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[This corrects the article DOI: 10.1371/journal.pone.0284900.].
PLOS ONE Staff
Violence against women and children (VAWC) is a significant health and human rights issue closely tied to multiple Sustainable Development Goals. While VAWC is prevalent in all countries, the severity and incidence of VAWC increase during wars, natural disasters, economic crises, and pandemics, all of which have affected Yemen in recent years. This systematic review synthesizes evidence from qualitative and quantitative studies on the types, prevalence, perpetrators of, and risk factors for VAWC in Yemen. Before initiating the search, the protocol and search strategy were registered to PROSPERO (CRD42021237855). We systematically searched four biomedical databases and grey literature sources and used reverse snowball sampling to identify eligible studies. The 31 studies included in the analysis depicted a range of forms of VAWC, encompassing honor violence, female genital mutilation and cutting, early and very early marriage, tourist marriage, family and intimate partner violence, and gender inequities in access to food, education, and medical care. Included studies reported a high prevalence of many forms of violence, including corporal punishment in schools and intimate partner violence. We reviewed study quality and how studies addressed ethical concerns in VAWC-related research. We found that several studies did not report ethics review or interviewer training and no studies discussed safety planning or addressing the mental health needs of participants in VAWC research. This systematic review provides a much-needed synthesis of existing research on VAWC in Yemen. Since the start of the 2014 war, Yemen has become the world's largest humanitarian crisis, with the highest rate of maternal mortality and gender inequality in the world. We only identified one study initiated after the recent war in Yemen. This deficiency represents a missed opportunity to understand how the ongoing war has reversed prior gains in reducing the prevalence of child and very early child marriage and introduced new forms of gender-based violence, including tourist marriage.
Shreedhar S, Arvind Chavan S, Al-Zumair M et al.
Gender-based violence (GBV) refers to a specific form of interpersonal violence that is rooted in gender inequities and unequal distribution of power. GBV is defined as any type of violence, including physical, sexual, psychological, and economic, perpetrated against individual(s) based on actual or perceived gender, gender identity, gender expression, sex or sex characteristics, sexual orientation, or divergence from social norms on masculinity and femininity. Cisgender (cis) and transgender (trans) women and girls of all ages, including adolescents and young adults (AYAs) of ages 10-24 years, disproportionately experience GBV. The Society for Adolescent Health and Medicine recognizes that GBV has been a long-standing threat, remains a public health crisis, and requires an urgent response to support the health and well-being of AYAs, especially cis and trans women and girls, worldwide. The Society for Adolescent Health and Medicine adopts the following positions: (1) GBV is a pervasive and harmful global health issue rooted in gender inequity; (2) An intersectionality framework that recognizes multiple layers of oppression should guide researchers, practitioners, and policymakers to address GBV among populations that are disproportionately affected; (3) Accurate and accessible data collection systems about GBV among AYAs should be established; (4) All AYA health service providers should be trained to deliver developmentally appropriate, healing-centered, culturally responsive, and evidence-informed GBV prevention and treatment strategies; (5) All AYAs should have equal access to developmentally appropriate education that disrupts gender inequality, a root cause of GBV; and (6) Governments should sign, ratify, adequately fund, and implement frameworks and policies to prevent and respond to GBV.
Society for Adolescent Health and Medicine
Introduction Female genital amputation is a harmful traditional practice that has adverse risks on health outcomes. Consequently, it affects girls and women's physical, psychological, and mental health conditions. However, evidence on female genital amputation factors among adolescent girls and young women in Ethiopia was limited. Method Secondary data analysis was conducted from the 2016 Ethiopian Demographic and Health Survey. A weighted sample size included in this study was 2961 adolescent girls and young women. Data management and further analysis were performed using Stata 14 software. An adjusted odds ratio with a 95% confidence interval was used for measuring a significant relationship between factors with the outcome variable. Result This study found that the prevalence of female genital amputation among adolescent girls and young women in Ethiopia was 53.4%. Among individual- and community-level variables included in the multivariable multilevel analysis: maternal age, religious status, marital status, maternal educational level, occupational status, residence areas, community uneducated level, and community mass media were significant factors for female genital amputation. Conclusion The prevalence of female genital amputation among adolescent girls and young women in Ethiopia remains high. Those individual- and community-level factors influence female genital amputation among adolescent girls and young women in Ethiopia. It requires health interventions on female genital amputation to improve behavioral changes and create awareness about harmful practices.
Gebeyehu AA, Anteneh RM, Dessie AM et al.
Background Female genital mutilation (FGM) is a harmful traditional practice involving the partial or total removal of external genitalia for non-medical reasons. Despite efforts to eliminate it, more than 200 million women and girls have undergone FGM, and 3 million more undergo this practice annually. Tracking the prevalence of FGM and identifying associated factors are crucial to eliminating the practice. This study aimed to determine the prevalence of FGM and associated factors among daughters aged 0-14 years. Methods The most recent Demographic Health Survey Data (DHS) datasets from sub-Saharan African countries were used for analysis. A multilevel modified Poisson regression analysis model was applied to identify factors associated with FGM. Data management and analysis were performed using STATA-17 software, and the pooled prevalence and adjusted odds ratio (AOR) with a 95% confidence interval (CI) were reported. Statistical significance was set at p ≤ 0.05. Results The study included a weighted sample of 123,362 participants. The pooled prevalence of FGM among daughters aged 0-14 years in sub-Saharan Africa was found to be 22.9% (95% CI: 16.2-29.6). The daughter's place of birth (AOR = 0.54, 95% CI: 0.48-0.62), mother's age (AOR = 1.72, 95% CI: 1.4-2.11), father's education (AOR = 0.92, 95% CI: 0.87-0.98), mother's perception about FGM (AOR = 0.42, 95% CI: 0.35-0.48), FGM as a religious requirement (AOR = 1.23, 95% CI: 1.12-1.35), mother's age at circumcision (AOR = 1.11, 95% CI: 1.01-1.23), residing in rural areas (AOR = 1.12, 95% CI: 1.05-1.19), and community literacy level (AOR = 0.90, 95% CI: 0.83-0.98) were factors associated with FGM. Conclusion The high prevalence of FGM among daughters aged 0-14 years in sub-Saharan Africa indicates the need for intensified efforts to curb this practice. Addressing the associated factors identified in this study through targeted interventions and policy implementation is crucial to eradicate FGM and protect the rights and well-being of girls.
Ayenew AA, Mol BW, Bradford B et al.
Introduction Although preconception health risks are strongly linked to adverse pregnancy outcomes and offer opportunities to improve women's health, consolidated evidence remains limited in Sub-Saharan Africa (SSA). This review aims to synthesize evidence on preconception health risks in SSA, a region with the highest global rates of maternal and neonatal mortality and morbidity. Methods We searched PubMed/MEDLINE, African Index Medicus, ScienceDirect, and Google Scholar for studies published up to June 30, 2023. Two reviewers independently assessed study quality using Joanna Briggs Institute tools. Studies with at least one modifiable preconception risk were included. Due to inconsistencies in outcome measurements, participant variability, and high heterogeneity, a meta-analysis was not reported. Findings were summarized in text, figures, and tables. Results In the review, researchers selected 83 articles from a total of 3,425 retrieved articles. Overall, this review revealed a high proportion of preconception health risks among the participants which includes underweight (0.64% to 36.2%), overweight (8.3% to 76.7%), anemia (36.7% to 58.1%), unintended pregnancy (4.2% to 94.3%), alcohol intake (5.3% to 68.7%), smoking (1.1% to 20.3%), chewing khat (9.9% to 27.6%), history of chronic medical conditions (2% to 16.6%), a history of adverse pregnancy outcomes (11% to 51.9%), sexually transmitted infections (1.3% to 29.2%), psychosocial distress (13.9% to 60%), and intimate partner violence (6.7% to 43.7%). Conclusion The systematic review found that numerous women in SSA encounter various preconception health risks factors. Therefore, the governments of respective countries need to give emphasis and adopt policies to integrate preconception care services in to the existing healthcare system so that both financial and human resources need to be mobilized. There is gaps in research, as the true burden of preconception health risks may be underestimated due to fragmented risk assessment methods. Review registration (PROSPERO: CRD42023446801).
Gebretsadik GG, Biratu AK, Gessessew A et al.
BACKGROUND: Sustainable Development Goal (SDG) 3 prioritises the promotion of equitable health outcomes and universal health coverage. In Ghana, there is limited information on the current implementation progress and challenges of the health and health-related SDGs (HHSDGs). The aim of this review was to conduct a situational analysis of the HHSDGs in Ghana whilst providing in-depth and updated literature on their implementation progress and challenges. METHODS: We conducted a scoping review guided by the Arksey and O’Malley framework. The Population, Concept and Context (PCC) framework was used to select literature. Peer-reviewed and grey literature with data collected between September 2015 and October 2022 were used. Exclusion criteria included non-HHSDG topics and studies outside the timeframe. Data were retrieved from Scopus, PubMed, Medline, CINAHL, EBSCOhost and grey literature sources. The process yielded 37 peer-reviewed articles and 14 grey literature records, comprising 11 organisational reports from websites, 2 theses, and 1 blog post. Systematic screening, guided by the PRISMA-ScR, and quality appraisal, using the Mixed Methods Appraisal Tool, were performed. Thematic synthesis was employed for the analysis of the data. RESULTS: Health and wellbeing (SDG 3), climate change and climate action (SDG 13), gender equality (SDG 5), zero hunger (SDG 2), and clean water and sanitation (SDG 6) were the identified HHSDGs. Mental health emerged as a key HHSDG, although not a stand-alone SDG. Our review indicates that Ghana has made progress in meeting some critical HHSDG targets, with further work needed to meet all targets. Ghana has made important progress toward the HHSDGs, including improvements in infectious disease control, access to clean water, gender equality initiatives, and the adoption of health innovations. Also, Ghana has significantly reduced the prevalence of overweight in children underfive. However, significant gaps remain in maternal and child health, mental health, sanitation, universal health coverage, and food security. These gapsare driven by persistent structural and socioeconomic barriers. CONCLUSIONS: These findings highlight the need for strengthened policies and targeted interventions to accelerate Ghana’s progress toward achieving the HHSDGs by 2030.
Doku DT, Nartey YA, Cudjoe O et al.
Background Worldwide, at least 230 million girls and women are affected by female genital mutilation/ cutting (FGM/C). FGM/C violates human rights and can cause irreparable harm and even lead to death. In 2022, more than 100,000 survivors of FGM/C lived in Germany, and more than 17,000 girls were considered at risk. Due to the increasing number, there is a need to improve the skills of professionals not only to treat FGM/C but also to prevent it, aiming to maintain or improve women's physical and mental health. However, previous studies mostly focused on health care providers, even though other professionals such as social workers, play an important role in the provision of sexual and reproductive health (SRH) care and are often the first point of contact. Therefore, the study's main objective was to understand challenges perceived by social workers in pregnancy counselling centres in the provision of good quality of SRH care for girls and women suffering from or endangered by FGM/C. Methods A quantitative self-administered cross-sectional online survey was sent by e-mail in 2021 to all pregnancy counselling centers in the German federal state of Bavaria. Results Among the 141 participants, 82% reported no or insufficient FGM/C knowledge and barriers to provide the best quality of care. The main findings were language obstacles (82.7%), perceived client's fear or shame (67.9%) and cultural difficulties (45.7%). Furthermore, participants also reported a lack of competence on the professional side (29.6%). Importantly, most participants (129 of 141; 92%) expressed interest in training. Conclusion Providing comprehensive good quality sexual and reproductive health care to women and girls affected from or endangered by FGM/C is challenging. The study revealed the importance of strengthening the skills of social workers and suggested the following strategies: (1) enhancing FGM/C knowledge and skills (including specialized competences e.g., in mental health) by improving training and information material for the target group, (2) improving referral pathways and addressing deficits in the existing care system (e.g. with health or legal institutions), and (3) developing trusting relationships with cultural (or traditional) mediators to build strong community networks.
Seifert N, Mürdter E, Schmidt NC
Background Female genital mutilation (FGM) has zero health benefits. It can lead to short- and long-term risks and complications, including physical, sexual, and mental health and well-being of girls and women. It is a worldwide public health issue with more than 80% prevalence in Africa. It is a global imperative to strengthen work for the elimination, and the United Nations Sustainable Development Goal (SDG) strives to eliminate FGM and monitor the progress made. However, one of a challenge in tracking progress is establishing baseline prevalence data within regions and countries. Therefore, this review aimed to pool the prevalence of FGM in Africa and identify the promoting factors among women and girls. Methods This review was conducted according to the PRISMA checklist guideline. Both published and unpublished studies conducted from 2012 onwards were eligible. Studies written in non-English languages were excluded. To retrieve relevant studies; PubMed/Medline, Google Scholar, Science Direct, African Journals Online databases, and African Index Medicus (AIM) were searched using a combination of searching terms. The Newcastle-Ottawa Assessment Scale (NOS) tool was used to assess the quality of each included study. The Cochran's Q chi-square and I2 statistical tests were used to evaluate the heterogeneity of the included studies. The Funnel plot and Egger's regression test (p value < 0.05) were used to evaluate meh publication bias. We used STATA for analysis and the overall and subgroup pooled effect size was estimated using the random effect model with DerSimonian and Laired pooled effect method. The overall prevalence of FGM and the adjusted odds ratio (AOR) with 95%CI (confidence interval) for contributing factors were calculated and presented using a forest plot. Result This study included 155 primary studies conducted on the prevalence and/or factors associated with FGM in Africa. The pooled prevalence of FGM was 56.4% (95%CI 49.7-63.6). The primary factors promoting the practice of FGM were family history of circumcision (AOR = 13.71, 95%CI 9.11-20.62), being a Muslim religion follower (AOR = 3.51, 95%CI 2.61-4.71), poor wealth index (AOR = 1.38, 95%CI1.27-1.51), higher age (AOR = 2.95, 95%CI 2.49-3.38), not attending formal education (AOR = 3.28, 95%CI 2.62-4.12), and rural residency (AOR = 2.27, 95%CI 1.84-2.80). Conclusion The prevalence of FGM in Africa was found to be high. This study also observed a variation in FGM prevalence across regions and countries and a slight temporal decline over the study period. As the global community enters the final decade dedicated to eliminating FGM, there remains much to be done to achieve the elimination goal.
Ayenew AA, Mol BW, Bradford B et al.
BACKGROUND: Femicide, the most extreme form of gender-based violence directed at women and girls, often lacks sufficient national statistical data in several countries. The United Nations Office on Drugs and Crime Global Study on Homicide reported that Ethiopian data were unavailable. Moreover, there is no published evidence regarding femicide cases. To address this gap, this study investigated femicide victims referred for medicolegal autopsies at St. Paul’s Hospital Millennium Medical College (SPHMMC) in Ethiopia. METHODS: A cross-sectional study was conducted to investigate all femicide cases (aged ≥ 15 years) that were observed over the course of one year, from January 1, 2021, to December 31, 2021, at SPHMMC. Data were summarized using descriptive statistics. Associations between categorical variables were assessed with the chi-square or Fisher’s exact test, and independent t-tests were used to compare means between groups. Statistical significance was determined as p < 0.05. RESULTS: There were 62 femicide cases, representing 10.7% of all female cases and 2.0% of all medicolegal deaths. Of the 62 femicide cases, 53.2% were classified as intimate femicide, with 87.9% involving current partners and 12.1% involving former partners. The remaining 46.8% were classified as non-intimate partner femicide. The average age of the victims was 33.4 years, with half between 21 and 30 years. Perpetrators averaged 30.5 years old, with the majority falling within the 31–40 age range. Quarrels and disputes (46.8%) were the most often cited motive, followed by jealousy (13%). Most femicides occurred at night (64.5%) within private residences (72.6%). A history of prior intimate partner violence was recorded in 39.4% of cases. Blunt trauma (50%) and sharp injuries (29%) were the most common mechanisms of injury. CONCLUSION: Femicide in Ethiopia is a significant public health and human rights concern, with a high proportion linked to intimate partner violence. The predominance of documented prior abuse, blunt trauma, domestic settings, and nighttime homicides reflects both the private nature of violence and systemic barriers to prevention. Integrating robust risk-assessment and early-warning mechanisms within healthcare, justice, and community structures is essential for identifying women at imminent risk and averting escalation to femicide.
Lema AS, Suleyman JS, Jonnalagadda KK et al.
