Drought and intimate partner violence towards women in 19 countries in sub-Saharan Africa during 2011-2018: A population-based study.

BACKGROUND: Drought has many known deleterious impacts on human health, but little is known about the relationship between drought and intimate partner violence (IPV). We aimed to evaluate this relationship and to assess effect heterogeneity between population subgroups among women in 19 sub-Saharan African countries. METHODS AND FINDINGS: We used data from 19 Demographic and Health Surveys from 2011 to 2018 including 83,990 partnered women aged 15-49 years. Deviations in rainfall in the year before the survey date were measured relative to the 29 previous years using Climate Hazards Group InfraRed Precipitation with Station data, with recent drought classified as ordinal categorical variable (severe: ≤10th percentile; mild/moderate: >10th percentile to ≤30th percentile; none: >30th percentile). We considered 4 IPV-related outcomes: reporting a controlling partner (a risk factor for IPV) and experiencing emotional violence, physical violence, or sexual violence in the 12 months prior to survey. Logistic regression was used to estimate marginal risk differences (RDs). We evaluated the presence of effect heterogeneity by age group and employment status. Of the 83,990 women included in the analytic sample, 10.7% (9,019) experienced severe drought and 23.4% (19,639) experienced mild/moderate drought in the year prior to the survey, with substantial heterogeneity across countries. The mean age of respondents was 30.8 years (standard deviation 8.2). The majority of women lived in rural areas (66.3%) and were married (73.3%), while less than half (42.6%) were literate. Women living in severe drought had higher risk of reporting a controlling partner (marginal RD in percentage points = 3.0, 95% CI 1.3, 4.6; p < 0.001), experiencing physical violence (marginal RD = 0.8, 95% CI 0.1, 1.5; p = 0.019), and experiencing sexual violence (marginal RD = 1.2, 95% CI 0.4, 2.0; p = 0.001) compared with women not experiencing drought. Women living in mild/moderate drought had higher risk of reporting physical (marginal RD = 0.7, 95% CI 0.2, 1.1; p = 0.003) and sexual violence (marginal RD = 0.7, 95% CI 0.3, 1.2; p = 0.001) compared with those not living in drought. We did not find evidence for an association between drought and emotional violence. In analyses stratified by country, we found 3 settings where drought was protective for at least 1 measure of IPV: Namibia, Tanzania, and Uganda. We found evidence for effect heterogeneity (additive interaction) for the association between drought and younger age and between drought and employment status, with stronger associations between drought and IPV among adolescent girls and unemployed women. This study is limited by its lack of measured hypothesized mediating variables linking drought and IPV, prohibiting a formal mediation analysis. Additional limitations include the potential for bias due to residual confounding and potential non-differential misclassification of the outcome measures leading to an attenuation of observed associations. CONCLUSIONS: Our findings indicate that drought was associated with measures of IPV towards women, with larger positive associations among adolescent girls and unemployed women. There was heterogeneity in these associations across countries. Weather shocks may exacerbate vulnerabilities among women in sub-Saharan Africa. Future work should further evaluate potential mechanisms driving these relationships.

Women's mental health: acute impact of COVID-19 pandemic on domestic violence.

The coronavirus disease 2019 (COVID-19) pandemic created a situation of general distress. Although the focus has been initially more on the physical health during the pandemic, mental health concerns linked to the lockdown have quickly risen. This study aims to assess the effect of the COVID-19-related lockdown on Tunisian women's mental health and gender-based violence. An online survey was conducted, using the Depression Anxiety and Stress Scales (DASS-21) and the Facebook Bergen Addiction Scale (FBAS). We chose a female-exclusive social group on Facebook and used the snowball sampling method. A total of 751 participants originating from all the Tunisian regions completed the questionnaire. More than half of the participants (57.3%) reported extremely severe distress symptoms, as per the DASS-21. Those who had a history of mental illness and who were allegedly abused during lockdown were found to have more severe symptoms of depression, anxiety, and stress. Around 40% of women reported problematic social media use. Violence against women also reportedly increased significantly during the lockdown (from 4.4 to 14.8%; p < 0.001). Psychological abuse was the most frequent type of violence (96%). Women who had experienced abuse before the lockdown were at an increased risk of violence during lockdown (p < 0.001; OR = 19.34 [8.71-43.00]). To our knowledge, this is the first study that evaluates the acute impact of COVID-19 on mental health and violence against women in Tunisia, Africa, and the Arab world. It may be a sound basis for developing a more effective psychological intervention aimed at women in these regions.

Correlates of African American sexual assault survivors' medical care seeking.

African American women are at higher risk for sexual assault than other racial/ethnic groups and have an overall high prevalence of lifetime sexual assault. Despite elevated risk and prevalence, African American survivors are often reluctant to use services in the aftermath of sexual assault. Yet, little research has focused exclusively on African American women's sexual assault experiences including their experiences of medical care seeking. A mail survey study was conducted in Chicago (2010-2011) to understand better African American women's sexual assault experiences in relationship to post-assault medical care seeking in a large community sample (N = 836). Multivariable regression analyses examined whether demographics, assault characteristics, trauma history, and post-assault psychosocial factors were related to medical care seeking. Results revealed unique correlates of immediate and long-term help-seeking from a variety of medical/health sources. Being of older age and lower income, perceived life threat, and delayed disclosure were related to less medical care seeking. Survivors who were assaulted by strangers, experienced interpersonal and contextual traumas, and who received tangible aid and mixed social reactions were related to medical care seeking. Implications for research and clinical practice with this population are provided.

Identification of abuse experiences of South Asian women in the US and women in Mumbai, India.

The authors describe the experiences of abuse drawn from in-depth interviews conducted with 20 South Asian women in the United States and a sample of 21 abused women in Mumbai, India. We describe five major themes that identify the nature of domestic violence experienced in these two contexts, barriers to help-seeking and exiting abuse, and the process of ending the abusive relationship. The research sheds light on the similarities and differences in the two contexts. We outlined the similarities in the following themes (a) type of abuse, (b) treatment of children (c) abandonment. We found differences in the following themes (d) joint meeting, (e) back and forth between natal and marital home.

Attitudes Toward Violence Against Women and the Factors That Affect Them in Kutahya, Turkey.

This cross-sectional descriptive study was conducted to determine the attitudes of women and men living in Kutahya, Turkey towards violence against women, and the factors that affect them. The data were collected using an Information Form for Women, an Information Form for Men, and the Attitude towards Violence Scale. The study was completed with 2959 participants; 1481 women and 1478 men. In the study, 41.3% of the women and 22.6% of the men reported being subject to violence. The mean score of the attitude towards violence scale was 41.57±11.83 for women and 49.38±11.52 for men (p <0.001). The mean scores on the attitude towards violence scale were found to be statistically significantly related to gender, education status, occupation, income status, co-educational status, co-occupation, marital age, family type, and subjection to violence (p <0.05). Socio-demographic and socio-cultural factors were found to influence the attitudes of women and men towards violence against women. The attitudes towards violence against women were found to be more positive in women. The rate of accepting violence as natural (acceptable) phenomena was found to be higher among men. That is, the attitudes of men towards violence against women are closer to the traditional approach, away from the modern approach.

Every cloud has a silver lining but "pathways to seeking formal-help and South-Asian immigrant women survivors of intimate partner violence".

It takes an inordinate amount of resiliency for South Asian (SA) immigrant women survivors of intimate partner violence (IPV)/domestic violence (DV) to seek outside help. The purpose of authors of this study is to understand the process/pathways used by abused SA women to seek formal sources of help. A convenience sample of adult SA women (N = 9), who were survivors of IPV was recruited from a SA women's organization located in a large Southwestern metropolitan area in the United States. In-depth interviews were conducted and analyzed resulting in five themes. Despite seeking help, participants experienced barriers in accessing formal help and leaving an abusive relationship.

"When I get married ": Contributing factors to intimate partner violence among married Jordanian women: A qualitative study.

The authors in this study have explored and sought to gain an understanding of the contributing factors related to intimate partner violence among married Jordanian women. A qualitative research design using ten semi-structured interviews was used. Our analysis revealed two main themes: "when I get married" and "the role of family". Financial, cultural and sexual factors were found to be vital in shaping the overall path of IPV. Therefore, if IPV is to be addressed carefully, then a multi-approach strategy within the social, legal and political levels of society is urgently needed.

Prevalence of intimate partner violence and reproductive health outcomes among Afghan refugee women in Iran.

Refugee women are at high risk of experiencing high level of Intimate Partner Violence (IPV) and its negative impacts. We conducted a cross-sectional population-based household survey with refugees in a settlement in the city of Semnan, Iran, from 2016 to 2017. Afghan refugee women (n = 188) with ages between 15 and 49 years were recruited for the survey. Overall, about 79.8% of the participants reported to have experienced a form of IPV in the past 12 months. IPV exposure is associated with a negative reproductive health outcome. The high prevalence of IPV found among refugee women in the present research and its strong links with poor reproductive health outcomes, underline the urgent need for the development and testing of appropriate interventions in refugee settlements.

Utilizing the PEN-3 model to identify socio-cultural factors affecting intimate partner violence against pregnant women in Suburban Hamadan.

Intimate partner violence occurs in all settings. In this paper the authors describe socio-cultural factors affecting intimate partner violence against pregnant women in suburban Hamadan.The PEN-3 model was utilized by semi-structured interviews with 18 pregnant women. According to women, cultural perceptions (patience in case of facing violence, faith in fate and normalization of violence), enablers (communication skills, economic status, and availability of legal support), and nurturers (family support and social expectation of obedience to men) were found to be important factors that influence violence.A better understanding of the cultural perceptions can help decision-makers in identifying the cultural appropriateness of interventions.

[Sexual violence against women in Tunisia]. / Violence sexuelle exercée sur les femmes en Tunisie.

BACKGROUND: Sexual violence exists everywhere in the world. It depends mainly on the cultural and religious norms conveyed in the various societies. This is a neglected area of research. Available data are insufficient, especially in Arab-Muslim context. METHODS: In this paper, we comprehensively review the scientific literature in order to clarify the cultural, religious and legal aspects of the concept of sexual violence against women in Tunisia, and ask the question of the urgent need to put in place strategies to counter this problem. RESULTS: The National Office for Family and Population published in 2011 the results of the national survey on violence against women in Tunisia, including data on sexual violence and its impact on women's health and well-being. According to this survey, 14.2% of women reported having been sexually abused by an intimate partner during their lifetime and 9.0% reported having experienced it during the last 12 months. One out of every six Tunisian women has been the victim of a sexual violence in a conjugal setting. More men than women legitimized violence against women in contexts where family control, especially conjugal control, is exercised over them. In a study examining the impact of culture and religion on experiences and sexual practice of women in Tunisian society, the majority of respondents thought that sexuality in women was a religious duty and that they do not have the right to refuse their husbands or to rebel. Thus, women would be doubly sanctioned having neither the right to express their desire nor not to respond to their husband's desire. A survey of a representative sample of Tunisian women found that 56.9% of the participants reported being victims of domestic violence, particularly sexual violence (10.7%) consisting mainly of rape and sodomy, at least once in their lifetime. This survey showed that those victims expressed dissatisfaction with overall quality of life. Moreover, contrary to Western literature, sexual violence was the least reported form of violence by teenage girls in Tunisian schools. Indeed, cultural values of modesty, virginity and honor are socially much more demanded for girls, in Arab countries in general, reinforcing staggering silence and inaction around violence experienced by school-aged adolescents. In Tunisian society, the cultural "solution" to rape wants the woman to marry her rapist which safeguards her family's integrity by legitimizing the union. CONCLUSION: Sexual violence has detrimental effects on female victims' physical and mental health. Even if the information on this form of violence is not easy to obtain in our environment, and that rates of subjects reporting sexual violence in their lifetimes are not important, the problem of sexual violence must be considered as a public health problem requiring urgent interventions and a greater institutional will.

Maternal mental health priorities, help-seeking behaviors, and resources in post-conflict settings: a qualitative study in eastern Uganda.

BACKGROUND: Limited knowledge exists to inform the selection and introduction of locally relevant, feasible, and effective mental health interventions in diverse socio-cultural contexts and health systems. We examined stakeholders' perspectives on mental health-related priorities, help-seeking behaviors, and existing resources to guide the development of a maternal mental health component for integration into non-specialized care in Soroti, eastern Uganda. METHODS: We employed rapid ethnographic methods (free listing and ranking; semi-structured interviews; key informant interviews and pile sorting) with community health workers (n = 24), primary health workers (n = 26), perinatal women (n = 24), traditional and religious healers (n = 10), and mental health specialists (n = 9). Interviews were conducted by trained Ateso-speaking interviewers. Two independent teams conducted analyses of interview transcripts following an inductive and thematic approach. Smith's Salience Index was used for analysis of free listing data. RESULTS: When asked about common reasons for visiting health clinics, the most salient responses were malaria, general postnatal care, and husbands being absent. Amongst the free listed items that were identified as mental health problems, the three highest ranked concerns were adeka na aomisio (sickness of thoughts); ipum (epilepsy), and emalaria (malaria). The terms epilepsy and malaria were used in ways that reflected both biomedical and cultural concepts of distress. Sickness of thoughts appeared to overlap substantially with major depression as described in international classification, and was perceived to be caused by unsupportive husbands, intimate partner violence, chronic poverty, and physical illnesses. Reported help-seeking for sickness of thoughts included turning to family and community members for support and consultation, followed by traditional or religious healers and health centers if the problem persisted. CONCLUSION: Our findings add to existing literature that describes 'thinking too much' idioms as cultural concepts of distress with roots in social adversity. In addition to making feasible and effective treatment available, our findings indicate the importance of prevention strategies that address the social determinants of psychological distress for perinatal women in post-conflict low-resource contexts.

South Asian women's coping strategies in the face of domestic violence in the United States.

We conducted in-depth telephone interviews with a convenience sample of 20 South Asian women experiencing domestic violence in the United States. Utilizing the emotion-focused and problem-focused coping framework, the researchers analyzed the narratives of abused South Asian women. Emotion-focused coping strategies include (a) spirituality and/or religion and (b) the role of children. Problem-focused coping strategies include (c) informal and formal support and (d) strategies of resisting, pacifying, safety planning. Implications for practice and future research in the United States and internationally are discussed.

Intimate partner violence screening and the comparative effects of screening mode on disclosure of sensitive health behaviours and exposures in clinical settings.

OBJECTIVE: Detecting sensitive health information in clinical settings is of scientific and practical importance. The purpose of this study was to determine whether mode of screening influenced disclosure of intimate partner violence (IPV) in patterns similar to other forms of sensitive information. STUDY DESIGN: This cross sectional study was designed to compare effects of face-to-face vs computer self-assessment for sensitive health information on disclosure rates. Multivariate logistic regression was used for the analysis. METHODS: Data were collected in 2012 from 639 eligible African American consenting women receiving services in women, infants and children (WIC) clinics. Women were randomized to complete assessments of sensitive exposures via computer-assisted self-interview (CASI) or face-to-face interview (FTFI). Those with complete information were included in the analysis (n = 616). RESULTS: Of 39 sensitive health exposures, reporting was higher for FTFI than CASI for exposure to IPV (7 of 7 outcomes), tobacco use (2 of 3 outcomes) and reproductive health care (2 of 3 outcomes). For example, face-to-face improved disclosure of IPV in the last year (adjusted odds ratios [aOR] = 2.27; 95% CI = 1.60-3.21) and any drug, tobacco or alcohol in the last week (aOR = 1.39; 95% CI = 1.00-1.93). CONCLUSION: Trained personnel may enhance disclosure above computer-based assessments for IPV for African American women receiving public assistance through The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Propensities to disclose sexual health behaviour and drug use by CASI may not apply to IPV in this population. The context and personal motivations influence women's decision to disclose IPV.

Cumulative trauma and partner conflict predict post-traumatic stress disorder in postpartum African-American women.

AIM AND OBJECTIVE: To describe relationships between cumulative trauma, partner conflict and post-traumatic stress in African-American postpartum women. BACKGROUND: Cumulative trauma exposure estimates for women in the USA range from 51-69%. During pregnancy, most trauma research has focused on physical injury to the mother. Post-traumatic stress disorder (PTSD) is associated with trauma and more prevalent in African-American women than women of other groups. Knowledge about both the rate and impact of cumulative trauma on pregnancy may contribute to our understanding of women seeking prenatal care, and disparities in infant morbidity and mortality. DESIGN: This retrospective, correlational, cross-sectional study took place on postpartum units of two Detroit hospitals. Participants were 150 African-American women aged between 18-45 who had given birth. METHODS: Mothers completed the Cumulative Trauma Scale, Conflict Tactics Scale, Clinician Administered Post-traumatic Stress Scale, Edinburgh Postnatal Depression Scale and a Demographic Data form. Descriptive statistics, correlations and multiple regressions were used for data analysis. RESULTS: All participants reported at least one traumatic event in their lifetime. Cumulative trauma and partner conflict predicted PTSD, with the trauma of a life-threatening event for a loved one reported by 60% of the sample. Nearly, one-fourth of the women screened were at risk for PTSD. Increased cumulative trauma, increased partner conflict and lower level of education were related to higher rates of PTSD symptoms. CONCLUSION: Both cumulative trauma and partner conflict in the past year predict PTSD. Reasoning was used most often for partner conflict resolution. RELEVANCE TO CLINICAL PRACTICE: The results of this study offer additional knowledge regarding relationships between cumulative trauma, partner conflict and PTSD in African-American women. Healthcare providers need to be sensitive to patient life-threatening events, personal failures, abuse and other types of trauma. Current evidence supports the need to assess for post-traumatic stress symptoms during pregnancy.

Help-Seeking Behavior in Survivors of Intimate Partner Violence: Toward an Integrated Behavioral Model of Individual Factors.

This study examined individual behavioral predictors of help-seeking using the frameworks of the Andersen model and the theory of planned behavior in a sample of help-seeking female survivors of intimate partner violence (IPV). In-person interviews were conducted with 372 women (Mage = 34.41 years, 66% African American). Results indicated that variables suggested by the Andersen model, including age, depression, psychological aggression, and posttraumatic stress-related arousal symptoms, were significant predictors of help-seeking. Variables suggested by the theory of planned behavior, including perceived helpfulness of resource and perceived controllability of the violence, were also significantly related to help-seeking. However, a combined model including variables from both theoretical approaches accounted for the most variance in help-seeking behavior. Overall, results suggest that these models are useful conceptualizations of help-seeking in an IPV population and that it is important to consider personal characteristics, need-based variables, and cognitive factors in outreach efforts.

Ethno-Racial Differences in Children's Attitudes and Beliefs About Violence.

One in 15 children in the United States are exposed to intimate partner violence (IPV) each year. Although much is known about the adverse effects of witnessing IPV on children, little attention has been given to the impact of IPV on children of diverse ethno-racial backgrounds. In particular, the association between IPV and children's attitudes and beliefs about violence across different ethno-racial populations remains to be explored. One hundred ninety children between the ages of 4 and 12 years of varying ethno-racial backgrounds who had witnessed recent IPV were interviewed regarding their attitudes and beliefs about IPV. Results show that younger children and White, Black, and Biracial children exhibited more deleterious attitudes and beliefs about violence after exposure to IPV than did older and Latina or Latino children. These findings may indicate the need for more tailored intervention programs that target the specific maladaptive beliefs expressed by children of various demographic groups.

Principles of care for women experiencing intimate partner violence: Views of expert Japanese health professionals and advocates.

In Japan, interventions for Intimate Partner Violence (IPV) in the health care setting are rare, partly due to Japanese cultural norms that marginalize women's IPV experiences. A thematic analysis of narratives of eight Japanese health professionals who are experts in IPV care identified shared core values and practices that have guided their development of culturally relevant IPV interventions: supporting women's autonomy to define what is at stake for her, appreciating unique trajectories and timing for recovery, and practicing shared decision-making. These shared practices may be essential for training health professionals to respond to IPV in Japan and elsewhere.

Love and resistance of mothers with intellectual disability from ethnocultural communities in Canada.

BACKGROUND: Mothers with intellectual disability are thought to be passive, dependent and in need of protection. This study contributes to a nascent body of research that challenges this schema, revealing how women with intellectual disability who are mothers resist oppression. METHODS: Narrative research methods underpinned by intersectionality theory were used to explore the lives of eight mothers with intellectual disability from various ethnocultural communities in Canada. A total of 33 in-depth interviews were conducted with these eight women over a period of 2 years. RESULTS: The lives of the women who took part in this study were marked by violence. The women resisted. Their resistance strategies addressed two kinds of relationships: their relationships with others and their relationship with themselves. CONCLUSION: The women in this study employed strategies of resistance, sometimes at great personal cost, to provide their children with a better life.

A national survey of attitudes toward intimate partner violence among married women in Kazakhstan, Kyrgyzstan, and Tajikistan: Implications for health prevention and intervention.

Attitudes toward intimate partner violence (IPV) can affect the prevalence of IPV, response of victims' to IPV (e.g., whether to seek help), and the response of professionals (e.g., police, social workers, health care professionals) to IPV. Knowledge about IPV-related attitudes is essential for developing effective social work and violence-related programs. Using data from the 2005-2006 Multiple Indicator Cluster Surveys, this study examines attitudes toward IPV and socio-demographic predictors of these attitudes among married women in Kazakhstan, Kyrgyzstan, and Tajikistan. Women were asked whether they approved of a husband beating his wife: if she goes out without telling him, neglects their children, argues, refuses to have sex, and burns food. The prevalence of IPV acceptance for at least one of the five reasons varied from 12.3% in Kazakhstan to 45.3% in Kyrgyzstan and 74.5% in Tajikistan. Women who were less educated, members of Asian ethnic groups, resided in middle-class urban areas, and lived in specific regions were more likely to accept IPV. Few age differences that emerged indicated that young women were more approving of IPV. Proactive efforts are needed to confront attitudes about gender roles and IPV in Tajikistan and Kyrgyzstan.

Intimate Partner Victimization and Health Risk Behaviors Among Pregnant Adolescents.

OBJECTIVES: To provide lifetime estimates of intimate partner victimization among pregnant adolescents and examine associations between victimization and health risk behaviors identified by the Centers for Disease Control and Prevention as leading causes of adolescent morbidity and mortality. METHODS: Participants (n = 1233) were predominantly Latina (58%) and non-Latina Black (34%) pregnant adolescents (aged 14-21 years) enrolled in a randomized controlled trial of group prenatal care in 14 clinical sites in New York City (2008-2012). They completed surveys to assess interpersonal victimization and risk behaviors: substance use, risky sexual behaviors, injuries or violence, unhealthy dietary behavior, and inadequate physical activity. RESULTS: Fifty-two percent reported intimate partner victimization, which was associated with nearly all health risk behaviors. CONCLUSIONS: Pregnant adolescents who experienced intimate partner victimization were significantly more likely to engage in health risk behaviors, which can have adverse health consequences. Expanded prevention programs tailored to specific needs of pregnant adolescents are needed. Health care providers and others who work with pregnant adolescents should consistently screen for and intervene in intimate partner victimization.