1
|
Wilson IM, Willoughby B, Tanyos A, Graham K, Walker M, Laslett AM, Ramsoomar L. A global review of the impact on women from men's alcohol drinking: the need for responding with a gendered lens. Glob Health Action 2024; 17:2341522. [PMID: 38700277 PMCID: PMC11073422 DOI: 10.1080/16549716.2024.2341522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 04/07/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Global evidence shows that men's harmful alcohol use contributes to intimate partner violence (IPV) and other harms. Yet, interventions that target alcohol-related harms to women are scarce. Quantitative analyses demonstrate links with physical and verbal aggression; however, the specific harms to women from men's drinking have not been well articulated, particularly from an international perspective. AIM To document the breadth and nature of harms and impact of men's drinking on women. METHODS A narrative review, using inductive analysis, was conducted of peer-reviewed qualitative studies that: (a) focused on alcohol (men's drinking), (b) featured women as primary victims, (c) encompassed direct/indirect harms, and (d) explicitly featured alcohol in the qualitative results. Papers were selected following a non-time-limited systematic search of key scholarly databases. RESULTS Thirty papers were included in this review. The majority of studies were conducted in low- to middle-income countries. The harms in the studies were collated and organised under three main themes: (i) harmful alcohol-related actions by men (e.g. violence, sexual coercion, economic abuse), (ii) impact on women (e.g. physical and mental health harm, relationship functioning, social harm), and (iii) how partner alcohol use was framed by women in the studies. CONCLUSION Men's drinking results in a multitude of direct, indirect and hidden harms to women that are cumulative, intersecting and entrench women's disempowerment. An explicit gendered lens is needed in prevention efforts to target men's drinking and the impact on women, to improve health and social outcomes for women worldwide.
Collapse
Affiliation(s)
- Ingrid M. Wilson
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
- Judith Lumley Centre, Latrobe University, Melbourne, Australia
| | - Bree Willoughby
- Centre for Alcohol Policy Research, Latrobe University, Melbourne, Australia
| | - Amany Tanyos
- Centre for Alcohol Policy Research, Latrobe University, Melbourne, Australia
| | - Kathryn Graham
- Institute of Mental Health Policy Research,Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Mary Walker
- Politics, Media and Philosophy, Latrobe University, Melbourne, Australia
| | - Anne-Marie Laslett
- Institute of Mental Health Policy Research,Centre for Addiction and Mental Health, Toronto, Canada
| | - Leane Ramsoomar
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
2
|
Sapkota BD, Simkhada P, Newton D, Parker S. Domestic Violence Against Women in Nepal: A Systematic Review of Risk Factors. TRAUMA, VIOLENCE & ABUSE 2024; 25:2703-2720. [PMID: 38288481 PMCID: PMC11370213 DOI: 10.1177/15248380231222230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2024]
Abstract
A systematic review was conducted to examine the factors that put women at risk of domestic violence in Nepal. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), PubMed, Cochrane, MEDLINE, CINAHL, and PsycINFO were searched supplemented by searching of the reference list manually. Of the 143 studies identified 24 were included in the final review. Search strategy was developed, and studies were included if they considered female participants (age 15-49 years) in heterosexual relationship, with exposure of different factors and whose outcomes were the magnitude of any form of violence (physical, sexual, and emotional/psychological). The Mixed Methods Appraisal Tool was used to assess the quality of the studies included. The findings are categorized based on the four levels of the ecological framework. At the individual level, the alcohol consumption level of husband, education level of both women and men, women's age at the time of marriage and childhood exposure to violence were found to be highly prevalent risk factors. At the relationship level, most prevalent risk factors were controlling husband and decision-making capacity of women. At the community level, belonging to underprivileged community or low caste system and living in Terai region were the risk factors. At the societal level, patriarchal belief and norms supporting violence were the risk factors. The complex nature of violence against women in Nepal requires culturally sensitive interventions along with organized efforts from the local and intra government to improve the status of Nepalese women at all levels of the ecological framework.
Collapse
|
3
|
Sapkota PM, Pandey AR, Adhikari B, Shrestha G, Piya R, Lamichhane B, Garu S, Joshi D, Baral SC. Intimate partner violence in Nepal: Analysis of Nepal Demographic and Health Survey 2022. PLoS One 2024; 19:e0308107. [PMID: 39150935 PMCID: PMC11329113 DOI: 10.1371/journal.pone.0308107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 07/15/2024] [Indexed: 08/18/2024] Open
Abstract
INTRODUCTION Intimate partner violence (IPV) is a major public health issue in Nepal. IPV has social and economic impacts on women, family, and the wider society. In this study, we aimed to determine factors associated with IPV among currently partnered women aged 15-49. METHODS We conducted a secondary data analysis of the Nepal Demographic and Health Survey (NDHS) 2022. The study examines the lifetime prevalence of IPV. IPV was measured in three domains: experience of physical violence, emotional violence, and sexual violence. Weighted univariate and multivariable logistic regression analysis were applied to determine factors associated with IPV. The results of logistic regression were presented as crude odds ratio (COR) and adjusted odds ratio (AOR) and their 95% confidence interval (CI). RESULTS Of 3853 women, 27.2% had experienced any form of IPV. The lifetime prevalence of physical violence, emotional violence, and sexual violence were 23.2%, 12.8%, and 7.1%, respectively. Higher odds of physical violence were reported among women aged 35-49 years (AOR: 2.13, 95% CI: 1.58-2.87), women without formal education (AOR: 1.51, 95% CI: 1.10-2.06), and women who justified wife-beating (AOR: 1.23, 95% CI: 1.00-1.52). Women from poor households (AOR: 1.61, 95% CI: 1.12-2.35) and women with uneducated partners (AOR: 1.66, 95% CI: 1.08-2.58) were at higher risk of experiencing sexual violence. Women with unemployed husbands reported a higher risk of physical violence (AOR: 2.72, 95% CI: 1.45-5.06) and emotional violence (AOR: 1.61, 95% CI: 1.12-2.35). CONCLUSION Almost one in three currently partnered women experienced some form of IPV in their lifetime. Various sociodemographic, partner-related, and women's empowerment-related factors were associated with experiencing IPV. Acknowledging and addressing these factors is essential to mitigating the high rates of IPV among reproductive aged women.
Collapse
Affiliation(s)
- Parash Mani Sapkota
- Research, Evaluation and Innovation Department, HERD International, Lalitpur, Nepal
| | - Achyut Raj Pandey
- Research, Evaluation and Innovation Department, HERD International, Lalitpur, Nepal
| | - Bikram Adhikari
- Research, Evaluation and Innovation Department, HERD International, Lalitpur, Nepal
| | - Grishu Shrestha
- Research, Evaluation and Innovation Department, HERD International, Lalitpur, Nepal
| | - Reecha Piya
- Research, Evaluation and Innovation Department, HERD International, Lalitpur, Nepal
| | - Bipul Lamichhane
- Research, Evaluation and Innovation Department, HERD International, Lalitpur, Nepal
| | - Shristi Garu
- Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Deepak Joshi
- Research, Evaluation and Innovation Department, HERD International, Lalitpur, Nepal
| | - Sushil Chandra Baral
- Research, Evaluation and Innovation Department, HERD International, Lalitpur, Nepal
| |
Collapse
|
4
|
Clark CJ, Ferguson G, Subedi S, Lad A, Hadd AR, Shrestha B, Shervinskie A, Tomar S, Baker H. Social norms, diffusion, and women's risk of intimate partner violence in Nepal: Impact assessment of a social and behavior Change communication intervention (Change Starts at home). SSM Popul Health 2024; 25:101583. [PMID: 38222673 PMCID: PMC10787293 DOI: 10.1016/j.ssmph.2023.101583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/17/2023] [Accepted: 12/09/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction Intimate partner violence (IPV) is a significant public health, human rights, and development issue. While existing evidence posits that addressing social norms is key to IPV prevention, successful IPV interventions that include a norms approach are limited in number and methodological rigor and rarely include a formal investigation of the diffusion of intervention impact. We contribute novel findings to this intellectual and programmatic space with evidence on a social and behavior change communication (SBCC) intervention (Change Starts at Home) in Nepal designed to prevent IPV and shift social norms towards greater gender equity. Methods Participants included 442 married women across 13 communities assessed at three timepoints: before intervention (baseline), at the completion of the core couple's curriculum and edutainment (midline), and at the conclusion of the diffusion curriculum (endline). Generalized estimating equations with propensity-score adjustments were used to determine change in outcomes at midline and endline for two intervention conditions (direct beneficiary, N = 173; and resident of the intervention community, (N = 178) relative to control (N = 91). Results IPV victimization significantly decreased in both intervention conditions at midline, with larger reductions in direct beneficiaries. At endline, direct beneficiaries had sustained reduction in IPV relative to control participants. Positive injunctive norms also significantly improved by midline for both intervention groups, whereas improvements in descriptive norms for intervention groups were matched by improvements in the control group at both midline and endline. Several secondary outcomes showed significant improvements for both intervention groups at midline and/or endline, including in-law violence, financial decision-making, communication, and relationship quality, with additional improvements for the direct beneficiaries in attitudes, leadership, GBV advocacy, and diffusion. Conclusion This study sheds light on the effectiveness of the Change intervention, the role of addressing social norms in IPV prevention efforts, and the benefits of organized diffusion.
Collapse
Affiliation(s)
- Cari Jo Clark
- Rollins School of Public Health, Emory University, 1518 Clifton Road NE, R Randall Rollins Building 628, Atlanta, GA, USA
| | | | | | - Arti Lad
- Equal Access International, Washington DC, USA
| | | | - Binita Shrestha
- Country Representative, Equal Access International, Kathmandu, Nepal
| | | | - Shweta Tomar
- Center on Gender Equity and Health, University of California San Diego, CA, USA
| | - Holly Baker
- Center on Gender Equity and Health, School of Public Health, University of California, San Diego, USA
| |
Collapse
|
5
|
Pettitt LA, Biswas RK, Bhowmik J. Women's Attitudes Toward Intimate Partner Violence in Low- and Middle-Income Countries of Southern Asia. Am J Health Promot 2024; 38:12-18. [PMID: 37621096 PMCID: PMC10748443 DOI: 10.1177/08901171231198451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
PURPOSE The present study identified the vulnerable IPV cohorts of South Asian women, and the prevalence of and predictors of the women's IPV acceptance. DESIGN Cross-sectional survey - the United Nations Children's Fund multiple index cluster survey. SETTING Many South Asian women are accepting of IPV. Studies mostly focus on individual countries. SUBJECT 103 139 ever-married women from Bangladesh, Laos and Nepal. MEASURES Women's attitudes toward IPV were measured using a set of five, fixed, binary responses. ANALYSIS Following bivariate analysis, complex survey weight adjusted logistic regression models were fitted for individual country data, and the pooled sample. RESULTS Of the sampled South Asian women 27.8% accepted IPV, and no major variation among countries in IPV acceptance. Education was the most reliable protector against IPV acceptance whereby, higher educational attainment systematically reduced IPV acceptance (OR = .61 [.56-.83]). Other significant protective factors were being un-married (Married OR = 1.34 [1.28-1.42]), having increased wealth (OR = .71 [.56-.83]), and being over 24 years old (OR = .88 [.83-.97]). CONCLUSION Only education produced absolute consistency at the country and region level; there seems to be no blanket solution for regionally reducing women's IPV acceptance rates in Southern Asia. Focus on the least educated women and making education more accessible should be prioritised. Future IPV studies can consider measurement methods for women's direct exposure to patriarchal standards and within community interaction.
Collapse
Affiliation(s)
- Lauren Alexandra Pettitt
- Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Raaj Kishore Biswas
- Charles Perkins Centre, School of Health Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Jahar Bhowmik
- Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, VIC, Australia
| |
Collapse
|
6
|
Bhatt B, Bhatt N, Karki A, Giri G, Baaniya B, Neupane B, Bogati S, Mahaju S, Poudel A, Pokharel S, Kafle N, Nepal S, Sapkota R, Shrestha S, Tuitui RL, Sagtani RA. Intimate partner violence against married women of reproductive age in Nepal during the COVID-19 pandemic. Heliyon 2023; 9:e20117. [PMID: 37809852 PMCID: PMC10559861 DOI: 10.1016/j.heliyon.2023.e20117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Intimate partner violence (IPV) is a significant public health concern in Nepal and its prevalence has increased during the COVID-19 pandemic. This study aimed to assess the prevalence of IPV among married women of reproductive age in Nepal during the pandemic. Methods A web-based survey was conducted with 420 participants using a validated questionnaire adopted from the World Health Organization. Descriptive and inferential statistical analyses were performed. Results Our study found that 52.62% of participants experienced IPV during the COVID-19 pandemic with economic violence being the most prevalent type (38.81%) and followed by behavioral control (37.14%), emotional violence (26.20%), physical violence (21.43%), and sexual violence (14.05%). Despite the high level of IPV, only 14% of participants sought help and only 6% reported the violence to the police. Univariate analyses showed that factors such as the husband's level of education and occupation, number of children, property ownership, husband's alcohol use, relationship and quarrels with the husband, fear of the husband, and participation in decision-making were associated with an increased risk of IPV. Multivariate analysis revealed that women involved in decision-making faced a 2.52 times higher risk of violence, that women who reported daily quarrels had a risk 5.47 times that of women who did not endorse fights, and that women who were afraid of their husbands had a risk 16 times that of women who did not report fear. Conclusion This study reveals a concerning prevalence of IPV among married women in Nepal during the COVID-19 pandemic. Our findings emphasize the low reporting rates and help-seeking behavior among IPV victims. They also highlight the significant influence of factors such as participation in decision-making, frequent quarrels, and fear. These findings underscore the urgent need to establish support systems for IPV victims and develop targeted interventions tailored to the local context. Furthermore, conducting comprehensive research and understanding the interplay of contributing factors can guide the formulation of effective strategies to combat this pervasive societal problem.
Collapse
Affiliation(s)
- Bandana Bhatt
- Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Navin Bhatt
- Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Ashmita Karki
- Central Department of Public Health, Institute of Medicine, Kathmandu, Nepal
| | | | | | - Bandana Neupane
- Nepal Health Sector Support Programme (NHSSP)/DFID/Ministry of Health and Population, Kathmandu, Nepal
| | | | - Satyam Mahaju
- Sukraraj Tropical and Infectious Disease Hospital, Kathmandu, Nepal
| | - Anubhav Poudel
- Sukraraj Tropical and Infectious Disease Hospital, Kathmandu, Nepal
| | | | | | - Shristi Nepal
- Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | | | - Sangita Shrestha
- Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Roshani Laxmi Tuitui
- Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | | |
Collapse
|
7
|
Mitchell A, Puri MC, Dahal M, Cornell A, Upadhyay UD, Diamond-Smith NG. Impact of Sumadhur intervention on fertility and family planning decision-making norms: a mixed methods study. Reprod Health 2023; 20:80. [PMID: 37231469 DOI: 10.1186/s12978-023-01619-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 05/08/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Mindful of social norms shaping health among women pressured to prove early fertility in Nepal, a bi-national research team developed and piloted a 4-month intervention engaging household triads (newly married women, their husbands, and mothers-in-law) toward advancing gender equity, personal agency, and reproductive health. This study evaluates the impact on family planning and fertility decision-making. METHODS In 2021, Sumadhur was piloted in six villages with 30 household triads (90 participants). Pre/post surveys of all participants were analyzed using paired sample nonparametric tests and in-depth interviews with a subset of 45 participants were transcribed and analyzed thematically. RESULTS Sumadhur significantly impacted (p < .05) norms related to pregnancy spacing and timing, and sex preference of children, as well as knowledge about family planning benefits, pregnancy prevention methods, and abortion legality. Family planning intent also increased among newly married women. Qualitative findings revealed improved family dynamics and gender equity, and shed light on remaining challenges. CONCLUSIONS Entrenched social norms surrounding fertility and family planning contrasted with participants' personal beliefs, highlighting needed community-level shifts to improve reproductive health in Nepal. Engagement of influential community- and family-members is key to improving norms and reproductive health. Additionally, promising interventions such as Sumadhur should be scaled up and reassessed.
Collapse
Affiliation(s)
- Ashley Mitchell
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA.
- Bixby Center for Global Reproductive Health, San Francisco, CA, USA.
| | - Mahesh C Puri
- Center for Research On Environment, Health and Population Activities, Kathmandu, Nepal
| | - Minakshi Dahal
- Center for Research On Environment, Health and Population Activities, Kathmandu, Nepal
| | | | - Ushma D Upadhyay
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Nadia G Diamond-Smith
- Department of Epidemiology and Biostatistics and Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| |
Collapse
|
8
|
Cornell A, Mitchell A, Puri M, Diamond-Smith N. The COVID-19 Pandemic in the Nawalparasi District of Nepal: a mixed methods assessment of increased alcohol use and violence against women. BMC Public Health 2023; 23:524. [PMID: 36934217 PMCID: PMC10024286 DOI: 10.1186/s12889-023-14997-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 01/05/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND In Nepal and across the globe, the COVID-19 pandemic has primed an environment for increased rates of violence against women (VAW). This paper explores pandemic-driven economic insecurity and increased alcohol use as instigators of VAW and Intimate Partner Violence (IPV) within newly married households in the rural, Nawalparasi region of Nepal. METHODS This study is a secondary analysis of data obtained from the Sumadhur Intervention pilot study that has been previously described and demonstrates successful implementation of group-based, household-level intervention for women's empowerment and sexual and reproductive health education (1). Our three sets of data were collected before and during the COVID-19 pandemic. The first set is from a Longitudinal Cohort of 200 newly married women who were surveyed twice a year from February 2017 through July 2020. The second data set is a subset cohort of newly married women, their husbands, and their mothers-in-law (31 women, 31 husbands and 31 mothers-in-law) who participated in Sumadhur in January 2021. The third data set was obtained through in-depth interviews in July 2021 from 15 households following Sumadhur. The interviews were thematically coded, and subthemes were identified. A t-test of the January 2021 survey data set was run to look at correlations between income loss, alcohol consumption and experience of IPV among newly married women. All other survey data was analyzed for change over time. RESULTS At three months after the onset of the pandemic (July 2020), the Longitudinal Cohort survey data from newly married women reported increased rates of husbands' alcohol use as well as personal experiences of IPV as compared to pre-pandemic averages. There was a statistically significant difference (p < 0.001) in the effects of income loss on increased alcohol use and experience of IPV. Qualitative results iterated the common theme of alcohol use and economic insecurity as upstream instigators of VAW in the community. CONCLUSIONS In the Nawalparasi district of Nepal, the pandemic has led to unstable economic situations that have instigated alcohol use among men, and increased rates of IPV among young, newly married women, and reports of VAW in the community. We have demonstrated a need for urgent programmatic and policy responses aimed at reducing VAW and IPV and protecting women during times of uncertainty and crisis.
Collapse
Affiliation(s)
- Alia Cornell
- Undergraduate Student, University of California Los Angeles, Los Angeles, USA.
| | - Ashley Mitchell
- Doctoral Student, Institute for Global Health Sciences, University of California, San Francisco, USA
| | - Mahesh Puri
- Director of Research, Center for Research On Environment Health and Population Activities (CREHPA), Kathmandu, Nepal
| | - Nadia Diamond-Smith
- Department of Epidemiology and Biostatistics and Institute for Global Health Sciences, University of California, San Francisco, USA
| |
Collapse
|
9
|
Cornell A, Diamond-Smith N, Mitchell A, Puri M. The COVID-19 Pandemic in the Nawalparasi District of Nepal: A Mixed Methods Assessment of Increased Alcohol Use and Intimate Partner Violence. RESEARCH SQUARE 2022:rs.3.rs-1786122. [PMID: 35860219 PMCID: PMC9298139 DOI: 10.21203/rs.3.rs-1786122/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background In Nepal and across the globe, the COVID-19 pandemic has primed an environment for increased rates of intimate partner violence (IPV). This paper examines how the upstream factors of alcohol use and economic insecurity in the Nawalparasi district of Nepal has brought about higher rates of IPV among newly married women. Methods This study is a secondary analysis of data obtained from the Sumadhur Intervention pilot study that has been previously described and demonstrates successful implementation of group-based, household-level intervention for women's empowerment and sexual and reproductive health education (1). Our three sets of data were collected before and during the COVID-19 pandemic. The first set is from a longitudinal cohort of 200 newly married women who were surveyed twice a year from February 2017 through July 2020. The second data set is from a cohort of newly married women, their husbands, and their mothers-in-law (31 women, 31 husbands and 31 mothers-in-law) who participated in Sumadhur in January 2021. The third data set was obtained through in-depth interviews in July 2021 from 15 households following Sumadhur . The interviews were thematically coded, and subthemes were identified. The survey data was analyzed for change over time. Results In households in the Nawalparasi district of Nepal, between 2019 and 2020 there was an increase in alcohol consumption with reports of drinking every day increasing from 9.2% to 13.6%. In July 2020, 30% (N=31/102) of newly married women said their husbands' alcohol consumption had increased since the pandemic. In 2019, 47.06% (N=88/187) of participants reported that they had experienced any form of IPV. In July 2021, 74% (N=23/31) of women reported being physically forced to have sexual intercourse with their husband when they did not want to and in the past four months, 68% (N=21/31) reported being forced to perform sexual acts against their will. The interviews highlighted the presence of alcohol use in the community as well as increased concerns over economic insecurity. Mothers-in-law consistently described increased rates of IPV and community violence since the pandemic. Conclusions The pandemic has led to precarious economic situations that have influenced alcohol use among men, and instances of IPV among young, newly married women. We have demonstrated a need for urgent programmatic and policy responses aimed at reducing IPV, which has increased during the pandemic. Family interventions centering on women, such as Sumadhur , are critical to implement along with community-wide emergency preparedness to ensure autonomy, safety, and wellbeing now and in future times of uncertainty.
Collapse
Affiliation(s)
| | | | | | - Mahesh Puri
- Center for Research on Environment Health and Population Activities
| |
Collapse
|
10
|
Akombi-Inyang B, Ghimire PR, Archibong E, Woolley E, Razee H. Association between intimate partner violence and male alcohol use and the receipt of perinatal care: Evidence from Nepal demographic and health survey 2011-2016. PLoS One 2021; 16:e0259980. [PMID: 34874942 PMCID: PMC8651139 DOI: 10.1371/journal.pone.0259980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022] Open
Abstract
The utilization of perinatal care services among women experiencing intimate partner violence (IPV) and male alcohol use is a major problem. Adequate and regular perinatal care is essential through the continuum of pregnancy to mitigate pregnancy and birth complications. The aim of this study is to determine the association between IPV and male alcohol use and the receipt of perinatal care in Nepal. This study used pooled data from 2011 and 2016 Nepal Demographic and Health Surveys (NDHS). A total of 3067 women who interviewed for domestic violence module and had most recent live birth 5 years prior surveys were included in the analysis. Multivariable logistic regression analysis was performed to determine the association between IPV and male alcohol use and the receipt of perinatal care. Of the total women interviewed, 22% reported physical violence, 14% emotional violence, and 11% sexual violence. Women who were exposed to physical violence were significantly more likely to report non-usage of institutional delivery [adjusted Odds Ratio (aOR) = 1.30 (95% Cl: 1.01, 1.68)] and skilled delivery assistants [aOR = 1.43 (95% Cl: 1.10, 1.88)]. Non-attendance of 4 or more skilled antenatal care visits was associated with a combination of alcohol use by male partner and exposure to emotional [aOR = 1.42 (95% Cl: 1.01, 2.00)] and physical violence [aOR = 1.39 (95% Cl: 1.03, 1.88)]. The negative association between IPV and perinatal care suggests it is essential to develop comprehensive community-based interventions which integrates IPV support services with other health services to increase the uptake of perinatal care through the continuum of pregnancy.
Collapse
Affiliation(s)
- Blessing Akombi-Inyang
- School of Population Health, University of New South Wales, Sydney, Australia
- School of Health Sciences, Western Sydney University, Penrith, Australia
- * E-mail:
| | - Pramesh Raj Ghimire
- School of Health Sciences, Western Sydney University, Penrith, Australia
- Ujyalo Nepal, Ratnanagar Municipality, Nepal
| | | | - Emma Woolley
- School of Education, Macquarie University, Sydney, Australia
| | - Husna Razee
- School of Population Health, University of New South Wales, Sydney, Australia
| |
Collapse
|
11
|
Morrison J, Giri R, Arjyal A, Kharel C, Harris‐Fry H, James P, Baral S, Saville N, Hillman S. Addressing anaemia in pregnancy in rural plains Nepal: A qualitative, formative study. MATERNAL & CHILD NUTRITION 2021; 17 Suppl 1:e13170. [PMID: 34241951 PMCID: PMC8269150 DOI: 10.1111/mcn.13170] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 12/01/2022]
Abstract
Maternal anaemia prevalence in low-income countries is unacceptably high. Our research explored the individual-, family- and community-level factors affecting antenatal care uptake, iron folic acid (IFA) intake and consumption of micronutrient-rich diets among pregnant women in the plains of Nepal. We discuss how these findings informed the development of a home visit and community mobilisation intervention to reduce anaemia in pregnancy. We used a qualitative methodology informed by the socio-ecological framework, conducting semi-structured interviews with recently pregnant women and key informants, and focus group discussions with mothers-in-law and fathers. We found that harmful gender norms restricted women's access to nutrient-rich food, restricted their mobility and access to antenatal care. These norms also restricted fathers' role to that of the provider, as opposed to the caregiver. Pregnant women, mothers-in-law and fathers lacked awareness about iron-rich foods and how to manage the side effects of IFA. Fathers lacked trust in government health facilities affecting access to care and trust in the efficacy of IFA. Our research informed interventions by (1) informing the development of intervention tools and training; (2) informing the intervention focus to engaging mothers-in-law and men to enable behaviour change; and (3) demonstrating the need to work in synergy across individual, family and community levels to address power and positionality, gender norms, trust in health services and harmful norms. Participatory groups and home visits will enable the development and implementation of feasible and acceptable strategies to address family and contextual issues generating knowledge and an enabling environment for behaviour change.
Collapse
Affiliation(s)
- Joanna Morrison
- UCL Institute for Global HealthUniversity College LondonLondonUK
| | | | | | | | - Helen Harris‐Fry
- Department of Population HealthLondon School of Hygiene & Tropical MedicineLondonUK
| | - Philip James
- Department of Population HealthLondon School of Hygiene & Tropical MedicineLondonUK
| | | | - Naomi Saville
- UCL Institute for Global HealthUniversity College LondonLondonUK
| | - Sara Hillman
- UCL Institute for Women's HealthUniversity College LondonLondonUK
| |
Collapse
|
12
|
Raifman S, Puri M, Arcara J, Diamond-Smith N. Is there an association between fertility and domestic violence in Nepal? AJOG GLOBAL REPORTS 2021; 1:100011. [DOI: 10.1016/j.xagr.2021.100011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
13
|
Kalk T, Shrestha B, Shrestha PN, Ferguson G, Bergenfeld I, Robbin Z, Clark CJ. A qualitative examination of alcohol use and IPV among Nepali couples in a violence prevention intervention. Glob Public Health 2020; 16:597-609. [PMID: 33090903 DOI: 10.1080/17441692.2020.1833959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Intimate partner violence (IPV) impacts the physical and mental health of one in three women globally, with equally high rates in rural Nepal. The risk of physical violence, stalking, harassment, and homicide between intimate partners increases when alcohol is used by the perpetrator. This study evaluates the impact of Change Starts at Home, a nine-month intervention to prevent IPV in which 360 married couples in the Terai region of Nepal listened to a serial radio drama and engaged in Listening Group Discussions. A sub-sample of 18 couples were selected for individual in-depth interviews that were taken at the end of the intervention and 16 months later. Participants strongly and consistently associated alcohol use with IPV against women in their own and others' relationships. Husbands and wives agreed that men sustained reductions in alcohol use, conflict, and perpetration of IPV, attributed to improvements in communication, conflict resolution, and a reduction in alcohol expenditure following the intervention. The results of this study suggest that integrating programming on alcohol reduction within IPV prevention interventions in the Terai region of Nepal has benefits on couple functioning, alcohol consumption, and IPV perpetration.
Collapse
Affiliation(s)
- Terah Kalk
- Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | | | | | | | - Irina Bergenfeld
- Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - Zoe Robbin
- Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - Cari Jo Clark
- Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| |
Collapse
|
14
|
Willie TC, Bastida C, Olavarrieta CD, Scolese A, Campos PA, Falb KL, Gupta J. Socioecological determinants of community resource utilisation among low-income women in Mexico City who experienced male-to-female intimate partner violence. Glob Public Health 2020; 15:1627-1638. [PMID: 32496865 DOI: 10.1080/17441692.2020.1775868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Women who experience intimate partner violence (IPV) face multiple barriers to seeking help from community resources, but little research has examined the impact of ecological influences on community resource utilisation among women living in low- and middle-income countries. The current study investigated individual-, relationship-, family-, and community-level influences on community resource utilisation among Mexican women experiencing IPV. Using baseline data from 950 women in Mexico City enrolled in a clinic-based randomised controlled trial, multilevel regressions were performed to assess associations between socioecological factors and women's community resource utilisation. 41.3% women used at least one resource. At the individual-level, every additional resource that women were aware of, was associated with a 20% increase in the total number of resources used (p < .001). Every additional lethal risk factor was associated with a 5% increase in the total number of resources used (p = .004). At the family-level, women who reported having an in-law encourage IPV used 46% more resources (p < .001). At the community-level, stronger supportive norms around community resource utilisation was associated with a 6% increase in the total number of resources (p = .01). These findings suggest the importance of addressing family and community factors in the broader ecological context of Mexican women's help-seeking behaviours.
Collapse
Affiliation(s)
- Tiara C Willie
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Claudia Diaz Olavarrieta
- Research Division, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Anna Scolese
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| | | | | | - Jhumka Gupta
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| |
Collapse
|
15
|
Shai N, Pradhan GD, Shrestha R, Adhikari A, Chirwa E, Kerr-Wilson A, Jewkes R. "I got courage from knowing that even a daughter-in-law can earn her living": Mixed methods evaluation of a family-centred intervention to prevent violence against women and girls in Nepal. PLoS One 2020; 15:e0232256. [PMID: 32427999 PMCID: PMC7237029 DOI: 10.1371/journal.pone.0232256] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 04/10/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND We developed, and pilot tested a family focused intervention Sammanit Jeevan "Living with Dignity" to reduce gender-based violence by husbands, change harmful social and gender norms and improve the economic conditions of women through young married women-led income generating activities (IGAs). METHODS We conducted a modified interrupted time series study and qualitative research to evaluate the intervention in two migrant communities in Baglung district, Nepal. We enrolled young married women, their husbands and in-laws from 100 families. 200 women and 157 men completed questionnaires before the programme, and 6, 12 and 18 months afterwards. 18 in-depth interviews were conducted before the programme and 6 and 12 months later. We analysed the data for trends. RESULTS The intervention positively impacted young married women's economic conditions, exposure to violence and changed inequitable gender attitudes. Some positive outcomes were observed among older women and men. Young women's past month earnings (35.0% - 81.3%, β = 0.11, p-value<0.001) and savings (29.0% - 80.2%, β = 0.14, p-value<0.001) more than doubled over time. Young women experienced much less past year physical IPV over time (10% - 4.4%, β = -0.08, p-value = 0.077). They also perceived that their mothers-in-law were less cruel (mean 9.0-8.6, β = -0.03, p-value = 0.035). Improvements were observed in young women's individual (mean 44.4-43.3, β = -0.04, p-value = 0.297) and perceived community gender attitudes (mean 54.4-51.4, β = -0.19, p-value<0.001) and they reported that their husbands were less controlling (mean 17.5-16.1, β = -007, p-value<0.001). These changes were supported by qualitative findings. CONCLUSIONS Whilst caution is needed in attributing the effect due to lack of control arm, the results suggest that with adequate time and seed funding, Sammanit Jeevan enabled considerable income generation, a strengthened the position of young women in the households and it reduced their exposure to violence in this community. It warrants further research to optimise its impact.
Collapse
Affiliation(s)
- Nwabisa Shai
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Ratna Shrestha
- Voluntary Services Overseas (VSO) Nepal, Kathmandu, Nepal
| | | | - Esnat Chirwa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
16
|
Clark CJ, Shrestha B, Ferguson G, Shrestha PN, Calvert C, Gupta J, Batayeh B, Bergenfeld I, Oakes JM. Impact of the Change Starts at Home Trial on Women's experience of intimate partner violence in Nepal. SSM Popul Health 2020; 10:100530. [PMID: 31890850 PMCID: PMC6928358 DOI: 10.1016/j.ssmph.2019.100530] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/05/2019] [Accepted: 12/11/2019] [Indexed: 11/23/2022] Open
Abstract
Intimate partner violence (IPV) affects 1 in 3 women worldwide. Research in low- and middle-income countries suggests that multicomponent interventions incorporating media, group work, and community mobilization may be effective at changing social norms that enable such violence. Our study aimed to evaluate the impact of a radio programme plus community engagement versus radio programming alone on the 12-month prevalence of IPV. Using a cluster randomized, repeat cross-sectional, single-blinded approach, thirty-six village communities were pair-matched within three districts in Nepal and randomly assigned to either control or intervention. Both groups were exposed to social behaviour change communication through radio programming. In addition, weekly listening and discussion groups (LDGs) were formed in intervention communities to meet and discuss radio programming over the 40-week intervention period. Participants were also exposed to other community mobilization activities such as street theatre and messaging from local leaders who were engaged in intervention programming. IPV was measured at baseline, 12 months post-baseline at program conclusion, and 28 months post-baseline using a simple random sample of 40 married women per cluster (n = approximately 1440 at each time point) along with 382 women who participated in the LDGs. Although control and intervention groups were demographically similar, baseline rates of IPV were higher in control areas. The trend in IPV for both groups was nonlinear, largely declining at midline (control condition) and rising again at endline (control and intervention conditions), possibly reflecting greater reporting due to awareness-raising activities. Significant differences between the two groups were largely absent at endline. Higher LDG attendance was associated with decreases in several forms of IPV, some of which persisted to endline. These findings suggest that intensive community engagement over longer timespans or social network measurement may be necessary to detect significant changes at the community level (NCT02942433).
Collapse
Affiliation(s)
- Cari Jo Clark
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Binita Shrestha
- Equal Access International, 1001 Connecticut Ave, NW Suite 909, Washington, DC, 20036,, USA
| | - Gemma Ferguson
- Equal Access International, 1001 Connecticut Ave, NW Suite 909, Washington, DC, 20036,, USA
| | | | - Collin Calvert
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South 2nd Street, Minneapolis, MN, 55454, USA
| | - Jhumka Gupta
- Department of Global and Community Health, College of Health and Human Services, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Brian Batayeh
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Irina Bergenfeld
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - J. Michael Oakes
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South 2nd Street, Minneapolis, MN, 55454, USA
| |
Collapse
|
17
|
Prevalence and correlates of partner violence among adolescent girls and young women: Evidence from baseline data of a cluster randomised trial in Tanzania. PLoS One 2019; 14:e0222950. [PMID: 31593577 PMCID: PMC6782098 DOI: 10.1371/journal.pone.0222950] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 09/10/2019] [Indexed: 11/19/2022] Open
Abstract
Background Little has been documented about partner violence among adolescent girls and young women (AGYW) who are out of school, a factor associated with HIV acquisition. To understand areas for prioritising HIV prevention intervention efforts, we explored the prevalence and correlates of partner violence among out of school AGYW in Shinyanga, Tanzania. Methods A cross-sectional analysis of data from AGYW aged 15–23 years recruited in a cluster randomised trial conducted between October and December 2017 was used to examine correlates of partner violence. Data were collected through an Audio Computer-Assisted Self-interview. Multivariate logistic regression analysis was used to evaluate the association. Results 2276 (75.5%) AGYW were sexually active. Of these, 816 (35.9%) reported having experienced violence from partners in the last six months. After adjusting for other covariates, being formerly married (AOR = 1.55, 95% CI:1.02, 2.37), having children (AOR = 1.79, 95% CI:1.47, 2.16), anxiety and depression symptoms (AOR = 3.27, 95%CI: 2.15, 4.96), having engaged in sex work in the past six months (AOR = 1.92, 95% CI: 1.45, 2.53) and economic deprivation (AOR = 1.61, 95% CI: 1.34,1.92) were significantly associated with partner violence. Conclusions Almost one in three sexually active AGYW had experienced partner violence in the 6 months preceding the survey. The findings underscore the need for future research to focus on understanding the reasons and dynamics underlying high level of partner violence among AGYW. Furthermore, there is a need for implementing intervention programs that aim to reduce economic deprivation among AGYWs and address social norms and structures perpetuating violence against AGYW. Trial registration ClinicalTrials.gov—IDNCT03597243.
Collapse
|