Impacts of an abbreviated personal agency training with refugee women and their male partners on economic empowerment, gender-based violence, and mental health: a randomized controlled trial in Rwanda.

INTRODUCTION: We assessed the impact of a personal agency-based training for refugee women and their male partners on their economic and social empowerment, rates of intimate partner violence (IPV), and non-partner violence (NPV). METHODS: We conducted an individually randomized controlled trial with 1061 partnered women (aged 18-45) living in a refugee camp in Rwanda. Women received two days of training, and their partners received one day of training. The follow-up survey where all relevant outcomes were assessed was carried out at 6-9 months post-intervention. RESULTS: At follow up, women in the intervention arm were more likely to report partaking in income generating activities (aIRR 1.27 (1.04-1.54), p < 0.05) and skill learning (aIRR 1.59 (1.39-1.82), p < 0.001) and reported a reduction in experience of physical or sexual NPV in the past six months (aIRR 0.65 (0.39-1.07), p < 0.09). While improved, no statistically significant impacts were seen on physical or sexual IPV (aIRR 0.80 (0.58-1.09), p = 0.16), food insecurity (ß 0.98 (0.93 to 1.03), p = 0.396), or clean cookstove uptake (aIRR 0.95 (0.88 to 1.01), p = 0.113) in the past six months. We found statistically significant reduction in physical and sexual IPV amongst those experiencing IPV at baseline (aIRR 0.72 (0.50 to 1.02), p < 0.07). Small improvements in self-efficacy scores and our indicator of adapting to stress were seen in the intervention arm. Some challenges were also seen, such as higher prevalence of probable depression and/or anxiety (aIRR 1.79 (1.00-3.22), p = 0.05) and PTSD (aIRR 2.07 (1.10-3.91), p < 0.05) in the intervention arm compared to the control arm. CONCLUSION: Our findings echo previous research showing personal agency training can support economic well-being of women. We also find potentially promising impacts on gender-based violence. However, there is some evidence that integration of evidence-based mental health support is important when enhancing agency amongst conflict-affected populations. TRIAL REGISTRATION NUMBER: The trial was registered with ClinicalTrials.gov, Identifier: NCT04081441 on 09/09/2019.

Systemic Occupational Health Needs of Gender-Based Violence Advocates: Findings From the Early Months of the Pandemic.

OBJECTIVE: This study explores occupational health burdens faced by domestic and sexual violence advocates, many of which intensified during the COVID-19 pandemic. It identifies key stressors and offers advocate-driven recommendations to improve their wellbeing, addressing the lack of system-level interventions in the occupational health literature. METHODS: Semistructured interviews were conducted with 22 advocacy professionals. Thematic content analysis guided transcript coding, and researchers shared initial results with participants in two member checking sessions to validate the preliminary findings. RESULTS: Advocates experienced logistical, emotional, and systemic stressors, including loss of peer support and unempathetic workplace cultures. Recommendations prioritize advocate wellbeing and call for systemic changes. CONCLUSIONS: Advocates' occupational stressors highlight the need for system-level solutions to enhance their occupational wellbeing, particularly during large-scale emergencies. Collaborative efforts among employers, funders, and staff are essential to address system deficiencies.

Understanding Body Resistance in El Salvador: A Qualitative Discussion of a Pilot Program for Embodied Empowerment.

This article evaluates a Body Resistance Program in an urban area of El Salvador. The goal of this program is to facilitate women's reclamation of bodily autonomy and recognition of their shared struggle, thereby laying a foundation for solidarity and structural change around gendered body norms. As a pilot project with limited scope, a key objective is to identify meaningful concepts that address the goals, motivations, and worldviews of Salvadoran participants. This article provides insights into their understandings and experiences of trauma, resistance, and embodied empowerment.

Grisi Siknis: A cultural idiom of gender-based violence and structural inequalities in eastern Nicaragua.

For the Miskitu of Nicaragua, Grisi Siknis is a contagious illness that predominantly affects women. It is characterized by numerous psychosomatic symptoms, including headache, fear, aggressive behavior, loss of consciousness, and periods of rapid frenzy. Although Grisi Siknis has gained academic and public attention due to its unique cultural elements and perceived sexual aspects, little is known how the contextual and gender dimensions of Grisi Siknis are played out in relation to the socio-political context in the region. Based on 16 months of ethnographic work in the Nicaraguan Miskitu Coast, including semi-structured interviews (n = 20) and participant observation, this article documents a semantic shift in the embodied and symbolic language of a cultural idiom of distress. I show how duhindu (Miskitu spirit associated with illness and misfortune) and witchcraft are symbols that share cultural resonance in the Miskitu community, while gender violence discourse is a new language incorporated into the logic of this cultural idiom of distress. I argue that this semantic shift allows the individuals in this study to communicate local experiences of complex forms of structural inequalities (migration status, unemployment, ethnic identity) and gender-based violence that tend to be normalized as a ubiquitous cultural problem while preserving the broader socio-cultural meaning the Grisi Siknis represents. The ethnographic accounts of Grisi Siknis provide empirical data to unpack the unexplored contextual processes and local discourses that transform the meaning and logic of cultural idioms of distress at the individual level of experience.

Relações de gênero na rede municipal de belo horizonte: formação docente continuada / Relaciones de género en la red municipal de belo horizonte: formación continuada / Gender relations in the municipal network of belo horizonte: continuous teacher training

RESUMO. Este texto apresenta o relato reflexivo do projeto de formação continuada docente na rede municipal de educação de Belo Horizonte, entre 2015 e 2018, no campo das relações de gênero. A parceria entre a Secretaria Municipal de Educação e a Pontifícia Universidade Católica de Minas Gerais promoveu as condições necessárias para a realização e integração das atividades acadêmicas de extensão, ensino e pesquisa nos níveis da graduação e pós-graduação. Apesar do contexto político nacional das ofensivas antigênero no campo educacional, a demanda por ações formativas partiu de docentes e gestores/as da educação ao se depararem com os impactos das assimetrias na aprendizagem entre meninas e meninos, bem como situações de violência de gênero na escola. À luz dos pressupostos teóricos pós- estruturalistas de gênero, a formação utiliza metodologias diversificadas como grupos de estudo, seminários, oficinas pedagógicas e estudos de caso em diferentes espaços da cidade como escolas, universidade e museus. A análise dos quatro anos do projeto revela a importância de uma abordagem interdisciplinar das relações de gênero e de caráter permanente, pois ações formativas isoladas têm se mostrado ineficazes.

RESUMEN. En este texto se presenta el informe de reflexión del proyecto de formación continua de profesores y profesoras de la Red Municipal de Educación de Belo Horizonte, entre 2015 y 2018, en el ámbito de las relaciones de género. La asociación entre el Departamento Municipal de Educación y la Pontificia Universidad Católica de Minas Gerais promovió las condiciones necesarias a la realización e integración de las actividades académicas de extensión, enseñanza e investigación en los niveles de licenciatura y posgrado. A pesar del contexto político nacional de las ofensivas de género en el ámbito educativo, la demanda de acciones de capacitación provino de los maestros y administradores de la educación cuando se enfrentaron a los impactos de las asimetrías en el aprendizaje entre niñas y niños, así como a situaciones de violencia de género en la escuela. A la luz de los supuestos teóricos postestructuralistas de género, la capacitación utiliza diversas metodologías como grupos de estudio, seminarios, talleres pedagógicos y estudios de caso en diferentes espacios de la ciudad como escuelas, universidades y museos. El análisis de los cuatro años del proyecto muestra la importancia de un enfoque interdisciplinario de las relaciones de género de carácter permanente, ya que las acciones formativas aisladas han demostrado ser ineficaces.

ABSTRACT. This text presents the reflective report of the project of continuous teacher training in the Municipal Education Network of Belo Horizonte, between 2015 and 2018, in the field of gender relations. Partnership between the Municipal Department of Education and the Pontifical Catholic University of Minas Gerais promoted the necessary conditions for the implementation and integration of academic activities of extension, education and research at undergraduate and graduate levels. Despite the national political context of gender offensives in the educational field, the demand for training actions came from teachers and education managers when they faced the impacts of asymmetries in learning between girls and boys, as well as situations of gender violence at school. In the light of the post-structuralist theoretical assumptions of gender, training uses diverse methodologies such as study groups, seminars, pedagogical workshops and case studies in different spaces of the city, such as schools, universities and museums. The analysis of the four years of the project revealed the importance of an interdisciplinary approach to gender relations of a permanent nature, since isolated training actions have proved ineffective.

Freedom-deprived women: social representations of prison, violence, and their consequences.

OBJECTIVE: To understand the social representations that women deprived of their freedom have of imprisonment, violence, and their consequences. METHOD: An exploratory-descriptive qualitative study with 15 women from a female penitentiary in the State of São Paulo, Brazil. Semistructured interview was used. Data submitted to thematic content analysis and interpreted under Social Representations. RESULTS: Categories identified: "Enclosed and abandoned in the prison environment": loss of contact with relatives, difficulties living in prison, and right to be reinserted into society. "Imprisoned in a cycle of social inequality": lack of support, access to education and employment opportunities, leading them to engage in new illicit activities and consequent imprisonment. FINAL CONSIDERATIONS: The social representations of prisoners suggest that they perceive themselves to be doubly "imprisoned", either from the objective point of view, as an individual deprived of freedom; or subjective, as citizens who have their rights disrespected and their possibilities of rehabilitation limited by the prison system.

Implementing a trauma-informed intervention for homeless female survivors of gender-based violence: Lessons learned in a large Canadian urban centre.

Gender-based violence is associated with an elevated risk of physical and psychological harm for girls and women. This study examines service user and provider experiences of a trauma-informed, peer-facilitated group psychosocial intervention (Peer Education and Connection through Empowerment [PEACE]) targeting female-identified youth experiencing homelessness and gender-based violence. Participants were recruited among service users and providers of the intervention, delivered in Toronto, Canada. We conducted 19 semi-structured interviews between May and October 2017, engaging 12 service users and 7 additional stakeholders (including social service providers, peers and program administrators). We elicited participant perspectives on the acceptability of the intervention and key enablers of successful implementation and engagement of the target population. Qualitative transcripts were analysed using thematic analysis. Service users, including survivors of sexual exploitation, forced marriage and honour crimes, described satisfaction with and acceptability of the intervention. A number of factors were perceived by service users and providers as contributing to the intervention's successful implementation, including a focus on service user needs, program quality, flexibility and accessibility and strong inter-and intra-agency networks. Introducing peers as mentors led to challenges that could be mitigated through peer mentor education and training to maintain healthy boundaries and enhance peer mentor retention. The need for clear guidelines on the management of trauma disclosures in community settings and a systems-wide approach to service provider and administrator training in the effective integration of peer support services also emerged as important areas for future development. A group-based, trauma-informed and peer-supported psychosocial intervention was acceptable to service users and providers and successfully engaged female-identified survivors of gender-based violence who were also experiencing homelessness. Findings add to the scant knowledge base on interventions to support this population and identify important areas for future research.

Service providers' perceptions of barriers to the implementation of trauma-focused substance use services for women in Cape Town, South Africa.

BACKGROUND: A substantial number of South African women with substance use disorders also report psychological trauma related to experiences of physical and sexual abuse. Trauma-focused substance use programmes may support recovery from co-occurring substance use disorders and psychological trauma, yet integrated programmes are not widely available in South Africa. As part of the process of developing a trauma-focused substance use programme for South African women, we explored service providers' views of the feasibility of implementing trauma-focused substance use interventions within usual care settings in Cape Town, including potential barriers that need to be considered when planning for implementation. METHODS: We conducted 16 in-depth interviews with key informants responsible for planning or delivering substance use, psychological trauma or gender-based violence services to women in Cape Town. Guided by Extended Normalisation Process Theory, interviews explored participants' perceptions of the potential value of trauma-focused substance use programmes, the feasibility of their implementation, and factors that may facilitate or hinder the implementation of trauma-focused substance use programmes. Qualitative data were analysed using the framework approach. RESULTS: Three themes emerged: (1) Potential for the implementation of trauma-focused substance use programmes, describing participants' views of the acceptability of these programmes; (2) Capacity for intersectoral collaboration, which participants considered necessary for limiting barriers to implementation; and (3) Co-operation with community structures to enhance capability for implementation. CONCLUSION: Findings show potential for implementing trauma-focused substance use interventions in South Africa, however context-specific capacity and capability barriers need to be considered and addressed for implementation to be successful.

[Coming from Afar and Rediscovering Oneself: Group Intervention for Immigrant and Refugee Women Having Experienced Violence]. / Venir de loin et se retrouver : intervention de groupe pour femmes immigrantes et réfugiées ayant vécu la violence.

Objectives This paper has a clinical perspective and presents an innovative intervention that could be offered in different institutions and practice environments. The object here is a group intervention addressed specifically to immigrant and refugee women having experienced different forms of violence. The consequences of being exposed to intentional and dehumanizing violence, paired with the challenges associated with migration and forced exile, can fragilize the individuals and challenge their capacity to adapt. Even though psychological and psychosocial support in the years following their arrival could be beneficial, immigrants and refugees rarely use institutional services, and experts point out that the services are not tailored to them. In that respect stems the importance of promoting the development of more meaningful interventions for immigrants and refugees, in accordance with the principle of equity and equality of chances to have access to appropriate services, but also to better equip the specialists by giving them access to safe and culturally sensitive interventions. Following that perspective, a group intervention for immigrants and refugees having experienced violence was created in 2010 with the collaboration of researchers from l'IUPLSSS and social workers from CIUSSS de l'Estrie-Chus. Method Firstly, this article aims to present this group intervention. Innovative features of the proposed program will be highlighted, followed by an overview of the clinical and empirical supports that recommend the use of groups and art to intervene with immigrants and refugees. A more detailed description of the intervention will follow, describing the objectives of the intervention as well as the intervention framework, including some necessary components to assure the therapeutic reach of the groups and the establishment of a safe space. Secondly, the article presents a brief summary of the preliminary results of a current study aiming to evaluate the impacts of the intervention. During this study, qualitative and quantitative data was collected from 3 groups (n = 17) and analyzed with content analysis and non-parametric analyses to measure the changes between pre and post intervention. Results The results of the qualitative and quantitative analyses show that women report positive changes at the end of the group, namely in regard to post-traumatic stress symptoms and different dimensions of their well-being. Conclusion To conclude, the advantages and limits of this intervention will be discussed, but also its relevance for the practice environments. Even if it isn't the only answer for the intervention in a post-violence context, it consists of a good option for providing adapted services to the reality and needs of immigrants and refugees.

Freedom-deprived women: social representations of prison, violence, and their consequences / Mujeres privadas de libertad: representaciones sociales de la prisión, la violencia y sus consecuencias / Mulheres privadas de liberdade: representações sociais de prisão, violência e suas consequências

ABSTRACT Objective: To understand the social representations that women deprived of their freedom have of imprisonment, violence, and their consequences. Method: An exploratory-descriptive qualitative study with 15 women from a female penitentiary in the State of São Paulo, Brazil. Semistructured interview was used. Data submitted to thematic content analysis and interpreted under Social Representations. Results: Categories identified: "Enclosed and abandoned in the prison environment": loss of contact with relatives, difficulties living in prison, and right to be reinserted into society. "Imprisoned in a cycle of social inequality": lack of support, access to education and employment opportunities, leading them to engage in new illicit activities and consequent imprisonment. Final considerations: The social representations of prisoners suggest that they perceive themselves to be doubly "imprisoned", either from the objective point of view, as an individual deprived of freedom; or subjective, as citizens who have their rights disrespected and their possibilities of rehabilitation limited by the prison system.

RESUMEN Objetivo: Comprender las representaciones sociales que las mujeres privadas de su libertad tienen sobre la prisión, la violencia y sus consecuencias. Método: Estudio cualitativo exploratorio-descriptivo realizado con 15 mujeres de una cárcel femenina del Estado de São Paulo, Brasil. Se utilizó una entrevista semiestructurada. Los datos se sometieron al análisis de contenido temático y fueron interpretados a la luz de las Representaciones Sociales. Resultados: Categorías identificadas: "Enclaustradas y abandonadas en el ámbito penitenciario": pérdida de contacto con los familiares, dificultades de convivencia en la prisión y en lo que se refiere al derecho a ser reintegradas en la sociedad. "Encarceladas en un ciclo de desigualdad social": falta de apoyo, acceso a la educación y oportunidades de empleo, llevándolas a involucrarse en nuevas actividades ilícitas y por consiguiente volver a ser encarceladas. Consideraciones Finales: Las representaciones sociales de las detenidas sugieren que ellas se sienten doblemente "encarceladas", tanto desde el punto de vista objetivo, como individuo privado de su libertad, como del subjetivo, ciudadanas cuyos derechos no son respetados y sus posibilidades de rehabilitación son limitadas por el sistema penitenciario.

RESUMO Objetivo: Compreender as representações sociais que mulheres privadas de liberdade têm sobre prisão, violência e suas consequências. Método: Estudo qualitativo exploratório-descritivo realizado com 15 mulheres de uma penitenciária feminina do estado de São Paulo, Brasil. Foi utilizada entrevista semiestruturada. Dados submetidos à análise de conteúdo temática e interpretados à luz das Representações Sociais. Resultados: Categorias identificadas: "Enclausuradas e abandonadas no ambiente prisional": perda de contato com familiares, dificuldades de convívio na prisão e direito de serem reinseridas na sociedade. "Aprisionadas em um ciclo de desigualdade social": falta de apoio, acesso à educação e oportunidades de emprego, levando-as ao envolvimento em novas atividades ilícitas e consequente aprisionamento. Considerações finais: As representações sociais das detentas sugerem que elas se percebem duplamente "aprisionadas", seja do ponto de vista objetivo, como indivíduo privado de liberdade; ou subjetivo, como cidadãs que têm seus direitos desrespeitados e suas possibilidades de reabilitação limitadas pelo sistema prisional.

Twenty-Five Years of Research and Advocacy on Violence Against Women: What Have We Accomplished, and Where Do We Go From Here? A Conversation.

This article is a conversation between two academic experts, Callie Rennison and Nikki Jones, who endeavor to sum up what has been accomplished in eliminating violence against women in the United States during the 25 years of the journal's existence. Domestic violence, rape, and sexual harassment are discussed. Although prevalence rates are down in domestic violence, rape and sexual harassment remain persistent problems. Looking at violence against women from an analysis of President Trump voters in the 2016 U.S. presidential election, Rennison and Jones observe the extent to which the current ideas and attitudes of women-both young and old-will need to change before violence can be eliminated. Rather than viewing events in the United States as totally negative, they see them as presenting new opportunities for greater understanding of violence against women and for new methods of prevention and perpetrator accountability.

Quasi-experimental evaluation using confirmatory procedures: A case study of an economic and social empowerment intervention to reduce girls' vulnerability to HIV in rural Mozambique.

PURPOSE: Our goal was to determine whether an economic and social empowerment intervention implemented in Zambézia Province, Mozambique reduced girls' vulnerability to HIV. We use this experience to discuss challenges of evaluating real-world interventions. METHODS: Two rounds of data were collected from 885 girls, 13-19 years, for this clustered, non-equivalent (two-stage) cohort trial. We used multi-level exact matching and difference-in-differences estimation to estimate intervention effects on two outcomes: girls' knowledge of gender-based violence and school attendance. RESULTS: Estimates of two outcomes analysed indicated no statistically significant intervention effects. Preliminary analysis of data from the intervention group revealed this study was unable to obtain accurate measures for five outcomes related to HIV vulnerability. CONCLUSIONS: Although our study did not find evidence of impact on the a priori selected outcomes, we report on our experience implementing this robust methodologic design and describe how the challenges encountered in this program setting affected our ability to attain results. We recommend prospective evaluation designs with random allocation be accommodated early during planning. When not possible, quasi-experimental studies should collect data from large samples. To reduce measurement bias, biological endpoints such sexually transmitted infections should serve as primary outcomes for programs intending to reduce sexual behaviors.

An exploration of gender-based violence in eastern Myanmar in the context of political transition: findings from a qualitative sexual and reproductive health assessment.

In March 2011, the Myanmar Government transitioned to a nominally civilian parliamentary government, resulting in dramatic increases in international investments and tenuous peace in some regions. In March 2015, Community Partners International, the Women's Refugee Commission, and four community-based organisations (CBOs) assessed community-based sexual and reproductive health (SRH) services in eastern Myanmar amidst the changing political contexts in Myanmar and Thailand. The team conducted 12 focus group discussions among women of reproductive age (18-49 years) with children under five and interviewed 12 health workers in Kayin State, Myanmar. In Mae Sot and Chiang Mai, Thailand, the team interviewed 20 representatives of CBOs serving the border regions. Findings are presented through the socioecological lens to explore gender-based violence (GBV) specifically, to examine continued and emerging issues in the context of the political transition. Cited GBV includes ongoing sexual violence/rape by the military and in the community, trafficking, intimate partner violence, and early marriage. Despite the political transition, women continue to be at risk for military sexual violence, are caught in the burgeoning economic push-pull drivers, and experience ongoing restrictive gender norms, with limited access to SRH services. There is much fluidity, along with many connections and interactions among the contributing variables at all levels of the socioecological model; based on a multisectoral response, continued support for innovative, community-based SRH services that include medical and psychosocial care are imperative for ethnic minority women to gain more agency to freely exercise their SR rights.

Temporalities of emergency: Migrant pregnancy and healthcare networks in Southern European borderlands.

In Greece, Italy, and Spain, austerity policies combined with the structural density of migration flows have had concrete social and material manifestations in the delivery of public health care. Through our ethnographic case studies in Lampedusa and southeastern Sicily, Melilla, and Athens, we examine the maternity care offered to migrant patients in the midst and the aftermath of the so-called "migration crisis" in state and non-state structures. Research was conducted in Athens and southeastern Sicily from August 2016 to August 2017; in Melilla from August 2016 to October 2016 and in January 2017; and in Lampedusa from August 2016 to January 2017. Data collected consist in semi-structured interviews and long-term ethnographic observations. The article explores whether and how the understanding or the labeling of the maternity care of migrants as an emergency within a context of professed crisis generates new norms of care within health-care delivery. Our findings suggest a) the adoption of solutions or practices that in the past might have been considered urgent, ad hoc, or creative; b) their normalization, deeply connected to the wider social landscape of these European peripheries and c) the institutionalization of humanitarianism in the context of these practices. Our research points out temporalities of emergency against the background of a professed migration crisis. In the context of austerity-driven underfunding, temporary solutions become entrenched, producing a lasting emergency. Yet, we argue that "emergency" can, at some point, generate practices of resistance that undermine, subtly yet significantly, its own normalization.

Measuring mistreatment of women throughout the birthing process: implications for quality of care assessments.

Measuring mistreatment and quality of care during childbirth is important in promoting respectful maternity care. We describe these dimensions throughout the birthing process from admission, delivery and immediate postpartum care. We observed 677 client-provider interactions and conducted 13 facility assessments in Kenya. We used descriptive statistics and logistic regression model to illustrate how mistreatment and clinical process of care vary through the birthing process. During admission, the prevalence of verbal abuse was 18%, lack of informed consent 59%, and lack of privacy 67%. Women with higher parity were more likely to be verbally abused [AOR: 1.69; (95% CI 1.03,2.77)]. During delivery, low levels of verbal and physical abuse were observed, but lack of privacy and unhygienic practices were prevalent during delivery and postpartum (>65%). Women were less likely to be verbally abused [AOR: 0.88 (95% CI 0.78, 0.99)] or experience unhygienic practices, [AOR: 0.87 (95% CI 0.78, 0.97)] in better-equipped facilities. During admission, providers were observed creating rapport (52%), taking medical history (82%), conducting physical assessments (5%). Women's likelihood to receive a physical assessment increased with higher infrastructural scores during admission [AOR: 2.52; (95% CI 2.03, 3.21)] and immediately postpartum [AOR 2.18; (95% CI 1.24, 3.82)]. Night-time deliveries were associated with lower likelihood of physical assessment and rapport creation [AOR; 0.58; (95% CI 0.41,0.86)]. The variability of mistreatment and clinical quality of maternity along the birthing process suggests health system drivers that influence provider behaviour and health facility environment should be considered for quality improvement and reduction of mistreatment.

Women's perspectives of mistreatment during childbirth at health facilities in Ghana: findings from a qualitative study.

Mistreatment of women during childbirth at health facilities violates their human rights and autonomy and may be associated with preventable maternal and newborn mortality and morbidity. In this paper, we explore women's perspectives on mistreatment during facility-based childbirth as part of a bigger World Health Organization (WHO) multi-country study for developing consensus definitions, and validating indicators and tools for measuring the burden of the phenomenon. Focus group discussions (FGDs) and in-depth interviews (IDIs) were used to explore experiences of mistreatment from women who have ever given birth in a health facility in Koforidua and Nsawam, Ghana. Interviews were audio-recorded, transcribed and thematic analysis conducted. A total of 39 IDIs and 10 FGDs involving 110 women in total were conducted. The major types of mistreatment identified were: verbal abuse (shouting, insults, and derogatory remarks), physical abuse (pinching, slapping) and abandonment and lack of support. Mistreatment was commonly experienced during the second stage of labour, especially amongst adolescents. Inability to push well during the second stage, disobedience to instructions from birth attendants, and not bringing prescribed items for childbirth (mama kit) often preceded mistreatment. Most women indicated that slapping and pinching were acceptable means to "correct" disobedient behaviours and encourage pushing. Women may avoid giving birth in health facilities in the future because of their own experiences of mistreatment, or hearing about another woman's experience of mistreatment. Consensus definitions, validated indicators and tools for measuring mistreatment are needed to measure prevalence and identify drivers and potential entry points to minimise the phenomenon and improve respectful care during childbirth.

Disrespect and abuse in maternity care: individual consequences of structural violence.

Disrespect and abuse of patients, especially birthing women, does occur in the health sector. This is a violation of women's fundamental human rights and can be viewed as a consequence of women's lives not being valued by larger social, economic and political structures. Here we demonstrate how such disrespect and abuse is enacted at an interpersonal level across the continuum of care in Tanzania. We describe how and why women's exposure to disrespect and abuse should be seen as a symptom of structural violence. Detailed narratives were developed based on interviews and observations of 14 rural women's interactions with health providers from their first antenatal visit until after birth. Narratives were based on observation of 25 antenatal visits, 3 births and 92 in-depth interviews with the same women. All women were exposed to non-supportive care during pregnancy and birth including psychological abuse, physical abuse, abandonment and privacy violations. Systemic gender inequality renders women excessively vulnerable to abuse, expressed as a normalisation of abuse in society. Health institutions reflect and reinforce dominant social processes and normalisation of non-supportive care is symptomatic of an institutional culture of care that has become dehumanised. Health providers may act disrespectfully because they are placed in a powerful position, holding authority over their patients. However, they are themselves also victims of continuous health system challenges and poor working conditions. Preventing disrespect and abuse during antenatal care and childbirth requires attention for structural inequalities that foster conditions that make mistreatment of vulnerable women possible.

The shifting axes of marginalities: the politics of identities shaping women's experiences during childbirth in Northeast India.

Institutional births in India, including the north eastern state of Assam, have increased steeply in the last decade such that 71% of all births now occur in facilities. Most analyses of disrespect and abuse during childbirth have largely framed the problem within a binary that juxtaposes all users of services in one category, subordinate to institutions and institutional actors. This commentary explores whether a different analysis is possible within a relational context where citizenship itself is graded, and not all marginal groups experience either the same form or the same intensity of mistreatment. Employing a historical lens including examining relations between non-elite groups, current discriminatory state policies and practices, and deepening conflicts over scarce resources, this commentary presents a more localised and granular understanding of how disrespect and abuse may manifest in institutional births in Assam. Experiences of disrespect and abuse during childbirth are mediated by axes of marginalities that are dynamic and non-isomorphic, shaped by state policies, the everyday practices of the citizens, the differential and unequal relations between the state and multiple marginal groups of citizens, and between citizens themselves. Reframing marginality in this way may lend itself to identifying sources of inequities that emanate from both within and outside of health systems, allowing for more sophisticated explorations of disrespect and abuse. This may help improve health systems to ensure that experience of childbirth is more humane, safe and respectful, independent of women's social identities and their locations in the larger political economy.

Social representations of nurses concerning domestic violence against women: study with a structural approach. / Representações sociais de enfermeiras acerca da violência doméstica contra a mulher: estudo com abordagem estrutural.

OBJECTIVE: To analyse the structure and contents of the social representations of nurses concerning domestic violence against women. METHODS: This is a qualitative study conducted with 100 nurses between May and September 2014 in two hospitals of Rio Grande, RS, Brazil. Data were collected through evocations and semi-structured interviews. The data were processed in Evoc software and subjected to contextual analysis, respectively. RESULTS: A negative representation was identified with core elements alluding to forms of violence and its judgment, expressed as "physical aggression" and "contempt". In the periphery, "fear" is how the professionals and the victims feel toward the aggressor and "submission" is mentioned as a cause of violence. The term "verbal aggression" in the contrast zone suggests the possibility of a subgroup with a different representation. CONCLUSIONS: A centralised view regarding physical injuries and the culpabilisation of domestic abuse victims can limit care actions, revealing the need to discuss this subject with health workers.