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Evidence regarding the relationship between married women’s autonomy and risk of marital violence remains mixed. Moreover, studies examining the contribution of specific aspects of women’s autonomy in influencing the risk of marital violence using measures of autonomy that incorporate its dynamic nature are rare. We investigated the relationship between women’s autonomy and their experience of marital violence in rural India using prospective data. We used data on 4,904 rural women drawn from two linked studies: the NFHS-2, conducted during 1998-1999 and a follow-up study for a subgroup of women carried out during 2002-2003. Three dimensions of autonomy were used: financial autonomy, freedom of movement, and household decision-making. Marital violence was measured as experience of physical violence in the year prior to the follow-up survey. Findings indicate the protective effects of financial autonomy and freedom of movement in reducing the risk of marital violence in the overall model. Furthermore, region-wise analysis revealed that in the more gender equitable settings of south India, financial autonomy exerted a protective influence on risk of marital violence. However, in the more gender-stratified settings of north India, none of the dimensions of autonomy were found to have any protective effect on women’s risk of marital violence. Results argue for an increased focus on strategies aimed at improving women’s financial status through livelihood skill-building opportunities, development of a strong savings orientation, and asset-building options.

Objective To estimate the prevalence of sex trafficking as a mode of entry into sex work and to examine associations between sex trafficking and HIV vulnerability, recent violence experience, and symptoms of sexual ill health among young female sex workers (FSWs). Methods A cross-sectional survey of 1137 FSWS aged 18–25 years residing in Andhra Pradesh, India, was conducted. Results In total, 574 (50.5%) FSWs entered sex work via trafficking. Trafficked FSWs had an increased risk of experiencing sexual violence (adjusted odds ratio [AOR] 2.09; 95% confidence interval [CI], 1.42–3.06) and physical/sexual violence (AOR 1.93; 95% CI, 1.24–3.01), and reporting more clients (AOR 2.25; 95% CI, 1.56–3.22) and more work days per week (AOR 1.48; 95% CI, 1.09–2.02). Symptoms of sexual ill health were not associated with mode of entry into sex work. Conclusion There is a high prevalence of entry into sex work via trafficking among young FSWs. A history of sex trafficking is associated with greater risk of recent physical and sexual violence and of HIV. Public health interventions must focus attention on young FSWs.

CONTEXT: Small proportions of Indian women report seeking treatment for symptoms suggestive of reproductive tract infections (RTIs). Most studies on treatment-seeking have focused broadly on women of reproductive age, and little is known about the experiences of adolescent girls and young women, particularly the unmarried. METHODS: Data from 2,742 married and 2,108 unmarried women aged 15-24 who reported at least one symptom of an RTI in the past three months were drawn from a subnationally representative survey of youth in India in 2006-2008. Multivariate logistic regression analysis was conducted to identify associations between respondents' characteristics and treatment-seeking from a formal medical provider. In addition, among those who had used such providers, associations between characteristics and use of private rather than public providers were identified. RESULTS: About two-fifths of married and one-third of unmarried women had sought treatment from formal medical providers for their RTI symptoms. While married women's experience of intimate partner violence was negatively associated with seeking treatment from a formal provider (odds ratio, 0.8), their perceived access to sexual and reproductive health services and their awareness of STI symptoms were positively associated with such treatment (1.3-1.4). Both married and unmarried women were more likely to seek treatment from private than from public providers, and two indicators of women's autonomy were positively correlated with using private providers (1.6-2.8). CONCLUSIONS: Limited treatment-seeking for RTI symptoms by young women underscores the need to address power imbalances within marriage and to encourage health care providers to develop appropriate strategies to reach younger, as well as unmarried, women. International Perspectives on Sexual and Reproductive Health, 2012, 38(2):90-98, doi:10.1363/3809012 In India, research and programmatic attention to women's experience of reproductive tract infections (RTIs), including STIs, has increased considerably through the 1990s and 2000s. Several policies and programs--including the National Population Policy 2000, (1) the National Health Policy 2002, (2) the National Rural Health Mission 2005 (3) and the National AIDS Control Programme Phase III (4)--have stressed the need for expanding women's access to services for prevention, screening and management of RTIs. Moreover, several small- and large-scale studies have documented a high prevalence of RTIs among women and shown that significant proportions of symptomatic women do not seek treatment. (5-20) Studies examining characteristics that are correlated with women's ability to seek treatment, however, are sparse, (6) and even less research has focused on young women. To address these gaps, this article uses data from a sub-nationally representative survey of young people in India to describe the prevalence of RTI symptoms among married and unmarried women and their treatment-seeking behavior. We assess associations between women's characteristics and seeking treatment from formal medical providers, as well as between characteristics and. treatment from private-sector instead of public-sector providers. BACKGROUND The prevalence of self-reported RT1 symptoms among Indian women has been found to be 11-18% in nationally representative snidies (7), (8) and 40-57% in small-scale studies, (9-11) while the prevalence of laboratory-diagnosed RT1s has ranged from 28% to 38%. (11), (12) Moreover, women aged 15-24 were as likely as those aged 25-39 to report symptoms of RTIs. (8) According to studies that have explored women's patterns of seeking treatment for RTI symptoms, between one-third and two-thirds of symptomatic women did not seek treatment. (9), (11-20) In the few studies that specifically examined treatment-seeking among married adolescent girls and young women, these subgroups were less likely than others to have sought treatment for RTI symptoms. …

This study examines the relationship between the husband's preference for a son, sex composition of children and risk of anaemia and underweight among married Indian women. Information was collected regarding 29,517 couples having at least one child in the nationally representative 2005-06 National Family Health Survey of India. The exposures were husband's preference for a son and sex composition of children: sons only, daughters only and mixed. Outcome included maternal underweight and moderate/severe anaemia. Husband's preference for a son was not found to be associated with his wife's risk of anaemia or underweight. Sex composition of the children was modestly associated with increased odds of anaemia among women from households with daughters only as compared with those with sons only [AOR: 1.19; 95% CI 1.04, 1.35]. The findings from this population-based study of socio-cultural norms around preference for a son and married Indian women's nutritional status do not support the hypothesis that husband's preference for sons influences the nutritional status of their wives. However, having daughters only is associated with maternal anaemia for reasons that remain to be established.

To examine experiences of perinatal (in pregnancy or post-partum) abuse from in-laws and to assess associations between such experiences and perinatal intimate partner violence (IPV) from husbands, as reported by Indian women residing in low-income communities in Mumbai. The present study includes both qualitative and quantitative research conducted across two phases of study. The qualitative phase involved face-to-face, semi-structured in-depth interviews (n = 32) with women seeking health care for their infants (6 months or younger) and self-reporting emotional or physical abuse from their husband. The quantitative arm involved survey data collection (n = 1,038) from mothers seeking immunization for their infants 6 months or younger at three large Urban Health Centers in Mumbai. Results of the qualitative study documented the occurrence of both non-physical and physical abuse from in-laws during pregnancy and post-partum. Non-physical forms of abuse included forced heavy domestic labor, food denial and efforts toward prevention of medical care acquisition. Quantitative results demonstrated that 26.3% of the sample reported perinatal abuse (non-physical and physical) from in-laws and that women experiencing perinatal sexual or physical IPV from husbands were significantly more likely to report perinatal abuse from in-laws (AOR = 5.33, 95% CI = 3.93–7.23). Perinatal abuse from in-laws is not uncommon among women in India and may be compromising maternal and child health in this context; such abuse is also linked to perinatal violence from husbands. Programs and interventions that screen and address IPV in pregnant and post-partum populations in India should be developed to include consideration of in-laws.

Quasi-experimental research designs, like experimental designs, test causal hypotheses. Quasi-experimental designs identify a comparison group that is as similar as possible to the intervention group in terms of baseline (pre-intervention) characteristics. The comparison group captures what would have been the outcomes if the programme/policy had not been implemented (i.e., the counterfactual). The key difference between an experimental and quasi-experimental design is that the latter lacks random assignment.

Indicators provide a signal to decision makers by indicating whether, and to what extent, a variable of interest has changed. They can be used at all levels of the results framework from inputs to impacts, and should be linked to the programme’s theory of change. Most important at the lower levels of the causal chain are monitoring indicators such as inputs (e.g., immunization kits supplied), activities (e.g., immunization days held) and outputs (e.g., clinics built). For higher-level indicators of outcomes and impact, however, monitoring tells us what has happened but not why it happened. To understand this, impact evaluation must be used to increase our understanding of the factors behind achieving or not achieving the goal.

Modelling is an approach to impact evaluation which uses mathematical models to describe social and economic relationships and to infer causality from an intervention to an outcome, and/or between an outcome and its determinants. Models with more than one equation are most valuable, as they allow for both direct and indirect effects and also two-way relationships to be captured. Models can be used to examine the impact of a programme or policy by introducing them as an exogenous change in some of the variables, parameters or equations.

A randomized controlled trial (RCT) is an experimental form of impact evaluation in which the population receiving the programme or policy intervention is chosen at random from the eligible population, and a control group is also chosen at random from the same eligible population. It tests the extent to which specific, planned impacts are being achieved. The distinguishing feature of an RCT is the random assignment of units (e.g. people, schools, villages, etc.) to the intervention or control groups. One of its strengths is that it provides a very powerful response to questions of causality, helping evaluators and programme implementers to know that what is being achieved is as a result of the intervention and not anything else.

This study examines the relationship between the husband's preference for a son, sex composition of children and risk of anaemia and underweight among married Indian women. Information was collected regarding 29,517 couples having at least one child in the nationally representative 2005-06 National Family Health Survey of India. The exposures were husband's preference for a son and sex composition of children: sons only, daughters only and mixed. Outcome included maternal underweight and moderate/severe anaemia. Husband's preference for a son was not found to be associated with his wife's risk of anaemia or underweight. Sex composition of the children was modestly associated with increased odds of anaemia among women from households with daughters only as compared with those with sons only [AOR: 1.19; 95% CI 1.04, 1.35]. The findings from this population-based study of socio-cultural norms around preference for a son and married Indian women's nutritional status do not support the hypothesis that husband's preference for sons influences the nutritional status of their wives. However, having daughters only is associated with maternal anaemia for reasons that remain to be established.

SummarySon preference has been considered as a determinant of women's risk of intimate partner violence (IPV) experience in India, although quantitative evidence from large nationally representative studies testing this relationship is limited. This study examines the association between husband's son preference, sex composition of children and risk of physical and sexual IPV victimization among wives. Information was collected for 26,284 couples in the nationally representative 2005–2006 National Family Health Survey of India. The exposures were husband's son preference measured as husband's desire for one or more sons greater than the number of daughters and sex composition of the household: only sons, only daughters and mixed. Outcome included past year physical and/or sexual IPV. The results showed that husband's reported son preference (RR: 1.05; 95% CI: 0.98–1.13) and sex composition of children were not associated with risk for IPV victimization in the models adjusted for socio-demographic factors. The findings from this first population-based study of socio-cultural norms around son preference and married Indian women's risk for IPV victimization indicate that cultural preference for sons does not influence women's risk for IPV victimization.

Empirical evidence regarding the relationship between use of child health services and maternal intimate partner violence (IPV) exposure is sparse. The present study examined the relationship between maternal IPV and childhood immunization status in India using the nationally representative NFHS-3 (n = 6947). Exposure was past year IPV and the outcome was full immunization. IPV victimization was associated with decreased likelihood of being fully immunized after controlling for a range of socio-demographic variables. We also found that differences in measurement of the immunization status (self-report vs. health card) had different implications for the observed association; women reporting IPV and not having the vaccination card were most vulnerable to lack of immunization of their children. Findings suggest the need for increased programmatic efforts to prevent both the prevalence of IPV as well as the multiple MCH consequences of such violence.

A 2010 study done in Calcutta a potential sex-trafficking hub for sexual exploitation across South Asia emphasizes the importance of understanding trafficking mechanisms. The study focuses on women and girls who had been trafficked for sexual exploitation were either removed by police or escaped and were receiving help from Sanlaap an NGO based in Calcutta. The findings highlight the persistence of sex trafficking within Calcutta while highlighting the need for trafficking prevention efforts especially because of the high rate of HIV infection among women and girls. Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.