Associations Between Women's Economic and Social Empowerment and Intimate Partner Violence: Findings From a Microfinance Plus Program in Rural North West Province, South Africa

Do Gender-Based Violence Interventions Consider the Impacts of Climate Change? A Systematic Review

Climate change and extreme weather events have been shown to increase incidences of gender-based violence (GBV). Numerous organizations have devoted significant time, resources, and effort to the design and implementation of interventions aimed at reducing GBV in Africa. Some interventions effectively reduce violence, but GBV persists and remains pervasive. The United Nations has called for GBV interventions that consider the impact of climate change on violence. This review aims to determine whether public health interventions intended to reduce GBV in Africa take into account the effects of climate change on the region and the population. PubMed, PsychArticles, and CINAHL databases were searched systematically in February 2023 for interventions conducted in Africa published between 2010 and 2023. There were a total of 86 articles in the final review that described 40 distinct interventions. The intervention designs included empowerment and participatory approaches (microfinance, microfinance plus, community education, and community engagement), changing social and cultural norms (community education, community engagement, and media), and school-based programs. None of the 40 interventions mentioned climate, weather, or climate change as a component of the intervention. There are several opportunities to improve existing, successful GBV interventions in order to increase their efficacy. GBV interventions could incorporate economic independence programs that do not rely on agriculture and include climate change education. These findings could facilitate the integration of two previously distinct research disciplines-climate change and GBV prevention-to inform future research and develop more effective and cost-efficient interventions.

Development of the Vietnamese Rape Myths Acceptance Scales: A Web-Based Survey of Young Adults

Rape myths-false but widely held beliefs that serve to deny and justify sexual aggression-present a major barrier to reporting and prevention of sexual violence in Vietnam and globally. Based on a parent study aimed at reducing sexual violence at two universities in Hanoi, we developed and assessed a contextualized measure of rape myths among young people in Vietnam. Items from previously validated rape myth acceptance (RMA) scales and data from qualitative research informed the development of 50 items, which were administered to Vietnamese 18-24-year-olds (n = 2,756 total, n = 1,798 cisgender women) via an anonymous link in February 2021. We used factor analysis to explore and test factor structure and multi-group factor analysis to assess measurement equivalence across gender. We calculated item-level discrimination and difficulty parameters and visualized information curves using item response theory analysis, informing the development of a short form. Four hypothesized subconstructs identified in the qualitative data emerged as factors: (1) "He didn't mean to"; (2) "She asked for it"; (3) "It wasn't really rape"; and (4) "Rape is a deviant event." A fifth factor, "She didn't protect herself," included four items from formative data. Confirming formative findings and prior literature, cisgender women had lower RMA than cisgender men, particularly on items related to victim-blaming. The Vietnamese Rape Myths Acceptance Scales were internally consistent and equivalent between cisgender men and women, capturing elements specific to the Vietnamese context and providing a tool for campus climate surveys and evaluations of sexual violence prevention programs.

Prevalence, correlates, and trends of intimate partner violence against women in Pakistan: Results from Pakistan Demographic and Health surveys 2012-13 and 2017-18

BACKGROUND

Intimate partner violence (IPV) is a global public health problem. The objectives of this study were to analyze the prevalence and correlates of IPV perpetrated by men against women from the recent nationally representative Pakistan Demographic and Health Survey (PDHS) 2017-18, and to analyze levels and trends of IPV perpetrated by current/former husbands from PDHS conducted in 2012-13, in the four provinces and the capital city.

METHODS

Association of having ever experienced IPV, defined as either emotional, physical and/or sexual violence, by ever married women aged 15-49, with 12 explanatory socio-demographic, attitudinal, and experiences were analyzed using simple and multiple logistic regression models.

RESULTS

The prevalence of having ever experienced IPV was 33.48% (95% CI: 30.76-36.32). In the final multivariable model, number of living children, having knowledge of parental physical IPV, husband's use of alcohol, and marital control were statistically significantly associated with IPV. Proportions and trend analysis of emotional and physical IPV between the PDHS 2017-18 and PDHS 2012-13, showed that in general, rural areas of provinces reported higher prevalence of emotional and physical IPV, compared with urban areas, and in general, emotional, and physical IPV prevalence declined from PDHS2012-13 to PDHS2017-18.

CONCLUSIONS

The prevalence of having experienced physical and/or sexual intimate partner violence in Pakistan was lower than the prevalence for the WHO Eastern Mediterranean region. However, IPV burden at the provincial urban-rural residency status underscore the need for location specific strategies to effectively address IPV in Pakistan.

Prevalence, Correlates, and Trends of Intimate Partner Violence Against Women in Cambodia: Findings From 2014 and 2021-22 Cross-Sectional Demographic and Health Surveys

Intimate partner violence (IPV) is globally endemic and a gross violation of human rights, in addition to abuse of intimacy by some men against their female intimate partners. Based on literature review, attitudinal, socio-demographic, and experiential attributes of 15 to 49 year old ever partnered women in the heterosexual relationships were identified. This study used the anonymized 2020-21Cambodia Demographic and Health Survey (CDHS) data to compute the IPV prevalence and its correlates, in addition to computing the changes in IPV prevalence at the urban, rural, and at the national levels using data from the 2014 CDHS. Identified attitudinal, socio-demographic, and experiential attributes were used in the bivariate and multivariable analysis. Simple and multiple logistic regression models were used for computing the bivariate and multivariate associations with IPV; additionally, trend analysis was done to compute changes in IPV prevalence between the 2 surveys. Lifetime prevalence of IPV was 20.70%, while the most common subtype was emotional IPV at 18.70%. Ten out of 12 correlates studied were found to be statistically significantly associated with IPV in the bivariate analysis. These were added in the multivariable model and 7 were found to be statistically significantly associated with IPV. Which included educational attainment of women and their intimate partners, number of living children, women's IPV acceptance, male partner's alcohol use, knowledge of physical beating of mother by one's father, and controlling behavior exercised by partner. During the intervening period between the 2 CDHSs, IPV and its subtypes were decreased in both urban and rural areas, as well as nationally. IPV decrease between the 2 DHSs and lower IPV rates in 2021-22 augur well for the health and human rights of Cambodian women. However, the ultimate target of eliminating IPV against women, will require measures that ensure economic and gender empowerment, and gender equality.

Prevalence, correlates, and trends of intimate partner violence against women in Sierra Leone: findings from 2013 and 2019 demographic and health surveys

Background

Intimate partner violence (IPV) is a globally pervasive public health and medical problem in addition to being a serious violation of women's rights. The two-fold objectives of this study were to compute the lifetime prevalence and correlates of IPV perpetrated by current/former husbands/partners of ever-married women aged 15-49 years using the nationally representative Sierra Leone Demographic and Health Survey (DHS) conducted in 2019; ethnicity-based levels and trends of IPV were also computed using the data from the DHS conducted in 2013 along with the 2019 DHS.

Methods

Twelve IPV correlates pertaining to socio-demographic, attitudinal, and experiential attributes were analyzed using logistic regression models for bivariate and multivariable analysis. IPV was computed as a composite variable comprising of physical, emotional, and/or sexual IPV.

Results

Lifetime prevalence of experiencing any kind of IPV was a staggering 60.81%, whereas emotional, physical, and sexual IPV prevalence were reported by 45.90%, 49.81%, and 8.14% of the respondents, respectively. No ethnicity reported a statistically significant decrease in any type of IPV during the intervening period between the two surveys. Five out of nine ethnicities reported a statistically significant increase in emotional IPV, while few ethnicities reported a statistically significant increase in one or more types of IPV.

Conclusion

The high lifetime prevalence of IPV is alarming and points to the need for targeted health promotion campaigns to reverse the tide of IPV in Sierra Leone, including focusing on changes in cultural and ethnicity-based norms and mores to ensure women's human rights are respected and upheld.

Psychosocial effects of gender-based violence among women in Vhembe district: A qualitative study

Background

The phenomenon of gender-based violence is a pertinent social problem in South Africa. The fear of reporting gender-based violence contributes to its continuation, marginalisation and silencing of victims.

Objectives

The study sought to explore the psychosocial effects of gender-based violence among women in Vhembe district.

Methods

An exploratory phenomenological research design was used and sampling was performed purposively from a population of women who experienced gender-based violence in a low-resource, rural setting of Vhembe district. Semi-structured telephonic interviews were used as the main method of data collection after permissions and informed consent were sought for conducting the study. Thematic content analysis was applied to convert the participants' statements into a meaningful framework to derive the findings.

Results

A total of 15 participants aged from 19 to 35 years participated in the study. Their psychosocial experiences of gender-based violence were depression, worthlessness, social isolation and anger directed towards children.

Conclusion

This research confirms that gender-based violence remains one of the most challenging problems associated with mental health problems in Vhembe district. It affirms the need to focus on awareness in rural areas afflicted by patriarchal attitudes, norms and stereotypes. Gender-based violence should to be viewed as human rights violation for victims' protection.

Contribution

The study contributes to the body of knowledge on the experiences of gender-based violence among marginalised women from rural areas.

A drop of love? Rainfall shocks and spousal abuse: Evidence from rural Peru

We investigate whether exposure to rainfall shocks affects the experience of physical intimate partner violence (P-IPV) among women in rural areas of the Peruvian Andes. Using data from the Demographic and Health Surveys over 2005-2014, we track changes in the probability that a woman experiences recent instances of P-IPV after being exposed to a rainfall shock during the last cropping season. Our results indicate that the probability that a woman experiences P-IPV increases by 8.5 percentage points (65 percent) after exposure to a dry, but not a wet, shock during the cropping season. We identify two complementary causal pathways of this effect: increased economic insecurity and poverty-related stress that deteriorates men's emotional well-being and mental health, and reduced female empowerment that affects women's ability to negotiate their preferences within the relationship.

The Impact of Poverty on Partner Violence Against Women Under Regional Effects: The Case of Turkey

Violence against women has been the subject of scientific literature in many fields and poverty has been one of the most important companions in this field. It can be found lots of empirical studies about violence against women for countries as Turkey too. However, regional considerations relating to people's socioeconomic condition have not been considered in these investigations although it has been indicated that these factors are important in terms of violence against women. Therefore, the main motivation of this study to investigate the impact of poverty on partner violence against women under the regional impacts in Turkey. The multinomial logit analysis preferred since the violence against women considered under three groups which are physical, sexual violence, and never experienced. The dataset received from the Survey on Domestic Violence Against Women in Turkey which was performed by Turkish Statistical Institute (TURKSTAT). This survey is performed in both 2008 and 2014 years. For this study, the 2008 data is chosen as it carries the information of "having a green card" which is a formal demonstration of being poor. Also, NUTS 2 (Nomenclature of territorial units for statistics) regions for Turkey are considered during the analysis. Based on the general results, the poverty status and regional effects of women, showed quite different results in terms of physical and sexual violence types. The poverty has a positive effect only on physical violence, not on sexual violence. Further, all regions have an important role on physical violence, while only less developed regions have a dominant impact on sexual violence. Also, the findings show that the intimate partners' bad habits make women more vulnerable to violence. According to the results, it can be suggested that developing policies based on regional effects and types of violence would be more effective.

Prevalence, Correlates, and Trends of Intimate Partner Violence Against Women in Gambia: Results From 2 National Cross-Sectional Health Surveys

No country is immune from intimate partner violence (IPV). The objectives of this study were to analyze the prevalence, correlates and trends of this global public health menace perpetrated by men against women using the most recent nationally representative Gambia Demographic and Health Survey (GDHS) 2019-20; with analysis of levels and trends of IPV perpetrated by current/former husbands/partners from ever-married women, from GDHS conducted in 2013, at the 8 subnational regions. IPV association with 12 covariates entailing socio-demographic, experiential and attitudinal characteristics was analyzed in bivariate and multivariable models, using simple and multiple logistic regression. Physical, emotional, and sexual IPV was reported by 29.09%, 24.03%, and 5.52% respectively. While prevalence of having experienced any type of IPV was39.23%. Statistically significant association of IPV with various covariates computed in univariate analysis were used in the multivariable logistic regression model. Women's and husband's educational attainment, wealth status, having witnessed father physically beat mother, and marital control exhibited by the husband were statistically significantly associated with IPV, in the final model. Physical, emotional, and sexual IPV increased from 2023 to 2019-20 in all 8 regions, with the exception of sexual IPV in Kanifing region. However, not all these changes were not statistically significant. Physical and sexual IPV prevalence in Gambia was slightly lower compared with the African region. The disturbing finding of increase in all 3 types of violence in all regions-with one exception-paints a dire scenario that augurs the imperative of women empowerment and revisiting of cultural norms for protecting women.

Association of spousal violence and women's empowerment status among the rural women of sub-Saharan Africa

Spousal violence (SV) is a global problem for women and its elimination is one of the prime targets of Sustainable Development Goal-5. Data from the Demographic and Health Surveys of seventeen countries, representing two sub-Saharan Africa (SSA) regions (East and Southern Africa [ESA] and West and Central Africa [WCA]), were used to examine the relationship between all types of SV and women's empowerment status among rural married women aged 15-49 years. Multivariate logistic regression analysis was used to explore adjusted associations, and a relative index of inequality (RII) and slope index of inequality (SII) were used to measure the inequality in experiencing SV by rural women based on their overall empowerment position. Within the period 2015-2019, the reported rate of SV was higher in the ESA (physical SV: 33.55%; sexual SV: 16.96%; any type of SV: 46.14%) than the WCA countries (physical SV: 27.80%; sexual SV: 7.63%; any type of SV: 40.83%), except for emotional SV (WCA: 31.28% vs ESA: 29.35%). In terms of overall empowerment status, rural WCA women were slightly ahead of their counterparts in the ESA region (46.09% and 44.64%, respectively). For both ESA and WCA countries, women who didn't justify violence and who had access to health care (except physical SV in WCA) showed negative but significant association with all types of SV in the adjusted analysis. Conversely, economic empowerment significantly increased the odds of experiencing physical and any type of SV in both regions. The significant risk ratios obtained from RII, for any SV were 0.83 and 1.09, and the β-coefficients from SII were -0.082 and 0.037 units, respectively, in ESA and WCA. Multi-sectoral microfinance-based intervening programmes and policies should be implemented regionally to empower women, especially in the economic, socio-culture, health care accessibility dimensions, and this will eventually reduce all types of spousal violence in rural SSA.

Correlates of co-occurring physical child punishment and physical intimate partner violence in Colombia, Mexico and Peru

Background

Violent discipline of children and intimate partner violence (IPV) against women are global public health and human rights problems. To address calls for more evidence on intersections, this study aimed to expand knowledge about correlates of physical child punishment, physical IPV against women and their co-occurrence (both) in the same household. 

Methods

Using national, population-based survey datasets from Colombia, Mexico and Peru, multinomial logistic regressions examined correlates of three mutually exclusive patterns of violence in the household: physical child punishment (only), physical IPV ever (only) and co-occurrence (both), each compared with no violence, after adjusting for other factors. Logistic regression was used to analyse odds ratios of physical child punishment in households affected by IPV past year and before past year compared with never, after adjusting for other factors.

Results

In all countries, adjusted odds ratios (aOR) of co-occurrence were significantly higher among women with lower education, more than one child, a child aged 2–5, a partner who tried to socially isolate her, and a history of childhood violence (caregiver violence and/or IPV exposure). They were significantly lower among women who reported collaborative partnerships (joint decision-making and/or shared chores). Co-occurrence was also significantly correlated with a history of child marriage/early motherhood in Colombia and Mexico, partner’s excess drinking in Mexico and Peru, agreement that physical child punishment was necessary in Peru and partner’s history of childhood violence in Colombia and Mexico. Evidence of shared risk factors was strongest for social isolation and caregiver histories of childhood violence and of shared protective factors for collaborative partnership dynamics. In all countries, associations between physical child punishment and physical IPV remained significant after adjusting for other factors, suggesting that correlations could not be explained by shared risk factors alone.

Conclusions

These findings are consistent with several theories relevant for violence prevention: 1) more collaborative, gender equitable partnerships may protect both children and women from violence; 2) violence between intimate partners may ‘spill over’ into violence against children (as correlations could not be explained by shared risk factors alone); and 3) there appears to be strong evidence of intergenerational transmission of violence.

Women's Economic Contribution, Relationship Status and Risky Sexual Behaviours: A Cross-Sectional Analysis from a Microfinance-Plus Programme in Rural South Africa

In sub-Saharan Africa, women bear a disproportionate burden of HIV/AIDS while also facing economic and gender inequalities. To explore the association of women’s economic contribution and relationship status with risky sexual behaviour, this study analysed cross-sectional data from 626 women aged 22 to 84 in rural South Africa. All women were enrolled in a microfinance plus gender training programme (Intervention with Microfinance for AIDS and Gender Equity (IMAGE)). We used univariable and multivariable logistic regression to explore the associations of relationship status and women’s household income contribution with inconsistent condom use, multiple sexual partners and transactional sex, respectively. We found that married, older women had the highest odds of inconsistent condom use, while those contributing all the household income had higher odds of multiple sexual partnerships, but lower odds of transactional sex compared to those with no contribution. Income contribution and relationship status have a nuanced relationship with sexual risk behaviours. Thus, economic strengthening interventions should target relevant vulnerable women while also addressing the broader social and economic drivers of risky sexual behaviour.

The Role of Socioeconomic Factors on Women's Risk of Being Exposed to Intimate Partner Violence

The most important thing learned about intimate partner violence (IPV) over the last 20 years is that violence is gendered and can be learned after faced and can only be understood in the context of gender inequality. To promote gender equality, a number of legal reforms and policies have been put in place over the last decade. The main problem is that there is relationship between all the socioeconomic and demographic factors. This begs the question, does the high educational level, social and economic status of a woman put her at lower risk of experiencing domestic violence? The study hypothesizes that those socioeconomic factors such as literacy, political rights, urbanization, laws against violence, the annual income of women, and the number of women in the labor force can affect IPV prevalence. The study uses secondary data concerning socioeconomic factors from 26 predominantly Muslim countries in Asia-Pacific and North Africa. Findings from the study show that socioeconomic factors such as literacy, political rights, a higher level of urbanization, and the laws against violence have significant impacts and may decrease the prevalence of IPV. However, other socioeconomic factors such as the annual income of women and increased women in the labor force produced unclear results. The test for collinearity on the impacts of each socioeconomic factor against one another was found to be insignificant.

Development of a women's empowerment index for Tanzania from the demographic and health surveys of 2004-05, 2010, and 2015-16

BACKGROUND

Women's empowerment is a multidimensional construct which varies by context. These variations make it challenging to have a concrete definition that can be measured quantitatively. Having a standard composite measure of empowerment at the individual and country level would help to assess how countries are progressing in efforts to achieve gender equality (SDG 5), enable standardization across and within settings and guide the formulation of policies and interventions. The aim of this study was to develop a women's empowerment index for Tanzania and to assess its evolution across three demographic and health surveys from 2004 to 2016.

RESULTS

Women's empowerment in Tanzania was categorized into six distinct domains namely; attitudes towards violence, decision making, social independence, age at critical life events, access to healthcare, and property ownership. The internal reliability of this six-domain model was shown to be acceptable by a Cronbach's α value of 0.658. The fit statistics of the root mean squared error of approximation (0.05), the comparative fit index (0.93), and the standardized root mean squared residual (0.04) indicated good internal validity. The structure of women's empowerment was observed to have remained relatively constant across three Tanzanian demographic and health surveys.

CONCLUSIONS

The use of factor analysis in this research has shown that women's empowerment in Tanzania is a six-domain construct that has remained relatively constant over the past ten years. This could be a stepping stone to reducing ambiguity in conceptualizing and operationalizing empowerment and expanding its applications in empirical research to study different women related outcomes in Tanzania.

Economic empowerment and intimate partner violence: a secondary data analysis of the cross-sectional Demographic Health Surveys in Sub-Saharan Africa

BACKGROUND

Intimate partner violence (IPV) has been recognized as a defining human rights, development and public health issue of our time. Economic empowerment is one of the most promising interventions to reduce IPV in sub-Saharan Africa, yet the evidence around economic factors that are key to ensure a reduction in IPV are still mixed. Furthermore, there is a lack of clarity on what kinds of economic empowerment works for which population group. This paper seeks a more nuanced understanding, by investigating whether the associations between indicators of economic empowerment and physical and/or sexual IPV are similar between the general population of women and among urban versus rural and young, or middle aged women versus older women.

METHODS

Using couples data from 25 DHS surveys across 15 countries (n = 70,993 women and men aged 15 and above at time of survey), we analyse how household wealth, men's and women's education and employment status, decision making on women's income, differences in education and employment of women and their partners and women's cash income are associated with physical and/or sexual IPV. We also provide sub-analyses for both urban and rural areas and for women aged, 15 to 24 25 to 34 and 35 to 49.

RESULTS

Across all surveys, 20% of women reported physical and/or sexual IPV in the last 12 months. On the one hand, our findings reinforced certain well-established patterns between women's economic empowerment and IPV, with women's and men's higher levels of education and increased household wealth  associated with a decrease in IPV, and women's employment, especially if only the woman worked, and women earning more than her partner associated with an increase in IPV. Most patterns did not differ across urban and rural settings and age groups, but notable differences emerged regarding household wealth, women's and men's employment in the last 12 months and relative employment and education.

CONCLUSIONS

Factors relating to women's economic empowerment are  vital in understanding and addressing IPV. Our analysis indicate however that future interventions need to consider the differing needs of urban and rural areas as well as be targeted to different age groups.

Sexual risk behaviors, mental health outcomes and attitudes supportive of wife-beating associated with childhood transactional sex among adolescent girls and young women: Findings from the Uganda Violence Against Children Survey

Compared to young men, Ugandan young women are disproportionately impacted by HIV. Childhood transactional sex may contribute to this disparity. Using data from the 2015 Uganda Violence Against Children Survey, we used logistic regression models to assess the association between childhood transactional sex and negative outcomes. Among 18-24-year-old young women who had sex prior to 18 (n = 982), those who ever engaged in transactional sex had 5.9 times [adjusted odds ratio (AOR); confidence interval (CI): 1.6–22.2] higher odds of having multiple sexual partners in the past year; 5.2 times (AOR; CI: 2.1–12.9) higher odds of infrequent condom use in the past year; 3.0 times (AOR; CI: 1.2–7.9) higher odds of hurting themselves intentionally; and 3.2 times (AOR; CI: 1.3–7.7) higher odds of having attitudes justifying spousal abuse than young women who never engaged in transactional sex. Interventions for transactional sex and HIV in Uganda should consider prioritizing prevention, harm-reduction and continued investment in adolescent girls’ and young women’s futures.

Trap in the Closet: Intra-Ethnic Marriage and Intimate Partner Violence in Sub-Saharan Africa

Intimate partner violence is a threat to achieving Sustainable Development Goal 5 by 2030. The challenge of intimate partner violence is prevalent among immigrants. However, little is known about the peculiarity of intimate partner violence in intra-ethnic marriages, especially among immigrants within sub-Saharan Africa. This study examined the factors contributing to intimate partner violence among Senegalese immigrants who live in Nigeria. It also examined the extent of intimate partner violence in intra-ethnic marriages. Referrals and exponential non-discriminative snowball sampling were utilized to interview 20 participants. Results show that social factors such as gender norms, cultural norms, patriarchy, and economic challenges were the major factors contributing to intimate partner violence among Senegalese immigrants living in Nigeria. Marriage to someone from the same ethnic group does not prevent intimate partner violence as the factors contributing to this social problem are not exclusive to ethnic group affiliation. Informal measures such as ethnic group association and neighborhood assistance are the measures used to resolve household violence among immigrants. Contextually, programs aimed at reducing and stopping intimate partner violence should incorporate the support of informal groups and community leaders who are the custodians of culture in the society.

Women's economic empowerment and health related decision-making in rural Sierra Leone

Maternal mortality rates during childbirth in Sierra Leone are amongst the highest globally, with 1360 maternal deaths per 100,000 live births. Furthermore, the country's neonatal mortality rate is estimated at 39 deaths per 1000 live births. There is growing recognition of the health consequences of gender inequality, but challenges in addressing it. Gendered power dynamics within households affect health outcomes, with men often controlling decisions about their family's health, including their family's use of health services. The Government's Free Health Care Initiative, which abolished user fees for pregnant women, lactating mothers and children under five is promising, however this reform alone is insufficient to meet health goals. Using in-depth interviews and focus group discussions with men and women, this study explores women's economic empowerment and health decision-making in rural Sierra Leone. Findings show the concept of power related to women's income generation, financial independence and being listened to in social relationships. Whilst women's economic empowerment was reported to ease marital tensions, men remained household authority figures, including regarding health decision-making. Economic interventions play an important role in supporting women's economic empowerment and in influencing gender norms, but men's roles and women's social empowerment, alongside economic empowerment, needs consideration.

Acceptability of a feasibility randomized clinical trial of a microenterprise intervention to reduce sexual risk behaviors and increase employment and HIV preventive practices (EMERGE) in young adults: a mixed methods assessment

BACKGROUND

Acceptability is a critical requisite in establishing feasibility when planning a larger effectiveness trial. This study assessed the acceptability of conducting a feasibility randomized clinical trial of a 20-week microenterprise intervention for economically-vulnerable African-American young adults, aged 18 to 24, in Baltimore, Maryland. Engaging MicroenterprisE for Resource Generation and Health Empowerment (EMERGE) aimed to reduce sexual risk behaviors and increase employment and uptake of HIV preventive behaviors.

METHODS

Thirty-eight participants were randomized to experimental (n = 19) or comparison group (n = 19). The experimental group received text messages on job openings plus educational sessions, mentoring, a start-up grant, and business and HIV prevention text messages. The comparison group received text messages on job openings only. Qualitative and quantitative post-intervention, in-person interviews were used in addition to process documentation of study methods.

RESULTS

Our results found that the study design and interventions showed promise for being acceptable to economically-vulnerable African-American young adults. The largely positive endorsement suggested that factors contributing to acceptability included perceived economic potential, sexual health education, convenience, incentives, and encouraging, personalized feedback to participants. Barriers to acceptability for some participants included low cell phone connectivity, perceived payment delays, small cohort size, and disappointment with one's randomization assignment to comparison group. Use of peer referral, network, or wait-list designs, in addition to online options may enhance acceptability in a future definitive trial. Expanding administrative and mentoring support may improve overall experience.

CONCLUSION

Microenterprise interventions are acceptable ways of providing young adults with important financial and sexual health content to address HIV risks associated with economic vulnerability.

TRIAL REGISTRATION

ClinicalTrials.gov. NCT03766165 . Registered 04 December 2018.

Intervention with Microfinance for AIDS and Gender Equity (IMAGE): Women's Engagement with the Scaled-up IMAGE Programme and Experience of Intimate Partner Violence in Rural South Africa

The Intervention with Microfinance for AIDS and Gender Equity (IMAGE) programme has been scaled up to three provinces in South Africa. This paper explores associations between women’s engagement in the intervention, intimate partner violence (IPV) and factors associated with IPV and partner abuse. We enrolled women receiving group-based microfinance loans plus gender training into the scaled-up IMAGE cohort study (n = 860). We present cross-sectional analysis on participants’ characteristics and intervention engagement and use multivariate logistic regression to explore associations. 17% of women reported lifetime (95% CI 15 to 20%) and 7% past year (95% CI 5 to 9%) IPV, 9% past-year economic (95% CI 7 to 11%) and 11% past-year emotional (95% CI 9 to 14%) abuse. Women under 35 years had higher levels of IPV and emotional abuse. 53% of women attended all the trainings, 83% continuously borrowed and 98% agreed the training had a major impact on their life. Attendance was associated with improved partner relationships (χ²p < 0.001), but not lower IPV risk. Odds of past-year IPV decreased the more types of support (e.g. advice) women received from group members (aOR 0.27, p < 0.001 among those reporting all support versus none or some). A similar pattern was seen for economic, but not emotional, abuse. The scaled-up IMAGE intervention is widely acceptable and may support improvements in partner relationships, but younger women need to be targeted. Group support appears to be a potentially important component of the intervention.

A Mixed-Methods Systematic Review: Infidelity, Romantic Jealousy and Intimate Partner Violence against Women

Infidelity and romantic jealousy (RJ) are commonly cited relational level drivers of intimate partner violence (IPV) but remain undertheorized and underutilized in IPV research and prevention. This global systematic review aims to characterize the existing research on real or suspected infidelity and RJ in relation to IPV and inform future research and programming. We systematically searched 11 databases for peer-reviewed research, published between April 2009 and 2019, that provided data on the prevalence or a measure of association (quantitative), or pathway (qualitative), between real or suspected infidelity or RJ, and IPV. Fifty-one papers from 28 countries were included and the evidence showed a consistent association between real or suspected infidelity, RJ and IPV. Our findings identify three overarching mechanisms and six pathways between infidelity, RJ and IPV. These provide support for prominent theories in the field related to patriarchal culture, threatened masculinities and femininities and a lack of emotional regulation and conflict resolution skills, but not evolutionary theories. Our findings suggest that researchers should use standardized measurement tools that make the distinction between RJ and suspected, confirmed and accusations of infidelity. Policy and programming should aim to transform traditional gender roles, accounting for infidelity and RJ and improving couple’s communication and trust.

Effectiveness of a multi-level intervention to reduce men's perpetration of intimate partner violence: a cluster randomised controlled trial

Background

Men’s perpetration of intimate partner violence (IPV) limits gains in health and wellbeing for populations globally. Largely informal, rapidly expanding peri-urban settlements, with limited basic services such as electricity, have high prevalence rates of IPV. Evidence on how to reduce men’s perpetration, change social norms and patriarchal attitudes within these settings is limited. Our cluster randomised controlled trial aimed to determine the effectiveness of the Sonke CHANGE intervention in reducing use of sexual and/or physical IPV and severity of perpetration by men aged 18–40 years over 2 years.

Methodology

The theory-based intervention delivered activities to bolster community action, including door-to-door discussions, workshops, drawing on the CHANGE curriculum, and deploying community action teams over 18 months. In 2016 and 2018, we collected data from a cohort of men, recruited from 18 clusters; nine were randomised to receive the intervention, while the nine control clusters received no intervention. A self-administered questionnaire, using audio-computer assisted software, asked about sociodemographics, gender attitudes, mental health, and the use and severity of IPV. We conducted an intention-to-treat analysis at the cluster level comparing the expected risk to observed risk of using IPV while controlling for baseline characteristics. A secondary analysis used latent classes (LCA) of men to see whether there were differential effects of the intervention for subgroups of men.

Results

Of 2406 men recruited, 1458 (63%) were followed to 2 years. Overall, we saw a reduction in men’s reports of physical, sexual and severe IPV from baseline to endpoint (40.2% to 25.4%, 31.8% to 15.8%, and 33.4% to 18.2%, respectively). Intention-to-treat analysis showed no measurable differences between intervention and control clusters for primary IPV outcomes. Difference in the cluster-level proportion of physical IPV perpetration was 0.002 (95% confidence interval [CI] − 0.07 to 0.08). Similarly, differences between arms for sexual IPV was 0.01 (95% CI − 0.04 to 0.06), while severe IPV followed a similar pattern (Diff = 0.01; 95% CI − 0.05 to 0.07). A secondary analysis using LCA suggests that among the men living in intervention communities, there was a greater reduction in IPV among less violent and more law abiding men than among more highly violent men, although the differences did not reach statistical significance.

Conclusion

The intervention, when implemented in a peri-urban settlement, had limited effect in reducing IPV perpetrated by male residents. Further analysis showed it was unable to transform entrenched gender attitudes and use of IPV by those men who use the most violence, but the intervention showed promise for men who use violence less.

Trial registration

ClinicalTrials.gov, NCT02823288. Registered on 30 June 2016.

Women's income and risk of intimate partner violence: secondary findings from the MAISHA cluster randomised trial in North-Western Tanzania

BACKGROUND

Intimate partner violence (IPV) is pervasive throughout the world, with profound consequences for women's health. While women's 'economic empowerment' is touted as a potential means to reduce IPV, evidence is mixed as to the role of different economic factors in determining women's risk. This paper explores associations and potential pathways between women's income and experience of IPV, in Mwanza city, Tanzania.

METHODS

We use data from married/cohabiting women (N = 740) enrolled in the MAISHA study, a cluster randomised trial of an IPV prevention intervention. Women were interviewed at baseline and 29-months later. We use logistic regression to model cross-sectional (baseline) and longitudinal associations between: a woman's monthly income (quartiles) and her past year risk of physical IPV, sexual IPV and economic abuse; and a woman's relative financial contribution to the household (same/less than partner; more than partner) and past year physical IPV and sexual IPV.

RESULTS

At baseline, 96% of respondents reported earning an income and 28% contributed more financially to the household than their partner did. Higher income was associated with lower past-year physical IPV risk at baseline and longitudinally, and lower sexual IPV at baseline only. No clear associations were seen between income and economic abuse. Higher relative financial contribution was associated with increased physical IPV and sexual IPV among all women at baseline, though only among control women longitudinally. Higher income was associated with several potential pathways to reduced IPV, including reduced household hardship, fewer arguments over the partner's inability to provide for the family, improved relationship dynamics, and increased relationship dissolution. Those contributing more than their partner tended to come from more disadvantaged households, argue more over their partner's inability to provide, and have worse relationship dynamics.

CONCLUSIONS

While women's income was protective against IPV, women who contributed more financially than their partners had greater IPV risk. Poverty and tensions over men's inability to provide emerge as potentially important drivers of this association. Interventions to empower women should not only broaden women's access to economic resources and opportunities, but also work with women and men to address men's livelihoods, male gender roles and masculinity norms.

TRIAL REGISTRATION

ClinicalTrials.gov #NCT02592252 , registered retrospectively (13/08/2015).