Globally, more than 12 million girls under the age of 18 are forced to marry every year. Progress on ending child marriage in the Arab region is slowing, and risks being reversed, due to an increase in conflict-affected populations and widespread economic crisis. The aim of this paper is to consider the research priorities across the region to inform effective and accelerated child marriage prevention and response programming within the Arab region. Seventy-three specialists supporting child marriage prevention and response programming in the Arab region engaged with up to three phases of an online Delphi consultation process on research gaps and the research environment between July 2019 and December 2021. Proposals of research gaps were elicited, reviewed, and rated by participants to confirm a shared learning agenda. Participants identified 50 different research gaps across 7 main areas, reaching a high level of consensus support for 23 of 50 statements. Clear consensus was reached in relation to an increased need to produce and use evidence to support programme development, and further research on specific drivers and consequences of child marriage. The least consensus was found in relation to how research can inform prevention and response efforts within the law and legal system. The results provide the foundation of a child marriage research agenda for the Arab region which takes into account regional distinctiveness and builds on the global momentum for child marriage research. Mechanisms are in place to do this through the Regional Action Forum, and other networks across the region.

ObjectiveTo examine incidence of child marriage among displaced and host populations in humanitarian settings.DesignCross-sectional surveys.SettingData were collected in Djibouti, Yemen, Lebanon and Iraq in the Middle East and in Bangladesh and Nepal in South Asia.ParticipantsAdolescent girls aged 10–19 in the six settings and age cohort comparators.Outcome measuresCumulative incidence of marriage by age 18.ResultsIn Bangladesh and Iraq, the hazard of child marriage did not differ between internally displaced populations (IDPs) and hosts (p value=0.25 and 0.081, respectively). In Yemen, IDPs had a higher hazard of child marriage compared with hosts (p value<0.001). In Djibouti, refugees had a lower hazard of child marriage compared with hosts (p value<0.001). In pooled data, the average hazard of child marriage was significantly higher among displaced compared with host populations (adjusted HR (aHR) 1.3; 95% CI 1.04 to 1.61).In age cohort comparisons, there was no significant difference between child marriage hazard across age cohorts in Bangladesh (p value=0.446), while in Lebanon and Nepal, younger cohorts were less likely to transition to child marriage compared with older comparators (p value<0.001). Only in Yemen were younger cohorts more likely to transition to child marriage, indicating an increase in child marriage rates after conflict (p value=0.034). Pooled data showed a downward trend, where younger age cohorts had, on average, a lower hazard of child marriage compared with older cohorts (aHR 0.36; 95% CI 0.29 to 0.4).ConclusionsWe did not find conclusive evidence that humanitarian crises are associated with universal increases in child marriage rates. Our findings indicate that decision-making about investments in child marriage prevention and response must be attuned to the local context and grounded in data on past and current trends in child marriage among communities impacted by crisis.

Household violence poses a significant threat to the physical and mental health of adolescent girls. In conflict-affected communities, increased stresses to safety, security, health, and livelihoods may heighten this risk. While it is widely evidenced that the caregiver-child relationship can increase or protect against girls’ risk of violence, less is known about the role of male siblings. Sibling Support for Adolescent Girls in Emergencies (SSAGE) used whole-family support programming to synchronously engage adolescent girls, their male siblings, and their caregivers in conflict-affected communities in Jordan and Niger, using gender-transformative approaches to explore the impacts of gender norms, power, and violence and encourage support and emotional connection. We conducted qualitative research activities, including focus group discussions, participatory group activities, and in-depth, paired, and key informant interviews with 469 SSAGE participants and program facilitators to explore SSAGE’s impact on the male-female sibling dyad in both settings. The multi-stakeholder team used a collaborative thematic analysis approach to identify emergent themes. Findings suggest that the inclusion of male siblings in family strengthening programs may have a positive impact on factors related to girls’ protection, with research participants discussing decreased perpetration of physical and verbal violence by male siblings, increased equity in household labor between siblings, and improved trust and mutual support among siblings. These changes were facilitated by improved communication and interrogation of positive gender identities. In humanitarian settings, interventions that support more gender-transformative, egalitarian, and emotionally effective relationships between male-female siblings can work towards improving girls’ protective assets. More research on the impact of this relationship on girls’ experience of immediate and long-term experience of violence is needed. In settings where gender power dynamics among male-female siblings are less salient, other relationship dyads should be explored.

While family functioning interventions show promise for improving adolescent girls' well-being in humanitarian contexts, few programs employ a gender-transformative approach to maximize benefits for adolescent girls. This paper presents findings from a mixed-methods pilot evaluation of a whole-family, gender-transformative intervention conducted with Syrian refugee families in Jordan. The Siblings Support of Adolescent Girls in Emergencies program was implemented with 60 Syrian refugee households in Azraq and Za'atari camps in Jordan. A quantitative survey was administered to 18 households at baseline and endline, and researchers conducted qualitative interviews and focus group discussions with caregivers, paired interviews and participatory discussions with adolescents, and key informant interviews with program mentors. Paired t-tests revealed statistically significant improvements in mental distress, resilience, and gender equitable attitudes in the full sample and for girls only and marginally significant improvements in family functioning. Qualitative findings revealed improvements in four domains of girls' well-being-self-efficacy, self-confidence, pro-social behavior, and mental health-through three primary pathways: family members' increased gender equitable attitudes, healthier intrahousehold communication, and greater affective involvement. Findings from this mixed-methods evaluation point to the potential value in merging gender-transformative and whole-family approaches in humanitarian programming to maximize positive impacts for adolescent girls.

BackgroundFemale genital mutilation (FGM) is widely recognized as a human rights violation. Little is known about FGM rates and practices in humanitarian settings, and about the impact of crisis on the drivers and consequences of FGM. This scoping review set out to investigate the current research landscape on FGM in humanitarian settings.MethodsWe conducted a search of electronic databases and gray literature published between 1990 and 2021. This was coupled with backward citation tracking on eligible studies and reviews. We analyzed studies that met our eligibility criteria using thematic analysis.ResultsWe found 13 peer-reviewed and four grey literature articles. Most studies were published in the last decade between 2010 and 2021, signaling growing attention to the issue. Five of the 17 articles provided estimates of incidence based on primary data collection amongst crisis-affected populations, ten focused on drivers, ten on consequences and five on interventions. The limited studies that have examined FGM in humanitarian settings indicate that the impact of crisis on FGM is multifaceted and context-specific, depending in part on interactions with host and other displaced communities and their social norms and practices. There is evidence that the acquisition and transfer of harmful social norms may take place during migration flows, but also that social norms underlying FGM may weaken in contexts of displacement, causing the practice to decrease. The incidence of FGM may also remain unchanged, but the type of FGM practiced may shift from more harmfully perceived forms to less radical forms. We found that drivers of FGM may be exacerbated, attenuated, or unchanged by crisis and displacement. Overall, there was predominant focus on medical consequences of FGM, and limited research on the social, economic, and psychological consequences of the practice. There was also a dearth of research into intervention effectiveness.ConclusionsDespite an increase in research on FGM in humanitarian settings, there is still a notable dearth of studies investigating the impact of emergencies on FGM and the factors that propel it. More research and documentation of evidence are needed to inform interventions and policies.

Pakistan regularly faces natural disasters and has a longstanding disaster risk management infrastructure. It is also a nation with high maternal and newborn mortality. Rahnuma-Family Planning Association of Pakistan, with support from the US Centers for Disease Control and Prevention, the Women’s Refugee Commission and the International Planned Parenthood Federation South Asia Region’s Sexual and Reproductive Health Programme in Crisis and Post Crisis Situations Initiative, embarked on building community capacity to prepare for and respond to sexual and reproductive health (SRH) risks in select disaster-prone areas in Pakistan, and linking communities to existing disaster risk management structures at national, regional and district levels.The initiative began with a training of trainers at the national level, which was cascaded to six union councils (UCs) in three districts in Khyber-Pakhtunkhwa, Punjab and Sindh provinces. Participants developed action plans for their respective UCs that addressed gaps in implementing the Minimum Initial Service Package (MISP) for SRH, the international standard of care for SRH in emergency settings. Communities spent 1.5 years implementing their action plans to strengthen their capacity to respond to SRH needs in the event of an emergency.Project learning highlights the benefits of investing in preparedness to strengthen core services and linking communities to existing formal structures. Action planning led to immediate gains and longer-term benefits. The MISP for SRH was integrated into disaster risk management at all levels. Community mobilisation, awareness raising and the creation of blood donor groups and emergency transport contributed to averting mortality at the community level.

ABSTRACT Introduction Incarceration, which affects more than 200,000 women annually, has a multidimensional negative impact on these women's health and wellbeing, including their sexual health. Sexual satisfaction, defined as a subjective evaluation of a sexual relationship, depends on several sociocultural and biopsychological factors, including the individual's physical and mental health, their schooling, and the intimacy setting. These factors are exacerbated in correctional facilities. Most obvious, is the women's lack of a desirable settings for sexual intimacy. It is essential to maintain sexual function in prison as women continue to be sexual beings with sexual needs. Despite this need, there are few initiatives addressing sexual health in incarcerated women, which is known to impact general and mental health, family function, and recidivism. The NJ Commission on Women's Reentry (NJCWR) was legislated to address the health and wellness of both incarcerated and reentry women, including their sexual health. Objective To study incarcerated women's sexual health and the impact of incarceration. Methods A Literature review was conducted on sexual function in US correctional facilities by searching PubMed/Medline and Google Scholar. Relevant publications were sought using keyword combinations including, "sexual function," "sexual satisfaction," "conjugate visits," "incarcerated women," "mental health," "general health," and "US correctional facilities." Results Correctional facilities often enforce abstinence on incarcerated women and adopt deprivation as a measure to resolve sexual desires during incarceration. Additionally, limited knowledge is available about the quality of sexual experiences in the small number of facilities that provide conjugal visits. The available literature shows high levels of sexual dysfunction amongst incarcerated women that is significantly correlated with an increase in mental health issues, aggression, and recidivism. Data suggest that sexual deprivation is more significantly associated with mental health disorders than partner status and romantic relationships. Incarcerated individuals have expressed the lack of sexual contact as "sexual torture." Alternative methods sought may be coercive, less satisfactory, and/or riskier behaviors, possibly leading to transmission of sexual diseases. Only six states allow conjugal visits even though it is a suggested solution with primarily benefits including lower sexual offenses, rape, and disciplinary records in prison. However, many facilities that permit conjugal visits lack private space for the couple. Conclusions Determinants of sexual health include complex cognitive, emotional, and physiological processes. Sexual deprivation and dysfunction dehumanize incarcerated women and negatively affect sexual health, in addition to overall general health. Sexual function and satisfaction is a primarily understudied area in the carceral system, considering all of the barriers to sexual expression. It is imperative for more initiatives, such as those being carried out by the NJCWR, in order to effectively address the needs of incarcerated women, including their sexual health. Disclosure No

ABSTRACT Audio Computer-Assisted Self-Interview (ACASI) has become increasingly popular for collecting data on sensitive topics among populations with lower levels of literacy. However, the development of an ACASI tool is an involved process that can be further complicated when working in humanitarian contexts during the COVID-19 pandemic. This study describes the development of an ACASI tool to be used in a family-focused intervention evaluation. Participants included adolescent girls aged 10-14, adolescent boys aged 15-19, and caregivers in Borno State, Nigeria. Data to inform the tool’s development were collected using cognitive interviews, ACASI demonstrations, and post-demonstration assessments with adolescent girls, adolescent boys, and caregivers, as well as a focus group discussion with enumerators. Data found high levels of acceptance for the tool and helped identify appropriate visual representations for various answer options to maximize usability. The survey was found to be too long to administer solely through ACASI; the final tool employs a combination of ACASI and computer-assisted personal interview formats. Findings highlight the importance of repeatedly piloting and testing these types of tools to ensure content and language resonate with intended users. However, the steps employed demonstrate that researchers can maintain a commitment to developing high-quality, community-grounded research tools despite challenges germane to humanitarian settings.

BackgroundHousehold violence is one of the most prevalent forms of gender-based violence faced by adolescent girls in humanitarian settings. A growing evidence base demonstrates the extent to which multiple forms of familial violence, including intimate partner violence, violence against children, and sibling violence overlap in the same households. However, existing evidence of family support programming that effectively reduces violence against girls by addressing intersecting forms of household violence are limited, particularly in the Global South. Through a qualitative implementation evaluation informed by a grounded theoretical approach, we explored the perceived impact of a gender transformative, whole-family support intervention aimed at building adolescent girls’ protective assets against violence, among program participants in two communities of internally displaced people Maiduguri, Borno State, Northeast Nigeria.MethodsWe conducted six in-depth interviews and six focus group discussions with adult caregivers; six participatory activities and four paired interviews with adolescent girls and boys; and 12 key informant interviews with program staff. Criterion sampling was used to recruit 21 male caregivers, 21 female caregivers, 23 adolescent boys, and 21 adolescent girls; purposive sampling was used to recruit 12 program staff to participate in qualitative research activities. We audio recorded, translated, and transcribed all interviews. In a collaborative coding process, a multi-stakeholder team used applied thematic analysis in Dedoose to identify emergent themes in the data.ResultsParticipants reported a decreased tolerance for and perpetration of violence against girls at the household level, and endorsed their right to protection from violence at the community level. However, alongside these self-reported changes in attitude and behavior, aspects of normative, patriarchal norms governing the treatment of adolescent girls were maintained by participants.ConclusionsThis study builds the evidence base for gender transformative, whole-family support programming and its impact on preventing violence against adolescent girls in humanitarian emergencies. Situating our findings in a feminist analysis of violence, this study calls attention to the complexity of gender norms change programming amongst families in conflict-affected settings, and highlights the need for programming which holistically addresses the relational, community, and structural drivers of violence against girls in emergencies.