Paramedic-conducted Mental Health Counselling for Abused Women in Rural Bangladesh: An Evaluation from the Perspective of Participants

This paper reports on evaluation of an initiative to use paramedics as the first-level mental health counsellors of abused women in rural Bangladesh (2003–2004) from the perspective of the abused women who participated in one or more counselling sessions. Thirty in-depth interviews, followed by a survey (n=372), targeted to cover all participants, were conducted in 2006. Overall, the arrangement, management of ethical issues, and skills of paramedics were rated favourably. Most (89%) abused women (n=372) considered the session useful; one-fourth of these women considered it very useful; and only a few abused women considered the session useless. Usefulness of the session was expressed mostly in terms of relief attained after talking about the issue. Most (87%) women reported being encouraged to be self-confident. In a context characterized by low self-confidence of women, lack of opportunity to talk about violence, and absence of professional mental health counselling services, this initiative is sufficiently promising to warrant further testing

Gender Norms, Violence in Childhood, and Men’s Coercive Control in Marriage: A Multilevel Analysis of Young Men in Bangladesh

Objective: Coercive control in marriage is common in patriarchal settings, but multilevel determinants are understudied. Method: Using a probability sample of 570 junior men (married, 18–34 years) from the Bangladesh survey of the 2011 UN Multi-Country Study of Men and Violence, we examined how exposure to violence in childhood and community-level gender norms were related to men’s attitudes about gender equity and use of controlling behavior. We tested whether community-level gender norms moderated the relationship between men’s exposure to violence in childhood and our outcomes. Results: According to results from multilevel Poisson regression models, as community gender norms become more equitable by 1 standard deviation, a junior married man’s expected rate of controlling behavior is lower by 0.11, and his rate of agreement with gender equitable attitudes is higher by 0.27. More gender-equitable community norms were negatively related to a junior married man’s use of controlling behavior. Childhood exposure to violence was not associated with use of controlling behavior. There was a significant cross-level interaction such that exposure to violence had a stronger negative impact on men’s gender equitable attitudes in communities with lower overall gender equity than those with higher overall gender equity. The corresponding cross-level interaction effect was not significant for the controlling behavior outcome. Conclusions: More equitable community gender norms may encourage more gender-equitable attitudes and discourage use of controlling behavior among junior men, suggesting that interventions to change community gender norms may reduce coercive control of women in marriage

Men’s Perpetration of Partner Violence in Bangladesh: Community Gender Norms and Violence in Childhood.

Men’s perpetration of intimate partner violence (IPV) is common, but its multilevel determinants are understudied. We leveraged novel data from a probability sample of married junior men (N = 570; age 18 to 34 years) from 50 urban and 62 rural communities who took part in the Bangladesh survey of the 2011 UN Multi-Country Study of Men and Violence. We tested whether lifetime count (or scope) of physical IPV acts perpetrated was negatively associated with more equitable community gender norms among married senior men (N = 938; age 35 to 49 years) and positively associated with greater exposure to childhood violence among junior men. We also tested whether more equitable community gender norms mitigated the association of more violence in childhood with the lifetime scope of physical IPV acts perpetrated. Among younger married men, 50% reportedly ever perpetrated physical IPV, the mean lifetime scope of physical IPV types perpetrated was 1.1 (SD 1.3) out of 5 listed. A majority (64%) reported childhood exposure to violence. In multilevel Poisson models, a man with more childhood exposure to violence had a higher log scope (estimate: 0.31, SE 0.04, p < .001), and a man living amid the most equitable gender norms had a lower log scope (estimate: −0.61, SE 0.17, p < .01) of physical IPV acts perpetrated; however, no significant cross-level interaction was observed. Interventions that address the trauma of childhood violence and that promote more equitable community gender norms may be needed to mitigate IPV perpetration by younger men

Early Prenatal Food Supplementation Ameliorates Thenegative Association of Maternal Stress With Birth Size in a Randomised Trial

Low birthweight increases the risk of infant mortality, morbidity and poor development. Maternal nutrition and stress influence birth size, but their combined effect is not known.We hypothesised that an early-invitation time to start a prenatal food supplementation programme could reduce the negative influence of prenatal maternal stress on birth size, and that effect would differ by infant sex. A cohort of 1041 pregnant women, who had delivered an infant, June 2003–March 2004, was sampled from among 3267 in the randomised controlled trial, Maternal Infant Nutritional Interventions Matlab, conducted in Matlab, Bangladesh. At 8 weeks gestation, women were randomly assigned an invitation to start food supplements (2.5 MJ d-1 ; 6 days a week) either early (~9 weeks gestation; early-invitation group) or at usual start time for the governmental programme (~20 weeks gestation; usual-invitation group). Morning concentration of cortisol was measured from one saliva sample/ woman at 28–32 weeks gestation to assess stress. Birth-size measurements for 90% of infants were collected within 4 days of birth. In a general linear model, there was an interaction between invitation time to start the food supplementation programme and cortisol with birthweight, length and head circumference of male infants, but not female infants. Among the usual-invitation group only, male infants whose mothers had higher prenatal cortisol weighed less than those whose mothers had lower prenatal cortisol. Prenatal food supplementation programmes that begin first trimester may support greater birth size of male infants despite high maternal stress where low birthweight is a public health concern

Early Prenatal Food Supplementation Ameliorates Thenegative Association of Maternal Stress With Birth Size in a Randomised Trial

Low birthweight increases the risk of infant mortality, morbidity and poor development. Maternal nutrition and stress influence birth size, but their combined effect is not known.We hypothesised that an early-invitation time to start a prenatal food supplementation programme could reduce the negative influence of prenatal maternal stress on birth size, and that effect would differ by infant sex. A cohort of 1041 pregnant women, who had delivered an infant, June 2003–March 2004, was sampled from among 3267 in the randomised controlled trial, Maternal Infant Nutritional Interventions Matlab, conducted in Matlab, Bangladesh. At 8 weeks gestation, women were randomly assigned an invitation to start food supplements (2.5 MJ d-1 ; 6 days a week) either early (~9 weeks gestation; early-invitation group) or at usual start time for the governmental programme (~20 weeks gestation; usual-invitation group). Morning concentration of cortisol was measured from one saliva sample/ woman at 28–32 weeks gestation to assess stress. Birth-size measurements for 90% of infants were collected within 4 days of birth. In a general linear model, there was an interaction between invitation time to start the food supplementation programme and cortisol with birthweight, length and head circumference of male infants, but not female infants. Among the usual-invitation group only, male infants whose mothers had higher prenatal cortisol weighed less than those whose mothers had lower prenatal cortisol. Prenatal food supplementation programmes that begin first trimester may support greater birth size of male infants despite high maternal stress where low birthweight is a public health concern

Paramedic-Conducted Mental Health Counselling for Abused Women in Rural Bangladesh: An Evaluation from the Perspective of Participants

This paper reports on evaluation of an initiative to use paramedics as the first-level mental health counsellors of abused women in rural Bangladesh (2003-2004) from the perspective of the abused women who participated in one or more counselling sessions. Thirty in-depth interviews, followed by a survey (n=372), targeted to cover all participants, were conducted in 2006. Overall, the arrangement, management of ethical issues, and skills of paramedics were rated favourably. Most (89%) abused women (n=372) considered the session useful; one-fourth of these women considered it very useful; and only a few abused women considered the session useless. Usefulness of the session was expressed mostly in terms of relief attained after talking about the issue. Most (87%) women reported being encouraged to be self-confident. In a context characterized by low self-confidence of women, lack of opportunity to talk about violence, and absence of professional mental health counselling services, this initiative is sufficiently promising to warrant further testing

Prevalence and Correlates of Physical Spousal Violence Against Women in Slum and Nonslum Areas of Urban Bangladesh

This study explored the prevalence and correlates of past-year physical violence against women in slum and non-slum areas of urban Bangladesh. We used multivariate logistic regression to analyze data from the 2006 Urban Health Survey, a population-based survey of 9122 currently married women aged 15–49 selected using a multi-stage cluster sampling design. The prevalence of reported past-year physical spousal violence was 31%. Prevalence of past-year physical spousal violence was higher in slums (35%) than in non-slums (20%). Slapping/arm-twisting and pushing/shaking/throwing something at the women were the most commonly reported acts of physical abuse. Multivariate analysis showed that the risk of physical spousal abuse was lower among older women, women with post-primary education, and those belonging to rich households and women whose husband considered their opinion in decision-making. Women were at higher risk of abuse if they had many children, believed that married woman should work if the husband is not making enough money, and approved wife beating norms. This study serves to confirm the commonness of physical spousal abuse in urban Bangladesh demonstrating the seriousness of this multifaceted phenomenon as a social and public health issue. The present findings suggest the need for comprehensive prevention and intervention strategies that capitalize on the interplay of individual and sociocultural factors that cause physical spousal violence. Our study adds to a growing literature documenting domestic violence against women in urban areas of developing south Asian nations

Gender‐Equitable Parental Decision Making and Intimate Partner Violence Perpetration in Bangladesh

Objective This article examines the relationship between the exposure of men as children to gender‐equitable parental decision making and the potential for subsequent later life engagement in intimate partner violence (IPV) in Bangladesh. Background Although researchers have recently begun to explore multilevel influences on IPV perpetration, no studies have examined how decision making between parents at home and within the community relates to IPV perpetration in low-income settings. Drawing on a theoretical framework of gendered social learning, gender-equitable parental decision making may be an important protective factor against IPV. Method This study uses a random probability sample of 1,499 married men in Bangladesh. The main outcome is physical IPV perpetration in adulthood, whereas two exposure variables measure the equity of parental decision making in the man's childhood home and his current community. A series of two-level negative binomial models, controlling for pertinent individual- and community-level factors, are estimated. Results Exposure in childhood to more equitable decision making between parents is negatively associated with a man's physical IPV perpetration in adulthood. Gender‐equitable parental decision making within one's current community is not significantly associated with IPV. Conclusion Boys who grow up exposed to more equitable decision making between parents in the home may be less likely to engage in physical IPV perpetration as an adult

Violence against Women with Chronic Maternal Disabilities in Rural Bangladesh

This study explored violence against women with chronic maternal disabilities in rural Bangladesh. During November 2006 - July 2008, in-depth interviews were conducted with 17 rural Bangladeshi women suffering from uterine prolapse, stress incontinence, or fistula. Results of interviews showed that exposure to emotional abuse was almost universal, and most women were sexually abused. The common triggers for violence were the inability of the woman to perform household chores and to satisfy her husband's sexual demands. Misconceptions relating to the causes of these disabilities and the inability of the affected women to fulfill gender role expectations fostered stigma. Emotional and sexual violence increased their vulnerability, highlighting the lack of life options outside marriage and silencing most of them into accepting the violence. Initiatives need to be developed to address misperceptions regarding the causes of such disabilities and, in the long-term, create economic opportunities for reducing the dependence of women on marriage and men and transform the society to overcome rigid gender norms

Relative importance of prenatal and postnatal determinants of stunting: data mining approaches to the MINIMat cohort, Bangladesh.

INTRODUCTION: WHO has set a goal to reduce the prevalence of stunted child growth by 40% by the year 2025. To reach this goal, it is imperative to establish the relative importance of risk factors for stunting to deliver appropriate interventions. Currently, most interventions take place in late infancy and early childhood. This study aimed to identify the most critical prenatal and postnatal determinants of linear growth 0-24 months and the risk factors for stunting at 2 years, and to identify subgroups with different growth trajectories and levels of stunting at 2 years. METHODS: Conditional inference tree-based methods were applied to the extensive Maternal and Infant Nutrition Interventions in Matlab trial database with 309 variables of 2723 children, their parents and living conditions, including socioeconomic, nutritional and other biological characteristics of the parents; maternal exposure to violence; household food security; breast and complementary feeding; and measurements of morbidity of the mothers during pregnancy and repeatedly of their children up to 24 months of age. Child anthropometry was measured monthly from birth to 12 months, thereafter quarterly to 24 months. RESULTS: Birth length and weight were the most critical factors for linear growth 0-24 months and stunting at 2 years, followed by maternal anthropometry and parental education. Conditions after birth, such as feeding practices and morbidity, were less strongly associated with linear growth trajectories and stunting at 2 years. CONCLUSION: The results of this study emphasise the benefit of interventions before conception and during pregnancy to reach a substantial reduction in stunting