"We are Forgotten": Forced Migration, Sexual and Gender-Based Violence, and Coronavirus Disease-2019

Gender in Post-Pandemic Research: The Potentials of Grounded Theory to Explicitly Guide Gender-Sensitive Inquiry on Discrimination and Violence

Amid the COVID-19 pandemic, a re-exacerbation of gender inequalities and violence against women was reported. For adequately responding to the causes of this situation and its aftermath, a detailed understanding of the gendered impacts of the pandemic and of subsequent developments is necessary. This aim may be supported by particularly using gender-sensitive modes of inquiry. Against this backdrop, we explore the methodological potential of grounded theory (GT) to explicitly guide gender-sensitive research. Given its methodological variations, we argue that an adequate handling of gender in GT can only be determined in relation to a researcher's positioning within the GT landscape. Thus, to assist readers in translating their gender sensitivity into GT practices, this article outlines various interpretations of GT elements, discussing their relation to gender. Furthermore, strategies addressing gender-related challenges are presented and underlined by, among others, studies on discrimination and violence.

The Continuum of Violence and Interstices in the Journeys and Bodies of Women on the Move From West Africa

On the migration route from Western and Central Africa to Europe, aggression toward women's bodies has played a prominent role. In this study, we analyze this route as a continuum of violence and also study the interstices to confront it. Using a biographical narrative methodology, we analyze the narratives of 52 migrant women, through life stories or creative narrative workshops carried out in Mali, Morocco, and Spain. The results allow us to systematize the continuum of violence that the women report, understood as a pedagogy of cruelty but also the possible spaces to build a safe landscape.

We returned home empty-handed: COVID-19, care, and contested citizenship of Naga migrant workers in northeast India

COVID-19 highlighted interconnections between matters of identity and citizenship, vulnerability, and inclusion in/exclusion from systems of care in times of crisis. Migrant workers from Nagaland state, northeast India, were disproportionately impacted by the pandemic's socioeconomic consequences. The public health emergency brought into question who is 'Indian' and the citizenship rights attached to that identity, heightening migrants' exclusion from central structures. Communitarian responses in Nagaland enhanced resilience in the face of often inadequate government responses; however, COVID-19 also exposed structural inequalities within and between Naga communities. This study shows that identity-based citizenship regimes and multi-nation federalism interact to increase minorities' exclusion during crises, and that crises can strengthen both divisions and solidarity at the local level in multi-nation federal systems. Inclusion in and exclusion from systems of care are shaped by and can reshape notions of identity and citizenship, underlining the need for inclusive sociopolitical systems to mitigate crises in multi-nation federal states.

A qualitative investigation of gender-based violence prevention and response using digital technologies in low resource settings and refugee populations

Background: Governmental and non-governmental organizations across medical, legal, and psychosocial sectors providing care to survivors of gender-based violence (GBV) and their families rapidly digitalized services during the COVID-19 pandemic. GBV prevention/response services working with women and children who are forcibly displaced and/or living in low-and-middle income countries (LMIC) were no exception to the rapid digitalization trend. Literature is lacking a critical synthesis of best practices and lessons learned since digitalization replaced major operations involved in GBV prevention/response.Objective: This research qualitatively investigated how GBV service providers, located in a range of socio-political settings, navigated the process of digitalizing GBV prevention/response during the COVID-19 crisis.Method: Semi-structured key informant interviews (KII) with GBV service providers in varied sectors were implemented virtually (2020-2021) in Brazil, Guatemala, Iraq, and Italy (regarding forcibly displaced women/girls for the latter). Participants were recruited using purposive and snowball sampling. Interview guides covered a range of topics: perceived changes in violence and service provision, experiences with virtual services, system coordination, and challenges. The KIIs were conducted in Portuguese, Spanish, Arabic, and Italian. Interviews were audio-recorded, transcribed, and translated into English. The research team conducted thematic analysis within and between countries using a structured codebook of data driven and theory driven codes.Results: Major themes concerned the: (1) spectrum of services that were digitalized during the COVID-19 crisis; (2) gender digital divide as a barrier to equitable, safe, and effective service digitalization; (3) digital violence as an unintended consequence of increased digitalization across social/public services.Conclusion: Digitalization is a balancing act with respect to (1) the variety of remotely-delivered services that are possible and (2) the access/safety considerations related to the gender digital divide and digital violence.

Burden, trend and determinants of various forms of domestic violence among reproductive age-group women in India: findings from nationally representative surveys

BACKGROUND

Violence, a notable human rights concern, has a public health impact across the globe. The study aimed to determine the prevalence and determinants of domestic violence among ever-married women aged 18-49 years in India.

METHODS

Secondary data analysis with National Family Health Survey 5, 2019-21 data (NFHS-5) was conducted. The complex sampling design of the survey was accounted-for during analysis. The primary outcome was domestic violence. Prevalence was reported with 95% confidence interval (CI). Prevalence ratio was reported to provide the factors associated with domestic violence using Poisson regression.

RESULTS

About 63 796 ever-married women aged 18-49 years covered under domestic violence module of NFHS-5 survey were included. Prevalence of domestic violence (12 months preceding the survey) was 31.9% (95% CI: 30.9-32.9%). Physical violence (28.3%) was the most common form followed by emotional (14.1%) and sexual violence (6.1%). Women with low education, being employed, husband being uneducated or with coercive behavior had significantly higher prevalence of domestic violence.

CONCLUSIONS

One-third of the reproductive age-group women were facing some form of domestic violence. Target group interventions like violence awareness campaigns, women supportive services and stringent law enforcement should be implemented to eliminate domestic violence by year 2030.

A policy review on the visibility of migrant women exposed to, and at risk of gender-based violence: Considerations for inclusive and equitable policies and programs in Canada

Gender based violence (GBV) has had distinct and disproportionate impact on the health and wellbeing of migrant women in Canada. Currently, there is dearth of documented information concerning the inclusion of migrant women in GBV-related public policies in Canada. The present study examines the extent to which Canadian public policies reflect and address the needs of migrant women who have experienced GBV. We conducted a policy review of publicly available documents at federal and provincial (British Columbia and Ontario) levels. Migrant women's visibility in the Canadian policy landscape remains limited, as their unique needs are often grouped into broader categories such as 'newcomers, or visible minorities'. This approach fails to acknowledge their distinct lived experiences. Regardless of the federal and provincial efforts in developing policies targeted at GBV prevention, several significant policy gaps came to light. These include the absence of well-defined protective measures for migrant women in precarious employment as well as the hurdles posed by immigration restrictions that pose a significant challenge for those seeking to leave abusive relationships, particularly in cases of dependent migration status. The highlighted policy gaps have negative impact on migrant women's social functioning, including limiting access to services and opportunities, and this has adverse effects on their overall health and wellbeing. To ensure the effectiveness and significance of GBV policies, it is imperative that policymakers acknowledge and target the distinct vulnerabilities and needs of migrant women who experience GBV. The inclusion of an intersectional perspective in the formulation and implementation of policies is essential, as it facilitates the recognition of the distinct needs of migrant women. Failure to acknowledge these varying needs and the real-life experiences of this diverse group can jeopardize the comprehensive and successful implementation of GBV response policies, not only in Canada but also worldwide. Prioritizing this aspect is crucial.

The health inequity and socioeconomic inequality faced by adolescent girls and women on the move living with or at high risk of HIV infection, during the COVID-19 pandemic in Nigeria

BACKGROUND

We assessed if women and girls on the move living with or at high risk of HIV faced increased health inequity and socioeconomic inequalities during the COVID-19 pandemic compared with other vulnerable women and girls.

METHODS

We used data collected through a survey conducted in Nigeria between June and October 2021. Women and girls living with or at risk of HIV were recruited voluntarily, using a combination of venue-based and snowball sampling. We performed multivariable logistic regression models per mobility and HIV status to determine associations between health inequity, socioeconomic inequalities and macrosocial characteristics.

FINDINGS

There were 3442 participants, of which 700 were on the move. We found no statistical difference between HIV-negative women and girls on the move and those not on the move. On the opposite, we found substantial differences in health inequity and socioeconomic inequalities between women and girls on the move living with HIV and those not on the move living with HIV. There are very strong associations between being a woman or girl on the move living with HIV and facing economic precarity (aOR 6.08, 95% CI 1.94 to 19.03), food insecurity (aOR 5.96, 95% CI 2.16 to 16.50) and experiencing more gender-based violence since COVID-19 started (aOR 5.61, 95% CI 3.01 to 10.47).

INTERPRETATION

Being a woman or girl on the move and living with HIV compound increased health and socioeconomic vulnerabilities. The COVID-19 crisis seems to have exacerbated inequalities and gender-based violence. These findings call for more feminist interventions to protect women on the move living with HIV during health crises.

A systematic review of the indirect impacts of COVID-19 on sexual and reproductive health services and outcomes in humanitarian settings

BACKGROUND

Humanitarian settings, particularly those in low-income and middle-income countries (LMICs), present increased sexual and reproductive health (SRH) challenges for individuals and health systems. Previous infectious disease outbreaks in such settings have negatively impacted SRH services and outcomes, as fragmented health systems are further overstretched. The COVID-19 pandemic has magnified the SRH challenges in LMIC humanitarian settings on an unprecedented scale. However, understanding of the impacts of COVID-19 is lacking. This review aimed to understand how the COVID-19 pandemic has impacted SRH service coverage, utilisation and outcomes in LMIC humanitarian settings, to inform current and future humanitarian research, programming and practice.

METHODS

A systematic review methodology was followed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting standards. Three search fields related to humanitarian settings, SRH and COVID-19 were applied, and limited to LMIC settings only. Three bibliographic databases and nine grey literature sources were searched. Articles meeting inclusion criteria at full-text screening were critically appraised using standardised tools. Data extraction was undertaken on included articles and analysed through narrative synthesis.

RESULTS

In total, 7742 citations were screened and 42 were included in the review. All included studies were cross-sectional. The quality was mostly medium to high. Narrative synthesis identified the reduced provision of, and access to, SRH services, and increased morbidity including sexual and gender-based violence and unplanned pregnancies. Impacts on service uptake varied across and within settings. Adaptations to improve SRH service access including telemedicine were reported; however, implementation was hindered by resource constraints.

CONCLUSIONS

The COVID-19 pandemic has indirectly negatively impacted SRH at the individual and health system levels in LMIC humanitarian settings. Further research on the impacts on service uptake is required. SRH programmers should target interventions to meet the increased SRH needs identified. Policy-makers must incorporate SRH into emergency preparedness and response planning to mitigate indirect impacts on SRH in future outbreaks.

Towards a climate-resilient primary health care service

Climate change has been declared as the biggest threat to human health in the 21st century. Not all family doctors are aware of the threats and how to tackle them. There are three key aspects to consider: the health and social effects of climate change, the challenge of climate change to primary health care (PHC) facilities and services, and the contribution of health services to the problem of climate change. Climate change and global pollution are ecological drivers associated with significant health and social effects that are often seen in PHC services. These ecological drivers impact health and society via a number of proximate causes, such as air pollution and decreased food production. The health and social effects include malnutrition, infectious diseases, non-communicable diseases, displacement and migration, and mental health problems. Climate change-induced extreme weather events are associated with immediate loss of life and injuries, destruction of homes and livelihoods, and disruption of PHC facilities and services. For adapting to these challenges, the World Health Organization has developed an operational framework for a climate-resilient health system. The Global Green and Healthy Hospitals agenda provides practical guidance for mitigating the contribution of health services to climate change. This article uses these frameworks to suggest practical steps that family doctors can take in leading climate adaptation and mitigation within PHC.

Vulnerability of migrant women during disasters: a scoping review of the literature

BACKGROUND

Disasters have an unequal impact on the population because of differences in conditions of vulnerability, exposure, and capacity. Migrants and women are among the groups that are at greater risk for and disproportionately affected by disasters. However, despite the large body of evidence that analyzes their vulnerability separately, disaster research that targets migrant women is scant. The aim of this scoping review was to analyze the published scientific literature concerning the vulnerability of migrant women and the consequent negative impact they experience during disasters.

METHODS

A literature search was conducted on December 15th, 2021 on Pubmed, Scopus, and Web of Science databases. No time filter was applied to the search. Information regarding the article's main characteristics and design, migrant women and their migration experience, as well as about the type of disaster was collected. The factors responsible for the vulnerability of migrant women and the negative outcomes experienced during a disaster were extracted and inductively clustered in main themes reflecting several vulnerability pathways. The review followed the Joanna Briggs Institute methodology for scoping reviews and relied on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).

RESULTS

After full text review, 14 articles met the inclusion criteria. All of them adopted a qualitative methodology and focused on COVID-19. The pandemic negatively affected migrant women, by triggering numerous drivers that increased their level of exposure and vulnerability. Overall, six vulnerability factors have been identified: legal status, poverty conditions, pre-existing health conditions, limited agency, gender inequality and language and cultural barriers. These resulted in nine impacts: worsening of mental health status, poor access to care, worsening of physical health conditions, fraud, exacerbation of poverty, gender-based violence, jeopardization of educational path, and unfulfillment of their religious needs.

CONCLUSIONS

This review provided an analysis of the vulnerability factors of migrant women and the pathways leading to negative outcomes during a disaster. Overall, the COVID-19 pandemic demonstrated that health equity is a goal that is still far to reach. The post-pandemic era should constitute the momentum for thoroughly addressing the social determinants of health that systematically marginalize the most vulnerable groups.

Gender-based violence in Latin America (Ecuador and Argentina): current state and challenges in the development of psychoeducational materials

Gender-based violence (GBV) is a complex social and public health problem, which represents a human rights violation. Globally, GBV tends to occur in intimate partner relationships. Latin American countries report high rates of this violence. Despite their social and historical differences, Ecuador and Argentina are among Latin countries that aim to dismantle patriarchy. Developing psychoeducation materials is one way in which communities can recognize and prevent GBV. Psycholinguistics can provide useful tools to facilitate learning about this social issue: prior studies suggest that promoting the establishment of discourse connections, the generation of emotion inferences and the emotional involvement of the comprehender facilitate written and spoken discourse comprehension. The aim of this commentary article is to present an overview of the current incidence of GBV in Ecuador and Argentina, and to highlight the contributions that preliminary research on discourse comprehension can make to facilitate learning about GBV prevention strategies. Finally, we will discuss possible research guidelines and future directions. We expect that this manuscript will contribute to highlighting the importance of promoting social awareness of GBV and, therefore, the crucial role of the design and implementation of scientifically based interventions.

The impact of the COVID-19 pandemic on gender-based violence and physical violence among women in Peru

Background: Gender-based violence (GBV) is an increasing social problem worldwide, but it has been neglected despite its high relevance to women’s health. In this study, we aim to assess the coronavirus disease 2019 (COVID-19) pandemic impact on GBV incidence in Peruvian, determine the physical violence prevalence and its associated factors among GBV victims. Methods: We assessed the impact of the COVID-19 pandemic on the GBV weekly incidence by fitting an autoregressive integrated moving average model. Additionally, we assessed the physical violence prevalence and its associated factors by fitting a multivariate Poisson regression model with a link log and robust variance. Results: We analyzed 588,587 cases of women victims of GBV and calculated an annual GBV incidence of 518, 714, 958, 596, and 846 cases per 100,000 women during the years 2017-2021, respectively. During the COVID-19 pandemic, the observed GBV weekly incidence went significantly below the forecasted GBV weekly incidence since 2021. Overall, most GBV cases were of middle to high-risk (76%), regular (75%), and verbal (82%) violence. Most victims were single (81%), rural (75%), mothers with children (60%), who did not complete high school (54%). Most aggressors were men (81%), paid workers (77%), had completed high school education (63%), and partner of their victims (58%). Around 44% of the victims suffered physical violence and its main associated factors were aggressor’s school education (adjusted prevalence ratio = 0.89; 95% confidence interval: 0.88-0.89), aggressor’s age <40 years old (1.30; 1.29-1.30), aggressor’s paid job (0.99; 0.98-0.99), prior violence report (1.27; 1.26-1.27), victim’s age <40 years old (1.23; 1.22-1.24), and victim non-Peruvian citizenship (1.04; 1.01-1.07). Conclusions: GBV is endemic in Peru, but the COVID-19 pandemic reduced its burden significantly in 2020-2021. Several characteristics of the cases, victims, and aggressors have changed over time, offering new opportunities for implementing interventions to address this social problem.

Forced Migration, Sexual and Gender-based Violence and Integration: Effects, Risks and Protective Factors

This paper is the first to use empirical evidence to directly examine the relationship between sexual and gender-based violence (SGBV) and multi-dimensional processes of integration of forced migrant SGBV survivors. While it is acknowledged that forced migrants are subjected to a continuum of violence, including SGBV, during the refugee journey, little is known about the long-term impact of SGBV and how it might be mitigated. Our paper, drawing on empirical evidence from 255 interviews with migrants and stakeholders in Australia, the UK, Sweden and Turkey, documented in detail the complex interactions between SGBV and integration using the Indicators of Integration framework. By bringing together the literature on the continuum of violence, SGBV and the Indicators of Integration framework, we identify, on the one hand, the impact of SGBV on integration, and, on the other, how the indicators framework can be used to identify protective and risk factors for forced migrant survivors.

Health professionals' perspectives on the impact of COVID-19 on sexual and gender-based violence (SGBV) and SGBV services in Rohingya refugee communities in Bangladesh

BACKGROUND

The COVID-19 pandemic has acutely affected Rohingya refugees living in camps in Cox's Bazar, Bangladesh. Reported increases in sexual and gender-based violence (SGBV) were attributed in part to pandemic-related public health measures. In addition, the Government of Bangladesh's restrictions to prevent the spread of COVID-19 have impacted the provision of comprehensive care for survivors of sexual violence. This study sought to understand how the COVID-19 pandemic affected SGBV and the provision of services for Rohingya survivors in Bangladesh.

METHODS

Interviews were conducted with 13 professionals who provided or managed health care or related services for Rohingya refugees after the onset of the COVID-19 pandemic in March 2020.

RESULTS

At the outset of the COVID-19 pandemic, organizations observed an increase in the incidences of SGBV. However, health care workers noted that the overall number of survivors formally reporting or accessing services decreased. The pandemic produced multiple challenges that affected health workers' ability to provide essential care and services to Rohingya survivors, including access to the camps, initial designation of SGBV-related services as non-essential, communications and telehealth, difficulty maintaining confidentiality, and donor pressure. Some emerging best practices were also reported, including engaging Rohingya volunteers to continue services and adapting programming modalities and content to the COVID-19 context.

CONCLUSIONS

Comprehensive SGBV services being deemed non-essential by the Government of Bangladesh was a key barrier to providing services to Rohingya survivors. Government restrictions adversely affected the ability of service providers to ensure that comprehensive SGBV care and services were available and accessible. The Government of Bangladesh has not been alone in struggling to balance the needs of displaced populations with the necessary precautions to prevent the spread of COVID-19 and its response can provide lessons to others overseeing the provision of services during epidemics and pandemics in other humanitarian settings. The designation of comprehensive services for survivors of SGBV as essential is vital and should be done early in establishing disease prevention and mitigation strategies.

“God Helped Us”: Resilience, Religion and Experiences of Gender-Based Violence and Trafficking among African Forced Migrant Women

In this article, I explore how faith and religion shaped the resilience of forced migrant women subjected to intersecting gender-based violence (GBV) and trafficking. Adopting a social constructivist perspective, I draw upon interviews with 11 Christian and 4 Muslim displaced survivors of 10 African nationalities temporarily residing in Tunisia. I first outline the experiences of intersecting violence to understand what displaced survivors were resilient to, and then describe faith pathways to resilience, sometimes with spiritual struggles and unmet religious needs. I delineate ways in which personal prayers and cooperating with God enabled all but one survivor to cope with exploitation and perilous journeys toward imagined refuge. I offer insights for practitioners working with forced migrants on the move and highlight the importance of spiritual support for displaced survivors who are religious. I discuss the findings and offer implications for future research and practice.