Educational Reinforcements of and Challenges to Gender Norms in Urban Sri Lanka

Background: In 2013, over half of surveyed Sri Lankan men and women expressed gender-inequitable attitudes equating masculinity with violence, and femininity with obedience to men. Gender-inequitable attitudes have been shown to be linked to gender-based violence (GBV) in multiple contexts. The goal of this research was to identify points of intervention at which programmes and policies could cultivate gender-equitable attitudes among youth in Sri Lanka, with a goal of reducing GBV in adulthood. Methods: Over 9 months, the lead author interviewed 18 young adults (ages 18-30) in urban Sri Lanka to understand how their experiences influenced their gender identity, as well as their perceptions of gender norms. Their responses were analysed using a directed content analysis approach to explore which factors have most influenced the processes of gender norm learning, acceptance, or rejection throughout Sri Lankan young adults’ lives. Themes of Interest: Single gender schooling reinforces gender-inequitable norms Girls are groomed for domestic chores, while boys are taught skills for employment and to excel in science Single-gender schools carry prestige and strong alumni networks that for some outweigh the negative gender stereotypes Femininity and Masculinity are performed very differently in schools: Boys are encouraged to play sports and display their physical strength Girls are encouraged to read and study but be prepared to put their academic goals on hold after marriage Schools are lacking strong sexual education and gender curricula: Even in schools with curricula, teachers opt out because of discomfort discussing sex Students are not prepared to negotiate consensual relationships or to identify gender-based violence Conclusion: Educational settings in urban Sri Lanka contribute to and reinforce inequitable gender norms among adolescents and young adults. Some points of intervention are: Increasing interaction between single-gender school students of different genders, Challenging gender stereotypes perpetuated by students and alumni Developing and implementing strong sexual education curricula

Learning from our mothers: examining the role of intergenerational knowledge transfer in advancing gender equity among Sri Lankan youth

Background In a 2013 survey, over half of Sri Lankan men and women expressed gender-inequitable attitudes that equated masculinity with violence, and femininity with obedience to men. High rates of gender-inequitable attitudes are a community-level risk factor for gender-based violence including rape and intimate partner violence. In Sri Lanka, public health practitioners focused on reducing the health disparities resulting from gender inequity need to better understand the processes by which gender-inequitable attitudes develop and how to prevent them. The goal of this research was to identify potential points of intervention at which appropriate programmes and policies could most effectively cultivate gender-equitable attitudes among young people in Sri Lanka. Methods Over 9 months in 2016 and 2017, we interviewed more than 30 young adults in Sri Lanka to understand how their experiences helped them to develop their own gender identity, as well as to understand and respond to gender norms. Their responses were analysed using a grounded theory approach to explore which factors have most influenced the processes of gender norm learning, acceptance, or rejection throughout Sri Lankan young adults’ lives. Findings Many interviews focused on the impact of elder family members on the interviewee\u27s perception and acceptance of gender norms. Many young adults who did not agree with gender-inequitable norms reported receiving advice from their parents or other elder relatives to disregard norms and pursue their own non-conforming interests. In one example, many non-working mothers insisted on their daughters working and becoming financially independent. Interpretation Young people in Sri Lanka are repeatedly confronted by gender-inequitable attitudes in school, the media, politics, and society at large. However, family members can support youth to develop gender equitable attitudes and behaviours within this gender-inequitable society. Harnessing elders’ positive wishes for their offspring\u27s future may prove essential to advancing gender equity in the next generation of Sri Lankan adults. Even from gender-inequitable roles, parents may still support gender equity, and could be encouraged through public health interventions to support their children in realising their full potential. Elder family members are an untapped public health resource for advancing gender equity and reducing its related health disparities among Sri Lankan youth

Impact of Adverse Childhood Experiences on Intimate Partner Violence Perpetration among Sri Lankan Men

In Sri Lanka, over one in three women experience intimate partner violence (IPV) victimization in their lifetime, making it a serious public health concern. Adverse childhood experiences (ACEs) such as child abuse and neglect, witnessing domestic violence, parental separation, and bullying are also widespread. Studies in Western settings have shown positive associations between ACEs and IPV perpetration in adulthood, but few have examined this relationship in a non-Western context. In the present study, we examined the association of ACEs with IPV perpetration among Sri Lankan men surveyed for the UN Multi-Country Study on Men and Violence in Asia and the Pacific. We found statistically significant positive associations between the number of ACE categories (ACE score) and emotional, financial, physical, and sexual IPV perpetration among Sri Lankan men. We analyzed the contributions of each ACE category and found that childhood abuse was strongly associated with perpetration of IPV in adulthood, with sexual abuse associated with the greatest increase in odds of perpetration (Adjusted odds ratio 2.36; 95% confidence interval: 1.69, 3.30). Witnessing abuse of one’s mother was associated with the greatest increase in the odds of perpetrating physical IPV (AOR 1.82; 95% CI: 1.29, 2.58), while lack of a male parental figure was not associated with physical IPV perpetration (AOR 0.76; 95% CI: 0.53, 1.09). These findings support a social learning theory of IPV perpetration, in which children who are exposed to violence learn to perpetrate IPV in adulthood. They also suggest that in Sri Lanka, being raised in a female-headed household does not increase the risk of IPV perpetration in adulthood compared to being raised in a household with a male parental figure. The relationship between being raised in a female-headed household (the number of which increased dramatically during Sri Lanka’s recent civil war) and perpetration of IPV warrants further study. Interventions that aim to decrease childhood abuse in Sri Lanka could both protect children now and reduce IPV in the future, decreasing violence on multiple fronts

Training university teachers and students in Sri Lanka on Gender Based Violence: testing of a participatory training program [version 1]

This article was migrated. The article was marked as recommended. In all societies, violence is a social problem and violation of human rights. Changing attitudes and behaviors, which accept violence at individual and societal levels are key components in prevention strategies. The aim of this study was to produce educational material on Gender Based Violence (GBV). A participatory study design including educators and university students was used to create four teaching modules. The teaching was evaluated by descriptive surveys before and after the training and focus group discussions followed the training session. The questionnaire covered attitudes to gender, violence and laws. One hundred eleven teachers and 25 students representing different faculties and universities participated in separate workshops in three Sri Lankan universities. The students lacked knowledge of the meaning of GBV, consequences and existing laws. Women held more gender-equitable attitudes. Both women and men favoured equal participation of work and decision in the households. Male undergraduates showed less accepting attitudes toward rape or blaming women for rape Three categories emerged after the FGDs; Make training module compulsory and teacher led; Mind your own business; What can be done. The newly prepared and context specific material was well-received by educators and students and they provided valuable inputs, which improved the educational modules

Does Proximity to Conflict Zones Moderate Associations Between Girl Child Marriage, Intimate Partner Violence, and Contraception in Postconflict Sri Lanka?

Women’s primary contraceptive method type is impacted by the gender inequities of girl child marriage and intimate partner violence (IPV). Outside of South Asia, proximity to conflict zones has been found to impact contraceptive use, girl child marriage, and IPV, possibly moderating associations between these variables. We created multinomial regression models using the 2016 Demographic and Health Survey data from postconflict Sri Lanka to study associations between primary contraceptive method type (modern spacing methods, sterilization, and traditional methods compared to no method) and the gender inequities of girl child marriage and past year sexual, physical, and emotional IPV and to assess whether and how these associations were moderated by proximity to conflict. We found that proximity to conflict moderated the relationships between girl child marriage, past year physical and emotional IPV, and primary contraceptive method type. Girl child marriage was associated with increased relative risk (RR) of modern spacing methods (adjusted RR ratio/aRRR: 1.81–2.21) across all levels of proximity to conflict. In districts distal to conflict, past year physical IPV was associated with decreased RR of sterilization (aRRR: 0.67) and traditional methods (aRRR: 0.63), and past year emotional IPV was associated with decreased RR of traditional methods (aRRR: 0.71). In districts central to conflict, past year emotional IPV was associated with increased RR of modern spacing methods (aRRR: 1.50). Our findings suggest that policymakers and providers who seek to improve reproductive health in Sri Lanka must consider the moderating impact of proximity to conflict on the relationship between contraceptive use and the gender inequities of girl child marriage and IPV

A mediation analysis of the role of girl child marriage in the relationship between proximity to conflict and past-year intimate partner violence in post-conflict Sri Lanka

Background Studies from many contexts indicate that proximity to conflict is associated with increased likelihood of intimate partner violence (IPV), and girl child marriage is associated with both proximity to conflict and increased IPV. In this study, we consider whether girl child marriage acts as a mediator of the association between proximity to conflict and IPV in the context of Sri Lanka, which sustained long-term conflict until 2009. Methods We analyzed responses of currently partnered women between ages 18 and 49 in the 2016 Sri Lankan Demographic and Health Survey (N = 13,691). Using logistic regression analyses, we measured associations between proximity to conflict (residence in districts which were central, proximal, or distal to the regions where the war occurred) and the outcomes of IPV and girl child marriage, and secondarily assessed girl child marriage as a possible mediator of the association between proximity to conflict and past year IPV. Results Women residing in districts central to conflict, as compared to districts distal to conflict, had increased odds of past year sexual, physical, and emotional IPV, with the odds of sexual IPV increasing the most (adjusted odds ratio/aOR 4.19, 95% confidence interval/CI 2.08–8.41). Residing in districts proximal to conflict compared to those distal to conflict was associated with lower odds of past year physical and emotional IPV, with the greatest decrease in emotional IPV (aOR 0.31, CI 0.18–0.54). Girl child marriage was more likely in districts central to conflict as opposed to those distal to conflict (aOR 1.89, CI 1.22–2.93), and partially mediated the relationship between centrality to conflict and IPV. Conclusions Our findings demonstrate that residing in districts central to conflict compared to those distal to conflict is associated with greater odds of IPV and girl child marriage in post-conflict Sri Lanka, with girl child marriage partially mediating the association between centrality to conflict and IPV. Residence in districts proximal to conflict appears protective against IPV. Future research should investigate what factors are responsible for decreased IPV in districts proximal to violence, and whether these factors can be reproduced to mitigate the increased prevalence of IPV in districts central to conflict

Associations between recent intimate partner violence and receipt and quality of perinatal health services in Uttar Pradesh

Background India suffers some of the highest maternal and neonatal mortality rates in the world. Intimate partner violence (IPV) can be a barrier to utilization of perinatal care, and has been associated with poor maternal and neonatal health outcomes. However, studies that assess the relationship between IPV and perinatal health care often focus solely on receipt of services, and not the quality of the services received. Methods and findings Data were collected in 2016–2017 from a representative sample of women (15-49yrs) in Uttar Pradesh, India who had given birth within the previous 12 months (N = 5020), including use of perinatal health services and past 12 months experiences of physical and sexual IPV. Multivariate logistic regression models assessed whether physical or sexual IPV were associated with perinatal health service utilization and quality. Reports of IPV were not associated with odds of receiving antenatal care or a health worker home visit during the third trimester, but physical IPV was associated with fewer diagnostic tests during antenatal visits (beta = -0.30), and fewer health topics covered during home visits (beta = -0.44). Recent physical and recent sexual IPV were both associated with decreased odds of institutional delivery (physical IPV AOR 0.65; sexual IPV AOR 0.61), and recent sexual IPV was associated with leaving a delivery facility earlier than recommended (AOR = 1.87). Neither form of IPV was associated with receipt of a postnatal home visit, but recent physical IPV was associated with fewer health topics discussed during such visits (beta = -0.26). Conclusions In this study, reduced quantity and quality of perinatal health care were associated with recent IPV experiences. In cases where IPV was not related to care receipt, IPV remained associated with diminished care quality. Additional study to understand the mechanisms underlying associations between IPV and care qualities is required to inform health services

Understanding gender-based violence and health in post-conflict Sri Lanka

Sri Lanka is experiencing the prolonged impacts of a nearly 30-year civil war which ended in 2009. Living in a post-conflict area has been found in multiple settings to be associated with increased likelihood of intimate partner violence and girl child marriage, as well as poor health outcomes such as reduced access to reproductive health care and child malnutrition. Using data from the 2016 Sri Lankan Demographic and Health Survey, this dissertation aims to understand associations between proximity to conflict, girl child marriage, intimate partner violence (IPV), and reproductive and child health outcomes. First, this dissertation examines the potential role of girl child marriage as a mediating factor in the associations between proximity to conflict and intimate partner violence in Sri Lanka; finding that residing in districts central to conflict (compared to districts distal to conflict) is associated with increased odds of girl child marriage and all forms of intimate partner violence, and that child marriage is a partial mediator of the association between centrality to conflict and all forms of intimate partner violence. Second, this dissertation examines how girl child marriage and intimate partner violence are associated with women's contraceptive method type, and how proximity to conflict moderates those relationships; finding that girl child marriage, physical IPV, and proximity to conflict are associated with differences in contraceptive method type, and that proximity to conflict moderates the associations of girl child marriage and physical IPV with contraceptive method type. Third, this dissertation explores whether maternal child marriage and intimate partner violence in Sri Lanka are associated with stunting (low height for age) among children ages 0-5 in Sri Lanka, and whether proximity to conflict moderates those relationships; finding that children in districts proximal and central to conflict experience reduced stunting compared to children in districts distal to conflict, and that proximity to conflict moderates associations of maternal sexual IPV and maternal emotional IPV with stunting. The findings of this dissertation advance the study of gender-based violence (GBV) and health in post-conflict Sri Lanka and add to the global literature on the health and social impacts of armed conflict