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Objective To estimate (1) lifetime prevalence of physical and sexual victimisation from husbands among a national sample of Bangladeshi women, (2) associations of unwanted pregnancy and experiences of husband violence, and (3) associations of miscarriage, induced abortion, and fetal death/stillbirth and such victimisation.Design Cross-sectional, nationally representative study utilizing matched husband-wife data from the 2004 MEASURE Bangladesh Demographic Health Survey.Setting Bangladesh.Population Married Bangladeshi women ages 13-40 years old (n = 2677).Methods Bivariate and multivariate logistic regression analysis.Main outcome measures Relations of intimate partner violence to unwanted pregnancy, miscarriage, induced abortion and stillbirth.Results Three out of four (75.6%) Bangladeshi women experienced violence from husbands. Less educated, poorer, and Muslim women were at greatest risk. Women experiencing violence from husbands were more likely to report both unwanted pregnancy (ORs adj 1.46-1.54) and a pregnancy loss in the form of miscarriage, induced abortion, or stillbirth (ORs adj 1.43-1.69). Assessed individually, miscarriage was more likely among victimised women (OR adj 1.81). A nonsignificant trend was detected for increased risk of induced abortion (OR adj 1.64); stillbirth was unrelated to violence from husbands.Conclusion Intimate partner violence is extremely prevalent and relates to unwanted pregnancy and higher rates of pregnancy loss or termination, particularly miscarriages, among Bangladeshi women. Investigation of mechanisms responsible for these associations will be critical to developing interventions to improve maternal, fetal, and neonatal health. Such programmes may be vital to reducing the significant health and social costs associated with both husband violence and unwanted and adverse pregnancy outcomes.

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BackgroundThe current conflict in Syria continues to displace thousands to neighboring countries, including Lebanon. Information is needed to provide adequate health and related services particularly to women in this displaced population.MethodsWe conducted a needs assessment in Lebanon (June-August 2012), administering a cross-sectional survey in six health clinics. Information was collected on reproductive and general health status, conflict violence, stress, and help-seeking behaviors of displaced Syrian women. Bivariate and multivariate analyses were conducted to examine associations between exposure to conflict violence, stress, and reproductive health outcomes.ResultsWe interviewed 452 Syrian refugee women ages 18–45 who had been in Lebanon for an average of 5.1 (± 3.7) months. Reported gynecologic conditions were common, including: menstrual irregularity, 53.5%; severe pelvic pain, 51.6%; and reproductive tract infections, 53.3%. Among the pregnancy subset (n = 74), 39.5% of currently pregnant women experienced complications and 36.8% of those who completed pregnancies experienced delivery/abortion complications. Adverse birth outcomes included: low birthweight, 10.5%; preterm delivery, 26.5%; and infant mortality, 2.9%. Of women who experienced conflict-related violence (30.8%) and non-partner sexual violence (3.1%), the majority did not seek medical care (64.6%). Conflict violence and stress score was significantly associated with reported gynecologic conditions, and stress score was found to mediate the relationship between exposure to conflict violence and self-rated health.ConclusionsThis study contributes to the understanding of experience of conflict violence among women, stress, and reproductive health needs. Findings demonstrate the need for better targeting of reproductive health services in refugee settings, as well as referral to psychosocial services for survivors of violence.

BackgroundGender-based violence against women, including intimate partner violence (IPV), is a pervasive health and human rights concern. However, relatively little intervention research has been conducted on how to reduce IPV in settings impacted by conflict. The current study reports on the evaluation of the incremental impact of adding “gender dialogue groups” to an economic empowerment group savings program on levels of IPV. This study took place in north and northwestern rural Côte d’Ivoire.MethodsBetween 2010 and 2012, we conducted a two-armed, non-blinded randomized-controlled trial (RCT) comparing group savings only (control) to “gender dialogue groups” added to group savings (treatment). The gender dialogue group consisted of eight sessions that targeted women and their male partner. Eligible Ivorian women (18+ years, no prior experience with group savings) were invited to participate. 934 out of 981 (95.2%) partnered women completed baseline and endline data collection. The primary trial outcome measure was an overall measure of past-year physical and/or sexual IPV. Past year physical IPV, sexual IPV, and economic abuse were also separately assessed, as were attitudes towards justification of wife beating and a woman’s ability to refuse sex with her husband.ResultsIntent to treat analyses revealed that compared to groups savings alone, the addition of gender dialogue groups resulted in a slightly lower odds of reporting past year physical and/or sexual IPV (OR: 0.92; 95% CI: 0.58, 1.47; not statistically significant). Reductions in reporting of physical IPV and sexual IPV were also observed (not statistically significant). Women in the treatment group were significantly less likely to report economic abuse than control group counterparts (OR = 0.39; 95% CI: 0.25, 0.60, p < .0001). Acceptance of wife beating was significantly reduced among the treatment group (β = -0.97; 95% CI: -1.67, -0.28, p = 0.006), while attitudes towards refusal of sex did not significantly change Per protocol analysis suggests that compared to control women, treatment women attending more than 75% of intervention sessions with their male partner were less likely to report physical IPV (a OR: 0.45; 95% CI: 0.21, 0.94; p = .04) and report fewer justifications for wife beating (adjusted β = -1.14; 95% CI: -2.01, -0.28, p = 0.01) ; and both low and high adherent women reported significantly decreased economic abuse (a OR: 0.31; 95% CI: 0.18, 0.52, p < 0.0001; a OR: 0.47; 95% CI: 0.27, 0.81, p = 01, respectively). No significant reductions were observed for physical and/or sexual IPV, or sexual IPV alone.ConclusionsResults from this pilot RCT suggest the importance of addressing household gender inequities alongside economic programming, because this type of combined intervention has potential to reduce levels of IPV. Additional large-scale intervention research is needed to replicate these findings.Trial registrationRegistration Number: NCT01629472.

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SYNOPSISObjective. We examined the context of economic insecurity and debt among female sex workers (FSWs), how this context varies among FSWs, and its association with experiences of violence and sexual risk factors for human immunodeficiency virus (HIV).Methods. We recruited FSWs aged $18 years (n5673) through respondentdriven sampling for a survey on HIV risk in this region. Using logistic regression models (adjusted for partner status, education, financial support, and literacy), we assessed the relation between debt and sexual and physical victimization as well as sexual risk. We also conducted qualitative interviews with a subsample of the survey participants and examined these for related themes.Results. In adjusted logistic regression models, FSWs who reported debt were more likely to report the following: recent physical violence (adjusted odds ratio [AOR] 5 2.4, 95% confidence interval [CI] 1.5, 3.9), unprotected sex with occasional clients in the past week (AOR52.3, 95% CI 1.2, 4.3), anal sex with clients in the past 30 days (AOR52.0, 95% CI 1.1, 3.9), and at least one sexually transmitted infection symptom in the past six months (AOR51.6, 95% CI 1.1, 2.4). FSWs with debt were more likely to report current husbands or other male partners, and less likely to report condom use with these partners, further increasing their sexual risk. Qualitative data elaborated on these findings. Conclusion. Findings indicate the violence-and HIV-related vulnerability ofFSWs who report debt and further highlight how male partners may contribute to the debt and economic insecurity of FSWs.

Objective: To assess the relationship between men's reported violence against wives and their sexual risk behaviours and sexual health. Design, setting and participants: Cross-sectional analyses of a survey of a nationally representative household-based sample of married men in Bangladesh (n = 3096). Main outcome measure(s): Physical and sexual violence against wives during the previous 12 months was assessed and examined for relations to men's extramarital sexual behaviours and sexually transmitted infection (STI) symptoms or diagnosis during this same period, as well as to men's disclosure of such infection to wives and condom use while infected. Results: More than 1 in 3 (36.84%) married Bangladeshi men reported physically and/or sexually abusing their wives in the past year. Men perpetrating such violence were more likely to report both premarital and extramarital sex partners (OR adj s 1.80-3.45; 95% CI 1.20 to 8.23); those reporting physical violence were more likely to report STI symptoms or diagnosis in the past year (OR adj s 1.68-2.52; 95% CI 1.24 to 3.73). Men perpetrating physical violence and contracting an STI were somewhat more likely to fail to disclose infection status to wives (OR adj 1.58; 95% CI 0.93 to 2.70) than infected men not reporting such abuse. Conclusions: Violence against wives is common among Bangladeshi men. Men who perpetrate such abuse represent increased risk regarding their wives' sexual health because they are more likely to both participate in extramarital sexual behaviour and contract an STI compared with non-abusive husbands. Given the growing epidemic of HIV infection among monogamous South Asian women based on intercourse with infected non-monogamous husbands, research and intervention regarding men's violence in marriage and implications of such behaviour for women's sexual health should be prioritised. I ntimate partner violence (IPV) is widely recognised as a global public health concern, with immediate and long-term consequences to women including injury, psychological distress and compromised sexual health. [1][2][3][4] Of tremendous recent concern is consistent evidence demonstrating an increased risk of contracting HIV/AIDS and other sexually transmitted infections (STIs) among women experiencing IPV.1 5-8 Diminished control over sexual protection evidenced among women who are abused 9-11 may partially explain these associations. However, evidence of increased rates of sexual risk behaviour (eg, extramarital and multiple sex partnering, no or inconsistent condom use and forced unprotected sex) 1 12-17 among male perpetrators of IPV indicates the need for investigations into the associations of men's abusive and sexual risk behaviours as potentially compromising both their own sexual health as well as that of their female partners.Advancing knowledge of this topic is of particularly grave importance in South Asia given recent evidence indicating rapid increases in HIV infection rates among married monogamous women in this region for whom husbands represent the only...