Increasingly, researchers and practitioners are examining connections between public and private cycles of violence. In complex emergency settings, these cycles of violence often intersect with conflicting norms and values as societies work toward sustainable peace. Gender norms, particularly norms of masculinity, are not often highlighted in transdisciplinary violence studies. Furthermore, few studies on either subject capture the perspectives and experiences of adolescent boys. This study seeks to explore adolescent boys’ (13-17 years) experiences with violence at home and in the community in “post-conflict” Colombia. Thematic qualitative analysis of 20 interview transcripts from 14 Colombian boys in Cundinamarca ( n = 5) and Córdoba ( n = 9) revealed themes of conflict avoidance, hegemonic masculinity, and opportunities for change in the form of positive coping habits. Further research into social and emotional coping behaviors and linkages to perpetuating violence between adolescence and adulthood is needed.
Amanda Browne, Cyril Bennouna, Khudejha Asghar et al.
INTRODUCTION: Refugee adolescents living in camps and settlements in low and middle-income countries are a vulnerable population who face protection and psychosocial risks. This study explores prevalence of child labor amongst adolescent refugees from South Sudan in two refugee settlements in Uganda, to understand impacts of child labor on mental health outcomes, and examines the influence of sex on these impacts. METHODS: Surveys were conducted in Adjumani and Kiryandongo refugee settlements, Uganda, with 470 adolescents between 13 and 17 interviewed between December 2014-February 2015. Univariate finite mixture modeling identified a two-cluster model of child labor. Logistic regression models assessed the association of child labor and mental health. RESULTS: A two-cluster solution for child labor activity was determined among the 332 adolescents who self-reported engaging in any child labor (Significant child labor: n = 174, 37%; moderate child labor cluster: n = 158, 34%; no child labor cluster: n = 138, 29%. Odds of depression amongst adolescents exposed to significant vs. no child labor was 4.15 (95% CI: 2.01-8.56), in a model examining interaction of sex and child labor and controlling for socio-demographic variables. For the anxiety outcome, girls exposed to significant vs. no child labor are less likely to report higher levels of anxiety (OR: 0.29, 95% CI: 0.09-0.90). CONCLUSIONS: Adolescents living in refugee settlements in Uganda report high levels of participation in child labor. Protection of adolescents from the risks involved with child labor in refugee contexts is an important and often over-looked area of child protection in humanitarian settings.
Sarah Rachel Meyer, Gary Yu, Eliana Rieders et al.
Background. Evidence suggests adolescent self-esteem is influenced by beliefs of how individuals in their reference group perceive them. However, few studies examine how gender- and violence-related social norms affect self-esteem among refugee populations. This paper explores relationships between gender inequitable and victim-blaming social norms, personal attitudes, and self-esteem among adolescent girls participating in a life skills program in three Ethiopian refugee camps. Methods. Ordinary least squares multivariable regression analysis was used to assess the associations between attitudes and social norms, and self-esteem. Key independent variables of interest included a scale measuring personal attitudes toward gender inequitable norms, a measure of perceived injunctive norms capturing how a girl believed her family and community would react if she was raped, and a peer-group measure of collective descriptive norms surrounding gender inequity. The key outcome variable, self-esteem, was measured using the Rosenberg self-esteem scale. Results. Girl's personal attitudes toward gender inequitable norms were not significantly predictive of self-esteem at endline, when adjusting for other covariates. Collective peer norms surrounding the same gender inequitable statements were significantly predictive of self-esteem at endline (ß = −0.130;p = 0.024). Additionally, perceived injunctive norms surrounding family and community-based sanctions for victims of forced sex were associated with a decline in self-esteem at endline (ß = −0.103;p = 0.014). Significant findings for collective descriptive norms and injunctive norms remained when controlling for all three constructs simultaneously. Conclusions. Findings suggest shifting collective norms around gender inequity, particularly at the community and peer levels, may sustainably support the safety and well-being of adolescent girls in refugee settings.
PURPOSE: Newcomer adolescent girls from the Middle East and North Africa region face intersectional challenges and opportunities upon resettlement. This study employs PhotoVoice participatory research methodology to explore perspectives on well-being and belonging shared by six students who resettled to Chicago from Iraq and Syria. METHODS: Two programme sessions consisted of participants reflecting on their photographic responses to four prompts in focus group discussions. The subsequent four sessions included qualitative analysis skill building, participant-led generation of thematic codes and diagrams using their data, and the creation of action plan posters to share back with the community. The research team then analysed all data using a grounded theory approach with constant comparative analysis. RESULTS: Four major themes emerged: 1) public spaces served as a vehicle for exploring well-being and belonging; 2) intersectional inclusion in public spaces was deemed a vital priority; 3) schools held an important role in facilitating belonging and access to public spaces; and 4) language was a critical barrier and facilitator to access and inclusion. CONCLUSIONS: Findings highlight the need for holistic approaches to support refugee youth in urban contexts and emphasize the role of schools in facilitating inclusive access to public spaces to strengthen newcomer students' well-being and belonging.
Alli Gillespie, Zahyyeh Abu-Rubieh, Lily Coll et al.
Violence against women and girls (VAWG) is a leading cause of mortality and morbidity worldwide, linked to numerous health, economic, and human rights outcomes. Target 5.2 of the Sustainable Development Goals calls for elimination of all forms of VAWG; however, progress toward achieving this goal has been inadequate. A lack of sufficient data and evidence has hindered global efforts to meet this target and hold governments accountable for action. While there have been substantial advancements in VAWG research methodology over the past three decades, researchers from diverse disciplines tend to work in silos, inhibiting progress in VAWG research. To address this challenge, we offer four key recommendations to support researchers in expanding transdisciplinary approaches: 1) leverage insights from a variety of VAWG data sources, 2) improve precision of VAWG definitions and outcomes, 3) create strategies to address underreporting, and 4) advance research ethics and equity. We conclude with a call to action for researchers, institutions, and donors to advance transdisciplinary research and foster collaboration, learning, and cross-fertilization across scientific fields to accelerate VAWG prevention efforts now and for future generations.
Kathryn Falb, Amber Peterman, Ragnhild Nordås et al.
Global guidance indicates that protections for gender and equity issues, such as gender-based violence (GBV), should be mainstreamed across sectors. One novel strategy that can be leveraged to illustrate the cross-cutting impacts of GBV is to investigate GBV syndemically. This systematic review identified, evaluated, and synthesized quantitative studies conducted in LMICs that tested syndemic theories involving GBV. A systematic search of the peer-reviewed literature was conducted in Medline, Global Health, Scopus, Anthro Source, Anthropology Plus, Web of Science, PsychInfo, and Gender Watch. Peer-reviewed empirical research published in English that used quantitative methods to test syndemic theories involving GBV in LMICs were included. 4068 references were retrieved, 2160 studies were screened against their titles/abstracts, and 227 studies were assessed for full text eligibility. Overall, 45 studies met the inclusion criteria. Most articles conceptualized GBV as an exposure that clustered with other epidemics. More than half of the evidence base investigated combinations of GBV, mental health, substance use, and HIV/AIDS. Research articles investigating the SAVA syndemic among men who have sex with men (MSM) and transgender women provided the strongest evidence, particularly in India. Notable analytical gaps pertained to GBV measurement challenges and statistical approaches to test contextual factors in LMICs. The current evidence base is predominantly focused on GBV syndemic models that inform response/harm mitigation efforts rather than prevention. Future research should concentrate on how the political environment perpetuates clustering and interactions, expanding the contexts studied beyond upper middle-income countries, and improving methodological rigor in terms of GBV measurement. • Syndemic theory posits that epidemics do not occur in isolation of one another and the wider context. • Global health research demonstrates that GBV is syndemic with HIV and substance use. • This systematic review synthesized studies that quantitatively tested GBV syndemics in LMICs. • GBV syndemics involving perpetration, maternal-child health co-morbidities, and in humanitarian settings were less studied. • Future research should focus on integrating context and robustly estimating the population prevalence of clustering.
Luissa Vahedi, Ilana Seff, Alexander C. Tsai et al.
BACKGROUND: Child psychological distress in refugee settings is a significant public health concern, which is exacerbated by poor caregiver mental health and functioning. However, there are limited studies about effective interventions to improve caregiver mental health in support of child wellbeing. The objective of the current study is to evaluate the effectiveness and implementation of the Journey of Life (JoL) intervention to improve caregiver mental health in a refugee camp in Western Uganda. METHODS: A waitlist-control quasi-experimental design is being implemented in the Kiryandongo refugee settlement (intervention n = 600, control n = 600). Caregiver mental distress, measured using the Kessler-6, was selected as the primary outcome. Secondary outcomes include (a) functioning measured by the World Health Organization Disability Assessment Schedule, (b) social support measured by the Medical Outcomes Study Social Support Survey, and (c) caregiving behaviors according to the Parental Acceptance and Rejection Questionnaire and the Child Protection Index. The study aims to examine the implementation of the JoL intervention through qualitative assessments of intervention feasibility, adaptations, and reach. DISCUSSION: This trial will add much-needed evidence for the implementation of caregiver psychosocial programming within the humanitarian community. Findings will be disseminated amongst local, regional, and global actors in order to guide potential scale up within humanitarian settings. TRIAL REGISTRATION: Clinical Trials NCT04817098 (Registered: 3/24/21).
Flora Cohen, Sabrina Hermosilla, Justin Knox et al.
BACKGROUND: The COVID-19 pandemic produced alarming rates of disease and mortality globally, yet few nations were as severely impacted as Brazil. The pandemic also exposed and exacerbated persistent forms of structural violence across Brazil, which complicated gender-based violence (GBV) prevention and response efforts. While structural violence is not new, the systemic pressure and uncertainty introduced by COVID-19 intensified the detrimental impact of structural violence on the lives of Brazilians impacted by GBV. This work qualitatively investigated how the COVID-19 pandemic amplified structural violence and GBV in Brazil. METHODS: We analyzed key informant interviews (KII) conducted with 12 service providers working in sectors related GBV prevention and response in Roraima, Boa Vista, and Rio de Janeiro. Interviews were audio-recorded, transcribed, and translated from Portuguese or Spanish into English, before applying deductive and inductive coding approaches through a collaborative data reduction process. The theoretical lens of structural violence outlined by Farmer and Rylko-Bauer guided the thematic development. RESULTS: Analyses identified three themes. First, structural violence manifests as policies of inaction and erasure, which reduce the opportunity for upward social mobility among GBV survivors including Black women, trans persons, and people who live in the favelas. Policies of inaction and erasure fail to acknowledge/adequately respond to the significant health and safety needs of these communities. Second, structural violence is a fundamental cause of violence against women and children. Finally, service providers described community driven responses that address the dire survival needs (i.e., food insecurity) imposed by COVID-19, within a context of structural violence. These community driven responses were innovative, agile, and based on dire needs expressed to, and observed by, the service providers interviewed. CONCLUSION: This analysis highlights how the COVID-19 pandemic exacerbated existing forms of structural violence prevalent throughout Brazil. Findings stress the urgency with which the Brazilian government and international organization must act to support community driven programs that strive to address the most basic human needs.
Luissa Vahedi, Samantha McNelly, Nina Lukow et al.
Background: Governmental and non-governmental organizations across medical, legal, and psychosocial sectors providing care to survivors of gender-based violence (GBV) and their families rapidly digitalized services during the COVID-19 pandemic. GBV prevention/response services working with women and children who are forcibly displaced and/or living in low-and-middle income countries (LMIC) were no exception to the rapid digitalization trend. Literature is lacking a critical synthesis of best practices and lessons learned since digitalization replaced major operations involved in GBV prevention/response.Objective: This research qualitatively investigated how GBV service providers, located in a range of socio-political settings, navigated the process of digitalizing GBV prevention/response during the COVID-19 crisis.Method: Semi-structured key informant interviews (KII) with GBV service providers in varied sectors were implemented virtually (2020–2021) in Brazil, Guatemala, Iraq, and Italy (regarding forcibly displaced women/girls for the latter). Participants were recruited using purposive and snowball sampling. Interview guides covered a range of topics: perceived changes in violence and service provision, experiences with virtual services, system coordination, and challenges. The KIIs were conducted in Portuguese, Spanish, Arabic, and Italian. Interviews were audio-recorded, transcribed, and translated into English. The research team conducted thematic analysis within and between countries using a structured codebook of data driven and theory driven codes.Results: Major themes concerned the: (1) spectrum of services that were digitalized during the COVID-19 crisis; (2) gender digital divide as a barrier to equitable, safe, and effective service digitalization; (3) digital violence as an unintended consequence of increased digitalization across social/public services.Conclusion: Digitalization is a balancing act with respect to (1) the variety of remotely-delivered services that are possible and (2) the access/safety considerations related to the gender digital divide and digital violence.
BACKGROUND: Intimate partner violence (IPV) is the most pervasive form of gender-based violence, often first experienced in adolescence. While the prevalence of IPV is known to be exacerbated in humanitarian settings, little is known in regard to the economic burden of IPV between conflict-affected and non-conflicted-affected groups of women and girls. This top-down costing study examines the total health burden of physical IPV in Colombia, and whether these costs differ by conflict exposure. METHODS: We utilized a nationally representative sample of 13-24-year-old females from the Violence Against Children Surveys (VACS) in Colombia conducted in 2018. Using physical IPV prevalence, the analysis was conducted in four steps: 1) estimate the relative risk of seven IPV-associated health outcomes among the sample and subgroups, 2) estimate the population attributable fraction of IPV for each health outcome, 3) quantify the burden of IPV in disability-adjusted life years (DALYs), and 4) assign health costs in US dollars to the estimated DALYs. RESULTS: We found that the single year health burden associated with physical IPV was $90.6 million USD. Moreover, nearly 40% of the economic burden of physical IPV among females aged 13-24 in Colombia was from those who were conflict-affected (24%). CONCLUSION: Our findings demonstrate that at least 16% of the overall health costs among females 13-24 in Colombia is from the preventable epidemic of physical IPV. In order to prevent and mitigate the costs of gender-based violence, multi-lateral and government investment is critically needed to prevent IPV and support women and girls.
Derek S. Brown, Melissa Meinhart, Catherine Poulton et al.
