The Impact of Armed Conflict on Adolescent Transitions: A Systematic Review of Quantitative Research on Age of Sexual Debut, First Marriage & First Birth in Young Women Under the Age of 20 Years

BACKGROUND:

Young women in conflict-affected regions are at risk of a number of adverse outcomes as a result of violence, economic deterioration and the breakdown of community structures and services. This paper presents the findings of a systematic review of quantitative literature reporting how key sexual and reproductive health (SRH) outcomes among young women under the age of 20 years are affected by exposure to armed conflict; namely, sexual debut, first marriage and first birth. Increases in these outcomes among young women are all associated with potential negative public health consequences. It also examines and documents possible causal pathways for any changes seen.

METHODS:

To fit with our inclusion criteria, all reviewed studies included outcomes for comparable populations not exposed to conflict either temporally or spatially. A total of 19 studies with results from 21 countries or territories met our inclusion criteria; seven presented findings on marriage, four on fertility and eight on both of these outcomes. Only one study reporting on sexual debut met our criteria.

RESULTS:

Findings show clear evidence of both declines and increases in marriage and childbirth among young women in a range of conflict-affected settings. Several studies that showed increases in marriage below the age of 20 years reported that such increases were concentrated in the younger teenagers. Trends in fertility were predominantly driven by marriage patterns. Suggested causal pathways for the changes observed could be grouped into three categories: involuntary, gender and psycho-social and economic and material factors.

CONCLUSION:

The review reveals a paucity of literature on the impact of conflict on SRH outcomes of young women. Further quantitative and qualitative studies are needed to explore how conflict influences SRH events in young women over both the short- and longer-term.

Summary of suggested causal pathways relating to marriage

	Involuntary	Gender and psycho-social	Economic and material
Marriage increase	Increased opportunity for social contact between the sexes	Fear of sexual violence or loss of honour for unmarried women leads to marriage at younger ages	Disruption in girls schooling leading to earlier marriage/childbirth
	Increased competition for remaining males as marriage partners	Desire for increased social cohesion	Increased poverty leading to transactional marriages/early marriage to gain bride price
		Increased pro-natalism and conservatism supports early marriage and childbirth
Marriage decrease	Disruption and separation of the sexes		Cost of marriage, lack of employment opportunities and destruction of infrastructure
	Lack of available males due to conscription and differential mortality

Full article at:   http://goo.gl/Fv8Auy

By:  Neal S1, Stone N2, Ingham R3.

• 1Department of Social Statistics and Demography, Social Sciences, University of Southampton, Southampton, S017 1BJ, UK. S.Neal@soton.ac.uk.
• 2Centre for Sexual Health Research, Department of Psychology, University of Southampton, Southampton, S017 1BJ, UK. ncs@soton.ac.uk.
• 3Centre for Sexual Health Research, Department of Psychology, University of Southampton, Southampton, S017 1BJ, UK. ri@soton.ac.uk.
• BMC Public Health. 2016 Mar 4;16(1):225. 

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The Effects of Sexual Violence on Psychosocial Outcomes in Formerly Abducted Girls in Northern Uganda

Background

The objective of this study is to investigate the effects of sexual violence on the odds of different psychosocial outcomes (depression, psychotic symptoms, somatic complaints, conduct problems, daily functioning, community relations, and stigma) among formerly abducted girls in Uganda.

Methods

Data from an on-going War-Affected Youth Study (WAYS) in Uganda was used to compute the prevalence of psychosocial problems (scores ≥ 75th percentile) among three categories of formerly abducted girls (1) no history of sexual violence without children, 2) a history of sexual violence without children, and 3) a history of sexual violence with children as a consequence) among 210 women (age 22.06, SD = 2.06, range 18–25). Multiple logistic regression analyses were used to examine differences in psychosocial outcomes by the different categories of formerly abducted girls.

Results

Compared to participants with no history of sexual violence and without any children, the odds of adverse psychosocial outcomes were increasingly higher for all psychosocial dimensions for those who reported sexual violence with or without children. Those with a history of sexual violence and with children as a consequence had more than five times the odds of reporting depressive symptoms, somatic complaints, and stigma compared to those who did not report sexual violence.

Conclusion

This study highlighted the risks of psychosocial problems among different categories of formerly abducted girls regarding sexual violence. Vulnerability to psychosocial problems among formerly abducted girls is further compounded by sexual violence, child care, stigma, and poverty.

Below:  Prevalence of psychosocial problems among formerly abducted girls in Northern Uganda

Full article at:   http://goo.gl/apW2Mm

By:   Kennedy Amone-P’Olak, Emilio Ovuga, and Peter Brian Jones

Department of Psychology, University of Botswana, Private Bag UB 00705, Gaborone, Botswana

Department of Psychiatry and Mental Health, Gulu University, P O Box 166, Gulu, Uganda

Department of Psychiatry, Herchel Smith Building for Brain & Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ UK

Kennedy Amone-P’Olak, Phone: 267 355 2825, Email: wb.bu.ipipom@enomA.ydenneK.

Contributor Information.

BMC Psychol. 2015; 3: 46.

Published online 2015 Dec 22. doi:  10.1186/s40359-015-0103-2 PMCID: PMC4689002

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Inter-Group Conflict & Cooperation: Field Experiments Before, During & After Sectarian Riots in Northern Ireland

The idea that cooperative groups out-compete less cooperative groups has been proposed as a theoretical possibility for the evolution of cooperation through cultural group selection. Previous studies have found an association between increased cooperation and exposure to inter-group violence, but most have not been able to identify the specific target of cooperation and are based on correlational data making it difficult to establish causality. 

In this study we test the hypothesis that inter-group conflict promotes parochial altruism (i.e., in-group altruism and out-group hostility) by using longitudinal data of a real-world measure of cooperation-charity and school donations-sampled before, during and after violent sectarian riots between Catholics and Protestants in Belfast, Northern Ireland. 

We find that conflict is associated with reductions in all types of cooperation, with reduced donations to a neutral charity, and both in-group and out-group primary schools. After the conflict, both in-group and out-group donations increased again. In this context we find no evidence that inter-group conflict promotes parochial altruism.

Below:  Map of Belfast with the neighborhoods Ballymacarrett 1 and Bellevue 2 in green and the 4 primary schools used in the donations experiments before, during and after the sectarian riots. Catholic primary schools (green markers) and Protestant primary schools (red markers).

Below:  Predicted donations by type over time. Predicted value (£) of an individual donating to the neutral charity Save the Children, an in-group primary school, an out-group primary school and all combined donations over time (before, during, and after the riots). These predicted values are controlled for individual household income, educational level, age, gender and religion. Error bars represent the standard errors.

Full article at:   http://goo.gl/mfidL5

By:   Silva AS1, Mace R1.

• 1Department of Anthropology, University College London London, UK. 

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HIV Incidence Prior To, During, and After Violent Conflict in 36 Sub-Saharan African Nations, 1990-2012: An Ecological Study

The aim of this study was to determine the association between violent conflict and HIV incidence within and across 36 sub-Saharan Africa countries between 1990 and 2012.

We used generalized linear mixed effect modeling to estimate the effect of conflict periods on country-level HIV incidence. We specified random intercepts and slopes to account for across and within country variation over time. We also conducted a sub-analysis of countries who experienced conflict to assess the effect of conflict intensity on country-level HIV incidence. All models controlled for level of economic development, number of refugees present in the country, and year.

We found that, compared to times of peace, the HIV incidence rate increased by 2.1 per 1000 infections per year (95%CI: 0.39, 3.87) in the 5 years prior to conflict. Additionally, we found a decrease of 0.7 new infections per 1000 people per year (95%CI: -1.44, -0.01) in conflicts with 25 to 1000 battle-related deaths and a decrease of 1.5 new infections per 1000 people per year (95%CI:-2.50, -0.52) for conflict with more than 1000 battle-related deaths, compared to conflicts with less than 25 battle-related deaths

Our results demonstrate that HIV infection rates increase in the years immediately prior to times of conflict; however, we did not identify a significant increase during and immediately following periods of violent conflict. Further investigation, including more rigorous data collection, is needed, as is increased aid to nations at risk of violent conflict to help in the fight against HIV/AIDS in sub-Saharan Africa.

Below: Annual Minimum, Maximum, and Mean HIV Incidence in 36 Countries in sub-Saharan Africa, 1990–2012

Full article at:  http://goo.gl/JbyPdU

By:  Brady W. Bennett, Brandon D. L. Marshall, Annie Gjelsvik, Stephen T. McGarvey, Mark N. Lurie

Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States of America

 

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