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

Experiences of African women who migrate to a developed country and encounter intimate partner violence: a systematic review of qualitative evidence

OBJECTIVE

The objective of this review was to synthesize the available evidence on the experiences of African women who migrated to a developed country and encountered intimate partner violence (IPV).

INTRODUCTION

IPV is a significant public health issue, and migrant women living in developed countries are particularly vulnerable to IPV, experiencing disproportionately higher rates of IPV. Understanding the experiences of these women can inform health policy and decision-making in clinical practice to minimize IPV.

INCLUSION CRITERIA

This review considered studies that included women of African descent, aged 16 years or older, who migrated from any of the 54 countries in the African continent to a developed country and who experienced IPV. Qualitative studies including, but not limited to, grounded theory, ethnography, phenomenology, case studies, and action research designs, were considered for inclusion.

METHODS

A comprehensive database search of CINAHL (EBSCOhost), Embase, MEDLINE (Ovid), PsycINFO (OvidSP), and Scopus was conducted in February 2022 and updated in November 2022 and February 2023. ProQuest Dissertations and Theses were searched for gray literature. Studies in the English language were considered, with no date limitation. Eligible studies were assessed by 2 independent reviewers for methodological quality. The findings were extracted and pooled, categorized by similarity of meaning, and synthesized using the JBI meta-aggregation method. The synthesized findings were graded using the ConQual approach.

RESULTS

Eleven qualitative studies were included in the review. The narratives of 234 women generated a total of 95 findings and 10 categories based on similarity of meaning, from which 4 synthesized findings were generated: i) The influence of cultural and gender norms, religion, and women's perceptions of IPV; ii) Control and the cone of silence; iii) Psychological and emotional impact of IPV and ways of coping; and iv) Support for women who are victims of IPV.

CONCLUSION

IPV is an ongoing issue for African migrant women in developed countries. The women reported that their partners continued their controlling behavior that was accepted in their country of birth, particularly regarding emotions and finances. The experience of IPV was exacerbated for women who did not have access to extended family members, and they often faced practical barriers in accessing available formal support. The synthesized findings from this review can be used to support the urgent need to address IPV in this migrant population.

SUPPLEMENTAL DIGITAL CONTENT

A Yoruba-language version of the abstract of this review is available at: http://links.lww.com/SRX/A77 .

Trends in Contacts Made by Immigrants to the National Domestic Violence Hotline, Before and During the COVID-19 Pandemic

OBJECTIVES

Immigrants in the United States are more likely than nonimmigrants to experience risk factors for intimate partner violence (IPV) and problems in getting support. The COVID-19 pandemic and recent incidents of xenophobia and anti-immigrant sentiment may have exacerbated exposure to IPV risk factors. We examined immigrant experiences of IPV before and during the COVID-19 pandemic.

METHODS

This study identified changes in characteristics of abuse, services used, referrals, and barriers to services among those who contacted the National Domestic Violence Hotline (NDVH) and identified as immigrants, reported immigration status as a concern, needed immigration support, and/or identified immigration status as a barrier to accessing services (N = 49 817). We used joinpoint regressions to examine whether the rate of change differed significantly from 2016-2019 (before the pandemic) to 2019-2021 (during the pandemic).

RESULTS

The number of immigrant contacts to NDVH peaked in 2017 (n = 9333) and declined 25% to 6946 in 2021. During 2016-2019, the percentage of contacts reporting the following increased significantly: technology-facilitated violence (+12.7 percentage points), economic/financial abuse (+10.8 percentage points), and involvement of firearms (+4.8 percentage points); during 2019-2021, these trends reversed. The percentage of contacts reporting separation or divorce was relatively flat until 2019 and then increased from 14.6% in 2019 to 19.9% in 2021 (+5.2 percentage points). Housing instability increased during 2017-2020 (+9.3 percentage points), but requests for shelters decreased (-4.5 percentage points). Immigration status and personal finances were commonly reported barriers to services; both decreased during 2016-2019 but then increased during 2019-2021.

CONCLUSIONS

This study can inform prevention and response strategies relevant for immigrants experiencing or reporting IPV.

Experience of Intimate Partner Violence and Non-Partner Sexual Violence in Conflict-Affected Settings: A Systematic Review and Meta-Analysis

This review aims to contribute to the understanding of violence against women and girls in conflict-affected and fragile settings through a systematic review and meta-analysis to document the available evidence on the prevalence of intimate partner violence and non-partner sexual violence during periods of armed conflict and in post-conflict periods. A total of 45 studies were included. Inclusion criteria were: population-based, observational studies that collected quantitative data with women (aged 15 years or older), included prevalence data on intimate partner violence or sexual violence, was collected in a conflict-affected context (active conflict or within 10 years after conflict) and was self-reported by women themselves. PubMed (Medline), PsycINFO, and Scopus were searched, and Demographic and Health Surveys were included for conflict-affected settings. The search covered literature published between January 1990 and August 2023. The results estimate that 39% of women and girls in conflict-affected settings have experienced physical or lifetime IPV, while 24% reported this violence in the past 12 months. For non-partner perpetrated violence, an estimated 21% of women and girls had experienced this violence in their lifetime and 11% reported having this experience during a period of conflict. When looking at sexual violence overall, an estimated 21% had experienced this violence, though there was considerable heterogeneity depending on the source of this data.

Accessibility and Perceived Impact of a Group Psychosocial Intervention for Women in Ecuador: A Comparative Analysis by Migration Status

There is increasing guidance promoting the provision of mental health and psychosocial support programs to both migrant and host community members in humanitarian settings. However, there is a lack of information on the respective experiences and benefits for migrant and host community members who are participating in mental health and psychosocial support programming. We evaluated a community-based psychosocial program for migrant and host community women, Entre Nosotras, which was implemented with an international non-governmental organization in Ecuador in 2021. Data on participant characteristics and psychosocial wellbeing were collected via pre/post surveys with 143 participants, and qualitative interviews were conducted with a subset (n = 61) of participants. All quantitative analyses were conducted in STATA, and qualitative analysis was done in NVivo. Attendance was higher for host community members. Specifically, 71.4% of host community members attended 4-5 sessions, whereas only 37.4% of migrants attended 4-5 sessions (p = 0.004). Qualitative analysis shows that the intervention was less accessible for migrants due to a variety of structural barriers. However, this analysis also demonstrated that both groups of women felt a greater sense of social connectedness after participating in the program and expressed gratitude for the bonds they formed with other women. Some migrant women described negative experiences with the host community because they felt as though they could not confide in host community women and speak freely in front of them. These results underscore how the migratory context influences the implementation of mental health and psychosocial support (MHPSS) programs. As humanitarian guidelines continue to emphasize the integration of host community members and displaced persons, it is critical to account for how the same intervention may impact these populations differently.

Comparing migration experiences of Venezuelan women and girls: a mixed-method, cross-sectional analysis of refugees/migrants in Ecuador, Peru and Brazil

Objective

Over the past decade, geopolitical turmoil in Venezuela has resulted in the displacement of 7.1 million people, resulting in a migration and refugee crisis.

Methods and analysis

This current cross-sectional, mixed-method research, which is focused on women and girls, examines differences in Venezuelan refugee/migrant demographics, migration characteristics, experiences and perceptions across nine locations in Ecuador, Peru and Brazil.

Results

A total of 9116 Venezuelan refugees/migrants shared 9339 migration experiences. Respondents in Brazil had been displaced for less time, reported more extreme poverty, perceived that they had received more support from the host community, and had more positive migration experiences. In contrast, respondents in Peru had been displaced for longer, were more likely to share experiences of insecurity/violence, perceived that they had not received adequate support and were more likely to report that the migration experience was negative. Respondents in Ecuador tended to provide more moderate responses somewhere between those from Brazil and Peru with one exception being around the impact of COVID-19, which they perceived more negatively.

Conclusion

It is critical to recognise that Venezuelan refugee/migrant populations are not homogenous and that their experiences, needs and priorities vary by location of settlement and migration route. From these findings, we recommend more open regularisation policies for Venezuelan nationals in Ecuador and Peru in addition to improved socioeconomic integration in accordance with the Quito Process. Sharing of successful models from other contexts may prove helpful.

Exploring the impact of Ecuador's policies on the right to health of Venezuelan migrants during the COVID-19 pandemic: a scoping review

Venezuela's ongoing economic and political crisis has forced >6 million people to emigrate from the country since 2014. In the Andean region, Ecuador is one of the main host countries for Venezuelan migrants and refugees. During the coronavirus disease 2019 (COVID-19) pandemic, specific measures were implemented in the country to control the spread of the disease and its associated impacts. In this context, we conducted a scoping review to understand how policies implemented by the Ecuadorian government during the pandemic impacted Venezuelan migrants' right to health. The literature search focused on scientific and grey publications between 2018 and 2022 in electronic databases and institutional websites, complemented by snowball sampling and expert advice. Our thematic analysis revealed discrepancies between the rights granted to migrants in Ecuador's legal framework and their practical implementation during the pandemic, with several instances of policy and programmatic infringement. The disruption of services further complicated migrant's options for regularization. Some measures, like border closures, negatively impacted migrants' health, including increased exposure to abuse and violence. While migrants were included in the country's COVID-19 vaccination plan, they were excluded from other national aid programmes. There are indications of an increase in xenophobia and discrimination stigmatizing migrants as 'disease carriers' and 'resource takers', resulting in a prioritization of services for the Ecuadorian population. We found limited research on the emergent topic of migrants' vulnerability and related health system challenges. Future research should include working in border zones, consider socioeconomic factors and further explore the poor implementation of Ecuador's legal framework towards upholding migrants' right to health.

Analyzing the Borderlands: A Regional Report on the Colombia–Ecuador Border on Political, Economic, Social, Legal, and Environment Aspects

This regional report critically analyzes the historical Colombia–Ecuador border issues using a PESL (political, economic, social, and legal) lens, extended in PESTLE, considering this a strategic planning approach, which includes the additional aspects of Legal and Environmental. Most studies of this region focus on terror, drug trafficking, and illegal border crossing, but other problems in this region remain understudied. Our review shows that, apart from the political issues, some social (gender-based violence), economic (unemployment), and legal issues (forced illicit activities) are prevalent in this border region. Mutual effective measures and policy actions are recommended to both the Colombian and Ecuadorian governments to improve border security issues, enhance economic activities, and mitigate social and environmental losses.

The role of gender and romantic jealousy in intimate partner violence against women, a mixed-methods study in Northern Ecuador

Male romantic jealousy is a commonly cited driver of intimate partner violence against women. An in-depth, contextualised understanding of the pathways and mechanisms from jealousy to intimate partner violence is, however, needed to inform programmes and interventions. We triangulated data from 48 interviews, eight focus groups and 1216 survey findings from low-income married women and men in northern Ecuador. Male jealousy was associated with controlling behaviours (aOR: 14.47, 95% CI: 9.47, 22.12) and sexual intimate partner violence (aOR: 2.4, 95% CI: 1.12, 5.12). Controlling behaviours were associated with physical and sexual intimate partner violence (aOR: 2.16, 95% CI: 1.21, 3.84). Qualitatively we found that most respondents framed jealousy within a discourse of love, and three triggers of male jealousy leading to intimate partner violence were identified: (1) community gossip, which acted as a mechanism of community control over women's movements and sexuality; (2) women joining the labour force, which was quantitatively associated with intimate partner violence and partially mediated by jealousy; and (3) women's refusal to have sex, which could lead husbands to coerce sex through accusations of infidelity. Gender-transformative interventions at the individual, couple and community level providing models of alternative masculinities and femininities may offer promise in reducing intimate partner violence in Ecuador. Importantly, future economic empowerment interventions should address jealousy to mitigate potential intimate partner violence backlash.

Maternal Care and Pregnancy Outcomes of Venezuelan and Colombian Refugees

BACKGROUND

Ecuador is a major host country for Colombians fleeing violence and Venezuelans escaping a complex humanitarian crisis, many of whom are pregnant women.

METHODS

We used national birth registry data (2018-2020) to compare the maternal care and infant outcomes of Venezuelan and Colombian immigrants with Ecuadorian nationals.

RESULTS

Venezuelan immigrants had a lower adjusted odds (AOR) for adequate prenatal care (AOR = 0.64;95%CI = 0.62,0.67) but a higher AOR for institutional (AOR = 2.68;95%CI = 1.84,3.93) and C-section delivery (AOR = 1.28;95%CI = 1.23,1.32) and birthing infants who were moderate-late preterm (AOR = 1.12;95%CI = 1.05,1.20), very preterm (AOR = 1.20;95%CI = 1.04,1.40), extremely pre-term (AOR = 1.65;95%CI = 1.27,2.14), low birthweight (LBW) (AOR = 1.11;95%CI = 1.05,1.17), very LBW (AOR = 1.35;95%CI = 1.12,1.62), and extremely LBW (AOR = 1.71;95%CI = 1.36,2.16). Colombians had decreased AORs for adequate prenatal care (AOR = 0.82;95%CI = 0.78,0.87) but increased AORs for institutional (AOR = 2.03;95%CI = 1.19,3.46) and C-section deliveries (AOR = 1.07;95%CI = 1.01,1.13) and birthing infants with moderate-late preterm (AOR = 1.17;95%CI = 1.05,1.30) but not LBW.

DISCUSSION

The findings underscore the need to address the causes of adequate prenatal care, excess C-sections, and poorer infant outcomes among refugee and immigrant women, especially Venezuelans.

The Psychosocial Impacts of Intimate Partner Violence against Women in LMIC Contexts: Toward a Holistic Approach

Work on the mental health impacts of intimate partner violence in low-and middle-income countries has focused primarily on clinical disorders such as post-traumatic stress disorder, depression, and substance abuse. This paper analyzes how non-clinical, psychosocial impacts from everyday stressors, particularly economic hardships and concern over one's children, cause extensive suffering and damage women survivors' well-being, influencing the development and expression of clinical disorders. Using a social ecological framework, the paper analyzes how psychosocial impacts arise at multiple levels, including societal levels where social norms often devalue women and privilege men, and how the stressor accumulation increases the harm caused by intimate partner violence (IPV) against women (IPVAW). Drawing on survivors' narratives and studies from diverse low and middle income country (LMIC) settings, including armed conflict and natural disaster settings, the paper underscores the importance of understanding both clinical impacts and the non-clinical, psychosocial impacts, which interact with and complement one another. Recognizing the interplay also between IPVAW and other forms of violence against girls and women, the paper calls for a more comprehensive approach to understanding and addressing the impacts of IPVAW. Recognizing the enormous variety within and across countries that are considered to be LMIC settings, the paper cautions against universalized approaches to understanding the effects of IPVAW and helping to support survivors.