A qualitative investigation of gender-based violence prevention and response using digital technologies in low resource settings and refugee populations.

Background: Governmental and non-governmental organizations across medical, legal, and psychosocial sectors providing care to survivors of gender-based violence (GBV) and their families rapidly digitalized services during the COVID-19 pandemic. GBV prevention/response services working with women and children who are forcibly displaced and/or living in low-and-middle income countries (LMIC) were no exception to the rapid digitalization trend. Literature is lacking a critical synthesis of best practices and lessons learned since digitalization replaced major operations involved in GBV prevention/response.Objective: This research qualitatively investigated how GBV service providers, located in a range of socio-political settings, navigated the process of digitalizing GBV prevention/response during the COVID-19 crisis.Method: Semi-structured key informant interviews (KII) with GBV service providers in varied sectors were implemented virtually (2020-2021) in Brazil, Guatemala, Iraq, and Italy (regarding forcibly displaced women/girls for the latter). Participants were recruited using purposive and snowball sampling. Interview guides covered a range of topics: perceived changes in violence and service provision, experiences with virtual services, system coordination, and challenges. The KIIs were conducted in Portuguese, Spanish, Arabic, and Italian. Interviews were audio-recorded, transcribed, and translated into English. The research team conducted thematic analysis within and between countries using a structured codebook of data driven and theory driven codes.Results: Major themes concerned the: (1) spectrum of services that were digitalized during the COVID-19 crisis; (2) gender digital divide as a barrier to equitable, safe, and effective service digitalization; (3) digital violence as an unintended consequence of increased digitalization across social/public services.Conclusion: Digitalization is a balancing act with respect to (1) the variety of remotely-delivered services that are possible and (2) the access/safety considerations related to the gender digital divide and digital violence.

Digitalization occurs when products and services are converted to digital forms; violence prevention/response services working with women and children who are forcibly displaced and/or living in low-and-middle income countries were no exception to the rapid trend of digitalization during the COVID-19 crisis.Using key informant interviews with service providers working in violence prevention and response sectors in Brazil, Guatemala, Iraq, and in Italy regarding forcibly displaced women/girls, we investigated the rapid digitalization of gender-based violence prevention/response during the COVID-19 crisis.The effectiveness, safety, and equitability of digitalized violence prevention/response services depends on how well they are balanced vis-a-vis the gender digital divide and risk of digital GBV.

"The pandemic only gave visibility to what is invisible": a qualitative analysis of structural violence during COVID-19 and impacts on gender-based violence in Brazil.

BACKGROUND: The COVID-19 pandemic produced alarming rates of disease and mortality globally, yet few nations were as severely impacted as Brazil. The pandemic also exposed and exacerbated persistent forms of structural violence across Brazil, which complicated gender-based violence (GBV) prevention and response efforts. While structural violence is not new, the systemic pressure and uncertainty introduced by COVID-19 intensified the detrimental impact of structural violence on the lives of Brazilians impacted by GBV. This work qualitatively investigated how the COVID-19 pandemic amplified structural violence and GBV in Brazil. METHODS: We analyzed key informant interviews (KII) conducted with 12 service providers working in sectors related GBV prevention and response in Roraima, Boa Vista, and Rio de Janeiro. Interviews were audio-recorded, transcribed, and translated from Portuguese or Spanish into English, before applying deductive and inductive coding approaches through a collaborative data reduction process. The theoretical lens of structural violence outlined by Farmer and Rylko-Bauer guided the thematic development. RESULTS: Analyses identified three themes. First, structural violence manifests as policies of inaction and erasure, which reduce the opportunity for upward social mobility among GBV survivors including Black women, trans persons, and people who live in the favelas. Policies of inaction and erasure fail to acknowledge/adequately respond to the significant health and safety needs of these communities. Second, structural violence is a fundamental cause of violence against women and children. Finally, service providers described community driven responses that address the dire survival needs (i.e., food insecurity) imposed by COVID-19, within a context of structural violence. These community driven responses were innovative, agile, and based on dire needs expressed to, and observed by, the service providers interviewed. CONCLUSION: This analysis highlights how the COVID-19 pandemic exacerbated existing forms of structural violence prevalent throughout Brazil. Findings stress the urgency with which the Brazilian government and international organization must act to support community driven programs that strive to address the most basic human needs.

Danger Zone or Newfound Freedoms: Exploring Women and Girls' Experiences in the Virtual Space during COVID-19 in Iraq.

During the COVID-19 pandemic, women and girls across the globe faced increased reliance on the digital space to access education, social support, and health and gender-based violence (GBV) services. While research from the last three years has explored how women and girls navigated and responded to their new virtual reality, minimal evidence has been generated from low-resource settings where access to technology may be limited. Further, no studies to date have examined these dynamics in Iraq, where women and girls already face numerous threats to safety due to various forms of structural violence and patriarchal family structures. This qualitative study aimed to examine women and girls' experiences in the digital space during COVID-19 in Iraq, including the benefits and risks of engagement as well as how access to the digital space was controlled. Data for the present analysis come from the authors' larger multi-country study investigating women and girls' safety and access to GBV services in the context of the COVID-19 pandemic and related public health measures employed to control the spread of the virus. In Iraq, semi-structured key informant interviews were conducted virtually with fifteen GBV service providers. Following the translation and transcription of interviews, the thematic analysis highlighted several benefits and challenges women and girls experienced as they tried to access and utilize technology for schooling, support services, and obtaining and spreading information. While many women and girls increasingly and successfully relied on social media to spread awareness of GBV cases, key informants noted that women and girls also faced increased risks of experiencing electronic blackmail. In addition to a substantial digital divide in this context-which manifested as differential access to technology by gender, rural/urban status, and socioeconomic status-intrahousehold control of girls' access to and use of technology left many adolescent girls unable to continue schooling and contributed to their further marginalization and consequent decline in well-being. Implications for women's safety and mitigation strategies are also discussed.

The Economic Cost of Violence Against Women and Girls in Low- and Middle-Income Countries: A Systematic Review of the Evidence.

Evidence demonstrating the economic burden of violence against women and girls can support policy and advocacy efforts for investment in violence prevention and response programming. We undertook a systematic review of evidence on the costs of violence against women and girls in low- and middle-income countries published since 2005. In addition to understanding costs, we examined the consistency of methodological approaches applied and identified and assessed common methodological issues. Thirteen articles were identified, eight of which were from sub-Saharan Africa. Eight studies estimated costs associated with domestic or intimate partner violence, others estimated the costs of interpersonal violence, female genital cutting, and sexual assaults. Methodologies applied to estimate costs were typically based on accounting approaches. Our review found that out-of-pocket expenditures to individuals for seeking health care after an episode of violence ranged from US$29.72 (South Africa) to US$156.11 (Romania) and that lost productivity averaged from US$73.84 to US$2,151.48 (South Africa) per facility visit. Most studies that estimated provider costs of service delivery presented total programmatic costs, and there was variation in interventions, scale, and resource inputs measured which hampered comparability. Variations in methodological assumptions and data availability also made comparisons across countries and settings challenging. The limited scope of studies in measuring the multifaceted impacts of violence highlights the challenges in identifying cost metrics that extend beyond specific violence episodes. Despite the limited evidence base, our assessment leads us to conclude that the estimated costs of violence against women and girls are a fraction of its true economic burden.

The Economic Burden of Intimate Partner Violence in Colombia: Estimated Health Costs Among Females Aged 13-24.

BACKGROUND: Intimate partner violence (IPV) is the most pervasive form of gender-based violence, often first experienced in adolescence. While the prevalence of IPV is known to be exacerbated in humanitarian settings, little is known in regard to the economic burden of IPV between conflict-affected and non-conflicted-affected groups of women and girls. This top-down costing study examines the total health burden of physical IPV in Colombia, and whether these costs differ by conflict exposure. METHODS: We utilized a nationally representative sample of 13-24-year-old females from the Violence Against Children Surveys (VACS) in Colombia conducted in 2018. Using physical IPV prevalence, the analysis was conducted in four steps: 1) estimate the relative risk of seven IPV-associated health outcomes among the sample and subgroups, 2) estimate the population attributable fraction of IPV for each health outcome, 3) quantify the burden of IPV in disability-adjusted life years (DALYs), and 4) assign health costs in US dollars to the estimated DALYs. RESULTS: We found that the single year health burden associated with physical IPV was $90.6 million USD. Moreover, nearly 40% of the economic burden of physical IPV among females aged 13-24 in Colombia was from those who were conflict-affected (24%). CONCLUSION: Our findings demonstrate that at least 16% of the overall health costs among females 13-24 in Colombia is from the preventable epidemic of physical IPV. In order to prevent and mitigate the costs of gender-based violence, multi-lateral and government investment is critically needed to prevent IPV and support women and girls.

"At the Root of COVID Grew a More Complicated Situation": A Qualitative Analysis of the Guatemalan Gender-Based Violence Prevention and Response System during the COVID-19 Pandemic.

A growing body of literature has documented an increased risk of gender-based violence (GBV) within the context of COVID-19 and service providers' reduced capacity to address this vulnerability. Less examined are the system-level impacts of the pandemic on the GBV sector in low- and middle-income countries. Drawing on the perspectives of 18 service providers working across various GBV-related sectors in Guatemala, we explored how the Guatemalan GBV prevention and response system operated during the COVID-19 pandemic. Findings highlight that the pandemic reinforced survivors' existing adversities (inadequate transportation access, food insecurity, digital divides), which subsequently reduced access to reporting, justice, and support. Consequently, the GBV prevention and response system had to absorb the responsibility of securing survivors' essential social determinants of health, further limiting already inflexible budgets. The pandemic also imposed new challenges, such as service gridlocks, that negatively affected survivors' system navigation and impaired service providers' abilities to efficiently receive reports and mobilize harm reduction and prevention programming. The findings underscore the systemic challenges faced by GBV service providers and the need to incorporate gender mainstreaming across public service sectors-namely, transportation and information/communication-to improve lifesaving GBV service delivery for Guatemalan survivors, particularly survivors in rural/remote regions.

"The pandemic made us stop and think about who we are and what we want:" Using intersectionality to understand migrant and refugee women's experiences of gender-based violence during COVID-19.

BACKGROUND: Migrant and refugee women have faced a myriad of challenges during COVID-19, which are often exacerbated by the interaction between this population's diverse identities and established systems in the local context. This qualitative study uses the lens of intersectionality to understand migrant and refugee women's experiences of gender-based violence and access to and quality of support services in Italy during the first year of COVID-19. METHODS: Data were gathered from 51 key informant interviews and eight focus group discussions of 31 participants. Key informants included service providers across sectors, including gender-based violence and anti-violence organizations, government and law, health, psychology, social work, and anti-trafficking administration. Focus group participants were migrant and refugee women aged 18-65 from the following countries of origin: Bangladesh, Cameroon, Colombia, El Salvador, Gambia, Ghana, Honduras, Libya, Nigeria, Pakistan, Peru, Senegal, and Syria. Interviews were audio-recorded, transcribed and coded using a collaborative process with partners from UNICEF. Transcripts were then evaluated for arising themes using three methods of intersectionality analysis. RESULTS: Data analysis revealed how COVID-19 converged with sexism, racism, and xenophobia in Italy, leading to increased public and domestic violence against refugee and migrant women. Another prominent theme was the exacerbated vulnerability for refugee and migrant women in precarious socioeconomic situations, which prompted many service providers to recognize and address gaps in service offerings and coordination around basic needs. However, due to resource constraints and bias, providers did not systematically incorporate inclusive language and cultural mediation into remote and online services, creating a heightened barrier to access for non-Italian women despite their complex needs. As such, refugee and migrant women highlighted community-based solidarity and support as protective factors during lockdown periods. CONCLUSION: Findings emphasize how overlapping dominant sociocultural and socioeconomic systems impacted refugee and migrant women's experiences of violence during COVID-19 in Italy, and how some support services were unprepared to respond to the complex needs of diverse, newcomer populations. We discuss how policymakers and practitioners might consider intersectionality in their preparedness and response planning for gender-based violence services during health emergencies moving forward.

Gender-based violence and infectious disease in humanitarian settings: lessons learned from Ebola, Zika, and COVID-19 to inform syndemic policy making.

BACKGROUND: The impacts of infectious disease outbreaks, epidemics, and pandemics are not gender neutral. Instead, infectious diseases and gender-based violence (GBV) mutually reinforce each other. Women and girls in humanitarian settings are disproportionately impacted as crises exacerbate gender inequality, violence, and community transmission. A syndemic model of infectious disease and GBV draws attention to their critical linkage, enabling more effective approaches to address both infectious disease transmission and GBV prevalence. MAIN BODY: Implementation of infectious disease control measures have been consistently absent of critical gender considerations in humanitarian settings. We drew learnings from Ebola, Zika, and COVID-19 to highlight how women and girls living in humanitarian settings have faced bi-directional syndemic vulnerabilities between GBV and infectious disease. Our findings indicate that Ebola, Zika, and COVID-19 exacerbated GBV risk and experience of GBV increased community transmission of these infectious diseases. Moreover, we identified a failure of existing policies to address this mutually deleterious linkage. Thus, we advocate for policymakers to ask three foundational questions: (i) What are the gendered bi-directional risk pathways between infectious disease and GBV?; (ii) How can we act on the gendered risk pathways?; and, (iii) Who should be involved in designing, implementing, and evaluating gender-sensitive policies? CONCLUSION: Our syndemic policy framework challenges existing thinking on a neglected issue that disproportionally impacts women and girls. By offering foundational guidance to address and thwart the syndemic of infectious disease and GBV in humanitarian settings, we endeavor to proactively and holistically address the reinforcing linkage between GBV and current or emergent infectious diseases.

Identifying the Impact of Intimate Partner Violence in Humanitarian Settings: Using an Ecological Framework to Review 15 Years of Evidence.

Intimate partner violence (IPV) is a pervasive form of gender-based violence that exacerbates in humanitarian settings. This systematic review examined the myriad IPV impacts and the quality of existing evidence of IPV in humanitarian settings. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) procedures, a total of 51 articles were included from the 3924 screened. We identified the impact of IPV across two levels of the ecological framework: individual and microsystem. Our findings corroborated previous evidence that indicated IPV to be associated with adverse physical and mental health for survivors. Our findings also uniquely synthesized the intergenerational impact of IPV in humanitarian settings. However, findings highlighted a glaring gap in evidence examining the non-health impact of IPV for survivors in humanitarian settings and across levels of the ecological framework. Without enhanced research of women and girls and the violence they experience, humanitarian responses will continue to underachieve, and the needs of women and girls will continue to be relegated as secondary interests. Investment should prioritize addressing the range of both health and non-health impacts of IPV among individuals, families, and communities, as well as consider how the humanitarian environment influences these linkages.

Forced Sex and Early Marriage: Understanding the Linkages and Norms in a Humanitarian Setting.

This mixed-methods study uses baseline data from a program evaluation in the Democratic Republic of Congo to examine two outcomes of interest: self-reported exposure to forced sex and belief that a girl's community would force her to marry her hypothetical rapist, for married and unmarried 13- to 14-year-old girls (n = 377). Married girls are more likely to report both outcomes. Qualitative in-depth interviews with girl participants (n = 30) and their caregivers (n = 31) were analyzed for themes related to forced sex and marriage, revealing the normalcy of girls marrying perpetrators and suggesting that some married girls in this setting may have been forced to marry their rapist.

Examining intersections between violence against women and violence against children: perspectives of adolescents and adults in displaced Colombian communities.

BACKGROUND: Research examining the interrelated drivers of household violence against women and violence against children is nascent, particularly in humanitarian settings. Gaps remain in understanding how relocation, displacement and ongoing insecurity affect families and may exacerbate household violence. METHODS: Employing purposive sampling, we used photo elicitation methods to facilitate semi-structured, in-depth interviews with female and male adolescents and adults aged 13-75 (n = 73) in two districts in Colombia from May to August of 2017. Participants were displaced and/or residing in neighborhoods characterized by high levels of insecurity from armed groups. RESULTS: Using inductive thematic analysis and situating the analysis within a feminist socioecological framework, we found several shared drivers of household violence. Intersections among drivers at all socioecological levels occurred among societal gender norms, substance use, attempts to regulate women's and children's behavior with violence, and daily stressors associated with numerous community problems. A central theme of relocation was of family compositions that were in continual flux and of family members confronted by economic insecurity and increased access to substances. CONCLUSIONS: Findings suggest interventions that systemically consider families' struggles with relocation and violence with multifaceted attention to socioecological intersections.

Creating opportunities through mentorship, parental involvement, and safe spaces (COMPASS) program: multi-country study protocol to protect girls from violence in humanitarian settings.

BACKGROUND: Violence against adolescent girls in humanitarian settings is of urgent concern given their additional vulnerabilities to violence and unique health and well-being needs that have largely been overlooked by the humanitarian community. In order to understand what works to prevent violence against adolescent girls, a multi-component curriculum-based safe spaces program (Creating Opportunities through Mentorship, Parental involvement and Safe Spaces - COMPASS) will be implemented and evaluated. The objectives of this multi-country study are to understand the feasibility, acceptability and effectiveness of COMPASS programming to prevent violence against adolescent girls in diverse humanitarian settings. METHODS/DESIGN: Two wait-listed cluster-randomized controlled trials are being implemented in conflict-affected communities in eastern Democratic Republic of Congo (N = 886 girls aged 10-14 years) and in refugee camps in western Ethiopia (N = 919 girls aged 13-19 years). The intervention consists of structured facilitated sessions delivered in safe spaces by young female mentors, caregiver discussion groups, capacity-building activities with service providers, and community engagement. In Ethiopia, the research centers on the overall impact of COMPASS compared to a wait-list group. In DRC, the research objective is to understand the incremental effectiveness of the caregiver component in addition to the other COMPASS activities as compared to a wait-list group. The primary outcome is change in sexual violence. Secondary outcomes include decreased physical and emotional abuse, reduced early marriage, improved gender norms, and positive interpersonal relationships, among others. Qualitative methodologies seek to understand girls' perceptions of safety within their communities, key challenges they face, and to identify potential pathways of change. DISCUSSION: These trials will add much needed evidence for the humanitarian community to meet the unique needs of adolescent girls and to promote their safety and well-being, as well as contributing to how multi-component empowerment programming for adolescent girls could be adapted across humanitarian settings. TRIAL REGISTRATION: Clinical Trials NCT02384642 (Registered: 2/24/15) & NCT02506543 (Registered: 7/19/15).

Potential and pitfalls in establishing the provenance of Earth-related samples in forensic investigations.

Earth scientists are often asked to establish or constrain the likely provenance of very small quantities of earth-related material as part of a forensic investigation. We tested the independent and collective interpretations of four experts with differing analytical skills in the prediction of sample provenance for three samples from different environmental settings. The methods used were X-ray diffraction, scanning electron microscopy, the assessment of pollen assemblages, and structural characterization of organic matter at the molecular level. Independent interpretations were less accurate than those where multiple techniques were combined. Collective interpretation was very effective in the assessment of provenance for two of the three sites where the mineralogy and plant communities were distinctive. At the other site, although the mineralogical analysis correctly identified the Triassic mudstone soil parent material, Carboniferous spores from domestic coal were initially interpreted as deriving directly from bedrock. Such an interpretation could be a common pitfall owing to anthropogenic redistribution of material such as coal.