Co-chaired by 1st Companion Jennifer Siebel Newsom and Pro Football Hall of Famer Ronnie Lott, the Council will spot a particular emphasis on youth physical wellbeing and mental wellness
SACRAMENTO – Governor Gavin Newsom now named 16 associates to the Governor’s Advisory Council on Physical Fitness and Mental Effectively-Staying, which is tasked with checking out approaches to market health and wellness amongst Californians of all ages. The Advisory Council is led by First Husband or wife Jennifer Siebel Newsom, who was a Division 1 athlete at Stanford University and a member of the women’s junior nationwide soccer staff, and Professional Football Corridor of Fame Inductee Ronnie Lott.
“The pandemic has put a highlight on the importance of actual physical and psychological health,” explained Governor Newsom. “We are dedicated to elevating balanced nutritional and fitness patterns, and psychological perfectly-getting, to aid create a more healthy, far more resilient California for all.”
“As a lifelong athlete and the mom of four younger young children, I’m eager to embark on this enjoyable partnership to give California small children with ample tools and options to create lifelong mental and bodily wellness methods,” reported 1st Associate Siebel Newsom. “After all, we know that lifetime practices all-around physical exercise, athletics, diet and wellness are formed in early childhood.”
The Advisory Council includes reps from wellbeing and wellness corporations, youth sports plans, schooling, the entertainment and health and fitness market, and other specialists on bodily and mental health and fitness:
Dr. Sergio Aguilar-Gaxiola, Professor of Medical Inner Medication, UC Davis University of Drugs, and Director of the Heart for Lowering Health and fitness Disparities at UC Davis
Brandi Chastain, Olympic and Globe Cup Winner, Nationwide Soccer Hall of Fame inductee, mom and grandmother, and cofounder of BAWSI
Jessica Cruz, CEO of NAMI California
Nisha Devi, Founder of Kala Wellness, Japanese Drugs Practitioner
Fran Gallati, CEO of YMCA of the East Bay
Ashley Hunter, Founder and Executive Director of Fit Young ones
Savannah Linhares, Varsity Ladies Basketball Mentor, Biology Instructor, Leadership and Backlink Crew Teacher at Chowchilla Substantial Faculty, and “Double-Goal” 2020 Coach of the Year, Good Coaching Alliance (PCA)
Cheryl Miller, Olympic Gold Medalist, NCAA Higher education Basketball 3-time Player of the 12 months, Head Coach Women’s Basketball at Cal Point out LA
Dr. Bill Resnick, psychiatrist and philanthropist, and mindfulness practitioner
Stephen Revetria, President, Giants Enterprises
Francesca Schuler, President of the California Physical fitness Alliance
Dr. Dan Siegel, Medical Professor of Psychiatry at the UCLA Faculty of Medicine and the founding Co-Director of the Mindful Recognition Investigate Centre
Renata Simril, President and CEO of LA84 Foundation
Dave Stewart, Former Major League Baseball Participant
Dr. Vernon Williams, Sports Neurologist and Founding Director of the Heart for Sports Neurology and Discomfort Drugs at Cedars-Sinai Kerlan-Jobe Institute
Kristi Yamaguchi, Olympic Gold Medalist, Founder of Generally Aspiration Basis
“During my job as a experienced athlete, I figured out the great importance of both equally actual physical and mental health,” claimed Ronnie Lott, who served safe 4 Tremendous Bowl victories for the San Francisco 49ers. “We as a society tend to spot a large aim on bodily well being, but currently being healthful in head is just as significant. I appear ahead to remaining aspect of this Advisory Council to make sure all California older people and small children can be healthy in head and human body.”
The Advisory Council’s activities may well consist of, amongst other items, furnishing steerage on the advancement of actual physical activity and wellness targets for Californians of all ages expanding awareness among the all age teams about the benefits of actual physical action, sporting activities, nourishment and psychological wellness encouraging intergenerational actual physical exercise functions endorsing equitable access to outdoor and physical routines for underserved communities and facilitating collaboration between federal, condition and neighborhood businesses, training, company and industry, the non-public sector, and many others in the promotion of actual physical exercise and psychological wellness.
Findings from our systematic review [16] were used to design a theoretical framework for the qualitative study [17]. Notable determinants identified in the systematic review were financial and time limitations, health/beauty paradox (= overweight/obesity as a sign of beauty and wealth), and lack of knowledge, self-efficacy, and skills. Qualitative study findings re-affirmed the systematic review findings concerning health/beauty paradox, knowledge, self-efficacy, and skills gaps. In addition, the qualitative study showed socio-cultural misconceptions around lifestyle PA, fruits, vegetables, and habitual orientation towards carbohydrate foods. We also found that there is a high trust in nutrition information shared on social and mass media, yet skills to evaluate this nutrition information are limited. Figure 1 below shows the logical model of needs assessment, summarises the determinants of dietary and PA in urban Uganda [16, 17].
Fig. 1
Logical model of needs assessment, summarizing the personal and environmental determinants of dietary and PA behavior in urban Uganda. Adapted from Yiga et al., [16] and Yiga et al., [17]
Step II: Formulation of behavioral intervention, performance, and change objectives
We hypothesised that changing the overall existing behaviours towards WHO healthy lifestyle guidelines in one intervention may meet strong resistance and thus may not be effective. For example, the planning group hypothesised that due to the existing health/beauty paradox and habitual orientation towards carbohydrate rich foods, interventions focusing directly on weight loss and reduction of portion sizes of foods rich in carbohydrates may meet strong resistance. Therefore, we decided to go for more feasible gradual changes able to enact clinically relevant metabolic improvements. We hypothesised that increased consumption of vegetables and fruits will indirectly translate into reduction of portion sizes of carbohydrate rich foods. In line with WHO health recommendations, the intervention aims to stimulate WRA to consume at least 400 g fruits and vegetables [13]. Moderate intensity PA that can be incorporated in daily life activities may be the achievable type of PA among WRA compared to structural high intensity PA [26]. Non-factual nutrition information influences dietary and PA behaviors in urban Uganda [17]. Thus, we decided to supplement the intervention with a component on information evaluation; to enact ability to distinguish evidence-based information from nonfactual information.
Accordingly, three behavioural intervention objectives were formulated.
1.
Women evaluate the accuracy of food, nutrition, and PA information.
2.
Women engage in moderate intensity PA for at least 150 min a week.
3.
Women consume at least one portion of vegetables and one portion of fruit every day.
Table 1 shows the behavioral intervention objectives, subdivided into POs providing the answer to the question; “what do the participants of the intervention need to do to achieve the behavioural objectives”. The model of food literacy [27] guided the formulation of POs. Food literacy is the interrelated combination of knowledge, skills and self-efficacy to (i) plan, (ii) select, (iii) prepare, (iv) eat food with the ultimate goal of developing a lifelong healthy, sustainable and gastronomic relationship with food within the prevailing environment [27, 28]. The POs were based on the above mentioned four components of food literacy (plan, select, prepare, and eat). For PA, a similar model was adopted, where “eat” was replaced with “do”, that is; plan, select, prepare, and do. The model of food literacy was chosen as it is a holistic behavior change model focusing on a “how to do approach” to initiate and sustain healthy eating habits [27, 28]. Evidence shows a positive association between food literacy and healthy dietary behaviors, particularly increased intake of vegetables and fruits [29, 30]. Table 2 shows the determinants considered to have a strong influence on accomplishing the created POs. Matrices of change objectives are presented in Additional file 3.
Table 1 Behavioural intervention objectives subdivided into performance objectives
Table 2 Determinants of performance objectives for behavior intervention objectives
Step III: Selection of theory-based methods and practical strategies
We aimed to create an intervention capable of initiating and sustaining behaviour change. Eleven BCTs scientifically shown to enact changes in knowledge, skills, self-efficacy, subjective norms, and social support were selected, Additional file 4. The selected BCTs are supported by the self-regulation theory and self-determination theory which specifies the need for autonomy, competence, and relatedness to attain a positive behaviour change [33, 34]. Accordingly, our intervention aims to create behavioural change through enacting autonomy, competence, and relatedness. Providing information coupled with motivation interviewing creates a positive intention [35]. Implementation intentions can be achieved through goal setting [24, 34, 35]. Goal setting necessitates competence, which we hypothesised to be attained through a combination of (i) action planning; (ii) guided practice; ii) self-monitoring; iv) feedback on performance and v) planning of coping plans [24, 26, 34,35,36]. To sustain the behavioural goals requires relatedness, which can be achieved using a combination of social support, role modelling, feedback, planning coping responses and motivation interviewing [20, 24, 34].
The selected BCTs were then operationalised into practical strategies. BCTs; motivational interviewing, role modelling, feedback, guided practice, social support through exchanging ideas and planning coping responses were translated into interactive group-based sessions. Brainstorming workshops with planning group II and FGDs with target group revealed that group sessions may be the best strategy to deliver the intervention in this setting.
“Through education sessions, like you come in this group and give us a health talk, like the way you have come, you teach us and then us we can go and teach our other friends out there. Like for us every Tuesday we be meeting here, very many of us, so if you say you will give us one Tuesday in a week or month, or the last Tuesday of a month and you come and teach us”. “It would be very nice, because literally I share the information with others, so it will move, it moves much faster, because these groups are not only here, but also have these groups in other dioceses, so we can go visit them, and the teach them, but in health centers you only visit when you’re sick”. “Yes it helps, what I know is good, I wish it for my friends and we act as a support for each, and we as well spread it to other groups, example of myself, I used to never eat pumpkin, but I got it from these ladies, that this pumpkin is good and with time I gradually started to eat it until it become part of my diet”, participants in FGD 4 and 6.
Additionally, a recent systematic review shows that diet and PA interventions delivered through group sessions are effective in promoting clinically relevant weight loss [34]. These groups provide opportunities for social support, experience sharing, and may create a motivating atmosphere [22, 34]. Our needs assessment as well revealed that the community and church small groups are an opportunity to share dietary and PA counselling [16, 17]. Our environmental asset assessment revealed existence of women groups within religious structures. Existing groups boosts social cohesion, a facilitator for behavioural change [22].
The reading culture of Ugandans is low.
“We need more of practical, and also the pamphlet, some of us don’t really understand so much, but if it brings out the picture very well, even I can pick interest in it”. “Pamphlets, some people are lazy to read”, participants in FGD 5.
So, the BCT of “providing information through imagery” was translated into infographics with less text and more locally recognisable visuals. Evidence as well shows that visuals increase attention, interest, and credibility of the messages [20].
During FGDs with the target group, participants emphasised the need for practical vegetable preparation skills.
“like we are trying to reduce cooking oil and other stuff from our daily life, so maybe we meet in a group, there is a demonstration whereby some food stuffs are prepared in the best possible way which is to the taste, and people learn how to prepare them, because most of us, do not know how to cook, that is the truth, but somebody may not even fry food, but it tastes so good, if you know how to mix the ingredients and so on. Yes, include cooking demonstrations”, participants in FGD 2.
Hence, BCT of “guided practice” was specifically translated into a practical vegetable group cooking session. We also included vegetable recipes based on locally available vegetables in the intervention infographics. Intervention strategies linked to personal metabolic health and lifestyle needs, and environmental opportunities may help drive behaviour change and positively influence health outcomes [37]. Thus, BCT of; implementation intentions, goal setting and action planning were translated in to; (i) creating “if then plans” in line with metabolic health, (ii) SMART fruit/vegetable/PA goals, detailed action plans to achieve set SMART goals drawn considering environmental opportunities. Figure 2 below shows the hypothesised intervention logical model (conceptual framework) of behavioural change. Practical strategies built from BCT are hypothesized to effect changes in the change objectives, which in turn translate in changes in the determinants. Changes in the determinants in turn result in attainment of POs and corresponding behavioural intervention objectives.
Fig. 2
hypothesised intervention logical model for behavioural change (conceptual framework for the intervention)
Step IV: Development of the intervention programme
The practical strategies were built into the intervention scope and sequence, Additional file 5. The intervention consists of five interactive group sessions, 150 min each, Fig. 3. A booklet (infographics); on benefits/recommendations, local vegetable recipes, and practical tips to eat more fruits, vegetables and do more PA is included as a guide, Additional file 6. Tools to assess PA and food environment for opportunities were included, Additional file 7. As well a self-monitoring tool for PA, fruit and vegetable intake was included for participants to track their behaviour daily goals for use in the feedback sessions, Additional file 8. The infographics were designed with locally recognisable images as cultural relevance of health promotion materials is vital for the success of an intervention [20]. Messages on the infographics were framed in a positive and active tone as evidence shows that positively framed messages are more acceptable [20].
Fig. 3
Showing delivery timeline of the intervention sessions, intervention content (organised practical strategies from step III), role of participants, and anticipated outcome per session
Brain storming workshop with planning group I and FGDs with the target group identified religious institution women group structures as an appropriate potential delivery channel. The women group structures boosts established social networks, community reach (85{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} Ugandans are Christians) and trust. The channel offers an opportunity for assessing the intervention effectiveness in an unrestricted real-life community setting.
“Religious institutions because they are transparent, religious organizations because they reach out to a bigger community and then they are transparent. The health centers, there is that rudeness, and still for health centers will only meet those people who come to them, but the church, you get a bigger audience”, “Come to churches like this, people really belong to this communities, then you say every third Saturday or Sunday of the month, from 4 to 5 pm, there will always be a nutritional class, for the first-time people may not come, but eventually they come, if it is a free class”, participants in FGD 4.
STEP V: Adoption and implementation plan
The intervention will be delivered through institutional religious women groups (results of environmental asset assessment framework – see step IV). Through meetings with the strategic community leaders, a collaboration was established with Our Lady of Africa Catholic Parish, Mbuya. Mbuya Catholic Parish has six sub parishes. Within these sub parishes they are existing women groups, and these groups will be utilized for face-to-face intervention group sessions. FGDs with target group and meetings with planning group II pointed at the importance of opinion peer leaders being part of the implementation team.
“Our women group leader has helped us a lot, she taught us the dangers of cooking in polyethene bags and taught us the use of banana leaves, us we had got so much used to using the polyethene bags, she can’t eat the food you have prepared in polyethene bags, even if she visits you and if you have cooked like that, she can’t eat that food. “We have musawo (village health team) in our group, she usually brings for us education sessions on how to eat, she goes a lot for these education sessions and what she learns she brings them back to us”, participants in FGD 6.
Scientific evidence shows that the efficacy and acceptability of health promotion interventions increases if peer opinion leaders within the target group are part of the implementation team [38]. Peer opinion leaders provide entry and legitimacy to the external change agents and may help drive changes in social norms. Selection of peer opinion leaders: the intervention will be delivered within existing women groups. Leaders of these existing groups will be selected to work as peer opinion leaders on the implementation team. The main role and responsibilities peer opinion leaders will be to (i) mobilize fellow women to participate in the intervention, (ii) follow up and (iii) give social support to participating women to attain set intervention goals. Women leaders will be given a two – day refresher training on mobilization and leadership skills, as mobilization is the routine responsibility for women leaders in their usual group meetings. The planning group I designed the sessions to be moderated by health behavior coach (PhD researcher) following the techniques of motivational interviewing [39]. A general guide (scope & sequence) will ensure consistency during the group sessions.
Step VI: Development of an evaluation plan
Study design, setting and timing
The effectiveness of the intervention will be evaluated through a cluster-randomized controlled trial. The intervention will be evaluated in Kampala, the capital city of Uganda. The six sub parishes of Mbuya catholic parish will be randomized to treatment and control arms, Fig. 4. The treatment arm will be exposed to both the developed intervention infographics and face to face group sessions while the control arm will only receive the developed intervention infographics. An awareness session will be organized to distribute the infographics to the control arm. Within the sub parishes, there are existing women groups. These existing groups will be utilized for face-to-face intervention group sessions. For the intervention purposes, each group will be limited to a maximum of 14 members. The study period is divided into two phases: a three-month intervention and a three-month post-intervention follow-up phase.
Fig. 4
Recruitment
The PhD researcher and women leaders of existing groups will make presentations about the intervention during one of the routine meetings. Flyers with details of the intervention will be distributed for sharing with members who are absent during the briefing. At the end of the presentations, interested participants will be invited for the first session to test their eligibility to participate in the study. Eligible participants will be provided with an informed consent form to endorse.
Inclusion criteria
i)
Sex (women),
ii)
Age (18 to 45 years),
iii)
Central obesity [waist circumference ≥ 80 cm]),
iv)
Fluent in either Luganda or English (sessions will be conducted in Luganda/English).
v)
Willingness to follow the three-months intervention and three months follow-up,
vi)
Willingness to sign the informed consent.
Exclusion criteria
i.
Being treated for diabetes Mellitus Type 1 or Type 2, hypertension, high cholesterol, or any other cardio-metabolic related disease.
ii.
Pregnancy.
Outcomes
Primary outcome is reduction in waist circumference. Decreases in waist circumference are recommended as critically important treatment target for reducing adverse cardiometabolic health risks [15]. Secondary outcomes include optimisation of, fasting blood glucose, total cholesterol, HDL, LDL, triglycerides, body composition, food literacy, PA, and fruit and vegetable intake.
Sample size calculation
Sample size calculation is based on waist circumference.
To calculate the sample size, we used the formula described by Rutterford, Copas [40], Table 3.
Table 3 Description of sample size calculation
Randomization
The six sub parishes (clusters) will be listed alphabetically. A cluster randomization with a 1:1 allocation will then be applied to randomize the sub parishes to either the treatment or control arm. In the sub parishes, women group leaders and participants will be blinded about the study arms.
Data collection
Table 4 gives an overview of the different measurements and time points during the study.
Table 4 Measurements and time points
Data analysis
Data will be analysed using R software. To evaluate the effects of the intervention, multilevel analysis will be used. Using this technique, regression coefficients will be adjusted for the clustering of observations within sub parishes. We will define two levels in our multi-level analysis: (1) participant and (2) sub parishes. Linear mixed effect models will be used to examine the effect of the intervention on each of the outcome values. All analyses will be performed according to the intention-to treat-principle [42]. To assess changes in metabolic health between the intervention and control groups, a linear mixed effect model will be built where “time” (end line measurement (M2) will be compared with base-line measurement (M1) and post-follow up measurement (M3)), treatment (and interaction of time and treatment) as well as age will be specified as fixed effects, and sub parishes and participants as random factors. For all linear mixed models, compatibility with mixed-model assumptions will be checked by inspection of residual plots and Q-Q plots. In the case of heteroscedastic residuals, data will be log transformed. Tukey or Benjamini–Hochberg procedures will be applied when performing post hoc analyses to further identify differences within treatments as well as between time points. Statistical outliers will be defined as any observation which has an absolute residual exceeding 3 times the residual standard deviation. p < 0.05 will be considered significant in all analyses.
NT Well being and local community organisation Nutritious Residing NT have designed the ‘Let’s Get Heading!’ manual with information, lesson strategies and action recommendations for Territory mother and father and carers to persuade youthful kids aged a person to five decades to get lively and transfer far more.
Only one in 5 Australian young children are assembly the actual physical activity rules. The recommendation is for small children aged one to 5 years to be active for at the very least a few several hours a working day.
NT Wellbeing Leading End Region Senior Community Wellness Dietitian and Nutritionist, Millie Feeney, claimed there had been numerous benefits for infants and toddlers who have interaction in normal physical action.
“Children who physical exercise usually acquire far more self-confidence and coordination, which will have long lasting benefits as they mature into young grown ups,” Feeney reported.
“Keeping lively can also strengthen a child’s temper, concentration, self-esteem and bone density – as nicely as aid them to sleep improved.”
Wholesome Living NT Education Manager, Chrissie Inglis, mentioned the tutorial was an uncomplicated software for dad and mom to enable establish their child’s gross and great motor capabilities, although getting tons of entertaining.
“Teaching small children to interact in physical exercise when they are young is a gift that will very last a life span,” Inglis mentioned.
“Supporting small children to be active will improve the chance they go on to love exercising via all levels of life, which we know is an significant part of keeping a nutritious way of life.”
Darwin mum, Ella Leonhardt, explained the guide was a superb useful resource she had used to assistance two of her young little ones, Jess, 3, and Chris, 5, work out far more.
Leonhardt shared “my youngsters enjoy actively playing with a ball, so we now carry 1 with us when we’re out and about. They see if they can toss, roll, kick it to every other 10 situations in a row. They get fired up when they access this purpose, so we then test for 20.
“Another favourite exercise is actively playing leapfrog. We collect leaves, sticks and bouquets and then the kids try leaping like a frog concerning them – or they operate and follow the leader.”
Leonhardt explained these games had been all excellent to play at a park, but also labored very well at house, even with their compact yard.
“The manual is suitable for various ages which is ideal presented my children are at distinctive levels of progress. I also have a six-month outdated daughter, Sophie, and am hunting forward to observing her begin to be energetic with her siblings in the coming months,” she reported.
Graphic: Chris Leonhardt, 5, from Darwin, has been obtaining additional exercise with his mum making use of a new tutorial for mothers and fathers on assisting kids training additional.
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Disclosures:
Kemmis and Weiner report no relevant financial disclosures.
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Susan Weiner, MS, RDN, CDCES, FADCES, talks with Karen Kemmis, PT, RN, DPT, MS, GCS, CDCES, FADCES, about the benefits and challenges of helping people with diabetes to increase physical activity.
Weiner:How can physical activity—or lack of activity— affect health for a person with diabetes?
Any physical activity can improve health for people with diabetes, and a higher level of activity can yield greater benefits.
Kemmis: Physical activity and exercise have long been known to benefit individuals with diabetes by improving immediate and long-term blood glucose, reducing cardiovascular risk factors, increasing strength and fitness, delaying or preventing type 2 diabetes, and promoting psychological and emotional health. More recently, we have learned that lack of physical activity can be harmful to health, leading to our focus on encouraging an increase in general movement throughout the day.
Susan Weiner
Karen Kemmis
Weiner:What is the difference between physical activity and exercise?
Kemmis: Physical activity includes any movement that uses energy. Exercise is a type of physical activity that is planned and structured with a goal of improving fitness. Some examples of physical activity include work activity, house and yard chores, child care, recreational activities and general movement throughout the day. Exercise examples include going for a planned walk, riding a bike, swimming, a resistance-training session, yoga or tai chi.
Both physical activity and exercise can provide health benefits that increase as the frequency, duration and intensity of the activity increases. For example, brief leisurely gardening can provide some benefit, whereas longer, more strenuous gardening will produce greater health benefits. The same is seen with exercise; a leisurely daily 10-minute walk or a low-intensity yoga session will provide some health benefit, but there will be a greater change with a longer walk at a brisk pace or a high-intensity aerobics class.
Weiner:Why might a person with diabetes need guidance with physical activity?
Kemmis: It can be challenging to start and maintain an active lifestyle for many reasons. For a person who is relatively inactive, the types and amount of exercise recommended for health benefits may seem overwhelming. Also, many people have physical barriers to being active, such as pain, decreased balance, lack of strength or poor general mobility. It is important to individualize activity recommendations to promote long-term success. Choosing the right type of activity, starting with a small increase from the current activity level and progressing at a pace to allow success without negative consequences are critical.
Weiner:What might be a good starting place for someone wishing to increase physical activity?
Kemmis: Combining an increase in physical activity and a decrease in sedentary time can promote early success. Both aerobic activity, such as walking, biking, swimming, dancing, vacuuming and yardwork, and strengthening, such as resistance training, stair climbing, lifting and carrying, and standing from sitting using only the legs, are beneficial for health and mobility. All physical activity can be done in short bouts spread throughout the day or as an exercise session. It is important to explain these options to the person with diabetes, especially someone who is leading a fairly sedentary life.
Weiner:How realistic is it to expect someone who has been sedentary to increase physical activity to a level that can affect their health?
Kemmis: Health benefits can start with any increase in physical activity, but improvements might not be obvious to the individual. It is important to describe various changes that might be seen when moving from a sedentary lifestyle to low level activity as a starting point. Small improvements in blood glucose, easier movement and perhaps changes in how clothes fit might be observed. It takes a lot of exercise, generally combined with a decrease in caloric intake, to create substantial changes in weight. Explaining this can help set realistic expectations and decrease frustration from lack of obvious improvement. A decrease in waist size may come before a change in weight with the benefit of less visceral fat and improved metabolic parameters. As the individual experiences these small changes, improved physical ability, greater motivation and better health can follow.
Some people with complications may have limitations in their physical activity, but generally some beneficial activity is still possible and can create positive effects. For example, a person with peripheral neuropathy should do daily foot checks and be sure shoes fit well, those with cardiovascular disease may need to exercise at a lower intensity and those with eye problems from diabetes may need to avoid straining during activity.
Weiner:When should someone be referred to physical therapy or another exercise specialist?
Kemmis: Many health care providers, including diabetes care and education specialists, can educate an individual on the recommendations for physical activity and exercise and provide general guidance. However, if pain, balance dysfunction, low vision or challenges with mobility are limitations, a referral to a physical or occupational therapist should be initiated. These specialists can prescribe exercise to create health benefits without increasing problems and can even work on decreasing the physical challenges. An exercise physiologist can guide and monitor a safe and effective exercise program for those with limitations, such as from cardiac issues or immobility, in an individual or group setting. Motivation or lack of understanding of exercise can be overcome with a referral to a personal trainer or a community exercise program.
For more information:
Karen Kemmis, PT, RN, DPT, MS, GCS, CDCES, FADCES, is the Diabetes Care and Eeducation Specialists team leader at the Joslin Diabetes Center Affiliate at SUNY Upstate Medical University. She can be reached at [email protected]; Twitter: @karen_kemmis.
Susan Weiner, MS, RDN, CDN, CDCES, FADCES, is co-author of The Complete Diabetes Organizer and Diabetes: 365 Tips for Living Well. She is the owner of Susan Weiner Nutrition PLLC and is the Endocrine Today Diabetes in Real Life column editor. She can be reached at [email protected]; Twitter: @susangweiner.
Intimate partner violence against women is a global public health problem with many short-term and long-term effects on the physical and mental health of women and their children. The Sustainable Development Goals (SDGs) call for its elimination in target 5.2. To monitor governments’ progress towards SDG target 5.2, this study aimed to provide global, regional, and country baseline estimates of physical or sexual, or both, violence against women by male intimate partners.
Methods
This study developed global, regional, and country estimates, based on data from the WHO Global Database on Prevalence of Violence Against Women. These data were identified through a systematic literature review searching MEDLINE, Global Health, Embase, Social Policy, and Web of Science, and comprehensive searches of national statistics and other websites. A country consultation process identified additional studies. Included studies were conducted between 2000 and 2018, representative at the national or sub-national level, included women aged 15 years or older, and used act-based measures of physical or sexual, or both, intimate partner violence. Non-population-based data, including administrative data, studies not generalisable to the whole population, studies with outcomes that only provided the combined prevalence of physical or sexual, or both, intimate partner violence with other forms of violence, and studies with insufficient data to allow extrapolation or imputation were excluded. We developed a Bayesian multilevel model to jointly estimate lifetime and past year intimate partner violence by age, year, and country. This framework adjusted for heterogeneous age groups and differences in outcome definition, and weighted surveys depending on whether they were nationally or sub-nationally representative. This study is registered with PROSPERO (number CRD42017054100).
Findings
The database comprises 366 eligible studies, capturing the responses of 2 million women. Data were obtained from 161 countries and areas, covering 90{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of the global population of women and girls (15 years or older). Globally, 27{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (uncertainty interval [UI] 23–31{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) of ever-partnered women aged 15–49 years are estimated to have experienced physical or sexual, or both, intimate partner violence in their lifetime, with 13{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (10–16{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) experiencing it in the past year before they were surveyed. This violence starts early, affecting adolescent girls and young women, with 24{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (UI 21–28{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) of women aged 15–19 years and 26{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (23–30{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) of women aged 19–24 years having already experienced this violence at least once since the age of 15 years. Regional variations exist, with low-income countries reporting higher lifetime and, even more pronouncedly, higher past year prevalence compared with high-income countries.
Interpretation
These findings show that intimate partner violence against women was already highly prevalent across the globe before the COVID-19 pandemic. Governments are not on track to meet the SDG targets on the elimination of violence against women and girls, despite robust evidence that intimate partner violence can be prevented. There is an urgent need to invest in effective multisectoral interventions, strengthen the public health response to intimate partner violence, and ensure it is addressed in post-COVID-19 reconstruction efforts.
Funding
UK Department for International Development through the UN Women–WHO Joint Programme on Strengthening Violence against Women Data, and UNDP-UN Population Fund-UNICEF-WHO-World Bank Special Programme of Research, Development, and Research Training in Human Reproduction, a cosponsored programme executed by WHO.
Introduction
Intimate partner violence against women is a grave human rights violation and serious global public health concern.
Global health. The global prevalence of intimate partner violence against women.
This violence refers to physically, sexually, and psychologically harmful behaviours in the context of marriage, cohabitation, or any other form of union, as well as emotional and economic abuse and controlling behaviours.
Intimate partner violence can have major short-term and long-term physical and mental health effects, including injuries, depression, anxiety, unwanted pregnancies, and sexually transmitted infections among others, and can also lead to death.
Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.
It is estimated that 38–50{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of the murders of women are committed by intimate partners globally.
The COVID-19 pandemic and its associated control measures (ie, lockdowns, mobility restrictions, and curfews) are further exacerbating the already heavy burden of intimate partner violence.
Immediate impact of stay-at-home orders to control COVID-19 transmission on socioeconomic conditions, food insecurity, mental health, and intimate partner violence in Bangladeshi women and their families: an interrupted time series.
The 2030 UN Agenda for Sustainable Development Goals (SDGs), adopted by member countries in 2015, calls for the elimination of violence against women and girls—namely through target 5.2 under goal 5 on gender equality and women’s empowerment.
UN Goal 5: achieve gender equality and empower all women and girls.
The first indicator of this target (5.2.1) specifically focuses on intimate partner violence, requiring countries to regularly report on “the proportion of ever-partnered women and girls aged 15 years and older subjected to physical, sexual or psychological violence by a current or former intimate partner”.
UN Goal 5: achieve gender equality and empower all women and girls.
To understand the true magnitude of the problem and to monitor the progress made globally and by countries individually in addressing violence against women, it is crucial to establish a baseline for the global, regional, and national prevalence estimates of intimate partner violence. The regular collection, analyses, and reporting of robust comparable data is the first necessary step to develop targeted evidence-based, effective, and sustainable intersectoral interventions, policies, and programmes aimed at preventing violence against women. In the last decade, there has been a substantial increase in the number of nationally representative population-based surveys collecting data on intimate partner violence.
A framework to model global, regional, and national estimates of intimate partner violence.
However, the measurement of intimate partner violence across surveys still shows notable variations in the quality of the surveys and types of measures used; for example, the definitions and items used to measure physical, sexual, psychological and other forms of intimate partner violence; women sampled (eg, ever-partnered, currently partnered only, or all women); age groups; and whether current or previous partners are included, making comparability across studies and countries challenging.
A framework to model global, regional, and national estimates of intimate partner violence.
Rigorous statistics and estimates on intimate partner violence that adjust for these variations are key to improving understanding of its prevalence, nature, and effect, and how these differ across age groups, countries, and regions.
The objective of this study is to provide baseline reliable and internationally comparable global, regional, and national prevalence estimates of lifetime and past year physical or sexual, or both, intimate partner violence by male partners against ever-partnered women, based on an analysis of data from population-based studies and surveys conducted between 2000 and 2018.
Results
The WHO Global Database contains 359 studies with information on lifetime intimate partner violence. For this analysis, two studies were excluded because they contained information on psychological violence only, 23 studies were excluded because they did not use act-specific questions, and 27 studies were excluded because they were outside of the study period (2000–18). A total of 307 studies were analysed for the lifetime intimate partner violence prevalence.
The Global Database contains 392 studies with infor-mation on past year intimate partner violence. Two studies were excluded because they contained information on psychological violence only, 29 studies were excluded because they did not use act-specific questions, and 29 studies were excluded because they were outside of our study period (2000–18). A total of 332 studies were analysed.
There were 307 unique studies conducted between 2000 and 2018, from 154 countries and areas, totalling 1 767 802 unique women responses, that were included to estimate the lifetime prevalence of physical or sexual, or both, intimate partner violence against women aged 15 years and older. The estimates for violence that occurred within the past year were informed by 332 studies from 159 countries and areas and 1 763 989 individual responses. In total, 366 unique studies from 161 countries and areas with data on lifetime or past year, or both, intimate partner violence underpin these estimates. For both time periods, these studies were representative of 90{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of the world’s population of ever-partnered women and girls aged 15 years and older.
A framework to model global, regional, and national estimates of intimate partner violence.
The results for the regional analyses by SDG and WHO regions are available in the appendix (pp 3–5). The study characteristics are displayed in table 2.
Table 2Characteristics of included studies on lifetime and past year intimate partner violence conducted between 2000 and 2018
Data presented as n or n/N ({e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}).
Globally, 27{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (UI 23–31{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) of ever-partnered women aged 15–49 years are estimated to have experienced physical or sexual, or both, intimate partner violence at least once in their lifetime (table 3). Among ever-partnered women aged 15 years and older, 26{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (22–30{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) are estimated to have experienced intimate partner violence at least once in their lifetime.
Table 3Global prevalence estimates of lifetime and past year physical or sexual, or both, intimate partner violence among ever-married or ever-partnered women, by age group, in 2018
Data presented as {e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (uncertainty interval {e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}).
Globally, it is estimated that 13{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (UI 10–16{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) of ever-partnered women aged 15–49 years have experienced physical or sexual violence, or both, from an intimate male partner within the year preceding the survey interview. This estimate is 10{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (8–12{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) for women aged 15 years and older.
The age disaggregated prevalence of physical or sexual, or both, intimate partner violence shows that such violence is already highly prevalent in the youngest age cohort (table 3, figure 1). Almost one in four ever-partnered adolescent girls between the ages of 15 and 19 are estimated to have experienced physical or sexual violence, or both, from an intimate partner since age 15 (24{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; UI 21–28{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}). The estimated lifetime prevalence of intimate partner violence is high at 26–28{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} for women between the ages of 20 and 44 years and is comparatively lower among women older than 60 years, at 23{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (19–31{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) for those aged 60–64 years and 23{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (18–30{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) for those aged 65 years and older. The prevalence estimates among the older age groups need to be interpreted with caution given their overlapping UIs. As with lifetime prevalence, physical or sexual, or both, intimate partner violence in the past year was highest among the youngest age cohorts: 16{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (UI 14–19{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) among those aged 15–19 years and 16{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (13–19{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) among those aged 20–24 years. The estimated prevalence of this type of violence within the past year was substantially lower among ever-partnered women aged 50 years and older, and was lowest among women aged 60–64 years (5{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 4–7{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) and those aged 65 years and older (4{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 3–7{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}).
Figure 1Global prevalence estimates of lifetime and past year physical or sexual, or both, intimate partner violence among ever-married or ever-partnered women, by age group, in 2018
Regional variations by the Global Burden of Diseases, Injuries, and Risk Factors Study classifications showed that the estimated lifetime prevalence of physical or sexual, or both, intimate partner violence among ever-partnered women aged 15–49 years (the age range for which there is the most data on intimate partner violence) was the highest in Oceania (49{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; UI 38–61{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) and central sub-Saharan Africa (44{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 33–55{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), followed by Andean Latin America (38{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 31–46{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) and eastern sub-Saharan Africa (38{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 31–44{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; table 4). The prevalence of lifetime physical or sexual, or both, intimate partner violence was also high, and more than the global average, in south Asia (35{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 26–46{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) and north Africa and the Middle East (31{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 24–40{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}).
Table 4Regional prevalence estimates of lifetime and past year physical or sexual, or both, intimate partner violence among ever-married or ever-partnered women aged 15–49 years, by Global Burden of Disease region, in 2018
Data presented as {e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (UI{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}). Country estimates are presented in the appendix (pp 6–10). UI=uncertainty interval.
The three regions with lowest lifetime intimate partner violence prevalence estimates were central Europe (16{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; UI 12–21{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), central Asia (18{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 13–24{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), and western Europe (20{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 15–26{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), although even these rates are still high.
As with the lifetime prevalence of intimate partner violence, the highest prevalence of past year physical or sexual, or both, intimate partner violence among ever-partnered women aged 15–49 years was in the regions of central sub-Saharan Africa (32{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; UI 22–43{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) and Oceania (29{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 19–40{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), followed by eastern sub-Saharan Africa (24{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 19–29{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) and south Asia (19{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 12–27{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; table 4).
Overall, mostly high-income countries including Australasia (3{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; UI 2–5{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), western Europe (4{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 3–6{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), central Europe (5{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 3–6{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), southern Latin America (5{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 3–8{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), and North America (6{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 4–9{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) had the lowest estimated prevalence rates of past year physical or sexual, or both, intimate partner violence among women aged 15–49 years.
Differences in the prevalence of intimate partner violence between the largely higher-income regions and low-income and middle-income regions were much more pronounced for prevalence in the past year compared with lifetime prevalence (figure 2).
Figure 2Map of 2018 lifetime versus past year prevalence of physical or sexual, or both, intimate partner violence among ever-partnered women aged 15–49 years by Global Burden of Disease region and Sustainable Development Goals super region
The appendix (pp 6–10) provides the 2018 prevalence estimates and 95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} UIs for lifetime and past year physical or sexual, or both, intimate partner violence among ever-partnered women aged 15–49 years, for every country and area that had at least one available data source that met the inclusion criteria for this analysis.
There was a wide variation in prevalence across countries (figure 3). The median prevalence estimates of lifetime physical or sexual, or both, intimate partner violence among ever-partnered women aged 15–49 years was highest in 19 countries (Kiribati [53{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Fiji [52{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Papua New Guinea [51{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Bangladesh and Solomon Islands [both 50{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Democratic Republic of the Congo and Vanuatu [both 47{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Afghanistan and Equatorial Guinea [both 46{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Uganda [45{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Liberia and Nauru [both 43{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Bolivia [42{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Gabon, South Sudan, and Zambia [all 41{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Burundi, Lesotho, and Samoa [all 40{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}]). The median estimates of these countries ranged from 53{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (UI 35–70{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) in Kiribati, 50{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (37–62{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) in Bangladesh, and 50{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (33–67{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) in the Solomon Islands, to 40{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (27–55{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) in Burundi, 40{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (21–62{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) in Lesotho, and 40{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (25–57{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) in Samoa. All except two of these 19 countries are in Oceania (excluding Australia and New Zealand), sub-Saharan Africa, or south Asia regions. A further 16 countries (Cameroon and Tuvalu [both 39{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Angola, Kenya, Marshall Islands, Peru, Rwanda, Timor-Leste, and Tanzania [all 38{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Ethiopia, Guinea, and Tonga [all 37{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Sierra Leone [36{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], and India, Federated States of Micronesia, and Zimbabwe [all 35{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}]), mainly from sub-Saharan Africa and south Asia, had the second highest prevalence ranges, with 35–39{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of ever-married or ever-partnered women aged 15–49 years having been subjected to physical or sexual, or both, violence from an intimate partner at least once in their lifetime.
Figure 3Map of prevalence estimates of lifetime physical or sexual, or both, intimate partner violence among ever-partnered women aged 15–49 years, in 2018
The group with the lowest prevalence estimates for lifetime physical or sexual violence, or both (ranging from 10 to 14{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), includes 12 countries (Georgia and Armenia [both 10{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Singapore [11{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Switzerland and Bosnia and Herzegovina [both 12{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Albania, Poland, North Macedonia, and Croatia [all 13{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], and Cuba, Azerbaijan, and the Philippines [all 14{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}]). Of the 12 countries, six were in subregions of Europe, with a prevalence between 12 and 13{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}, and three were countries in western Asia, with prevalence estimates for lifetime physical or sexual violence, or both, of: 10{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (UI 6–17{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) in Armenia, 10{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (6–18{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) in Georgia, and 14{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (8–22{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) in Azerbaijan. The other three countries were: Singapore with 11{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (5–22{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), Cuba with 14{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (8–23{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), and the Philippines with 14{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (10–21). Four additional countries from Europe and one from central Asia had prevalence between 15 and 16{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}.
Figure 4 presents a map with the country-level past year prevalence of physical or sexual, or both, intimate partner violence among ever-partnered women aged 15–49 years. The 14 countries with the highest prevalence estimates of intimate partner violence in the past year (ranging from 25–36{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) were Democratic Republic of the Congo (36{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; UI 23–50{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), Afghanistan (35{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 22–50{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), Papua New Guinea (31{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 19–45{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), Vanuatu (29{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 16–48{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), Equatorial Guinea (29{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 16–46{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), Solomon Islands (28{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 15–46{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), Timor-Leste (28{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 19–40{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), Zambia (28{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 19–39{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), Ethiopia (27{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 17–38{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), Liberia (27{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 17–40{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), South Sudan (27{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 13–48{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), Uganda (26{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 18–36{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), Angola (25{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 14–39{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), and Kiribati (25{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; 14–42{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}). There were 14 additional countries (Tanzania [24{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Bangladesh, Fiji, Kenya, and Rwanda [all 23{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Burundi, Cameroon, and Gabon [all 22{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], Central African Republic, Guinea, and Federated States of Micronesia [21{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}], and Nauru, Sierra Leone, and Tuvalu [20{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}]) that had prevalence rates between 20 and 24{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}, mainly from the sub-Saharan African and Oceania regions.
Figure 4Map of prevalence estimates of past year physical or sexual, or both, intimate partner violence among ever-partnered women aged 15–49 years, in 2018
Of the 30 countries with the lowest prevalence estimates for past year physical or sexual violence, or both (up to 4{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), 24 were high-income countries. 23 of the 30 countries within this lowest prevalence range were in Europe. The other seven were Australia, Canada, Japan, New Zealand, Singapore, Sri Lanka, and Uruguay.
Discussion
Our study confirms that, concerningly, physical or sexual violence, or both, against women by male intimate partners is highly prevalent globally. Overall, we found that more than one in four (27{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) ever-partnered women aged 15–49 years had experienced physical or sexual violence, or both, from a current or former intimate partner at least once in their lifetime; and one in seven (13{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) had experienced it in the past year. This finding means that in 2018, up to 492 million ever-partnered women aged 15–49 years had been subjected to this type of violence by an intimate partner at least once since the age of 15 years.
This study also draws attention to the high amount of recent or current intimate partner violence experienced by young women, with one in six women (16{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) aged 15–24 years estimated to have been subjected to physical or sexual, or both, intimate partner violence within the year preceding the survey. This finding is concerning because adolescence and early adulthood are important life stages in which the foundations for healthy relationships are built; this violence has long-lasting effects on women’s health and overall wellbeing.
Intimate partner violence among adolescents and young women: prevalence and associated factors in nine countries: a cross-sectional study.
We found that the lifetime and past year prevalence of physical or sexual, or both, intimate partner violence varied widely across regions and countries, with higher prevalence rates of both types in low-income and middle-income countries and regions than high-income countries. These differences between higher-income and lower-income regions were notably more pronounced with past year prevalence than lifetime prevalence, and the relative differences between lifetime and past year prevalence were smaller in low-income and middle-income countries and regions. It is important to note that there are 28 countries with past year physical or sexual, or both, intimate partner violence prevalence that is substantially higher than the global average. Several of these are countries affected by conflict. These findings are consistent with the different social, economic, and political circumstances that are associated with intimate partner violence and limit women’s ability to leave abusive relationships, such as economic insecurity, gender inequitable norms, high amounts of societal stigma, economic insecurity, discriminatory family law, and inadequate support services.
Attitudes towards domestic violence in 49 low- and middle-income countries: a gendered analysis of prevalence and country-level correlates.
The limitations of these analyses first include the reliance on the availability and quality of existing violence against women survey data and measures. The modelled estimates and UIs presented in this Article are the most accurate that could be derived from the available 2000–18 prevalence data from 161 countries and areas on intimate partner violence. However, although there has been an increase in the number of national population-based surveys with such data, there are gaps in the availability of data in some geographical regions, and not all surveys are recent or use gold standard measures.
Global health. The global prevalence of intimate partner violence against women.
Second, all estimates in this study are based on women’s self-reported experiences of being subjected to intimate partner violence. Given the sensitive nature of the issue, the true prevalence of physical or sexual, or both, intimate partner violence is likely to be higher. Survey design and implementation, including interviewer training, play an important role in enabling disclosure and affect survey results.
WHO Putting women first: ethical and safety recommendations for research on domestic violence against women.
Third, the definition of a partnership is variable across contexts, and we relied on the survey’s definition of a partnership. However, some studies might not have captured all partnership types and this could have affected our estimates, especially among adolescent and younger women.
Fourth, our estimates for women aged 60 years and older are limited by the relative paucity of empirical observations. Because most data, especially for low-income and middle-income countries, came from demographic and health surveys, data availability is skewed towards women of reproductive age in the 15–49 year range. Although this group of women might be at a higher risk of intimate partner violence, there is a need for more and better quality data to optimally capture the violence experienced by older women
Violence against older women: a systematic review of qualitative literature.
and across the life course.
And finally, psychological intimate partner violence has substantial negative effects on women. However, this type of violence could not be included in the current estimation process because of the challenges that exist with variations in definitions, measurement, and non-standardisation across surveys and countries.
Emotional abuse: a neglected dimension of partner violence.
Work by WHO is underway to address these challenges and overcome this limitation.
We need to continue strengthening, standardising, and building capacity for the collection, reporting, and use of data on violence against women to support countries’ efforts and to monitor progress at national, regional, and global levels. We recommend that governments invest in dedicated surveys on violence against women or comprehensive modules with specially trained interviewers and adherence to ethical and safety standards to better estimate the magnitude of violence against women. These improved estimates are crucial to the development of effective prevention policies and programmes. There is a need to develop robust survey measures to better understand violence experienced by women living with multiple forms of discrimination, for example those living with disabilities, indigenous and minority ethnic or migrant women, transgender women, and women in same-sex partnerships, for which there are currently few data.
Addressing violence against women: a call to action.
Despite the limitations in available data, this study unequivocally establishes the persistently high prevalence of intimate partner violence. Notably, intimate partner violence is preventable. There has been a substantial increase in the body of knowledge on what works to prevent violence against women and girls in the last decade.
WHO RESPECT women: preventing violence against women.
This framework, endorsed by 14 agencies and funders, organises evidence-based interventions for the prevention of violence against women through seven strategies. Several high-level initiatives, such as the Action Coalition on Gender-based violence of the Generation Equality Forum, are advocating for and investing in countries to do more when it comes to evidence-based prevention, including developing community-based and school-based interventions that promote gender equality and challenge gender stereotypes and discriminatory norms, reforming discriminatory laws, and ensuring women’s access to formal wage employment and secondary and higher education. Other programmes showing promise with regards to violence prevention focus on transforming attitudes that justify violence against women and promoting more equitable relationships within the family, reducing exposure to violence during childhood and reducing child abuse, and increasing access to cash transfers, particularly women’s access to cash transfers.
UN WomenUNFPAWHOUNDPUNODC Essential services package for women and girls subject to violence.
Although progress has been made in implementing such programmes, this progress is grossly insufficient to meet the SDG target of eliminating violence against women by 2030. This problem is likely to have been further exacerbated by the COVID-19 pandemic that has caused an unprecedented setback in efforts towards the reduction of violence against women.
Violence against women during COVID-19 pandemic restrictions.
Although these estimates are based on pre-COVID-19 survey data, helpline, police, and other service data suggest that the pandemic and its associated lockdowns might have led to further increases in intimate partner violence.
Violence against women during COVID-19 pandemic restrictions.
The full effect of the COVID-19 pandemic will only be known when population-based surveys are able to fully resume. The need to scale up existing interventions and the preparedness of health and other sectors to ensure women’s access to services centered around people who have experienced intimate partner violence and referrals is even more pressing.
Intimate partner violence affects the lives of millions of women, children, families, and societies worldwide. These data clearly show that this violence predates the COVID-19 pandemic and will probably continue long after. Preventing intimate partner violence from happening in the first place is necessary and urgent. Governments, societies, and communities need to take heed, invest more, and act with urgency to reduce violence against women, including by addressing it in post-COVID-19 reconstruction efforts.
LS contributed to the study design, data extraction and curation, investigation, methods, validation, microdata analysis, visualisation, writing the original draft, and reviewing and editing the manuscript. MM-G contributed to the data curation, formal analysis, investigation, methods, validation, visualisation, and reviewing and editing the manuscript. HS contributed to the systematic review design and protocol, the study design, data extraction and curation, investigation, methods, and reviewing and editing the manuscript. SRM contributed to the search strategy design and protocol, study design, data extraction, and curation, investigation, and reviewing the manuscript. CG-M conceptualised the study and contributed to the study design, funding acquisition, investigation, validation, methods, project administration, resources, supervision, and reviewing and editing the manuscript. CG-M had full access to all the data in the study and had final responsibility for the decision to submit for publication.
The Virginia Section of Schooling suggests their not too long ago designed fairness-targeted social-psychological finding out expectations are in place to “ensure just about every student in Virginia attends a college that maximizes their opportunity and prepares them for the future: academically, socially, and emotionally.”
The advancement of SEL criteria for Virginia educational facilities is a action in the right path, but how will universities actually employ these improvements?
Dwelling Monthly bill 753, handed for the duration of the 2020 session of Virginia’s Basic Assembly, implored the VDOE to create a concrete definition of social-emotional studying and to establish grade-distinct guidance criteria. The new standards designed by the Virginia Division of Schooling are simply a vision for how SEL will be included into schools. They determine social-psychological discovering as “the process by which all-young people today and adults purchase and implement the understanding, skills and attitudes to produce healthy identities, take care of thoughts and obtain personalized and collective plans, truly feel and demonstrate empathy for other people, create and keep supportive relationships and make accountable and caring selections.”
I propose that the VDOE should really embed SEL tactics into actual physical training courses. That would fulfill two (self recognition and self management) of 5 core competencies laid out by the Collaborative for Educational, Social, and Emotional Discovering, a nonprofit which advocates for implementation of social and psychological learning. If SEL have been to be seamlessly built-in into physical training classes, it would tension the strategy that very well-becoming is just as dependent on social and psychological wellness as it is on actual physical well being.
It comes as no shock that students’ social and psychological wellbeing was shaken by COVID-19. College students today are simultaneously dealing with the consequences of unfinished studying and unfinished social-psychological growth. A 2021 study conducted by McKinsey & Co surveyed 16,370 mothers and fathers throughout each individual point out in the United States on their child’s psychological wellbeing throughout COVID-19. The study identified that “80 p.c of mom and dad experienced some stage of issue about their child’s mental overall health or social and psychological health and fitness and advancement since the pandemic started.” Learners need to have social-psychological understanding in our recent climate more than at any time prior to. SEL must no lengthier be a perceived “add-on” in a system, but a essential element of the class alone.
One particular of the wanted results for self-recognition is to “recognize and recognize the interactions involving one’s possess feelings and thoughts.” This desired result of self-awareness aligns effectively with a system in mindfulness. Massachusetts general public faculties, these types of as Westborough Higher School, have correctly implemented this kind of applications into actual physical education and learning classes by giving a motion course entitled “Head, System and Soul,” which introduces pupils to aware meditation, yoga, pilates and tai chi. Self-management is the 2nd core competency that can be logically applied to a physical training classroom. One particular of the overarching concepts for this main competency is for students to “demonstrate the competencies similar to reaching personalized and academic targets.”
Actual physical schooling academics can give instruction on goal-location, in unique with a target on “SMART (Specific, Measurable, Attainable, Appropriate, and Well timed)” objectives. College students could build Clever objectives for their development in particular units, these kinds of as my proposed mindfulness study course. They could even apply their aims to pursuits outdoors of the bodily schooling classroom.
The VDOE solicited public reviews on the proposed VDOE requirements adhering to passage by the Basic Assembly. Just one comment states “leave character growth to the moms and dads.” But character enhancement in schools is foundational. Lecturers are pushed to nurture certain values in their learners that will help results outside the house of a classroom setting. College students shell out a period of time of important advancement in a university placing, and it really should partly be the accountability of actual physical educators to lay the groundwork for holistic accomplishment.
Social-emotional discovering should really preferably be included in all classroom options. But for now, I believe Virginia educational institutions ought to prioritize streamlined instruction in physical education courses. Actual physical training lessons now scaffold college students toward wholesome social and emotional growth, and this can be more enforced by SEL-dependent class parts presented to all K-12 students. In doing so, Virginia would get 1 a lot more move in the suitable course.
Lila Newberry is a sophomore at the School of William & Mary researching public policy.
