What a critical public health perspective can add to the analysis of healthcare responses to gender-based violence that focus on asking.

In this comment I analyze the effects of approaching gender-based violence as a public health problem, that the health system should address through 'daring to ask'. I acknowledge the potential of the 'daring to ask' strategy, but I also argue that asking has effects, and that we should be aware of them.

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.

"I Reject it, But That's What Normally Happens": Grey Zones of Gender-Based Violence and Gender Roles in Young People.

There has been growing concern about the increase in gender-based violence (GBV) among young people. The aim of this study was to explore the grey zones in GBV alongside gender (masculinities and femininities) discourses in young adults. We used the concept of a "grey zone" as an analytical tool to identify possible contradictory discursive positions where the notions of victims and perpetrators of GBV converge and become ambiguous. We performed a qualitative study based on 20 semi-structured interviews and 4 focus groups (October 2019 to February 2020) in Spain with a sample of 49 cisgender women and men, aged between 18 and 24, some involved in feminist activism and some not. We conducted a sociological analysis of the discourse system. Study findings show how culturally constructed gender norms intervene in the ways in which young people understand and deal with GBV. When asked general questions about GBV, this concept was problematized along with gender assumptions and two discursive positions were identified: the discourse of "men as authors of GBV" and the discourse of "GBV as an individual genderless issue." When vignettes of everyday GBV situations were shown, grey zones became visible when discussing subtle forms of GBV influenced by the myths of romantic love, victim-blaming around sexual violence, digital GBV and bystander men intervention on GBV. In those grey zones, discourses on GBV were articulated around unequal notions of gender that, in turn, served as its justification, reproduction, and normalization. The grey zones identified represent contexts of oppression that illustrate how GBV is systematically reproduced, as well as the ways in which young people can be involved in it, perpetuating power and health inequalities. Our findings provide information as a guide to design GBV interventions and prevention actions that incorporate a focus on gender configurations.

Systematic Review of the Economics of School-Based Interventions for Dating Violence and Gender-Based Violence.

Dating and relationship violence (DRV) and gender-based violence (GBV) among children and young people incur a high cost to individuals and society. School-based interventions present an opportunity to prevent DRV and GBV early in individuals' lives. However, with school resources under pressure, policymakers require guidance on the economics of implementing interventions. As part of a large systematic review funded by the National Institute for Health and Care Research (NIHR), we searched for economic evaluations and costing studies of school-based interventions for DRV and GBV. No formal economic evaluations were identified. Seven studies reporting costs, cost savings, or resource use for eight interventions were identified. The largest costs of implementing interventions were related to staff training and salaries but savings could be made by implementing interventions on a large scale. The potential cost savings of avoided DRV and GBV far outweighed the costs of implementation.

Sexual Harassment in Low- and Middle-Income Countries: A Qualitative Systematic Review.

Sexual harassment is a pervasive form of gender-based violence that has negative social and health impacts, yet there is only limited research available on sexual harassment in low- and middle-income countries (LMICs). The aim of this qualitative systematic review was to better understand how participants across a variety of countries and settings conceptualized sexual harassment and to investigate its causal factors, consequences, coping strategies, and recommendations for prevention and interventions. We searched eight databases and included English language qualitative studies published from 1990 until June 2021 if they mentioned sexual harassment in LMICs and included female or male participants aged 12 and older. This resulted in 34 included studies. Overall, this review established that sexual harassment was salient in participants' lives, yet their conceptualizations of sexual harassment varied widely and were strongly influenced by contextual and sociocultural factors. Overall, our review has highlighted (1) the conflation of sexual harassment and sexual violence, (2) the intersections of gendered power with other hierarchies of authority, age, and socio-economic status and how the role of power is different in street versus educational and workplace settings, (3) the patriarchal norms, gender inequalities, and normalization of gender-based violence that enable sexual harassment and silence those affected by it, (4) the varied expectations of how women should cope with sexual harassment in order for their experiences to be validated, and (5) the need for gender norms change and fair and effective policies in order to not only prevent sexual harassment but also address the underlying causes.

Towards Ethical International Research Partnerships in Gender-Based Violence Research: Insights From Research Partners in Kenya.

Research with survivors of gender-based violence in low- and middle-income countries is important to improve understanding of experiences of violence and the policies that can help combat it. But this research also implies risks for survivors, such as re-traumatization, safety concerns, and feelings of exploitation. These risks are magnified if research is undertaken by researchers from high-income countries, whose positionality produces power inequalities affecting both participants and research partners. This article describes the ethical challenges of international gender-based violence research from the perspective of Kenyan researchers and organizations and identifies recommendations about how to prevent them.

Rights based approaches to sexual and reproductive health in low and middle-income countries: A systematic review.

INTRODUCTION: The Sustainable Development Goals, which are grounded in human rights, involve empowering women and girls and ensuring that everyone can access sexual and reproductive health and rights (Goal 5). This is the first systematic review reporting interventions involving rights-based approaches for sexual and reproductive health issues including gender-based violence, maternity, HIV and sexually transmitted infections in low and middle-income countries. AIMS: To describe the evidence on rights-based approaches to sexual and reproductive health in low and middle-income countries. METHODS: EMBASE, MEDLINE and Web of Science were searched until 9/1/2020. Inclusion criteria were: Study design: any interventional study.Population: females aged over 15 living in low and middle-income countries.Intervention: a "rights-based approach" (defined by the author) and/or interventions that the author explicitly stated related to "rights".Comparator: clusters in which no intervention or fewer components of an intervention were in place, or individuals not exposed to interventions, or exposed to fewer intervention components.Outcome: Sexual and reproductive health related outcomes. A narrative synthesis of included studies was undertaken, and outcomes mapped to identify evidence gaps. The systematic review protocol was registered on PROSPERO (CRD42019158950). RESULTS: Database searching identified 17,212 records, and 13,404 studies remained after de-duplication. Twenty-four studies were included after title and abstract, full-text and reference-list screening by two authors independently. Rights-based interventions were effective for some included outcomes, but evidence was of poor quality. Testing uptake for HIV and/or other sexually transmitted infections, condom use, and awareness of rights improved with intervention, but all relevant studies were at high, critical or serious risk of bias. No study included gender-based violence outcomes. CONCLUSION: Considerable risk of bias in all studies means results must be interpreted with caution. High-quality controlled studies are needed urgently in this area.

Approaches to gender-based violence and legal abortion in health services during COVID-19 lockdown.

This study is interested in analyzing how health services address gender-based violence and legal abortion in a context of mandatory preventive social isolation. Between May and June 2020, 27 telephone interviews were conducted with healthcare professionals and key informants from Córdoba and Resistencia. Changes in detection, methods, and demand were identified, related to the reorganization of the healthcare system, modifications in the care relationship, and the resources needed to respond to demand. The pandemic has deepened barriers to women's access to health services and has added new ones. Networks among healthcare professionals, feminist healthcare practices, and innovative approaches were identified as facilitators of access, which have been central in mitigating the effects of the pandemic and guaranteeing rights.

Este estudio buscó indagar cómo los servicios de salud abordan las violencias de género y la interrupción legal del embarazo en contexto de aislamiento social preventivo y obligatorio. Entre mayo y junio de 2020, se realizaron 27 entrevistas telefónicas a profesionales sanitarios e informantes claves de las ciudades argentinas de Córdoba y Resistencia. Se identificaron cambios en la detección, abordaje y demanda vinculados a la reorganización sanitaria, las modificaciones en la relación asistencial y los recursos necesarios para canalizar la demanda. La pandemia ha profundizado los obstáculos de acceso a servicios sanitarios de las mujeres y ha generado otros nuevos. Ante ello, las redes entre profesionales, la práctica sanitaria feminista y los abordajes innovadores fueron identificados como facilitadores de acceso, claves para amortiguar la pandemia y garantizar derechos.

[Measures to contain gender-based violence during the COVID-19 pandemic]. / Medidas de contención de la violencia de género durante la pandemia de COVID-19.

Crises, emergencies and times of unrest have been linked to increased interpersonal violence, including violence against women. Following the declaration of alarm status and quarantine, different measures have been implemented to mitigate the possible effect of gender violence (Contingency Plan against Gender-Based Violence in Coronavirus Crisis or Royal Decree Law on Emergency Measures). This document reviews the measures adopted so far by the government of Spain, the autonomous governments and the initiatives formulated in different countries. In the absence of concrete economic measures to date, and the scenario of economic uncertainty, we conclude that it is not possible to prevent gender-based violence in a comprehensive way, without considering the increase in unemployment, temporary and instability employment, economic dependency or the overload of household chores and reproductive tasks, among other elements that facilitate it.

The Maternal Frame and the Rise of the Counterpublic Among Naga Women.

Nagaland has witnessed violent conflict for over five decades. It is a heavily militarized space where draconian laws like the Armed Forces Special Powers Act allow army personnel to go unchallenged even after committing violent crimes. Few women have used their tradition-specific gendered role strategically to subvert gender norms and exhibit agency against violence within the conflict situation and the systemic violence that bars them from entering the public-political sphere. This article studies how women from the Naga tribal communities use their tradition-specific gender roles of motherhood to gain agency and resist the formation of a hostile, gendered social space.

Violence Against Women: Representations, Interpretations, and Education.

Cultural representations of violence against women have been mystified, eroticized, and depicted as heroic, camouflaging, and trivializing acts of violence as a societal norm for thousands of years. This themed issue invites people to re/claim identities and power, and enter into a global cultural discourse connected with cross-disciplinary channels and creative work.

Understanding the costs and the cost structure of a community-based HIV and gender-based violence (GBV) prevention program: the Woza Asibonisane Community Responses Program in South Africa.

BACKGROUND: The Woza Asibonisane Community Responses (CR) Programme was developed to prevent HIV infections and gender-based violence (GBV) within four provinces in South Africa. The Centre for Communication Impact (CCI) in collaboration with six partner non-governmental organizations (NGOs) implemented the programme, which was comprised of multiple types of group discussion and education activities organized and facilitated by each NGO. To date, little information exists on the cost of implementing such multi-objective, multi-activity, community-based programmes. To address this information gap, we estimated the annual cost of implementing the CR Programme for each NGO. METHODS: We used standard methods to estimate the costs for each NGO, which involved a package of multiple activities targeted to distinct subpopulations in specific locations. The primary sources of information came from the implementing organizations. Costs (US dollars, 2017) are reported for each partner for one implementation year (the U.S. Government fiscal year (10/2016-09/2017). In addition to total costs disaggregated by main input categories, a common metric--cost per participant intervention hour--is used to summarize costs across partners. RESULTS: Each activity included in the CR program involve organizing and bringing together a group of people from the target population to a location and then completing the curriculum for that activity. Activities were held in community settings (meeting hall, community center, sports grounds, schools, etc.). The annual cost per NGO varied substantially, from $260,302 to $740,413, as did scale based on estimated total participant hours, from 101,703 to 187,792 participant hours. The cost per participant hour varied from $2.8-$4.6, with NGO labor disaggregated into salaries for management and salaries for service delivery (providing the activity curriculum) contributing to the largest share of costs per participant hour. CONCLUSIONS: The cost of implementing any community-based program depends on: (1) what the program implements; (2) the resources used; and (3) unit costs for such resources. Reporting on costs alone, however, does not provide enough information to evaluate if the costs are 'too high' or 'too low' without a clearer understanding of the benefits produced by the program, and if the benefits would change if resources (and therefore costs) were changed.

Lessons Never Learned: Crisis and gender-based violence.

The COVID-19 pandemic exposes underlying inequalities in our socio-economic and health systems, such as gender-based violence (GBV). In emergencies, particularly ones that involve quarantine, GBV often increases. Policymakers must utilize community expertise, technology and existing global guidelines to disrupt these trends in the early stages of the COVID-19 epidemic. Gender norms and roles relegating women to the realm of care work puts them on the frontlines in an epidemic, while often excluding them from developing the response. It is critical to value women's roles in society and include their voices in the decision-making process to avoid unintended consequences and ensure a comprehensive response that caters to the needs of the most vulnerable groups.

'To minimise that risk, there are some costs we incur': Examining the impact of gender-based violence on the urban poor.

Urban environments marked by violence create fear that can have real impacts on the urban poor, particularly women and girls. Any efforts to tackle poverty and promote health must address the impacts to their access to livelihoods and education, healthcare, markets, and social support that underlie wellbeing. This study aimed to elucidate specific impacts that violence and fear have on the very poor in rapidly growing cities and the coping strategies employed. This multi-country qualitative study was conducted in Dhaka, Bangladesh, Port-au-Prince, Haiti; and Addis Ababa, Ethiopia. Participants in all three cities employed similar tactics to avoid violence. People adjusted how, when, and where they travel and how they interact with people who threaten them. These coping strategies led participants to spend more money on goods and to restrict access to livelihood opportunities, education, healthcare, and social activities. Women are impacted more than men in all spheres and city specific differences are highlighted. Residents of urban slums, particularly women, in these three cities cope with urban violence in many ways, suffering consequences in a range of categories - leading to significant impacts to their own health and well-being and their families.

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.

Taking on the Taliban: Ethical issues at the frontline of academia.

This article reflects on the challenges of developing academic research that is undertaken to create social change. I describe the ways that my research has been generated and guided by activism. Even though the descriptor of my research interests is generally gender-based violence and mental health, my research is situated within an ongoing political discourse that fundamentally opposes and normatively challenges ideologies such as those implemented at a governmental level during the Taliban regime in Afghanistan that continue to have power over Afghan women's lives. I critique the emergence of two research projects that work with women survivors of violence and develop trauma therapeutic interventions using traditional storytelling. My positionality as a woman of Muslim origin and an academic in the U.K. resulted in inescapable juxtapositions and the necessary blurring of the boundaries between personal and professional viewpoints as well as highlighting the potency of traumatic stories in contexts of conflict, oppression, silencing and marginalization. I go on to explain why I have a moral obligation as an ethicist working in global health, with resources and expertise, to systematically develop my research questions and objectives in accordance with the end-goal of tackling and deconstructing harmful ideologies and practices towards women and girls in societies marred by the violent complexities of national and international conflicts.

A blended training programme for healthcare professionals aimed at strengthening territorial networks for the prevention and contrast of gender-based violence.

OBJECTIVES: a blended training programme combining residential meetings (de visu) and distance training course (DTC) have been developed in order to provide the key elements for prevention, individuation, and care of women victims of violence. DESIGN: the Project involved the identification and testing of a systematic methodology of blended training addressed to social and health operators of 28 Emergency Room (ER) Units in 4 Italian regions (Lombardy - Northern Italy, Lazio - Central Italy, Campania and Sicily - Southern Italy). Tuscany region (Central Italy) collaborated through experts in the field from the Grosseto Task Force. This training approach specifically aimed to increase the professional competences for diagnosis, management and treatment of gender-based violence, as well as to strengthen multidisciplinary territorial networks against violence. SETTING AND PARTICIPANTS: in this Project, 28 ERs in the four Italian regions mentioned above were selected because of their involvement in managing gender-based violence. This selection was performed by a coordinator, one for each region, who also coordinated the recruitment of personnel to be involved in the training programme. The programme has therefore been proposed to social and health operators and police officers in the ERs recruited. In each ER, two referents were identified (a doctor and a nurse) in order to ensure a constant connection between the course participants and the experts involved in the management of the Project and the DTC platform. MAIN OUTCOME MEASURES: evaluation of the increase of knowledge relatively to gender-based violence issue in the ER professionals who have concluded the blended training programme. A systematic analysis and comparison of all accesses concerning women aged ≥14 years in the period 1 July-31 December 2014 (before the blended training programme) and in the period 1 July-31 December 2016 (after the blended training program). RESULTS: among the 866 registered professionals, 636 participants (73.5%) completed the course, 202 (23.3%) professionals did not complete it, 21 (2.4%) did not pass the certification test, and 7 (0.8%) participated as Auditors. Among the participants who completed the course, most of them (70.8%) were females; the average age was 45 for both males and females. The most represented professional role was the nurse (61%), followed by the medical doctor (27.2%). Based on our data, in the post-training period, an increased number of cases of violence were correctly recorded in comparison to the pre-training period. CONCLUSION: the Project allowed to define a training strategy for health professionals of the ERs who respond daily to the health needs of women who are victims of violence. The blended training programme combining residential meetings (de visu) and distance training course has been developed in order to provide the key elements for prevention, individuation, and care of women victims of violence. The observed improvement in the recording and management of cases of gender-based violence is probably due to a greater competence in the awareness and use of specific diagnostic codes by ER professionals.

Utility of crime surveys for Sustainable Development Goals monitoring and violence prevention using a public health approach.

The Sustainable Development Goals (SDGs) have highlighted interpersonal violence and violence against women and girls as impediments to development globally. South Africa is adversely affected by violence and injury. The annual Victims of Crime Survey (VoCS) provides a potentially useful source of complementary data to bolster vital registration and police crime statistics, but it may not provide data that are sufficiently accurate and reliable to inform prevention efforts. We conducted a critical assessment of the VoCS's methodological robustness and strength as a data source for high-level analyses, adopting a public health and SDGs monitoring perspective that was based on expert opinion and comparison with other data sources. We concluded that either the survey methods should be improved to provide findings that are better aligned with the SDGs agenda and are robust enough to inform high-quality research and prevention, or the funds used to conduct the VoCS should be redirected to other more suitable instruments.