BMC International Health and Human Rights is an open access journal publishing original peer-reviewed research articles in relation to health and disease in developing and transitional countries, as well as all issues relating to the impact of health policies, programs and practices on human rights. BMC International Health and Human Rights is indexed/tracked/covered by PubMed, CAS, Scopus, EMBASE and Google Scholar.

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

    Mikyas Abera; Ansha Nega; Yifokire Tefera; Abebaw Addis Gelagay (BMC, 2020-12-01)
    Abstract 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

    Priscila França De Araújo; Ligia Regina Franco Sansigolo Kerr; Carl Kendall; George W. Rutherford; David W. Seal; Roberto da Justa Pires Neto; Patrícia Neyva da Costa Pinheiro; Marli Teresinha Gimeniz Galvão; Larissa Fortunato Araújo; Francisco Marto Leal Pinheiro (BMC, 2020-12-01)
    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

    Hamdia Mirkhan Ahmed (BMC, 2020-11-01)
    Abstract 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

    Priscila França De Araújo; Ligia Regina Franco Sansigolo Kerr; Carl Kendall; George W. Rutherford; David W. Seal; Roberto da Justa Pires Neto; Patrícia Neyva da Costa Pinheiro; Marli Teresinha Gimeniz Galvão; Larissa Fortunato Araújo; Francisco Marto Leal Pinheiro (BMC, 2020-10-01)
    Abstract 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

    Elisabet Le Roux; Julienne Corboz; Nigel Scott; Maggie Sandilands; Uwezo Baghuma Lele; Elena Bezzolato; Rachel Jewkes (BMC, 2020-10-01)
    Abstract 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?

    Barbara Pavlikova; Jitse P. van Dijk (BMC, 2020-09-01)
    Abstract 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

    Mirjam D. Rodella Sapia; Tenzin Wangmo; Stéphanie Dagron; Bernice S. Elger (BMC, 2020-09-01)
    Abstract 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

    Ellahe Bahrami_Vazir; Sakineh Mohammad-Alizadeh-Charandabi; Mahin Kamalifard; Fatemeh Ghelichkhani; Azam Mohammadi; Mojgan Mirghafourvand (BMC, 2020-09-01)
    Abstract 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

    Zemenu Yohannes Kassa; Berhan Tsegaye; Abebaw Abeje (BMC, 2020-09-01)
    Abstract 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.
  • A renewed call for transdisciplinary action on NCDs

    Brigit Toebes; Marlies Hesselman; Jochen O. Mierau; Jitse P. van Dijk (BMC, 2020-08-01)
    Abstract Notwithstanding COVID-19, non-communicable diseases (NCDs) will be the leading cause of death in every region in the world by 2030. This contribution, which forms an introduction to our collection of articles in this journal, identifies elements for a transdisciplinary research agenda between law, public health, health economics and international relations aimed at designing concrete interventions to curb the NCD pandemic, both globally and domestically.
  • Status and associated factors of birth registration in selected districts of Tigray region, Ethiopia

    Shishay Tadesse Abay; Ataklti Gebreyesus Gebre-egziabher (BMC, 2020-07-01)
    Abstract Background Birth registration establishes the existence of a child under law and provides the foundation for ensuring many of his/her rights. Despite its significance, a continuous, effective and comprehensive birth registration system has not been established in Ethiopia until the recent past. This paper examines the status of child’s birth registration and its associated factors in selected districts of Tigray Region, Ethiopia. Method A community-based cross-sectional study was conducted from April to May 2018 among 383 randomly selected mothers who had given birth to at least one child since August 2016. A structured questionnaire was used to gather the quantitative data. Qualitative data were collected using key informant interviews and focus group discussions. To analyze the data, SPSS version 20 was used. Logistic regression analysis was employed to assess the association between dependent and independent variables. Results Findings reveal that significant number of the respondents did not have knowhow about birth registration and its uses. As a result, only 117(30%) of them registered the birth of their children and secured certificates. Inaccessibility of the registrar offices, lack of relevant manpower and political will of the government were reported as major reasons for such a gap. Mother’s education was identified to be positively associated with the likelihood of a child being registered. Children born from mothers living in urban areas were found more likely to be registered compared to their rural counterpart [AOR = 1.46, 95% CI = 0.76, 2.76]. In light of Religion, children from the Muslim community had better opportunity for birth registration and owning birth certificate compared to children from Orthodox Christian parents. Compared to those who have possessed own birth certificates, the likelihood of mothers who did not possess own birth certificates to register the birth of their children was found lower by the factor of 86% [AOR = 0.14, 95%CI = 0.07, 0.26]. Conclusion Birth registration of a child and subsequent issuance of certificate should be pursued as a right issue. To make this a reality, extensive awareness raising programs that underscore the need for a birth registration and its significance for rural communities is needless to say critical.
  • Universal cervical cancer control through a right to health lens: refocusing national policy and programmes on underserved women

    Katrina Perehudoff; Heleen Vermandere; Alex Williams; Sergio Bautista-Arredondo; Elien De Paepe; Sonia Dias; Ana Gama; Ines Keygnaert; Adhemar Longatto-Filho; Jose Ortiz (BMC, 2020-07-01)
    Abstract Background Cervical cancer claims 311,000 lives annually, and 90% of these deaths occur in low- and middle-income countries. Cervical cancer is a highly preventable and treatable disease, if detected through screening at an early stage. Governments have a responsibility to screen women for precancerous cervical lesions. Yet, national screening programmes overlook many poor women and those marginalised in society. Under-screened women (called hard-to-reach) experience a higher incidence of cervical cancer and elevated mortality rates compared to regularly-screened women. Such inequalities deprive hard-to-reach women of the full enjoyment of their right to sexual and reproductive health, as laid out in Article 12 of the International Covenant on Economic, Social and Cultural Rights and General Comment No. 22. Discussion This article argues first for tailored and innovative national cervical cancer screening programmes (NCSP) grounded in human rights law, to close the disparity between women who are afforded screening and those who are not. Second, acknowledging socioeconomic disparities requires governments to adopt and refine universal cancer control through NCSPs aligned with human rights duties, including to reach all eligible women. Commonly reported- and chronically under-addressed- screening disparities relate to the availability of sufficient health facilities and human resources (example from Kenya), the physical accessibility of health services for rural and remote populations (example from Brazil), and the accessibility of information sensitive to cultural, ethnic, and linguistic barriers (example from Ecuador). Third, governments can adopt new technologies to overcome individual and structural barriers to cervical cancer screening. National cervical cancer screening programmes should tailor screening methods to under-screened women, bearing in mind that eliminating systemic discrimination may require committing greater resources to traditionally neglected groups. Conclusion Governments have human rights obligations to refocus screening policies and programmes on women who are disproportionately affected by discrimination that impairs their full enjoyment of the right to sexual and reproductive health. National cervical cancer screening programmes that keep the right to health principles (above) central will be able to expand screening among low-income, isolated and other marginalised populations, but also women in general, who, for a variety of reasons, do not visit healthcare providers for regular screenings.
  • Female genital mutilation/cutting in Sierra Leone: are educated women intending to circumcise their daughters?

    Edward Kwabena Ameyaw; Justice Kanor Tetteh; Ebenezer Kwesi Armah-Ansah; Kofi Aduo-Adjei; Aisha Sena-Iddrisu (BMC, 2020-07-01)
    Abstract Background Female genital mutilation/cutting (FGM/C) has been recognized as a gross violation of human rights of girls and women. This is well established in numerous international legal instruments. It forms part of the initiation ceremony that confers womanhood in Sierra Leone. Girls and women who are subjected to this practice are considered to be ready for marriage by their parents and communities and are rewarded with celebrations, gifts, and public recognition. Following this, we examined the relationship between education and women’s FGM/C intention for their daughters in Sierra Leone. Methods We used cross-sectional data from the women’s file of the 2013 Sierra Leone Demographic and Health Survey (SLDHS) to explore the influence of education on FGM/C intention among women in the reproductive age (15–49). A sample of 6543 women were included in the study. Our analysis involved descriptive computation of education and FGM/C intention. This was followed by a two-level multilevel analysis. Fixed effect results were reported as Odds Ratios and Adjusted Odds Ratios with their respective credible intervals (CrIs) whilst results of the random effects were presented as variance partition coefficients and median odds ratios. Results Our findings showed that women who had no formal education were more likely to intend to circumcise their daughters [aOR = 4.3, CrI = 2.4–8.0]. Among the covariates, women aged 20–24 [aOR = 2.3, CrI = 1.5–3.4] were more likely to intend to circumcise their daughters compared to women between 45 and 49 years old. Poorest women were more likely to report intention of circumcising their daughters in the future compared with the richest [aOR = 2.1, CrI = 1.3–3.2]. We noted that, 63.3% of FGM/C intention in Sierra Leone is attributable to contextual factors. Conclusion FGM/C intention is more common among women with no education, younger women as well as women in the lowest wealth category. We recommend segmented female-child educational and pro-poor policies that target uneducated women in Sierra Leone. The study further suggests that interventions to end FGM/C need to focus on broader contextual and social norms in Sierra Leone.
  • International norm development and change: can international law play a meaningful role in curbing the lifestyle disease pandemic?

    Preslava Stoeva (BMC, 2020-07-01)
    Abstract Background The magnitude of the noncommunicable epidemic is difficult to overstate. The projected cost of the epidemic is substantial. It disproportionately affects people in low- and middle-income countries as well as poorer and marginalised communities in high-income countries. The international community has taken various steps to address the four modifiable risk factors causing the majority of noncommunicable diseases (NCDs), however, action has so far fallen short of expectations. Both analysts and international institutions are advocating the adoption of a new international legal norm to address the NCD crisis. Main text Drawing on existing knowledge from international relations and international legal studies, this article argues that a new international treaty is not only currently improbable, but also not strictly desirable. In-depth critical analysis and reflection is needed regarding the strengths and weaknesses of a legal approach to addressing the NCD pandemic. The argument is set out in three sections - the first reviews contributions of agentic constructivism, which focus on the process of normative emergence and change, and draws on empirical examples to highlight overlooked aspects of normative development and how they relate to NCD politics. The second engages with the critique of legal principles. Critical approaches to law seek to expose the myths that legal principles are neutral, objective, good. The third section discusses the characteristics of practice in the NCD field and its implications on process and principles for the pursuit of a legal solution to the NCD crisis. Conclusions Any advocacy for an international norm to address NCDs needs to be nuanced and demonstrate awareness of the nature and character of both the norm development process and resulting international legal principles. As analysts, we are responsible for advocating inclusive and ethical norms, but also for highlighting the implications of inequalities and differences between and within states and societies. There may be a viable international legal instrument that would support dedicated policies to curb the NCD epidemic, but such an instrument needs to be actively advocated for and negotiated with a wide range of stakeholders, navigating a complex international framework of existing norms and conflicting, powerful interests.
  • The role of local and regional authorities in prevention and control of NCDs: the case of Poland

    Robert Tabaszewski (BMC, 2020-07-01)
    Abstract Background Freedom from noncommunicable diseases is a component of the human right to health. The obligation to reduce the pandemic of civilisation diseases should result from the provisions of the constitution, national law and local regulations. This means that representatives of local and regional communities also take responsibility for limiting the pandemic of civilisation diseases. Main body The goal of this debate is to examine the effectiveness of the decentralised polish model for dividing the competences of preventing and combating non-communicable diseases into three levels: local, regional and central. The representatives of regional and local communities are responsible for encouraging the inhabitants of their communities to change their lifestyle: eating habits, increase physical activity, remain outdoors more frequently, reduce stimulants, and apply prevention, namely undergo regular medical check-ups and provide the body with all the necessary nutrients. Limiting the proliferation of noncommunicable diseases also requires, in vertical terms, sound financial efforts on the part of local authorities. In the example of Poland, the claim about the effectiveness of the multi-level governance model which is presented in the literature will be verified. Conclusion The excessive division of competences and the dispersion of resources between regional and local authorities may hamper the effective treatment and prevention of NCDs. A lack of cooperation between the central government, which carries out an independent policy on public health, and local authorities, which use only a portion of the public funds allocated to health, obstructs the debate on priorities at the societal level and does not encourage residents to take a stand on how to allocate extra funds.
  • A social-ecological examination into the research, policy and health service delivery environment related to early marriage and sexual and gender-based violence among youth in Jordan

    Jewel Gausman; Areej Othman; Abeer Dababneh; Maysoon Dabobe; Iqbal Hamad; Insaf Daas; Ana Langer (BMC, 2020-07-01)
    Abstract Background The determinants of sexual- and gender-based violence (SGBV) and early marriage are embedded across different levels of the social ecological system, including at the individual, family, community, and policy levels. In Jordan and the Middle East, SGBV, honor killing, and early marriage are priority public health and human rights issues that often overlap, and affect a significant percentage of youth. Jordan is home to a large number of refugees from across the Middle East, who may be even more vulnerable to these forms of violence than the local youth. The purpose of this analysis is to 1) synthesize the existing literature and 2) present the perspectives of key stakeholders to identify research gaps, programmatic lessons learned, and opportunities for policy change from an ecological perspective at the individual, community, health-system, and policy/legal levels. Methods This study includes 1) a systematic literature review of both published and unpublished literature since 2008 and 2) focus group discussions (FGDs) with key stakeholders representing 18 international and local governmental and non-governmental organizations. Results The literature review included 27 documents. Stakeholder discussions highlighted important research and policy gaps. Prevalence estimates of SGBV, honor killing, and early marriage vary across sources; however, all of them indicate that they remain important issues for youth in Jordan. Several sources indicate that early marriage has been increasing in Jordan since the beginning of the war in Syria, especially among Syrian refugees. Refugee youth are particularly vulnerable to SGBV and early marriage given the worsening economic situation in Jordan. The norms, attitudes, and practices that support SGBV in Jordan appear to be reinforced within families and communities. Despite ongoing programs, SGBV services are limited, especially for youth, and there is little awareness of service availability amongst target populations. Laws and policies continue to offer legal justification for SGBV, honor killing, and early marriage. Discussion As countries across the Middle East face instability and continue to struggle with the urgent health needs of large refugee and youth populations, this review provides valuable insight relevant to research, programs, and policy in Jordan and across the region.
  • Illicit financial flows and the provision of child and maternal health services in low- and middle-income countries

    Bienvenido Ortega; Jesús Sanjuán; Antonio Casquero (BMC, 2020-07-01)
    Abstract Background Illicit financial flows (IFFs) drain domestic resources with harmful social effects, especially in countries which are too poor to mobilise the revenues required to finance the provision of essential public goods and services. In this context, this article empirically examined the association between IFFs and the provision of essential health services in low- and middle-income countries. Methods Firstly, a set of indicators was selected to represent the overall coverage of essential health services at the country level. Next, a linear multivariate regression model was specified and estimated for each indicator using cross-sectional data for 72 countries for the period 2008–2013. Results After controlling for other relevant factors, the main result of the regression analysis was that an annual 1 percentage point (p.p.) increase in the ratio of IFFs to total trade was associated with a 0.46 p.p. decrease in the level of family planning coverage, a 0.31 p.p. decrease in the percentage of women receiving antenatal care, and a 0.32 p.p. decrease in the level of child vaccination coverage rates. Conclusions These findings suggest that, for the whole sample of countries considered, at least 3.9 million women and 190,000 children may not receive these basic health care interventions in the future as a consequence of a 1 p.p. increase in the ratio of IFFs to total trade. Moreover, given that family planning, reproductive health, and child immunisation are foundational components of health and long-term development in poor countries, the findings show that IFFs could be undermining the achievement of the 2030 Agenda for Sustainable Development.
  • Where boys don’t dance, but women still thrive: using a development approach as a means of reconciling the right to health with the legitimization of cultural practices

    Melisa Demir; Bilkis Vissandjée; Danielle Jacobson; Gillian Einstein (BMC, 2020-06-01)
    Abstract Human rights language has become a common method of internationally denouncing violent, discriminatory or otherwise harmful practices, notably by framing them as reprehensible violations of those fundamental rights we obtain by virtue of being human. While often effective, such women’s rights discourse becomes delicate when used to challenge practices, which are of important cultural significance to the communities in which they are practiced. This paper analyses human rights language to challenge the gender disparity in access to health care and in overall health outcomes in certain countries where such disparities are influenced by important cultural values and practices. This paper will provide selected examples of machismo and marianismo discourses in certain Latin American countries on the one hand and of female genital cutting/excision (FGC/E) in practicing countries, both of which exposed to women’s rights language, notably for causing violations of women’s right to health. In essence, a reflective exercise is provided here with the argument that framing such discourses and practices as women’s rights violations. Calling for their abandonment have shown that it may not only be ineffective nor at times appropriate, it also risks delegitimizing associated discourses, norms and practices thereby enhancing criticisms of the women’s rights movement rather than adopting its principles. A sensitive community-based collaborative approach aimed at understanding and building cultural discourses to one, which promotes women’s capabilities and health, is proposed as a more effective means at bridging cultural and gender gaps.
  • Development and validation of the LoVI: the Laws on Violence against women and girls Index

    Kathryn M. Yount; Patricia C. Lewis; Cari Jo Clark; Lori Heise; Ruchira T. Naved; Lauren Maxwell (BMC, 2020-05-01)
    Abstract Background Violence against women and girls (VAWG) is a human-rights violation with adverse long-term and inter-generational consequences. Redefining VAWG as legally unacceptable is one strategy for social change. The co-occurrence of national laws against VAWG is understudied, and tools to monitor the national legal environment are lacking. We developed the Laws on Violence against Women and Girls Index (LoVI) to measure global progress to develop comprehensive national legislation against child marriage, sexual harassment, domestic violence, and marital rape. Methods Using data from 2016 and 2018 for 189 countries from the World Bank Women, Business, and the Law database, we used factor analysis to assess the dimensionality of the LoVI. We examined the distribution of the LoVI across countries and regions, and the relationship of national rankings on the LoVI with those for other indicators from the United Nations, Demographic and Health Surveys, and World Factbook. Results A single LoVI factor showed good model fit in the factor analysis. National LoVI rankings were positively associated with gender equality in human development and economic rights-related rankings and negatively associated with rates of justifying wife beating and of lifetime and prior-year physical and/or sexual IPV. The LoVI was not associated with national indicators for human development and income inequality. Conclusion The LoVI is a concise, coherent, validated index to monitor the progress of nations on adopting comprehensive legislation to advance 2030 Sustainable Development Goal 5, to eliminate VAWG.
  • “An ethnographic exploration of factors that drive policing of street-based female sex workers in a U.S. setting - identifying opportunities for intervention”

    Katherine H. A. Footer; Bradley E. Silberzahn; Sahnah Lim; Steven Huettner; Victor A. Kumar; Derek Loeffler; Sarah M. Peitzmeier; Susan G. Sherman (BMC, 2020-05-01)
    Abstract Background Building on a broader sociological discourse around policing approaches towards vulnerable populations, increasing public health and human rights evidence points to policing practices as a key health determinant, particularly among street-based sex workers. Despite the importance of policing as a structural health determinant, few studies have sought to understand the factors that underlie and shape harmful policing practices towards sex workers. This study therefore aimed to explore the drivers for policing attitudes and practices towards street-based cisgender female sex workers. Methods Drawing on ethnographic methods, 280 h of observations with police patrol and 10 stakeholder interviews with senior police leadership in Baltimore City, USA were carried out to better understand the drivers for policing strategies towards cisgender female sex workers. Analysis was data- and theory-driven, drawing on the concepts of police culture and complementary criminological and sociological literature that aided exploration of the influence of the ecological and structural environment on policing practices. Results Ecological factors at the structural (e.g., criminalization), organizational (e.g., violent crime control), community and individual level (e.g., stigmatizing attitudes) emerged as key to shaping individual police practices and attitudes towards cisgender female sex workers in this setting. Findings indicate senior police support for increased alignment with public health and human rights goals. However, the study highlights that interventions need to move beyond individual officer training and address the broader structural and organizational setting in which harmful police practices towards sex work operate. Conclusions A more in-depth understanding of the circumstances that drive law enforcement approaches to street-based sex work is critical to the collaborative design of interventions with police in different settings. In considering public health-police partnerships to address the rights and health of sex worker populations in the U.S. and elsewhere, this study supports existing calls for decriminalization of sex work, supported by institutional and policy reforms, neighborhood-level dialogues that shift the cultural landscape around sex work within both the police and larger community, and innovative individual-level police trainings.

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