1
|
Wood SN, Perrin N, Akumu I, Asira B, Clough A, Glass N, Campbell J, Decker MR. Risk for Severe Intimate Partner Violence in Nairobi's Informal Settlements: Tailoring the Danger Assessment to Kenya. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300116. [PMID: 38290753 PMCID: PMC10906551 DOI: 10.9745/ghsp-d-23-00116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Understanding the risk for severe intimate partner violence (IPV) can help women and providers assess danger. The validated, widely used Danger Assessment (DA) developed for this purpose has not been tested in a low- and middle-income country (LMIC). We tailored the DA to Nairobi, Kenya, and prospectively evaluated baseline danger against severe IPV at 3-month follow-up. METHODS We used data from the myPlan Kenya trial conducted in 3 informal settlements in Nairobi, Kenya, from 2017 to 2018. DA items were refined through formative and pilot phases, yielding minor wording modifications. Quantitative analyses prospectively evaluated baseline DA against severe IPV at 3-month follow-up to understand the predictive effect of the (1) original 20-item DA, (2) 16-item Kenya-DA (highest relative risk ratios [RRR] with severe IPV), and (3) 16-item Kenya-DA weighted (weighting based on strength of RRRs). Diagnostic criteria, including C-statistics, sensitivity, specificity, receiver operating characteristic curve, and area under the curve, were examined; logistic regressions quantified the odds of each metric predicting severe IPV at follow-up. RESULTS The original 20-item DA produced the highest specificity (75.41%) and lowest sensitivity (57.14%), resulting in the overall lowest C-statistic. Compared to the 16-item Kenya-DA, the Kenya-DA weighted produced slightly higher sensitivity (66.67% vs. 64.29%) and specificity (77.05% vs. 72.13%), resulting in the highest C-statistic (0.78 vs. 0.75). All versions successfully predicted severe IPV at 3-month follow-up (original DA: odds ratio [OR]=1.26, 95% confidence interval [CI]=1.12, 1.41, P<.001; Kenya-DA: OR=1.33, 95% CI=1.16, 1.53, P<.001; Kenya-DA weighted: OR=1.19, 95% CI=1.10, 1.28, P<.001). Several factors identified as homicide risk factors in other settings were not prospectively associated with severe IPV. CONCLUSION Within a high-danger LMIC context, all 3 DA configurations performed well diagnostically. We recommend the 16-item Kenya-DA given the value for simplicity and field implementation, whereas the Kenya-DA weighted can add accuracy for research purposes.
Collapse
Affiliation(s)
- Shannon N Wood
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Nancy Perrin
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Irene Akumu
- Mashinani Department, Ujamaa-Africa, Nairobi, Kenya
| | - Ben Asira
- Mashinani Department, Ujamaa-Africa, Nairobi, Kenya
| | - Amber Clough
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Nancy Glass
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Global Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jacquelyn Campbell
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michele R Decker
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
2
|
Onyango EO, Elliott SJ. Victims or perpetrators, agency, and politics of intimate partner violence in the social construction of health and wellbeing: a qualitative study from Kenya. Sex Reprod Health Matters 2023; 31:2272762. [PMID: 37955525 PMCID: PMC10653651 DOI: 10.1080/26410397.2023.2272762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
Deeply rooted cultural beliefs and norms relating to the position and the responsibilities assigned to men and women play a significant role in propagating intimate partner violence (IPV). It is yet to be understood in what ways experiences of IPV contribute to how people socially construct their health and wellbeing as they navigate the tensions created by the prevailing sociocultural systems. To address this knowledge gap, we employed a social constructionist perspective and the eco-social model to explore how Kenyans aged 25-49 years socially construct their health and wellbeing in relation to their experiences of IPV. We conducted nine in-depth interviews and ten focus group discussions in four counties in Kenya between January and April of 2017. Textual analysis of the narratives reveals that although men are usually framed as perpetrators of violence, they may also be victims of reciprocal aggression by women, as recently witnessed in cases where women retaliate through gang attacks, chopping of male genitalia, and scalding with water. However, women are still disproportionately affected by gender-based violence because of the deeply rooted gender imbalances in patriarchal societies. Women experience social stigma associated with such violence and when separated or divorced in situations of unsafe relationships, they are viewed as social misfits. As such, most women opt to stay in unhealthy relationships to avoid social isolation. These experiences are not only unhealthy for their psychological wellbeing but also for their physical health and socioeconomic status and that of their offspring.
Collapse
Affiliation(s)
- Elizabeth O. Onyango
- Assistant Professor, School of Public Health, University of Alberta, 11405 87 Ave NW, AB T6G 1C9, Edmonton, Canada
| | - Susan J. Elliott
- Professor, Faculty of Geography and Environmental Management, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1Canada
| |
Collapse
|
3
|
Ringwald B, Tolhurst R, Taegtmeyer M, Digolo L, Gichuna G, Gaitho MM, Phillips–Howard PA, Otiso L, Giorgi E. Intra-Urban Variation of Intimate Partner Violence Against Women and Men in Kenya: Evidence from the 2014 Kenya Demographic and Health Survey. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:5111-5138. [PMID: 36062755 PMCID: PMC9900693 DOI: 10.1177/08862605221120893] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Although urban areas are diverse and urban inequities are well documented, surveys commonly differentiate intimate partner violence (IPV) rates only by urban versus rural residence. This study compared rates of current IPV victimization among women and men by urban residence (informal and formal settlements). Data from the 2014 Kenya Demographic and Health Survey, consisting of an ever-married sample of 1,613 women (age 15-49 years) and 1,321 men (age 15-54 years), were analyzed. Multilevel logistic regression was applied to female and male data separately to quantify the associations between residence and any current IPV while controlling for regional variation and other factors. Results show gendered patterns of intra-urban variation in IPV occurrence, with the greatest burden of IPV identified among women in informal settlements (across all types of violence). Unadjusted analyses suggest residing in informal settlements is associated with any current IPV against women, but not men, compared with their counterparts in formal urban settlements. This correlation is not statistically significant when adjusting for women's education level in multivariate analysis. In addition, reporting father beat mother, use of current physical violence against partner, partner's alcohol use, and marital status are associated with any current IPV against women and men. IPV gets marginal attention in urban violence and urban health research, and our results highlight the importance of spatially disaggregate IPV data-beyond the rural-urban divide-to inform policy and programming. Future research may utilize intersectional and syndemic approaches to investigate the complexity of IPV and clustering with other forms of violence and other health issues in different urban settings, especially among marginalized residents in informal urban settings.
Collapse
Affiliation(s)
| | | | | | - Lina Digolo
- The Prevention Collaborative, Nairobi,
Kenya
| | | | | | | | | | | |
Collapse
|
4
|
Keynejad RC, Bitew T, Mulushoa A, Howard LM, Hanlon C. Pregnant women and health workers' perspectives on perinatal mental health and intimate partner violence in rural Ethiopia: a qualitative interview study. BMC Pregnancy Childbirth 2023; 23:78. [PMID: 36709257 PMCID: PMC9883891 DOI: 10.1186/s12884-023-05352-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 01/05/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Mental health conditions are common during the perinatal period and associated with maternal, foetal, and neonatal morbidity and mortality. There is an established bidirectional relationship between mental health conditions and intimate partner violence (IPV), including during and after pregnancy. Mean lifetime prevalence of physical, sexual or emotional IPV exposure among women in rural Ethiopia is estimated to be 61% and may be even higher during the perinatal period. We aimed to explore the perspectives of women and antenatal care (ANC) health workers on the relationship between all types of IPV and perinatal mental health, to inform the adaptation of a psychological intervention for pregnant women experiencing IPV in rural Ethiopia. METHODS We conducted in-depth qualitative interviews with 16 pregnant women and 12 health workers in the Gurage zone of the Southern Nations, Nationalities and People's Region of Ethiopia, between December 2018 and December 2019. We conducted thematic analysis of English-translated transcripts of audio-recorded Amharic-language interviews. RESULTS Participants contextualised IPV as the primary form of abusive treatment women experienced, connected by multiple pathways to emotional and bodily distress. Patriarchal norms explained how the actions of neighbours, family, community leaders, law enforcement, and government agents in response to IPV often reinforced women's experiences of abuse. This created a sense of powerlessness, exacerbated by the tension between high cultural expectations of reciprocal generosity and severe deprivation. Women and health workers advocated a psychological intervention to address women's powerlessness over the range of difficulties they faced in their daily lives. CONCLUSIONS Women and health workers in rural Ethiopia perceive multiple, interconnected pathways between IPV and perinatal emotional difficulties. Contrary to expectations of sensitivity, women and health workers were comfortable discussing the impact of IPV on perinatal mental health, and supported the need for brief mental health interventions integrated into ANC.
Collapse
Affiliation(s)
- Roxanne C. Keynejad
- grid.13097.3c0000 0001 2322 6764Section of Women’s Mental Health, Health Service and Population Research Department, PO31 David Goldberg Building, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, Denmark Hill, London, SE5 8AF UK
| | - Tesera Bitew
- grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adiyam Mulushoa
- grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Louise M. Howard
- grid.13097.3c0000 0001 2322 6764Section of Women’s Mental Health, Health Service and Population Research Department, PO31 David Goldberg Building, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, Denmark Hill, London, SE5 8AF UK
| | - Charlotte Hanlon
- grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia ,grid.7123.70000 0001 1250 5688Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia ,grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health, Health Service and Population Research Department, PO31 David Goldberg Building, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, Denmark Hill, London, SE5 8AF UK
| |
Collapse
|
5
|
Decker MR, Wood SN, Thomas HL, Thiongo M, Guiella G, Fiacre B, Onadja Y, Gichangi P. Violence against women from partners and other household members during COVID-19 in Burkina Faso and Kenya. BMC Public Health 2022; 22:1857. [PMID: 36195851 PMCID: PMC9532234 DOI: 10.1186/s12889-022-14197-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/29/2022] [Indexed: 11/27/2022] Open
Abstract
Background Global evidence indicates increases in gender-based violence (GBV) during the COVID-19 pandemic following mitigation measures, such as stay at home orders. Indirect effects of the pandemic, including income loss, strained social support, and closed or inaccessible violence response services, may further exacerbate GBV and undermine help-seeking. In Kenya and Burkina Faso, as in many settings, GBV was prevalent prior to the COVID-19 pandemic. Studies specific to COVID-impact on GBV in Kenya indicate mixed results and there remains a lack of evidence from Burkina Faso. Our study takes a comprehensive lens by addressing both intimate partner violence (IPV) and non-partner household abuse through the COVID-19 pandemic in two priority settings. Methods Annual, national cross-sections of women ages 15–49 completed survey data collection in November–December 2020 and December 2020–March 2021; the GBV module was limited to one woman per household [Kenya n = 6715; Burkina n = 4065]. Descriptive statistics, Venn diagrams, and logistic and multinomial regression characterized prevalence of IPV and other household abuse, frequency relative to the COVID-19 pandemic, help-seeking behaviors, and predictors of IPV and household abuse across the socioecological framework. Results In both settings, past-year IPV prevalence exceeded non-partner household abuse (Kenya: 23.5%IPV, 11.0%household; Burkina Faso: 25.7%IPV, 16.2%household). Over half of those affected in each setting did not seek help; those that did turned first to family. Among those with past-year experiences, increased frequency since COVID-19 was noted for IPV (16.0%Burkina Faso; 33.6%Kenya) and household violence (14.3%Burkina Faso; 26.2%Kenya). Both context-specific (i.e., financial autonomy in Burkina Faso) and universal (i.e., COVID-related income loss) risk factors emerged. Conclusion Past-year IPV and household violence against women in Kenya and Burkina Faso were prevalent, and in some cases, intensified during the COVID-19 pandemic. Across settings, help-seeking from formal services was notably low, likely reflecting shame, blame, and stigmatization identified as barriers in pre-COVID literature. Both primary prevention and survivor-centered support services, including those related to economic empowerment, should be integrated within COVID-recovery efforts, and extended into the post-pandemic period to fully meet women’s safety needs.
Collapse
Affiliation(s)
- Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E4142, Baltimore, MD, 21205, USA. .,Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E4142, Baltimore, MD, 21205, USA.,Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Haley L Thomas
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E4142, Baltimore, MD, 21205, USA
| | - Mary Thiongo
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
| | - Georges Guiella
- Institut Supérieur des Sciences de la Population (ISSP/Université Joseph Ki-Zerbo), Ouagadougou, Burkina Faso
| | - Bazie Fiacre
- Institut Supérieur des Sciences de la Population (ISSP/Université Joseph Ki-Zerbo), Ouagadougou, Burkina Faso
| | - Yentéma Onadja
- Institut Supérieur des Sciences de la Population (ISSP/Université Joseph Ki-Zerbo), Ouagadougou, Burkina Faso
| | - Peter Gichangi
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya.,Technical University of Mombasa, Mombasa, Kenya.,Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
6
|
Winter SC, Aguilar NJ, Obara LM, Johnson L. "Next, it will be you": Women's Fear of Victimization and Precautionary Safety Behaviors in Informal Settlement Communities in Nairobi, Kenya. Violence Against Women 2022; 28:2966-2991. [PMID: 34859703 DOI: 10.1177/10778012211045718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Around one billion people live in informal settlements globally, including over half of Nairobi, Kenya's 3 million residents. The purpose of this study was to explore women's fear of victimization within Mathare, an informal settlement in Nairobi, Kenya and how fear of victimization influences women's behaviors. Fifty-five in-depth interviews were conducted with women in 2015-2016. A modified grounded theory approach guided data collection and analysis. Findings suggest fear of victimization is a serious concern in informal settlements, but women have found ways to adapt their behaviors to cope and to continue to function and protect their children despite fearing victimization.
Collapse
Affiliation(s)
| | - Nathan J Aguilar
- School of Social Work, 5798Columbia University, New York, NY, USA
| | - Lena M Obara
- School of Social Work, 242612Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Laura Johnson
- School of Social Work, 16043Temple University, Philadelphia, USA
| |
Collapse
|
7
|
Wood SN, Kennedy SR, Akumu I, Tallam C, Asira B, Zimmerman LA, Glass N, Decker MR. Understanding the Link Between Reproductive Coercion and Covert Use of Contraception as a Safety Strategy for Women Experiencing Violence in Nairobi's Urban Informal Settlements. Violence Against Women 2022; 29:1343-1367. [PMID: 36000323 DOI: 10.1177/10778012221108422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This mixed-methods study examined the relationship between reproductive coercion (RC) and covert contraceptive use among intimate partner violence survivors in Nairobi, Kenya. Quantitative analyses utilize baseline data from the myPlan Kenya trial (n = 321). Purposive in-depth interviews (IDIs) (n = 30) explored women's reproductive safety strategies. Multinomial analyses indicated increased covert use and decreased overt use compared to nonuse, for women experiencing RC; logistic models similarly report increased odds of covert use with RC experience. Qualitative data contextualize women's reasons for use and challenges faced. Integration of reproductive safety strategies into family planning and violence services can improve the safe use of contraception.
Collapse
Affiliation(s)
- Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Irene Akumu
- Mashinani Department, Ujamaa-Africa, Nairobi, Kenya
| | | | - Ben Asira
- Mashinani Department, Ujamaa-Africa, Nairobi, Kenya
| | - Linnea A Zimmerman
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nancy Glass
- Johns Hopkins School of Nursing, Baltimore, MD, USA.,Department of International Health, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Global Health, 15851Johns Hopkins University, Baltimore, MD, USA
| | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins School of Nursing, Baltimore, MD, USA.,Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
8
|
Ringwald B, Kababu M, Ochieng CB, Taegtmeyer M, Zulaika G, Phillips-Howard PA, Digolo L. Experiences and Perpetration of Recent Intimate Partner Violence Among Women and Men Living in an Informal Settlement in Nairobi, Kenya: A Secondary Data Analysis. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP423-NP448. [PMID: 32370597 DOI: 10.1177/0886260520916268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Evidence suggests an overlap between intimate partner violence (IPV) experience and perpetration. However, few studies in sub-Saharan Africa have investigated experience and perpetration of IPV among women and men within the same community. This study reports prevalence of past-year IPV experience and perpetration among women and men living in an informal settlement in Nairobi, Kenya, and factors associated with IPV. Data analyzed for this study involved a geographically distributed random sample of 273 women and 429 men who participated in a community survey. We approximated prevalence of IPV experience and perpetration and used logistic regression for estimating associations between individual-level factors and IPV. Women and men experienced similar levels of IPV, but a significantly higher proportion of men reported physical and sexual IPV perpetration. Witnessing violence between parents in childhood was associated with women's physical and sexual, and men's sexual IPV experience; and with women perpetrating emotional, and men perpetrating sexual IPV. Less equitable gender attitudes were associated with men's perpetration of physical IPV. More equitable gender knowledge was associated with women's experience of sexual IPV, and with men perpetrating IPV. Perceived skills to challenge gender inequitable practices were negatively associated with men perpetrating sexual IPV. In conclusion, we found IPV experience and perpetration were highly correlated, and that, contrary to commonly reported gender gaps, men and women experienced similar rates of IPV. We make suggestions for future research, including on IPV prevention interventions in areas with such IPV prevalence that would be beneficial for women and men and future generations.
Collapse
|
9
|
Allen EM, Munala L, Henderson JR. Kenyan Women Bearing the Cost of Climate Change. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312697. [PMID: 34886422 PMCID: PMC8656926 DOI: 10.3390/ijerph182312697] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022]
Abstract
Climate change-induced crises can aggravate intimate partner violence (IPV); the loss of income when weather affects the agricultural industry can exacerbate violence at home. In Kenya, climate change has increased precipitation during the rainy season and raised temperatures during the dry season, resulting in floods and droughts. For 75% of Kenyans, agricultural activities are their primary source of income. This research aims to assess patterns in IPV and severe weather events (SWE). We examined Integrated Public Use Microdata Series-Demographic Health Survey (IPUMS-DHS) data from 2008 and 2014 for IPV severity and frequency. We used Emergency Events Database (EM-DAT) data along with GPS coordinates to identify SWEs (defined as any flood >10 days) by county in Kenya. Overall, women were more likely to experience IPV if their spouse worked in agriculture (Odds Ratio (OR) = 1.22, 95% Confidence Interval (CI): 1.10–1.36). There was a 60% increase in the odds of reporting IPV in counties that experienced an SWE as compared to counties that did not experience an SWE (OR = 1.60, 95% CI: 1.35–1.89). This analysis further supports the growing body of research that suggests a relationship between climate change-related weather events and violence against women.
Collapse
Affiliation(s)
- Elizabeth M. Allen
- Correspondence: (E.M.A.); (L.M.); Tel.: +651-690-6021 (E.M.A.); +651-690-6265 (L.M.)
| | - Leso Munala
- Correspondence: (E.M.A.); (L.M.); Tel.: +651-690-6021 (E.M.A.); +651-690-6265 (L.M.)
| | | |
Collapse
|
10
|
Wood SN, Kennedy SR, Hameeduddin Z, Asira B, Tallam C, Akumu I, Wanjiru I, Glass N, Decker MR. "Being Married Doesn't Mean You Have to Reach the End of the World": Safety Planning With Intimate Partner Violence Survivors and Service Providers in Three Urban Informal Settlements in Nairobi, Kenya. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP10979-NP11005. [PMID: 31587653 DOI: 10.1177/0886260519879237] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Intimate partner violence (IPV) harms women physically, sexually, and psychologically. Safety strategies, or harm reduction techniques implemented by women undergoing recurrent violence, may help mitigate the negative health, economic, and social consequences of IPV. This study aimed to understand recommended and utilized safety strategies among three urban informal settlements in Nairobi, Kenya. Semi-structured key informant discussions (KIDs; n = 18) with community-based service providers and focus group discussions (FGDs; n = 49) with IPV survivors were conducted. All interviews were audio-recorded, transcribed, and translated verbatim from Swahili to English. Inductive thematic analysis was used to structure codes. Convergence matrices were used to analyze emergent strategies by data source (service providers vs. IPV survivors). Women preferred safety strategies that they could implement unassisted as first line of harm reduction. Strategies included removing stressors, proactive communication, avoidance behaviors, sexual and reproductive health (SRH), economic, leaving partner for safety, child safety, and securing personal property. Strategies recommended by service providers and utilized by IPV survivors differed, with clear divergence indicated for leaving the abusive relationship, SRH, and personal property strategies. Innovative strategies emerged from IPV survivors for safeguarding property. Similar to upper-income and other low and middle-income contexts, women experiencing IPV in urban informal settlements of Nairobi actively engage in behaviors to maximize safety and reduce harm to themselves and their families. Integration of strategies known to be helpful to women in these communities into community-based prevention and response is strongly encouraged. Increased synergy between recommended and implemented safety strategies can enhance programming and response efforts.
Collapse
Affiliation(s)
- Shannon N Wood
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Zaynab Hameeduddin
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | - Nancy Glass
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Center for Global Health, Johns Hopkins University, Baltimore, MD, USA
| | - Michele R Decker
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
11
|
Brown LL, Perkins JM, Hargrove JL, Pahl KE, Mogoba P, van Zyl MA. Correlates of Safety Strategy Use Among South African Women Living With HIV and at Risk of Intimate Partner Violence. Violence Against Women 2021; 28:1505-1522. [PMID: 34157908 PMCID: PMC8692488 DOI: 10.1177/10778012211021108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intimate partner violence (IPV) and HIV are correlated and endemic in South Africa. However, safety strategy use to prevent IPV among HIV-positive women is understudied. This study assesses correlates of specific safety strategy use among 166 Black South African women recently experiencing IPV and testing positive for HIV. Associations were observed between consultation with formal (i.e., counselors, clergy, IPV specialists) and informal networks (i.e., friends/family) and participant language (isiZulu, isiXhosa, Sesotho, and English), past year IPV, and engaging in HIV care. Future HIV-IPV programs should consider how characteristics of different IPV safety strategies may influence strategy uptake and ultimately HIV care.
Collapse
Affiliation(s)
- Leslie Lauren Brown
- Meharry Medical College, School of Medicine, Nashville, TN, USA.,Nashville CARES, Nashville, TN, USA
| | - Jessica Mayson Perkins
- Vanderbilt University, Nashville, TN, USA.,Vanderbilt Institute of Global HealthUniversity, Nashville, TN, USA
| | | | | | - Phepo Mogoba
- University of Cape Town, Western Cape, South Africa
| | | |
Collapse
|
12
|
Mengo C, Sharma BB, Beaujolais B. Informal and formal systems of care for women experiencing intimate partner violence in Kenya. Health Care Women Int 2021; 43:827-850. [PMID: 33720812 DOI: 10.1080/07399332.2021.1883617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Several factors influence a victim's decision on whether or not to seek help after experiencing Intimate Partner Violence (IPV). This study used data from the Demographic and Health Surveys (DHS) for Kenya (2014) of ever married women (n = 5265). Majority of the women did not seek help after experiencing IPV (55.5%). Women justification for IPV decreased the odds of seeking help from informal services by 0.75 times and formal services by 0.58 times. Understanding cultural determinants of help seeking would contribute in the development of effective policies and programs for preventing and responding to IPV in Kenya and across the world.
Collapse
Affiliation(s)
- Cecilia Mengo
- College of Social Work, The Ohio State University, Columbus, Ohio, USA
| | - Bonita B Sharma
- Department of Social Work, University of Texas at San Antonio, San Antonio, Texas, USA
| | | |
Collapse
|
13
|
Wood SN, Glass N, Decker MR. An Integrative Review of Safety Strategies for Women Experiencing Intimate Partner Violence in Low- and Middle-Income Countries. TRAUMA, VIOLENCE & ABUSE 2021; 22:68-82. [PMID: 30669943 DOI: 10.1177/1524838018823270] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Intimate partner violence (IPV) is prevalent and a leading source of morbidity and mortality to women worldwide. Safety planning is a cornerstone of harm reduction and violence support in many upper income countries. Far less is known about safety strategies used by women in low- and middle-income countries (LMICs) where the IPV support service infrastructure may be more limited. This study aimed to review the literature regarding safety strategies in LMICs. A PubMed search was conducted using search terms "safety," "coping," "harm reduction," and "intimate partner violence." Inclusion criteria comprised IPV studies mentioning characterization and utilization of safety strategies that were written in English and conducted in an LMIC. Our search yielded 16 studies (in-depth interviews, n = 5; focus group discussions, n = 2; case study, n = 2; mixed qualitative methods, n = 4; mixed methods, n = 1; and semi-structured quantitative survey, n = 2). Four distinct themes of strategies emerged: engaging informal networks, removing the stressor/avoidance, minimizing the damage to self and family through enduring violence, and building personal resources. IPV-related safety strategies literature primarily emerged from site-specific qualitative work. No studies provided effectiveness data for utilized strategies. Across geoculturally diverse studies, results indicate that women are engaging in strategic planning to minimize abuse and maximize safety. Women highlighted that safety planning strategies were feasible and acceptable within their communities. Further research is needed to test the effectiveness of these strategies in decreasing revictimization and increasing health and well-being. Further adoption of safety strategies into violence programming could increase monitoring and evaluation efforts.
Collapse
Affiliation(s)
- Shannon N Wood
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nancy Glass
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Center for Global Health, Johns Hopkins University, Baltimore, MD, USA
| | - Michele R Decker
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
14
|
Decker MR, Wood SN, Hameeduddin Z, Kennedy SR, Perrin N, Tallam C, Akumu I, Wanjiru I, Asira B, Frankel A, Omondi B, Case J, Clough A, Otieno R, Mwiti M, Glass N. Safety decision-making and planning mobile app for intimate partner violence prevention and response: randomised controlled trial in Kenya. BMJ Glob Health 2020; 5:bmjgh-2019-002091. [PMID: 32675229 PMCID: PMC7368487 DOI: 10.1136/bmjgh-2019-002091] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/10/2020] [Accepted: 03/15/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Intimate partner violence (IPV) threatens women’s health and safety globally, yet services remain underdeveloped and inaccessible. Technology-based resources exist, however, few have been adapted and tested in low-resource settings. We evaluate the efficacy of a community-partnered technology solution: culturally and linguistically adapted version of the myPlan app, a tailored safety decision-making and planning intervention, administrated by trained lay professionals. Methods This randomised, controlled, participant-blinded superiority trial compares safety-related outcomes at baseline, immediate post intervention and 3-month follow-up among women at risk of and experiencing IPV in Nairobi, Kenya. Women were randomised (1:1 ratio) to: (1) myPlan Kenya (intervention); or (2) standard IPV referrals (control). Primary outcomes were safety preparedness, safety behaviour and IPV; secondary outcomes include resilience, mental health, service utilisation and self-blame. Results Between April 2018 and October 2018, 352 participants (n=177 intervention, n=175 control) were enrolled and randomly assigned; 312 (88.6%, n=157 intervention, n=155 control) were retained at 3 months. Intervention participants demonstrated immediate postintervention improvement in safety preparedness relative to control participants (p=0.001). At 3 months, intervention participants reported increased helpfulness of safety strategies used relative to control participants (p=0.004); IPV reduced in both groups. Among women reporting the highest level of IPV severity, intervention participants had significant increase in resilience (p<0.01) compared with controls, and significantly decreased risk for lethal violence (p<0.01). Conclusions Facilitated delivery of a technology-based safety intervention appropriately adapted to the context demonstrates promise in improving women’s IPV-related health and safety in a low-resource, urban setting. Trial registration number Pan African Clinical Trial Registry (PACTR201804003321122).
Collapse
Affiliation(s)
- Michele R Decker
- Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA .,Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.,Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shannon N Wood
- Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Zaynab Hameeduddin
- Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - S Rachel Kennedy
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Nancy Perrin
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | | | | | | | | | - Ariel Frankel
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - James Case
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Amber Clough
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | | | | | - Nancy Glass
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.,International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Center for Global Health, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
15
|
Decker MR, Wood SN, Kennedy SR, Hameeduddin Z, Tallam C, Akumu I, Wanjiru I, Asira B, Omondi B, Case J, Clough A, Otieno R, Mwiti M, Perrin N, Glass N. Adapting the myPlan safety app to respond to intimate partner violence for women in low and middle income country settings: app tailoring and randomized controlled trial protocol. BMC Public Health 2020; 20:808. [PMID: 32471469 PMCID: PMC7260790 DOI: 10.1186/s12889-020-08901-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/12/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is a leading threat to women's health and safety globally. Women in abusive relationships make critical decisions about safety and harm reduction while weighing multiple competing priorities, such as safety of children, housing and employment. In many low- and middle-income countries (LMIC), IPV prevention and response services are limited and women lack access to safety planning resources. In high-resource settings, an interactive safety decision aid app (myPlan) has been found valuable in reducing decisional conflict and empowering women to take action in accordance with their safety priorities. This paper describes 1) the community-participatory formative process used to adapt the myPlan app content, interface, and implementation for the Kenya context, and 2) the randomized clinical trial study protocol for efficacy evaluation of myPlan Kenya. METHODS A community-participatory formative process engaged service providers and stakeholders, as well as IPV survivors for adaptation, followed by an in-depth pilot and final refinements. A randomized clinical trial design will then be used to determine efficacy of the myPlan Kenya app compared to standard care among women reporting IPV or fear of partner and living in an urban settlement. myPlan Kenya app provides and solicits information on a) relationship health; b) safety priorities; and c) severity of relationship violence. Based on the woman's inputs, the evidence-based algorithm developed for myPlan Kenya generates a tailored safety plan. Outcome measures are assessed at baseline, immediate post-intervention, and 3-month post-baseline. Difference-in-differences analysis compares primary (e.g. safety preparedness, safety behavior, IPV), and secondary outcomes (e.g. resilience, mental health, service utilization, self-blame) across timepoints by group. DISCUSSION Formative phase revealed high feasibility and acceptability of a technology-based intervention for safety planning in this LMIC setting. This phase generated essential refinements to myPlan Kenya app readability, content and implementation, including increased visualization of messaging, and implementation via community health volunteers (CHVs). The resulting trial will be the first to evaluate efficacy of a community-partnered technology-based IPV intervention in a LMIC. Our adaptation process and trial results will inform researchers and interventionists to integrate multiple data sources to adapt IPV intervention content and interface in settings where technology-based interventions for IPV are novel and literacy is limited. TRIAL REGISTRATION Pan African Clinical Trial Registry approval received 25 April 2018 (PACTR201804003321122); retrospectively registered.
Collapse
Affiliation(s)
- Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA. .,Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | | | - Zaynab Hameeduddin
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | | | - Irene Akumu
- Ujamaa-Africa, Mashinani Department, Nairobi, Kenya
| | | | - Ben Asira
- Ujamaa-Africa, Mashinani Department, Nairobi, Kenya
| | | | - James Case
- Johns Hopkins School of Nursing, Baltimore, USA
| | | | | | - Morris Mwiti
- Ujamaa-Africa, Mashinani Department, Nairobi, Kenya
| | | | - Nancy Glass
- Johns Hopkins School of Nursing, Baltimore, USA.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Center for Global Health, Johns Hopkins University, Baltimore, USA
| |
Collapse
|