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Im H, Saleh M, Khetarpal RM. Embodiment of structural vulnerability: illness experiences among Somali refugee women in urban displacement. ETHNICITY & HEALTH 2024:1-24. [PMID: 39087316 DOI: 10.1080/13557858.2024.2385112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/22/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVES Forced migration and its subsequent sequelae have caused refugees to face significant adversities throughout the displacement process, making them susceptible to significant health issues. Refugees displaced in Africa are a group especially vulnerable to poor health outcomes, experiencing a documented decline in overall physical and mental health status and rise in mortality from non-communicable diseases (NCDs). Despite the heightened health risks experienced by Somali refugees, particularly women, research into their complex illness experiences and co-/multimorbid health conditions is scarce, leaving a gap in our understanding of the multifaceted health challenges of this population. DESIGN Using structural vulnerability theory, this study explores how the broader host context shapes illness experiences for Somali refugee women in Kenya. Specifically, we describe the factors associated with illness experiences of urban Somali refugee women and how this compares with women with other similarly situated identities, such as Somali Kenyan women, other/non-Somali refugees, and Kenyan women. In-depth interviews were conducted with 43 women in Eastleigh, Kenya. RESULTS Using hybrid thematic analysis, the emergent themes were grouped into three distinct domains: (1) multimorbid, complex illness experiences, (2) embodiment of structural vulnerability, and (3) distinct/shared vulnerability among refugee/non-refugee women. Results suggest that illness experiences of displaced refugee women are inextricably linked to traumatic experiences before displacement, as well as the experiences of transmigration stressors and the hostile socio-legal dynamics encountered post-displacement. CONCLUSIONS Our findings also have implications for the need to consider intersectional identities when examining for differential exposure to structural risks and the susceptibility to poor health experiences as well as supports the need for urgent change and improvement in systems of social protection and basic care for refugees experiencing prolonged displacement.
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Affiliation(s)
- Hyojin Im
- School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
| | - Muna Saleh
- School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
| | - Rupa M Khetarpal
- Center for Research on Ending Violence, The State University of New Jersey, Rutgers, NJ, USA
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González-Rodríguez A, Natividad M, Palacios-Hernández B, Ayesa-Arriola R, Cobo J, Monreal JA. An Evaluation of a Women's Clinic: The Healthcare and Learning Project of the Functional Unit for Women with Schizophrenia. Healthcare (Basel) 2024; 12:1483. [PMID: 39120186 PMCID: PMC11312130 DOI: 10.3390/healthcare12151483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 08/10/2024] Open
Abstract
Gender differences exist in mental and physical health in schizophrenia, and healthcare education is part of the associated clinical approach. The main goal of the present paper is to describe a women's clinic for schizophrenia and carry out a narrative review about innovative healthcare and learning strategies in the context of women who suffer from schizophrenia, and to discuss innovative strategies for both healthcare and learning projects to be applied in this context. Observing the development of our unit, four clear innovation phases can be distinguished: the generation of new ideas (clinical and social needs), strategic planning (five observatories), the execution of these strategies (observatories/teams/interventions) and feedback, iteration and scaling. We found that the observatory for morbi-mortality adopted a retroactive proactive approach, and the observatory for hyperprolactinemia was proactive and deliberate. We describe the innovation aspects, both clinical and educational, as incremental. There was one exception, the introduction of a social exclusion and discrimination observatory, that from our perspective, was not gradual, but transformative. Future learning projects should include the role of social sciences and humanities and new technologies. Our pilot project gave us the opportunity to apply new learning methods to a relatively neglected field of care.
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Affiliation(s)
- Alexandre González-Rodríguez
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.A.M.)
| | - Mentxu Natividad
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.A.M.)
| | - Bruma Palacios-Hernández
- Perinatal Mental Health Research Laboratory, Center for Transdisciplinary Research in Psychology (CITPsi), Autonomous University of the State of Morelos, Cuernavaca 62350, Mexico;
| | - Rosa Ayesa-Arriola
- Department of Psychiatry, Marqués de Valdecilla University Hospital, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), School of Medicine, University of Cantabria, 39005 Santander, Spain;
- Faculty of Psychology, National University of Distance Education (UNED), 39008 Santander, Spain
| | - Jesús Cobo
- Department of Mental Health, Hospital Universitari Parc Taulí, 1 Parc Taulí, 08208 Sabadell, Spain;
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Spain
| | - José A. Monreal
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.A.M.)
- Institut de Neurociències, Universitat Autònoma de Barcelona (UAB), 08221 Terrassa, Spain
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Kalra N, Habumugisha L, Shankar A. Impacts of an abbreviated personal agency training with refugee women and their male partners on economic empowerment, gender-based violence, and mental health: a randomized controlled trial in Rwanda. BMC Public Health 2024; 24:1306. [PMID: 38745312 PMCID: PMC11092213 DOI: 10.1186/s12889-024-18780-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/06/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION We assessed the impact of a personal agency-based training for refugee women and their male partners on their economic and social empowerment, rates of intimate partner violence (IPV), and non-partner violence (NPV). METHODS We conducted an individually randomized controlled trial with 1061 partnered women (aged 18-45) living in a refugee camp in Rwanda. Women received two days of training, and their partners received one day of training. The follow-up survey where all relevant outcomes were assessed was carried out at 6-9 months post-intervention. RESULTS At follow up, women in the intervention arm were more likely to report partaking in income generating activities (aIRR 1.27 (1.04-1.54), p < 0.05) and skill learning (aIRR 1.59 (1.39-1.82), p < 0.001) and reported a reduction in experience of physical or sexual NPV in the past six months (aIRR 0.65 (0.39-1.07), p < 0.09). While improved, no statistically significant impacts were seen on physical or sexual IPV (aIRR 0.80 (0.58-1.09), p = 0.16), food insecurity (β 0.98 (0.93 to 1.03), p = 0.396), or clean cookstove uptake (aIRR 0.95 (0.88 to 1.01), p = 0.113) in the past six months. We found statistically significant reduction in physical and sexual IPV amongst those experiencing IPV at baseline (aIRR 0.72 (0.50 to 1.02), p < 0.07). Small improvements in self-efficacy scores and our indicator of adapting to stress were seen in the intervention arm. Some challenges were also seen, such as higher prevalence of probable depression and/or anxiety (aIRR 1.79 (1.00-3.22), p = 0.05) and PTSD (aIRR 2.07 (1.10-3.91), p < 0.05) in the intervention arm compared to the control arm. CONCLUSION Our findings echo previous research showing personal agency training can support economic well-being of women. We also find potentially promising impacts on gender-based violence. However, there is some evidence that integration of evidence-based mental health support is important when enhancing agency amongst conflict-affected populations. TRIAL REGISTRATION NUMBER The trial was registered with ClinicalTrials.gov, Identifier: NCT04081441 on 09/09/2019.
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Affiliation(s)
- Naira Kalra
- Africa Region Gender Innovation Lab, Office of the Chief Economist, The World Bank Group, Washington D.C., USA
| | | | - Anita Shankar
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
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Asefa EY, Haile AB, Mohamed OY, Berhanu D. The magnitude of gender-based violence, health consequences, and associated factors among women living in post-war woredas of North Shewa zone, Amhara, Ethiopia, 2022. Front Glob Womens Health 2024; 5:1335254. [PMID: 38774250 PMCID: PMC11106405 DOI: 10.3389/fgwh.2024.1335254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 04/23/2024] [Indexed: 05/24/2024] Open
Abstract
Background Gender-based violence (GBV) is a pervasive global public health concern and a violation of human rights, particularly pronounced in conflict settings where it is often used as a tool of warfare to instill fear and control populations. Objective Assessment of Magnitude, Associated Factors, and Health Consequences of GBV among women living in war-affected woredas of North Shewa zone, Ethiopia, 2022. Methods A community-based cross-sectional study was conducted, involving 845 randomly selected women living in conflict zones. Data on GBV experiences over the previous 3 months were collected through interviewer-administered questionnaires developed from literature review. The collected data underwent validation, entry into EPI data, and analysis using SPSS. Findings are summarized using descriptive statistics, AOR and 95% confidence interval. Result The magnitude of GBV in this study was (490, 58.0%) where, (466, 55.0%) psychological violence, (254, 30.1%) physical violence, and (135, 16.0%) reported sexual violence. A majority of the physical violence, (161, 63.4%), occurred during conflict period, with (143, 56.3%) of these cases involving armed forces, and (161, 63.4%) women experiencing physical violence in their homes. Urban Residence AOR = 2.65, CI, (1.82-3.89), Educational status of Secondary education AOR = 0.33, CI, (0.19-0.57, and ≥College AOR = 0.17, CI, (0.09-0.35), Occupation of Housewife AOR = 1.88, CI, (1.20-2.94), Private employee AOR = 6.95, CI, (3.70-13.04), Gov't employee AOR = 5.80, CI, (2.92-11.50), and others (Students) AOR = 3.46, CI, (1.98-6.01), Ever had sexual intercourse AOR = 0.46, CI, (0.25-0.83), Have heard about SRH AOR = 0.59, CI, (0.40-0.89), Have had previous GBV exposure AOR = 0.24, CI, (0.15-0.38), having a previous history of sexual violence AOR = 0.30, CI, (0.16-0.57), and Number of sexual partner AOR = 1.84, CI, (1.13-2.99) were identified to be associated factors of GBV in our study area. The most commonly reported consequences of GBV were Anxiety, depression, physical injuries, self-blame, women had school dropout, and abortion. Conclusion The study reveals a higher prevalence of GBV, resulting in profound physical, social, mental, and reproductive health challenges for survivors. To address this, multi-sectoral cooperation is advised to enhance women's empowerment, access to information, and psycho-social support in affected areas. Furthermore, national policymakers are urged to implement preventive measures during conflict and establish legal mechanisms to ensure accountability for perpetrators.
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Affiliation(s)
- Eyosiyas Yeshialem Asefa
- School of Public Health, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Assalif Beyene Haile
- Department of Midwifery, School of Nursing & Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Osman Yimer Mohamed
- Department of Midwifery, School of Nursing & Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Dagimawit Berhanu
- Department of Nursing, School of Nursing & Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
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Jolof L, Rocca P, Carlsson T. Women's experiences of trauma-informed care for forced migrants: A qualitative interview study. Heliyon 2024; 10:e28866. [PMID: 38596047 PMCID: PMC11002685 DOI: 10.1016/j.heliyon.2024.e28866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 03/11/2024] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Forced migration affect the health and wellbeing of millions of women. The aim was to explore experiences of trauma-informed care among women who are forced migrants. Methods This was an exploratory qualitative study. Eleven women who had concluded treatment at multidisciplinary trauma centers in Sweden were interviewed, recruited through consecutive sampling. Audio-recorded interviews were transcribed and analyzed with systematic text condensation. Results Women dealt with mental and physical manifestations in a challenging psychosocial situation. Various structural and individual barriers were addressed that hindered access to adequate health services. Women appreciated various benefits of the treatment and recalled the care as supportive and compassionate. However, undergoing treatment was considered demanding, requiring significant determination and energy. Participants suggested that peer support could enhance the support. Conclusions Migrant women experience a range of health-related burdens and encounter barriers to trauma-informed care. While demanding, treatment has the potential to alleviate symptoms. Health professionals and stakeholders providing trauma-informed care need to ensure that their services are accessible and culturally sensitive towards the unique needs of women. Peer support has the potential to enhance support further, which need further evaluation.
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Affiliation(s)
- Linda Jolof
- The Red Cross Treatment Center for Persons Affected by War and Torture, Malmö, Sweden
| | - Patricia Rocca
- The Red Cross Treatment Center for Persons Affected by War and Torture, Malmö, Sweden
| | - Tommy Carlsson
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
- The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Mehrab Z, Stundal L, Venkatramanan S, Swarup S, Lewis B, Mortveit HS, Barrett CL, Pandey A, Wells CR, Galvani AP, Singer BH, Leblang D, Colwell RR, Marathe MV. An agent-based framework to study forced migration: A case study of Ukraine. PNAS NEXUS 2024; 3:pgae080. [PMID: 38505694 PMCID: PMC10949908 DOI: 10.1093/pnasnexus/pgae080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 02/06/2024] [Indexed: 03/21/2024]
Abstract
The ongoing Russian aggression against Ukraine has forced over eight million people to migrate out of Ukraine. Understanding the dynamics of forced migration is essential for policy-making and for delivering humanitarian assistance. Existing work is hindered by a reliance on observational data which is only available well after the fact. In this work, we study the efficacy of a data-driven agent-based framework motivated by social and behavioral theory in predicting outflow of migrants as a result of conflict events during the initial phase of the Ukraine war. We discuss policy use cases for the proposed framework by demonstrating how it can leverage refugee demographic details to answer pressing policy questions. We also show how to incorporate conflict forecast scenarios to predict future conflict-induced migration flows. Detailed future migration estimates across various conflict scenarios can both help to reduce policymaker uncertainty and improve allocation and staging of limited humanitarian resources in crisis settings.
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Affiliation(s)
- Zakaria Mehrab
- Biocomplexity Institute & Initiative, University of Virginia, Charlottesville, VA 22904, USA
- Department of Computer Science, University of Virginia, Charlottesville, VA 22904, USA
| | - Logan Stundal
- Biocomplexity Institute & Initiative, University of Virginia, Charlottesville, VA 22904, USA
- Department of Political Science, University of Virginia, Charlottesville, VA 22904, USA
| | | | - Samarth Swarup
- Biocomplexity Institute & Initiative, University of Virginia, Charlottesville, VA 22904, USA
| | - Bryan Lewis
- Biocomplexity Institute & Initiative, University of Virginia, Charlottesville, VA 22904, USA
| | - Henning S Mortveit
- Biocomplexity Institute & Initiative, University of Virginia, Charlottesville, VA 22904, USA
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA 22904, USA
| | - Christopher L Barrett
- Biocomplexity Institute & Initiative, University of Virginia, Charlottesville, VA 22904, USA
- Department of Computer Science, University of Virginia, Charlottesville, VA 22904, USA
| | - Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520, USA
| | - Chad R Wells
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520, USA
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520, USA
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610, USA
| | - David Leblang
- Department of Political Science, University of Virginia, Charlottesville, VA 22904, USA
| | - Rita R Colwell
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park, MD 20742, USA
| | - Madhav V Marathe
- Biocomplexity Institute & Initiative, University of Virginia, Charlottesville, VA 22904, USA
- Department of Computer Science, University of Virginia, Charlottesville, VA 22904, USA
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Cayreyre L, Korchia T, Loundou A, Jego M, Théry D, Berbis J, Gentile G, Auquier P, Khouani J. Lifetime sexual violence experienced by women asylum seekers and refugees hosted in high-income countries: Literature review and meta-analysis. J Forensic Leg Med 2024; 101:102622. [PMID: 38061112 DOI: 10.1016/j.jflm.2023.102622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/22/2023] [Accepted: 11/16/2023] [Indexed: 01/23/2024]
Abstract
Screening and care for victims of sexual violence (SV) among asylum seekers and refugees (ASRs) living in High-income host countries were prioritized by the WHO in 2020. The lack of stabilized prevalence findings on lifetime SV among ASRs in High-income countries hinders the development of adequate health management. The objective of this study was to determine the lifetime prevalence of SV experienced by ASRs living in High-income countries. We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included in the meta-analysis if the sample consisted exclusively of asylum seekers or refugees over the age of 16 living in High-income countries and if they reported a lifetime prevalence of experienced SV. The results of the meta-analysis were expressed with 95 % confidence intervals (CIs) as estimates of lifetime SV prevalence using a random-effects model. The estimated lifetime prevalence of SV among women ASRs was 44 % (95 % CI, 0.24-0.67) and 27 % (95 % CI, 0.18-0.38) for both sexes. This meta-analysis revealed a high prevalence of SV among ASRs hosted in High-income countries and suggest the importance of developing specific screening and care programs in these host countries.
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Affiliation(s)
- Laura Cayreyre
- Department of General Practice, Aix Marseille University, Marseille, France
| | - Théo Korchia
- Department of Psychiatry, La Conception University Hospital, Marseille, France; Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, Canada
| | - Anderson Loundou
- Aix Marseille University, CEReSS, UR3279, Marseille, France; APHM, Department of Public Health, Marseille, France
| | - Maeva Jego
- Department of General Practice, Aix Marseille University, Marseille, France; Aix Marseille University, CEReSS, UR3279, Marseille, France
| | - Didier Théry
- Department of General Practice, Aix Marseille University, Marseille, France
| | - Julie Berbis
- Aix Marseille University, CEReSS, UR3279, Marseille, France; APHM, Department of Public Health, Marseille, France
| | - Gaëtan Gentile
- Department of General Practice, Aix Marseille University, Marseille, France; Aix Marseille University, Institut des Neurosciences des Systèmes, INS UMR1106, France
| | - Pascal Auquier
- Aix Marseille University, CEReSS, UR3279, Marseille, France; APHM, Department of Public Health, Marseille, France
| | - Jérémy Khouani
- Department of General Practice, Aix Marseille University, Marseille, France; Aix Marseille University, CEReSS, UR3279, Marseille, France.
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Shalak M, Markson F, Nepal M. Gender-Based Violence and Women Reproductive Health in War Affected Area. Korean J Fam Med 2024; 45:12-17. [PMID: 38008709 PMCID: PMC10822726 DOI: 10.4082/kjfm.23.0169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 11/28/2023] Open
Abstract
Manifestations of gender-based violence although many, and sometimes more pronounced in areas of armed conflict, go unnoticed due to multiple factors. Gender-based violence targeted towards women, affect their overall health negatively, particularly the reproductive well-being. Major conflicts arising in the Middle East over the past 10-15 years, ranging from the Arab uprising to the Syrian civil war, have drawn attention world-wide. This study aims to shed light on the importance of recognizing violence against women, its effect on their reproductive health, and the policies that should be implemented to limit its adverse impact. Towards this end, we have highlighted the important role played by all healthcare professionals, epidemiologists, and surveyors working in peace and war areas to recognize such atrocities towards women.
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Affiliation(s)
- Manar Shalak
- Department of Medicine, WVU Health Science Center, West Virginia University, Morgantown, WV, USA
- Division of Geriatrics, Palliative Medicine & Hospice, WVU Health Sciences Center North, West Virginia University, Morgantown, WV, USA
| | - Favor Markson
- Department of Internal Medicine, NYC Health & Hospital, Bronx, NY, USA
| | - Manoj Nepal
- Department of Medicine, WVU Health Science Center, West Virginia University, Morgantown, WV, USA
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Gambir K, Hutchison C, Alexander L, Alessi EJ. Addressing the needs of cisgender, heterosexual men and LGBTIQ+ survivors of sexual violence: a scoping review of service delivery and funding priorities among humanitarian organisations. Glob Public Health 2024; 19:2371389. [PMID: 39003749 DOI: 10.1080/17441692.2024.2371389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 06/16/2024] [Indexed: 07/16/2024]
Abstract
Sexual violence in humanitarian contexts is a global public health issue. Yet, evidence suggests that humanitarian organisations may not always be inclusive of cisgender, heterosexual men and LGBTIQ+ survivors in their responses. This scoping review examines the extent to which global organisations focusing on sexual and gender-based violence (SGBV) address the needs of cisgender, heterosexual men and LGBTIQ+ survivors in service delivery and funding priorities. We examined grey literature published from 2013-2023 on SGBV service delivery and funding priorities in humanitarian contexts. Forty-seven documents were included in the final analyses, which comprised content and thematic analyses. Many of the documents acknowledged cisgender, heterosexual men or LGBTIQ+ individuals as at-risk groups; however, there was a lack of comprehensive discussion of these groups. Documents on LGBTIQ+ individuals referred to the group as a monolith, making little distinction among the LGBTIQ+ experience and the need to tailor responses to meet intersectional needs. Documents on men emphasised their role as perpetrators and allies, while overlooking that they also experience sexual violence. Findings support the critical need to address gaps in humanitarian programme and donor priorities to better ensure inclusion of cisgender, heterosexual men and LGBTIQ+ individuals without ignoring the needs of women and girls.
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Pérez-Vázquez S, Bonilla-Campos A. Women Refugee's Perceptions, Experiences and Coping Mechanisms in Situations of Sexual and Gender-Based Violence (SGBV): A Metasynthesis. TRAUMA, VIOLENCE & ABUSE 2023; 24:3313-3327. [PMID: 36189681 DOI: 10.1177/15248380221126470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Women represent almost half of the 20 million refugees worldwide, and although they play a key role in their communities, their voices and needs are often missing from research and policies directed to this population. A qualitative systematic review, or metasynthesis, was conducted to examine the experiences, perceptions, coping mechanisms, and psychological discourses of women refugees in situations of sexual and gender-based violence (SGBV) that occur during the travel, interception, and destination migratory stages. A systematic search was conducted on five multidisciplinary databases and was complemented with a manual search, resulting on a total of 511 articles which were screened for eligibility. Only qualitative, peer-reviewed, and English-written research articles were selected, and they were required to (1) focus on women refugees above 15 years of age and (2) report on their experiences, perceptions, psychological discourses, and/or coping with SGBV during their migration across countries (international migration). Ultimately, a total of 14 qualitative research articles were selected for the review. Using the thematic synthesis approach as a guideline, the results were summarized in the following themes: experiences of SGBV, perception of SGBV, perception of the risk factors creating and perpetuating their vulnerability, coping with SGBV, barriers to help-seeking, and psychological consequences. Despite the broad search, only information about some types of SGBV experiences from Asian and African refugee communities was found. Nonetheless, the available qualitative information on this topic is effectively integrated, knowledge gaps are identified, and future research, interventions, and policies using an integrated and culturally sensitive framework are suggested.
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Vahedi L, Qushua N, Seff I, Doering M, Stoll C, Bartels SA, Stark L. Methodological and Ethical Implications of Using Remote Data Collection Tools to Measure Sexual and Reproductive Health and Gender-Based Violence Outcomes among Women and Girls in Humanitarian and Fragile Settings: A Mixed Methods Systematic Review of Peer-Reviewed Research. TRAUMA, VIOLENCE & ABUSE 2023; 24:2498-2529. [PMID: 35607868 PMCID: PMC10486180 DOI: 10.1177/15248380221097439] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Purpose: This systematic review investigates the methodological and ethical implications of using remote data collection tools to measure sexual/reproductive health (SRH) and gender-based violence (GBV) outcomes among women and girls in humanitarian and fragile settings. Methods: We included empirical studies of all design types that collected any self-reported primary data related to SRH/GBV using information and communication technology, in the absence of in-person interactions, from women and girls in humanitarian and fragile settings. The search was run in March 2021 without filters or limits in Ovid Medline, Embase, Web of Science, Clinicaltrials.gov, and Scopus. Quality was assessed using an adapted version of the MMAT tool. Two reviewers independently determined whether each full text source met the eligibility criteria, and conflicts were resolved through consensus. A-priori extraction fields concerned methodological rigor and ethical considerations. Results: 21 total studies were included. The majority of studies were quantitative descriptive, aiming to ascertain prevalence. Telephone interviews, online surveys, and mobile applications, SMS surveys, and online discussion forums were used as remote data collection tools. Key methodological considerations included the overuse of non-probability samples, lack of a defined sampling frame, the introduction of bias by making eligibility contingent on owning/accessing technology, and the lack of qualitative probing. Ethical consideration pertained to including persons with low literacy, participant safety, use of referral services, and the gender digital divide. Conclusion: Findings are intended to guide SRH/GBV researchers and academics in critically assessing methodological and ethical implications of using remote data collection tools to measure SRH and GBV in humanitarian and fragile settings.
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Affiliation(s)
- Luissa Vahedi
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Najat Qushua
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Ilana Seff
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Michelle Doering
- Becker Medical Library, Washington University in St. Louis, St. Louis, MO, USA
| | - Carrie Stoll
- Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Susan A. Bartels
- Department of Emergency Medicine, Queen’s University, Kingston ON, Canada
- Department of Public Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Lindsay Stark
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
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Ramage K, Stirling-Cameron E, Ramos NE, Martinez SanRoman I, Bojorquez I, Spata A, Baltazar Lujano B, Goldenberg SM. "When you leave your country, this is what you're in for": experiences of structural, legal, and gender-based violence among asylum-seeking women at the Mexico-U.S. border. BMC Public Health 2023; 23:1699. [PMID: 37659997 PMCID: PMC10474729 DOI: 10.1186/s12889-023-16538-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/16/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Recent U.S. immigration policy has increasingly focused on asylum deterrence and has been used extensively to rapidly deport and deter asylum-seekers, leaving thousands of would-be asylum-seekers waiting indefinitely in Mexican border cities, a large and growing proportion of whom are pregnant and parenting women. In the border city of Tijuana, Mexico, these women are spending unprecedented durations waiting under unsafe humanitarian conditions to seek safety in the U.S, with rising concerns regarding increases in gender-based violence (GBV) among this population during the COVID-19 pandemic. Given existing gaps in evidence, we aimed to describe the lived experiences of GBV in the context of asylum deterrence policies among pregnant and parenting asylum-seeking women at the Mexico-U.S. border. METHODS Within the community-based Maternal and Infant Health for Refugee & Asylum-Seeking Women (MIHRA) study, we conducted semi-structured qualitative interviews with 30 asylum-seeking women in Tijuana, Mexico between June and December 2022. Eligible women had been pregnant or postpartum since March 2020, were 18-49 years old, and migrated for the purposes of seeking asylum in the U.S. Drawing on conceptualizations of structural and legal violence, we conducted a thematic analysis of participants' experiences of GBV in the context of asylum deterrence policies and COVID-19. RESULTS Pregnant and parenting asylum-seeking women routinely faced multiple forms of GBV perpetuated by asylum deterrence policies at all stages of migration (pre-migration, in transit, and in Tijuana). Indefinite wait times to cross the border and inadequate/unsafe shelter exacerbated further vulnerability to GBV. Repeated exposure to GBV contributed to poor mental health among women who reported feelings of fear, isolation, despair, shame, and anxiety. The lack of supports and legal recourse related to GBV in Tijuana highlighted the impact of asylum deterrence policies on this ongoing humanitarian crisis. CONCLUSION Asylum deterrence policies undermine the health and safety of pregnant and parenting asylum-seeking women at the Mexico-U.S. border. There is an urgent need to end U.S. asylum deterrence policies and to provide respectful, appropriate, and adequately resourced humanitarian supports to pregnant and parenting asylum-seeking women in border cities, to reduce women's risk of GBV and trauma.
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Affiliation(s)
- Kaylee Ramage
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
| | - Emma Stirling-Cameron
- Centre for Gender and Sexual Health Equity, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Isela Martinez SanRoman
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
- Center for Latin American Studies, San Diego State University, San Diego, CA, USA
| | - Ietza Bojorquez
- Department of Population Studies, El Colegio de la Frontera Norte, Tijuana, Mexico
| | - Arianna Spata
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
- Center for Latin American Studies, San Diego State University, San Diego, CA, USA
| | | | - Shira M Goldenberg
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA.
- Centre for Gender and Sexual Health Equity, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, USA.
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Coulson J, Sharma V, Wen H. Understanding the global dynamics of continuing unmet need for family planning and unintended pregnancy. CHINA POPULATION AND DEVELOPMENT STUDIES 2023; 7:1-14. [PMID: 37193368 PMCID: PMC10075166 DOI: 10.1007/s42379-023-00130-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/19/2023] [Indexed: 04/08/2023]
Affiliation(s)
- Justine Coulson
- United Nations Population Fund, China Office, Beijing, China
| | - Vinit Sharma
- United Nations Population Fund, Asia Pacific Regional Office, Bangkok, Thailand
| | - Hua Wen
- United Nations Population Fund, China Office, Beijing, China
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Adeyinka S, Lietaert I, Derluyn I. It Happened in the Desert, in Libya and in Italy: Physical and Sexual Violence Experienced by Female Nigerian Victims of Trafficking in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4309. [PMID: 36901324 PMCID: PMC10002192 DOI: 10.3390/ijerph20054309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
Nigerian girls and women constitute a large percentage of African victims of human trafficking in Italy. Extensive research has been conducted on the causes, push-and-pull factors, and the perpetrators in the phenomenon of trafficking Nigerian women and girls into Italy. However, limited data exist on the women and girls' narratives of their experiences during their migratory journey from Nigeria to Europe. Using data collected through a mixed method, longitudinal design, 31 female Nigerian victims of trafficking in Italy were interviewed for this study. This study gives voice to the experiences of sexual violence that these women and girls encounter during transit, leading to many of them arriving in Italy severely traumatized. It also discusses the health impact of these experiences and the different survival strategies that they are forced to employ. The study shows how sexual and physical violence is employed by smugglers, traffickers, and people in authority alike. It shows that the violence experienced along the way does not end after arrival in the destination country (in this case, Italy), but is, in some cases, exacerbated and similar to previous experiences of violence.
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15
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Aburto JM, di Lego V, Riffe T, Kashyap R, van Raalte A, Torrisi O. A global assessment of the impact of violence on lifetime uncertainty. SCIENCE ADVANCES 2023; 9:eadd9038. [PMID: 36735794 PMCID: PMC9897660 DOI: 10.1126/sciadv.add9038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/29/2022] [Indexed: 06/18/2023]
Abstract
Uncertainty around age at death, or lifetime uncertainty, is a key public health indicator and a marker of inequality in survival. How does the extent of violence affect lifetime uncertainty? We address this question by quantifying the impact of violence on dispersion in the ages at death, the metric most used to measure lifetime uncertainty. Using mortality data from the Global Burden of Disease Study and the Internal Peace Index between 2008 and 2017, we find that the most violent countries are also those with the highest lifetime uncertainty. In the Middle East, conflict-related deaths are the largest contributor to lifetime uncertainty. In Latin America, a similar pattern is attributable to homicides. The effects are larger in magnitude for men, but the consequences remain considerable for women. Our study points to a double burden of violence on longevity: Not only does violence shorten individual lives, but it also makes the length of life less predictable.
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Affiliation(s)
- José Manuel Aburto
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Leverhulme Centre for Demographic Science, Department of Sociology and Nuffield College, University of Oxford, Oxford, UK
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Vanessa di Lego
- Wittgenstein Centre (IIASA, OeAW, University of Vienna), Vienna Institute of Demography at the Austrian Academy of Sciences, Vienna, Austria
| | - Tim Riffe
- Max Planck Institute for Demographic Research, Rostock, Germany
- OPIK, Department of Sociology and Social Work, University of the Basque Country UPV/EHU, Leioa Bizkaia, Spain
- Ikerbasque, Basque Foundation for Science, Bilbao, Spain
| | - Ridhi Kashyap
- Leverhulme Centre for Demographic Science, Department of Sociology and Nuffield College, University of Oxford, Oxford, UK
| | | | - Orsola Torrisi
- London School of Economics, London, UK
- Social Science Division, New York University Abu Dhabi, Abu Dhabi, UAE
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16
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Cardenas P, Ásgeirsdóttir BB, Sam DL, Doná G. Stressful life events, psychological symptoms, and social support of children and young asylum-seekers in Iceland. Scand J Public Health 2022:14034948221142080. [DOI: 10.1177/14034948221142080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Children and young asylum-seekers are often exposed to stressful life events (SLEs) and risk developing psychological symptoms. However, risk and protective factors can positively and negatively influence this vulnerable group’s mental health. Aims: To examine the SLE experiences and psychological symptoms of children and youth who seek refuge in Iceland. And to study the role that gender, travelling (un)accompanied and perceived social support play in the development of psychological symptoms for this population. Methods: Participants were 75 children and youth of ages 13 to 24 years who sought asylum in Iceland ( M = 19.7, SD =3.0, 66.7% male). Sociodemographic and social support data were collected via face-to-face interviews, with the help of interpreters when required, while SLEs, post-traumatic stress, depression, anxiety and behavioural symptoms measures were administered to participants. Results: The results indicated that participants who travelled alone to Iceland had experienced more SLEs than those who travelled accompanied. SLE experiences were associated with post-traumatic stress disorder (PTSD) and other psychological symptoms. Results also revealed that SLE and perceived peer support played a significant role in predicting PTSD symptoms. Conclusions: Children and young asylum-seekers are exposed to a high number of SLEs, which increases their risk of developing psychological problems. This potential risk underlines the need for early assessments and intervention. Moreover, higher levels of social support were related to less severe PTSD symptoms, suggesting that social resources act as protective factors for these children and youth in helping them cope with SLEs.
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Affiliation(s)
| | | | | | - Giorgia Doná
- Department of Social Sciences, School of Education and Communities,University of East London, UK
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Capasso A, Skipalska H, Chakrabarti U, Guttmacher S, Navario P, Castillo TP. Patterns of Gender-Based Violence in Conflict-Affected Ukraine: A Descriptive Analysis of Internally Displaced and Local Women Receiving Psychosocial Services. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP21549-NP21572. [PMID: 34964399 PMCID: PMC9240103 DOI: 10.1177/08862605211063009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Since 2014, a protracted armed conflict has afflicted eastern Ukraine, resulting in the displacement of over 1.4 million residents. The resulting humanitarian crisis has placed women, particularly displaced women, at greater risk of gender-based violence (GBV). In Ukraine, reports of GBV were higher following the start of the conflict (22.4% in 2014 vs. 18.3% in 2007), with displaced women suffering from GBV nearly three times more than non-displaced residents (15.2% vs. 5.3%). Many GBV incidents in Ukraine have been reported along the "contact line," the border separating government from non-government-controlled areas. This study compares types of GBV experienced by displaced and local (non-displaced) women receiving psychosocial support in order to identify the gaps in services during a time of conflict. Data was collected by mental healthcare providers from 11,826 women (25.5% displaced; 74.5% local) aged 15 to 69 receiving psychosocial services in five conflict-affected regions from February 2016 to June 2017. Group differences were assessed using Pearson's chi-squared or Fisher's exact tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. Overall, almost half of the women experienced intimate partner violence and psychological abuse. Compared to residents, displaced women were more likely to report non-domestic GBV incidents involving sexual and economic violence. Almost 8% of violent incidents against displaced women occurred at checkpoints or at reception centers for internally displaced persons (IDP) and 20% were perpetrated by armed men. Consistent with the literature, this study suggests that displaced women are more vulnerable to attacks by persons outside the home and by armed groups. Our findings underscore the need to expand violence prevention programs to address the unique vulnerabilities of displaced women before, during, and after displacement. Programs should be tailored to prevent violence within and outside the home. Increased prevention efforts are needed in areas with high concentrations of armed men, along the contact line, and at IDP reception centers to protect displaced women. This is particularly urgent in the context of increased GBV due to COVID-19.
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Affiliation(s)
- Ariadna Capasso
- NYU School of Global Public Health, New York University, New York, NY, USA
| | - Halyna Skipalska
- Ukrainian Foundation for Public Health, Kiev, Ukraine
- HealthRight International, New York, NY, USA
| | | | - Sally Guttmacher
- NYU School of Global Public Health, New York University, New York, NY, USA
- HealthRight International, New York, NY, USA
| | - Peter Navario
- NYU School of Global Public Health, New York University, New York, NY, USA
- HealthRight International, New York, NY, USA
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18
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Blukacz A, Carreño Calderon A, Obach A, Cabieses B, Peroncini J, Oliva A. Perceptions of Health Needs among Venezuelan Women Crossing the Border in Northern Chile during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15175. [PMID: 36429892 PMCID: PMC9690325 DOI: 10.3390/ijerph192215175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
In parallel to the COVID-19 pandemic, Chile has experienced a significant influx of international migrants, many of whom are Venezuelan women who have entered the country through unauthorized crossing points. In this context, gender and migration intersect as the social determinants of health, leading to their experiencing a range of adverse events. This poses important challenges in terms of short- and long-term health outcomes, the social determinants of health, and access to healthcare. This study aims at describing Venezuelan women's perceptions of their health needs as they migrate to Chile via an unauthorized crossing point, with a focus on adverse events throughout the migration cycle, self-reported health needs, and responses. A qualitative case study was carried out with 22 participants in the Antofagasta region of Chile, including Venezuelan migrant women, healthcare professionals, and social workers from the public healthcare system, stakeholders from non-governmental and international organizations, and local government officials. The semi-structured, individual interviews were analyzed thematically. The results show that Venezuelan women face a range of adverse events throughout the migration cycle. The perceived health needs that are reported are sometimes linked to these adverse events or existed prior to migration and were exacerbated throughout the migratory cycle. Addressing these physical and mental health needs is essential for short- and long-term individual and public health; however, despite substantial efforts to ameliorate the situation, persisting gaps in access to care are reported.
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Affiliation(s)
- Alice Blukacz
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7610658, Chile
| | - Alejandra Carreño Calderon
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7610658, Chile
| | - Alexandra Obach
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7610658, Chile
| | - Báltica Cabieses
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7610658, Chile
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Jeniffer Peroncini
- Subsistema Chile Crece Contigo, Subsecretaria de la Niñez, Ministerio de Desarrollo Social y Familia, Santiago 8320000, Chile
| | - Alejandra Oliva
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7610658, Chile
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19
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Hawkey AJ, Ussher JM, Perz J. What do women want? Migrant and refugee women's preferences for the delivery of sexual and reproductive healthcare and information. ETHNICITY & HEALTH 2022; 27:1787-1805. [PMID: 34569377 DOI: 10.1080/13557858.2021.1980772] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Migrant and refugee women experience inequities in sexual and reproductive health (SRH) care, reflected in the low uptake of SRH services. It is essential for healthcare providers and educators to be aware of women's preferences for SRH information and service delivery, to provide culturally responsive care. Identifying migrant and refugee women's preferences for SRH information and service delivery is the objective of this study. DESIGN This study investigated this issue, in communities of migrant and refugee women living in Australia and Canada. Eighty-four individual interviews and 16 focus groups comprising 85 participants were conducted (total n = 169), with migrant and refugee women aged 18 years and over from Afghanistan, India (Punjab), Iraq, Somalia, South Sudan, Sri-Lanka (Tamil), Sudan and various South American (Latina) backgrounds. Nine individual interviews were also undertaken with community interviewers, who were migrant or refugee women themselves. RESULTS Thematic analyses identified that migrant and refugee women are enthusiastic to learn about SRH across the lifespan, using a variety of modalities including group education delivered by community leaders; online and written material; and information provided by general practitioners. Participants emphasised the need for empathetic SRH care, which encompassed longer times for consultations, being seen as experts of their own bodies, privacy and healthcare provided by women practitioners. Greater engagement with migrant and refugee men was positioned as an additional solution to addressing SRH concerns of women. CONCLUSION Insights from this study can help facilitate the co-design and evaluation of acceptable and sustainable programs to address inequities in SRH experienced by migrant and refugee women.
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Affiliation(s)
- Alexandra J Hawkey
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Jane M Ussher
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Janette Perz
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
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20
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Stark L, Robinson MV, Seff I, Gillespie A, Colarelli J, Landis D. The Effectiveness of Women and Girls Safe Spaces: A Systematic Review of Evidence to Address Violence Against Women and Girls in Humanitarian Contexts. TRAUMA, VIOLENCE & ABUSE 2022; 23:1249-1261. [PMID: 33612087 DOI: 10.1177/1524838021991306] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
One in three women and girls will experience violence in their lifetime. In conflict and postconflict settings, the incidence of violence against women and girls (VAWG) is exacerbated, resulting in increased negative social, economic, health, and psychosocial effects. In an attempt to prevent and respond to the occurrence of VAWG in humanitarian settings, Women and Girls Safe Spaces (WGSS) have been promoted as a promising intervention. The authors conducted a systematic review to examine the current quantitative evidence available on the impact and effectiveness of WGSS programs. The authors reviewed relevant peer-reviewed and gray literature using predefined search terms for potential inclusion. Seven records met inclusion criteria. Records included evaluations of WGSS programs implemented in the Democratic Republic of the Congo, Ethiopia, Uganda, Tanzania, Kenya, Bangladesh, and Pakistan. While none of the studies reported reductions in exposure to or incidence of VAWG among program participants, three evaluations demonstrated moderate improvements in psychosocial well-being, social support, and attitudes toward rites of passage. Additionally, only three of the seven evaluations employed rigorous methodologies. This study illustrates the paucity of existing quantitative evidence around the impact of WGSS and the need for further research examining the potential benefits of this widely implemented intervention for women and girls. A stronger evidence base has the potential to inform policy and program development and to help governments, organizations, and communities better allocate limited resources in response to VAWG.
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Affiliation(s)
- Lindsay Stark
- 51503Brown School, Washington University in St. Louis, MO, USA
| | | | - Ilana Seff
- 51503Brown School, Washington University in St. Louis, MO, USA
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Alli Gillespie
- 51503Brown School, Washington University in St. Louis, MO, USA
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Lee SM. Investigating the Effect of Compassion Fade in Volunteer Tourism. Behav Sci (Basel) 2022; 12:bs12090319. [PMID: 36135123 PMCID: PMC9495921 DOI: 10.3390/bs12090319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 11/24/2022] Open
Abstract
This study investigated the relationship between the type of volunteer tourism (human vs. flora vs. fauna) and the type of message (individual with no statistic vs. individual with small statistic vs. individual with large statistic) and potential tourists’ attitudes towards volunteer tourism and their intention to donate their time. To do so, this study conducted a between-subject 3 × 3 factorial design online experiment, where the influences of compassion fade on attitudes and behavioral intention to donate time for volunteer tourism, along with the impacts of positive affect, emotional involvement, and credibility, were examined. The results of the current study revealed that type of volunteer tourism and type of message do not affect attitude towards volunteer tourism and attitude towards the ad. Further analysis indicated that, among all three mediating variables, only positive affect mediated the relationship between type of volunteer tourism and attitude towards volunteer tourism, and all other hypotheses were not statistically significant. Moreover, the results indicated that there is a positive relationship between perceived ad credibility and attitude towards the ad, and also between perceived ad credibility and attitude towards volunteer tourism. The implications of these results are discussed based on the empirical findings.
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Affiliation(s)
- Sae-Mi Lee
- The Center for Regional Development, Chonnam National University, Gwangju 61186, Korea
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22
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Adejumo OA, Ntoimo L, Odimayo MS, Adebimpe WO, Okiei B, Osungbemiro W, Olajuyigbe E, Igbafe K, Temitayo-Oboh A, Faboya T, Oludiran O, Okonofua FE. Experience of Gender-based Violence by Internally Displaced Women in Southern Nigeria: A Cross-sectional Study. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP12794-NP12819. [PMID: 33719710 DOI: 10.1177/08862605211001464] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Gender-based violence (GBV) is a reproductive health issue prevalent among persons in conflict and post-conflict situations, but is largely under-reported in Nigeria. Although GBV affects both sexes, the prevalence is higher in women as compared to men. The objective of this study was to assess the experiences of female internally displaced persons (IDPs) in Nigeria during conflict and post-conflict situations. The study was conducted among IDPs in Edo State, south-south region of Nigeria. Data were collected with a semi-structured questionnaire administered on 300 female IDPs. Descriptive and inferential analyses were conducted. GBV perpetrated by non-family members during conflict was experienced by 22.2% of the respondents while 13.5% experienced post-conflict violence. Up to 12.2% reported violence by intimate partners. Physical violence was commonly experienced during conflict, while sexual violence was most common post-conflict. Logistic regression analysis showed that the vulnerable categories of women were adolescents, unmarried women, women of Hausa origin, women who never attended school, and those whose displacement took place in the year prior to the study. The IDP camp appeared to offer some protection against GBV as those who had stayed in the camp longer were less likely to experience post-conflict GBV. The lack of implementation of effective laws and regulations that prevent violence against women and punish perpetuators in the country, and the ineffective security systems are some of the factors that sustain GBV. The results of this study have implications for the design of programs for the prevention of GBV during conflict and post-conflict situations.
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Affiliation(s)
| | | | | | | | - Benedette Okiei
- University of Medical Sciences (UNIMED), Ondo State, Nigeria
| | | | | | - Kate Igbafe
- University of Medical Sciences (UNIMED), Ondo State, Nigeria
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Phillimore J, Block K, Bradby H, Ozcurumez S, Papoutsi A. Forced Migration, Sexual and Gender-based Violence and Integration: Effects, Risks and Protective Factors. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2022. [DOI: 10.1007/s12134-022-00970-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AbstractThis 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.
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van Daalen KR, Kallesøe SS, Davey F, Dada S, Jung L, Singh L, Issa R, Emilian CA, Kuhn I, Keygnaert I, Nilsson M. Extreme events and gender-based violence: a mixed-methods systematic review. Lancet Planet Health 2022; 6:e504-e523. [PMID: 35709808 PMCID: PMC10073035 DOI: 10.1016/s2542-5196(22)00088-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 05/03/2023]
Abstract
The intensity and frequency of extreme weather and climate events are expected to increase due to anthropogenic climate change. This systematic review explores extreme events and their effect on gender-based violence (GBV) experienced by women, girls, and sexual and gender minorities. We searched ten databases until February, 2022. Grey literature was searched using the websites of key organisations working on GBV and Google. Quantitative studies were described narratively, whereas qualitative studies underwent thematic analysis. We identified 26 381 manuscripts. 41 studies were included exploring several types of extreme events (ie, storms, floods, droughts, heatwaves, and wildfires) and GBV (eg, sexual violence and harassment, physical violence, witch killing, early or forced marriage, and emotional violence). Studies were predominantly cross-sectional. Although most qualitative studies were of reasonable quality, most quantitative studies were of poor quality. Only one study included sexual and gender minorities. Most studies showed an increase in one or several GBV forms during or after extreme events, often related to economic instability, food insecurity, mental stress, disrupted infrastructure, increased exposure to men, tradition, and exacerbated gender inequality. These findings could have important implications for sexual-transformative and gender-transformative interventions, policies, and implementation. High-quality evidence from large, ethnographically diverse cohorts is essential to explore the effects and driving factors of GBV during and after extreme events.
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Affiliation(s)
| | - Sarah Savić Kallesøe
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Centre for Infectious Disease Genomics and One Health, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Fiona Davey
- Health Equity Network, University of Cambridge, Cambridge, UK
| | - Sara Dada
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems, School of Nursing, Midwifery, and Health Systems, University College Dublin, Dublin, Ireland
| | - Laura Jung
- Medical Faculty, Leipzig University, Leipzig, Germany
| | - Lucy Singh
- London School of Hygiene & Tropical Medicine, London, UK
| | - Rita Issa
- Institute for Global Health, University College London, London, UK
| | - Christina Alma Emilian
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Isla Kuhn
- Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Ines Keygnaert
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Maria Nilsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Chynoweth SK, Buscher D, Martin S, Zwi AB. Characteristics and Impacts of Sexual Violence Against Men and Boys in Conflict and Displacement: A Multicountry Exploratory Study. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP7470-NP7501. [PMID: 33118459 DOI: 10.1177/0886260520967132] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Evidence of sexual violence against men and boys in many conflict-affected settings is increasingly recognized. Yet relatively little is currently known about the varied forms, sites, and impacts of this violence. Further, scant research on sexual violence against men and boys in displacement contexts has been undertaken to date. To begin to address these knowledge gaps, we undertook a multicountry, qualitative, exploratory study to gain insights into these issues. Study settings and populations were Rohingya refugees in Bangladesh; refugees and migrants who had traveled through Libya residing in Italy; and refugees from eastern Democratic Republic of the Congo (DRC), Somalia, and South Sudan residing in Nairobi and Mombasa, Kenya. Methods included 55 semi-structured focus group discussions with 310 refugees and semi-structured key informant interviews with 148 aid workers and human rights experts. Data were thematically analyzed using NVivo 12. Findings suggest that sexual violence against men and boys may not be rare in Myanmar (northern Rakhine state), Libya, eastern DRC, and South Sudan. Frequently reported forms of violence in these settings were genital violence, forced witnessing of sexual violence, and rape. Sites where violence was often reported included border crossings, along the roadside, and during imprisonment. In host countries, forms of sexual violence included sexual abuse of boys, sexual exploitation particularly of adolescents and persons with diverse sexual orientation and gender identity, and rape. Impacts on survivors involved short- and long-term physical, mental, economic, and familial dimensions. These findings aim to inform sexual violence-related prevention, mitigation, and response efforts in humanitarian settings. More research is warranted, including on sexual violence against men and boys in Somalia, sexual violence by family and community members in conflict and displacement settings, sexual exploitation of adolescent boys, and sexual violence including sexual exploitation of persons with diverse sexual orientation and gender identity.
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Affiliation(s)
- Sarah K Chynoweth
- Women's Refugee Commission, New York, NY, USA
- The University of New South Wales, Sydney, NSW, Australia
| | | | - Sarah Martin
- Gender Associations International Consulting, Berlin, Germany
| | - Anthony B Zwi
- The University of New South Wales, Sydney, NSW, Australia
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Mora Ladino M, Villaquirán JE, Arboleda Trujillo MA, Pacichana-Quinayáz SG, Fandiño-Losada A, Gutiérrez Martínez MI. Exposure to gender violence in a population of women consulting a Community Psychiatry service in Cali, Colombia. Rev Salud Publica (Bogota) 2022. [DOI: 10.15446/rsap.v24n2.100270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo Conocer las características sociales, sintomatología mental y exposiciones a hechos de violencia de mujeres consultantes a un servicio de salud mental comunitaria en una Institución de Atención Primaria.
Metodología Se realizó un estudio de corte trasversal descriptivo en el programa de Psiquiatría Comunitaria de dos centros asistenciales de la Red de Salud de Ladera E. S. E. en Cali, Colombia. Se analizó el contenido de 157 registros del año 2018, usando estadística descriptiva para las variables sociodemográficas, clínicas y relacionadas con su historial psiquiátrico.
Resultados El 43,59% del total de las mujeres consultó por trastornos afectivos, ninguna enunció situaciones relacionadas con violencia en el motivo de consulta. Sin embargo, cerca del 16% enunció situaciones de violencia en el apartado de “enfermedad actual”, mientras que el 39,49% lo señaló como parte de los “antecedentes personales”, y el 15,29% lo relacionó con los “antecedentes familiares”. tras comparar este grupo de mujeres expuestas a violencia con las no expuestas, se encontró que los trastornos depresivos eran más frecuentes en el grupo expuesto (58,53%; p=0,035). El manejo farmacológico fue más frecuente en mujeres no expuestas y de tipo psicosocial en mujeres expuestas (p<0,05).
Conclusiones Aunque se hubiese enunciado alguna forma de violencia dentro del contenido de las historias clínicas, menos del 2% de los reportes incluyó diagnósticos relacionados con violencia de género.
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Singh A, El-Bassel N, Kaushal N, Meinhart M, Hartmann JK, Mukherjee T, Khadra M, Jaber R, Al-Qutob R, Dasgupta A. Financial dependence and intimate partner violence (IPV) among married Syrian refugee women living in non-camp settings in Jordan. JOURNAL OF GLOBAL HEALTH REPORTS 2022. [DOI: 10.29392/001c.33049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ajita Singh
- Columbia University School of Social Work, New York, USA
| | | | - Neeraj Kaushal
- Columbia University School of Social Work, New York, USA
| | | | | | - Trena Mukherjee
- Columbia University, Mailman School of Public Health, New York, USA
| | - Maysa’ Khadra
- University of Jordan School of Medicine, Amman, Jordan
| | - Ruba Jaber
- University of Jordan School of Medicine, Amman, Jordan
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Sharma V, Ausubel E, Heckman C, Rastogi S, Kelly JTD. Promising practices for the monitoring and evaluation of gender-based violence risk mitigation interventions in humanitarian response: a multi-methods study. Confl Health 2022; 16:11. [PMID: 35248125 PMCID: PMC8898064 DOI: 10.1186/s13031-022-00442-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 02/17/2022] [Indexed: 11/21/2022] Open
Abstract
Background Risks of gender-based violence (GBV) are exacerbated in humanitarian crises. GBV risk mitigation interventions aim to reduce exposure to GBV and ensure that humanitarian response actions and services themselves do not cause harm or increase the risk of violence. The 2015 IASC Guidelines for Integrating Gender-Based Violence Interventions in Humanitarian Action (‘GBV Guidelines’) are a globally endorsed resource that provides comprehensive guidance for all humanitarian actors and sectors on GBV risk mitigation. While uptake of GBV risk mitigation approaches across multiple humanitarian sectors has occurred, there is limited understanding of how to monitor and evaluate GBV risk mitigation interventions. Methods A multi-methods study was conducted in 2019 to identify promising practices for the monitoring and evaluation (M&E) of GBV risk mitigation interventions in non-GBV sectors and to develop a set of illustrative case examples. The study included a comprehensive desk review of 145 articles, documents and resources from the published and grey literature, as well as 11 in-depth interviews and five focus group discussions with humanitarian practitioners. Using Dedoose software and a codebook developed a priori, qualitative data were transcribed and coded and a content analysis was conducted. Excerpts focusing on promising practices from the qualitative data and the desk review were analyzed together and grouped by thematic area. Similar promising practices were combined and consolidated to create a final list, and case examples were identified. Results Current promising practices for M&E of GBV risk mitigation activities in the following categories are described: (1) Coordination and collaboration, (2) Designing M&E approaches and tools for GBV risk mitigation activities, (3) Contextualization, (4) Developing and selecting indicators, (5) Data collection, (6) Data analysis and use of findings, (7) Potential safety concerns for affected populations and staff, and (8) Staff capacity and engagement. These are supplemented with seven diverse case examples to illustrate application of the promising practices using real-world examples. Conclusion This paper highlights current promising practices for M&E of GBV risk mitigation interventions in humanitarian response. Further application of these practices—alongside ongoing documentation of emerging approaches—will be critical to ensuring that GBV risk mitigation interventions are more rigorously tested with the aim of building the evidence base on the effectiveness of different GBV risk mitigation interventions within specific humanitarian sectors.
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Psychological Interventions for Survivors of Intimate Partner Violence in Humanitarian Settings: An Overview of the Evidence and Implementation Considerations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052916. [PMID: 35270610 PMCID: PMC8910593 DOI: 10.3390/ijerph19052916] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 01/27/2023]
Abstract
This paper provides an analytical overview of different types of psychological interventions that have demonstrated efficacy in low-income and/or humanitarian settings and points to special considerations that may be needed if used with women who have been subjected to gender-based violence (GBV). This paper reviews diverse therapeutic modalities and contrasts them across several domains, including their conventional use and principles; their documented use and efficacy in humanitarian settings; any special considerations or modifications necessary for GBV-affected clients; and any additional resources or implementation concerns when working in low-income contexts. By examining the evidence base of multiple interventions, we hope to provide clinicians and GBV-prevention advocates with an overview of tools/approaches to provide survivor-centered, trauma-informed responses to GBV survivors. This analysis responds to the growing recognition that gender-based violence, in particular intimate partner violence and sexual violence, is strongly associated with mental health problems, including anxiety, depression, and post-traumatic stress. This is likely to be exacerbated in humanitarian contexts, where people often experience multiple and intersecting traumatic experiences. The need for mental health services in these settings is increasingly recognized, and a growing number of psychological interventions have been shown to be effective when delivered by lay providers and in humanitarian settings.
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Sapire R, Ostrowski J, Maier M, Samari G, Bencomo C, McGovern T. COVID-19 and gender-based violence service provision in the United States. PLoS One 2022; 17:e0263970. [PMID: 35171963 PMCID: PMC8849472 DOI: 10.1371/journal.pone.0263970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 02/01/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Gender-based violence (GBV) policies and services in the United States (U.S.) have historically been underfunded and siloed from other health services. Soon after the onset of the COVID-19 pandemic, reports emerged noting increases in GBV and disruption of health services but few studies have empirically investigated these impacts. This study examines how the existing GBV funding and policy landscape, COVID-19, and resulting state policies in the first six months of the pandemic affect GBV health service provision in the U.S. METHODS This is a mixed method study consisting of 1) an analysis of state-by-state emergency response policies review; 2) a quantitative analysis of a survey of U.S.-based GBV service providers (N = 77); and 3) a qualitative analysis of in-depth interviews with U.S.-based GBV service providers (N = 11). Respondents spanned a range of organization types, populations served, and states. RESULTS Twenty-one states enacted protections for GBV survivors and five states included explicit exemptions from non-essential business closures for GBV service providers. Through the surveys and interviews, GBV service providers note three major themes on COVID-19's impact on GBV services: reductions in GBV service provision and quality and increased workload, shifts in service utilization, and funding impacts. Findings also indicate GBV inequities were exacerbated for historically underserved groups. DISCUSSION The noted disruptions on GBV services from the COVID-19 pandemic overlaid long-term policy and funding limitations that left service providers unprepared for the challenges posed by the pandemic. Future policies, in emergency and non-emergency contexts, should recognize GBV as essential care and ensure comprehensive services for clients, particularly members of historically underserved groups.
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Affiliation(s)
- Rachel Sapire
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, United States of America
- * E-mail:
| | - Jennifer Ostrowski
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, United States of America
- Program on Global Health Justice and Governance, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Malia Maier
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, United States of America
- Program on Global Health Justice and Governance, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Goleen Samari
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, United States of America
- Program on Global Health Justice and Governance, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Clarisa Bencomo
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, United States of America
- Program on Global Health Justice and Governance, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Terry McGovern
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, United States of America
- Program on Global Health Justice and Governance, Columbia University Mailman School of Public Health, New York, New York, United States of America
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Blackmore R, Gray KM, Melvin GA, Newman L, Boyle JA, Gibson-Helm M. Identifying post-traumatic stress disorder in women of refugee background at a public antenatal clinic. Arch Womens Ment Health 2022; 25:191-198. [PMID: 34351511 DOI: 10.1007/s00737-021-01167-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
The aim of this study was to investigate symptomatology and diagnoses of PTSD and subthreshold PTSD and the screening properties of the Harvard Trauma Questionnaire (HTQ) within a sample of Dari-speaking women of refugee background receiving antenatal care. This cross-sectional study administered the HTQ to 52 Dari-speaking women at a public pregnancy clinic. The trauma module from the Structured Clinical Interview (SCID-5) was administered. Interview material was presented to an expert panel, blinded to the HTQ screening results, in order to achieve consensus diagnoses of PTSD using Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) criteria. Three women (5.8%) met DSM-5 criteria for PTSD. Eleven women (21.15%) met criteria for subthreshold PTSD, defined as meeting two or three of the DSM-5 criteria domains. A comparison of HTQ cut-off scores was conducted and a score of ≥ 2.25 on the HTQ demonstrated excellent sensitivity 1.00 (95% CI 0.29-1.00) and specificity 0.76 (95% CI 0.61-0.87) in detecting PTSD; however, a wide confidence interval for sensitivity was found. A cut-off score of ≥ 2 provided the best balance of sensitivity 1.00 (95% CI 0.72-1.00) and specificity 0.80 (95% CI 0.65-0.91) when assessing for subthreshold PTSD. Screening for perinatal PTSD for women of refugee background is recommended, in order to identify those at risk of DSM diagnosis and also those women experiencing distressing PTSD symptomatology.
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Affiliation(s)
- Rebecca Blackmore
- Monash Centre for Health, Research & Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia
| | - Kylie M Gray
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK.,Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Glenn A Melvin
- Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, Australia.,Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Melbourne, Australia
| | - Louise Newman
- Centre for Women's Mental Health, The Royal Women's Hospital, Melbourne, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health, Research & Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia
| | - Melanie Gibson-Helm
- Monash Centre for Health, Research & Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia. .,Centre for Women's Health Research, Te Tātai Hauora O Hine, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand.
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Murray SM, Lasater ME, Guimond MF, Poku O, Musci R, Al-Fataftah M, Kasina L, Lwambi M, Salaimeh A, Falb K. Measuring sexual violence stigma in humanitarian contexts: assessment of scale psychometric properties and validity with female sexual violence survivors from Somalia and Syria. Confl Health 2021; 15:96. [PMID: 34952621 PMCID: PMC8709979 DOI: 10.1186/s13031-021-00431-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/09/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Valid measures of sexual violence stigma that can be readily incorporated into program monitoring and evaluation systems are needed to strengthen gender-based violence (GBV) services in humanitarian emergencies. This study sought to assess the psychometric properties, construct validity, and measurement invariance of sexual violence stigma scales among female Somali GBV survivors in Kenya and Syrian GBV survivors in Jordan to identify an abbreviated scale that could be used across humanitarian contexts. METHODS We administered measures of sexual violence stigma to 209 female survivors of sexual violence aged 15 and older in Kenya and Jordan. Exploratory factor analysis was used to assess the underlying latent structure, and Item Response Theory was used to estimate item difficulty and discrimination parameters to guide efforts to shorten the scales. Differential item functioning (DIF) by site was assessed using Multiple Indicators, Multiple Causes models. Construct validity of the sexual violence stigma scales was assessed by estimating correlations with functional impairment, depression, and disability. RESULTS The sexual violence stigma measure exhibited distinct factor structures among Somali and Syrian GBV survivors. Among Somali survivors, a two-factor model with separate felt (10 items) and enacted (4 items) stigma constructs was identified, with scales for both domains exhibiting good internal consistency (Cronbach's alpha = 0.93 and 0.88, respectively). In Jordan, a single factor solution was uncovered for a 15-item stigma scale with good internal consistency (alpha = 0.86). The shortened core sexual stigma scale consisting of the 4 items that did not exhibit DIF had a Cronbach's alpha of 0.82 in Kenya and 0.81 in Jordan. The felt stigma scale in Kenya, the full stigma scale in Jordan, and abbreviated core stigma scales in both countries were meaningfully correlated with depression, while correlations with functional impairment were weaker and inconsistent across scales. CONCLUSIONS An abbreviated core set of invariant perceived and internalized sexual violence stigma items demonstrated evidence of construct validity in two diverse settings. The ability of this measure to be efficiently administered as a part of routine program monitoring and evaluation activities, with the potential addition of items from a measurement bank to improve contextual relevance, can facilitate improvements in the delivery and quality of gender-based violence programs in humanitarian emergencies.
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Affiliation(s)
- Sarah M. Murray
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway Street, Baltimore, MD 21205 USA
| | - Molly E. Lasater
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway Street, Baltimore, MD 21205 USA
| | - Marie-France Guimond
- grid.420433.20000 0000 8728 7745Airbel Impact Lab, International Rescue Committee, New York, NY USA
| | - Ohemaa Poku
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway Street, Baltimore, MD 21205 USA
| | - Rashelle Musci
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway Street, Baltimore, MD 21205 USA
| | - Manal Al-Fataftah
- Women Protection and Empowerment Program, International Rescue Committee, Amman, Jordan
| | - Lilian Kasina
- Design Monitoring and Evaluation Unit, International Rescue Committee, Nairobi, Kenya
| | - Mercy Lwambi
- Women’s Protection and Empowerment Program, International Rescue Committee, Nairobi, Kenya
| | - Asma Salaimeh
- Monitoring, Evaluation, Accountability and Learning Unit, International Rescue Committee, Amman, Jordan
| | - Kathryn Falb
- grid.420433.20000 0000 8728 7745Airbel Impact Lab, International Rescue Committee, Washington, DC USA
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Berthe-Kone O, Ventura-Miranda MI, López-Saro SM, García-González J, Granero-Molina J, Jiménez-Lasserrotte MDM, Fernández-Sola C. The Perception of African Immigrant Women Living in Spain Regarding the Persistence of FGM. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13341. [PMID: 34948950 PMCID: PMC8704587 DOI: 10.3390/ijerph182413341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/27/2022]
Abstract
Approximately 200 million women and girls have undergone female genital mutilation (FGM) worldwide. Migration has spread the practice of FGM around the world, thus making it a global public health issue. The objective of this descriptive qualitative study was to explore the perceptions of Sub-Saharan immigrant women in Spain in relation to the causes of the persistence of FGM. In-depth interviews were carried out with 13 female FGM survivors of African origin, followed by inductive data analysis using ATLAS.ti software. Two main themes emerged from the analysis: (1) A family ritual symbolic of purification and (2) a system of false beliefs and deception in favour of FGM. The FGM survivors living in Europe are aware that FGM is a practice that violates human rights yet persists due to a system of false beliefs rooted in family traditions and deception that hides the reality of FGM from young girls or forces them to undergo the practice. The ritualistic nature of FGM and the threat of social exclusion faced by women who have not had it performed on them contributes to its persistence nowadays.
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Affiliation(s)
- Ousmane Berthe-Kone
- Surgical Critical Resuscitation, Torrecárdenas University Hospital, 04009 Almeria, Spain;
| | - María Isabel Ventura-Miranda
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almeria, Spain; (J.G.-G.); (J.G.-M.); (M.d.M.J.-L.); (C.F.-S.)
| | | | - Jessica García-González
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almeria, Spain; (J.G.-G.); (J.G.-M.); (M.d.M.J.-L.); (C.F.-S.)
| | - José Granero-Molina
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almeria, Spain; (J.G.-G.); (J.G.-M.); (M.d.M.J.-L.); (C.F.-S.)
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago 7500000, Chile
| | - María del Mar Jiménez-Lasserrotte
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almeria, Spain; (J.G.-G.); (J.G.-M.); (M.d.M.J.-L.); (C.F.-S.)
| | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almeria, Spain; (J.G.-G.); (J.G.-M.); (M.d.M.J.-L.); (C.F.-S.)
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago 7500000, Chile
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Tankink JB, Verschuuren AEH, Postma IR, van der Lans PJA, de Graaf JP, Stekelenburg J, Mesman AW. Childbirths and the Prevalence of Potential Risk Factors for Adverse Perinatal Outcomes among Asylum Seekers in The Netherlands: A Five-Year Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412933. [PMID: 34948540 PMCID: PMC8700803 DOI: 10.3390/ijerph182412933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/26/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022]
Abstract
This five-year cross-sectional study mapped the prevalence of several known risk factors for adverse perinatal outcomes in asylum-seeking women in The Netherlands. Characteristics of 2831 registered childbirths among residents of asylum seekers centers (ASCs) in The Netherlands from 2016 to 2020 were included. Results showed a high general and teenage birthrate (2.15 and 6.77 times higher compared to the Dutch, respectively). Most mothers were pregnant upon arrival, and the number of births was highest in the second month of stay in ASCs. Another peak in births between 9 and 12 months after arrival suggested that many women became pregnant shortly after arrival in The Netherlands. Furthermore, 69.5 percent of all asylum-seeking women were relocated between ASCs at least once during pregnancy, which compromises continuity of care. The high prevalence of these risk factors in our study population might explain the increased rate of adverse pregnancy outcomes in asylum seekers compared to native women found in earlier studies. Incorporating migration-related indicators in perinatal health registration is key to support future interventions, policies, and research. Ultimately, our findings call for tailored and timely reproductive and perinatal healthcare for refugee women who simultaneously face the challenges of resettlement and pregnancy.
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Affiliation(s)
- Julia B. Tankink
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands;
- Correspondence: (J.B.T.); (A.E.H.V.)
| | - Anouk E. H. Verschuuren
- Global Health Unit, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Correspondence: (J.B.T.); (A.E.H.V.)
| | - Ineke R. Postma
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Peggy J. A. van der Lans
- Department of Obstetrics and Gynecology, Hospital Twente ZGT/MST, 7512 KZ Enschede, The Netherlands;
| | - Johanna P. de Graaf
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands;
| | - Jelle Stekelenburg
- Global Health Unit, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, The Netherlands
| | - Annelies W. Mesman
- Netherlands Association for Community Health Services (GGD GHOR Nederland), Zwarte Woud 2, 3524 SJ Utrecht, The Netherlands;
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Ovental A, Doyev R, Mangel L, Herzlich J, Hadanny A, Marom R. Neonatal morbidity among African refugee women in Israel: a case-control study. BMJ Open 2021; 11:e050778. [PMID: 34880015 PMCID: PMC8655578 DOI: 10.1136/bmjopen-2021-050778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Reports on neonatal morbidity (NM) among refugees in developed countries remain inconsistent. We aimed to compare NM among infants of African refugees in Israel to the native population based on a large population sample. DESIGN A case-control study. SETTING A tertiary hospital in Israel. PARTICIPANTS Data on hospital-based live births of refugee women and their newborns who were born in 2014 and 2017 were retrieved from medical records. Perinatal and neonatal data were compared between the refugee group and the native residents matched for gestational age and year of birth as well as within the refugee group. PRIMARY OUTCOME Prevalence of NM among African refugees in Israel. RESULTS Newborns delivered by 357 refugee women (mean age 30.2 years) and 357 controls (mean age 32.2 years) were analysed. Both groups were similar for the newborns' weight and gestational age. There were no significant differences in NM between the groups. A within-refugee comparison conducted between 2014 and 2017 yielded significant differences in birth weight (3051.4 vs 3373.6 gr, p<0.001, 95% CI (198.3 to 446.2), d=0.56), the number of twin deliveries (10 vs 4, p=0.002, Φ=0.173), the number of neonates evaluated as small for gestational age (15 vs 10, p=0.003, Φ=0.167) and the use of human milk (71% vs 93%, p<0.001, Φ=-0.298). CONCLUSIONS We conclude that NM among neonates born to refugee mothers was not higher than that of neonates born to native Israeli mothers. We suggest that successful implementation of health policies for refugees has improved their accessibility to mother-child health services.
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Affiliation(s)
- Amit Ovental
- Department of Neonatology, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Reut Doyev
- Department of Neonatology, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Laurence Mangel
- Department of Neonatology, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jacky Herzlich
- Department of Neonatology, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Amir Hadanny
- The Mina and Everard Goodman Faculty of Life Sciences, Bar Ilan University, Ramat Gan, Israel
| | - Ronella Marom
- Department of Neonatology, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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The impact of interventions to reduce risk and incidence of intimate partner violence and sexual violence in conflict and post-conflict states and other humanitarian crises in low and middle income countries: a systematic review. Confl Health 2021; 15:86. [PMID: 34819111 PMCID: PMC8611888 DOI: 10.1186/s13031-021-00417-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/21/2021] [Indexed: 01/16/2023] Open
Abstract
Sexual violence and intimate partner violence are exacerbated by armed conflict and other humanitarian crises. This narrative systematic review of evidence for interventions to reduce risk and incidence of sexual and intimate partner violence in conflict, post-conflict and other humanitarian crises, updates and expands our review published in 2013. A search of ten bibliographic databases for publications from January 2011 to May 2020 used database specific key words for sexual/intimate partner violence and conflict/humanitarian crisis. The 18 papers, describing 16 studies were undertaken in conflict/post-conflict settings in 12 countries. Six intervention types were reported: i) personnel; ii) community mobilisation; iii) social norms; iv) economic empowerment; v) empowerment; and vi) survivor responses, with the most common being economic empowerment (n = 7) and gendered social norms interventions (n = 6). Combined interventions were reported in nine papers. Four studies identified non-significant reductions in incidence of sexual/ intimate partner violence, showing an evident positive trend; all four evaluated gendered social norms or economic empowerment singly or in combination. Evidence for improved mental health outcomes was found for some economic empowerment, social norms and survivor interventions. Some evidence of reduced risk of sexual violence and intimate partner violence was identified for all intervention types. Qualitative studies suggest that experiences of social connection are important for women who participate in programming to address sexual and intimate partner violence. Interventions with multiple strategies appear to hold merit. Achieving and demonstrating reduced sexual and intimate partner violence remains challenging in this context. Future research should continue to explore how social norms interventions can be most effectively delivered, including the impact of including mixed and same sex groups. Work is needed with local partners to ensure programs are contextually adapted.
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Narratives of experiences of violence of Venezuelan migrant women sheltered at the northwestern Brazilian border. PLoS One 2021; 16:e0260300. [PMID: 34797877 PMCID: PMC8604314 DOI: 10.1371/journal.pone.0260300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 11/06/2021] [Indexed: 11/19/2022] Open
Abstract
Objectives To know the experiences of Venezuelan migrant women living in shelters in Roraima state at the northwestern border between Venezuela and Brazil regarding situations of violence as part of the dynamics of everyday life. Materials and methods Data were collected in January 2020 through 12 focus group discussions (FGDs) with 5 to 14 Venezuelan migrant women aged 18–49 years old living transitorily in five shelters established by the United Nations High Commissioner for Refugees (UNHCR) and the Brazilian government. We obtained individual and shared views on the experiences regarding violence that migrant women may experience in their everyday life. To organize the FGDs, variations in age and the time women were living at the shelters were considered. All FGDs were held in a place at the shelter that guaranteed privacy and secrecy so that women could express themselves freely. The initial question was broad and open ended and was followed by more specific questions about situations of domestic violence and other types of violence. Results The main themes identified were the following: i) women’s perceptions on domestic violence, ii) women’s perceptions on how humanitarian organizations were managing the episodes of domestic violence, and iii) situations considered violence in everyday life at the shelters. The FGDs showed that the reported violence inside the shelters was high, and several forms of violence emerged. Violence was identified as physical aggression and psychological threats, and violence in everyday life at the shelter included xenophobia when the migrants went outside the shelters that was perceived and described as violence. Conclusions According to the perspective of Venezuelan migrant women violence was part of everyday life among those living in the UNHCR shelters at the northwestern border of Brazil-Venezuela. These women are not comfortable with this situation, and it is difficult for them to understand and handle the episodes of violence.
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Mattelin E, Khanolkar AR, Fröberg F, Jonsson L, Korhonen L. 'Long journey to shelter': a study protocol: a prospective longitudinal analysis of mental health and its determinants, exposure to violence and subjective experiences of the migration process among adolescent and young adult migrants in Sweden. BMJ Open 2021; 11:e043822. [PMID: 34593481 PMCID: PMC8487179 DOI: 10.1136/bmjopen-2020-043822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION According to the UN Refugee Agency (UNHCR), around 40% of the 79.5 million forcibly displaced persons in the end of the year 2019 were children. Exposure to violence and mental health problems such as posttraumatic stress disorder are frequently reported among migrant children, but there is a knowledge gap in our understanding of the complex longitudinal interplay between individual, social and societal risk and resilience factors that impact mental health and well-being, quality of life and ability to function and adapt. There is also an urgent societal need to facilitate interdisciplinary and intersectoral collaborative efforts to develop effective methods to prevent, detect and respond to the needs of the migrants. This project will study adolescent and young adult migrants in Sweden using multiple methods such as quantitative analysis of data from a prospective cohort study and qualitative analysis of data gathered from teller-focused interviews. The aim is to understand how different factors impact mental health and integration into the Swedish society. Furthermore, individual experiences related to the migration process and exposure to violence will be studied in detail. METHODS AND ANALYSIS Study participants will include 490 migrants aged 12-25 years recruited through social services, healthcare, social media and the civil society. A subsample of adolescents (n=160) will be re-interviewed after 1 year. Data are collected using structured and semi-structured interviews along with saliva and hair sampling. Measures include sociodemographic data, longitudinal data on mental health and its determinants, including genotypes and stress-hormone levels, access to healthcare and the process of migration, including settlement in Sweden. ETHICS AND DISSEMINATION The Regional Ethics Board of Linköping (2018/292-31 and 2018/504-32) and the National Ethics Board (2019-05473,2020-00949 and 2021-03001) have approved the study. Results will be made available to participants, their caregivers, professionals working with migrants, researchers and the funders.
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Affiliation(s)
- Erica Mattelin
- Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Amal R Khanolkar
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Frida Fröberg
- Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Linda Jonsson
- Department of Social Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Laura Korhonen
- Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Child and Adolescent Psychiatry and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Meyerhoff J, Iyiewuare P, Mulder LA, Rohan KJ. A qualitative study of perceptions of risk and protective factors for suicide among Bhutanese refugees. ASIAN AMERICAN JOURNAL OF PSYCHOLOGY 2021; 12:204-214. [PMID: 34659648 PMCID: PMC8516114 DOI: 10.1037/aap0000235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Over 100,000 ethnically Nepalese, "Lhotshampa," people experienced systematic oppression, disenfranchisement, and violence during the latter part of the 20th century. The Lhotshampa people were forced to flee their homes in southern Bhutan and enter refugee camps in Nepal for over 20 years. As of this writing, most Bhutanese refugees have been resettled in other countries (primarily the United States, Canada, and Australia). As the two remaining Nepalese refugee camps prepare to close, a growing suicide crisis is developing among many Bhutanese refugees. Bhutanese refugees resettled in the United States are dying by suicide at approximately twice the rate of the general U.S. population. It is crucial to examine, qualitatively, the nature of both risk and protective factors from the perspective of Bhutanese refugees, themselves. Our study included 15 Bhutanese refugees (8 men, 7 women) recruited from a community sample as part of a parent project examining culturally responsive suicide risk assessment. Mean age across both genders was 38.4 years (range of 22-55 years). Participants in our study were asked open-ended questions about suicide risk and prevention. We conducted a thematic analysis, synthesized risk and protective themes, and applied a socio-ecological framework to the data. We found risk themes included psychological distress and vulnerability, substance use, social and familial discord, interpersonal violence, isolation, and postmigration stressors. Protective themes included low levels of substance use, de-stigmatization of mental health concerns, strong social connections, reduced postmigration stressors, increased access to mental health care, and strong awareness within the host community of migration-related challenges.
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Affiliation(s)
- Jonah Meyerhoff
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | | | | | - Kelly J. Rohan
- Department of Psychological Science, University of Vermont
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Risk and protective factors for GBV among women and girls living in humanitarian setting: systematic review protocol. Syst Rev 2021; 10:238. [PMID: 34454625 PMCID: PMC8403411 DOI: 10.1186/s13643-021-01795-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 08/23/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND While one in three women around the world are estimated to have experienced intimate partner or sexual violence, these rates are often exacerbated during conflict and humanitarian crisis. This systematic review seeks to provide an overview of existing research on risk and protective factors associated with gender-based violence (GBV) in conflict and humanitarian settings. METHODS Studies will be searched from the following databases: PubMed (Medline); PsycINFO; Scopus; Global Health; and Cochrane Center trials registrar. In addition, targeted searches of the internet repositories for GBV will be conducted. We will include studies that are published between January 1995 and December 2020 and document risk or protective factors for gender-based violence against women and girls in conflict or humanitarian settings. Two reviewers will independently screen and extract data for the review, with a third reviewer arbitrating disputes and ensuring quality. A quality assessment of the included studies will be undertaken using a modified GRADE system. Narrative synthesis will be utilized to analyze the data. DISCUSSION The results of this study will inform the design and delivery of GBV prevention programs in conflict and humanitarian settings as well as contribute to the attainment of Sustainable Development Goal 5. The results will be published in a peer-reviewed journal and will be utilized at the World Health Organization to inform efforts to prevent GBV in conflict and humanitarian settings. SYSTEMATIC REVIEW REGISTRATION The protocol has been registered with PROSEPERO ( CRD42020198695 ).
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Logie CH, Okumu M, Lukone SO, Loutet M, McAlpine A, Latif M, Berry I, Kisubi N, Mwima S, Kyambadde P, Neema S, Small E, Balyejjusa SM, Musinguzi J. Ngutulu Kagwero (agents of change): study design of a participatory comic pilot study on sexual violence prevention and post-rape clinical care with refugee youth in a humanitarian setting in Uganda. Glob Health Action 2021; 14:1940763. [PMID: 34402763 PMCID: PMC8381980 DOI: 10.1080/16549716.2021.1940763] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
With over 1.4 million refugees, Uganda is Sub-Saharan Africa’s largest refugee-hosting nation. Bidi Bidi, Uganda’s largest refugee settlement, hosts over 230,000 residents. There is a dearth of evidence-based sexual violence prevention and post-rape clinical care interventions in low- and middle-income humanitarian contexts tailored for refugee youth. Graphic medicine refers to juxtaposing images and narratives, often through using comics, to convey health promotion messaging. Comics can offer youth-friendly, low-cost, scalable approaches for sexual violence prevention and care. Yet there is limited empirical evaluation of comic interventions for sexual violence prevention and post-rape clinical care. This paper details the study design used to develop and pilot test a participatory comic intervention focused on sexual violence prevention through increasing bystander practices, reducing sexual violence stigma, and increasing post exposure prophylaxis (PEP) knowledge with youth aged 16–24 and healthcare providers in Bidi Bidi. Participants took part in a single-session peer-facilitated workshop that explored social, sexual, and psychological dimensions of sexual violence, bystander interventions, and post-rape clinical care. In the workshop, participants completed a participatory comic book based on narratives from qualitative data conducted with refugee youth sexual violence survivors. This pilot study employed a one-group pre-test/post-test design to assess feasibility outcomes and preliminary evidence of the intervention’s efficacy. Challenges included community lockdowns due to COVID-19 which resulted in study implementation delays, political instability, and attrition of participants during follow-up surveys. Lessons learned included the important role of youth facilitation in youth-centred interventions and the promise of participatory comics for youth and healthcare provider engagement for developing solutions and reducing stigma regarding SGBV. The Ngutulu Kagwero (Agents of change) project produced a contextually and age-tailored comic intervention that can be implemented in future fully powered randomized controlled trials to determine effectiveness in advancing sexual violence prevention and care with youth in humanitarian contexts.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada.,United Nations University Institute for Water, Environment & Health (UNU-INWEH), Hamilton, ON, Canada
| | - Moses Okumu
- School of Social Work, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.,School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - Miranda Loutet
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Alyssa McAlpine
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Maya Latif
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Isha Berry
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Nelson Kisubi
- Uganda Refugee and Disaster Management Council, Yumbe, Uganda
| | - Simon Mwima
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL, USA.,National AIDS Coordinating Program, Ugandan Ministry of Health, Kampala, Uganda
| | - Peter Kyambadde
- National AIDS Coordinating Program, Ugandan Ministry of Health, Kampala, Uganda.,Most at Risk Population Initiative (MARPI), Kampala, Uganda
| | - Stella Neema
- Department of Anthropology & Sociology, Makerere University, Kampala, Uganda
| | - Eusebius Small
- School of Social Work, University of Texas Arlington, Arlington, TX, USA
| | | | - Joshua Musinguzi
- National AIDS Coordinating Program, Ugandan Ministry of Health, Kampala, Uganda
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Mental Health and Traumatization of Newly Arrived Asylum Seeker Adults in Finland: A Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137160. [PMID: 34281097 PMCID: PMC8297147 DOI: 10.3390/ijerph18137160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 11/30/2022]
Abstract
Asylum seekers frequently experience potentially traumatic events (PTEs), but the type and frequency vary depending on the country of origin. The cumulative effect of multiple PTEs and other stressors expose asylum seekers to a significant risk of mental ill health. The aim of the study was to examine the prevalence of PTEs, depression and anxiety symptoms, risk for psychological trauma, psychotropic medication use and previous mental health diagnoses among adult asylum seekers in the Asylum Seekers Health and Wellbeing (TERTTU) Survey (n = 784 respondents, participation rate 78.6%). A substantial majority (88.7%, 95% CI 86.9–90.3) of asylum seekers reported one or more PTEs before arriving to Finland. PTEs during the asylum-seeking journey were reported at 12.0% (95% CI 10.7–13.4), however, when examined by region of origin, the proportion was 34.5% (95% CI 29.5–39.8) for asylum seekers from Africa (excluding North Africa). Significant symptoms of depression were reported by 41.7% (95% CI 39.6–43.9) of asylum seekers and symptoms of anxiety by 34.2% (95% CI 32.1–36.2). Half of the asylum seekers were assessed as having at least a medium-risk for psychological trauma. Prevalence rates were higher among females and asylum seekers from Africa. This study highlights the importance of using screening tools to identify asylum seekers with severe mental health problems that may need referral to further assessment and treatment. Asylum seekers from Africa (excluding North Africa) should be given additional attention in initial health screenings and examinations.
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Salami B, Iwuagwu S, Amodu O, Tulli M, Ndikom C, Gommaa H, Lavin T, Kariwo M. The health of internally displaced children in sub-Saharan Africa: a scoping review. BMJ Glob Health 2021; 5:bmjgh-2020-002584. [PMID: 32859650 PMCID: PMC7454178 DOI: 10.1136/bmjgh-2020-002584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/09/2022] Open
Abstract
Background Internally displaced children are those who have been forced to flee their homes due to severe unfavourable conditions (war, violence or disasters) but have not crossed international borders. Emerging research shows these children face multiple health challenges. However, we found no review focused solely on the health of such internally displaced children. Thus, this review sought to examine what is known about their health and their health concerns. Methods A scoping review of the literature was conducted. A total of 10 databases were searched in January 2019, yielding 6602 articles after duplicates were eliminated. Two research assistants independently selected articles that met inclusion criteria. A numerical summary and thematic analysis were conducted to facilitate data extraction and data analysis. Results A total of 25 articles met the inclusion criteria, including 16 quantitative, 6 qualitative and 3 mixed methods studies. The findings reveal elevated mental health problems and infectious diseases in this population. Findings on the nutritional status of internally displaced children as a broad group are mixed, with some studies showing poorer nutritional status among the children in this group and others showing poorer nutritional health status among host society children. Internally displaced children also experience challenges with access to health services. Premigration factors (trauma) and postmigration factors (humanitarian assistance on displacement) all contribute to the health of internally displaced children. Conclusion Findings provide insight into the complex array of factors influencing the health of internally displaced children. More intervention studies are required to address the needs of this population.
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Affiliation(s)
- Bukola Salami
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Oluwakemi Amodu
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Mia Tulli
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Chizoma Ndikom
- Department of Nursing, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Hayat Gommaa
- Department of Nursing Sciences, Ahmadu Bello University, Zaria, Kaduna, Nigeria
| | - Tina Lavin
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Michael Kariwo
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Fahme SA, Sieverding M, Abdulrahim S. Sexual and reproductive health of adolescent Syrian refugee girls in Lebanon: a qualitative study of healthcare provider and educator perspectives. Reprod Health 2021; 18:113. [PMID: 34092236 PMCID: PMC8183084 DOI: 10.1186/s12978-021-01170-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background Adolescent Syrian refugee girls in Lebanon are thought to experience a disproportionate risk of poor sexual and reproductive health, related in part to conflict and displacement. The purpose of this qualitative study was to explore healthcare provider and educator perceptions of the sexual and reproductive health determinants and care-seeking behaviors of this vulnerable population. The findings of the study will inform a health intervention that aims to reduce early marriage and improve access to sexual and reproductive health information and services. Methods In-depth interviews and focus group discussions were conducted with stakeholders who work with adolescent Syrian refugee girls in an under-resourced area of eastern Lebanon bordering Syria. Data analysis followed principles of Clarke and Braun’s thematic analysis. Results Study participants perceived adolescent pregnancy, reproductive tract infections, and sexual- and gender-based violence as major population health needs. The study also identified a number of influencing structural and sociocultural determinants of health, including early marriage, adolescent disempowerment, and men’s disengagement from care. A conceptual framework based upon the Gelberg–Andersen Behavioral Model for Vulnerable Populations was developed to relate these determinants and guide pathways for potential interventions. Conclusions Adolescent sexual and reproductive health interventions among Syrian refugees in Lebanon should adopt a multi-pronged, community-based approach to address underlying health determinants and engage with men and parents of adolescents. Special attention should be given to provider biases in healthcare settings accessible to adolescents, as these may reflect underlying tensions between host and refugee populations and discourage adolescents from seeking care. Studies suggest that adolescent Syrian refugee girls in Lebanon are at risk of early marriage and related poor sexual and reproductive health outcomes, yet little is known about this population’s specific sexual and reproductive health needs and care-seeking practices. To help fill this gap, we conducted a qualitative study with healthcare providers and educators who provide adolescent Syrian refugee girls with sexual and reproductive health services and education. The study aimed to better understand this population’s health needs and behaviors to aid in the development of a sexual and reproductive health program for Syrian refugee girls that seeks to reduce early marriage. Respondents identified adolescent pregnancy, reproductive tract infections and sexual and gender-based violence as major health issues in this population. Early marriage, disruption of education, restrictive gender roles and men’s detachment from healthcare were all recognized as potential risk factors. Stigma and bias, even among the study participants themselves, were also found to be potential barriers to care. We adapted a behavioral model for healthcare-seeking practices among vulnerable populations to categorize these risks and develop recommendations for health interventions in this community. Sexual and reproductive health initiatives in this population should be multi-faceted, community-based and aimed not only at adolescents but also their spouses and parents, who hold decision-making power.
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Affiliation(s)
- Sasha Abdallah Fahme
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
| | - Maia Sieverding
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Sawsan Abdulrahim
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Hendrickson ZM, Leddy AM, Galai N, Beckham SW, Davis W, Mbwambo JK, Likindikoki S, Kerrigan DL. Mobility for sex work and recent experiences of gender-based violence among female sex workers in Iringa, Tanzania: A longitudinal analysis. PLoS One 2021; 16:e0252728. [PMID: 34081739 PMCID: PMC8174717 DOI: 10.1371/journal.pone.0252728] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/20/2021] [Indexed: 11/25/2022] Open
Abstract
Female sex workers are highly mobile, which may influence their risk of experiencing physical and sexual violence. However, there remains a paucity of research, particularly longitudinal, from Sub-Saharan Africa exploring mobility and gender-based violence among female sex workers. To address this gap, this study examined the longitudinal relationship between work-related mobility and recent experience of physical or sexual gender-based violence from a client or partner among female sex workers in Iringa, Tanzania. A secondary data analysis was conducted using baseline and 18-month follow-up data from Project Shikamana, a community empowerment-based combination HIV prevention intervention. Responses from 387 female sex workers aged 18 years and older participating in both baseline and follow-up were analyzed. Unadjusted and adjusted Poisson regression models with robust variance estimations, accounting for clustering of female sex workers' responses over time, were fit. Final models adjusted for socio-demographic characteristics and aspects of participants' living situations and work environments. Recent physical or sexual violence from a client or partner was common (baseline: 40%; follow-up: 29%). Twenty-six percent of female sex workers at baseline, and 11% at follow-up, had recently traveled outside of Iringa for sex work. In the final adjusted longitudinal model, female sex workers recently mobile for sex work had a 25% increased risk of any recent experience of physical or sexual gender-based violence when compared with their non-mobile counterparts (adjusted incidence rate ratio: 1.25; 95% CI: 1.03-1.53; p<0.05). Interventions must identify ways-such as mobile support services, linkages and referrals to health and other social services while traveling, or the use of mobile or digital technology-to address mobile female sex workers' unique needs while traveling. Future quantitative and qualitative research is needed to understand the context of female sex workers' mobility and how and why mobility influences risk environments and experiences of gender-based violence.
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Affiliation(s)
- Zoé Mistrale Hendrickson
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Anna M. Leddy
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Statistics, University of Haifa, Mt Carmel, Haifa, Israel
| | - S. Wilson Beckham
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Wendy Davis
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
| | - Jessie K. Mbwambo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Samuel Likindikoki
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Deanna L. Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
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Familiar I, Muniina PN, Dolan C, Ogwal M, Serwadda D, Kiyingi H, Bahinduka CS, Sande E, Hladik W. Conflict-related violence and mental health among self-settled Democratic Republic of Congo female refugees in Kampala, Uganda - a respondent driven sampling survey. Confl Health 2021; 15:42. [PMID: 34039400 PMCID: PMC8157662 DOI: 10.1186/s13031-021-00377-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Violence and traumatic events are highly prevalent among refugees, but less is known about the impact of these experiences among self-settled refugees in the country of asylum. We evaluated the association between traumatic experiences and PTSD and depression symptoms among female Democratic Republic of Congo (DRC) refugees living in Kampala, Uganda. METHODS Participants were recruited using respondent driven sampling in one refugee service center in Kampala, Uganda. Eligibility criteria included: Congolese nationality, age 18+ years, self-settled in Kampala for at least 6 months, refugee status or documentation of application for refugee status. Only data from female participants were included in this analysis. Depression symptoms were screened with the Patient Health Questionnaire-2, and symptom criteria for PTSD and traumatic experiences were evaluated with the Harvard Trauma Questionnaire. Logistic regression models were performed to separately assess associations between mental health outcomes (PTSD and depression), rape and non-sexual violence. RESULTS Five hundred eighty women with a mean age of 33 years were interviewed. Among participants, 73% (95% CI:67-78%) met symptom criteria for PTSD, 57% (95% CI: 51-63%) for depression, and 65% reported thoughts of ending one's life. 79% of women reported experience of rape, for over half (54%) it occurred more than once, and 82% were gang raped. Crude and adjusted odds ratios (ORs) show that PTSD was most strongly associated with being raped (OR = 2.43, p < 0.01), lacking shelter (OR = 2.86, p < 0.01), lacking food or water (OR = 2.53, p = 0.02), lacking access to health care (OR = 2.84, p < 0.01), forced labor (OR = 2.6, p < 0.01), extortion and/or robbery (OR = 3.08, p < 0.01), experiencing the disappearance/kidnapping of a family member or friend (OR = 2.72, p < 0.01), and witnessing the killing or murder of other people (OR = 3.28, p < 0.01). Depression was significantly associated with several traumatic experiences including rape (OR = 2.3, p = 0.01), and experiencing the disappearance/kidnapping of a child or spouse (OR = 1.99, p = 0.01). CONCLUSIONS Refugee women self-settled in Kampala reported high lifetime experiences of violence and traumatic events including rape, as well as high rates of PTSD and depression. Future programming addressing self-settled refugees and their settlement in host countries may benefit from including local and national integration strategies.
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Affiliation(s)
- Itziar Familiar
- Department of Psychiatry, Michigan State University, East Lansing, MI USA
| | | | - Chris Dolan
- Refugee Law Project, School of Law, Makerere University, Kampala, Uganda
| | - Moses Ogwal
- School of Public Health, Makerere University, Kampala, Uganda
| | - David Serwadda
- Department of Disease Control, School of Public Health, Makerere University, Kampala, Uganda
| | - Herbert Kiyingi
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | | | - Enos Sande
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Wolfgang Hladik
- Division of Global HIV and TB, Centers for Disease Control and Prevention, MS E-30, 1600 Clifton Rd, Atlanta, GA-30333 USA
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Oladeji O, Oladeji B, Chamla D, Safiyanu G, Mele S, Mshelia H, Agbor J. Sexual Violence-Related Pregnancy Among Internally Displaced Women in an Internally Displaced Persons Camp in Northeast Nigeria. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:4758-4770. [PMID: 30095013 DOI: 10.1177/0886260518792252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Sexual violence is quite common in conflict situations and puts women at risk of unintended pregnancies. In the northeast region of Nigeria with the ongoing insurgency, a substantial number of women are kidnapped and subjected to forced marriages and repeated sexual assaults. This study set out to report on the disclosure and outcomes of sexual violence-related pregnancies (SVRPs) among women liberated from insurgents and relocated to one of largest Internally Displaced Persons (IDP) camps located in Borno State, northeast Nigeria. The clinic records of women with SVRP were reviewed. Forty-seven women with SVRP were identified by the health care providers using a snowball technique to reach as many of the women with SVRP as possible. The mean age of the participants was 15.3 years (SD = 3.4 years), and all the participants had spent 2 years or more in captivity. Most of the women first disclosed the pregnancy to their peers before disclosure to health care providers or family members. All the women initially requested to have the pregnancy terminated; however, abortion services are not offered in the clinic in line with the country's restrictive abortion laws. Following counseling and psychosocial support offered in the clinic, 19 (40%) of the women continued with the pregnancy and were delivered in the camp clinic while the remaining 26 women left the camp shortly after disclosure and pregnancy outcomes are not known. SVRP is not uncommon in humanitarian settings with its associated stigma and unwillingness among the survivors to keep the pregnancy. There is a need for further studies to provide more insight into the extent of this problem and help-seeking for SVRPs especially for women in such difficult circumstances to provide needed empirical information to drive advocacy efforts for more comprehensive services.
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Affiliation(s)
| | | | | | | | - Sule Mele
- Borno State Primary Health Care Development Agency, Maiduguri, Nigeria
| | - Helni Mshelia
- Borno State Primary Health Care Development Agency, Maiduguri, Nigeria
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Vallejo-Martín M, Sánchez Sancha A, Canto JM. Refugee Women with a History of Trauma: Gender Vulnerability in Relation to Post-Traumatic Stress Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094806. [PMID: 33946312 PMCID: PMC8125581 DOI: 10.3390/ijerph18094806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/25/2021] [Accepted: 04/29/2021] [Indexed: 11/16/2022]
Abstract
Refugees represent a population whose living conditions have a strong impact on their mental health. High rates of post-traumatic stress disorder (PTSD), more than other mental disorders, have been found in this group, with women having the highest incidence. The objective of the present systematic review was to identify and examine studies from the last fifteen years on the relationship between the impact of traumatic experiences and PTSD psychopathology in refugee women. Twelve studies were included, from which the overall results approved this relation. In addition, six of these studies show that exposure to sexual trauma in refugee women is associated with the high odds of being at risk for PTSD. These findings suggest that gender-related traumatic experiences can explain the high rate of PTSD in refugee women and highlight the unmet need for psychosocial health care in this population.
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Affiliation(s)
- Macarena Vallejo-Martín
- Department of Social Psychology, Social Work, Social Anthropology and East Asia Studies, Faculty of Psychology and Speech Therapy, University of Malaga, 29016 Malaga, Spain;
- Correspondence:
| | - Ana Sánchez Sancha
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, University of Malaga, 29016 Malaga, Spain;
| | - Jesús M. Canto
- Department of Social Psychology, Social Work, Social Anthropology and East Asia Studies, Faculty of Psychology and Speech Therapy, University of Malaga, 29016 Malaga, Spain;
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Capasso A, Skipalska H, Guttmacher S, Tikhonovsky NG, Navario P, Castillo TP. Factors associated with experiencing sexual violence among female gender-based violence survivors in conflict-afflicted eastern Ukraine. BMC Public Health 2021; 21:789. [PMID: 33894760 PMCID: PMC8067375 DOI: 10.1186/s12889-021-10830-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background Since 2014, over 1.6 million people have been forcibly displaced by the conflict in eastern Ukraine. In 2014, 8% of reproductive-aged women in Ukraine had ever experienced sexual violence, compared to 5% in 2007. This increase was driven by non-domestic sexual violence. Our study examined characteristics of women in eastern Ukraine receiving psychosocial services following sexual violence compared to survivors of other forms of gender-based violence. Methods Intake data collected between February 2016 and June 2017 by psychosocial service providers in five conflict-affected areas of Ukraine from women, aged 15–49, (N = 8525), was analyzed. Descriptive analysis and covariate adjusted logistic and negative binomial regressions were used to identify socioeconomic, incident and access to services factors associated with having experienced sexual violence compared to other forms of violence. Results Among this sample of survivors receiving psychosocial services, 2.6% (n = 220) reported experiencing sexual violence. A majority of sexual violence acts reported were committed by non-domestic perpetrators (61.4%); followed by intimate partners (25.9%). Almost half of sexual violence cases occurred at home (49.1%). Experiencing sexual violence was positively associated with being younger, single and internally displaced, and negatively with engaging in unpaid labor, such as childcare. Women who experienced sexual violence delayed seeking care by 4 days compared to other gender-based violence survivors. Sexual violence survivors were less likely than physical violence survivors to have reported the incident prior to receiving care (adjusted odds ratio = 0.39; 95% confidence interval = 0.28–0.54). Conclusions Non-domestic and intimate partner sexual violence were both prevalent in our sample. Compared to survivors disclosing other types of gender-based violence, sexual violence survivors appear to face unique barriers to reporting and accessing timely care. Prevention and outreach programs tailored to the specific vulnerabilities, such as displacement status, and needs of sexual violence survivors in conflict settings are urgently needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10830-9.
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Affiliation(s)
- Ariadna Capasso
- NYU School of Global Public Health, New York University, 726 Broadway, New York, NY, 10012, USA.
| | - Halyna Skipalska
- Ukrainian Foundation for Public Health, Kiev, Ukraine.,HealthRight International Ukraine Country Office, Kiev, Ukraine
| | | | | | - Peter Navario
- NYU School of Global Public Health, New York University, 726 Broadway, New York, NY, 10012, USA.,HealthRight International, New York, NY, USA
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Keating C, Treves-Kagan S, Buller AM. Intimate partner violence against women on the Colombia Ecuador border: a mixed-methods analysis of the liminal migrant experience. Confl Health 2021; 15:24. [PMID: 33832514 PMCID: PMC8028576 DOI: 10.1186/s13031-021-00351-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 03/16/2021] [Indexed: 12/04/2022] Open
Abstract
Background Intimate partner violence (IPV) has serious long-term health and psychological consequences and is highly prevalent in Latin America and among displaced populations. Liminality - the ambiguous in-between state of individuals completing a migratory journey - represents a state of legal, economic, and physical insecurity. Through the framework of liminality, this analysis seeks to understand the unique challenges faced by displaced Colombian women in Ecuador including their experience of IPV. Methods We performed a secondary analysis of 15 in-depth interviews and 319 longitudinal surveys, conducted on the border of Ecuador and Colombia, following a sequential explanatory mixed-methods design. We analysed interviews thematically and mapped the main themes onto complementary quantitative variables. We conducted logistic regression with identified risk and protective factors (measured at time 1) and recent IPV (measured at time 2), controlling for demographic characteristics and IPV at time 1. Results Our mixed-methods analysis revealed four main mechanisms by which displacement influenced the social and economic realities of Colombian women years after crossing the border, compounding their risk of IPV and limiting their ability to escape it. Lack of legal residence and documentation, violence experienced along life course and migratory continuums which increased their risk for later revictimisation, social isolation including loss of support networks and restricted mobility and lastly, financial stress. Conclusions This research highlights the critical importance of supporting the economic and social integration of migrants and refugees in host communities, as well as the need to carefully consider migration-related vulnerabilities in IPV prevention and response interventions. As the regional refugee crisis grows, policy makers must consider how the long-term marginalisation of refugee women contributes to their victimisation. This research also supports the idea of incorporating gender synchronised, transformative IPV prevention and response programmes into migration-related and poverty alleviation international development efforts.
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Affiliation(s)
- Colleen Keating
- London School of Hygiene and Tropical Medicine, Keppel St, London, England
| | - Sarah Treves-Kagan
- Department of Health Behaviour, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Ana Maria Buller
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, England.
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