Community cohesion and violence against women in Ghana, Pakistan, and South Sudan: A secondary data analysis.

BACKGROUND: Much knowledge has been accumulated on individual-level risks and protective factors of violence against women. However, the influence of factors operating at the community level, such as community cohesion, remains unclear, especially in low- and middle-income countries. This study examined whether community cohesion, a combined measure of mutual trust and tolerance, affects women's likelihood of experiencing intimate partner violence, violence perpetrated by a family member, and violence occurring in public spaces. METHODS: Data on 4785 women aged between 18 and 60 years in Ghana, Pakistan, and South Sudan, initially collected by the 'What Works to Prevent Violence Against Women and Girls' Research and Innovation Programme, were used for this study. Binary logistic regression analyses were used to assess the association between a composite measure of community cohesion and recent experience of physical, sexual, and psychological violence while controlling for different individual-, community-, and state-level variables. RESULTS: Multivariate analyses revealed that community cohesion was associated with lower risks of public spaces violence (adjusted odds ratio = 0.396, 95% confidence interval = 0.312-0.503, P < 0.001) and family member violence (adjusted odds ratio = 0.839, 95% confidence interval = 0.754-0.934, P < 0.001). There was no statistically significant association between intimate partner violence and community cohesion, but adjusted models showed that women with more developed social networks were at higher risks of experiencing intimate partner violence (adjusted odds ratio = 1.104, 95% confidence interval = 1.062-1.148, P < 0.001). CONCLUSION: Our findings suggest that community cohesion may have a protective effect against the most visible forms of violence against women. However, this effect may be attenuated or even eliminated by other individual- or household-level mechanisms in the case of violence between intimates or family members.

The health-related impacts and costs of violence against women and girls on survivors, households and communities in Ghana.

Past research on violence in Ghana primarily discusses domestic violence and some types of sexual violence, but lacks a comprehensive analysis of violence against women and girls (VAWG) and its wider costs and impacts. Our study on the social costs of VAWG is a unique contribution, which aims to fill that gap. Through indepth interviews (IDIs) and focus group discussions (FGDs) with adult women and men, we explored the health impact of VAWG and the resulting social and economic consequences on survivors, their families and their communities. The research, which took place in the Eastern, Central, and Greater Accra regions of Ghana, points to several physical and mental health outcomes among survivors including physical injuries and disability, as well as impacts on mental health such as anxiety and suicidal ideation. Many VAWG survivors also experience stigma and social isolation. Our findings also reveal that survivors' families can bear various social and economic costs. Lack of public and private service provision and shelters for survivors heighten these impacts. Without institutional support for survivors, families and communities absorb these costs of VAWG.

Recommendations for teaching upon sensitive topics in forensic and legal medicine in the context of medical education pedagogy.

Undergraduate medical curricula typically include forensic and legal medicine topics that are of a highly sensitive nature. Examples include suicide, child abuse, domestic and sexual violence. It is likely that some students will have direct or indirect experience of these issues which are prevalent in society. Those students are vulnerable to vicarious harm from partaking in their medical education. Even students with no direct or indirect experience of these issues may be vulnerable to vicarious trauma, particularly students who are especially empathetic to cases presented. Despite these risks, instruction relating to these topics is necessary to ensure the competencies of graduating doctors to respond appropriately to cases they encounter during their professional careers. However, risk can be minimised by a well-designed and thoughtfully delivered educational programme. We provide recommendations for the successful inclusion of sensitive forensic and legal medicine topics in undergraduate medical curricula.