Prevention of domestic violence against women and children in low-income and middle-income countries

A Systematic Review of Interventions to Reduce Gender-Based Violence Among Women and Girls in Sub-Saharan Africa

Sub-Saharan Africa (SSA) is disproportionately affected by gender-based violence (GBV). We systematically reviewed English language, peer-reviewed, quantitative evaluations of interventions to reduce violence against women and girls (VAWG) in SSA that involved a comparison group and reported GBV incidence, or GBV-related attitudes, norms and symptoms as an outcome. We identified 53 studies published between January 2000 and April 2020 and classified these programmes from an empowerment perspective using the following categories: social, economic, combined social and economic and psychological empowerment interventions. Our review found social empowerment interventions effective for transforming gender attitudes and norms and reducing GBV, and psychological empowerment interventions effective for managing GBV-related symptoms. The evidence for economic empowerment interventions was equivocal. Key elements of successful interventions included participatory group learning, engaging male partners, engaging the community, longer duration and utilising existing platforms. Promising approaches for further research included gender specific programmes, psychological empowerment interventions delivered by lay workers and psychological empowerment interventions focused on GBV reduction.

Considerations in designing trauma-focused interventions for displaced Afghan women

In light of the 2021 United States military withdrawal from Afghanistan, as well as the humanitarian crises of mass displacement and subsequent health system strain that have ensued, practitioners worldwide will need to develop a more nuanced understanding of the adverse life experiences that women from Afghanistan frequently endorse. As they bear a disproportionate impact of constraints within Afghan society, and as patriarchal systems affect most of their life domains, women from Afghanistan may present with high levels of baseline trauma upon resettlement, and health systems may seek to attenuate this distress; However, the nature of these traumatogenic events may shape women's receptivity to psychosocial interventions, particularly those which are at least partially rooted in Western modalities. In the absence of sufficient literature on evidence-based interventions for this population, a diversity of ethnographic and clinical literature is synthesized, including literature on interventions alleged to be compatible with Afghan norms. As it will be essential to support Afghan women's mental health following social reorganization on a massive scale, considerations arising from the interdisciplinary literature are offered so that they may inform the development of structured, trauma-focused interventions and so that the health systems with which they interface may be better prepared to serve them.

Are Children Harmed by Being Locked up at Home? The Impact of Isolation during the COVID-19 Pandemic on the Phenomenon of Domestic Violence

The phenomenon of violence against children is a very complex one. There are many types of child abuse, and they are culturally dependent to a significant degree. Although studies show that children generally only suffer from mild COVID-19 infection, some social restrictions introduced during the pandemic, such as home isolation, may have many severe consequences on the population's mental health. Studies on this topic suggest that violence against children increased during lockdown due to the COVID-10 pandemic. This narrative review summarizes this available literature on the subject and discusses the different forms of violence against children, their cultural aspects, the impact of the COVID-19 pandemic on the phenomenon of violence, the long-term consequences of the above, and forms of assistance for abused minors.

Is the Parwarish parenting intervention feasible and relevant for young people and parents in diverse settings in India? A mixed methods process evaluation

OBJECTIVE

To assess the feasibility, acceptability and relevance of the Parwarish, a positive parenting intervention (adapted from PLH-Teens) in three diverse settings in India.

DESIGN

This mixed methods study used the Medical Research Council framework for process evaluations of complex interventions.

SETTING

This study was set in disadvantaged communities in urban Agra, rural Uttar Pradesh and tribal Jharkhand in India.

PARTICIPANTS

Data were collected from 86 facilitators, implementers, parents and teens who participated in the Parwarish intervention among 239 families.

INTERVENTION

Couples from target communities facilitated groups of parents and teens over the 14-module structured, interactive Parwarish intervention which focused on building communication, reducing harsh parenting and building family budgeting skills.

OUTCOME MEASURES

We assessed relevance, acceptability and feasibility of the intervention using mixed methods. Qualitative data collected included semistructured interviews and focus group discussions with implementers, facilitators, parents and young people who were transcribed, translated and thematically analysed to develop themes inherent in the data. Quantitative data which assessed attendance, fidelity to the intervention and facilitator training and coaching were analysed descriptively.

RESULTS

Findings were grouped under the three domains of facilitation, community engagement and programme support with the following seven themes: (1) community-based facilitators increased contextual validity of the intervention; (2) gender relations were not only influenced by Parwarish implementation but were also influenced and transformed by Parwarish; (3) facilitator responsiveness to group concerns increased participation; (4) participation gathered momentum; (5) Parwarish's strong core and porous periphery allowed adaptations to local contexts; (6) technology that included Skype and WhatsApp enhanced implementation and (7) critical reflection with community trained coaches strengthened facilitation quality and programme fidelity.

CONCLUSION

This study found Parwarish engaging, feasible and acceptable in three diverse, low-income communities, although constrained by patriarchal gender relations. It paves the way for larger-scale implementation in other South Asian settings.

Mega-map of systematic reviews and evidence and gap maps on the interventions to improve child well-being in low- and middle-income countries

BACKGROUND

Despite a considerable reduction in child mortality, nearly six million children under the age of five die each year. Millions more are poorly nourished and in many parts of the world, the quality of education remains poor. Children are at risk from multiple violations of their rights, including child labour, early marriage, and sexual exploitation. Research plays a crucial role in helping to close the remaining gaps in child well-being, yet the global evidence base for interventions to meet these challenges is mostly weak, scattered and often unusable by policymakers and practitioners. This mega-map encourages the generation and use of rigorous evidence on effective ways to improve child well-being for policy and programming.

OBJECTIVES

The aim of this mega-map is to identify, map and provide an overview of the existing evidence synthesis on the interventions aimed at improving child well-being in low- and middle-income countries (LMICs).

METHODS

Campbell evidence and gap maps (EGMs) are based on a review of existing mapping standards (Saran & White, 2018) which drew in particular of the approach developed by 3ie (Snilstveit, Vojtkova, Bhavsar, & Gaarder, 2013). As defined in the Campbell EGM guidance paper; "Mega-map is a map of evidence synthesis, that is, systematic reviews, and does not include primary studies" (Campbell Collaboration, 2020). The mega-map on child well-being includes studies with participants aged 0-18 years, conducted in LMICs, and published from year 2000 onwards. The search followed strict inclusion criteria for interventions and outcomes in the domains of health, education, social work and welfare, social protection, environmental health, water supply and sanitation (WASH) and governance. Critical appraisal of included systematic reviews was conducted using "A Measurement Tool to Assess Systematic Reviews"-AMSTAR-2 rating scale (Shea, et al., 2017).

RESULTS

We identified 333 systematic reviews and 23 EGMs. The number of studies being published has increased year-on-year since 2000. However, the distribution of studies across World Bank regions, intervention and outcome categories are uneven. Most systematic reviews examine interventions pertaining to traditional areas of health and education. Systematic reviews in these traditional areas are also the most funded. There is limited evidence in social work and social protection. About 69% (231) of the reviews are assessed to be of low and medium quality. There are evidence gaps with respect to key vulnerable populations, including children with disabilities and those who belong to minority groups.

CONCLUSION

Although an increasing number of systematic reviews addressing child well-being topics are being published, some clear gaps in the evidence remain in terms of quality of reviews and some interventions and outcome areas. The clear gap is the small number of reviews focusing explicitly on either equity or programmes for disadvantaged groups and those who are discriminated against.

Interventions for reducing violence against children in low- and middle-income countries: An evidence and gap map

BACKGROUND

More than half of the children in the world experience some form of interpersonal violence every year. As compared with high-income countries, policy responses in low- and middle-income countries (LMICs) are limited due to resource constraints and paucity of evidence for effective interventions to reduce violence against children in their own contexts, amongst other factors.

OBJECTIVES

The aim of this evidence and gap map (EGM) is to provide an overview of the existing evidence available and to identify gaps in the evidence base on the effectiveness of interventions to reduce violence against children in LMICs. This report covers evidence published in English; a follow-up study is under preparation focusing on evidence in five additional languages-Arabic, Chinese, French, Portuguese and Spanish.

METHODS

The intervention-outcome framework for this EGM is based on INSPIRE-Seven Strategies for Ending Violence against Children, published by WHO and other partners in 2016. The seven strategies include implementation and enforcement of laws; norms and values, safe environment; parent-child and caregiver support; income and economic strengthening; response and support services; education and life skills. The search included both academic and grey literature available online. We included impact evaluations and systematic reviews that assessed the effectiveness of interventions to reduce interpersonal violence against children (0-18 years) in LMICs (World Bank, 2018b). Interventions targeting subpopulation of parents, teachers and caregivers of 0-18 years' age group were also included. A critical appraisal of all included studies was carried out using standardised tools.

RESULTS

The map includes 152 studies published in English of which 55 are systematic reviews and 97 are impact evaluations. Most studies in the map are from Sub-Saharan Africa. Education and life skills are the most widely populated intervention area of the map followed by income and economic strengthening interventions. Very few studies measure impact on economic and social outcomes, and few conduct cost-analysis.

CONCLUSION

More studies focusing on low-income and fragile and conflict-affected settings (FCS) and studying and reporting on cost-analysis are required to address gaps in the evidence. Most interventions covered in the literature focused on addressing a wide range of forms of violence and harm, which limited understanding of how and for whom the interventions work in a given context, for specific forms of violence. More impact evaluation studies are required that assess specific forms of violence, gendered effects of interventions and on diverse social groups in a given context, utilising mixed methods.

Physical Violence Against Children and Adolescents in Porto: A 5-Year Study

The aim of the present study was to analyze the prevalence of physical violence against children and adolescents (PVCA) in a 5-year period in the city of Porto, Portugal. All forensic reports between 2009 and 2013 in the clinical services of the North Branch of the National Institute of Legal Medicine and forensic sciences were analyzed. Victims were classified according to sex, age, relationship with perpetrator, traumatic consequences of the event, and year of occurrence. Statistical analysis was performed using SPSS (Version 22.0). Continuous variables were described when appropriated frequencies were displayed. The association between variables was evaluated using chi-square, Fisher's exact test, or Kruskal-Wallis test, when appropriate and a logistic regression was performed. The margin of error for the statistical tests was 5.0%. A total of 2,148 occurrences were evaluated. Most subjects were male, and mean victim age was 13 years. The single most frequent perpetrator was an unknown individual, but most offenders were known to the victim. The majority site of injury was the face. The larger number of complaints of aggression maintained a similar frequency over the 5 years analyzed. A physical examination to confirm the reasons between the complaint and the type of aggression was performed and shown a high relationship. Adolescents were more susceptible to violence than younger children were. The most affected region was the face.

Using Applied Theater in Primary, Secondary, and Tertiary Prevention of Intimate Partner Violence: A Systematic Review

There is an immediate need to advance knowledge around the effective prevention of intimate partner violence (IPV), which is responsible for significant negative health and well-being outcomes for women around the world. Creative approaches are being explored internationally-this systematic review provides a timely synthesis of applied theater interventions addressing primary, secondary, and tertiary IPV prevention. Six hundred and ten articles were identified through a comprehensive search of five cross-disciplinary databases. Eleven studies discussed in 15 quantitative and qualitative peer-reviewed articles and one book chapter met the inclusion criteria and were included in the review. Articles were appraised using a standardized quality assessment tool and were analyzed within the context of IPV prevention. Of the reviewed studies, five were classified as primary prevention, four secondary, and two focused on tertiary prevention. Specific strategies used by each of the studies included healthy relationship training, rising awareness and community advocacy, service provider training, bystander training, and working with survivors. While the paucity and quality of current literature make it difficult to determine overall efficacy, this review points to the potential of applied theater as a useful prevention strategy, particularly when interactive, participatory methods are incorporated. Further, applied theater could be an effective tool for working in culturally diverse settings as well as with minority groups. Future applied theater program planning needs to include comprehensive evaluation. More rigorous investigation, involving mixed-method research approaches, is required to fully understand the potential of applied theater as a tool in the context of IPV prevention.

Associations between young children's exposure to household violence and behavioural problems: Evidence from a rural Kenyan sample

Little is known about how young children in low- and middle-income countries (LMICs) experience violence in their homes, and how different types of household violence may affect child development. This study reports on levels of exposure to household violence and associations with child behavioural outcomes in preschool-aged children in western Kenya. A sample of 465 caregivers, whose children (n = 497) attended early learning centres supported by an international NGO, were enrolled in the study. Caregivers reported on exposure to intimate partner violence (IPV), household discipline practices, attitudes about gender roles, and child behavioural outcomes. Multivariable analysis showed significant predictive effects of IPV (regression coefficient = 1.35, SE = 0.54, p = 0.01) and harsh psychological child discipline (regression coefficient = 0.74, SE = 0.22, p = 0.001), but not physical discipline (regression coefficient = 0.42, SE = 0.24, p = 0.08), on worse child behavioural problems. These findings indicate that child exposure to violence in different forms is highly prevalent, and associated with poorer outcomes in young children. Community-based programmes focused on parenting and early child development are well-positioned to address household violence in LMIC settings, but must be supported to provide a broader understanding of violence and its immediate and long-term consequences.

Perception of Beninese on intimate partner violence: evidence from 2011-2012 Benin demographic health survey

Background

Violence against women remains an important issue of inequality in African societies, with several consequences to health, social and economic status. This study aims to identify the factors related to the perception of intimate partner violence in Benin.

Methods

Data on intimate partner violence was collected by conducting live interviews, and from the Benin Demographic and Health Survey 2012. The dependent variable was acceptance of intimate partner violence. The independent variables were socio-demographic features such as age, level of education, matrimonial status, ethnicity, religion, place of residence and the index of economic well-being. Logistic regressions were performed and odds ratios (OR) with a confidence interval of 95% (CI_95%) were estimated.

Results

Among the 21,574 people who answered the questions relating to violence against women by an intimate partner, the prevalence of acceptance of intimate partner violence was 15.77%. Ethnicity, level of education, administrative department of residence, religion, and socio-economic quintile were factors associated with the respondents’ acceptance of violence against women by an intimate partner.

Conclusion

Acceptance of intimate partner violence could be a major obstacle to the success of some health programs. There is a need to break the norms that support the vulnerability of women in Beninese society.

Factors Associated With Domestic Violence Against Women in Iran: An Exploratory Multicenter Community-Based Study

Domestic violence against women committed by intimate partners is a worldwide concern especially in developing countries. The aim of this study was to assess the problem among Iranian women and identify associated risk factors. Using a cross-sectional multicenter design, 1,600 women in six different areas of Iran were surveyed. A measure of domestic violence against women was administered and demographic information collected. Logistic regression models were used to identify factors associated with domestic violence. The prevalence of domestic violence among participants were emotional (64%), physical (28%), and sexual (18%). Higher education (both women and their partners), employment status of partner (being employed), and lower number of children lowered the risk, whereas history of previous marriage (for either women or their partners), unstable marriage, substance abuse, crowded family situation, and lower socioeconomic status increased the risk of domestic violence. There is a high prevalence of domestic violence, particularly emotional, against women by their partners. Preventive measures are recommended such as increasing public awareness, improving in socioeconomic status of families, educating women about what they can do, and encouraging counseling for the couple or the woman alone.

Do First Generation Immigrant Adolescents Face Higher Rates of Bullying, Violence and Suicidal Behaviours Than Do Third Generation and Native Born?

We conducted a systematic review to examine first generation immigrant adolescents’ likelihood of experiencing bullying, violence, and suicidal behaviours compared to their later-generation and native born counterparts, and to identify factors that may underlie these risks. Eighteen studies met full inclusion criteria. First generation immigrant adolescents experience higher rate of bullying and peer aggression compared to third generation and native counterparts. Refugee status and advanced parental age were associated with increased parent to child aggression among South East Asians. Family cohesion was associated with lower rates of violence. Suicidal ideation was lower across most immigrant adolescents’ ethnicities, with the exception of Turkish and South Asian Surinamese female adolescents in the Netherlands. Bullying and peer aggression of immigrant children and adolescents and potential mitigating factors such as family cohesion warrant research and program attention by policymakers, teachers and parents.

Review of child maltreatment in immigrant and refugee families

OBJECTIVES

Study results on child maltreatment based on general population samples cannot be extrapolated with confidence to vulnerable immigrant or refugee families because of the specific characteristics and needs of these families. The aims of this paper are 1) to conduct an evidence review of the prevalence, risk factors and protective factors for child maltreatment in immigrant and refugee populations, and 2) to integrate the evidence in an analytical ecosystemic framework that would guide future research.

METHODS

We used a 14-step process based on guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Canadian Collaboration for Immigrant and Refugee Health. We searched major databases from "the oldest date available to July 2014". The eligibility criteria for paper selection included qualitative or quantitative methodologies; papers written in English or French; papers that describe, assess or review prevalence, risk and protection factors for child maltreatment; and a studied population of immigrants or refugees.

SYNTHESIS

Twenty-four articles met the criteria for eligibility. The results do not provide evidence that immigrant or refugee children are at higher risk of child maltreatment. However, recently settled immigrants and refugees experience specific risk factors related to their immigration status and to the challenges of settlement in a new country, which may result in high risk of maltreatment.

CONCLUSION

Future research must incorporate more immigrant and refugee samples as well as examine, within an ecosystemic framework, the interaction between migratory and cultural factors with regard to the prevalence, consequences and treatment of child maltreatment for the targeted groups.

Exploring domestic violence and social distress in Australian-Indian migrants through community theater

In many parts of the world, young adult women have higher levels of common mental disorders than men. The exacerbation of domestic violence (DV) by migration is a salient social determinant of poor mental health. Ecological models describe factors contributing to DV as operating at individual, family, cultural, and societal levels. We explored the interplay among these factors in an Indian community living in Melbourne, Australia, in a qualitative participatory action research study using a modified Forum Theater approach. We here present findings on connections between migration, societal factors, and social/family/cultural factors in DV. The study captured the voices of women living in the community as they describe how DV contributes to their emotional difficulties. Improved understanding of the sociocultural dynamics of DV and the associated social distress in this migrant Indian community can be used to guide the development of culturally sensitive prevention and response programs to assist migrant women from the Indian subcontinent who present with psychopathology and suicidal behaviors associated with DV.

Women's approval of domestic physical violence against wives: analysis of the Ghana demographic and health survey

Background

Intimate partner violence (IPV) has serious consequences for the physical, psychological, and reproductive and sexual health of women. However, the factors that make women to justify domestic violence against wives in many sub-Saharan African countries have not been explored. This study investigates factors that influence women approval of domestic physical violence among Ghanaian women aged 15–49.

Method

A nationally representative sampled data (N = 10,607) collected in the 2003 and 2008 Ghana Demographic and Health Survey were used. Multivariate logistic regression was used to study the associations between women’s economic and socio-demographic characteristics and their approval of domestic physical violence against wives.

Results

Women aged 25–34 and 15–24 were 1.5 and 1.3 times, respectively, more likely to approve domestic physical violence against wives compared to those aged 35 years and above. Furthermore, women with no education (OR = 3.1, CI = 2.4–3.9), primary education (OR = 2.6, CI = 2.1–3.3) and junior secondary education (OR = 1.8, CI = 1.4–2.2) had higher probability of approving domestic physical violence compared to a woman who had secondary education or higher. Compared to women with Christian belief, Moslems (OR = 1.5, CI = 1.3–1.8) and Traditional believer (OR = 1.7, CI = 1.2–2.4) were more likely to approve domestic physical violence of wives. Women who were in the richest, rich and middle wealth index categories were less likely to approve domestic physical violence of wives compared to the poorest.

Conclusion

These findings fill a gap in understanding economic and socio-demographic factors associated with approval of domestic physical violence of wives. Interventions and policies should be geared at contextualizing intimate partner violence in terms of the justification of this behaviour, as this can play an important role in perpetration and victimization.