Sub-optimal household water access is associated with greater risk of intimate partner violence against women: evidence from Nepal

Domestic Violence Against Women in Nepal: A Systematic Review of Risk Factors

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.

Water, sanitation, and intimate partner violence: Insights from Kibra Slums, Nairobi

Background

Intimate partner violence (IPV) poses significant health and social challenges for women, particularly in slums characterised by limited access to basic amenities like water and sanitation facilities. This study aimed to investigate the association between accessibility of water, sanitation and hygiene (WASH) facilities and IPV among women in Kibra, Nairobi county, Kenya.

Methods

A cross-sectional study design utilising a modified Demographic Health and Survey questionnaire was conducted among women aged 15-49 in Kibra slums. Data on water and sanitation accessibility and IPV experiences were collected from 1068 participants. Quantitative analysis by use of logistic regression, was conducted to assess associations between WASH accessibility and IPV.

Results

Among the participants, 64.0% reported experiences of IPV. Women who had access to water inside household; adjusted odds ratio (AOR) = 0.44 (95% CI = 0.31-0.64) and sanitation AOR = 0.57 (95% CI = 0.37-0.88) had decreased odds of experiencing IPV whereas reliance on external water sources such as outside pipes AOR = 18.18 (95% CI = 8.62-38.33) or vendors AOR = 14.42 (95% CI = 6.88-30.24) had heightened IPV vulnerability.

Conclusions

Access to clean water and sanitation is associated with reduced likelihood of women experiencing IPV in slums whereas access to water outside household is associated with increased likelihood of experiencing IPV. Connecting households with water to improve access and construction of adequate sanitation facilities may protect women against intimate partner violence in slums.

The Link Between Intimate Partner Violence and Food Insecurity: A Review of Quantitative and Qualitative Studies

Intimate partner violence (IPV) and food insecurity are global health issues that affect millions of people worldwide. Numerous studies show that IPV and food insecurity are linked; however, there is a lack of synthesis of this research. Using a systematic search and review, we examined the international quantitative and qualitative research published on the link between IPV and food insecurity. We searched for peer-reviewed, English-language articles with participants above the age of 16 in 4 large online databases. Fifty-six studies were included from around the world that discussed the link between food insecurity and IPV perpetration and/or victimization. We found evidence in both qualitative and quantitative studies for a meaningful connection between these two global health isues. We also reviewed the literature on moderators and mediators (e.g., mental health). Our findings indicate the importance of implementing IPV prevention strategies which also address household food insecurity, and the potential for food insecurity resources to provide IPV resources. Future research should focus more frequently on IPV perpetration as opposed to victimization, and further examine the moderating and mediating mechanisms that inform the link between IPV and food insecurity.

Water insecurity is associated with gender-based violence: A mixed-methods study in Indonesia

Gender Based Violence (GBV) is a global pandemic and water insecurity is increasing in intensity and extent. This study explores the association between these two global health threats. Cross-sectional, quantitative data were collected via surveys (n = 365 adult women) to measure household water insecurity (HWI) and women's experiences of GBV in the last year. Qualitative data were collected from semi-structured interviews (n = 24 men and women), two focus group discussions (n = 25 men and women) and a multi-stakeholder meeting (n = 35 men and women) to explore experiences, attitudes and risk factors associated with HWI and GBV. Multivariate logistic regression analysis showed that women in water insecure households were more than twice as likely to report experiencing GBV in the last year (OR = 2.2, CI: 1.0-4.9, p = 0.051). Examining household water insecurity scores as a continuous variable revealed an increased odds of reporting GBV with each increase in the HWISE score (OR = 1.1, CI: 1.0; 1.1, p < 0.001). Qualitative data indicates that the intersection between HWI, a patriarchal social organization and a caste system produced water-related conflicts between intimate partners, between daughters-in-law and their in-laws, and between masters and enslaved women. These results are presented using an integrated theoretical framework - a Feminist Political Ecology of Health (FPEH) - to illustrate the many ways women encounter and experience multi-dimensional forms of violence across scales in connection to water insecurity. The combination of robust qualitative and quantitative data presented in this study suggests that HWI may be causally related to GBV in this context.

Men's household water fetching in India: Gender inequity is associated with greater responsibility and related risks

INTRODUCTION

Household water fetching elevates physical and emotional harms, and these are generally assumed to accrue to women due to gendered labor assignments. But even in cases like India where fetching remains a highly feminized task, there are households where the primary responsibility is assumed by men.

METHODS

We test the proposition that men's responsibility for water fetching is predicted by greater gender equity, reflected in measures of wives' empowerment. We used an extremely large, nationally representative Demographic and Health Survey dataset from India (2019-2020), narrowed to only households in which spouses co-reside with off-plot water sources (N = 10 616), and applying a multinomial regression approach.

RESULTS

In >20% of households, men are the primary fetchers. They are more likely to have primary responsibility when water is more distant, privately purchased, or transported by vehicle. Contrary to predictions, men assume greater responsibility for household water fetching as their wives' empowerment measures decrease and when they want to control their movement.

CONCLUSION

Married men in India sometimes assume responsibility for water fetching, but this is not explained by greater household gender equity. The findings also suggest that when men are responsible for fetching they have heightened risk of some forms of physical trauma but less relative psychological harm. Detailing why men fetch water matters for identifying and mitigating the physical and emotion harms of bearing responsibility for water labor, with implications for how gender should be conceptualized in water interventions intending to improve health and well-being.

Water insecurity is associated with intimate partner violence among female adolescents and youth but not males in rural Tanzania: A cross-sectional study

Food insecurity increases intimate partner violence (IPV), but less is known about water insecurity (WI) and IPV. We examined the association between household WI and IPV among adolescents and youth in the Mbeya and Iringa regions of Tanzania. The cross-sectional sample comprised 977 males and females aged 18-23 years living in rural, impoverished households. We conducted multivariate logistic regression analyses to estimate the association between experiences of WI [measured by the Household Water Insecurity Experiences (HWISE-4) Scale] and physical and/or emotional IPV (measured by an adapted Conflict Tactics Scale). Overall, WI (HWISE ≥4) was associated with 74% higher odds of any IPV (marginal effects (ME) of 7.8 percentage points (pp)), compared to those not WI. Among females (but not males), WI was associated with 3-fold higher odds of any IPV (OR = 3.00; 95% CI: [1.52, 5.94]; ME  = 14 pp). Compared to non-WI females, WI females had 5- and 2-fold higher odds of IPV (ME = 30.8 and 11.3 pp) among the ever married and never married sub-samples, respectively. The association between WI and IPV among females was attenuated (OR = 1.93; 95% CI: [0.93, 3.97]) when adjusting for household food insecurity. Ameliorating water insecurity is a promising avenue for IPV reduction.

The association between access to key household resources and violence against women

We provide the first comprehensive analysis of the association between two key household resources (drinking water and toilet access) and both non-partner violence (NPV) and intimate partner violence (IPV) experienced by women. We use data from a nationally representative household survey for India obtained from the latest (fourth) round of the National Family Health Survey conducted in 2015-16. We employ logistic regression method and also use inverse-probability-weighted regression adjustment to control for selection bias. We find that NPV decreases with access to drinking water, while IPV decreases with provision of toilets. These results are found to be robust to an alternative method viz. propensity score matching and selection on unobservables using the Rosenbaum bounds approach.

Water journeys: Household water insecurity, health risks, and embodiment in slums and informal settlements

Water insecurity is a critical public-health challenge in Africa's urban informal settlements, where most of the population often lacks access to household taps. In these settings, water fetching is disproportionately performed by women. While water fetching is physically laborious and exposes women to multiple risks, the water-insecurity literature has predominantly focused on household experiences, ignoring women's water-collection journeys. This paper uses the water journey as a window into the embodied dimensions of water insecurity. Combining theoretical insights from embodiment, embodied political ecology of health, and time geographies, we use video-recorded walking interviews to analyze women's everyday water journeys in Ntopwa, an urban informal settlement in Blantyre, Malawi, from initial decision making through exposure to water-fetching risks and household practices regarding use and storage. We identify three principal sources of environmental risk- terrain, built environment, and human behavior-that present challenges for water collectors. Using the walking interview as a heuristic, we show how the seemingly simple practice of water fetching is compounded by complex decision making, constant spatiotemporal trade-offs, and exposure to diverse risks, all of which have embodied health consequences. Based on our findings, we conclude that interventions seeking to improve household water insecurity must consider the embodied effects of water-fetching journeys. This study also provides methodological insights into using walking interviews and videos for water and health research.

Experiences of inequalities in access to safe water and psycho-emotional distress in Ghana

Research suggests that experiences of water insecurity may negatively impact the psycho-emotional wellbeing of water-insecure households. This paper examines how perceived inequalities in water access mediate the relationship between water insecurity and psycho-emotional distress. Data were collected among 1192 men and women in Ghana who are active water collectors within their households. We employed a binary logistics regression to identify the determinants of psycho-emotional distress. Sobel test was used to test the indirect effect of water insecurity and psycho-emotional distress through perceived inequalities. The results show that wealth (OR = 6.6, CI = 2.784-14.076), number of people in a household (OR = 1.07, CI = 1.002-1.145) and perceived inequalities (OR = 4.6, CI = 2.737-7.907) are significant predictors of psycho-emotional distress. Sobel test indicated that the point estimate (PE) of the indirect effect between water insecurity and psycho-emotional distress through perceived inequality is -0.136 (p = 0.000), meaning households were less likely to experience psycho-emotional distress if they felt that safe water facilities were equally distributed. The findings suggest that the distribution of water resources in cities with water challenges, no matter how scarce those resources are, has a profound effect on psycho-emotional distress. In resources constrained cities, there is a need for holistic water-related interventions that make inclusivity and fairness their primary focus.

Exploring linkages between climate change and sexual health: a scoping review protocol

INTRODUCTION

The effects of climate change and associated extreme weather events (EWEs) present substantial threats to well-being. EWEs hold the potential to harm sexual health through pathways including elevated exposure to HIV and other sexually transmitted infections (STIs), disrupted healthcare access, and increased sexual and gender-based violence (SGBV). The WHO defines four components of sexual health: comprehensive sexuality education; HIV and STI prevention and care; SGBV prevention and care; and psychosexual counselling. Yet, knowledge gaps remain regarding climate change and its associations with these sexual health domains. This scoping review will therefore explore the linkages between climate change and sexual health.

METHODS AND ANALYSIS

Five electronic databases (MEDLINE, EMBASE, PsycINFO, Web of Science, CINAHL) will be searched using text words and subject headings (eg, Medical Subject Headings (MeSH), Emtree) related to sexual health and climate change from the inception of each database to May 2021. Grey literature and unpublished reports will be searched using a comprehensive search strategy, including from the WHO, World Bank eLibrary, and the Centers for Disease Control and Prevention. The scoping review will consider studies that explore: (a) climate change and EWEs including droughts, heat waves, wildfires, dust storms, hurricanes, flooding rains, coastal flooding and storm surges; alongside (b) sexual health, including: comprehensive sexual health education, sexual health counselling, and HIV/STI acquisition, prevention and/or care, and/or SGBV, including intimate partner violence, sexual assault and rape. Searches will not be limited by language, publication year or geographical location. We will consider quantitative, qualitative, mixed-methods and review articles for inclusion. We will conduct thematic analysis of findings. Data will be presented in narrative and tabular forms.

ETHICS AND DISSEMINATION

There are no formal ethics requirements as we are not collecting primary data. Results will be published in a peer-reviewed journal and shared at international conferences.

Intimate Partner Violence against Women Living in Inadequate Conditions in Sub-Saharan Africa: A Meta-Analysis of Demographic and Health Survey Data

Intimate partner violence (IPV) against women is a major public health problem and is widespread in sub-Saharan Africa (SSA). However, little is known about its environmental determinants. This study aimed to investigate whether inadequate living conditions are associated with IPV victimization in women in SSA. We analyzed cross-sectional data for 102,714 women in 25 SSA countries obtained from the Demographic and Health Surveys Program. Logistic regression was used to estimate the country-specific effects of inadequate living conditions (housing with at least one of four characteristics of unimproved water, unimproved sanitation, insufficient space, and unfinished materials) on multiple forms of IPV. Random effects meta-analysis was used to combined the country-specific estimates. We found an association between inadequate living conditions and a higher likelihood of experiencing any (OR = 1.12, 95% CI 1.03 to 1.23, p = 0.012), sexual (OR = 1.18, 95% CI 1.05 to 1.34, p = 0.008), emotional (OR = 1.12, 95% CI 1.02 to 1.23, p = 0.023), and physical (OR = 1.15, 95% CI 1.03 to 1.28, p = 0.010) IPV. The associations were stronger for rural and less-educated women. These findings suggest that future research to establish a causal link between living conditions and IPV and to elucidate the underlying pathways is crucial to design IPV interventions in SSA.

Re-examining the effects of drought on intimate-partner violence

Droughts are associated with several societal ills, especially in developing economies that rely on rainfed agriculture. Recently, researchers have begun to examine the effect of droughts on the risk of Intimate-Partner Violence (IPV), but so far this work has led to inconclusive results. For example, two large recent studies analyzed comparable data from multiple sub-Saharan African countries and drew opposite conclusions. We attempt to resolve this apparent paradox by replicating previous analyses with the largest data set yet assembled to study drought and IPV. Integrating the methods of previous studies and taking particular care to control for spatial autocorrelation, we find little association between drought and most forms of IPV, although we do find evidence of associations between drought and women's partners exhibiting controlling behaviors. Moreover, we do not find significant heterogeneous effects based on wealth, employment, household drinking water sources, or urban-rural locality.

Household water insecurity will complicate the ongoing COVID-19 response: Evidence from 29 sites in 23 low- and middle-income countries

In March 2020, the World Health Organization (WHO) issued a set of public guidelines for Coronavirus Disease 2019 (COVID-19) prevention measures that highlighted handwashing, physical distancing, and household cleaning. These health behaviors are severely compromised in parts of the world that lack secure water supplies, particularly in low- and middle-income countries (LMICs). We used empirical data gathered in 2017-2018 from 8,297 households in 29 sites across 23 LMICs to address the potential implications of water insecurity for COVID-19 prevention and response. These data demonstrate how household water insecurity presents many pathways for limiting personal and environmental hygiene, impeding physical distancing and exacerbating existing social and health vulnerabilities that can lead to more severe COVID-19 outcomes. In the four weeks prior to survey implementation, 45.9% of households in our sample either were unable to wash their hands or reported borrowing water from others, which may undermine hygiene and physical distancing. Further, 70.9% of households experienced one or more water-related problems that potentially undermine COVID-19 control strategies or disease treatment, including insufficient water for bathing, laundering, or taking medication; drinking unsafe water; going to sleep thirsty; or having little-to-no drinking water. These findings help identify where water provision is most relevant to managing COVID-19 spread and outcomes.

Water and mental health

There is a well‐established connection among water quality, sanitation, and physical health. The potentially important relationship between water and mental health is considerably less studied. Reviewing evidence from ethnography, geography, folklore, indigenous studies, rural medicine, drought research, and large‐n statistical studies, we argue there is now good theoretical rationale and growing evidence of water insecurity as a possible driver of mental ill‐health. Furthermore, some nascent evidence suggests that emotionally meaningful interactions with water might improve mental health outcomes. Leveraging these literatures, we address the many ways in which mental health outcomes are conceptualized and operationalized in water research, including as emotional distress, perceived stress, depressive symptoms, anxiety symptoms, somatic symptoms, and quality of life. We outline arguments supporting seven possible (and likely interlocking) mechanisms that could explain such a relationship: (a) material deprivation and related uncertainty, (b) shame of social failure, (c) worry about health threats, (d) loss of connections to people and places, (e) frustration around opportunity losses and restricted autonomy, (f) interpersonal conflict and intimate partner violence, and (g) institutional injustice or unfairness. However, we explain that as most existing studies are ethnographic, qualitative, or cross‐sectional, a causal relationship between water and mental ill‐health is yet to be confirmed empirically. More research on this topic is needed, particularly given that poorly understood connections may create barriers to achieving Sustainable Development Goals 3 (health) and 6 (water). We further suggest that tracking mental health indicators may provide unique and as‐yet underappreciated insights into the efficacy of water projects and other development interventions.

This article is categorized under: