Sexual and Reproductive Healthcare Needs of Refugee Women Exposed to Gender-Based Violence: The Case for Trauma-Informed Care in Resettlement Contexts.

This paper assesses literature regarding the sexual and reproductive healthcare (SRH) needs of resettled refugee women who experienced gender-based violence (GBV) and trauma-informed care (TIC) principles utilized among SRH service providers. A systematic search identified relevant studies published between 2000 and 2021; no articles found reflected both SRH and TIC principles among refugee women. The search was therefore separated into two aims: to review the literature about SRH needs for refugee women in resettlement countries who experienced GBV (Aim 1) and to examine the use of TIC principles in SRH care among women who experienced GBV (Aim 2). Thematic analysis of the articles identified key themes. Twenty-six articles were included in the analysis across both aims (Aim 1 = 8, Aim 2 = 18). Aim 1 articles shared three factors shaping the SRH needs of resettled refugee women: the centrality of violence and trauma; structural barriers to SRH care; and actions, practices, and resources for service providers. Aim 2 articles illustrated seven key principles of TIC used in SRH service provision, such as empowerment; trauma-specific services and integrated care; connection; safety; collaboration; identity culture and context; and trustworthiness. Resettled refugee women's experiences of violence necessitate trauma-informed SRH health care. While there is limited peer-reviewed literature regarding TIC-SRH care for refugee women, the findings regarding the SRH needs of refugee women and the findings regarding the implementation of TIC in SRH collectively frame recommendations for how SRH can be infused with TIC. An example from practice, in the form of the Refugee Women's Health Clinic, is included as an exemplar of TIC SRH principles in action for the health of resettled refugee women who have survived gendered violence.

The Use and Effectiveness of the Whole School Approach in School-Based Interventions Addressing Gender-Based Violence in Sub-Saharan Africa: A Systematic Review.

Adolescents and young people in sub-Saharan Africa (SSA) experience high rates of gender-based violence (GBV). The whole school approach (WSA) is an established benchmark of effective school-based interventions to address this issue. We conducted a systematic review of peer-reviewed literature using PubMed/Medline, EMBASE, Scopus, Web of Science, Cochrane Library, Clinicaltrials.gov, and Google Scholar (1) to determine the characteristics, measured outcomes, and effectiveness of school-based GBV interventions and (2) to examine each papers' alignment with WSA and methodological quality. We developed a comprehensive intervention characteristics form for data extraction and analyzed the selected studies' quality using the modified Methodological Quality Rating Scale. To measure alignment with WSA implementation standards, we expanded the application of the WSA by creating the Whole School Approach Rating Scale (WSARS) for assessing school-based GBV interventions. Most interventions (n = 14/16) we reviewed effectively addressed at least one of the three outcomes of interest (i.e., sexual violence, physical violence, and GBV-related knowledge/attitudes). Over half (n = 9/16) of the studies were rated high on the WSARS. However, we observed no significant differences in effectiveness between studies rated high and those rated low on the WSARS. Our results indicate that school-based GBV interventions could be an effective and sustainable strategy for addressing GBV in and around schools.

Help-seeking among college survivors of dating and sexual violence: a qualitative exploration of utilization of university-based victim services.

Objective: Study uses qualitative data to examine help-seeking decisions as well as the drivers and barriers to utilization of university-based victim services through the accounts of survivors. Participants: The current study involves the analysis of 33 semi-structured interviews that were conducted with dating and sexual violence (DSV) survivors at a large, Mid-Atlantic University who both did and did not utilize university-based victim services. Methods: Data were analyzed using a thematic analysis approach. Results: Analysis shows that while survivors of DSV undergo a process of help-seeking that is similar to those described in previous help-seeking models, there are additional factors that contribute to a reluctancy to seek services at a university-based victim services center in particular that must be accounted for in the literature. Conclusions: The findings from the current study underscore the importance of understanding the specific drivers and barriers to utilization of university-based victim services.

Do You Believe Your Partner is Capable of Killing You? An Examination of Female IPV Survivors' Perceptions of Fatality Risk Indicators.

Advocates in the field of intimate partner violence (IPV) have started to more actively engage survivors around their own perceptions of their lethality risk, as well as assist them in developing strategies for reducing and managing risk related to reassault and intimate partner homicide (IPH). Although research has examined the risk factors most associated with risk and utilized this information in the development and validation of risk assessment tools to be used with survivors, less is known about which indicators survivors most associate with lethality risk. This study aims to fill this gap by examining which risk indicators IPV survivors associate with fatality risk. Classification and regression tree analyses were used to differentiate between women who believed their partners were capable of killing them and those who did not. Data on a sample of 213 survivors of IPV used in this analysis were collected as part of a larger study in which a risk assessment instrument was piloted across four counties within New Jersey in 2016. More than three fourths of participants believed that their abuser was capable of killing them. Alhough the majority of survivors in the study felt as though their abusers were capable of killing them, there was variation in how survivors prioritized risk indicators. Factors associated with fatality risk included: (a) prior homicide threats; (b) whether the abusers had control over survivors' daily activities; (c) abusers' access to a gun; and (d) abusers' drug use. Findings suggest that IPV survivors need targeted intervention strategies around IPH, particularly those at higher perceived risk levels given the presence of risk indicators and their perceptions of lethality threat.

Socioeconomic Factors and Patterns of Intimate Partner Violence among Ever-Married Women in Uganda: Pathways and Actions for Multicomponent Violence Prevention Strategies.

Intimate partner violence (IPV) is a severe public health problem in sub-Saharan Africa (SSA) with harmful effects on the physical, psychological, and socioeconomic wellbeing of survivors and their families. In SSA, IPV is associated with mental health disorders, high-risk behaviors, and HIV vulnerability, especially among women. In Uganda, poor socioeconomic status increases women's vulnerability to IPV. Yet there is limited evidence on the association between socioeconomic factors and IPV severity in Uganda. Our study used population-based data to (a) establish different patterns describing the severity of IPV experiences, (b) explore associations between socioeconomic factors and severity of IPV experiences among Ugandan ever-married women, and (c) examine direct and indirect pathways from socioeconomic factors to severity of IPV experiences. Data were drawn from the 2016 Uganda Demographic and Health Survey's sample of 7,536 ever-married women aged 15-49 years. A latent class analysis examined distinct patterns of IPV severity among this sample, yielding a four-class solution: low violence (n = 5,059; 67.1%); high physical violence, low sexual violence (n = 1,501; 19.9%); high sexual violence, moderate physical violence (n = 535; 7.1%); and high sexual and severe physical violence (n = 441; 5.9%). Using the low violence group as the reference category, we conducted a multinomial logistic regression that found significant associations between secondary education (aOR 2.35, 95% CI: [1.06, 5.24]), poorest on the wealth index (aOR 2.00, 95% CI: [1.13, 3.54]), and severe IPV experiences. Decision-making (aOR 0.81, 95% CI: [0.68, 0.96]) played a protective role against membership in the high sexual and physical violence class compared to the reference category. Using path analysis, we found that labor force participation partially mediated the path from wealth index and education to IPV severity. Findings indicate the need for interventions that aim to keep girls in school and target schools, communities, and media platforms to address gender norms, economic vulnerability, and comprehensive screening for multiple forms of violence.

Measurement invariance of the Brief Sense of Community Scale across non-Hispanic, Black and Hispanic college students.

Ethnic-racial background may influence college students' psychological sense of community (PSOC). Thus, it is critical to examine whether this construct is conceptualized similarly between non-Hispanic, Black and Hispanic students. This study tested the measurement invariance of the Brief Sense of Community Scale (BSCS) across the two groups. We used data from a self-administered online survey provided to college students in 2016 in a Northeastern urban university (non-Hispanic, Black = 307; Hispanic = 409). We tested the measurement invariance of the BSCS using a series of nested multigroup confirmatory factor analyses with increasingly restrictive sets of parameters. Measurement invariance of the BSCS across non-Hispanic, Black and Hispanic college students was achieved. The BSCS successfully measures the multidimensionality of PSOC across the two groups in a college setting. Students' score on the BSCS is not biased by measurement invariance related to cultural influences. When using the BSCS, community psychologists and researchers can have confidence that the observed differences in PSOC across non-Hispanic, Black and Hispanic college students are attributable to true differences rather than a cultural understanding of the construct.

Comprehensive Prevention of Campus Sexual Violence: Expanding Who Is Invited to the Table.

There are calls for sexual violence prevention to be more comprehensive and align with a socio-ecological approach. However, there is lack of models with specificity on how to engage additional stakeholders. Whole School Approach (WSA) frameworks have been used to address health promotion and bullying prevention and can be a useful model for guiding campus sexual violence prevention work. WSA models situate violence as a community issue and one where all community members have a role to play in prevention. Rather than focusing on addressing individual behavior, WSA frameworks address the role of the larger school environment in serving as a protective factor against violence, abuse, and harassment. A review of the literature on WSA frameworks in other disciplines reveals a number of potential ways to translate key elements of WSA models to the field of campus sexual violence prevention. In particular, mechanisms can be applied to expand the role of students, faculty, staff, parents/significant adults, institutional leadership, and the larger community.

Sexual Violence of Liberian School Age Students: An Investigation of Perpetration, Gender, and Forms of Abuse.

This study examined the perpetration of sexual violence within the institutional setting of primary schools in Liberia using secondary analysis of data collected from 811 Liberian school aged participants (298 girls and 513 boys). The study looked specifically at the perpetration of: 1) sexual violation, 2) transactional sex, and 3) sexual coercion. Sexual violation was the most common form of sexual violence experienced, followed by sexual coercion, and then transactional sex. Findings showed statistically significant differences in experiences of transactional sex and sexual coercion, with girls more likely to experience both forms of violence. Further, girls were more likely to experience sexual abuse by a teacher and religious figure. Perpetration by teachers, school staff, and religious figures were all linked to transactional sex. Results showed that transactional sex was most highly statistically significantly associated with teachers while perpetration by a religious figure was statistically significantly associated with sexual coercion. Girls had three times of the odds of experiencing transactional sex and coercion. We conclude that there is a need for interventions to prevent sexual abuse from occurring in educational institutions. In particular, there is a need for protective mechanisms addressing the transactional nature of abuse with teachers and school staff.

Administering the U.S. Family Violence Option: The role of stigma in waiver recommendations.

The Family Violence Option (FVO) was designed to help survivors of domestic violence (DV) more easily secure income support in the United States (U.S.), without placing them at risk of further abuse. The objective of this study is to determine whether the decision-making of advocates responsible for determining waiver recommendations under the FVO is influenced by the relationship status of DV survivors. Recursive partitioning was used to analyse data from a sample of 237 survivor risk assessments from four New Jersey counties to determine which women receive waiver recommendations and which do not. Advocates completed risk assessments for the women and were instructed to make recommendations on waivers based on their assessment. Workers' decision-making was examined using classification and regression trees (CART) to determine what case factors made it more or less likely for survivors to be recommended waivers. The CART results were supplemented with logistic regression analyses to ensure validity. For two of three waivers, survivors who reported currently residing with their abuser or who had ended the relationship recently were less likely to receive waiver recommendations than those who had been out of the relationship for a longer period of time (OR = 0.09-0.21), even when accounting for the type and severity of DV and the impacts of the violence on survivors' mental health. The results indicate that DV advocates' decision-making is complicated by factors independent of survivors' case characteristics. This can affect the safety and well-being of women attempting to leave violent relationships by affecting their access to resources.

Early sexual debut: A multi-country, sex-stratified analysis in sub-Saharan Africa.

This study examined outcomes associated with early sexual debut in five sub-Saharan African countries for males and females, separately. We employed Violence Against Children Surveys (VACS) from Kenya, Malawi, Nigeria, Tanzania, and Uganda, restricting samples to males and females age 18-24 years. Early sexual debut was defined as having one's first sexual intercourse before 15. Logistic, Ordinary Least Squares, and Poisson regressions were utilised to estimate associations between early sexual debut and outcomes across four ecological domains: individual, family, peer/partner, and community. Regressions were stratified by sex. The prevalence of early sexual debut ranged from 8.6% in Tanzania to 17.7% in Malawi. Males were more likely to report early sexual debut in Kenya (16.3%, compared to 6.7% for females; P < 0.001) and Uganda (15%, compared to 10.4% for females; P = 0.037). In Nigeria, 14.5% of females reported early sexual debut, compared to 5.4% of males (P < 0.001). Early sexual debut was associated with only one outcome in the individual and family domains, and was most consistently associated with outcomes in the peer/partner domain. Differences in these relationships for males and females suggest programs and policies working to reduce early sexual debut and promote healthy sexual relationships among young adolescents should thoughtfully consider framing messaging through a gendered lens.

Providing services to trafficking survivors: Understanding practices across the globe.

PURPOSE: Human trafficking is a global issue, with survivors representing all genders, ages, races, ethnicities, religions, and countries. However, little research exists that identifies effective practices in supporting survivors of human trafficking. The research that does exist is Western-centric. To fill this gap in the literature, the goal of this research was to understand practices used throughout the globe with adult human trafficking survivors. METHODS: A qualitative approach was utilized. Providers from 26 countries, across six different continents, were interviewed to allow for a comprehensive and multi-faceted understanding of practices in working with survivors. RESULTS: Participants identified utilizing an empowerment-based, survivor, and human life-centered approach to working with survivors, emphasized the importance of engaging in community level interventions, and highlighted the importance of government recognition of human trafficking. DISCUSSION: Findings provide information from the perspective of advocates on best practices in the field that can be used by agencies to enhance human trafficking programming.