Systematic review of social norms, attitudes, and factual beliefs linked to the sexual exploitation of children and adolescents

"I have learned that nothing is given for free": an exploratory qualitative evaluation of a social norms edutainment intervention broadcast on local radio to prevent age-disparate transactional sex in Kigoma, Tanzania

BACKGROUND

Promising evidence supports the effectiveness of edutainment interventions in shifting norms to prevent violence against women and girls and other harmful practices, yet further research into mechanisms and pathways of impact is needed to inform intervention development, delivery and scale-up. This exploratory qualitative evaluation examined the feasibility and indications of change in attitudes, beliefs, norms and behaviours following the broadcast of a radio drama aired to prevent age-disparate transactional sex in Kigoma, Tanzania.

METHODS

Over seven weeks, six episodes were broadcast on local radio weekly, between November and December 2021 in Kigoma, targeting adolescent girls (aged 13-15 years) and their caregivers. Reflection sessions were conducted twice a week with 70 girls across seven schools, supplemented by after-school Girls' Club listening sessions for a subgroup of 30 girls. We conducted seven before and after focus group discussions, five with girls (n = 50), one with men caregivers (n = 9) and one with women caregivers (n = 9) and analysed them using thematic and framework analysis approaches.

RESULTS

Overall, we found that while girls exhibited significant engagement with the drama, caregiver participation, particularly among men, was low. Thus, no clear changes were detected in men. We did not find any differences in impact based on listening sessions' attendance vs. home listening. We detected positive changes among girls and women in four thematic areas after listening to the drama: (1) participant's increasingly challenged perceptions about what kinds of girls and men take part in age-disparate transactional sex, what can be exchanged, and men's motivations for engaging; (2) there was a shift from attributing blame for age-disparate transactional sex relationships from girls to men; (3) girl's reported increased agency and confidence to avoid age-disparate transactional sex relationships; and (4) we found a heightened sense of responsibility and recognition for the role of parents, peers and community members in preventing age-disparate transactional sex.

CONCLUSIONS

These findings highlight the need for further implementation research to explore ways to effectively engage men. They also underscore the potential of engaging, evidence-based edutainment interventions in fostering spontaneous critical reflection about complex behaviours such as age-disparate transactional sex, and diffusing key messages among target populations without the use of organised diffusion activities.

Insights Into Child Abuse and Neglect in the Washington DC, Maryland, and Virginia (DMV) Area: Evidence and Opportunities

Child abuse and neglect (CAN) significantly impact health, the economy, and society. This narrative review examines CAN in the Washington DC, Maryland, and Virginia (DMV) region, comparing it with national and international levels. The review highlights high CAN rates in the DMV, driven by factors such as socioeconomic status, parental substance abuse, and child vulnerabilities. Screening and reporting challenges, exacerbated by the COVID-19 pandemic, impede accurate data collection. This review emphasizes the need for standardized reporting mechanisms, economic investment in public health, and intersectoral collaboration. It recommends targeted support for at-risk families, specialized care for vulnerable children, and the development of predictive screening tools. Continuous research on regional and cultural factors and the pandemic's impact is crucial for future resilience. Addressing CAN requires a comprehensive approach involving prevention, early detection, intervention, and policy reform to safeguard the well-being of children.

Prevalence and correlates of depressive disorders in commercially sexual exploited children: A cross-sectional study in Mombasa, Kenya

BACKGROUND

Commercial sexual exploitation of children (CSEC) is a global concern and is among the common forms of sexual violence against children. In Kenya, about 32 % of girls and 16 % of boys experience sexual violence before the age of 18 years. While much has been written about the impact of child sexual exploitation, there's little on the prevalence of depressive disorders among CSE children.

OBJECTIVES

This study was conducted to assess the prevalence and correlates of depressive disorders among CSE children in Mombasa, Kenya.

PARTICIPANTS AND SETTING

The study was conducted among CSE children (10-17 years) in Mombasa County.

METHODS

A cross-sectional study conducted between May 2021 and June 2022. A total of 409 CSE children were enrolled, using a case management approach. Data was collected using the child identification tool and the Patient Health Questionnaire (PHQ-9), at the first counselling session to determine the prevalence of depression levels.

RESULTS

Of the 409 children, 367 (90 %) were girls while 42 (10 %) were boys. The mean age was 15 years (10-17) (SD = 1.4, t = 0.765). In 286 (70 %) 'Depression unlikely' was recorded, while 123 (30 %) 'Depression likelihood.' Prevalence of mild to severe depression was significantly higher in girls than boys (p = 0.002). Other determinants of depression were having a primary level of education (p = 0.03) and being an orphan. (p = 0.03).

CONCLUSION

It is important to prioritize mental health interventions such as screening and early diagnosis of mental health among CSE children in order to prevent and manage both short and long term effects.

Exploring the effect of early menarche on sexual violence among adolescent girls and young women in southeastern Ghana: a longitudinal mediation analysis

Research from several high-income countries links early menarche with an increased risk for sexual violence. However, the role of early menarche in adolescent girls' and young women's sexual violence risk in sub-Saharan Africa, where sexual violence rates are high, is not well understood. The current study explores the association between early menarche and sexual violence in Ghana with secondary analysis of data collected from 700 adolescent girls and young women followed over three years. Logistic regressions were used to assess the cross-sectional association between early menarche and sexual violence. Generalised estimating equations were used to assess whether the association between early menarche and sexual violence persisted over time. Inverse odds weighting was used to test potential mediators of the association between early menarche and sexual violence. Sexual violence was fairly common in the study sample, with 27% reporting having experienced sexual violence at baseline, and approximately 50% at year three. Early menarche was associated with 72% greater odds of having experienced sexual violence at baseline (95% confidence interval: 1.01-2.93). However, the odds ratio attenuated and lost significance over the three-year study period, with a lower risk of sexual violence among girls with early menarche at year three. Neither child marriage nor early sexual initiation significantly mediated the association between early menarche and sexual violence. The findings suggest that early-maturing girls may be particularly vulnerable to sexual violence in early adolescence, thus necessitating prevention interventions around the time of menarche to reduce the risk for sexual violence.

Sexual exploitation of children: Barriers for boys in accessing social supports for victimization

BACKGROUND

The global evidence regarding sexual exploitation of children (SEC) is expanding, however, the majority of research continues to focus on girls. ECPAT International's Global Boys Initiative is a major contribution to broadening knowledge by exploring how sexual exploitation impacts boys specifically.

OBJECTIVE

This discussion paper explores data from the initiative to better understand how boys and children of all genders may be impacted by sexual exploitation.

PARTICIPANTS AND SETTING

During 2019-21, research was undertaken by ECPAT member organizations into the sexual exploitation of boys in 10 primarily low-and-middle income countries globally. The initiative also supported a global systematic scoping review of published and gray literature published in this issue (Moss et al., in press).

METHODS

Gender norms analysis of Initiative data identifies critical thematic issues impairing access to support services for victimized boys.

RESULTS

Most disconcerting is gender-based stigmatization from services that can compound children's trauma. Justice-based, rather than trauma-informed models of support predominate in responses for boys. Legal frameworks create barriers when binary gendered terminology defines sexual violence, thereby excluding anyone other than women and girls from protection.

CONCLUSIONS

Three solutions emerged to improve access to support for more children affected by sexual exploitation: (1) challenge problematic gender norms and consequent practices, such as gendered terminology in legislation, that create barriers for boys and gender-diverse children; (2) create psychologically, emotionally, and physically safe circumstances (i.e. trauma-informed care) for all children to know help-seeking is possible; and (3) undertake proactive support that specifically connects boys and gender-diverse children to therapeutic services like drop-in centers, night-time counseling, and emergency shelter.

Promoting Sexual Consent Principles in the Sexual and Reproductive Health Care of Adolescents and Young Adults

Mutual sexual consent is an essential component of healthy sexual relationships. The ability to communicate with a partner about any physical/sexual contact, including kissing, touching, or sexual intercourse, is necessary for a mutually respectful relationship. Healthcare clinicians (HCCs) and health education programs should stress the importance of sexual consent and recognize the frequency of nonconsensual sexual activity and sexual violence among adolescents and young adults (AYAs). HCCs and those who work with youth need to be aware of the cultural context and norms along with legal parameters for sexual consent in their geographic area. Infrastructure support, including programs to develop clinician skills, time for thoughtful and sensitive discussions about sexual consent, and community referral options, is necessary for HCCs to be able to have the skills and time to review the important aspects of sexual consent with their patients. Research is needed to advance evidence-based practices to prevent nonconsensual sexual contact among AYAs and to effectively disseminate and implement best practices.

Shifting social norms to prevent age-disparate transactional sex in Tanzania: what we can learn from intervention development research

This paper reflects on the development process (2015-2020) of the Learning Initiative for Norms, Exploitation, and Abuse (LINEA) Intervention. The LINEA Intervention is a multi-component social norms intervention to prevent age-disparate transactional sex in Tanzania. This paper aims to: (1) critically reflect on the LINEA Intervention development process by retrospectively comparing it with a pragmatic, phased framework for intervention development in public health, the Six Essential Steps for Quality Intervention Development (6SQuID); and (2) discuss the usefulness and applicability of this framework to guide intervention development for gender-based violence prevention. This paper contributes to a growing field of intervention development research to improve the designs of interventions to prevent gender-based violence. Findings showed that the LINEA Intervention development approach mostly aligned with the steps in 6SQuID framework. However, the LINEA Intervention development process placed particular emphasis on two phases of the 6SQuID framework. First, the LINEA Intervention development process included significant investment in formative research, feasibility testing, and refinement; and second, the LINEA Intervention was informed by a clearly articulated behavior change theory-social norms theory. Beyond the 6SQuID framework the LINEA Intervention development process: (i) followed a non-linear, iterative process; (ii) applied ongoing feasibility testing to refine the intervention, and (iii) relied on co-development with local implementers and participants. This paper suggests future components for a robust intervention development process, highlighting beneficial additions to the 6SQuID approach, a well-recognized intervention development sequence. Particularly useful additions include incorporating sufficient time, flexibility, and resources to foster meaningful collaborations and iteration on the intervention design.

Breaking the cycles of violence with narrative exposure: Development and feasibility of NETfacts, a community-based intervention for populations living under continuous threat

BACKGROUND

Interpersonal violence damages mental health and frequently leads to aggressive defence strategies. If survivors are subsequently blamed for the events, both consequences worsen. Stigma flourishes, especially when survivors are silenced so that details of the trauma remain unknown. Breaking the secrecy both at the individual and collective level is key to enable the healing and reconciliation of individuals and communities living under continuous threat.

METHOD

The NETfacts health system is a stepped care model with three components: (1) Narrative Exposure Therapy (NET), an evidence-based trauma therapy that includes survivor testimony (2) NET for Forensic Offender Rehabilitation (FORNET) acknowledges that perpetrators are frequently also victims and assists in reducing aggression and the attraction to violence, and (3) a community intervention disseminating and discussing Facts derived from NET treatment (NETfacts) to challenge the collective avoidance of atrocities and other traumatic material. The intervention was piloted in a community with 497 adult residents in Eastern Democratic Republic of Congo. The willingness of clients to consent to sharing their anonymised testimonies (with a focus on sexual violence survivors and ex-combatants) was investigated, together with other components of feasibility including security and clinical safety, extent of support of respected local authorities and participation rates. As secondary outcomes, clinical and social measures were assessed before and post NETfacts among 200 village residents of whom 160 self-enrolled and 40 had not participated in any form of treatment.

RESULTS

Implementation was feasible with 248 clients from a partner project giving consent to use their testimonies and high support of respected local authorities and participation rates (56% of residents self-enrolled in NETfacts). Immediate beneficial effects were shown for posttraumatic stress and rejection of rape myths among NETfacts participants who experienced multiple traumatic events in their own past. Attitudes towards ex-combatants improved and the perceived lack of social acknowledgement after trauma increased independent from participation. No significant change was observed for depressive symptoms.

CONCLUSION

NETfacts is a feasible and promising approach to challenge the culture of secrecy surrounding trauma, suppression and social exclusion. Long term effectiveness requires further evaluation.

Commercial Sexual Exploitation of Children and Adolescents in Europe: A Systematic Review

OBJECTIVES

The objective of this review is to provide a systematic and critical summary of findings regarding empirical studies conducted on commercial sexual exploitation of children (CSEC) in Europe. The purpose is to gain an understanding of the characteristics and main topics addressed in European research on CSEC, identify gaps, and give suggestions for future studies.

METHOD

The review was guided by the "Preferred Reporting Items for Systematic Review and Meta-Analysis-Protocols". A comprehensive search on several databases was conducted to identify published and unpublished empirical research on CSEC in Europe, revealing 3,846 documents. In total, 56 research papers that focused specifically on CSEC in European samples were included.

SYNTHESIS

Research concerning European studies of CSEC and trafficking for purposes of sexual exploitation has developed significantly over the last 20 years but is still rather limited and mainly focused on the UK and Sweden. Most of the studies reviewed suffer from important methodological flaws such as an inaccurate definition of the phenomenon analyzed, small and convenience samples, and nonvalidated and nonspecific instruments.

CONCLUSIONS

Findings from this study demonstrate the need for greater exploration and research around a number of areas of sexual exploitation of children in Europe. Further work is necessary in terms of capacity building, training, and awareness-raising for society as a whole and, specifically, professionals providing direct support to children and young people at risk of exploitation.

NETfacts: An integrated intervention at the individual and collective level to treat communities affected by organized violence

War and crises affect mental health, social attitudes, and cultural norms, which can exacerbate the state of long-term insecurity. With decades of armed conflict, the Democratic Republic of Congo is one example, and violence has become normalized in civilian settings. In this study, we tested the effectiveness of the NETfacts health system, an integrated model of evidence-based individual trauma treatment (Narrative Exposure Therapy [NET]) and a trauma-informed community-based intervention (NETfacts). Alongside changes in mental health outcomes (posttraumatic stress disorder, depression, social disapproval, and shame) we also investigated change in attitudes, including rape myth acceptance, stigmatization of survivors of sexual violence, and skepticism about the reintegration of former combatants. To test whether the additional community intervention is superior to individual NET alone, we implemented a randomized controlled design with six villages and interviewed a sample of 1,066 community members. Our results demonstrate that the NETfacts health system in comparison with NET alone more effectively reduced rape myth acceptance and with it ongoing victimization and perpetration. Community members of the NETfacts group also presented with less stigmatizing attitudes against survivors of sexual violence. Skepticism about the reintegration of former combatants declined in both groups. NETfacts appears to have increased motivation to engage in individual treatment. Synergizing the healing effects of individual and collective trauma exposure, the NETfacts health system appears to be an effective and scalable approach to correct degrading or ignominious norms and restore functioning and mental health in postconflict communities.

A qualitative study exploring parent-daughter approaches for communicating about sex and transactional sex in Central Uganda: Implications for comprehensive sexuality education interventions

INTRODUCTION

Ugandan adolescent girls and young women are disproportionately impacted by human immunodeficiency virus, and this is largely driven by their engagement in transactional sex. Globally, parent-daughter communication about sex is associated with increased contraceptive use and delayed/decreased sexual activity, but research on parent-daughter communication about transactional sex is lacking. This paper elucidates local perspectives on, and experiences of parent-daughter communication about sex and transactional sex, to inform family-level comprehensive sexuality education interventions.

METHODS

We conducted a secondary, thematic analysis of 13 focus group discussions (n = 119) and 30 in-depth interviews collected between 2014 and 2015 with adolescent girls and young women aged 14+, and men and women in Kampala and Masaka.

RESULTS

We found that parents used three approaches to discuss sex and transactional sex with their daughters: (1) frightening their daughters into avoiding sex; (2) being "strict"; and (3) relying on mothers rather than fathers to "counsel" daughters. Mother-daughter communication about transactional sex was common, but frequently unidirectional. Adolescent girls and young women bringing home gifts sparked conversations about the risks of transactional sex, although less in poorer households. Mothers felt they lacked control over their daughters' sexual behaviors and thus restricted their movements and friendships to try to prevent them from having sex. In contrast to previous research, we found some evidence of mothers encouraging condom use and father-daughter communication about sex.

CONCLUSIONS

Family-level comprehensive sexuality education interventions targeting parent-daughter communication about sex could further highlight the role that fathers might play, and emphasize communication about the inequitable power dynamics in transactional sex and condom negotiation skills, while reducing fear surrounding parent-daughter communication.

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].

Adolescent girls' perceived readiness for sex in Central Uganda - liminal transitions and implications for sexual and reproductive health interventions

Young women in Uganda are at risk of negative sexual and reproductive health outcomes, in part because of sex with older men. Theoretically grounded in the concept of liminality, this paper examines perceived markers of adolescent girls' suitability for sexual activity. In 2014, we conducted 19 focus group discussions and 44 in-depth interviews in two communities in Uganda. Interviews were conducted using a semi-structured tool, audio-recorded and transcribed verbatim. Interviews examined markers of transition between childhood, adolescence and adulthood and how these were seen as relating to girls' perceived readiness for sex. Analysis was thematic. Pre-liminal status was most often accorded to childhood. Sex with a child was strongly condemned. Physical changes during puberty and children's increasing responsibility, autonomy and awakening sexuality reflected a liminal stage during which girls and young women were not necessarily seen as children and were increasingly described as suitable for sex. Being over 18, leaving home, and occupying 'adult' spaces reflected post-liminal status and perceived appropriateness for sexual activity including for girls under the age of 18. Interventions that seek to prevent early sexual debut and sexual activity with older men have the potential to reduce sexual and reproductive health risks.

Development and Validation of a Mobile Game for Culturally Sensitive Child Sexual Abuse Prevention Education in Tanzania: Mixed Methods Study

Background

Globally, 3 out of 20 children experience sexual abuse before the age of 18 years. Educating children about sexual abuse and prevention is an evidence-based strategy that is recommended for ending child sexual abuse. Digital games are increasingly being used to influence healthy behaviors in children and could be an efficient and friendly approach to educating children about sexual abuse prevention. However, little is known on the best way to develop a culturally sensitive game that targets children in Africa—where sexual education is still taboo—that would be engaging, effective, and acceptable to parents and caretakers.

Objective

This study aimed to develop a socioculturally appropriate, mobile-based game for educating young children (<5 years) and parents and caretakers in Tanzania on sexual abuse prevention.

Methods

 HappyToto children’s game was co-designed with 111 parents and caretakers (females: n=58, 52.3%; male: n=53, 47.7%) of children below 18 years of age and 24 child experts in Tanzania through surveys and focus group discussions conducted from March 2020 to April 2020. From these, we derived an overview of topics, sociocultural practices, social environment, and game interface designs that should be considered when designing child sexual abuse prevention (CSAP) education interventions. We also conducted paper prototyping and storyboarding sessions for the game’s interface, storylines, and options. To validate the application’s prototype, 32 parents (females: n=18, 56%; males: n=14, 44%) of children aged 3-5 years and 5 children (females: n=2, 40%; males: n=3, 60%) of the same age group played the game for half an hour on average. The parents undertook a pre-post intervention assessment on confidence and ability to engage in CSAP education conversations, as well as exit surveys on the usability and sociocultural acceptability of the game, while children were quizzed on the topics covered and their enjoyment of the game.

Results

Parents and caregivers showed interest in the developed game during the conducted surveys, and each parent on average navigated through all the parts of the game. The confidence level of parents in talking about CSAP increased from an average of 3.56 (neutral) before using the game to 4.9 (confident) after using the game. The ability scores, calculated based on a range of topics included in CSAP education talks with children, also increased from 5.67 (out of 10) to 8.8 (out of 10) after the game was played. Both confidence level and ability scores were statistically significant (P<.001). All 5 children were interested in the game and enjoyed the game-provided activities.

Conclusions

The HappyToto game can thus be an effective technology-based intervention for improving the knowledge and skills of parents and children in CSAP education.

Failing the rights: sexual vulnerability, access to services and barriers to contraceptives among adolescents in Narok County, Kenya

Purpose

Around one in five girls in Kenya, aged 15 to 19 years old are either pregnant or have given birth. Of 47 counties, adolescent pregnancy is highest in Narok, where about 40% of girls aged 15 to 19 years old have begun childbearing. This study aims to explore drivers to sexual activity, access to sexual and reproductive health (SRH) services and barriers to contraceptive use among adolescents in Narok County, Kenya to inform the design of SRH interventions and safeguard young people’s rights to sexual health.

Design/methodology/approach

A cross-sectional mixed methods study was conducted in December 2019. Quantitative data were collected through structured questionnaires among girls aged 15 to 19 years old who were either pregnant or had given birth and those who had not and boys aged 15 to 19 years old. Qualitative data were collected through focus group discussions with adolescent girls and boys and through structured key informant interviews with parents, community leaders and health workers.

Findings

The mean age at first sexual intercourse for both genders was 15 years. While the majority of girls and boys knew where to access SRH services, few used contraception during their last sexual activity. There was no significant difference in the condom or other contraceptive methods use between girls who had begun child bearing and those who had not (p = 0.549 and p = 0.563, respectively). Key drivers for sexual activity among young people were poverty and peer pressure. Cultural practices such as female genital mutilation and early marriage contributed to early sex. Community attitudes toward contraception discouraged young people from taking up contraceptives.

Originality/value

This mixed methods study explores the drivers of adolescent pregnancy in Narok, Kenya, the county with the highest rates of adolescent pregnancy; twice the national pregnancy rates. Understanding the drivers of pregnancy and the underlying human rights violations will help policymakers and health leaders to design interventions which will improve outcomes.

To add insult to injury: Stigmatization reinforces the trauma of rape survivors - Findings from the DR Congo

BACKGROUND

Survivors of sexual violence are frequently condemned and socially excluded. Myths about rape may translate into stigmatization, diminish disclosure, prevent help-seeking from support structures and worsen mental health. Areas of conflict or organized violence remain the evident hotspots of sexual victimization. However, little is known about prevalence and predictors of rape myths in these settings or their association with survivors' disclosure, stigmatization and psychopathology.

METHOD

Between September 2018 and May 2019, we assessed in a representative sample of 1066 individuals from six communities in Eastern DRC traumatic exposure, sexual perpetration, threats to social integrity, perceived stigmatization (perceived lack of social acknowledgement, shame), stigmatizing attitudes towards survivors (negative attitudes and willingness to provide support, rape myths acceptance), and mental illness (PTSD, depression).

RESULTS

Survivors of sexual violence (33%, n = 184 of women, 16%, n = 84 of men) reported more traumatic exposure, threats to social integrity, shame, perceived lack of social acknowledgement, PTSD symptoms and depression. Their social environment affirmed various stigmatizing attitudes (5-89% affirmations). Beliefs in rape myths were predicted by its average acceptance in the community, education, and witness of others' sexual victimization. The rates of cases whose history of sexual victimization was socially disclosed were higher in communities and among survivors with low rape myths acceptance and disclosure showed associations with perceived stigmatization. Rape myths acceptance among individuals without a history of sexual victimization was associated with survivors' recently experienced threats to social integrity which predicted their stigma perceptions and mental illness.

CONCLUSION

Rape myths acceptance in the community is associated with stigma and trauma-related mental illness of sexual violence survivors. This adds up to the psychic burden of trauma.

A Mixed-Methods Systematic Review: Infidelity, Romantic Jealousy and Intimate Partner Violence against Women

Infidelity and romantic jealousy (RJ) are commonly cited relational level drivers of intimate partner violence (IPV) but remain undertheorized and underutilized in IPV research and prevention. This global systematic review aims to characterize the existing research on real or suspected infidelity and RJ in relation to IPV and inform future research and programming. We systematically searched 11 databases for peer-reviewed research, published between April 2009 and 2019, that provided data on the prevalence or a measure of association (quantitative), or pathway (qualitative), between real or suspected infidelity or RJ, and IPV. Fifty-one papers from 28 countries were included and the evidence showed a consistent association between real or suspected infidelity, RJ and IPV. Our findings identify three overarching mechanisms and six pathways between infidelity, RJ and IPV. These provide support for prominent theories in the field related to patriarchal culture, threatened masculinities and femininities and a lack of emotional regulation and conflict resolution skills, but not evolutionary theories. Our findings suggest that researchers should use standardized measurement tools that make the distinction between RJ and suspected, confirmed and accusations of infidelity. Policy and programming should aim to transform traditional gender roles, accounting for infidelity and RJ and improving couple's communication and trust.

How far do parenting programmes help change norms underpinning violence against adolescents? Evidence from low and middle-income countries

Recent years have seen an upsurge in parent education programmes in low and middle-income countries (LMICs) that aim to help reduce violence against children. This article draws on a narrative review that examined the impact of 42 programmes working with parents of adolescents in LMICs. Here we focus on 17 initiatives that aimed to reduce neglect of, or physical, emotional or sexual violence against adolescents, or to reduce child marriage. Programmes aiming to prevent sexual violence or child marriage generally focused more strongly on understanding and challenging prevailing norms, while those oriented to preventing physical and emotional violence emphasised sharing information and practising new communication skills. We argue that key elements of programme design (group-based participatory sessions, formative research that enabled sensitive framing and adaptation of content) have strong potential to help shift norms that underpin violence against adolescents. To fulfil their potential to change norms underpinning violence against adolescents, programmes should expand their reach, with a particular focus on embedding initiatives within institutions that can take them to scale, promoting male engagement, and support participants to maintain changes over the long-term.

Sexual health of adolescent girls and young women in Central Uganda: exploring perceived coercive aspects of transactional sex

Adolescent girls and young women (AGYW) in Uganda are at risk of early sexual debut, unwanted pregnancy, violence, and disproportionally high HIV infection rates, driven in part by transactional sex. This paper examines the extent to which AGYW’s participation in transactional sex is perceived to be coerced. We conducted 19 focus group discussions and 44 in-depth interviews using semi-structured tools. Interviews were audio recorded, and transcribed verbatim. Data were analysed using a thematic analysis. While AGYW did not necessarily use the language of coercion, their narratives describe a number of coercive aspects in their relationships. First, coercion by force as a result of “de-toothing” a man (whereby they received money or resources but did not wish to provide sex as “obligated” under the implicit “terms” of the relationships). Second, they described the coercive role that receiving resources played in their decision to have sex in the face of men’s verbal insistence. Finally, they discussed having sex as a result of coercive economic circumstances including poverty, and because of peer pressure to uphold modern lifestyles. Support for income-generation activities, microfinance and social protection programmes may help reduce AGYW’s vulnerability to sexual coercion in transactional sex relationships. Targeting gender norms that contribute to unequal power dynamics and social expectations that obligate AGYW to provide sex in return for resources, critically assessing the meaning of consensual sex, and normative interventions building on parents’ efforts to ascertain the source of their daughters’ resources may also reduce AGYW’s vulnerability to coercion.