• Overall, diet patterns have changed dramatically for traditionally pastoral communities in rural Tanzania,
with younger and more sedentary communities experiencing the most significant changes.
• While social and environmental changes underlie the altered food choice behaviors, proximal factors such as
cost and availability of foods dictated decisions at the point of purchase and appeared to accelerate pattern
shifts. For example, cereals, refined grains and processed foods were the most affordable and accessible food
items in the markets while traditional fruits and vegetables have declined substantially in availability over
the past several decades.
• Participants expressed concern regarding these dietary shifts and implications for both social identity and
long-term health, with expressed concerns around childhood malnutrition due to reduced milk supply,
pregnancy/postpartum complications due to declining blood consumption, and increased chronic diseases
related to increased consumption of cereals, fats and oils, and soft drinks.
• Participants exhibited a strong desire for enhanced land tenure policies to ensure access to quality grazing
lands and water sources.
• A high value on children’s health was expressed by participants who emphasized a need for more inclusive
nutrition and health education pertaining to balanced diets.
Women comprise two-thirds of the global-health (GH) workforce but are underrepresented in leadership. GH departments are platforms to advance gender equality in GH leadership. Using a survey of graduates from one GH department, we compared women's and men's post-training career agency and GH employment and assessed whether gender gaps in training accounted for gender gaps in career outcomes. Master-of-Public-Health (MPH) and mid-career-fellow alumni since 2010 received a 31-question online survey. Forty-four per cent of MPH alum and 24% of fellows responded. Using logistic regression, we tested gender gaps in training satisfaction, career agency, and GH employment, unadjusted and adjusted for training received. Women (N = 293) reported lower satisfaction with training (M7.6 vs 8.2) and career agency (leadership ability: M6.3 vs 7.4) than men (N = 60). Women more often than men acquired methods-related skills (95% vs 78%), employment recommendations (42% vs 18%), and group membership. Men more often than women acquired leadership training (43% vs 23%), award recommendations (53% vs 17%), and conference support (65% vs 35%). Women and men had similar odds of GH employment. Accounting for confounders and gender-gaps in training eliminated gender gaps in five of six career-agency outcomes. Panel studies of women's and men's career trajectories in GH are needed.
Background: Measurement of women's agency in specific sociocultural conditions, particularly in Middle Eastern settings, has received limited attention, making its usefulness as an outcome or predictor of gender equality unclear.
Aims: This study aimed to construct and validate a multidimensional and context-specific scale of women's agency in rural Minya, Egypt.
Methods: Using data from 608 ever-married women in 2012, confirmatory and exploratory factor analysis were used to construct a scale measuring women's agency in rural Minya. The scale was validated through exploratory structural equation models.
Results: The 21-item model consisted of three factors (decision-making, freedom of movement and gender role attitudes), each corresponding to a previously-theorized domain of women's agency. The three factors were positively correlated, supporting women's agency as a multidimensional, context-specific construct. The strongest correlation was between decision-making and freedom of movement (0.410), and then between freedom of movement and gender attitudes (0.307); the weakest correlation was between decision-making and gender attitudes (0.211). Although we hypothesized that each domain would be positively associated with age, only decision-making was significantly and positively associated with women's age.
Conclusion: Similarities between the items used here and a study at the national level in Egypt suggest these indicators could be used in various Egyptian settings to monitor progress on the United Nations Sustainable Development Goal 5 on empowering women and girls, and to assess the effect of policies and programmes. Future research should build on the findings to identify the best observable indicators of women's agency in Egypt and elsewhere.
Purpose:
Discrimination has detrimental effects on mental health, particularly among Black, Indigenous, and people of color who are also sexual minority women (BIPOC SMW); however, measurement of multiple intersecting forms of discrimination (e.g., race, gender, and sexual identity discrimination among BIPOC SMW) poses methodological challenges. This analysis uses latent class analysis (LCA) to examine the influences of discrimination on mental health in a convenience sample of BIPOC SMW.
Methods:
Online survey data from BIPOC SMW aged 18–29 years (n = 324) were used to estimate latent classes for discrimination type (race, gender, and sexual identity). Data for this study were collected from July to October 2018. Adjusted linear regressions examined the influences of discrimination profiles on perceived stress and depressive symptoms.
Results:
Utilizing LCA, the following four classes emerged: (1) low discrimination; (2) mid-level discrimination; (3) high racial, medium gender, and low sexual identity discrimination; (4) high discrimination. Classes 3 and 4 were positively associated with perceived stress and depressive symptoms relative to Class 1 in adjusted models.
Conclusion:
This analysis highlights the importance of intersectionality and the adverse impact of multiple forms of discrimination on mental health outcomes for BIPOC SMW. Respondents reporting higher levels of racial or multiple forms of discrimination had poorer mental health outcomes. LCA is a promising analytical tool for investigating intersectional stigma and discrimination. There is an urgent need to develop tailored, culturally appropriate intersectional mental health interventions to address the multiple identities and oppressions faced by BIPOC SMW.
The Economic Coercion Scale 36 (ECS-36) is a validated scale measuring women’s exposure to economic coercion for low-income countries. A valid short form is needed to facilitate parsimonious measurement of economic coercion in general surveys or program evaluations. We used data from a probability sample of 930 married women 15–49 years in Matlab, Bangladesh. We selected 21 items from the ECS-36 based on theory, content coverage, and item and dimensional information. We evaluated external validity with measures of non-economic intimate partner violence and depressive symptoms. We tested measurement invariance of the short-form scale across participants and non-participants of microfinance programs. A final, 20-item scale captured husband’s interference with wife’s (1) acquisition of economic resources and (2) use or maintenance of economic resources. IRT results of the ECS-20 demonstrated precision over the higher range of the economic coercion trait. Tests of external validity confirmed expected correlations of the ECS-20 with measures of IPV and depressive symptoms. The ECS-20 was measurement invariant across groups of women who did and did not participate in microfinance programs. The ECS-20, a valid short-form of the ECS-36, is suitable for general surveys and monitoring potential adverse impacts of microfinance programs targeting women.
The year 2020—five years since 189 countries signed the Sustainable Development Goals (SDGs)—has been consumed by the global response to COVID-19. To date, this pandemic has resulted in over 38 million cases and well over a million deaths [1]. One collateral effect of COVID-19 has been the setting aside of many SDGs and efforts to track progress towards them. Attention to children during the pandemic has concentrated on school closures, food insecurity, and access to care within health systems taxed by COVID-19 mitigation and response efforts [2]. The situation of child and adolescent health before COVID-19, and consequences of the pandemic on specific health targets for SDG 3, therefore deserve attention.
Objective: To provide the first study in Vietnam of how gendered social learning about violence and exposure to nonfamily institutions influence women's attitudes about a wife's recourse after physical intimate partner violence (IPV).
Method: A probability sample of 532 married women, ages 18 to 50 years, was surveyed in July through August, 2012 in Mỹ Hào district. We fit a multivariate linear regression model to estimate correlates of favoring recourse in 6 situations using a validated attitudinal scale. We split attitudes toward recourse into 3 subscales (disfavor silence, favor informal recourse, favor formal recourse) and fit 1 multivariate ordinal logistic regression model for each behavior to estimate correlates of favoring recourse.
Results: On average, women favored recourse in 2.8 situations. Women who were older and had witnessed physical IPV in childhood had less favorable attitudes about recourse. Women who were hit as children, had completed more schooling, worked outside agriculture, and had sought recourse after IPV had more favorable attitudes about recourse.
Conclusions: Normative change among women may require efforts to curb family violence, counsel those exposed to violence in childhood, and enhance women's opportunities for higher schooling and nonagricultural wage work. The state and organizations working on IPV might overcome pockets of unfavorable public opinion by enforcing accountability for IPV rather than seeking to alter ideas about recourse among women.
India and the United States – both large, diverse, and unequal democracies – have responded very differently to the COVID-19 pandemic. Yet, in both cases, the poor have been disproportionately burdened. In India, a hurried and unplanned lockdown caused extreme distress among workers and poorer sections of society while social protections have been woefully inadequate. In the US, working classes and racial minorities are bearing the brunt of COVID-19 infections and deaths. Precipitous actions to reopen the economy, and overt references to workers as ‘human capital stock’ [1], are exposing a vulgar and partisan mindset, in which productivity ‘trumps’ both equity and humanity.
Background: Intimate partner violence (IPV) harms the health of women and their children. In Vietnam, 31% of women report lifetime exposure to physical IPV, and surprisingly, women justify physical IPV against wives more often than do men.
Objective: We compare men’s and women’s rates of finding good reason for wife hitting and assess whether differences in childhood experiences and resources and constraints in adulthood account for observed differences.
Methods: Probability samples of married men (N = 522) and women (N = 533) were surveyed in Vietnam. Ordered logit models assessed the proportional odds for women versus men of finding more “good reasons” to hit a wife (never, 1–3 situations, 4–6 situations).
Results: In all situations, women found good reason to hit a wife more often than did men. The unadjusted odds for women versus men of reporting more good reasons to hit a wife were 6.55 (95% CI 4.82 – 8.91). This gap disappeared in adjusted models that included significant interactions of gender with age, number of children ever born, and experience of physical IPV as an adult.
Discussion: Having children was associated with justifying wife hitting among women but not men. Exposure to IPV in adulthood was associated with justifying wife hitting among men but was negatively associated with justification of IPV among women. Further study of the gendered effects of resources and constraints in adulthood on attitudes about IPV against women will clarify women’s more frequent reporting than men’s that IPV against women is justified.
Child marriage (before age 18) is a risk factor for intimate partner violence (IPV) against women. Worldwide, Bangladesh has the highest prevalence of IPV and very early child marriage (before age 15). How the community prevalence of very early child marriage influences a woman’s risk of IPV is unknown. Using panel data (2013–2014) from 3,355 women first married 4–12 years prior in 77 Bangladeshi villages, we tested the protective effect of a woman’s later first marriage (at age 18 or older), the adverse effect of a higher village prevalence of very early child marriage, and whether any protective effect of a woman’s later first marriage was diminished or reversed in villages where very early child marriage was more prevalent. Almost one-half (44.5 %) of women reported incident physical IPV, and 78.9 % had married before age 18. The village-level incidence of physical IPV ranged from 11.4 % to 75.0 %; the mean age at first marriage ranged from 14.8 to 18.0 years. The mean village-level prevalence of very early child marriage ranged from 3.9 % to 51.9 %. In main-effects models, marrying at 18 or later protected against physical IPV, and more prevalent very early child marriage before age 15 was a risk factor. The interaction of individual later marriage and the village prevalence of very early child marriage was positive; thus, the likely protective effect of marrying later was negated in villages where very early child marriage was prevalent. Collectively reducing very early child marriage may be needed to protect women from IPV.