Understanding the menstrual hygiene management challenges facing displaced girls and women: findings from qualitative assessments in Myanmar and Lebanon

Background

There is a significant gap in empirical evidence on the menstrual hygiene management (MHM) challenges faced by adolescent girls and women in emergency contexts, and on appropriate humanitarian response approaches to meet their needs in diverse emergency contexts. To begin filling the gap in the evidence, we conducted a study in two diverse contexts (Myanmar and Lebanon), exploring the MHM barriers facing girls and women, and the various relevant sectoral responses being conducted (e.g. water, sanitation and hygiene (WASH), Protection, Health, Education and Camp Management).

Methods

Two qualitative assessments were conducted: one in camps for internally displaced populations in Myanmar, and one with refugees living in informal settlements and host communities in Lebanon. Key informant interviews were conducted with emergency response staff in both sites, and focus group discussion and participatory mapping activities conducted with adolescent girls and women.

Results

Key findings included that there was insufficient access to safe and private facilities for MHM coupled with displacement induced shifts in menstrual practices by girls and women. Among staff, there was a narrow interpretation of what an MHM response includes, with a focus on supplies; significant interest in understanding what an improved MHM response would include and acknowledgement of limited existing MHM guidance across various sectors; and insufficient consultation with beneficiaries, related to discomfort asking about menstruation, and limited coordination between sectors.

Conclusions

There is a significant need for improved guidance across all relevant sectors for improving MHM response in emergency context, along with increased evidence on effective approaches for integrating MHM into existing responses.

     

Gender-based violence and trauma in marginalized populations of women: Role of biological embedding and toxic stress

Abstract

Gender-based violence (GBV) and trauma can dysregulate and recalibrate environmentally sensitive physiological (i.e. central nervous, endocrine, and immune) systems placing survivors at risk for multiple health problems. The researchers build the case that the effects of GBV are likely to be particularly high impact and contribute to health disparities for marginalized survivors of GBV. Further, the researchers underscore a need for a multi-level bio-socio-ecological model that deciphers, characterizes, and explains individual differences in these effects and the need to establish an evidence base from which to derive interventions that address biological effects of toxic stress among marginalized survivors of GBV.     

Breast cancer screening in older African-American women: qualitative research findings

PURPOSE. The purpose of this study was to gain a better understanding of the cultural meanings that shape the breast cancer screening behavior of older African-American women. DESIGN. Qualitative research methods elicited social and cultural themes related to breast cancer screening. SETTING. Focus group interviews were conducted in the natural settings (churches, etc.) of older African-American women. SUBJECTS. Interviews were conducted with 132 members from 14 social networks of older African-American women. MEASURES. A focus group guide asked about 1) perceived risk of breast cancer, 2) behavioral intentions about breast cancer screening, 3) health seeking behavior, and 4) social support. RESULTS. For older African-American women: other health concerns are of more concern than breast cancer; age is generally not recognized as a risk factor for breast cancer; fear of finding breast cancer and its social consequences are salient barriers to mammography; they tend to rely on breast self-exam rather than mammography to detect a breast problem; cost may be more an issue of competing priorities than cost per se; the tradition is to go to doctors for a problem, not prevention; and women in their own social networks are important sources of social support for health concerns. CONCLUSIONS. These data offer explanations for mammography screening in older African-American women and emphasize the strength of naturally existing sources of social support for designing interventions to increase breast cancer screening.     

The services for women victims of sexual violence: a qualitative study

OBJECTIVE: To assess public services attending female victims of sexual violence in the city of Sao Paulo. METHODS: This is a qualitative study conducted in two public services attending female victims of sexual violence. Interviews with 42 women were conducted, 13 of whom had sought these services for assistance and 29 were professionals working in these services. Evaluation of the services was based on the categories: reception, access, resolvability and sanitary responsibility. RESULTS: The analysis of the interviews per category has shown that there was reception in both services, problems with respect to access due to the lack of information concerning these services, and quality resolvability with a multi-professional team. As to the sanitary responsibility, it is present in these specialized services but is deficient in the emergency services and basic health care units. Many women are unaware of the rights they are entitled to with respect to specialized services. Frequently their late arrival compromises the efficacy of care. There are deficiencies both in terms of reference and counter reference. CONCLUSIONS: The results ratify the importance of these services and the need for their decentralized expansion. Health courses should introduce the theme of sexual violence at the undergraduate level.     

Linking cervical cancer to the human papillomavirus: findings from a qualitative study with Mexican women

Cervical cancer is an important cause of mortality for women in developing countries. Researchers have established a link between cervical cancer and the human papillomavirus (HPV). We explored Mexican women's beliefs about cervical cancer and sexually transmitted infections (STIs), including HPV, to better understand the social implications of this linkage. We conducted eight focus groups with middle-aged and young women in Mexico City. Cervical cancer elicited different social and emotional responses than STIs; participants generally attached less culpability to it and saw it as more life threatening. Information campaigns should take into account differences in lay conceptions of these illnesses.     

Gender-based violence and HIV sexual risk behavior: Alcohol use and mental health problems as mediators among women in drinking venues, Cape Town

Gender-based violence is a key determinant of HIV infection among women in South Africa as elsewhere. However, research has not examined potential mediating processes to explain the link between experiencing abuse and engaging in HIV sexual risk behavior. Previous studies suggest that alcohol use and mental health problems may explain how gender-based violence predicts sexual risk. In a prospective study, we examined whether lifetime history of gender-based violence indirectly affects future sexual risk behavior through alcohol use, depression and post-traumatic stress disorder (PTSD) in a high-risk socio-environmental context. We recruited a cohort of 560 women from alcohol drinking venues in a Cape Town, South African township. Participants completed computerized interviews at baseline and 4 months later. We tested prospective mediating associations between gender-based violence, alcohol use, depression, PTSD, and sexual risk behavior. There was a significant indirect effect of gender-based violence on sexual risk behavior through alcohol use, but not mental health problems. Women who were physically and sexually abused drank more, which in turn predicted more unprotected sex. We did not find a mediated relationship between alcohol use and sexual risk behavior through the experience of recent abuse or mental health problems. Alcohol use explains the link between gender-based violence and sexual risk behavior among women attending drinking venues in Cape Town, South Africa. Efforts to reduce HIV risk in South Africa by addressing gender-based violence must also address alcohol use.     

Examining long-acting reversible contraception non-use among Australian women in their 20s: findings from a qualitative study

Australian women use less effective, short-term methods of contraception more often than any other method, despite the availability of much more effective long-acting reversible contraception (LARC). Although research examining the low uptake of LARC among Australian women has increased over the past few years, we still know little about the factors influencing this phenomenon. Using data from semi-structured telephone interviews with 15 Australian women in their 20s, this paper explores contraceptive experience to better understand the non-use of LARC. Findings highlight the ubiquity of the use of the oral contraceptive pill and perceptions of LARC as a more serious contraceptive choice. Among participants, the intrauterine device (IUD) was viewed particularly unfavourably. Furthermore, LARC was shown to be only considered for use after dissatisfaction with shorter-term methods (usually the Pill) if at all. Overall, these findings suggest further education in dispelling myths and discomfort around LARC use, while simultaneously recognising and respecting women’s decisions to not use LARC methods.     

The association between armed conflict,violence and mental health: a cross sectional study comparing two populations in Cundinamarca department,Colombia

Background

Exposure to violence in general and to armed conflict in particular has been consistently associated with an increased prevalence of mental illness. Colombia has sustained an internal armed conflict for decades and is considered one of the most violent countries in the world. However, certain areas have been more exposed to the conflict than others.

Methods

This is a cross sectional study comparing two communities from different villages in the department of Cundinamarca, Colombia. One, Guasca, was directly impacted by armed conflict. The other one; Guatavita has never been affected by armed conflict. We applied two different instruments: the PHQ scale and a short standardized interview in order to estimate the prevalence of major psychiatric disorders and their link to violent events. Forty-two volunteers from each village were evaluated through a personal interview using these two instruments.

Findings

Of the population surveyed in Guatavita, 2.4% reported direct exposure to violence compared to 23.8% from Guasca. In the population exposed directly to violent events, the prevalence of all disorders was greater than in the non-exposed population with an OR of 1.46 (95% CI 0.3809 - 5.5989) for anxiety; 4.54 (95% CI 1.1098 - 18.5984) for depression; 6.0 (95% CI 1.2298 - 30.2263) for somatization disorder; and 4.4 (95% CI 1.2037 - 16.0842) for alcohol abuse.

Interpretation

There is a statistically significant association between the history of armed conflict, violence and the presence of mental illnesses, particularly depression, somatization disorder and alcohol abuse. Special attention should be paid to the detection, prevention and treatment of these disorders when dealing with populations exposed to violence and to armed conflict in particular.

     

Marital violence in Barranquilla [Colombia]: prevalence and risk factors

OBJECTIVE: To determine the prevalence of violence against women of fertile age living in a couple and identify the personal, socioeconomic, and family function characteristics associated with this phenomenon. METHODS: We performed a cross-sectional study in a random sample of 275 women of fertile age living in the neighborhood of Carlos Meisel in Barranquilla, Colombia. Information was gathered through a structured questionnaire and face-to-face interviews at the participants' homes. The questionnaire was adapted from the World Health Organization's recommendations on ethics and safety when investigating domestic violence. The questionnaire included items on personal characteristics, habitual alcohol and drug consumption, family function test (Family Apgar), socioeconomic characteristics, and physical abuse in the 12 months prior to the interview. RESULTS: The prevalence of marital violence was 22.9%. Women aged 25-29 years old were the most commonly affected (33.3%). Factors associated with violence were habitual alcohol consumption in women (Odds ratio [OR] = 6.02; 95% confidence interval [95% CI], 1.7-22.2) and in the spouse (OR = 10.11; 95% CI, 5.1-20.1) and drug consumption by the husband (OR = 11.01; 95% CI, 4.2-29.5). A monthly wage of less than 300,000 Colombian pesos (140 euros) was also significantly associated with domestic violence as was moderate or severe family dysfunction (respectively, OR = 16.9; 95% CI, 4.8-59.0; OR = 81.6; 95% CI, 18.8-335). CONCLUSIONS: Because this was a cross-sectional study, the results should be interpreted with caution. Nevertheless, violence against women in the study sample was associated with potentially modifiable factors.     

Kala-azar in displaced people from southern Sudan: epidemiological, clinical and therapeutic findings.

Six hundred and ninety-three patients with kala-azar were seen in Khartoum, Sudan, from January 1989 to February 1990. They were almost exclusively from the Nuer tribe, originating from the western Upper Nile province in southern Sudan, an area not known previously to be endemic for kala-azar. Because of the civil war in southern Sudan no treatment was available locally and massive migration to northern Sudan occurred; many died on the way. All age groups were affected; there was a slight male preponderance (56%). In the clinical presentation, marked generalized lymphadenopathy was prominent (84%). Splenomegaly was absent in 4% of cases. Patients usually showed anaemia, leucopenia and/or thrombocytopenia. 623 patients were treated with sodium stibogluconate, 10 mg/kg for 30 d; relapse occurred in 4% and death in 12%. Latterly, 70 patients were treated with sodium stibogluconate at 2 x 10 mg/kg for 15 d, with relapse in 6% and death in 6%. The difference between the 2 regimens in the number of relapses and deaths was not significant. The outbreak may have been caused by a combination of factors: the introduction of the parasite from an endemic area to a non-immune population, the presence of malnutrition caused by loss of cattle and unavailability of other food sources, and possibly an ecological change in favour of the sandfly vector.     

Partner violence and health: results from the first national study on violence against women in Norway

BACKGROUND: Violence against women has long been considered a hidden health burden. Questions about violence have not been included in health surveys; hence, little is known about prevalence and the consequences for health in the general population. No national study has been conducted in Norway. AIMS: To estimate the prevalence of partner violence in Norway and the relationship between victimization and somatic health and depression and anxiety and post-traumatic stress symptoms. METHODS: Data collection was performed by Statistics Norway. Among a random sample of women aged 20-55 years, 2,407 women returned the questionnaire (63.3%), of whom 2,143 were ever-partnered. Selected demographic characteristics were obtained from registers. RESULTS: In total, 26.8% of 2,143 ever-partnered women had experienced any violence by their partner during their lifetime, and 5.5% in the year before the study. Low educational level, being unmarried, separated or divorced, currently being unemployed, receiving social security benefits and having no children were significantly associated with reporting partner violence. Exposure to partner violence was associated with poor health, depressive and post-traumatic stress symptoms, gynaecological complaints, injuries, and disability, and remained so after controlling for age, education, unemployment, relationship break-up and low economic status. CONCLUSIONS: Partner violence is common and was associated with a range of somatic and mental health problems. Thus, violence against women by their partners is an important public health concern.     

From political to personal violence: Links between conflict and non-partner physical violence in post-conflict Liberia

ABSTRACT

War and interpersonal violence together account for a large burden on global health. Yet very few studies look at the relationship between these types of aggression. Non-partner physical violence (NPPV) is an often-understudied form of gender-based violence (GBV). This analysis draws on two datasets from one conflict-affected country, Liberia, to evaluate the impact of conflict on NPPV post-conflict. The Armed Conflict Location and Event Dataset (ACLED) measures the intensity of the conflict in Liberia from 1999-2003, while the Demographic and Heath Survey (DHS) data measure women's experiences with violence four years post-conflict. Almost half of women surveyed (45%) indicated that they experienced any kind of NPPV, highlighting the widespread nature of this issue. A multilevel modelling approach was used to account for the nesting of individuals within districts. Women living in districts that experienced conflict events in four or five years were almost three times as likely (aOR 2.93, p?<?.001) to experience past-year NPPV compared to individuals living in no conflict districts. Findings from this study suggest women residing in a conflict event-affected district may be at heightened risk of increased violence even years after peace is declared.     

HIV-positive women report more lifetime partner violence: findings from a voluntary counseling and testing clinic in Dar es Salaam,Tanzania

OBJECTIVES: Experiences of partner violence were compared between HIV-positive and HIV-negative women. METHODS: Of 340 women enrolled, 245 (72%) were followed and interviewed 3 months after HIV testing to estimate the prevalence and identify the correlates of violence. RESULTS: The odds of reporting at least 1 violent event was significantly higher among HIV-positive women than among HIV-negative women (physical violence odds ratio [OR] = 2.63; 95% confidence interval [CI] = 1.23, 5.63; sexual violence OR = 2.39; 95% CI = 1.21, 4.73). Odds of reporting partner violence was 10 times higher among younger (< 30 years) HIV-positive women than among younger HIV-negative women (OR = 9.99; 95% CI = 2.67, 37.37). CONCLUSIONS: Violence is a risk factor for HIV infection that must be addressed through multilevel prevention approaches.     

Collective violence and attitudes of women toward intimate partner violence: Evidence from the Niger Delta

Background  

The Niger Delta region of Nigeria has been undergoing collective violence for over 25 years, which has constituted a major public health problem. The objectives of this study were to investigate the predictors of women's attitudes toward intimate partner violence in the Niger Delta in comparison to that of women in other parts of Nigeria.