Is violence against men a problem in Sri Lanka?

BACKGROUND: Gender-based violence (GBV) among men is a universally present phenomenon that is mostly unacknowledged. The relative lack of research in this area leads to a deficiency of evidence ascribing due recognition to GBV among men. This, in turn, leads to not identifying it as a social problem, hence, poor development of resources for victims as well as poor help-seeking behaviour patterns are prevalent, especially in Southeast Asia. AIMS: We aimed to determine the prevalence of GBV among men in Colombo, Sri Lanka. METHOD: A descriptive cross-sectional analytical community survey was conducted to explore GBV against 1280 Sinhala-speaking men, selected using a multistage cluster sampling method in Colombo district, Sri Lanka. The GBV among men questionnaire (GBVMQ) was developed and culturally validated. A multiple logistic regression model was developed and nine correlates of GBV were identified and adjusted odds ratios estimated. RESULTS: The prevalence of GBV was 35.8% (95% CI 33.1 -38.6). The prevalence of Verbal GBV was 34.7% (95% CI 32.1 -37.5). Childhood sexual abuse was 7.6% (95% CI 6.2 -9.2). Being subjected to ridicule as cowardly or unmanly (AOR = 25.3, 95% CI 5.58 -114.7, P<0.0010), Childhood sexual abuse (AOR = 4.4, 95% CI 1.73 -11.09, P = 0.002) showed positive associations with statistical significance. CONCLUSION: The results highlight the importance of having services for men as well as women. Enabling inclusiveness of men in mandates of state and private institutions catering for GBV would be a strategy in moving forward for Sri Lanka.

Domestic violence: a cross-sectional study among pregnant women in different regions of Sri Lanka.

OBJECTIVES: The aims of this study were to assess the regional differences in domestic violence among pregnant women in the capital district and in the tea plantation sector of Sri Lanka, to explore potential contributory factors and to assess whether healthcare workers addressed domestic violence and disclosure among survivors. DESIGN: A cross-sectional study was carried out using interviewer-administered Abuse Assessment Screen. SETTING: Fifty-seven antenatal clinic centres in the capital district and 30 in the tea plantation sector. PARTICIPANTS: Pregnant women between 6 and 40 weeks of gestational age. In the capital district, 1375 women were recruited from antenatal clinic centres in the urban (n=25) and in the rural areas (n=32), and 800 women from 30 centres in the tea plantation sector. The response rate in the capital district was 95.6% and 96.7% in the tea plantation sector. RESULTS: Among the total sample of pregnant women (n=2088), the prevalence of 'ever abused' was 38.6%, and the prevalence of 'currently abused' was 15.9%. 'Ever abused' (31.5% vs 50.8%) and 'currently abused' (10% vs 25.8%) were significantly higher (P<0.001) among the women living in the tea plantation sector. 'Ever abused' was associated with living in the tea plantation sector, being employed, living far from gender-based violence care centre and of Muslim ethnicity, after adjusting for age, education and family income. Only 38.8% of all participants had been asked by healthcare workers about abuse. Living in the tea plantation sector and lower level of education were associated with not being asked. Among those who reported 'ever abused', only 8.7% had disclosed the experience to a healthcare worker. CONCLUSION: Domestic violence was prevalent and highest among women in the tea plantation sector compared with the capital district. The capacity of healthcare workers in addressing domestic violence should be increased.

Training university teachers and students in Sri Lanka on Gender Based Violence: testing of a participatory training program.

This article was migrated. The article was marked as recommended. In all societies, violence is a social problem and violation of human rights. Changing attitudes and behaviors, which accept violence at individual and societal levels are key components in prevention strategies. The aim of this study was to produce educational material on Gender Based Violence (GBV). A participatory study design including educators and university students was used to create four teaching modules. The teaching was evaluated by descriptive surveys before and after the training and focus group discussions followed the training session. The questionnaire covered attitudes to gender, violence and laws. One hundred eleven teachers and 25 students representing different faculties and universities participated in separate workshops in three Sri Lankan universities. The students lacked knowledge of the meaning of GBV, consequences and existing laws. Women held more gender-equitable attitudes. Both women and men favoured equal participation of work and decision in the households. Male undergraduates showed less accepting attitudes toward rape or blaming women for rape Three categories emerged after the FGDs; Make training module compulsory and teacher led; Mind your own business; What can be done. The newly prepared and context specific material was well-received by educators and students and they provided valuable inputs, which improved the educational modules.

'Even though a man takes the major role, he has no right to abuse': future male leaders' views on gender-based violence in Sri Lanka.

BACKGROUND: Distinct gender roles influence gender inequality and build the foundation for gender-based violence. Violence against women is a major public health problem in all societies, and a violation of human rights. Prevalence surveys on gender-based violence have been published from Sri Lanka, but qualitative studies on men's perceptions are lacking. OBJECTIVES: The aim of this study was to explore young educated Sri Lankan men's perceptions of violence against women. METHODS: Seven focus-group discussions were held. Men at the end of their university studies were purposefully selected. A topic guide was used, covering various scenarios of violence against women. Qualitative content analysis was carried out. RESULTS: Four categories were developed through the analytic process: fixed gender roles - patriarchal values are accepted in society, female mobility control, and slowly changing attitudes; violence not accepted but still exists - sexual harassment exists everywhere, different laws for different people, female tolerance of violence, and men's right to punish; multiple factors cause violence - alcohol, violent behavior is inherited, violence culturally accepted, low education, and lack of communication; and prevention of violence against women - both parents must engage and socialize girls and boys equally, life skills education, premarital counselling, working places value clarification, and more women in politics and boards are suggested. CONCLUSIONS: Medical and management students, possible future male leaders of the country, have suggestions of prevention strategies in life skills to reduce gender-based violence and to increase knowledge of health consequences with the aim of changing attitudes.

Content Analysis of Food and Beverages Advertisements Targeting Children and Adults on Television in Sri Lanka.

INTRODUCTION: Food marketing is one of the main factors in the increase in childhood obesity. The objective is to compare the strategies used for promotion of food and beverages advertisements on Sri Lankan television for children and adults. METHOD: Among 16 analog television channels in Sri Lanka, 50% of the channels were selected randomly after stratifying according to language. Recording was during weekdays and weekends. In total, 95 different food and beverages advertisements were analyzed irrespective of the channel. RESULTS: Among all food and beverages-related advertisements, 78% were child focused, and among these 74% claimed health benefits. A statistically significant difference was found in terms of implications related to nutrition or health (P < .05). None of the advertisements contained disclaimers. CONCLUSION AND RECOMMENDATIONS: The Ministry of Health needs to pursue all food and beverages-focused advertisements for policy formulation and implementation.

Addressing domestic violence through antenatal care in Sri Lanka's plantation estates: Contributions of public health midwives.

Domestic violence in pregnancy is a significant health concern for women around the world. Globally, much has been written about how the health sector can respond effectively and comprehensively to domestic violence during pregnancy via antenatal services. The evidence from low-income settings is, however, limited. Sri Lanka is internationally acknowledged as a model amongst low-income countries for its maternal and child health statistics. Yet, very little research has considered the perspectives and experiences of the key front line health providers for pregnant women in Sri Lanka, public health midwives (PHMs). We address this gap by consulting PHMs about their experiences identifying and responding to pregnant women affected by domestic violence in an underserved area: the tea estate sector of Badulla district. Over two months in late 2014, our interdisciplinary team of social scientists and medical doctors met with 31 estate PHMs for group interviews and a participatory workshop at health clinics across Badulla district. In the paper, we propose a modified livelihoods model to conceptualise the physical, social and symbolic assets, strategies and constraints that simultaneously enable and limit the effectiveness of community-based health care responses to domestic violence. Our findings also highlight conceptual and practical strategies identified by PHMs to ensure improvements in this complex landscape of care. Such strategies include estate-based counselling services; basic training in family counselling and mediation for PHMs; greater surveillance of abusive men's behaviours by male community leaders; and performance evaluation and incentives for work undertaken to respond to domestic violence. The study contributes to international discussions on the meanings, frameworks, and identities constructed at the local levels of health care delivery in the global challenge to end domestic violence. In turn, such knowledge adds to international debates on the roles and responsibilities of health care professionals in responding to and preventing domestic violence.

'Disrespectful men, disrespectable women': men's perceptions on heterosexual relationships and premarital sex in a Sri Lankan Free Trade Zone - a qualitative interview study.

BACKGROUND: Gender norms have been challenged by unmarried rural women's migration for employment to urban Sri Lankan Free Trade Zones (FTZ). Men are described as looking for sexual experiences among the women workers, who are then accused of engaging in premarital sex, something seen as taboo in this context. Increased sexual and reproductive health and rights (SRHR) risks for women workers are reported. To improve SRHR it is important to understand the existing gender ideals that shape these behaviours. This qualitative study explores men's perspectives on gender relations in an urban Sri Lankan FTZ, with a focus on heterosexual relationships and premarital sex. Further, possible implications for SRHR of women workers in FTZs are discussed. METHODS: Eighteen qualitative semi-structured interviews were conducted with men living or working in an urban Sri Lankan FTZ and were analysed using thematic analysis. RESULTS: Two conflicting constructions of masculinity; the 'disrespectful womaniser' and the 'respectful partner', were discerned. The 'disrespectful womaniser' was perceived to be predominant and was considered immoral while the 'respectful partner' was considered to be less prevalent, but was seen as morally upright. The migrant women workers' moral values upon arrival to the FTZ were perceived to deteriorate with time spent in the FTZ. Heterosexual relationships and premarital sex were seen as common, however, ideals of female respectability and secrecy around premarital sex were perceived to jeopardize contraceptive use and thus counteract SRHR. CONCLUSION: The 'disrespectful' masculinity revealed in the FTZ is reflective of the patriarchal Sri Lankan society that enables men's entitlement and sexual domination over women. Deterioration of men's economic power and increase of women's economic and social independence may also be important aspects contributing to men's antagonistic attitudes towards women. The promotion of negative attitudes towards women is normalized through masculine peer pressure. This and ambivalence towards women's premarital sex are undermining the SRHR and well-being of women, but also men, in the FTZ. Awareness and counteraction of destructive gender power relations are essential for the improvement of the SRHR of women and men in the FTZ and the surrounding society.

Task shifting and sharing in maternal and reproductive health in low-income countries: a narrative synthesis of current evidence.

Reducing maternal mortality and providing universal access to reproductive health in resource poor settings has been severely constrained by a shortage of health workers required to deliver interventions. The aim of this article is to determine evidence to optimize health worker roles through task shifting/sharing to address Millennium Development Goal 5 and reduce maternal mortality and provide universal access to reproductive health. A narrative synthesis of peer-reviewed literature from 2000 to 2011 was undertaken with retrieved documents assessed using an inclusion/exclusion criterion and quality appraisal guided by critical assessment tools. Concepts were analysed thematically. The analysis identified a focus on clinical tasks (the delivery of obstetric surgery, anaesthesia and abortion) that were shifted to and/or shared with doctors, non-physician clinicians, nurses and midwives. Findings indicate that shifting and sharing these tasks may increase access to and availability of maternal and reproductive health (MRH) services without compromising performance or patient outcomes and may be cost effective. However, a number of issues and barriers were identified with health workers calling for improved in-service training, supervision, career progression and incentive packages to better support their practice. Collaborative approaches involving community members and health workers at all levels have the potential to deliver MRH interventions effectively if accompanied by ongoing investment in the health care system.

Negotiating respectability: migrant women workers' perceptions of relationships and sexuality in free trade zones in Sri Lanka.

Migration has implications for women's sexual and reproductive health and rights. Our purpose with this study was to explore unmarried migrant women's perceptions of relationships and sexuality in the context of Sri Lankan Free Trade Zones. Sixteen semi-structured qualitative interviews were analyzed using thematic analysis. We found that the women's perceptions were influenced by gendered hegemonic notions of respectability and virginity. Complex gender relations both worked in favor of and against women's sexual and reproductive health and rights. Programs for improvement of migrant women's health should be informed by contextualized analysis of gender relations with its various dimensions and levels.

Unmarried women's ways of facing single motherhood in Sri Lanka - a qualitative interview study.

BACKGROUND: In Sri Lanka, motherhood within marriage is highly valued. Sex out of wedlock is socially unacceptable and can create serious public health problems such as illegal abortions, suicide and infanticide, and single motherhood as a result of premarital sex is considered shameful. The way unmarried women facing single motherhood reflect on and make use of their agency in their social environments characterised by limited social and financial support has consequences for the health and well-being of both themselves and their children. The aim of this study was to explore and describe how unmarried women facing single motherhood in Sri Lanka handle their situation. METHODS: This qualitative study comprised semi-structured interviews with 28 unmarried pregnant women or single mothers. The data were analysed by qualitative content analysis and the results related to the conceptual framework of social navigation. RESULTS: The women facing single motherhood expressed awareness of having trespassed norms of sexuality through self-blame, victimhood and obedience, and by considering or attempting suicide. They demonstrated willingness to take responsibility for becoming pregnant before marriage by giving the child up for adoption, bringing up the child themselves, claiming a father for their child, refraining from marriage in the future, permanently leave their home environment, and taking up employment. Throughout the interviews, the women expressed fear of shame, and striving for familial and societal acceptance and financial survival. CONCLUSIONS: A social environment highly condemning of unmarried motherhood hindered these women from making strategic choices on how to handle their situation. However, to achieve acceptance and survival, the women tactically navigated norms of femininity, strong family dependence, a limited work market, and different sources of support. Limited access to resources restricted the women's sexual and reproductive health and rights, including their ability to make acceptable and healthy choices for themselves and their children.

Intimate partner violence against women in the capital province of Sri Lanka: prevalence, risk factors, and help seeking.

This article presents findings from a cross-sectional community survey exploring intimate partner violence (IPV) against women in the Western province of Sri Lanka. Findings show that lifetime prevalence of physical violence (34%), controlling behavior (30%), and emotional abuse (19%) was high and the prevalence of sexual violence was low (5%). Young women and those with partners who abused alcohol/drugs and had extra-marital affairs are at increased risk of violence. Although living in a patriarchal society, low prevalence of child marriages and lack of dowry-related violence could be to Sri Lankan women's advantage relative to their Asian counterparts in preventing IPV.

Executive functions and child problem behaviors are sensitive to family disruption: a study of children of mothers working overseas.

Mothers in Sri Lanka are increasingly seeking overseas employment, resulting in disruption of the childcare environment. The present study was designed to evaluate the effects of maternal migration on executive function (EF) and behavior, thereby also contributing to the scientific understanding of environmental effects--or more specifically family effects--on children's neurocognitive functioning. A sample of 60 healthy 11-year-old children whose mothers had been working overseas for more than 1 year formed the study group, and a comparison group was recruited from the same schools. Evaluations were made twice over a 1-year interval with regard to the EF components inhibition and working memory as well as teacher ratings of internalizing and externalizing behavior. The children in the study group were found to have poorer EF and higher levels of externalizing behaviors. A composite score of inhibition partially mediated the group effect on externalizing behavior. Current home environment was assessed using the HOME scale, was poorer for the study group and was related to EF, but not to behavior problems. Keeping in mind the correlational nature of the present data, our results were discussed in relation to studies showing cognitive effects of stress.

Unmarried women's decisions on pregnancy termination: Qualitative interviews in Colombo, Sri Lanka.

BACKGROUND: In Sri Lanka pregnancy termination is very restricted by law and social norms. Premarital sex, and pregnancies are not generally accepted and unmarried pregnant women are vulnerable in their decision-making on pregnancy termination. OBJECTIVES: The objective of this study was to describe the circumstances of becoming pregnant and factors considered in the decision-making for seeking pregnancy termination in a sample of unmarried women in Colombo, Sri Lanka. METHODS: Individual qualitative interviews were conducted with 19 unmarried women seeking pregnancy terminations at a reproductive health centre in Colombo, Sri Lanka. The interviews were later analysed using qualitative content analysis. RESULTS: Becoming pregnant in a love relationship was predominant in this sample. Awareness of contraceptives varied and initial reaction to the pregnancy involved strong contradictory emotions. Multiple interrelated factors were considered in the decision-making for termination. Family pressure was the most prominent factor followed by the partner's qualities and attitude towards the pregnancy, economic factors and own feelings, values and future fertility. The women described that their own emotional, religious and economic reasons for continuing the pregnancy were often outweighed by their responsibility to the family, male partner and unborn child. CONCLUSIONS: These unmarried women's sexual and reproductive rights were limited and for many the pregnancy termination was socially unsafe. They found themselves at the interface of two value systems. Modern values allow for relationships with men prior to marriage; whereas, traditional values did not. The limited possibilities to prevent pregnancies and little hope for support if continuing the pregnancy; made women seek pregnancy termination despite own doubts.

Menopausal symptoms and quality of life during the menopausal transition in Sri Lankan women.

OBJECTIVE: To assess the prevalence of menopausal symptoms in a population of Sri Lankan women and the relationship with their health-related quality of life. DESIGN: A community-based, cross-sectional study was conducted on 683 women ages 45 to 60 years living in the district of Colombo, Sri Lanka. A cluster sampling method was used for recruitment of the sample. Information was collected on demographic, socioeconomic, menstrual, and reproductive history using structured interviews. The Menopause Rating Scale was used to assess menopausal symptoms and the Short Form 36 health survey was used to assess the health-related quality of life. RESULTS: Of the sample, 59.4% were postmenopausal and 18.4% were perimenopausal; 90% of the sample had one or more menopausal symptoms. The most prevalent menopausal symptoms were joint and muscular discomfort (74.7%), physical and mental exhaustion (53.9%), and hot flushes (39.1%). Hot flushes, sleep problems, and joint/muscular discomfort showed an increase in prevalence from the premenopausal category to the postmenopausal category (P < 0.05 for all). Chronic illness in the women was significantly associated with the presence of menopausal symptoms (P < 0.01). Women with menopausal symptoms had significantly lower (P < 0.05) quality-of-life scores in most of the domains of the Short Form 36 compared with women without symptoms. CONCLUSIONS: The majority of these Sri Lankan women reported one or more menopausal symptom. Chronic illness was significantly associated with these symptoms. The presence of menopausal symptoms was significantly associated with a decreased health-related quality of life in the women.