Disability status and violence against women in the home in North Kivu, Democratic Republic of Congo

Sexual lives and reproductive health outcomes among persons with disabilities: a mixed-methods study in two districts of Ghana

INTRODUCTION

People with disabilities (PwDs) constitute a large and diverse group within the global population, however, their sexual and reproductive health (SRH) needs are often neglected, particularly in low-and middle-income countries. This may result in adverse outcomes, such as sexually transmitted infections (STIs), unintended pregnancies, and experience of interpersonal violence (IV). This study aimed to assess the factors that influence the sexual lives of PwDs in two districts of Ghana.

METHODS

A sequential explanatory mixed-methods study design was used to collect data from PwDs. Quantitative data were obtained from 402 respondents using a pretested questionnaire, and qualitative data gathered from 37 participants using in-depth interviews. The quantitative data were analysed using descriptive and inferential statistics, while the qualitative data were analysed using inductive thematic analysis.

RESULTS

Most PwDs (91%) reported that they have ever had sex, which was associated with age, disability severity, and household size. The prevalence of poor SRH status, STIs, unintended pregnancy, pregnancy termination, and unsafe abortion were 10.5%, 5.7%, 6.4%, 21.6%, and 36.9% respectively. These outcomes were influenced by education, income, health insurance subscription, and proximity to a health facility. The prevalence of IV was 65%, which was related to disability type and severity. The qualitative data revealed five main themes: curiosity to engage in sexual activities, feelings of despair and insecurity with abled partners, preference for sexual relationships with other PwDs, IV and its perpetrators, and adverse SRH outcomes.

CONCLUSION

The study findings indicate that most adult PwDs have ever had sex and they face various challenges in their sexual lives. They experience multiple forms of abuse and neglect from different perpetrators at different levels of society, which have negative impacts on their well-being. There is a need for comprehensive and inclusive interventions that address the SRH needs of PwDs, as well as the underlying social and structural factors that contribute to their vulnerability. Further research is recommended to explore the perspectives of stakeholders on how to improve the SRH outcomes of PwDs.

Exploring Disability as a Determinant of Girl Child Marriage in Fragile States: A Multicountry Analysis

PURPOSE

Fragile states are countries characterized by poverty, conflict, political instability, insecurity, and disaster. In such settings, there are high levels of disability and women and girls are disproportionately impacted by violence. Despite the 2030 Sustainable Development Goal's call for both the elimination of violence against women and girls and disability-disaggregated data, few studies have investigated how disability may be associated with girl child marriage (GCM) and how these two factors impact intimate partner violence (IPV). This study sought to assess the prevalence and associations of disability with GCM and IPV among currently married/cohabiting women (aged 20-24 years) in fragile states.

METHODS

A secondary data analysis of pooled nationally representative data from four Demographic and Health Surveys were analyzed using multivariable regressions to examine the associations between disability, GCM, and IPV (N = 3,119). The association between disability and GCM was further analyzed by multinomial regressions. These weighted analyses accounted for complex survey designs.

RESULTS

Overall, 54.4% of GCM occurred among women with disabilities. Disabled women were more likely to report GCM compared to women without disabilities (adjusted odds ratio = 1.62, 95% confidence interval = 1.16-2.28). Among disabled women with a history of GCM, 41.3% experienced past-year IPV. Disabled women with a history of GCM were more likely to report past-year IPV compared to nondisabled women and no GCM (adjusted odds ratio = 1.78, confidence interval = 1.21-2.62).

DISCUSSION

GCM and IPV (e.g., past-year, lifetime) among disabled girls may be pervasive in fragile states, underscoring the need for additional research examining the mechanisms driving these observations and to inform inclusive programming and policy.

The association between women's disability and acceptance towards intimate partner violence among women and their male partners: A multi-country analysis

OBJECTIVE

To examine whether disabled women are more likely to report accepting attitudes towards intimate partner violence (IPV) than non-disabled women, and whether male partners of disabled women are more likely to accept IPV than male partners of non-disabled women.

METHODS

Secondary analysis of nationally representative cross-sectional data from the Demographic Health Survey (DHS) in nine countries. Logistic regression examined the relationship between (1) women's disability and IPV acceptance (n = 114 695) and (2) women's disability and their male partners' IPV acceptance (n = 20 566); pooled and country-specific estimates were calculated.

RESULTS

IPV acceptance ranged from 5% to 80% among women and from 5% to 56% among male partners. Overall, disabled women were more accepting of IPV than non-disabled women (pooled adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.08-1.20), with country-specific aOR ranging from 1.05 to 1.63. Overall, disabled women's male partners had higher likelihood of IPV acceptance than non-disabled women's partners (pooled aOR 1.13, 95% CI 1.00-1.28).; country-specific estimates varied (aOR range from 0.56 to 1.40).

CONCLUSION

Disabled women and their male partners had higher IPV acceptance compared with non-disabled women and their male partners. More research is needed to better understand this association, including disability-associated discrimination. Findings underscore the importance of more research with disabled women and their partners to address IPV.

Sexual violence and associated factors among reproductive-age females with disabilities in central Sidama National Regional State, Ethiopia: a multilevel analysis

BACKGROUND

Sexual violence is one of the most common problems in reproductive health that causes different traumatic events that lead to mental, social, and physical problems. Females with disabilities are subjected to more traumatic events and consequences. In Ethiopia, there are limited evidences about the prevalence and associated factors of sexual violence among reproductive-aged females with disabilities. Therefore, this study aimed to assess the prevalence and associated factors of sexual violence among females with disabilities in reproductive-age in central Sidama National Regional State, Ethiopia.

METHODS

A multistage sampling technique was used to select 645 reproductive-age females with disabilities. Initially, three districts were purposefully selected, from which 30 kebeles and study participants were selected randomly from June 20 to July 15, 2022. A face-to-face interviewing technique was used to collect the data. The data were analyzed using a multilevel logistic regression analysis model. The measures of associations were reported using the adjusted odds ratio (AOR) and its 95% confidence interval (CI).

RESULTS

The prevalence of sexual violence among reproductive-age females with disabilities was 59.8% (95% CI: 56, 63.56). Residing in an urban setting (AOR = 0.51; 95% CI: 0.29, 0.88), being an adult (25 to 34 years old) (AOR = 5.9; CI: 3.01, 11.6), being an adult (35 to 49 years old) (AOR = 3.47; CI: 1.48, 8.14), having no sexuality information (AOR = 11.3; CI: 6.24, 20.5), and having hearing disabilities (AOR = 3.19; CI: 1.49, 6.83) were factors associated with sexual violence.

CONCLUSIONS

Sexual violence among reproductive-age females with disabilities is noticeably high. Place of residence, sexual orientation, age, and disability type were all factors associated with sexual violence. Therefore, providing sexuality education, giving high attention (information and education about sexuality) to rural residents, and considering females with hearing disabilities are important to minimize sexual violence among reproductive-age females with disabilities.

How People With Intellectual or Development Disabilities Cope With Verbal Violence

Violence against people is a widespread phenomenon and violence against people with disabilities even more common. Studies have examined different types of violence toward people with disabilities, but there has been almost no research to date on verbal violence involving people with intellectual or development disabilities (IDD). The present research focused on this subject. A qualitative study was conducted using an intervention program. The research questions were (a) what can help people with IDD expand their understanding of verbal violence and differentiate different situations of verbal violence and (b) what can help people with IDD expand their means for handling verbal violence of their own and that directed toward them? The sample included 64 people (45 males, 19 females; ages 22-75) with mild IDD, who were divided into four groups of 16 participants each in the intervention program. The findings indicate that the participants' conceptualization of verbal violence improved after the intervention program. Three main themes were identified: (a) differentiation between good and bad; (b) choosing how to handle verbal violence; and (c) helping others cope with verbal violence. Consistent with the humanistic perspective, the findings show that people with IDD can learn to handle verbal violence toward them in a way that promotes their understanding, enables them to choose their reactions, and affects those around them, as well as strengthening their self-efficacy. The research contributes to the sparse knowledge regarding verbal violence, especially against people with IDD, and offers ways of intervening to help them handle verbal violence.

The prevalence of intimate partner violence against women with disabilities: a systematic review of the literature

PURPOSE

Although systematic reviews have already been conducted on violence and disability, the evidence is not conclusive in Intimate Partner Violence (IPV). This study examined the prevalence of IPV in women with disabilities, taking account of the different types of violence and disability.

METHODS

We performed a search in five databases. We included observational studies that analysed the frequency of IPV in women with disabilities compared to women without. Two independent reviewers selected and assessed studies. We made a qualitative synthesis according to the type of IPV analysed in relation to disability.

RESULTS

We identified 26 articles. The frequency and risk of IPV were greater in women with disabilities than in those without. All of the articles that studied financial violence, 81.3% of those that studied physical violence, 78.5% of those that studied psychological violence, 75% of those that studied physical/sexual violence, 73.3% of those that studied sexual violence and 50% of those that studied any type of violence found a significant association whit disability.

CONCLUSIONS

Women with disabilities are at higher risk of IPV. Rehabilitation centers and its professionals must have a leading role in the identification of these situations and this should be considered in IPV prevention plans.Implications for rehabilitationPeople with disabilities are at higher risk of multiple types of violence.Violence against women with disabilities therefore involves two public health issues interacting simultaneously.Rehabilitation centers and its professionals should have a leading role in the identification of IPV in women with disabilities.IPV prevention plans should consider rehabilitation centers and its professionals as a main component of interventions in women with disabilities.

Disability and intimate partner violence in fragile states: A multi-country analysis

The 2030 Sustainable Development Goals call for both the elimination of violence against women and girls and disability-disaggregated data. However, few population-based, multi-country studies have examined how disability impacts intimate partner violence (IPV) in fragile settings. Demographic and Health Survey data from five countries (Pakistan, Timor-Leste, Mali, Uganda, and Haiti) were pooled and analyzed to assess the relationship between disability and IPV (N = 22,984). Pooled analysis revealed an overall disability prevalence of 18.45%, with 42.35% lifetime IPV (physical, sexual and/or emotional), and 31.43% past-year IPV. Women with disabilities reported higher levels of past-year and lifetime IPV compared to those without disabilities (AOR 1.18; 95% CI 1.07, 1.30; AOR 1.31; 95% CI 1.19, 1.44, respectively). Women and girls with disabilities may be disproportionately impacted by IPV in fragile settings. More global attention is needed to address IPV and disability in these settings.

Preventing Co-occurring Intimate Partner Violence and Child Abuse in Eastern Democratic Republic of Congo: The Role of Family Functioning and Programmatic Reflections

Co-occurring intimate partner violence (IPV) and child abuse occur at staggering levels in eastern Democratic Republic of Congo (DRC), yet little is known about the relationship between these forms of violence and a feminst-grounded conceptualization of family functioning nor how best to programmatically address these multiple forms of violence in the home. Analysis of cross-sectional baseline data from 203 adult couple dyads participating in a randomized controlled trial was undertaken to (1) understand the correlation of family functioning and violence in the home in North Kivu, DRC; (2) unpack potential shared correlates of violence in the home and family functioning, such as attitudes and behaviors; and (3) describe programmatic implications for delivering violence prevention programming that seeks to address multiple forms of violence in the home. Findings suggest over half of all families reported experiencing IPV against women or use of child abuse by any caregiver. Moderate levels of family functioning were also reported, although women reported lower levels. In adjusted models, a one-point change in family functioning score was associated with a 0.12 reduction in odds of co-occurring experience of IPV and use of child abuse for women, and a 0.03 reduction in odds of co-occurring perpetration for men. A focus on improving family functioning as a primary outcome, alongside explicit targeting of harmful gender norms and skills-based approaches, may be a promising avenue to integrate approaches from different violence prevention fields while maintaining a strong dedication to intersectional feminist-grounded approaches that allows for separate, but at times combined, approaches to reducing IPV and child abuse in the home.

Risk factors for violence against women in high-prevalence settings: a mixed-methods systematic review and meta-synthesis

INTRODUCTION

Violence against women (VAW) affects one in three women globally. In some countries, women are at much higher risk. We examined risk factors for VAW in countries with the highest 12-month prevalence estimates of intimate partner violence (IPV) to develop understanding of this increased risk.

METHODS

For this systematic review, we searched PUBMED, CINAHL, PROQUEST (Middle East and North Africa; Latin America and Iberia; East and South Asia), Web of Science, EMBASE and PsycINFO (Ovid) for records published between 1 January 2000 and 1 January 2021 in English, French and Spanish. Included records used quantitative, qualitative, or mixed-methods, reported original data, had VAW as the main outcome, and focused on at least one of 23 countries in the highest quintile of prevalence figures for women's self-reported experiences of physical and/or sexual violence in the past 12 months. We used critical interpretive synthesis to develop a conceptual model for associations between identified risk factors and VAW.

RESULTS

Our search identified 12 044 records, of which 241 were included for analysis (2 80 360 women, 40 276 men, 274 key informants). Most studies were from Bangladesh (74), Uganda (72) and Tanzania (43). Several quantitative studies explored community-level/region-level socioeconomic status and education as risk factors, but associations with VAW were mixed. Although fewer in number and representing just one country, studies reported more consistent effects for community-level childhood exposure to violence and urban residence. Theoretical explanations for a country's high prevalence point to the importance of exposure to other forms of violence (armed conflict, witnessing parental violence, child abuse) and patriarchal social norms.

CONCLUSION

Available evidence suggests that heightened prevalence of VAW is not attributable to a single risk factor. Multilayered and area-level risk analyses are needed to ensure funding is appropriately targeted for countries where VAW is most pervasive.

PROSPERO REGISTRATION NUMBER

The review is registered with PROSPERO (CRD42020190147).

Developing an Inclusive Conceptual Model for Preventing Violence in the Home in Humanitarian Settings: Qualitative Findings From Myanmar and the Democratic Republic of Congo

This qualitative study sought to explore the shared risk factors and social norms that may underpin the co-occurrence of intimate partner violence, child maltreatment, and violence against other marginalized household members in the home. Data are drawn from participants who completed either in-depth interviews (N = 51 men, N = 52 women participants) or focus groups (N = 22 men, N = 23 women participants) and were living in two distinct humanitarian settings: North Kivu, Democratic Republic of the Congo, and Northern Shan State and Southern Kachin State, Myanmar. Within this overarching objective, attention to these shared drivers for violence in the home, which may arise from people having multiple and interacting social identities, such as disability status, gender, and age, was explored through an inclusion lens and inductive coding approaches. Findings point to risk factors of violence in the home at all levels of the ecological model, which are underpinned at the macro level by gender inequality, armed conflict, and political instability, among other factors. With the community and family levels, gender inequality manifested in norms related to the acceptability of violence, family reputation, and aged and gendered power hierarchies within the home. Shared risk factors of violence at these levels also included displacement/migration-related stressors, inconsistent income, and lack of community resources to support families, especially for those with disabilities. At the most time-proximal level, interactions between role (non)fulfillment, inability of families to meet their basic needs, alcohol and substance abuse, and abusive expressions of anger were found to catalyze instances of violence in the home. The conceptual model also illuminates potential levers and inclusive entry points that prevent violence in the home for diverse women, children, persons with disabilities, and older persons. Key attention to addressing gender inequality and acceptance of violence must be a cornerstone of sustainable programming, alongside complementary approaches that address other shared risk factors.

Disability, violence, and mental health among Somali refugee women in a humanitarian setting

BACKGROUND

There is limited evidence on the relationship between disability, experiences of gender-based violence (GBV), and mental health among refugee women in humanitarian contexts.

METHODS

A cross-sectional analysis was conducted of baseline data (n = 209) collected from women enrolled in a cohort study of refugee women accessing GBV response services in the Dadaab refugee camps in Kenya. Women were surveyed about GBV experiences (past 12 months, before the last 12 months, before arriving in the refugee camps), functional disability status, and mental health (anxiety, depression, post-traumatic stress), and we explored the inter-relationship of these factors.

RESULTS

Among women accessing GBV response services, 44% reported a disability. A higher proportion of women with a disability (69%) reported a past-year experience of physical intimate partner violence and/or physical or sexual non-partner violence, compared to women without a disability (54%). A higher proportion of women with a disability (32%) experienced non-partner physical or sexual violence before arriving in the camp compared to women without a disability (16%). Disability was associated with higher scores for depression (1.93, 95% confidence interval (CI) 0.54-3.33), PTSD (2.26, 95% CI 0.03-4.49), and anxiety (1.54, 95% CI 0.13-2.95) after adjusting for age, length of encampment, partner status, number of children, and GBV indicators.

CONCLUSIONS

A large proportion of refugee women seeking GBV response services have disabilities, and refugee women with a disability are at high risk of poor mental health. This research highlights the need for mental health and disability screening within GBV response programming.