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IntroductionThe COVID-19 pandemic, together with the subsequent social distancing measures, could lead to shifts in family and fertility planning. This study aimed to explore the associations between the COVID-19 pandemic and changes in fertility intentions among an international sample of reproductive-aged women.MethodsA multi-country, cross-sectional study based on data from 10 672 women aged 18–49 years who participated in the International Sexual Health And REproductive Health (I-SHARE) study, which organised an international online survey between July 2020 and February 2021. Factors associated with changes in fertility intentions were explored using multinomial probit regression models. Cluster-robust standard errors were used to calculate model parameters.ResultsOf 10 672 included reproductive-aged women, 14.4% reported changing their fertility intentions due to the pandemic, with 10.2% postponement and 4.2% acceleration. Women who had ever been isolated/quarantined were more likely to postpone their fertility intentions (adjusted odds ratio (AOR)=1.41; 95% CI 1.18 to 1.69) compared with those who had not; women who lived with a steady partner were more likely to want children sooner (AOR=1.57; 95% CI 1.10 to 2.23) compared with those who did not; and those who reported a higher frequency of getting angry, feeling frustrated, or worrying about their finances were more likely to postpone their fertility intentions. The main findings were robust in the sensitivity analyses.ConclusionsMost women who changed fertility intentions because of the pandemic have postponed intentions to expand their families. The pandemic-induced exposures were associated with these postponements.

Several highly publicised rapes and murders of young women in India and South Africa have focused international attention on sexual violence. These cases are extremes of the wider phenomenon of sexual violence against women, but the true extent is poorly quantified. We did a systematic review to estimate prevalence.

ABSTRACTBackground:Pre-exposure prophylaxis (PrEP) for HIV prevention is safe and effective in reducing HIV incidence. However, more evidence of PrEP knowledge, willingness and distribution preferences is required for scale-up among young people at-risk.Objective:To understand young people PrEP awareness, willingness and roll-out preferences.Methods: Young people (18–24y) were selected through multi-stage sampling in a cross-sectional household survey in low-income communities. Self-administered interviews collected participants’ data about PrEP awareness, attitudes, willingness and HIV-risk practices. Data were descriptively analysed by gender. Regression models assessed factors associated with PrEP awareness and willingness by district.Results:Of the 1917 participants interviewed 44.6% (men = 39.4% vs women = 49%, p = 0.001) were PrEP aware, 49.0% were willing to use PrEP. Participants most preferred PrEP distribution channels were public clinics (51.2%) and hospitals (23.8%). More men than women preferred distribution through schools (11.9% vs7.8%; p = 0.002) and NGOs (8.5%vs5.4%; p = 0.008). The biggest barrier to PrEP willingness was inadequate PrEP knowledge (10.0%) but more men than women disliked taking pills daily (4.1%vs2.0%; p-value = 0.007). Gendered determinants to use PrEP were side effects (51%; men = 47% vs women = 55%; p = 0.001) and pill effectiveness (29.5%; men = 26.4% vs women = 32.6%; p = 0.003). In both districts PrEP knowledge was associated with being female and media use. The associations between PrEP awareness and having multiple sexual partnerships, HIV knowledge, HIV self-test willingness and belonging to social clubs differed by district. PrEP willingness was positively associated with having TB and PrEP knowledge in each district but district differences were observed in media and occupation factors.Conclusions:The study shows young people’s low levels of PrEP awareness. It also shows relatively increased willingness, gendered PrEP awareness and distribution preferences. Promoting youth’s PrEP awareness requires a multifarious media strategy.Abbreviations:HIV: human immunodeficiency virus; AIDS: Acquired immunodeficiency syndrome; aOR: Adjusted Odds ratio; PLWH: People living with HIV; PrEP: Pre-exposure Prophylaxis; UNAIDS: Joint United Nations Programme on HIV and AIDS; uOR: Unadjusted odds ratio; TB: Tuberculosis; WHO: World health Organisation; MSM: Men who have sex with men

ABSTRACTBackground: Intimate partner violence (IPV) against women continues to be a public health burden globally.Objectives: To assess prevalence and factors associated with women’s experiences of past 12 months physical/sexual IPVMethods: A two-stage cluster-based national cross-sectional survey in which women were randomly selected for participation was conducted among 5295 women aged 15–49 years. IPV in the last 12 months was assessed using the WHO interviewer-administered questionnaire for measuring violence against women. Participants’ wife beating attitudes, partner controlling behaviours, household decision-making, STI history, HIV status and demographic characteristics were assessed. Multivariate logistic regression was conducted to assess factors associated with IPV.Results: Of the 5292 women interviewed, mean age was 31.5 years and 84.7% were married. Over one-fifth of the women (20.2: 95%CI 19.1–21.3) were physically/sexually abused in the last 12 months. IPV was associated with gender inequitable norms and practices which include lacking household decision-making power (aOR 2.05, 1.71–2.47), experiencing low (aOR 2.05; 1.71–2.47) or high (aOR 4.5; 3.62–5.60) partner controlling behaviours (vs none) and endorsing low (aOR 1.29) or high (aOR 1.36) wife beating attitudes (vs none), having sexual self-efficacy (aOR 1.19; 1.10–1.41), experiencing emotional abuse (aOR 4.50; 3.62–5.60) and having a sexually transmitted infection (STI) (aOR 1.36, 1.04–1.77). IPV was also associated with women’s empowerment factors including possessing household assets (aOR 1.26, 1.03–1.54) and reporting current media usage (aOR 1.29; 1.04–1.61). Demographic factors associated with IPV were age and number of children.Conclusions: This study provides evidence that IPV is a significant public health and societal problem as one in five women were abused in the past year. Younger women, less empowered women, women in inequitable intimate relationships and women endorsing traditional gender norms were at increased risk of abuse. IPV prevention programmes must prioritise transforming traditional gender norms and women’s economic empowerment.