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Grace KT, Glass NE, Miller E, Alexander KA, Holliday CN, Decker MR. Birth Control Sabotage Motivation and Measurement: A Mixed-Methods Analysis among Latina Women. Violence Against Women 2024; 30:1634-1655. [PMID: 36567608 PMCID: PMC10290727 DOI: 10.1177/10778012221145292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Reproductive coercion (RC) is a type of intimate partner violence that includes birth control sabotage (BCS). We explored the perceived intent behind BCS to refine RC measurement, using a mixed-methods design with a clinic-based sample of Latina women (13 interviews; 482 surveys). Women perceived partners used BCS for reasons beyond pregnancy promotion. Specifically, 16.8% of participants reported any past-year RC; this decreased to 9.5% when asked if their partner used BCS with the sole intent of getting them pregnant. RC measures and assessment should separate behavior from intent in BCS questions to not underestimate the prevalence and to guide clinical response.
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Affiliation(s)
- Karen Trister Grace
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nancy E Glass
- Johns Hopkins University, School of Nursing, Baltimore, MD, USA
| | - Elizabeth Miller
- Division of Adolescent Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | | | | | - Michele R Decker
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
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Grosso A, Bowring AL, Njindam IM, Decker MR, Lyons C, Rao A, Tamoufe U, Fako GH, Fouda G, Levitt D, Turpin G, Billong SC, Zoung-Kanyi Bissek AC, Njoya O, Baral S. Sexually Transmitted Infection Risks and Symptoms Heightened Among Female Sex Workers who Started Selling Sex Before the Age of 18 in Five Cities in Cameroon. AIDS Behav 2024; 28:898-906. [PMID: 37843686 PMCID: PMC10896857 DOI: 10.1007/s10461-023-04196-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/17/2023]
Abstract
Many adolescents under 18 years old who sell sex are at elevated risk for sexually transmitted infection (STI) acquisition, which may persist into adulthood. There has been limited study of the burden of the risks and vulnerabilities among women who started selling sex as adolescents across Sub-Saharan Africa. In this study, a Adult female sex workers (FSW) recruited through respondent-driven sampling in five cities in Cameroon from December 2015 to October 2016 completed a questionnaire and human immunodeficiency virus (HIV) and syphilis testing. Multivariable logistic regression analysis controlling for age was used to identify factors associated with reporting selling sex before age 18. Selling sex before age 18 was reported by 11.5% (256/2,220) of FSW. Initiation of selling sex as an adolescent was positively associated with experiencing dysuria (adjusted odds ratio [aOR]:1.50, 95% confidence interval [CI]:1.08-2.10) or genital warts (aOR:1.78, 95% CI:1.08-2.94) and negatively associated with prior recent testing for HIV (aOR:0.71, 95% CI:0.53-0.96) or STIs (aOR:0.65, 95% CI:0.44-0.96). Consistent condom use with clients was negatively associated with early initiation of selling sex (aOR:0.58, 95% CI:0.42-0.80), while experience of recent sexual violence was positively associated with early initiation (aOR:1.74, 95% CI:1.15-2.63). There were no independent significant differences in HIV (24.5%) or syphilis (8.3%) prevalence. Given the limited use of HIV and STI testing services by women who sold sex as adolescents, the prevalence of forced sex, condomless sex, and STI symptoms were high. Programs serving FSW should more vigorously aim to serve adolescents and adults who began selling sex early.
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Affiliation(s)
- Ashley Grosso
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, 112 Paterson Street, New Brunswick, NJ, 08901, USA.
| | - Anna L Bowring
- Department of Epidemiology, Johns Hopkins University, 615 N Wolfe , MD, Baltimore, 21205, USA
- Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
| | | | - Michele R Decker
- Department of Population, Family, and Reproductive Health, Johns Hopkins University, 615 N Wolfe St Baltimore, MD, Baltimore, 21205, USA
| | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins University, 615 N Wolfe , MD, Baltimore, 21205, USA
| | - Amrita Rao
- Department of Epidemiology, Johns Hopkins University, 615 N Wolfe , MD, Baltimore, 21205, USA
| | - Ubald Tamoufe
- Metabiota, Avenue Mvog-Fouda Ada, Av 1.085, Carrefour Intendance BP, Yaoundé, 15939, Cameroon
| | - Guy H Fako
- Care and Health Program, Yaoundé, Cameroon
| | - Ghislaine Fouda
- CARE Cameroon, Villa La Rose (3è étage, Av. Churchill, Yaoundé, Cameroon
| | - Daniel Levitt
- CARE USA, 115 Broadway, 5th floor, New York, NY, 10006, USA
- FHI 360, New York, United States
| | - Gnilane Turpin
- Department of Epidemiology, Johns Hopkins University, 615 N Wolfe , MD, Baltimore, 21205, USA
| | - Serge C Billong
- Groupe Technique Central, CNLS, Rue Henri Dunant, Yaoundé, Cameroon
| | | | - Oudou Njoya
- Department of Internal Medicine, Yaoundé University Hospital Center, Joseph Tchooungui Akoa, Yaoundé, Cameroon
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University, 615 N Wolfe , MD, Baltimore, 21205, USA
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Wood SN, Perrin N, Akumu I, Asira B, Clough A, Glass N, Campbell J, Decker MR. Risk for Severe Intimate Partner Violence in Nairobi's Informal Settlements: Tailoring the Danger Assessment to Kenya. Glob Health Sci Pract 2024; 12:e2300116. [PMID: 38290753 PMCID: PMC10906551 DOI: 10.9745/ghsp-d-23-00116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Understanding the risk for severe intimate partner violence (IPV) can help women and providers assess danger. The validated, widely used Danger Assessment (DA) developed for this purpose has not been tested in a low- and middle-income country (LMIC). We tailored the DA to Nairobi, Kenya, and prospectively evaluated baseline danger against severe IPV at 3-month follow-up. METHODS We used data from the myPlan Kenya trial conducted in 3 informal settlements in Nairobi, Kenya, from 2017 to 2018. DA items were refined through formative and pilot phases, yielding minor wording modifications. Quantitative analyses prospectively evaluated baseline DA against severe IPV at 3-month follow-up to understand the predictive effect of the (1) original 20-item DA, (2) 16-item Kenya-DA (highest relative risk ratios [RRR] with severe IPV), and (3) 16-item Kenya-DA weighted (weighting based on strength of RRRs). Diagnostic criteria, including C-statistics, sensitivity, specificity, receiver operating characteristic curve, and area under the curve, were examined; logistic regressions quantified the odds of each metric predicting severe IPV at follow-up. RESULTS The original 20-item DA produced the highest specificity (75.41%) and lowest sensitivity (57.14%), resulting in the overall lowest C-statistic. Compared to the 16-item Kenya-DA, the Kenya-DA weighted produced slightly higher sensitivity (66.67% vs. 64.29%) and specificity (77.05% vs. 72.13%), resulting in the highest C-statistic (0.78 vs. 0.75). All versions successfully predicted severe IPV at 3-month follow-up (original DA: odds ratio [OR]=1.26, 95% confidence interval [CI]=1.12, 1.41, P<.001; Kenya-DA: OR=1.33, 95% CI=1.16, 1.53, P<.001; Kenya-DA weighted: OR=1.19, 95% CI=1.10, 1.28, P<.001). Several factors identified as homicide risk factors in other settings were not prospectively associated with severe IPV. CONCLUSION Within a high-danger LMIC context, all 3 DA configurations performed well diagnostically. We recommend the 16-item Kenya-DA given the value for simplicity and field implementation, whereas the Kenya-DA weighted can add accuracy for research purposes.
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Affiliation(s)
- Shannon N Wood
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Nancy Perrin
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Irene Akumu
- Mashinani Department, Ujamaa-Africa, Nairobi, Kenya
| | - Ben Asira
- Mashinani Department, Ujamaa-Africa, Nairobi, Kenya
| | - Amber Clough
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Nancy Glass
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Global Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jacquelyn Campbell
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michele R Decker
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Gichangi PB, Byrne ME, Thiongo MN, Waithaka M, Devoto B, Gummerson E, Wood SN, Anglewicz P, Decker MR. Impact of COVID-19 on the mental health of adolescents and youth in Nairobi, Kenya. Front Psychiatry 2024; 14:1209836. [PMID: 38389711 PMCID: PMC10881828 DOI: 10.3389/fpsyt.2023.1209836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/07/2023] [Indexed: 02/24/2024] Open
Abstract
Objective To report on the mental health status of adolescents and youth in relation to the COVID-19 pandemic in Nairobi County, Kenya. Methodology This was a mixed-methods study with cross-sectional quantitative and qualitative components conducted in Nairobi County, Kenya from August to September 2020. The quantitative survey involved phone interviews of n = 1,217 adolescents and youth. Qualitative components included virtual focus group discussions (FGDs) with adolescents and youth (n = 64 unmarried youths aged 16-25 years, across 8 FGDs) and youth-serving stakeholders (n = 34, across 4 FGDs), key informant interviews (n = 12 higher-level stakeholders from Ministries of Health, Gender, and Education), and in-depth interviews with youth (n = 20) so as to examine the COVID-19 impact on mental health. Results Among the participants, 26.6% of young men and 30.0% of young women reported probable depressive symptoms, of whom 37.7% of young men and 38.9% of young women reported little interest or pleasure in doing various activities. Hopelessness and feeling down nearly every day was additionally reported by 10.7% of young women and 6.3% of young men. Further, about 8.8% of young men and 7.6% of young women reported they could not get the emotional help and support they may need from people in their life. Multivariable regression results showed an association between depressive symptoms and reduced working hours due to COVID-19 and increased intimate partner violence. Additionally, the results show that respondents with higher emotional help and support were less likely to report depressive symptoms. Qualitative results confirm the quantitative findings and exemplify the negative behavior arising from the impact of adherence to COVID-19 prevention measures. Conclusion Mental health issues were common among adolescents and youth and may have been augmented by isolation and economic hardships brought about by COVID-19 restrictions. There is a need for concerted efforts to support adolescents and young people to meet their mental health needs, while considering the unique variations by gender. There is need to urgently strengthen the mental health system in Kenya, including via integrating psychosocial support services in communities, schools, and healthcare services, to ensure adolescents and young persons are not left behind.
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Affiliation(s)
- Peter B Gichangi
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
- Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Meagan E Byrne
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Mary N Thiongo
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
| | - Michael Waithaka
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
| | - Bianca Devoto
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Elizabeth Gummerson
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Philip Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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5
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Miller E, Grace KT, Silverman JG, Decker MR, Alexander KA. Preventing reproductive coercion in adolescence. Lancet Child Adolesc Health 2024; 8:91-93. [PMID: 37980919 DOI: 10.1016/s2352-4642(23)00293-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 11/21/2023]
Affiliation(s)
- Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15213, USA.
| | - Karen T Grace
- School of Nursing, George Mason University, Fairfax, VA, USA
| | - Jay G Silverman
- UC San Diego School of Medicine, San Diego, CA, USA; Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Michele R Decker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Dadabhai S, Quaynor L, Bandala-Jacques A, Seyama L, Rahman MH, Phiri R, Decker MR, Taha TE. Intimate partner violence and excess fertility among women of reproductive age in Malawi. PLoS One 2024; 19:e0297959. [PMID: 38277363 PMCID: PMC10817113 DOI: 10.1371/journal.pone.0297959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 01/14/2024] [Indexed: 01/28/2024] Open
Abstract
PURPOSE Gender inequity and adverse health outcomes continue to be of concern among women in sub-Saharan Africa. We determined prevalence of intimate partner violence and excess fertility (having more children than desired) in reproductive age women in Malawi. We also explored factors associated with these outcomes and with spousal fertility intentions. PATIENTS AND METHODS In a cross-sectional study, a total of 360 women and 410 men were recruited using multi-stage sampling from communities in a peri-urban setting in Blantyre District, Southern Malawi in 2021. Women and men were separately interviewed by trained study workers using a structured questionnaire. In addition to descriptive analyses, we used univariate and multivariate logistic regression models to assess associations of risk factors with the outcomes of intimate partner violence and excess fertility. RESULTS Among women, lifetime prevalence of intimate partner violence was 23.1%, and excess fertility was experienced by 25.6%. Intimate partner violence was associated with male partners alcohol consumption (adjusted odds ratio 2.13; P = 0.019). Women were more likely to report excess fertility if they were older (adjusted odds ratio 2.0, P<0.001, for a 5-year increase). Alcohol consumption by the male partner (adjusted odds ratio 2.14; P = 0.025) and women being able to refuse sex with their male partner (adjusted odds ratio 0.50; P = 0.036) were associated with discordant fertility preferences. CONCLUSIONS Intimate partner violence, excess fertility, and social and health inequities continue to be prevalent in Malawi. These data suggest the underlying proximal and distal factors associated with these adverse outcomes such as alcohol consumption may be addressed through education, couple interactive communication, and community dialogue. To ensure sustainability and effectiveness, strong leadership involvement, both governmental and non-governmental, is needed.
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Affiliation(s)
- Sufia Dadabhai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Laura Quaynor
- Department of Advanced Studies in Education, Johns Hopkins School of Education, Baltimore, Maryland, United States of America
| | - Antonio Bandala-Jacques
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Linly Seyama
- Kamuzu University of Health Sciences-Johns Hopkins Research Project, Blantyre, Malawi
| | - Md Hafizur Rahman
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, United States of America
| | | | - Michele R. Decker
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Taha E. Taha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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7
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Sherwood J, Phuengsamran D, Janyam S, Murray SM, Holliday CN, Darawuttimaprakorn N, Decker MR. Violence Victimization and Alcohol Use Among Venue-Based Female Sex Workers in Pattaya, Thailand: Unpacking the Temporal Relationship. Violence Against Women 2023:10778012231177997. [PMID: 37259530 DOI: 10.1177/10778012231177997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Female sex workers (FSWs) face prevalent violence victimization and alcohol consumption at work, yet the bidirectional pathways between these factors are not well defined. Using cohort data from 232 venue-based FSWs in Pattaya, associations of violence and alcohol use were examined within a time period and prospectively via structural equation models. Within the time period, violence victimization and alcohol use were consistently associated; by contrast, violence was not prospectively associated with FSW alcohol use. Findings define alcohol as an important risk factor for violence in sex work environments. Alcohol safety interventions should be explored as a vital component of FSW violence prevention.
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Affiliation(s)
- Jennifer Sherwood
- Public Policy Office, amfAR, Foundation for AIDS Research, Washington, DC, USA
| | - Dusita Phuengsamran
- Institute for Population and Social Research, Mahidol University, Bangkok, Thailand
| | - Surang Janyam
- Service Workers in Group Foundation, Bangkok, Thailand
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Charvonne N Holliday
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | - Michele R Decker
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Wood SN, Thomas HL, Thiongo M, Guiella G, Bazié F, Onadja Y, Mosso R, Fassassi R, Gichangi P, Decker MR. Intersection of reproductive coercion and intimate partner violence: cross-sectional influences on women's contraceptive use in Burkina Faso, Côte d'Ivoire and Kenya. BMJ Open 2023; 13:e065697. [PMID: 37164455 PMCID: PMC10173961 DOI: 10.1136/bmjopen-2022-065697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVES Among nationally representative cross-sections of women in need of contraception from Burkina Faso, Côte d'Ivoire and Kenya, we aimed to: (1) examine the intersection of past-year physical/sexual intimate partner violence (IPV), emotional IPV and reproductive coercion (RC) and (2) assess the impact of physical/sexual IPV, emotional IPV and RC on women's contraceptive use outcomes, including current contraceptive use, method type and covert use. DESIGN The present analysis uses cross-sectional female data collected in Burkina Faso (December 2020-March 2021), Côte d'Ivoire (October-November 2021) and Kenya (November-December 2020). SETTINGS Burkina Faso, Côte d'Ivoire and Kenya PARTICIPANTS: Analytical samples were restricted to partnered women with contraceptive need who completed a violence module (Burkina Faso n=1863; Côte d'Ivoire n=1105; Kenya n=3390). PRIMARY AND SECONDARY OUTCOME MEASURES The exposures of interest-past-year emotional IPV, physical/sexual IPV and RC-were assessed using abridged versions of the Revised Conflict and Tactics Scale-2 and Reproductive Coercion Scale, respectively. Outcomes of interest included current contraceptive use, contraceptive method type (female controlled vs male compliant), and covert contraceptive use, and used standard assessments. RESULTS Across sites, 6.4% (Côte d'Ivoire) to 7.8% (Kenya) of women in need of contraception experienced RC; approximately one-third to one-half of women experiencing RC reported no other violence forms (31.7% in Burkina Faso to 45.8% in Côte d'Ivoire), whereas physical/sexual IPV largely occurred with emotional IPV. In multivariable models, RC was consistently associated with covert use (Burkina Faso: aOR 2.84 (95% CI 1.21 to 6.64); Côte d'Ivoire: aOR 4.45 (95% CI 1.76 to 11.25); Kenya: aOR 5.77 (95% CI 3.51 to 9.46)). Some IPV in some settings was also associated with covert use (emotional IPV, Burkina Faso: aOR 2.99 (95% CI 1.56 to 5.74); physical/sexual, Kenya: aOR 2.35 (95% CI 1.33 to 4.17)). CONCLUSIONS Across settings, covert use is a critical strategy for women experiencing RC. Country policies must recognise RC as a unique form of violence with profound implications for women's reproductive health.
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Affiliation(s)
- Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Haley L Thomas
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mary Thiongo
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
| | - Georges Guiella
- Institut Supérieur des Sciences de la Population, Ouagadougou, Centre, Burkina Faso
| | - Fiacre Bazié
- Institut Supérieur des Sciences de la Population, Ouagadougou, Centre, Burkina Faso
| | - Yentéma Onadja
- Institut Supérieur des Sciences de la Population, Ouagadougou, Centre, Burkina Faso
| | - Rosine Mosso
- Ecole Nationale Superieure de Statistique et d'Economie Appliquee, Abidjan, Côte d'Ivoire
| | - Raimi Fassassi
- Ecole Nationale Superieure de Statistique et d'Economie Appliquee, Abidjan, Côte d'Ivoire
| | - Peter Gichangi
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
- Technical University of Mombasa, Mombasa, Kenya
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
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Wood SN, Byrne ME, Thiongo M, Devoto B, Wamue-Ngare G, Decker MR, Gichangi P. Fertility and contraceptive dynamics amidst COVID-19: who is at greatest risk for unintended pregnancy among a cohort of adolescents and young adults in Nairobi, Kenya? BMJ Open 2023; 13:e068689. [PMID: 37130679 PMCID: PMC10163330 DOI: 10.1136/bmjopen-2022-068689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES Among youth in Nairobi, we (1) characterised fertility and contraceptive use dynamics by gender; (2) estimated pregnancy prevalence over the pandemic; and (3) assessed factors associated with unintended pandemic pregnancy for young women. DESIGN Longitudinal analyses use cohort data collected at three timepoints prior to and during the COVID-19 pandemic: June to August 2019 (pre-pandemic), August to October 2020 (12-month follow-up) and April to May 2021 (18-month follow-up). SETTING Nairobi, Kenya. PARTICIPANTS At initial cohort recruitment, eligible youth were aged 15-24 years, unmarried and residing in Nairobi for at least 1 year. Within-timepoint analyses were restricted to participants with survey data per round; trend and prospective analyses were restricted to those with complete data at all three timepoints (n=586 young men, n=589 young women). PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes comprised fertility and contraceptive use for both genders, and pregnancy for young women. Unintended pandemic pregnancy (assessed at 18-month follow-up) was defined as a current or past 6-month pregnancy with intent to delay pregnancy for more than 1 year at 2020 survey. RESULTS While fertility intentions remained stable, contraceptive dynamics varied by gender-young men both adopted and discontinued coital-dependent methods, whereas young women adopted coital-dependent or short-acting methods at 12-month follow-up (2020). Current pregnancy was highest at 2020 (4.8%), and approximately 2% at 2019 and 2021. Unintended pandemic pregnancy prevalence was 6.1%, with increased odds for young women recently married (adjusted OR (aOR)=3.79; 95% confidence interval (CI) 1.83-7.86); recent contraceptive use was protective against unintended pandemic pregnancy (aOR=0.23; 95% CI 0.11-0.47). CONCLUSIONS Current pregnancy in Nairobi was highest at the height of the COVID-19 pandemic (2020), and subsided to pre-pandemic levels by 2021 data collection; however, requires further monitoring. New marriages posed considerable risk for unintended pandemic pregnancy. Contraceptive use remains a crucial preventive strategy to averting unintended pregnancy, particularly for married young women.
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Affiliation(s)
- Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Meagan E Byrne
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mary Thiongo
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
| | - Bianca Devoto
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Grace Wamue-Ngare
- Department of Sociology, Gender and Development Studies, Kenyatta University, Nairobi, Kenya
| | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Peter Gichangi
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
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Allen ST, White RH, Nestadt DF, Tomko C, Decker MR, Sherman SG. Who Asks About HIV/STI Status?: An Analysis of Women Who Sell Sex and Inject Drugs. AIDS Behav 2023; 27:1666-1673. [PMID: 36318423 DOI: 10.1007/s10461-022-03898-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 05/16/2023]
Abstract
Communication about HIV and sexually transmitted infections (STI) is a cornerstone of risk reduction, yet there is a dearth of research that examines communication patterns among persons with dual risks for HIV/STI acquisition, such as women who sell sex and inject drugs (WSSID). We used logistic regression to identify factors associated with WSSID (N = 211) in Baltimore, Maryland always asking new clients about their HIV/STI status. Most WSSID were non-Hispanic White (73%) and 74% reported current homelessness. 50% of WSSID reported always asking new clients about their HIV/STI status. Experiencing depressive symptoms (adjusted odds ratio [aOR]: 0.53; 95% confidence interval [CI]: 0.29, 0.96) and having condomless sex with clients (aOR 0.31; 95% CI: 0.17, 0.57) were inversely associated with WSSID always asking new clients about their HIV/STI status. Recent entry into sex work (aOR 2.99; 95% CI: 1.30, 6.87) was positively associated with always asking new clients about their HIV/STI status. Enhancing HIV/STI communication in combination with engagement in other risk mitigation strategies may decrease disease incidence among WSSID.
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Affiliation(s)
- Sean T Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA.
| | - Rebecca Hamilton White
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA
| | - Danielle F Nestadt
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA
| | - Catherine Tomko
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA
| | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., 21205, Baltimore, MD, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA
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Yirgu R, Wondimagegnehu A, Qian J, Milkovich R, Zimmerman LA, Decker MR, Glass N, Seid F, Zekarias L, Wood SN. Needs and unmet needs for support services for recently pregnant intimate partner violence survivors in Ethiopia during the COVID-19 pandemic. BMC Public Health 2023; 23:725. [PMID: 37081421 PMCID: PMC10117258 DOI: 10.1186/s12889-023-15634-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/08/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Globally, 2-14% of women experience intimate partner violence (IPV) during pregnancy. Timely response to IPV is critical to mitigate related adverse health outcomes. Barriers to accessing limited IPV support services are pervasive in low- and middle-income countries (LMICs), such as Ethiopia; key barriers include mistrust, stigmatization, and self-blame, and discourage women from disclosing their experiences. Infection control measures for COVID-19 have the potential to further disrupt access to IPV services. METHODS In-depth qualitative interviews were undertaken from October-November 2020 with 24 women who experienced IPV during recent pregnancy to understand the needs and unmet needs of IPV survivors in Ethiopia amid the COVID-19 pandemic. Trained qualitative interviewers used a structured note-taking tool to allow probing of experiences, while permitting rapid analysis for timely results. Inductive thematic analysis identified emergent themes, which were organized into matrices for synthesis. RESULTS Qualitative themes center around knowledge of IPV services; experiences of women in seeking services; challenges in accessing services; the impact of COVID-19 on resource access; and persistent unmet needs of IPV survivors. Notably, few women discussed the violence they experienced as unique to pregnancy, with most referring to IPV over an extended period, both prior to and during COVID-19 restrictions. The majority of IPV survivors in our study heavily relied on their informal network of family and friends for protection and assistance in resolving the violence. Though formal IPV services remained open throughout the pandemic, restrictions resulted in the perception that services were not available, and this perception discouraged survivors from seeking help. Survivors further identified lack of integrated and tailored services as enduring unmet needs. CONCLUSIONS Results reveal a persistent low awareness and utilization of formal IPV support and urge future policy efforts to address unmet needs through expansion of services by reducing socio-cultural barriers. COVID-19 impacted access to both formal and informal support systems, highlighting needs for adaptable, remote service delivery and upstream violence prevention. Public health interventions must strengthen linkages between formal and informal resources to fill the unmet needs of IPV survivors in receiving medical, psychosocial, and legal support in their home communities.
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Affiliation(s)
- Robel Yirgu
- Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | | | - Jiage Qian
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rachel Milkovich
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Linnea A Zimmerman
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michele R Decker
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Nancy Glass
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Center for Global Health, Johns Hopkins University, Baltimore, MD, USA
| | - Fatuma Seid
- Ethiopia Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Lensa Zekarias
- Ethiopia Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Shannon N Wood
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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12
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Grace KT, Decker MR, Holliday CN, Talis J, Miller E. Reproductive coercion in college health clinic patients: Risk factors, care seeking and perpetration. J Adv Nurs 2023; 79:1464-1475. [PMID: 35362185 PMCID: PMC9525448 DOI: 10.1111/jan.15207] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
AIMS Reproductive coercion is associated with poor health outcomes in women. This study examined exposure to and use of reproductive coercion and care seeking among college students. DESIGN A cross-sectional survey was administered to 2291 college students of all genders seeking care in college health and counselling centres as baseline data for a cluster-randomized controlled trial. METHODS Online surveys were collected (9/2015-3/2017). Descriptive statistics, chi-square, Fisher's exact and t-tests were analysed. RESULTS Among female participants, 3.1% experienced reproductive coercion in the prior 4 months. Experience was associated with older age (p = .041), younger age at first intercourse (p = .004), Black/African American race (p < .001), behaviourally bisexual (p = .005), more lifetime sexual partners (p < .001) and ever pregnant (p = .010). Sexually transmitted infection (p < .001), recent drug use or smoking (p = .018; p = .001), requiring special health equipment (p = .049), poor school performance (p < .001) and all categories of violence (p = <.001-.015) were associated with women's reproductive coercion experience. Participants who experienced reproductive coercion were more likely to seek care for both counselling and healthcare, (p = .022) and sexually transmitted infection (p = .004). Among males, 2.3% reported recent use of reproductive coercion; these participants reported sexual violence perpetration (p = .005), less condom use (p = .003) and more sexual partners than non-perpetrators (p < .001). CONCLUSION Although reproductive coercion was reported infrequently among college students, those students experiencing it appear to be at risk for poor health and academic outcomes. Health and counselling centres are promising settings to address RC and related health behaviours.
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Affiliation(s)
- Karen Trister Grace
- George Mason University, School of Nursing, Fairfax, Virginia, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michele R. Decker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Janine Talis
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Wood SN, Thomas HL, Guiella G, Bazie F, Mosso R, Fassassi R, Akilimali PZ, Thiongo M, Gichangi P, Oumarou S, OlaOlorun FM, Omoluabi E, Khanna A, Kibira SPS, Makumbi F, Decker MR. Correction: Prevalence and correlates of reproductive coercion across ten sites: commonalities and divergence. Reprod Health 2023; 20:54. [PMID: 36998081 PMCID: PMC10064589 DOI: 10.1186/s12978-023-01591-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
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14
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Wood SN, Thomas HL, Guiella G, Bazié F, Mosso R, Fassassi R, Akilimali PZ, Thiongo M, Gichangi P, Oumarou S, OlaOlorun FM, Omoluabi E, Khanna A, Kibira SPS, Makumbi F, Decker MR. Prevalence and correlates of reproductive coercion across ten sites: commonalities and divergence. Reprod Health 2023; 20:22. [PMID: 36707833 PMCID: PMC9881347 DOI: 10.1186/s12978-023-01568-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/13/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Reproductive coercion (RC) is a type of abuse where a partner asserts control over a woman's reproductive health trajectories. Recent research emphasizes that RC experiences may differ within and across low- and middle-income countries (LMICs), as compared to higher income contexts, given social pressures surrounding childbearing. To date, nationally representative surveys have lacked comprehensive measures for RC, leading to gaps in understanding its prevalence and risk factors. Across eight LMICs (10 sites), we aimed to (1) validate the RC Scale; (2) calculate prevalence of RC and specific behaviors; and (3) assess correlates of RC. METHODS This analysis leverages cross-sectional Performance Monitoring for Action (PMA) data collected from November 2020 to May 2022. Analyses were limited to women in need of contraception (Burkina Faso n = 2767; Côte d'Ivoire n = 1561; Kongo Central, Democratic Republic of Congo (DRC) n = 830; Kinshasa, DRC n = 846; Kenya n = 4588; Kano, Nigeria n = 535; Lagos, Nigeria n = 612; Niger n = 1525; Rajasthan, India n = 3017; Uganda n = 2020). Past-year RC was assessed via five items adapted from the original RC Scale and previously tested in LMICs. Confirmatory factor analysis examined fit statistics by site. Per-item and overall prevalence were calculated. Site-specific bivariate and multivariable logistic regression examined RC correlates across the socioecological framework. RESULTS Confirmatory factor analysis confirmed goodness of fit across all sites, with moderate internal consistency (alpha range: 0.66 Cote d'Ivoire-0.89 Kinshasa, DRC/Lagos, Nigeria). Past-year reported prevalence of RC was highest in Kongo Central, DRC (20.3%) and lowest in Niger (3.1%). Prevalence of individual items varied substantially by geography. Polygyny was the most common RC risk factor across six sites (adjusted odds ratio (aOR) range: 1.59-10.76). Increased partner education levels were protective in Kenya and Kano, Nigeria (aOR range: 0.23-0.67). Other assessed correlates differed by site. CONCLUSIONS Understanding RC prevalence and behaviors is central to providing woman-centered reproductive care. RC was most strongly correlated with factors at the partner dyad level; future research is needed to unpack the relative contributions of relationship power dynamics versus cultural norms surrounding childbearing. Family planning services must recognize and respond to women's immediate needs to ensure RC does not alter reproductive trajectories, including vulnerability to unintended pregnancy.
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Affiliation(s)
- Shannon N. Wood
- grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E4009, Baltimore, MD 21205 USA ,grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Haley L. Thomas
- grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E4009, Baltimore, MD 21205 USA
| | - Georges Guiella
- grid.463389.30000 0000 9980 0286Institut Supérieur des Sciences de la Population (ISSP/University of Ouagadougou), Ouagadougou, Burkina Faso
| | - Fiacre Bazié
- grid.463389.30000 0000 9980 0286Institut Supérieur des Sciences de la Population (ISSP/University of Ouagadougou), Ouagadougou, Burkina Faso
| | - Rosine Mosso
- grid.508476.80000 0001 2107 3477Ecole Nationale Superieure de Statistique et Appliquee d’Abidjan (ENSEA), Abidjan, Côte d’Ivoire
| | - Raimi Fassassi
- grid.508476.80000 0001 2107 3477Ecole Nationale Superieure de Statistique et Appliquee d’Abidjan (ENSEA), Abidjan, Côte d’Ivoire
| | - Pierre Z. Akilimali
- grid.9783.50000 0000 9927 0991Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Mary Thiongo
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
| | - Peter Gichangi
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya ,grid.449703.d0000 0004 1762 6835Technical University of Mombasa, Mombasa, Kenya ,grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Sani Oumarou
- Institut National de la Statistique du Niger, Niamey, Niger
| | - Funmilola M. OlaOlorun
- grid.9582.60000 0004 1794 5983College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Elizabeth Omoluabi
- grid.8974.20000 0001 2156 8226University of the Western Cape, Cape Town, South Africa
| | - Anoop Khanna
- grid.464858.30000 0001 0495 1821Indian Institute of Health Management Research, Sanganer, Jaipur, India
| | - Simon Peter Sebina Kibira
- grid.464858.30000 0001 0495 1821Indian Institute of Health Management Research, Sanganer, Jaipur, India
| | - Fredrick Makumbi
- grid.11194.3c0000 0004 0620 0548Makerere University School of Public Health, Kampala, Uganda
| | - Michele R. Decker
- grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E4009, Baltimore, MD 21205 USA ,grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA ,grid.21107.350000 0001 2171 9311Johns Hopkins School of Nursing, Baltimore, USA
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15
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Wood SN, Milkovich R, Thiongo M, Gichangi P, Byrne ME, Devoto B, Anglewicz P, Decker MR. Disruptions to youth contraceptive use during COVID-19: Mixed-methods results from Nairobi, Kenya. PLOS Glob Public Health 2023; 3:e0001005. [PMID: 36962989 PMCID: PMC10021138 DOI: 10.1371/journal.pgph.0001005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/16/2023] [Indexed: 02/25/2023]
Abstract
Ensuring access to sexual and reproductive health (SRH) services for adolescents is a global priority, given the detrimental health and economic impact of unintended pregnancies. To examine whether and how COVID-19 affected access to SRH services, we use mixed-methods data from young men and women in Nairobi, Kenya to identify those at greatest risk of contraceptive disruptions during COVID-19 restrictions. Analyses utilize cross-sectional data collected from August to October 2020 from an existing cohort of youth aged 16-26. Unadjusted and adjusted logistic regression examined sociodemographic, contraceptive, and COVID-19-related correlates of contraceptive disruption among users of contraception. Qualitative data were collected concurrently via focus group discussions (n = 64, 8 groups) and in-depth interviews (n = 20), with matrices synthesizing emergent challenges to obtaining contraception by gender. Among those using contraception, both young men (40.4%) and young women (34.6%) faced difficulties obtaining contraception during COVID-19. Among young men, difficulty was observed particularly for those unable to meet their basic needs (aOR = 1.60; p = 0.05). Among young women, risk centered around those with multiple partners (aOR = 1.91; p = 0.01), or who procured their method from a hospital (aOR = 1.71; p = 0.04) or clinic (aOR = 2.14; p = 0.03). Qualitative data highlight economic barriers to obtaining contraceptives, namely job loss and limited supply of free methods previously available. Universal access to a variety of contraceptive methods during global health emergencies, including long-acting reversible methods, is an essential priority to help youth avert unintended pregnancies and withstand periods of disruptions to services. Non-judgmental, youth-friendly services must remain accessible throughout the pandemic into the post-COVID-19 period.
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Affiliation(s)
- Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Rachel Milkovich
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Mary Thiongo
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
| | - Peter Gichangi
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
- Department of Public Health and Primary Care, Technical University of Mombasa, Mombasa, Kenya
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Meagan E Byrne
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Bianca Devoto
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Philip Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States of America
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16
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Wood SN, Dozier JL, Karp C, Desta S, Decker MR, Shiferaw S, Seme A, Yirgu R, Zimmerman LA. Pregnancy coercion, correlates, and associated modern contraceptive use within a nationally representative sample of Ethiopian women. Sex Reprod Health Matters 2022; 30:2139891. [PMID: 36469634 PMCID: PMC9728127 DOI: 10.1080/26410397.2022.2139891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Partner-perpetrated pregnancy coercion inhibits women's reproductive autonomy. However, few studies have quantified pregnancy coercion and its effects on women's health within low- and middle-income countries. Among a national sample of Ethiopian women, this study aimed to: (1) assess the prevalence of past-year pregnancy coercion and explore regional differences; (2) identify correlates; (3) examine the relationship between pregnancy coercion and modern contraceptive use. Analyses utilise cross-sectional data from Performance Monitoring for Action (PMA)-Ethiopia, a nationally representative sample of females aged 15-49 conducted from October to November 2019. Past-year pregnancy coercion was assessed via five items and analysed dichotomously and categorically for severity. Among women in need of contraception, bivariate and multivariable logistic regression examined associations between variables of interest, per aim, accounting for sampling weights and clustering by enumeration area. Approximately 20% of Ethiopian women reported past-year pregnancy coercion (11.4% less severe; 8.6% more severe), ranging from 16% in Benishangul-Gumuz to 35% in Dire Dawa. Increasing parity was associated with decreased odds of pregnancy coercion. Among women in need of contraception, experience of pregnancy coercion was associated with a 32% decrease in odds of modern contraceptive use (aOR = 0.68; 95% CI: 0.53-0.89); when disaggregated by severity, odds decreased for most severe pregnancy coercion (aOR = 0.59; 95% CI = 0.41-0.83). Results indicate that partner-perpetrated pregnancy coercion is prevalent across diverse regions of Ethiopia, and most severe forms could interrupt recent gains in contraceptive coverage and progress to sexual and reproductive health and rights. Providers must be aware of potential contraceptive interference and address coercive influences during contraceptive counselling.
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Affiliation(s)
- Shannon N Wood
- Assistant Scientist, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Correspondence:
| | - Jessica L Dozier
- PhD Student, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Celia Karp
- Assistant Scientist, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Selamawit Desta
- Director of Survey Operations, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michele R Decker
- Bloomberg Professor of American Health, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Women’s Health and Rights Program Director, Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Joint Professor, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Solomon Shiferaw
- Associate Professor, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Assefa Seme
- Associate Professor, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Robel Yirgu
- Associate Professor, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Linnea A Zimmerman
- Assistant Professor, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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17
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Bevilacqua KG, Williams A, Wood SN, Wamue-Ngare G, Thiongo M, Gichangi P, Decker MR. Sexual harassment before and during the COVID-19 pandemic among adolescent girls and young women (AGYW) in Nairobi, Kenya: a cross-sectional study. BMJ Open 2022; 12:e066777. [PMID: 36253036 PMCID: PMC9577274 DOI: 10.1136/bmjopen-2022-066777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Sexual harassment among adolescent girls and young women (AGYW) is a prevalent and understudied form of gender-based violence (GBV) with negative impacts on health and well-being. The COVID-19 pandemic raised global concern about GBV within homes; less is known about how it affected GBV in public spaces. METHODS Present analyses use cross-sectional data from a cohort of adolescents and young adults residing in Nairobi, Kenya, restricted to female participants. Data were collected August-October 2020 via phone after implementation of COVID-19 restrictions. Prevalence of past-year sexual harassment and harassment relative to COVID-19 restrictions were calculated for overall sample, and by individual, household, and pandemic-related factors. Multivariate negative binomial regression models examine correlates of (1) past-year sexual harassment and (2) increases in sexual harassment relative to COVID-19 restrictions. RESULTS Overall, 18.1% of AGYW experienced past-year sexual harassment at the 2020 survey. Among this group, 14.6% experienced sexual harassment pre-COVID-19 only, 18.8% after only and 66.6% at both time points. Among the latter group, 34.9% reported more occurrences following COVID-19 restrictions, 20.5% reported less occurrences and 44.7% reported no change in occurrence. Overall, 42.0% of AGYW experienced an increase in sexual harassment while 58.0% experienced no increase since COVID-19. In adjusted models, past-year sexual harassment was associated with higher educational attainment (adjusted risk ratio, aRR 2.11; 95% CI 1.27 to 3.52) and inability to meet basic financial needs (aRR 1.67; 95% CI 1.05 to 2.66). Increased sexual harassment since COVID-19 was associated with having full control to leave the home (aRR 1.69; 95% CI 1.00 to 2.90). CONCLUSIONS Sexual harassment among AGYW in Nairobi, Kenya was prevalent before and during COVID-19 restrictions. Safety in public spaces remains a highly gendered issue that impacts women's safety and ability to participate in public life. Prevention and support services to address sexual harassment remain an important element in ensuring safe, sustainable public spaces.
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Affiliation(s)
- Kristin G Bevilacqua
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - A Williams
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Baltimore, Maryland, USA
| | - G Wamue-Ngare
- Department of Sociology, Gender and Development Studies, Kenyatta University, Nairobi, Kenya
- Women's Economic Empowerment Hub, Kenyatta University, Nairobi, Kenya
| | - Mary Thiongo
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
| | - P Gichangi
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Baltimore, Maryland, USA
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Decker MR, Wood SN, Thomas HL, Thiongo M, Guiella G, Fiacre B, Onadja Y, Gichangi P. Violence against women from partners and other household members during COVID-19 in Burkina Faso and Kenya. BMC Public Health 2022; 22:1857. [PMID: 36195851 PMCID: PMC9532234 DOI: 10.1186/s12889-022-14197-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/29/2022] [Indexed: 11/27/2022] Open
Abstract
Background Global evidence indicates increases in gender-based violence (GBV) during the COVID-19 pandemic following mitigation measures, such as stay at home orders. Indirect effects of the pandemic, including income loss, strained social support, and closed or inaccessible violence response services, may further exacerbate GBV and undermine help-seeking. In Kenya and Burkina Faso, as in many settings, GBV was prevalent prior to the COVID-19 pandemic. Studies specific to COVID-impact on GBV in Kenya indicate mixed results and there remains a lack of evidence from Burkina Faso. Our study takes a comprehensive lens by addressing both intimate partner violence (IPV) and non-partner household abuse through the COVID-19 pandemic in two priority settings. Methods Annual, national cross-sections of women ages 15–49 completed survey data collection in November–December 2020 and December 2020–March 2021; the GBV module was limited to one woman per household [Kenya n = 6715; Burkina n = 4065]. Descriptive statistics, Venn diagrams, and logistic and multinomial regression characterized prevalence of IPV and other household abuse, frequency relative to the COVID-19 pandemic, help-seeking behaviors, and predictors of IPV and household abuse across the socioecological framework. Results In both settings, past-year IPV prevalence exceeded non-partner household abuse (Kenya: 23.5%IPV, 11.0%household; Burkina Faso: 25.7%IPV, 16.2%household). Over half of those affected in each setting did not seek help; those that did turned first to family. Among those with past-year experiences, increased frequency since COVID-19 was noted for IPV (16.0%Burkina Faso; 33.6%Kenya) and household violence (14.3%Burkina Faso; 26.2%Kenya). Both context-specific (i.e., financial autonomy in Burkina Faso) and universal (i.e., COVID-related income loss) risk factors emerged. Conclusion Past-year IPV and household violence against women in Kenya and Burkina Faso were prevalent, and in some cases, intensified during the COVID-19 pandemic. Across settings, help-seeking from formal services was notably low, likely reflecting shame, blame, and stigmatization identified as barriers in pre-COVID literature. Both primary prevention and survivor-centered support services, including those related to economic empowerment, should be integrated within COVID-recovery efforts, and extended into the post-pandemic period to fully meet women’s safety needs.
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Affiliation(s)
- Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E4142, Baltimore, MD, 21205, USA. .,Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E4142, Baltimore, MD, 21205, USA.,Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Haley L Thomas
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E4142, Baltimore, MD, 21205, USA
| | - Mary Thiongo
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
| | - Georges Guiella
- Institut Supérieur des Sciences de la Population (ISSP/Université Joseph Ki-Zerbo), Ouagadougou, Burkina Faso
| | - Bazie Fiacre
- Institut Supérieur des Sciences de la Population (ISSP/Université Joseph Ki-Zerbo), Ouagadougou, Burkina Faso
| | - Yentéma Onadja
- Institut Supérieur des Sciences de la Population (ISSP/Université Joseph Ki-Zerbo), Ouagadougou, Burkina Faso
| | - Peter Gichangi
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya.,Technical University of Mombasa, Mombasa, Kenya.,Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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19
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Kaur A, Grace KT, Holliday CN, Denhard L, Miller J, Decker MR. Organizational Readiness for Intimate Partner Violence Response among Supportive Housing Providers: A Capacity Assessment in Maryland. J Interpers Violence 2022; 37:NP17036-NP17051. [PMID: 33975500 DOI: 10.1177/08862605211015223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Intimate partner violence (IPV) frequently leads to housing instability and homelessness among survivors. While the client populations of many housing support programs are likely to include IPV survivors who have unique safety needs, the organizational readiness of these housing providers to identify and support IPV survivors is not clear. This study assessed organizational readiness for IPV response among Rapid Re-Housing (RRH) and Transitional Housing (TH) providers in Maryland, whose client populations include women (n = 32). We adapted the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) to create the Housing provider Readiness to Manage IPV Survey (H-REMIS), inclusive of IPV-related perceptions, policies, staff training and capability, and resources. The 12-point H-REMIS demonstrated acceptable internal consistency reliability (Cronbach's α = 0.748). Descriptive and comparative analyses domains by IPV-specific (n = 4) and general (n = 28) housing providers assessed readiness and identified areas for improvement. IPV-specific providers had higher mean organizational readiness for IPV response scores relative to non-IPV specific providers (11.3 and 7.5, respectively). High readiness areas included perceiving the importance of IPV and staff having adequate time, space, and comfort level to address IPV. Areas of low readiness included development and use of IPV response policies as well as staff training on IPV. This assessment documents concerning gaps in organizational readiness for IPV response among supportive housing providers, and pinpoints areas where training and capacity building can be most valuable. The process of improving readiness in the supportive housing sector must involve capacity building and a systems-level approach in order to ensure that all supportive housing providers are prepared to meet the needs of IPV survivors among their client population.
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Affiliation(s)
- Arshdeep Kaur
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Langan Denhard
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Janice Miller
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- House of Ruth Maryland, Baltimore, MD, USA
| | - Michele R Decker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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20
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Wood SN, Kennedy SR, Akumu I, Tallam C, Asira B, Zimmerman LA, Glass N, Decker MR. Understanding the Link Between Reproductive Coercion and Covert Use of Contraception as a Safety Strategy for Women Experiencing Violence in Nairobi's Urban Informal Settlements. Violence Against Women 2022; 29:1343-1367. [PMID: 36000323 DOI: 10.1177/10778012221108422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This mixed-methods study examined the relationship between reproductive coercion (RC) and covert contraceptive use among intimate partner violence survivors in Nairobi, Kenya. Quantitative analyses utilize baseline data from the myPlan Kenya trial (n = 321). Purposive in-depth interviews (IDIs) (n = 30) explored women's reproductive safety strategies. Multinomial analyses indicated increased covert use and decreased overt use compared to nonuse, for women experiencing RC; logistic models similarly report increased odds of covert use with RC experience. Qualitative data contextualize women's reasons for use and challenges faced. Integration of reproductive safety strategies into family planning and violence services can improve the safe use of contraception.
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Affiliation(s)
- Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Irene Akumu
- Mashinani Department, Ujamaa-Africa, Nairobi, Kenya
| | | | - Ben Asira
- Mashinani Department, Ujamaa-Africa, Nairobi, Kenya
| | - Linnea A Zimmerman
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nancy Glass
- Johns Hopkins School of Nursing, Baltimore, MD, USA.,Department of International Health, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Global Health, 15851Johns Hopkins University, Baltimore, MD, USA
| | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins School of Nursing, Baltimore, MD, USA.,Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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21
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Schneider KE, Tomko C, Nestadt DF, Rouhani S, White RH, Decker MR, Galai N, Sherman SG. Understanding the longitudinal relationship between substance use and violent victimization among street-based women who exchange sex in Baltimore, Maryland. Int J Drug Policy 2022; 109:103824. [PMID: 35985083 DOI: 10.1016/j.drugpo.2022.103824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/11/2022] [Accepted: 08/05/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Women who exchange sex (WES) experience extensive interpersonal violence from multiple perpetrators. Violence towards WES contributes to poor mental and behavioral health outcomes, including high rates of drug use. However, it is difficult to disentangle the temporal relationship between drug use and violence among WES. METHODS We used data from 251 WES, who completed baseline and 6-month follow up surveys. WES reported baseline sociodemographic characteristics, including homelessness and hunger. Participants reported their drug use by type and violent experiences by perpetrator at each time point. We conducted a path analysis examining the associations between drug use and violent victimization over time. RESULTS Participants were on average 37.8 years old, non-Hispanic White (57.4%) and experiencing high levels of structural vulnerability (59.4% homelessness; 58.6% weekly hunger). Drug use and violence were significantly correlated within each time point. Prospectively, baseline violent victimization was significantly associated with drug use (ß (SE) = 0.13 (0.06)) and violence (ß (SE) = 0.47 (0.05)) at follow up. Baseline drug use was associated with drug use at follow up (ß (SE) = 0.45 (0.05)) but was not significantly associated with violence at follow up (ß (SE) = 0.10 (0.06)). CONCLUSIONS Violence and drug use are closely linked in this population; and violence appears to facilitate sustained drug use. Interventions to address the dual epidemics of violence and substance use in this population should address underlying trauma as well as socio-structural drivers of violence as well as tailored harm reduction services for this population.
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Affiliation(s)
- Kristin E Schneider
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA.
| | - Catherine Tomko
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Danielle Friedman Nestadt
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Saba Rouhani
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Rebecca Hamilton White
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Michele R Decker
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; Department of Statistics, University of Haifa, Mt Carmel, Israel
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
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22
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Williams A, Wood SN, Stuart H, Wamue-Ngare G, Thiongo M, Gichangi P, Devoto B, Decker MR. Gendered time use during COVID-19 among adolescents and young adults in Nairobi, Kenya. EClinicalMedicine 2022; 49:101479. [PMID: 35747177 PMCID: PMC9167856 DOI: 10.1016/j.eclinm.2022.101479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 11/07/2022] Open
Abstract
Background Gender disparities in time use contribute to poor outcomes in women. Large-scale disruptions can affect time use. The objectives of this study were to characterize time use across the pandemic by gender and to assess how gender associates with 2021-time use, overall and by 2020 economic dependency status. Methods A prospective cohort of youth in Nairobi, Kenya, completed phone-based surveys in August-October 2020 and April-May 2021. Time use was characterized at both time points and 1,777 participants with complete time use data at both time points were included in the analysis. 2021-time use was regressed on gender and stratified by 2020 economic dependency status. Findings At both time points, significant gender differences in time use found young men with more time on paid work and less time on domestic work [1·6 h; 95% CI: 1·1, 2·2] and [-1·9 h; 95% CI: -1·1, -1·5], respectively; 2021. In adjusted models, the gender differential in unpaid domestic work were significant overall and at all levels of economic dependency (dependent, semi-dependent, independent). The gender differential in paid work was evident among semi-dependent and independent. Interpretation Young women spent less time on paid work and more time on domestic duties than male counterparts, consistently across a six-month period during the pandemic, suggesting gendered time poverty. Resulting gendered gaps in earnings can contribute to women's longer-term economic vulnerability. Funding This work was supported by the Bill & Melinda Gates Foundation [010481].
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Affiliation(s)
- Anaise Williams
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shannon N. Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Grace Wamue-Ngare
- Department of Sociology, Gender and Development Studies, Kenyatta University, Nairobi, Kenya
- Women's Economic Empowerment Hub, Kenyatta University, Nairobi, Kenya
| | - Mary Thiongo
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
| | - Peter Gichangi
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
- Technical University of Mombasa, Mombasa, Kenya
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Bianca Devoto
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michele R. Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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23
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Wood SN, Milkovich R, Thiongo M, Byrne ME, Devoto B, Wamue-Ngare G, Decker MR, Gichangi P. Product-access challenges to menstrual health throughout the COVID-19 pandemic among a cohort of adolescent girls and young women in Nairobi, Kenya. EClinicalMedicine 2022; 49:101482. [PMID: 35692218 PMCID: PMC9165989 DOI: 10.1016/j.eclinm.2022.101482] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Access to menstrual hygiene products enables positive health for adolescent girls and young women (AGYW). Among AGYW in Nairobi, Kenya, this prospective mixed-methods study characterised menstrual health product-access challenges at two time points during the COVID-19 pandemic; assessed trajectories over the pandemic; and examined factors associated with product-access trajectories. METHODS Data were collected from an AGYW cohort in August-October 2020 and March-June 2021 (n=591). The prevalence of menstrual health product-access challenges was calculated per timepoint, with trajectories characterizing product-access challenges over time. Logistic regression models examined associations with any product-access challenge throughout the pandemic; multinomial and logistic regressions further assessed factors associated with trajectories. Qualitative data contextualize results. FINDINGS In 2020, 52·0% of AGYW experienced a menstrual health product-access challenge; approximately six months later, this proportion dropped to 30·3%. Product-access challenges during the pandemic were heightened for AGYW with secondary or lower education (aOR=2·40; p<0·001), living with parents (aOR=1·86; p=0·05), not the prime earner (aOR=2·27; p=0·05); and unable to meet their basic needs (aOR=2·25; p<0·001). Between timepoints, 38·0% experienced no product-access challenge and 31·7% resolved, however, 10·2% acquired a challenge and 20·1% experienced sustained challenges. Acquired product-access challenges, compared to no challenges, were concentrated among those living with parents (aOR=3·21; p=0·05); multinomial models further elucidated nuances. Qualitative data indicate deprioritization of menstrual health within household budgets as a contributor. INTERPRETATION Menstrual health product-access challenges are prevalent among AGYW during the pandemic; barriers were primarily financial. Results may reflect endemic product-access gaps amplified by COVID-specific constraints. Ensuring access to menstrual products is essential to ensure AGYW's health needs. FUNDING This work was supported, in whole, by the Bill & Melinda Gates Foundation [010481].
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Affiliation(s)
- Shannon N. Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Corresponding author at: Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, 615 N. Wolfe Street Room E4009 Baltimore, MD 21205, USA.
| | - Rachel Milkovich
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mary Thiongo
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
| | - Meagan E. Byrne
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bianca Devoto
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Grace Wamue-Ngare
- Women's Economic Empowerment Hub, Kenyatta University, Nairobi, Kenya
- Department of Sociology, Gender and Development Studies, Kenyatta University, Nairobi, Kenya
| | - Michele R. Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Peter Gichangi
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
- Technical University of Mombasa, Mombasa, Kenya
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Belgium
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Letourneau EJ, Assini-Meytin LC, Nair R, Stuart EA, Decker MR, McGinty EB. Health insurance expansion and family violence prevention: A conceptual framework. Child Abuse Negl 2022; 129:105664. [PMID: 35580400 DOI: 10.1016/j.chiabu.2022.105664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 06/15/2023]
Abstract
Family violence, including child maltreatment (CM) and intimate partner violence (IPV), plagues far too many American families, particularly those in low-income communities. CM and IPV are intertwined and impose a significant emotional, health and financial burden on children and families and an economic burden on our country. Although these and other forms of violence are influenced by shared risk factors across the socioecological spectrum, prevention efforts typically intervene on a single type of violence at a microsystem level via individual or family intervention. Research is needed to identify policies operating at macrosystem levels that reduce, at scale, multiple forms of violence affecting children. In this paper, we propose a three-step theory of change through which health insurance expansions might reduce rates of CM and IPV, using Medicaid expansion as an exemplar. The proposed framework can inform research examining the link between health insurance and the primary prevention of CM and IPV.
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Affiliation(s)
- Elizabeth J Letourneau
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Luciana C Assini-Meytin
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Reshmi Nair
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michele R Decker
- Department of Population Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emma Beth McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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25
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Thiongo M, Gichangi P, Macho PK, Byrne ME, Kimani P, Waithaka M, Radloff S, Anglewicz P, Decker MR. Implementation of respondent driven sampling in Nairobi, Kenya, for tracking key family planning indicators among adolescents and youth: lessons learnt. BMC Res Notes 2022; 15:200. [PMID: 35672785 PMCID: PMC9171948 DOI: 10.1186/s13104-022-06038-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Adolescents and youth constitute a significant proportion of the population in developing nations. Conventional survey methods risk missing adolescents/youth because their family planning/contraception (FP/C) behavior is hidden. Respondent-driven sampling (RDS), a modified chain-referral recruitment sampling approach, was used to reach unmarried adolescents/youth aged 15-24 in Nairobi, Kenya to measure key FP/C indicators. Seeds were selected and issued with three coupons which they used to invite their peers, male or female, to participate in the study. Referred participants were also given coupons to invite others till sample size was achieved. We report on key implementation parameters following standard RDS reporting recommendations. RESULTS A total of 1674 coupons were issued to generate a sample size of 1354. Coupon return rate was 82.7%. Study participants self-administered most survey questions and missing data was low. Differential enrolment by gender was seen with 56.0% of females recruiting females while 44.0% of males recruited males. In about two months, it was possible to reach the desired sample size using RDS methodology. Implementation challenges included presentation of expired coupons, recruitment of ineligible participants and difficulty recruiting seeds and recruits from affluent neighborhoods. Challenges were consistent with RDS implementation in other settings and populations. RDS can complement standard surveillance/survey approaches, particularly for mobile populations like adolescents/youth.
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Affiliation(s)
- Mary Thiongo
- International Centre for Reproductive Health, Mombasa, Kenya
| | - Peter Gichangi
- International Centre for Reproductive Health, Mombasa, Kenya
- Technical University of Mombasa, Mombasa, Kenya
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Present Address: P.O. Box, Nairobi, 2631-00202 Kenya
| | - Patrick K. Macho
- School of Public Health, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Meagan E. Byrne
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Peter Kimani
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Michael Waithaka
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Scott Radloff
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Philip Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Michele R. Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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26
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Decker MR, Grace KT, Holliday CN, Bevilacqua KG, Kaur A, Miller J. Safe and Stable Housing for Intimate Partner Violence Survivors, Maryland, 2019‒2020. Am J Public Health 2022; 112:865-870. [PMID: 35420894 PMCID: PMC9137013 DOI: 10.2105/ajph.2022.306728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 11/04/2022]
Abstract
House of Ruth Maryland is a comprehensive intimate partner violence (IPV) service provider. Our academic‒practitioner partnership conducted a prospective, quasi-experimental evaluation (n = 70) of on-site transitional housing and community-based rapid rehousing to meet the safety and stability needs of individuals made homeless because of IPV. By 6-month follow-up, both IPV revictimization and housing instability significantly improved (P < .001). Housing supports through an IPV service provider advanced the dual goals of safety and housing stability for IPV survivors. Safe, affordable housing is an IPV prevention strategy. (Am J Public Health. 2022;112(6):865-870. https://doi.org/10.2105/AJPH.2022.306728).
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Affiliation(s)
- Michele R Decker
- At the time of the study, all authors were affiliated with Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Janice Miller is also with House of Ruth Maryland (HRM), Baltimore
| | - Karen Trister Grace
- At the time of the study, all authors were affiliated with Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Janice Miller is also with House of Ruth Maryland (HRM), Baltimore
| | - Charvonne N Holliday
- At the time of the study, all authors were affiliated with Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Janice Miller is also with House of Ruth Maryland (HRM), Baltimore
| | - Kristin G Bevilacqua
- At the time of the study, all authors were affiliated with Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Janice Miller is also with House of Ruth Maryland (HRM), Baltimore
| | - Arshdeep Kaur
- At the time of the study, all authors were affiliated with Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Janice Miller is also with House of Ruth Maryland (HRM), Baltimore
| | - Janice Miller
- At the time of the study, all authors were affiliated with Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Janice Miller is also with House of Ruth Maryland (HRM), Baltimore
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Nestadt DF, Tomko C, Schneider KE, Kerrigan D, Decker MR, Sherman SG. Co-occurring Threats to Agency Among Female Sex Workers in Baltimore, Maryland. J Interpers Violence 2022; 37:NP8818-NP8843. [PMID: 33300442 PMCID: PMC9136478 DOI: 10.1177/0886260520978188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Driven largely by the unequal distribution of power, female sex workers (FSW) globally bear a disproportionately high burden of HIV, sexually transmitted infections, and interpersonal violence. Prior literature has identified a number of multi-level factors that may serve to constrain FSWs' agency, or their ability to define and take action to realize goals. Among these are work-based violence and substance use, which are potentiated by the criminalization of sex work and structural vulnerability. Quantitative research related to U.S.-based FSWs' own sense of agency, as well as the barriers that may impede it, is sparse. We sought to identify patterns of various threats to agency and explore to what extent they were associated with perceived agency among a cohort of 381 FSW in Baltimore, Maryland, United States, using latent class analysis. Latent class indictors were past-six-month experience of client-perpetrated sexual violence, client-perpetrated physical violence, homelessness, food insecurity, arrest, daily crack-cocaine use, and daily heroin use. Perceived agency was measured using the short form of the Pearlin Mastery Scale. We identified three typologies of threatened agency among women in our sample: a "threatened by structural factors, drug use, and violence" class, a "threatened by structural factors and drug use" class, and a "less threatened" class. Mean perceived agency score was significantly lower for the class characterized by client-perpetrated violence than for either of the other classes. This suggests violence, in the context of deeper, structural power imbalances embedded in hunger, homelessness, and drug use, may dramatically reduce one's sense of agency and operate as a critical barrier to empowerment. Our study adds important insights to the broader FSW community empowerment literature and supports the need for interventions to bolster both individual and collective agency among U.S.-based FSW, including interventions to prevent sex work-related violence.
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Affiliation(s)
| | - Catherine Tomko
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Susan G. Sherman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Wood SN, Yirgu R, Wondimagegnehu A, Qian J, Milkovich RM, Decker MR, Glass N, Seid F, Zekarias L, Zimmerman LA. Impact of the COVID-19 pandemic on intimate partner violence during pregnancy: evidence from a multimethods study of recently pregnant women in Ethiopia. BMJ Open 2022; 12:e055790. [PMID: 35414554 PMCID: PMC9006189 DOI: 10.1136/bmjopen-2021-055790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 03/15/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES This multimethods study aimed to: (1) compare the prevalence of intimate partner violence (IPV) during pregnancy pre-COVID-19 and during the COVID-19 pandemic using quantitative data and (2) contextualise pregnant women's IPV experiences during the COVID-19 pandemic through supplemental interviews. DESIGN Quantitative analyses use data from Performance Monitoring for Action-Ethiopia, a cohort of 2868 pregnant women that collects data at pregnancy, 6 weeks, 6 months and 1-year postpartum. Following 6-week postpartum survey, in-depth semistructured interviews contextualised experiences of IPV during pregnancy with a subset of participants (n=24). PARTICIPANTS All pregnant women residing within six regions of Ethiopia, covering 91% of the population, were eligible for the cohort study (n=2868 completed baseline survey). Quantitative analyses were restricted to the 2388 women with complete 6-week survey data (retention=82.7%). A purposive sampling frame was used to select qualitative participants on baseline survey data, with inclusion criteria specifying completion of quantitative 6-week interview after the onset of the COVID-19 pandemic, and indication of IPV experience. INTERVENTIONS A State of Emergency in Ethiopia was declared in response to the COVID-19 pandemic approximately halfway through 6-week postpartum interview, enabling a natural experiment (n=1405 pre-COVID-19; n=983 during-COVID-19). PRIMARY OUTCOME MEASURES IPV during pregnancy was assessed via the 10-item Revised Conflict and Tactics Scale. RESULTS 1-in-10 women experienced any IPV during pregnancy prior to COVID-19 (10.5%), and prevalence of IPV during pregnancy increased to 15.1% during the COVID-19 pandemic (aOR=1.51; p=0.02). Stratified by residence, odds of IPV during the pandemic increased for urban women only (aOR=2.09; p=0.03), however, IPV prevalence was higher in rural regions at both time points. Qualitative data reveal COVID-19-related stressors, namely loss of household income and increased time spent within the household, exacerbated IPV. CONCLUSIONS These multimethods results highlight the prevalent, severe violence that pregnant Ethiopian women experience, with pandemic-related increases concentrated in urban areas. Integration of IPV response and safety planning across the continuum of care can mitigate impact.
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Affiliation(s)
- Shannon N Wood
- Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robel Yirgu
- Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | | | - Jiage Qian
- Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rachel Mait Milkovich
- Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michele R Decker
- Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Nancy Glass
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
- Center for Global Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fatuma Seid
- Ethiopia Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Lensa Zekarias
- Ethiopia Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Linnea A Zimmerman
- Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Decker MR, Lyons C, Guan K, Mosenge V, Fouda G, Levitt D, Abelson A, Nunez GT, Njindam IM, Kurani S, Baral S. A Systematic Review of Gender-Based Violence Prevention and Response Interventions for HIV Key Populations: Female Sex Workers, Men Who Have Sex With Men, and People Who Inject Drugs. Trauma Violence Abuse 2022; 23:676-694. [PMID: 35144502 DOI: 10.1177/15248380211029405] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Gender-based violence (GBV) is that perpetrated based on sex, gender identity, or perceived adherence to socially defined gender norms. This human rights violation is disproportionately experienced by HIV key populations including female sex workers (FSW), people who inject drugs (PWID), and men who have sex with men (MSM). Consequently, addressing GBV is a global priority in HIV response. There is limited consensus about optimal interventions and little known about effectiveness. Our systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered in International Prospective Register of Systematic Reviews. Peer-reviewed and non-peer-reviewed literature were searched for articles that described a GBV prevention or response intervention specifically for key populations including FSW, PWID, and MSM. Results were organized by level(s) of implementation and pillars of a comprehensive GBV response: prevention, survivor support, and accountability/justice. Of 4,287 articles following removal of duplicates, 32 unique interventions (21 FSW, seven PWID, and nine MSM, not mutually exclusive) met inclusion criteria, representing 13 countries. Multisectoral interventions blended empowerment, advocacy, and crisis response with reductions in violence. Individual-level interventions included violence screening and response services. Violence-related safety promotion and risk reduction counseling within HIV risk reduction programming reduced violence. Quantitative evaluations were limited. Violence prevention and response interventions for FSW, PWID, and MSM span individual, community, and multisectoral levels with evidence of promising practices at each level. The strongest evidence supported addressing violence in the context of sexually transmitted infection/HIV risk reduction. As interventions continue to emerge, the rigor of accompanying evaluations must simultaneously advance to enable clarity on the health and safety impact of GBV prevention and response programming.
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Affiliation(s)
- Michele R Decker
- Department of Population, Family and Reproductive Health, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carrie Lyons
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathleen Guan
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vanessa Mosenge
- Continuum of Prevention, Care and Treatment of HIV/AIDS with Most at Risk Populations in Cameroon, CARE International, Yaoundé, Cameroon
| | - Ghislane Fouda
- Continuum of Prevention, Care and Treatment of HIV/AIDS with Most at Risk Populations in Cameroon, CARE International, Yaoundé, Cameroon
| | - Daniel Levitt
- Continuum of Prevention, Care and Treatment of HIV/AIDS with Most at Risk Populations in Cameroon, CARE USA, New York City, NY, USA
| | - Anna Abelson
- Department of Population, Family and Reproductive Health, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gnilane Turpin Nunez
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Iliassou Mfochive Njindam
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shaheen Kurani
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stefan Baral
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Grace KT, Holliday CN, Bevilacqua K, Kaur A, Miller J, Decker MR. Sexual and Reproductive Health and Reproductive Coercion in Women Victim/Survivors Receiving Housing Support. J Fam Violence 2022; 38:713-722. [PMID: 35283554 PMCID: PMC8901387 DOI: 10.1007/s10896-022-00362-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 06/14/2023]
Abstract
Housing instability and intimate partner violence (IPV) compromise women's sexual and reproductive health (SRH) through reduced contraceptive access and increased risk of unintended pregnancy. This study describes the reproductive health status and needs of IPV survivors receiving housing support and explores factors influencing their experience of reproductive coercion (RC), specifically. Cross-sectional baseline data from a quasi-experimental study of 70 IPV survivors enrolled in housing programs in the Baltimore, MD, metropolitan area from June 2019 through December 2020 were analyzed. Of the 70 women enrolled in the study, 70.3 percent (n = 45) desired to avoid pregnancy, but 57.4 percent were either using no contraceptive method (31.2%) or methods with low effectiveness (26.2%). Approximately, 1 in 6 women (16.4%, n = 11) experienced RC in the past 3 months, which was associated with frequency and severity of IPV (p = 0.001 to 0.005) and PTSD (p = 0.001), as well as not sharing children with the abusive partner (p = 0.002). This study highlights reproductive health risks in an important and under-studied population of women seeking housing due to IPV. Leaving an abusive relationship is a uniquely vulnerable time, and also a time of opportunity, as women are accessing services that can be tailored to their SRH needs. Significant results highlight vulnerability to and consequences of RC in this population. This study has implications for IPV support programs and housing programs that serve women.
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Affiliation(s)
- Karen Trister Grace
- School of Nursing, College of Health and Human Services, George Mason University, 4400 University Drive, MSN 3C4, Fairfax, VA 22030 USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | | | | | - Arshdeep Kaur
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Merrill KG, Campbell JC, Kennedy CE, Burke VM, Miti S, Frimpong C, Decker MR, Abrams EA, Mwansa JK, Denison JA. 'So hurt and broken': A qualitative study of experiences of violence and HIV outcomes among Zambian youth living with HIV. Glob Public Health 2022; 17:444-456. [PMID: 33428559 PMCID: PMC8272734 DOI: 10.1080/17441692.2020.1864749] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Emerging data show associations between violence victimisation and negative HIV outcomes among youth in sub-Saharan Africa. We conducted in-depth interviews with adolescents and young adults living with HIV (aged 15-24 years) in Ndola, Zambia, to better understand this relationship. We purposively selected 41 youth (24 females, 17 males) with varied experiences of violence and virologic results. Analysis used thematic coding. Two-thirds of participants said violence affected their medication adherence, clinic attendance, and/or virologic results. They focused on the negative effects of psychological abuse from family members in homes and peers at schools, which were the most salient forms of violence raised, and sexual violence against females. In contrast, they typically depicted physical violence from caregivers and teachers as a standard discipline practice, with few impacts. Youth wanted HIV clinic settings to address verbal abuse and emotional maltreatment, alongside physical and sexual violence, including through peer mentoring. Violence - especially verbal and emotional forms - must be recognised as a potential barrier to HIV self-management among youth living with HIV in the region. Further testing of clinic, home, and school-based interventions may be critical to reducing levels of violence and improving HIV outcomes in this vulnerable but resilient population.Trial registration: ClinicalTrials.gov identifier: NCT04115813.
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Affiliation(s)
- Katherine G. Merrill
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jacquelyn C. Campbell
- Department of Community-Public Health, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Caitlin E. Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Virginia M. Burke
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sam Miti
- Arthur Davison Children’s Hospital, Ndola, Zambia
| | | | - Michele R. Decker
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth A. Abrams
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Julie A. Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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32
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Decker MR, Holliday CN, Hameeduddin Z, Shah R, Miller J, Dantzler J, Goodmark L. Defining Justice: Restorative and Retributive Justice Goals Among Intimate Partner Violence Survivors. J Interpers Violence 2022; 37:NP2844-NP2867. [PMID: 32741238 DOI: 10.1177/0886260520943728] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Intimate partner violence (IPV) and sexual violence (SV) are drivers of women's morbidity and mortality yet remain among the most underreported crimes in the United States. Understanding IPV/SV survivors' justice preferences and justice definitions can strengthen violence prevention and response systems. In-depth interviews were conducted with women who experienced past-year IPV (n = 26), to explore their justice preferences and recommendations. Primary themes included accountability, safety, and rehabilitation, with examples within and outside the current justice system, and across restorative and retributive justice frameworks. Women sought accountability through a variety of means. Retributive approaches like incarceration offered accountability as well as fleeting safety, but were critically limited in addressing the root causes of violence and, in some cases, were felt to exacerbate the problem. Women's expressed needs and preferences centered on restorative aspects of justice, including perpetrator's acknowledgment of harm, achieving physical safety and stability, and perpetrator rehabilitation through counseling. Paradoxically, women's safety-related justice goals both encouraged and discouraged their engagement in the formal justice system. The discordance between women's justice preferences and their perceptions and experiences within the current justice system illustrate complex and difficult trade-offs faced by survivors in achieving physical, social, and economic safety. Moreover, they likely contribute to the low levels of IPV/SV reporting to police. Women's goals were aligned with restorative justice principles, illustrating the value of this approach. In an era of unprecedented dialogue on justice reform, results provide direction for integrating restorative justice practices to strengthen the justice response to violence against women.
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Affiliation(s)
- Michele R Decker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Roma Shah
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- University of Maryland School of Social Work, Baltimore, USA
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Decker MR, Bevilacqua K, Wood SN, Ngare GW, Thiongo M, Byrne ME, Williams A, Devoto B, Glass N, Heise L, Gichangi P. Gender-based violence during COVID-19 among adolescent girls and young women in Nairobi, Kenya: a mixed-methods prospective study over 18 months. BMJ Glob Health 2022; 7:bmjgh-2021-007807. [PMID: 35210310 PMCID: PMC8882641 DOI: 10.1136/bmjgh-2021-007807] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/20/2022] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Adolescent girls and young women (AGYW) disproportionately experience gender-based violence (GBV), which can increase during emergencies like the COVID-19 pandemic. METHODS A cohort of youth ages 15-24 in Nairobi, Kenya was surveyed at three time points over an 18-month period prior to and during the COVID-19 pandemic: June-August 2019 (prepandemic), August-October 2020 (12-month follow-up) and May 2021 (18-month follow-up). We characterise (1) prevalence, relative timing and help-seeking for leading forms of GBV, (2) GBV trajectories over 18 months and (3) associations of individual, dyad and COVID-related factors on GBV trajectories among AGYW (n=612) in Nairobi, Kenya. Virtual focus group discussions (n=12) and interviews (n=40) contextualise quantitative results. RESULTS Intimate partner violence (IPV) prevalence hovered at 17% across time points (ever at pre-pandemic; past 12 months at 12-month follow-up (2020); past 6 months at 18-month follow-up (2021)); non-partner sexual violence (SV) was 3% at 12-month and 18-month follow-up. Overall, 27.6% of AGYW experienced IPV during the pandemic. IPV during the pandemic was associated with work as the primary pre-COVID activity, low social support and partner age difference >4 years. Among AGYW partnered at all three time points, 66.2% stayed IPV-free (no IPV), 9.2% saw IPV resolve by 18-month follow-up, while 11.1% had IPV start and 13.6% experienced intermittent IPV. Help-seeking for IPV and SV in 2020 (11.1% and 4.6%, respectively) increased to 21.7% and 15.1%, respectively, by 2021. Qualitative results speak to impacts of curfews, and pandemic-related financial stress in prompting conflict and threatening traditional gender roles, and underlying conditions that enable IPV. CONCLUSION The persistence of IPV against AGYW in Nairobi prior to and during the COVID-19 pandemic reflects endemic conditions and pandemic-specific stressors. Youth, including unmarried youth, remain a priority population for GBV prevention and survivor-centred response.
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Affiliation(s)
- Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA .,Bill and Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kristin Bevilacqua
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Bill and Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Grace Wamue Ngare
- Department of Sociology, Gender and Development Studies, Kenyatta University, Nairobi, Kenya.,Women's Economic Empowerment Hub, Kenyatta University, Nairobi, Kenya
| | - Mary Thiongo
- International Centre for Reproductive Health Kenya, Nairobi, Kenya
| | - Meagan E Byrne
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Bill and Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Anaise Williams
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bianca Devoto
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nancy Glass
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Lori Heise
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Peter Gichangi
- International Centre for Reproductive Health Kenya, Nairobi, Kenya.,Department of Public Health and Primary Care, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
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Grace KT, Decker MR, Alexander KA, Campbell J, Miller E, Perrin N, Glass N. Reproductive Coercion, Intimate Partner Violence, and Unintended Pregnancy Among Latina Women. J Interpers Violence 2022; 37:1604-1636. [PMID: 32486886 PMCID: PMC8162928 DOI: 10.1177/0886260520922363] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Reproductive coercion (RC) describes a range of behaviors that restrict reproductive autonomy including pregnancy coercion, birth control sabotage, and controlling the outcome of a pregnancy. RC is associated with pregnancies that are mistimed and unwanted (i.e., unintended). Past research demonstrates that Latina women have higher risk for RC and for unintended pregnancy. This cross-sectional descriptive study with Latina women (n = 482) examined prevalence and risk factors for RC, evaluated the association of RC and unintended pregnancy among women with a past-year pregnancy, and explored use of safety and harm reduction strategies. A tablet survey was administered to women attending a community health center, between the ages of 15 and 45, who self-identified as Latina and who had a dating or sexual partner in the past year. Approximately one in six (16.8%) experienced past-year RC and risk factors included younger age (adjusted odds ratio [AOR] = 0.95, 95% confidence interval [CI] = [0.91, 1.00], p = .038) and concurrent intimate partner violence (IPV; AOR = 4.47, 95% CI = [2.06, 9.70], p < .001). IPV questions were specific to the partner involved with RC behaviors. For the 185 participants who reported a past-year pregnancy, RC was associated with lower pregnancy planning scores (β = -.27, 95% CI = [-0.41, -0.13], p < .001). The combination of experiencing RC and IPV appeared particularly potent in lowering pregnancy planning scores (β = -.15, 95% CI = [-0.29, 0.00], p = .052). Approximately 10.6% of participants engaged in harm reduction strategies, most commonly ending an unhealthy or abusive relationship (6.1%) and using less detectable methods of contraception so that partners would not find out (3.4%). The study articulates the risk of RC and its intersection with IPV and unintended pregnancy for Latina women. Providers working with racially and ethnically marginalized women have an important role in promoting safety and harm reduction strategies that include offering less detectable methods of contraception and support in leaving unhealthy and abusive relationships.
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Affiliation(s)
| | - Michele R Decker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Nancy Perrin
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Nancy Glass
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
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Decker MR, Meyer SR, Branchini Risko C, Abshir N, Mar AA, Robinson WC. Trafficking, Client and Police Violence, Sexual Risk and Mental Health Among Women in the Sex Industry at the Thai-Myanmar Border. Violence Against Women 2021; 28:2677-2699. [PMID: 34859727 DOI: 10.1177/10778012211060860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study describes sex trafficking and associations with violence and health among female migrants in the sex industry in Mae Sot, Thailand. The mixed-methods study included a qualitative interview phase (n = 10), followed by a cross-sectional survey phase (n = 128). Entry via trafficking (force, fraud, or coercion [FFC], or as minors) was prevalent (76.6%), primarily FFC (73.4%). FFC was associated with inconsistent condom use, inability to refuse clients, poor health, and anxiety. Past-year violence was normative including client sexual violence (66.4%), client coercion for condom nonuse (> 95%), and police extortion (56%). Working conditions enabled violence irrespective of mode of entry. Profound unmet needs exist for safety and access to justice irrespective of trafficking history.
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Affiliation(s)
- Michele R Decker
- Department of Population, Family & Reproductive Health, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Public Health and Human Rights, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sarah R Meyer
- Program on Forced Migration and Health, Mailman School of Public Health, Columbia University, Baltimore, MD, USA
| | - Casey Branchini Risko
- Department of International Health, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - W Courtland Robinson
- Department of Population, Family & Reproductive Health, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of International Health, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Decker MR, Wood SN, Byrne ME, Yao-N’dry N, Thiongo M, Gichangi P, M. OlaOlorun F, Koffi AK, Radloff S, Ahmed S, O. Tsui A. Gendered power dynamics and threats to sexual and reproductive autonomy among adolescent girls and young adult women: A cross-sectional survey in three urban settings. PLoS One 2021; 16:e0257009. [PMID: 34843466 PMCID: PMC8629179 DOI: 10.1371/journal.pone.0257009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/23/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Gendered economic and social systems can enable relational power disparities for adolescent girls and young women (AGYW), and undercut autonomy to negotiate sex and contraceptive use. Less is known about their accumulation and interplay. This study characterizes relationship power imbalances (age disparity, intimate partner violence [IPV], partner-related fear, transactional sex, and transactional partnerships), and evaluates associations with modern contraceptive use, and sexual/reproductive autonomy threats (condom removal/"stealthing", reproductive coercion, ability to refuse sex, and contraceptive confidence). METHODS Cross-sectional surveys were conducted with unmarried, currently-partnered AGYW aged 15-24 recruited via respondent-driven sampling in Abidjan, Côte d'Ivoire (n = 555; 2018-19), Nairobi, Kenya (n = 332; 2019), and Lagos, Nigeria (n = 179; 2020). Descriptive statistics, Venn diagrams, and multivariate regression models characterized relationship power imbalances, and associations with reproductive autonomy threats and contraceptive use. FINDINGS Relationship power imbalances were complex and concurrent. In current partnerships, partner-related fears were common (50.4%Nairobi; 54.5%Abidjan; 55.7%Lagos) and physical IPV varied (14.5%Nairobi; 22.1%Abidjan; 9.6%Lagos). IPV was associated with reproductive coercion in Nairobi and Abidjan. Age disparate relationships undermined confidence in contraception in Nairobi. In Nairobi and Lagos, transactional sex outside the relationship was associated with condom stealthing. INTERPRETATION AGYW face simultaneous gendered power differentials, against the backdrop of gendered social and economic systems. Power imbalances were linked with coercive sexual/reproductive health experiences which are often underrecognized yet represent a potent link between gendered social systems and poor health. Pregnancy prevention efforts for AGYW must address reproductive autonomy threats, and the relational power imbalances and broader gendered systems that enable them.
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Affiliation(s)
- Michele R. Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Shannon N. Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Meagan E. Byrne
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Nathalie Yao-N’dry
- Association Ivoirienne pour le Bien-Etre Familial (AIBEF), Abidjan, Côte d’Ivoire
| | - Mary Thiongo
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
| | - Peter Gichangi
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
| | | | - Alain K. Koffi
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Scott Radloff
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Amy O. Tsui
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Decker MR, Wood SN, Thiongo M, Byrne ME, Devoto B, Morgan R, Bevilacqua K, Williams A, Stuart HC, Wamue- Ngare G, Heise L, Glass N, Anglewicz P, Gummerson E, Gichangi P. Gendered health, economic, social and safety impact of COVID-19 on adolescents and young adults in Nairobi, Kenya. PLoS One 2021; 16:e0259583. [PMID: 34752473 PMCID: PMC8577767 DOI: 10.1371/journal.pone.0259583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/21/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Infectious disease outbreaks like COVID-19 and their mitigation measures can exacerbate underlying gender disparities, particularly among adolescents and young adults in densely populated urban settings. METHODS An existing cohort of youth ages 16-26 in Nairobi, Kenya completed a phone-based survey in August-October 2020 (n = 1217), supplemented by virtual focus group discussions and interviews with youth and stakeholders, to examine economic, health, social, and safety experiences during COVID-19, and gender disparities therein. RESULTS COVID-19 risk perception was high with a gender differential favoring young women (95.5% vs. 84.2%; p<0.001); youth described mixed concern and challenges to prevention. During COVID-19, gender symmetry was observed in constrained access to contraception among contraceptive users (40.4% men; 34.6% women) and depressive symptoms (21.8% men; 24.3% women). Gender disparities rendered young women disproportionately unable to meet basic economic needs (adjusted odds ratio [aOR] = 1.21; p<0.05) and in need of healthcare during the pandemic (aOR = 1.59; p<0.001). At a bivariate level, women had lower full decisional control to leave the house (40.0% vs. 53.2%) and less consistent access to safe, private internet (26.1% vs. 40.2%), while men disproportionately experienced police interactions (60.1%, 55.2% of which included extortion). Gender-specific concerns for women included menstrual hygiene access challenges (52.0%), increased reliance on transactional partnerships, and gender-based violence, with 17.3% reporting past-year partner violence and 3.0% non-partner sexual violence. Qualitative results contextualize the mental health impact of economic disruption and isolation, and, among young women, privacy constraints. IMPLICATIONS Youth and young adults face gendered impacts of COVID-19, reflecting both underlying disparities and the pandemic's economic and social shock. Economic, health and technology-based supports must ensure equitable access for young women. Gender-responsive recovery efforts are necessary and must address the unique needs of youth.
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Affiliation(s)
- Michele R. Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- * E-mail:
| | - Shannon N. Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Mary Thiongo
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
| | - Meagan E. Byrne
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Bianca Devoto
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Rosemary Morgan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Kristin Bevilacqua
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Anaise Williams
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - H. Colleen Stuart
- Johns Hopkins Carey Business School, Baltimore, MD, United States of America
| | - Grace Wamue- Ngare
- Department of Sociology, Gender and Development Studies, Kenyatta University, Nairobi, Kenya
- Women’s Economic Empowerment Hub, Kenyatta University, Nairobi, Kenya
| | - Lori Heise
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Nancy Glass
- Johns Hopkins School of Nursing, Baltimore, MD, United States of America
- Center for Global Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Philip Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Elizabeth Gummerson
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Peter Gichangi
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
- Technical University of Mombasa, Mombasa, Kenya
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Park JN, Decker MR, Bass JK, Galai N, Tomko C, Jain KM, Footer KHA, Sherman SG. Cumulative Violence and PTSD Symptom Severity Among Urban Street-Based Female Sex Workers. J Interpers Violence 2021; 36:10383-10404. [PMID: 31679445 PMCID: PMC7195245 DOI: 10.1177/0886260519884694] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Female sex workers (FSW) are a marginalized and vulnerable population at high risk of gender-based violence within and outside of their occupation. However, FSW remain underrepresented in the trauma and mental health literature. The aims of this study were to (a) characterize exposure to violence among street-based FSW, including violence type, patterns over the life course, and key perpetrator groups, and (b) examine the multivariate associations between posttraumatic stress disorder (PTSD) symptom severity and two constructs (revictimization across life stages and cumulative violence). Data were drawn from the Sex Workers and Police Promoting Health in Risky Environments (SAPPHIRE) study, an observational community-based cohort of street-based FSW recruited through targeted sampling across Baltimore, Maryland (USA) in 2016 to 2017. PTSD symptom severity was measured using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5). At baseline, 61% of FSW screened positive for PTSD symptoms. The mean PCL-5 score was 38.6. We documented extensive histories of sexual and physical violence (lifetime: 81.8%; childhood and adult revictimization: 15.0% for sexual and 37.7% for physical). The vast majority of perpetrators were male and included paying clients, police officers, family members, and intimate partners. Exposure to childhood and adult sexual violence were independently associated with higher PTSD severity (p < .05), with marginal associations observed for physical violence. Data supported a cumulative violence model of PTSD severity (p < .05). Binge drinking also appeared to be a contributing factor (p < .05). The levels of PTSD observed among our sample were comparable with that reported among treatment-seeking war veterans. Our findings underscore the urgent need for tailored trauma-informed interventions and policies to address violence among urban street-based FSW, a population experiencing extremely high levels of violence, PTSD, and substance use.
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Affiliation(s)
- Ju Nyeong Park
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michele R Decker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Judith K Bass
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Noya Galai
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catherine Tomko
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kriti M Jain
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Susan G Sherman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Merrill KG, Mwansa JK, Miti S, Burke VM, Abrams EA, Frimpong C, Decker MR, Campbell JC, Denison JA. Experiences with a violence and mental health safety protocol for a randomized controlled trial to support youth living with HIV. Glob Health Res Policy 2021; 6:40. [PMID: 34654487 PMCID: PMC8518229 DOI: 10.1186/s41256-021-00224-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/03/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Safety protocols are an essential component of studies addressing violence and mental health but are rarely described in the published literature from Sub-Saharan Africa. We designed and implemented a safety protocol within Project YES! (Youth Engaging for Success), which enrolled 276 youth living with HIV (ages 15-24 years) in a randomized controlled trial of a peer-mentoring intervention across four HIV clinics in Ndola, Zambia. METHODS Youth who reported severe violence and/or suicidal thoughts on research surveys or during meetings with youth peer mentors (YPM) were referred to designated healthcare providers (HCP). We explored experiences with the safety protocol using: a) monitoring data of referrals, and b) in-depth interviews with youth (n = 82), HCP (n = 10), YPM (n = 8), and staff (n = 6). Descriptive statistics were generated and thematic analysis of coded transcripts and written memos performed. RESULTS Nearly half of youth enrolled (48% of females, 41% of males) were referred to a HCP at least once. The first referral was most often for sexual violence (35%) and/or suicidal ideation/depression (29%). All referred youth aged 15-17 years and over 80% of referred youth aged 18 + agreed to see a HCP. HCP referred 15% for additional services outside the clinic. Twenty-nine youth, all HCP, all YPM, and all staff interviewed discussed the safety protocol. Most youth felt "encouraged," "helped," "unburdened," and "relieved" by their meetings with HCP; some expressed concerns about meeting with HCP. The safety protocol helped HCP recognize the need to integrate care for violence and mental health with medication adherence support. HCP, YPM, and study staff raised implementation challenges, including youth choosing not to open up to HCP, time and resource constraints, deficiencies in HCP training, and stigma and cultural norms inhibiting referrals outside the clinic for emotional trauma and mental health. CONCLUSIONS Implementing a safety protocol within an HIV clinic-based research study is possible and beneficial for youth and HCP alike. Implementation challenges underscore that HCP in Zambia work in over-stretched healthcare systems. Innovative strategies must address deficiencies in training and resources within HIV clinics and gaps in coordination across services to meet the overwhelming need for violence and mental health services among youth living with HIV.
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Affiliation(s)
- Katherine G Merrill
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
| | | | - Sam Miti
- Arthur Davison Children's Hospital, Ndola, Zambia
| | - Virginia M Burke
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Elizabeth A Abrams
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | | | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jacquelyn C Campbell
- Department of Community-Public Health, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Julie A Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Ritter J, Dasgupta A, Raj A, Decker MR, Nair S, Trivedi A, Naik D, Donta B, Saggurti N, Silverman JG. Measuring Gender-Based Household Maltreatment in Urban Slums of Mumbai, India. J Interpers Violence 2021; 36:9232-9254. [PMID: 31364469 DOI: 10.1177/0886260519864370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Emerging research has documented non-violent forms of abuse against wives in India. Gender-based household maltreatment (GBHM) has been linked to poor maternal and child health outcomes, but the measurement of GBHM requires statistical validation. The objective of this study is to evaluate a new measure of GBHM of women by husbands and in-laws during the perinatal period for validity and internal reliability (before, during, and post pregnancy). This study utilized cross-sectional quantitative data collected from women (n = 1,049) seeking immunizations for their infants <6 months of age at large urban health centers in three major slum communities in Mumbai, India. After domain mapping and item consolidation, exploratory factor analysis identified a single factor among final scale items for each perinatal time period, with Velicer's Minimum Average Partial (meeting criterion at <0.065) confirming a single factor. Overall, the measure shows good internal reliability and both face and construct validity. On these merits, the measure should be assessed for utility in determining whether the more commonly reported non-violent forms of abuse act as a risk factor for poor maternal and child health outcomes.
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Affiliation(s)
- Julie Ritter
- Center on Gender Equity and Health, University of California, San Diego, CA, USA
| | - Anindita Dasgupta
- Social Intervention Group, Columbia University School of Social Work, New York, NY, USA
| | - Anita Raj
- Center on Gender Equity and Health, University of California, San Diego, CA, USA
| | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Saritha Nair
- Indian Council of Medical Research-National Institute of Medical Statistics, New Delhi, India
| | - Amruta Trivedi
- Center on Gender Equity and Health, University of California, San Diego, CA, USA
| | - Dattaram Naik
- Indian Council of Medical Research-National Institute for Research in Reproductive Health, Mumbai, India
| | - Balaiah Donta
- Indian Council of Medical Research-National Institute for Research in Reproductive Health, Mumbai, India
| | | | - Jay G Silverman
- Center on Gender Equity and Health, University of California, San Diego, CA, USA
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Wood SN, Kennedy SR, Hameeduddin Z, Asira B, Tallam C, Akumu I, Wanjiru I, Glass N, Decker MR. "Being Married Doesn't Mean You Have to Reach the End of the World": Safety Planning With Intimate Partner Violence Survivors and Service Providers in Three Urban Informal Settlements in Nairobi, Kenya. J Interpers Violence 2021; 36:NP10979-NP11005. [PMID: 31587653 DOI: 10.1177/0886260519879237] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Intimate partner violence (IPV) harms women physically, sexually, and psychologically. Safety strategies, or harm reduction techniques implemented by women undergoing recurrent violence, may help mitigate the negative health, economic, and social consequences of IPV. This study aimed to understand recommended and utilized safety strategies among three urban informal settlements in Nairobi, Kenya. Semi-structured key informant discussions (KIDs; n = 18) with community-based service providers and focus group discussions (FGDs; n = 49) with IPV survivors were conducted. All interviews were audio-recorded, transcribed, and translated verbatim from Swahili to English. Inductive thematic analysis was used to structure codes. Convergence matrices were used to analyze emergent strategies by data source (service providers vs. IPV survivors). Women preferred safety strategies that they could implement unassisted as first line of harm reduction. Strategies included removing stressors, proactive communication, avoidance behaviors, sexual and reproductive health (SRH), economic, leaving partner for safety, child safety, and securing personal property. Strategies recommended by service providers and utilized by IPV survivors differed, with clear divergence indicated for leaving the abusive relationship, SRH, and personal property strategies. Innovative strategies emerged from IPV survivors for safeguarding property. Similar to upper-income and other low and middle-income contexts, women experiencing IPV in urban informal settlements of Nairobi actively engage in behaviors to maximize safety and reduce harm to themselves and their families. Integration of strategies known to be helpful to women in these communities into community-based prevention and response is strongly encouraged. Increased synergy between recommended and implemented safety strategies can enhance programming and response efforts.
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Affiliation(s)
- Shannon N Wood
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Zaynab Hameeduddin
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | - Nancy Glass
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Center for Global Health, Johns Hopkins University, Baltimore, MD, USA
| | - Michele R Decker
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Nestadt DF, Park JN, Galai N, Beckham SW, Decker MR, Zemlak J, Sherman SG. Sex workers as mothers: Correlates of engagement in sex work to support children. Glob Soc Welf 2021; 8:251-261. [PMID: 36935888 PMCID: PMC10019358 DOI: 10.1007/s40609-021-00213-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 06/18/2023]
Abstract
BACKGROUND Globally, most female sex workers (FSW) are mothers but are rarely considered as such in public health and social service programs and research. We aimed to quantitatively describe FSW who are mothers and to examine correlates of current engagement in sex work to support children among a cohort of FSW in Baltimore, Maryland, United States (U.S.). METHODS The study utilized baseline survey and HIV/STI testing data from the Sex workers And Police Promoting Health In Risky Environments (SAPPHIRE) study of women engaged in street-based sex work in Baltimore, Maryland. Variable selection and interpretation were guided by Connell's theory of Gender and Power. We used bivariate and multivariate logistic regression analyses to examine correlates of engagement in sex work to support children among FSW mothers. RESULTS Our sample included 214 FSW with children, of whom 27% reported supporting children as a reason for the current engagement in sex work. Median age was 36 years, and mean number of children was 2.88. 20.6% were currently living with any of their minor aged children, and this was significantly more common among mothers engaged in sex work to support children (57.9% vs. 7%; p<0.001). 38.7% had ever lost legal custody of children, which was significantly less common among those supporting children through sex work (26.8% vs. 42.9%; p=0.033). In multivariate analyses, the following were independently associated with engaging in sex work to support children: African-American versus white race (aOR=2.62; 95% CI:1.18-5.82; p=0.018); less housing instability (aOR=0.42; 95% CI:0.20-0.89; p=0.024); initiating sex work at age <23 (aOR=2.59; 95% CI:1.23-5.46; p=0.012); less frequent intoxication during sex with clients (aOR=0.31; 95% CI:0.14-0.67; p=0.003); and reporting mental health as most important health concern (aOR=2.37; 95% CI:1.09-5.17; p=0.029). CONCLUSIONS FSW mothers who report engagement in sex work to support children are distinct from their counterparts in key areas related to HIV and other health outcomes. Neglecting to account for this important social role may lead to missed opportunities to meaningfully promote physical and mental health and to engage women on their own terms. Future research and interventions should seek to address FSW as whole social beings and center their experiences and needs as mothers.
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Affiliation(s)
- Danielle Friedman Nestadt
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Statistics, University of Haifa, Mount Carmel, Israel
| | - S. W. Beckham
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michele R. Decker
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jessica Zemlak
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Susan G. Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Alexander KA, Willie TC, McDonald-Mosley R, Campbell JC, Miller E, Decker MR. Associations Between Reproductive Coercion, Partner Violence, and Mental Health Symptoms Among Young Black Women in Baltimore, Maryland. J Interpers Violence 2021; 36:NP9839-NP9863. [PMID: 31296104 PMCID: PMC6954344 DOI: 10.1177/0886260519860900] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This study examined the associations of reproductive coercion (RC) with mental health of Black adolescent and young adult women. We tested RC as a predictor of depression and post-traumatic stress disorder (PTSD) symptoms. We also explored the interaction of exposure to RC and physical and sexual intimate partner violence (IPV) as they relate to depression and PTSD symptoms. A primarily community-based convenience sample of 188 self-identified Black women, aged 18 to 25 years, in Baltimore, Maryland, completed computer-based cross-sectional surveys. Lifetime RC (37.8%) and IPV (48.9%) were prevalent in this sample. Nearly 10% of the young women reported experiencing RC without IPV; 38% of the sample reported experiencing both types of violence. Depression (69%) and PTSD (47.1%) symptoms were more prevalent among women with RC than among women without RC. Adjusted results revealed RC and IPV were independently associated with depression (adjusted odds ratioRC = 2.86, 95% CI = [1.38, 5.94] and adjusted odds ratioIPV = 5.15, 95% CI = [2.47, 10.76]). Similarly, RC and IPV were independently associated with PTSD (adjusted odds ratioRC = 2.41, 95% CI = [1.15, 5.08] and adjusted odds ratioIPV = 3.04, 95% CI = [1.39, 6.63]). Findings suggest that RC and IPV independently contribute to mental health morbidities among this population of women. Current policies in health care practice increasingly recommend provision of screening for IPV, including RC. These practices should extend to women receiving services in community-based settings, thus strengthening the linkage to referral for further mental health treatment and victim service support. In the context of the social burdens affecting young Black women's health, a comprehensive approach that integrates mental health and reproductive/sexual health care is essential for women reporting RC experiences.
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Affiliation(s)
| | | | | | | | | | - Michele R. Decker
- Bloomberg School of Public Health, Department of Population, Family, and Reproductive Health
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Peitzmeier SM, Wirtz AL, Beyrer C, Peryshkina A, Sherman SG, Colantuoni E, Decker MR. Polyvictimization Among Russian Sex Workers: Intimate Partner, Police, and Pimp Violence Cluster With Client Violence. J Interpers Violence 2021; 36:NP8056-NP8081. [PMID: 30966847 PMCID: PMC9476162 DOI: 10.1177/0886260519839431] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Female sex workers (FSW) are a key population in the HIV epidemic and face high levels of violence. While women globally are predominantly at risk of intimate partner violence (IPV), FSW are additionally vulnerable to violence from clients, police, and pimps associated with their occupation. FSW are therefore at risk of cumulative trauma from polyvictimization, or violence from multiple types of perpetrators. Polyvictimization is a driver of morbidity and mortality in numerous populations, but there has been little research on how multiple types of victimization are related to one another in FSW. A cross-sectional survey was conducted among 754 FSW from three cities in the Russian Federation. Surveys assessed lifetime experiences of client, police, intimate partner, and pimp violence. Multivariate log-binomial and Poisson regression were used to test associations between these types of violence. Forty-five percent experienced any type of violence, including 31.7% from clients, 16.0% from police, 15.7% from intimate partners, and 11.4% from pimps. One fifth (20.4%) experienced polyvictimization. Client violence was central to polyvictimization: Only 5.9% of polyvictimization occurs without client violence. When client violence was not present, police, pimp, or IPV co-occurred significantly less than would be expected under an assumption that these types of violence occur independently (p < .001). However, they co-occurred more than would be expected when client violence is present. After adjusting for other types of violence experienced and demographic factors, experiencing client violence was independently associated with police violence (adjusted relative risk [ARR] = 2.77, 95% confidence interval [CI] [1.67, 4.59]), IPV (ARR = 3.67, 95% CI [1.95, 6.89]), and pimp violence (ARR = 5.26, 95% CI [2.80, 9.86]). Client violence may drive exposure to other types of violence and enable polyvictimization in a way that other types of violence do not in this setting. Violence prevention interventions may achieve maximal effect in reducing multiple types of violence by focusing on client violence.
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Affiliation(s)
- Sarah M Peitzmeier
- University of Michigan, Ann Arbor, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea L Wirtz
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chris Beyrer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Susan G Sherman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Michele R Decker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Kelly JTD, Colantuoni E, Robinson C, Decker MR. Quantifying the Ripple Effects of Civil War: How Armed Conflict Is Associated with More Severe Violence in the Home. Health Hum Rights 2021; 23:75-89. [PMID: 34194203 PMCID: PMC8233021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Both the fields of public health and that of human rights seek to improve human well-being, including through reducing and preventing all forms of violence, to help individuals attain the highest quality of life. In both fields, mathematical methods can help "visibilize" the hidden architecture of violence, bringing new methods to bear to understand the scope and nuance of how violence affects populations. An increasing number of studies have examined how residing in a conflict-affected place may impact one of the most pervasive forms of violence-intimate partner violence (IPV)-during and after conflict. This paper contributes to this effort by examining whether severe forms of IPV are associated with previous experience of political violence in one conflict-affected country: Liberia. Our findings indicate that living in a district with conflict fatalities increased the risk of IPV among women by roughly 60%. Additionally, living in a district with conflict fatalities increased the risk of a past-year injury from IPV by 50%. This analysis brings to light links between two of the most pervasive forms of violence-political violence and violence against women. The findings suggest that women residing in a district that is more highly affected by conflict, not only people experiencing direct trauma during conflict, may be at risk of increased violence long after peace is declared. These findings point to the need for targeted programs that address IPV postconflict.
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Affiliation(s)
- Jocelyn T. D. Kelly
- Director of the Program on Gender, Rights and Resilience at the Harvard Humanitarian Initiative, Cambridge, USA
| | - Elizabeth Colantuoni
- Senior Scientist in the Department of Biostatistics at the Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Courtland Robinson
- Associate Professor in the Department of International Health and Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Michele R. Decker
- Associate Professor in the Department of Population, Family and Reproductive Health and Director of the Women’s Health and Rights Program at the Center for Public Health Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Sherwood J, Roemer M, Honermann B, Jones A, Millett G, Decker MR. Restrictions On US Global Health Assistance Reduce Key Health Services In Supported Countries. Health Aff (Millwood) 2021; 39:1557-1565. [PMID: 32897794 DOI: 10.1377/hlthaff.2020.00061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The 2017 expanded Mexico City Policy prohibits non-US-based nongovernmental organizations from receiving US global health assistance if they either perform or refer for abortion services. We study the effects of the expanded policy on implementing partners of US-funded HIV programming by the President's Emergency Plan for AIDS Relief (PEPFAR) via a primary survey in all recipient countries and key-informant interviews in South Africa and the Kingdom of Eswatini (May-November 2018). Survey results showed that 28 percent (56 of 198) of organizations reported stopping or reducing at least one service in response to the policy. Reported service reductions included reducing the delivery of information about sexual and reproductive health, pregnancy counseling, contraception provision, and HIV testing and counseling. Interview data highlighted how these reductions were often a result of decreased patient flows or implementation of the expanded policy beyond what is required. Reductions disproportionately harmed pregnant women, youth, and key populations such as sex workers and men who have sex with men. Reduced delivery of sexual and reproductive health services has the potential to negatively affect many intended beneficiaries of PEPFAR funding, especially in areas with high HIV prevalence. Policy makers must respond to disruptions in service delivery and end any implementation that undermines US investment in high-quality HIV and sexual and reproductive health services.
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Affiliation(s)
- Jennifer Sherwood
- Jennifer Sherwood is a policy manager in the Public Policy Office at amfAR, the Foundation for AIDS Research, in Washington, D.C
| | - Matthea Roemer
- Matthea Roemer is a research assistant in the Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Brian Honermann
- Brian Honermann is the deputy director of public policy at amfAR, the Foundation for AIDS Research
| | - Austin Jones
- Austin Jones is a senior research associate in the Public Policy Office at amfAR, the Foundation for AIDS Research
| | - Greg Millett
- Greg Millett is vice president and director of public policy at amfAR, the Foundation for AIDS Research
| | - Michele R Decker
- Michele R. Decker is an associate professor in the Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
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Merrill KG, Campbell JC, Decker MR, McGready J, Burke VM, Mwansa JK, Miti S, Frimpong C, Kennedy CE, Denison JA. Past-Year Violence Victimization is Associated with Viral Load Failure Among HIV-Positive Adolescents and Young Adults. AIDS Behav 2021; 25:1373-1383. [PMID: 32761474 PMCID: PMC8052241 DOI: 10.1007/s10461-020-02958-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We examined the relationship between past-year violence victimization and viral load (VL) failure among consecutively-sampled male and female adolescents and young adults, aged 15-24, in four HIV clinics in Ndola, Zambia. Measures of past-year physical violence, psychological abuse, and forced sex were adapted from the ICAST-C and WHO Multi-Country Study. Using logistic regression, we derived associations between VL failure (≥ 1000 copies/mL) and: any victimization; cumulative victimization; and types and perpetrators of violence. Among 272 youth (59.2% female, 72.8% perinatally infected), 73.5% (n = 200) experienced past-year violence and 36.8% (n = 100) had VL failure. Higher odds of VL failure were observed for participants who reported high frequency of any violence versus no violence victimization (adjusted OR, aOR: 3.58; 95% CI 1.14-11.27), high frequency of psychological abuse versus no psychological abuse (aOR: 3.32; 95% CI 1.26-8.70), any versus no violence from a family member other than a parent/caregiver for physical violence (aOR: 2.18, 95% CI 1.05-4.54) and psychological abuse (aOR: 2.50; 95% CI 1.37-4.54), and any versus no physical violence from a friend/peer (aOR: 2.14, 95% CI 1.05-4.36). Past-year violence victimization was associated with VL failure when considering the frequency, type, and perpetrator of violence. Programs addressing violence among youth living with HIV may be critical to improving viral suppression and preventing onward transmission.
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Affiliation(s)
- Katherine G Merrill
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
| | - Jacquelyn C Campbell
- Department of Community-Public Health, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Michele R Decker
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John McGready
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Virginia M Burke
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | | | - Sam Miti
- Arthur Davison Children's Hospital, Ndola, Zambia
| | | | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Julie A Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Holliday CN, Bevilacqua K, Grace KT, Denhard L, Kaur A, Miller J, Decker MR. Examining the Neighborhood Attributes of Recently Housed Partner Violence Survivors in Rapid Rehousing. Int J Environ Res Public Health 2021; 18:ijerph18084177. [PMID: 33920892 PMCID: PMC8071223 DOI: 10.3390/ijerph18084177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/01/2021] [Accepted: 04/07/2021] [Indexed: 11/25/2022]
Abstract
Survivors’ considerations for re-housing following intimate partner violence (IPV) are understudied despite likely neighborhood-level influences on women’s safety. We assess housing priorities and predictors of re-housing location among recent IPV survivors (n = 54) in Rapid Re-housing (RRH) in the Baltimore-Washington Metropolitan Area. Choropleth maps depict residential location relative to census tract characteristics (neighborhood deprivation index (NDI) and residential segregation) derived from American Community Survey data (2013–2017). Linear regression measured associations between women’s individual, economic, and social factors and NDI and segregation. In-depth interviews (n = 16) contextualize quantitative findings. Overall, survivors re-housed in significantly more deprived and racially segregated census tracts within their respective regions. In adjusted models, trouble securing housing (B = 0.74, 95% CI: 0.13, 1.34), comfortability with proximity to loved ones (B = 0.75, 95% CI: 0.02, 1.48), and being unsure (vs unlikely) about IPV risk (B = −0.76, 95% CI: −1.39, −0.14) were significantly associated with NDI. Economic dependence on an abusive partner (B = −0.31, 95% CI: −0.56, −0.06) predicted re-housing in segregated census tracts; occasional stress about housing affordability (B = 0.39, 95% CI: 0.04, 0.75) predicted re-housing in less segregated census tracts. Qualitative results contextualize economic (affordability), safety, and social (familiarity) re-housing considerations and process impacts (inspection delays). Structural racism, including discriminatory housing practices, intersect with gender, exacerbating challenges among survivors of severe IPV. This mixed-methods study further highlights the significant economic tradeoffs for safety and stability, where the prioritization of safety may exacerbate economic devastation for IPV survivors. Findings will inform programmatic policies for RRH practices among survivors.
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Affiliation(s)
- Charvonne N. Holliday
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (K.B.); (K.T.G.); (A.K.); (M.R.D.)
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
- Correspondence:
| | - Kristin Bevilacqua
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (K.B.); (K.T.G.); (A.K.); (M.R.D.)
| | - Karen Trister Grace
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (K.B.); (K.T.G.); (A.K.); (M.R.D.)
- Department of Advanced Nursing Practice, School of Nursing & Health Studies, Georgetown University, Washington, DC 20057, USA
| | - Langan Denhard
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Arshdeep Kaur
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (K.B.); (K.T.G.); (A.K.); (M.R.D.)
| | | | - Michele R. Decker
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (K.B.); (K.T.G.); (A.K.); (M.R.D.)
- Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
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49
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Campbell JC, Sabri B, Budhathoki C, Kaufman MR, Alhusen J, Decker MR. Unwanted Sexual Acts Among University Students: Correlates of Victimization and Perpetration. J Interpers Violence 2021; 36:NP504-NP526. [PMID: 29294944 PMCID: PMC5878971 DOI: 10.1177/0886260517734221] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Unwanted sexual experiences are common among university students in the United States and pose a substantial public health concern. Campus policies and programs to prevent unwanted sexual incidents in university settings require research on prevalence and risk correlates of both victimization and perpetration. This study determined the prevalence of unwanted sexual victimization and perpetration experiences among students, both before and after joining the university, and examined risk correlates for both unwanted sexual victimization and perpetration experiences. Data were collected from 3,977 full-time graduate and undergraduate students using an online survey in a large private university. The findings revealed nearly one in eight students surveyed were victimized by unwanted sexual incidents at the university. Risk correlates of victimization by unwanted sexual incidents included female gender, undergraduate student status, and victimization experiences prior to joining the university. Most (95.5%) sexual violence incidents occurred when the victim was incapacitated due to alcohol, substance, or asleep. An acquaintance, peer, or colleague was the most frequently reported perpetrator. Risk correlates of perpetration included male gender, undergraduate student status, and perpetration of unwanted sexual activities before joining the university. Perpetrators most frequently reported perpetration of unwanted sexual behaviors against a current or former intimate partner or a stranger. The findings highlight the importance of enhanced efforts to reduce prevalence of unwanted sexual incidents, particularly among students most at risk for victimization and perpetration.
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50
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Wood SN, Glass N, Decker MR. An Integrative Review of Safety Strategies for Women Experiencing Intimate Partner Violence in Low- and Middle-Income Countries. Trauma Violence Abuse 2021; 22:68-82. [PMID: 30669943 DOI: 10.1177/1524838018823270] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Intimate partner violence (IPV) is prevalent and a leading source of morbidity and mortality to women worldwide. Safety planning is a cornerstone of harm reduction and violence support in many upper income countries. Far less is known about safety strategies used by women in low- and middle-income countries (LMICs) where the IPV support service infrastructure may be more limited. This study aimed to review the literature regarding safety strategies in LMICs. A PubMed search was conducted using search terms "safety," "coping," "harm reduction," and "intimate partner violence." Inclusion criteria comprised IPV studies mentioning characterization and utilization of safety strategies that were written in English and conducted in an LMIC. Our search yielded 16 studies (in-depth interviews, n = 5; focus group discussions, n = 2; case study, n = 2; mixed qualitative methods, n = 4; mixed methods, n = 1; and semi-structured quantitative survey, n = 2). Four distinct themes of strategies emerged: engaging informal networks, removing the stressor/avoidance, minimizing the damage to self and family through enduring violence, and building personal resources. IPV-related safety strategies literature primarily emerged from site-specific qualitative work. No studies provided effectiveness data for utilized strategies. Across geoculturally diverse studies, results indicate that women are engaging in strategic planning to minimize abuse and maximize safety. Women highlighted that safety planning strategies were feasible and acceptable within their communities. Further research is needed to test the effectiveness of these strategies in decreasing revictimization and increasing health and well-being. Further adoption of safety strategies into violence programming could increase monitoring and evaluation efforts.
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Affiliation(s)
- Shannon N Wood
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nancy Glass
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Center for Global Health, Johns Hopkins University, Baltimore, MD, USA
| | - Michele R Decker
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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