The effect of a savings intervention on women's intimate partner violence victimization: heterogeneous findings from a randomized controlled trial in Colombia

Interventions addressing family violence and mental illness or substance use in low- and middle-income countries: A systematic review

Most family violence research has been conducted in high-income countries, although family violence rates are higher in low- and middle-income countries (LMICs), and outcomes more severe. Given the strong associations of family violence with substance use and mental illness, the aim of this systematic review was to examine interventions that targeted familial violence and at least one other condition of substance use or mental illness to determine effective treatments in LMICs. We conducted a systematic review of interventions that addressed family violence and mental illness or substance use. A committee of three researchers independently screened titles and abstracts and conducted full-text eligibility assessments. Two researchers conducted a risk of bias assessment. Data were extracted using a structured spreadsheet and narratively synthesized. Our search identified 29 articles produced from 19 studies conducted in 13 LMICs. Most (n = 15) studies randomized to study condition. Lack of blinding was the most common threat. The external validity of studies was generally poor. Fourteen studies had a primary intervention target of family violence, mental health, substance use, economic improvement, or HIV. None of the studies showed improvements in all intervention areas. Child maltreatment was less likely to be addressed than intimate partner violence (IPV). Targeted interventions for substance and mental health mostly improved primary outcomes, although they were less effective in reducing IPV. Evidence-based treatments must be rigorously evaluated before innovations in implementation can occur. Interventions overwhelmingly addressed IPV victimization and should consider how to work with couples and include men and children.

Empowering women facing gender-based violence amid COVID-19 through media campaigns

COVID-19 heightened women's exposure to gender-based and intimate partner violence, especially in low-income and middle-income countries. We tested whether edutainment interventions shown to successfully combat gender-based and intimate partner violence when delivered in person can be effectively delivered using social (WhatsApp and Facebook) and traditional (TV) media. To do so, we randomized the mode of implementation of an intervention conducted by an Egyptian women's rights organization seeking to support women amid COVID-19 social distancing. We found WhatsApp to be more effective in delivering the intervention than Facebook but no credible evidence of differences across outcomes between social media and TV dissemination. Our findings show little credible evidence that these campaigns affected women's attitudes towards gender or marital equality or on the justifiability of violence. However, the campaign did increase women's knowledge, hypothetical use and reported use of available resources.

Assessment of Microfinance Interventions and Intimate Partner Violence: A Systematic Review and Meta-analysis

IMPORTANCE

An estimated 27% of ever-partnered women aged 15 to 49 years have experienced intimate partner violence (IPV) in their lifetimes, which has been associated with a wide range of both acute and chronic illness. Poverty is thought to be a major driver of IPV, and economic empowerment programs may reduce violence.

OBJECTIVE

To evaluate whether microfinance interventions are associated with reductions in various forms of IPV.

DATA SOURCES

On August 3, 2022, PubMed, CINAHL, Embase, Web of Science, EconLit, and 5 global health databases were searched from inception.

STUDY SELECTION

Included studies were randomized clinical trials evaluating the effect of microfinance interventions vs control on exposure to IPV. This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline.

DATA EXTRACTION AND SYNTHESIS

Authors independently assessed study eligibility, extracted prespecified data, and evaluated risk of bias using the Cochrane Risk of Bias tool.

MAIN OUTCOMES AND MEASURES

Outcome measures of interest were exposure to overall IPV and 4 World Health Organization-designated IPV domains: physical, psychological and emotional, sexual, and controlling behaviors. Univariate meta-analyses using a random effects model were used to calculate the standardized mean differences (SMDs) and 95% CIs for each IPV outcome. The Grading of Recommendations Assessment, Development, and Evaluation method was used to rate the certainty of findings.

RESULTS

Overall, 10 randomized clinical trials met inclusion criteria, with a total of 16 136 participants, of whom 98% identified as women, with a mean age of 28.9 years. Compared with no intervention, participation in microfinance was associated with lower rates of psychological and emotional violence (SMD, 0.87; 95% CI, 0.80-0.95; I2 = 46%; high certainty), sexual violence (SMD, 0.76; 95% CI, 0.63-0.90; I2 = 44%; low certainty), and controlling behaviors (SMD, 0.82; 95% CI, 0.74-0.92; I2 = 54%; high certainty). There was no significant association with physical violence (SMD, 0.89; 95% CI, 0.76-1.04; very-low certainty).

CONCLUSIONS AND RELEVANCE

This systematic review and meta-analysis of microfinance interventions found a reduction in exposure to psychological and emotional IPV as well as controlling behaviors among participants receiving microfinance interventions, with high certainty evidence. Further work is needed to evaluate which types of microfinance interventions are most effective at reducing the various forms of IPV.

The Effect of Female Economic Empowerment Interventions on the Risk of Intimate Partner Violence: A Systematic Review and Meta-Analysis

Women's economic empowerment is an essential component of the United Nations Sustainable Development Goals. Not only is it an end in itself but it has further been promoted for its potential to create positive externalities, including the reduction of intimate partner violence (IPV). However, the link between economic empowerment and the risk of IPV remains theoretically ambiguous. Marital dependency theory predicts that women with more financial resources hold higher bargaining power and are in a better position to leave potentially abusive relationships. Conversely, Resource theory posits that an increase in women's financial resources may clash with traditional gender roles, which may prompt their partner to reassert their status through violent means. In light of this debate, we conducted a meta-analysis of 19 randomized controlled trials assessing the impact of economic empowerment interventions on IPV. Based on a total sample size of 44,772 participants and robust variance estimation, our meta-analysis shows that women's economic empowerment was associated with a significant reduction in the pooled measure of emotional, sexual, and physical IPV. We further documented tentative evidence suggesting that these effects may be amplified when additional gender sensitization training is included in such programs. Despite the overall positive effects, some included studies reported increases in IPV, primarily in the form of partners exerting controlling behavior and dominance over financial resources. Our results therefore emphasize a need to prioritize women's safety in the process of designing economic empowerment programs and to closely monitor the potential risk of conflict and violence within beneficiaries' households.

Association between Sociodemographic Factors and Abuse by a Parent or Intimate Partner Violence among Haitian Women: A Population-Based Study

One in three Haitian women, and two in three Haitian children, experience physical abuse. This study aims to assess characteristics of abused Haitian women and identify effective sources of support. This cross-sectional study used multiple logistic regression models to analyze sociodemographic characteristics of Haitian women, associations with abuse-exposure from a parent/intimate partner (IPV)/any perpetrator, and impacts of seeking help for abuse, from police/doctors/family. About 9.1% experienced abuse by a parent, 8.6% from IPV. Women abused by a parent were less likely to be employed (OR = 0.74, [95% CI = 0.59–0.93]) and more likely to have an often-drunk partner (2.10, [1.54–2.87]). IPV-exposed women were more likely to have primary education (1.56, [1.12–2.16]), an often-drunk partner (3.07, [2.24–4.22]) and less likely to live rurally (0.65, [0.47–0.89]). Seeking help from own family for IPV exposure was strongly associated with having a job (2.00, [1.04–3.89]) (P for interaction = 0.039) and seeking help from partner’s family for IPV was strongly associated with having an often-drunk husband (8.80, [3.07–25.23]) (p for interaction <0.001). We recommend family-based interventions targeting men’s perceptions about abuse and their alcohol consumption, introducing programs/policies integrating women into the workforce, and havens for abuse victims to confidentially receive individualized support.

Wealth and depression: A scoping review

INTRODUCTION

The inverse relation between income and depression is well established. Less is understood about the relation between wealth and depression. We therefore conducted a scoping review to answer the question: What is known from the existing literature about the relation between wealth and depression?

METHODS

We searched for studies and articles in Medline (via PubMed), Embase, PsycINFO, PsycArticles, EconLit, and SocINDEX from inception through July 19, 2020. Ninety-six articles were included in our review. Key article characteristics were year of publication, sample size, country, study design, definition of depression, definition of wealth, and association between wealth and depression. Thirty-two longitudinal articles were included in a detailed charted review.

RESULTS

Depression was defined in a relatively standard manner across articles. In contrast, definitions and measurements of wealth varied greatly. The majority of studies in the full review (n = 56, 58%) and half of the studies in the longitudinal charted review (n = 16, 50%) reported an inverse relation between wealth and depression. The longitudinal charted review showed that (1) macro-economic events influenced depression, (2) wealth status influenced depression across the lifecourse, (3) wealth protected against depression in the face of stressors such as job loss, (4) subjective or psychosocial factors such as perception of wealth, relative comparison, and social status modified the relation between wealth and depression, and (5) savings interventions were successful in reducing depression and varied by context.

CONCLUSION

These findings suggest that wealth should be included in our consideration of the forces that shape mental health.

Domestic violence and social norms in Norway and Brazil: A preliminary, qualitative study of attitudes and practices of health workers and criminal justice professionals

BACKGROUND

Gender-based domestic violence has gained significant visibility in recent years and is currently considered a priority in the field of public health. This preliminary, qualitative study explores how social norms and professional regulations impact the attitudes and practices of health workers and criminal justice professionals regarding domestic violence against women in Brazil and Norway.

METHODS

A total of 16 semi-structured, in-depth interviews were conducted; eight in two different cities in Brazil, and eight in two different cities in Norway. In each country, four health workers and four criminal justice professionals were interviewed. We focused on the participants' experiences with cases of domestic violence, their perceptions of their professional responsibilities, as well as the challenges they encounter. We analysed the transcribed interviews using a focused open coding process.

FINDINGS

The participants ranged in age from 32 to 59. All of them worked, with and without supervision, in cases involving domestic violence victims. In all four study locations, the professionals felt that they had not received enough training in how to handle domestic violence. Some medical doctors reported becoming personally detached over time, especially when the victims did not admit that their injuries were due to domestic violence. In the Brazilian cities, some professionals reported that women who were beaten by their partners were themselves responsible for the situation. This was not the case in the Norwegian cities. Both countries have laws and regulations that have been put in place to guide professionals who provide services to victims of domestic violence. For many reasons, professionals do not always follow these regulations. For the Norwegian health workers, confidentiality was an important factor explaining why they did not always report suspected domestic violence to the police. For the Brazilian health workers, the fear of having to testify in court, and thus potentially being vulnerable to violence themselves, was a factor that made some not want to involve the justice system. In both countries, the participating professionals reported the need for closer collaboration with social workers and mental health specialists, since domestic violence is closely related to both social norms in the communities and to individual psychological factors.

CONCLUSION

Individual characteristics and experiences, the emphasis on confidentiality and the fear of repercussions may affect the way health and criminal justice workers perceive and deal with domestic violence cases. The findings in the study thus indicate that personal psychological factors and social norms concerning the acceptability of domestic violence are critical risk factors for women, and that a multi-professional approach is needed. The findings from this preliminary study can serve as background for larger and more comprehensive studies of how professionals handle cases of domestic violence.

Sexual violence and eclampsia: analysis of data from Demographic and Health Surveys from seven low- and middle-income countries

Background

Scientific literature has provided clear evidence of the profound impact of sexual violence on women’s health, such as somatic disorders and mental adverse outcomes. However, consequences related to obstetric complications are not yet completely clarified. This study aimed to assess the association of lifetime exposure to intimate partner sexual violence with eclampsia.

Methods

We considered all the seven Demographic and Health Surveys (DHS) that included data on sexual violence and on signs and symptoms suggestive of eclampsia for women of reproductive age (15-49 years). We computed unadjusted and adjusted odds ratios (OR) to evaluate the risk of suggestive eclampsia by ever subjected to sexual violence. A sensitivity analysis was conducted restricting the study population to women who had their last live birth over the 12 months before the interview.

Results

Self-reported experience of sexual violence ranged from 3.7% in Mali to 9.2% in India while prevalence of women reporting signs and symptoms compatible with eclampsia ranged from 14.3% in Afghanistan to 0.7% in the Philippines. Reported sexual violence was associated with a 2-fold increased odd of signs and symptoms suggestive of eclampsia in the pooled analysis. The sensitivity analysis confirmed the strength of the association between sexual violence and eclampsia in Afghanistan and in India.

Conclusions

Women and girls in low-and-middle-income countries are at high risk of sexual violence, which may represent a risk factor for hypertensive obstetric complication. Accurate counseling by health care providers during antenatal care consultations may represent an important opportunity to prevent adverse outcomes during pregnancy.