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Background Conducting ethical and rigorous research to measure the effectiveness of humanitarian programs is urgently needed given the global level of displacement and conflict, yet traditional approaches to evaluation research may be too slow and disruptive for acute humanitarian settings. The current case study utilizes an experience of implementing a mixed methods evaluation conducted between March–August 2018 in northern Raqqa Governorate, Syria. The key research objectives were to examine the influence of an unconditional, three-month cash transfer program on household basic needs and women’s wellbeing, including experiences of violence. This setting was selected for the research as it shared many aspects of an acute emergency within a protracted conflict given its recent opening of access to humanitarian aid programming following the withdrawal of ISIS as well as influxes of internally displaced persons fleeing airstrikes and fighting in Raqqa City in late 2017. Discussion The current case study was scientifically important as the use of cash assistance in emergencies has increased exponentially in recent years. Yet, little is still known about how cash assistance designed to help households meet their basic needs may also influence women’s overall wellbeing in the home. Challenges of conducting the research included selecting an emergency site appropriate for research, implementing an evaluation that would not delay or disrupt critical cash assistance programming, and measurement of sensitive violence against women outcomes. Four strategies were identified to meet the challenges of conducting an evaluation in such a setting, which included: (1) developing clear decision-making criteria for assessing feasibility; (2) frontloading processes to reduce time lag in launching research; (3) integrating the research approach within programming; and (4) closely collaborating with practitioners throughout the study, especially for research on sensitive topics like violence against women. Conclusions Advance consideration of these factors through a pre-positioning process will allow for timely, ethical, and rigorous research to be implemented in the immediate aftermath of a crisis. Such studies should be prioritized to ensure the highest effectiveness and efficiency of humanitarian aid for populations grappling with acute emergencies.

Improving women’s agency, namely their ability to define goals and act on them, is crucial for advancing gender equality and the empowerment of women. Yet, existing frameworks for measuring women’s...

INTRODUCTION: Few studies have investigated how IPV, and patterns of IPV experiences, may impact children’s school attendance in low- and middle-income countries. METHODS: Using baseline data from a sub-sample of 659 women in Mexico City enrolled in a randomized controlled trial who reported having a child under age 18 and in school, multilevel latent class analysis (LCA) was used to classify women based on their reported IPV experiences. Multilevel risk regression analyses examined associations between latent class membership and IPV-related disruptions in children’s schooling. Latent classes were identified in a prior study. RESULTS: Overall, 23.3% of women reported their child’s school attendance was disrupted due to IPV. LCA identified four distinct classes of IPV experiences: Low Physical and Sexual Violence (39.1%); Low Physical and High Sexual Violence class (14.8%), High Physical and Low Sexual Violence and Injuries (36.5%); and High Physical and Sexual Violence and Injuries (9.6%). Compared with women in the Low Physical and Sexual Violence class, women in the High Physical and Sexual Violence and Injuries class and women in the High Physical and Low Sexual Violence and Injuries class were at greater risk of IPV disrupting children’s school attendance (ARR=3.39, 95% CI=2.34, 4.92; ARR=2.22, 95% CI=1.54, 3.19, respectively). No other statistically significant associations emerged. DISCUSSION: High disruptions in children’s school attendance due to IPV were reported and were differentially related to patterns of IPV experiences. Findings underscore the need to understand underlying mechanisms. Future work integrating both violence against women and violence against children is needed.

Cash and voucher assistance is an efficient way to deliver assistance in emergency settings, and evidence demonstrates that cash programmes have consistent positive impacts on food security and oth...

BackgroundDisrupting women’s employment is a strategy that abusive partners could use to prevent women from maintaining economic independence and stability. Yet, few studies have investigated disruptions in employment among victims of intimate partner violence (IPV) in low-income and middle-income countries. Moreover, even fewer have sought to identify which female victims of IPV are most vulnerable to such disruptions.MethodsUsing baseline data from 947 women in Mexico City enrolled in a randomised controlled trial, multilevel latent class analysis (LCA) was used to classify women based on their reported IPV experiences. Furthermore, multilevel logistic regression analyses were performed on a subsample of women reporting current work (n=572) to investigate associations between LCA membership and IPV-related employment disruptions.ResultsOverall, 40.6% of women who were working at the time of the survey reported some form of work-related disruption due to IPV. LCA identified four distinct classes of IPV experiences: Low Physical and Sexual Violence (39.1%); High Sexual and Low Physical Violence class (9.6%); High Physical and Low Sexual Violence and Injuries (36.5%); High Physical and Sexual Violence and Injuries (14.8%). Compared with women in the Low Physical and Sexual Violence class, women in the High Physical and Sexual Violence and Injuries class and women in the High Physical and Low Sexual Violence and Injuries class were at greater risk of work disruption (adjusted relative risk (ARR) 2.44, 95% CI 1.80 to 3.29; ARR 2.05, 95% CI 1.56 to 2.70, respectively). No other statistically significant associations emerged.ConclusionIPV, and specific patterns of IPV experiences, must be considered both in work settings and, more broadly, by economic development programmes.Trial registration numberNCT01661504.

Background Rigorous evaluations of health sector interventions addressing intimate partner violence (IPV) in low- and middle-income countries are lacking. We aimed to assess whether an enhanced nurse-delivered intervention would reduce IPV and improve levels of safety planning behaviors, use of community resources, reproductive coercion, and mental quality of life. Methods We randomized 42 public health clinics in Mexico City to treatment or control arms. In treatment clinics, women received the nurse-delivered session (IPV screening, supportive referrals, health/safety risk assessments) at baseline (T1), and a booster counselling session after 3 months (T2). In control clinics, women received screening and a referral card from nurses. Surveys were conducted at T1, T2, and T3 (15 months from baseline). Our main outcome was past-year physical and sexual IPV. Intent-to-treat analyses were conducted via three-level random intercepts models to evaluate the interaction term for treatment status by time. Results Between April and October 2013, 950 women (480 in control clinics, 470 in treatment clinics) with recent IPV experiences enrolled in the study. While reductions in IPV were observed for both women enrolled in treatment (OR, 0.40; 95% CI, 0.28–0.55; P

Background. Raqqa Governorate, Syria has recently been affected by overlapping conflicts related to the Syrian Civil war and occupation by ISIS, resulting in widespread displacement and disruption of economic livelihoods. However, little information is currently known about mental health needs and risk factors among women. Therefore, this study sought to examine potential risk factors for depressive symptoms among married women living in northern Syria. Methods. Data were collected between March and April 2018 as part of an evaluation of an International Rescue Committee cash transfer program targeted toward vulnerable households. Using cross-sectional data from 214 married women participating in the program, linear regression models were generated to explore the associations between depressive symptoms [nine-item Patient Health Questionnaire (PHQ-9)] and its potential risk factors, including food insecurity, perceived deprivation of basic needs [the Humanitarian Emergency Settings Perceived Needs Scale (HESPER) scale], and past-3-month intimate partner violence (IPV). Results. The average depressive symptom score was 10.5 (s.d.: 4.9; range: 2–27). In the final adjusted model, any form of recent IPV (β = 2.25; 95% CI 0.92–3.57; p = 0.001), severe food insecurity (β = 1.62; 95% CI 0.27–2.96; p = 0.02) and perceived needs (β = 0.38; 95% CI 0.18–0.57; p = 0.0002) were associated with an increase in depressive symptoms. Conclusion. Study findings point to the need to address the mental health needs of women in conflict-affected areas of Syria. Programming to address risk factors for depression, including IPV and other factors associated with daily stressors such as food insecurity and deprivation of basic needs, may be effective in reducing depression in this population.

Purpose Little is known about whether effectiveness of intimate partner violence prevention programming varies for women who were married as child brides, given their additional social vulnerabilities. This subanalysis sought to assess treatment heterogeneity based on child marriage status for an intervention seeking to reduce intimate partner violence. Methods A randomized controlled trial assessing the incremental effectiveness of gender dialogue groups in addition to group savings on changing past-year intimate partner violence was conducted in Cote d'Ivoire (2010–2012). Stratified models were constructed based on child marriage status to assess for effect modification. Analysis was restricted to married women with data on age at marriage (n = 682). Results For child brides (N = 202), there were no statistically or marginally significant decreases in physical and/or sexual violence, physical violence, or sexual violence. The odds of reporting economic abuse in the past year were lower in the intervention arm for child brides relative to control group child brides (odds ratio [OR] = .33; 95% confidence interval [CI] = .13–.85; p = .02). For nonchild brides (N = 480), women were less likely to report physical and/or sexual violence (OR = .54; 95% CI = .28–1.04; p = .06), emotional violence (OR = .44; 95% CI = .25–.77; p = .004), and economic abuse (OR = .36; 95% CI = .20–.66; p = .001) in the combined intervention arm than their group savings–only counterparts. Conclusions Findings suggest that intervention participants with a history of child marriage may have greater difficulty benefiting from interventions that seek to reduce intimate partner violence.

Objective To assess the independent associations of partner-perpetrated reproductive coercion, intimate partner violence (IPV), in-law reproductive coercion, and in-law abuse with recent probable post-traumatic stress disorder (PTSD), and to test their relationship with PTSD symptoms when controlling for the other types of abuse among partnered women in rural Cote d’Ivoire. Methods Cross-sectional analyses were conducted using logistic generalized estimating equations, which accounted for village-level clustering. Data were drawn from baseline data from a randomized controlled trial among 24 villages in rural Cote d’Ivoire (n = 953 partnered women). Three adjusted models were used to test associations of reproductive coercion and abuse with probable PTSD. Results Partner-perpetrated reproductive coercion was experienced by 176 (18.5%) women. In model 3, which accounted for the co-occurrence of abuses, partner-perpetrated reproductive coercion (odds ratio [OR] 2.3; 95% confidence interval [CI], 1.4–3.9) and partner-perpetrated IPV (OR 1.7; 95% CI, 1.1–2.7) were the most significant predictors of past-week probable PTSD (P Conclusion Reproductive coercion may be a significant contributor to poor mental health. The mental health impacts of reproductive coercion and IPV should be considered within psychosocial programming for rural Ivorian communities to address the full range of traumatic experiences that may have been experienced by women.

Refugee women may experience multiple forms of victimization. The hypotheses underlying the present analyses were that experiences of victimization during conflict and intimate partner violence (IPV) would be associated with heightened odds of suicide ideation among refugee women living in 3 camps along the Thai-Burma border. Descriptive statistics were generated to describe the prevalence of conflict victimization, past-year IPV victimization, past-month suicide ideation, and covariates among partnered women with complete data (N = 848) from a cross-sectional survey conducted in early 2008. Logistic generalized estimating equations were used to assess the crude and adjusted relationships between variables. The mean age of women was 32.12 years, 91.0% were married, and 78.8% were of Karen ethnicity. Overall, 7.4% of women reported past-month suicide ideation. Of those women who did not experience any victimization or conflict victimization only, 5.1% and 5.2% reported suicide ideation, respectively. By contrast 26.7% of women who experienced only IPV victimization reported suicide ideation, and 50.0% of women who experienced both forms of victimization reported suicide ideation. Understanding each form of violence victimization and their relationships to suicide ideation may be important for targeting psychosocial services and violence prevention programs within protracted refugee settings.

Background: Audio-Computer Assisted Self- Interview (ACASI) is a method of data collection in which participants listen to pre-recorded questions through headphones and respond to questions by selecting their answers on a touch screen or keypad, and is seen as advantageous for gathering data on sensitive topics such as experiences of violence. This paper seeks to explore the feasibility and acceptability of using ACASI with adolescent girls and to document the implementation of such an approach in two humanitarian settings: conflict-affected communities in eastern Democratic Republic of Congo (DRC) and refugee camps along the Sudan-Ethiopia border. Methods: This paper evaluates the feasibility and acceptability of implementing ACASI, based on the experiences of using this tool in baseline data collections for COMPASS (Creating Opportunities through Mentorship, Parental involvement, and Safe Spaces) impact evaluations in DRC (N = 868) and Ethiopia (N = 919) among adolescent girls. Descriptive statistics and logistic regression models were generated to examine associations between understanding of the survey and selected demographics in both countries. Results: Overall, nearly 90% of girls in the DRC felt that the questions were easy to understand as compared to approximately 75% in Ethiopia. Level of education, but not age, was associated with understanding of the survey in both countries. Conclusions: Financial and time investment to ready ACASI was substantial in order to properly contextualize the approach to these specific humanitarian settings, including piloting of images, language assessments, and checking both written translations and corresponding verbal recordings. Despite challenges, we conclude that ACASI proved feasible and acceptable to participants and to data collection teams in two diverse humanitarian settings.

Violence against adolescent girls in humanitarian settings is of urgent concern given their additional vulnerabilities to violence and unique health and well-being needs that have largely been overlooked by the humanitarian community. In order to understand what works to prevent violence against adolescent girls, a multi-component curriculum-based safe spaces program (Creating Opportunities through Mentorship, Parental involvement and Safe Spaces – COMPASS) will be implemented and evaluated. The objectives of this multi-country study are to understand the feasibility, acceptability and effectiveness of COMPASS programming to prevent violence against adolescent girls in diverse humanitarian settings. Two wait-listed cluster-randomized controlled trials are being implemented in conflict-affected communities in eastern Democratic Republic of Congo (N = 886 girls aged 10–14 years) and in refugee camps in western Ethiopia (N = 919 girls aged 13–19 years). The intervention consists of structured facilitated sessions delivered in safe spaces by young female mentors, caregiver discussion groups, capacity-building activities with service providers, and community engagement. In Ethiopia, the research centers on the overall impact of COMPASS compared to a wait-list group. In DRC, the research objective is to understand the incremental effectiveness of the caregiver component in addition to the other COMPASS activities as compared to a wait-list group. The primary outcome is change in sexual violence. Secondary outcomes include decreased physical and emotional abuse, reduced early marriage, improved gender norms, and positive interpersonal relationships, among others. Qualitative methodologies seek to understand girls’ perceptions of safety within their communities, key challenges they face, and to identify potential pathways of change. These trials will add much needed evidence for the humanitarian community to meet the unique needs of adolescent girls and to promote their safety and well-being, as well as contributing to how multi-component empowerment programming for adolescent girls could be adapted across humanitarian settings. Clinical Trials NCT02384642 (Registered: 2/24/15) & NCT02506543 (Registered: 7/19/15).

The sole reference to sexual and reproductive health in the Millennium Development Goals (MDGs) is in MDG 5, which relates to improvement in maternal health. A great deal of attention has been focused upon measuring achievement of this goal, which called for a 75% reduction in maternal mortality ratios from 1990 by the year 2015. Although no scenario suggests that MDG 5 will have been reached by 2015, a number of new comprehensive estimation exercises have shown varying calculations. We fully concur with the need to systematically assess progress on maternal health in order to hold governments and other actors accountable. However, in this article, we agree with others that it was inappropriate for the MDGs to become national planning targets and argue that in the case of MDG 5, this elision was exacerbated by the principal indicator chosen: maternal mortality ratios (MMRs). Second, we explain why MMRs are inappropriate indicators to measure national progress from a human rights perspective and, in turn, set out criteria derived from human rights principles to apply in selecting indicators to measure maternal mortality, and provide the example of process indicators related to emergency obstetric care. Third, we go on to note that the debate about measuring maternal mortality in the context of the MDGs has in many ways displaced the larger and more important political debate, highlighted at the Cairo Conference in 1994, about what societal reforms are required to advance women's sexual and reproductive health and rights. Finally, we argue that real progress on women's health and rights pre- and post-2015 requires reopening that debate, and we call for engagement by the SRHR communities in this process.

Please cite this paper as: Gupta J, Falb K, Kpebo D, Annan J. Abuse from in-laws and associations with attempts to control reproductive decisions among rural women in Cote d'Ivoire: a cross-sectional study. BJOG 2012;119:1058–1066. Objective To document the lifetime prevalence of abuse from in-laws (both nonphysical maltreatment and physical violence), the forms of in-law abuse and reproductive control, and the relationship between experiences of in-law abuse and reproductive control among partnered women in rural Cote d'Ivoire. Design Cross-sectional study using baseline data (October 2010) from a randomised controlled trial examining socio-economic interventions on reduction of violence against Ivorian women. Setting Rural Cote d'Ivoire. Population A total of 981 Ivorian women aged 18 years and older who reported having a male partner and a current source of stable income. Methods Bivariate and multivariable logistic regression. Main outcome measures Lifetime, in-law-perpetrated reproductive control. Results More than one in four (27.0%) women reported experiencing lifetime in-law abuse. In adjusted logistic regression analysis, in-law abuse was significantly associated with in-law-perpetrated reproductive control (adjusted odds ratio 6.9; 95% confidence interval 3.9–12.2; P

BACKGROUND Stressful life events in childhood during critical periods of development have long-term psychological and neurobiological sequelae, which may affect risk for HIV infection across the life course. METHODS Data were from a nationally representative sample of 13,274 US men (National Epidemiologic Survey on Alcohol and Related Conditions, 2004-2005). Weighted multivariable logistic regression models examined (1) the association of childhood violent events before age 18 on 12-month incident HIV infection and (2) whether posttraumatic stress disorder (PTSD) diagnosis (clinical interview) mediated the association between early life events and HIV. RESULTS Overall, the 12-month HIV incidence was

Background Interpersonal violence is a major public health concern in humanitarian contexts, and adolescent girls are uniquely vulnerable. There is little evidence on effective violence prevention programmes targeting this population. We investigated the efficacy, feasibility, and acceptability of a life skills and safe spaces programme to reduce violence exposure for conflict-affected adolescent girls. Methods Evaluations were conducted in Ethiopia, the Democratic Republic of Congo (DRC), and Pakistan. In Ethiopia and DRC, the programme was evaluated via cluster-randomised controlled trials in refugee camps. In Ethiopia, girls aged 13–19 were enrolled. Girls and their caregivers in the treatment group received the intervention and the control group was waitlisted. In DRC, girls aged 10–14 and their caregivers were enrolled. All girls received the intervention and treatment was randomised for caregivers. In both Ethiopia and DRC, the primary outcome was girls' exposure to sexual violence. In Pakistan, a mixed-methods evaluation design focused on feasibility and acceptability. A single-group within-participants pre-post test was administered to 78 internally displaced and host community girls aged 12–19 enrolled in the programme. Qualitative in-depth interviews were conducted with a subset of 15 girls at endline. Primary outcomes included perceptions of programme content and changes in freedom of movement, safety, self-esteem, and hope. Findings In Ethiopia, 919 girls were enrolled, 457 in the intervention group and 462 in the wait-list group. At 12-month follow-up, the intervention was not significantly associated with reduction in exposure to sexual violence (aOR=0·96, 95% CI 0·59–1·57). In DRC, 869 girls ages 10–14 and 764 caregivers were enrolled. 389 caregivers received the intervention and 375 were wait-listed. At 12-month follow-up, the intervention was not significantly associated with reduction in exposure to sexual violence (aOR=0·95, 95% CI 0·65–1·37). In Pakistan, programme content was perceived as acceptable and freedom of movement, safety, self-esteem, and hope increased over time. Interpretation The intervention was feasible and acceptable in Pakistan, but further research and programmatic adaptations are needed to prevent adolescent violence in humanitarian contexts. Funding UK Department for International Development.

Objective To examine patterns of conflict-related violence and intimate partner violence (IPV) and their associations with emotional distress among Congolese refugee women living in Rwanda. Design Cross-sectional study. Setting Two Congolese refugee camps in Rwanda. Participants 548 ever-married Congolese refugee women of reproductive age (15–49 years) residing in Rwanda. Primary outcome measure Our primary outcome was emotional distress as measured using the Self-Report Questionnaire-20 (SRQ-20). For analysis, we considered participants with scores greater than 10 to be experiencing emotional distress and participants with scores of 10 or less not to be experiencing emotional distress. Results Almost half of women (49%) reported experiencing physical, emotional or sexual violence during the conflict, and less than 10% of women reported experiencing of any type of violence after fleeing the conflict. Lifetime IPV was reported by approximately 22% of women. Latent class analysis derived four distinct classes of violence experiences, including the Low All Violence class, the High Violence During Conflict class, the High IPV class and the High Violence During and After Conflict class. In multivariate regression models, latent class was strongly associated with emotional distress. Compared with women in the Low All Violence class, women in the High Violence During and After Conflict class and women in the High Violence During Conflict had 2.7 times (95% CI 1.11 to 6.74) and 2.3 times (95% CI 1.30 to 4.07) the odds of experiencing emotional distress in the past 4 weeks, respectively. Furthermore, women in the High IPV class had a 4.7 times (95% CI 2.53 to 8.59) greater odds of experiencing emotional distress compared with women in the Low All Violence class. Conclusions Experiences of IPV do not consistently correlate with experiences of conflict-related violence, and women who experience high levels of IPV may have the greatest likelihood for poor mental health in conflict-affected settings.

Almost 60% of Ivorian women residing in rural, conflict-affected communities report experiencing intimate partner violence (IPV) during their lifetime; this can lead to increased risk of negative reproductive and maternal health outcomes [1]. IPV could also be associated with food insecurity [2], which could further increase vulnerability to poor reproductive health. The aim of the present study was to explore associations between food insecurity and IPV among urban Ivorian women. Language: en

Background Intimate partner violence (IPV) victimization is a prevalent issue among women residing in Mexico City. Comprehensive and integrated health care provider (HCP) delivered programs in clinic-settings are needed, yet few have been evaluated in Latin America, including Mexico. In addition, there has been minimal attention to interventions among lower income women presenting at settings outside of antenatal care clinics. The current randomized controlled trial seeks to increase midlevel HCPs’ capacity, specifically nurses, who are often the first point of contact in this setting, to identify women presenting at health clinics with experiences of IPV and to assist these women with health risk mitigation. Specific outcomes include changes in past-year IPV (physical and/or sexual), reproductive coercion, safety planning, use of community resources, and quality of life. Methods/Design Forty-two public health clinics in Mexico City were randomized to treatment or control clinics. Nurses meeting eligibility criteria in treatment groups received an intensive training on screening for IPV, providing supportive referrals, and assessing for health and safety risks. Nurses meeting eligibility criteria at control clinics received the standard of care which included a one-day training focused on sensitizing staff to IPV as a health issue and referral cards to give to women. Women were screened for eligibility (currently experiencing abuse in a heterosexual relationship, 18-44 years of age, non-pregnant or in first trimester) by research assistants in private areas of waiting rooms in health clinics. Consenting women completed a baseline survey and received the study protocol for that clinic. In treatment clinics, women received the nurse delivered session at baseline and received a follow-up counseling session after three months. Surveys are conducted at baseline, three months, and fifteen months from baseline. Discussion This study will provide important insight into whether a nurse-delivered program can assist women currently experiencing abuse in a Latin American context. Findings can be used to inform IPV programs and policies in Mexico City’s public health clinics. Trial registration NCT01661504

BackgroundLittle is known about the interconnectedness of maternal deaths and impacts on children, beyond infants, or the mechanisms through which this interconnectedness is established. A study was conducted in rural Tanzania to provide qualitative insight regarding how maternal mortality affects index as well as other living children and to identify shared structural and social factors that foster high levels of maternal mortality and child vulnerabilities.Methods and findingsAdult family members of women who died due to maternal causes (N = 45) and key stakeholders (N = 35) participated in in-depth interviews. Twelve focus group discussions were also conducted (N = 83) among community leaders in three rural regions of Tanzania. Findings highlight the widespread impact of a woman's death on her children's health, education, and economic status, and, by inference, the roles that women play within their families in rural Tanzanian communities.ConclusionsThe full costs of failing to address preventable maternal mortality include intergenerational impacts on the nutritional status, health, and education of children, as well as the economic capacity of families. When setting priorities in a resource-poor, high maternal mortality country, such as Tanzania, the far-reaching effects that reducing maternal deaths can have on families and communities, as well as women's own lives, should be considered.

To assess the association between lifetime violence victimization and self-reported symptoms associated with pregnancy complications among women living in refugee camps along the Thai-Burma border. Cross-sectional survey of partnered women aged 15–49 years living in three refugee camps who reported a pregnancy that resulted in a live birth within the past 2 years with complete data (n = 337). Variables included the lifetime prevalence of any violence victimization, conflict victimization, intimate partner violence (IPV) victimization, self-reported symptoms of pregnancy complications, and demographic covariates. Logistic generalized estimating equations, accounting for camp-level clustering, were used to assess the relationships of interest. Approximately one in six women (16.0 %) reported symptoms related to pregnancy complications for their most recent birth within the last 2 years and 15 % experienced violence victimization. In multivariable analyses, any form of lifetime violence victimization was associated with 3.1 times heightened odds of reporting symptoms (95 % CI 1.8–5.2). In the final adjusted model, conflict victimization was associated with a 3.0 increase in odds of symptoms (95 % CI 2.4–3.7). However, lifetime IPV victimization was not associated with symptoms, after accounting for conflict victimization (aOR: 1.8; 95 % CI 0.4–9.0). Conflict victimization was strongly linked with heightened risk of self-reported symptoms associated with pregnancy complications among women in refugee camps along the Thai-Burma border. Future research and programs should consider the long-term impacts of conflict victimization in relation to maternal health to better meet the needs of refugee women.

This study examined disparities in lifetime substance misuse by sexual orientation among 2,653 patients engaged in care at an urban community health center in Boston, MA, as well as the potential mediating roles of childhood abuse

Violence against women in the aftermath of conflict represents a growing area of concern. However, little is known about violence perpetrated by a woman's in-laws and how these experiences may be related to adverse experiences during a crisis. Therefore, guided by the ecological model, the objectives of the following analysis were to (1) document adverse experiences during the crisis among rural Ivorian women and (2) investigate the association between such experiences and abuse perpetrated by partners' extended families, among a sample of women residing in rural Cote d'Ivoire. Utilising data from a baseline survey conducted in 2010, we generated descriptive statistics and used generalised estimating equations to assess the relationships of interest. Women whose family was victimised during the crisis had 1.7 times the odds of reporting past-year in-law abuse compared to those women whose families did not experience such adversity (95% CI: 1.1-2.4), and women who experienced a personal form of adversity had twice the odds of reporting past-year in-law abuse compared to women who did not report victimisation (95% CI: 1.2-3.2). Being forced to flee was not statistically associated with in-law abuse. Findings underscore the importance of addressing in-law abuse in order to promote women's health in post-conflict settings.

BACKGROUND: Gender-based violence against women, including intimate partner violence (IPV), is a pervasive health and human rights concern. However, relatively little intervention research has been conducted on how to reduce IPV in settings impacted by conflict. The current study reports on the evaluation of the incremental impact of adding "gender dialogue groups" to an economic empowerment group savings program on levels of IPV. This study took place in north and northwestern rural Côte d'Ivoire. METHODS: Between 2010 and 2012, we conducted a two-armed, non-blinded randomized-controlled trial (RCT) comparing group savings only (control) to "gender dialogue groups" added to group savings (treatment). The gender dialogue group consisted of eight sessions that targeted women and their male partner. Eligible Ivorian women (18+ years, no prior experience with group savings) were invited to participate. 934 out of 981 (95.2%) partnered women completed baseline and endline data collection. The primary trial outcome measure was an overall measure of past-year physical and/or sexual IPV. Past year physical IPV, sexual IPV, and economic abuse were also separately assessed, as were attitudes towards justification of wife beating and a woman's ability to refuse sex with her husband. RESULTS: Intent to treat analyses revealed that compared to groups savings alone, the addition of gender dialogue groups resulted in a slightly lower odds of reporting past year physical and/or sexual IPV (OR: 0.92; 95% CI: 0.58, 1.47; not statistically significant). Reductions in reporting of physical IPV and sexual IPV were also observed (not statistically significant). Women in the treatment group were significantly less likely to report economic abuse than control group counterparts (OR = 0.39; 95% CI: 0.25, 0.60, p < .0001). Acceptance of wife beating was significantly reduced among the treatment group (β = -0.97; 95% CI: -1.67, -0.28, p = 0.006), while attitudes towards refusal of sex did not significantly change Per protocol analysis suggests that compared to control women, treatment women attending more than 75% of intervention sessions with their male partner were less likely to report physical IPV (a OR: 0.45; 95% CI: 0.21, 0.94; p = .04) and report fewer justifications for wife beating (adjusted β = -1.14; 95% CI: -2.01, -0.28, p = 0.01) ; and both low and high adherent women reported significantly decreased economic abuse (a OR: 0.31; 95% CI: 0.18, 0.52, p < 0.0001; a OR: 0.47; 95% CI: 0.27, 0.81, p = 01, respectively). No significant reductions were observed for physical and/or sexual IPV, or sexual IPV alone. CONCLUSIONS: Results from this pilot RCT suggest the importance of addressing household gender inequities alongside economic programming, because this type of combined intervention has potential to reduce levels of IPV. Additional large-scale intervention research is needed to replicate these findings. TRIAL REGISTRATION: REGISTRATION NUMBER: NCT01629472.

Objective To document the prevalence and characteristics of conflict victimization and its associations with past-year intimate partner violence (IPV) among refugee women affected by the protracted conflict in Burma (Myanmar). Methods A cross-sectional survey was conducted among 861 women living in 3 refugee camps along the Thai–Burma border from February to April 2008. Descriptive statistics were generated regarding experiences of conflict victimization and generalized estimating equations were used to determine the odds of reporting past-year IPV. Results In all, 9.6% of partnered women reported conflict victimization and 7.9% of women reported experiencing past-year IPV. After accounting for demographic variables, women who experienced conflict victimization were 5.9 times more likely to report past-year IPV than women who had not experienced conflict victimization (95% confidence interval, 5.0–6.9). Conclusion Given the strong association uncovered in the present study, interventions to reduce the negative effects of conflict victimization should incorporate other forms of violence prevention, including IPV. Future longitudinal research is needed to discern pathways through which these experiences are related.

OBJECTIVE: To assess the relationship between bullying peers as a child and adult intimate partner violence perpetration in a clinic-based sample of adult men. School bullying perpetration and intimate partner violence perpetration are both thought to stem from desire for power and control over others. DESIGN: A cross-sectional survey was conducted between January 2005 and December 2006. SETTING: Three urban community health centers in Boston, Massachusetts. PARTICIPANTS: Men aged 18 to 35 years (n = 1491) seeking services at participating community health centers. Main Exposure School bullying perpetration. Outcome Measure Past-year physical or sexual violence perpetration against a female partner (intimate-partner violence [IPV]). RESULTS: Two-fifths of men reported perpetrating school bullying as a child (n = 610; 40.9%). Men who rarely bullied in school were 1.53 times more likely to perpetrate past-year IPV than men who did not bully (95% confidence interval [CI], 1.02-2.29); this risk was elevated to 3.82 times more likely to perpetrate any past-year IPV for those men who bullied peers frequently (95% CI, 2.55-5.73). CONCLUSIONS: The present study indicates that bullying peers in school as a child, especially frequent bullying perpetration, is associated with increased risk for men's perpetration of IPV as an adult. The effect remains strong after controlling for common prior risk factors for both bullying and IPV perpetration. Future research is needed to discern the mechanisms and underlying root causes of abusive behavior, such as power and control, as a means to prevent violence perpetration across settings and life stages. Language: en

Objectives To examine associations between intimate partner violence (IPV) against Indian women and risk of death among their infants and children, as well as related gender-based disparities. Design Analyses of nationally representative data to estimate adjusted hazard ratios (aHRs) and attributable risks for infant and child mortality based on child gender and on IPV against mothers. Setting India. Participants Women aged 15 to 49 years (n = 59 467) across all 29 Indian states participating in the Indian National Family Health Survey 3 provided information about 158 439 births and about infant and child mortality occurring during the 20 years before the survey. Main Outcome Measures Maternal IPV and infant and child ( Results Infant mortality was greater among infants whose mothers experienced IPV (79.2 of 1000 births) vs those whose mothers did not experience IPV (59.1 of 1000 births) (aHR, 1.09; 95% confidence interval [CI], 1.03-1.15); this effect was significant only for girls (1.15; 1.07-1.24; for boys, 1.04; 0.97-1.11). Child mortality was also greater among children whose mothers experienced IPV (103.6 of 1000 births) vs those whose mothers did not experience IPV (74.8 per 1000 births) (aHR, 1.10; 95% CI, 1.05-1.15); again, this effect was significant only for girls (1.14; 1.07-1.21; for boys, 1.05; 0.99-1.12). An estimated 58 021 infant girl deaths and 89 264 girl child deaths were related to spousal violence against wives annually, or approximately 1.2 million female infant deaths and 1.8 million girl deaths in India between December 1985 and August 2005. Conclusion Intimate partner violence against women should be considered an urgent priority within programs and policies aimed at maximizing survival of children in India, particularly those attempting to increase the survival of girls 5 years and younger.

A 2010 study done in Calcutta a potential sex-trafficking hub for sexual exploitation across South Asia emphasizes the importance of understanding trafficking mechanisms. The study focuses on women and girls who had been trafficked for sexual exploitation were either removed by police or escaped and were receiving help from Sanlaap an NGO based in Calcutta. The findings highlight the persistence of sex trafficking within Calcutta while highlighting the need for trafficking prevention efforts especially because of the high rate of HIV infection among women and girls. Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.