Intimate partner violence and infant feeding practices in India: a cross-sectional study.

Intimate partner violence (IPV) is widespread; yet research is thin and equivocal regarding its potential adverse effects on infant feeding practices. With a national sample of 3552 mothers and infants aged 180 days or younger from the 2005-2006 National Family Health Survey for India, we used logistic regression to estimate the unadjusted and adjusted associations of maternal reported lifetime exposure to any IPV and to physical or sexual IPV with feeding practices at birth and in the prior 24 h. Compared with their unexposed counterparts, mothers exposed to any IPV and to any physical or sexual IPV had higher adjusted odds of giving their infant liquids [aOR 1.32, 95% confidence interval (CI) 1.04-1.66; aOR 1.37, 95% CI 1.08-1.75, respectively], and thus lower adjusted odds of exclusively breastfeeding their infant in the prior 24 h (aOR 0.78, 95% CI 0.62-0.98; aOR 0.74, 95% CI 0.58-0.95). Mothers exposed to physical or sexual IPV also had higher adjusted odds of feeding their infant solids in the prior 24 h (aOR 1.50, 95% CI 1.01-2.23). Exposure to IPV was not significantly associated with breastfeeding immediately after birth or with bottle feeding in the prior 24 h. Perinatal screening for IPV, and addressing IPV and feeding practices in exposed mothers, may improve maternal health and infant nutrition in similar settings.

Measuring attitudes about intimate partner violence against women: the ATT-IPV scale.

In lower-income settings, women more often than men justify intimate partner violence (IPV). Yet, the role of measurement invariance across gender is unstudied. We developed the ATT-IPV scale to measure attitudes about physical violence against wives in 1,055 married men and women ages 18-50 in My Hao district, Vietnam. Across 10 items about transgressions of the wife, women more often than men agreed that a man had good reason to hit his wife (3 % to 92 %; 0 % to 67 %). In random split-half samples, one-factor exploratory factor analysis (EFA) (N 1 = 527) and confirmatory factor analysis (CFA) (N 2 = 528) models for nine items with sufficient variability had significant loadings (0.575-0.883; 0.502-0.897) and good fit (RMSEA = 0.068, 0.048; CFI = 0.951, 0.978, TLI = 0.935, 0.970). Three items had significant uniform differential item functioning (DIF) by gender, and adjustment for DIF revealed that measurement noninvariance was partially masking men's lower propensity than women to justify IPV. A CFA model for the six items without DIF had excellent fit (RMSEA = 0.019, CFI = 0.994, TLI = 0.991) and an attitudinal gender gap similar to the DIF-adjusted nine-item model, suggesting that the six-item scale reliably measures attitudes about IPV across gender. Researchers should validate the scale in urban Vietnam and elsewhere and decompose DIF-adjusted gender attitudinal gaps.

Fertility decline, girls' well-being, and gender gaps in children's well-being in poor countries.

The influences of recent dramatic declines in fertility on girls' and boys' well-being in poorer countries are understudied. In panels of 67-75 poorer countries, using 152-185 Demographic and Health Surveys spanning 1985-2008, we examined how declining total fertility and women's increasing median age at first birth were associated with changes in girls' well-being and gender gaps in children's well-being, as reflected in their survival, nutrition, and access to preventive healthcare. In adjusted random-effects models, these changes in fertility were associated with gains in girls' survival at ages 1-4 years, vaccination coverage at ages 12-23 months, and nutrition at 0-36 months (for women's later first childbearing). Declining total fertility was associated with similar gains for boys and girls with respect to vaccination coverage but intensified gender gaps in mortality at ages 1-4 years and malnutrition at ages 0-36 months, especially in higher-son-preference populations. Later increases in women's median age at first birth-reflecting more equitable gender norms-were associated with declines in these gaps. Promoting equitable investments in children through family planning programs in higher-fertility societies is warranted.

Intimate partner violence and women's economic and non-economic activities in Minya, Egypt.

Intimate partner violence (IPV) against women is widespread, but its implications for their economic and non-economic activities are understudied. Leveraging new data from 564 ever-married women aged 22­65 in rural Minya, Egypt, we estimated logistic regressions and zero-inflated negative binomial regressions to test spillover, compensation, and patriarchal bargaining theories about the influences of women's exposure to IPV on their engagement in and time spent on market, subsistence, domestic, and care work. Supporting compensation theory, exposures to lifetime, recent, and chronic physical or sexual IPV were associated with higher adjusted odds of performing market work in the prior month, and exposures to recent and chronic IPV were associated with higher adjusted odds of performing subsistence work in this period. Supporting compensation and patriarchal bargaining theories, exposures to recent and chronic IPV were associated with more time spent on domestic work in the prior day. Supporting spillover and patriarchal bargaining theories, exposures to lifetime IPV of all forms were associated with lower adjusted odds of performing mostly nonspousal care work in the prior day, and this association was partially mediated by women's generalized anxiety. Women in rural Minya who are exposed to IPV may escalate their housework to fulfill local norms of feminine domesticity while substituting economic activities for nonspousal care work to enhance their economic independence from violent partners.

Women's empowerment and generalized anxiety in Minya, Egypt.

Gender disparities in mental health are global, with women experiencing higher rates than men of anxiety disorders, mood disorders, and attempted suicide. Women's low social status may partly explain these disparities, yet evidence from Arab and Middle Eastern settings is limited. We assessed whether women's empowerment - or acquisition of enabling resources, and in turn, enhanced agency - was associated with their lower generalized anxiety. For 539 ever-married women 22-65 years who participated in the 2005 Egypt Demographic Health Survey (EDHS) and a 2012 follow-up survey in rural Minya, we estimated linear reduced-form and mediation regression models to assess the associations of women's premarital enabling resources with their generalized anxiety in 2012, overall and through measures of their marital agency in 2005. Women's higher schooling attainment, premarital economic activity, later age at first marriage, and greater proximity to natal (or birth) family had significant, adjusted associations with lower generalized anxiety. Measures of women's agency in marriage had mixed associations with generalized anxiety, but their inclusion modestly reduced the coefficients for premarital resources. Parallel qualitative findings confirmed nuanced associations between women's exclusive decision-making and their mental health. Efforts to enhance women's education and premarital economic activity might be combined with efforts to delay first marriage and ensure women's extra-marital social support to maximize their empowerment and its mental-health benefits.

Measuring attitudes about women's recourse after exposure to intimate partner violence: the ATT-RECOURSE scale.

Attitudes about intimate partner violence (IPV) against women are widely surveyed, but attitudes about women's recourse after exposure to IPV are understudied, despite their importance for intervention. Designed through qualitative research and administered in a probability sample of 1,054 married men and women 18 to 50 years in My Hao District, Vietnam, the ATT-RECOURSE scale measures men's and women's attitudes about a wife's recourse after exposure to physical IPV. Data were initially collected for nine items. Exploratory factor analysis (EFA) with one random split-half sample (N 1 = 526) revealed a one-factor model with significant loadings (0.316-0.686) for six items capturing a wife's silence, informal recourse, and formal recourse. A confirmatory factor analysis (CFA) with the other random split-half sample (N 2 = 528) showed adequate fit for the six-item model and significant factor loadings of similar magnitude to the EFA results (0.412-0.669). For the six items retained, men consistently favored recourse more often than did women (52.4%-66.0% of men vs. 41.9%-55.2% of women). Tests for uniform differential item functioning (DIF) by gender revealed one item with significant uniform DIF, and adjusting for this revealed an even larger gap in men's and women's attitudes, with men favoring recourse, on average, more than women. The six-item ATT-RECOURSE scale is reliable across independent samples and exhibits little uniform DIF by gender, supporting its use in surveys of men and women. Further methodological research is discussed. Research is needed in Vietnam about why women report less favorable attitudes than men regarding women's recourse after physical IPV.

Understanding global trends in maternal mortality.

CONTEXT: Despite the fact that most maternal deaths are preventable, maternal mortality remains high in many developing countries. Target A of Millennium Development Goal (MDG) 5 calls for a three-quarters reduction in the maternal mortality ratio (MMR) between 1990 and 2015. METHODS: We derived estimates of maternal mortality for 172 countries over the period 1990-2008. Trends in maternal mortality were estimated either directly from vital registration data or from a hierarchical or multilevel model, depending on the data available for a particular country. RESULTS: The annual number of maternal deaths worldwide declined by 34% between 1990 and 2008, from approximately 546,000 to 358,000 deaths. The estimated MMR for the world as a whole also declined by 34% over this period, falling from 400 to 260 maternal deaths per 100,000 live births. Between 1990 and 2008, the majority of the global burden of maternal deaths shifted from Asia to Sub-Saharan Africa. Differential trends in fertility, the HIV/AIDS epidemic and access to reproductive health are associated with the shift in the burden of maternal deaths from Asia to Sub-Saharan Africa. CONCLUSIONS: Although the estimated annual rate of decline in the global MMR in 1990-2008 (2.3%) fell short of the level needed to meet the MDG 5 target, it was much faster than had been thought previously. Targeted efforts to improve access to quality maternal health care, as well as efforts to decrease unintended pregnancies through family planning, are necessary to further reduce the global burden of maternal mortality.

A New Method for Deriving Global Estimates of Maternal Mortality.

Maternal mortality is widely regarded as a key indicator of population health and of social and economic development. Its levels and trends are monitored closely by the United Nations and others, inspired in part by the UN's Millennium Development Goals (MDGs), which call for a three-fourths reduction in the maternal mortality ratio between 1990 and 2015. Unfortunately, the empirical basis for such monitoring remains quite weak, requiring the use of statistical models to obtain estimates for most countries. In this paper we describe a new method for estimating global levels and trends in maternal mortality. For countries lacking adequate data for direct calculation of estimates, we employed a parametric model that separates maternal deaths related to HIV/AIDS from all others. For maternal deaths unrelated to HIV/AIDS, the model consists of a hierarchical linear regression with three predictors and variable intercepts for both countries and regions. The uncertainty of estimates was assessed by simulating the estimation process, accounting for variability both in the data and in other model inputs. The method was used to obtain the most recent set of UN estimates, published in September 2010. Here, we provide a concise description and explanation of the approach, including a new analysis of the components of variability reflected in the uncertainty intervals. Final estimates provide evidence of a more rapid decline in the global maternal mortality ratio than suggested by previous work, including another study published in April 2010. We compare findings from the two recent studies and discuss topics for further research to help resolve differences.