The Media and Sexual Violence Among Adolescents: Findings from a Qualitative Study of Educators Across Vietnam.

Growing access to technology and media has presented new avenues of influence on youth attitudes and norms regarding sexuality and sexual violence, as well as new technological pathways through which to perpetrate sexual violence. The aim of this research was to understand contextual influences on and needs for scale-up of sexual violence prevention programming in the media-violence context of Vietnam. We conducted 45 interviews with high school teachers (n = 15), university lecturers (n = 15), and affiliates from youth-focused community service organizations (n = 15) from across Vietnam. Additionally, we conducted four sector-specific focus groups with a sub-sample of interview participants (k = 4, n = 22). Media and technology were brought up consistently in relation to sexual violence prevention and sexual health information. Key informants noted that, in Vietnam, generational differences in acceptability of sex and lack of comprehensive sexuality education intersect with new technological opportunities for exposure to sexual information and media. This creates a complex landscape that can promote sexual violence through priming processes, instigate mimicry of violent media, and presents new opportunities for the perpetration of sexual violence though technology. Development of comprehensive sexual education, including violence prevention education, is imperative, with consideration of age-specific needs for Vietnamese youth.

Development of the Vietnamese Rape Myths Acceptance Scales: A Web-Based Survey of Young Adults.

Rape myths-false but widely held beliefs that serve to deny and justify sexual aggression-present a major barrier to reporting and prevention of sexual violence in Vietnam and globally. Based on a parent study aimed at reducing sexual violence at two universities in Hanoi, we developed and assessed a contextualized measure of rape myths among young people in Vietnam. Items from previously validated rape myth acceptance (RMA) scales and data from qualitative research informed the development of 50 items, which were administered to Vietnamese 18-24-year-olds (n = 2,756 total, n = 1,798 cisgender women) via an anonymous link in February 2021. We used factor analysis to explore and test factor structure and multi-group factor analysis to assess measurement equivalence across gender. We calculated item-level discrimination and difficulty parameters and visualized information curves using item response theory analysis, informing the development of a short form. Four hypothesized subconstructs identified in the qualitative data emerged as factors: (1) "He didn't mean to"; (2) "She asked for it"; (3) "It wasn't really rape"; and (4) "Rape is a deviant event." A fifth factor, "She didn't protect herself," included four items from formative data. Confirming formative findings and prior literature, cisgender women had lower RMA than cisgender men, particularly on items related to victim-blaming. The Vietnamese Rape Myths Acceptance Scales were internally consistent and equivalent between cisgender men and women, capturing elements specific to the Vietnamese context and providing a tool for campus climate surveys and evaluations of sexual violence prevention programs.

Collateral effects of COVID-19 stay-at-home orders on violence against women in the United States, January 2019 to December 2020.

BACKGROUND: The necessary execution of non-pharmaceutical risk-mitigation (NPRM) strategies to reduce the transmission of COVID-19 has created an unprecedented natural experiment to ascertain whether pandemic-induced social-policy interventions may elevate collateral health risks. Here, we assess the effects on violence against women (VAW) of the duration of NPRM measures that were executed through jurisdictional-level orders in the United States. We expect that stay-at-home orders, by reducing mobility and disrupting non-coresident social ties, are associated with higher incident reporting of VAW. METHODS: We used aggregate data from the Murder Accountability Project from January 2019 through December 2020, to estimate count models examining the effects of the duration of jurisdictional-level (N = 51) stay-at-home orders on femicide. Additionally, we used data from the National Incident-Based Reporting System to estimate a series of count models that examined the effects of the duration of jurisdictional-level (N = 26) stay-at-home orders on non-lethal violence against women, including five separate measures of intimate partner violence (IPV) and a measure of non-partner sexual violence. RESULTS: Results from the count models indicated that femicide was not associated with COVID-19 mitigation strategies when adjusted for seasonal effects. However, we found certain measures of non-lethal VAW to be significantly associated in adjusted models. Specifically, reported physical and economic IPV were positively associated with stay-at-home orders while psychological IPV and non-partner sexual violence were negatively associated with stay-at-home orders. The combination measure of all forms of IPV was positively associated with the duration of stay-at-home orders, indicating a net increase in risk of IPV during lockdowns. CONCLUSIONS: The benefits of risk-mitigation strategies to reduce the health impacts directly associated with a pandemic should be weighed against their costs with respect to women's heightened exposure to certain forms of violence and the potentially cascading impacts of such exposure on health. The effects of COVID-19 NPRM strategies on IPV risk nationally and its immediate and long-term health sequelae should be studied, with stressors like ongoing pandemic-related economic hardship and substance misuse still unfolding. Findings should inform the development of social policies to mitigate the collateral impacts of crisis-response efforts on the risk of VAW and its cascading sequelae.

Longitudinal study of COVID-19 stay-at-home orders' impact on deaths of despair in the United States, January 2019 to December 2020.

BACKGROUND: The COVID-19 pandemic led to increase in mental health problems and substance misuse. Yet, little is known about its impact on rates of deaths of despair (death by suicide and drug overdose). Our objective was to determine the impact of COVID-19 stay-at-home orders on deaths of despair using population-level data. We hypothesized that the longer duration of stay-at-home orders would increase rates of deaths of despair. METHODS: Utilizing quarterly suicide and drug-overdose mortality data from the National Center for Health Statistics from January 2019 through December 2020, we estimated fixed-effects models to examine the effects of the duration of stay-at-home orders as differentially implemented in 51 jurisdictions in the United States on each outcome. RESULTS: Controlling for seasonal patterns, the duration of jurisdictional-level stay-at-home order was positively associated with drug-overdose death rates. The duration of stay-at-home orders was not associated with suicide rates when adjusting for calendar quarter. CONCLUSIONS: Findings suggest an increase in age-adjusted drug-overdose death rates in the United States from 2019 to 2020 possibly attributable to the duration of jurisdictional COVID-19 stay-at-home orders. This effect may have operated through various mechanisms, including increases in economic distress and reduced access to treatment programs when stay-at-home orders were in effect.

Preventing sexual violence in Vietnam: qualitative findings from high school, university, and civil society key informants across regions.

BACKGROUND: Sexual violence by young men against women is common, but efficacious primary prevention interventions tailored to men are limited in low- and middle-income settings like Vietnam. GlobalConsent, a web-based sexual violence prevention intervention tailored to university men in Hanoi, is efficacious. Implementation research is needed to understand facilitators and barriers to scaling GlobalConsent and prevention programs generally. We conducted qualitative research with key informants from three youth-focused organizational settings to understand the context of implementation in Vietnam. METHODS: Interviews with university (n = 15), high-school (n = 15) and non-governmental (n = 15) key informants focused on perceptions about sexual violence among young people and prevention programming. Four focus group discussions with 22 interviewed informants, following the Consolidated Framework for Implementation Research, asked about facilitators and barriers to implementing GlobalConsent. Narratives were transcribed, translated, and coded inductively and deductively to identify salient themes. RESULTS: Outer-setting influences included greater expectations for sex among young people alongside norms favoring men's sexual privilege, ostensibly ambiguous and lax laws on sexual violence, government ministries as bureaucratic but potential allies, external subject-matter experts, and the media. Inner-setting influences included variable cultures regarding openness to discuss sexual violence and equitable gender norms, variable departmental coordination, limited funding and 'red tape' especially in public institutions, inconsistent student access to technologies, and limited time and competing priorities among students and teachers. Several actors were considered influential, including institutional leaders, human-resource staff, the Youth Union, and student-facing staff. Important characteristics of individuals for implementation included subject-matter expertise, science or social science training, younger age, engagement in social justice related activities, and more open attitudes about sex. Regarding characteristics of sexual violence prevention programming, some participants preferred online formats for busy students while others suggested hybrid or in-person formats, peer education, and incentives. Participants generally accepted the content of GlobalConsent and suggested adding more content for women, ancillary support services, and adapted content for high-school students. CONCLUSIONS: Implementation of sexual violence prevention programs in youth-focused organizations in Vietnam requires multilevel strategies that connect outer-setting subject-matter experts with supportive inner-setting leaders and student-facing staff to overcome normative and organizational constraints, and thereby, to deliver institution-wide programming.

Adolescent boys' and girls' perspectives on social norms surrounding child marriage in Nepal.

According to recent data, in Nepal, 38.2% of women aged 20-24 years are married by the age of 18. This analysis of CARE's Tipping Point Initiative seeks to compare Nepali adolescent boys' and girls' perceptions of empirical and normative expectations around child, early and forced marriage. A baseline survey of 1,134 adolescent girls and 1,154 adolescent boys provided 11 items for descriptive quantitative analysis. Thirty in-depth interviews and 16 focus groups were conducted with young people aged 12-16 years and analysed using modified Grounded Theory. Themes in the data produced thick descriptions of gender roles/responsibilities, employment, mobility and marriage. Comparisons by gender of normative and empirical expectations, and sanctions on child, early and forced marriage were produced. Gender roles/responsibilities underpin social norms for mobility, marriage and employment, and are connected by subthemes with a focus on responsibility for household chores, interaction between unmarried adolescents, education/financial stability, honour/reputation, and parental decision-makers). Participants agreed on gendered labour, women's employment, and parents as decision-makers. Areas of disagreement included repercussions for interactions between unmarried adolescents, girls' mobility, attributes of the ideal woman, and maintaining family honour. Programming recommendations include focusing on the inter-relatedness of boys' and girls' wellbeing, communication between girls and parents, and structural support for education Research recommendations include identifying factors underlying sexual harassment and constructs of masculinity and femininity.

Global measurement of intimate partner violence to monitor Sustainable Development Goal 5.

BACKGROUND: One third of women experience intimate partner violence (IPV) and potential sequelae. Sustainable Development Goal (SDG) 5.2-to eliminate violence against women, including IPV-compels states to monitor such violence. We conducted the first global measurement-invariance assessment of standardised item sets for IPV. METHODS: Demographic and Health Surveys (DHS) from 36 Lower-/Middle-Income Countries (LMICs) administering 18 IPV items during 2012-2018 were included. Analyses were performed separately for two items sets: lifetime physical IPV (seven items) and controlling behaviours (five items). We performed country-specific exploratory and confirmatory factor analyses (EFA/CFA). Datasets meeting benchmarks for acceptable item loadings and model-fit statistics were included in multiple-group CFA (MGCFA) to test for exact measurement invariance. Based on findings, alignment optimization (AO) was performed to assess approximate measurement invariance (< 25% of model parameters non-invariant). For each item set, national rankings based on AO-derived scores and on prevalence estimates were compared. AO-derived scores were correlated with type-specific IPV prevalences to assess correspondence. RESULTS: National rates of physical IPV (5.6-50.5%) and controlling behavior (25.9-84.7%) varied. For each item set, item loadings and model-fit statistics were adequate in country-specific, unidimensional EFAs and CFAs. Both unidimensional constructs lacked exact invariance in MGCFA but achieved approximate invariance in AO analysis (12.3% of model parameters for physical IPV and 6.7% for controlling behaviour non-invariant). For both item sets, national rankings based on AO-derived scores were distributed similarly to rankings based on prevalence. However, estimates often were not significantly different cross-nationally, precluding national-level comparisons regardless of estimation strategy. Three physical-IPV items (slap, twist, choke) and two controlling-behaviour items (meet female friends; contact with family) warrant cognitive testing to improve their psychometric properties. Correlations of AO-derived scores for physical IPV (0.48-0.66) and controlling behaviours (0.49-0.87) with prevalences of lifetime physical, sexual, psychological IPV as well as controlling behaviour varied. CONCLUSIONS: Seven DHS lifetime physical-IPV items and five DHS controlling-behaviour items were approximately invariant across 36 LMICs spanning five world regions, such that cross-national comparisons of factor means are reasonable. Measurement-invariance testing over time will inform their utility to monitor SDG5.2.1; cross-national, cross-time measurement-invariance testing of improved sexual and psychological IPV item-sets is needed.

Gender norms and sexual consent in dating relationships: a qualitative study of university students in Vietnam.

Social norms surrounding sex and relationships remain gendered among young people in Vietnam, with men maintaining a privileged role in heterosexual relationships. This analysis explored how university students in Vietnam perceived prevailing gender norms, and how these norms influenced men's understanding of sexual consent in dating relationships. This analysis drew primarily on in-depth interviews with heterosexual men and secondarily from interviews with women attending two universities in Hanoi in 2018. Thematic analysis of the interviews revealed a broader narrative about how prevailing gender norms shape men's dating behaviour and beliefs about consent. Participants expected young men to be independent and decisive. Men were seen as free to initiate dating and sexual encounters. Some participants expected young women to be accommodating in dating relationships, although acceptable relationships for women were restricted, and premarital sex was a reputational risk. Most participants described cues for consent and non-consent for sex; however, dismissal of women's refusals, and normalised sexual coercion were common. Among university men in Hanoi, gender norms privileging men and growing expectations of premarital sex may be normalising sexual coercion in dating relationships. University educational programmes are needed to promote equitable gender norms, affirmative sexual consent and expanded definitions of sexual coercion.

Outness, discrimination, and depressive symptoms among bi+ women: The roles of partner gender and sexual identity.

Bisexual and other non-monosexual (bi+) women are at higher risk than monosexual women for mental health problems. While being in a relationship is typically associated with better health outcomes, research suggests an inverse association for bisexual women. Despite emerging evidence of differences in bisexual women's experiences based on the gender of their partner, few studies have considered partner sexual identity. To address this gap, the current study examined influences of partner gender and sexual identity on outness, discrimination, and depressive symptoms in a cross-sectional study of 608 bi+ cisgender women. Adjusting for other demographics, being in a relationship with a bisexual cisgender woman, a lesbian cisgender woman, or a bisexual cisgender man was positively associated with outness and discrimination compared to being in a relationship with a heterosexual cisgender man. Findings highlight the importance of accounting for partner gender and sexual identity in order to understand bi+ women's experiences.

Community Influences on Female Genital Mutilation/Cutting: A Comparison of Four Francophone West African Countries.

Despite long-term efforts to encourage abandonment of female genital mutilation/cutting (FGMC), the practice remains widespread globally. FGMC is situated in specific social and historical contexts, and both prevalence and rates of decline vary widely across practicing countries. However, cross-national comparative research on the determinants of FGMC is sparse. This paper adds to the limited body of rigorous, theoretically grounded quantitative studies of FGMC and takes a step toward advancing cross-national comparative research. We apply an integrated theoretical framework that brings together norms-based and gender-based explanations of community-level influences on FGMC. We test this framework in four francophone West African countries, drawing on comparable nationally representative data from the Demographic and Health Surveys in Burkina Faso (2010), Côte d'Ivoire (2011-2012), Guinea (2012), and Mali (2012-2013). Results show that community-level FGMC norms and community-level gendered opportunities are associated with girls' risk of FGMC, but that the direct and moderating associations vary qualitatively across countries. Our findings highlight the contribution of context-specific social and institutional processes to the decline or persistence of FGMC.

The Reproductive Agency Scale (RAS-17): development and validation in a cross-sectional study of pregnant Qatari and non-Qatari Arab Women.

BACKGROUND: Sustainable Development Goal (SDG) 5 prioritizes women's empowerment and gender equality, alone and as drivers of other SDGs. Efforts to validate universal measures of women's empowerment have eclipsed efforts to develop refined measures in local contexts and lifecycle stages. Measures of women's empowerment across the reproductive lifecycle remain limited, including in the Arab Middle East. METHODS: In this sequential, mixed-methods study, we developed and validated the Reproductive Agency Scale 17 (RAS-17) in 684 women having a normal pregnancy and receiving prenatal care at Hamad Medical Corporation in Doha, Qatar. Participants varied in age (19-46 years), trimester, gravidity (M3.3[SD2.1], range 1-14), and parity (M2.1[SD1.5], range 0-7). Using qualitative research and questionnaire reviews, we developed 44 pregnancy-specific and non-pregnancy-specific agency items. We performed exploratory then confirmatory factor analyses (EFA/CFA) in random split-half samples and multiple-group CFA to assess measurement invariance of the scale across Qatari (n = 260) and non-Qatari Arab (n = 342) women. RESULTS: Non-Qatari women agreed more strongly than Qatari women that every woman should have university education, and working outside home benefitted women. Qatari women agreed more strongly than non-Qatari women that a woman should be free to sell her property. Qatari women reported more influence than non-Qatari women in decisions about spending their money (M4.6 versus M4.4), food they can eat (M4.4 versus M4.2), and rest during pregnancy (M4.5 versus M4.2). Qatari and non-Qatari women typically reported going most places with permission if accompanied. A 17-item, three-factor model measuring women's intrinsic agency or awareness of economic rights (5 items) and instrumental agency in decision-making (5 items) and freedom of movement (7 items) had good fit and was partially invariant across groups. CONCLUSIONS: The RAS-17 is a contextual, multidimensional measure of women's reproductive agency validated in pregnant Qatari and non-Qatari Arab women. This scale integrates pregnancy-specific and non-pregnancy-specific items in dimensions of intrinsic agency and instrumental agency relevant to Arab women of reproductive age. The RAS-17 may be useful to screen for low reproductive agency as a predictor of maternal and perinatal outcomes. The RAS-17 should be validated in other samples to assess its full applicability across the reproductive life cycle.

Preventing sexual violence in college men: a randomized-controlled trial of GlobalConsent.

BACKGROUND: Sexual violence-any sexual act committed against a person without freely given consent-disproportionately affects women. Women's first experiences of sexual violence often occur in adolescence. In Asia and the Pacific, 14% of sexually experienced adolescent girls report forced sexual debut. Early prevention with men that integrates a bystander framework is one way to address attitudes and behavior while reducing potential resistance to participation. METHODS: This paper describes a study protocol to adapt RealConsent for use in Vietnam and to test the impact of the adapted program-GlobalConsent-on cognitive/attitudinal/affective mediators, and in turn, on sexual violence perpetration and prosocial bystander behavior. RealConsent is a six-session, web-based educational entertainment program designed to prevent sexual violence perpetration and to enhance prosocial bystander behavior in young men. The program has reduced the incidence of sexual violence among men attending an urban, public university in the Southeastern United States. We used formative qualitative research and the Centers for Disease Control and Prevention's Map of the Adaptation Process to adapt RealConsent. We conducted semi-structured interviews with college men (n = 12) and women (n = 9) to understand the social context of sexual violence. We conducted focus group discussions with university men and stakeholders (n = 14) to elicit feedback on the original program. From these data, we created scripts in storyboard format of the adapted program. We worked closely with a small group of university men to elicit feedback on the storyboards and to refine them for acceptability and production. We are testing the final program-GlobalConsent-in a randomized controlled trial in heterosexual or bisexual freshmen men 18-24 years attending two universities in Hanoi. We are testing the impact of GlobalConsent (n = 400 planned), relative to a health-education attention control condition we developed (n = 400 planned), on cognitive/attitudinal/affective mediators, prosocial bystander behavior, and sexual violence perpetration. DISCUSSION: This project is the first to test the impact of an adapted, theoretically grounded, web-based educational entertainment program to prevent sexual violence perpetration and to promote prosocial bystander behavior among young men in a middle-income country. If effective, GlobalConsent will have exceptional potential to prevent men's sexual violence against women globally. TRIAL REGISTRATION: U.S. National Library of Medicine Clinicaltrials.gov NCT04147455 on November 1, 2019 (Version 1). Retrospectively registered. Protocol amendments will be submitted to clinicaltrials.gov .

Development and validation of the LoVI: the Laws on Violence against women and girls Index.

BACKGROUND: Violence against women and girls (VAWG) is a human-rights violation with adverse long-term and inter-generational consequences. Redefining VAWG as legally unacceptable is one strategy for social change. The co-occurrence of national laws against VAWG is understudied, and tools to monitor the national legal environment are lacking. We developed the Laws on Violence against Women and Girls Index (LoVI) to measure global progress to develop comprehensive national legislation against child marriage, sexual harassment, domestic violence, and marital rape. METHODS: Using data from 2016 and 2018 for 189 countries from the World Bank Women, Business, and the Law database, we used factor analysis to assess the dimensionality of the LoVI. We examined the distribution of the LoVI across countries and regions, and the relationship of national rankings on the LoVI with those for other indicators from the United Nations, Demographic and Health Surveys, and World Factbook. RESULTS: A single LoVI factor showed good model fit in the factor analysis. National LoVI rankings were positively associated with gender equality in human development and economic rights-related rankings and negatively associated with rates of justifying wife beating and of lifetime and prior-year physical and/or sexual IPV. The LoVI was not associated with national indicators for human development and income inequality. CONCLUSION: The LoVI is a concise, coherent, validated index to monitor the progress of nations on adopting comprehensive legislation to advance 2030 Sustainable Development Goal 5, to eliminate VAWG.

Corrigendum to "Development of the project-level Women's Empowerment in Agriculture Index (pro-WEAI)" [World Development 122 (2019) 675-692].

[This corrects the article DOI: 10.1016/j.worlddev.2019.06.018.].

Comfort in Labor: "Like Being Able to Exhale".

Comfort is a fundamental human need to seek relief, ease, and transcendence. Comfort is relevant to women in labor who experience intense pain and mixed emotions. The subjective meaning of comfort in labor for women is not fully understood. This work was part of a phenomenological study of the experience of childbirth, in which the dynamic of keeping-it-together-falling-apart was identified as an essential quality of women's perceptions of childbirth. Comfort was a salient element of keeping-it-together-falling-apart. In this report, the concept of comfort is explored in greater depth, using qualitative descriptive analysis. Eight participants, aged 23 to 38 years, with spontaneous vaginal births, were each interviewed twice about the childbirth experience. Comfort was a holistic experience of relaxation and relief, where the needs of the body and the person were being met. Comfort and pain coexisted with each other, and relief of pain did not always provide comfort. Women had an innate knowledge of comfort, but their capacity for choice was at times restricted by caregivers in the hospital. There are aspects of labor care that do not support comfort, particularly as it relates to mobility and choice. Prioritizing comfort as well as pain relief may contribute to a more holistic, satisfying birth experience for women.

Cognitive interviewing to improve women's empowerment questions in surveys: Application to the health and nutrition and intrahousehold relationships modules for the project-level Women's Empowerment in Agriculture Index.

In 2015, the United Nations adopted the Sustainable Development Goals, which include fostering gender equality and women's empowerment and ending hunger and malnutrition. To monitor progress and evaluate programmes that aim to achieve these goals, survey instruments are needed that can accurately assess related indicators. The project-level Women's Empowerment in Agriculture Index (pro-WEAI) is being developed to address the need for an instrument that is sensitive to changes in empowerment over the duration of an intervention. The pro-WEAI includes new modules with previously untested survey questions, including a health and nutrition module (focused on women's agency in this area) and an intrahousehold relationships module. This study uses cognitive interviewing to identify how new survey questions might be misinterpreted and to understand what experiences women are referencing when they respond to these questions. This was undertaken with the goal of informing revision to the modules. The study was conducted in Bangladesh with women from nuclear, extended, and migrant-sending households and from two regions of the country to identify difficulties with interpretation and response formulation across these groups. Findings revealed that questions were generally understood, but participants occasionally responded to the wrong part of the question, did not understand key phrases, or were uncomfortable with questions. The findings also suggested ways to revise the modules and strengthen the pro-WEAI. The revised pro-WEAI health and nutrition and intrahousehold relationships modules will advance the ability to measure changes in these domains and their relationship with the health and nutritional status of women and their children.

Human and economic resources for empowerment and pregnancy-related mental health in the Arab Middle East: a systematic review.

This systematic review synthesizes research on the influence of human and economic resources for women's empowerment on their pre- and postnatal mental health, understudied in the Arab world. We include articles using quantitative methods from PubMed and Web of Science. Two researchers reviewed databases and selected articles, double reviewing 5% of articles designated for inclusion. Twenty-four articles met inclusion criteria. All 24 articles measured depression as an outcome, and three included additional mental health outcomes. Nine of 17 studies found an inverse association between education and depression; two of 12 studies found contradictory associations between employment and depression, and four of six studies found a positive association between financial stress and depression. These results suggest that there is a negative association between education and depression and a positive association between financial stress and depression among women in the Arab world. Firm conclusions warrant caution due to limited studies meeting inclusion criteria and large heterogeneity in mental health scales used, assessment measures, and definitions of human and economic resources for women's empowerment. It is likely that education reduces depression among postpartum women and that financial stress increases their depression. These findings can be used to aid in the design of interventions to improve mother and child outcomes. However, more research in the Arab world is needed on the relationship between human and economic resources for women's empowerment and perinatal mental health, and more consistency is needed in how resources and mental health are measured.

Validation of three mental health scales among pregnant women in Qatar.

OBJECTIVES: The objective of this study is to validate three mental health scales in a targeted sample of pregnant Arab women living in Qatar: the Kuwait University Anxiety Scale, the Perceived Stress Scale, and the Edinburgh Postnatal Depression Scale. METHODS: Random split-half exploratory factor analysis and confirmatory factor analyses (n = 336; n = 331), conducted separately, were used to evaluate scale dimensionality, factor loadings, and factor structure of the KUAS, the PSS, and the EPDS. RESULTS: Fit statistics for the three scales suggested adequate fit to the data and estimated factor loadings were positive, similar in magnitude, and were significant. The final CFA model for the KUAS supported a 19-item, two factor structure. CFA models also confirmed 8- and 10-item, single-factor structures for the PSS and EPDS, respectively. CONCLUSIONS: The validation of scales for these aspects of mental health in Arab pregnant women is critical to ensure appropriate screening, identification, and treatment to reduce the risk of sequelae in women and their children. Findings offer a useful comparison to mental-health scale validations in other Arab contexts.

Measurement properties of the project-level Women's Empowerment in Agriculture Index.

Women's empowerment is a process that includes increases in intrinsic agency (power within); instrumental agency (power to); and collective agency (power with). We used baseline data from two studies-Targeting and Realigning Agriculture for Improved Nutrition (TRAIN) in Bangladesh and Building Resilience in Burkina Faso (BRB)-to assess the measurement properties of survey questions operationalizing selected dimensions of intrinsic, instrumental, and collective agency in the project-level Women's Empowerment in Agricultural Index (pro-WEAI). We applied unidimensional item-response models to question (item) sets to assess their measurement properties, and when possible, their cross-context measurement equivalence-a requirement of measures designed for cross-group comparisons. For intrinsic agency in the right to bodily integrity, measured with five attitudinal questions about intimate partner violence (IPV) against women, model assumptions of unidimensionality and local independence were met. Four items showed good model fit and measurement equivalence across TRAIN and BRB. For item sets designed to capture autonomy in income, intrinsic agency in livelihoods activities, and instrumental agency in: livelihoods activities, the sale or use of outputs, the use of income, and borrowing from financial services, model assumptions were not met, model fit was poor, and items generally were weakly related to the latent (unobserved) agency construct. For intrinsic and instrumental agency in livelihoods activities and for instrumental agency in the sale or use of outputs and in the use of income, items sets had similar precision along the latent-agency continuum, suggesting that similar item sets could be dropped without a loss of precision. IRT models for collective agency were not estimable because of low reported presence and membership in community groups. This analysis demonstrates the use of IRT methods to assess the measurement properties of item sets in pro-WEAI, and empowerment scales generally. Findings suggest that a shorter version of pro-WEAI can be developed that will improve its measurement properties. We recommend revisions to the pro-WEAI questionnaire and call for new measures of women's collective agency.

Development of the project-level Women's Empowerment in Agriculture Index (pro-WEAI).

With growing commitment to women's empowerment by agricultural development agencies, sound methods and indicators to measure women's empowerment are needed to learn which types of projects or project-implementation strategies do and do not work to empower women. The Women's Empowerment in Agriculture Index (WEAI), which has been widely used, requires adaptation to meet the need for monitoring projects and assessing their impacts. In this paper, the authors describe the adaptation and validation of a project-level WEAI (or pro-WEAI) that agricultural development projects can use to identify key areas of women's (and men's) disempowerment, design appropriate strategies to address identified deficiencies, and monitor project outcomes related to women's empowerment. The 12 pro-WEAI indicators are mapped to three domains: intrinsic agency (power within), instrumental agency (power to), and collective agency (power with). A gender parity index compares the empowerment scores of men and women in the same household. The authors describe the development of pro-WEAI, including: (1) pro-WEAI's distinctiveness from other versions of the WEAI; (2) the process of piloting pro-WEAI in 13 agricultural development projects during the Gender, Agriculture, and Assets Project, phase 2 (GAAP2); (3) analysis of quantitative data from the GAAP2 projects, including intrahousehold patterns of empowerment/disempowerment; and (4) a summary of the findings from the qualitative work exploring concepts of women's empowerment in the project sites. The paper concludes with a discussion of lessons learned from pro-WEAI and possibilities for further development of empowerment metrics.