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      A social-ecological examination into the research, policy and health service delivery environment related to early marriage and sexual and gender-based violence among youth in Jordan

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          Abstract

          Background

          The determinants of sexual- and gender-based violence (SGBV) and early marriage are embedded across different levels of the social ecological system, including at the individual, family, community, and policy levels. In Jordan and the Middle East, SGBV, honor killing, and early marriage are priority public health and human rights issues that often overlap, and affect a significant percentage of youth. Jordan is home to a large number of refugees from across the Middle East, who may be even more vulnerable to these forms of violence than the local youth. The purpose of this analysis is to 1) synthesize the existing literature and 2) present the perspectives of key stakeholders to identify research gaps, programmatic lessons learned, and opportunities for policy change from an ecological perspective at the individual, community, health-system, and policy/legal levels.

          Methods

          This study includes 1) a systematic literature review of both published and unpublished literature since 2008 and 2) focus group discussions (FGDs) with key stakeholders representing 18 international and local governmental and non-governmental organizations.

          Results

          The literature review included 27 documents. Stakeholder discussions highlighted important research and policy gaps. Prevalence estimates of SGBV, honor killing, and early marriage vary across sources; however, all of them indicate that they remain important issues for youth in Jordan. Several sources indicate that early marriage has been increasing in Jordan since the beginning of the war in Syria, especially among Syrian refugees. Refugee youth are particularly vulnerable to SGBV and early marriage given the worsening economic situation in Jordan. The norms, attitudes, and practices that support SGBV in Jordan appear to be reinforced within families and communities. Despite ongoing programs, SGBV services are limited, especially for youth, and there is little awareness of service availability amongst target populations. Laws and policies continue to offer legal justification for SGBV, honor killing, and early marriage.

          Discussion

          As countries across the Middle East face instability and continue to struggle with the urgent health needs of large refugee and youth populations, this review provides valuable insight relevant to research, programs, and policy in Jordan and across the region.

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          Most cited references31

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          Prevalence and Health Impact of Intimate Partner Violence and Non-partner Sexual Violence Among Female Adolescents Aged 15-19 Years in Vulnerable Urban Environments: A Multi-Country Study.

          Globally, adolescent women are at risk for gender-based violence (GBV) including sexual violence and intimate partner violence (IPV). Those in economically distressed settings are considered uniquely vulnerable.
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            The impact of neighborhoods on intimate partner violence and victimization.

            Research on intimate partner violence (IPV) and victimization is widespread across disciplines. To date, the majority of research underscores the importance of individual-level factors to explain IPV, thereby neglecting the significance of macro-level elements. Nevertheless, research suggests that the characteristics of the neighborhood where an individual lives are important for fully understanding IPV. This review focuses on the effects of neighborhoods and macro-level context on violence between intimate partners, specifically identifying empirical studies that have examined contextual predictors of IPV utilizing the major tenets of social disorganization theory. The authors note consistencies and differences across research results and describe study features that may influence the patterns of these findings. Finally, the authors provide both theoretical and methodological recommendations for future research.
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              Setting research priorities for adolescent sexual and reproductive health in low- and middle-income countries

              OBJECTIVE: To conduct an expert-led process for identifying research priorities in adolescent sexual and reproductive health in low- and middle-income countries. METHODS: The authors modified the priority-setting method of the Child Health and Nutrition Research Initiative (CHNRI) to obtain input from nearly 300 researchers, health programme managers and donors with wide-ranging backgrounds and experiences and from all geographic regions. In a three-Phase process, they asked these experts to: (i) rank outcome areas in order of importance; (ii) formulate research questions within each area, and (iii) rank the formulated questions. FINDINGS: Seven areas of adolescent sexual and reproductive health were identified as important: (i) maternal health; (ii) contraception; (iii) gender-based violence; (iv) treatment and care of patients with human immunodeficiency virus (HIV) infection; (v) abortion; (vi) integration of family planning and HIV-related services and (vii) sexually transmitted infections. Experts generated from 30 to 40 research questions in each area, and to prioritize these questions, they applied five criteria focused on: clarity, answerability, impact, implementation and relevance for equity. Rankings were based on overall mean scores derived by averaging the scores for individual criteria. Experts agreed strongly on the relative importance of the questions in each area. CONCLUSION: Research questions on the prevalence of conditions affecting adolescents are giving way to research questions on the scale-up of existing interventions and the development of new ones. CHNRI methods can be used by donors and health programme managers to prioritize research on adolescent sexual and reproductive health.
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                Author and article information

                Contributors
                jgausman@mail.harvard.edu
                A.Othman@ju.edu.jo
                abeer.dababneh75@gmail.com
                maysoon.d@johud.org.jo
                iqbal@johud.org.jo
                insaf.daas@gmail.com
                alanger@hsph.harvard.edu
                Journal
                BMC Int Health Hum Rights
                BMC Int Health Hum Rights
                BMC International Health and Human Rights
                BioMed Central (London )
                1472-698X
                13 July 2020
                13 July 2020
                2020
                : 20
                : 16
                Affiliations
                [1 ]GRID grid.38142.3c, ISNI 000000041936754X, Women and Health Initiative, Department of Global Health and Population, , Harvard TH Chan School of Public Health, ; Boston, MA USA
                [2 ]GRID grid.9670.8, ISNI 0000 0001 2174 4509, Maternal and Child Health Nursing Department, School of Nursing, , The University of Jordan, ; Amman, Jordan
                [3 ]GRID grid.9670.8, ISNI 0000 0001 2174 4509, Center for Women’s Studies, , The University of Jordan, ; Amman, Jordan
                [4 ]Jordanian Hashemite Fund for Human Development, Amman, Jordan
                Author information
                http://orcid.org/0000-0002-9880-2591
                Article
                234
                10.1186/s12914-020-00234-y
                7359002
                32660477
                db88fbfd-356b-4219-8873-73b964c2fddc
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 19 May 2019
                : 19 May 2020
                Funding
                Funded by: Netherlands Organisation for Scientific Research
                Award ID: W 08.560.012
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Health & Social care
                refugees,youth,adolescents,sexual violence,gender-based violence,honor killing,early marriage,syria,jordan,middle east

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