Breaking silos between peace research and global health: A review of gender, global health and violence edited by Tiina Vaittinen and Catia C. Confortini

Mazeda Hossain and Leah Kenny review Gender, Global Health and Violence: Feminist Perspectives on Peace and Disease, edited by Tiina Vaittinen and Catia C. Confortini. This book review was originally published on LSE Women, Peace and Security blog. If you are interested in the topics discussed in this review, you can explore the 2021 Women, Peace and Security Forum which features posts written by contributors to Gender, Global Health and Violence. Gender, Global Health and Violence: Feminist Perspectives on Peace and Disease. Tiina Vaittinen and Catia C. Confortini (eds). Rowman and Littlefield. 2019

Evaluation of gender-based violence (GBV) case management services in the Dadaab refugee camps

The research aimed to understand how a comprehensive case management GBV response intervention can influence access to care and health and safety outcomes among refugee GBV survivors. To our knowledge, this pilot evaluation is one of the first in a refugee camp setting to evaluate an intervention that aims to respond to violence against refugee women using a task sharing approach. The study used a parallel convergent mixed methods study design. This dataset contains quantitative data collected from female survivors accessing GBV services

An innovative and integrated model for global outbreak response and research - a case study of the UK Public Health Rapid Support Team (UK-PHRST)

Background Despite considerable institutional experimentation at national and international levels in response to calls for global health security reform, there is little research on organisational models that address outbreak preparedness and response. Created in the aftermath of the 2013–16 West African Ebola epidemic, the United Kingdom’s Public Health Rapid Support Team (UK-PHRST) was designed to address critical gaps in outbreak response illuminated during the epidemic, while leveraging existing UK institutional strengths. The partnership between the government agency, Public Health England, and an academic consortium, led by the London School of Hygiene and Tropical Medicine, seeks to integrate outbreak response, operational research and capacity building. We explored the design, establishment and early experiences of the UK-PHRST as one of the first bodies of its kind globally, paying particular attention to governance decisions which enabled them to address their complex mission. Methods We conducted a qualitative case study using 19 in-depth interviews with individuals knowledgeable about the team’s design and implementation, review of organisational documents, and observations of meetings to analyse the UK-PHRST’s creation, establishment and initial 2 years of operations. Results According to key informants, adopting a triple mandate (response, research and capacity building) established the team as novel in the global epidemic response architecture. Key governance decisions recognised as vital to the model included: structuring the team as a government-academic collaboration which leveraged long-term and complementary UK investments in public health and the higher education sector; adopting a more complex, dual reporting and funding structure to maintain an ethos of institutional balance between lead organisations; supporting a multidisciplinary team of experts to respond early in outbreaks for optimal impact; prioritising and funding epidemic research to influence response policy and practice; and ensuring the team’s activities reinforced the existing global health architecture. Conclusion The UK-PHRST aims to enhance global outbreak response using an innovative and integrated model that capitalises on institutional strengths of the partnership. Insights suggest that despite adding complexity, integrating operational research through the government-academic collaboration contributed significant advantages. This promising model could be adopted and adapted by countries seeking to build similar outbreak response and research capacities

Sex trafficking and sexual exploitation in settings affected by armed conflicts in Africa, Asia and the Middle East: systematic review

Background Sex trafficking and sexual exploitation has been widely reported, especially in conflict-affected settings, which appear to increase women’s and children’s vulnerabilities to these extreme abuses. Methods We conducted a systematic search of ten databases and extensive grey literature to gather evidence of sex trafficking and sexual exploitation in conflict-affected settings. International definitions of “sexual exploitation” and “sex trafficking” set the indicator parameters. We focused on sexual exploitation in forms of early or forced marriage, forced combatant sexual exploitation and sexual slavery. We extracted prevalence measures, health outcomes and sexual exploitation terminology definitions. The review adhered to PRISMA guidelines and includes quality appraisal. Results The search identified 29 eligible papers with evidence of sex trafficking and sexual exploitation in armed conflict settings in twelve countries in Africa, Asia, and the Middle East. The evidence was limited and not generalizable, due to few prevalence estimates and inconsistent definitions of “sexual exploitation”. The prevalence estimates available indicate that females were more likely than males to be victims of sexual exploitation in conflict settings. In some settings, as many as one in four forced marriages took place before the girls reached 18 years old. Findings suggest that the vast majority of former female combatants were sexually exploited during the conflict. These studies provided various indicators of sexual exploitation compatible to the United Nation’s definition of sex trafficking, but only 2 studies identified the exploitation as trafficking. None of the studies solely aimed to measure the prevalence of sex trafficking or sexual exploitation. Similar descriptions of types of sexual exploitation and trafficking were found, but the inconsistent terminology or measurements inhibited a meta-analysis. Conclusions Findings indicate there are various forms of human trafficking and sexual exploitation in conflict-affected settings, primarily occurring as early or forced marriage, forced combatant sexual exploitation, and sexual slavery. The studies highlight the extraordinary vulnerability of women and girls to these extreme abuses. Simultaneously, this review suggests the need to clarify terminology around sex trafficking in conflict to foster a more cohesive future evidence-base, and in particular, robust prevalence figures from conflict-affected and displaced populations

Evaluation of a violence prevention intervention and lessons for future research in conflict settings: Working with men to prevent violence against women - a community survey, cluster randomised controlled trial and nested cohort study in Cote d'Ivoire

Background Evidence from armed conflict settings points to high levels of intimate partner violence (IPV) against women. Current knowledge on how to prevent IPV is limited – especially within waraffected settings. This research aims to inform the prevention of IPV in conflict-affected settings, specifically identifying community exposures to violence and traumatic events and their consequences among men and women and the impact of an IPV prevention intervention in Côte d’Ivoire. Methods This thesis represents a coordinated programme of research comprised of four studies: (1) a systematic review of violence against women (VAW) prevention interventions in conflict settings; (2) a community survey to determine community levels of exposure and perpetration of IPV, non-partner violence and traumatic events before, during and after a period of conflict; (3) a cluster randomised controlled trial to determine the added value of an IPV prevention intervention working with men; and (4) a nested cohort study to assess the gendered and temporal impact of violence and the intervention on mental health. Results The systematic review uncovered an extensive VAW prevention programme but limited research on its effectiveness. The community survey found high levels of IPV, non-partner violence and traumatic events among women and men. Women experienced higher overall levels of violence compared with men. The cluster RCT found significant differences between men in the intervention and control groups with regard to their ability to manage conflict and their increased engagement in gender-equitable behaviours. Among women, the cohort study found that factors significantly associated with post-traumatic stress disorder (PTSD) included male partner alcohol use and experience of IPV in the past year. Men were strongly protected from PTSD if they cohabitated with their female partner. A research commentary further advocates for violence prevention programming in conflict settings with attention to all forms of violence against women, including IPV. Conclusion In conflict-affected settings, policy approaches and interventions that aim to improve the lives of survivors should work towards programming that promotes gender equality and protects women and girls from abuse

A conceptual framework for analysing partnership and synergy in a global health alliance: case of the UK Public Health Rapid Support Team.

Partnerships have become increasingly important in addressing complex global health challenges, a reality exemplified by the COVID-19 pandemic and previous infectious disease epidemics. Partnerships offer opportunities to create synergistic outcomes by capitalizing on complimentary skills, knowledge and resources. Despite the importance of understanding partnership functioning, research on collaboration is sparse and fragmented, with few conceptual frameworks applied to evaluate real-life partnerships in global health. In this study, we aimed to adapt and apply the Bergan Model of Collaborative Functioning (BMCF) to analyse partnership functioning in the UK Public Health Rapid Support Team (UK-PHRST), a government-academic partnership, dedicated to outbreak response and research in low- and middle-income countries. We conducted a literature review identifying important elements to adapt the framework, followed by a qualitative case study to characterize how each element, and the dynamics between them, influenced functioning in the UK-PHRST, exploring emerging themes to further refine the framework. Elements of the BMCF that our study reinforced as important included the partnership's mission, partner resources (skills, expertise and networks), leadership, the external environment, management systems and communication. Additional elements identified in the literature and critical to partnership functioning of the UK-PHRST included governance and financial structures adopted, trust and power balance, organizational culture, strategy and evaluation and knowledge management. Because of the way the UK-PHRST was structured, fostering team cohesion was an important indicator of synergy, alongside collaborative advantage. Dividing the funding and governance equally between organizations was considered crucial for maintaining institutional balance; however, diverse organizational cultures, weak communication practices and perceived power imbalances compromised team cohesion. Our analysis allowed us to make recommendations to improve partnership functioning at a critical time in the evolution of the UK-PHRST. The analysis approach and framework presented here can be used to evaluate and strengthen the management of global health partnerships to realize synergy

Men's and women's experiences of violence and traumatic events in rural Cote d'Ivoire before, during and after a period of armed conflict.

OBJECTIVE: We assessed men's and women's experiences of gender based violence and other traumatic events in Côte d'Ivoire, a West African conflict-affected setting, before, during and after a period of active armed conflict (2000-2007). DESIGN: Cross-sectional, household survey. SETTING: 12 rural communities directly impacted by the Crisis in Côte d'Ivoire, spanning regions controlled by government forces, rebels and UN peacekeepers in 2008. PARTICIPANTS: 2678 men and women aged 15-49 years. PRIMARY OUTCOME MEASURES: Violence exposures measured since age 15. Questions included intimate partner physical and sexual violence; physical and sexual violence by others (including combatants) and exposure to traumatic events before, during and after the Crisis period (2000-2007). RESULTS: Physical and/or sexual violence since age 15 was reported by 57.1% women and 40.2% men (p=0.01); 29.9% women and 12.3% men reported exposure to any violence in the past year. Nearly 1 in 10 women (9.9%) and 5.9% men (p=0.03) were forced to have sex by a non-partner since age 15, and 14.8% women and 3.3% men (p=0.00) reported their first sexual experience was forced. Combatants were rarely reported as sexual violence perpetrators (0.3% women). After the Crisis, intimate partner physical violence was the most frequently reported form of violence and highest among women (20.9% women, 9.9% men, p=0.00). Fearing for their life was reported by men and women before, during and after the Crisis. CONCLUSIONS: Sexual violence in conflict remains a critical international policy concern. However, men and women experience different types of violence before, during and after conflict. In many conflict settings, other forms of violence, including intimate partner violence, may be more widespread than conflict-related sexual violence. Alongside service provision for rape survivors, our findings underscore the need for postconflict reconstruction efforts to invest in programmes to prevent and respond to intimate partner violence and trauma

Conditional cash transfers for maternal health interventions: Factors influencing uptake in North-Central Nigeria

Background: Nigeria accounts for a significant proportion of global maternal mortality figures with little progress made in curbing poor health indices. In a bid to reverse this trend, the Government of Nigeria initiated a conditional cash transfer (CCT) programme to encourage pregnant women utilize services at designated health facilities. This study aims to understand experiences of women who register for CCT services and explore reasons behind non-uptake of those women who do not register. Methods: We conducted this study in a rural community in North Central Nigeria. Having identified programme beneficiaries by randomly sampling contact details obtained from the programme database, using snowball sampling method we sourced non-beneficiaries list based on recommendations from beneficiaries and other community members. Thereafter we undertook semi-structured interviews on both beneficiaries and non-beneficiaries and analysed data obtained thematically. Results: Our findings revealed that, while beneficiaries of the programme were influenced by the cash transfers, cash may not be sufficient incentive for uptake by non-beneficiaries of CCT in Nigeria. Factors such as community and spousal influence, availability of free drugs, proximity to health facility are critical factors that affect uptake in our study context. On the other hand, poor programme administration, mistrust for government initiatives as well as poor quality of services could significantly constrain service utilization despite cash transfers. Conclusion: Considering that a number of barriers to uptake of the CCT programme are similar to barriers to maternal health services, it is essential that maternal health services are available, accessible and of acceptable quality to target recipients for CCT programmes to reach their full implementation potential

Engaging men to transform inequitable gender attitudes and prevent intimate partner violence: a cluster randomised controlled trial in North and South Kivu, Democratic Republic of Congo

IntroductionThe study objective was to understand the effectiveness of Engaging Men through Accountable Practice (EMAP), a group-based discussion series which sought to transform gender relations in communities, on intimate partner violence (IPV), gender inequitable attitudes and related outcomes.MethodsA two-armed, matched-pair, cluster randomised controlled trial was conducted between 2016 and 2018 in eastern Democratic Republic of Congo. Adult men (n=1387) and their female partners (n=1220) participated in the study. The primary outcomes of the study were female report of past year physical and/or sexual IPV and men’s intention to commit violence. Secondary outcomes included men’s gender attitudes, women’s economic and emotional IPV, women’s perception of negative male behaviours and perceived quality of the relationship.ResultsMen in EMAP reported significant reductions in intention to commit violence (β=−0.76; SE=0.23; p&lt;0.01), decreased agreement with any reason that justifies wife beating (OR=0.59; SE=0.08; p&lt;0.01) and increased agreement with the ability of a woman to refuse sex for all reasons (OR=1.47; SE=0.24; p&lt;0.05), compared with men in the control group. We found no statistically significant differences in women’s experiences of IPV between treatment and control group at follow-up (physical or sexual IPV: adjusted OR=0.95; SE=0.14; p=0.71). However, female partners of men in EMAP reported significant improvements to the quality of relationship (β=0.28; p&lt;0.05) and significant reductions in negative male behaviour (β=−0.32; p&lt;0.01).ConclusionInterventions engaging men have the potential to change gender attitudes and behaviours in conflict-affected areas. However, while EMAP led to changes in gender attitudes and behaviours related to perpetration of IPV, the study showed no overall reduction of women’s experience of IPV. Further research is needed to understand how working with men may lead to long-term and meaningful changes in IPV and related gender equitable attitudes and behaviours in conflict areas.Trial registration numberNCT02765139.</jats:sec

The impact of urbanization and rapid population growth on the groundwater regime in Dhaka city, Bangladesh

Dhaka city with an area of about 306 Km2 and a population of more than 20 million is located in the central part of Bangladesh. Immense and prolonged groundwater abstraction due to rapid unplanned urbanization and population blast in this city have led to significant decline in groundwater level in the last three decades. 78% of the supplied water comprises groundwater from the Dupi Tila Sandstone aquifer system. Hydrogeological and geophysical data aided to the delineation of three different aquifers (based on lithology): Upper Dupi Tila aquifer (UDA), Middle Dupi Tila aquifer (MDA) and Lower Dupi Tila aquifer (LDA). The evaluation of long-term hydrographs, piezometric maps and synthetic graphical overviews of piezometric trends in both the UDA and MDA depicts that the rate of dropping of groundwater level (GWL) is very substantial. Massive pumping in the city has altered its natural hydrologic system. The groundwater level has dropped on average 2.25 m/year and 2.8 m/year in UDA and MDA, respectively, in the whole city in 2018, whereas the average rate of decline in the center of the depression cone during this time was 4.0 m/year and 5.74 m/year respectively. Presently, the groundwater level elevation has declined to levels lower than -85 and -65 m PWD in UDA and MDA, respectively. The changes in pattern and magnitude of depression cones in UDA and MDA are directly associated with the city expansion and number of deep tube wells installed over a certain period in particular parts of the city. The depletion of GWL from 1980 to 2018 is very notable. There is only limited vertical recharge possible in the UDA and MDA as they are semi-confined aquifers, and only lateral flow mostly in the UDA and MDA from the surroundings is to be expected. In this regard the long-term management of groundwater resources in Dhaka city is urgently needed, otherwise the condition may go beyond control