Economic Abuse of Women in Intimate Relationships in Ghana: Consequences and Coping Strategies.

Economic abuse is a significant gender-based problem in Ghana and sub-Saharan Africa, but few studies explore the consequences of this type of abuse on women's lives and their coping strategies. This study examined the narratives of 16 Ghanaian women in intimate relationships who experienced economic abuse in the Greater Accra, Ashanti, and Upper East regions of Ghana. Results indicate economic abuse negatively affected female survivors' jobs, businesses, and food security and led to physical violence and adverse health implications. Some women coped by relying on external family networks, religion, and theft from husbands, while others trivialized their experiences.

COVID-19, pandemic lockdowns and intimate partner violence among HIV-positive women in Ghana.

This study examines the prevalence and risk factors of physical, sexual, psychological, and economic violence during lockdowns associated with COVID-19 among HIV-positive women in Ghana. Data were collected in August 2021 from a cross-section of 538 HIV-positive women aged 18 years and older in the Lower Manya Krobo District in the Eastern region of Ghana. Logit models were used to explore relationships between women's self-reported experiences of physical, sexual, psychological /emotional, and economic violence under lockdown and key socio-economic and demographic characteristics. The findings indicate moderate to high prevalence of intimate partner violence (IPV) under lockdown in our sample: physical violence (30.1%), sexual violence (28.6%), emotional/psychological violence (53.7%), and economic violence (54.2%). IPV was higher on all four measures for educated women, poorer women, employed women, cohabiting and married women, and HIV seroconcordant couples.

Physical, sexual, and psychosocial health impacts of child abuse: Evidence from Ghana.

Child abuse is a significant global health problem. While data on child abuse in Ghana are scant, anecdotal evidence suggests the vast majority of Ghanaian children have experienced some form of physical or sexual abuse. This paper explores links between early childhood abuse and health outcomes using a life course perspective. Nationally representative cross-sectional data were collected from a sample of 2289 ever-married Ghanaian women in 2017. Women provided retrospective accounts of different types of violence in early childhood. Random-effects logit models were used to examine the impact of two dimensions of early childhood abuse (physical and sexual) on the physical, sexual, and psychosocial health outcomes of women in later years. Women who experienced childhood physical abuse, but not often, were significantly more likely to report physical disabilities in later years than women who did not experience it. Women reporting childhood sexual abuse were more likely to be depressed in later years than those who never experienced such abuse. They were also significantly more likely to report sexually transmitted diseases. Our findings provide support for the life course theory by showing abuse experienced in childhood could have a long-term impact. We therefore suggest the need for early interventions to address child abuse.

Understanding sibling violence and its impact over the life course: The case of Ghana.

Sibling relationships are a significant part of family dynamics, and sibling violence may be manifested in these relationships. Sibling violence has rarely been examined in the domestic violence literature on sub-Saharan Africa, so little is known about its prevalence or consequences. This study used a life course perspective to examine the effects of sibling violence on Ghanaian women's intimate partner violence (IPV) victimization and perpetration in adulthood. Data were collected from about 1700 ever-married Ghanaian women aged 18 years and above between May and August 2022. Logit models were used to explore retrospective accounts of women's experience of various types of sibling violence in childhood and their later victimization and/or perpetration of IPV. Results showed sibling violence was prevalent in our sample: 51.2% experienced sibling emotional violence, 39.5% experienced physical violence, and 2.3% experienced sexual violence. Our findings generally supported the life course perspective. Women with experiences of sibling physical, sexual, and emotional violence were significantly more likely to perpetrate physical, sexual, and emotional IPV in adulthood. Similarly, women with experiences of sibling violence were more likely to report IPV victimization in later years. Domestic violence interventions should pay attention to sibling relationships in children's early years.

Interventions impacting the accessibility of sexual reproductive health services for head porters in sub-Saharan Africa- A scoping review protocol.

Head porters working in markets in sub-Saharan Africa (SSA) are one of the world's most vulnerable and socioeconomically disadvantaged groups. They consist predominantly of uneducated women and girls seeking to escape poverty, early marriage, and other issues of domestic violence. Most female head porters are in their reproductive years and often lack access to sexual reproductive health services (SRHS) despite being at high risk for sexually transmitted infections (STIs), unplanned pregnancies, and gender-based violence. The low priority for women and girls' SRH in many SSA countries highlights the need to explore the factors influencing the accessibility of services for failure to do so restrains human development. An initial search of the literature was conducted and revealed no current scoping or systematic reviews on the accessibility to SRHS for female head porters in SSA. We outline a scoping review protocol, using the Joanna Briggs Institute methodology, to determine the interventions that influence the accessibility of SRHS for female head porters in SSA. The protocol is registered with Open Science Framework (https://osf.io/hjfkd). Findings will not only be valuable for female head porters but for all vulnerable female groups in SSA who experience high SRH risks and social disparities.

"The Little Money I Get Is Used to Buy Drugs": A Qualitative Exploration of the Economic Cost of Intimate Partner Violence for Female Survivors in Ghana.

Empirical research confirms the economic costs of intimate partner violence (IPV) for women. Yet, scholarship on this topic is lacking in Ghana, where IPV against women is commonplace. We used in-depth interviews with 15 female survivors of IPV in the Eastern Region to examine the economic costs of IPV for women. Findings showed that the economic costs were both direct and indirect. Direct costs included out-of-pocket payments for medical and nonmedical services, while indirect costs included diminished work abilities, increased absenteeism from work, and lowered work productivity. Ghanaian policymakers must enforce and strengthen policies to prevent violence against women.

Intimate Partner Violence and Health Outcomes Among Women Living With HIV/AIDS in Ghana: A Cross-Sectional Study.

Intimate partner violence (IPV) is known to have negative health consequences for victims. For women living with HIV/AIDS, whose health may be compromised, exposure to IPV can be devastating. Yet few (if any) studies have explored the health implications of exposure to IPV among HIV-positive women. We begin to fill this gap by examining the effects of various dimensions of IPV (physical, sexual, psychological/emotional, and economic) on the cardiovascular, psychosocial, and sexual reproductive health outcomes of HIV-positive women in Ghana. Data were collected from a cross-section of 538 HIV-positive women aged 18 years and older in the Lower Manya Krobo District in the Eastern Region. We used logit models to explore relationships between IPV and health. The findings indicate high prevalence of IPV in our sample: physical violence (61%), sexual violence (50.9%), emotional/psychological violence (79.6%), and economic violence (66.8%). Generally, participants with experiences of IPV reported cardiovascular health problems, unwanted pregnancies and pregnancy loss, and poor psychosocial health. Our findings suggest the importance of screening for IPV as part of HIV care in Ghana.

Motivations and Barriers to Help-Seeking Among Female Victims of Intimate Partner Violence in Ghana.

This study used qualitative data from 30 women in three of Ghana's 16 administrative regions to explore motivations and barriers to help-seeking among victims of intimate partner violence. Results of the thematic analysis showed low reporting to formal support networks, such as the Domestic Violence and Victim Support Unit or the police, with higher preference for informal sources, such as family members and friends. Motivations to seek help included fatigue, severity of abuse, abusive partner's negligence in honoring marital obligations, and trust in family members. Barriers to help-seeking included: fear of divorce, stigmatization, lack of trust in formal support channels, sociocultural norms emphasizing gender role expectations, and family privacy.

Examining the effects of individual and neighbourhood socioeconomic status/wealth on hypertension among women in the Greater Accra Region of Ghana.

Hypertension is one of the leading causes of morbidity and mortality among women in sub-Saharan Africa. Although research on the relationship between individual-level socioeconomic status (SES) and hypertension exists, to the best of our knowledge, limited empirical studies examined the effects of neighbourhood-level SES/wealth on the risks of living with hypertension in Ghana. Using data from the 2009 Women's Health Study of Accra (WHSA-II), and applying multilevel logistic regression, this study investigates the effects of both individual and neighbourhood wealth status on hypertension among women in the Greater Accra Region of Ghana. The results show that individual-level SES/wealth is a significant determinant of hypertension among Ghanaian women in Accra. Specifically, wealthy women are more likely to be hypertensive compared to poorer women. However, the effect of neighbourhood SES/wealth was attenuated after adjusting for individual-level SES/wealth. These findings suggest that it is important to develop health promotion programs targeted at a segment of SES group in the prevention, control and management of hypertension among women in the Greater Accra Region of Ghana.

Risk factors for Caesarean sections in Ghana: evidence from the Ghana Maternal Health Survey.

A Caesarean section can be a life-saving intervention in case of pregnancy complications or difficult labour. The prevalence of Caesarean section continues to increase, especially in sub-Saharan Africa, yet the reasons for this remain largely unexplored. This study investigated risk factors contributing to the decision to perform Caesarean sections in Ghana using data from 8645 women aged 15-49 years from the 2017 Ghana Maternal Health Survey. The data were analysed by applying complementary log-log and logit models. The majority of Ghanaian women (about 87%) reported preferring vaginal delivery to Caesarean section. Of those who had undergone a Caesarean section for their most recent birth, about 55% had an elective rather than an emergency section. Women with labour complications (prolonged/obstructed labour) were significantly more likely to have a Caesarean section (OR=4.09, 95% CI=3.10-5.41). Furthermore, women with maternal complications, particularly prolonged/obstructed labour, were less likely to have an elective Caesarean section than those who had no such complications (OR=0.25, 95% CI=0.14-0.46). Compared with poorer women, wealthy women were significantly more likely to have an elective Caesarean section (OR=1.84, 95% CI=1.08-3.14). The findings suggest that beyond maternal complications, women's socioeconomic and demographic characteristics are important risk factors for undergoing a Caesarean section in Ghana.

Barriers to Help-Seeking for Sexual Violence Among Married or Cohabiting Women in Ghana.

While sexual violence against women has gained attention in sub-Saharan Africa, research examining help-seeking remains limited. Scholarship on barriers to help-seeking among sexually abused married or cohabiting women is particularly lacking. We used the barriers model and held 15 in-depth interviews with sexually abused Ghanaian married or cohabiting women to examine help-seeking behaviors. Participants identified multiple barriers to help-seeking, including financial difficulties, lack of social support, and stigma. The results corroborate the barriers model's formulation of the challenges faced by female survivors in reporting violence. They indicate the need to improve laws to promote help-seeking among women with experiences of sexual violence.

Trends in type 1 diabetes diagnosis in Ghana.

BACKGROUND: Despite the fact that the rate of type 1 diabetes (T1D) is increasing worldwide, there exists a dearth of information on the disease in most sub-Saharan African countries. The goal of this study was to determine the enrolment trend of T1D using data compiled over 28 y from a teaching hospital in Kumasi, Ghana. METHODS: Information collected included sex, age at diagnosis and date of T1D diagnosis. We identified trends from 1992 to 2018, divided into 3 y intervals. RESULTS: From 1992 to 2018, 1717 individuals with T1D were enrolled in the diabetes clinic at the Komfo Anokye Teaching Hospital. The male:female ratio was 1:1.2. The number of individuals diagnosed with T1D decreased among the 10-19 y age group during the 1992-1994 period, followed by a progressive increase within the same age group during the subsequent period (from 35.4% in 1995-1997 to 63.2% in 2016-2018). There was a decline in the proportion of children 0-9 y of age diagnosed during the study period (from 5.1% in 1992-1994 to 3.6% in 2016-2018). CONCLUSIONS: In our study population, a decreasing trend of T1D enrolments was observed in general while among adolescents an increasing trend was observed.

Silent and Lethal: Consequences of Sexual Violence Against Married Women in Ghana.

Extant research, mostly in western countries, confirms the consequences of sexual violence against women, but academic scholarship on this topic remains scant for Ghana. This study built on existing research by exploring the consequences of sexual violence against married women in the Eastern Region of Ghana. Data were obtained from in-depth interviews purposely conducted with 15 survivors of sexual violence. The thematic analysis showed that sexual violence was accompanied by physical and emotional abuse. Following sexual violence and abuse, these women experienced physical injuries, psychological problems, sexual and reproductive health problems, and suicidal ideations. These health difficulties significantly undermined their economic activities and depleted their income. Sexual violence clearly affects women's empowerment; campaigns against gender-based violence should make sexual violence a top priority in Ghana and elsewhere.

Intimate Partner Violence (IPV) Against HIV-Positive Women in Sub-Saharan Africa: A Mixed-Method Systematic Review and Meta-Analysis.

OBJECTIVES: To systematically analyze and summarize the literature on intimate partner violence (IPV) against HIV-positive women in sub-Saharan Africa (SSA) and to identify their risk factors for IPV. METHOD: A comprehensive review of the literature using the Preferred Reporting Item for Systematic Review and Meta-Analysis (PRISMA) and Meta-Analyses of Observational Studies in Epidemiology (MOOSE) yielded 1,879 articles (PubMed = 1,251, Embase = 491, Web of Science = 132, and identified additional records = 5). Twenty were selected for quantitative and qualitative assessment and synthesis. We employed a random effects model with generic inverse variance method and estimated the odds ratios. FINDINGS: Results indicated a high prevalence of physical, sexual, and emotional violence against women living with HIV/AIDS in SSA. Educational background, alcohol use, marital status, previous experiences with IPV, and employment status were identified as significant risk factors. We also assessed the methodological quality of the articles by examining publication bias and some heterogeneity statistics. CONCLUSION: There is limited research on IPV against HIV-positive women in SSA. However, the few existing studies agree on the importance of targeting HIV-positive women with specific interventions given their vulnerability to IPV and to address factors exacerbating these risks and vulnerabilities.

Determinants of Sexual Violence Against Married Women: Qualitative Evidence From Ghana.

Some evidence suggests that in sub-Saharan Africa, sexual violence is commonplace among married women, yet this problem is underresearched. Using qualitative methods and applying Heise's social-ecological model, this study examined the experiences of 15 Ghanaian women suffering sexual violence in their marriages. Results from the thematic analysis indicate several determinants of sexual violence. Whereas some participants identified macro-level and exosystem factors, including poverty, others pointed to micro-level and ontogenic factors, such as husbands' substance abuse. The results corroborate the core idea of Heise's framework, namely, that structural- and individual-level factors make women vulnerable to violence. The study concludes that Ghanaian legal and policy frameworks must be enforced and strengthened to address the etiology of sexual violence and abuse.

The contexts of housing stability and change among HIV-positive persons in the Lower Manya Krobo Municipality, Ghana.

Due to stigma, discrimination and economic insecurity, persons living with HIV/AIDS (PLWHAs) are highly vulnerable to housing instability. For instance, PLWHAs are more likely to either remain stable in inadequate homes or change residence. Yet, few studies explore the contexts of housing stability and change among PLWHAs, especially in sub-Saharan Africa, where the majority reside. This study used qualitative in-depth interviews to explore the narratives of 38 PLWHAs on the contexts of housing stability and the circumstances leading to change in residence. On diagnosis with HIV, the majority of PLWHAs (58%) changed housing locations, mostly from bad to worse conditions. Reasons for change include: eviction due to stigma and discrimination, inability to afford rent, quest to hide HIV status and death of a cohabiting partner. Our findings suggest policy makers should pay attention to the deplorable and poor housing conditions of PLWHAs in Ghana.

Determinants of Low Birth Weight in Ghana: Does Quality of Antenatal Care Matter?

OBJECTIVES: Low birth weight is a public health issue that contributes to perinatal and infant mortality, especially in limited-resource settings, but there is limited understanding of the determinants of low birth weight and the contributions of quality antenatal care to maintaining healthy birth weights for newborns in such settings. This study aims at establishing links between birthweight and quality antenatal care in Ghana. METHODS: We used data collected from the recent 2017 Ghana Maternal Health Survey and applied complementary log-log models to investigate relationships between the quality of antenatal care (screening/diagnostic procedures, clinical interventions, type of health provider) and low birth weight in Ghana. RESULTS: The results reveal that compared to women who received low quality clinical interventions, those who received high quality interventions were significantly less likely to have a low birth weight baby. Similarly, women who made the recommended number of antenatal visits (at least eight) were significantly less likely to have a baby with low birth weight than women making fewer visits. CONCLUSION: Our findings suggest that while the number of antenatal visits is important, the quality of care received during such visits is equally relevant to reducing low birth weight in Ghana.

Social Support Systems and the Self-Management of Non-Communicable Diseases (NCDs) in Ghana.

There is a large body of literature on the role of social support systems in the management of chronic conditions in the West, with limited research on the sub-Saharan African and Ghanaian context. In the past, the organization and delivery of formal health services in Ghana were geared towards the treatment of infectious diseases rather than non-communicable diseases (NCDs). We conducted qualitative interviews with a sample of 33 NCD patients purposefully selected from two teaching hospitals in Ghana. The information they provided indicated that the most common types of support received were instrumental and emotional. While a majority of stroke patients experienced activity limitations related to bathing and cooking, they received the emotional support necessary to maintain their psychological well-being. Overall, we found social connections and relationships were an important strategy in the promotion of the physical and mental well-being of these NCD patients.

Ghanaian Women's Knowledge and Perceptions of Services Available to Victims of Intimate Partner Violence.

This article presents qualitative findings on women's knowledge and perceptions of services available to victims of domestic violence in Ghana. In addition, the challenges to access of service and service delivery are explored. Semistructured interviews were conducted with 10 female residents of Sowutuom, a periurban community in Accra, Ghana. An additional three semistructured interviews were also conducted with local service providers in Accra. Results showed that awareness among respondents of available services was low. The majority of women had heard of the Domestic Violence and Victim Support Unit of the Ghana Police Service, though they had limited knowledge of the kind of support provided by this service provider. In addition, most women expressed doubt in the ability of these services to adequately handle cases of intimate partner violence. This study demonstrates that more educational campaigns need to be carried out to raise awareness among Ghanaians on domestic violence and the formal interventions available in the country.

Intimate Partner Violence and the Sexual and Reproductive Health Outcomes of Women in Ghana.

Few studies have examined the relationships between intimate partner violence (IPV) and the sexual and reproductive health outcomes of women in sub-Saharan countries in general and Ghana specifically. This study began to fill the gap by investigating whether individual- and community-level IPV influenced unwanted pregnancy and pregnancy loss among women in Ghana. Nationally representative cross-sectional data were collected from 2,289 ever-married women, and multilevel modeling was used to estimate individual- and community-level effects. At the individual level, IPV was significantly associated with unwanted pregnancy and pregnancy loss. Women with experience of both physical and sexual violence were more likely to have reported an unwanted pregnancy and a pregnancy loss. However, only those experiencing sexual violence reported unwanted pregnancies. Similarly, community-level IPV was associated with sexual health outcomes. Respondents in communities with higher levels of sexual violence were significantly more likely to have had unwanted pregnancies. The findings corroborate calls for policy makers to consider IPV a reproductive health issue. They also emphasize the need to move beyond individual-level interventions to consider structural and community contexts when addressing the sexual and reproductive health outcomes of women in Ghana.