Honor, violence, and children: A systematic scoping review of global evidence.

BACKGROUND: Although the harmful effects of honor-based violence (HBV) against women have been well documented, less is known about how HBV affects children and adolescents. AIMS: 1) To describe the contexts, research methods and populations included in research on HBV and children; 2) to outline conceptual and methodological approaches, including definitions of honor; 3) to describe how honor-based practices affect children's experiences of violence. METHODS: We searched seven electronic databases using search terms for honor, violence and children which resulted in 7122 unique records. 468 records were selected for full-text review. Articles reporting findings on the effects of honor-based harm or violence against children were included in the final sample for data extraction. We conducted bibliometric and thematic analyses of extracted data. RESULTS: In total, 101 articles were included. Most studies were published after 2007, conducted in Europe (n = 46) or in North America (n = 21), and most used qualitative methods (n = 58) followed by quantitative methods (n = 32). In most studies (n = 74) children, especially girls, were included as experiencing HBV or being a victim of homicide related to HBV. A smaller sample of studies (n = 24) included children, especially boys, as perpetrators of HBV. Studies documented the following effects of HBV on children: violence; family rejection and control; homicide or honor killing; forced/early marriage; female genital cutting; gang membership/violence; hymen exam or reconstruction; sex work, or suicide. RECOMMENDATIONS: Further research on HBV should be child and youth centered, situated in the Global South, engage with and interview young people directly, and offer recommendations for action.

Is the UN receiving ethical approval for its research with human participants?

This paper examines the institutional mechanisms supporting the ethical oversight of human participant research conducted by the United Nations (UN). The UN has served an instrumental role in shaping international standards on research ethics, which invariably require ethical oversight of all research studies with human participants. The authors' experiences of conducting research collaboratively with UN agencies, in contrast, have led to concern that the UN frequently sponsors, or participates in, studies with human participants that have not received appropriate ethical oversight. It is argued that the institutional mechanisms in place to prevent research with human participants from being undertaken by the UN without ethical oversight do not, at present, extend substantively beyond the provision of guidelines and online training offered by a minority of UN bodies. The WHO and UNICEF are identified as notable exceptions, having implemented various measures to prevent health research with human participants from being undertaken without ethical oversight. Yet, it is highlighted that the WHO and UNICEF are not the only UN bodies that undertake health research with human participants and there are countless actors under the umbrella of the UN system that are regularly involved in non-health research with human participants. Arguments for the pursuit of the highest standard of ethical oversight by UN bodies are presented. Moving forward, the paper asks the question: is it time for the UN to set the standards for the oversight of ethical oversight?

Understanding ethical challenges of family planning interventions in sub-Saharan Africa: a scoping review.

Background: Improving the design of family planning (FP) interventions is essential to advancing gender equality, maternal health outcomes, and reproductive autonomy for both men and women. While progress has been made towards applying a rights-based approach to FP interventions in sub-Saharan Africa, the ethical implications of FP interventions has been underreported and underexplored. Several ethical challenges persist related to measuring success, choice, and target population. Methods: We conducted a scoping review to understand if and how FP interventions published between 2000 and 2020 within sub-Saharan Africa address the ethical challenges raised within the literature. We identified a total of 1,652 papers, of which 40 were included in the review. Results: Our review demonstrated that the majority of family planning interventions in sub-Saharan Africa place a strong emphasis, on measuring success through quantitative indicators such as uptake of modern contraception methods among women, specifically those that are married and visiting healthcare centres. They also tend to bias the provision of family planning by promoting long-acting reversible contraception over other forms of contraception methods potentially undermining individuals' autonomy and choice. The interventions in our review also found most interventions exclusively target women, not recognising the importance of gender norms and social networks on women's choice in using contraception and the need for more equitable FP services. Conclusion: The results of this review highlight how FP interventions measured success through quantitative indicators that focus on uptake of modern contraception methods among women. Utilising these measures makes it difficult to break away from the legacy of FP as a tool for population control as they limit the ability to incorporate autonomy, choice, and rights. Our results are meant to encourage members of the global family planning community to think critically about the ethical implications of their existing interventions and how they may be improved. More public health and policy research is required to assess the effect of applying the new indicators with the FP community as well as explicitly outlining monitoring and evaluation strategies for new interventions to allow for programme improvement and the dissemination of lessons learned.

The role of partners, parents and friends in shaping young women's reproductive choices in Peri-urban Nairobi: a qualitative study.

BACKGROUND: Contraceptive use among young women in Nairobi remains low despite high general knowledge of family planning (FP) methods. This paper draws on social norms theory to explore the role of key influencers (partners, parents and friends) in women's FP use and how women anticipate normative reactions or sanctions. METHODS: A qualitative study with 16 women, 10 men and 14 key influencers across 7 peri-urban wards in Nairobi, Kenya. Interviews were conducted during the COVID-19 pandemic in 2020 by phone. A thematic analysis was conducted. RESULTS: Women identified parents, specifically mothers, aunts, partners, friends and healthcare workers as key influencers on FP. Their interactions with these key influencers varied based on trust, the information they needed about FP, and whether they perceived a key influencer to perpetuate or challenge existing social norms on FP. Mothers were perceived to understand the social risks of using FP and thus could advise on discreet FP use, and aunts were trusted and approachable sources to impartially describe the benefits and drawbacks of FP. Although women identified partners as key FP decision makers, they were cognisant of possible power imbalances affecting a final FP choice. CONCLUSIONS: FP interventions should consider the normative influence key actors have on women's FP choices. Opportunities to design and deliver network-level interventions which seek to engage with social norms surrounding FP in order to challenge misconceptions and misinformation among key influencers should be explored. Intervention design should consider dynamics of secrecy, trust and emotional closeness that mediate discussions of FP to address changing norms. Further training to change norms held by healthcare providers about why women, in particular unmarried young women, access FP should be provided to reduce barriers for FP access.

Women's decisions to use family planning (FP) are influenced by social norms, the unwritten rules of appropriate actions within social networks, and are shaped by advice and information received from key influencers­important individuals who shape what is acceptable within social networks. The aim of this study was to understand how key influencers uphold and transmit information and norms about FP, and explore who women consult as they make FP decisions and why they consult these key influencers.We interviewed 16 women, 10 partners and 14 key influencers in peri-urban Nairobi, Kenya.We found that key influencers for decisions about FP included mothers, aunts, partners, friends and healthcare providers. In making a decision about FP use, women consulted key influencers based on who they deemed trustworthy to keep their FP use secret and described less trust to speak with men about FP in their social networks. Mothers understood the social risks of using FP and so could advise on its discreet use, and aunts were approachable sources of impartial information about FP. Although women identified partners as key decision makers, they were aware that power imbalances might affect final FP choices.Our findings underscore the importance of FP interventions working with women's social networks and to address social norms influencing women's decisions in using FP. Interventions to change FP norms should consider dynamics of secrecy, trust and emotional closeness that affect FP discussions among women's networks.

'Our courage has grown': a grounded theory study of enablers and barriers to community action to address violence against women in urban India.

Transforming communities into supportive environments for women facing risks of violence requires community members to play an active role in addressing violence against women (VAW). We did a grounded theory study of enablers and barriers to community response to ongoing violence, sampling from programme areas of a non-governmental organisation (NGO)-led community mobilisation intervention in informal settlements in Mumbai, India. We held 27 focus group discussions and 31 semistructured interviews with 113 community members and 9 NGO staff, along with over 170 hours of field observation. We found that residents responded to violence in diverse ways, ranging from suicide prevention to couple mediation to police and NGO referral. Enabling and constraining factors fit into a social ecological model containing intrapersonal, immediate social network, and wider societal levels. We identified four themes interlinking factors: legitimacy of action, collective power, protection against risk and informal leadership. Legitimacy of action was negotiated in the context of individual disputes, making community members question not only whether VAW was 'wrong', but who was 'wrong' in specific disputes. Collective power through neighbourhood solidarity was key to action but could be curtailed by violent gang crime. Interveners in incidents of VAW turned out to need significant physical, social and legal protection against reprisal. However, repeat interveners could become informal leaders wielding influential prosocial reputations that incentivised and facilitated action. Our model integrates multiple perspectives on community action into one analytical framework, which can be used by implementers to ensure that community members receive encouragement, support and protection to act.

Violence in Quilombola women living in rural communities in Brazil.

OBJETIVE: To estimate the prevalence of psychological, physical, and sexual violence perpetrated against women by their intimate partner (IP) in Quilombola communities located in Espírito Santo State, Brazil. METHODS: The data is from a population-based cross-sectional study of Quilombola women conducted from 2017 to 2018. In-person interviews collected information on women's sociodemographic characteristics, behaviors, and their experience of violence perpetrated by their IP. The analysis used chi-square test and hierarchical logistic regression. RESULTS: 219 women (94.8% of the invited ones) agreed to participate in the study. 59.0% (95%CI: 5.25-65.5) reported psychological violence; 41% (95%CI: 34.5-47.5) physical violence; and 8.2% (95%CI: 4.6-11.8) sexual violence. Psychological violence was associated with having three or more sexual partners in life, when compared to those who had up to two partners (p = 0,009), and previous violence involving other people outside of family increased the chance of suffering psychological violence by an IP more than nine times (p ≤ 0.001). Regarding physical violence, the association with use of barrier contraception (p = 0.031) and having a partner with other sexual partners (p = 0.024) were protective factors for IP violence. Having 3 or more sexual partners in the last 12 months (p = 0.006), partner using illicit drugs (p = 0,006), and alcoholism in the family (p = 0,001), increased the chance of suffer physical violence by the partner. Sexual violence perpetrated by the IP was associated with miscarriage (p = 0.016), partner using drugs (p = 0.020), and gynecological symptoms (p = 0.045). CONCLUSIONS: These results showed the high frequency of intimate partner violence in Quilombola women and highlight the importance of reducing social and race inequities for interrupting the culture of violence against women.

Gender norms and family planning amongst pastoralists in Kenya: a qualitative study in Wajir and Mandera.

There is growing recognition among global health practitioners of the importance of rights-based family planning (FP) programming that addresses inequities. Despite Kenya achieving its national FP target, inequities in access and use of modern FP remain, especially amongst marginalised nomadic and semi-nomadic pastoralist communities. Few studies explore norms affecting FP practices amongst nomadic and semi-nomadic pastoralists and how these can influence social and behaviour change (SBC) interventions. We carried out 48 in-depth interviews and 16 focus group discussions with women and men from pastoralist communities in North Eastern Kenya in November 2018. Data were analysed thematically. Results from focus groups and interviews confirmed themes, while allowing differences between the qualitative approaches to emerge. We found that large family size was a descriptive and injunctive norm in both nomadic and semi-nomadic communities. The desire for around 10 children was sustained by religious beliefs and pastoralist ways of living. Despite a desire for large families, maintaining child spacing was encouraged and practised through breastfeeding and sexual abstinence. Most participants viewed modern FP negatively and as something used by "others". However, it was acceptable in order to prevent severe negative health outcomes. Future FP research to inform interventions should continue to consider community fertility preferences and the rationale for these, including norms, religion and power dynamics. Targeted qualitative social norms research could inform multi-component SBC interventions in this context.

Protocol: Mapping social networks, social influence and sexual health among youth in rural KwaZulu-Natal, the Sixhumene cohort study.

Background: Sexual behaviour and sexually transmitted infections are strongly affected by social connections, and interventions are often adapted more readily when diffused through social networks. However, evidence on how young people acquire ideas and change behaviour through the influence of important social contacts is not well understood in high-HIV-prevalence settings, with the result that past peer-led HIV-prevention interventions have had limited success. Methods: We therefore designed a cohort study (named Sixhumene or 'we are connected') to follow young people in three rural and small-town communities in uMkhanyakude district, KwaZulu-Natal, South Africa, and the people that these youth identify as important in their lives. We will interview them five times over three years, at each visit collecting information on their socioeconomic, social and sexual health lives, and testing them for HIV and herpes simplex virus 2 (HSV-2). We will use this information to understand how these young people's sexual health decisions are formed. This will include evaluating how poor sexual health outcomes are correlated across social networks, how youth mimic the attitudes and behaviours of those around them, who is at greatest risk of acquiring HIV and HSV-2, and who might be most influential within communities and thus best able to promote protective interventions. Discussion: The information gathered through this study will allow us to describe social connection and influence spread through these real-world social networks, and how this leads to sexual health outcomes. Sixhumene will provide vital inputs for mathematical models of communities and spreading processes, as well as inform the development of effective interventions to protect the sexual health of community members through appropriate targeting with optimised messaging requiring fewer resources.

Remote methods for research on violence against women and children: lessons and challenges from research during the COVID-19 pandemic.

Collecting data to understand violence against women and children during and after the COVID-19 pandemic is essential to inform violence prevention and response efforts. Although researchers across fields have pivoted to remote rather than in-person data collection, remote research on violence against women, children and young people poses particular challenges. As a group of violence researchers, we reflect on our experiences across eight studies in six countries that we redesigned to include remote data collection methods. We found the following areas were crucial in fulfilling our commitments to participants, researchers, violence prevention and research ethics: (1) designing remote data collection in the context of strong research partnerships; (2) adapting data collection approaches; (3) developing additional safeguarding processes in the context of remote data collection during the pandemic; and (4) providing remote support for researchers. We discuss lessons learnt in each of these areas and across the research design and implementation process, and summarise key considerations for other researchers considering remote data collection on violence.

Social normative origins of the taboo gap and implications for adolescent risk for HIV infection in Zambia.

Zambian Demographic and Health Survey data reveal that increased discordance between professed attitudes and measures of behaviour regarding premarital sex among adults is strongly associated with increased risk of HIV in adolescents, particularly girls. We hypothesised that this was due to the reluctance to talk about premarital sex, resulting in a situation we call the "taboo gap" where sexual behaviour is a forbidden topic and adolescents feel unable to seek advice or sexual and reproductive health services. Our analysis revealed that the taboo gap is rooted in harmful gender norms that are perpetuated by schools, churches, cultural influences, development programmes and health systems. Challenges like food insecurity and household poverty may place girls in positions where they are vulnerable to sexual exploitation, increasing their risk of exposure to HIV. Unmarried adolescents, particularly girls, report being ridiculed when they go to reproductive health clinics, which discourages them from seeking care in the future. Strengthening peer support and parent-child interactions are important programmatic elements. We conclude that discordance serves as a novel measure and harbinger for the presence of gender norms which generated a taboo gap that impeded carseeking and increased risk for HIV among adolescents, especially girls, in Zambia. We propose that successful interventions must involve a multifaceted, gender transformative approach which engages peers and stakeholders in schools, churches, clinics, and families, particularly parents, to reduce the gendered gap in HIV risk and transmission.

How social norms contribute to physical violence among ever-partnered women in Uganda: A qualitative study.

This paper contributes to the literature that studies how social norms sustain undesirable behavior. It establishes how norms contribute to intimate partner physical violence against women. First, norms organize physical violence as a domestic and private matter. Second, they organize physical violence as a constituent part of women's lives, thereby normalizing women's experience of abuse. Third, norms define appropriate boundaries within which male partners perpetrate violence. The findings draw essential information for social change interventions that target improvement in women's and girls' wellbeing. For social and behavioral programmes to change harmful norms, they have to deconstruct physical violence as a private matter, advance the de-normalization of physical violence, and dismantle acceptable boundaries within which violence happens.

Use of digital media for family planning information by women and their social networks in Kenya: A qualitative study in peri-urban Nairobi.

Access to information about family planning (FP) continues to have financial, physical and social barriers among young women living in Kenya. This paper draws on social norms theory to explore how young women and their social networks access FP information on digital media (e.g., WhatsApp, websites). Qualitative phone interviews were conducted with 40 participants - young women, their partners and key influencers - in seven peri-urban wards in Nairobi, Kenya. Data were analyzed using thematic analysis. Findings suggested that young women, their partners and key influencers predominately accessed FP information online through their informal networks, but identified healthcare workers as the most trusted sources of FP information. In digital spaces, participants described being more comfortable sharing FP information as digital spaces allowed for greater privacy and reduced stigma to talk about FP openly. Our findings highlight the importance of digital media in disseminating FP information among young women and their networks, the differences in norms governing the acceptability to talk about FP online vs. in-person and the significance of targeting misinformation about FP in digital media spaces.

Effect of imbalanced sampling and missing data on associations between gender norms and risk of adolescent HIV.

Background: Despite strides towards gender equality, inequalities persist or remain unstudied, due potentially to data gaps. Although mapped, the effects of key data gaps remain unknown. This study provides a framework to measure effects of gender- and age-imbalanced and missing covariate data on gender-health research. The framework is demonstrated using a previously studied pathway for effects of pre-marital sex norms among adults on adolescent HIV risk. Methods: After identifying gender-age-imbalanced Demographic and Health Survey (DHS) datasets, we resampled responses and restricted covariate data from a relatively complete, balanced dataset derived from the 2007 Zambian DHS to replicate imbalanced gender-age sampling and covariate missingness. Differences in model outcomes due to sampling were measured using tests for interaction. Missing covariate effects were measured by comparing fully-adjusted and reduced model fitness. Findings: We simulated data from 25 DHS surveys across 20 countries from 2005-2014 on four sex-stratified models for pathways of adult attitude-behaviour discordance regarding pre-marital sex and adolescent risk of HIV. On average, across gender-age-imbalanced surveys, males comprised 29.6% of responses compared to 45.3% in the gender-balanced dataset. Gender-age-imbalanced sampling significantly affected regression coefficients in 40% of model-scenarios (N = 40 of 100) and biased relative-risk estimates away from gender-age-balanced sampling outcomes in 46% (N = 46) of model-scenarios. Model fitness was robust to covariate removal with minor effects on male HIV models. No consistent trends were observed between sampling distribution and risk of biased outcomes. Interpretation: Gender-health model outcomes may be affected by sampling gender-age-imbalanced data and less-so by missing covariates. Although occasionally attenuated, the effect magnitude of gender-age-imbalanced sampling is variable and may mask true associations, thus misinforming policy dialogue. We recommend future surveys improve balanced gender-age sampling to promote research reliability. Funding: Bill & Melinda Gates Foundation grant OPP1140262 to Stanford University.

Personal beliefs and social norms regarding the sexual exploitation of girls in age-disparate transactional sexual relationships in Brazil: a mixed-methods study.

BACKGROUND: In the global debate around transactional sex little attention has concentrated on Brazil, despite ranking fourth globally in absolute number of girls married or co-habiting by the age of 15 years, and evidence showing that these unions often begin as age-disparate transactional sex (ADTS). This article contributes to filling this gap by exploring the personal beliefs and social norms related to ADTS in urban (favela) communities of Rio de Janeiro, Brazil between adult men (> 18 years) and girls and adolescents (G/A) (< 18 years) with a minimum 5-year age disparity. The primary objective of this study was to identify the social norms that promote and prevent ADTS, and the dynamics between individual beliefs and social norms, to provide contextualized recommendations to prevent ADTS in this setting. METHODS: An exploratory, sequential, mixed-methods design was used, starting with a qualitative phase that included semi-structured, in-depth interviews and focus groups, and a subsequent quantitative phase comprising of a community survey. The items for the quantitative questionnaires were developed based on the qualitative results. RESULTS: Mixed methods results indicate that in these communities ADTS is normalised and not considered exploitative. We identified three themes related to the reasons ADTS occurs: girls' responsibility, male desires and benefits of ADTS. Men's role in ADTS was largely minimised because of a general acceptance of a notion of masculinity characterised by hypersexuality and lack of impulse control. Individual beliefs, however, did not tend to align with these social norms. CONCLUSIONS: In this study, personal beliefs and social norms often did not align, suggesting that initiatives working to change personal or attitudes regarding ADTS may not lead to meaningful change in ADTS behaviours, and social norms interventions may be more effective. Our findings reinforce the need to develop programs tailored to local understandings of ADTS, targeting not only girls but also a wide range of actors. Interventions could also consider the structural factors acting in local and global contexts that promote or prevent ADTS.

This article explores the personal beliefs and social norms related to the exchange of sexual favours or relationships for material favours, gifts and/or support in some form, between adult men (> 18 years) and girls and adolescents (< 18 years) with a minimum 5-year age difference. We used interviews, focus groups and questionnaires to understand the factors that promote and prevent these sexual relationships between men and girls. Motivators for these relationships were often related to girls' responsibilities, male desires and the benefits of these relationships. Men's responsibility for their participation in these relationships with girls were often minimised due to a general acceptance of men as overly sexual and lacking impulse control. In this study, personal beliefs and social norms were often not aligned, suggesting that interventions focused on changing personal beliefs or attitudes about these sexual relationships may not be enough to change social norms. The findings highlight the need to develop solutions that consider a wider range of actors, instead of interventions focused only on girls. The study findings also support the need to further investigate how communities and shared expectations can influence sexual relationships in exchange for goods between adult men and girls and adolescents.

Gender Norms and Gender Equality in Full-Time Employment and Health: A 97-Country Analysis of the World Values Survey.

Background: Almost nowhere in the world do women participate as much as men in the labor force. Despite differences in countries' economic, social and cultural contexts, gender norms-unwritten rules of acceptable actions for men and women-have been found to affect women's labor participation across contexts. Gender norms include those regulating who takes care of children, who is expected to earn more, and in which sectors men and women should work. Importantly, norms affect access to labor markets at times of scarcity: when there's only work for one, gender norms can dictate whether a woman or man gets the job. Advocates of equal labor force participation point to evidence that employment can contribute to people's health and well-being; yet the evidence is mixed and contradictory, and mostly comes from high-income countries. In restrictive normative contexts in which women are assigned the role of family caretaker, full time employment (FTE) might be particularly burdensome. At the same time, the literature lacks a cross-country analysis of how gender norms affect women's FTE and their health when employed full time, despite qualitative research providing clear evidence of the influence of gender norms on labor participation. Aims: In this paper we examine: (1) how gender norms affect women's access to FTE across 97 countries; (2) associations between FTE and women's self-reported health self-rated (SRH) across different normative contexts (i.e., countries where it is common vs. uncommon for women to stay home); and (3) how women's FTE and gender norms changed over time in four countries. Data: We used time-series data from the World Values Survey and European Values Survey conducted in over 100 countries between 1981 and 2014. Both surveys attempt to capture norms, beliefs and values in addition to sociodemographic information among a nationally representative adult population in each country. The sample for the cross-sectional analyses (aims 1 and 2) included 97 countries and 131,132 respondents. The sample for aim 3 included data from Argentina, Egypt, Finland and Japan. Variables: Our outcome of interest was pro-equality norms in the context of access to the labor market for women. Respondents were asked "if jobs are scarce, men should have more right to a job than women do?". Response options included no, neither or yes. We created a binary variable to represent pro-equality norms. We included employment status and SRH as exposures of interest. Analysis: We used individual-level data to generate on-average and sex-stratified estimates of the outcome and exposures for each country, at each time point. We estimated the percentage of all respondents, of women, and of men who held pro-equality norms (believe that men should not have more right to a job than women), the percentage who were employed full time, and the average level of SRH. To measure gender inequality in FTE, we also estimated the absolute difference in FTE between women and men for each country at each time point. First, we conducted descriptive, cross-sectional ecological analyses using one survey per country from wave 5 or 6 (whichever was most recent) to examine associations between pro-equality norms and employment status as a proxy for associations between norms and the context of employment in each country. We also examined associations between pro-equality norms and SRH. We then specified adjusted logistic regression models with controls for age, sex and education to examine associations between pro-equality norms and employment status. To examine if the relationship between FTE and SRH varied by normative context, we grouped countries in quartiles of pro-equality norms. Finally, we conducted descriptive ecological analyses of the relationship between pro-equality norms and employment status over time in four countries. Results: Objective 1: Gender norms intersect with socio-cultural contexts in determining women's FTE. While in some countries gender norms aligned positively with women's access to employment (i.e., more equal norms matched more equality in FTE), in Eastern Europe and South America we observed a mismatch. In Eastern Europe we found strong norms against equal access but small sex differences in FTE. In South America, we observed a stark difference in FTE favoring men, despite positive gender norms promoting women's paid employment. Objective 2: We found the association between SRH and FTE to vary across normative contexts. For instance, while in Scandinavian countries it was protective to be a woman in FTE and harmful not to work full-time, we found the opposite effect in Middle Eastern countries. Objective 3: We found a general tendency to move toward greater equality in norms and FTE over time everywhere in the world. However, political and economic events can generate variations over time and setbacks in progress toward equality.We specifically looked at 4 countries: Argentina, Egypt, Finland and Japan and assessed the effects of economic, political and national legislative changes on FTE over time. Implications: This paper contributes to the conversation on tensions between universal justice and contextual factors affecting one's health. To achieve purposeful and global universal health and justice, policy makers and global health practitioners must design effective, context-relevant interventions that are deeply and transparently informed by the values they embody. As we strive to achieve global gender equality, its meanings and purposes will vary across contexts in ways that demand people-led conversations and interventions.

Associations of attitudes and social norms with experiences of intimate partner violence among married adolescents and their husbands in rural Niger: a dyadic cross-sectional study.

BACKGROUND: Prior cross-sectional research suggests that both men's and women's attitudes towards intimate partner violence (IPV) are predictive of women's IPV experience, although this can vary greatly by context. In general, women who have experienced IPV are likely to report attitudes accepting of it. Men who perpetrate IPV may also report attitudes accepting of it, although some research has found that there is not always an association. Studies that investigate these dynamics often conflate attitudes with social norms, or use attitudes as a proxy for social norms, given that valid measures on social norms are usually lacking. Here we conduct a secondary data analysis to ask how are men's and women's IPV-related attitudes associated with women's reports of IPV and how are men's and women's perceived social norms associated with women's reports of IPV. METHODS: Dyadic data were collected from a representative sample of married adolescent girls and their husbands in 48 rural villages of the Dosso region of Niger (N = 1010). Assessments included logistic regression analyses of husbands' and wives' reports of individual attitudes towards IPV, and social norms based on husbands' and wives' perceptions of their communities' beliefs related to gender roles and acceptability of IPV. RESULTS: Eight percent of women in this sample reported IPV. We found that, consistent with other research, wives who have reported IPV are more likely to report attitudes in support of IPV, while for husbands whose wives report IPV, that relationship is insignificant. On the other hand, husbands who report that people in their community believe there are times when a woman deserves to be beaten are more likely to have perpetrated IPV, while for wives there is no association between the community norm and IPV reporting. Finally, wives who report that people in their community hold inequitable gender norms in general are more likely to have experienced IPV, while for husbands, community gender norms are not predictive of whether their wives have reported IPV. CONCLUSIONS: Our results are evidence that IPV prevention interventions focused solely on individual attitudes may be insufficient. Targeting and assessment of social norms are likely critical to advancing understanding and prevention of IPV.

Quantitative Proxies for Social Norms: A Proposed Approach for Interrogating Clustering, Reference Groups, and Validity.

A growing number of researchers studying intimate partner violence (IPV) employ aggregate measures of relevant attitudes to serve as proxy measures for norms around IPV. However, there is a lack of consistency in how these measures are constructed and how their validity is confirmed. The first aim of this study is to demonstrate and validate innovative techniques for exploring social norms proxies in quantitative data and identifying the relative appropriateness of different available reference groups. The second aim is to demonstrate how such an approach can contribute to IPV research. The analysis employed data from the 2016 Tanzania International Men and Gender Equality Survey, including 1008 men and 1008 women ages 15-49 years. An attitudinal score measuring acceptance of IPV and two measures for individual-level descriptive and injunctive norms were constructed. The intraclass correlation coefficient (ICC) was used to assess the extent of clustering for the attitudinal score within several sets of groupings. Bivariate multi-level Ordinary Least Squares regressions estimated the predictive effect of an individual's group norm proxy on their descriptive or injunctive norms. Attitudinal clustering was most significant for reference groups defined as males only across villages and males only across a combination of villages and marital status, with ICCs of 0.229 and 0.236, respectively. Men's social norms were found to be correlated with reference groups comprised of both men only and women only, though men's norms were substantially more correlated with the attitudes of men in their reference group than with women's. Results highlight the importance of critically examining the validity of proxy measures for social norms prior to their inclusion in analysis. Findings also underscore the importance of collecting attitudinal data from men to better understand norms around IPV.

Measuring social norms and attitudes about age-disparate transactional sex: Psychometric testing of the NAATSS.

Background: Transactional sex between girls under 18 years-old and adult men at least ten years older, known as age-disparate transactional sex (ADTS), is an established risk factor for HIV, STI and early pregnancy among girls and women. Social norms or beliefs about what others expect from you and what others do can sustain behaviours such as ADTS even when individuals may be personally against them. In order to evaluate interventions to change social norms, validated instruments for measuring change in personal beliefs and social norms regarding ADTS are needed. Methods: Items for the Norms and Attitudes on Age-Disparate Transactional Sex Scale (NAATSS) were generated based on qualitative interviews and expert panel review. The reliability and validity of the NAATSS was tested in a representative sample (N = 431) from Brazilian favelas. Factor analysis assessed construct validity, Cronbach's alpha assessed reliability, and t-tests and analysis of variances tested hypothesized differences between gender, age, and previous experience with ADTS in both the social norms and personal beliefs domains. Findings: Factor analysis revealed three factors in each domain. The factors were labelled "Attributions to Girls' Behaviour" which has 5 items, "Men's Motivations" with 5 items, and "Girls' Readiness to have Sex" with 3 items. The subscales evidenced acceptable reliability with Cronbach's alphas ranging from 0.72 to 0.83 for the social norms subscales and 0.59 to 0.82 for the personal beliefs subscales. Interpretation: The items were developed based on qualitative research and expert rankings and the resulting Norms and Attitudes on ADTS Scale exhibits strong psychometric properties. Each of the three subscales within the two domains illustrate good factor structure, acceptable internal consistency reliability, and are supported by the significance of the hypothesized group differences. Funding: This work was supported by the OAK Foundation [grant number OCAY-16-188].