Journal Articles

Violence against women (VAW) and violence against children (VAC) are public health issues of global concern. Intimate partner violence (IPV) is a commonly occurring form of VAW and there is evidence to suggest that IPV and VAC frequently co-occur within the same families. This systematic literature review searched for studies published in any language between 1st January 2000 to 16th February 2021 and identified 33 studies that provided findings for co-occurring IPV and VAC in 24 low- and middleincome countries (PROSPERO: CRD42020180179). These studies were split into subgroups based on the types of cooccurring violence they present and meta-analyses were conducted to calculate pooled odds ratios (ORs) within these subgroups. Our results indicate a significant association between IPV and VAC, with all pooled ORs showing a significant positive association between the two. Almost half of the studies focused exclusively on co-occurrence between male-to-female IPV and female caregiver-to-child VAC; few authors reported on male caregiver-to-child violence. Only three studies identified risk factors for co-occurring IPV and VAC, and those that did suggested conflicting findings on the risks associated with maternal age, alcohol and drug use, and parental education level. We also found incongruity in the violence definitions and measurements used across studies. Future research should aim to develop more consistent definitions and measurements for co-occurrence and move beyond solely examining dyadic and unidirectional violence occurrence in families; this will allow us to better understand the interrelationships between these different forms of abuse.

Poverty is a structural driver of risky sexual behaviors. While cash transfers can mitigate some of this risk, complementary interventions have been posited as a way to further reduce multidimensional vulnerability. We examine the impacts of a multicomponent intervention targeted to Tanzanian adolescents on their sexual behaviors and reproductive health. The intervention comprised livelihood and life skills training, mentoring, and health facilities’ strengthening. Data come from a cluster randomized controlled trial, where one study arm received the intervention and the other was randomized to control, but both arms participated in a government cash transfer program. Among 1,933 adolescents interviewed over three rounds, we found increases in contraceptive and HIV knowledge. The program also increased health seeking and HIV testing among boys, but slightly reduced age at sexual debut among girls. There were no impacts on contraceptive use, number of sexual partners, or pregnancy. Findings support the value of an adolescent intervention, and the fact that it was delivered within a social protection platform suggests a potential for scalability. Additional efforts are required to delay sexual debut and reduce the number of sexual partners and pregnancy, possibly through addressing supply-side barriers and social norms, or through additional linkages to economic opportunities.

Globally, around 650 million girls and women married before their 18th birthday. According to recent data, Sub-Saharan Africa accounts for the largest share of child, early, and forced marriage and unions (CEFMU), with 35 percent, followed by South Asia, with 30 percent. But as research expands, new geographies are coming into focus, including Latin America and the Caribbean, where one in four girls under the age of 18 are married.

Despite the evidence emerging from new settings, research still tends to focus on a limited subset of countries. Although the prevalence of CEFMU is greater in low- and middle-income countries, child marriage also occurs in high-income countries: for example, between 2000 and 2015, more than 200,000 minors, of whom 87 percent were girls and 13 percent were boys, were married in the United States.

Scholars and activists agree that the proportion of girls getting married early in many countries across the globe is very high compared to their male counterparts. However, analyses of CEFMU tend to focus solely on age to describe and explain this phenomenon. The underlying assumption is that once girls reach the age of 18, they are at reduced risk of violence and nonconsensual marriage. This ignores other important factors that place girls at risk, such as poverty, gender inequalities, including harmful gender norms, traditional understandings of femininities and girlhood, and gender-based violence.

The role child marriage plays in controlling female bodies, specifically young girls, and regulating their sexuality continues to be under-addressed in the discourse around gender equality and CEFMU. The aim of this special edition of the Journal of Adolescent Health is to present recent research on the diverse manifestations of child marriage around the world. This means going beyond geographies on which rich evidence already exists in order to amplify diverse voices and highlight the intersections between this practice and other manifestations of gender inequality and oppression.

The collection of studies in this supplement takes this wholistic approach, so well captured in the commentary by Kimball and Dwivedi: “Our intention was never simply to work toward stopping child marriage, but to approach it via its root causes and to develop more holistic, transformational processes” for responding to the practice.

This editorial paper presents 11 papers related to the special issue proposed by UNICEF on the Education Response to COVID-19. The COVID-19 pandemic provoked an education emergency of unprecedented scale. At its onset in February 2020, school closures were announced in the worst-hit countries. At the peak of the crisis, 90 per cent of learners worldwide had had their education disrupted. Some learners, especially those from the most marginalised population groups, were put at risk of permanent dropout, provoking long-term and significant negative effects on children’s life-long wellbeing and the socio-economic development of their communities and countries. This special issue, which received contributions from UNICEF staff and various researchers, focuses on the impact of school closures, the effectiveness of remote learning solutions, equity implications, the mitigation of learning loss and notions around re-opening better. Different research perspectives and evidence is gathered to help strengthen policy considerations and future planning. The conclusion emphasizes building on the innovative solutions generated by the response to the crisis to make education systems more resilient, whilst also reinforcing the focus on equity and inclusion so that pre-existing disparities are not exacerbated in the future.

This article investigates to what extent disrupted schooling and dropout affects children’s acquisition of foundational skills prior to and during the COVID-19 pandemic. Using household survey data from thirteen low- and lower-middle-income countries, we find that missing or dropping out of school is associated with lower reading and numeracy outcomes. Drawing on global surveys conducted during the pandemic, we find that countries’ remote learning responses are often inadequate to keep all children learning, avoid dropout, and mitigate the learning losses our findings predict, particularly for marginalized children and those at the pre-primary level.

While numerous studies evaluate the effectiveness of teacher training and textbook distribution programs, few look at the effects of training programs on vulnerable students, those at the lower end of academic performance. Addressing this gap is important to improve the efficiency of student learning and address the equity gaps in early education. Our study makes this point with two models of a program that combines teacher training with textbook distribution in Papua and West Papua Provinces of Indonesia. Between two waves of data collection in 2015 and 2017, we find that participation in the program is significantly associated with improvements in early grade reading ability, observing increases in reading scores (with or without adjustment for time spent in the program). We also find a significant decline in zero-scorers, that is, students who cannot read a single word correctly; students in program schools (under both models) are at least 80 percent less likely to score zero than their peers in control schools by 2017. Our approach highlights the importance of incorporating the equity perspective in program evaluation through an explicit focus on vulnerable students.

This paper investigates the effects of social assistance on subjective well-being looking at the case of Kyrgyzstan. For this purpose, we exploit recent changes in the design of social assistance and apply a difference in difference (DiD) method combined with an inverse probability weighting (IPW) technique. In contrast to the existing literature, we find that in the short-term, the receipt of social assistance benefits is associated with lower levels of subjective well-being. Our findings also reveal that participation in social assistance leads to some reduction in satisfaction regarding recipients’ own economic conditions. Moreover, we find that the negative effects on subjective well-being disappear for the oldest generations, which experienced the dissolution of the Soviet Union. By contrast, the effect is negative for the youth, who grew up in a new society where needing help is ultimately the responsibility of the individual citizen. For individuals with high trust in political institutions, the negative effect of state intervention does not hold, while it persists in case of low trust in political institutions.

The coronavirus disease 2019 (COVID-19) pandemic has affected children’s risk of violence in their homes, communities and online, and has compromised the ability of child protection systems to promptly detect and respond to cases of violence. However, the need to strengthen violence prevention and response services has received insufficient attention in national and global pandemic response and mitigation strategies. In this paper, we summarize the growing body of evidence on the links between the pandemic and violence against children. Drawing on the World Health Organization’s INSPIRE framework to end violence against children, we illustrate how the pandemic is affecting prevention and response efforts. For each of the seven INSPIRE strategies we identify how responses to the pandemic have changed children’s risk of violence. We offer ideas for how governments, policy-makers, and international and civil society organizations can address violence in the context of a protracted COVID-19 crisis. We conclude by highlighting how the current pandemic offers opportunities to improve existing child protection systems to address violence against children. We suggest enhanced multisectoral coordination across the health, education, law enforcement, housing, child and social protection sectors. Actions need to prioritize the primary prevention of violence and promote the central role of children and adolescents in decision-making and programme design processes. Finally, we stress the continued need for better data and evidence to inform violence prevention and response strategies that can be effective during and beyond the COVID-19 pandemic.

UNICEF operates in 190 countries and territories, where it advocates for the protection of children’s rights and helps meet children’s basic needs to reach their full potential. Embedded implementation research (IR) is an approach to health systems strengthening in which (a) generation and use of research is led by decision-makers and implementers; (b) local context, priorities, and system complexity are taken into account; and (c) research is an integrated and systematic part of decision-making and implementation. By addressing research questions of direct relevance to programs, embedded IR increases the likelihood of evidence-informed policies and programs, with the ultimate goal of improving child health and nutrition.

This paper presents UNICEF’s embedded IR approach, describes its application to challenges and lessons learned, and considers implications for future work.

From 2015, UNICEF has collaborated with global development partners (e.g. WHO, USAID), governments and research institutions to conduct embedded IR studies in over 25 high burden countries. These studies focused on a variety of programs, including immunization, prevention of mother-to-child transmission of HIV, birth registration, nutrition, and newborn and child health services in emergency settings. The studies also used a variety of methods, including quantitative, qualitative and mixed-methods.

UNICEF has found that this systematically embedding research in programs to identify implementation barriers can address concerns of implementers in country programs and support action to improve implementation. In addition, it can be used to test innovations, in particular applicability of approaches for introduction and scaling of programs across different contexts (e.g., geographic, political, physical environment, social, economic, etc.). UNICEF aims to generate evidence as to what implementation strategies will lead to more effective programs and better outcomes for children, accounting for local context and complexity, and as prioritized by local service providers. The adaptation of implementation research theory and practice within a large, multi-sectoral program has shown positive results in UNICEF-supported programs for children and taking them to scale.