Intimate partner violence in 46 low-income and middle-income countries: an appraisal of the most vulnerable groups of women using national health surveys.

Introduction: Intimate partner violence (IPV) against women is a critical public health issue that transcends social and economic boundaries and considered to be a major obstacle to the progress towards the 2030 women, children and adolescents' health goals in low-income and middle-income countries (LMICs). Standardised IPV measures have been increasingly incorporated into Demographic and Health Surveys carried out in LMICs. Routine reporting and disaggregated analyses at country level are essential to identify populational subgroups that are particularly vulnerable to IPV exposure. Methods: We examined data from 46 countries with surveys carried out between 2010 and 2017 to assess the prevalence and inequalities in recent psychological, physical and sexual IPV among ever-partnered women aged 15-49 years. Inequalities were assessed by disaggregating the data according to household wealth, women's age, women's empowerment level, polygyny status of the relationship and area of residence. Results: National levels of reported IPV varied widely across countries-from less than 5% in Armenia and Comoros to more than 40% in Afghanistan. Huge inequalities within countries were also observed. Generally, richer and more empowered women reported less IPV, as well as those whose partners had no cowives. Different patterns across countries were observed according to women's age and area of residence but in most cases younger women and those living in rural areas tend to be more exposed to IPV. Conclusion: The present study advances the current knowledge by providing a global panorama of the prevalence of different forms of IPV across LMICs, helping the identification of the most vulnerable groups of women and for future monitoring of leaving no one behind towards achieving the elimination of all forms of violence among women and girls.

Intimate partner violence against low-income women in Mexico City and associations with work-related disruptions: a latent class analysis using cross-sectional data.

BACKGROUND: Disrupting women's employment is a strategy that abusive partners could use to prevent women from maintaining economic independence and stability. Yet, few studies have investigated disruptions in employment among victims of intimate partner violence (IPV) in low-income and middle-income countries. Moreover, even fewer have sought to identify which female victims of IPV are most vulnerable to such disruptions. METHODS: Using baseline data from 947 women in Mexico City enrolled in a randomised controlled trial, multilevel latent class analysis (LCA) was used to classify women based on their reported IPV experiences. Furthermore, multilevel logistic regression analyses were performed on a subsample of women reporting current work (n=572) to investigate associations between LCA membership and IPV-related employment disruptions. RESULTS: Overall, 40.6% of women who were working at the time of the survey reported some form of work-related disruption due to IPV. LCA identified four distinct classes of IPV experiences: Low Physical and Sexual Violence (39.1%); High Sexual and Low Physical Violence class (9.6%); High Physical and Low Sexual Violence and Injuries (36.5%); High Physical and Sexual Violence and Injuries (14.8%). Compared with women in the Low Physical and Sexual Violence class, women in the High Physical and Sexual Violence and Injuries class and women in the High Physical and Low Sexual Violence and Injuries class were at greater risk of work disruption (adjusted relative risk (ARR) 2.44, 95% CI 1.80 to 3.29; ARR 2.05, 95% CI 1.56 to 2.70, respectively). No other statistically significant associations emerged. CONCLUSION: IPV, and specific patterns of IPV experiences, must be considered both in work settings and, more broadly, by economic development programmes. TRIAL REGISTRATION NUMBER: NCT01661504.

Cerrar la brecha: revisión mundial acerca de las intersecciones entre la violencia contra la mujer y la violencia contra los niños y las niñas

[RESUMEN]. Antecedentes. La comunidad internacional ha reconocido que la violencia contra la mujer (VCM) y la violencia en la niñez (VCN) representan problemas mundiales en el ámbito de la salud pública y los derechos humanos. Históricamente, las investigaciones, los programas y las políticas sobre estas formas de violencia han seguido trayectorias paralelas, si bien distintas. Por esta razón, algunos han instado a emprender esfuerzos para cerrar las brechas, en parte sobre la base de la evidencia científica que parece indicar que las personas y las familias a menudo están expuestas a múltiples formas de violencia que pueden ser difíciles de abordar de manera aislada, y que la violencia en la niñez eleva el riesgo de la violencia contra la mujer. Métodos. En este artículo se presenta una revisión narrativa de la evidencia científica sobre las áreas donde se observa una intersección de la violencia en la niñez y la violencia contra la mujer, incluida la violencia sexual infligida por personas distintas de la pareja, especialmente en los países de ingresos bajos y medianos. Resultados. Se identificaron seis áreas de intersección: 1) la VCM y la VCN comparten varios los factores de riesgo; 2) las normas sociales con frecuencia apoyan estas formas violencia y desalientan la búsqueda de ayuda; 3) el maltrato infantil y la violencia infligida por la pareja con frecuencia coexisten en el mismo hogar; 4) tanto la VCM como la VCN pueden generar efectos intergeneracionales; 5) muchas formas de VCM y de VCN acarrean consecuencias comunes y mutuamente exacerbantes a lo largo de la vida; y 6) la VCM y la VCN intersecan durante la adolescencia, periodo de mayor vulnerabilidad a ciertos tipos de violencia. Conclusiones. La evidencia sobre las intersecciones entre estas dos formas de violencia indica que la consolidación de los esfuerzos realizados para abordar los factores comunes de riesgo puede contribuir a prevenir las dos formas de violencia. Las consecuencias y los efectos intergeneracionales comunes sugieren que es necesario realizar intervenciones tempranas más integradas. La adolescencia se encuentra tanto en un punto intermedio de los ámbitos tradicionales de los dos tipos de violencia como dentro de estos ámbitos, por lo que amerita mayor atención. Entre las oportunidades de establecer una mayor colaboración se encuentran la capacitación de los prestadores de servicios para abordar las múltiples formas de violencia, una mejor coordinación entre los servicios dirigidos a las mujeres y los dirigidos a los niños y las niñas, la adopción de estrategias en los entornos escolares, la implementación de programas para padres, madres y cuidadores y la elaboración de programas relacionados con la salud y el desarrollo de los adolescentes. Además, es necesario que haya una mayor coordinación entre los investigadores que trabajan en la VCM y la VCN a medida que los países se preparan para medir el progreso en el logro de los Objetivos de Desarrollo Sostenible establecidos para el 2030.

[ABSTRACT]. Background. The international community recognises violence against women (VAW) and violence against children (VAC) as global human rights and public health problems. Historically, research, programmes, and policies on these forms of violence followed parallel but distinct trajectories. Some have called for efforts to bridge these gaps, based in part on evidence that individuals and families often experience multiple forms of violence that may be difficult to address in isolation, and that violence in childhood elevates the risk of violence against women. Methods. This article presents a narrative review of evidence on intersections between VAC and VAW _ including sexual violence by non-partners, with an emphasis on low- and middle-income countries. Results. We identify and review evidence for six intersections: 1) VAC and VAW have many shared risk factors. 2) Social norms often support VAWand VAC and discourage help-seeking. 3) Child maltreatment and partner violence often co-occur within the same household. 4) Both VAC and VAW can produce intergenerational effects. 5) Many forms of VAC and VAW have common and compounding consequences across the lifespan. 6) VAC and VAW intersect during adolescence, a time of heightened vulnerability to certain kinds of violence. Conclusions. Evidence of common correlates suggests that consolidating efforts to address shared risk factors may help prevent both forms of violence. Common consequences and intergenerational effects suggest a need for more integrated early intervention. Adolescence falls between and within traditional domains of both fields and deserves greater attention. Opportunities for greater collaboration include preparing service providers to address multiple forms of violence, better coordination between services for women and for children, school-based strategies, parenting programmes, and programming for adolescent health and development. There is also a need for more coordination among researchers working on VAC and VAW as countries prepare to measure progress towards 2030 Sustainable Development Goals.

Bridging the gaps: a global review of intersections of violence against women and violence against children

Background: The international community recognises violence against women (VAW) and violence against children (VAC) as global human rights and public health problems. Historically, research, programmes, and policies on these forms of violence followed parallel but distinct trajectories. Some have called for efforts to bridge these gaps, based in part on evidence that individuals and families often experience multiple forms of violence that may be difficult to address in isolation, and that violence in childhood elevates the risk of violence against women. Methods: This article presents a narrative review of evidence on intersections between VAC and VAW including sexual violence by non-partners, with an emphasis on low- and middle-income countries. Results: We identify and review evidence for six intersections: 1) VAC and VAW have many shared risk factors. 2) Social norms often support VAWand VAC and discourage help-seeking. 3) Child maltreatment and partner violence often co-occur within the same household. 4) Both VAC and VAW can produce intergenerational effects. 5) Many forms of VAC and VAW have common and compounding consequences across the lifespan. 6) VAC and VAW intersect during adolescence, a time of heightened vulnerability to certain kinds of violence. Conclusions: Evidence of common correlates suggests that consolidating efforts to address shared risk factors may help prevent both forms of violence. Common consequences and intergenerational effects suggest a need for more integrated early intervention. Adolescence falls between and within traditional domains of both fields and deserves greater attention. Opportunities for greater collaboration include preparing service providers to address multiple forms of violence, better coordination between services for women and for children, school-based strategies, parenting programmes, and programming for adolescent health and development. There is also a need for more coordination among researchers working on VAC and VAW as countries prepare to measure progress towards 2030 Sustainable Development Goals.

Placing gender at the centre of health programming: challenges and limitations.

In this paper we argue that a gender analysis is fundamental to health and health planning. We begin with a definition of gender and related concepts including equity and equality. We discuss why gender is key to understanding all dimensions of health including health care, health seeking behaviour and health status, and how a gender analysis can contribute to improved health policies and programming. Despite the many reasons for incorporating gender issues in health policies and programmes many obstacles remain, including the lack of attention to gender in the training of health professionals and the lack of awareness and sensitivity to gender concerns and disparities in the biomedical community. We argue that the key to placing gender values firmly in place in Health for All renewal is a change in philosophy at all levels of the health sector and suggest ways in which such a change can be implemented in the areas of policy, research, training and practical programmes and interventions.