Forced marriage, forced sex: The perils of childhood for girls

The impact of cultural origin on the psychiatric expertise in Switzerland: a focus on sexual violence illustrated by two criminal cases

Cultural biases and integration in novel socio-geographic contexts are relevant factors for the understanding of dynamics beneath sexual violence, and possibly play a role in modifying responsibility and perpetrators treatment. Here we offer a conceptual analysis of the relevant literature and two case study. Cultural factors influence power dynamics and individual values, impacting the occurrence of sexual violence; the understanding of "coercion" varies across cultures, and cultural legitimization may ensue. The consequences of sexual assault also differ, with shame prevailing in socio-centric societies and guilt in ego-centric societies. Rape and gender-based violence is influenced by masculinity and femininity concepts, the former identified with power. Dominance, rather than sexual gratification, can lead to sexual violence, which could also be a "male backlash" against gender equality. Biological theories link sexual violence to genetic factors; a psychodynamic perspective suggests an unconscious social reproduction of masculine culture and delves into possible explanations for violent behavior. Acculturation strategies and acculturative stress are explored, with a focus on Berry's strategies and on Camilleri's model of identity in intercultural situations. The impact of cultural factors on responsibility is discussed, highlighting variability in criminal laws and attitudes towards cultural offenses in different countries. The analysis of two criminal cases accused of rape, revealed common and diverging elements. Both individuals come from favorable socio-economic backgrounds, and lacked of prior or present psychiatric diagnoses. Integration difficulties, psychosexual attitudes, and the improper application of cultural codes played a crucial role. In conclusion, anthropological and ethnopsychiatric knowledge should be integrate into forensic assessments. Early detection of non-acculturation elements is need to prevent criminal behaviors, and a diagnostic instrument as a validated rating scale should be implemented.

‘Now, She’s a Child and She Has a Child’—Experiences of Syrian Child Brides in Lebanon after Early Marriage

This study examined the lived experiences of Syrian refugee child brides to understand their needs as they navigate new social roles after marriage. A cross-sectional study was conducted in Lebanon using SenseMaker® to collect narratives from married Syrian girls age 13 and older and from their parents. Thematic analysis using inductive coding was performed. Identified themes were organized according to an adaptation of Bronfenbrenner’s socioecological theory of human development to present experiences across all levels of the girls’ interactions and potential influences. Themes at the microsystem level included overwhelming domestic expectations and worry about their own children in the girls’ roles as young mothers. Experiences of intimate partner violence and family conflict were common. At the exosystem level, participants described safety concerns and financial and legal system challenges. The macrosystem level highlighted social expectations around married girls discontinuing education and around separation or divorce. As efforts continue to prevent child marriage within the Syrian crisis and globally, understanding experiences of already married girls is critical to providing support for mitigating harm to child brides. Programs might consider safety planning, parenting supports, access to skills training and education, peer-to-peer social networking, and engaging husbands or families of child brides.

Lifetime and Child Sexual Violence, Risk Factors and Mental Health Correlates Among a Nationally Representative Sample of Adolescents and Young Adults in Haiti: A Public Health Emergency

Very little is known in Haiti and the Caribbean regarding child and lifetime sexual victimization. Using a nationally representative sample of adolescents and young adults aged 15-24, this study aimed to document the prevalence, risk factors and mental health correlates of lifetime and child sexual violence in Haiti. A national cross-sectional surrvey was conducted in Haiti, using a multistage sampling frame, stratified by geographical department, urban or rural setting, gender, and age groups (15-19 and 20-24 years). The final sample included 3586 household participants (47.6% female). A weighted sample of 3945 individuals was obtained and used in the following analyses. Overall rate of lifetime and child sexual violence was, respectively, 27.44% (95% CI 25.94-28.94) and 11.27% (95% CI 10.18-12.35). Lifetime sexual violence rate was significantly higher among female participants (29.02%; 95% CI 27.5-30.55) compared to male (25.73%, 95% CI 24.26-27.2), χ² = 4.63, p < .05, but there was no significant gender difference for child sexual victimization. Experiences of family physical violence, emotional abuse by mother and father, divorce of parents, and other physical violence were strongly associated with higher odds of sexual victimization. Participants who reported having experienced sexual violence are more at risk to meet criteria of PTSD (OR = 1.96, 95% CI 1.66-2.32; p < .0001), depression (OR = 1.73, 95% CI 1.47-2.02; p < .0001), psychological distress (OR =1.72, 95% CI 1.47-2.02; p < .0001), and substance abuse (OR = 1.33, 95% CI 1.13-1.57; p < .0001). Findings demonstrate that sexual violence is a public health emergency in Haiti. They provide evidence for the development of prevention and intervention programs.

Overlooked and unaddressed: A narrative review of mental health consequences of child marriages

Child Marriage (before the age of 18) affects over 12 million young women globally, annually. Despite acknowledgement of the negative impacts of the practice on reproductive health, mental health consequences are largely overlooked. Given the ability for poor mental health to intensify other health and social challenges, understanding the mental health consequences linked to child marriage is vital. Our study is the first to examine how mental health is approached in current literature on child marriage. Our conceptual framework was informed by a rapid assessment of key issues in the field. Systematic searches of papers published between 2000-2020 were completed on four electronic databases with no language restrictions. Our protocol was registered on Prospero (CRD42019139685). Articles were assessed using PRISMA guidelines, and their quality assessed using the Joanna Briggs Institute Critical Appraisal Tools. Of the 4,457 records identified, 21 papers meeting inclusion criteria were analysed using narrative synthesis. The final sample included 5 qualitative, 1 mixed-methods and 15 quantitative studies (14 cross-sectional and 1 longitudinal study) reporting on data from 12 countries, largely in the global south. Intimate partner violence, poverty, challenges in childbirth and isolation were identified as social factors linked to emotional distress by those married as children. Depression was the most reported mental disorder. Anxiety, phobias, psychological distress, substance misuse, negative well-being and anti-social personality disorder were reported less frequently. Findings highlight that while significant emotional distress and specific mental health conditions are linked to child marriage, gaps in our understanding remain. Future studies are needed to; clarify directionality in these relationships; understand the mental health needs of young men, LGBTQI communities and those in humanitarian settings. Given the well documented cyclical relationship between social determinants and mental health conditions, we outline a series of community-oriented interventions which blend psychological, social and structural support to promote mental health and wellbeing in the contexts of child marriage.

A true face of Indian married couples: Effect of age and education on control over own sexuality and sexual violence

INTRODUCTION

Though there are several interventions evaluated over the past 25 years, significant knowledge gaps continue to exist regarding the effective prevention of sexual violence. This study explored the socio-economic and context-specific distinctive characteristics of husbands and wives on sexual autonomy and unwanted sexual experiences of currently married women in India.

METHODOLOGY

We have utilized the recent round of National Family Health Survey (NFHS-4, 2015-16) data for this exploration. The NFHS-4 survey had adopted a stratified two-stage sample design to reach out to the survey households. A total of 63,696 couples are included in the analysis comprising of women of 15-49 years age and men of 15-54 years age. Multivariate techniques have been applied to understand the adjusted effects of socio-economic and demographic variables on control over their sexuality and sexual violence.

RESULTS

Uneducated women married to uneducated men experienced more sexual violence and had less control over their sexuality than the other categories. The adjusted multivariate logistic model shows that educated husbands were significantly more likely to exercise control over their educated wives' sexuality (AOR = 0.88; CI:0.78-0.99). Women having older husbands were significantly less likely to be having no-control over own sexuality (AOR = 0.89; CI:0.83-0.95) and experienced sexual violence (AOR = 0.81; CI:0.70-0.95). Women having comparatively more-educated husbands were significantly less likely to experience sexual violence (AOR = 0.62; CI:0.47-0.81). Muslim women were significantly more likely to have no control overown sexuality. SC/ST women were significantly more likely to experience sexual violence (28%).

CONCLUSIONS

This study highlights the factors associated with control over one's sexuality and preponderance to sexual violence: age, education, spouse working status, wealth status, husband's alcohol consumption, women autonomy, decision-making, and freedom for mobility. This study suggests that empowering women with education, creating awareness regarding reproductive health, and addressing their socio-economic needs to help them achieve autonomy and derive decision-making power.

Early sexual debut: A multi-country, sex-stratified analysis in sub-Saharan Africa

This study examined outcomes associated with early sexual debut in five sub-Saharan African countries for males and females, separately. We employed Violence Against Children Surveys (VACS) from Kenya, Malawi, Nigeria, Tanzania, and Uganda, restricting samples to males and females age 18-24 years. Early sexual debut was defined as having one's first sexual intercourse before 15. Logistic, Ordinary Least Squares, and Poisson regressions were utilised to estimate associations between early sexual debut and outcomes across four ecological domains: individual, family, peer/partner, and community. Regressions were stratified by sex. The prevalence of early sexual debut ranged from 8.6% in Tanzania to 17.7% in Malawi. Males were more likely to report early sexual debut in Kenya (16.3%, compared to 6.7% for females; P < 0.001) and Uganda (15%, compared to 10.4% for females; P = 0.037). In Nigeria, 14.5% of females reported early sexual debut, compared to 5.4% of males (P < 0.001). Early sexual debut was associated with only one outcome in the individual and family domains, and was most consistently associated with outcomes in the peer/partner domain. Differences in these relationships for males and females suggest programs and policies working to reduce early sexual debut and promote healthy sexual relationships among young adolescents should thoughtfully consider framing messaging through a gendered lens.

Obstetric and perinatal outcomes for twin pregnancies in adolescent girls

This was a nine-year retrospective cohort study to investigate obstetric and perinatal outcomes in a cohort of adolescent girls with twin pregnancies from a major Australian tertiary centre in Brisbane, Australia. The adolescent cohort was aged <19 years and the control group was aged 20-24 years. The total study cohort comprised of 183 women. Of these, the adolescent cohort contained 29 girls (15.8%) and the control group comprised of 154 women (84.2%). Adolescent girls were less likely to delivery via an elective caesarean section compared to women in the control group (10.3% vs. 25.7%, p < 0.001). There were no differences in duration of labour, post-partum haemorrhage or perineal trauma rates. After controlling for the confounding effects of parity, chronicity and birth weight, birth <28 weeks remained significant (aOR 11.20, 95% CI 2.97-42.18, p < 0.001) for the adolescent cohort. There was a higher proportion of adolescents whose babies had an adverse composite perinatal outcome (87.9% vs. 69.5%, OR 3.20 95% CI: 1.40-7.31, p = 0.01) however significance was lost after adjusting for parity, chorionicity, birthweight and gestation at birth (aOR 3.27 95% CI: 0.95-11.31, p = 0.06). Our results show that obstetric and perinatal outcomes for twin pregnancies in teenagers were broadly similar compared to controls although the risk of extreme preterm birth was increased after controlling for confounders.

Demographic characteristics and pregnancy outcomes in adolescents - Experience from an Australian perinatal centre

BACKGROUND

Adolescent pregnancy is defined as pregnancy in girls aged 10-19 years and can be associated with increased risks.

AIM

To investigate obstetric and perinatal outcomes in a cohort of adolescent girls from a major Australian tertiary centre.

MATERIALS AND METHODS

This was a nine-year retrospective cohort study of women who birthed at the Mater Mother's Hospital (MMH) in Brisbane, Australia between 1 January 2007 and 31 December 2015. The adolescent cohort was aged <19 years and the control group was aged 20-24 years.

RESULTS

Over the study period the total study cohort comprised 8904 women. Of these, the adolescent cohort consisted of 1625 girls (18.2%) and the control group consisted of 7279 women (81.8%). Adolescents were more likely to be nulliparous, single, of Indigenous ethnicity or to have refugee status. They had higher rates of smoking, asthma, diabetes mellitus and thyroid disease. They were more likely to have an uncomplicated spontaneous vaginal delivery but were less likely to have an intact perineum and had higher rates of pre-term delivery and low birth weight babies. There were no differences in rates of postpartum haemorrhage.

CONCLUSIONS

Teenage pregnancy results in poorer obstetric and perinatal outcomes. A focus on optimising maternal health care and providing culturally appropriate antenatal and intrapartum care is imperative to improving outcomes.

Violences en famille : quelles réponses institutionnelles ?

Si la famille est en général synonyme d’intimité et de relations de confiance, elle peut également être un lieu d’abus, de contrôle ou de violences. Les diverses formes de violences qui se déroulent dans la sphère privée ont été dénoncées dès les années 1970 par les mouvements féministes. Elles ont alors fait l’objet d’une variété de politiques et d’actions publiques ayant pour vocation de défendre et d’accompagner les victimes, de punir et soigner les agresseurs ou de rétablir des liens familiaux distendus. En s’attachant à la façon dont ces violences ont été définies dans des contextes différents, en Europe, en Amérique du Nord et en Amérique latine, cet article a pour ambition de donner à voir les perspectives variées que recouvrent des catégories d’action publique aussi diverses que violences conjugales, violences domestiques, violences intrafamiliales ou encore féminicides ou fémicides, et les conséquences que ces différentes visions du problème ont sur sa prise en charge. Largement influencé par les études genre et la sociologie des problèmes publics, cet article, notamment à travers la présentation des contributions qui composent ce numéro de la revue Enfances Familles Générations, entend questionner les notions de violences de genre dans le cadre familial, dont les frontières sont fluctuantes et investies de façon variée, ainsi que les formes d’institutionnalisation du problème et les solutions qui sont envisagées.

Sexual violence against women: Understanding cross-cultural intersections

Interpersonal violence whether it is sexual or nonsexual, remains a major problem in large parts of the world. Sexual violence against children and women brings with it long-term sequelae, both psychiatrically and socially. Apart from sexual gratification itself, sexual violence against women is often a result of unequal power equations both real and perceived between men and women and is also strongly influenced by cultural factors and values. Within sociocentric and ego-centric cultures, the roles and representations of genders, and attitudes toward sexual violence differ. Cultures which are described as feminist, provide equal power to both men and women. Sexual violence is likely to occur more commonly in cultures that foster beliefs of perceived male superiority and social and cultural inferiority of women. Although culture is an important factor to understand sexual violence in its entirety, we need to look at, as well as beyond cultural structures, their strengths and weaknesses.

The prevalence and determinants of sexual violence against young married women by husbands in rural Nepal

BACKGROUND

Sexual violence within marriage is a public health and human rights issue; yet it remains a much neglected research area, especially in Nepal. This paper represents one of the first attempts to quantify the extent of sexual violence and its determinants among young married women in Nepal.

METHODS

A cross-sectional survey was conducted among 1,296 married women aged 15-24 years in four major ethnic groups in rural Nepal. The survey data were used to estimate the prevalence and identify determinants of sexual violence. The relative importance of different correlates of sexual violence in the past 12 months at the individual, household and community levels were examined by using a multi-level multivariate statistical approach.

RESULTS

Of the young women surveyed 46% had experienced sexual violence at some point and 31% had experienced sexual violence in the past 12 months. Women's autonomy was found to be particularly protective against sexual violence both at the individual and community level. Women's educational level was not found to be protective, while the educational level of the husband was found to be highly protective.

CONCLUSIONS

The high prevalence of sexual violence against young women by husbands found in this study is a matter for serious concern and underscores the need for a comprehensive response by policymakers.

Husband's control and sexual coercion within marriage: findings from a population-based survey in Egypt

This article examined sexual coercion within marriage in Egypt. Using cross-sectional survey data from a representative sample of married Egyptian women (N = 5,240), associations between forced intercourse and husband's control, as well as other relevant sociodemographic factors, were assessed through binary logistic regression models. The lifetime prevalence of forced intercourse was 6.2% and 4.6% during the past year, and husband's control was significantly associated with forced intercourse during a woman's lifetime (odds ratio = 3.5) and past year (odds ratio = 2.8). Interventions addressing gender patriarchy and men's control may decrease incidence of sexual coercion in Egypt and similar contexts.

Commentary: Prevention of violence against children: a framework for progress in low- and middle-income countries

Violence against children has been the least reported, studied, and understood area of child injuries. Initial awareness emerged from international conferences and resolutions, followed by national policies and statements. More effective responses around the world will require action. Although previous calls for action have pointed to important activities (gathering of baseline data, passing of legal reforms, and providing services to those who experience violence), the agenda is limited. Data collection needs to be continuous, systematic, and sustainable, and should enable ongoing evaluation of intervention programs. An inter-sectoral approach to violence against children incorporating public health, criminal justice, social services, education, non-governmental organizations, media, and businesses is imperative if the growing burden is to be mitigated. Thus we offer a framework, building on earlier recommendations, to focus on four domains: national surveillance, intervention research, legislation and policy, and partnerships and collaboration.

Child sexual abuse myths: attitudes, beliefs, and individual differences

Child sexual abuse myths comprise incorrect beliefs regarding sexual abuse, victims, and perpetrators. Relations among myth acceptance, responses to disclosure, legal decisions, and victims' subsequent psychological and health outcomes underscore the importance of understanding child sexual abuse myths. Despite accurate knowledge regarding child sexual abuse among many professional and other individuals, child sexual abuse myths persist. A Google search produced 119 child sexual abuse myths, some with overlapping themes. Coders grouped myths into four categories: (a) minimizations or exaggerations of the extent of harm child sexual abuse poses, (b) denials of the extent of child sexual abuse, (c) diffusions of perpetrator blame, and (d) perpetrator stereotypes. This review provides available data regarding the prevalence for these myths, empirical research that refutes or confirms myth categories, and considerations of cultural contexts and implications.