Financial inclusion and intimate partner violence: What does the evidence suggest?

Financial inclusion is an area of growing global interest in women's empowerment policy and programming. While increased economic autonomy may be expected to reduce the prevalence of intimate partner violence, the mechanisms and contexts through which this relationship manifests are not well understood. This analysis aims to assess the relationship between women's financial inclusion and recent intimate partner violence using nationally-representative data from 112 countries worldwide. Levels of both financial inclusion and recent intimate partner violence varied substantially across countries (ranging from 2-100%, and 1-46%, respectively), and across regions. In multivariate global analyses, increased levels of women's financial inclusion were associated with lower levels of recent intimate partner violence after accounting for asset-based enablers of economic autonomy and gender norms; this relationship was lost upon the inclusion of measures of national context (i.e., development and fragility). These results underscore that the relationship between financial inclusion and recent intimate partner violence is complex, follows many pathways, and is affected by context. In low and middle income countries, asset-based enablers of economic autonomy, gender norms and national context explained much of the relationship between financial inclusion and recent intimate partner violence. In those low and middle income countries with high levels of controlling behavior by male spouses, financial inclusion was associated with higher levels of recent intimate partner violence. These findings further suggest that initiatives that aim to prevent intimate partner violence by way of increased economic autonomy may be ineffective in the absence of broader social change and support, and indeed, as seen in countries with higher levels of men's controlling behavior, backlash may increase the risk of violence. Efforts to improve women's financial inclusion need to recognize that its relationship with intimate partner violence is complex, and that it requires an enabling environment supportive of women's rights and autonomy.

Disrupting gender norms in health systems: making the case for change.

Restrictive gender norms and gender inequalities are replicated and reinforced in health systems, contributing to gender inequalities in health. In this Series paper, we explore how to address all three through recognition and then with disruptive solutions. We used intersectional feminist theory to guide our systematic reviews, qualitative case studies based on lived experiences, and quantitative analyses based on cross-sectional and evaluation research. We found that health systems reinforce patients' traditional gender roles and neglect gender inequalities in health, health system models and clinic-based programmes are rarely gender responsive, and women have less authority as health workers than men and are often devalued and abused. With regard to potential for disruption, we found that gender equality policies are associated with greater representation of female physicians, which in turn is associated with better health outcomes, but that gender parity is insufficient to achieve gender equality. We found that institutional support and respect of nurses improves quality of care, and that women's empowerment collectives can increase health-care access and provider responsiveness. We see promise from social movements in supporting women's reproductive rights and policies. Our findings suggest we must view gender as a fundamental factor that predetermines and shapes health systems and outcomes. Without addressing the role of restrictive gender norms and gender inequalities within and outside health systems, we will not reach our collective ambitions of universal health coverage and the Sustainable Development Goals. We propose action to systematically identify and address restrictive gender norms and gender inequalities in health systems.

Gender equality and gender norms: framing the opportunities for health.

The Sustainable Development Goals offer the global health community a strategic opportunity to promote human rights, advance gender equality, and achieve health for all. The inability of the health sector to accelerate progress on a range of health outcomes brings into sharp focus the substantial impact of gender inequalities and restrictive gender norms on health risks and behaviours. In this paper, the fifth in a Series on gender equality, norms, and health, we draw on evidence to dispel three myths on gender and health and describe persistent barriers to progress. We propose an agenda for action to reduce gender inequality and shift gender norms for improved health outcomes, calling on leaders in national governments, global health institutions, civil society organisations, academic settings, and the corporate sector to focus on health outcomes and engage actors across sectors to achieve them; reform the workplace and workforce to be more gender-equitable; fill gaps in data and eliminate gender bias in research; fund civil-society actors and social movements; and strengthen accountability mechanisms.

How are the domains of women's inclusion, justice, and security associated with maternal and infant mortality across countries? Insights from the Women, Peace, and Security Index.

Women's autonomy and empowerment in their homes, communities, and societies at large have been shown, through many direct and indirect pathways, to be associated with maternal and infant health. A novel global measure-the Women, Peace, and Security (WPS) Index-that bridges insights from gender and development indices with those from peace and security has recently been developed to capture the constructs of women's inclusion, justice, and security, using indicators and targets in the Sustainable Development Goals. This paper adds to the growing literature about the importance of gender inequality to key mortality outcomes for women and children by investigating the associations between nations' WPS Index scores and maternal mortality ratios and infant mortality rates. We use a range of international databases to obtain country-level data from 144 nations on health, demographic, income, and gender equality indicators. The aim is to highlight the role of women's inclusion, justice, and security in explaining national rates of maternal and infant mortality. Fully adjusted Poisson regression models indicate that a one point (0.01) increase on the WPS Index score is associated with a 2.0% reduction in the number of maternal deaths and a 2.3% reduction in the number of infant deaths. For a country such as Sierra Leone, with a maternal mortality ratio of 1360 maternal deaths per 100,000 live births, a one point improvement in the WPS Index would correspond to a maternal mortality ratio of 1,332, or 28 fewer deaths per 100,000 births. These associations are ecological and apply to the average level of mortality at the country level rather than the likelihood or risk faced at the individual level. Although we cannot claim causality for the observed relations in the cross-country regressions, the findings and recurring patterns are both suggestive and encouraging about the potential contributions of women's inclusion, justice, and security to maternal and infant mortality.

Longitudinal analysis of the impact of economic empowerment on risk for intimate partner violence among married women in rural Maharashtra, India.

The purpose of this study was to assess via longitudinal analysis whether women's economic empowerment and financial inclusion predicts incident IPV. This prospective study involved analysis of three waves of survey data collected from rural young married women (n = 853 women) in Maharashtra at baseline and 9&18 month follow-ups. This study, which was in the field from 2012 to 2014, was conducted as part of a larger family planning evaluation study unrelated to economic empowerment. Participants were surveyed on economic empowerment, as measured by items on women's income generation and joint decision-making of husband's income, and financial inclusion, as measured by bank account ownership. Women's land ownership and participation in microloan programs were also assessed but were too rare (2-3% reporting) to be included in analyses. Longitudinal regression models assessed whether women's economic empowerment predicted incident IPV at follow-up. At Wave 1 (baseline), one in ten women reported IPV in the past six months; 23% reported income generation; 58% reported having their own money; 61% reported joint control over husband's money, and 10% reported bank ownership. Women's income generation and having their own money did not predict IPV over time. However, women maintaining joint control over their husband's income were at a 60% reduced risk for subsequent incident IPV (AOR = 0.40; 95% CI = 0.18, 0.90), and women gaining joint control over time were at a 70% reduced risk for subsequent incident IPV (AOR = 0.30; 95% CI = 0.13, 0.72), relative to women whose husbands maintained sole control over his income. Women who initiated a new bank account by Wave 3 also had a 56% reduced likelihood of reporting incident IPV in this same wave (AOR = 0.44; 95% CI = 0.22, 0.93), relative to those who maintained no bank account at Waves 1 and 3. These findings suggest that women's joint control over husband's income and her financial inclusion as indicated by bank ownership appear to reduce risk for IPV, whereas her income generation or control over her own income do not. Awareness of and participation in financial inclusion services may help reduce women's risk for IPV in rural India and elsewhere.