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Open Access Publications from the University of California

Scholarly Works (59 results)

  • Thesis
  • Peer Reviewed
UC San Diego Electronic Theses and Dissertations (2020)

In the West African nation of Niger, adolescent girls have the highest total fertility rate in the world, attributable to high rates of early marriage and childbirth. Gender norms that place men in decision-making positions and charge women with childbearing and childrearing, preclude engagement in discussions about fertility and family planning (FP) and as a result, contraceptive use remains low. As men are increasingly included in FP promotion efforts alongside women, it is important to understand the forces that shape couples’ interactions in the FP process. Utilizing data from married adolescent girls and their husbands in the Dosso region of Niger, this dissertation studies individual-, family-, and community-level factors to better understand how couples communicate about contraception and make decisions about actual contraceptive use. First, this work assesses the effects of couples’ individual attitudes about FP on spousal communication about contraception. This includes the separate, joint, and interacting effects of adolescent wives’ and husbands’ individual attitudes and their relationship with recent

discussions about contraception, including those that were wife-initiated and wife-led. Second, is an examination of the effects of a community-based, gender-synchronized FP promotion program, including individual- and group-based approaches, on spousal communication about contraception. A study of the potential mediating effects of spousal communication about contraception sheds light on whether this is an important intermediate outcome of such programs. Finally, this dissertation seeks to characterize men’s social networks and their impact on men’s FP-related attitudes and behaviors. The work will also explore how FP messages spread through these networks to spur social change. Findings will help advance the study of relationship dynamics as they pertain to contraceptive use and improve the design and implementation of programs that aim to encourage more equitable FP decision-making.

    Cover page: Understanding the Multilevel Factors Related to Spousal Communication and Contraception Among Married Adolescent Girls and their Husbands in Dosso, Niger
    • Article
    • Peer Reviewed
    UC San Diego Previously Published Works (2014)
    Jay Silverman and Anita Raj discuss the policies and interventions required to address the range of poor reproductive outcomes for women and adolescents, including loss of reproductive control, associated with intimate partner violence. Please see later in the article for the Editors' Summary
      Cover page: Intimate Partner Violence and Reproductive Coercion: Global Barriers to Women's Reproductive ControlCreative Commons 'BY' version 4.0 license
      • Thesis
      • Peer Reviewed
      UC San Diego Electronic Theses and Dissertations (2021)

      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.

        Cover page: Understanding gender-based violence and health in post-conflict Sri Lanka
        • Article
        • Peer Reviewed
        UC San Diego Previously Published Works (2015)
        This study examines the effects of number and sex of siblings on malnutrition of boys and girls under-5 in South Asia. Cross-sectional analyses were conducted on Demographic and Health Surveys data on children under-5 in Bangladesh (N = 7,861), India (N = 46,655) and Nepal (N = 2,475). Data were pooled across countries, and multinomial logistic regression was used to assess the relationship between number and sex of siblings and malnutrition outcomes (wasting, stunting, underweight; based on anthropometric data), adjusting for country and key social and maternal-child health indicators in sex stratified analyses. Number of brothers increased the odds for severe wasting [1 vs. 0 brothers adjusted odds ratio (AOR) = 1.31, 95 % CI = 1.11, 1.55; 2 vs. 0 brothers AOR = 1.36, 95 % CI = 1.07, 1.73] for girls but not boys. Having more male siblings and more female siblings increased the odds of stunting for boys and girls, but effect of 3+ sisters on severe stunting was significantly stronger for girls than boys (girls- 3+ vs. 0 sisters AOR = 2.25, 95 % CI = 1.88, 2.70; boys- 3+ vs. 0 sisters AOR = 1.37, 95 % CI = 1.13, 1.67). For underweight, three or more sisters increased the odds for severe underweight for girls (AOR = 1.27, 95 % CI = 1.04, 1.57) but not boys. Having brothers heightens girl risk for acute malnutrition (wasting), where having multiple sisters increases girl risk for chronic malnutrition (stunting/underweight). Boy malnutrition is less affected by siblings. Findings suggest that issues of son preference/daughter aversion may affect child malnutrition in South Asia.
          Cover page: Gendered Effects of Siblings on Child Malnutrition in South Asia: Cross-sectional Analysis of Demographic and Health Surveys from Bangladesh, India, and Nepal
          • Article
          • Peer Reviewed
          UC San Diego Previously Published Works (2015)

          Objective

          To assess associations between marital violence and type of contraception among women in South Asia.

          Methods

          Cross-sectional analyses were conducted using marital violence data collected during the most recent Demographic and Health Surveys from Bangladesh (n=3665), India (n=56357), and Nepal (n=3037). Data were pooled to assess associations of marital violence (physical or sexual) with modern contraception use (current spacing or sterilization).

          Results

          Sexual marital violence was associated with both modern spacing contraception (adjusted odds ratio [AOR] 1.30; 95% confidence interval [CI], 1.13-1.49) and sterilization (AOR 0.79; 95% CI, 0.70-0.88). Sexual violence was reported more often by pill users (9.8% vs 5.5% for non-users) but less often by condom users (4.5% vs 5.8% for non-users).

          Conclusion

          Sexual marital violence might increase use of contraception that need not require husband involvement (pill) but decrease use of methods that require his cooperation (condom) or support for mobility, funds, or time (sterilization).
            Cover page: Associations of marital violence with different forms of contraception: Cross‐sectional findings from South Asia
            • Article
            • Peer Reviewed
            UC Davis Previously Published Works (2010)
            To assess the prevalence of intimate partner violence (IPV) and associations with health care-seeking patterns among female patients of adolescent clinics, and to examine screening for IPV and IPV disclosure patterns within these clinics. A self-administered, anonymous, computerized survey was administered to female clients ages 14–20 years (N = 448) seeking care in five urban adolescent clinics, inquiring about IPV history, reasons for seeking care, and IPV screening by and IPV disclosure to providers. Two in five (40%) female urban adolescent clinic patients had experienced IPV, with 32% reporting physical and 21% reporting sexual victimization. Among IPV survivors, 45% reported abuse in their current or most recent relationship. IPV prevalence was equally high among those visiting clinics for reproductive health concerns as among those seeking care for other reasons. IPV victimization was associated with both poor current health status (AOR 1.57, 95% CI 1.03–2.40) and having foregone care in the past year (AOR 2.59, 95% CI 1.20–5.58). Recent IPV victimization was associated only with past 12 month foregone care (AOR 2.02, 95% CI 1.18–3.46). A minority (30%) reported ever being screened for IPV in a clinical setting. IPV victimization is pervasive among female adolescent clinic attendees regardless of visit type, yet IPV screening by providers appears low. Patients reporting poor health status and foregone care are more likely to have experienced IPV. IPV screening and interventions tailored for female patients of adolescent clinics are needed.
              Cover page: Intimate Partner Violence and Health Care-Seeking Patterns Among Female Users of Urban Adolescent Clinics
              • Article
              • Peer Reviewed
              UC San Diego Previously Published Works (2018)
              The purpose of this study was to assess via longitudinal analysis whether women's economic empowerment and financial inclusion predicts incident IPV. This prospective study involved analysis of three waves of survey data collected from rural young married women (n = 853 women) in Maharashtra at baseline and 9&18 month follow-ups. This study, which was in the field from 2012 to 2014, was conducted as part of a larger family planning evaluation study unrelated to economic empowerment. Participants were surveyed on economic empowerment, as measured by items on women's income generation and joint decision-making of husband's income, and financial inclusion, as measured by bank account ownership. Women's land ownership and participation in microloan programs were also assessed but were too rare (2-3% reporting) to be included in analyses. Longitudinal regression models assessed whether women's economic empowerment predicted incident IPV at follow-up. At Wave 1 (baseline), one in ten women reported IPV in the past six months; 23% reported income generation; 58% reported having their own money; 61% reported joint control over husband's money, and 10% reported bank ownership. Women's income generation and having their own money did not predict IPV over time. However, women maintaining joint control over their husband's income were at a 60% reduced risk for subsequent incident IPV (AOR = 0.40; 95% CI = 0.18, 0.90), and women gaining joint control over time were at a 70% reduced risk for subsequent incident IPV (AOR = 0.30; 95% CI = 0.13, 0.72), relative to women whose husbands maintained sole control over his income. Women who initiated a new bank account by Wave 3 also had a 56% reduced likelihood of reporting incident IPV in this same wave (AOR = 0.44; 95% CI = 0.22, 0.93), relative to those who maintained no bank account at Waves 1 and 3. These findings suggest that women's joint control over husband's income and her financial inclusion as indicated by bank ownership appear to reduce risk for IPV, whereas her income generation or control over her own income do not. Awareness of and participation in financial inclusion services may help reduce women's risk for IPV in rural India and elsewhere.
                Cover page: Longitudinal analysis of the impact of economic empowerment on risk for intimate partner violence among married women in rural Maharashtra, India
                • Article
                • Peer Reviewed
                UC San Diego Previously Published Works (2022)
                This study aimed to understand whether maternal child marriage and past year intimate partner violence (IPV) impact stunting among Sri Lankan children under 5 years old, and, secondarily, whether proximity to conflict is associated with stunting. Additionally, we assessed whether proximity to conflict moderates the relationships between maternal child marriage and past year IPV (sexual, physical, and emotional). We tested these questions using logistic regression analyses of the 2016 Sri Lankan Demographic and Health Survey (n = 4941 mother-child dyads). In country-wide adjusted analyses, we did not find associations between maternal child marriage or IPV and stunting (p > 0.05). Children in districts proximal and central to conflict were significantly less likely to be stunted compared to children in districts distal to conflict (proximal adjusted odds ratio/aOR: 0.43, 95% confidence interval/CI: 0.22-0.82; central aOR: 0.53, CI: 0.29-0.98). We found significant interaction effects on stunting between proximity to conflict and both sexual and emotional IPV, which we further explored in stratified analyses. In districts distal to conflict, maternal sexual IPV was significantly associated with increased odds of stunting (aOR: 2.71, CI: 1.16-6.35), and in districts central to conflict, maternal emotional IPV was significantly associated with increased odds of stunting (aOR: 1.80, CI: 1.13-2.89). Maternal emotional IPV was significantly associated with decreased odds of stunting in districts proximal to conflict (aOR: 0.42, CI: 0.18-0.96). Maternal child marriage and physical IPV were not associated with stunting in Sri Lanka. Variations in associations between maternal IPV and stunting across Sri Lanka may reflect the lasting and differential impact of conflict, as well as differential humanitarian responses which may have improved child nutrition practices and resources in districts central and proximal to conflict. Policies and programs addressing stunting in Sri Lanka should consider the role of maternal IPV as well as community-level variations based on proximity to conflict.
                  Cover page: Measuring the impacts of maternal child marriage and maternal intimate partner violence and the moderating effects of proximity to conflict on stunting among children under 5 in post-conflict Sri Lanka
                  • Article
                  • Peer Reviewed
                  UCLA Previously Published Works (2022)
                  Intimate partner violence (IPV) is associated with poor HIV care linkage and retention, medication adherence, and viral suppression. However, limited knowledge exists regarding potential mechanisms linking IPV to these outcomes. We aimed to (a) identify the top barriers to accessing HIV care experienced by women living with HIV (WLHIV) who report a history of IPV and have suppressed viral load (VL) versus unsuppressed VL and (b) understand how these barriers influence VL, comparing WLHIV with a history of IPV to WLHIV without a history of IPV. Study data come from newly diagnosed WLHIV in rural Uganda participating in the standard-of-care control arm of a randomized trial (n = 152). Descriptive results ranking mean scores from highest to lowest showed that, among women with a history of IPV, irrespective of viral suppression status, paying for transportation to come to clinic, having to wait at the clinic for long periods of time, and finding a clinic within reasonable travel distance were the top three barriers to accessing HIV care. WLHIV with a history of IPV were significantly more likely to have unsuppressed VL versus suppressed VL if they reported higher levels of difficulty finding a clinic within reasonable travel distance (RRR = 1.7, 95% CI [1.1-2.7]), getting permission to take time off from work (RRR = 1.5, 95% CI [1.0-2.9]), and finding time to come to the clinic for an appointment (RRR = 1.6, 95% CI [1.0-2.6]). The same relationships were not present among WLHIV without a history of IPV, suggesting these barriers and their effect on VL may be uniquely related to IPV. Interventions should address IPV and HIV care continuum outcomes in tandem, targeting barriers to accessing HIV care likely associated with IPV. Additional research is necessary to better understand how IPV relates to HIV care barriers and VL.
                    Cover page: Perceived Barriers to HIV Care and Viral Suppression Comparing Newly Diagnosed Women Living with HIV in Rural Uganda with and without a History of Intimate Partner Violence
                    • Article
                    • Peer Reviewed
                    UC San Diego Previously Published Works (2016)

                    Objective

                    To explore factors associated with trafficking (deceptive/coercive entry to sex trade) among female bar/spa entertainers who traded sex in the Philippines.

                    Method

                    Female bar/spa entertainers who traded sex in the past 6months were recruited from 25bar/spa venues in Metro Manila (April 2009-January 2010) and assessed via cross-sectional survey data collection for HIV-risk-related socio-structural factors associated with deceptive/coercive entry into the sex trade. The study employed hierarchical linear modeling.

                    Results

                    Of 166bar/spa entertainers assessed, 19 (11.4%) reported being deceived/coerced (i.e. trafficked) into their first jobs. Trafficking history was independently associated with current drug use (adjusted odds ratio [AOR] 2.05; 95% confidence interval [CI] 1.00-3.97) decreased availability of condoms at venues for entertainers (AOR 0.18; 95% CI 0.05-0.71) and, conversely, increased peer support for practicing safer sex behaviors (AOR 3.08; 95% CI 1.63-5.09). Those deceived/coerced into their positions were more likely than non-trafficked women to have been recruited by an agency who came to their rural province (AOR 12.07; 95% CI 1.77-82.25) as opposed to getting the job from advertisement (AOR 0.10; 95% CI 0.02-0.65) or a friend/acquaintance (AOR 0.02; 95% CI 0.00-0.48).

                    Conclusion

                    The findings have implications for designing interventions to prevent and target trafficked women in the Philippines who may be more vulnerable to substance use and, potentially, HIV infection.
                      Cover page: Socio‐structural and behavioral risk factors associated with trafficked history of female bar/spa entertainers in the sex trade in the Philippines
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