Search

In this analysis, we assess whether laws that promote gender equity and freedom from violence are associated with a lower risk of prior-year physical and sexual intimate partner violence (IPV) among adolescent girls and adult women (AGW) and whether these laws protect more and less vulnerable AGW equally. We included all 15 countries that administered the Domestic Violence Module in a Demographic and Health Survey since 2015. The primary exposure was a validated, country-level index of laws on violence against women and girls (LoVI). A multilevel approach was used to model five forms of violence (prior-year partner physical, sexual, physical or sexual violence and prior-year non-partner physical violence or sexual violence) among ever-partnered, non-widowed adolescent girls 13–19 years (n = 6691) and women 20–49 years (n = 119 343). Across countries, partner physical violence ranged from 0% to 33% and sexual violence from 0% to 23%. Laws on marital rape, child marriage and sexual harassment were negatively associated with prior-year physical and sexual IPV for women and girls. Comprehensive domestic violence legislation was unrelated to girls’ experiences of prior-year physical or prior-year sexual IPV. No interaction was observed between LoVI component laws and a score meant to capture adolescent vulnerability. Three of the four LoVI component laws had consistent, negative associations with partner violence for girls and women, but negative associations were stronger for women than girls. Thus, while laws promoting gender equity and freedom from violence are generally protective, they may be more so for women than adolescent girls. Future research should explore the impact of gender equitable laws on women’s and adolescent girls’ experiences of violence, and countries may consider more comprehensive legal protections against violence for adolescent girls.

Social and economic changes in Vietnam since the economic restructuring of the 1980s have caused a shift in norms about premarital sex. While expectations of female chastity remain, sex before marriage is becoming more common among young people. As the formative phase of a parent randomized controlled trial, the present study examined the normative context of sex in dating relationships from the perspectives of young women and men in Vietnam. Men (n = 12) and women (n = 9) studying at two universities in Hanoi participated in semi-structured interviews that explored perspectives on sexual relationships and sexual coercion among their peers. Thematic analysis synthesized participant narratives into broader themes. Our findings confirmed that, as social norms evolve in Vietnam, young women must navigate shifting, and often contradictory, expectations about sex and dating relationships. Women and men expressed the belief that competing sexual expectations often can limit young women’s sexual agency and contribute to the normalization of sexual coercion in dating relationships. However, some women were embracing greater sexual freedom and reframing norms in ways that reflected their sexual agency. Efforts are needed to address these conflicting expectations, to deepen young men’s understanding of this conflict, and to prevent sexual coercion in young adulthood.

Despite the adverse effects of sexual harassment, measurement gaps persist. Using a sequential, mixed-methods approach, we adapted and validated the Sexual Experiences Questionnaire (SEQ) to measure sexual harassment victimization among college-going women in Jordan. From a 213-item pool and qualitative data from students at the study site, we removed 50 items and collapsed or rephrased 163 items into selected 27 items for examination. After expert reviewers and study-site staff assessed content validity, we replaced three items. Items were tested using cognitive interviews ( n = 7) and then administered in a survey to 567 women students. We sequentially performed exploratory factor analysis (EFA) with a random split-half sample ( N1= 283), confirmatory factor analysis (CFA) with the second sample ( N2= 284), and confirmatory bifactor analysis. Five items with cross-factor loadings were dropped. Model fit for the final four-factor EFA and CFA was adequate (EFA: RMSEA: 0.013, CFI: 0.996, TLI: 0.994; CFA: RMSEA 0.020, CFI: 0.988, TLI: 0.986). Three factors were similar to those identified in the SEQ—gender harassment, sexual coercion, and unwanted sexual attention—but we also identified a fourth factor—physical-contact sexual harassment. The bifactor analysis suggested that the scale was unidimensional (general factor ECV=.701 and PUC =.727). The unidimensional scale was positively associated with depressive symptoms. Using an adapted SEQ, sexual harassment is a measurable construct in the Jordanian university context. Further validation of this tool and efforts to capture each dimension of sexual harassment in the Arab region is needed.

Economic coercion is a form of intimate partner violence (IPV) that is distinct from but often co-occurs with physical, psychological, and sexual IPV. Women’s experiences of economic coercion are understudied in low- and middle-income countries, despite increases in women’s economic opportunities in these settings. Bangladesh is a salient site to understand how women experience, interpret and give meaning to economic coercion because historical gender inequalities in access to economic opportunities and resources are changing in favor of greater participation of women in economic activities. We conducted in-depth qualitative interviews with 24 married women aged 19–47 years to understand their experiences of economic coercion with respect to their involvement in income-generating activities in rural Bangladesh. Overall, we found that women’s experiences of economic coercion were multi-dimensional, and influenced by women’s participation in income-generating activities. In this setting, three major domains of economic coercion by husbands emerged from women’s narratives: denial of access to income-generating activities, coercive control over resources, and economic neglect. Furthermore, participant narratives reflected the continued influence of the patriarchal family system, and the gendered power relations therein, on women’s experiences of economic coercion, despite increases in women’s involvement in income-generating activities. Our results suggest that women’s experiences of economic coercion influence their participation in income-generating activities in Matlab, Bangladesh. Interventions to increase women’s economic opportunities should consider the barriers and potential repercussions of women’s involvement.

Social norms surrounding sex and relationships remain gendered among young people in Vietnam, with men maintaining a privileged role in heterosexual relationships. This analysis explored how university students in Vietnam perceived prevailing gender norms, and how these norms influenced men's understanding of sexual consent in dating relationships. This analysis drew primarily on in-depth interviews with heterosexual men and secondarily from interviews with women attending two universities in Hanoi in 2018. Thematic analysis of the interviews revealed a broader narrative about how prevailing gender norms shape men's dating behaviour and beliefs about consent. Participants expected young men to be independent and decisive. Men were seen as free to initiate dating and sexual encounters. Some participants expected young women to be accommodating in dating relationships, although acceptable relationships for women were restricted, and premarital sex was a reputational risk. Most participants described cues for consent and non-consent for sex; however, dismissal of women's refusals, and normalised sexual coercion were common. Among university men in Hanoi, gender norms privileging men and growing expectations of premarital sex may be normalising sexual coercion in dating relationships. University educational programmes are needed to promote equitable gender norms, affirmative sexual consent and expanded definitions of sexual coercion.

Using Komter’s theory of hidden gender power in marriage, we explore how young Qatari women’s aspirations are influenced by their parents, future husbands, and the internalization of social norms about gender dynamics. Interviewing a convenience sample of 28 Qatari women, ages 18 to 25 years old and attending university in Qatar, we explore the ways in which women acquiesce to or resist the gendered barriers they face to fulfilling their aspirations for education and career. Interviews were conducted in Arabic and translated into English. Using a qualitative descriptive design for analysis, interviews were coded deductively following the interview guide and then inductively to allow themes to emerge from the data. Our results showed that women experienced an array of forces that shaped their aspirations. Although women did experience some explicit limitations, women more often self-imposed limitations based on their perceptions of what they thought their parents or future husbands would approve. The majority of women engaged in active strategies of negotiation to achieve their goals. Whereas some women recognized the structural constraints imposed on them by prevailing gender norms, other women found ways to counter identified social constraints. We conclude that Komter’s notion of invisible power as entirely unseen should be expanded because many women were “insider-outsiders” and saw how invisible power operated on other women, if not on themselves. We discuss the ways in which structural power affects young women’s aspirations in a strongly patriarchal setting.

Bisexual and other non-monosexual (bi+) women are at higher risk than monosexual women for mental health problems. While being in a relationship is typically associated with better health outcomes, research suggests an inverse association for bisexual women. Despite emerging evidence of differences in bisexual women's experiences based on the gender of their partner, few studies have considered partner sexual identity. To address this gap, the current study examined influences of partner gender and sexual identity on outness, discrimination, and depressive symptoms in a cross-sectional study of 608 bi+ cisgender women. Adjusting for other demographics, being in a relationship with a bisexual cisgender woman, a lesbian cisgender woman, or a bisexual cisgender man was positively associated with outness and discrimination compared to being in a relationship with a heterosexual cisgender man. Findings highlight the importance of accounting for partner gender and sexual identity in order to understand bi+ women's experiences.

ObjectivesThe objective of this study is to validate three mental health scales in a targeted sample of pregnant Arab women living in Qatar: the Kuwait University Anxiety Scale, the Perceived Stress Scale, and the Edinburgh Postnatal Depression Scale.MethodsRandom split-half exploratory factor analysis and confirmatory factor analyses (n = 336;n = 331), conducted separately, were used to evaluate scale dimensionality, factor loadings, and factor structure of the KUAS, the PSS, and the EPDS.ResultsFit statistics for the three scales suggested adequate fit to the data and estimated factor loadings were positive, similar in magnitude, and were significant. The final CFA model for the KUAS supported a 19-item, two factor structure. CFA models also confirmed 8- and 10-item, single-factor structures for the PSS and EPDS, respectively.ConclusionsThe validation of scales for these aspects of mental health in Arab pregnant women is critical to ensure appropriate screening, identification, and treatment to reduce the risk of sequelae in women and their children. Findings offer a useful comparison to mental-health scale validations in other Arab contexts.

Objective This article examines the relationship between the exposure of men as children to gender‐equitable parental decision making and the potential for subsequent later life engagement in intimate partner violence (IPV) in Bangladesh. Background Although researchers have recently begun to explore multilevel influences on IPV perpetration, no studies have examined how decision making between parents at home and within the community relates to IPV perpetration in low-income settings. Drawing on a theoretical framework of gendered social learning, gender-equitable parental decision making may be an important protective factor against IPV. Method This study uses a random probability sample of 1,499 married men in Bangladesh. The main outcome is physical IPV perpetration in adulthood, whereas two exposure variables measure the equity of parental decision making in the man's childhood home and his current community. A series of two-level negative binomial models, controlling for pertinent individual- and community-level factors, are estimated. Results Exposure in childhood to more equitable decision making between parents is negatively associated with a man's physical IPV perpetration in adulthood. Gender‐equitable parental decision making within one's current community is not significantly associated with IPV. Conclusion Boys who grow up exposed to more equitable decision making between parents in the home may be less likely to engage in physical IPV perpetration as an adult.

Gender-based violence (GBV) against women is a pervasive global human-rights violation. This systematic review of reviews synthesized research about the mental health and empowerment outcomes of GBV for adolescent girls and young women (ages 10–24) in low- and middle-income countries (LMIC). GBV exposures included child maltreatment, female genital mutilation/cutting, child marriage, intimate partner violence (IPV), and non-partner sexual violence. PubMed and PsycINFO searches were supplemented with expert consultations and searches of reference lists and key organizational websites. Sixteen systematic reviews were quality rated and summarized. Study-level data were extracted from the five highest quality reviews (N = 25 unique studies) and results from 41 samples were synthesized. Empowerment studies were too few to synthesize. Reviews and extracted studies were predominantly from Asia and Africa and addressed child maltreatment, IPV, and non-partner sexual violence. We included combined samples with adolescent girls and adult women (ages 9–60 years) and found consistent associations between GBV and composite measures of mental health, suicidal ideation and behavior, and symptoms of depression, posttraumatic stress, and eating disorders. Findings suggest that GBV must be addressed to cultivate mental health for adolescent girls and young women globally.

BackgroundOne third of women experience IPV and potential sequelae. Sustainable Development Goal (SDG) 5.2—to eliminate all violence against women, including IPV— compels national governments to monitor such violence. We conducted the first global measurement-invariance assessment of standardized physical IPV items.MethodsThirty-six Demographic and Health Surveys (DHS) from 36 Lower-/Middle-Income Countries (LMICs) administering the same 18 IPV items during 2012-2018 were included. We performed exploratory and confirmatory factor analyses (EFA/CFA) with seven physical IPV items, which are the most behaviorally specific and reliable. Datasets meeting EFA/CFA model fit criteria (loadings>.35, RMSEA.95) were included in multiple-group CFA to test strict measurement invariance, and in alignment optimization (AO) to test approximate measurement invariance. We compared national rankings based on AO-derived scores and lifetime physical IPV prevalences, and correlated AO-dervied scores with physical, sexual, and psychological IPV prevalences.ResultsEstimated lifetime physical IPV varied widely (5.6%-50.5%). All loadings and fit statistics met thresholds in country-specific EFA/CFAs. A unidimensional, seven-item physical IPV construct lacked scalar invariance in multiple-group CFA but achieved approximate measurement invariance in AO analysis, as 12.3% (ConclusionsSeven DHS physical-IPV items were approximately invariant across 36 LMICs spanning five regions and are reasonable for cross-national, grouped comparison of physical IPV. Measurement-invariance testing over time will inform their utility to monitor SDG5.2.1; cross-national and cross-time measurement-invariance testing of other IPV item sets is warranted.

Sexual harassment (SH) is a form of gender-based violence (GBV) that negatively impacts women’s physical, mental, social, and financial well-being. Although SH is a global phenomenon, it also is a contextualized one, with local and institutional norms influencing the ways in which harassment behavior manifests. As more women attend institutions of higher education in Jordan, these women are at increased risk of experiencing SH in university settings, with potential implications for their health and future employment. Social norms theory, which examines the informal rules governing individual behavior within groups, has been a useful framework for understanding and developing interventions against GBV globally. We sought to apply a social-norms lens to the understanding and prevention of SH at a Jordanian university. To gain a comprehensive and nuanced picture of social norms surrounding SH, we collected qualitative data using three complementary methods: focus group discussions (n = 6) with male and female students (n = 33); key informant interviews with staff and faculty (n = 5); and a public, participatory event to elicit anonymous short responses from students (n = 317). Using this data, we created a codebook incorporating social-norms components and emergent themes. As perceived by participants, SH was unacceptable yet common, characterized as a weak norm primarily because negative sanctioning of harassers was unlikely. Distal norms related to gender and tribal affiliation served to weaken further norms against SH by blaming the victim, preventing reporting, discouraging bystander intervention, and/or protecting the perpetrator. The complexity of the normative environment surrounding SH perpetration will necessitate the use of targeted, parallel approaches to change harmful norms. Strengthening weak norms against SH will require increasing the likelihood of sanctions, by revising university policies and procedures to increase accountability, increasing the acceptability of bystander intervention and reporting, and fostering tribal investment in sanctioning members who harass women. Creating dialogue that emphasizes the harmful nature of SH behaviors and safe spaces to practice positive masculinity also may be an effective strategy to change how male students interact in the presence of peers. Any social norms change intervention will need to consider the various reference groups that dictate and enforce norms surrounding SH.

Assessing progress toward Sustainable Development Goal (SDG) 5, to achieve gender equality and to empower women, requires monitoring trends in intimate partner violence (IPV). Current measures of IPV may miss women’s experiences of economic coercion, or interference with the acquisition, use, and maintenance of financial resources. This sequential, mixed-methods study developed and validated a scale for economic coercion in married women in rural Bangladesh, where women’s expanding economic opportunities may elevate the risks of economic coercion and other IPV. Forty items capturing lifetime and prior-year economic coercion were adapted from formative qualitative research and prior scales and administered to a probability sample of 930 married women 16–49 years. An economic coercion scale (ECS) was validated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) with primary data from random-split samples ( N1 = 310; N2 = 620). Item response theory (IRT) methods gauged the measurement precision of items and scales over the range of the economic-coercion latent trait. Multiple-group factor analysis assessed measurement invariance of the economic-coercion construct. Two-thirds (62.26%) of women reported any lifetime economic coercion. EFA suggested a 36-item, two-factor model capturing barriers to acquire and to use or maintain economic resources. CFA, multiple group factor analysis, and multidimensional IRT methods confirmed that this model provided a reasonable fit to the data. IRT analysis showed that each dimension provided most precision over the higher range of the economic coercion trait. The Economic Coercion Scale 36 (ECS-36) should be validated elsewhere and over time. It may be added to violence-specific surveys and evaluations of violence-prevention and economic-empowerment programs that have a primary interest measuring economic coercion. Short-form versions of the ECS may be developed for multipurpose surveys and program monitoring.

Background Bullying is an understudied global social problem. While school-level factors are a recognized influence on bullying victimization, the elements of a ‘girl-friendly’ school that may reduce the risk of bullying victimization among girls and prevent dropout is understudied in lower- and middle-income countries (LMICs). This study used baseline data from the evaluation of the Room-to-Read (RtR) Girls’ Education Program (GEP) in Nepal to assess the relationship of a conceptually grounded gender-equitable school (GES) index with girls’ risk of direct and relational bullying victimization, adjusted for potential confounders at the individual and school levels. Methods The school sample included all 24 RtR GEP schools and 25 community schools attended by girls in a comparison cohort, representing 729 grade six girls with complete outcome data. We employed multilevel negative binomial regression to assess the relationship between the GES score (higher scores indicate greater support for girls), and girls’ risk of peer victimization, controlling for individual- and school-level covariates. Results On average, girls reported 2.84 direct victimizations and 0.27 relational victimizations in the prior week. The first component of the GES index, a generalized measure of school-level support for girls, showed a significant negative relationship with weekly relational bullying victimization in models with all school- and individual-level covariates. In the full model, a one-point higher score on the generalized GES component accounted for a 26% lower risk of relational bullying victimization in the prior week. Conclusion School-level policies, practices, and pedagogy designed to support girls may reduce their exposure to relational aggression, a form of bullying that girls most often perpetrate. In LMICs, the school may be an ideal place to raise awareness about the types and effects of peer bullying and to promote prosocial bystander behavior. Further research is needed to identify factors related to other forms of bullying.

Depression is a worldwide problem, and is especially prevalent in lower-income countries with insufficient resources and widespread poverty, such as Bangladesh. Yet multilevel determinants of depressive symptoms in men have not been studied in this context. We leverage a novel dataset from men in Bangladesh to determine the community- and individual-level influences of masculine dominance strain and financial strain on the frequency of married men’s depressive symptoms in Bangladesh. Data were collected between January and June, 2011, as part of the UN Multi-Country Study of Men and Violence, conducted by The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Masculine dominance strain at both levels was related to the frequency of depressive symptoms. Financial strain only at the individual level was related to the frequency of depressive symptoms. We conclude that community-level economic interventions may not directly influence individual-level depression; however, addressing customary conceptions of masculinity at the community and individual level and addressing individual-level financial strain are promising joint strategies to improve married men’s mental health in Bangladesh and similar settings.

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.

Objective Coercive control in marriage is common in patriarchal settings, but multilevel determinants are understudied. Method Using a probability sample of 570 junior men (married, 18-34 years) from the Bangladesh survey of the 2011 UN Multi-Country Study of Men and Violence, we examined how exposure to violence in childhood and community-level gender norms were related to men's attitudes about gender equity and use of controlling behavior. We tested whether community-level gender norms moderated the relationship between men's exposure to violence in childhood and our outcomes. Results According to results from multilevel Poisson regression models, as community gender norms become more equitable by 1 standard deviation, a junior married man's expected rate of controlling behavior is lower by 0.11, and his rate of agreement with gender equitable attitudes is higher by 0.27. More gender-equitable community norms were negatively related to a junior married man's use of controlling behavior. Childhood exposure to violence was not associated with use of controlling behavior. There was a significant cross-level interaction such that exposure to violence had a stronger negative impact on men's gender equitable attitudes in communities with lower overall gender equity than those with higher overall gender equity. The corresponding cross-level interaction effect was not significant for the controlling behavior outcome. Conclusions More equitable community gender norms may encourage more gender-equitable attitudes and discourage use of controlling behavior among junior men, suggesting that interventions to change community gender norms may reduce coercive control of women in marriage.

The Weathering Effect is a theory that links stress exposure, over the life-course, with racial disparities in reproductive outcomes, through the effects of social adversity on a woman’s body. The concept of maternal “weathering” captures cumulative somatic and psychological adversities that can exacerbate the effects of aging. Much of the evidence for weathering comes from observational studies linking self-report measures with reproductive outcomes. The purpose of this review is to explore biological mechanisms that underlie these observations. We focus on spontaneous abortion because this event is understudied despite evidence of racial disparities in this outcome. Spontaneous abortion is the most common pregnancy failure, and it happens early in pregnancy. Early pregnancy is a time most susceptible to the harmful effects of immune dysregulation that may, in part, result from adversities experienced before pregnancy begins. In exploring these mechanisms, we draw on well-defined signaling processes observed in the stressor-depression relationship. Pro-inflammatory dysregulation, for example, has particular relevance to immunological control occurring early in pregnancy. Early pregnancy immunologic changes affect the trajectories of pregnancy via control of trophoblastic invasion. Within the first few weeks of pregnancy, uterine derived cytokines operate within cytokine networks and play a critical role in this invasion. Programming for pro-inflammatory dysregulation can occur before conception. This dysregulation, brought into early pregnancy, has implications for viability and success of the index pregnancy. These patterns suggest early pregnancy health is susceptible to stress processing pathways that influence this immunologic control in the first six to eight weeks of pregnancy. In this review, we discuss the known mediating role of immune factors in the stressor-depression relationship. We also discuss how adversity experienced before the index pregnancy, or “pre-pregnancy” may influence these pathways, and subsequently influence early pregnancy health. There is a need to understand adversity, experienced before pregnancy, and mechanisms driving the effects of these experiences on pregnancy outcomes. This approach is a useful entry point for understanding racial inequities in pregnancy health through an understanding of differences in exposures to adversity. We hypothesize that spontaneous abortion involves cyclical changes within a woman’s reproductive tract in response to stressors that are established well before a woman enters into pregnancy. Furthermore, we propose mechanisms that potentially drive weathering processes relevant to reproductive disparities. We also examine what is known about pre-pregnancy stress exposures associated with race, inequity, and adversity, and their potential impact on neuroendocrine and immune changes affecting early pregnancy risk.

Objective To explore the complexity of women's birth experiences in the context in which they occur and to describe how these influence women's well-being in labor. Design Qualitative method with a phenomenological approach, following the analysis principles of van Manen. Participants and setting Eight women from different ethnic and socioeconomic backgrounds in Atlanta, Georgia, United States with a recent, healthy birth were interviewed twice about their experience of the labor journey. The first interview was 3–12 weeks post-partum, with the second interview at 10–22 weeks post-partum. Findings The phenomenon of childbirth was a dynamic fluctuating between keeping it together and falling apart. The changes in emotion were created by a sensitive feedback loop between the woman and her environment, the physical space, and interactions with humans present. Four characteristics supported and created this phenomenon: confidence, comfort, agency and connection. Confidence was believing in one's physical ability to birth the baby while at the same time, having the emotional resources to cope with the experience. Comfort was essential to manage pain and difficult emotions. The presence of comfort changed the meaning and experience of pain and increased relaxation. Agency was overtly supported in labor, but compromised by hospital routine and unresponsive caregiver practices, and was diminished by women's vulnerability in labor. When agency was compromised, falling apart increased, and there was a move towards intense negative emotion. In labor, women wanted an authentic human connection, being known as a person. This connection was a mechanism to support the other characteristics of comfort, confidence, and agency. Implications for practice Clinicians need to accommodate the complex, dynamic fluctuations of emotion during birth addressing both the physical and non-physical aspects of the person. Birth care practices and childbirth research need to account for the complexity of birth as a holistic experience, specifically regarding the emotional shifts as well as the women's sensitivity to the environment and everything contained in it. There is a need for more research related to the dynamics of emotional changes in labor, how these changes affect labor physiology and influence normal birth and birth outcomes.

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.

© 2016 American Psychological Association. Men's perpetration of intimate partner violence (IPV) is common, but its multilevel determinants are understudied. We leveraged novel data from a probability sample of married junior men (N = 570; age 18 to 34 years) from 50 urban and 62 rural communities who took part in the Bangladesh survey of the 2011 UN Multi-Country Study of Men and Violence. We tested whether lifetime count (or scope) of physical IPV acts perpetrated was negatively associated with more equitable community gender norms among married senior men (N = 938; age 35 to 49 years) and positively associated with greater exposure to childhood violence among junior men. We also tested whether more equitable community gender norms mitigated the association of more violence in childhood with the lifetime scope of physical IPV acts perpetrated. Among younger married men, 50% reportedly ever perpetrated physical IPV, the mean lifetime scope of physical IPV types perpetrated was 1.1 (SD 1.3) out of 5 listed. A majority (64%) reported childhood exposure to violence. In multilevel Poisson models, a man with more childhood exposure to violence had a higher log scope (estimate: 0.31, SE 0.04, p < .001), and a man living amid the most equitable gender norms had a lower log scope (estimate:-0.61, SE 0.17, p < .01) of physical IPV acts perpetrated; however, no significant cross-level interaction was observed. Interventions that address the trauma of childhood violence and that promote more equitable community gender norms may be needed to mitigate IPV perpetration by younger men.

This systematic review of reviews synthesizes evidence on the impact of interventions to prevent violence against adolescent girls and young women 10–24 years (VAWG) in low- and middle-income countries (LMICs). Theories of women's empowerment and the social ecology of multifaceted violence frame the review. Child abuse, female genital mutilation/cutting (FGMC), child marriage, intimate partner violence (IPV), and sexual violence were focal outcomes. Our review followed the Assessment of Multiple Systematic Reviews (AMSTAR) for the systematic review of reviews, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for a systematic review of recent intervention studies. Of 35 reviews identified between June 7 and July 20, 2016, 18 were non-duplicate systematic reviews of medium-to-high quality. Half of these 18 reviews focused on interventions to prevent IPV. Only four focused on adolescents, of which three focused on child marriage and one compared findings across early and late adolescence. None focused on interventions to prevent child abuse or sexual violence in adolescent/young women. From these 18 reviews and the supplemental systematic review of intervention studies, data were extracted on 34 experimental or quasi-experimental intervention studies describing 28 interventions. Almost all intervention studies measured impacts on one form of VAWG. Most studies assessed impacts on child marriage (n = 13), then IPV (n = 8), sexual violence (n = 4), child abuse (n = 3), and FGMC (n = 3). Interventions included 1–6 components, involving skills to enhance voice/agency (n = 17), social networks (n = 14), human resources like schooling (n = 10), economic incentives (n = 9), community engagement (n = 11) and community infrastructure development (n = 6). Bundled individual-level interventions and multilevel interventions had more favorable impacts on VAWG. Interventions involving community engagement, skill-building to enhance voice/agency, and social-network expansion show promise to reduce VAWG. Future interventions should target poly-victimization, compare impacts across adolescence, and include urban, out-of-school, married, and displaced/conflict-affected populations in LMICs, where VAWG may be heightened.

We investigate the Women’s Agency Scale (WAS) using 2006-2012 panel data for 4,012 married women from the Egyptian Labor Market Panel Survey. A confirmatory factor analysis shows women’s agency is a multidimensional factor and its structure is invariant across time. Pending further cross-cultural and longitudinal validation, the WAS appears to be a valid measure to assess changes in women’s ability to exercise choice over time, with important implications for testing the impact of women’s empowerment programs and for monitoring progress towards achieving the United Nations Sustainable Development Goal (SDG) Five of gender equality and to empower women and girls.

Background Higher schooling attainment for girls is associated with improved maternal and child health outcomes. In low- and middle-income countries, girls drop out of school at higher rates than boys beginning in early adolescence due to factors such as son preference and lack of access to menstrual supplies. Methods Using principal components analysis, we created a gender-equitable school (GES) index with data from 159 secondary schools in Nepal to measure school-level factors that may influence girls' secondary school pass rates. Results A component describing girls’ safety and hygiene was positively associated with school-wide pass rates for girls, and to a lesser degree for boys. Conclusions The GES index has diagnostic and programmatic utility in programs aimed at supporting girls’ education and health.

Background. Sustainable Development Goal (SDG) 5 prioritizes women’s empowerment, alone and to advance other SDGs. Measures of women’s empowerment have been resource focused; yet, agency (an aspect of empowerment) captures conscientization — the emergence of critical awareness and action for change. A comprehensive measure of women’s agency would capture intrinsic power within to overcome dominated consciousness, instrumental power to pursue aspirations, and collective power with others to pursue shared goals. A valid measure of women’s multidimensional agency is needed to monitor real progress toward SDG5 and women’s well-being. Methods. In this sequential, mixed-methods study, we developed and validated the Women’s Agency Scale 61 (WAS-61) in 930 married women 15–49 years and living with their husband in Matlab, Bangladesh. Using theory, qualitative research, and questionnaire reviews, we developed an item pool to capture women’s intrinsic (43 items), instrumental (23 items), and collective (17 items) agency. We performed exploratory then confirmatory factor analyses (EFA/CFA) in random split-half samples, and estimated pairwise and factor score correlations to confirm that the dimensions of agency were distinct but related in expected ways. In future work, we will perform multiple-group CFA to assess to what extent the WAS-61 is measurement invariant across salient sub-groups of women. Results. A 29-item, three-factor CFA model measured women’s intrinsic agency as endorsement of gender equity and rights (non-justification of wife beating, gender-equitable attitudes) and confidence in capabilities (comfort expressing opinion and going places outside home) (loading: 0.35-0.93, RMSEA=0.04, CFI=0.94, TLI=0.93). Significant pairwise factor correlations (0.10–0.55) confirmed that the intrinsic-agency dimensions were distinct but related. A 27-item, three-factor CFA model measured women’s instrumental agency as use of financial services, voice with husband, and mobility/voice outside home (loading: 0.43-0.99, RMSEA=0.05, CFI=0.94, TLI=0.93). Significant pairwise factor correlations (0.36–0.58) confirmed that the instrumental-agency dimensions were distinct but related. To capture women’s collective agency, an 8-item, one-factor CFA model measured leadership of others (loading: 0.52-0.84, RMSEA=0.10, CFI=0.97, TLI=0.96), and a 7-item, one-factor CFA model measured influence in their community (loading: 0.54-0.83, RMSEA=0.10, CFI=0.96, TLI=0.95). Significant, and generally higher, within-construct than cross-construct pairwise correlations suggested that the dimensions of women’s agency were distinct but related (intrinsic: 0.13–0.60; instrumental: 0.40–0.72; collective: 0.58; cross-construct: 13 of 21 correlations < 0.30). Intrinsic agency in mobility/voice outside home was strongly correlated with measures of instrumental and collective agency (0.28–0.51). Instrumental agency in use of financial services and mobility/voice outside the home were strongly correlated with measures of collective agency (0.38–0.47). Conclusions. The WAS-61 is a comprehensive measure of women’s multidimensional agency validated in married women in rural Bangladesh. These novel scales capture well-defined dimensions of intrinsic, instrumental, and collective agency that are distinct but related. Women’s intrinsic agency in voice/mobility outside the home is strongly related to their instrumental and collective agency, and women’s instrumental agency in use of financial services and voice/mobility outside the home is strongly related to their collective agency. These findings suggest that all dimensions of women’s conscientization are inter-related and necessary for women’s empowerment and well-being. We will test measurement in-variance of the WAS-61 across salient sub-groups of women, and the WAS-61 should be validated in urban women and other samples to confirm its widespread utility for impact assessment of health and development programs and national monitoring. Evidence of time in-variance of the WAS-61 would confirm its utility to monitor national and program-level changes in women’s agency and its influences on other SDGs.

Background To understand better the total burden of interpersonal violence on society, it is useful to assess the prevalence of interpersonal violence among both, men and women. Exposure to multiple forms of interpersonal violence, referred to as polyvictimization, has been associated with more severe health consequences than exposure to any form separately. The aims of this study were to assess the prevalence of emotional, physical and sexual interpersonal violence in childhood, adulthood and at both childhood and adulthood among men and women in Estonia, analyze the patterns of interpersonal violence and socio-demographic correlates of polyvictimization in adulthood by gender. Methods The analysis was based on two population-based, cross-sectional, self-administered surveys carried out among men and women in Estonia in 2014. In both surveys, the NorVold Abuse questionnaire was used to measure exposure to interpersonal violence. Men and women aged 18–44 were included to the analysis. Results Among men 66.6% and among women 54.2% had been exposed to at least one form of interpersonal violence during lifetime. Men had been more often exposed to isolated physical interpersonal violence, among women the distribution of different forms of interpersonal violence was more even and exposure to sexual violence was more common. The prevalence of polyvictimization in adulthood was two times higher among women compared to men and more socio-demographic correlates, were associated with it. Exposure to violence in childhood was associated with polyvictimization in adulthood across gender. Conclusions The prevalence of interpersonal violence in Estonia is high among men and women. The most prevalent forms and patterns of interpersonal violence, however, differ by gender, as do the socio-demographic correlates. Screening for interpersonal violence, in childhood and adulthood, and gender-specific interventions are needed, especially for high-risk groups identified in this study. Primary prevention of childhood violence should be a priority, as it was associated with higher risk for exposure to violence later in life across gender.

Background: Prior studies of the association between intimate partner violence (IPV) and depressive symptoms have typically excluded economic coercion (EC), a common form of partner violence. We estimated associations of EC and other forms of IPV with depressive symptoms among women in Matlab, Bangladesh. Methods: Data were collected from cross-sectional surveys with married women 15-49 years. We examined relationships of EC, physical/psychological/sexual IPV, and depressive symptoms using structural equation models (SEM). Past-week depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression scale. Lifetime EC was assessed using a bi-dimensional, 36-item scale. Lifetime physical/sexual/psychological IPV was assessed with a 20-item scale. Covariates were age, age at marriage, and schooling; partner’s schooling; and household wealth. Findings: Among 929 women, 82·2% reported any past-week depressive symptoms. Lifetime experience of EC ranged from 41·9% (control over access to work, schooling, and training) to 50·0% (control over use/maintenance of economic resources), while any lifetime physical/psychological/sexual IPV was 89·5%. The standardized association of physical/psychological/sexual IPV with depressive symptoms, adjusted for covariates, was 0·350 (p < 0.0001, R2 = 0·143); when additionally adjusted for two EC measures, the association was attenuated (0.017, p = 0·817). Coercion involving the use and maintenance of economic resources had a significant, adjusted association with depressive symptoms (0·480, p < 0·001, R2 = 0·221). Interpretation: EC is prevalent and attenuates the association of physical/sexual/psychological IPV with depressive symptoms. Addressing EC with other forms of IPV may be necessary to reduce depressive symptoms in exposed women. Funding Statement: This study was supported by research grant 1R21HD093027 (PI Yount) from the Eunice Kennedy Shriver National Institute of Child Health and Development. Declaration of Interests: The authors have no conflicts of interest to report. Ethics Approval Statement: The Institutional Review Boards of Emory University (IRB00097428) and the International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b) (PR17077) reviewed and approved the study protocol.

This paper presents a mixed-methods study that examines the relationship between women’s empowerment, household food security, and maternal and child diet diversity (as one indicator of nutrition security) in two regions of Tanzania. Indicators across three domains of women’s empowerment were scored and matched to a household food insecurity access scale. Qualitative research helped appreciate the gender dynamics affecting the women’s empowerment-food security and women’s empowerment-nutrition security nexus. In cluster adjusted regression analyses, scores from each domain were significantly associated with women’s dietary diversity, but not with household food security. All three empowerment domains were positively associated with food security and nutrition in the qualitative analysis. This article discusses these findings and shows the pathways by which respondents saw their empowerment to affect their household food security.

In the Asia-Pacific region, individual sexual stigma contributes to elevated rates of depression among sexual minority men. Less well understood is the role of socio-structural sexual stigma despite evidence that social context influences the experience of stigma. We use data from the United Nations Multi-country Study on Men and Violence to conduct a multilevel test of associations between individual- and cluster unit–level indicators of sexual stigma and depressive symptoms among sexual minority men ( n = 562). In the full model, individual-level sexual stigma is not associated with depressive symptoms, although there is significant variation in the association between individual stigma and depressive symptoms across clusters. Contrary to expectation, at the community level, homophobic injunctive norms are negatively associated with depressive symptoms. We discuss the implications for policies, programs, and future research to improve mental health among sexual minority men in the region.

We proposed and tested a feminist social-ecological theory about daughters’ experience of female genital mutilation/cutting (FGMC) in Egypt, where over 90% of women ages 15–49 are cut. FGMC has potential adverse effects on demographic and health outcomes and has been defined as a human-rights violation. Contextual factors are important determinants of FGMC, but an integrated theory is lacking, and quantitative multilevel research is limited. We theorized that more favorable community-level gender systems, including gender norms opposing FGMCandexpanded opportunities for women outside of the family, would be associated with a daughter’s lower risk of FGMC and would strengthen the negative association of a mother’s opposition to FGMC with her daughter’s risk of cutting. Using a national sample of 14,171 mother-daughter dyads from the 2014 Egypt Demographic and Health Survey, we estimated multilevel discrete-time hazard models to test these relationships. Community gender norms opposing FGMC had significant direct, negative associations with the hazard that a daughter was cut, but women’s opportunities outside the family did not. Maternal opposition to FGMC was negatively associated with cutting a daughter, and these associations were stronger where community opposition to FGMC and opportunities for women were greater. Results provided good support for a gender-systems theory of the multilevel influences on FGMC. Integrated, multilevel interventions that address gender norms about FGMC and opportunities for women in the community, as well as beliefs about the practice among the mothers of at-risk daughters may be needed for sustainable declines in the practice.

Objective To provide the first study in Vietnam of how gendered social learning about violence and exposure to non-family institutions influence women's attitudes about a wife's recourse after physical IPV. Method A probability sample of 532 married women, ages 18-50 years, was surveyed in July-August, 2012 in Mỹ Hao district. We fit a multivariate linear regression model to estimate correlates of favoring recourse in six situations using a validated attitudinal scale. We split attitudes towards recourse into three subscales (disfavor silence, favor informal recourse, favor formal recourse) and fit one multivariate ordinal logistic regression model for each behavior to estimate correlates of favoring recourse. Results On average, women favored recourse in 2.8 situations. Women who were older and had witnessed physical IPV in childhood had less favorable attitudes about recourse. Women who were hit as children, had completed more schooling, worked outside agriculture, and had sought recourse after IPV had more favorable attitudes about recourse. Conclusions Normative change among women may require efforts to curb family violence, counsel those exposed to violence in childhood, and enhance women's opportunities for higher schooling and non-agricultural wage work. The state and organizations working on IPV might overcome pockets of unfavorable public opinion by enforcing accountability for IPV rather than seeking to alter ideas about recourse among women.

Semi-structured interviews with 31 men in Hung Yen Province in Northern Vietnam are used to elucidate a conceptual narrative to understand men’s perceptions and perpetration of intimate partner violence (IPV) in Vietnam. This narrative suggests that cultural definitions of masculinity and changes in women’s participation in the labor force have contributed to status conflicts that normalize IPV as part of masculine superiority. The narratives of both IPV perpetrators and non-perpetrators demonstrate how violence is incorporated into the cultural definition of masculinity and illustrates how men use this definition to minimize their own and other men’s perpetration. We suggest that attempts to reduce IPV in Vietnam must address constructions of masculinity and the socio-historical context of IPV by providing gender-sensitivity training and opportunities for men to evaluate critically how constructions of masculinity in their families and communities contribute to IPV perpetration.

The effect of intimate partner violence (IPV) on mental health remains understudied in the Arab world. Using data from 608 ever-married women in rural Minya, Egypt who took part in the 2005 Egypt Demographic Health Survey (EDHS) and a 2012 follow-up survey, we assessed how a woman’s enabling resources and risk factors influenced the association of her exposure to IPV with her generalized anxiety. Results from multivariate regression models showed that proximity to natal kin, prior schooling, and engagement in market work 12 months before marriage had protective effects on generalized anxiety associated with IPV. Childhood abuse from mother also had a protective effect on this relationship. Similar abuse from the brother exacerbated the effects of anxiety when a woman was exposed to IPV. Empowerment programs can encourage women to attend school and engage in market or subsistence work, while suggesting strategies to improve the relationship of women with natal kin.

This study examined factors that mitigate or heighten HIV risk among HIV-negative wives in serodiscordant relationships in Gujarat, India. Grounded theory was used to analyze 46 interviews (23 couples) where husbands were HIV-positive and wives were HIV-negative. A conceptual framework emerged from analysis from which we identified five pathways and four key behaviors: (a) safer sex, (b) no sex, (c) coercive sex, and (d) unprotected sex. Most couples either practiced safe sex or abstained from sex. Factors such as wives’ assertiveness, a wife’s fear of acquiring HIV, mutual understanding, positive sex communication, and a husband’s desire to protect wife influenced safe sex/sexual abstinence. Factors such as desire for children, a husband’s alcohol use, and intimate partner violence influenced coercive and unprotected sex. Counseling topics on sex communication, verbal and non-verbal safer sex strategies, as well as addressing intimate partner violence and alcohol use may be important in preventing risk to HIV-negative wives.

Currently, no counseling guidelines exist for HIV serodiscordant couples in India. One-on-one interviews were conducted with married, serodiscordant couples in Western India, from which one couple was selected to explicate the factors that elevated HIV risk, using an intrinsic case study approach. This case study describes the factors that contribute to HIV risk in a married serodiscordant couple, including shifts in spousal roles, history of child sexual abuse, unfulfilled sexual desire, unprotected sex with extramarital relations, intimate partner violence, and inconsistent condom use with marital partner. Although there were improvements in the couple’s relationship after HIV entered their lives, shifts in relationship dynamics and behaviors exacerbated HIV risk. Early and ongoing counseling interventions with couples are key, as relationship dynamics and behaviors can change over time. HIV service providers must be trained appropriately to address the spectrum of risk that may lie in HIV serod...

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.

This systematic review synthesizes research on the influence of human and economic resources for women's empowerment on their pre- and postnatal mental health, understudied in the Arab world. We include articles using quantitative methods from PubMed and Web of Science. Two researchers reviewed databases and selected articles, double reviewing 5% of articles designated for inclusion. Twenty-four articles met inclusion criteria. All 24 articles measured depression as an outcome, and three included additional mental health outcomes. Nine of 17 studies found an inverse association between education and depression; two of 12 studies found contradictory associations between employment and depression, and four of six studies found a positive association between financial stress and depression. These results suggest that there is a negative association between education and depression and a positive association between financial stress and depression among women in the Arab world. Firm conclusions warrant caution due to limited studies meeting inclusion criteria and large heterogeneity in mental health scales used, assessment measures, and definitions of human and economic resources for women's empowerment. It is likely that education reduces depression among postpartum women and that financial stress increases their depression. These findings can be used to aid in the design of interventions to improve mother and child outcomes. However, more research in the Arab world is needed on the relationship between human and economic resources for women's empowerment and perinatal mental health, and more consistency is needed in how resources and mental health are measured. ispartof: Archives of Women's Mental Health vol:22 issue:1 pages:1-14 ispartof: location:Austria status: Published online

Studies from the social and health sciences have tended to view the household as the locus of access to and distribution of care, resources, monitoring and modeling for children's wellbeing. Obesity may present a special case for the study of investments in children, being a component of health for which more of certain inputs may not lead to better outcomes. We expanded on common measures of household structure in the child health literature by considering co-residence and relatedness of parents, grandparents, other relatives, and other children. Data were from a longitudinal sample of 6,700 children participating in the Early Childhood Longitudinal Study Kindergarten Class of 1998-99 (ECLS-K), the largest U.S. national dataset with measures of child anthropometrics and household structure at seven time-points over nine years. We used lagged survey-adjusted regressions to estimate associations between household structure and subsequent changes in children's weight between ages 5 and 14 years in terms of BMI gain and incident obesity. Adjusting for household structure more thoroughly, children living in households with two parents rather than one parent did not experience advantages in terms of less excess weight gain or lower incidence of obesity during elementary and middle school. Children living with a grandmother gained more weight than children not living with a grandmother. Living with siblings and with non-related adults was associated with less weight gain. These findings corroborate a scenario in which, for health problems associated with caloric surplus, classic household factors have more complex associations with child wellbeing.

Existing data suggest that there are distinct patterns (or classes) of intimate partner violence (IPV) experience that depart from dichotomous categorizations used to monitor progress toward Sustainable Development Goal 5.2. Less is known about the patterning of IPV in non-Western settings. This study estimates distinct classes of IPV experience in Nepal and examines potential community-level variability in these classes and in the association between IPV class and depressive symptoms. This study used data collected in 2016 from a random sample of Nepalese married women of reproductive age (N = 1440) living in 72 communities in three districts (Nawalparasi, Chitwan, and Kapilvastu). We used fixed effects and random effects latent class models of 2 through 6 classes. We fit a negative binomial regression model adjusted for relevant confounders to examine the relationship of the latent IPV classes with depressive symptoms. A four-class model was the best fitting. It included a “low exposure” class (77.36% of the sample) characterized by a low probability of experiencing any form of IPV, a “sexual violence” class (9.03% of the sample) characterized by a high probability of experiencing a form of sexual violence, a “moderate violence” class (6.60% of the sample) characterized by modest probabilities of experiencing less severe emotional and physical IPV, and a “systematic violence” class (7.01% of the sample) characterized by a high probability of being exposed to all forms of IPV. Adding random effects did not improve model fit, suggesting no community-level variations in classes. Relative to membership in the low exposure class, membership in all other classes was associated with a higher count of depressive symptoms. Those in the systematic class had a mean weighted symptom count 2.29 times that of the low exposure group. Classes of IPV exposure must be identified to ensure that surveillance and programming are attuned to women's experiences of violence., Highlights • First quantitative examination of classes in women's experience of IPV in Nepal. • First multilevel LCA to identify common classes of IPV across communities. • Classes of experience corroborate those found in other settings. • Classes of experience are different from the way that IPV is monitored globally.

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.

In patriarchal settings like Bangladesh, men’s use of coercive control to sustain male dominance may increase their life satisfaction if such behavior is widely accepted and internalized. Yet, the influence of men’s perpetration of intimate partner violence (IPV) on their life satisfaction is unknown. We assess the associations of controlling behavior and IPV perpetration with life satisfaction using data from the Bangladesh component of the UN Multi-country Study on Men and Violence. This survey was conducted from January to June, 2011 in a multistage, random sample of men from urban Dhaka and rural Matlab sub-district of Chandpur district. Analyses included ever-partnered men (N = 1,572). In unadjusted structural equation models, men who reported controlling behavior had higher average life satisfaction; whereas, those reporting psychological IPV perpetration had lower life satisfaction. Adjusting for covariates, men’s controlling behavior remained positively associated with their life satisfaction, while psychological and physical IPV perpetration were negatively associated with life satisfaction. In Bangladesh, men’s controlling behavior may be so central to normative masculinity that it is internalized, and its instrumental success enhances men’s life satisfaction. Yet, the adverse influence of IPV perpetration on life satisfaction supports social-psychological theories of self-determination, whereby behaviors that are normative but not internalized undermine men’s psychological needs, contributing to lower life satisfaction. In settings like Bangladesh, integrated theories of masculinity under patriarchy and self-determination may be needed to understand men’s coercive control, IPV perpetration, and well-being.

Using the survey responses of 522 married men (eighteen to fifty-one years) in Vietnam, we explored how gendered social learning in boyhood and challenges to men’s expected status in marriage may increase the risk that men perpetrate intimate partner violence (IPV) against their wives. Over one-third (36.6 percent) of the participants reported having ever perpetrated psychological, physical, or sexual IPV against their current wife. Accounting for other characteristics of men in the sample, witnessing IPV as a boy, being physically maltreated as a boy, and being the same age or younger than one’s wife were associated with almost two to three times higher odds of perpetrating any IPV. Men with thirteen to eighteen completed grades of schooling had about half the adjusted odds of ever perpetrating any IPV than men with twelve or fewer completed grades (aOR = 0.56). The determinants of men’s perpetration of physical IPV and psychological IPV were, largely, similar. Programs to prevent men’s perpetration of IPV should address the parenting practices of boys that legitimize men’s aggression and gendered status expectations in marriage, which when challenged, may lead husbands to respond with violence. Engaging men to endorse nonviolent masculinities is an important consideration for future intervention.

Despite widespread assumptions about women's empowerment and agency in the Arab Middle East, psychometric research of these constructs is limited. Using national data from 6214 married women ages 16-49 who took part in the 2006 Egypt Labor Market Panel Survey, we applied factor analysis to explore and then to test the factor structure of women's agency. We then used multiple indicator multiple cause structural equations models to test for differential item functioning (DIF) by women's age at first marriage, a potential resource for women's agency. Our results confirm that women's agency in Egypt is multi-dimensional and comprised of their (1) influence in family decisions, including those reserved for men, (2) freedom of movement in public spaces, and (3) attitudes about gender, specifically violence against wives. These dimensions confirm those explored previously in selected rural areas of Egypt and South Asia. Yet, three items showed significant uniform DIF by women's categorical age at first marriage, with and without a control for women's age in years. Models adjusting for DIF and women's age in years showed that women's older age at first marriage was positively associated with the factor means for family decision-making and gender-violence attitudes, but not freedom of movement. Our findings reveal the value of our analytical strategy for research on the dimensions and determinants of women's agency. Our approach offers a promising model to discern "hierarchies of evidence" for social policies and programs to enhance women's empowerment.

Background Women’s mental health in the perinatal period is understudied worldwide and in Arab countries especially. Aim This systematic review explores evidence of the association between women’s social resources for empowerment in the Arab World and their mental health in the prenatal and postnatal (≤1 year postpartum) periods. Methods Guided by Kabeer’s framework of empowerment, the authors applied a search string in PubMed and Web of Science databases to identify studies in countries of the Arab League (hereafter the Arab World) that address mental health and social resources for women’s empowerment in the perinatal period. Findings Of 1865 electronically retrieved articles, 23 met the inclusion criteria. Overall, the majority of studies found a positive association between social resources for empowerment and perinatal mental health. Seven studies explored the relationship between familial or general social support and prenatal mental health in Arab women, and found a significant positive association. Sixteen of the 18 studies of women in the postnatal period found that enabling familial, extra-familial, and/or general social support was positively associated with mental health. Conclusion This review demonstrates an association between social resources and perinatal mental health, but there is a dearth of research in this area. We call for additional research on Arab women in the perinatal period using context-specific but standardized tools to assess social resources and mental health. Evidence on positive mental health, resilience, and the influence of social resources can guide the improvement of prenatal and postpartum care services. This study was made possible by a NPRP award (NPRP 7-666-5-081), from the Qatar National Research Fund (QNRF), a member of the Qatar Foundation. The statements made herein are solely the responsibility of the authors. Scopus

Social norms increasingly are the focus of intimate partner violence (IPV) prevention strategies but are among the least examined contextual factors in quantitative violence research. This study assesses the within-community, between-community, and contextual effect of a new measure of social norms (PVNS: Partner Violence Norms Scale) on women's risk of IPV. Data come from baseline surveys collected from 1435 female, married, reproductive-age participants, residing in 72 wards in three districts (Chitwan, Kapilvastu, Nawalparasi) in Nepal who were enrolled in a cluster randomized trial testing the impact of a social behavioral change communication intervention designed to prevent IPV. Results of unconditional multilevel logistic regression models indicated that there was cluster-level variability in the 12-month prevalence of physical (ICC = 0.07) and sexual (ICC = 0.05) IPV. Mean PVNS scores also varied across wards. When modeled simultaneously, PVNS scores aggregated to the ward-level and at the individual-level were associated with higher odds of physical (ORind = 1.12, CI = 1.04, 1.20; ORward = 1.40, CI = 1.15, 1.72) and sexual (ORind = 1.15, CI = 1.08, 1.24; ORward = 1.47, CI = 1.24, 1.74) IPV. The contextual effect was significant in the physical (0.23, se = 0.11, t = 2.12) and sexual (0.24, se = 0.09, t = 2.64) IPV models, suggesting that the ward-level association was larger than that at the individual-level. Adjustment for covariates slightly attenuated the ward-level association and eliminated the contextual association, suggesting that individual perceptions and the collective community phenomena were equally strong predictors of women's risk of IPV and should be taken into consideration when planning interventions. PVNS is a promising measure of social norms underpinning women's risk of IPV and warrants further psychometric testing.

The 2030 Agenda for Sustainable Development prioritizes women's empowerment in Sustainable Development Goal (SDG) #5: to achieve gender equality and empowerment among all women and girls. Research on the relationships of women's empowerment and nutrition has focused on the child's nutrition. Less is known about how women's empowerment influences their own nutritional status. We examined the pathways by which three domains of women's empowerment (WE)-assets, intrinsic agency, and instrumental agency-may influence women's nutritional status (WNS) in East Africa. We used data from 42,721 married non-pregnant women, 15-49 years old interviewed in Demographic and Health Surveys (DHS) from five east Africa countries (2011-2016). WNS was operationalized through body mass index (BMI) and altitude-adjusted blood-hemoglobin level (Hb). A latent factor for women's human/social assets (assets) measured women's enabling resources. Two additional latent factors measured women's intrinsic agency (power within; women's non-justification of intimate partner violence (IPV) against wives) and instrumental agency (power to; influence in household decision-making). We used structural equation models with latent variables to estimate the strength of the hypothesized pathways from women's assets to WNS through measures of intrinsic and instrumental agency. All three domains of WE had direct, positive associations with women's BMI [(estimate (95% CI) (Assets: [0.17 (0.14,0.20)]; Intrinsic Agency: [0.25 (0.22,0.27)]; Instrumental Agency [0.08 (0.03,0.10)])]. Women's instrumental agency was positively associated with women's Hb [0.12 (0.09,0.14)]. Total associations, including direct and indirect effects, with women's BMI were positive through intrinsic agency & instrumental agency. Total associations with women's Hb were positive through instrumental agency. Direct and indirect effects from assets through both components of agency to BMI were higher in magnitude by household wealth category. Domains of WE were positively associated with WNS. Findings indicate that the process of women's empowerment may be an important driver of their nutritional status.