Gender Based Violence against Women in Sub-Saharan Africa: A Systematic Review and Meta-Analysis of Cross-Sectional Studies

Healthcare providers' perceived barriers and facilitators to screening for intimate partner violence in pregnant women attending prenatal clinics

AIM

To examine healthcare providers' extent of and perceived barriers and facilitators to screening for intimate partner violence in pregnant women attending prenatal clinics.

DESIGN

Cross-sectional descriptive design was used to collect data from 130 healthcare providers.

METHODS

Seventeen healthcare providers from 17 prenatal clinics in Kanungu district, Uganda, were recruited via convenience sampling to participate in an online survey implementing a modified Normalization Measure Development instrument. Data were collected between February 2023 and March 2023 (02/8/2023 to 03/12/2023) and analysed using descriptive and Mann-Whitney U test and chi-square tests.

RESULTS

Slightly more than half (56%) of healthcare providers report screening pregnant women for intimate partner violence. There was a statistically significant relationship between healthcare providers screening for intimate partner violence and having previous training on intimate partner violence screening. The only barrier to screening identified was a lack of understanding of how intimate partner violence screening affects the nature of participant's own work. There were numerous potential facilitators identified for healthcare providers' intimate partner violence screening.

CONCLUSION

Although higher-than-expected number of healthcare providers reported screening of pregnant women for intimate partner violence, the extent of screening is still suboptimal. The barrier to screening identified needs to be addressed and facilitators promoted. Receiving training among healthcare providers on intimate partner violence screening was associated with higher levels of screening; thus, this needs to be enhanced to optimize screening rates. Future studies should assess screening practices objectively and implement interventions to improve healthcare providers' intimate partner violence screening rates.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Screening for intimate partner violence should be part of standard care provided by healthcare providers to all pregnant women during prenatal clinic visits. The study supports the need for more training for healthcare providers in aspects related to intimate partner violence screening in order to ensure prompt diagnosis and treatment of those affected, identify those at risk and increase awareness. There is a need to enhance healthcare providers' capacity for intimate partner violence screening through education by integrating intimate partner violence screening pre- and post-registration courses and preparation programs or curriculum.

IMPACT

Intimate partner violence (IPV) in pregnancy is a global health problem. Screening for IPV by healthcare providers is suboptimal. This study found that only 56% of healthcare providers were routinely screening for IPV in Ugandan prenatal clinics. This study identified the main facilitators and one barrier to IPV screening.

REPORTING METHOD

This study has adhered to the relevant EQUATOR guidelines for quantitative studies.

PATIENT AND PUBLIC CONTRIBUTION

No patient was involved in this study.

Intimate Partner Violence and Level of Household Food Scarcity in Mozambique

Although food insecurity in its various forms is consistently associated with the presence of intimate partner violence (IPV), it is still unknown if various levels of severity of hunger predict IPV when important extraneous mental health, interpersonal, and social support indicators are considered. The study applied a posttest-only comparison group quasi-experimental design. The samples were randomly drawn from married women (n = 202) in Mozambique. The logistic regression model showed a significant association between multiple forms of IPV and multiple forms of food scarcity; women experiencing severe hunger were consistently between 3.5- and 5-times greater odds of reporting IPV compared to those without hunger, even when controlling for important covariates.

Applying Mobile Technology to Address Gender-Based Violence in Rural Nigeria: Experiences and Perceptions of Users and Stakeholders

This paper documents the results of an intervention conducted in Nigeria to test the effectiveness of a mobile phone technology, text4life, in enabling women to self-report gender-based violence (GBV). Women experiencing GBV and other challenges related to sexual and reproductive health and rights were requested to use their mobile phones to text a code to a central server. In turn, the server relayed the messages to trained nearby health providers and civil society organization (CSO) officials who reached out to provide health care and social management services to the callers. Interviews were conducted with some callers, health care providers, and CSO staff to explore their experiences with the device. The interviews and data from the server were analyzed qualitatively and quantitatively. The results indicate that over a 27-month period, 3,403 reports were received by the server, 34.9% of which were reporting GBV. While interviewees perceived that a large proportion of the women were satisfied with the use of text4life, and many received medical treatment and psychological care, the consensus opinion was that many women reporting GBV did not wish to pursue police or legal action. This was due to women's perceptions that there would be negative cultural and social backlash should they pursue civil punishments for their partners. We conclude that a mobile phone device can be used effectively to report GBV in low-resource settings. However, the device would be more useful if it contributes to equitable primary prevention of GBV, rather than secondary prevention measures.

Exploring the sexual and reproductive health knowledge, practices and needs of adolescents living with perinatally acquired HIV in Côte d'Ivoire: a qualitative study

INTRODUCTION

Adolescents face unique challenges in accessing appropriate information and services regarding sexuality and reproductive health (SRH). This poor access can lead to sexual behaviours that could put them at risk of unintended pregnancies and sexually transmitted infections. Adolescents living with HIV (ALHIV) have specific SRH needs that remain unmet. We explored the SRH knowledge, practices and needs of ALHIV in Abidjan, Côte d'Ivoire.

METHODS

Between April and September 2023, a qualitative study using semi-structured individual interviews was conducted with nine male and nine female ALHIV without previous pregnancies, and eight ALHIV who became pregnant. All consented and were ALHIV acquired perinatally, aged 15-19 years, informed of their HIV status, and followed in three paediatric HIV care centres in Abidjan. participating in the paediatric IeDEA West African Cohort and enrolled in the ANRS12390 OPTIMISE-AO project aimed at improving HIV disclosure process and adherence to antiretroviral treatment. A focus group discussion was conducted with five peer-educators, aged 23-31 years, participating in the OPTIMISE-AO project to gather their perspectives on adolescent SRH. Interviews were conducted in French, and a thematic analysis was performed.

RESULTS

All participants expressed difficulty in talking about SRH with their parents or health professionals and turned to their friends for advice. All feared transmitting HIV. One-third of female participants reported having experienced non-consensual sex and sexual violence. Participants reported low levels of condom use, despite having good knowledge of its purpose. Reasons for not using condoms included difficulties in negotiating for girls, as well as having an undetectable viral load, which was seen by adolescents as a condition for waiving condom use. As hormonal contraceptives were subject to many negative beliefs justifying their non-use, alternative methods, such as emergency contraceptive pills or traditional plants, were used to prevent pregnancy.

CONCLUSION

ALHIV reported unmet SRH needs, particularly in terms of accessing reliable information and appropriate support. Integrating SRH care into paediatric HIV care, organising SRH discussion groups led by peer-educators, and improving access to a range of contraceptives may address these needs to enhance SRH outcomes for ALHIV.

Planning with a gender lens: A gender analysis of pandemic preparedness plans from eight countries in Africa

Background

Health planning and priority setting with a gender lens can help to anticipate and mitigate vulnerabilities that women and girls may experience in health systems, which is especially relevant during health emergencies. This study examined how gender considerations were accounted for in COVID-19 pandemic response planning in a subset of countries in Africa.

Methods

Multi-country document review of national pandemic response plans (published before July 2020 and as of March 2022) from Ethiopia, Ghana, Kenya, Nigeria, Rwanda, South Africa, Uganda, and Zambia, supplemented with secondary data on gender representation on planning committees. A gender analysis framework informed the study design and the Morgan et al. matrix guided data extraction and analysis.

Results

All plans reflected implicit and explicit considerations of the impacts of the pandemic responses on women and girls. Through a gender lens, the implicit considerations focused on ensuring safety and protections (e.g., training, access to personal protective equipment) for community and facility-based health care workers and broad engagement of the community in risk communication. The explicit gender considerations, reflected in a minority of plans, focused on addressing gender-based violence and providing access to essential services (e.g., sexual and reproductive health care, psychosocial supports), products (e.g., menstrual hygiene products) and social protection measures. Women were underrepresented on the COVID-19 planning committees in all countries.

Conclusions

The plans reflected varying national efforts to develop pandemic responses that anticipated and reflected unique vulnerabilities faced by women, though subsequent plans reflected further consideration of gender-relevant impacts compared to initial plans. Embedding a gender lens in emergency preparedness planning furthers equity and could support anticipation and timely mitigation of negative outcomes for women and girls who are often further marginalized during health emergencies.

Multilevel determinants of physical violence among ever-partnered women in South Africa

BACKGROUND

Violence against women continues to be a challenge in many countries. Many women suffer physical violence at the hands of their intimate partners and sometimes this leads to their deaths. This study aimed to examine the multilevel determinants of physical violence among ever-partnered women in South Africa.

METHODS

We used data from the 2016 South Africa Demographic and Health Survey. The study has a weighted sample size of 4169 ever-partnered women aged 18-49 years, based on the domestic violence module. We included univariate, bivariate and multilevel logistic regression analysis. We included a two-level model to measure the relationship between the selected background characteristics and physical violence.

RESULTS

The prevalence of physical violence among ever-partnered women was 20.6%. The bivariate findings showed that educational status, employment status, witness to inter-parental violence, partner's drinking habits, household wealth, educational difference, and province were statistically associated with physical violence. The multilevel analysis showed some evidence of between-cluster variation in physical violence. We found that age, education, employment status, witness to inter-parental violence, partner's drinking habits, household wealth, education difference, place of residence, and province were key predictors of physical violence. The odds of physical violence were more than two-fold in the Eastern Cape and Mpumalanga compared to Gauteng.

CONCLUSION

The study highlighted various key factors explaining physical violence. The findings suggest the need for targeted interventions aimed at specific communities of women, such as those from the Eastern Cape and Mpumalanga, as well as interventions that will empower women and address gender inequalities.

'You are looked upon as a luxury tool': Young Tanzanian women's perception of community norms supporting partner violence during transactional sex (kudanga)

This paper explores the definition of, and perceived community attitudes, toward kudanga, a Swahili street term for a type of transactional sex practised in Dar es Salaam, Tanzania. Rooted in economic and gender disparity, transactional sex increases adolescent girls' and young women's vulnerability to HIV and gender-based violence. We sought to understand perceived community attitudes about kudanga, and how the internalisation of norms surrounding gender-based violence relate to the experiences of young women who practise kudanga. Using qualitative data from focus group discussions with 37 young women, we found that community perceptions of kudanga were largely negative, and those who engaged in it were looked down upon and despised. Violence and lack of sexual agency were normalised when doing kudanga. However, young women understood kudanga to often be their best option to obtain economic stability and felt strongly that those who practised kudanga should not be stigmatised. Our research provides further evidence that transactional sex exists on a continuum and highlights the importance of reducing community stigma surrounding transactional sex as a means of decreasing risk of HIV and gender-based violence for young women. To our knowledge, this article is the first to explore kudanga.

Gender-based violence and its determinants among refugees and internally displaced women in Africa: systematic review and meta-analysis

BACKGROUND

Gender-based violence is a serious public health concern and affects a large number of women and girls in humanitarian emergencies. Despite this, there is a dearth of the summary data to address the issue. Therefore, this study aimed to assess the estimated pooled magnitude and factors associated with gender-based violence among refugees and internally displaced women in Africa.

METHODS

PubMed/MEDLINE, Google Scholar, African Journals OnLine, PsycINFO, and EMBASE were among the databases that were used to search the primary articles. The reviewed papers were articles that evaluated the prevalence and contributing variables of gender-based violence against refugees and internally displaced women in Africa. We extracted the data using a Microsoft Excel spreadsheet, which we exported into Stata version 14 for further analysis. The I2 test was applied to identify statistical heterogeneity. We used a random effect meta-analysis methodology because of the heterogeneity. A funnel plot and Egger's weighted regression test were used to examine publication bias.

RESULTS

This systematic review and meta-analysis reviewed 17 primary studies with a total of 6,161 refugees and internally displaced women in Africa. The findings of this study revealed that the estimated pooled prevalence of gender-based violence among refugees and internally displaced women was determined to be 48.20% (95% CI: 39.28, 57.12). Young age (AOR = 3.68, CI: 2.63, 5.14), alcohol consumption (AOR = 2.53, CI: 1.56, 4.11), and having no social protection (AOR = 3.21, CI: 2.22, 4.63) were factors significantly associated with gender-based violence.

CONCLUSIONS AND RECOMMENDATIONS

The present study showed that almost half of refugees and internally displaced women residing in Africa were survivors of gender-based violence. Younger women, alcohol users, and those without social protection were more likely to experience gender-based violence. Therefore, it is recommended that accessible information about the consequences of gender-based violence and early intervention for survivors be provided, taking these factors into consideration.

Factors associated with sexual violence against reproductive-age women in Ghana: A multilevel mixed-effects analysis

BACKGROUND

Sexual violence against women is a pervasive public health challenge and human rights violation, with global prevalence rates of approximately one in three women affected, notably prevalent in African countries. Understanding its multifaceted determinants is crucial for developing targeted intervention strategies. Thus, this study aimed to investigate factors associated with sexual violence against reproductive-age ever-married women in Ghana.

METHODS

A weighted sample of 3,816 reproductive-age ever-married women from the 2022 Ghana Demographic and Health Survey (DHS) was included. To accommodate the hierarchical nature of the DHS data and the binary outcome variable 'sexual violence', a multilevel mixed-effect logistic regression model was employed. The deviance value was utilized for selecting the best-fitted model. In the multivariable multilevel binary logistic regression analysis, adjusted odds ratios (AORs) along with their respective 95% confidence intervals (CIs) were utilized to gauge the association strength, with statistical significance set at a p-value < 0.05.

RESULT

The prevalence of sexual violence was found to be 8.80% (95% CI: 7.94-9.74). Factors positively associated with sexual violence included women's decision-making autonomy (AOR = 1.39, 95% CI: 1.08-1.74), husband/partner's alcohol consumption (AOR = 3.88, 95% CI: 2.98-5.06), sex of household head (AOR = 1.31, 95% CI: 1.02-1.68), and justification of beating (AOR = 1.35, 95% CI: 1.01-1.81). Conversely, women's age showed a negative association with sexual violence (AOR = 0.68, 95% CI: 0.48-0.98).

CONCLUSION

In conclusion, prioritizing initiatives that empower women in decision-making roles, provide support for those struggling with alcohol consumption, and raise awareness about its impact on interpersonal relationships and the risk of sexual violence is essential. Furthermore, addressing harmful gender norms, particularly those justifying violence, and considering demographic characteristics are vital components of comprehensive strategies to prevent and mitigate sexual violence.

Sexual violence against ever-married reproductive-age women in East Africa: further analysis of recent demographic and health surveys

BACKGROUND

Sexual violence is a violation of women's rights, resulting in significant physical and psychological challenges and adverse reproductive health outcomes. Addressing these issues demands urgent public health interventions and support systems to mitigate the profound impact on individuals and societies. Thus, this study aimed to assess sexual violence against ever-married reproductive-age women in East Africa.

METHODS

Data retrieved from the recent Demographic and Health Survey (DHS) of East African countries was used, and a weighted sample of 40,740 ever-married reproductive-age women was included. To identify factors associated with sexual violence, multilevel mixed-effects models utilizing robust Poisson regression were applied. Akaike's and Bayesian information criteria, as well as deviance, were utilized to compare the models. In the multivariable regression model, adjusted prevalence ratios (APR) with 95% confidence intervals (CI) were used to estimate the strength of association, with statistical significance set at a p-value < 0.05.

RESULT

The pooled proportion of sexual violence among ever-married reproductive-age women in East Africa was 13.05% (95% CI: 12.74-13.36). The multivariable multilevel robust Poisson regression revealed that age at first cohabitation/marriage, having a primary educational level, being employed, residing in a female-headed household, having a husband/partner who drinks alcohol, and living in rural areas were positively associated with sexual violence. On the contrary, having secondary and higher educational levels and living in communities with a high proportion of uneducated women were negatively associated with sexual violence.

CONCLUSION

Empowering girls and women through education reduces their vulnerability. Effective programs should prioritize workplace safety, financial independence, and robust legal protections against harassment and abuse. Raising awareness about the impact of alcohol abuse on relationships and the heightened risk of sexual violence is crucial. Moreover, enhancing access to support services and community networks, especially in rural areas, is essential for preventing and responding to sexual violence.

Help-seeking behaviors and determinant factors among women exposed to intimate partner violence in East Africa based on recent demographic and health survey data: a multilevel analysis

Introduction

Human rights violations and violence against women are serious public health issues that have numerous detrimental repercussions on one's physical, emotional, sexual, and reproductive health. According to studies, women's perceptions and traits of violence are highly predictive of their likelihood of seeking help against violence. Even though intimate partner violence is a huge challenge nowadays in Africa, there is a low level of help-seeking behavior. Conducting this study at the East African level on help-seeking behavior can provide a clue for policy-makers. Therefore, this study aimed to reveal the prevalence of help-seeking behavior against intimate partner violence and determinant factors among women in East Africa.

Method

Multilevel logistic regression analysis was carried out among East Africans using recent demographic and health survey data. A total of 7,387 participants aged 15 to 49 years were included in this study from East African countries. Individual- and community-level variables were considered to determine the associated factors with help-seeking behaviors against intimate partner violence with 95% CI and AOR.

Results

The prevalence of help-seeking behavior against intimate partner violence among women was 38.07% with 95% CI (36.96%, 39.18%). Husbands drink alcohol [AOR = 1.46: 95% CI (1.33, 1.61)], women who have work [AOR = 1.33: 95% CI (1.19, 1.50)], and women with higher educational status [AOR = 1.36: 95% CI (1.16, 1.59)] were factors associated with help-seeking behavior against intimate partner violence.

Conclusion

Approximately four out of 10 women were seeking help for intimate partner violence in East Africa. Husbands drinking alcohol, women's high educational status, and women having occupations were the factors that were associated with help-seeking behaviors against intimate partner violence.

Spatial distribution and determinants of physical intimate partner violence among women in Kenya: Evidence from the 2022 Kenya Demographic and Health Survey

BACKGROUND

Despite global, regional, and national efforts to address intimate partner violence (IPV), physical IPV persists as a significant challenge in Kenya. This study employs geospatial analysis to examine the spatial distribution and determinants of physical intimate partner violence among women, aiming to inform targeted interventions and policies.

METHODS

The study used a secondary analysis of a cross-sectional study design based on the 2022 Kenya demographic and health survey. Analyses were conducted using Stata version 17.0 and ArcMap version 10.8. Spatial autocorrelation and hotspot assessment were conducted in the geospatial analysis, while a multilevel logistic regression model was used to examine determinants of physical violence among reproductive-aged women.

RESULTS

The study found 28.8% (10,477) of the surveyed women reported experiencing physical intimate partner violence. The spatial analysis identified significant clusters in the southwest and central regions, with women in sub-counties like Chepaluugu, Konion, Sotik, Bumula, and Metayos among others experiencing more violence. Conversely, women in areas in the North East and South East corners such as Kisauni, Tarabaj, Waijir North, Lafey, and Mandera North and South among others showed little or no physical intimate partner violence. Multivariable logistic regression identified age, education, wealth index, partner domineering indicators, and justification of wife beating to be associated with physical intimate partner violence. Higher education and wealth were associated with lower violence odds, while partner domineering indicators and justification of wife beating increased odds.

CONCLUSION

Spatial variations in intimate partner violence risk for women in Kenya underscore the need for targeted government interventions. Focusing on hotspot regions, especially among women with the poorest wealth index, no formal education, and older age, is crucial. Implementing behavior change campaigns addressing violence justification and partner dominance is vital. Active involvement of male partners in programs aiming to eliminate intimate partner violence is essential for comprehensive impact.

The effect of sexual education based on the Sexual Health Model on sexual function among women living in the suburbs: study protocol for a randomized controlled trial

INTRODUCTION

Suburban population is increasingly growing in Iran. People in the suburbs usually have limited sexual information and there are limited studies into their sexual issues. This study aims the effect of sexual education (SE) based on the Sexual Health Model (SHM) on sexual functioning among women living in the suburbs.

METHODS

This is a randomized controlled trial with two parallel groups. Seventy-six women will be selected through simple random sampling from healthcare centers in suburban areas and will be allocated to a control group (n = 38) and an intervention group (n = 38) with a randomization ratio of 1:1. Participants in the intervention group will receive SHM-based SE in three120 min weekly sessions which will be held using the lecture, question-and-answer, group discussion, and educational booklet methods. Data will be collected through a demographic and midwifery characteristics questionnaire, the Female Sexual Function Index, the Depression Anxiety Stress Scale, and the Sexual Quality of Life-Female, and will be analyzed through the analysis of covariance as well as the independent-sample t, the paired-sample t, and the Chi-square tests.

DISCUSSION

We hope this study provides a clear framework for decision-makers and healthcare providers to provide appropriate policies and interventions for SE and thereby improve the sexual health of women in the suburbs.

TRIAL REGISTRATION

This study was registered in the Iranian Registry of Clinical Trials on 2024.03.05 (code: IRCT20231121060133N1).

Association Between Domestic Violence and Mental Health Among Nepalese Women: Results from a Nationally Representative Sample

This study aims to examine the association between exposure to domestic violence and mental health outcomes, such as symptoms of depression and anxiety among married women in Nepal. The 2022 Nepal Demographic and Health Survey was used. Descriptive, bivariate, and multivariate logistic regression analyses were employed. A complex sampling frame was used to ensure the accuracy of the sample. A total of 4,211 women aged 15 to 49 years were analyzed. Among women between the ages of 15 and 49, 22.8% experience anxiety, and 22.5% experience depressive symptoms. Nearly 50% of women who had experienced domestic violence had symptoms of anxiety and depression. At the multivariate level, in Model 1, the study found that wealthy women were less likely to have anxiety (OR = 0.75; 95% CI [0.58, 0.96] and depression (OR = 0.70; 95% CI [0.54, 0.91]) than poor women. Similarly, women of the former untouchable caste were more likely to have anxiety (OR = 1.51; 95% CI [1.14, 2.00]) and depression (OR = 1.20; 95% CI [0.91, 1.58]) than high-caste women. In Model 2, the odds of anxiety and depressive symptoms were 1.70 (95% CI [1.29, 2.24]) and 1.99 (95% CI [1.48, 2.67]), respectively, for those women who had experienced severe physical violence. The odds of experiencing anxiety and depression were 2.88 (95% CI [2.28, 3.64]) and 3.04 (95% CI [2.32, 3.98]) times, respectively, for those women who had experienced emotional abuse. Similarly, women who had been sexually assaulted had 2.34 (95% CI [1.72, 3.20]) and 1.67 times (95% CI [1.23, 2.26]) more likely to experience anxiety and depression than women who had never been sexually assaulted. We found a strong association between mental health problems and women's experience of domestic violence. To address the mental health of Nepalese women, it is critical to strengthen domestic violence prevention programs, especially those targeting the lowest social strata of the population.

Gender-based violence care in Mauritania: Experience and caseload of six specialized hospital units (2018-2023)

Since 2017, six specialized care units, the USPEC (Unités Spéciales de Prise en Charge) have been implemented in Mauritanian hospitals with the support of the international organization Médicos del Mundo. They provide healthcare and comprehensive assistance to victims of gender-based violence (GBV), such as sexual violence (SV), intimate-partner violence (IPV), female genital mutilation (FGM), adolescent pregnancy and child marriage. In this retrospective, observational study, we investigated the caseload of the six USPEC countrywide between January 1st, 2018, and June 30th, 2023. We analyzed consultation data, victims' sociodemographic characteristics, types of violence they were subjected to, specific patterns-location, relationship with the perpetrator, reoccurrence-, and medical care they received. 3550 cases were attended to, with a threefold increase in the mean number of monthly cases between 2018 and 2023. Women and girls accounted for 95.1% of victims; 78.7% were under 18 years old and 21.9% were under 12. All male victims (n = 172) were children. SV represented 79.8% of the caseload, early marriage/pregnancy 10.4%, IPV 7%, and FGM 0.7%. 80% of perpetrators were known to the victims, and the acts of violence had taken place in the victims´ own home for 60%. The proportion of cases received within 72 hours increased noticeably within the first two years before stabilizing at an average 81.3%. 7.21% of patients received local or surgical treatment and 1.8% were hospitalized. After SV, 996 received emergency contraception while 627, who sought care with delay, were already pregnant. Our findings suggest that the USPEC model responds to both victims' and the health system's needs to address GBV. Prevention, declaration and follow-up of pregnancy as a result of SV in young girls, likely constituted a major motivation for healthcare-seeking, yet more research is needed to document bottlenecks faced by GBV victims to access such services.

Kinship, lineage resources (wealth flow transfers), and intimate partner violence among women in Ghana

Previous research has established relationships between lineage and intimate partner violence (IPV). The findings suggest matrilineal women experience less IPV than patrilineal women. However, the IPV outcomes of bilateral women are unknown because of the limited operationalization of lineage with ethnicity. In our study, we used self-reported and multidimensional measures of lineage to explore its relationship with IPV, focusing particularly on the mechanisms linking the two. We hypothesized that wielding resources would be negatively associated with IPV. Furthermore, matrilineal women's access to lineage resources would reduce their vulnerability to IPV relative to patrilineal women. To examine these hypotheses, we collected data from 1700 ever-married Ghanaian women residing in three ecological zones (coastal, middle, northern). Path analysis was used to explore resources as mechanisms linking lineage and IPV. Our findings indicated resources were patterned by lineage. Matrilineal women benefitted more from maternal family members than patrilineal women and vice versa. Consistent with the standard resource theory, women's access to resources protected against IPV, and the effects were stronger for matrilineal than patrilineal women. Irrespective of how lineage was measured, matrilineal women experienced lower levels of IPV than patrilineal women. The IPV outcomes for bilateral women were mixed. Part of matrilineal women's reduced IPV risk was explained through access to maternal resources. While patrilineal women experienced higher levels of IPV, this was reversed with resources from paternal kin members. Our findings suggest that as resources are fundamental to reducing IPV, lineage can serve as a conduit for resource exchange and wealth transfer.

A qualitative exploration of the reasons and influencing factors for pregnancy termination among young women in Soweto, South Africa: a Socio-ecological perspective

BACKGROUND

Pregnancy termination is an essential component of reproductive healthcare. In Southern Africa, an estimated 23% of all pregnancies end in termination of pregnancy, against a backdrop of high rates of unintended pregnancies and unsafe pregnancy terminations, which contributes to maternal morbidity and mortality. Understanding the reasons for pregnancy termination may remain incomplete if seen in isolation of interpersonal (including family, peer, and partner), community, institutional, and public policy factors. This study therefore aimed to use a socio-ecological framework to qualitatively explore, in Soweto, South Africa, i) reasons for pregnancy termination amongst women aged 18-28 years, and ii) factors characterising the decision to terminate.

METHODS

In-depth interviews were conducted between February to March 2022 with ten participants of varying parity, who underwent a termination of pregnancy since being enrolled in the Bukhali trial, set in Soweto, South Africa. A semi-structured, in-depth interview guide, based on the socioecological domains, was used. The data was analysed using reflexive thematic analysis, and a deductive approach.

RESULTS

An application of the socio-ecological framework indicated that the direct reasons to terminate a pregnancy fell into the individual and interpersonal domains of the socioecological framework. Key reasons included financial dependence and insecurity, feeling unready to have a child (again), and a lack of support from family and partners for the participant and their pregnancy. In addition to these reasons, Factors that characterised the participants' decision experience were identified across all socio-ecological domains and included the availability of social support and (lack of) accessibility to termination services. The COVID-19 pandemic and resultant lockdown policies also indirectly impacted participants' decisions through detrimental changes in interpersonal support and financial situation.

CONCLUSIONS

Amongst the South African women included in this study, the decision to terminate a pregnancy was made within a complex structural and social context. Insight into the reasons why women choose to terminate helps to better align legal termination services with women's needs across multiple sectors, for example by reducing judgement within healthcare settings and improving access to social and mental health support.

A scoping review on the nature and impact of gender based violence on women primary producers

BACKGROUND

Women in low- and middle-income countries (LMICs) are primary producers of subsistence food and significant contributors to the agricultural economy. Gender Based Violence (GBV) adversely impacts their capacity to contribute and sustain their families and undermines social, economic, and human capital. Addressing GBV, therefore, is critical to creating safe and inclusive environments for women as primary producers to participate fully in rural communities. The aim of this scoping review is to explore the existing evidence on GBV in the context of women primary producers in LMICs to inform research gaps and priorities.

METHODS

A scoping review was conducted using PubMed, Web of Science, Ebscohost and Google Scholar using keywords related to GBV and women producers in LMICs. Peer-reviewed journal articles published between January 2012 and June 2022 were included in the review. Duplicates were removed, titles and abstracts were screened, and characteristics and main results of included studies were recorded in a data charting form. A total of 579 records were identified, of which 49 studies were eligible for inclusion in this study.

RESULTS

Five major themes were identified from our analysis: (1) extent and nature of GBV, (2) the impact of GBV on agricultural/primary production livelihood activities, (3) sociocultural beliefs, practices, and attitudes, (4) aggravating or protective factors, and (5) GBV interventions. Addressing GBV in agriculture requires inclusive research approaches and targeted interventions to empower women producers, promote gender equality, enhance agricultural productivity, and contribute to broader societal development. Despite attempts by researchers to delve into this issue, the pervasive under-reporting of GBV remains a challenge. The true extent and nature of GBV perpetrated against women is far from fully understood in this context.

CONCLUSION

Despite the significant challenges posed by GBV to the health, economy and livelihoods of women primary producers in LMICs, there is a paucity in the current state of knowledge. To make meaningful progress, more research is required to understand the relationship between GBV and agricultural settings, and to gain nuanced insight into the nature and impact of GBV on women primary producers in different regions and contexts.

COVID-19, pandemic lockdowns and intimate partner violence among HIV-positive women in Ghana

This study examines the prevalence and risk factors of physical, sexual, psychological, and economic violence during lockdowns associated with COVID-19 among HIV-positive women in Ghana. Data were collected in August 2021 from a cross-section of 538 HIV-positive women aged 18 years and older in the Lower Manya Krobo District in the Eastern region of Ghana. Logit models were used to explore relationships between women's self-reported experiences of physical, sexual, psychological /emotional, and economic violence under lockdown and key socio-economic and demographic characteristics. The findings indicate moderate to high prevalence of intimate partner violence (IPV) under lockdown in our sample: physical violence (30.1%), sexual violence (28.6%), emotional/psychological violence (53.7%), and economic violence (54.2%). IPV was higher on all four measures for educated women, poorer women, employed women, cohabiting and married women, and HIV seroconcordant couples.

Gender-based violence and its health risks on women in Yaoundé, Cameroon

INTRODUCTION

Gender-based violence (GBV) is a major public health problem that disproportionately affects women. In Cameroon, as well as other countries worldwide, GBV has immediate effects on women's health, with one in three women experiencing physical or sexual violence from an intimate partner, affecting their physical and reproductive health. The objective of this study was to determine the health risks associated with GBV among women in Yaoundé.

METHODS

A cross-sectional study was conducted in Yaoundé (Cameroon), from August to October 2022. Adverse health outcome included mental disorders, physical trauma, gynaecological trauma, behavioral disorders, and any other disorder. Tests of associations were used to establish relationships between qualitative variables. Associations were further quantified using crude odds ratio (OR) for univariate analysis and adjusted odds ratio (aOR) for multivariate analysis with 95% confidence interval (CI). Independent variables included: Physical violence, Sexual violence, Economic violence, Emotional violence, Age, Number of children, and Marital status. Variables with p-value˂0.05 were considered statistically significant.

RESULTS

A total of 404 women aged 17 to 67 years were interviewed. Emotional violence was the most commonly reported violence (78.8%), followed by economic violence (56.9%), physical violence (45.8%) and sexual violence (33.7%). The main reasons for violence were jealousy (25.7%), insolence (19.3%) and the refusal to have sexual intercourse (16.3%). The prevalences of adverse health outcomes were physical trauma (90.9%), followed by mental disorders (70,5%), gynaecological trauma (38.4%), behavioral disorders (29.7%), and other (5.5%). Most victims reported at least one of the above-mentioned conditions (80.2%). Women who were victims of any kind of violence had a higher likelihood of experiencing adverse health outcomes: physical violence [OR = 34.9, CI(10.8-112.9), p < 0.001]; sexual violence [OR = 1.5, CI(0.9-2.7), p = 0.11]; economic violence [OR = 2.4, CI(1.4-3.9), p = 0.001]; and emotional violence [OR = 2.9, CI(1.7-4.9), p < 0.001]. Using multiple binary logistic regression, only physical violence [aOR = 15.4, CI(6.7-22.5), p = 0.001] remained highly associated with an increased likelihood of having adverse health outcomes.

CONCLUSION

This study underscores the urgent need for comprehensive interventions to address GBV, including improved reporting and documentation of cases, increased awareness among healthcare providers, the establishment of support networks for victims, primary and secondary prevention of GBV. It is essential that the Government of Cameroon, through the Ministries in charge of Health and Women's Empowerment, minimizes the health effects of GBV through early identification, monitoring, and treatment of GBV survivors by providing them with high-quality health care services.

Men's Narratives of Sexual Intimate Partner Violence in Urban Mwanza, Northwestern Tanzania

Engaging men has been established as central in addressing intimate partner violence. Yet few studies on intimate partner violence explored men's perspectives on what constitutes sexual violence in relationships only. To explore how men conceptualize sexual violence, we engaged a qualitative approach to unpack men's narratives of sexual IPV. The study was conducted in Mwanza, Tanzania using in-depth interviews with 30 married men. Men shared a broad spectrum of unacceptable behaviors that clearly or potentially connote sexual violence. Some of the acts were deemed to constitute sexual violence when directed to both men and women, while some were perceived as sexual violence when directed to women or men only. Threatened manhood underpinned men's conceptualization of sexual violence against them by their partners. Although a large part of men's narratives of sexual violence towards women seemed to challenge the common sexual scripts existing in patriarchal societies, some of their accounts indicated the persistence of traditional presumptions of masculine sexual entitlement. Our findings uncover additional dimensions of sexual violence that go beyond what is included in the current global frameworks, underscoring the critical need of giving people a voice in their local contexts in defining what sexual intimate partner violence entails for them. This may increase the likelihood of interventions becoming more acceptable and effective when targeting sexual violence, thereby contributing to reduced levels of sexual intimate partner violence.

Intimate Partner Violence, prevalence and its consequences: a community-based study in Gambella, Ethiopia

Abstract

Introduction

Intimate partner violence is defined as any behavior by a current or past male intimate partner during marriage, cohabitation, or any other formal or informal union that causes physical, sexual, or psychological harm. Men are the most common perpetrators of this against women. It affects almost one-third of all women worldwide.

Objective

This study aimed to assess the prevalence, consequences, and factors associated with intimate partner violence among partnered women in Gambella town.

Methods

A community-based, cross-sectional study design was employed. A systematic random sampling technique was used to select the study participants. Data was collected using a pretested, structured questionnaire. The data were entered and analyzed using SPSS software version 25. The bivariate and multivariate logistic regression method was used to identify factors associated with intimate partner violence. Variables with a p-value <0.05 were considered significantly associated with intimate partner violence.

Results

The overall prevalence of intimate partner violence in the lifetime and the last 12 months was 58.8, 95% CI (54.0, 63.6), and 51.8, 95% CI (46.7, 56.8), respectively. More than half (53.3%) of the violence resulted in physical injury, while 32.9% were separated from their partners whereas, mother's history of exposure to IPV [AOR: 1.8, 95% CI (1.03-3.27), p < 0.05], respondent's age [AOR: 3.4, 95% CI (1.8, 6.5), p < 0.001], substance use [AOR:2.5, 95% CI (1.5-4.1), p < 0.001], disagreement on sexual intercourse [AOR:3.2, 95% CI (1.8-5.7), p < 0.01], monthly family income [AOR:0.32, 95% CI: (0.16-0.63), p < 0.01] and family size [AOR:2.8, 95% CI: (1.6-4.8), p < 0.01] were significantly associated with IPV.

Conclusion

The study indicated that the prevalence of intimate partner violence was very high. Age of the woman, family size, substance use, economic status, were among factors significantly associated with intimate partner violence. Therefore, responsible stakeholders should respond to the deep-rooted and highly complicated gender inequality by implementing preventive measures.

Magnus J, Assefa N, Wordofa MA. The protocol for a cluster randomized controlled trial to evaluate couple-based violence prevention education and its ability to reduce intimate partner violence during pregnancy in Southwest Ethiopia

BACKGROUND

A significant proportion of women in Ethiopia suffer from violence by their intimate partner during pregnancy, which has adverse maternal and newborn outcomes. Couple-focused interventions are effective in reducing and/or controlling violence between women and their intimate partners. However, interventions addressing intimate partners of the victims are not well studied, particularly in the Ethiopian setting. This study aims to assess the effect of couple-based violence prevention education on intimate partner violence during pregnancy.

METHODS

We will use a cluster randomized controlled trial to evaluate the effectiveness of couple-based violence prevention education compared to routine care in reducing intimate partner violence during pregnancy. Sixteen kebeles will be randomly assigned to 8 interventions and 8 control groups. In the trial, 432 couples whose wife is pregnant will participate. Health extension workers (HEWs) will provide health education. Data will be collected at baseline and endline. All the collected data will be analyzed using Stata version 16.0 or SPSS version 25.0. We will use the McNemar test to assess the differences in outcomes of interest in both intervention and control groups before and after the intervention for categorical data. A paired t-test will be used to compare continuous outcome of interest in the intervention and the control groups after and before the intervention. The GEE (Generalized Estimating Equation), will be used to test the independent effect of the intervention on the outcome of the interest. Data analysis will be performed with an intention-to-treat analysis approach. During the analysis, the effect size, confidence interval, and p-value will be calculated. All tests will be two-sided, and statistical significance will be declared at p < 0.05.

DISCUSSION

We expect that the study will generate findings that can illuminate violence prevention strategies and practices in Ethiopia.

TRIAL REGISTRATION

It has been registered on ClinicalTrials.gov as NCT05856214 on May 4, 2023.

Association between the survey-based women's empowerment index (SWPER) and intimate partner violence in sub-Saharan Africa

BACKGROUND

Intimate partner violence (IPV) is high among women of reproductive age in sub-Saharan Africa (SSA). However, empowering women enables them to confront and mitigate IPV. In this study, we examined the association between the survey-based women's empowerment index (SWPER) and IPV in SSA.

METHODS

We used data from the Demographic and Health Surveys of 19 countries conducted from 2015 to 2021. Our study was restricted to a weighted sample of 82,203 women of reproductive age who were married or cohabiting. We used spatial maps to show the proportions of women who experienced past-year IPV. A five-modelled multilevel binary logistic regression analysis was adopted to examine the association between SWPER and IPV. The results were presented using the adjusted odds ratio (AOR) with their respective 95% confidence interval (CI). Statistical significance was set at p < 0.05.

RESULTS

With physical and emotional violence, the country with the highest prevalence was Sierra Leone, with a prevalence of 39.00% and 38.97% respectively. Rwanda (10.34%), Zambia (11.09%), Malawi (15.00%), Uganda (16.88%), and Burundi (20.32%) were the hotspot countries for sexual violence. Angola (34.54%), Uganda (41.55%), Liberia (47.94%), and Sierra Leone (59.98%) were the hotspot countries for IPV. A high SWPER score in attitudes to violence significantly decreased the odds of IPV [AOR = 0.70; 95% CI = 0.66, 0.75]. Also, women with medium score in decision-making were less likely to experience IPV compared to those with lower scores [AOR = 0.89; 95% CI = 0.83, 0.95]. However, higher odds of experiencing IPV was found among women with medium score in autonomy compared to those with low scores [AOR = 1.07; 95% CI = 1.01, 1.14].

CONCLUSIONS

Our study has shown that the three dimensions of SWPER significantly predict IPV among women. Consequently, it is crucial that sub-Saharan African countries implement various initiatives, such as IPV advocacy programs and economic livelihood empowerment initiatives. These initiatives should not only aim to improve women's attitudes to domestic violence but also to enhance their social independence, autonomy, and decision-making capacity.

Navigating challenges: a socioecological analysis of sexual and reproductive health barriers among Eritrean refugee women in Ethiopia, using a key informant approach

OBJECTIVES

The study aimed to explore the experiences and perceptions of healthcare providers (HCPs) regarding the sexual and reproductive health (SRH) challenges of Eritrean refugee women in Ethiopia.

DESIGN

A qualitative exploratory design with the key informant approach.

SETTING AND PARTICIPANTS

The study was conducted in the Afar regional state, North East, Ethiopia. The study participants were HCP responsible for providing SRH care for refugee women.

RESULTS

Eritrean refugee women have worse health outcomes than the host population. The SRH needs were found to be hindered at multiple layers of socioecological model (SEM). High turnover and shortage of HCP, restrictive laws, language issues, cultural inconsistencies and gender inequalities were among the main barriers reported. Complex multistructural factors are needed to improve SRH needs of Eritrean refugee women.

CONCLUSIONS

A complex set of issues spanning individual needs, social norms, community resources, healthcare limitations and structural mismatches create significant barriers to fulfilling the SRH needs of Eritrean refugee women in Ethiopia. Factors like limited awareness, cultural taboos, lack of safe spaces, inadequate healthcare facilities and restrictive policies all contribute to the severe limitations on SRH services available in refugee settings. The overlap in findings underscores the importance of developing multilevel interventions that are culturally sensitive to the needs of refugee women across all SEM levels. A bilateral collaboration between Refugees and Returnees Service (RRS) structures and the Asayta district healthcare system is critically important.

Correlates of Intimate Partner Violence Victimization and Perpetration in Adolescents and Young Adults in Sub-Saharan Africa: A Systematic Review

Intimate partner violence (IPV) is a global public health crisis with long-term adverse consequences for both victims and perpetrators. Patterns of violence often begin during adolescence, yet most interventions target adult relationships. A systematic review was conducted to identify correlates of IPV victimization and perpetration among adolescents and young adults in sub-Saharan Africa (SSA). Eligible studies included participants 10 to 24 years old, took place in SSA, and tested a statistical association between a correlate and an IPV outcome. Correlates were defined as any condition or characteristic associated with statistically significant increased or decreased risk of IPV victimization or perpetration. PsycInfo, PubMed, Embase, and African Index Medicus were searched and included studies published between January 1, 2000 and February 4, 2022. The search resulted in 3,384 original studies, of which 55 met inclusion criteria and were analyzed. Correlates were first qualitatively synthesized by developmental period (e.g., early adolescence, older adolescence, and young adulthood) and then organized in a conceptual framework by correlate type (e.g., socio-demographic; health, behavior, and attitudes; relational; or contextual). Over two decades of literature reveals variability in evidence by developmental period but also substantial overlap in the correlates of victimization and perpetration. This review identifies multiple points for intervention and results suggest the urgent need for earlier, developmentally appropriate prevention efforts among younger adolescents as well as combined approaches that target both victimization and perpetration of IPV.

The wording matters: Gender equality laws and women's attitudes towards domestic violence in Africa

In this paper, we documented the association between specific wordings regarding domestic violence within gender equality laws and women's attitudes towards domestic violence in African countries. To do so, we used data on the longitudinal Demographic and Health Survey conducted between 2003 and 2018, and we empirically conducted a difference-in-differences analysis that captures variations in the country and timing of the inclusion of specific wordings addressing domestic violence in the legislative framework that encompasses the general principle of gender equality. The empirical analysis showed that the inclusion of a specific article criminalizing domestic violence within a country's general gender equality law contributed to a statistically significant and substantial decrease in the likelihood of women deeming wife-beating behaviors justifiable. We further conducted an analysis of heterogeneity by socioeconomic status, as defined by urban status, wealth, literacy, and access to information; we found that the association between laws' wordings and attitudes towards domestic violence appeared statistically significant and sizeable in all socioeconomic groups.

The relationship between intimate partner violence and child malnutrition: a retrospective study in 29 sub-Saharan African countries

Introduction and background

Intimate partner violence (IPV) and child malnutrition are global public health issues. Assessing the association between IPV and child anthropometric failures (stunting, underweight, and wasting) in 29 Sub-Saharan African (SSA) countries can provide significant global health solutions. Some studies have found an association between IPV against women and child malnutrition, but the conclusions are inconsistent. The physical and psychological conditions, living environment, and rights of the mother may be involved.

Methods

We collected and analyzed the Demographic and Health Surveys data (2010-2021) of 29 SSA countries. The main exposure variables were various types of IPV, classified as physical, sexual, and emotional violence. The outcome was the child's development index, which can be roughly divided into stunting, wasting, and underweight. An adjusted binary logistic regression model was used to test the relationship between IPV and children's nutritional status.

Results

A total of 186,138 children under 5 years of age were included in the analysis; 50,113 (27.1%) of the children were stunted, 11,329 (6.1%) were wasted, and 39,459 (21.3%) were underweight in all regions. The child's gender, age, duration of breastfeeding, complementary feeding, and vitamin A supplements intake in the past 6 months were associated with their nutritional status (p < 0.001). Sexual violence was the strongest factor associated with stunting, which remained statistically significant after controlling all variables (AOR = 1.11; 95% CI: 1.02, 1.21; p = 0.012). We also found a small negative association between wasting and IPV. For underweight, there were no associations with IPV after controlling for all variables (p > 0.05).

Conclusion

IPV is positively associated with child stunting in SSA countries. Sexual violence showed a strong positive correlation with stunting. Wasting was unexpectedly negatively associated with IPV. There was no clear correlation between underweight and violence.

Water insecurity is associated with intimate partner violence among female adolescents and youth but not males in rural Tanzania: A cross-sectional study

Food insecurity increases intimate partner violence (IPV), but less is known about water insecurity (WI) and IPV. We examined the association between household WI and IPV among adolescents and youth in the Mbeya and Iringa regions of Tanzania. The cross-sectional sample comprised 977 males and females aged 18-23 years living in rural, impoverished households. We conducted multivariate logistic regression analyses to estimate the association between experiences of WI [measured by the Household Water Insecurity Experiences (HWISE-4) Scale] and physical and/or emotional IPV (measured by an adapted Conflict Tactics Scale). Overall, WI (HWISE ≥4) was associated with 74% higher odds of any IPV (marginal effects (ME) of 7.8 percentage points (pp)), compared to those not WI. Among females (but not males), WI was associated with 3-fold higher odds of any IPV (OR = 3.00; 95% CI: [1.52, 5.94]; ME  = 14 pp). Compared to non-WI females, WI females had 5- and 2-fold higher odds of IPV (ME = 30.8 and 11.3 pp) among the ever married and never married sub-samples, respectively. The association between WI and IPV among females was attenuated (OR = 1.93; 95% CI: [0.93, 3.97]) when adjusting for household food insecurity. Ameliorating water insecurity is a promising avenue for IPV reduction.

Prevalence and determinants of intimate partner sexual violence among pregnant women in sub-Saharan Africa: Evidence from the most recent DHS data 2015-2022

INTRODUCTION

Intimate partner sexual violence (IPSV) is sexual violence against women by a current or former sexual partner. Sexual violence among pregnant women is higher in low-income countries, particularly in sub-Saharan Africa (SSA), which has numerous negative impacts for both the mother and the growing fetus. There is no recent and distinct information on the magnitude and factors associated with IPSV among pregnant women in SSA.

OBJECTIVE

This study aimed to assess the prevalence of IPSV and its determinants among pregnant women in SSA.

DESIGN

A cross-sectional study design using demographic health survey data from 2015 to 2022 in 20 sub-Saharan African countries was used.

METHODS

The analysis was conducted using a weighted sample of 10,775 women who were pregnant during the survey period (2015-2022). A multilevel logistic regression model was used to identify the determinants of IPSV among pregnant women. The adjusted odds ratio at 95% confidence interval (95% CI) was computed to assess the strength and significance of the association between explanatory and outcome variables. Factors with a p-value of <0.05 are declared statistically significant.

RESULT

In this study, the pooled prevalence of IPSV among pregnant women in SSA was 11.06% (95% CI: 10.48-11.67). Respondents currently working, male-headed households, presence of justified beating, respondent mother's history of abuse, respondent having no media access, respondent having self-reported sexually transmitted diseases (STIs), partner alcohol use, and residing in East Africa had increased odds of IPSV during pregnancy. On the other hand, nulliparous respondents, respondents involved in healthcare decision-making, households with a high wealth index, and residents of West Africa had decreased odds of IPSV among pregnant women.

CONCLUSION

This study revealed that a significant proportion (11%) of pregnant women experienced intimate partner sexual violence during pregnancy in SSA. Hence, the government, policymakers, and other relevant authorities should give special attention to women's at-risk of sexual violence, including women who live in households with justified beatings, women with STIs, working women's, women with drunken partners, and non-autonomous women's. Prioritization of the east African region, increasing media access, and promoting a healthy lifestyle in the community shall be done to reduce the burden of the problem.

Assessing the role of depression in reducing intimate partner violence perpetration among young men living in urban informal settlements using a mediation analysis of the Stepping Stones and Creating Futures intervention

BACKGROUND

Stepping Stones and Creating Futures (SS/CF) is a gender transformative and economic empowerment intervention that has effectively reduced the perpetration of intimate partner violence (IPV) by young men living in informal settlements in South Africa.

OBJECTIVE

This study examines whether depression mediated the association between SS/CF intervention and decreased IPV.

METHOD

Data from a two-arm cluster randomised community-based controlled trial that evaluated the effectiveness of SS/CF in lowering IPV were obtained from 674 young men aged 18-30 within urban informal settlements in South Africa. After being randomly assigned to either the experimental arm (SS/CF) or the control arm, the participants were followed up for 24 months. Logistic regression using mediation analysis was conducted to see whether changes in depressive symptoms mediated the association between the intervention and reduced IPV perpetration.

RESULTS

Findings from the mediation analysis indicated that those assigned to the SS/CF experimental group reported lower depression (β = -0.42, p < 0.05) at 12 months, and this was subsequently associated with reduced IPV (β = 0.43, p < 0.05) at 24 months. The direct path from SS/CF to IPV was originally (β = -0.46, p < 0.01), but reduced in the mediation model to (β = -0.13, p = 0.50). Depressive symptoms mediated the association between the SS/CF intervention and decreased IPV perpetration.

CONCLUSION

These findings suggest that one pathway through which SS/CF decreased IPV was through improvement in mental health (i.e. depression). Future IPV prevention interventions may consider incorporating components that focus on improving mental health as a way of also reducing IPV perpetration in disadvantaged settings.

Attitudes of Individuals with Alcohol and Substance Addiction Towards Violence Against Women

The aim of this study was to determine the attitudes of alcohol and substance dependent individuals towards violence against women. This cross-sectional study was completed with n=105 patients who were followed up in the Alcohol and Substance Addiction Treatment and Research Center of a state hospital. In this study, personal information form and ISKEBE attitudes towards violence against women scale were used as data collection tools. Among the patients diagnosed with alcohol-substance use disorder, n=53 (60.9%) were between the ages of 18-34 and n=70 (66.7%) were single. Of the patients, n=36 (52.2%) had been exposed to any type of domestic violence. The attitude scores of patients diagnosed with alcohol-substance use disorder towards violence against women were measured as 99.89 ± 22.1. In the current study, patients diagnosed with alcohol-substance use disorder who were male, lived in rural areas, had poor income status and had low educational level were found to have negatively low attitudes towards violence against women. In conclusion of this study, further studies and practices to determine and improve attitudes towards violence against women in patients diagnosed with alcohol-substance use disorder are recommended.

The missed pandemic: Intimate partner violence in female mental-health-care-users during the COVID-19 pandemic

Adverse childhood experiences (ACEs) and interpersonal violence (IPV) in mentally ill women are often neglected and need to be reviewed in light of the suggested increase in IPV during the COVID-19 pandemic.We investigated the prevalence of ACEs and IPV in women living with severe mental illness (SMI) attending an outpatient psychiatry service at a public hospital in KwaZulu-Natal, South Africa, during the COVID-19 pandemic. We also described the association of ACEs with later IPV.A written survey comprising socio-demographic and clinical questionnaire, WHO Adverse Childhood Experiences International Questionnaire (ACE-IQ) for ACEs and the Women abuse screening tool (WAST) for IPV, was completed by the 154 women with SMI.141 (91.6%) participants scored positive for ACEs and 104 (67.5%) had experienced three or more ACEs. The most prevalent forms of ACEs were emotional neglect 72 (46.8%), one or no parents, parental separation, or divorce 104 (67.5%), contact sexual abuse 67 (43.5%) and witnessing a household member treated violently 67 (43.5%). Sixty-one (46.6%) participants reported IPV with scores  13 (indicative of abuse). On logistic regression, experience of three or more ACEs was significantly associated with IPV in adulthood (aOR 3.3, 95% CI: 1.2-9.6).The high prevalence of IPV and association of IPV with cumulative ACEs reflect firstly the hidden epidemic of domestic violence and secondly the vulnerability of those with ACEs to become victims of abuse later which is often  missed in the care of women with SMI.

Nurses' experiences of perceiving violence and abuse of women in Saudi Arabia: A phenomenological study

AIM

To explore the practices, understanding, and experiences of nurses and nursing students about domestic violence and abuse in Saudi Arabia.

BACKGROUND

Domestic violence and abuse is a well-known public health issue and a clear violation of human rights resulting in detrimental effects on women's health.

INTRODUCTION

Societal and cultural barriers in Saudi Arabia limit women's rights and disclosure of violence within marriage and families, preventing access to health care and support. There are few reports of this phenomenon in Saudi Arabia.

METHODS

We used a hermeneutic phenomenological approach to acquire in-depth insights into nurses' perceptions and experiences regarding domestic violence and abuse. Eighteen nurses and student nurses were recruited from Riyadh, Saudi Arabia, using convenience sampling. Data were gathered between October 2017 and February 2018 through in-depth semistructured interviews, organized using NVivo 12 and analyzed manually to identify consistent themes. This study adhered to the consolidated criteria for reporting qualitative research.

FINDINGS

An overarching concept of "being disempowered" was identified, which was present at three levels: a lack of nurses' professional preparation, insufficient organizational structures and processes, and wider social and cultural components.

CONCLUSION

This study provides an in-depth account of nurses' practices, understanding, and experiences of domestic violence and abuse, highlighting the sensitivity and difficulties of addressing the problem in hospitals across Saudi Arabia and potentially other similar countries.

IMPLICATIONS

The study's findings will inform the development of nursing education and practice in Saudi Arabia, as well as pave the way toward formulating effective strategies with needed modifications in curriculum, organizations, policy, procedures, and laws.

A socio-legal imperative of domestic violence prohibition in Africa vis-a-vis Nigerian legal structure for sexually abused women

Domestic violence is a major issue globally. It is one of the most heinous crimes which has and still results in numerous deaths, still receives the least amount of attention, and its negative influence is being underrated. In Africa, it is customarily acceptable for a woman to be beaten by her husband as a form of discipline, and Nigeria is not an exception. To think otherwise, that it cannot be socially acceptable and legally upheld for a man to beat his wife as a form of discipline, is to deny an existing reality. Section 282 of the Nigerian Penal Code encourages men to beat their wives when necessary. This form of permissible violence is often viewed as a family issue. Hence women are hesitant or reluctant to speak up about their experiences. The stigma that usually follows speaking up or voicing out is better imagined than experienced. This study, therefore, provides credible information on domestic violence incidents in Nigeria and Africa. The methodology utilised is the doctrinal legal research method with reports from existing literature and tertiary data sources such as newspapers and website sources. It discusses legislation enacted to prevent and prohibit domestic violence in Nigeria and how influential they have been on the nation at large. By way of comparative analysis, we examine domestic violence occurrences in some selected African countries and the European continents in relation to Nigeria. It also delves into the violation of the principles of gender equality by some Nigerian customs and traditional practices. This study then makes recommendations on how to address the issue. Through its insightful engagement, this study found, among others, that domestic violence is widespread in Africa and that a national law prohibiting the act and holding perpetrators accountable is not only imperative in Nigeria but across the African continent.

Intimate partner violence and antenatal care utilization predictors in Uganda: an analysis applying Andersen's behavioral model of healthcare utilization

BACKGROUND

Optimal utilization of antenatal care (ANC) services improves positive pregnancy experiences and birth outcomes. However, paucity of evidence exists on which factors should be targeted to increase ANC utilization among women experiencing intimate partner violence (IPV) in Uganda.

OBJECTIVE

To determine the independent association between IPV exposure and ANC utilization as well as the predictors of ANC utilization informed by Andersen's Behavioral Model of Healthcare Utilization.

METHODS

We analyzed 2016 Uganda Demographic and Health Survey data that included a sample of 1,768 women with children aged 12 to 18 months and responded to both ANC utilization and IPV items. Our outcome was ANC utilization, a count variable assessed as the number of ANC visits in the last 12 months preceding the survey. The key independent variable was exposure to any IPV form defined as self-report of having experienced physical, sexual and/or emotional IPV. Covariates were grouped into predisposing (age, formal education, religion, problem paying treatment costs), enabling (women's autonomy, mass media exposure), need (unintended pregnancy, parity, history of pregnancy termination), and healthcare system/environmental factors (rural/urban residence, spatial accessibility to health facility). Poisson regression models tested the independent association between IPV and ANC utilization, and the predictors of ANC utilization after controlling for potential confounders.

RESULTS

Mean number of ANC visits (ANC utilization) was 3.71 visits with standard deviation (SD) of ± 1.5 respectively. Overall, 60.8% of our sample reported experiencing any form of IPV. Any IPV exposure was associated with lower number of ANC visits (3.64, SD ± 1.41) when compared to women without IPV exposure (3.82, SD ± 1.64) at p = 0.013. In the adjusted models, any IPV exposure was negatively associated with ANC utilization when compared to women with no IPV exposure after controlling for enabling factors (Coef. -0.03; 95%CI -0.06,-0.01), and healthcare system/environmental factors (Coef. -0.06; 95%CI -0.11,-0.04). Predictors of ANC utilization were higher education (Coef. 0.27; 95%CI 0.15,0.39) compared with no education, high autonomy (Coef. 0.12; 95%CI 0.02,0.23) compared to low autonomy, and partial media exposure (Coef. 0.06; 95%CI 0.01,0.12) compared to low media exposure.

CONCLUSION

Addressing enabling and healthcare system/environmental factors may increase ANC utilization among Ugandan women experiencing IPV. Prevention and response interventions for IPV should include strategies to increase girls' higher education completion rates, improve women's financial autonomy, and mass media exposure to improve ANC utilization in similar populations in Uganda.

Adolescent mental health in post-conflict communities: results from a cross-sectional survey in Northern Uganda

PURPOSE

This study evaluated adolescents' mental health their knowledge, attitudes, and beliefs about mental health conditions, and their access to critical mental health services in Lira District, northern Uganda. The political history of the region, the epicenter of the decades-long conflict between the Lord's Resistance Army and the Ugandan government, makes for an interesting case study of the political and social determinants of mental health of those directly impacted by conflict, and on subsequent generations growing up in post-conflict communities.

METHODS

This paper presents the results of a community-based participatory research study carried out by youth public health ambassadors in Lira District, Uganda. The study consisted of a mixed methods cross-sectional survey of households, schools, and healthcare facilities.

RESULTS

The study found 66% of adolescents indicated poor well-being and possible symptoms of depression and 41% of adolescents reported at least 4 childhood trauma events. Over 35% reported feeling extremely sad and 60% reported feeling socially isolated during the COVID lockdowns that lasted from 2020 to 2021. Nearly half of the adolescents aged 14-17 surveyed (N = 306) believed that witchcraft caused mental health problems, while less than 20% believed that traumatic experiences could be a cause. Forty percent of respondents had no idea of where to seek mental health care, and few facilities had mental health services available.

DISCUSSION

These findings illustrate the need to study the political and social determinants of mental health, especially on those directly impacted by armed conflict and for the generations growing up in post-conflict communities as they seek to rebuild.

Formal support services and (dis)empowerment of domestic violence victims: perspectives from women survivors in Ghana

BACKGROUND

As part of efforts to prevent violence against women, several countries have institutionalized formal support services including legislations to prevent, protect victims, and deter perpetrators of domestic violence (DV). Prior research on formal support service utilization shows that DV survivors do not get the necessary services they deserve. However, much remains to be known about the experiences of women survivors of DV who accessed a range of formal support services and how their experiences (dis)empowered them. Here, we assessed the experiences of Ghanaian women survivors of DV with formal support services vis-à-vis the provisions of the Ghana DV Act and insights of subject experts.

METHODS

From May to August 2018, we recruited a total of 28 participants: 21 women survivors of DV in Weija-Gbawe Municipality of Ghana, and 7 experts from the police, human rights, and health professions. We used two sets of in-depth interview guides: one to collect data on survivors' experiences, and the second for the insights of experts. We performed summary descriptive statistics on survivors' sociodemographic characteristics and used thematic analysis to assess their experiences of DV; and access to, patronage, and response of formal support services.

RESULTS

Of 21 DV survivors, 19 (90.1%) were aware of the existence of the DV law, however none was well informed of their entitlements. DV survivors have low formal education and are not economically empowered. Some DV survivors are revictimized in the process of accessing formal services. DV survivors expect the government to provide them with shelter, upkeep, medical, and legal aid. All the 21 survivors had at least one contact with a women's rights organization and were knowledgeable of their supporting services namely legal services, temporary shelter, and psychosocial support.

CONCLUSIONS

The experiences of DV survivors do not reflect the legal provisions of Ghana's DV Act. Government under funding of formal services and negative gender norms are disempowering to survivors. NGOs are popular among women survivors of DV in Ghana for the education, legal, and material support they provide. A close collaboration between the government and NGOs could better mitigate DV in Ghana.

Healthcare workers' perceptions of sexual violence during the COVID-19 pandemic in the Eastern Cape

BACKGROUND

The South African government implemented lockdown restrictions in order to prevent the spread of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).

AIM

This study explored the effects of the coronavirus disease 2019 (COVID-19) pandemic on sexual violence in the Eastern Cape province through the lens of healthcare workers' (HCWs) experiences.

SETTING

A Thuthuzela care centre in the Eastern Cape province, South Africa.

METHODS

This qualitative study brings together the findings from thematic analysis of semi-structured interviews conducted among 11 purposively selected HCWs in May 2022.

RESULTS

Overall, three themes emerged from the study: the effects of COVID-19 on sexual violence, profile of the survivors and recommendations for combating sexual violence in the region. Most respondents believed that the COVID-19 pandemic caused a surge in the incidence of sexual violence, although all acknowledged that movement restrictions affected reporting. The participants treated mostly black women and children's survivors, who experienced physical injuries simultaneously. The respondents' narratives revealed that educational campaigns targeting boys and men could reduce sexual violence in the region. In addition, it was recommended that stricter laws and harsher penalties would serve as deterrents for perpetrators of sexual violence in the country.

CONCLUSION

The COVID-19 lockdown restrictions exposed the vulnerabilities of black women and children to sexual violence in the study setting. Educational programmes aimed at re-orientating boys and men in both rural and urban communities should be implemented.Contributions: This study provides an insight into the perceived effect of the COVID-19 pandemic on sexual violence in the Amathole district and South Africa.

The significance of feeling safe for resilience of adolescents in sub-Saharan Africa

Introduction

Adolescents in sub-Saharan Africa (SSA) are exposed to several challenges and risk factors, linked to historical legacies. Sub-Saharan Africa has one of the highest rates of poverty and inequality in the world, is one of the regions most negatively affected by climate change, performs poorly on many health measures, and has high rates of different forms of violence, especially gender-based violence. These contextual challenges impact adolescent mental health outcomes, preventing them to access resilience-enabling pathways that support positive outcomes despite adversity. This study aimed to contribute to knowledge generation on resilience of young people in the understudied SSA region by investigating which variables directly (or indirectly) affect the resilience of adolescents.

Methods

Purposive sampling was used to collect quantitative survey data from 3,312 adolescents (females = 1,818; males = 1,494) between the ages of 12 and 20 years, participating in interventions implemented by a non-governmental organization, the Regional Psychosocial Support Initiative. Data were collected in Angola (385, 11.6%), Eswatini (128, 3.9%), Kenya (390, 11.8%), Lesotho (349, 10.5%), Mozambique (478, 14.4%), Namibia (296, 8.9%), South Africa (771, 23.3%), Uganda (201, 6.1%), and Zambia (314, 9.5%). The survey collected data on socio-demographic status, resilience (CYRM-R), depression (PHQ-9), self-esteem (Rosenberg Self-Esteem Scale) and feelings of safety (self-developed scale). Mental health was defined as lower levels of depression, higher levels of self-esteem and higher levels of feeling safe. A mediation analysis was conducted to investigate the relationship between the predictors (the socio-demographic variables) and the output (resilience), with the mediators being depression, self-esteem and feeling safe (which all link to mental health).

Results

This study contributes to a gap in knowledge on country-level comparative evidence on significant predictors that impact resilience outcomes (directly or indirectly) for adolescents in sub-Saharan African countries. The results indicate that, when considering all countries collectively, feeling safe is the only predictor that has a significant direct effect on overall resilience and personal resilience, but not on caregiver resilience. When considering each country separately, feeling safe has a direct effect on overall, personal and caregiver resilience for all countries; but not for South Africa and Mozambique.

Discussion

The results provide evidence on which to craft youth development interventions by measuring mediators (depression, self-esteem and feeling safe) and resilience for adolescents in sub-Saharan Africa. The overall results of the present paper point toward a contextually relevant pathway to supporting their resilience, namely, the need to systemically target the creation and/or strengthening of structures that enable adolescents to feel safe.

A Student-Centric Evaluation of a Program Addressing Prevention of Gender-Based Violence in Three African Countries

Studies investigating the effectiveness of school-related gender-based violence prevention programs seldom report on the extent to which students themselves value and recommend such programs. Yet, along with evidence about effectiveness in relation to shifts in knowledge, attitudes, or intentions, student-valuing is a significant indicator that the programs can make a positive contribution to students' lives. This mixed-method study analyses survey and focus group data collected from ninety-two schools in three African countries (Tanzania, Zambia, and Eswatini). Students found the program contributed to improved peer relationships and identified the five most useful components as learning about gender equality and human rights, learning how to obtain help for those affected by violence, understanding and communicating about their emotions, strategies to avoid joining in with bullying and harassment, and understanding the effects of gender-based violence.

Psychological, social, and physical ecologies for child resilience: a South African perspective

Children live in a complex world surrounded by global concerns such as climate change, economic instability, threats of terrorism and war. However, in South Africa, one may note that children face several additional challenges including high unemployment rates in families, exposure to violence, living in conditions of poverty, exposure to HIV/AIDS, and high levels of orphanhood. Compounding these problems is the economic situation in the country where the government is unable to provide adequate support for children in various domains. Understanding the mechanisms through which children successfully adapt to their environments and transition into adulthood are important to understand. Resilience research seeks to understand these mechanisms and underlying processes that enable some individuals to recover from adversity against all odds. Therefore, there is an increased movement not only toward understanding resilience processes in children, which enable them to develop into fully functional and upstanding citizens of society despite the adversities they face, but also how resilience research can be translated into practice to be used by service professionals such as psychologists, school counselors, social workers, and teachers. Adopting a socioecological understanding of resilience, the author reviews literature on the psychological, social, and physical ecologies for child resilience globally. Special emphasis is placed on the ecologies of child resilience within the African context and South Africa in particular. A socioecological perspective positions child resilience within four important levels, namely individual, relationships, community, and society. The salient features of child resilience within a South African context are discussed within the four levels highlighting the implications for interventions to promote child resilience. The implications have global value because child resilience is a phenomenon that needs global attention.

Gender-Based Violence - Magnitude and Types in Northwest Ethiopia

Background

Violence Against Women (VAW) becomes a serious public health issue as unnecessary morbidity and mortalities affect women and girls. Women who experience violence had the possibility of another of violence. Although gender-based violence (GBV) is a common problem in Ethiopia, the burden is not well studied.

Objective

This study determines the magnitude of Gender-Based Violence among women receiving Sexual and Reproductive Health Services in a Specialized Hospital.

Methods

Institution-based retrospective follow-up study was conducted at the University of Gondar Comprehensive Specialized Hospital among gender-based violence (GBV) service users from January 2017 to January 2022. Data were collected from register logbooks and also medical records for some variables, using a tool prepared by refereeing literature and adapting locally available resources and researchers experiences. Epi-info 7 was used to enter the data and exported it to SPSS V-23 for analysis. Descriptive statistics like frequencies, percentages, means and standard deviations are computed for all variables.

Results

The lifetime proportion of sexual and physical violence was found to be 81% and 5%, respectively, while 3% of women experienced both sexual and physical violence. One hundred seventy (29.4%) of the incidents were done by an intimate-partners (boyfriend/husband). The majority (86%) had extra genital injuries. After genital examination, about one-fourth (25%) of survivors had fresh hymenal tears. About three-fourths (75.1%) of the survivors visit the health facility within threes day after the incident.

Conclusion

The study found that GBV is common in Northwest Ethiopia. Future research should involve sensitive methods and grounded approaches to explore survivors' experiences and views on local gender cultures and other contextual factors. Establishing One-stop-center could improve the quality of the services provided to the women.

A socio-legal imperative of domestic violence prohibition in Africa vis-a-vis Nigerian legal structure for sexually abused women

Domestic violence is a major issue globally. It is one of the most heinous crimes which has and still results in numerous deaths, still receives the least amount of attention, and its negative influence is being underrated. In Africa, it is customarily acceptable for a woman to be beaten by her husband as a form of discipline, and Nigeria is not an exception. To think otherwise, that it cannot be socially acceptable and legally upheld for a man to beat his wife as a form of discipline, is to deny an existing reality. Section 282 of the Nigerian Penal Code encourages men to beat their wives when necessary. This form of permissible violence is often viewed as a family issue. Hence women are reluctant to speak up about their experiences. The stigma that usually follows speaking up or voicing out is better imagined than experienced. This study, therefore, provides credible information on domestic violence incidents in Nigeria and Africa. The methodology utilised is the doctrinal legal research method with reports from existing literature and tertiary data sources such as newspapers and website sources. It discusses legislation enacted to prevent and prohibit domestic violence in Nigeria and how influential they have been on the nation at large. By way of comparative analysis, we examine domestic violence occurrences in some selected African countries and the European continents concerning Nigeria. It also delves into the violation of the principles of gender equality by some Nigerian customs and traditional practices. This study then makes recommendations on how to address the issue. Through its insightful engagement, this study found, among others, that domestic violence is widespread in Africa and that a national law prohibiting the act and holding perpetrators accountable is not only imperative in Nigeria but across the African continent.

War-related sexual and gender-based violence in Tigray, Northern Ethiopia: a community-based study

INTRODUCTION

Sexual and gender-based violence (SGBV) during armed conflicts has serious ramifications with women and girls disproportionally affected. The impact of the conflict that erupted in November 2020 in Tigray on SGBV is not well documented. This study is aimed at assessing war-related SGBV in war-affected Tigray, Ethiopia.

METHODS

A community-based survey was conducted in 52 (out of 84) districts of Tigray, excluding its western zone and some districts bordering Eritrea due to security reasons. Using a two-stage multistage cluster sampling technique, a total of 5171 women of reproductive age (15-49 years) were randomly selected and included in the study. Analysis used weighted descriptive statistics, regression modelling and tests of associations.

RESULTS

Overall, 43.3% (2241/5171) of women experienced at least one type of gender-based violence. The incidents of sexual, physical and psychological violence, and rape among women of reproductive age were found to be 9.7% (500/5171), 28.6% (1480/5171), 40.4% (2090/5171) and 7.9% (411/5171), respectively. Of the sexual violence survivors, rape accounted for 82.2% (411/500) cases, of which 68.4% (247) reported being gang raped. Young women (aged 15-24 years) were the most affected by sexual violence, 29.2% (146/500). Commonly reported SGBV-related issues were physical trauma, 23.8% (533/2241), sexually transmitted infections, 16.5% (68/411), HIV infection, 2.7% (11/411), unwanted pregnancy, 9.5% (39/411) and depression 19.2% (431/2241). Most survivors (89.7%) did not receive any postviolence medical or psychological support.

CONCLUSIONS

Systemic war-related SGBV was prevalent in Tigray, with gang-rape as the most common form of sexual violence. Immediate medical and psychological care, and long-term rehabilitation and community support for survivors are urgently needed and recommended.

Understanding Gender-Based Violence Service Delivery in CDC-Supported Health Facilities: 15 Sub-Saharan African Countries, 2017-2021

Gender-based violence (GBV) is a complex issue deeply rooted in social structures, making its eradication challenging. GBV increases the risk of HIV transmission and is a barrier to HIV testing, care, and treatment. Quality clinical services for GBV, which includes the provision of HIV postexposure prophylaxis (PEP), vary, and service delivery data are lacking. We describe GBV clinical service delivery in 15 countries supported by the President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention. Through a descriptive statistical analysis of PEPFAR Monitoring, Evaluation, and Reporting (MER) data, we found a 252% increase in individuals receiving GBV clinical services, from 158,691 in 2017 to 558,251 in 2021. PEP completion was lowest (15%) among 15-19-year-olds. Understanding GBV service delivery is important for policy makers, program managers, and providers to guide interventions to improve the quality of service delivery and contribute to HIV epidemic control.

Physical violence during pregnancy in sub-Saharan Africa: why it matters and who are most susceptible?

OBJECTIVE

The study assessed the prevalence of physical violence against pregnant women and its associated factors in sub-Saharan Africa (SSA).

DESIGN

We analysed cross-sectional data of 108971 women in sexual unions from the most recent Demographic and Health Surveys of 26 countries in SSA. The predictors of physical violence were examined using a multilevel binary logistic regression. All the results were presented as adjusted odds ratios (aORs) with their corresponding 95% confidence intervals (CIs).

SETTING

Twenty-six countries in SSA.

PARTICIPANTS

108 971 women who had ever been pregnant.

OUTCOME MEASURE

Physical violence during pregnancy.

RESULTS

Physical violence was identified in 6.0% of pregnant women in SSA. The highest prevalence (14.0%) was reported in South Africa, while Burkina Faso recorded the lowest (2.1%). Women who had primary (aOR=1.26, 95% CI=1.15, 1.38) and secondary education (aOR=1.15, 95% CI=1.01,1.32); those who were cohabiting (aOR=1.21, 95% CI=1.11, 1.32); those who were working (aOR=1.17, 95% CI=1.08, 1.28); and those whose partners had primary (aOR=1.15, 95% CI=1.04, 1.28) and secondary education (aOR=1.14, 95% CI=1.01, 1.28) were more likely to experience physical violence during pregnancy compared with those who had no formal education; those who were married; those who were not working, and those whose partners had no formal education, respectively. Moreover, women whose partners consumed alcohol (aOR=2.37, 95% CI=2.20, 2.56); those who had parity of four or more (aOR=2.06, 95% CI=1.57, 2.72); and those who perceived intimate partner violence (IPV) as a culturally accepted norm (aOR=1.55, 95% CI=1.44, 1.67) had higher odds of experiencing physical violence during pregnancy compared to those whose partners did not consume alcohol, those with parity zero, and those who did not perceive IPV as culturally accepted, respectively. On the contrary, women who were aged 35-39, those who were of the richest wealth index, and those in rural areas had reduced odds of experiencing physical violence during pregnancy.

CONCLUSION

Based on the findings, community leaders are encouraged to liaise with law enforcement agencies to strictly enforce laws on gender-based violence by prosecuting perpetrators of IPV against pregnant women as a deterrent. Also, intensifying education on what constitutes IPV and the potential consequences on the health of pregnant women, their children, and their families will be laudable. Improving the socioeconomic status of women may also help to eliminate IPV perpetration against women at their pregnancy stage.

Prevalence, patterns, and determinants of gender-based violence among women and girls in IDP camps, Mogadishu-Somalia

Background

Gender-based violence (GBV) against women and girls, is a global pandemic that affects 1 in 3 women in their lifetime. Somalia is one of the leading countries in human rights violations and has one of the highest rates of sexual and gender-based violence (SGBV) worldwide. Such violence is more prevalent among women and girls in internally displaced persons (IDP) camps who lack livelihood and civil protections. Therefore, this study was designed to identify the prevalence and the determinants of gender-based violence in IDP camps in Deynile district, Somalia.

Methods

This is a cross-sectional study design conducted in IDP camps in Deynile District from August 1 to September 30, 2022. A total of three hundred eighty-four women and girls aged 18 years and above living in the selected IDP camps were involved in the study. The camps were selected randomly while households and participants were selected systematic random sampling. The recall period was set at 12 months (August 2021 to July 2022). Participants were interviewed by well-trained research assistants using pre-tested structured questionnaire. Data was entered into and analyzed with SPSS 25.0. Logistic regression was used, and the significance level was set at p value ≤ 0.05.

Result

The study revealed that gender-based violence was quite common in the IDP camps in Mogadishu's Deynile area. Physical abuse was the most prevalent type of GBV, which was primarily committed by intimate partners, parents, and other family members. The main factors associated with gender-based violence were young age (OR=4.77, 95% CI: 1.96-11.63, p<0.001), extended family structure (OR=7.89, 95% CI: 4.30-14.47, p<0.001), household size >5 individuals (OR=1.86, 95% CI:1.04-3.30, p<0.005), employment (OR=1.57, 95% CI: 1.0.41-2.32, p<0.05), substance misuse (OR=3.25, 95% CI: 1.57-6.73, p<0.05), a long distance to the nearest police station (OR=2.75, 95% CI:1.51-5.00, p<0.005), and camp safety protection (OR=1.94, 95% CI:1.24-3.30, p<0.005).

Conclusion and recommendations

There was a high prevalence of gender-based violence in the IDP camps in Mogadishu's Deynile area. The most common form of GBV was physical violence mainly perpetuated by intimate partners. The study recommends improving some of the modifiable factors that were strongly associated with gender-based violence.

Sexual violence and associated factors among women of reproductive age in Rwanda: a 2020 nationwide cross-sectional survey

BACKGROUND

Sexual violence against women is a global public health issue with both short- and long-term effects on the physical and mental health of women. This study aimed to determine the prevalence of sexual violence and its associated factors among women of reproductive age in Rwanda.

METHODS

We used secondary data from the 2020 Rwanda Demographic and Health Survey of 1,700 participants, who were selected using multistage stratified sampling. Multivariable logistic regression was conducted to explore factors associated with sexual violence using SPSS (version 25).

RESULTS

Of the 1,700 women of reproductive age, 12.4% (95%CI: 11.0-14.1) had experienced sexual violence. Justified beating (AOR = 1.34, 95%CI: 1.16-1.65), not having health insurance (AOR = 1.46, 95%CI: 1.26-2.40), not being involved in healthcare decision-making (AOR = 1.64, 95%CI: 1.99-2.70), having a husband/partner with primary (AOR = 1.70, 95%CI: 5.47-6.21) or no education (AOR = 1.84, 95%CI: 1.21-3.37), as well as having a husband/partner who sometimes (AOR = 3.37, 95%CI: 1.56-7.30) or often (AOR = 12.87, 95%CI: 5.64-29.38) gets drunk were positively associated with sexual violence. However, women from male-headed households (AOR = 0.52, 95%CI: 0.29-0.92) were less likely to experience sexual violence.

CONCLUSIONS

There is a need to demystify negative culturally-rooted beliefs favouring sexual violence, such as justified beating, as well as increase efforts to promote women's empowerment and healthcare access. Moreover, engaging men in anti-sexual violence strategies is paramount to addressing male-related issues that expose women to sexual violence.

The effects of exposure to physical and emotional violence from partners on psychological resilience, forgiveness, happiness, life satisfaction, and depression level in Turkish women

The data of this descriptive and correlational study were collected from 583 women between October 2021 and December 2021 with information form, Brief Resilience Scale, Oxford Happiness Scale-Short Form, Epidemiological Research Center Depression Scale, Heartland Forgiveness Scale, and Life Satisfaction Scale. There is a statistically significant difference between the resilience, happiness, and life satisfaction levels of women exposed to physical violence from their partners and the presence of depression (p < .001). A statistically significant difference was found between the presence of depression and resilience, happiness, and life satisfaction (p < .001) and forgiveness (p = .004) in women who were exposed to emotional violence from their partners. While resilience, happiness, and life satisfaction levels decreased in women who were exposed to physical violence from their partners, the incidence of depression increased. While the presence of depression increased in women who were exposed to emotional violence from their partners, the level of resilience, happiness, life satisfaction, and forgiveness decreased.