Submission ID 130261
| Issue/Objective | Reproductive coercion and abuse (RCA) is an under-recognised form of gender-based violence that limits women's ability to make free and informed decisions about childbearing. In humanitarian settings, including among refugee populations, reproductive decision making is shaped not only by intimate partners but also by family members, community norms, and structural constraints linked to displacement, service access, and governance systems. However, existing RCA measures are largely developed in stable settings and focus mainly on partner-driven behaviours, which limits their ability to capture the full range of pressures experienced in these contexts. This study addresses this gap by developing and validating a comprehensive RCA scale tailored to refugee populations. The objective is to generate a contextually relevant and psychometrically robust tool that captures multi-level influences on reproductive decision making. This work is directly aligned with the conference theme of advancing equity in global health, as it strengthens the measurement of hidden forms of violence, supports more accurate evidence generation in humanitarian contexts, and informs policies and interventions that uphold sexual and reproductive health and rights among displaced populations. |
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| Methodology/Approach | We conducted a multi-phase scale development and validation study among Rohingya refugee women in Bangladesh. Initial items were generated through a systematic review and qualitative interviews with diverse community stakeholders. Items were refined through a three-round Delphi process and cognitive interviews. The final items were field tested in a survey of 1,142 women. Psychometric evaluation included item performance assessment, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) using split samples. Internal consistency, construct validity, and external validity were assessed using standard psychometric approaches, including regression analyses examining associations with contraceptive use and unintended pregnancy. |
| Results | Of 24 initial items, 14 were retained following assessment of item performance and conceptual relevance. Factor analyses supported a two-factor structure representing individual-level and structural or community-level coercion. The model demonstrated good fit (comparative fit index 0.95-0.98, root mean square error of approximation 0.04-0.05, and standardised root mean square residual 0.015). Internal consistency was high (Cronbach's alpha 0.88-0.89; omega 0.87-0.98), and convergent validity was supported by average variance extracted values above 0.70. RCA was associated with higher odds of unwanted pregnancy (individual-level: odds ratio 2.92, 95% CI 1.92-4.45; structural or community-level: 2.06, 1.36-3.12). Associations with contraceptive use were weaker and not statistically significant (individual-level: 0.76, 0.57-1.00; structural or community-level: 0.98, 0.75-1.27), although they remained directionally consistent with theoretical expectations. |
| Discussion/Conclusion | This study provides a validated and contextually relevant measure of RCA that captures both interpersonal and structural dimensions in humanitarian settings. The scale advances measurement beyond partner-focused tools and highlights the importance of addressing multi-level drivers of reproductive autonomy in displaced populations. |
| Presenters and Affiliations | Nuruzzaman Khan Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Australia Karen Block Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Australia. |
