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Intimate partner violence (IPV) is the most common form of violence against women and girls (VAWG). Research has shown that gender inequitable attitudes, economic stressors, and armed conflict are among the many risk factors for IPV. Armed conflict can leave women and girls even more vulnerable to gender-based violence and create a context in which hegemonic masculinity may escalate different forms of VAWG. In South Sudan, a country that has been affected by continued armed conflicts, more than half of ever-partnered women and girls have reported experiencing physical or sexual IPV. This study reports on two population-based surveys targeting women and men in South Sudan. Logistic regression analyses were conducted using a sub-sample of ever-partnered men in South Sudan to examine the effect of several predictors on lifetime perpetration of IPV. Findings show a number of factors that were associated with increased odds of ever perpetrating IPV including perpetrating non-partner sexual violence, exposure to non-partner physical violence, and the number of controlling behaviors perpetrated against women partners. These findings suggest that perpetration of IPV is linked to gender inequality and exposure to and normalization of violence. Overall, this research contributes to our in-depth understanding of how experiences of armed conflict may contribute to perpetration of VAWG.

This paper presents the results of nearly three decades of partnership between feminist researchers and activists to prevent violence against women and girls (VAWG) in Nicaragua. A household survey conducted in 1995 in León, the country's second-largest city, revealed that 55 per cent of women had experienced lifetime physical intimate partner violence (IPV), and 27 per cent had experienced IPV in the last 12 months. The study results were instrumental in changing domestic violence laws in Nicaragua. A follow-up study in 2016 found a decrease of 63 per cent in lifetime physical IPV and 70 per cent in 12-month physical IPV. This paper examines possible explanations for the reduction, including the policy reforms resulting from feminist advocacy. We compare risk and protective factors for physical IPV, such as changes in women's attitudes towards violence, their use of services, and knowledge of laws, using data from both the 1995 and 2016 surveys, as well as three waves of Demographic and Health Surveys. We conclude that the decline in IPV can be partially attributed to the efforts of the Nicaraguan women's movements to reform laws, provide services for survivors, transform gender norms, and increase women's knowledge of their human rights.

Background While one in three women around the world are estimated to have experienced intimate partner or sexual violence, these rates are often exacerbated during conflict and humanitarian crisis. This systematic review seeks to provide an overview of existing research on risk and protective factors associated with gender-based violence (GBV) in conflict and humanitarian settings. Methods Studies will be searched from the following databases: PubMed (Medline); PsycINFO; Scopus; Global Health; and Cochrane Center trials registrar. In addition, targeted searches of the internet repositories for GBV will be conducted. We will include studies that are published between January 1995 and December 2020 and document risk or protective factors for gender-based violence against women and girls in conflict or humanitarian settings. Two reviewers will independently screen and extract data for the review, with a third reviewer arbitrating disputes and ensuring quality. A quality assessment of the included studies will be undertaken using a modified GRADE system. Narrative synthesis will be utilized to analyze the data. Discussion The results of this study will inform the design and delivery of GBV prevention programs in conflict and humanitarian settings as well as contribute to the attainment of Sustainable Development Goal 5. The results will be published in a peer-reviewed journal and will be utilized at the World Health Organization to inform efforts to prevent GBV in conflict and humanitarian settings. Systematic review registration The protocol has been registered with PROSEPERO (CRD42020198695).

This systematic review provides an overview of existing research on risk and protective factors associated with violence against women and girls (VAWG) in conflict and natural disaster settings. PubMed (Medline); PsycINFO; Scopus; and Cochrane Center trials registrar were searched as well as relevant internet repositories for VAWG research. The inclusion criteria covered studies that were published between January 1995 and December 2020, documented risk and/or protective factors for VAWG in conflict or natural disaster-affected settings and included primary or secondary data analysis. A total of 1,413 records were initially identified and 86 articles (covering 77 studies) were included in the final analysis. The findings show that many preexisting risk factors for VAWG are exacerbated in armed conflict and natural disaster-affected settings. Poverty and economic stress, men’s substance abuse, exposure to violence, changing gender roles in contexts of inequitable gender norms, and a lack of social support are some of the risk factors associated with male perpetration or female experience of violence. In addition, risk factors specific to experiences during armed conflict or in a natural disaster (e.g., displacement, insecurity or congestion in and around displacement camps, militarization of society, killing of family, destruction of property, etc.) are associated with higher prevalence of VAWG in these contexts.

This article presents the results of a qualitative study on the context and different forms of violence committed against women and girls in South Sudan. The study documents many forms of sexual and physical violence against women and girls in South Sudan, including conflict-related sexual violence, intimate partner violence, nonpartner sexual violence, child and forced marriage, and abduction. Violence occurred during three overarching contexts: armed conflict, gender inequality, and the economic crisis. The custom of bride price, combined with the economic crisis, is a key driver of many other forms of violence.

BackgroundGlobally, it is estimated that at least one out of every three women experiences violence by an intimate partner and/or non-partner throughout their lifetime. Women and girls are at even higher risk of violence in conflict and humanitarian crises. Although effort has expanded to build rigorous evidence and research on violence against women and girls (VAWG) among conflict-affected populations, methodological and ethical challenges remain. Basic ethical research practices are more challenging in conflict-affected populations and therefore require supplementary protections. While it is important to follow international ethical guidelines, in practice it is sometimes difficult depending on the setting. The aim of this paper is to present the main ethical challenges that occur when conducting research on VAWG in conflict and humanitarian settings, as well as potential strategies to address these challenges, based on a recent study carried out in South Sudan in 2016.Case presentationThis paper provides an analysis utilizing the World Health Organization guidelines on doing research on VAWG and in conflict and humanitarian settings. The paper analyses four main components: the first component is a risk-benefit assessment, which includes identifying the research gap and evaluating feasibility with local stakeholders. The second component is a methodological and conceptual approach, which involves both local stakeholders and external experts in order to develop flexible methods that can be used in a volatile conflict setting. The third component is safety considerations, which emphasizes the importance of collaborating with a partner with strong local networks. The last component is analysis and research uptake. This component describes the importance of developing different research products, and disseminating them in a way to ensure they would be relevant and minimize any risks to the participants.ConclusionsThe study in South Sudan provided an excellent opportunity to put into practice the international ethical guidelines to carry out research on VAWG in conflict and humanitarian settings. The study enabled the research team to reflect on the guidelines and develop strategies to cope with new methodological and ethical challenges that arose in this complex setting, adapting the guidelines, as necessary. It demonstrated the necessity of developing a strong yet adaptable methodology with multiple alternative plans to solve any safety or ethical issues that occur throughout the entirety of the study. It also revealed the importance of collaborating with an implementing partner and gathering input from both local and international stakeholders on research design, analysis and uptake. Most importantly, the study in South Sudan emphasized that this type of complex research requires significant planning, in addition to substantial financial and human resources. Donor buy-in and flexibility is therefore essential.

Summary In this Series paper, we review evidence for interventions to reduce the prevalence and incidence of violence against women and girls. Our reviewed studies cover a broad range of intervention models, and many forms of violence—ie, intimate partner violence, non-partner sexual assault, female genital mutilation, and child marriage. Evidence is highly skewed towards that from studies from high-income countries, with these evaluations mainly focusing on responses to violence. This evidence suggests that women-centred, advocacy, and home-visitation programmes can reduce a woman's risk of further victimisation, with less conclusive evidence for the preventive effect of programmes for perpetrators. In low-income and middle-income countries, there is a greater research focus on violence prevention, with promising evidence on the effect of group training for women and men, community mobilisation interventions, and combined livelihood and training interventions for women. Despite shortcomings in the evidence base, several studies show large effects in programmatic timeframes. Across different forms of violence, effective programmes are commonly participatory, engage multiple stakeholders, support critical discussion about gender relationships and the acceptability of violence, and support greater communication and shared decision making among family members, as well as non-violent behaviour. Further investment in intervention design and assessment is needed to address evidence gaps.

Intimate partner and sexual violence among adolescents is common throughout the world, with devastating effects on their physical and mental health and well-being that can last a lifetime. Until recently, virtually all of the rigorously evaluated interventions to prevent adolescent intimate partner and sexual violence (IP/SV) came from high-income countries. The majority of these interventions were conducted in schools and college campuses and largely focused on reducing perpetration and victimization among both boys and girls in dating relationships. In the last decade, a growing body of evidence has emerged in low- and middle-income countries (LMIC), which addresses other forms of violence against adolescents including early and forced marriage, sexual violence, and intimate partner violence, both in dating relationships as well as in marriage. This chapter reviews the evidence from both high- as well as LMIC regarding the effectiveness of interventions to address IP/SV among adolescents, including school and community-based approaches.

Objective. To study the neuroendocrine release of cortisol in response to perceived stress among pregnant women exposed to partner violence and how this affects the duration of pregnancy and the intrauterine growth of the infant. Design. Cross-sectional community-based study. Setting. Health and Demographic Surveillance System of Leon, Nicaragua. Population. One-hundred and forty-seven pregnant women. Methods. Standardized scales to measure intimate partner violence, social resources, perceived stress, and socio-economic conditions were applied. Two salivary samples for cortisol were collected in the morning and afternoon on the same day. Linear regression and path analysis were used. Main outcome measures. Cortisol levels, gestational age, and weight at delivery. Results. Partner violence during the pregnancy, low social resources, and perceived maternal stress were associated with high level of salivary cortisol. Pregnant women with high cortisol levels were significantly more likely to give birth to small-for-gestational age babies, but not to deliver preterm. A substantial decrease of birthweight, 121-186 g, was associated with an increase in cortisol in association with violence exposure. Conclusion. Partner violence during pregnancy is a stressor that provokes high levels of cortisol, which is associated with reduction of birthweight.

Summary Background Violence against women is a serious human rights abuse and public health issue. Despite growing evidence of the size of the problem, current evidence comes largely from industrialised settings, and methodological differences limit the extent to which comparisons can be made between studies. We aimed to estimate the extent of physical and sexual intimate partner violence against women in 15 sites in ten countries: Bangladesh, Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia and Montenegro, Thailand, and the United Republic of Tanzania. Methods Standardised population-based household surveys were done between 2000 and 2003. Women aged 15–49 years were interviewed and those who had ever had a male partner were asked in private about their experiences of physically and sexually violent and emotionally abusive acts. Findings 24 097 women completed interviews, with around 1500 interviews per site. The reported lifetime prevalence of physical or sexual partner violence, or both, varied from 15% to 71%, with two sites having a prevalence of less than 25%, seven between 25% and 50%, and six between 50% and 75%. Between 4% and 54% of respondents reported physical or sexual partner violence, or both, in the past year. Men who were more controlling were more likely to be violent against their partners. In all but one setting women were at far greater risk of physical or sexual violence by a partner than from violence by other people. Interpretation The findings confirm that physical and sexual partner violence against women is widespread. The variation in prevalence within and between settings highlights that this violence in not inevitable, and must be addressed.

Violence against women is a serious health and development concern, as well as a violation of women's human rights. Violence against women has a devastating effect on women's sexual and reproductive health, as well as the health of their children, and is rooted in gender inequality. Reducing violence against women is therefore a key strategy for the achievement of the Millennium Development Goals. Key lessons have emerged from more than two decades of experiences dealing with violence against women within the health sector. Interventions must go beyond training and curricula reform and utilize a system-wide approach, including changes in policies, procedures and attention to privacy and confidentiality. Providers must work together with other sectors, particularly at a community level, to strengthen local networks for support of survivors of violence. Prevention activities are critical, particularly those that seek to change cultural norms and laws that encourage violence and discriminate against women and girls.

Violence against women and girls, once seen as a relatively rare occurrence, has now gained international recognition, not only as serious violation of human rights, but as a significant public health concern, as well as a barrier to social and economic development. Globally, at least one woman in every three is beaten, raped or otherwise abused during her lifetime [1]. Most often the violence is committed by someone close to her, usually an intimate partner, although violence for the purpose of commercial exploitation or as a weapon of war has increased at an alarming rate over the last decade. Although the specific forms of violence against women vary among countries, they share common roots in unequal power relations between men and women. Therefore, efforts to reduce violence must be framed in the context of promoting gender equity and women’s empowerment.

The importance of a sound research strategy for measuring and understanding violence against women cross-culturally is well recognized. However, the value of specialized interviewer training to attain these data is not always fully appreciated. This article describes interviewer selection and training in the World Health Organization (WHO) Multi-Country Study on Women’s Health and Domestic Violence and highlights their importance. Such training ensures high-quality data and cross-country comparability, protects the safety of respondents and interviewers, and increases the impact of the study. Moreover, women are not only willing to share experiences with trained and empathetic interviewers but also find the interview a positive experience.

Epidemiological research involving people has inherent risks. The Council for International Organization of Medical Sciences provides guidance on the ethical principles of epidemiological research, including respect for people, non-maleficence, beneficience, and justice. In this article we discuss the challenges of applying each principle to population research on domestic violence, an issue in which poorly designed research could put women in violent relationships at substantial risk. Main concerns include ensuring safety of respondents in a context in which many live with their abuser, protecting confidentiality when breaches could provoke an attack, and ensuring the interview process is affirming and does not cause distress. The inherent risks entailed in research can only be justified if the interview is used to provide information on available services and is a source of immediate referral when necessary, if high-quality data are obtained, and if findings are used to raise awareness of, and improve services for, women who experience domestic violence.

The results of three population-based studies on violence against women in Nicaragua are compared in this article. Two of the studies were regional in scope (León and Managua) and focused specifically on women's experiences of violence, whereas the third study was a Demographic and Health Survey (DHS) conducted with a nationally representative sample of women. The lifetime prevalence estimates for women's undergoing physical violence from a partner were significantly higher in the León study (52 percent) and Managua study (69 percent), compared with that given in the DHS (28 percent). Possible explanations for the differences are examined through pooled multivariate logistic regression analysis, as well as analysis of six focus-group discussions carried out with field-workers and staff from the three studies. The most important differences that were found concerned ethical and safety procedures and the interview setting. The results indicate that prevalence estimates for violence are highly sensitive to methodological factors, and that underreporting is a significant threat to validity.

OBJECTIVES: This study measured the prevalence, frequency, and severity of physical wife abuse and its risk factors in León, Nicaragua. METHODS: A cross-sectional survey was conducted with a representative sample of 488 women 15 to 49 years of age. RESULTS: The lifetime prevalence of spousal violence was 52% among ever-married women (n = 360). Spousal violence was significantly positively associated with poverty, parity, urban residence, and history of violence in the husband's family. No significant associations were found between spousal violence and women's age, education, marital dependency, or occupation. CONCLUSIONS: Wife abuse constitutes a major public health problem in Nicaragua, requiring urgent measures for prevention and treatment for victims.

This study aimed to measure the prevalence of emotional distress among women in Leon Nicaragua and to identify risk factors for emotional distress with special reference to wife abuse. A survey was performed among a representative sample of women aged 15-49. Among ever-married women 20% were classified as experiencing emotional distress at the time of the interview and 52% reported physical partner abuse at some point in their lives. Women reporting abuse were six times more likely to experience emotional distress. An estimated 70% of all cases of emotional distress found among ever-married women were attributable to wife abuse. The study underscores the need to improve screening and care for battered women within mental health services in Nicaragua. (authors)

Public awareness in Nicaragua regarding domestic violence has undergone a profound transformation in the last few years. Once viewed as a private problem affecting few women, it is now considered a major social problem. This is largely due to the work of a broad-based movement spearheaded by the National Network of Women Against Violence, which includes over 150 women's groups and hundreds of individual women all over the country. This Network conducted a year-long campaign which culminated in the passage of a new Domestic Violence Law in 1996. The process of drafting, lobbying and mobilising support for the new law was successful due to the creation of strategic alliances with politicians, government officials, community leaders, and professionals from a broad range of disciplines. Epidemiological and participatory research provided data that convinced policymakers of the need for reform. This paper traces the history of the anti-violence movement since the 1980s and describes the multiple strategies used to place domestic violence on the national political agenda.

Objective To explore how intimate partner violence (IPV) is associated with unintended pregnancy and abortion in primarily low- and middle-income countries. Methods Population data are presented from 17 518 ever-partnered women participating in the WHO Multi-country Study on Women's Health and Domestic Violence in 15 sites in 10 countries. Using multiple logistic regression analyses, associations between physical and/or sexual partner violence and abortion and unintended pregnancy were explored. Results Women with a history of IPV had significantly higher odds of unintended pregnancy in 8 of 14 sites and of abortion in 12 of 15 sites. Pooled estimates showed increased odds of unintended pregnancy (adjusted OR 1.69; 95% CI, 1.53–1.86) and abortion (adjusted OR 2.68; 95% CI, 2.34–3.06), after adjusting for confounding factors. Reducing IPV by 50% could potentially reduce unintended pregnancy by 2%–18% and abortion by 4.5%–40%, according to population-attributable risk estimates. Conclusion IPV is a consistent and strong risk factor for unintended pregnancy and abortion across a variety of settings. Unintended pregnancy terminated through unsafe abortion can result in death or serious complications. Therefore, reducing IPV can significantly reduce risks to maternal and reproductive health.

Suicidal behaviours are one of the most important contributors to the global burden of disease among women, but little is known about prevalence and modifiable risk factors in low and middle income countries. We use data from the WHO multi-country study on women's health and domestic violence against women to examine the prevalence of suicidal thoughts and attempts, and relationships between suicide attempts and mental health status, child sexual abuse, partner violence and other variables. Population representative cross-sectional household surveys were conducted from 2000-2003 in 13 provincial (more rural) and city (urban) sites in Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia, Thailand and Tanzania. 20967 women aged 15-49 years participated. Prevalence of lifetime suicide attempts, lifetime suicidal thoughts, and suicidal thoughts in the past four weeks were calculated, and multivariate logistic regression models were fit to examine factors associated with suicide attempts in each site. Prevalence of lifetime suicide attempts ranged from 0.8% (Tanzania) to 12.0% (Peru city); lifetime thoughts of suicide from 7.2% (Tanzania province) to 29.0% (Peru province), and thoughts in the past four weeks from 1.9% (Serbia) to 13.6% (Peru province). 25-50% of women with suicidal thoughts in the past four weeks had also visited a health worker in that time. The most consistent risk factors for suicide attempts after adjusting for probable common mental health disorders were: intimate partner violence, non-partner physical violence, ever being divorced, separated or widowed, childhood sexual abuse and having a mother who had experienced intimate partner violence. Mental health policies and services must recognise the consistent relationship between violence and suicidality in women in low and middle income countries. Training health sector workers to recognize and respond to the consequences of violence may substantially reduce the health burden associated with suicidal behaviour.

To assess independent and interaction effect of experience of intimate partner violence and depression on risk of child death.Community-based cohort design.The study was conducted within the demographic surveillance site of Butajira Rural Health Program in south central Ethiopia.Women (n=561) who gave birth to a live child.Exposure status comprising physical, sexual and emotional violence by intimate partner was based on the WHO multi-country questionnaire on violence against women. Depression status was measured using the Composite International Diagnostic Interview. Risk of child death and its association with maternal exposure to violence and/or being depressed was analysed by incidence, rate ratios and interaction.The child death in the cohort was 42.1 (95% CI, 32.7 to 53.5) children per 1000 person years, and maternal depression is associated with child death. The risk of child death increases when maternal depression is combined with physical and emotional violence (RR=4.0; 95% CI, 1.6 to 10.1) and (RR=3.7; 95% CI, 1.3 to 10.4), showing a synergistic interaction.An awareness of the devastating consequences on child survival in low income setting of violence against women and depression is needed among public health workers as well as clinicians, for both community and clinical interventions.

Summary Background This article summarises findings from ten countries from the WHO multi-country study on women's health and domestic violence against women. Methods Standardised population-based surveys were done between 2000 and 2003. Women aged 15–49 years were interviewed about their experiences of physically and sexually violent acts by a current or former intimate male partner, and about selected symptoms associated with physical and mental health. The women reporting physical violence by a partner were asked about injuries that resulted from this type of violence. Findings 24 097 women completed interviews. Pooled analysis of all sites found significant associations between lifetime experiences of partner violence and self-reported poor health (odds ratio 1·6 [95% CI 1·5–1·8]), and with specific health problems in the previous 4 weeks: difficulty walking (1·6 [1·5–1·8]), difficulty with daily activities (1·6 [1·5–1·8]), pain (1·6 [1·5–1·7]), memory loss (1·8 [1·6–2·0]), dizziness (1·7 [1·6–1·8]), and vaginal discharge (1·8 [1·7–2·0]). For all settings combined, women who reported partner violence at least once in their life reported significantly more emotional distress, suicidal thoughts (2·9 [2·7–3·2]), and suicidal attempts (3·8 [3·3–4·5]), than non-abused women. These significant associations were maintained in almost all of the sites. Between 19% and 55% of women who had ever been physically abused by their partner were ever injured. Interpretation In addition to being a breach of human rights, intimate partner violence is associated with serious public-health consequences that should be addressed in national and global health policies and programmes. Funding WHO; Governments of the Netherlands, Norway, Sweden, Switzerland, and UK; Rockefeller Foundation; Urban Primary Health Care project of the Government of Bangladesh; Swedish Agency for Research Cooperation with Developing Countries (SAREC/Sida); United Nations Fund for Population Activities (UNFPA); and Trocaire.

Worldwide, patterns of violence against women differ markedly from violence against men. For example, women are more likely than men to be sexually assaulted or killed by someone they know. The United Nations has defined violence against women as gender-based violence, to acknowledge that such violence is rooted in gender inequality and is often tolerated and condoned by laws, institutions, and community norms. Violence against women is not only a profound violation of human rights, but also a costly impediment to a country's national development. While gender-based violence occurs in many forms throughout the life cycle, this review focuses on two of the most common types - physical intimate partner violence and sexual violence by any perpetrator. Unfortunately, the knowledge base about effective initiatives to prevent and respond to gender-based violence is relatively limited. Few approaches have been rigorously evaluated, even in high-income countries. And such evaluations involve numerous methodological challenges. Nonetheless, the authors review what is known about more and less effective - or at least promising - approaches to prevent and respond to gender-based violence. They present definitions, recent statistics, health consequences, costs, and risk factors of gender-based violence. The authors analyze good practice initiatives in the justice, health, and education sectors, as well as multisectoral approaches. For each of these sectors, they examine initiatives that have addressed laws and policies, institutional reforms, community mobilization, and individual behavior change strategies. Finally, the authors identify priorities for future research and action, including funding research on the health and socioeconomic costs of violence against women, encouraging science-based program evaluations, disseminating evaluation results across countries, promoting investment in effective prevention and treatment initiatives, and encouraging public-private partnerships.

The authors present an overview of gender-based violence (GBV) in Latin America, with special emphasis on good practice interventions to prevent GBV or offer services to its survivors or perpetrators. Intimate partner violence and sexual coercion are the most common forms of GBV, and these are the types of GBV that they analyze. GBV has serious consequences for women's health and well-being, ranging from fatal outcomes, such as homicide, suicide, and AIDS-related deaths, to nonfatal outcomes, such as physical injuries, chronic pain syndrome, gastrointestinal disorders, complications during pregnancy, miscarriage, and low birth-weight of children. GBV also poses significant costs for the economies of developing countries, including lower worker productivity and incomes, and lower rates of accumulation of human and social capital. The authors examine good practice approaches in justice, health, education, and multisectoral approaches. In each sector, they identify good practices for: (1) law and policies; (2) institutional reforms; (3) community-level interventions; and (4) individual behavior change strategies.

This report presents major findings from a field research conducted in Meskan and Mareko district in south central Ethiopia. The research was conducted by a multidisciplinary team with extensive field research experiences in the areas of domestic violence reproductive health mental health and epidemiology. Over 3000 women were systematically selected for the study both from urban and rural areas. Data were collected using standard questionnaires for domestic violence and mental health developed by the World Health. The results show that 59% of women suffered from sexual violence and 49% from physical violence by a partner at some point in their lives. During the twelve months prior to the survey 44% of women reported sexual violence and 29% suffered partner violence. Major lifetime mental health problems include depressive episode Somatoform disorder and recurrent depressive episodes diagnosed in 6% 3% and 2% of the women respectively. Women who suffered from domestic violence also reported more symptoms of mental distress although the degree of association is not fully explored in this report. The majority of violence reported by women was inflected by intimate partners. The low status of women in the society a lack of general awareness about human/women’s rights and weakness in the law enforcement system are some of the reasons for the wide spread violence. To end violence against women and promote a healthy and secure life for women coordinated efforts by all concerned are needed. Efforts must also focus in improving the conditions of the family as a whole. (authors)

This paper provides an overview of the extent and nature of gender-based violence and its health consequences, particularly on sexual and reproductive health.

To assess whether being physically abused during pregnancy increases the risk of a low birth weight (LBW) infant.We conducted a hospital-based case-control study in León, Nicaragua. Cases consisted of 101 newborns with a birth weight under 2500 g, and for each case two controls with a birth weight over 2500 g were selected randomly from infants born the same day. Anthropometry of newborns was done immediately after birth, and background information and data on experiences of violence and potential confounders were obtained through private interviews with mothers. Crude and adjusted odds ratios (ORs) and population-attributable proportion were calculated for exposure to partner abuse in relation to LBW. Multivariate logistic regression analysis was used to control for potential confounding.Seventy-five percent of LBW newborns (cases) were small for gestational age and 40% were preterm. Twenty-two percent of the mothers of LBW infants had experienced physical abuse during pregnancy by their intimate partners compared with 5% of controls. Low birth weight was associated with physical partner abuse even after adjustment for age, parity, smoking, and socioeconomic status (OR 3.9; 95% confidence interval 1.7, 9.3). Given a causal interpretation of the association, about 16% of the LBW in the infant population could be attributed to physical abuse by a partner in pregnancy.Physical abuse by a partner during pregnancy is an independent risk factor for LBW.

STUDY OBJECTIVE—To describe the responses of women in León, Nicaragua to partner abuse and identify contextual factors associated with the use of certain coping mechanisms and the likelihood of permanent separation. DESIGN—Cross sectional population-based survey. SETTING—León, Nicaragua. PARTICIPANTS—188 women 15-49 years of age who had experienced physical partner abuse, out of 488 women interviewed. MAIN RESULTS—66% of women defended themselves effectively from abuse either physically or verbally. Forty one per cent of women had left home temporarily because of violence and 20% had sought help outside the home. Women experiencing severe abuse were more likely to leave or seek help, whereas women with less severe abuse were more able to defend themselves effectively. Seventy per cent of women eventually left abusive relationships. Help seeking and temporary separations increased the likelihood of a permanent separation, whereas women who defended themselves and were able to stop the violence, at least temporarily, were more likely to remain in abusive relationships. CONCLUSIONS—Women in Nicaragua use a variety of methods in order to overcome physical partner abuse. Temporary leaving and help seeking are critical steps in the process of leaving a violent relationship. However, many women indicated that they did not receive support for their situation. More interventions are needed to help women recognise and deal with violence, as well as strengthening the community support networks available to abused women. Keywords: partner abuse; violence; women

Aims: The objective was to describe experiences of sexual abuse occurring before 19 years of age among men and women in Leon, Nicaragua and to explore the possible association to later sexual risk behavior. Method: A sub-sample of literate urban men and women 25–44 years of age was selected from a representative sample of households in Leon. After an invitation to a public health event, 154 men (53% of the invited) and 213 women (66% of those invited) participated in giving written answers to an anonymous questionnaire. Results: Twenty percent of men and 26% of women reported that they had experienced sexual abuse. Women had been victims of attempted or completed rape twice as often as men, 15% as compared to 7%. Thirty-three percent of the abuse towards boys and 66% of the abuse towards girls was committed by family members. Women who had experienced attempted or completed rape were more likely to later have had a higher number of sexual partners compared to non-abused or moderately abused women. Conclusions: Sexual abuse of children and adolescents of both sexes is common in Nicaragua. The results underscore the urgent need to address this serious problem more openly, and to make more resources available for the prevention of sexual abuse and for support to victims.

The aim of this study was to describe the characteristics of domestic violence against women in Leon, Nicaragua. A survey was carried out among a representative sample of 488 women between the ages of 15-49. The physical aggression sub-scale of the Conflict Tactics Scale was used to identify women suffering abuse. In-depth interviews with formerly battered women were performed and narratives from these interviews were analysed and compared with the survey data. Among ever-married women 52% reported having experienced physical partner abuse at some point in their lives. Median duration of abuse was 5 years. A considerable overlap was found between physical, emotional and sexual violence, with 21% of ever-married women reporting all three kinds of abuse. Thirty-one percent of abused women suffered physical violence during pregnancy. The latency period between the initiation of marriage or cohabitation and violence was short, with over 50% of the battered women reporting that the first act of violence act took place within the first 2 years of marriage. Significant, positive associations were found between partner abuse and problems among children, including physical abuse. Both the survey data and the narrative analysis pointed to extreme jealousy and control as constant features of the abusive relationship. Further, the data indicate that battered women frequently experience feelings of shame, isolation and entrapment which, together with a lack of family and community support, often contribute to women's difficulty in recognizing and disengaging from a violent relationship. These findings are consistent with theoretical conceptualisations of domestic violence developed in other countries, suggesting that, to a large degree, women's experiences of violence transcend specific cultural contexts.

This Policy Forum presents new global evidence on the extent of domestic violence against women. Data from more than 24,000 women in 10 geographically and culturally varied countries involved in the WHO Multi-Country Study on Women9s Health and Domestic Violence highlights that violence is widespread and illustrates the degree to which levels vary between settings. It argues that violence against women is a complex social problem with far-reaching health consequences and one that urgently needs to be addressed.

The World Health Organization (WHO), in response to the lack of data on the magnitude and nature of violence against women, initiated a multicountry study on women's health and domestic violence. The WHO study, implemented in eight countries, was the first global effort to gather reliable and comparable data on domestic violence and women's health across countries. The study also demonstrates how carefully developed and applied research can act as a useful intervention at many levels of society and government and for all participants, researchers as well as respondents. The study further illustrates how partnering with researchers and women's organizations to collect evidence of the magnitude, consequences, and determinants of domestic violence can help strengthen national efforts to address violence against women and can act as a facilitating force for change.

Background Intimate partner violence (IPV) against women is a global public health and human rights concern. Despite a growing body of research into risk factors for IPV, methodological differences limit the extent to which comparisons can be made between studies. We used data from ten countries included in the WHO Multi-country Study on Women's Health and Domestic Violence to identify factors that are consistently associated with abuse across sites, in order to inform the design of IPV prevention programs. Methods Standardised population-based household surveys were done between 2000 and 2003. One woman aged 15-49 years was randomly selected from each sampled household. Those who had ever had a male partner were asked about their experiences of physically and sexually violent acts. We performed multivariate logistic regression to identify predictors of physical and/or sexual partner violence within the past 12 months. Results Despite wide variations in the prevalence of IPV, many factors affected IPV risk similarly across sites. Secondary education, high SES, and formal marriage offered protection, while alcohol abuse, cohabitation, young age, attitudes supportive of wife beating, having outside sexual partners, experiencing childhood abuse, growing up with domestic violence, and experiencing or perpetrating other forms of violence in adulthood, increased the risk of IPV. The strength of the association was greatest when both the woman and her partner had the risk factor. Conclusions IPV prevention programs should increase focus on transforming gender norms and attitudes, addressing childhood abuse, and reducing harmful drinking. Development initiatives to improve access to education for girls and boys may also have an important role in violence prevention.