Assessment of sexual violence among street females in Bahir-Dar town, North West Ethiopia: a mixed method study

Utilization of modern contraceptives and associated factors among women of homeless reproductive age in Adama town, Oromia, Ethiopia

BACKGROUND

Family planning refers to a conscious effort by a couple to limit or space the number of children they have through the use of contraceptive methods. Contraceptive utilization is a practice that helps individuals or couples avoid unwanted pregnancy. A lack of family planning puts homeless individuals at a higher risk of unwanted pregnancies and sexually transmitted infections. However, there is little data about modern contraceptive utilization among homeless women in the study area.

OBJECTIVES

It has aimed to assess the utilization of modern contraceptives and associated factors among homeless reproductive-age women in Adama town, 2023.

METHODS

A community-based cross-sectional study was conducted in Adama town among 286 homeless women. A convenience sampling technique was used. The data were collected through face-to-face interviews using a pretested structured questionnaire. The collected data were cleaned, coded, and entered into Epi Info, and the data were exported to the Statistical Package for Social Sciences (SPSS) version 22. Descriptive statistics were used to characterize the study population. The associations between dependent and independent variables were modeled using binary logistic regression. The adjusted odds ratio (AOR) and 95% confidence interval (CI) were used to estimate associations, and a P value < 0.05 was considered to indicate statistical significance.

RESULTS

Out of the planned 289 respondents, 286 (98.9%) were participated. The prevalence of modern contraceptive utilization was 56.6% [95% CI: (50.7, 62.2)]. Among the utilizers, implants (52.5%), injectables (42%), and pills (5.5%) were used. Homeless women aged 25-34 years [AOR = 4.22, 95% CI: (1.77, 10.05)], a formal education [AOR = 3.04, 95% CI: (1.21, 7.60)], a slept off-street [AOR = 2.81, 95% CI: (1.25, 6.34)], a monthly income greater than or equal to 2400 Ethiopian birr [AOR = 4.18, 95% CI: (2.11, 8.29)], a sexual intercourse AOR = 3.14, 95% CI: (1.17, 8.40)], and a history of pregnancy after joining the street life [AOR = 9.21, 95% CI: (3.67, 23.12)] were factors significantly associated with the utilization of modern contraceptives.

CONCLUSION

The prevalence of modern contraceptive utilization among homeless women was relatively higher than in previous studies. The associated factors for contraceptive utilization included age, education, place for sleeping, income, sexual intercourse and history of pregnancy after joining the street life. The Regional and Adama town Health Bureau and facilities should develop targeted interventions (considering age, educational, and other disparities) to reduce the unmet need for modern contraception and halt unnecessary health outcomes among homeless women, their children, and families.

Utilization of modern contraceptives and associated factors among women of homeless reproductive age in Adama town, Oromia, Ethiopia

BACKGROUND

Family planning refers to a conscious effort by a couple to limit or space the number of children they have through the use of contraceptive methods. Contraceptive utilization is a practice that helps individuals or couples avoid unwanted pregnancy. A lack of family planning puts homeless individuals at a higher risk of unwanted pregnancies and sexually transmitted infections. However, there is little data about modern contraceptive utilization among homeless women in the study area.

OBJECTIVES

It has aimed to assess the utilization of modern contraceptives and associated factors among homeless reproductive-age women in Adama town, 2023.

METHODS

A community-based cross-sectional study was conducted in Adama town among 286 homeless women. A convenience sampling technique was used. The data were collected through face-to-face interviews using a pretested structured questionnaire. The collected data were cleaned, coded, and entered into Epi Info, and the data were exported to the Statistical Package for Social Sciences (SPSS) version 22. Descriptive statistics were used to characterize the study population. The associations between dependent and independent variables were modeled using binary logistic regression. The adjusted odds ratio (AOR) and 95% confidence interval (CI) were used to estimate associations, and a P value < 0.05 was considered to indicate statistical significance.

RESULTS

Out of the planned 289 respondents, 286 (98.9%) were participated. The prevalence of modern contraceptive utilization was 56.6% [95% CI: (50.7, 62.2)]. Among the utilizers, implants (52.5%), injectables (42%), and pills (5.5%) were used. Homeless women aged 25-34 years [AOR = 4.22, 95% CI: (1.77, 10.05)], a formal education [AOR = 3.04, 95% CI: (1.21, 7.60)], a slept off-street [AOR = 2.81, 95% CI: (1.25, 6.34)], a monthly income greater than or equal to 2400 Ethiopian birr [AOR = 4.18, 95% CI: (2.11, 8.29)], a sexual intercourse AOR = 3.14, 95% CI: (1.17, 8.40)], and a history of pregnancy after joining the street life [AOR = 9.21, 95% CI: (3.67, 23.12)] were factors significantly associated with the utilization of modern contraceptives.

CONCLUSION

The prevalence of modern contraceptive utilization among homeless women was relatively higher than in previous studies. The associated factors for contraceptive utilization included age, education, place for sleeping, income, sexual intercourse and history of pregnancy after joining the street life. The Regional and Adama town Health Bureau and facilities should develop targeted interventions (considering age, educational, and other disparities) to reduce the unmet need for modern contraception and halt unnecessary health outcomes among homeless women, their children, and families.

Effect of women's literacy status on maternal healthcare services utilisation in Ethiopia: a stratified analysis of the 2019 mini Ethiopian Demographic and Health Survey

OBJECTIVES

Maternal mortality remains unacceptably high in sub-Saharan Africa with 533 maternal deaths per 100 000 live births, accounting for 68% of all maternal deaths worldwide. Most maternal deaths could be prevented by adequate maternal health service use. The study examined the effect of literacy status on maternal health services utilisation among reproductive-age women in Ethiopia.

DESIGN

A cross-sectional study.

SETTINGS

Ethiopia.

PARTICIPANTS

A weighted sample of 3839 reproductive-age women who gave birth in the last 5 years preceding the survey and whose literacy status was measured were included in this study. The survey used a two-stage stratified cluster sampling technique.

PRIMARY AND SECONDARY OUTCOME MEASURES

This study used a dataset from the recent Ethiopia Mini Demographic and Health Surveys. We assessed the maternal health service utilisation among reproductive-age women. Multivariable logistic regression analyses were employed to assess the association between literacy status and maternal healthcare utilisation while controlling for other factors. Adjusted OR with a 95% CI was reported.

RESULTS

About 63.8% of reproductive-age women were illiterate. The prevalence of antenatal care (ANC) 1, ANC 4, skilled birth attendance and postnatal care (PNC) services utilisation was 74.9%, 43.5%, 51.9% and 32.0%, respectively. Literate women had significantly higher ANC 1, ANC 4, skilled birth attendance, and PNC services utilisation than illiterate women (p<0.001). Regional variation, wealth status, age at first birth, birth order and birth intervals were significantly associated with maternal healthcare utilisation among both literate and illiterate women. Similarly, ANC booking timing and utilisation, age of household head and religious affiliation were associated with institutional delivery and PNC utilisation.

CONCLUSION

Literate women had a significantly higher maternal healthcare services utilisation than illiterate, modified by sociodemographic and obstetric-related factors. Hence, wholehearted efforts should be directed towards educating and empowering women.

Correlates of intimate partner violence among pregnant and parenting adolescents: a cross-sectional household survey in Blantyre District, Malawi

BACKGROUND

Despite efforts from the government and developmental partners to eliminate gender-based violence, intimate partner violence (IPV) remains a pervasive global health and human rights problem, affecting up to 753 million women and girls globally. Few studies on IPV have focused on pregnant and parenting adolescent (PPA) girls in Africa, although the region has the highest rates of adolescent childbearing. This limited attention results in the neglect of pregnant and parenting adolescents in policies and interventions addressing IPV in the region. Our study examined IPV prevalence and its individual, household, and community-level correlates among pregnant and parenting adolescent girls (10-19 years) in Blantyre District, Malawi.

METHODS

We collected data from a cross-section of pregnant and parenting adolescent girls (n = 669) between March and May 2021. The girls responded to questions on socio-demographic and household characteristics, lifetime experience of IPV (i.e., sexual, physical, and emotional violence), and community-level safety nets. We used multilevel mixed-effect logistic regression models to examine the individual, household, and community-level factors associated with IPV.

RESULTS

The lifetime prevalence of IPV was 39.7% (n = 266), with more girls reporting emotional (28.8%) than physical (22.2%) and sexual (17.4%) violence. At the individual level, girls with secondary education (AOR: 1.72; 95% CI: 1.16-2.54), who engaged in transactional sex (AOR: 2.29; 95% CI: 1.35-3.89), and accepted wife-beating (AOR: 1.97; 95% CI: 1.27-3.08) were significantly more likely to experience IPV compared to those with no education/primary education, who never engaged in transactional sex and rejected wife beating. Girls aged 19 (AOR: 0.49; 95% CI: 0.27-0.87) were less likely to report IPV than those aged 13-16. At the household level, girls with fair and poor partner support had higher odds of experiencing IPV, but the effect size did not reach a significant level in the parsimonious model. A high perception of neighborhood safety was associated with a lower likelihood of experiencing IPV (AOR: 0.81; 95% CI: 0.69-0.95).

CONCLUSION

Intimate partner violence is rife among pregnant and parenting adolescent girls in Malawi, underscoring the need for appropriate interventions to curb the scourge. Interventions addressing IPV need to target younger adolescents, those engaging in transactional sex, and those having weaker community-level safety nets. Interventions to change social norms that drive the acceptance of gender-based violence are also warranted.

violência para mulheres em situação de rua

A probabilidade de que mulheres em situação de rua sofram violações de direitos, é grande. Nesse sentido, esta pesquisa buscou compreender como as mulheres em situação de rua percebem a violência nesse espaço e quais estratégias de enfrentamento adotam. Trata-se de um estudo qualitativo no qual foram realizadas entrevistas semiestruturadas nas ruas, com 17 mulheres em situação de rua, maiores de 18 anos, na região da Grande Florianópolis. Os dados foram analisados por meio de análise de conteúdo. Os resultados apontaram histórias de vida permeadas por situações violentas, que repercutem negativamente em suas vidas, sendo por elas utilizadas diferentes estratégias de enfrentamentos. Ademais, houve reflexões das entrevistadas sobre as diferenças das vivências entre homens e mulheres em situação de rua. Contudo, algumas mulheres buscaram desconstruir os estereótipos de fragilidade da mulher. 

Pregnancy and sexual related problems among women living on the street in dire Dawa City, Eastern Ethiopia, 2021: qualitative study

Background

The problem of women and youths living on the street is a global phenomenon. It has created countless problems while they lived on the street; such as unwanted pregnancies, sexual exploitation and prostitution. It is a frequent observation to see women begging on the streets of major cities in Ethiopia having one or two babies by their sides. This study will give an in-depth understanding of the distressing and highly challenging problem among women on the street regarding pregnancy and related problems.

Objective

To explore pregnancy and sexual-related problems among women living on the street in Dire Dawa city, Eastern Ethiopia 2021.

Methods

A community-based phenomenological qualitative study was conducted at Dire Dawa city. Data was collected from homeless women and Key informants through focus group discussion and in-depth interviews using a semi-structured tool aided by a voice recorder. Data were analyzed thematically using computer-assisted qualitative data analysis software Atlas.ti7. The thematic analysis with inductive approach goes through 6 steps; Familiarization, Coding, Generating themes, Reviewing themes, Defining and naming themes and Writing up.

Result

Women living on the street are more likely to experience physical abuse, sexual harassment, Sexual transmitted infection, unprotected sex and unwanted pregnancy. As a result, the fate of this pregnancy is abortion leads to high risk of getting health complications as most abortions are made in illegal and unsafe ways.

Conclusion

Teen pregnancy, STI, rape and unsafe abortion are the major concerns as it accompanied by their homelessness situation and abusive lifestyles. The regional health bureau needs to understand the extent of problem and plan to organize an awareness creation program on STI, risk of pregnancy and SRH services.

Women experiencing homelessness in Dire Dawa city: Coping mechanisms and suggestions to stakeholder, 2021

BACKGROUND

In Ethiopia, the number of homeless girls and women is increasing, and the government has yet to devise a strategy to address the issue of teenage homelessness. They are influenced by numerous dimensions of health, including physical health, mental health, and social isolation. At all stages of homelessness, the stakeholders and homeless people must work together to address the issue. As a result, this study will be helpful to generate relevant data that may guide policymakers in designing solutions for this underserved group of people.

OBJECTIVES

To explore coping mechanisms and suggestions to stakeholders among women experiencing homelessness in Dire Dawa city, eastern Ethiopia, 2021.

DESIGN

A community-based phenomenological qualitative study was conducted at Dire Dawa city.

METHODS

Data were collected from women experiencing homelessness and key informants through focus group discussion and in-depth interviews using a semi-structured tool. A total of 31 women experiencing homelessness (13 in-depth interviews and 3 focus group discussion with 6 participants in each) and 2 key informants participated in this study. Data were analyzed thematically using computer-assisted qualitative data analysis software Atlas.ti 7. The thematic analysis follows six steps: familiarization, coding, generating themes, reviewing themes, naming themes, and writing up.

RESULTS

Two major themes were driven: coping mechanisms and suggestions to stakeholders. There are three subthemes under the coping mechanism (begging, survival sex, and child prostitution) while there are a total of seven subthemes under suggestions to stakeholders (integration and collaboration, special attention to children, family education, shelter and job, schooling, sexual education, and addiction rehabilitation).

CONCLUSION

Child prostitution and survival sex are a very common coping mechanism which is practiced by women experiencing homelessness. Changing society's mindset and paying special attention to children is critical. Furthermore, the government and various stakeholders should work together to develop a rehabilitation program for street children who have been exposed to substance use.

Safe abortion service utilization and associated factors among insecurely housed women who experienced abortion in southwest Ethiopia, 2021: A community-based cross-sectional study

Background

Insecurely housed women are more vulnerable to physical and mental health issues than the general population, making access to a safe abortion more difficult. Though Ethiopia has a penal code regarding safe abortion care, there has been a dearth of studies investigating the safe abortion care practice among those insecurely housed women. Thus, this study aimed at assessing the magnitude of safe abortion service uptake and its determinants among insecurely housed women who experienced abortion in southwest Ethiopia.

Methods

A community-based cross-sectional study was conducted in three towns in southwest Ethiopia from May 20-July 20, 2021. A total of 124 street-involved women were included in the study. They were selected by snowball sampling technique and data was collected through a face-to-face interview. The data were entered into Epi-data Version 3.1 and exported to SPSS 21 for analysis. A bivariable and multivariable logistic regression analyses were performed to determine the association of independent variables with the outcome variable. The level of significance was determined at a p-value <0.05. To determine whether the model is powerful enough in identifying any significant effects that do exist on the dependent variables, a power analysis was performed via a Post-hoc Statistical Power Calculator for Multiple Regressions.

Results

The magnitude of safe abortion service utilization among insecurely housed women was found to be 27.9% [95% CI: 20.1, 34.2]. Average daily income [AOR:3.83, 95% CI: 1.38, 10.60], knowledge of safe abortion services [AOR:3.94; 95% CI: 1.27,9.24], and affordability of the service [AOR: 3.27; 95% CI:1.87, 8.41] were identified as significant predictors of safe abortion service among insecurely housed women.

Conclusion and recommendation

The magnitude of safe abortion service utilization among insecurely housed women in the study area was low. The respective town health offices and health care providers at the facility level should strive to improve awareness about safe abortion service’s legal framework, and its availability. In addition, a concerted effort is needed from local administrators, NGOs, and healthcare managers to engage those insecurely housed women in income-generating activities that allow them to access safe abortion and other reproductive and maternal health services.

Exploring Sexual and Reproductive Health Needs and Associated Barriers of Homeless Young Adults in Urban Ghana: A Qualitative Study

BACKGROUND

Homelessness has become a major global and public health challenge, especially in low- and middle-income countries. This phenomenon predisposes young adults to severe psychosocial and health challenges.

AIM

To explore the sexual and reproductive health needs and behaviours of homeless young adults and challenges in accessing these services.

METHODS

A semi-structured interview guide was used for data collection from in-depth interviews, focus group discussions, and key informant interviews. Data were collected between 01 June and 31 July 2020 from 30 participants using in-depth interviews, two focus group discussions involving 12 participants, and one key informant interview. Thematic analysis was used to analyse transcripts from the interviews.

RESULTS

The findings show that certain behavioural patterns associated with homelessness impact the lives of homeless young adults in their sexual and reproductive health (SRH) choices, beliefs, and perspectives. This group faces several challenges in accessing sexual and reproductive health services (SRHS) such as modern contraceptives and abortion care. The high cost, and undesirable and unfriendly attitude of service providers in health facilities pose as barriers to accessing SRHS by homeless young adults.

CONCLUSION

Sustainable and proactive measures must be put in place to address the identified barriers. Timely delivery of accurate information and educative materials, ensuring affordability, and setting up of accessible and friendly facilities could improve SRHS for this group.

SOCIAL AND PUBLIC POLICY IMPLICATIONS

This study may inform and support policy guideline development to address homelessness and SRH needs of young adults in urban Ghana.

OlaOlorun F, Koffi AK, Radloff S, Ahmed S, O. Tsui A. Gendered power dynamics and threats to sexual and reproductive autonomy among adolescent girls and young adult women: A cross-sectional survey in three urban settings

BACKGROUND

Gendered economic and social systems can enable relational power disparities for adolescent girls and young women (AGYW), and undercut autonomy to negotiate sex and contraceptive use. Less is known about their accumulation and interplay. This study characterizes relationship power imbalances (age disparity, intimate partner violence [IPV], partner-related fear, transactional sex, and transactional partnerships), and evaluates associations with modern contraceptive use, and sexual/reproductive autonomy threats (condom removal/"stealthing", reproductive coercion, ability to refuse sex, and contraceptive confidence).

METHODS

Cross-sectional surveys were conducted with unmarried, currently-partnered AGYW aged 15-24 recruited via respondent-driven sampling in Abidjan, Côte d'Ivoire (n = 555; 2018-19), Nairobi, Kenya (n = 332; 2019), and Lagos, Nigeria (n = 179; 2020). Descriptive statistics, Venn diagrams, and multivariate regression models characterized relationship power imbalances, and associations with reproductive autonomy threats and contraceptive use.

FINDINGS

Relationship power imbalances were complex and concurrent. In current partnerships, partner-related fears were common (50.4%Nairobi; 54.5%Abidjan; 55.7%Lagos) and physical IPV varied (14.5%Nairobi; 22.1%Abidjan; 9.6%Lagos). IPV was associated with reproductive coercion in Nairobi and Abidjan. Age disparate relationships undermined confidence in contraception in Nairobi. In Nairobi and Lagos, transactional sex outside the relationship was associated with condom stealthing.

INTERPRETATION

AGYW face simultaneous gendered power differentials, against the backdrop of gendered social and economic systems. Power imbalances were linked with coercive sexual/reproductive health experiences which are often underrecognized yet represent a potent link between gendered social systems and poor health. Pregnancy prevention efforts for AGYW must address reproductive autonomy threats, and the relational power imbalances and broader gendered systems that enable them.

Utilization of modern contraceptives and associated factors among street women in Dire Dawa, Eastern Ethiopia: a mixed study

INTRODUCTION

Unwanted pregnancy and sexually transmitted diseases are the major problems in street women because of the non-utilization of modern contraceptives. To the best of our knowledge, no studies have assessed the utilization of modern contraceptives and associated factors among street women in the study area. Therefore, this study aimed to determine the utilization of modern contraceptives and its associated factors among street women.

METHODS

A community-based cross-sectional study using mixed methods was conducted from February 16th to April 10, 2021, among all censuses and 615 reproductive-aged street women. Face-to-face and in-depth interviews were employed to generate quantitative and qualitative data, respectively. Binary logistic regression was used to analyze the association between modern contraceptive utilization and independent variables with statistical significance set at p < 0.05. Qualitative data were analyzed using a thematic approach.

RESULTS

Approximately half 279 (50.3%) (95% CI: 46.3%, 54.4%) street women currently used modern contraceptives. Factors significantly associated were women aged 25-34 years [AOR = 5.5, 95% CI: 1.2-24], distance from a nearby health facility within 30 min [AOR = 9.2, 95% CI: 1.6-51], getting advice from health professionals [AOR = 14.3; 95% CI = 5.3-38.4], discussed with their sexual partners about the utilization of modern contraceptives [AOR = 6.2, 95% CI: 2.4-16.5], a history of pregnancy [AOR = 2.7, 95% CI: 1.2-6], the desire to have a child after two years [AOR = 2.2, 95% CI: 1.1-4.7], and women who faced rape in street life [AOR = 5.4; 95% CI = 1.9-15.3]. Fear of side effects, misperceptions, and the desire to have a child are the main identified themes for the key barriers to using modern contraceptives.

CONCLUSION

The proportion of street women currently using modern contraceptives was low. Age, distance from the health facility, discussion with health professionals, discussion with sexual partners, history of pregnancy, desire time to have a child in the future, and history of rape were factors significantly associated with the use of modern contraceptives. Most of the participants' reasons for the lack of use of modern contraceptives were fear of its side effects.

Risky Sexual Practice among Street Dwelling People in Southern Ethiopia: A mixed-Method Study

Background

The number of street dwellers in major cities in Ethiopia is rapidly increasing. However, their sexual health needs are not that much studied. Hence, this study assessed risky sexual practice and associated factors among street dwelling people in southern Ethiopia.

Methods

A cross-sectional study employing a mixed method was conducted. For the quantitative part, a snowball sampling technique was made to conduct face-to-face interviews among 842 respondents. In-depth interviews among street dwellers and key informant interviews among stakeholders were conducted to collect qualitative data.A pre-tested and structured interviewer-administered questionnaire was used to collect data. The collected data were entered using Epidata and exported to SPSS for analysis, and qualitative data analyzed by thematic analysis approach.

Results

About one third, 266(31.6%), of the participants had risky sexual practices within the last year of the study period. Sexual violence such as gang rape and same-sex practice were reported qualitatively. Male respondents (AOR: 3.24, 95%CI: 2.09-5.02) had a more likelihood of risky sexual practice than females. Living in Dilla (AOR: 9.62, 95%CI: 4.49-20.58) and Wolaita Soddo towns (AOR: 14.35, 95%CI: 6.29-32.69) had also a more likelihood of risky sexual practice than living in Hawassa. Moreover, the daily average income of 21-50 Birr (AOR: 0.52, 95%CI: 0.29-0.92) had a less likelihood of risky sexual practice compared to those with a daily average income of 5-20 Birr.

Conclusion

Risky sexual practice among street dwelling people is found high. The Federal Ministry of Health and other stakeholders should work to cut risky sexual practices among street dwelling people.

Prevalence and factors associated with intimate partner violence among the adolescent girls and young women in South Africa: findings the 2017 population based cross-sectional survey

BACKGROUND

Evidence indicate that intimate partner violence (IPV) is disturbingly high among South African adolescent girls and young women (AGYW). Understanding prevalence and risk factors for IPV among these emerging adults is critical for developing appropriate interventions to prevent adverse health outcomes later in life. This study investigates the prevalence and factors associated with lifetime physical IPV experience among AGYW, aged 15-24 years, using the South African national HIV prevalence, incidence, behaviour and communication survey conducted in 2017.

METHODS

The data used in this secondary analysis was obtained from a cross-sectional, population-based household survey data, conducted using a multi-stage stratified random cluster sampling approach. Multivariate stepwise backward logistic regression modelling was used to determine factors associated with IPV.

RESULTS

Of 716 AGYW that responded to the two commonly answered questions on IPV, 13.1% (95% CI: 9.6-17.6) indicated that they experienced IPV. The odds of reporting experiences of IPV were significantly lower among AGYW residing in high SES households [AOR = 0.09 (95% CI: 0.02-0.47), p = 0.004] than low SES households, and those residing in rural informal/tribal areas [AOR = 0.01 (95% CI: 0.00-0.22), p = 0.004] than urban areas. AGYW experiencing IPV had higher odds of reporting psychological distress compared to their counterparts [AOR = 4.37 (95% CI, 0.97-19.72), p = 0.054].

CONCLUSION

The findings highlight the need for targeted structural and psychosocial interventions in low SES households and especially in urban areas.

Modern Contraceptive Utilization and Determinant Factors among Street Reproductive-Aged Women in Amhara Regional State Zonal Towns, North West Ethiopia, 2019: Community-Based Study

Objective

Reproductive-aged women living on the street, with no doubt, are with lesser benefits of exercising their reproductive rights. Pregnancies from this marginalized population are likely to be unplanned, unwanted, and unsupported. The aim of this study, therefore, was to assess modern contraception utilization and associated factors among street reproductive-aged women in Amhara regional state zonal towns.

Method

A community-based cross-sectional study was conducted among street reproductive-aged women in Amhara regional state zonal towns. A single population proportion formula was used to calculate the sample size, a similar literature-based tool adaptation was done, and a semistructured, pretested sectioned questionnaire was used. Cluster sampling technique was used to reach the study participants. Data was entered into Epi Info version 7 and exported to SPSS version 23 for analysis. A multivariable logistic regression model was fitted to control the possible effect of confounders, and finally, the independent variables were identified on the basis of OR, with 95% CI and p values less than 0.05.

Results

604 street reproductive-aged women were interviewed in the study which make the response rate 94.2%. The study revealed that current modern contraceptive utilization among the study participants was found to be 38.9%. Having history of pregnancy in street life (AOR = 1.70, 1.1-2.7), having three or more live children (AOR = 6.4, 2.0-20.4), undesiring to have additional children in the future (AOR = 2.7, 1.4-5.1), mentioning three to four (AOR = 2.2, 1.5-3.3) and five or more modern contraceptive types (AOR = 5.5, 1.4-21.0), and discussion with sexual partners for contraceptive use (AOR = 6.6, 4.3-10.1) were variables significantly associated with modern contraceptive utilization. Modern contraceptive utilization among the street reproductive-aged women was low. Authors suggest that awareness creation and male partner involvement in the maternal services may be important to increase contraceptive utilization.

Risky sexual behavior and associated factors among sexually-active unmarried young female internal migrants working in Burayu Town, Ethiopia

BACKGROUND

Young female internal migrants are highly vulnerable to risky sexual behaviors (RSB) which may result in serious health problems such as unintended pregnancy, abortion and sexually transmitted infections including HIV. RSB includes early sexual debut (before 18 years), having multiple sexual partners, sex without a condom or inconsistent use of condom and sex under the influence of substance use. This study aimed to assess the magnitude and the factors associated with RSB among sexually-active unmarried young female internal migrants in Burayu Town, Ethiopia.

METHODS

A cross sectional study design was used for the study. A total of 267 respondents was recruited into the study using a simple random sampling technique. A semi-structured interviews-administered questionnaire was used to obtain information from the study participants. The collected data were cleaned, coded and entered into Epi data version 3.1 and then exported to SPSS Ver.21 for analysis. Multiple logistic regression models were used to indicate the association between dependent and independent variables.

THE RESULTS

About 35% of the young female internal migrants had sexual debut before the age of 18 years; 64.4% had sex without condom or inconsistently used condom; nearly one quarter of the participants had multiple sexual partners, and 29.6% had sex under the influence of substance uses. The magnitude of RSB among the study participants was (79.1%). Sexting [AOR 3.47(95%; CI;1.10-11.94)], frequent engagement in social media [AOR 10.9(95%;CI;2.31-51.89)], feeling of embarrassment to buy condom [AOR 8.28(95%; CI; 2.10-32.62)], unfavorable attitude toward using condom for steady and loving relationship [AOR 5.72(95%; CI; 1.47-22.24)] were related with RSB while self-efficacy [AOR 0.15(95%: CI; 0.04-0.57)] to use condom and perceived risks of getting pregnant [AOR 0.05(95%; CI; 0.01-0.23)] were found to be protective factors.

CONCLUSION

The study found high levels of RSB among sexually-active unmarried young female internal migrants. This finding suggests an urgent need of intervention to promote safe sex among this group. Special attention and prompt interventions are needed to promote the use of condoms.

A social-ecological examination into the research, policy and health service delivery environment related to early marriage and sexual and gender-based violence among youth in Jordan

Background

The determinants of sexual- and gender-based violence (SGBV) and early marriage are embedded across different levels of the social ecological system, including at the individual, family, community, and policy levels. In Jordan and the Middle East, SGBV, honor killing, and early marriage are priority public health and human rights issues that often overlap, and affect a significant percentage of youth. Jordan is home to a large number of refugees from across the Middle East, who may be even more vulnerable to these forms of violence than the local youth. The purpose of this analysis is to 1) synthesize the existing literature and 2) present the perspectives of key stakeholders to identify research gaps, programmatic lessons learned, and opportunities for policy change from an ecological perspective at the individual, community, health-system, and policy/legal levels.

Methods

This study includes 1) a systematic literature review of both published and unpublished literature since 2008 and 2) focus group discussions (FGDs) with key stakeholders representing 18 international and local governmental and non-governmental organizations.

Results

The literature review included 27 documents. Stakeholder discussions highlighted important research and policy gaps. Prevalence estimates of SGBV, honor killing, and early marriage vary across sources; however, all of them indicate that they remain important issues for youth in Jordan. Several sources indicate that early marriage has been increasing in Jordan since the beginning of the war in Syria, especially among Syrian refugees. Refugee youth are particularly vulnerable to SGBV and early marriage given the worsening economic situation in Jordan. The norms, attitudes, and practices that support SGBV in Jordan appear to be reinforced within families and communities. Despite ongoing programs, SGBV services are limited, especially for youth, and there is little awareness of service availability amongst target populations. Laws and policies continue to offer legal justification for SGBV, honor killing, and early marriage.

Discussion

As countries across the Middle East face instability and continue to struggle with the urgent health needs of large refugee and youth populations, this review provides valuable insight relevant to research, programs, and policy in Jordan and across the region.

Prevalence of Violence Against Women in Ethiopia: A Meta-Analysis

Violence against women (VAW) is a major public health problem globally, particularly in developing countries including Ethiopia. Accordingly, sustainable development goal (SDG) 5 (by United Nation) prioritizes VAW and calls for the design and implementation of programs relevant to its elimination by 2030. However, little is known about the epidemiology of VAW as all estimates from few, cross-sectional studies so far are inconsistent and inconclusive. This study, therefore, was conducted to determine the pooled national prevalence of VAW in Ethiopia. Databases including PUBMED, MEDLINE, Cochrane review, CINAHL, African Journals Online, and Google Scholar were reviewed, using relevant search engines. The meta-analysis was conducted using STATA 14 software, and forest plots were used to present the pooled estimates of VAW. The Cochran Q, I² statistics, and Egger's test were used to test heterogeneity and publication bias of the included studies. A total of 36 published articles, 23,782 participants, were included in the meta-analysis. The overall pooled lifetime and the past 12 months VAW prevalence was 46.93% (95% confidence interval [CI] = [39.96, 54.00]) and 37.02% (95% CI [26.47, 47.56]), respectively. The pooled lifetime physical, sexual, and psychological violence were 38.15%, 39.33%, and 39.51%, respectively. Pooled lifetime prevalence of rape was 13.02%. Overall, nearly half of Ethiopian women experience lifetime VAW, with substantial levels of physical, sexual, or psychological violence. The country should work toward enhancing gender equality, coupled with addressing risk factors at multiple levels, using community- and institution-based approaches to prevent VAW and to specifically achieve SDG₅ of eliminating VAW by 2030.

Prevalence and determinants of gender-based violence among high school female students in Wolaita Sodo, Ethiopia: an institutionally based cross-sectional study

BACKGROUND

Gender-based violence (GBV) often occurs in resource-limited settings such as Ethiopia. It could result in psychological and physical adverse outcomes such as stress, anxiety, depression, unsafe abortion, unwanted pregnancy, and sexually transmitted infections. This study aimed to assess the prevalence and factors associated with gender-based violence among female high school students in Wolaita Sodo, Ethiopia.

METHODS

An institutionally based-cross-sectional study was conducted in Wolaita Sodo, Ethiopia. A total of 604 female high school students were recruited through multi-stage stratified sampling techniques. The gender-based-violence assessment tool, validated by the World Health Organization, was used to assess gender-based-violence and other determinants. The strength of statistical association was measured by adjusted odds ratios and 95% confidence intervals. Statistical significance was declared at p-value < 0.05.

RESULTS

The lifetime prevalence of GBV, sexual violence, and physical violence were found to be 63.2, 37.2, and 56.3%, respectively. The prevalence of sexual violence before and after joining the current school as well as in the current academic year were 30.5, 37.2, and 22% respectively. Having regular boy-friends (AOR = 2.02; 95% CI:1.07-3.79), being sexually active (AOR = 6.10; 95% CI: 2.49-14.92), having female or male friends who drink alcohol (AOR = 2.18; 95% CI:1.26-3.77), students witnessed their mothers being beaten by their partners or husband (AOR = 1.92; 95% CI:1.19-3.11) and joining public school (AOR = 1.74; 95% CI:1.11-2.76) were significantly associated with gender-based violence.

CONCLUSION

The prevalence of gender-based-violence was high. This needs a due concern from governmental, non-governmental and civic organizations as well as other responsible bodies to tackle factors associated with GBV in this study. Further large scale studies incorporating male students are warranted to elucidate the factors associated with GBV in Ethiopia.

Sexually transmitted disease among street dwellers in southern Ethiopia: a mixed methods study design

Background

Lack of knowledge about sexual violence, its consequences, substance use and homelessness are major problems that make street dwellers susceptible to sexually transmitted diseases. Hence, this study assessed knowledge, attitudes and treatment-seeking behaviors related to sexually transmitted diseases among street dwellers in southern Ethiopia.

Methods

An explanatory sequential mixed-methods study design was conducted among 842 respondents. A simple random sampling technique was used to select seven cities among fourteen major cities of the region. The sample was allocated proportionally to each selected city. In order to identify and fill in the required sample size, a snowball sampling technique was used. A pre-tested and structured interviewer-administered questionnaire was used to collect quantitative data. The collected data were entered using Epidata and exported to SPSS version 23.0 for further analysis. Unstructured questionnaires were also used to collect 21 in-depth interviews and 10 key informants’ interviews. Respondents for in-depth interviews were selected purposively during quantitative data collection.

Results

Most street dwellers were aware of (86.7%) and had a favourable attitude towards (84.4%) prevention and management of sexually transmitted diseases. A portion of respondents experienced bad-smelling genital discharge (13.8%), genital ulcers (11.2%) and a burning sensation (14.5%) during urination, in the previous year. Among those who experienced symptoms of sexually transmitted disease, only 15.3% of them received treatment from a health care provider. Fear of questions raised by providers was one of the reasons for not seeking care according to our qualitative findings.

Conclusions

In this study, a significant number of street dwellers reported experiencing symptoms of a sexually transmitted disease. Despite having awareness about sexually transmitted diseases, seeking treatment from a health center was found to be low based on both quantitative and qualitative findings. We recommend that health care providers should undergo special training to address the sexual and reproductive health problems of street dwellers.

Global and regional burden of disease and injury in 2016 arising from occupational exposures: a systematic analysis for the Global Burden of Disease Study 2016

OBJECTIVES

This study provides an overview of the influence of occupational risk factors on the global burden of disease as estimated by the occupational component of the Global Burden of Disease (GBD) 2016 study.

METHODS

The GBD 2016 study estimated the burden in terms of deaths and disability-adjusted life years (DALYs) arising from the effects of occupational risk factors (carcinogens; asthmagens; particulate matter, gases and fumes (PMGF); secondhand smoke (SHS); noise; ergonomic risk factors for low back pain; risk factors for injury). A population attributable fraction (PAF) approach was used for most risk factors.

RESULTS

In 2016, globally, an estimated 1.53 (95% uncertainty interval 1.39-1.68) million deaths and 76.1 (66.3-86.3) million DALYs were attributable to the included occupational risk factors, accounting for 2.8% of deaths and 3.2% of DALYs from all causes. Most deaths were attributable to PMGF, carcinogens (particularly asbestos), injury risk factors and SHS. Most DALYs were attributable to injury risk factors and ergonomic exposures. Men and persons 55 years or older were most affected. PAFs ranged from 26.8% for low back pain from ergonomic risk factors and 19.6% for hearing loss from noise to 3.4% for carcinogens. DALYs per capita were highest in Oceania, Southeast Asia and Central sub-Saharan Africa. On a per capita basis, between 1990 and 2016 there was an overall decrease of about 31% in deaths and 25% in DALYs.

CONCLUSIONS

Occupational exposures continue to cause an important health burden worldwide, justifying the need for ongoing prevention and control initiatives.

Domestic violence related disclosure among women and girls in Ethiopia: a systematic review and meta-analysis

Background

Domestic violence is common public health problem. Domestic violence related disclosure is an important first step in the process of prevention, control and treatments of domestic violence related adverse effect. Thus, this systematic review and meta-analysis aimed to determine the pooled prevalence of domestic violence related disclosure and synthesize its associated factors.

Methods

We followed the PRISMA Guidelines to report the results of the finding. Databases including PubMed, Cochrane Library and Web of Sciences were searched. The heterogeneity between studies was measured by the index of heterogeneity (I² statistics) test. Funnel plots and Egger’s test were used to determine publication bias. Moreover, sensitivity analysis was carried out. To calculate the pooled prevalence, a random effects model was utilized.

Results

Twenty one eligible studies were included in this systematic review and meta-analysis. The pooled prevalence of domestic violence related non-disclosure was found to be 36.2% (95% CI, 31.8–40.5%). Considering violence as normal or not serious, shame, embarrassment and fear of disclosure related consequences were the common barriers for non-disclosure.

Conclusion

More than one third of women and girls were not disclosed their experience of domestic violence. The finding of this study suggests the need of evaluation and strengthening of the collaborative work among different sectors such as: policy-makers, service providers, administrative personnel and community leaders including the engagement of men partner. This study also suggests the needs of women empowerments against the traditional belief, attitude, and practice.

Unseen, unheard and unprotected: prevalence and correlates of violence among female sex workers in Mozambique

Violence against women, including female sex workers, is a public health concern worldwide. This is the first study in Mozambique to estimate the prevalence of and factors associated with physical and sexual violence against female sex workers. We used data collected from 1,250 women recruited using respondent-driven sampling in the cities of Maputo, Beira and Nampula in 2011-12. Participants were 15 years of age and reported having had sex for money in the preceding six months. Prevalence of physical or sexual violence (defined as being hit or battered or raped or forced to have sex within the last 6 months) ranged from 10.0% to 25.6%. Strangers (37.0%) and acquaintances (31.2%) were reported to be the most frequent perpetrators of sexual violence. Among participants who experienced sexual violence, 65.9% and 87.0% did not seek medical care and police assistance, respectively. Physical or sexual violence was associated with city (adjusted odds ratio [AOR] 2.6 and 2.0 Nampula and Beira vs Maputo), age (AOR 1.9, aged 15-24 years vs aged 25 and older), unprotected sex with last client (AOR 1.6) and self-reported sexually transmitted infections (AOR 2.1). The high prevalence of violence found confirms the need for interventions to mitigate this problem.

Prevalence and correlates of physical violence and rape among female sex workers in Ethiopia: a cross-sectional study with respondent-driven sampling from 11 major towns

OBJECTIVE

This study examined the prevalence and correlates of physical violence and rape among female sex workers (FSWs) in Ethiopia.

DESIGN

A cross-sectional study using respondent-driven sampling technique.

SETTING

Eleven major towns in Ethiopia.

PARTICIPANTS

4900 FSWs.

MAIN OUTCOME MEASURES

The prevalence of experiences of physical beating and rape.

RESULTS

Among FSWs, 17.5% reported physical beating within the last year and 15.2% reported rape since they started selling sex. FSWs aged 35+ years (AOR 0.59, 95% CI 0.38 to 0.92) were less exposed to physical beating than those aged 15-24 years. FSWs working on the street (AOR 1.92, 95% CI 1.53 to 2.39), in red-light houses (AOR 1.63, 95% CI 1.12 to 2.38) and in local drinking houses (AOR 1.35, 95% CI 1.02 to 1.78) experienced more physical beating than FSWs working in bars/hotels. FSWs who consumed alcohol four or more days in a week (AOR 1.92, 95% CI 1.21 to 3.04), and who chewed khat frequently experienced more physical violence. Rape was associated with having a low monthly income, drinking alcohol four or more days per week (AOR 2.33, 95% CI 1.47 to 3.7), experience of heavy episodic drinking in a month (AOR 1.71, 95% CI 1.24 to 2.38) and chewing khat 3-4 days per week (AOR 2.15, 95% CI 1.55 to 2.98). Condom breakage was more frequent among FSWs who reported both physical beating (AOR 1.51, 95% CI 1.25 to 1.84) and rape (AOR 1.26, 95% CI 1.03 to 1.55).

CONCLUSION

FSWs in Ethiopia are vulnerable to physical and sexual violence, and the risk increases when they are younger, street-based and high consumers of alcohol or khat. Therefore, targeted efforts are needed for prevention and harm reduction.

The Prevalence and Correlates of Physical and Sexual Violence Affecting Female Sex Workers in Swaziland

Female sex workers (FSW) have a heightened vulnerability to violence and negative sexual/reproductive health outcomes. Limited research has examined how experiencing physical and sexual violence (PSV) mediates risk for poor health outcomes among FSW in Swaziland. The present analyses aim to contribute to literature linking violence with poor health outcomes, high-risk behaviors, and reduced health service-seeking among FSW. Data were analyzed from a cross-sectional study conducted in Swaziland between July and September 2011 with 325 adult women who reported exchanging sex for money, goods, or favors in the last 12 months, recruited through respondent-driven sampling (RDS). Logistic regression was used to assess the relationship between PSV and ancillary violence/abuse exposures, risk behaviors, and sexual/reproductive and mental health outcomes. PSV was conceptualized as either ever having been beaten up as a result of selling sex or ever being forced to have sex since the age of 18, or both. Prevalence of PSV in this sample was 59.0% in crude estimation, and 48.4% (95% confidence interval [CI]:[39.2,57.6]) with RDS weighting. Separate RDS-weighted estimates of being beaten up as a result of sex work and ever being forced to have sex were 32.4% (95%CI=[24.4,40.4]) and 33.1% (95%CI =[25.0,41.2%]), respectively. Experiencing PSV was associated with being blackmailed (adjusted odds ratio [aOR]= 1.93, 95%CI= [1.07,3.52]), non-injection drug use in the last 12 months (aOR= 1.84, 95%CI= [1.02,3.33]), and feeling afraid to seek health services as a result of selling sex (aOR = 1.74, 95%CI= [1.01,2.99]). Given these findings, violence prevention strategies should be prioritized in programs that address Swazi FSW health, empowerment, and safety.

"The women, they maltreat them… therefore, we cannot assure that the future society will be good": Male perspectives on gender-based violence: A focus group study with young men in Haiti

The purpose of this study was to explore the perceptions of violence against women (VAW) held by Haitian men to gain a better understanding of why VAW occurs. Women in Haiti have experienced significant violence, both before and following the 2010 earthquake. Fifteen men aged 26 to 47 participated in a focus group. The data revealed three themes: men's beliefs about VAW and its context, factors influencing VAW, and recommended interventions. When approaching VAW, men must be part of the collective effort. Their insights are valuable when planning and implementing interventions to decrease VAW in Haiti and worldwide.

Prevalence and predictors of sexual violence among commercial sex workers in Northern Ethiopia

Background

Gender-based violence is a natural outgrowth of the stigma and discrimination experienced by commercial sex workers (CSWs) across the globe. In light of this, the current study aimed to describe the prevalence and character of sexual violence, as well as any risk factors for violence, experienced by CSWs in Mekelle City, Northern Ethiopia.

Methods

A cross-sectional study was conducted in Mekelle City in April 2013. 250 CSWs were selected for participation using simple random sampling. Data were collected via a questionnaire instrument. Descriptive statistics and multiple logistic regression analyses were performed using SPSS 20 for Windows.

Results

The overall prevalence of sexual violence among CSWs was 75.6 %. Basic literacy [(AOR = 5.3, 95 % of CI (1.15–25.20)], completion of only elementary school [AOR = 6.9, 95 % of CI (1.55–31.25)], completion of only high school [AOR = 7.9, 95 % of CI (1.65–38.16)], being married [(AOR = 3.8, 95 % CI (1.34–11.09)], engaging in sex work for 1–4 years [(AOR = 5.3, 95 % CI(1.7–16.2)] and drug use [AOR = 5.3, 95 % of CI (1.78–16.21)] were all significant risk factors for sexual violence. CSWs with lower monthly income were also more likely to experience sexual violence; monthly income of 51.2–101.9 USD yielded AOR = 2.4 (95 % CI 1.12–5.37) and monthly income of 102.2–153.1 USD yielded AOR = 7.9 (95 % CI 2.46–25.58), compared to CSWs earning 153.2 USD or more.

Conclusion

The prevalence of sexual violence among CSWs is high. Lower educational attainment, being married, lower monthly income, drug use, and shorter duration of sex work are all risk factors for sexual violence.

Material deprivation and unemployment affect coercive sex among young people in the urban slums of Blantyre, Malawi: A multi-level approach

We explore relations among material deprivation (measured by insufficient housing, food insecurity and poor healthcare access), socio-economic status (employment, income and education) and coercive sex. A binary logistic multi-level model is used in the estimation of data from a survey of 1071 young people aged 18–23 years, undertaken between June and July 2013, in the urban slums of Blantyre, Malawi. For young men, unemployment was associated with coercive sex (odds ratio [OR]=1.77, 95% confidence interval [CI]: 1.09–3.21) while material deprivation (OR=1.34, 95% CI: 0.75–2.39) was not. Young women in materially deprived households were more likely to report coercive sex (OR=1.37, 95% CI: 1.07–2.22) than in non-materially deprived households. Analysis of local indicators of deprivation is critical to inform the development of effective strategies to reduce coercive sex in urban slums in Malawi.

•

Local measures were used for an analysis of association between deprivation and coercive sex.

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Unemployment was associated with coercive sex among young men.

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Material deprivation was associated with coercive sex among young women.

Sexual violence against female sex workers in The Gambia: a cross-sectional examination of the associations between victimization and reproductive, sexual and mental health

Background

Female sex workers (FSW) are a vulnerable population for sexual violence and poor sexual and reproductive health outcomes. Sexual violence against FSW has not been widely studied in The Gambia. This study will report the prevalence of and evaluate the health issues correlated with forced sex perpetrated by clients against FSW in The Gambia, and will secondly aim to inform future research and efforts to improve health outcomes for survivors of violence.

Methods

A cross-sectional survey was administered among 251 FSW accrued through a combination of chain referral and venue-based sampling in The Gambia. Eligibility criteria included being over 16 years old and having exchanged sex for money, goods, or favors in the past 12 months.

Results

There is a high prevalence of sexual violence against FSW in The Gambia, with 29% (n = 70) of participants reporting a client forced them to have sex in their lifetime. Women who reported forced sex by a client were more likely to report symptoms of depression (aOR 2.15, CI: 1.10 – 4.16 p < 0.05), unwanted pregnancy (aOR: 2.69, CI: 1.12 – 6.49 p < 0.05) and report “no”, “difficult” or “somewhat difficult” access to condoms (aOR: 3.31, CI: 1.76 – 6.26 p < .01) compared to women who did not report forced sex. Client-perpetrated forced sex was also negatively associated with receiving any sexually transmitted infection (STI) test in the past 12 months (aOR: 0.49, CI: .26 – .91 p < .05).

Conclusion

FSW who experience sexual violence by a client are more likely to experience poor sexual, reproductive and mental health outcomes. Responding to sexual violence among FSW, including providing survivors with access to post-exposure prophylaxis, emergency contraception, and mental health services, must be a priority given the prevalence of forced sex and links with poor health outcomes. Efforts to reduce sexual violence against FSW is a vital strategy to improve the health and safety of FSW as well as impact the spread of HIV/STIs in The Gambia.

Prevalence and Health Impact of Intimate Partner Violence and Non-partner Sexual Violence Among Female Adolescents Aged 15-19 Years in Vulnerable Urban Environments: A Multi-Country Study

PURPOSE

Globally, adolescent women are at risk for gender-based violence (GBV) including sexual violence and intimate partner violence (IPV). Those in economically distressed settings are considered uniquely vulnerable.

METHODS

Female adolescents aged 15-19 from Baltimore, Maryland, USA; New Delhi, India; Ibadan, Nigeria; Johannesburg, South Africa; and Shanghai, China (n = 1,112) were recruited via respondent-driven sampling to participate in a cross-sectional survey. We describe the prevalence of past-year physical and sexual IPV, and lifetime and past-year non-partner sexual violence. Logistic regression models evaluated associations of GBV with substance use, sexual and reproductive health, mental health, and self-rated health.

RESULTS

Among ever-partnered women, past-year IPV prevalence ranged from 10.2% in Shanghai to 36.6% in Johannesburg. Lifetime non-partner sexual violence ranged from 1.2% in Shanghai to 12.6% in Johannesburg. Where sufficient cases allowed additional analyses (Baltimore and Johannesburg), both IPV and non-partner sexual violence were associated with poor health across domains of substance use, sexual and reproductive health, mental health, and self-rated health; associations varied across study sites.

CONCLUSIONS

Significant heterogeneity was observed in the prevalence of IPV and non-partner sexual violence among adolescent women in economically distressed urban settings, with upwards of 25% of ever-partnered women experiencing past-year IPV in Baltimore, Ibadan, and Johannesburg, and more than 10% of adolescent women in Baltimore and Johannesburg reporting non-partner sexual violence. Findings affirm the negative health influence of GBV even in disadvantaged urban settings that present a range of competing health threats. A multisectoral response is needed to prevent GBV against young women, mitigate its health impact, and hold perpetrators accountable.