Early marriage and women’s empowerment: the case of child-brides in Amhara National Regional State, Ethiopia

Background Women, especially those who marry as children, experience various forms and degrees of exclusion and discrimination. Early marriage is a harmful traditional practice that continues to affect millions around the world. Though it has declined over the years, it is still pervasive in developing countries. In Ethiopia, Amhara National Regional State (or alternatively Amhara region) hosts the largest share of child-brides in the country. This study aimed at assessing the effects of early marriage on its survivors’ life conditions – specifically, empowerment and household decision-making – in western Amhara. Methods This study employed community-based cross-sectional study design. It adopted mixed method approach – survey, in-depth interview and focus group discussion (FGD) – to collect, analyse and interpret data on early marriage and its effects on household decision-making processes. The survey covered 1278 randomly selected respondents, and 14FGDs and 6 in-depth interviews were conducted. Statistical procedures – frequency distribution, Chi-square, logistic regression – were used to test, compare and establish associations between survey results on women empowerment for two groups of married women based on age at first marriage i.e., below 18 and at/after 18. Narratives and analytical descriptions were integrated to substantiate and/or explain observed quantitative results, or generate contextual themes. Results This study reported that women married at/after 18 were more involved in household decision-making processes than child-brides. Child-brides were more likely to experience various forms of spousal abuse and violence in married life. The study results illustrated how individual-level changes, mainly driven by age at first marriage, interplay with structural factors to define the changing status and roles of married women in the household and community. Conclusion Age at first marriage significantly affected empowerment at household level, and women benefited significantly from delaying marriage. Increase in age did not automatically and unilaterally empowered women in marriage, however, since age entails a cultural definition of one’s position in society and its institutions. We recommend further research to focus on the nexus between the household and the social-structural forms that manifest at individual and community levels, and draw insights to promote women’s wellbeing and emancipation.

Correction to: Behind bars: the burden of being a woman in Brazilian prisons

An amendment to this paper has been published and can be accessed via the original article.

Quality of life of women from families of martyred individuals in the Kurdistan region of Iraq as a conflict area in the Middle East

Background Quality of life (QOL) research develops data and insight into issues that pertain not only to the individual, but that can also apply to the population as a whole. This study aimed to analyze the QOL of Kurdish women from families of martyred individuals in the Kurdistan region of Iraq. Methods A cross-sectional study of 380 women from families of martyred individuals was conducted. All women were patients at the Medical Center of Martyr Families in Erbil City from January 2018 to April 2019. Data were collected through interviews and the WHOQOL-BREF scale was used to measure QOL. The women’s QOL scores were divided into four categories (i.e., quartiles): 1st, 2nd, 3rd and 4th quartile. Kruskal-Wallis and Chi-Square tests were used for data Analysis. Results The women’s QOL scores fell into the following quartiles: Overall QOL and General Health (n = 66.6%) in the 1st quartile, Physical and Psychological Health (n = 56.9%) in the 2nd quartile, Social Relationships (n = 47.9%) in the 3rd quartile, Environmental health (n = 85.6%) in the 2nd and 3rd quartile. The total QOL of more than half (n = 52.1%) of the women studied were in 1st and 2nd quartiles. Conclusion Women from families of martyred individuals were not satisfied with their QOL, especially in terms of Physical and Psychological Domains. International political and humanitarian actions are needed to reduce the destructive consequences of war and conflict on these suffering women.

Behind bars: the burden of being a woman in Brazilian prisons

Background Brazil has the third largest prison population in the world. In 2016, the female prison population totaled 42,000, an increase of 656% over the population recorded in the early 2000s. The objective of this study was to describe the socialeconomic and reproductive health of women in Brazilian prisons, and the specific assistance received within the prison system. Methods This is a first of its kind national survey conducted in 15 female prisons in eight Brazilian states between 2014 and 2015. The sample consisted of 1327 women in closed or semi-open prison regimes. Data collection used Audio Computer-Assisted Self-Interviewing (ACASI). STATA v.15. Was use in analysis. The study was submitted to the Research Ethics Committee of the Federal University of Ceará, under CEP protocol No. 1,024,053. Results The population was overwhelmingly Black or Brown, poor and little educated. When women worked previously, they had worked as domestic servants and were the sole source of income for their families. Most were mothers, with 39% having children less than 10 years old, now in the care of others. Most were in jail for drug-related crimes. Prisons were crowded, with more than 2/3rds of the inmates sharing a cell with 6 or more inmates. Services were provide, but women had not had a cervical cancer screening within the past 3 years and breast cancer screening was not conducted. Conclusions Overall, given their backround and prison conditions they are unlikely to change the circumstances that brought them to prison in the first place.

Engaging with faith groups to prevent VAWG in conflict-affected communities: results from two community surveys in the DRC

Background An evaluation was conducted of a three-year intervention focused on violence against women and girls (VAWG) and implemented in the conflict-affected north-east of the Democratic Republic of Congo (DRC), a country with high rates of VAWG. The intervention addressed VAWG, and especially sexual violence, by specifically engaging with communities of faith and their leaders. Methods Two community surveys were conducted, one before and one after the intervention, in three health areas in Ituri Province in the DRC. At both baseline and endline, data was collected from male and female members of randomly selected households in 15 villages (five per health area) in which the intervention was being implemented. At baseline the sample comprised 751 respondents (387 women, 364 men) and at endline 1198 respondents (601 women, 597 men). Questionnaires were interviewer-administered, with sensitive questions related to experience or perpetration of violence self-completed by participants. Results The study showed significantly more equitable gender attitudes and less tolerance for IPV at endline. Positive attitude change was not limited to those actively engaged within faith communities, with a positive shift across the entire community in terms of gender attitudes, rape myths and rape stigma scores, regardless of level of faith engagement. There was a significant decline in all aspects of IPV in the communities who experienced the intervention. While the experience and perpetration of IPV reported at endline did not track with exposure to the intervention, it is plausible that in a context where social norm change was sought, the impact of the intervention on those exposed could have had an impact on the behaviour of the unexposed. Conclusion This intervention was premised on the assumption that faith leaders and faith communities are a key entry point into an entire community, able to influence an entire community. Research has affirmed this assumption and engaging with faith leaders and faith communities can thus be a strategic intervention strategy. While we are confident of the link between the social norms change and faith engagement and project exposure, the link between IPV reduction and faith engagement and project exposure needs more research.

The Framework Convention on Tobacco Control in Slovakia and in Finland: one law, two different practices?

Background The Framework Convention on Tobacco Control (FCTC) was ratified in 2004 in Slovakia and in 2005 in Finland. The aim of this study was to compare the implementation of the FCTC in the national laws and policies regarding smoking in Finland and Slovakia. Methods In this case study the following areas are compared: the legal framework; the monitoring system and health promotion; treatment; and policies aimed at reducing tobacco consumption. We report on these in this order after a short historical introduction. Results The legal frameworks are similar in Slovakia and in Finland. Finland far exceeds the minimum legal requirements. Slovakian regulations reflect the FCTC requirements; however, social tolerance is very high. In Finland the monitoring system and health promotion are aimed more at tobacco consumption. Slovakia does not follow the surveillance plans recommended by WHO so strictly; often there are no current data available. No additional documents regarding the FCTC have been adopted in Slovakia. The financial contribution to treatment is very low. Slovakian tobacco control policy is more focused on repression than on prevention, in contrast to Finland. Smoking bans meet European standards. Excise duties rise regularly in both countries. Conclusion Implementation of the FCTC is at different levels in the compared countries. Finland has a clear plan for achieving the goal of a smoking-free country. Slovakia meets only the minimum standard required for fulfillment of its international obligations. Its policy should become more transparent by making more up-to-date data available.

Understanding access to professional healthcare among asylum seekers facing gender-based violence: a qualitative study from a stakeholder perspective

Background When it comes to gender-based violence (GBV), migrant women and girls represent the most vulnerable group. GBV can happen at any stage of migrants’ flight and/or during the asylum process. It has severe consequences on their life and health. Victims therefore need timely access to healthcare. This study explores the context GBV victims face when they seek refuge in Switzerland. Methods Qualitative methodology was used where we conducted five semi-structured focus groups and three interviews. A total of sixteen stakeholders participated in the study. They were either involved in the asylum process or provided healthcare to asylum seekers. We analyzed the data using framework analysis. Results Study participants noted lack of confidence of the GBV victims in the legal and in the healthcare systems as major barriers to disclosure of GBV. Since only GBV exerted before fleeing the home country gives the right to asylum, they pointed out that victims do not disclose GBV that took place after they left their home country. Language was identified as a barrier to disclosure of GBV as well as to healthcare access. Continuity of care at the moment of transfer from federal to cantonal (i.e. state) accommodations is another issue that was deemed critical. Study participants felt that health professionals must be trained to identify GBV victims. The first-contact caregiver available to these victims was deemed as the most competent professional that could act as a “GBV coordinator”. Conclusion In Switzerland, access to healthcare is guaranteed to all asylum seekers on a legal and structural level. Yet, health seeking by GBV survivors is hindered by factors such as lack of confidence in the legal system, trust in health providers, and continuity of care during the asylum process. Building trust in legal institutions, health structures, and professionals should be enhanced to facilitate disclosure and to strengthen resilience. This includes a healthcare system with competent professionals, support with language and cultural needs, as well as seamless continuity of care beyond cantonal borders.

The correlation between sexual dysfunction and intimate partner violence in young women during pregnancy

Background Sexual function is one of the main aspects of life. Pregnancy affects sexual function. The aim of this study was to determine the sexual dysfunction in young pregnant women and its correlation with intimate partner violence (IPV). Methods This cross-sectional study was conducted using two-stage cluster sampling method. The data were collected using a socio-demographic questionnaire, Female Sexual Function Index (FSFI), and Conflict Tactics Scale (CTS2). Multivariate logistic regression was used to determine the relationships between sexual dysfunction with IPV and socio-demographic factors. Results The results of this study on 346 pregnant women aged 18–29 years showed that mean (SD = standard deviation) of the total sexual function score was 25.4 (5.9), within a possible score range of 2 to 36. About 66% of the young pregnant women had a sexual dysfunction. The lowest and the highest prevalence of sexual dysfunction were in sub domains of sexual satisfaction and sexual desire, respectively. The prevalence of overall IPV against young women was 63%. The most common type of IPV experienced by women was psychological aggression (56.6%). There were statistically significant relationships between sexual dysfunction and IPV (OR (Odds Ratio) = 0.4, 95% Confidence Interval = 0.2 to 0.6, p < 0.001), sufficiency of income for expenses (0.2, 0.1 to 0.6, p = 0.005), husband educational level (0.5, 0.3 to 0.9, p = 0.028) and marriage duration (1.9, 1.0 to 3.7, p = 0.044). Conclusions Sexual dysfunction has a high prevalence in young pregnant women and IPV had correlation with sexual dysfunction. The routine screening for sexual dysfunction and IPV is recommended during pregnancy for detection and consulting.

Disrespect and abuse of women during the process of childbirth at health facilities in sub-Saharan Africa: a systematic review and meta-analysis

Background Disrespectful and abusive treatment of women by health care providers during the process of childbirth at health facility is an international problem. There is a lack of data on disrespect and abuse of women during the process of childbirth at health facilities in Sub-Saharan Africa. The purpose of this study was to determine the prevalence of disrespect and abuse of women during the process of childbirth at health facilities in sub-Saharan Africa. Methods The PRISMA guideline protocol was followed to write the systematic review and meta-analysis. Published studies were searched from Medline, PubMed, CINAHL, EMBASE, Maternal and infant care, science direct, and PsycINFO. Articles were accessed by three reviewers (ZY, BT and AA) using the following key terms, “attitude of health personnel” AND “delivery obstetrics*/nursing” OR “maternity care” AND “disrespect” OR “abuse” OR “professional misconduct” AND “parturition” AND “prevalence” AND “professional-patient relations” AND “Sub-Saharan Africa”. Additional articles were retrieved by cross referencing of reference. The heterogeneity of studies were weighed using Cochran’s Q test and I2 test statistics. Publication bias was assessed by Egger’s test. Results Thirty three studies met the inclusion and included in this systematic review and meta–analysis of disrespect and abuse of women during the process of childbirth at health facilities. The pooled prevalence of disrespect and abuse women during the process of childbirth at health facilities in Sub-Saharan Africa was 44.09% (95% CI: 29.94–58.24).Particularly physical abuse was 15.77% (95% CI: 13.38–18.15), non-confidential care was 16.87% (95% CI: 14.49–19.24), abandonment was 16.86% (95% CI: 13.88–19.84) and detention was 4.81% (95% CI: 3.96–5.67). Conclusion In this study disrespect and abuse of women during the process of childbirth at health facilities are high compared with other studies, particularly non-confidential care and abandonment his high compared with other studies. This study points out that the ministry of health, health care providers, maternal health experts shall due attention to women’s right during the process of childbirth at health facilities.