkey, and how these were influenced by their displacement. Discussions in Arabic were audio-recorded, transcribed and translated into English. Data were coded inductively, and analysed thematically. RESULTS Syrian adolescent girls and young women expressed an increased sense of vulnerability to violence since their displacement. Due to financial strains and limited educational opportunities, they were often encouraged by parents to work or marry, both of which they perceived to increase the risks of violence. In contrast, some adults suggested that marriage could protect adolescent girls and young women from risks of violence associated with working. Being alone outside the home was viewed as risky by all participants due to pervasive sexual, verbal and physical harassment, aggression, and even kidnapping attempts. To limit these risks, many parents reported keeping adolescent girls and young women at home, or ensuring that they were accompanied by male relatives when in public. CONCLUSIONS Syrian adolescent girls and young women face multiple risks of violence following displacement related to altered social trajectories. Some family-based strategies to protect young women from violence could reinforce restrictive gender norms and increase risks of violence. Interventions to address violence should include providing safe spaces, access to education and safe transport for young women, and financial support for families as well as community-based interventions to address the daily risks of sexual harassment in public spaces.
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Affiliation(s)
- Alison Wringe
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, UK.
| | - Ekua Yankah
- Women and Health Alliance International (WAHA), Paris, France.,University of New South Wales, Sydney, Australia
| | - Tania Parks
- Women and Health Alliance International (WAHA), Paris, France.,Institut d'études politiques de Paris, Paris, France
| | - Omar Mohamed
- University of California Berkeley, Berkeley, California, USA.,Gobee Group, Oakland, California, USA
| | | | - Olivia Speed
- Women and Health Alliance International (WAHA), Paris, France
| | - Rebecca Hémono
- Women and Health Alliance International (WAHA), Paris, France
| | - Bridget Relyea
- Women and Health Alliance International (WAHA), Paris, France
| | | | - Jaspal S Sandhu
- University of California Berkeley, Berkeley, California, USA.,Gobee Group, Oakland, California, USA
| | - Jennifer Scott
- Women and Health Alliance International (WAHA), Paris, France.,Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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24
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Yount KM, Krause KH, Miedema SS. Preventing gender-based violence victimization in adolescent girls in lower-income countries: Systematic review of reviews. Soc Sci Med 2017; 192:1-13. [PMID: 28941786 DOI: 10.1016/j.socscimed.2017.08.038] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 08/17/2017] [Accepted: 08/28/2017] [Indexed: 01/08/2023]
Abstract
This systematic review of reviews synthesizes evidence on the impact of interventions to prevent violence against adolescent girls and young women 10-24 years (VAWG) in low- and middle-income countries (LMICs). Theories of women's empowerment and the social ecology of multifaceted violence frame the review. Child abuse, female genital mutilation/cutting (FGMC), child marriage, intimate partner violence (IPV), and sexual violence were focal outcomes. Our review followed the Assessment of Multiple Systematic Reviews (AMSTAR) for the systematic review of reviews, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for a systematic review of recent intervention studies. Of 35 reviews identified between June 7 and July 20, 2016, 18 were non-duplicate systematic reviews of medium-to-high quality. Half of these 18 reviews focused on interventions to prevent IPV. Only four focused on adolescents, of which three focused on child marriage and one compared findings across early and late adolescence. None focused on interventions to prevent child abuse or sexual violence in adolescent/young women. From these 18 reviews and the supplemental systematic review of intervention studies, data were extracted on 34 experimental or quasi-experimental intervention studies describing 28 interventions. Almost all intervention studies measured impacts on one form of VAWG. Most studies assessed impacts on child marriage (n = 13), then IPV (n = 8), sexual violence (n = 4), child abuse (n = 3), and FGMC (n = 3). Interventions included 1-6 components, involving skills to enhance voice/agency (n = 17), social networks (n = 14), human resources like schooling (n = 10), economic incentives (n = 9), community engagement (n = 11) and community infrastructure development (n = 6). Bundled individual-level interventions and multilevel interventions had more favorable impacts on VAWG. Interventions involving community engagement, skill-building to enhance voice/agency, and social-network expansion show promise to reduce VAWG. Future interventions should target poly-victimization, compare impacts across adolescence, and include urban, out-of-school, married, and displaced/conflict-affected populations in LMICs, where VAWG may be heightened.
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Affiliation(s)
- Kathryn M Yount
- Hubert Department of Global Health, Emory University, 1518 Clifton Rd, NE, Atlanta, GA 30322, USA; Department of Sociology, Emory University, 1555 Dickey Dr., Atlanta, GA 30322, USA.
| | - Kathleen H Krause
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd, NE, Atlanta, GA 30322, USA
| | - Stephanie S Miedema
- Department of Sociology, Emory University, 1555 Dickey Dr., Atlanta, GA 30322, USA
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25
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Peterman A, Pereira A, Bleck J, Palermo TM, Yount KM. Women's Individual Asset Ownership and Experience of Intimate Partner Violence: Evidence From 28 International Surveys. Am J Public Health 2017; 107:747-755. [PMID: 28398779 DOI: 10.2105/ajph.2017.303694] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the oft-perceived protective relationship between women's asset ownership and experience of intimate partner violence (IPV) in the previous 12 months. METHODS We used international survey data from women aged 15 to 49 years from 28 Demographic and Health Surveys (2010-2014) to examine the association between owning assets and experience of recent IPV, matching on household wealth by using multivariate probit models. Matching methods helped to account for the higher probability that women in wealthier households also have a higher likelihood of owning assets. RESULTS Asset ownership of any type was negatively associated with IPV in 3 countries, positively associated in 5 countries, and had no significant relationship in 20 countries (P < .10). Disaggregation by asset type, sole or joint ownership, women's age, and community level of women's asset ownership similarly showed no conclusive patterns. CONCLUSIONS Results suggest that the relationship between women's asset ownership and IPV is highly context specific. Additional methodologies and data are needed to identify causality, and to understand how asset ownership differs from other types of women's economic empowerment.
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Affiliation(s)
- Amber Peterman
- Amber Peterman, Audrey Pereira, and Tia M. Palermo are with the Social and Economic Policy Unit at the UNICEF Office of Research-Innocenti, Italy. Jennifer Bleck is with the Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa. Kathryn M. Yount is with the Hubert Department of Global Health and Department of Sociology, Emory University, Atlanta, GA
| | - Audrey Pereira
- Amber Peterman, Audrey Pereira, and Tia M. Palermo are with the Social and Economic Policy Unit at the UNICEF Office of Research-Innocenti, Italy. Jennifer Bleck is with the Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa. Kathryn M. Yount is with the Hubert Department of Global Health and Department of Sociology, Emory University, Atlanta, GA
| | - Jennifer Bleck
- Amber Peterman, Audrey Pereira, and Tia M. Palermo are with the Social and Economic Policy Unit at the UNICEF Office of Research-Innocenti, Italy. Jennifer Bleck is with the Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa. Kathryn M. Yount is with the Hubert Department of Global Health and Department of Sociology, Emory University, Atlanta, GA
| | - Tia M Palermo
- Amber Peterman, Audrey Pereira, and Tia M. Palermo are with the Social and Economic Policy Unit at the UNICEF Office of Research-Innocenti, Italy. Jennifer Bleck is with the Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa. Kathryn M. Yount is with the Hubert Department of Global Health and Department of Sociology, Emory University, Atlanta, GA
| | - Kathryn M Yount
- Amber Peterman, Audrey Pereira, and Tia M. Palermo are with the Social and Economic Policy Unit at the UNICEF Office of Research-Innocenti, Italy. Jennifer Bleck is with the Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa. Kathryn M. Yount is with the Hubert Department of Global Health and Department of Sociology, Emory University, Atlanta, GA
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26
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Wachter K, Horn R, Friis E, Falb K, Ward L, Apio C, Wanjiku S, Puffer E. Drivers of Intimate Partner Violence Against Women in Three Refugee Camps. Violence Against Women 2017; 24:286-306. [DOI: 10.1177/1077801216689163] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This qualitative study examined the “drivers” of intimate partner violence (IPV) against women in displacement to identify protective factors and patterns of risk. Qualitative data were collected in three refugee camps in South Sudan, Kenya, and Iraq ( N = 284). Findings revealed interrelated factors that triggered and perpetuated IPV: gendered social norms and roles, destabilization of gender norms and roles, men’s substance use, women’s separation from family, and rapid remarriages and forced marriages. These factors paint a picture of individual, family, community and societal processes that exacerbate women’s risk of IPV in extreme conditions created by displacement. Implications for policy and practice are indicated.
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Affiliation(s)
| | - Rebecca Horn
- Queen Margaret University Edinburgh, Musselburgh, Scotland
| | | | - Kathryn Falb
- The International Rescue Committee, New York, NY, USA
| | - Leora Ward
- The International Rescue Committee, Washington, DC, USA
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27
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Perceptions and Experiences of Intimate Partner Violence in Abidjan, Côte d'Ivoire. PLoS One 2016; 11:e0157348. [PMID: 27310143 PMCID: PMC4911101 DOI: 10.1371/journal.pone.0157348] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 05/29/2016] [Indexed: 11/30/2022] Open
Abstract
Background Men and women’s perceptions of intimate partner violence (IPV) within crisis-affected populations are not well understood. This mixed-methods study examined the frequency of IPV against women in urban Cote d’Ivoire, and qualitatively explored how men and women perceive the impact of various forms of IPV on health, everyday activities, and feelings of shame. Methods A survey was administered to Ivorian women (N = 80) to measure the frequency of IPV, and ten focus group discussions were conducted with women (n = 46) and men (n = 45) to explore perceptions of different forms of IPV, including its impacts on disruptions to health, everyday activities, and experiences of shame. Results Half of all surveyed women (53.6%) reported past year exposure to physical, sexual, or emotional IPV. Of the multiple types of violence, emotional IPV was most common (46.4%), followed by sexual IPV (21.7%) and physical IPV (17.4%). Focus group participants identified additional forms of violence including economic IPV and community discrimination. Lack of financial resources and unemployment were common problems among crisis-affected women and were described as an underlying source of IPV. Both women and men reported that shame and stigma play a large role in how women experience the repercussions of IPV, regardless of the form of violence, with public episodes of IPV almost always seen as more detrimental than private episodes of IPV. Conclusions These results underscore the need for increased social support mechanisms for women to reduce the shame, stigma, and isolation associated with their experiences. The creation of safe and supportive spaces for women to talk about and challenge social norms may be an important first step in reducing community shaming and the secrecy that often surrounds IPV. Safe spaces along with broader societal outreach, including challenging men’s social positions and creating opportunities for increasing economic resources can, in turn potentially decrease the frequency of IPV and its deleterious impacts on a woman’s well-being
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28
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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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