Men's violence against women in rural Bangladesh: undermined or exacerbated by microcredit programmes?

Intimate Partner Violence Against Women and Labor Productivity: The Mediating Role of Morbidity

This study determines that morbidity presents a mediating impact between intimate partner violence against women and labor productivity in terms of absenteeism and presenteeism. Partial least squares structural equation modeling (PLS-SEM) was used on a nationwide representative sample of 357 female owners of micro-firms in Peru. The resulting data reveals that morbidity is a mediating variable between intimate partner violence against women and absenteeism (β = 0.213; p < .001), as well as between intimate partner violence against women and presenteeism (β = 0.336; p < .001). This finding allows us to understand how such intimate partner violence against women negatively affects the workplace productivity in the context of a micro-enterprise, a key element in many economies across the world.

The association between marital violence and reproductive and sexual health outcomes of women: A multi-country study of South Asia

In this study, we examined the relationship between marital violence(MV) and reproductive and sexual health outcomes of women of Bangladesh, India, Nepal and Pakistan. The lifetime MV inflicted by husbands on their wives was highest at 53% in Bangladesh, India(37%), Pakistan(28%) and Nepal(28%) respectively. Overall, our results in this study suggest that MV perpetrated by husbands on their wife is significantly associated with unintended pregnancy, pregnancy termination, current use of any modern contraceptive methods and sexually transmitted infections, but inconsistent associations are appeared across countries. Lifetime sexual violence and physical-sexual force were significantly and positively associated with unintended pregnancy and pregnancy termination respectively, whereas, all types of MV were significantly and positively related with the symptom of sexually transmitted diseases in the women. Appropriate measures should be undertaken to combat Violence against women(VAW) and necessary services should be provided to the victimized women to uphold their reproductive and sexual rights.

Microfinance and Violence Against Women in Rural Guatemala

Violence against Women (VaW) has come to be recognized as a serious human rights abuse with important consequences not only for women but for whole societies. Since VaW has several manifestations, it is possible to differentiate among different types of violence. In this article, a broad theoretical framework with different dimensions of gender violence was adapted to a Latin American social and cultural context to measure three out of the five main types of violence: economic violence, emotional psychological violence, and coercive control. The goal of this article is to provide empirical evidence to determine whether access to microfinance services plays a role in reducing VaW. To this end, we designed and performed a cross-sectional study with a treatment and a control group in rural Guatemala. A sample of 883 rural women in the "Altiplano" area of Guatemala (448 women with microfinance services and 435 without) was surveyed from May to November 2012. The results of the bivariate logistic regression showed evidence of association between access to microfinance services and reduction of VaW. After adjusting for covariates, global, economic, and emotional psychological violence maintained a negative and statistically significant association with microfinance, while only coercive control showed no statistical association with microfinance services. Access to microcredits showed a very clear relationship to reducing economic and emotional violence but not coercive control, a factor that may be determined by social and cultural norms. In contrast to Status Inconsistency Theory, which has been tested primarily in Asia, our study of Guatemala showed that increased status and economic independence of women due to their participation in microfinance services reduced VaW.

Prevalence, associated factors, and disclosure of intimate partner violence among mothers in rural Bangladesh

BACKGROUND

The purpose of this study is to assess the prevalence and associated factors of physical and sexual intimate partner violence (IPV) among married women of reproductive age in a rural population in northeast Bangladesh. In addition, we examined women's sharing and disclosure of violence experience with others.

METHODS

This cross-sectional study uses data from a household survey of 3966 women conducted in 2014 in the Sylhet District of Bangladesh. Interviews were completed in respondent's homes by trained local female interviewers.

RESULTS

Twenty-nine percent (28.8%, 95% CI 27.4-30.3%) of the women reported ever experiencing physical or sexual IPV by their spouse; 13.2% (95% CI 12.1-14.3%) reported physical or sexual IPV in the past year. Of the 13.2%, 10.1% (95% CI 9.2-11.1%) reported experiencing physical IPV and 4.6% (95% CI 4.0-5.3%) reported sexual IPV. In a combined model, the adjusted odds of having experienced physical or sexual IPV in the past year were higher for women who were raised in households with history of IPV (AOR = 4.35, 95% CI 3.26-5.80); women with no formal education (AOR = 1.76, 95% CI 1.30-2.37); women whose husbands had no formal education (AOR = 1.63, 95% CI 1.22-2.17); Muslim (AOR = 1.63, 95% CI 1.03-2.57); women younger than age 30 (AOR = 1.53, 95% CI 1.11-2.12); and women who were members of an NGO or microcredit financial organization (AOR = 1.38, 95% CI 1.04-1.82). Wealth, parity, number of household members, and pregnancy status (pregnant, postpartum, neither pregnant nor postpartum) were not associated with physical or sexual IPV after adjusting for other factors. Data on disclosure was available for women who reported experiencing physical violence in the last year; only 31.8% of victims told someone about the violence they had experienced and 1% reported to police, clerics, health workers, or a counselor altogether.

CONCLUSIONS

In rural northeast Bangladesh, a high proportion of women of reproductive age experience physical or sexual IPV. Women do not often speak of these experiences, especially to anyone outside of family. Interventions aimed at preventing future IPV and addressing current IPV should focus on women who witnessed IPV in childhood, as well as younger women and less educated couples.

TRIAL REGISTRATION

This study was registered as a Clinical Trial (Identifier: NCT01702402). https://clinicaltrials.gov/ct2/show/NCT01702402.

Ethics in field experimentation: A call to establish new standards to protect the public from unwanted manipulation and real harms

In 1966, Henry Beecher published his foundational paper "Ethics and Clinical Research," bringing to light unethical experiments that were routinely being conducted by leading universities and government agencies. A common theme was the lack of voluntary consent. Research regulations surrounding laboratory experiments flourished after his work. More than half a century later, we seek to follow in his footsteps and identify a new domain of risk to the public: certain types of field experiments. The nature of experimental research has changed greatly since the Belmont Report. Due in part to technological advances including social media, experimenters now target and affect whole societies, releasing interventions into a living public, often without sufficient review or controls. A large number of social science field experiments do not reflect compliance with current ethical and legal requirements that govern research with human participants. Real-world interventions are being conducted without consent or notice to the public they affect. Follow-ups and debriefing are routinely not being undertaken with the populations that experimenters injure. Importantly, even when ethical research guidelines are followed, researchers are following principles developed for experiments in controlled settings, with little assessment or protection for the wider societies within which individuals are embedded. We strive to improve the ethics of future work by advocating the creation of new norms, illustrating classes of field experiments where scholars do not appear to have recognized the ways such research circumvents ethical standards by putting people, including those outside the manipulated group, into harm's way.

Missed Opportunities for Addressing Intimate Partner Violence Through Microcredit: Qualitative Findings From Bangladesh

Microcredit has shown mixed results when used to reduce intimate partner violence (IPV). This study explored microcredit and IPV in Bangladesh by conducting 12 focus groups with married men and women. Participants described challenges to microcredit participation highlighting "missed opportunities" for reducing IPV, including needs to (a) prevent violence sparked by loan disputes, (b) incorporate skill development to improve women's agency as a means of reducing IPV, and (c) mindfully engage men in the loan process to help address men's unequal gender ideologies. These modifications to microcredit programs are proposed to maximize positive change on gender and IPV.

Empowerment and Intimate Partner Violence in Pakistan: Results From a Nationally Representative Survey

Using empowerment theory, the current study examines antecedents of lifetime experience of intimate partner violence, intimate partner violence experienced in the last 12 months, emotional violence, and husbands' controlling behaviors toward their wives in Pakistan. Using data from a subsample of 658 women from the nationally representative Pakistan Demographic and Health Survey 2012-2013, this study examined whether empowerment variables, such as household decision-making power, economic decision-making power, and adherence to patriarchy, operationalized as justification of wife beating, contribute to intimate partner violence using logistic regression analyses. Results indicate that adherence to patriarchal norms, household decision-making power, and higher education was found to be associated with lifetime prevalence of intimate partner violence. Adherence to patriarchal norms, economic decision-making power, and higher education was found significantly associated with intimate partner violence in the past 12 months. Adherence to patriarchal norms was significantly associated with experiencing emotional violence as well as controlling behaviors by husbands. In conclusion, women's adherence to patriarchal norms is a reflection of the patriarchal society in which they live; indeed, this was found to be the most important predictor of women's experience of intimate partner violence, when different types of violence were assessed. Implications for social work practice are discussed.

Financial inclusion and intimate partner violence: What does the evidence suggest?

Financial inclusion is an area of growing global interest in women’s empowerment policy and programming. While increased economic autonomy may be expected to reduce the prevalence of intimate partner violence, the mechanisms and contexts through which this relationship manifests are not well understood. This analysis aims to assess the relationship between women’s financial inclusion and recent intimate partner violence using nationally-representative data from 112 countries worldwide. Levels of both financial inclusion and recent intimate partner violence varied substantially across countries (ranging from 2–100%, and 1–46%, respectively), and across regions. In multivariate global analyses, increased levels of women’s financial inclusion were associated with lower levels of recent intimate partner violence after accounting for asset-based enablers of economic autonomy and gender norms; this relationship was lost upon the inclusion of measures of national context (i.e., development and fragility). These results underscore that the relationship between financial inclusion and recent intimate partner violence is complex, follows many pathways, and is affected by context. In low and middle income countries, asset-based enablers of economic autonomy, gender norms and national context explained much of the relationship between financial inclusion and recent intimate partner violence. In those low and middle income countries with high levels of controlling behavior by male spouses, financial inclusion was associated with higher levels of recent intimate partner violence. These findings further suggest that initiatives that aim to prevent intimate partner violence by way of increased economic autonomy may be ineffective in the absence of broader social change and support, and indeed, as seen in countries with higher levels of men’s controlling behavior, backlash may increase the risk of violence. Efforts to improve women’s financial inclusion need to recognize that its relationship with intimate partner violence is complex, and that it requires an enabling environment supportive of women’s rights and autonomy.

Socioeconomic Vulnerability and Sexually Transmitted Infection Among Pregnant Haitian Women

BACKGROUND

Despite evidence that education and poverty act through distinct pathways to influence sexually transmitted infection (STI), few studies have examined the unique, independent associations of these socioeconomic vulnerabilities with sexual risk behaviors and STI among women.

METHODS

From August to October 2013, women at an antenatal clinic in Gressier, Haiti, were interviewed and tested for chlamydial infection, gonorrhea, and trichomoniasis (N = 200). We measured low educational attainment as less than 9 years of schooling and currently living in poverty based on crowding, defined as more than 2 people sleeping in one room. We used logistic regression to estimate independent associations between each socioeconomic indicator and outcomes of sexual behaviors and STI.

RESULTS

Approximately 29% of the sample had a current STI (chlamydia, 8.0%; gonorrhea, 3.0%; trichomoniasis, 20.5%), with 2.5% testing positive for more than 1 STI. Forty percent of the sample reported low educational attainment and 40% reported current poverty. Low educational attainment was associated with early risk behaviors, including twice the odds of earlier sexual debut (adjusted odds ratio [AOR], 2.09; 95% confidence interval [CI],: 1.14-3.84). Poverty was associated with reporting the current main sexual partner to be nonmonogamous (AOR, 2.01; 95% CI, 1.00-4.01) and current STI (AOR, 2.50; 95% CI, 1.26-4.98).

CONCLUSIONS

Education and poverty seem to independently influence STI behaviors and infection, with low education associated with early sexual risk and poverty associated with current risk and infection. Improving women's educational attainment may be important in improving risk awareness, thereby reducing risky sexual behaviors and preventing a trajectory of STI risk.

Science Mapping of the Global Knowledge Base on Microfinance: Influential Authors and Documents, 1989–2019

The use of microfinance in poverty alleviation and, by extension, as an instrument for sustainable social and economic development, represents a novel idea in sustainable finance. This study employed science mapping to examine 4049 Scopus-indexed documents explicitly concerned with microfinance. The goals of the review were to document the distribution of microfinance literature by type, volume, time, and geography, and to identify influential authors, articles, and a potential intellectual structure of this knowledge base. The first microfinance research was conducted in 1989, but the field attracted increased attention only after 2006, when the Nobel Peace Prize was awarded to microfinance pioneer Muhammad Yunus. This study does not find any single dominant school of thought in the field of microfinance, but rather identified three thematic research clusters: (1) a concentration on institutional aspects of microfinance, (2) scholars who used sophisticated research methods to evaluate the impact of microfinance, and (3) groundbreaking microfinance literature related to social justice more generally. As the first-ever, comprehensive bibliometric review of research on microfinance, this study provides benchmarks against which to assess the future evolution of this literature, a reference for scholars entering this domain, and targets for future development of this field of sustainability scholarship.

Delivering development? Evidence on self-help groups as development intermediaries in South Asia and Africa

Donors and governments increasingly seek to deliver development projects through community-based organizations such as self-help groups (SHGs), but little is known about the effectiveness of such arrangements. This article briefly summarizes hypotheses regarding the effectiveness of interventions using SHGs and presents the results of an evidence review on the impacts of interventions delivered through SHGs on health, finance, agriculture and empowerment outcomes in South Asia and sub-Saharan Africa. Though the impacts of SHG-based interventions are generally positive, the evidence base is limited and does not generally test whether alternative delivery mechanisms might be more effective.

An Assessment of the Prevalence, Perceived Significance, and Response to Dowry Solicitation and Domestic Violence in Bangladesh

The current study focuses on the prevalence of two pervasive gender-related crimes in Bangladesh: dowry solicitation and domestic violence. We assess victim perceptions of how these two crimes rank in significance compared with other types of crimes experienced and the actions victim households took in response. Our research builds on prior qualitative studies by making use of nation-wide household survey data, collected by the World Bank, to examine dowry and domestic violence in the context of all legal conflicts experienced by households in every administrative region of the country. The analyses show that both dowry solicitation and domestic violence rank in the top five most common crimes, including violent and non-violent crimes. Women report more experiences of dowry solicitation and domestic violence, with urban females most frequently disclosing both. Among the households that experienced multiple types of violent and non-violent crimes, 55.9% of dowry and 70.8% of domestic violence victims reported another crime ranked higher in significance. Of the households that considered these two crimes the most serious they experienced, 56.1% of dowry and 32.5% of domestic violence households took no action at all in response. Among the households that took action, most eschewed both police and state judicial institutions. Choosing to act alone or with the help of family members was the most frequent response. The findings illustrate the need for governance reforms in Bangladesh and may inform state and non-state improvement initiatives.

Is Women's Empowerment Associated With Help-Seeking for Spousal Violence in India?

Violence against women by their husbands is a problem for women worldwide. However, the majority of women do not seek help. This article presents findings from a national survey in India on empowerment-related correlates of help-seeking behaviors for currently married women who experienced spousal violence. We examined individual-, relationship-, and state-level measures of empowerment on help-seeking from informal and formal sources. Findings indicate that help-seeking is largely not associated with typical measures of empowerment or socio-economic development, whereas state-level indicators of empowerment may influence help-seeking. Although not a target of this study, we also note that injury from violence and the severity of the violence were among the strongest factors related to seeking help. Taken together, the low prevalence of help-seeking and lack of strong individual-level correlates, apart from severe harm, suggests widespread barriers to seeking help. Interventions that affect social norms and reach women and men across social classes in society are needed in addition to any individual-level efforts to promote seeking help for spousal violence.

WOMEN'S EMPOWERMENT AND INTIMATE PARTNER VIOLENCE IN BANGLADESH: INVESTIGATING THE COMPLEX RELATIONSHIP

The aim of this study was to assess whether women's empowerment ensures reduced intimate partner violence (IPV). The differential relationship between women's empowerment and IPV among married women in Bangladesh was investigated using 2007 Demographic and Health Survey data. Logistic regression models were used to assess whether women's empowerment had any influence on their likelihood of experiencing IPV while controlling for other covariates. The analyses revealed that older cohorts of women, who were more empowered, were more vulnerable to physical violence than less-empowered, younger women. The likelihood of being affected by physical violence among less-empowered, childless women was greater than that of more-empowered women with only male children. Less-empowered, uneducated women were more likely to experience physical violence than more-empowered, primary-educated women. Less-empowered women who had been married for less than 5 years were more likely to suffer from physical violence than more-empowered women who had been married for more than 19 years. The likelihood of experiencing sexual violence was not found to have any significant association with women's empowerment. The findings suggest that although women's empowerment in Bangladesh is gradually improving, some sub-groups of empowered women are still susceptible to IPV.

Does Intimate Partner Violence Decline as Women's Empowerment becomes Normative? Perspectives of Bangladeshi Women

Studies addressing the relationship between women's empowerment and intimate partner violence (IPV) have yielded conflicting findings. Some suggest that women's economic and social empowerment is associated with an increased risk of intimate partner violence (IPV), arguably because men use often IPV to enforce their dominance and reassert inegalitarian gender norms when patriarchal norms are challenged; other studies suggest the converse. It is important to understand why these findings are contradictory to create a more sound basis for designing both women's empowerment interventions and anti-violence interventions. The aim of this study is to clarify the relationship between women's empowerment and IPV in a setting where gender roles are rapidly changing and IPV rates are high. We examine some of the ways in which the nature of women's empowerment evolved in six villages in rural Bangladesh during a 12-year period in which surveys have documented a decline of 11 points in the percentage of married women experiencing IPV in the prior year. The paper is based on data from 74 life history narratives elicited from 2011 to 2013 with recently married Bangladeshi women from the six villages, whom other community residents identified as empowered. Our findings suggest that women's empowerment has evolved in several ways that may be contributing to reductions in IPV: in its magnitude (for example, many women are earning more income than they previously did), in women's perceived exit options from abusive marriages, in the propensity of community members to intervene when IPV occurs, and in the normative status of empowerment (it is less likely to be seen as transgressive of gender norms). The finding that community-level perceptions of empowered women can evolve over time may go a long way in explaining the discrepant results in the literature.

Men's perspectives on women's empowerment and intimate partner violence in rural Bangladesh

Intimate partner violence (IPV) may increase as women in patriarchal societies become empowered, implicitly or explicitly challenging prevailing gender norms. Prior evidence suggests an inverse U-shaped relationship between women's empowerment and IPV, in which violence against women first increases and then decreases as more egalitarian gender norms gradually gain acceptance. By means of focus-group discussions and in-depth interviews with men in 10 Bangladeshi villages, this study explored men's evolving views of women, gender norms and the legitimacy of men's perpetration of IPV in the context of a gender transition. It examines men's often-contradictory narratives about women's empowerment and concomitant changes in norms of masculinity, and identifies aspects of women's empowerment that are most likely to provoke a male backlash. Findings suggest that men's growing acceptance of egalitarian gender norms and their self-reported decreased engagement in IPV are driven largely by pragmatic self-interest: their desire to improve their economic status and fear of negative consequences of IPV.

Men's Perceptions of Women's Participation in Development Initiatives in Rural Bangladesh

Without taking masculine issues into account, women’s participation in development initiatives does not always guarantee their empowerment, health, and welfare in a male-dominated society. This study aimed to explore men’s perceptions of women’s participation in development (WPD) in rural Bangladesh. In adopting a qualitative approach, the study examined 48 purposively selected married and unmarried men aged 20–76 years in three northwest villages. Data collection was accomplished through four focus group discussions (FGDs) with 43 men clustered into four groups and through individual interviews with five other men. A qualitative content analysis of the data revealed an overall theme of “feeling challenged by fears and hopes,” indicating variations in men’s views on women’s participation in development initiatives as represented by three main categories: (a) fearing the loss of male authority, (b) recognizing women’s roles in enhancing family welfare, and (c) valuing women’s independence. In the context of dominant patriarchal traditions in Bangladesh, these findings provide new insight into dynamics and variations of men’s views, suggesting a need to better engage men during different stages of women-focused development initiatives.

Impact of demographic variables on women's economic empowerment: An ordered probit model

The present study aimed to empirically examine the demographic variables that determine women's economic empowerment. A sample of 500 married women between 21 and 49 years old (M_age = 35.49, SD = 7.66) was conveniently selected from district Multan (Pakistan). Control over economic resources was used as a proxy for women's economic empowerment. Ordered probit regression was run to assess the demographic determinants (i.e., age, education, paid job, income, and property) of economic empowerment of the least empowered, moderately empowered, and highly empowered women. Paid job, age, income, and property appeared as positive and significant predictors of women's economic empowerment. Implications of the study were also discussed.

Prevalence of Violence: Male and Female Seasonal Agricultural Workers' Approach to Violence in Turkey

The objective of this study is to determine the male and female seasonal agricultural workers' perception of violence, prevalence of violence, frequency of victimization, and their related factors. Quantitative and qualitative data were used, and 89.5% of women were exposed to violence that included the restriction of their human rights. The sample consisted of 1,211 women and 1,064 men. Their marital status, duration of work, and attention to their health affected the violence exposure. Arabic people who were unmarried, had a poor educational background, and poor health perception approved of the physical violence.

Household Financial Management and Women’s Experiences of Intimate Partner Violence in the Philippines

This study explores the causal impact of independent management of household finances upon women’s experiences of intimate partner violence (IPV) in the Philippines. Propensity score matching is used to generate a casual estimate of the impact of women’s roles as household financial managers on their experiences of IPV. Findings demonstrate that managing household finances independently significantly increased the severity of IPV women experienced from their partners compared with women who managed finances jointly with partners. Findings reinforce the importance of explicit attention to intrahousehold power dynamics and gender norms in the implementation of microfinance interventions intended to empower women.

Women's Empowerment as a Protective Factor Against Intimate Partner Violence in Bangladesh: A Qualitative Exploration of the Process and Limitations of Its Influence

Literature on the relationship between intimate partner violence (IPV) against women and women's empowerment is contradictory. Findings from a recent survey in rural Bangladesh suggest that empowerment is becoming protective even though IPV rates remain high. We construct qualitative case studies exploring factors and social processes underlying relationships between empowerment and IPV in four villages. Empowerment may be protective against IPV in the aggregate, but this relationship can be subverted at the micro level. Interventions are needed to reinforce the potential of empowerment to reduce IPV and counteract factors such as geographic isolation and limited employment opportunities that inhibit empowerment.

Microfinance Participation and Domestic Violence in Bangladesh: Results From a Nationally Representative Survey

This article examines domestic violence among women who participate in microfinance in Bangladesh. Secondary analysis of survey data from nationally representative Bangladesh Demographic and Health Survey was used to investigate the association between microfinance participation and domestic violence of 4,163 ever-married women between the ages of 18 and 49 years. Outcome measure is experience of domestic violence as measured by a modified Conflict Tactics Scale (CTS) and predictor variables include microfinance, binary indicator of relatively better economic status, autonomy, decision-making power, and demographic variables. The likelihood of experiencing domestic violence was not found to vary with microfinance participation. However, the interaction effect of microfinance and better economic status was found to be significantly associated with domestic violence (9% increased probability). Experience of domestic violence was negatively associated with older age, higher education of the husband, and autonomy. In Bangladesh, microfinance participation may be associated with a higher probability of experiencing domestic violence for women with relatively better economic status, but not for the poorest of the poor.

Familial Power and Women's Contradictory Responses to Attitudinal Questions About Intimate Partner Violence in Rural Bangladesh

Research is lacking on how power processes can influence women's reporting of their attitudes about intimate partner violence (IPV) against women. Structural elements of textual data were investigated as potential evidence of latent power. Overall, the majority of the women switched their response at least once throughout the interview, and the context of these contradictory responses provide evidence that women's reporting of attitudes about IPV against women may be understood as arising in part from latent power processes. New methodological tools are needed to better understand women's personal attitudes about IPV against women.

Employment status and intimate partner violence among Mexican women

Exploring risk factors and profiles of intimate partner violence in other countries provides information about whether existing theories of this phenomenon hold consistent in different cultural settings. This study will present results of a regression analysis involving domestic violence among Mexican women (n = 83,159). Significant predictors of domestic violence among Mexican women included age, number of children in the household, income, education, self-esteem, family history of abuse, and controlling behavior of the husband. Women's employment status was not a significant predictor when all variables were included in the model; however, when controlling behavior of the husband was withdrawn from the model, women's employment status was a significant predictor of domestic violence toward women. Results from this research indicate that spousal controlling behavior may serve as a mediator of the predictive relationship between women's employment status and domestic violence among Mexican women. Findings provide support for continued exploration of the factors that mediate experiences of domestic violence among women worldwide.

The Explanatory Role of Relationship Power and Control in Domestic Violence Against Women in Nicaragua

This study offers a feminist psychology analysis of various aspects of relationship power and control and their relative explanatory contribution to understanding physical, psychological, and sexual violence against women. Findings from structured interviews with 345 women from rural Nicaragua ( Mage = 44) overwhelmingly demonstrate that measures of power and control reflecting interpersonal relationship dynamics have the strongest predictive power for explaining violence when compared in multivariate analyses to several of the more commonly used measures. These findings have implications for future research and the evaluation of interventions designed to decrease levels of violence against women.

Strengthening the enabling environment for women and girls: what is the evidence in social and structural approaches in the HIV response?

There is growing interest in expanding public health approaches that address social and structural drivers that affect the environment in which behaviour occurs. Half of those living with HIV infection are women. The sociocultural and political environment in which women live can enable or inhibit their ability to protect themselves from acquiring HIV. This paper examines the evidence related to six key social and structural drivers of HIV for women: transforming gender norms; addressing violence against women; transforming legal norms to empower women; promoting women's employment, income and livelihood opportunities; advancing education for girls and reducing stigma and discrimination. The paper reviews the evidence for successful and promising social and structural interventions related to each driver. This analysis contains peer-reviewed published research and study reports with clear and transparent data on the effectiveness of interventions. Structural interventions to address these key social and structural drivers have led to increasing HIV-protective behaviours, creating more gender-equitable relationships and decreasing violence, improving services for women, increasing widows' ability to cope with HIV and reducing behaviour that increases HIV risk, particularly among young people.

Perceived decline in intimate partner violence against women in Bangladesh: qualitative evidence

The Bangladesh government, nongovernmental organizations, donors, and advocacy groups have attempted various interventions to promote gender equality and reduce intimate partner violence (IPV) against women, but rigorous evaluations of these interventions are rare and few published studies have yet to show that any of them has had a substantial impact. This study presents qualitative evidence from four villages in central and northern Bangladesh drawn from 11 group discussions (6 with men, 5 with women), 16 open-ended interviews with men, and 62 women's life history narratives. The findings strongly suggest that IPV is declining in these villages as women's economic roles expand and they gain a stronger sense of their rights. Periodic surveys are recommended to measure trends in the incidence of IPV in settings where transitions in gender systems are under way.

Interactions between microfinance programmes and non-economic empowerment of women associated with intimate partner violence in Bangladesh: a cross-sectional study

OBJECTIVE

This study aims to examine the associations between microfinance programme membership and intimate partner violence (IPV) in different socioeconomic strata of a nationally representative sample of women in Bangladesh.

METHODS

The cross-sectional study was based on a nationally representative interview survey of 11 178 ever-married women of reproductive age (15-49 years). A total of 4465 women who answered the IPV-related questions were analysed separately using χ(2) tests and Cramer's V as a measure of effect size to identify the differences in proportions of exposure to IPV with regard to microfinance programme membership, and demographic variables and interactions between microfinance programme membership and factors related to non-economic empowerment were considered.

RESULTS

Only 39% of women were members of microfinance programmes. The prevalence of a history of IPV was 48% for moderate physical violence, 16% for severe physical violence and 16% for sexual violence. For women with secondary or higher education, and women at the two wealthiest levels of the wealth index, microfinance programme membership increased the exposure to IPV two and three times, respectively. The least educated and poorest groups showed no change in exposure to IPV associated with microfinance programmes. The educated women who were more equal with their spouses in their family relationships by participating in decision-making increased their exposure to IPV by membership in microfinance programmes.

CONCLUSIONS

Microfinance plans are associated with an increased exposure to IPV among educated and empowered women in Bangladesh. Microfinance firms should consider providing information about the associations between microfinance and IPV to the women belonging to the risk groups.

Microcredit and domestic violence in Bangladesh: an exploration of selection bias influences

This article explores the relationship between women's participation in microcredit groups and domestic violence in Bangladesh. Several recent studies have raised concern about microcredit programs by reporting higher levels of violence among women who are members. These results, however, may be attributable to selection bias because members might differ from nonmembers in ways that make them more susceptible to violence to begin with. Using a sample of currently married women from the 2007 Bangladesh Demographic Health Survey (BDHS) (N = 4,195), we use propensity score matching (PSM) as a way of exploring selection bias in this relationship. Results suggest that the previously seen strong positive association between membership and violence does not hold when an appropriate comparison group, generated using PSM, is used in the analyses. Additional analyses also suggest that levels of violence do not differ significantly between members and nonmembers and instead could depend on context-specific factors related to poverty. Members for whom a match is not found report considerably higher levels of violence relative to nonmembers in the unmatched group. The background characteristics of members and nonmembers who do not match suggest that they are more likely to be younger and from relatively well-to-do households.

A systematic review of income generation interventions, including microfinance and vocational skills training, for HIV prevention

Income generation interventions, such as microfinance or vocational skills training, address structural factors associated with HIV risk. However, the effectiveness of these interventions on HIV-related outcomes in low- and middle-income countries has not been synthesized. The authors conducted a systematic review by searching electronic databases from 1990 to 2012, examining secondary references, and hand-searching key journals. Peer-reviewed studies were included in the analysis if they evaluated income generation interventions in low- or middle-income countries and provided pre-post or multi-arm measures on behavioral, psychological, social, care, or biological outcomes related to HIV prevention. Standardized forms were used to abstract study data in duplicate and study rigor was assessed. Of the 5218 unique citations identified, 12 studies met criteria for inclusion. Studies were geographically diverse, with six conducted in sub-Saharan Africa, three in South or Southeast Asia, and three in Latin America and the Caribbean. Target populations included adult women (N = 6), female sex workers/bar workers (N = 3), and youth/orphans (N = 3). All studies targeted females except two among youth/orphans. Study rigor was moderate, with two group-randomized trials and two individual-randomized trials. All interventions except three included some form of microfinance. Only a minority of studies found significant intervention effects on condom use, number of sexual partners, or other HIV-related behavioral outcomes; most studies showed no significant change, although some may have had inadequate statistical power. One trial showed a 55% reduction in intimate partner violence (adjusted risk ratio 0.45, 95% confidence interval 0.23-0.91). No studies measured incidence/prevalence of HIV or sexually transmitted infections among intervention recipients. The evidence that income generation interventions influence HIV-related behaviors and outcomes is inconclusive. However, these interventions may have important effects on outcomes beyond HIV prevention. Further studies examining not only HIV-related outcomes but also causal pathways and intermediate variables, are needed. Additional studies among men are also needed.

Men's views on gender and sexuality in a Bangladesh village

The violation of women's sexual rights is a crucial public health problem, which is often related to the way people view gender and sexuality in a society. This study explores married men's typical views on gender, family, and sexuality in a rural Bangladesh context. Using a qualitative methodological approach, 10 married men were purposively included from a northwest village. The study revealed that married men's views about gender and sexuality are heavily influenced by patriarchal norms. Men think that a wife is the property of her husband and that the wife should obey her husband by giving sex to her husband whenever he wants. Men also think that if women fail to obey their husbands or please them sexually, men are allowed to beat their wives. Interviews explored that the violation of women's sexual rights might be closely related to men's gendered views about women's rights.

Community understandings of and responses to gender equality and empowerment in Rakai, Uganda

Women's rights and gender empowerment programmes are now part of the international agenda for improving global public health, the benefits of which are well documented. However, the public health community has, yet, to address how people define and understand gender equality and how they enact the process of empowerment in their lives. This study uses safe homes and respect for everyone (SHARE), an anti-violence intervention in rural Rakai, Uganda, as a case study to investigate perceptions of gender equality. Investigators analysed 12 focus groups of adult women and men to explore how macro-level concepts of gender equality are being processed on an interpersonal level and the effects on health outcomes. Respondents generally agreed that women lack basic rights. However, they also expressed widespread disagreement about the meanings of gender equality, and reported difficulties integrating the concepts of gender equality into their interpersonal relationships. Community members reported that equality, with the resulting shift in gender norms, could expose women to adverse consequences such as violence, infidelity and abandonment with increased sexual health risks, and potential adverse effects on education. Efforts to increase women's rights must occur in conjunction with community-based work on understandings of gender equality.

A typology of structural approaches to HIV prevention: a commentary on Roberts and Matthews

Renewed enthusiasm for biomedical HIV prevention strategies has followed the recent publication of several high-profile HIV antiretroviral therapy-based HIV prevention trials. In a recent article, Roberts and Matthews (2012) accurately note some of the shortcomings of these individually targeted approaches to HIV prevention and advocate for increased emphasis on structural interventions that have more fundamental effects on the population distribution of HIV. However, they make some implicit assumptions about the extent to which structural interventions are user-independent and more sustainable than biomedical or behavioral interventions. In this article, I elaborate a simple typology of structural interventions along these two axes and suggest that they may be neither user-independent nor sustainable and therefore subject to the same sustainability concerns, costs, and potential unintended consequences as biomedical and behavioral interventions.

Examining the determinants of sexual violence among young, married women in Southern India

The prevalence of sexual violence is increasingly being studied in India. Yet the determinants of sexual violence, irrespective of physical violence, remain largely unexplored. Here the authors identify the determinants of sexual violence, and additionally, explore how the presence of physical violence modifies these determinants. A cross-sectional analysis is conducted using baseline data from a longitudinal study involving young married women attending reproductive health clinics in Southern India. A multivariable logistic regression analysis is conducted to first identify determinants of sexual violence and then repeated after stratifying elements based on presence or absence of physical violence identified from participants' reports. 36% and 50% of the participants report experiencing sexual and physical violence, respectively. After adjusting for other covariates, women's partners' characteristics are found most significantly associated with their odds of experiencing sexual violence. These characteristics include husbands' primary education, employment as drivers, alcohol consumption, and having multiple sex partners. Women's contribution to household income also increases their odds of experiencing sexual violence by almost twofold; however, if they are solely responsible for "all" household income, the relationship is found to be protective. Physical violence modifies the determinants of sexual violence, and among women not experiencing physical violence, husbands' primary education and employment as drivers increase women's odds of experiencing sexual violence nearly threefold, and women who contribute "all" the household income (n = 62) do not experience sexual violence. These relationships are not significant among women experiencing physical violence. Study findings improve the understanding of the determinants of sexual violence. Future research is needed to examine the risk factors for different types of GBV independently and to tease apart the differences in risk factors depending on women's experiences. The significance of male partners' characteristics warrants in-depth research, and in order to promote gender-equitable norms, future interventions need to focus on male behaviors and men's day-to-day survival challenges, all of which likely influence conflicts in marital relationships.

Attitudes towards justifying intimate partner violence among married women in Bangladesh

This study examines women's attitude towards intimate partner violence among 331 Bangladeshi women in five selected disadvantaged areas of Dhaka city. This study used a shorter version of the Inventory of Beliefs about Wife Beating (IBWB) to measure women's attitude towards intimate partner violence. The results revealed that the mean score on the wife-beating scale of 15 items was 7.81 (SD = 4.893). Significant amounts of the variance (42.9%) in women's attitude towards intimate partner violence can be attributed to respondent's education (B = -0.60, p < 0.001), husband's education (B = -1.251, p < 0.01), exposure to mass media (B = -1.251, p < 0.01), respondent's current age (B = 0.081, p < 0.05), age at marriage (B = 0.215, p < 0.01), intimate partner violence victimization within the last 12 months (B = -1.533, p < 0.001) and women receiving micro-credit (small-scale loan or financial assistance) (B = -2.214, p < 0.001). The paper concludes with a discussion of the implications of the findings.

Piloting a Savings-Led Microfinance Intervention with Women Engaging in Sex Work in Mongolia: Further Innovation for HIV Risk Reduction

This paper describes a pilot study testing the feasibility of an innovative savings-led microfinance intervention in increasing the economic empowerment and reducing the sexual risk behavior of women engaging in sex work in Mongolia. Women’s economic vulnerability may increase their risk for HIV by compromising their ability to negotiate safer sex with partners and heightening the likelihood they will exchange sex for survival. Microfinance has been considered a potentially powerful structural HIV prevention strategy with women conducting sex work, as diversification of income sources may increase women’s capacity to negotiate safer transactional sex. With 50% of all reported female HIV cases in Mongolia detected among women engaging in sex work, direct prevention intervention with women conducting sex work represents an opportunity to prevent a potentially rapid increase in HIV infection in urban Mongolia. The piloted intervention consisted of a matched savings program in which matched savings could be used for business development or vocational education, combined with financial literacy and business development training for women engaging in sex work. Results of the pilot demonstrate participants’ increased confidence in their ability to manage finances, greater hope for pursuing vocational goals, moderate knowledge gains regarding financial literacy, and an initial transition from sex work to alternative income generation for five out of nine participants. The pilot findings highlight the potential for such an intervention and the need for a clinical trial testing the efficacy of savings-led microfinance programs in reducing HIV risk for women engaging in sex work in Mongolia.

Does economic empowerment protect women from intimate partner violence?

Background:

The current study compared working and non-working groups of women in relation to intimate partner violence. The paper aims to explore the relationship between women's economic empowerment, their exposures to IPV and their help seeking behavior using a nationally representative sample in India.

Methods:

This was a cross sectional study of 124,385 ever married women of reproductive age from all 29 member states in India. Chi-square tests were used to examine differences in proportions of dependent variables (exposure to IPV) and independent variables. Multivariate logistic regressions were used to assess the independent contribution of the variables of economic empowerment in predicting exposure to IPV.

Results:

Out of 124,385 women, 69432 (56%) were eligible for this study. Among those that were eligible 35% were working. In general, prevalence of IPV (ever) among women in India were: emotional violence 14%, less severe physical violence 31%, severe physical violence 10% and sexual violence 8%. For working women, the IPV prevalence was: emotional violence 18%, less severe physical violence 37%, severe physical violence 14% and sexual violence 10%; whilst for non-working women the rate was 12, 27, 8 and 8 percents, respectively. Working women seek more help from different sources.

Conclusions:

Economic empowerment is not the sole protective factor. Economic empowerment, together with higher education and modified cultural norms against women, may protect women from IPV.

Prevalence and correlates of physical spousal violence against women in slum and nonslum areas of urban Bangladesh

This study explores the prevalence and correlates of past-year physical violence against women in slum and nonslum areas of urban Bangladesh. The authors use multivariate logistic regression to analyze data from the 2006 Urban Health Survey, a population-based survey of 9,122 currently married women aged between 15 and 49 who were selected using a multistage cluster sampling design. The prevalence of reported past-year physical spousal violence is 31%. Prevalence of past-year physical spousal violence is higher in slums (35%) than in nonslums (20%). Slapping/arm-twisting and pushing/shaking/ throwing something at the women are the most commonly reported acts of physical abuse. Multivariate analysis shows that the risk of physical spousal abuse is lower among older women, women with post-primary education, and those belonging to rich households and women whose husbands considered their opinion in decision making. Women are at higher risk of abuse if they had many children, believe that married woman should work if the husband is not making enough money, and approve wife-beating norms. This study serves to confirm the commonness of physical spousal abuse in urban Bangladesh, demonstrating the seriousness of this multifaceted phenomenon as a social and public health issue. The present findings suggest the need for comprehensive prevention and intervention strategies that capitalize on the interplay of individual and sociocultural factors that cause physical spousal violence. Our study adds to a growing literature documenting domestic violence against women in urban areas of developing south Asian nations.

What Matters for Marginalized Girls and Boys in Bangladesh: A Capabilities Approach for Understanding Educational Well-Being and Empowerment

Ensuring the education of marginalized children has become an important agenda in order to reach the goals of universal primary education and gender equality. Education policies and projects aiming to target marginalized children often do so on the basis of demographic variables, such as sex, ethnicity, poverty and geography. We argue that this approach to defining marginality does not sufficiently address underlying discriminatory conditions and norms that perpetuate inequalities. In this article, we employed a capabilities approach as an analytical frame to understand what girls and boys in a rural district in Bangladesh reason affects their educational well-being and empowerment. We draw on critical feminist perspectives of empowerment to illustrate how gendered inequalities are perpetuated in the structures and norms in communities and schools. We argue that specific conditions can differentially marginalize or empower, and these conditions have persistent gendered patterns. Conditions of a safe, supportive, and quality educational environment foster possibilities for empowerment and well-being, and conversely, a lack of these conditions can marginalize children from achieving well-being through education.

Assessing the incremental effects of combining economic and health interventions: the IMAGE study in South Africa

OBJECTIVE

To explore whether adding a gender and HIV training programme to microfinance initiatives can lead to health and social benefits beyond those achieved by microfinance alone.

METHODS

Cross-sectional data were derived from three randomly selected matched clusters in rural South Africa: (i) four villages with 2-year exposure to the Intervention with Microfinance for AIDS and Gender Equity (IMAGE), a combined microfinance-health training intervention; (ii) four villages with 2-year exposure to microfinance services alone; and (iii) four control villages not targeted by any intervention. Adjusted risk ratios (aRRs) employing village-level summaries compared associations between groups in relation to indicators of economic well-being, empowerment, intimate partner violence (IPV) and HIV risk behaviour. The magnitude and consistency of aRRs allowed for an estimate of incremental effects.

FINDINGS

A total of 1409 participants were enrolled, all female, with a median age of 45. After 2 years, both the microfinance-only group and the IMAGE group showed economic improvements relative to the control group. However, only the IMAGE group demonstrated consistent associations across all domains with regard to women's empowerment, intimate partner violence and HIV risk behaviour.

CONCLUSION

The addition of a training component to group-based microfinance programmes may be critical for achieving broader health benefits. Donor agencies should encourage intersectoral partnerships that can foster synergy and broaden the health and social effects of economic interventions such as microfinance.

Correlates of violent response among Peruvian women abused by an intimate partner

The authors sought to identify correlates of violent response among women exposed to intimate partner violence (IPV) in Lima, Peru. A structured questionnaire was used to collect information on exposure to IPV and women's physical violent reaction towards their abuser. Women who were sexually abused by their partners, as compared with women who experienced emotional abuse only, were more than twice as likely to respond in a violent manner to the abuse (OR = 2.32, 95% CI = 1.14-4.74). Similarly, women who reported being physically abused, were 4 times as likely than those who experienced emotional abuse only to retaliate in a physically violent manner (OR = 4.04, 95% CI = 2.68-6.11). Women's educational status, history of witnessing parental violence as a child, and type of IPV are significantly associated with women's violent response. Community support networks and culturally appropriate intervention programs designed to prevent and mitigate the impact of IPV are needed.

Domestic violence and contraceptive use in a rural Indian village

This study uses qualitative methods to examine how domestic violence affects the use of contraceptives by women in a rural village in India. The study highlights how multilevel factors are linked to a woman's ability to contracept and make fertility decisions in a context where being a wife implies obedience, limited mobility, sexual availability, and high fertility. The authors find that violence is normalized, or considered acceptable, if women do not adhere to expected gender roles. Although women's ability to make autonomous decisions is shown to be limited, the study explores covert strategies used to avoid pregnancy, which also tend to increase women's risk of experiencing domestic violence.

Exploring the role of economic empowerment in HIV prevention

It has been argued that women's economic vulnerability and dependence on men increases their vulnerability to HIV by constraining their ability to negotiate the conditions, including sexual abstinence, condom use and multiple partnerships, which shape their risk of infection. In the face of escalating infection rates among women, and particularly young women, many have pointed to the potential importance of economic empowerment strategies for HIV prevention responses. Global evidence suggests that the relationship between poverty and HIV risk is complex, and that poverty on its own cannot be viewed simplistically as a driver of the HIV epidemic. Rather, its role appears to be multidimensional and to interact with a range of other factors, including mobility, social and economic inequalities and social capital, which converge in a particularly potent way for young women living in southern Africa. To date, there have been few interventions that have explicitly attempted to combine economic empowerment with the goal of HIV prevention, and even fewer that have been rigorously evaluated. This paper explores how programmes such as microfinance, livelihood training and efforts to safeguard women's food security and access to property have begun to incorporate an HIV prevention focus. Although such circumscribed interventions, by themselves, are unlikely to lead to significant impacts on a national or regional scale, they are useful for testing cross-sectoral partnership models, generating practical lessons and providing a metaphor for what might be possible in promoting women's economic empowerment more broadly. Despite numerous calls to 'mainstream AIDS' in economic development, cross-sectoral responses have not been widely taken up by government or other stakeholders. We suggest potential reasons for limited progress to date and conclude by presenting programme and policy recommendations for further exploring and harnessing linkages between economic empowerment and HIV prevention in Southern Africa.

Economic violence to women and girls: is it receiving the necessary attention?

Most studies on gender-based violence (GBV) have focused on its physical, sexual, and psychological manifestations. This paper seeks to draw attention to the types of economic violence experienced by women, and describes its consequences on health and development. Economic violence experienced included limited access to funds and credit; controlling access to health care, employment, education, including agricultural resources; excluding from financial decision making; and discriminatory traditional laws on inheritance, property rights, and use of communal land. At work women experienced receiving unequal remuneration for work done equal in value to the men's, were overworked and underpaid, and used for unpaid work outside the contractual agreement. Some experienced fraud and theft from some men, illegal confiscation of goods for sale, and unlawful closing down of worksites. At home, some were barred from working by partners; while other men totally abandoned family maintenance to the women. Unfortunately, economic violence results in deepening poverty and compromises educational attainment and developmental opportunities for women. It leads to physical violence, promotes sexual exploitation and the risk of contracting HIV infection, maternal morbidity and mortality, and trafficking of women and girls. Economic abuse may continue even after the woman has left the abusive relationship. There is need for further large-scale studies on economic violence to women. Multi-strategy interventions that promote equity between women and men, provide economic opportunities for women, inform them of their rights, reach out to men and change societal beliefs and attitudes that permit exploitative behavior are urgently required.