Association between exposure to political violence and intimate-partner violence in the occupied Palestinian territory: a cross-sectional study

Women, peace and insecurity: The risks of peacebuilding in everyday life for women in Sri Lanka and Nepal

Truth telling processes, initiatives to prosecute war-time perpetrators, and ex-combatant reintegration are examples of common peacebuilding practices after war. Yet, little is known of how women are affected by peacebuilding initiatives such as these, or how they perceive these initiatives for peace. For many women, peace after war does not bring peace to everyday life; research shows that domestic violence increases during and after war. In addition, some peacebuilding measures have been found to increase risk and insecurity, not least for women. To better understand the interconnections between gender and post-conflict attitudes to peacebuilding, we asked 2,041 women and men in Sri Lanka and Nepal of their views on post-war peace initiatives. In line with our expectations, we find that women are more skeptical than men towards peacebuilding measures that involve increased risk in everyday life, such as truth-telling and coexisting with former adversaries and warring groups reintegrating in local communities. There are no gender differences pertaining to peacebuilding initiatives that take place far away at the national level, for example, concerning accountability or, in the case of Nepal, the peace agreement. Our findings suggest that international peacebuilding practice is blind to the everyday insecurities of women after war. That a basic gendered lens is missing from most peacebuilding designs is both alarming and deeply troubling, but identifying this critical aspect provides the opportunity for imperative change. By shedding light on the challenges women face after war, we hope this article contributes to finding ways to mitigate unknown and unintended side-effects of peacebuilding efforts, and thereby to the development of better, evidence-based peacebuilding practice-of benefit to both men and women.

Navigating health challenges: the interplay between occupation-imposed movement restrictions, healthcare access, and community resilience

BACKGROUND

Transportation plays a significant role in health, community resilience, and access to basic needs such as healthcare, social services, education, and job opportunities. Health and community resilience are, however, impacted by a multitude of complex and unequal factors, such as transportation restrictions exacerbated by the Israeli occupation. The goal of the research was to examine the intricate relationships that exist in Palestine between movement restrictions imposed by occupation, health outcomes, and community resilience.

METHOD

A self-structured questionnaire, devised based on expert conversations and previous literature, was used in this descriptive, quantitative study to explore health and resilience outcomes. Age, gender, marital status, place of residence, and means of transportation were among the various factors that were utilized to describe the socio-demographics of the study sample (n = 202). The researchers employed stepwise multiple regression and descriptive statistics for the data analysis.

RESULTS

Study findings indicated that transportation restrictions have significant direct and indirect health consequences. A significant direct effect is observed, signifying a negative correlation between restrictions and health; increased transportation restrictions are consistently correlated with a decline in health. The study emphasized how place of residence affects health outcomes, with higher scores for campers and people living in green line areas. It also underscores that public means of transportation are found to be better for health outcomes than private cars.

CONCLUSION

This study emphasized that roadblocks, checkpoints, and military incursions make it difficult for Palestinians to receive medical care, which has a detrimental impact on their health and well-being. It also underscores the need for significant reforms in Palestinian health and transportation systems to enhance infrastructure and healthcare access. The Palestinian Authority should invest in public transportation and community resilience programs to address transportation-related health issues, especially in villages, due to frequent settler attacks.

Comparing health systems readiness for integrating domestic violence services in Brazil, occupied Palestinian Territories, Nepal and Sri Lanka

Domestic violence (DV) is a global prevalent health problem leading to adverse health consequences, yet health systems are often unprepared to address it. This article presents a comparative synthesis of the health system's pre-conditions necessary to enable integration of DV in health services in Brazil, Nepal, Sri Lanka and occupied Palestinian Territories (oPT). A cross-country, comparative analysis was conducted using a health systems readiness framework. Data collection involved multiple data sources, including qualitative interviews with various stakeholders; focus-group discussions with women; structured facility observations; and a survey with providers. Our findings highlight deficiencies in policy and practice that need to be addressed for an effective DV response. Common readiness gaps include unclear and limited guidance on DV, unsupportive leadership coupled with limited training and resources. Most providers felt unprepared, lacked guidance and felt unsupported and unprotected by managers and their health system. While in Brazil most providers felt they should respond to DV cases, many in Sri Lanka preferred not to. Such organizational and service delivery challenges, in turn, also affected how health providers responded to DV cases leaving them not confident, uncertain about their knowledge and unsure about their role. Furthermore, providers' personal beliefs and values on DV and gender norms also impacted their motivation and ability to respond, prompting some to become 'activists' while others were reluctant to intervene and prone to blame women. Our synthesis also pointed to a gap in women's use of health services for DV as they had low trust in providers. Our conceptual framework demonstrates the importance of having clear policies and highlights the need to engage leadership across every level of the system to reframe challenges and strengthen routine practices. Future research should also determine the ways in which women's understanding and needs related to DV help-seeking are addressed.

Armed conflicts and experience of intimate partner violence among women in Afghanistan: analysis of the 2015 Afghanistan DHS data

OBJECTIVE

Armed conflicts and intimate partner violence (IPV) impose a burden on individual and societal well-being. Given the history of armed conflict in Afghanistan and the high prevalence of IPV, this study aims to examine the influence of armed conflicts on IPV among Afghan women.

METHODS

Multilevel logistic regression models were applied to the 2015 Afghanistan Demographic and Health Survey (N=10 414 women aged 15-49). Armed conflict severity was measured using the conflict index issued by the Office for the Coordination of Humanitarian Affairs, IPV was measured by three types of violence, including emotional, physical and sexual violence. All analyses were conducted by using STATA V.15.1.

RESULTS

Over 52% of women experienced at least one type of IPV, with 33.01%, 49.07%, and 8.99% experiencing emotional, physical, and sexual violence, respectively. The regression results show that armed conflicts were significantly and positively associated with the experience of all types of IPV. In addition, the association between armed conflicts and the experience of emotional IPV was positively moderated by women's attitudes towards IPV.

CONCLUSION

Our findings suggest that women living in high-conflict regions were more prone to experience IPV, particularly women with positive attitudes towards IPV. Promoting progressive gender roles, women's empowerment, awareness of IPV and inclusion of women in conflict resolution will help deal with the issue of IPV.

Risk and Protective Factors for Violence Against Women and Girls Living in Conflict and Natural Disaster-Affected Settings: A Systematic Review

This systematic review provides an overview of existing research on risk and protective factors associated with violence against women and girls (VAWG) in conflict and natural disaster settings. PubMed (Medline); PsycINFO; Scopus; and Cochrane Center trials registrar were searched as well as relevant internet repositories for VAWG research. The inclusion criteria covered studies that were published between January 1995 and December 2020, documented risk and/or protective factors for VAWG in conflict or natural disaster-affected settings and included primary or secondary data analysis. A total of 1,413 records were initially identified and 86 articles (covering 77 studies) were included in the final analysis. The findings show that many preexisting risk factors for VAWG are exacerbated in armed conflict and natural disaster-affected settings. Poverty and economic stress, men's substance abuse, exposure to violence, changing gender roles in contexts of inequitable gender norms, and a lack of social support are some of the risk factors associated with male perpetration or female experience of violence. In addition, risk factors specific to experiences during armed conflict or in a natural disaster (e.g., displacement, insecurity or congestion in and around displacement camps, militarization of society, killing of family, destruction of property, etc.) are associated with higher prevalence of VAWG in these contexts.

Past-year intimate partner violence perpetration among people with and without depression: an individual participant data (IPD) meta-mediation analysis

PURPOSE

To investigate whether (1) depression is associated with increased risk of past-year intimate partner violence (IPV) perpetration, disaggregated by sex, after controlling for potential confounders; (2) observed associations are mediated by alcohol misuse or past-year IPV victimisation.

METHODS

Systematic review and individual participant data (IPD) meta-mediation analysis of general population surveys of participants aged 16 years or older, that were conducted in a high-income country setting, and measured mental disorder and IPV perpetration in the last 12 months.

RESULTS

Four datasets contributed to meta-mediation analyses, with a combined sample of 12,679 participants. Depression was associated with a 7.4% and 4.8% proportion increase of past-year physical IPV perpetration among women and men, respectively. We found no evidence of mediation by alcohol misuse. Among women, past-year IPV victimisation mediated 45% of the total effect of depression on past-year IPV perpetration. Past-year severe IPV victimisation mediated 60% of the total effect of depression on past-year severe IPV perpetration. We could not investigate IPV victimisation as a mediator among men due to perfect prediction.

CONCLUSIONS

Mental health services, criminal justice services, and domestic violence perpetrator programmes should be aware that depression is associated with increased risk of IPV perpetration. Interventions to reduce IPV victimisation might help prevent IPV perpetration by women. Data collection on mental disorder and IPV perpetration should be strengthened in future population-based surveys, with greater consistency of data collection across surveys, as only four studies were able to contribute to the meta-mediation analysis.

A scoping review linking early childhood caries to violence, neglect, internally displaced, migrant and refugee status

BACKGROUND

The aim of the scoping review was to identify and synthesize the available literature concerning the relationship between the status of refugees, migrants, and internally displaced persons (IDPs) and Early Childhood Caries (ECC) as it relates to the United Nation's Sustainable Development Goal 16 (SDG 16).

METHODS

Data regarding the links between the status of refugees, migrants, and internally displaced persons (IDPs) and Early Childhood Caries (ECC), and the associations between ECC and maternal and child exposure to physical and sexual abuse, insecurity, crime, exploitation, torture, and displacement were extracted. The search was carried out in January 2023 across three databases (PubMed, Web of Science, and Scopus). Only publications in English with accessible full texts were included. Descriptive statistics were utilized to summarize the categories of the retrieved papers, and graphical representation was employed for visualization purposes. The relationships between the publications and each of the 10 targets of Sustainable Development Goal 16 (SDG 16) were also assessed.

RESULTS

Forty-five studies were reviewed. Most studies (42.2%) originated from the Americas Regions, while no studies were identified from the Africa Region. A significant portion (46.7%) of the papers focused on abuse, violence, and neglect as risk factors for ECC. Migrants, refugees, and IDPs were the most investigated populations (44.4%). Only one study specifically focused on IDPs and migrants respectively. The prevalence of untreated caries was higher among migrants, refugees, and IDPs compared to the host community, ECC was more prevalent among children who experienced abuse, neglect, or were in protective care. The was no clear direction on the associations between ECC and intimate partner violence, adverse childhood experiences, and wars. In terms of the SDGs, the reviewed publications addressed four targets (SDG16.1, SDG16.2, SDG16.3, and SDG16.5) out of the ten targets outlined in SDG 16.

CONCLUSION

There is available evidence regarding the connections between ECC and war, refugees, migration, violence, and neglect, as outlined in SDG 16. Future studies are needed to investigate how forced movements directly affects ECC status, how disruptions of peace and stability is a risk factor for ECC, and the associations between ECC and other indicators related to SDG 16 targets.

Gender-Based Violence, Subjective Quality of Life, and Mental Health Outcomes Among Palestinian Women: The Mediating Role of Social Support and Agency

We tested the association between gender-based violence (GBV), subjective quality of life, and mental distress manifested by anxiety, depression, and stress among Palestinian women exposed to political and military violence. Depression, Anxiety and Stress Scale-21, Berlin Social Support Scales, WHO-5 subjective Quality of Life Scale, Women's Agency Scale 61, and Violence Against Women Questionnaire were administered to 332 purposely selected participants. Structural equation modeling was applied to address the study hypothesis. A conceptual model depicting GBV as a predictor, mental distress as an outcome variable, and agency and social support as mediators was confirmed.

The Effects of Polyvictimization by Intimate Partners on Suicidality Among Salvadoran Women

Intimate partner violence (IPV) victims tend to suffer from various mental health issues. Mental health issues, including suicidal thoughts and attempts caused by IPV victimization, might be more severe among women in El Salvador, where violence against women is prevalent overall. Although polyvictimization, which is defined as experiencing more than one type of violence by one or multiple partners, is associated with more severe mental health consequences than victimization by just a single form of violence due to accumulative trauma, not enough attention has been paid to this phenomenon among Salvadoran women. Thus, guided by trauma theory, this study aimed to examine the impact of polyvictimization from different types of violence (i.e., physical, sexual, emotional, and economic) on suicidal thoughts and attempts among Salvadoran women using the 2017 Violence Against Women National Survey. A nationally representative sample of 3,074 Salvadoran women aged 15 years or older and who had experienced an intimate relationship in their lifetime, recruited through a multistage random sampling design, was analyzed in this study using logistic regression analyses. We found that psychological and economic violence, along with physical and sexual violence, had statistically significant associations with suicidal thoughts and attempts, and polyvictimization increased suicidal thoughts and attempts. Based on this study's findings, we recommend effective research and practice or intervention implementation for addressing IPV and associated mental health problems among Salvadoran women.

No Escape: Mass Incarceration and the Social Ecology of Intimate Partner Violence Against Women

Women in heavily policed and incarcerated communities face extremely high rates of intimate partner violence (IPV)-but how criminal legal system contact affects such violence remains poorly understood. This study explores the social ecology of IPV by fitting structural equation models to longitudinal, dyadic data from households in contact with the criminal legal system (N = 2,224) and their local communities. Results suggest that a complex of factors at multiple social-ecological levels-including adverse local conditions, dysfunctional couple conflict, and men's behavioral health and perceptions of their neighborhoods-may put women at heightened risk of IPV victimization in a time of mass incarceration.

Orthopaedic surgeons can play important role in identifying victims of domestic violence in the emergency department - narrative review of Brazilian literature

Over the last year, with the social isolation imposed by the coronavirus disease pandemic, there has been a significant increase in complaints associated with physical violence against women. In the present study, an exploratory literature review was carried out on the role of the on-call orthopedic surgeon when faced with a suspicion of domestic violence, in accordance with Brazilian legislation. The main objective of the study was to show the role of this specialist in identifying victims of domestic violence by recognizing their profiles and associated risk factors. The secondary objectives were to demonstrate the most common skeletal and non-skeletal injuries in this type of violence and to present a quick and practical guide on how to identify, approach, and manage cases of domestic violence against women. The findings revealed that the main aggressors were close partners, such as spouses and ex-spouses. Young adult women, black or multiracial, and low socioeconomic status are major risk factors for intimate partner violence. Head and neck injuries are the most frequently observed lesions in this population, with more than one-third of victims reporting falls. Musculoskeletal injuries are present in up to 42% of victims of domestic violence, occurring predominantly in the upper limbs and chest, and are the leading cause of death in women aged 1 to 34 years. A practical guide for orthopedic surgeons who work in emergency departments is proposed, with basic information about their role and responsibility in identifying potential victims of intimate partner violence.

Intimate Partner Violence Against Women in the Arab Countries: A Systematic Review of Risk Factors

Intimate partner violence (IPV) profoundly damages physical, sexual, reproductive, and psychological health, as well as social well-being of individuals and families. We sought in this systematic review to examine the risk factors according to the integrative ecological theoretical framework for IPV for women living in the Arab countries. We searched Embase, PubMed, PsycINFO, and SCOPUS, supplemented by hand searching of reference lists. A research strategy was developed and observational studies were included if they considered female participants (age ≥13) in heterosexual relationships, estimates of potential risk factors of IPV, and IPV as a primary outcome. We conducted a narrative synthesis of the risk factors data from 30 cross-sectional studies. Factors associated with increased IPV against women were extracted and categorized into four levels according to the updated integrative ecological model. At the individual level, risk factors were either related to victims or perpetrators of IPV. Factors relating to marriage, conflict within the family, etc., were explored and included within the family level, whereas factors relating to the extended family and the nature of marriage were included in the community level. Finally, risk factors relating to the cultural context that are influenced by the political and religious backgrounds were included in the societal level. The complex structure of violence against women in the Arab world calls for socioculturally sensitive interventions, which should be accompanied by systematic and structured work aimed at improving Arab women's status at all levels.

Prevalence and Social-Ecological Correlates of Intimate Partner Violence in a Conflict Zone-Evidence From the 2015 Afghanistan Demographic and Health Survey

This study examined the prevalence and social-ecological correlates of male-to-female intimate partner violence (IPV) in Afghanistan. Using data from the 2015 Afghanistan Demographic and Health Survey, which included 20,793 currently married women, we found that the past-year prevalence of physical IPV was highest (46%), followed by emotional (34%) and sexual forms (6%). Results also showed that the risk of IPV in general was associated with an array of community and societal-, family and relationship-, and person-level factors. Our findings point to potential intervention targets for women in this conflict zone where IPV is a highly pervasive and complex societal challenge.

Trauma Exposure and Intimate Partner Violence Among Young Pregnant Women in Liberia

Intimate partner violence (IPV) is a global threat to women's health and may be elevated among those exposed to traumatic events in post-conflict settings, such as Liberia. The purpose of this study was to examine potential mediators between lifetime exposure to traumatic events (i.e., war-related trauma, community violence) with recent experiences of IPV among 183 young, pregnant women in Monrovia, Liberia. Hypothesized mediators included mental health (depression, posttraumatic stress symptoms), insecure attachment style (anxious and avoidant attachment), and attitudes indicative of norms of violence (attitudes justifying wife beating). We tested a parallel multiple mediation model using the PROCESS method with bias-corrected and accelerated bootstrapping to test confidence intervals (CI). Results show that 45% of the sample had experienced any physical, sexual, or emotional IPV in their lifetime, and 32% in the 2 months prior to the interview. Exposure to traumatic events was positively associated with recent IPV severity (β = .40, p < .01). Taken together, depression, anxious attachment style, and justification of wife beating significantly mediated the relationship between exposure to traumatic events and experience of IPV (β = .15, 95% CI = [0.03, 0.31]). Only anxious attachment style (β = .07, 95% CI = [0.03, 0.16]) and justification of wife beating (β = .05, 95% CI = [0.01, 0.16]) were identified as individual mediators. This study reinforces pregnancy as an important window for both violence and mental health screening and intervention for young Liberian women. Furthermore, it adds to our theoretical understanding of mechanisms in which long-term exposure to traumatic events may lead to elevated rates of IPV in Liberia, and points to the need for trauma-informed counseling and multilevel gender transformative public health approaches to address violence against women.

Armed conflict, HIV, and syndemic risk markers of mental distress, alcohol misuse, and intimate partner violence among couples in Uganda

Northeastern Uganda has suffered from protracted armed conflict and HIV/AIDS and has some of the highest rates of intimate partner violence (IPV) globally. Little is known about how exposure to conflict and HIV influence individuals' syndemic risk markers or those of their partners. We conducted a population-based study using multistage sampling across three districts in Northeastern Uganda. We randomly surveyed 605 women aged 13-49 years and estimated syndemic problems for currently partnered women (N = 561) who reported for their male partners. Syndemic problems were lower in the low-conflict district than the high-conflict district, p = .009. Conflict exposure was associated with couples' syndemic scores, respondent: β = 0.182, p < .001; partner: β = .181, p < .001. Problem scores were significantly higher among women whose partner was either HIV positive, p = .031, or had an unknown HIV status, p = .016, compared with those whose partner was HIV negative. The total effects of women's, β = .15, p = .034, and men's, β = .137, p = .038, armed conflict exposure on male-to-female IPV were significant. For male partners, there were significant total effects of having an unknown, β = .669, p < .001, or positive, β = 1.143, p < .001, HIV status on experiencing female-to-male IPV. These results suggest that syndemic problems and corresponding treatments should consider couple influences. Addressing mediating problems of mental distress and alcohol misuse may reduce the risk of male-to-female IPV. Providing couple-based HIV psychosocial interventions could reduce men's exposure to IPV.

Charting a Course towards Resilience Following Adverse Childhood Experiences: Addressing Intergenerational Trauma via Strengths-Based Intervention

Early research on adverse childhood experiences (ACEs) provided staggering evidence of the significant ramifications of ACEs on physical health and functioning. It brought to the forefront the importance of addressing trauma and family dysfunction to enhance public health. Over the past several decades, the study of childhood adversity has blossomed, with expanded conceptualizations and assessments of ACEs. This review brings together various biological, psychological, and sociological principles that inform our understanding of ACEs and our approach to treatment. Specifically, we document the evolution of ACEs research, focusing on the intergenerational impact of ACEs, the importance of incorporating a resilience framework when examining ACEs, and implementing interventions that address adversity across generations and at multiple levels of the social ecology. Evidence is provided to support the evolving perspective that ACEs have long-lasting effects beyond the ACE(s)-exposed individual, with significant attention to the impact of parental ACEs on child development. An intergenerational and multilevel approach to understanding and addressing ACEs offers specific areas to target in interventions and in public policy.

The social determinants of health and health seeking behaviour in populations affected by armed conflict: a qualitative systematic review

This systematic review explored the relationship between the social determinants of health and health seeking behaviour of individuals affected by armed conflicts. A systematic search of all available evidence was conducted through well-known academic databases. Seven studies met the inclusion criteria and were quality assessed. The synthesis revealed that the social determinants of health in times of conflict also determine the level of health seeking in these individuals. The social determinants were grouped in three main themes a) individual and economic b) sociocultural c) political and health systems. The three themes show that armed conflicts affect health seeking behaviour of individuals in a multi-layered manner with strong connections across the social determinants. This review shows that individuals are forced to choose between fulfilling their basic needs and attending health services. This is further compounded by the lack of health provision in conflict settings. Future research must address the social determinants of health when examining health seeking behaviour of conflict affected populations.

Combating IPV With Community Leaders in Honduras: An Evaluation of an IPV Training Program Among Teachers and Health Professionals

Intimate partner violence (IPV) among women in Latin America, including Honduras, is serious. To help IPV victims, a community-based educational program has been implemented. This study aims to examine the impact of IPV training among teachers and health care professionals (n = 160) on increases in IPV knowledge, attitudes, and self-efficacy when dealing with IPV victims using a pretest and posttest design. We found that the treatment group who received IPV training showed significantly lower justification for IPV, higher gender equality attitudes, and higher IPV knowledge as well as higher confidence levels in identifying IPV victims and safety planning for victims. We concluded that the IPV training program using the community-based approaches has the potential to help IPV victims in Honduras. More efforts should be made to increase the educational opportunities the community members can receive.

Physical and Sexual Violence Experienced by Male War-Affected Youth: Implications for Post-Conflict Functioning and Intimate Relationships

This study explored the association between war violence exposure during armed conflict and intimate partner violence (IPV) victimization, and the impact of positive community and family reintegration on IPV among a sample (N = 92) of war-affected male youth, post-conflict Sierra Leone. Trained Sierra Leonean researchers conducted face-to-face interviews with youth and their caregivers. Results indicate that exposure to violence during armed conflict as well as community and family reintegration were negatively associated with psychological IPV perpetration. Community reintegration was negatively associated with physical IPV. Sexual victimization was negatively associated with sexual IPV perpetration, whereas physical victimization had positive association. More research needs to be done on male war-affected youth as victims of physical, psychological, and sexual violence during conflict and the impact this has on the quality of their intimate relationships, occurrence of IPV in those relationships (as victims in addition to being perpetrators), and their community reintegration.

Intimate partner violence against women on the Colombia Ecuador border: a mixed-methods analysis of the liminal migrant experience

Background

Intimate partner violence (IPV) has serious long-term health and psychological consequences and is highly prevalent in Latin America and among displaced populations. Liminality - the ambiguous in-between state of individuals completing a migratory journey - represents a state of legal, economic, and physical insecurity. Through the framework of liminality, this analysis seeks to understand the unique challenges faced by displaced Colombian women in Ecuador including their experience of IPV.

Methods

We performed a secondary analysis of 15 in-depth interviews and 319 longitudinal surveys, conducted on the border of Ecuador and Colombia, following a sequential explanatory mixed-methods design. We analysed interviews thematically and mapped the main themes onto complementary quantitative variables. We conducted logistic regression with identified risk and protective factors (measured at time 1) and recent IPV (measured at time 2), controlling for demographic characteristics and IPV at time 1.

Results

Our mixed-methods analysis revealed four main mechanisms by which displacement influenced the social and economic realities of Colombian women years after crossing the border, compounding their risk of IPV and limiting their ability to escape it. Lack of legal residence and documentation, violence experienced along life course and migratory continuums which increased their risk for later revictimisation, social isolation including loss of support networks and restricted mobility and lastly, financial stress.

Conclusions

This research highlights the critical importance of supporting the economic and social integration of migrants and refugees in host communities, as well as the need to carefully consider migration-related vulnerabilities in IPV prevention and response interventions. As the regional refugee crisis grows, policy makers must consider how the long-term marginalisation of refugee women contributes to their victimisation. This research also supports the idea of incorporating gender synchronised, transformative IPV prevention and response programmes into migration-related and poverty alleviation international development efforts.

Toward a Contextually Valid Assessment of Partner Violence: Development and Psycho-Sociometric Evaluation of the Gendered Violence in Partnerships Scale (GVPS)

This article presents a new measure for intimate partner violence (IPV), the Gendered Violence in Partnerships Scale (GVPS). The scale was developed in the Middle East with the aim to contribute to the global perspective on IPV by providing a contextual assessment tool for partner violence against women in violent-torn settings embedded in a patriarchal social structure. In an effort to generate a scale including IPV items relevant to the women of the population, a pragmatic step-wise procedure, with focus group discussions and expert panels, was performed. The study’s analyses resulted in an 18-item checklist featuring four subscales of the GVPS that are based on a new typology of male-to-female partner violence presenting an alternative to the commonly used classification by type of abuse (i.e., physical, psychological, sexual acts). Therein, dominating behaviors, existential threats, impulsive aggression, and aggravated physical assault were identified as reflective of the lived realities of women in the war-torn Middle East, which was confirmed in factor analysis. The scale’s psychometric properties were assessed with data from 1,009 displaced women in Iraq, and associations with measures of psychopathology were determined. Implications for IPV assessment and prevention possibilities in humanitarian contexts and beyond are discussed.

A call for greater conceptual clarity in the field of mental health and psychosocial support in humanitarian settings

AIMS

When the Interagency Standing Committee (IASC) adopted the composite term mental health and psychosocial support (MHPSS) and published its guidelines for MHPSS in emergency settings in 2007, it aimed to build consensus and strengthen coordination among relevant humanitarian actors. The term MHPSS offered an inclusive tent by welcoming the different terminologies, explanatory models and intervention methods of diverse actors across several humanitarian sectors (e.g., health, protection, education, nutrition). Since its introduction, the term has become well-established within the global humanitarian system. However, it has also been critiqued for papering over substantive differences in the intervention priorities and conceptual frameworks that inform the wide range of interventions described as MHPSS. Our aims are to clarify those conceptual frameworks, to argue for their essential complementarity and to illustrate the perils of failing to adequately consider the causal models and theories of change that underlie our interventions.

METHODS

We describe the historical backdrop against which the term MHPSS and the IASC guidelines were developed, as well as their impact on improving relations and coordination among different aid sectors. We consider the conceptual fuzziness in the field of MHPSS and the lack of clear articulation of the different conceptual frameworks that guide interventions. We describe the explanatory models and intervention approaches of two primary frameworks within MHPSS, which we label clinical and social-environmental. Using the examples of intimate partner violence and compromised parenting in humanitarian settings, we illustrate the complementarity of these two frameworks, as well as the challenges that can arise when either framework is inappropriately applied.

RESULTS

Clinical interventions prioritise the role of intrapersonal variables, biological and/or psychological, as mediators of change in the treatment of distress. Social-environmental interventions emphasise the role of social determinants of distress and target factors in the social and material environments in order to lower distress and increase resilience in the face of adversity. Both approaches play a critical role in humanitarian settings; however, the rationale for adopting one or the other approach is commonly insufficiently articulated and should be based on a thorough assessment of causal processes at multiple levels of the social ecology.

CONCLUSIONS

Greater attention to the 'why' of our intervention choices and more explicit articulation of the causal models and theories of change that underlie those decisions (i.e., the 'how'), may strengthen intervention effects and minimise the risk of applying the inappropriate framework and actions to a particular problem.

Adaptive work in the primary health care response to domestic violence in occupied Palestinian territory: a qualitative evaluation using Extended Normalisation Process Theory

BACKGROUND

A health system response to domestic violence against women is a global priority. However, little is known about how these health system interventions work in low-and-middle-income countries where there are greater structural barriers. Studies have failed to explore how context-intervention interactions affect implementation processes. Healthcare Responding to Violence and Abuse aimed to strengthen the primary healthcare response to domestic violence in occupied Palestinian territory. We explored the adaptive work that participants engaged in to negotiate contextual constraints.

METHODS

The qualitative study involved 18 participants at two primary health care clinics and included five women patients, seven primary health care providers, two clinic case managers, two Ministry of Health based gender-based violence focal points and two domestic violence trainers. Semi-structured interviews were used to elicit participants' experiences of engaging with HERA, challenges encountered and how these were negotiated. Data were analysed using thematic analysis drawing on Extended Normalisation Process Theory. We collected clinic data on identification and referral of domestic violence cases and training attendance.

RESULTS

HERA interacted with political, sociocultural and economic aspects of the context in Palestine. The political occupation restricted women's movement and access to support services, whilst the concomitant lack of police protection left providers and women feeling exposed to acts of family retaliation. This was interwoven with cultural values that influenced participants' choices as they negotiated normative structures that reinforce violence against women. Participants engaged in adaptive work to negotiate these challenges and ensure that implementation was safe and workable. Narratives highlight the use of subterfuge, hidden forms of agency, governing behaviours, controls over knowledge and discretionary actions. The care pathway did not work as anticipated, as most women chose not to access external support. An emergent feature of the intervention was the ability of the clinic case managers to improvise their role.

CONCLUSIONS

Flexible use of ENPT helped to surface practices the providers and women patients engaged in to make HERA workable. The findings have implications for the transferability of evidenced based interventions on health system response to violence against women in diverse contexts, and how HERA can be sustained in the long-term.

Domestic Violence in Arab Society: A Comparison of Arab and Jewish Women in Shelters in Israel

The aim of the current study was to address a gap in the literature by determining prevalence, specific types of violence, and risk factors of intimate partner violence (IPV) among Israeli born Arab women compared with Israeli born Jewish women. The following measures were compared: demographic and socioeconomic measures; measures relating to the characteristics of the violence, that is, the three types of violence (physical, emotional, and verbally threatening), sense of danger, and history of violence in childhood; family support levels; and perpetrator characteristics. The sample consisted of 154 Israeli born Arab women and 149 Israeli born Jewish women who were staying in shelters for victims of domestic violence in Israel. A comparison of the two groups revealed that the Arab women were exposed to more physical violence and received less family support than did their Jewish counterparts. The proportion of Arab perpetrators with access to weapons was higher than that of Jewish perpetrators, whereas the proportion of police complaints against Jewish perpetrators was higher than that against Arab perpetrators. Arab women were also younger, less educated, and less a part of the workforce than Jewish women. The contribution of the woman's age to the variance in levels of physical violence was negative and significant. In contrast, the contribution of her sense of danger, and various perpetrator characteristics, was positive. Moreover, the interaction between sense of danger × ethnicity contributed significantly to levels of violence. This study extends the existing knowledge about the contribution of ethnicity as one of many variables that play a role in the lives of women who are victims of domestic violence and highlights the need to develop, in particular, unique individual, community, and social interventions for Arab women in Israeli society.

Risk Markers for Women's Physical Intimate Partner Violence Victimization in Iran: A Meta-Analysis

In this study, evidence from 14 studies examines 16 unique risk markers for intimate partner violence (IPV) victimization for Iranian women. Large-to-medium effect sizes were found for emotional abuse victimization, depression, poor mental health, poor physical health, partner's drug use, living in a patriarchal household, and partner having experienced child abuse as risk markers. Higher levels of education and higher levels of household income were significant protective markers against IPV victimization for Iranian women. Partner's education, partner's employment, being employed, being pregnant, age, partner's age, and length of the relationship were not significant risk markers for IPV victimization among Iranian women.

Associations between exposures to occupation-related events, depression and intimate partner violence among women in the occupied Palestinian Territories

War and conflict impact on women's mental health and experiences of intimate partner violence (IPV), including in the occupied Palestinian Territories (oPT). Drawing on a cross-sectional population representative sample (n=534) collected in February 2017 in the oPT, we sought to (i) characterise the patterning of occupation-related events among women (18+) living in the oPT, (ii) to descriptively assess factors associated with this patterning, (iii) to assess the health impacts of occupation-related events by this patterning, specifically experience of IPV and poor mental health, and (iv) to assess the pathways through which occupation-related events are associated with IPV experience. Using Latent Class Analysis we identified three 'classes' of exposure to occupation-related events: 1 in 20 experienced multiple forms directed at themselves, their families and homes, 42.3% reported experiences against family members and their homes, and half reported relatively few direct experiences of occupation-related violence. Group membership was associated with increased past year IPV experience, and depressive symptoms. Using structural equation modelling we demonstrate that experiences of occupation-related events increased IPV experience via two mediated pathways; increased gender inequitable attitudes, and increased depressive symptoms and quarrelling with their husband. Preventing IPV requires addressing occupation-related events as well as transforming gender norms.

Association of War-Related and Gender-Based Violence With Mental Health States of Yazidi Women

IMPORTANCE

Yazidi women in northern Iraq have experienced severe human rights violations through attacks by the so-called Islamic State group, with severe consequences for their health. However, no studies to date have investigated how war-related and gender-based violence, including partner violence, are associated with mental health disorders in this population.

OBJECTIVE

To evaluate the associations between Yazidi women's experiences of violence (ie, war violence, partner violence, enslavement) and their mental health.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study of 326 women was conducted in camps for displaced persons in the Kurdistan region of Iraq between January and July 2017. Participants were married women from the Yazidi population in northern Iraq who were affected by Islamic State attacks. Participants were selected via household-randomized sampling. Data analysis was conducted from December 2018 to September 2019.

EXPOSURES

Experiences of enslavement, war-related events, and intimate partner violence were measured with event checklists.

MAIN OUTCOMES AND MEASURES

Posttraumatic stress disorder (PTSD) and depression levels were measured using culturally validated instruments.

RESULTS

A total of 326 women (mean [SD] age, 34.3 [12.9] years) participated in the study. Almost all participants reported the experience of at least 1 war-related violent event (325 [99.7%]), 54 (16.6%) reported a history of abduction and sexual slavery, and 215 (66.0%) reported the experience of at least 1 type of intimate partner violence in the past year. There were no significant differences between women who did and did not experience abduction regarding exposure to intimate partner violence. Rates of PTSD and depression symptoms were high among the whole sample, and women who experienced abduction reported significantly higher levels of psychopathology than those who did not (mean [SD] PTSD score: 61.48 [12.38] vs 47.61 [14.42]; t324 = -6.91; P < .001; mean [SD] depression score: 3.07 [0.68] vs 2.43 [0.68]; t324 = -6.78; P < .001). Multivariate hierarchical regressions revealed that psychopathology was associated with exposure to war-related events (PTSD: β = 0.29; P < .001; depression: β = 0.27; P < .001) as well as with exposure to gender-based violence in Islamic State captivity (PTSD: β = 0.19; P = .001; depression: β = 0.28, P < .001) and in their marriage (PTSD: β = 0.13; P = .008; depression: β = 0.18; P < .001).

CONCLUSIONS AND RELEVANCE

In this study, interviewed Yazidi women often experienced intimate partner violence as well as war-related and gender-based violence under Islamic State attacks and enslavement, experiences that were associated with mental health impairment. The findings underline the importance of also addressing gender-based violence within health care approaches for war-affected populations.

Supporting Syrian families displaced by armed conflict: A pilot randomized controlled trial of the Caregiver Support Intervention

BACKGROUND

The impact of armed conflict and displacement on children's mental health is strongly mediated by compromised parenting stemming from persistently high caregiver stress. Parenting interventions for refugees emphasize the acquisition of parenting knowledge and skills, while overlooking the deleterious effects of chronic stress on parenting. War Child Holland's Caregiver Support Intervention (CSI) aims to strengthen parenting by lowering stress and improving psychosocial wellbeing among refugee parents, while also increasing knowledge and skill related to positive parenting. The CSI is a nine-session group intervention delivered by non-specialist providers.

OBJECTIVE

We describe the findings of a two-arm pilot randomized controlled trial of the CSI with Syrian refugees in Lebanon. The primary aim was to test the feasibility of our study methodology prior to conducting a definitive RCT.

METHODS

We recruited 78 families (151 parents), who were randomized to the CSI or a waitlist control group. Data were collected at baseline and post-intervention.

RESULTS

Randomization was successful, retention was high (99 %), as was intervention completion (95 % among women, 86 % among men). Implementation fidelity was excellent. Blinding was largely, though not completely effective. The CSI group showed significantly increased parental warmth and responsiveness, decreased harsh parenting, lowered stress and distress, improved psychosocial wellbeing, and improved stress management. CSI parents reported increased child psychosocial wellbeing. Control families showed no significant change on any variable.

CONCLUSIONS

Findings demonstrate the feasibility of our methodology for a definitive RCT, and suggest that the CSI shows promise as a scalable approach to strengthening parenting in refugee communities. Trial registration # ISRCTN33665023.

Intimate Partner Violence Prevalence, Recurrence, Types, and Risk Factors Among Arab, and Jewish Immigrant and Nonimmigrant Women of Childbearing Age in Israel

This research set out to determine prevalence, recurrence, types, and risk factors for intimate partner violence (IPV) among women of childrearing age across Israel, attending to diversity in these factors by ethnicity and immigration status. The first nationwide study of its kind, this research was based on a stratified proportional cluster sample of 1,401 Arab, and Jewish immigrant and nonimmigrant women (aged 16-48 years) who visited 63 maternal and child health (MCH) clinics between October 2014 and October 2015. Female research staff interviewed women face-to-face in a private room at the MCH clinics using a structured questionnaire in the women's main language (Arabic or Hebrew). We measured IPV using a 10-item questionnaire used for screening at some MCH clinics. Response rate was 74%. In the multivariate analysis, we used generalized estimating equations (GEEs) to adjust for the MCH clinic cluster effect. We found marked differences in the prevalence of IPV among Arab, and Jewish immigrant and nonimmigrant women (67%, 30%, and 27%, respectively). Types (physical, verbal and social) and recurrence of IPV were significantly higher among Arab women compared with the other two groups. In the GEE analysis, compared with IPV among Jewish nonimmigrants, IPV among Arab women persisted after considering socioeconomic, sociodemographic, and reproductive factors (odds ratio = 3.83; 95% confidence interval = [2.55, 5.72]). Low family income was the main risk factor for IPV for all women. Among Arab women, younger age, high religiosity, and living in urban settings were associated with higher IPV. These results suggest that diversity (ethnicity and immigration status) should be considered when developing tailored policies and interventions to protect women from IPV.

"Women hope the situation will change, and their husbands will change with it": narratives of intimate partner violence in Gaza

The authors' purpose in conducting this study was to identify barriers faced by survivors of intimate partner violence (IPV) in accessing services in Gaza. We collected data via in-depth interviews with women (ages 18-49; n = 25). Respondents were recruited through convenience sampling from women's organizations. Interviews were transcribed, translated, and coded using an inductive approach. Results indicate three main factors that influence help-seeking: perceived transgression of traditional gender roles; distrust of women's centers; and contextual acceptance of IPV. An understanding of emic perceptions of IPV can inform the design and delivery of support services and increase access to interventions for women in Gaza.

Unmet health care needs among children of mothers exposed to violence

BACKGROUND

Existing literature shows that maternal exposure to violence has negative consequences on the health and behavioral outcomes of their children, but how it affects unmet child healthcare needs is unknown.

OBJECTIVES

To examine associations between maternal violence exposure and unmet child healthcare needs in vulnerable families.

PARTICIPANTS AND SETTING

We used data from the third and fifth years of Fragile Families and Child Wellbeing Study, a birth cohort study of urban children born between 1998 and 2000 n = 2848.

METHODS

Mothers completed a self-reported questionnaire or interview. Maternal violence exposure was measured through direct (victim) and indirect (witness) exposure. Unmet child healthcare needs was operationalized through: not having seen a doctor when needed, not having a well-child visit in the past year, and never had a dental check-up.

RESULTS

In adjusted logistic regression models, children of mothers who were victims of violence were more likely to not have seen a doctor when needed (odds ratio = 3.36, p < 0.01), not have a well-child visit in the past year (odds ratio = 2.50, p < 0.01), and never have a dental check-up (odds ratio = 1.54, p < 0.01). There was no association between maternal witnessing violence and unmet child healthcare needs.

CONCLUSIONS

In this study of urban children, having a mother who was a victim of violence was associated with unmet healthcare needs. These findings underscore the need to invest in efforts to reduce the prevalence of violence. Such efforts would reduce unmet child healthcare needs in vulnerable families.

Predictors of Interpersonal Violence in the Household in Humanitarian Settings: A Systematic Review

Interpersonal violence against women and children has increasingly been recognized as a public health priority in humanitarian emergencies. However, because the household is generally considered a private sphere, violence between family members remains neglected. A systematic literature review was conducted to identify predictors of household violence in humanitarian emergencies. PubMed, Web of Science, and Scopus were searched from January 1, 1998, to February 16, 2016. A predictor was defined as any individual, household, or community-level exposure that increases or decreases the risk associated with physical, sexual, or emotional interpersonal violence between two or more people living together. All studies reporting on quantitative research were eligible for inclusion. Results were analyzed using qualitative synthesis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed as applicable. The search strategy resulted in 2,587 original records, of which 33 studies met inclusion criteria. Thirty-two of the 33 studies used a cross-sectional design. This was the first known systematic review of predictors of household violence in humanitarian settings. The household framework drew attention to several factors that are associated with violence against both women and children, including conflict exposure, alcohol and drug use, income/economic status, mental health/coping strategies, and limited social support. There is a need for longitudinal research and experimental designs that can better establish temporality between exposures and household violence outcomes, control for confounding, and inform practice. In the interim, programmers and policy makers should try to leverage the predictors identified by this review for integrated violence prevention and response strategies, with the important caveat that ongoing evaluation of such strategies is needed.

Strengthening parenting in conflict-affected communities: development of the Caregiver Support Intervention

BACKGROUND

There is robust evidence that compromised parenting, stemming from persistently high stress, mediates the impact of war and displacement on children's mental health and psychosocial wellbeing. Parenting interventions generally prioritize the acquisition of parenting knowledge and skills, while under-attending to parental stress and distress. This paper describes the development of the Caregiver Support Intervention (CSI), a nine-session group intervention for conflict-affected parents of children aged 3-13, that aims to strengthen parenting both indirectly, by lowering stress and improving psychosocial wellbeing among parents, and directly, by increasing knowledge and skill related to positive parenting.

METHODS

We describe the multi-phase, iterative process by which we developed the CSI, and illustrate the essential role of community input in shaping the intervention and strengthening its cultural fit and perceived usefulness. We used focus group data from participants in successive cycles of implementation, feedback, and revision, as well as quantitative data and expert consultation to develop a culturally and empirically grounded intervention.

RESULTS

This mixed-method, iterative approach to intervention development enabled us to develop a psychosocial intervention for conflict-affected caregivers that is feasible, acceptable, and perceived by participants as useful in addressing their own wellbeing and their parenting. Focus group data support the underlying model in which caregiver wellbeing powerfully influences parenting.

CONCLUSIONS

Programs aimed at strengthening parenting in conflict-affected communities should substantively address caregiver wellbeing. An iterative approach incorporating community feedback can help ensure intervention acceptability and feasibility. We also illustrate the feasibility of involving men in parenting interventions.

Sexual violence and eclampsia: analysis of data from Demographic and Health Surveys from seven low- and middle-income countries

Background

Scientific literature has provided clear evidence of the profound impact of sexual violence on women’s health, such as somatic disorders and mental adverse outcomes. However, consequences related to obstetric complications are not yet completely clarified. This study aimed to assess the association of lifetime exposure to intimate partner sexual violence with eclampsia.

Methods

We considered all the seven Demographic and Health Surveys (DHS) that included data on sexual violence and on signs and symptoms suggestive of eclampsia for women of reproductive age (15-49 years). We computed unadjusted and adjusted odds ratios (OR) to evaluate the risk of suggestive eclampsia by ever subjected to sexual violence. A sensitivity analysis was conducted restricting the study population to women who had their last live birth over the 12 months before the interview.

Results

Self-reported experience of sexual violence ranged from 3.7% in Mali to 9.2% in India while prevalence of women reporting signs and symptoms compatible with eclampsia ranged from 14.3% in Afghanistan to 0.7% in the Philippines. Reported sexual violence was associated with a 2-fold increased odd of signs and symptoms suggestive of eclampsia in the pooled analysis. The sensitivity analysis confirmed the strength of the association between sexual violence and eclampsia in Afghanistan and in India.

Conclusions

Women and girls in low-and-middle-income countries are at high risk of sexual violence, which may represent a risk factor for hypertensive obstetric complication. Accurate counseling by health care providers during antenatal care consultations may represent an important opportunity to prevent adverse outcomes during pregnancy.

Armed Conflict, Intimate Partner Violence, and Mental Distress of Women in Northeastern Uganda: A Mixed Methods Study

As global mental health research and programming proliferate, research that prioritizes women's voices and examines marginalized women's mental health outcomes in relation to exposure to violence at community and relational levels of the socioecological model is needed. In a mixed methods, transnational study, we examined armed conflict exposure, intimate partner violence (IPV), and depressive symptoms among 605 women in Northeastern Uganda. We used analysis of variance to test between groups of women who had experienced no IPV or armed conflict, IPV only, armed conflict only, and both; and linear regression to predict depressive symptoms. We used rapid ethnographic methods with a subsample (n = 21) to identify problem prioritization; and, to characterize women's mental health experiences, we conducted follow up in-depth interviews (n = 15), which we analyzed with grounded theory methods. Thirty percent of the sample met the cut-off for probable major depressive disorder; women exposed to both IPV and armed conflict had significantly higher rates of depression than all other groups. While women attributed psychological symptoms primarily to IPV exposure, both past-year IPV and exposure to armed conflict were significantly associated with depressive symptoms. Women identified socioeconomic neglect as having the most impact and described three interrelated mental health experiences that contribute to thoughts of escape, including escape through suicide. Policy efforts should be interprofessional, and specialists should collaborate to advance multi-pronged interventions and gender-informed implementation strategies for women's wellbeing.

A Whole Life Of Threats: A Qualitative Exploration Of Lived Experiences Of Palestinian Women Suffering From Intimate Partner Violence

Background

Violence against women is a widespread public health problem in the Palestinian community considered to be a traditional community. It is usually underreported due to cultural and religious issues. The present study was carried out in order to deepen the understanding of the feelings, thoughts, and perceptions of Palestinian women living in the Gaza Strip and suffering from intimate partner violence.

Methods

Hermeneutic phenomenological study was conducted. The recruited 11 Palestinian women suffering from intimate partner violence were selected via purposive means. Semi-structured in-depth interviews conducted from May to Sept 2018 were used to understand their lived experience. Data was analyzed through the Van Manen method.

Results

In the process of data analysis, living in a threatening world was the main theme that was extracted from the data. The theme refers to the condition that participants were committed to their marriage and are compelled to remain in a threatening situation. That was interpreted as a whole life of threats, which was labeled as the main theme emerging from three sub-themes. This main theme included 3 subthemes namely “live in a physically threatening environment”, “live in psychologically threatening environment”, and “live in sexual threatening environment”.

Conclusion

As revealed in our study, the participant suffered extremely from intimate partner violence and its consequences, which negatively affected their lives. However, their concerns about their children and lack of support were barriers for them to get a divorce; therefore, abused women need help to deal with their current lives like access to social and psychological counseling.

Intimate partner violence against Palestinian women in Gaza strip: Prevalence and correlates

Context:

Intimate partner violence (IPV) affects gravely the victims and is resulting in negative physical and psychological consequences.

Aims:

This paper aimed to determine the prevalence of IPV against women in Gaza strip and associated factors. Moreover, to explore women's seeking behaviors to help.

Settings and Design:

Cross-sectional study.

Methods and Materials:

Community internet-based survey was conducted using the Heart Insult Threat Scout questionnaire and the reporting behavior of respondent to violence act.

Statistical Analysis Used:

A number of 517 ever married women responded and data were entered and analyzed using SPSS software version 23.

Results:

About 517 women participated. Of which, 23% (119/517) reported exposure to any types of IPV. Multivariate logistic regression showed factors associated with IPV were as follows: husbands who are drug user (OR = 27.577, CI95%: 5.153–147.591; P < 0.001), husband exposure to violence in childhood (OR = 9.174, CI95%: 4.753–7.727; P > 0.001), and family with a special needs child (OR = 2.956, CI95%: 1.131–8.607; P < 0.05). Approximately, two-thirds of the victims tended to keep silent toward violence and dealt with it as a private and family issue; hence, they hesitated to communicate with others or seek any help to protect themselves.

Conclusions:

About 23% from the study participants experience violence in their life time. Factors associated with IPV are husband's drug abuse, having a child with special needs, and husband's childhood experience of violence. Qualitative researches are needed to understand the women experience to violence and sociocultural barrier for disclosure.

Prevalence of intimate partner violence against women in the Arab world: a systematic review

Background

Violence against women has particular importance for women’s health and wellbeing in the Arab world, where women face persistent barriers to social, political and economic equality. This review aims to summarize what is known about the prevalence of physical, sexual and emotional/psychological intimate partner violence (IPV) against women in the 22 countries of the Arab League, including geographic coverage, quality and comparability of the evidence.

Methods

A systematic review of IPV prevalence in Arab countries was carried out among peer-reviewed journal articles and national, population-based survey reports published by international research programmes and/or governments. Following PRISMA guidelines, Medline and the Social Sciences Citation Index were searched with Medical Subject Headings terms and key words related to IPV and the names of Arab countries. Eligible sources were published between January 2000 and January 2016, in any language. United Nations databases and similar sources were searched for national surveys. Study characteristics, operational definitions and prevalence data were extracted into a database using Open Data Kit Software. Risk of bias was assessed with a structured checklist.

Results

The search identified 74 records with population or facility-based IPV prevalence data from eleven Arab countries, based on 56 individual datasets. These included 46 separate survey datasets from peer-reviewed journals and 11 national surveys published by international research programmes and/or governments. Seven countries had national, population-based IPV estimates. Reported IPV prevalence (ever) ranged from 6% to more than half (59%) (physical); from 3 to 40% (sexual); and from 5 to 91% (emotional/ psychological). Methods and operational definitions of violence varied widely, especially for emotional/psychological IPV, limiting comparability.

Conclusions

IPV against women in Arab countries represents a public health and human rights problem, with substantial levels of physical, sexual and emotional/psychological IPV documented in many settings. The evidence base is fragmented, however, suggesting a need for more comparable, high quality research on IPV in the region and greater adherence to international scientific and ethical guidelines. There is a particular need for national, population-based data to inform prevention and responses to violence against women, and to help Arab countries monitor progress towards the Sustainable Development Goals.

Occupation, settlement, and the social determinants of health for West Bank Palestinians

A contentious issue in the Israel-Palestine conflict is the ongoing construction of settlements in the occupied West Bank along with its related policies, both of which have had impacts on the lives of resident Palestinians. These impacts have been documented by various UN and non-governmental agencies yet have been insufficiently studied in the academic literature. This article aims to review the literature on the social determinants of health for West Bank Palestinians and understand how settlement construction and policy influence these determinants. To accomplish these aims, the article first includes an analysis of how military infrastructure, resource allocation, land appropriation and house demolition related to the settlements influence the lives of West Bank Palestinians. The article then proceeds to review available literature on the social determinants of health in the West Bank, most notably: access to healthcare, exposure to political violence, economic conditions and water contamination, with the goal of understanding how settlement-related policies are related to these social determinants of health.

Continuous Traumatic Stress and the Life Cycle: Exposure to Repeated Political Violence in Israel

PURPOSE OF REVIEW

Millions of individuals and families live under continual exposure to threat such as protracted socio-political conflict or community violence facing current and future danger. The construct of continuous traumatic stress (CTS) was suggested as a supplement perspective for the understanding of the specific impact of living under both current and realistic future threat. Yet, the unique parameters, utility, and validity of the construct CTS are underexplored.

RECENT FINDINGS

Currently, CTS describes both the exposure and the unique clinical conglomerate of distress. In this paper, we first elaborate on the rationale for the construct of CTS. Then, we present evidence on the consequences of exposure to CTS in the Israeli context of continual ongoing and prolonged political violence. Research on CTS is presented across the life cycle with an emphasis on risk and protective factors from a developmental perspective. We conclude with implications for research, assessment, and interventions.

Gender-Related Ideological and Structural Macrosocial Factors Associated With Intimate Partner Violence Against European Women

Intimate partner violence against women (IPVAW) is investigated mostly at the individual level, which ignores the role of macrosocial variables and possible interactions between them. We explored how two ideological gender-related macrosocial factors (traditional gender role beliefs and attitudes toward gender equality) and one structural gender-related macrosocial factor (the economic Gender Equality Index) are associated with physical, psychological, and sexual IPVAW in Europe. We examined their interactions with individual-level factors in predicting IPVAW. Secondary analysis ( N = 30,284 heterosexual women) of the 2015 European Union Agency for Fundamental Rights’ Violence Against Women survey revealed that 26.1% of women in Europe reported at least one act of physical, psychological, or sexual violence. Generalized linear mixed models analysis revealed that individual-level factors (women’s education, childhood victimization, equal say about income, partner’s alcohol consumption, and an aggressive partner) were associated with IPVAW. Adding the Eurobarometer of Gender Equality ( N = 28 countries) and the Gender Equality Index ( N = 28 countries), attitudes more favorable to gender equality were related to lower rates of psychological victimization; more traditional gender role beliefs predicted higher rates of sexual victimization. Ideological gender-related macrofactors played an important role in cross-level interactions with individual-level factors. To reduce the rates of IPVAW victimization, clinicians, educators, and policy makers need to focus on individual predictors and macrofactors to promote societal attitudes toward equality and change traditional gender role socialization. Additional online materials for this article are available on PWQ’s website at http://journals.sagepub.com/doi/suppl/10.1177/0361684319839367

What Difference Does Peace Make? Intimate Partner Violence and Violent Conflict in Northern Ireland

This article investigates how the transition from violent conflict to peaceful political settlement has shaped intimate partner violence (IPV) in Northern Ireland focusing on three issues, which are policing, paramilitarism, and firearms. It does so on the basis of comparative analysis of interview findings with more than 100 women victims of IPV from across Northern Ireland conducted at two junctures: first in 1992 during a period of violent conflict, and later in 2016 at a time of enduring peace. The findings trace the changes that have occurred across these areas and highlight any problems that remain in the post-conflict environment.

Domestic Violence and Humanitarian Crises: Evidence from the 2014 Israeli Military Operation in Gaza

Using qualitative data from 21 group discussions and unique survey data from a representative cross-section of 439 women in the Gaza Strip, we investigate how the Israeli military operation "Protective Edge" in 2014 influenced domestic violence (DV), accounting for risk factors at different levels of the ecological model. We combine our survey data with secondary data on infrastructure destruction across Gaza's neighborhoods, and use propensity score matching techniques to address endogeneity concerns. Our results show that the military operation increased DV, and that this effect manifests itself at relatively low-levels of destruction. Our analysis suggests that the mechanisms are displacement, a lowered ability of married women to contribute to household decision-making, and reduced social support networks.

Prevalence of intimate partner violence and reproductive health outcomes among Afghan refugee women in Iran

Refugee women are at high risk of experiencing high level of Intimate Partner Violence (IPV) and its negative impacts. We conducted a cross-sectional population-based household survey with refugees in a settlement in the city of Semnan, Iran, from 2016 to 2017. Afghan refugee women (n = 188) with ages between 15 and 49 years were recruited for the survey. Overall, about 79.8% of the participants reported to have experienced a form of IPV in the past 12 months. IPV exposure is associated with a negative reproductive health outcome. The high prevalence of IPV found among refugee women in the present research and its strong links with poor reproductive health outcomes, underline the urgent need for the development and testing of appropriate interventions in refugee settlements.

Trauma exposure and IPV experienced by Afghan women: Analysis of the baseline of a randomised controlled trial

BACKGROUND

Four decades of conflict has indelibly impacted the lives of Afghans, exposing many to different forms of trauma. The aim of this paper investigate a hypothesis that (mostly war related) trauma is a key driver of partner violence in Afghanistan.

METHODS

1,463 women aged 18-48 were recruited into a randomised controlled trial (RCT) to evaluate a women empowerment intervention in 8 villages of Kabul and Nangarhar provinces. The women were interviewed at baseline. The analysis uses multivariable logistic regression and structural equation modelling (SEM) to describe relationships between measures.

RESULTS

57.4% of women reported exposure to one of four types of trauma: 23.3% an armed attack, 39.4% had felt close to death, 10.6% witnessed a friend or family member being killed and 21.4% witnessed the death of a stranger or someone unknown. Trauma exposure was associated with being older, Pashtan, madrassa educated, and food insecure. Women who were trauma exposed were more likely to have ever experienced IPV, have hit their children in the last 4 weeks, and be hit by a sibling or relative of their husband or their mother-in-law in the last year. They held less patriarchal personal gender attitudes and perceived the community to be more patriarchal. The SEM showed that all pathways between trauma exposure and IPV were ultimately mediated by either (mostly mental) ill-health or quarrelling, but not both of these. There were multiple paths through which trauma exposure impacted women's past year experience of physical IPV. One was mediated by childhood trauma exposure and a latent variable for ill health. Other paths were mediated by women's education and personal gender attitudes and ill-health, or else by quarrelling. Trauma exposure was related to lower educational levels. Another path was mediated by less patriarchal personal gender attitudes and ill health. Community gender attitudes was a mediating variable on a path which was also mediated by ill health and another mediated by quarrelling. It was also a mediator on a path which included personal gender attitudes and ill-health. Food insecurity mediated another path with ill health. It was also connected to childhood trauma, community gender attitudes and educational level.

CONCLUSION

Trauma exposure due to conflict will persist until the conflict ends but the impact on women can be ameliorated. This analysis suggests interventions to reduce women's exposure to IPV should focus on reducing poverty, changing social norms on gender, providing relationship skills to help reduce quarrelling and supporting women's mental health.

Armed conflict, alcohol misuse, decision-making, and intimate partner violence among women in Northeastern Uganda: a population level study

BACKGROUND

Relations among and interactions between exposure to armed conflict, alcohol misuse, low socioeconomic status, gender (in)equitable decision-making, and intimate partner violence (IPV) represent serious global health concerns. Our objective was to determine extent of exposure to these variables and test pathways between these indicators of interest.

METHODS

We surveyed 605 women aged 13 to 49 who were randomly selected via multistage sampling across three districts in Northeastern Uganda in 2016. We used Mplus 7.4 to estimate a moderated structural equation model of indirect pathways between armed conflict and intimate partner violence for currently partnered women (n = 558) to evaluate the strength of the relationships between the latent factors and determine the goodness-of-fit of the proposed model with the population data.

RESULTS

Most respondents (88.8%) experienced conflict-related violence. The lifetime/ past 12 month prevalence of experiencing intimate partner violence was 65.3%/ 50.9% (psychological) and 59.9%/ 43.8% (physical). One-third (30.7%) of women's partners reportedly consumed alcohol daily. The relative fit of the structural model was superior (CFI = 0.989; TLI = 0.989). The absolute fit (RMSEA = 0.029) closely matched the population data. The partner and joint decision-making groups significantly differed on the indirect effect through partner alcohol use (a1b1  = 0.209 [0.017: 0.467]).

CONCLUSIONS

This study demonstrates that male partner alcohol misuse is associated with exposure to armed conflict and intimate partner violence-a relationship moderated by healthcare decision-making. These findings encourage the extension of integrated alcohol misuse and intimate partner violence policy and emergency humanitarian programming to include exposure to armed conflict and gendered decision-making practices.

From the battlefield to the bedroom: a multilevel analysis of the links between political conflict and intimate partner violence in Liberia

Objectives

Assess the link between levels of armed conflict and postconflict intimate partner violence (IPV) experienced by women in Liberia.

Methods

Armed Conflict Location and Event Data Project data were used to measure conflict-related fatalities in districts in Liberia during the country’s civil war from 1999 to 2003. These data were linked to individual-level data from the 2007 Demographic and Health Survey, including past-year IPV. Multilevel logistic models accounting for the clustering of women within districts evaluated the relationship of conflict fatalities with postconflict past-year IPV. Additional conflict measures, including conflict events and cumulative years of conflict, were assessed.

Results

After adjusting for individual-level characteristics correlated with IPV, residence in a conflict fatality-affected district was associated with a 50% increase in risk of IPV (adjusted OR (aOR): 1.55, 95% CI 1.26 to 1.92). Women living in a district that experienced 4–5 cumulative years of conflict were also more likely to experience IPV (aOR 1.88, 95% CI 1.29 to 2.75).

Conclusion

Residing in a conflict-affected district even 5 years after conflict was associated with postconflict IPV.

Policy implications

Recognising and preventing postconflict IPV violence is important to support long-term recovery in postconflict settings.

An individually randomized controlled trial to determine the effectiveness of the Women for Women International Programme in reducing intimate partner violence and strengthening livelihoods amongst women in Afghanistan: trial design, methods and baseline findings

Background

Intimate Partner Violence (IPV) is the most common form of violence in conflict and post-conflict settings, but there are few evaluations of interventions to prevent IPV in such settings.

Methods

The Women for Women International (WfWI) intervention is a year-long combined economic and social empowerment intervention for marginalized women survivors of conflict. Primarily, it seeks to support women to achieve four key outcomes: women earn and save money; women improve their health and well-being; women influence decisions in their homes and communities; women connect to networks for support. The organization recognizes Violence Against Women and Girls (VAWG) as a significant barrier to women’s empowerment and expects to see reduction in VAWG, and specifically IPV, as part of building women’s social and economic empowerment. This program is being quantitatively evaluated through an individually randomized control trial amongst women in Afghanistan, with a 24-month follow up. A comparison of baseline characteristics of participants is also included as well as a discussion of implementation of the baseline research.

Discussion

There is a high demand amongst Afghan women for such interventions, and this posed challenges in completing the randomization and baseline. In addition, the complex security situation in Afghanistan also posed challenges. However, despite these issues, recruitment was successfully achieved and the arms were balanced on socio-demographic measures. The evaluation will contribute to the limited evidence base on interventions to prevent IPV in conflict-affected settings.

Trial registration

NCT03236948. Registered 28 July 2017, retrospectively registered.

Psychosocial problems in traumatized refugee families: overview of risks and some recommendations for support services

This article is an abridged version of a report by an advisory council to the German government on the psychosocial problems facing refugee families from war zones who have settled in Germany. It omits the detailed information contained in the report about matters that are specific to the German health system and asylum laws, and includes just those insights and strategies that may be applicable to assisting refugees in other host countries as well. The focus is on understanding the developmental risks faced by refugee children when they or family members are suffering from trauma-related psychological disorders, and on identifying measures that can be taken to address these risks. The following recommendations are made: recognizing the high level of psychosocial problems present in these families, providing family-friendly living accommodations, teaching positive parenting skills, initiating culture-sensitive interventions, establishing training programs to support those who work with refugees, expanding the availability of trained interpreters, facilitating access to education and health care, and identifying intervention requirements through screening and other measures.