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Adverse childhood experiences (ACEs) are a global public health problem, including in low- and middle-income country settings, and are associated with increased risk of intimate partner violence (IPV) during young adulthood. However, current measurement of ACEs may underestimate sequelae of different combinations, or classes, of ACEs and mask class-specific associations with adult exposure to IPV. We used data among ever-partnered young women and men aged 18–24 years from the Cambodia Violence Against Children Survey ( Nw = 369; Nm = 298). Participants retrospectively reported on seven ACEs and lifetime physical and/or sexual IPV victimization and perpetration. Latent classes comprised of ACEs were used as predictors of physical and/or sexual IPV perpetration and victimization, controlling for household wealth. Identified latent classes for women were “Low ACEs” (60%), “Community Violence and Physical Abuse” (23%), and “Physical, Sexual and Emotional Abuse” (17%). Latent classes for men were “Low ACEs” (48%) and “Household and Community Violence” (52%). Among women, those in the Physical, Sexual and Emotional Abuse class were more likely to experience and perpetrate physical and/or sexual IPV in their romantic relationships compared to the reference group (Low ACEs). Women in the Community Violence and Physical Abuse class were more likely to perpetrate physical and/or sexual IPV, but not experience IPV, compared to women in the Low ACEs class. Among men, those in the Household and Community Violence class were more likely to perpetrate physical and/or sexual IPV against a partner, compared to men in the Low ACEs class. Overall, patterns of ACEs were differently associated with IPV outcomes among young women and men in Cambodia. National violence prevention efforts might consider how different combinations of childhood experiences shape risk of young adulthood IPV and tailor interventions accordingly to work with youth disproportionately affected by varied combinations of ACEs.

Women comprise two-thirds of the global-health (GH) workforce but are underrepresented in leadership. GH departments are platforms to advance gender equality in GH leadership. Using a survey of graduates from one GH department, we compared women's and men's post-training career agency and GH employment and assessed whether gender gaps in training accounted for gender gaps in career outcomes. Master-of-Public-Health (MPH) and mid-career-fellow alumni since 2010 received a 31-question online survey. Forty-four per cent of MPH alum and 24% of fellows responded. Using logistic regression, we tested gender gaps in training satisfaction, career agency, and GH employment, unadjusted and adjusted for training received. Women (

Women’s empowerment is an indicator of social change and a priority of the Sustainable Development Goals. Debate continues on what domains constitute women’s empowerment and how to measure empowerment across countries. Demographic and Health Surveys (DHS) are the most widely available source of data on women’s empowerment. However, measurement invariance often is assumed, but not tested. We used DHS data from Ethiopia, Kenya, Rwanda, Tanzania, and Uganda to test factor structure and measurement invariance of women’s empowerment among married women ages 15–49. Factor analysis confirmed a three-latent-domain model of women’s empowerment in each country capturing women’s human/social assets, gender attitudes related to wife abuse, and women’s participation in household decisions. Multi-country confirmatory factor analysis (CFA) identified an invariant three-factor model of women’s empowerment and a subset of country-specific items. Our results offer a standardized, invariant measure of women’s empowerment that can be applied to monitor women’s empowerment cross-nationally in East Africa, and possibly beyond.

Sexual stigma has deleterious effects on the health and wellbeing of sexual minority women. In low- and middle-income countries, theories and research on stigma against sexual minority women largely focus on sexuality-related stigma processes, such as internalized homophobia or perceived or enacted stigma due to sexual identity, attraction or practice. Yet, there is considerable gender diversity among sexual minority women. Further, sexuality and gender identity may intersect with broader gender inequalities to influence the experience of stigma among some groups. In this study, we conducted 21 qualitative life-history interviews with self-identified toms in Bangkok, the capital city of Thailand, to evaluate whether and how gender identity, independent of and together with same-sex sexuality, influences experiences of stigma among gender non-conforming sexual minority women. We find that the pervasive experiences of stigma against toms derive as much from their assumed masculinity in Thai society, as from their same-sex sexuality. Notably, coercive feminization (attempts by others to orient toms toward sexual and gendered expectations of Thai femininity) and boundary policing (expressed hostility toward tom gender performance and sexual intimacy with feminine Thai women) were manifestations of concurrent gender non-conformity and sexual stigma, shaped in turn by the unique location of toms within the Thai gender/sex system. We propose that research and theories on stigma and health among sexual minorities systematically integrate a gender perspective, to elucidate the effects of gender identity and location within the gender structure on sexual minority experiences of stigma.

Objectives The health and social effects of women's microfinance participation remain debated. Methods Using propensity-score methods, we assessed effects of microfinance participation on novel measures of agency; intimate partner violence (IPV) exposure; and depressive symptoms in 930 wives in Matlab, Bangladesh interviewed 11/2018–01/2019. Results Participants, versus non-participants, were married younger (16.7 vs. 17.4 years), more often Muslim (90.7% vs. 86.2%), less schooled (5.4 vs. 6.8 grades), and more often had husbands (27.0% vs. 19.6%) and mothers (63.2% vs. 50.5%) without schooling. Participants and non-participants had similar unadjusted mean scores for prior-week depressive symptoms, prior-year IPV, and intrinsic attitudinal agency (gender-equitable attitudes; non-justification of wife beating). Participants had higher unadjusted mean scores for intrinsic voice/mobility; instrumental agency (using financial services, voice with husband, voice/mobility outside home); and collective agency. Average adjusted treatment effects were non-significant for depressive symptoms, IPV, and attitudinal intrinsic agency, and significantly favorable for other agency outcomes. Conclusions Microfinance participation had no adverse health effects and favorable empowerment effects in Bangladeshi wives. Policy Implications. Microfinance can empower women without adverse health effects. Social-norms programming with men and women may be needed to change gendered expectations about the distribution of unpaid labor and the rights of women.

Measurement of women's agency in specific sociocultural conditions, particularly in Middle Eastern settings, has received limited attention, making its usefulness as an outcome or predictor of gender equality unclear.This study aimed to construct and validate a multidimensional and context-specific scale of women's agency in rural Minya, Egypt.Using data from 608 ever-married women in 2012, confirmatory and exploratory factor analysis were used to construct a scale measuring women's agency in rural Minya. The scale was validated through exploratory structural equation models.The 21-item model consisted of three factors (decision-making, freedom of movement and gender role attitudes), each corresponding to a previously-theorized domain of women's agency. The three factors were positively correlated, supporting women's agency as a multidimensional, context-specific construct. The strongest correlation was between decision-making and freedom of movement (0.410), and then between freedom of movement and gender attitudes (0.307); the weakest correlation was between decision-making and gender attitudes (0.211). Although we hypothesized that each domain would be positively associated with age, only decision-making was significantly and positively associated with women's age.Similarities between the items used here and a study at the national level in Egypt suggest these indicators could be used in various Egyptian settings to monitor progress on the United Nations Sustainable Development Goal 5 on empowering women and girls, and to assess the effect of policies and programmes. Future research should build on the findings to identify the best observable indicators of women's agency in Egypt and elsewhere.تمكين المرأة في مصر: إنشاء مقياس متعدد الأبعاد والتحقُّق منه في ريف محافظة المنيا.رانيا سالم، يوك فاي شونج، ستيفاني ميديما، كاثرين يونت.هناك أبحاث محدودة أُجريت لقياس تمكين المرأة في ظل أوضاع اجتماعية وثقافية محددة، لا سيما في السياقات الشرق أوسطية.هدفت هذه الدراسة إلى إنشاء مقياس متعدد الأبعاد ومحدد السياق حول تمكين المرأة في المناطق الريفية بالمنيا، في مصر، والتحقُّق منه.باستخدام بيانات تعود لعام 2012 مستمدة من 608 سيدة سبق لها الزواج، أُجري تحليل عاملي توكيدي واستكشافي لإنشاء مقياس يتيح قياس تمكين المرأة في ريف المنيا. وتم التحقق من المقياس من خلال نماذج معادلات تركيبية استكشافية.تألف النموذج المكون من 21 بنداً من ثلاثة عوامل (صُنع القرار، وحرية التنقل، والمواقف إزاء الدور الجندري)، والتي توافقت مع واحد من مجالات تمكين المرأة سبق وأن وُضعت له نظرية. وظهرت علاقة ارتباطية إيجابية بين العوامل الثلاثة، ما يدعم تمكين المرأة باعتباره مفهوماً متعدد الأبعاد ومحدد السياق. وكانت العلاقة الارتباطية الأقوى بين صنع القرار وحرية التنقل (0.410)، يتبعها العلاقة الارتباطية بين حرية التنقل والمواقف إزاء الدور الجندري (0.307)؛ بينما كانت العلاقة الارتباطية الأضعف بين صنع القرار والمواقف إزاء الدور الجندري (0.211). وبالرغم من وضع افتراض بوجود علاقة ارتباط إيجابية بين عمر المرأة وكل مجال من المجالات الثلاثة على حدة، فقد كان صنع القرار هو العامل الأوحد الذي ارتبط بصورة جوهرية وإيجابية بعمر المرأة.توحي أوجه التشابه بين البنود المستخدمة هنا والمستخدمة في دراسة أخرى جرت على المستوى الوطني بأن تلك المؤشرات يمكن استخدامها في سياقات مصرية عديدة لرصد التقدم المحرز بشأن الهدف الخامس من أهداف التنمية المستدامة المتعلق بتمكين المرأة والفتيات، وكذلك تقييم الأثر المترتب على السياسات والبرامج في هذا المضمار. وينبغي على الأبحاث القادمة البناء على هذه النتائج من أجل تحديد أفضل المؤشرات القابلة للملاحظة حول تمكين المرأة في مصر وفي غيرها من البُلدان.Le pouvoir d’agence des femmes en Égypte : établissement et validation d’une échelle multidimensionnelle dans la région rurale de Minya.La mesure du pouvoir d’agence des femmes dans des conditions socioculturelles spécifiques, en particulier au Moyen-Orient, n’a fait l’objet que de peu d’attention ; de ce fait, son utilité en tant que résultat ou que facteur prédictif n’est pas claire.La présente étude avait pour objectif d’établir et de valider une échelle multidimensionnelle et spécifique au contexte du pouvoir d’agence des femmes dans la région rurale de Minya en Égypte.Sur la base de données recueillies en 2012 auprès de 608 femmes mariées ou l’ayant été, des analyses factorielles confirmatoire et exploratoire ont été utilisées pour mettre au point une échelle permettant d’évaluer le pouvoir d’agence des femmes dans la région rurale de Minya. L’échelle a été validée à l’aide de modèles d’équations structurelles exploratoires.Le modèle constitué de 21 items comprenait trois facteurs (prise de décisions, liberté de mouvement et attitudes sexospécifiques) qui correspondaient chacune à un domaine précédemment théorisé se rapportant au pouvoir d’agence des femmes. Les trois facteurs étaient corrélés positivement, confirmant le pouvoir d’agence des femmes en tant que concept multidimensionnel et spécifique au contexte. La corrélation la plus forte était celle entre la prise de décisions et la liberté de mouvement (0,410), puis entre la liberté de mouvement et les attitudes sexospécifiques (0,307) ; la corrélation la plus faible étant celle entre la prise de décisions et les attitudes sexospécifiques (0,211). Bien que l’on ait émis l’hypothèse que chaque domaine serait positivement associé à l’âge, seule la prise de décisions a été corrélée de manière significative et positive à l’âge des femmes.Les similitudes entre les items utilisés ici et une étude menée au niveau national en Égypte laissent penser que ces indicateurs pourraient être utilisés dans divers contextes égyptiens pour suivre les progrès de la réalisation de l’Objectif 5 du développement durable sur l’autonomisation des femmes et des filles, et évaluer l’impact des politiques et des programmes. Les recherches futures devraient s’appuyer sur ces conclusions pour identifier les meilleurs indicateurs observables du pouvoir d’agence des femmes en Égypte et ailleurs.

Globalization theories have proliferated over the past two decades. However, global developments have yet to be systematically incorporated into theories around violence against women. This article proposes to add a global level to the existing ecological model framework, popularized by Lori Heise in 1998, to explore the relationships between global processes and experiences of violence against women. Data from the Maldives and Cambodia are used to assess how globalized ideologies, economic development and integration, religious fundamentalisms, and global cultural exchange, as components of a larger globalization process, have affected men and women’s experiences and perceptions of violence against women.

In this essay, we discuss the under-representation of women in leadership positions in global health (GH) and the importance of mentorship to advance women's standing in the field. We then describe the mentorship model of GROW, Global Research for Women. We describe the theoretical origins of the model and an adapted theory of change explaining how the GROW model for mentorship advances women's careers in GH. We present testimonials from a range of mentees who participated in a pilot of the GROW model since 2015. These mentees describe the capability-enhancing benefits of their mentorship experience with GROW. Thus, preliminary findings suggest that the GROW mentorship model is a promising strategy to build women's leadership in GH. We discuss supplemental strategies under consideration and next steps to assess the impact of GROW, providing the evidence to inform best practices for curricula elsewhere to build women's leadership in GH.

Women's empowerment is associated with improved child nutrition, and both underpin the achievement of multiple Sustainable Development Goals (SDGs). We examined pathways by which women's empowerment influences child nutritional status. We pooled nationally representative data from Demographic and Health Surveys (2011–2016) collected from married women with children aged 6–24 months in Ethiopia, Kenya, Rwanda, Tanzania, and Uganda (n = 13,780). We operationalized child nutritional status using anemia, height-for-age z-score (HAZ), and weight-for-age z-score (WHZ). We operationalized women's empowerment using a validated measure comprised of three latent domains: social/human assets (“assets”), intrinsic agency (attitudes about intimate partner violence), and instrumental agency (influence in household decision making). We used structural equation models with latent constructs to estimate hypothesized pathways from women's empowerment to child nutritional status with further mediation by maternal body mass index (BMI) and stratification by wealth. Women's empowerment domains were directly and positively associated with maternal BMI (estimate±SE: assets, 0.17 ± 0.03; intrinsic agency, 0.23 ± 0.03; instrumental agency, 0.03 ± 0.01). Maternal BMI was directly and positively associated with child HAZ (0.08 ± 0.04) and child WHZ (0.35 ± 0.03). Assets were indirectly associated with child HAZ and WHZ through intrinsic agency and maternal BMI. In the lowest wealth category, the direct effects from women's empowerment to child nutritional status were significant (assets and instrumental agency were associated with anemia; intrinsic agency associated with HAZ). In the highest wealth category, direct effects from women's empowerment on child nutritional status were significant (intrinsic and instrumental agency associated with WHZ). Improving women's empowerment, especially intrinsic agency, in East Africa could improve child nutrition directly and via improved maternal nutrition. These findings suggest that efforts to realize SDG 5 may have spillover effects on other SDGs. However, strategies to improve nutrition through empowerment approaches may need to also address household resource constraints., Highlights • Empowerment domains associated differently with child nutrition in East Africa. • Paths from empowerment to child nutrition differ by household wealth. • Assets and Intrinsic agency more relevant for anthropometric status.