Exploring Disability as a Determinant of Girl Child Marriage in Fragile States: A Multicountry Analysis

PURPOSE

Fragile states are countries characterized by poverty, conflict, political instability, insecurity, and disaster. In such settings, there are high levels of disability and women and girls are disproportionately impacted by violence. Despite the 2030 Sustainable Development Goal's call for both the elimination of violence against women and girls and disability-disaggregated data, few studies have investigated how disability may be associated with girl child marriage (GCM) and how these two factors impact intimate partner violence (IPV). This study sought to assess the prevalence and associations of disability with GCM and IPV among currently married/cohabiting women (aged 20-24 years) in fragile states.

METHODS

A secondary data analysis of pooled nationally representative data from four Demographic and Health Surveys were analyzed using multivariable regressions to examine the associations between disability, GCM, and IPV (N = 3,119). The association between disability and GCM was further analyzed by multinomial regressions. These weighted analyses accounted for complex survey designs.

RESULTS

Overall, 54.4% of GCM occurred among women with disabilities. Disabled women were more likely to report GCM compared to women without disabilities (adjusted odds ratio = 1.62, 95% confidence interval = 1.16-2.28). Among disabled women with a history of GCM, 41.3% experienced past-year IPV. Disabled women with a history of GCM were more likely to report past-year IPV compared to nondisabled women and no GCM (adjusted odds ratio = 1.78, confidence interval = 1.21-2.62).

DISCUSSION

GCM and IPV (e.g., past-year, lifetime) among disabled girls may be pervasive in fragile states, underscoring the need for additional research examining the mechanisms driving these observations and to inform inclusive programming and policy.

The association between women's disability and acceptance towards intimate partner violence among women and their male partners: A multi-country analysis

OBJECTIVE

To examine whether disabled women are more likely to report accepting attitudes towards intimate partner violence (IPV) than non-disabled women, and whether male partners of disabled women are more likely to accept IPV than male partners of non-disabled women.

METHODS

Secondary analysis of nationally representative cross-sectional data from the Demographic Health Survey (DHS) in nine countries. Logistic regression examined the relationship between (1) women's disability and IPV acceptance (n = 114 695) and (2) women's disability and their male partners' IPV acceptance (n = 20 566); pooled and country-specific estimates were calculated.

RESULTS

IPV acceptance ranged from 5% to 80% among women and from 5% to 56% among male partners. Overall, disabled women were more accepting of IPV than non-disabled women (pooled adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.08-1.20), with country-specific aOR ranging from 1.05 to 1.63. Overall, disabled women's male partners had higher likelihood of IPV acceptance than non-disabled women's partners (pooled aOR 1.13, 95% CI 1.00-1.28).; country-specific estimates varied (aOR range from 0.56 to 1.40).

CONCLUSION

Disabled women and their male partners had higher IPV acceptance compared with non-disabled women and their male partners. More research is needed to better understand this association, including disability-associated discrimination. Findings underscore the importance of more research with disabled women and their partners to address IPV.

Ea$ing into the USA: study protocol for adapting the Economic and Social Empowerment (EA$E) intervention for US-based, forcibly based populations

INTRODUCTION

Immigrant and forcibly displaced women and girls are disproportionately impacted by the harmful health consequences of intimate partner violence (IPV) in the USA. Economic and Social Empowerment (EA$E), a women's protection and empowerment intervention, has shown promising reductions in IPV and gender inequities among forcibly displaced populations (FDPs) in low-income and middle-income countries. However, research on the integration of gender equity interventions into economic empowerment programming for FDPs within the USA is lacking. Additionally, there is growing interest in integrating gender equity programmes among US-based refugee resettlement organisations, including the International Rescue Committee (IRC). We describe our study protocol for examining the feasibility, acceptability and appropriateness of EA$E for use with US-based FDPs, and recommendations for adaptation.

METHODS AND ANALYSIS

This is a convergent parallel study to guide the adaptation of EA$E for use with US-based FDPs. Mixed methods (quantitative and qualitative) will be used for the adaptation research. Quantitative data will consist of brief surveys, and qualitative data will consist of focus group discussions (FGDs). Our research will be guided by the 'administration' phase of the ADAPT-ITT framework, which entails pretesting the intervention with the new target audience and implementation context to examine acceptability, appropriateness and feasibility to receive feedback to inform modifications of the original intervention. This is done via theatre testing, an innovative approach to pretesting that allows the new target audience to experience the intervention and provide feedback. We will conduct FGDs with IRC staff (n=4, total of 24 participants) and refugee clients (n=8, total of 48 participants, women and men, French and English speaking).

ETHICS AND DISSEMINATION

The study has received approval from the George Mason University Human Subjects Committee (#1686712-7) and IRC (via reliance agreement). Results will be made available to refugee resettlement organisations, policymakers, funders and other researchers. This study has been registered in Open Science Framework (https://doi.org/10.17605/OSF.IO/SZDVY).

Disability and intimate partner violence in fragile states: A multi-country analysis

The 2030 Sustainable Development Goals call for both the elimination of violence against women and girls and disability-disaggregated data. However, few population-based, multi-country studies have examined how disability impacts intimate partner violence (IPV) in fragile settings. Demographic and Health Survey data from five countries (Pakistan, Timor-Leste, Mali, Uganda, and Haiti) were pooled and analyzed to assess the relationship between disability and IPV (N = 22,984). Pooled analysis revealed an overall disability prevalence of 18.45%, with 42.35% lifetime IPV (physical, sexual and/or emotional), and 31.43% past-year IPV. Women with disabilities reported higher levels of past-year and lifetime IPV compared to those without disabilities (AOR 1.18; 95% CI 1.07, 1.30; AOR 1.31; 95% CI 1.19, 1.44, respectively). Women and girls with disabilities may be disproportionately impacted by IPV in fragile settings. More global attention is needed to address IPV and disability in these settings.

Life Disruptions, Symptoms Suggestive of Endometriosis, and Anticipated Stigma Among College Students in the United States

Background: Endometriosis is a chronic gynecological condition impacting 1 in 10 women of reproductive age. Research with adult women documents high levels of disruptions in academic, professional, family, and social lives due to pain. Less research has been conducted with college-aged populations. Although stigma has been noted as a key factor in contributing to diagnostic delay, little research has focused on examining stigma, endometriosis symptoms, and disruptions. This study aims at documenting the frequency of social, academic, and work disruptions experienced by college-aged women due to symptoms suggestive of endometriosis and at examining the relationship between disruptions and anticipated stigma.

Methods: An online survey was conducted in April 2019 among a nationally drawn sample (N = 468) of undergraduate women to assess symptoms suggestive of endometriosis, disruptions to daily life, and stigma experiences.

Results: High levels of life disruptions due to symptoms suggestive of endometriosis were documented (88% any disruption, 82.7% social, 58.8% academic, and 34.4% work). Adjusted analysis (accounting for demographics and symptoms) showed that any disruptions, social disruptions, academic disruptions, or work disruptions were significantly associated with a higher mean anticipated stigma score (β = 0.37, 95% confidence interval [CI]: 0.15–0.59; β = 0.32, 95% CI: 0.13–0.51; β = 0.32, 95% CI: 0.17–0.46; β = 0.55, 95% CI: 0.23–0.54; respectively).

Conclusions: Many young women experience disruptions that affect their academic, work, and social lives. These disruptions due to symptoms suggestive of endometriosis also impact stigma experiences. More interventions tailored to address stigma and minimize disruptions are needed in public health.