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Background Global evidence shows that men’s harmful alcohol use contributes to intimate partner violence (IPV) and other harms. Yet, interventions that target alcohol-related harms to women are scarce. Quantitative analyses demonstrate links with physical and verbal aggression; however, the specific harms to women from men’s drinking have not been well articulated, particularly from an international perspective. Aim To document the breadth and nature of harms and impact of men’s drinking on women. Methods A narrative review, using inductive analysis, was conducted of peer-reviewed qualitative studies that: (a) focused on alcohol (men’s drinking), (b) featured women as primary victims, (c) encompassed direct/indirect harms, and (d) explicitly featured alcohol in the qualitative results. Papers were selected following a non-time-limited systematic search of key scholarly databases. Results Thirty papers were included in this review. The majority of studies were conducted in low- to middle-income countries. The harms in the studies were collated and organised under three main themes: (i) harmful alcohol-related actions by men (e.g. violence, sexual coercion, economic abuse), (ii) impact on women (e.g. physical and mental health harm, relationship functioning, social harm), and (iii) how partner alcohol use was framed by women in the studies. Conclusion Men’s drinking results in a multitude of direct, indirect and hidden harms to women that are cumulative, intersecting and entrench women’s disempowerment. An explicit gendered lens is needed in prevention efforts to target men’s drinking and the impact on women, to improve health and social outcomes for women worldwide.

Objectives To describe associations between men’s poor mental health (depressive and post-traumatic stress symptomatology) and their perpetration of intimate partner violence (IPV) and non-partner sexual violence (NPSV), and women’s mental health and their experiences of IPV and NPSV in five settings in the Global South.Design A pooled analysis of data from baseline interviews with men and women participating in five violence against women and girls prevention intervention evaluations.Setting Three sub-Saharan African countries (South Africa, Ghana and Rwanda), and one Middle Eastern country, the occupied Palestinian territories.Participants 7021 men and 4525 women 18+ years old from a mix of self-selecting and randomly selected household surveys.Main outcome measures All studies measured depression symptomatology using the Centre for Epidemiological Studies-Depression, and the Harvard Trauma Scale for post-traumatic stress disorder (PTSD) symptoms among men and women. IPV and NPSV were measured using items from modified WHO women’s health and domestic violence and a UN multicountry study to assess perpetration among men, and experience among women.Findings Overall men’s poor mental health was associated with increased odds of perpetrating physical IPV and NPSV. Specifically, men who had more depressive symptoms had increased odds of reporting IPV (adjusted OR (aOR)=2.13; 95%CI 1.58 to 2.87) and NPSV (aOR=1.62; 95% CI 0.97 to 2.71) perpetration compared with those with fewer symptoms. Men reporting PTSD had higher odds of reporting IPV (aOR=1.87; 95% CI 1.44 to 2.43) and NPSV (aOR=2.13; 95% CI 1.49 to 3.05) perpetration compared with those without PTSD. Women who had experienced IPV (aOR=2.53; 95% CI 2.18 to 2.94) and NPSV (aOR=2.65; 95% CI 2.02 to 3.46) had increased odds of experiencing depressive symptoms compared with those who had not.Conclusions Interventions aimed at preventing IPV and NPSV perpetration and experience must account for the mental health of men as a risk factor, and women’s experience.

Objectives To test associations between men’s past year alcohol use and patterns of drinking, and their perpetration of intimate partner violence (IPV) and non-partner sexual violence (NPSV). To test the associations between women’s reports of partner alcohol use and their experience of IPV, in three countries in Africa.Design Pooled analysis of cross-sectional baseline data from men and women participating in four IPV prevention studies across Africa and Asia.Setting Data from five data sets generated by four violence against women and girls prevention studies in three countries in sub-Saharan Africa, South Africa, Ghana and Rwanda.Participants 8104 men 18+ years old and 5613 women 18+ years old from a mix of volunteer and randomly selected samples.Main outcome measures Studies employed comparable measures of past year alcohol use, harmful alcohol use (Alcohol Use Disorder Identification Test scale) and items from modified WHO Women’s Health and Domestic Violence to measure physical IPV and NPSV perpetration among men and IPV experience among women.Findings Overall harmful alcohol use among men was associated with a substantially increased odds of perpetrating physical IPV (adjusted OR (aOR)=3.45 (95% CI 2.56 to 4.64)) and NPSV (aOR=2.64 (95% CI 1.85 to 3.76)) compared with non-drinkers. Women who had seen their partner occasionally drunk (aOR=2.68 (95% CI 2.13 to 3.36)) or frequently drunk (aOR=5.94 (95% CI 4.19 to 8.41)) in the past 12 months had an increased odds of experiencing physical IPV.Conclusions Alcohol use is associated with increased IPV and NPSV perpetration for men and (physical) IPV experience for women. Reported frequency of IPV and NPSV increase with increasing levels and frequency of alcohol use. Interventions aimed at reducing alcohol may also lead to reductions in IPV and NPSV perpetration and experience.

Background: Informal settlements have high rates of poor mental health, yet little research has looked at PTSD-depression co-occurrence in these settings. We investigated the prevalence of depression, PTSD, and comorbid PTSD-depression amongst a non-clinical sample of 18–30 year old women, in informal settlements in South Africa. Methods: Cross-sectional analysis of self-selecting young women, enrolled at baseline of an intervention trial. We assessed the occurrence of depression, PTSD and co-occurring PTSD and depression, and used multinomial and logistic regressions to assess risk factors for these. Results: Depression, PTSD and comorbid PTSD-depression were reported by 45.2%, 21.0% and 18.6% of the women respectively. Depression was associated with social group membership (ß -0.74, p = 0.022), food insecurity (ß. 0.97, p = 0.001), stress related to lack of work (ß 0.61, p = 0.022), childhood traumas (ß 0.07, p = 0.004), IPV (ß 0.58, p = 0.007), other lifetime traumas (ß 0.51, p = 0.021) and alcohol misuse (ß 0.04, p = 0.002). Comorbid PTSD-depression was associated with social group membership (ß -0.73, p = 0.008), lack of work stress (ß 1.13, p = 0.009), disability (ß 0.99, p = 0.002), childhood traumas (ß 0.19, p

Background: Understanding the drivers of intimate partner violence (IPV), perpetrated by men and experienced by women, is a critical task for developing effective prevention programmes. Objectives: To provide a comprehensive assessment of the drivers of IPV. Methods: A comprehensive review of the drivers of IPV, at the end of a six-year programme of research through the What Works to Prevent Violence Against Women and Girls Global Programme with reference to other important research in the field. Results: Broadly, we argue that IPV is driven by poverty, patriarchal privilege, and the normative use of violence in interpersonal relationships. These factors also increase childhood trauma, poor mental health and substance misuse, and poor communication and conflict in relationships, which in turn impact on IPV. Disability status, and contexts of armed conflict, or post-conflict, further reinforce and exacerbate these risks. We move beyond describing associations towards describing the causal pathways through which these factors operate to increase IPV. Conclusions: Specific recommendations about the future of further research on drivers of IPV include a greater focus on understanding the causal pathways from drivers to IPV and clearly delineating association from causality in studies, particularly for women and girls with disabilities, in armed conflicts, and adolescent girls and young women. To achieve this, we recommend extensive in-depth qualitative research, and complex quantitative modeling studies. Understanding drivers and causal pathways better will enable the identification of points of entry for the development of more effective IPV prevention interventions.

Background: Alcohol is a risk factor for the leading causes of mortality and morbidity among young people globally. Youth drinking, initiated in early adolescence and continued into early adulthood, is influenced by maternal socio-demographic factors and maternal education. Limited prospective data exists in South Africa on the prevalence of alcohol use during adolescence and adolescent and maternal socio-demographic correlates. Objective: To examine the prevalence of lifetime alcohol use during early (13 years) and late (18 years) adolescence in Soweto, South Africa, and its association with child and maternal socio-demographic factors. Methods: Data on alcohol use in early adolescence (age 13 years) and late adolescence (age 18 years) were collected using self-completed pen and paper and self-completed computer-based questionnaires, respectively. Univariate analyses were conducted on child (gender and number of school years repeated by grade 7), maternal socio-demographic correlates (education, marital status, and age), and household socioeconomic status (SES). Bivariate logistic regression analyses examined associations between alcohol use and all child and maternal socio-demographic factors. Multivariate logistic regression analyses were conducted on all the variables found to be significantly (pB0.10) associated with alcohol use to examine the predictive value on alcohol use at early and late adolescence. Results: Lifetime alcohol use increased from 22% at early adolescence to 66% at late adolescence. In multivariate analyses, gender, maternal education, and SES predicted lifetime alcohol use at early adolescence, while gender, maternal education, marital status, and SES were predictive of the same at late adolescence. Conclusion: This study aids researchers and practitioners to identify maternal and child socio-demographic risk profiles for alcohol use to inform policies and programmes.