This study examines intimate partner violence (IPV) attitudes and experience among women and men in Uganda to inform IPV-prevention programs in the region. Nationally representative population-based data from women aged 15 to 49 and men aged 15 to 54 were collected between May and October 2006 as part of the Uganda Demographic and Health Survey. The survey included questions on women’s and men’s attitudes toward wife beating and information on IPV victimization (women) and perpetration (men). More than half of men and nearly three quarters of women have attitudes supportive of wife beating in Uganda. More than half of married women report IPV victimization, and 40% of married men report perpetration. Women and men who reported witnessing their fathers beating their mothers were more likely to report IPV victimization (perpetration for men). Witnessing violence was also associated with positive attitudes toward wife beating among men. IPV-prevention programs need to address the important role of having witnessed wife beating between the mother and the father on men’s subsequent attitudes and behaviors. Women who witnessed wife beating are also the most likely to have supportive attitudes and IPV experience, possibly indicating that their relationship expectations are different than women who did not witness violence. Community-based prevention programs targeting men and women are needed in Uganda and elsewhere in sub-Saharan Africa where gender norms that justify IPV prevail.

The relationship between intimate partner violence (IPV) and early marriage is explored using the 2005-2006 India National Family Health Survey (NFHS-3). The NFHS-3 collected data from a representative sample of women and men in India with a large enough sample size to have a representative sample at the state level. The focus is on youth from Bihar and Rajasthan, two states with high IPV and early marriage. Multivariate logistic regression analyses demonstrate that women aged 20 to 24 who married before age eighteen, the legal age at marriage in India, are more likely to have ever experienced IPV in their lifetime and recently experienced IPV (in the last 12 months) than their counterparts who married later. The results were significant in Rajasthan but not in Bihar. To reduce IPV, targeted efforts must be made to decrease the proportion of India’s girls who are married under the legal age of marriage.

In Ghana, the site of this study, the maternal mortality ratio and under-five mortality rate remain high indicating the need to focus on maternal and child health programming. Ghana has high use of antenatal care (95%) but sub-optimum levels of institutional delivery (about 57%). Numerous barriers to institutional delivery exist including financial, physical, cognitive, organizational, and psychological and social. This study examines the psychological and social barriers to institutional delivery, namely women’s decision-making autonomy and their perceptions about social support for institutional delivery in their community. This study uses cross-sectional data collected for the evaluation of the Maternal and Newborn Referrals Project of Project Fives Alive in Northern and Central districts of Ghana. In 2012 and 2013, a total of 2,527 women aged 15 to 49 were surveyed at baseline and midterm (half in 2012 and half in 2013). The analysis sample of 1,606 includes all women who had a birth three years prior to the survey date and who had no missing data. To determine the relationship between institutional delivery and the two key social barriers—women’s decision-making autonomy and community perceptions of institutional delivery—we used multi-level logistic regression models, including cross-level interactions between community-level attitudes and individual-level autonomy. All analyses control for the clustered survey design by including robust standard errors in Stata 13 statistical software. The findings show that women who are more autonomous and who perceive positive attitudes toward facility delivery (among women, men and mothers-in-law) were more likely to deliver in a facility. Moreover, the interactions between autonomy and community-level perceptions of institutional delivery among men and mothers-in-law were significant, such that the effect of decision-making autonomy is more important for women who live in communities that are less supportive of institutional delivery compared to communities that are more supportive. This study builds upon prior work by using indicators that provide a more direct assessment of perceived community norms and women’s decision-making autonomy. The findings lead to programmatic recommendations that go beyond individuals and engaging the broader network of people (husbands and mothers-in-law) that influence delivery behaviors.

Ghana is attracting global attention for efforts to provide health insurance to all citizens through the National Health Insurance Scheme (NHIS). With the program’s strong emphasis on maternal and child health, an expectation of the program is that members will have increased use of relevant services. This paper uses qualitative and quantitative data from a baseline assessment for the Maternal and Newborn errals Evaluation from the Northern and Central Regions to describe women’s experiences with the NHIS and to study associations between insurance and skilled facility delivery, antenatal care and early care-seeking for sick children. The assessment included a quantitative household survey (n = 1267 women), a quantitative community leader survey (n = 62), qualitative birth narratives with mothers (n = 20) and fathers (n = 18), key informant interviews with health care workers (n = 5) and focus groups (n = 3) with community leaders and stakeholders. The key independent variables for the quantitative analyses were health insurance coverage during the past three years (categorized as all three years, 1–2 years or no coverage) and health insurance during the exact time of pregnancy. Quantitative findings indicate that insurance coverage during the past three years and insurance during pregnancy were associated with greater use of facility delivery but not ANC. Respondents with insurance were also significantly more likely to indicate that an illness need not be severe for them to take a sick child for care. The NHIS does appear to enable pregnant women to access services and allow caregivers to seek care early for sick children, but both the quantitative and qualitative assessments also indicated that the poor and least educated were less likely to have insurance than their wealthier and more educated counterparts. Findings from the qualitative interviews uncovered specific challenges women faced regarding registration for the NHIS and other barriers such lack of understanding of who and what services were covered for free. Efforts should be undertaken so all individuals understand the NHIS policy including who is eligible for free services and what services are covered. Increasing access to health insurance will enable Ghana to further improve maternal and child health outcomes.

Men play crucial role in contraceptive decision-making, particularly in highly gender-stratified populations. Past research examined men’s attitudes toward fertility and contraception and the association with actual contraceptive practices. More research is needed on whether men’s attitudes on gender equality are associated with contraceptive behaviors; this is the objective of this study.