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Growing evidence suggests that community-based interventions in low- and middle-income countries (LMICs) can effectively address harmful social norms that promote or sustain gender inequality and drive violence against women (VAW). However, understanding what actions communities are already taking to address harmful social norms and prevent VAW is an essential first step for intervention development. Towards this goal, drawing on collective action theory, we conducted a realist analysis of secondary qualitative data collected with communities in India, Afghanistan, Peru and Rwanda. We coded interview and focus-group data from 232 participants to identify the contexts, mechanisms and outcomes (CMO) relevant for community action. We synthesized CMO configurations from each dataset into a conceptual framework composed of three middle-range theories of mechanisms driving community action to prevent VAW in LMICs. Our results highlight the importance of dedicated spaces for discussing VAW, VAW leaders as positive role models, and community perceptions of VAW as a problem worthy of intervention. In Rwanda and Peru, there was strong evidence to support the operation of these mechanisms. Contextual factors, including national and local policy and programmes targeting VAW, activated mechanisms that led to community action. In India and Afghanistan, evidence for the presence of these mechanisms was weaker, with social norms about women's position and violence being a private family matter preventing communities from addressing violence. Despite contextual differences, our data demonstrated communities in all four settings were somewhere along a pathway of change towards VAW prevention. This supports the need to build future prevention interventions on pre-existing mechanisms that trigger community action, rather than implementing existing interventions without local adaptation. Our conceptual framework serves as a tool for assessing these mechanisms of community action as part of intervention development research, centring community knowledge and fostering local ownership for more relevant and sustainable VAW prevention interventions.

Background Human trafficking and labor exploitation are prevalent in Southeast Asia and have substantial health consequences for children and adolescents. Research on pre-departure circumstances and trafficking experiences show that gender plays a key role in shaping the experience of exploited children and adolescents. Objective This study estimates how youth’s concerns and hopes for the future influence the mental health outcomes of male and female children and adolescents. Participants and Setting Data were collected in face-to-face interviews with 517 children and adolescents (10–19 years old) who attended post-trafficking services between year 2010 and year 2013 in Cambodia, Thailand or Vietnam. Methods Multivariable logistic regression models were fitted to estimate the association of children and adolescents’ post-trafficking concerns and hopes for the future with mental health outcomes, namely symptoms of depression, anxiety and Post Traumatic Stress Disorder (PTSD). The analysis was stratified by sex. Results In adjusted analysis, children and adolescents’ concerns about social ostracization and maltreatment by others in their community of origin were associated with all three outcomes in males and with depression in females. Being concerned about their own mental health was associated with all outcomes, with a potentially stronger effect observed in males for depression (AOR 9.14, CI:1.21–68.68), anxiety (AOR 13.47, CI:1.70–106.48) and PTSD (AOR 8.36, CI:1.22–56.9) than in females where the odds for depression (AOR 3.24, CI:1.92–5.48), anxiety (AOR 3.05, CI:1.82–5.11) and PTSD (AOR 1.85, CI:1.08–3.14) were much lower. Conclusions Young people’s post-trafficking care needs and reintegration planning should be designed based on their current mental health, personal security, family and financial resources and age-related capacity.

Background : Human trafficking is a recognized human rights violation, and a public health and global development issue. Violence is often a hallmark of human trafficking. This study aims to describe documented cases of violence among persons identified as victims of trafficking, examine associated factors throughout the trafficking cycle and explore prevalence of abuse in different labour sectors. Methods and Findings : The IOM Victim of Trafficking Database (VoTD) is the largest database on human trafficking worldwide. This database is actively used across all IOM regional and country missions as a standardized anti-trafficking case-management tool. This analysis utilized the cases of 10,369 trafficked victims in the VoTD who had information on violence. Results : The prevalence of reported violence during human trafficking included: 54% physical and/or sexual violence; 50% physical violence; and 15% sexual violence, with 25% of women reporting sexual violence. Experiences of physical and sexual violence among trafficked victims were significantly higher among women and girls (AOR 2.48 (CI: 2.01,3.06)), individuals in sexual exploitation (AOR 2.08 (CI: 1.22,3.54)) and those experiencing other forms of abuse and deprivation, such as threats (AOR 2.89 (CI: 2.10,3.98)) and forced use of alcohol and drugs (AOR 2.37 (CI: 1.08,5.21)). Abuse was significantly lower among individuals trafficked internationally (AOR 0.36 (CI: 0.19,0.68)) and those using forged documents (AOR 0.64 (CI: 0.44,0.93)). Violence was frequently associated with trafficking into manufacturing, agriculture and begging (>55%). Conclusions : An analysis of the world's largest data set on trafficking victims indicates that violence is indeed prevalent and gendered. While these results show that trafficking-related violence is common, findings suggest there are patterns of violence, which highlights that post-trafficking services must address the specific support needs of different survivors.

Violence against women and girls is prevalent worldwide but historically has been overlooked and condoned. Growing international recognition of these violations creates opportunities for elimination, although solutions will not be quick or easy. Governments need to address the political, social, and economic structures that subordinate women, and implement national plans and make budget commitments to invest in actions by multiple sectors to prevent and respond to abuse. Emphasis on prevention is crucial. Community and group interventions involving women and men can shift discriminatory social norms to reduce the risk of violence. Education and empowerment of women are fundamental. Health workers should be trained to identify and support survivors and strategies to address violence should be integrated into services for child health, maternal, sexual, and reproductive health, mental health, HIV, and alcohol or substance abuse. Research to learn how to respond to violence must be strengthened. The elimination of violence against women and girls is central to equitable and sustainable social and economic development and must be prioritised in the agenda for development after 2015.

Objectives To strengthen the evidence-base for policy and practice for support of children outside of family care requires effective, efficient and sustainable mechanisms for monitoring and evaluation. Toward that end, two core questions guided a systematic review of evidence: What strategies are appropriate for monitoring the needs and circumstances of children outside of family care? What strategies are suitable for evaluating the impact of the programs intended to serve such children? Methods A structured document search and review process was implemented within the context of the U.S. Government Evidence Summit on Protecting Children Outside of Family Care of December 2011. Through successive review phases, initially using structured screening criteria, followed by thematic review by an expert panel, 73 documents were identified for analysis. Results Analysis of models and strategies indicates that: (1) tools are available for assessment of children's needs, but require refining to accommodate contextual demands; (2) well-designed evaluations are able to identify the influence of assistance; (3) long-term follow-up is crucial to developing a strong evidence-base on effective strategies; and (4) insights into systems-wide monitoring mechanisms are emerging. In addition to describing key components of monitoring and evaluation strategies, findings draw attention to the evaluation of children's resiliency and protective factors, community based monitoring and the role of caregivers, as well as concerns over the stigmatization of children (through data collection methodologies encouraging the ‘labeling’ of children) and the importance of children's participation. Conclusions Fostering a stronger evidence-base to improve protection for vulnerable children requires evaluations that are integrated into program development, use context-appropriate methodologies able to assess intervention scalability and employ more longitudinal designs to explore children's trajectories. Further, future programming will benefit from systems-wide data coordination and international comparisons, research that emphasizes coping and resilience mechanisms, and children's participation in monitoring and evaluation.

Migration is a crucial issue for public health, with currently nearly a quarter of a billion international migrants and more than three times this number of migrants moving within their home country.1,2 Migration is not a new phenomenon, but international and internal migration seems to be increasing, triggered by displacement of large numbers of people in low-income and middle-income countries due to conflict, natural disasters, people's search for safety, and voluntary reasons such as economic opportunities.

The trafficking of women and girls into forced prostitution and other slavery-like or exploitative conditions is a gross violation of human rights. So dehumanising is this crime that one 17-year-old Romanian woman who was trafficked to the UK and forced to sell sex explained that while being sold from country to country and client to client she felt like a “piece of meat with two eyes." The WHO Ethical and Safety Recommendations on Interviewing Trafficked Women released in October 2003 addresses many ethical and safety issues related to meeting with and gathering information from trafficked women. (excerpt)