There were 697 press releases posted in the last 24 hours and 150,815 in the last 365 days.

Democracy, Human Rights, and Labor: FY 14: Gender-based violence among stateless and national populations in Cote d'Ivoire

October 2017

Report by Johns Hopkins University

TABLE OF CONTENTS

EXECUTIVE SUMMARY.................................................................................................................... 3

INTRODUCTION AND BACKGROUND............................................................................................. 7

METHODS........................................................................................................................................ 9

Overview....................................................................................................................................... 9

Appendix 1 provides the detailed methodology of the qualitative and quantitative phases................. 9

RESULTS........................................................................................................................................... 9

Demographic characteristics.......................................................................................................... 9

Reproductive health and children.................................................................................................. 12

Lifetime experiences of childhood, intimate partner, and non-partner violence among women...... 12

Lifetime experiences of childhood, intimate partner, and non-partner violence among men........... 14

Perpetration of intimate and non-partner violence among national and stateless men.................. 14

Correlates of violence victimization among stateless women and men........................................... 15

General Health............................................................................................................................. 18

DISCUSSION................................................................................................................................... 19

Conclusions and recommendations:.............................................................................................. 21

JHU AND ASA STUDY TEAMS........................................................................................................ 23

ACKNOWLEDGMENTS................................................................................................................... 23

Appendix 1 Detailed Study Methodology................................................................................... 24

Qualitative research..................................................................................................................... 24

Quantitative Research.................................................................................................................. 24

Appendix 2: Results Tables.......................................................................................................... 28

REFERENCES.................................................................................................................................. 39

Global estimates suggest that approximately 10 million people worldwide are living without any legal citizenship. Stateless persons face overwhelming obstacles that limit their access to basic entitlements and protections, leaving them vulnerable to discrimination and abuse. Research on health and access to care is generally limited among stateless persons and, currently, there is a dearth of information on statelessness and its relationship to gender based violence (GBV).

The aims of the project were to understand the demographics, experiences, and vulnerabilities of GBV and general health status among stateless populations. This study focused on stateless populations, which is defined as populations who currently live in Cote d’Ivoire who are not citizens of another country nor are migrants because the persons do not have birth certificate from any country or their parents do have national certificate from their country of origin.

Methods: To achieve study aims we utilized a mixed methodology approach, conducted in two phases. The first phase included qualitative research with stateless persons and key informants who serve these populations. Qualitative research enabled us to obtain contextual descriptions of experiences related to documentation, GBV and GBV-related health issues, and access to health care. The second phase included an epidemiologic survey conducted among stateless and national populations, which was informed by qualitative findings. The epidemiologic survey was developed to collect data on a wide array of GBV experiences and GBV-related health indicators as well as to assess availability and access to related GBV services. These two methods were complementary in nature, providing both numeric estimates and contextual support of the topics of interest. This study was conducted by Johns Hopkins University and a local implementing organization, Afrique Secours et Assistance (ASA) and the UNHCR country office in Abidjan, Cote d’Ivoire.

Results: A quantitative cross-sectional survey was conducted throughout Cote d’Ivoire from March 8-May 4, 2017 in rural settings (45 communities) where stateless populations are known to reside and where local leaders and their community were willing to participate in the survey.

A total of 364 women participated, of whom 167 were nationals and 197 were stateless. Compared to national female participants, stateless females were less likely to have ever attended school, less likely to have attended secondary school or college (among those who attended school), and less likely to have a dual parent household during childhood (55.4% vs. 62.9%). In addition, stateless female participants were more likely to have faced challenges with legally marrying someone due to their lack of birth registration and less likely to have enough to meet basic needs for each month (Figure 1).

Figure 1: Demographic differences among surveyed women

A total of 221 men participated, of whom 104 were nationals and 117 were stateless. Similar to stateless female participants, stateless males were less likely to have ever attended school, less likely to have attended secondary school, or college (among those who attended school), less likely to have grown up in a dual parent household less likely to be married, and more likely to have ever faced challenges with legally marrying someone when compared to their national counterparts (Figure 2). In addition, stateless men were less likely to be legally able to open a bank account, and less likely to have health insurance. Stateless men’s partners were less likely than national men’s partners to be able to open a bank account (36.8 vs. 73.4%). Both male and female stateless participants reported the same challenges among their children.

Figure 2: Demographic differences among surveyed men

Approximately one-third of stateless and national women reported physical abuse during childhood (aged 15 years), 7% reported childhood sexual abuse, and 33% reported any childhood physical or sexual abuse. Forty percent reported lifetime physical IPV in adulthood, 27% lifetime sexual IPV, and 40% lifetime physical or sexual IPV, with no difference by nationality status. Among women reporting any IPV victimization, less than one-quarter ever reported IPV victimization to an authority. Sixteen percent of national and stateless women reported physical violence during adulthood by a non-partner. Slightly fewer national than stateless women reported experiencing sexual violence victimization by a non-partner (6.7% vs. 2.2%) and 20% reported any physical or sexual violence by a non-partner with no difference by nationality. In total, approximately 53% of national and stateless women reported any lifetime physical or sexual violence in adulthood or childhood, with no significant difference by nationality status.

Figure 3. Violence victimization among surveyed women

As a child, 47% of men reported experiencing physical abuse, 8% childhood sexual abuse, and 49% any childhood physical or sexual abuse, with no difference by nationality. One in five men (21.3%) reported physical violence during adulthood, 4% sexual violence, and 25% any physical or sexual violence by a partner or non-partner, with no difference by nationality. In total, 25% of national male participants reported any lifetime violence victimization.

Figure 4. Violence victimization among surveyed men

Stateless women were more likely to report difficulty getting money for medical advice or treatment (72.7% vs. 50.0%), and concerns about deportation when accessing healthcare (40.2% vs. 1.3%) relative to national women. Stateless men were also more likely than national participants to report concerns getting money needed for health advice or treatment (73.9% vs. 48.5%), distance to the health facility (37.9% vs. 20.2%) and fear of deportation when accessing healthcare (39.7% vs. 0%) compared to national men.

Conclusions: Gender-based violence is high in Cote d’Ivoire, but does not appear to be different by national or stateless status. However, disparities in basic rights places stateless populations in vulnerable situations. Further, concerns of deportation and worse economic positions prevent stateless persons from accessing healthcare and protection services, potentially including services for GBV.

Emerging research has been conducted to analyze the legal status, legal rights, and livelihoods of stateless persons, yet there is a dearth of evidence as to how statelessness impacts risks and experiences of gender-based violence (GBV), related health outcomes, and access to care for GBV. Global estimates suggest that approximately 10 million people worldwide are living without any legal citizenship.[1] The human rights of stateless persons are protected under international human rights law, though state recognition and respect for these rights is mixed.[2] Some states manipulate nationality and citizenship requirements in an effort to oppress and ostracize minority religious, ethnic and racial groups. As a result, stateless persons often face overwhelming obstacles that limit their access to basic entitlements and protections, leaving them vulnerable to discrimination and abuse.

A comprehensive review of the literature has revealed that most published work either focuses on the legal challenges of statelessness or offers an evaluation of the social, political and economic effects of statelessness on populations. There is a dearth of literature that exists on the situation and contexts of GBV, statistical estimates of GBV, and GBV related health impacts among stateless populations. Current research establishes that displaced women and refugee women are at increased risk of GBV,[3-7] but there is little information on GBV among stateless populations. By exploring this relationship, this proposed study aims to characterize the contexts and risks of GBV among stateless populations and establish recommendations for policy change and programming options to addressing GBV among these stateless populations.

The effects of migration and conflict, hurdles in issuance of birth certificates, challenging definitions of nationality, and discrimination have resulted in an estimated 700,000 persons who are stateless or at-risk for statelessness in Côte d’Ivoire.[8, 9] Migration is one of the principal factors associated with statelessness, whether this was related to historical migration (prior to independence) or a recent migration. The border between Burkina Faso and Côte d’Ivoire serves as the busiest migrant route in Africa. Over the past few decades millions of migrants from Burkina Faso, Mali and Ghana have traveled to Côte d’Ivoire to work or seek asylum, and thousands of Ivoirians have returned home after fleeing conflict or persecution. In fact, as of 2013, an estimated 12.3% of population in Côte d’Ivoire were migrants.[10] Individuals who migrated prior to independence were given one year to apply for naturalization after independence; however, most failed to do so. Speculation by UNHCR suggests this missed opportunity was due to lack of awareness or individual belief they were Ivorian and did not require registration. The lack of documentation has extended down through generations of long-term migrations and the current failure to keep government records of migrations prevents recent migrant from obtaining documentation.[11] Côte d’Ivoire also currently receives a large number of refugee returns, receiving over 80,000 in 2012-13. The majority of these individuals, and the children born in asylum, also return without documentation or birth certificates – approximately 80% of returnees are returning to areas where civil records have been destroyed by conflict. Moreover, the legacy of statelessness associated with lack of documentation and lost of documentation as a result of conflict also affects those who were born in Cote d’Ivoire. Statelessness subsequently is passed on from one generation to the next.

The challenge to national documentation is attributable to ambiguous and restrictive national laws of citizenship: Ivorian nationality is based on the jus sanguinis principle of citizenship, meaning that nationality is determined by parentage, not by location of birth. Specifically, this requires having at least one Ivorian parent, though prior to independence there was no Ivorian nationality or ethnicity.[12] This law was later amended to provide nationality to anyone born in the country prior to 1972; however, this resulted in the nationalization of only a few hundred.[11] The nationality code has enabled the discrimination of specific minorities groups, referred to as “dioulas”, who are various ethnicities but predominantly of the Muslim faith living in Northern Côte d’Ivoire. Birth and residence in Côte d’Ivoire, these groups have been excluded from citizenship on the basis of being considered ‘foreign.’[12] Children who are double orphans or abandoned also risk statelessness, as a birth certificate verifying relation to an Ivorian national is necessary to prove nationality.

A large number of people living in Côte d’Ivoire experience administrative hurdles, difficulty verifying their nationality, and are thus stateless or at risk for becoming stateless. Ambiguous definitions and complicated rules for conferring nationality to children and unregistered adults make the process of obtaining documentation of Ivorian citizenship extremely difficult. Special certificates of nationality are issued in the process to effect naturalization. Once issued, these certificates are only valid for 6 months and can be questioned by authorities and revoked by the courts. A key barrier to this is the requirement of verification by demonstration of one’s birth certificate and proof of citizenship of at least one family member. In a setting with limited documentation, meeting these requirements is challenging for many applicants.[8, 11] Without a certificate of nationality a person is unable to own property, access state health and education services or obtain a state identity card. Failure to demonstrate documents at checkpoint restricts movement, unless the traveler can pay a bribe. Ivorian nationality is required for land ownership, preventing demonstration of ownership in the case of land disputes, particularly in areas where returnees reside.[11]

In the absence of data on GBV among stateless persons, some general information can be drawn from conflict-affected communities in Côte d’Ivoire. The country’s civil war resulted in a dire humanitarian situation in the country, with 67% of women reporting that they had experienced some form of GBV, often within the context of conflict.[13] A study of 12 rural, conflict-affected communities estimated that approximately 10% of women and 6% of men had experience a lifetime history of forced sex. Moreover, recent intimate partner physical violence (last 12 months) was prevalent and reported by 21% and 10% of women and men, respectively. Across physical and sexual violence, perpetrators were rarely combatants, but were more commonly acquaintances, strangers and family member, including both genders. [14] Evidence of perpetration by non-combatants is important, highlighting perpetration of GBV during opportunities of vulnerability, and may be similar for stateless persons who lack access to basic rights, justice, and healthcare and who may, themselves, have been affected by conflict.

Other qualitative research from conflict-affected women in Uganda suggests that extended family members are often the perpetrators of GBV in the aftermath of a conflict.[15] Little attention is given to GBV inflicted upon women by extended family members, although intra-familial GBV has been associated with many of the same negative health affects reported by victims of IPV.[16] A 2013 post-conflict study examining GBV in Côte d’Ivoire found that women who experienced adversity or whose family had been victimized in the conflict reported increased rates of past-year in-law abuse, affecting almost 25% of studied women in the last 12 month.[17]

While national law prohibits rape, with penalty of 5 – 20 years in prison, there is no law protecting women from spousal rape and does not specifically outlaw IPV.[9] Even for those who experience rape, women residing in Cote D’Ivoire without certification of citizenship would be limited in their access to state services, including healthcare and education, putting them at increased risk for continued abuse and subsequent or continued negative health outcome.[11] Moreover, survivors of rape are required to pay for a medical certificate, limiting access those who cannot afford to pay.[9]

Given the current dearth of information on GBV among stateless populations and traditional approaches that focus on identity, land ownership and basic rights, the research findings on GBV experiences, related health outcomes and access to appropriate care produced by this study will provide new evidence for advocacy and may expose new policy implications and inform policy and programming for stateless populations.

The aims of the project were to understand the demographics, experiences, and vulnerabilities of GBV and general health status among stateless populations. This study focused on stateless populations, which is defined as populations who currently live in Cote d’Ivoire who are not citizens of another country nor are migrants because the persons do not have birth certificate from any country or their parents do have national certificate from their country of origin. These individuals are legally recognized by UNHCR as stateless populations. Definitions and measures were guided by the 2011 UNHCR guidance document on measuring stateless populations.[18] The definition of gender-based violence followed the definition provided by the UN agencies, as “an umbrella term for any harmful act that is perpetrated against a person’s will, and that is based on socially ascribed (gender) differences between males and females. The nature and extent of specific types of GBV vary across cultures, countries, and regions.”[19]

To achieve study aims we utilized a mixed methodology approach, conducted in two phases. The first phase included qualitative research with 23 stateless persons and key informants who serve these populations. Qualitative research enabled us to obtain contextual descriptions of experiences related to documentation, GBV and GBV-related health issues, and access to health care. The second phase was conducted in March 8-May 4, 2017 and included an epidemiologic survey conducted among stateless and national populations (364 women and 221 men), which was informed by qualitative findings. The epidemiologic survey was developed to collect data on a wide array of GBV experiences and GBV-related health indicators as well as to assess availability and access to related GBV services. These two methods were complementary in nature, providing both numeric estimates and contextual support of the topics of interest. This study was conducted by Johns Hopkins University and a local implementing organization, Afrique Secours et Assistance (ASA) and the UNHCR country office in Abidjan, Cote d’Ivoire.

Appendix 1 provides the detailed methodology of the qualitative and quantitative phases. The following description provides the results from the in-depth qualitative and quantitative analysis.

A total of 364 women participated, of whom 167 were nationals and 197 were stateless. National and stateless women were approximately the same age distribution, with the median age at 28 years old (IQR: 23-38). Compared to national female participants, stateless females were less likely to have ever attended school (14.1% vs 60.5%, respectively), less likely to have attended secondary school or college (among those who attended school), less likely to have a dual parent household during childhood (69.6% vs. 32.4%), and less likely to have grown up in a dual parent household (55.4% vs. 62.9%). In addition, stateless female participants were more likely to have faced challenges with legally marrying someone due to their lack of birth registration (35.2% vs. 1.0%) and less likely to have enough to meet basic needs for each month. There was no difference in employment in the last month (60.6%) but stateless female participants were also more likely to have seasonal positions (51.7% vs. 33.5%), less likely to be able to legally open a bank account (0.5% vs. 79.9%), and less likely to have health insurance (0.0% vs. 8.5%). In terms of partner characteristics, stateless women’s partners were less likely to be able to open a bank account (52.0% vs 82.0%) and less likely to have health insurance (0.0% vs. 14.4%) relative to the partners of national women. Appendix Table 2 describes demographic characteristics of male and female stateless and national participants.

Figure 1: Demographic differences among surveyed women

A total of 221 men participated, of whom 104 were nationals and 117 were stateless. National men were older on average, with the median age at 44 years (IQR: 34-56) compared to stateless men at 27 years (IQR: 22-37). Similar to stateless female participants, stateless males were less likely to have ever attended school (30.8 vs. 74.0), less likely to have attended secondary school or college (among those who attended school), less likely to have grown up in a dual parent household (43.6% vs. 77.5%), less likely to be married (27.4% vs. 69.4%), and more likely to have ever faced challenges with legally marrying someone (49.0% vs. 4.5%) when compared to their national counterparts. In addition, stateless men were less likely to be legally able to open a bank account (0.9% vs. 86.0%), and less likely to have health insurance (0.9% vs. 9.0%). Stateless men’s partners were less likely than national men’s partners to be able to open a bank account (36.8 vs. 73.4%).

Figure 2: Demographic differences among surveyed men

Qualitative interviews provide insights into the livelihood challenges related to lack of documentation. This is particularly pertinent with regards to barriers to employment, property ownership, travel constraints, bank accounts and health insurance.

“The papers (national and birth certificates) do everything. If you do not have papers ... none of your problems can be solved. Wherever you go, they ask for papers ... wherever you go, they will ask for papers ... but what if you do not have papers… none of your problems can be solved.” ID3, Female, 28yo

“I cannot get employed because I do not have my papers…. Never. If you don’t have Ivorian documents… you will be dismissed..” FGD, Male, 41yo

“I don’t have my papers… Even if you put your child in school… [the child] will arrive at a certain level, the child will not have access to a job… due to the fact that you do not have papers and you are not from here. So it causes them to return to the land for many of our children. They return to the land to be farmers, to be planters or tradesmen” Female, 50yo

“If you do not have your documents, you cannot own the motorcycle. You can buy the motorcycle but you cannot prove that the motorcycle is yours” Male, 37yo

“I worked and got a bit of money. I bought a land to make a cocoa field. But, currently, I don’t know how to do the deed of purchase. I have already bought the land, I have to make the papers ... But I don’t have my documents, I cannot prove that this land is mine. It is a difficulty.” Male, 51yo

[Can you open a bank account?] I wished… but without papers I cannot open it [bank account]” ID5, Female, 40yo

Stateless female participants were more likely to be currently using any kind of contraceptive method compared to national women (30.5% vs. 16.0%). Among those with children, stateless women were less likely to have registered all or at least some of their children as an Ivoirian national. Children of stateless women were also less likely to have access to health insurance (0.6% vs. 13.8%). Appendix Table 3 provides descriptive characteristics of reproductive health among male and female stateless and national populations in Cote d’Ivoire.

Partners of stateless male participants were less likely to have ever been pregnant (60.09% vs. 85.4%). Among those with children, stateless men were less likely to have registered all of their children, less likely to have children with access to health insurance (0.0% vs. 13.6%), and less likely to have children unable to continue past secondary school.

Qualitative findings illustrate the challenges of registering children for Ivorian nationality and the challenges that children of stateless parents face with regards to access to secondary school and access to health insurance.

“If you want to enroll a child in school; the birth certificate of the child is requested… So, without a certificate, you cannot register the child.” FGD, stateless female, 37 yo

“I am a foundling…, I never knew my parents… I don’t have my papers… so I could not go to school, I do not know how to read, I cannot write. I have 11 children and none of them can get their papers. Life is difficult for my children. They cannot get good jobs” ID16, stateless female, 45yo

“…because, when you will go declare her [2 yo daughter]; they will ask you to do it yourself, they will ask you for your papers, do you know that? You know! So, if you do not have papers yourself, how are you going to do it [for his daughter]? You see?” ID23, stateless male, 32yo

“In Cote d’Ivoire, here, already even from 3 years old, children start to go to school; But only when you arrive at 5th grade, for examination purposes, you are always ask for a birth certificate and it is from there that they ask for it or for a supplementary judgment.” FGD, service provider

“It is in 5th grade that everyone is asked to bring a birth certificate. If you can bring it, you have no worries; if you are not able to bring it, you are rejected.” FGD, stateless male, 41 yo

Approximately one-third of stateless and national women reported physical abuse during childhood (aged 15 years), 7% reported childhood sexual abuse, and 33% reported any childhood physical or sexual abuse. Appendix Table 4 provides a summary of lifetime experiences of violence among national and stateless women in Cote d’Ivoire.

Forty percent reported lifetime physical IPV in adulthood, 27% lifetime sexual IPV, and 40% lifetime physical or sexual IPV, with no difference by nationality status. Among women reporting any IPV victimization, less than one-quarter ever reported IPV victimization to an authority. Sixteen percent of national and stateless women reported physical violence during adulthood by a non-partner. Slightly fewer national than stateless women reported experiencing sexual violence victimization by a non-partner (6.7% vs. 2.2%) and 20% reported any physical or sexual violence by a non-partner with no difference by nationality.

In total, approximately 53% of national and stateless women reported any lifetime physical or sexual violence in adulthood or childhood, with no significant difference by nationality status.

Figure 3. Violence victimization among surveyed women

Qualitative findings:

“When you don’t have any papers, you are at risk of being raped than someone who has his papers; because when you are raped, you cannot go to the police, you are afraid of going to the police.” ID16, stateless female, 45yo

“[Do you think there is a difference in experiences with regards to GBV among stateless persons compared to those who have documents?]”:

“It is the same…, there is no difference. Violence is a common here.” FGD, service provider

“It is not necessarily just the undocumented who are [victims of violence]. It is balanced.” FGD, service provider

“there is no difference and there is not more violence that is done to those who do not have papers.” FGD, police representative

“The gentleman and the woman are together and that the gentleman does not even want to listen to the woman, does not even want to respect the woman rights. The gentleman may be violent towards the woman. It can be physical, it can be moral and then it can be rape. So, for me… the first three years of my marriage I was without having children, there were problems, difficulties at home. I did not even know that today I am was going to be here. He hit me… even morally [psychological violence] there was a lot… There are many others who are in the same situation as me.” ID3, stateless female, 28yo

“[GBV] can happen everywhere, on the road to the plantation, … on the way to get water, … even in your house. If the husband is not there, they can do everything possible to come and catch you.” ID3, stateless female, 28yo

“In this village, when people drink alcohol there is a lot of problem. There is a lot of beating.” ID1, stateless female, 45yo

As a child, 47% of men reported experiencing physical abuse, 8% childhood sexual abuse, and 49% any childhood physical or sexual abuse, with no difference by nationality. One in five men (21.3%) reported physical violence during adulthood, 4% sexual violence, and 25% any physical or sexual violence by a partner or non-partner, with no difference by nationality. In total, 25% of national male participants reported any lifetime violence victimization. Appendix Table 5 provides a description of lifetime experiences of violence victimization among men in Cote d’Ivoire.

Figure 4. Violence victimization and perpetration among surveyed men

Qualitative findings:

“Alcohol problems disturb some women here in this village… there are some men [who are victims of violence a lot here… not necessarily physical. There are no women hitting their husbands, but there is a lot of humiliation, too many… it happens in my house.” ID6, stateless male, 43 yo

“There have been cases of physical violence and psychological violence of women [perpetration] on their husbands. There are also cases of sexual violence against men. But here in Bouafle, a man never had the courage to come and tell us that his wife beat him.” FGD, service provider

Among all males with any intimate partner in their lifetime, 15% of national and stateless male participants reported lifetime physical IPV perpetration, 10% physical IPV perpetration during a partner’s pregnancy, 16% sexual IPV perpetration, and 25% physical or sexual IPV perpetration. No differences were observed by nationality status. In terms of non-partner violence, fewer stateless men reported physically harming a woman who was not their partners, compared to national males (2.6% vs. 8.1%), while only 1.4% of national and stateless male participants reported sexual violence perpetration. In total, 6% of men reported physical or sexual non-partner violence perpetration, with no difference by nationality status. Appendix Table 6 provides a summary of lifetime experiences of intimate partner and non-partner violence perpetration among national and stateless men in Cote d’Ivoire.

Table 1 summarizes the relationship between demographic factors, partner characteristics, and lifetime violence victimization among stateless women who experienced any lifetime violence victimization (N=191). Stateless women who reported any lifetime experience of violence were more likely to be to have seasonal or infrequent employment and have ever been married without their consent, relative to those without lifetime experiences of violence.

Table 1. Correlates of lifetime violence victimization among stateless women

 

Lifetime experience of violence victimization

 
 

No

Yes

Total

 

(N=109)

(N=82)

(N=191)

n (%)

n (%)

n (%)

p-value

Age (years) (n=191)

       

18-20

26 (23.9)

23 (28.0)

49 (25.7)

0.213

21-30

43 (39.4)

39 (47.6)

82 (42.9)

 

31-40

12 (11.0)

9 (11.0)

21 (11.0)

 

>41

28 (25.7)

11 (13.4)

39 (20.4)

 

Ever attended school (n=191)

12 (11.0)

15 (18.3)

27 (14.1)

0.153

Highest level of school attended (n=27)

       

Primary

12 (100.0)

13 (86.7)

25 (92.6)

0.189

Secondary

0 (0.0)

2 (13.3)

2 (7.4)

Worked in the past month (n=187)

66 (62.3)

45 (55.6)

111 (59.4)

0.368

Among those who worked, frequency of employment (n=125)

   

Throughout the year

39 (54.9)

18 (33.3)

57 (45.6)

0.043**

Seasonally

17 (23.9)

16 (29.6)

33 (26.4)

Once in a while

15 (21.1)

20 (37.0)

35 (28.0)

Legally able to open a bank account (n=313)

1 (0.9)

0 (0.0)

1 (0.5)

0.381

Each month participant has enough to… (n=149)

   

0.564

Meet basic needs of the family

18 (22.0)

14 (20.9)

32 (21.5)

Meet basic needs for most but not all of the month

12 (14.6)

13 (19.4)

25 (16.8)

Meet basic needs for about half of the month

13 (15.9)

8 (11.9)

21 (14.1)

Meet basic needs for less than half of the month

20 (24.4)

11 (16.4)

31 (20.8)

Never have enough to meet basic needs

19 (23.2)

21 (31.3)

40 (26.8)

House ownership (n=189)

   

Alone

17 (15.9)

7 (8.5)

24 (12.7)

0.11

Jointly

31 (29.0)

18 (22.0)

49 (25.9)

Does not own

59 (55.1)

57 (69.5)

116 (61.4)

Ever saw or heard family violence (n=7)

3 (75.0)

3 (100.0)

6 (85.7)

Participant under 18 at first marriage (n=120)

38 (55.1)

27 (52.9)

65 (54.2)

Forced marriage (n=125)

37 (51.4)

37 (69.8)

74 (59.2)

0.038**

Partner ever attend school (n=120)

25 (38.5)

25 (45.5)

50 (41.7)

0.439

Partner school level (n=81)

     

0.542

Primary

16 (66.7)

13 (59.1)

29 (63.0)

 

Secondary

8 (33.3)

8 (36.4)

16 (34.8)

 

College

0 (0.0)

1 (4.5)

1 (2.2)

 

Partner employment status (n=117)

       

Formal full-time work

14 (22.2)

10 (18.5)

24 (20.5)

0.382

Works occasionally

41 (65.1)

36 (66.7)

77 (65.8)

Looking for work/ unemployed

2 (3.2)

5 (9.3)

7 (6.0)

Retired

5 (7.9)

1 (1.9)

6 (5.1)

Studying

1 (1.6)

1 (1.9)

2 (1.7)

Don't know

0 (0.0)

1 (1.9)

1 (0.9)

Partner alcohol use (n=112)

     

0.335

Never

36 (53.7)

29 (52.7)

65 (53.3)

 

Once per month or less

10 (14.9)

4 (7.3)

14 (11.5)

 

Few times per week/ daily

21 (31.3)

22 (40.0)

43 (35.2)

 

*Marginally significant

     
             

Table 2 summarizes the demographic and partner correlates of lifetime violence victimization among stateless men (N=112). Though not significantly different, stateless men who report lifetime violence victimization tended to report being employed in seasonal or infrequent jobs and having a partner who used alcohol.

Table 2. Correlates of lifetime violence victimization among stateless men

Lifetime experience of violence victimization

 

No (N=86)

Yes (N=26)

Total (N=112)

 

n (%)

n (%)

n (%)

p-value

Age (years) (n=112)

   

18-20

17 (19.8)

5 (19.2)

22 (19.6)

0.298

21-30

34 (39.5)

11 (42.3)

45 (40.2)

 

31-40

17 (19.8)

6 (23.1)

23 (20.5)

 

>41

18 (20.9)

4 (15.4)

22 (19.6)

 

Ever attended school (n=35)

24 (27.9)

11 (42.3)

35 (31.3)

0.165

Highest level of school attended (n=170)

       

Primary

23 (95.8)

11 (100.0)

34 (97.1)

0.492

Secondary

1 (4.2)

0 (0.0)

1 (2.9)

 

Worked in the past month (n=112)

69 (80.2)

21 (80.8)

90 (80.4)

0.952

Among those worked, employment was seasonal or once in a while (n=110)

 

Throughout the year

49 (58.3)

10 (38.5)

59 (53.6)

0.161

Seasonally

23 (27.4)

9 (34.6)

32 (29.1)

 

Once in a while

12 (14.3)

7 (26.9)

19 (17.3)

 

Legally able to open a bank account (n=112)

1 (1.2)

0 (0.0)

1 (0.9)

0.581

Each month participant has enough to… (n=107)

     

Meet basic needs of the family

25 (30.5)

7 (28.0)

32 (29.9)

0.921

Meet basic needs for most but not all of the month

16 (19.5)

6 (24.0)

22 (20.6)

 

Meet basic needs for about half of the month

6 (7.3)

1 (4.0)

7 (6.5)

 

Meet basic needs for less than half of the month

13 (15.9)

3 (12.0)

16 (15.0)

 

Never have enough to meet basic needs

22 (26.8)

8 (32.0)

30 (28.0)

 

House ownership (n=112)

       

Alone

27 (31.4)

6 (23.1)

33 (29.5)

0.661

Jointly

12 (14.0)

3 (11.5)

15 (13.4)

 

Does not own

46 (53.5)

16 (61.5)

62 (55.4)

 

Ever saw or heard family violence (n=4)

2 (66.7)

1 (100.0)

3 (75.0)

0.505

Partner school level (n=14)

       

Primary

8 (66.7)

1 (50.0)

9 (64.3)

0.649

Secondary

4 (33.3)

1 (50.0)

5 (35.7)

 

Partner employment status (n=38)

       

Formal full time work

0 (0.0)

1 (9.1)

1 (2.6)

0.468

Works occasionally

21 (77.8)

8 (72.7)

29 (76.3)

 

Looking for work/ unemployed

3 (11.1)

1 (9.1)

4 (10.5)

 

Don't know

3 (11.1)

1 (9.1)

4 (10.5)

 

Partner legally able to open a bank account (n=37)

10 (37.0)

4 (40.0)

14 (37.8)

0.869

Partner alcohol use (n=42)

       

Never

23 (71.9)

9 (90.0)

32 (76.2)

0.417

Once per month or less

4 (12.5)

0 (0.0)

4 (9.5)

 

Few times per week/ daily

5 (15.6)

1 (10.0)

6 (14.3)

 

Money that participant earns is more than partner (n=111)

1 (1.2)

1 (3.8)

2 (1.8)

0.370

Person who makes decisions about healthcare for participant (n=42)

   

Participant

11 (35.5)

6 (54.5)

17 (40.5)

0.582

Partner

4 (12.9)

1 (9.1)

5 (11.9)

 

Participant and partner jointly

13 (41.9)

4 (36.4

17 (40.5)

 

Other family member

3 (9.7)

0 (0.0)

3 (7.1)

 

*Marginally significant

 

Few female participants self-rated their health as poor or very poor (national: 8.7% vs. stateless: 10.2%). One in five women reported elevated symptoms of depression, with no difference by nationality status. Stateless women were more likely to report difficulty in getting money for medical advice or treatment (72.7% vs. 50.0%), and concerns about deportation when accessing healthcare (40.2% vs. 1.3%) relative to national women.

Similarly, few male participants self-rated their health as poor or very poor (national: 8.1% vs. stateless: 8.7%). Despite similar health ratings, stateless men reported lower use of hospitals (4.5% vs. 15.2%) Stateless and national men reported similar levels of depressive symptomatology (22.5%); however, stateless men were also more likely to report concerns getting money needed for health advice or treatment (73.9% vs. 48.5%), distance to the health facility (37.9% vs. 20.2%) and fear of deportation when accessing healthcare (39.7% vs. 0%) compared to national men.

Appendix Table 7 provides the descriptive health characteristics of stateless and national men and women in Cote d’Ivoire.

This study sought to explore the context of statelessness and assess the association between statelessness and experiences of GBV among men and women in Cote d’Ivoire. Over 350 women and 220 men, approximately half of whom were stateless, participated in community-based surveys in early 2017.

Major differences between stateless persons and those with Ivoirian nationality existed on the basis of basic demographics. Both women and men who were stateless were less likely to have ever attended school or attended secondary school; were more likely to face challenges legally marrying a partner; less likely to have any form of health insurance; less likely to own the land upon which they lived; and less likely to be able to open a bank account, compared to those with Ivoirian nationality – all of which are likely attributable to the fact that a lack of citizenship prohibits basic access to legal services and education. These same issues were mirrored among the partners/spouses of stateless persons, dually negatively impacting the family. Building on these challenges, statelessness impacts employment for these individuals; while employment levels were the same, slightly less than 50% of stateless women and men reported only having enough to meet basic needs to less than half of the month or never. These challenges may cause partners to travel elsewhere for work and may be attributable to the forty percent or less of stateless men and women who reported growing up in a dual parent household.

Statelessness also drastically affects the livelihood of children. Few stateless parents reported that their children had been registered in Cote d’Ivoire. Stateless children were 22 times less likely to have access health insurance (0.6% stateless vs. 13.8% nationals). Children of stateless persons were also less likely to continue past secondary school. Consequently, these children of stateless parents are less able to be employed when they reach adulthood and more likely to become work on plantations or sell goods like their parents.

Despite demographic differences between stateless and national participants, there were no differences in terms of lifetime GBV victimization or perpetration. Violence victimization was generally high: one-third of women experienced violence during childhood, 40% reported lifetime physical or sexual IPV, and 20% reported lifetime physical or sexual non-partner violence during adulthood, with no differences by stateless or nationality status. Experiences of violence victimization were generally correlated with experiences of statelessness, as stateless women who reported any lifetime experience of violence were more likely to be to have seasonal or infrequent employment and have ever been married without their consent, relative to those without lifetime experiences of violence.

Similarly, 49% of men reported any violence victimization during childhood and 25% reported any physical or sexual violence victimization during adulthood, with no difference by nationality status. While there was no statistically significant difference, stateless men who report lifetime violence victimization tended to report being employed in seasonal or infrequent jobs and having a partner who used alcohol. One-quarter of men reported lifetime physical or sexual IPV perpetration and 6% reported any physical or sexual violence against a woman who was not their partner/spouse, but IPV and non-partner violence perpetration was not associated with statelessness or nationality status.

Limited data prohibited an assessment of whether there were significant differences in access to care among stateless and national population. However, significant differences in access to care did exist between the two populations, suggesting these same issues would translate to care for experiences of GBV. Stateless men and women were more likely to report difficulty getting money for medical advice or treatment, be inhibited by distance to health facilities, and to report concerns about deportation when accessing healthcare relative to national populations, suggesting critical barriers to use of health services.

The findings presented in this study show marked similarities and differences when compared to a recent and related survey of GBV among national and stateless populations in the Dominican Republic. In the Dominican Republic, statelessness has emerged recently due to the reinterpretation of laws pertaining to citizenship of children born to immigrants, which has rendered stateless a large population of Dominicans of Haitian descent. Though the mechanisms of statelessness are different, findings from both studies from Cote d’Ivoire and the Dominican Republic highlight significant disparities in basic rights, such as access to education, register children as nationals, open a bank account, legally marry and divorce, purchase land and/or housing, and gain legal, formal employment. A stark contrast, however, was the difference in the relative prevalence of GBV; in the Dominican Republic, stateless women were more likely to experience gender-based violence as children or adults than national women, whereas in Cote d’Ivoire, such a difference did not exist. This is surprising, given that other studies of women living in displacement or as immigrants tend to have higher risk of GBV than their national counterparts. It may be a valid finding that stateless women in Cote d’Ivoire are at equal risk of GBV or it may an artifact of under-reporting of GBV by minority women who are concerned about potential outcomes of reporting GBV. Nonetheless, both studies found that stateless women who experience GBV have low access to healthcare and protection services. Also noteworthy was the finding that stateless persons in both countries reported avoiding healthcare because of fear of deportation, despite the fact that stateless persons in Cote d’Ivoire are reportedly not at risk of deportation. Ultimately, GBV is high in both countries and access to appropriate services to address GBV among stateless persons is exceedingly limited.

Limitations: These study findings should be interpreted in light of several limitations. First, the majority of persons encountered during the survey were at-risk for stateless rather than truly stateless. The at-risk for statelessness faced a myriad of obstacles that prevented them from obtaining their documents, namely: unable to afford to fees associated with processing birth certificate and/or nationality certificates; not aware of the importance of having legal documents; did not know how or where to go to register for documentations; and not having the proper documentations from their parents to show proof of citizenship. As this study is focused on stateless persons and not on at-risk populations, we have dedicated a significant effort to maximize our chances to obtain the desired sample for the study by: committing more time on the field for data collection; traveling to remote locations where stateless persons are known to reside; and reaching out to key stakeholders (regional prefects/sub-prefects, village leaders and community leader before the survey and during the survey) to raise awareness of the study to inform the target population to be available for the study.

Second, we conducted household sampling in the context of multiple challenges. At the time of the survey, there were observations of recent governmental officials forced relocation of stateless persons living in or near one the largest national parks in the region, Marahoue National Park. There were significant rumors and confusion of potential deportation of stateless person by governmental officials. Community members sometimes indicated concern that the study team might have been sent by immigration officials. As a result, this made the sampling difficult due to fear among the target population. We aimed to overcome this by ensuring all data that were collected were anonymous and working with local promoters and community members to explain the purpose of the study. Hiring of staff that were from the area and who spoke the same local dialect and understood the situations faced by the communities also helped to improve response rates.

Third, we collected data during the daytime to ensure staff safety. This, however, reduced our response rates among men, who were often out of the house during the daytime for work in the plantations. This also reduced our response rate of women of Muslim religious background, which prohibited them from speaking to anyone not from the community without the permission of the husband, a large number of whom were not available during the daytime hours of the survey work. Conducting data collection during the weekends, however, facilitated recruitment of more male and female participants. Fourth, some locations where stateless persons are known to reside are in remote localities near the border of Liberia are difficult to access to road conditions that are not passable.

Finally, no sampling frame exists for stateless persons in Cote d’Ivoire that would allow for probability-based sampling, which would provide representative GBV prevalence estimates. We overcame this challenge by collecting data among stateless and neighborhood-matched national persons who were residing in the same areas. This matched approach to sampling allowed us to control for unmeasured confounders related to socio-economic status and geographic distances of stateless and national participants. Further, the sample size was powered to detect difference in GBV experience by nationality status, but was not powered to assesses differences in terms of access to healthcare for GBV, which are reported by smaller numbers of individuals. However, significant differences in terms of general access to healthcare were observed and likely translate to care for GBV among stateless women and men.

Gender-based violence is prevalence in Cote d’Ivoire, though there are no differences in violence victimization nor perpetration between national and stateless populations. Evidence suggests, however, that statelessness and the lack of rights that follow, place stateless populations in situations of vulnerability. Further, fear of deportation and poor access to well-paying positions limits access to healthcare for stateless populations and may do so when seeking care and protection following experiences of violence. Ensuring access to documentation and citizenship is critical to improving the access to basic rights among these populations. Until then, services to ensure access to care and protection without proof of citizenship are urgently needed.

The following recommendations are drawn from this study:

  1. Health access: The Ivoirian government is in the process of scaling up GBV programming, which includes focal points in each locality. At this time, it appears that this program is heterogeneously implemented and mostly targeted to urban settings. The government should ensure that that GBV programs are scaled up in rural settings and accessible regardless of nationality, which will allow stateless persons who experience GBV to access appropriate services.
  2. Access to justice: Access to justice is limited for stateless persons by the need for documentation of legal status and, often, by the need for payments to receive medical certification of gender-based violence. Removing requirements related to documentation and payments for medical certifications will aid in opening the pathway to reporting cases and ensuring protection against GBV.
  3. Process of documentation: The process to improve documentation of citizenship status is a long, complicated and costly process. This leaves a large population either at-risk of statelessness or fully stateless. It is critical for the government to simplify process of documentation to reduce the number of people who are stateless or at-risk of statelessness. While the prevalence of GBV is similar among stateless and nationals, there are significant barriers that exist for survivors to GBV who are stateless. The misconceptions and stigma surrounding the burden of showing proof of documentation before one can report experiences of GBV to authorities and before accessing GBV services; the fear of deportation; and the financial burden placed on survivors of GBV to access for GBV services are towering barriers for persons are stateless or who do not have documentations of nationality. A national approach to improve GBV awareness and addressing misconceptions and reducing financial burdens to access needed services regardless of one’s documentation status will resolve challenges in accessing GBV care and reporting among the populations. Until the process of documentation is simplified, stakeholders involved in stateless issues can separately address barriers related to access to education, access to bank accounts for financial protection, and access to healthcare and perceptions of deportation associated with accessing healthcare.

The study was designed, collected, analyzed, and interpreted by the following team members:

Johns Hopkins University

Afrique Secours et Assistance

Dr. Alexander Vu (Principal Investigator)

Dr. Andrea Wirtz

Mme Alice Koiho

Cintilla Kouassi

Sahnah Lim

Anne Leon Kaza

Diane Katele Kone

Pierre Muhoza

Benjamin Boa

The achievement of this study is due to the support and involvement of many people and organizations. We thank the United Nations High Commissioner for Refugees and Afrique Secours et Assistance for their support in connecting us with local communities and in some locations providing housing for our study team. We acknowledge and appreciate the input of Dr. Leslie Roberts who provided consultation to sampling and statistical methodology.

This project was funded as a gift of the U.S. Government (U.S. Department of State, Bureau of Population, Refugees, and Migration).

Qualitative research was conducted from February 21 to 28, 2017 in six sites of Cote d’Ivoire: Central region (Bouafle, Koupela, Garongoro); Southwestern region (Bagohouo, Nidrou), and Abidjan. The areas around the Central and Southwestern regions contain the largest concentration of stateless persons in Cote d’Ivoire because of the large concentrations of cocoa plantations in these regions.

Participants: Inclusion criteria for in-depth interviews required participants to be ≥18 years, born to parents or from a single head of household who is not Ivorian nationality, whose parents do not have national certificate from any country that neighbors Cote d’Ivoire, and currently without birth certificate from any country. Service providers were required to have at least one year of experience serving the stateless population, providing service in some capacity to the target population. These participants included health promoters, social workers from the local justice system and from local hospitals, non-governmental organization service providers, police representatives and administrators for the Ministry of Health/Social Affairs.

Recruitment and consent: Recruitment was facilitated by local promoters who were familiar with the locations in which qualitative research took place. Local health promoters identified candidate participants, described the purpose of the study, and escorted interested candidate participants to the interview site. Prior to commencement of interviews, the interviewer read a consent script, which described the study purpose, procedures, and risks related to participation. The interviewer asked for the participant’s consent to participate and, separately, for consent to record the interview/discussion. All data collection was anonymous and audio recordings were saved on password protected computers at the end of each working day and erased from the audio recorder to protect participant information and confidentiality.

Data collection: Twenty-three in-depth interviews were conducted with participants who were of the affected population. One focus group of nine stateless participants was convened in Koupela. Two focus groups (Bouafle and Abidjan) of approximately eight participants per group were convened with service providers or community leaders. In-depth interviews and focus group discussions followed semi-structured interview/discussion guides and were conducted directly in French or in English with French interpretation.

Data analysis: All audio recordings were transcribed and translated by certified transcription agencies and de-identified transcripts were entered into ATLAS.ti qualitative data analysis software. Transcripts underwent thematic analysis based on areas of interest that guided the development of the interview guide and themes that emerged from the data following grounded theory.[20, 21] Codes were refined and elaborated during the analysis through the constant comparison method. The finalized codebook was applied to all transcripts by the analytic team (AW, SL, EC) in order to minimize bias.

A quantitative cross-sectional survey was conducted throughout the Cote d’Ivoire from March 8-May 4, 2017 in rural settings (45 communities) where stateless populations are known to reside and where local leaders and their community were willing to participate in the survey (Table 1).

Table 1. Communities that participated in quantitative survey

Region

Village

Region

Village

Blolequin

1. Tinhou

Meaguy

23. Touadji 2

2. Tuambly

24. Pogreagui

3. Dedjean

25. Anokro

4. Petit guiglo

26. Zongokro

5. Diboké

27. Serigbangan

6. Zouhayi

28. Abodagui

7. Zeaglo

29. Issakro

8. Zouzankro

30. Moussa carrefour

9. Felixkro

31. Tereadji 2

10. Beoué

32. Gbogbo

Duekoué

11. Bagohouo

33. Kranalekro

12. Nidrou

34. Abodakro

13. Sibably

35. Kangakro

14. Ponan vahi

36. Kouadiobakro

15. Yrozon

37. Yaoblékro

16. Niambly

Soubré

38. Galléa

Touleupleu

17. Meo

Bouaflé

39. Koupela

18. Tuobly

40. Tenkodogo

Danané

19. Gbinta

41. Garango

20. Glan houye

42. Koudougou

21. Gbapleu

43. Saria

22. Danipleu

Zuenoula

44. Kaya

   

45. Ouagadougou

Survey development: With input from ASA, portions of previously validated sets of surveys were adapted and included from: 1) WHO Multi-country Study on Women’s Health and Domestic Violence against Women[22] which includes collection of both intimate partner violence (IPV) and non-partner violence victimization; 2) UN research on perpetration of violence[23-25]; 3) the Hopkins Symptom Checklist- Depression subscale[26]; and items developed by our research team focusing on social norms about violence and others derived from qualitative findings. The adapted questionnaire was translated from English to French and then back-translated by local translators; back-translations were then reviewed by the research team and the local ASA team. Additional edits were made through an iterative process to ensure that the translation captured the essence of each question. The surveys were then programmed in English and French for tablet-based data collection, which was deemed a more secure method than paper-based data collection.

Sampling frame: The research team had consulted with UNHCR, local organizations working with stateless persons, and local community leaders for all available information for possible sampling frame of stateless persons living in the Cote d’Ivoire. To the best of our knowledge, there was no available sampling frame at the time when we conducted the survey.

Sampling Plan: The aim of the study was to measure proportions of key indicators relating to demographics, GBV, GBV-related health impacts and health care access among the stateless population, compared to the populations with legal citizenship. We controlled for socio-economic status between stateless and legal citizens by sampling the population with legal citizenship who live in closest proximity to the surveyed stateless participants. Given the challenge of the sampling frame that could not be established, we adjusted our sampling methodology as follows:

  1. Identification of all communities where stateless populations are known to reside;
  2. Consult, inform and request for participation in the survey from local non-governmental organizations and stateless community leaders who work in the respective communities;
  3. Raise awareness of the survey’s goals, objectives and expected date of survey with community leaders within communities that have agreed to participate in the survey;
  4. Upon arrival to the prospective community being surveyed, local community promoters informed community members about the survey. Community leaders were consulted on the general map of the community being surveyed using satellite Google Earth images and estimates of the number of stateless persons living in the community.
  5. The community was divided into subsections, from which a subsection was randomly selected using a random number table. If the subsection had more than approximately 30 households, it was further divided and the process of random selection was repeated until an area was chosen with approximately 30 households to facilitate the process of randomly selecting a household. A house was selected randomly to look for the first stateless person to interview using the inclusion criteria described below under participant recruitment. If the household did not have a stateless person, surveyors went to the next nearest household as measured from the front door of one dwelling to the front door of the next.
  6. When a survey with a stateless person was completed, the surveyor then identified and interviewed the next nearest person of legal citizenship of the same gender using the same method above. If the person who has legal citizenship is not found based on the inclusion criteria, the surveyor will proceed to the next nearest house until the target respondent type is found. This process was repeated, alternating between a person who was stateless and one with legal citizenship, using the most recent house with a completed survey as the reference for the selection of the next nearest house to sample. If the interviewer could not find a person to sample, most often a person of legal citizenship in that same community, after one hour, then the surveyors continued sampling for only the stateless persons until they had surveyed eight respondents/interviews. The team would then proceed to the next nearest community to sample for the match of persons with citizenship and to match for the same gender.
  7. Staff trained as survey supervisors oversaw the household selection process and reviewed completed surveys on the iPad to assure completeness.

Participants: The inclusion criteria for stateless persons were: 1) aged 18 years or older; 2) do not have any birth certificate from any country; 3) whose parents do not have national certificate from any country; or 4) if the person is a foundling who have never known their parents. The inclusion criteria for a person with legal citizenship were: 1) aged 18 years or older; 2) has a national certificate from Cote d’Ivoire; or 3) if either parent has a national certificate from Cote d’Ivoire. To avoid potentially raising undue concern, we did not ask participants to provide documentation for verification of nationality.

Recruitment and consent: Recruitment was facilitated by local community leader who was familiar with the community to be sampled. Prior to commencement of interviews, the interviewer read a consent script, which described the study purpose, procedures, and risks related to participation. The interviewer asked for the participant’s consent to participate and, separately, for consent to record the interview/discussion. Verbal consent was obtained from all participants from a standardized consent script that was read to the participants by the surveyors. Verbal – in lieu of written consent – was used to ensure that all data collection was anonymous; a written consent would have otherwise been the only linking identifier of the data to the participant. A copy of the informed consent was made available for the participants if they preferred to retain a copy. All participants were provided with information essential for informed consent prior to participation in the discussion/interviews. All participants were informed about the potential risks in participating in the study and measures taken by the study team to protect participants. All participants were notified that they could withdraw from the study at any time without penalty. All data collection was anonymous and data was recorded on an iPad tablet. The data on the iPad table was then uploaded on an encrypted and password protected server at the end of each working day. The data on the iPad was erased from the tablet after uploading of data to protect participant information and confidentiality.

Data analysis: Quantitative data collected from household surveys were reviewed and cleaned by the JHU study team (AW). The final data set was cleaned using systematic methods to check for and remove inconsistencies or errors. Analyses were descriptive in nature, comparing demographic, health, and GBV data between stateless and national populations and between men and women separately. Because participants were generally matched 1:1 across the stateless and national populations, we did not include additional adjustments for population size or clustering by site location. Variables of interest were tabulated and Pearson chi-squared statistics were calculated to assess for significant differences across stateless and national populations.

Ethics approval: Prior to initiation of all qualitative and quantitative data collection, ethical approval was obtained from the Johns Hopkins School of Medicine Institutional Review Board and the local Institutional Review Board from the Ministry of Public Health National Research Ethics Committee in Cote d’Ivoire.

A protocol was developed for data collection to ensure confidentiality and safety, including no requirement to provide names in order to protect participant confidentiality and minimize sensitivity. Participants in focus group discussions were asked to respect the privacy of each participant by not talking about the content of the discussion with other individuals who did not attend the group. The research plan was developed with deliberate attention toward minimizing the risk of harm to participants. The research team members were trained to stop the discussion/interview if a participant appeared to be upset or distressed by participation. All research staff and participating partner organizational staff members were trained to read and review the consent prior to commencing the study and answer any questions from the participants. Steps to be taken to protect the safety and confidentiality of information about all participants included the use of study code numbers for identification, reporting aggregate data only, omitting identifiers on the tapes, transcripts and demographic survey. All study data were stored on a password-protected computer in locked files secured by the research team. No data was shared with individuals outside the research team. All study team members and data collectors were required to complete training and provide a certificate of training in human subjects research prior to data collection. All research team members were trained on the purpose of the study, qualitative or quantitative research methods, human subjects protections and consent, and were required to adhere to institutional codes of conduct and policies prohibiting sexual exploitation and abuse.

Table 2. Demographics among national and stateless women and men in Cote d'Ivoire

 
 

Females

Males

 
 

National

Stateless

Total

 

National

Stateless

Total

   

(N = 161)

(N = 191)

(N = 104)

(N = 117)

 

n (%)

n (%)

n (%)

p-value

n (%)

n (%)

n (%)

p-value

 

Demographics

 

   

   

Median age (IQR)

30 (26-40)

26 (20-35)

28 (23-38)

 

44 (34-56)

27 (22-37)

34 (26-46)

   

Ever attended school (women, n=348; men, n=221)

95 (60.5)

27 (14.1)

122 (35.1)

77 (74.0)

36 (30.8)

113 (51.1)

 

Highest level of school attended (women, n=122; men, n=111)

                 

Primary

59 (62.1)

25 (92.6)

84 (68.9)

0.01**

33 (44.0)

35 (97.2)

68 (61.3)

 

Secondary

32 (33.7)

2 (7.4)

34 (27.9)

36 (48.0)

1 (2.8)

37 (33.3)

 

College

4 (4.2)

0 (0.0)

4 (3.3)

6 (8.0)

0 (0.0)

6 (5.4)

 

Religion (women, n=345; men, n=215)

                 

Christianity

106 (67.5)

111 (59.0)

217 (62.9)

0.048

51 (50.0)

40 (35.4)

91 (42.3)

0.032

 

Islam

20 (12.7)

46 (24.5)

66 (19.1)

22 (21.6)

40 (35.4)

62 (28.8)

 

Animism

21 (13.4)

19 (10.1)

40 (11.6)

19 (18.6)

15 (13.3)

34 (15.8)

 

Other

10 (6.4)

12 (6.4)

22 (6.4)

10 (9.8)

18 (15.9)

28 (13)

 

Moved to current town (women, n=339; men, n=211)

112 (71.8)

122 (66.7)

234 (69.0)

0.309

52 (51)

54 (49.5)

106 (50.2)

0.835

 

Dual parent household during childhood

110 (69.6)

60 (32.4)

170 (49.6)

79 (77.5)

48 (43.6)

127 (59.9)

 

(women, n =343); men, n=212)

 

Marital status (women, n=344; men, n=156)

                 

Divorced/separated

10 (6.3)

9 (4.8)

19 (5.5)

0.290

2 (2.8)

3 (3.6)

5 (3.2)

 

Engaged

12 (7.6)

10 (5.4)

22 (6.4)

6 (8.3)

6 (7.1)

12 (7.7)

 

Living with someone, but not married

58 (36.7)

53 (28.5)

111 (32.3)

32 (30.77)

33 (28.21)

65 (29.4)

 

Married

48 (30.4)

79 (42.5)

127 (36.9)

50 (69.4)

23 (27.4)

73 (46.8)

 

Never married

17 (10.8)

20 (10.8)

37 (10.8)

13 (18.1)

52 (61.9)

65 (41.7)

 

Widowed

13 (8.2)

15 (8.1)

28 (8.1)

1 (1.4)

0 (0.0)

1 (0.6)

 

Ever faced challenges with legally marrying someone due to registration issues (women, n=227; men, n=116)

1 (1)

43 (35.2)

44 (19.4)

3 (4.5)

24 (49.0)

27 (23.3)

   

Median age of participant when first partnered (IQR)

19 (18-23)

17 (15-20)

18 (16-22)

27 (24-32)

25 (20-28)

25.5

(21-30)

   

Forced marriage (women, n=223; men, n=113)

59 (60.2)

74 (59.2)

133 (59.6)

0.897

40 (59.7)

27 (58.7)

67 (59.3)

   

Worked in the past month

97 (62.2)

111 (59.4)

208 (60.6)

0.589

78 (78.8)

93 (80.9)

171 (79.9)

   

(women, n=343; men, n=214)

 

Among those who worked, employment was seasonal or once in a while (women, n=235; men, n=213)

   

Throughout the year

56 (50.9)

57 (45.6)

113 (48.1)

44 (44.0)

61 (54.0)

105 (49.3)

 

Seasonal

30 (27.3)

33 (26.4)

63 (26.8)

0.535

41 (41.0)

32 (28.3)

73 (34.3)

0.15

 

Once in a while

24 (21.8)

35 (28)

59 (25.1)

15 (15.0)

20 (17.7)

35 (16.4)

 

Each month participant has enough to…(women, n=275; men, n=207)

             

Meet basic needs of the family

45 (35.7)

32 (21.5)

77 (28.0)

0.017

37 (38.1)

32 (29.1)

69 (33.3)

0.28

 

Meet basic needs for most but not all of the month

29 (23.0)

25 (16.8)

54 (19.6)

15 (15.5)

22 (20.0)

37 (17.9)

 

Meet basic needs for about half of the month

13 (10.3)

21 (14.1)

34 (12.4)

7 (7.2)

7 (6.4)

14 (6.8)

 

Meet basic needs for less than half of the month

15 (11.9)

31 (20.8)

46 (16.7)

7 (7.2)

17 (15.5)

24 (11.6)

 

Never have enough to meet basic needs

24 (19.0)

40 (26.8)

64 (23.3)

31 (32.0)

32 (29.1)

63 (30.4)

 

Legally able to open a bank account

123 (79.9)

1 (0.5)

124 (36.4)

86 (86)

1 (0.9)

87 (40.5)

 

(women, n= 341; men, n=215)

 

Health insurance (women, n=341; men, n=215)

13 (8.5)

0 (0.0)

13 (3.8)

9 (9.0)

1 (0.9)

10 (4.7)

0.005

 

House ownership (women, n=344; men, n=215)

               

Alone only

17 (11.0)

24 (12.7)

41 (11.9)

0.814

35 (35.0)

33 (28.7)

68 (31.6)

 

Does not own

44 (28.4)

49 (25.9)

93 (27.0)

23 (23.0)

64 (55.6)

87 (40.5)

 

Jointly only

94 (60.6)

116 (61.4)

210 (61.0)

42 (42.0)

18 (15.7)

60 (27.9)

 

Land ownership (women, n=343; men, n=215)

               

Alone only

22 (14.2)

15 (8.0)

37 (10.8)

0.055

45 (45.0)

31 (27.0)

76 (35.4)

 

Does not own

30 (19.4)

27 (14.4)

57 (16.6)

30 (30.0)

71 (61.7)

101 (47.0)

 

Jointly only

103 (66.5)

146 (77.7)

249 (72.6)

25 (25.0)

13 (11.3)

38 (17.7)

 

Partner demographics and behavior

                 

Current/most recent partner ever attended school (women, n= 222; men, n=112)

81 (79.4)

50 (41.7)

131 (59.0)

31 (45.6)

14 (31.8)

45 (40.2)

0.147

 
 

Current partner employment status (women, n=210; men, n=103)

         

Formal full time work

24 (25.8)

24 (20.5)

48 (22.9)

0.747

8 (12.5)

1 (2.6)

9 (8.7)

0.431

 

Works occasionally

55 (59.1)

77 (65.8)

132 (62.9)

42 (65.6)

30 (76.9)

72 (69.9)

 

Looking for work/unemployed

8 (8.6)

7 (6.0)

15 (7.1)

6 (9.4)

4 (10.3)

10 (9.7)

 

Retired

3 (3.2)

6 (5.1)

9 (4.3)

1 (1.6)

0 (0.0)

1 (1.0)

 

Don't know

2 (2.2)

1 (0.9)

3 (1.4)

7 (10.9)

4 (10.3)

11 (10.7)

 

Current partner health insurance (women, n=206; men=111)

13 (14.4)

0 (0.0)

13 (6.3)

4 (5.9)

0 (0.0)

4 (3.6)

0.105

 

Current partner legally able to open bank account (women, n=191; men, n=102)

73 (82.0)

53 (52.0)

126 (66.0)

47 (73.4)

14 (36.8)

61 (59.8)

 

*Marginally significant

         

Table 3. Reproductive health and children among stateless and national participants

   

Females

Males

 

National

Stateless

Total

 

National

Stateless

Total

 

(N = 161)

(N = 191)

(N = 104)

(N = 117)

n (%)

n (%)

n (%)

p-value

n (%)

n (%)

n (%)

p-value

Ever used any contraceptive method (women, n=339; men, n=211)

No

104 (68.9)

154 (81.9)

258 (76.1)

0.004

71 (72.4)

87 (77.0)

158 (74.9)

0.011

Yes

46 (30.5)

30 (16.0)

76 (22.4)

27 (27.6)

19 (16.8)

46 (21.8)

Never had intercourse

1 (0.7)

4 (2.1)

5 (1.5)

0 (0.0)

7 (6.2)

7 (3.3)

Currently using any contraceptive method (women, n=77; men, n=48)

No

25 (53.2)

14 (46.7)

39 (50.6)

0.583

15 (51.7)

8 (42.1)

23 (47.9)

0.408

Yes

21 (44.7)

16 (53.3)

37 (48.1)

14 (48.3)

10 (52.6)

24 (50.0)

Exclude/Refused

1 (2.1)

0 (0.0)

1 (1.3)

0 (0.0)

1 (5.3)

1 (2.1)

Current partner knows of contraceptive use (women n=37)

No

6 (28.6)

3 (18.8)

9 (24.3)

0.022

N/A

N/A

N/A

 

Yes

15 (71.4)

8 (50)

23 (62.2)

N/A

N/A

N/A

 

No current partner

0 (0.0)

5 (31.3)

5 (13.5)

N/A

N/A

N/A

 

Current/most recent partner ever refused to use contraceptive method (women n=37; men n= 46)

4 (19.0)

4 (25.0)

8 (21.6)

0.663

4 (14.8)

3 (15.8)

7 (15.2)

0.928

Decision-maker on contraceptive use (Women, n=37; Men n=46)

Mainly respondent

11 (50.0)

9 (56.3)

20 (52.6)

0.463

5 (18.5)

2 (10.5)

7 (15.2)

0.444

Mainly partner

2 (9.1)

0 (0.0)

2 (5.3)

3 (11.1)

5 (26.3)

8 (17.4)

Joint decision

9 (40.9)

7 (43.8)

16 (42.1)

18 (66.7)

12 (63.2)

30 (65.2)

Ever (wife ever) been pregnant (women, n=341; men, n=204)

140 (92.1)

159 (84.1)

299 (87.7)

0.026

82 (85.4)

60 (55.6)

142 (69.6)

Number of children able to register as a Ivorian national (women, n=294; men, n=139)

none

15 (10.9)

76 (48.7)

39 (13.3)

11 (13.4)

38 (66.7)

49 (35.3)

all

108 (78.3)

56 (35.9)

91 (31.0)

62 (75.6)

13 (22.8)

75 (54.0)

some, but not all

15 (10.9)

24 (15.4)

164 (55.8)

9 (11.0)

6 (10.5)

15 (10.8)

All children have access to health insurance (women, n=294; men, n=138)

19 (13.8)

1 (0.6)

20 (6.8)

11 (13.6)

0 (0.0)

11 (8.0)

0.004

Number of children not able to continue to with school (women, n=288; men, n=131)

none

85 (63.9)

91 (58.7)

176 (61.1)

0.463

51 (65.4)

31 (58.5)

82 (62.6)

0.526

all

7 (5.3)

5 (3.2)

12 (4.2)

7 (9.0)

4 (7.5)

13 (9.9)

some, but not all

13 (9.8)

15 (9.7)

28 (9.7)

9 (11.5)

6 (11.3)

13 (9.9)

N/A

28 (21.1)

44 (28.4)

72 (25.0)

11 (14.1)

12 (22.6)

23 (17.6)

~For males, questions refer to their female partner; %For males, question refers to participant's refusal of wife's contraceptive use; *Marginally significant

                             

Table 4 Lifetime experiences of violence among national and stateless women in Cote d'Ivoire

 

National

Stateless

Total (N=352)

 

(N = 161)

(N = 191)

n (%)

n (%)

n (%)

p-value

Exposure to violence

       

Mother ever hit father (n=173)

4 (3.6)

0 (0.0)

4 (2.3)

0.126

Father ever hit mother (n=171)

10 (9.2)

7 (11.3)

17 (9.9)

0.657

Ever saw or heard family violence (n=20)

13 (100.0)

6 (85.7)

19 (95.0)

0.162

Divorced/separated due to violence (n=222)

27 (26.2)

10 (8.4)

37 (16.7)

0.657

Childhood violence

       

Physical child abuse (n=336)

49 (32.5)

57 (30.8)

106 (31.5)

 

Perpetrator of physical child abuse (n=106)

     

Other female family member

17 (34.7)

29 (50.9)

46 (43.4)

0.094

Other male family member

6 (12.2)

16 (28.1)

22 (20.8)

0.045

Mother

11 (22.4)

7 (12.3)

18 (17.0)

0.164

Father

12 (24.5)

5 (8.8)

17 (16.0)

0.028

Teacher

7 (14.3)

2 (3.5)

9 (8.5)

0.047

Someone at school

6 (12.2)

2 (3.5)

8 (7.5)

0.09

Someone from another community

2 (4.1)

5 (8.8)

7 (6.6)

0.332

Female friend of family

4 (8.2)

2 (3.5)

6 (5.7)

0.301

Stepmother

2 (4.1)

2 (3.5)

4 (3.8)

0.877

Stranger

2 (4.1)

1 (1.8)

3 (2.8)

0.471

Male friend of family

3 (6.1)

0 (0.0)

3 (2.8)

0.058

Stepfather

1 (2.0)

0 (0.0)

1 (0.9)

0.279

Other

0 (0.0)

4 (7.0)

4 (3.8)

0.059

Sexual child abuse (n=333)

14 (9.4)

9 (4.9)

23 (6.9)

0.107

Perpetrator of sexual child abuse (n=23)

       

Male friend of family

6 (42.9)

2 (22.2)

9 (34.8)

0.311

Boyfriend

5 (35.7)

2 (22.2)

7 (30.4)

0.493

Other male family member

1 (7.1)

2 (22.2)

3 (13.0)

0..295

Stranger

1 (7.1)

1 (11.1)

2 (8.7)

0.742

Someone at school/work

0 (0.0)

1 (11.1)

1 (4.3)

0.202

Other

1 (7.1)

1 (11.1)

2 (8.7)

0.742

Any child physical or sexual abuse (n=336)

52 (34.4)

58 (31.4)

110 (32.7)

0.549

Ever been injured as result of child physical/sexual abuse (n=111)

9 (17.0)

4 (6.9)

13 (11.7)

0.099*

Ever went to hospital (among those with injuries; n=13)

1 (11.1)

2 (50.0)

3 (23.1)

0.125

Ever received healthcare for injury (among those with injuries; n=13)

No

7 (77.8)

2 (50.0)

9 (69.2)

0.277

Yes, always

0 (0.0)

1 (25.0)

1 (7.7)

Yes, sometimes

2 (22.2)

1 (25.0)

3 (23.1

Intimate partner violence (IPV)

       

Lifetime physical IPV (n=352)

65 (40.4)

74 (38.7)

139 (39.5)

0.870

Lifetime sexual IPV (n=325)

42 (29)

46 (25.6)

88 (27.1)

0.492

Lifetime physical or sexual IPV (n=352)

65 (40.4)

74 (38.7)

139 (39.5)

0.755

Ever beaten/physically assaulted by partner during pregnancy (n=297)

9 (6.5)

15 (9.5)

24 (8.1)

0.341

Ever punched/kicked in abdomen while pregnant (n=24)

3 (33.3)

7 (46.7)

10 (41.7)

0.521

Ever reported violence victimization to an authority (n=35)

4 (23.5)

4 (22.2)

8 (22.9)

0.927

Action taken if violence was reported (n=8)

2 (50.0)

3 (75.0)

5 (62.5)

0.465

Authorities prevented violence from happening again if violence was reported (n=5)

0 (0.0)

3 (100.0)

3 (60.0)

0.025**

Non-partner violence (adult; ages 15 and older)

     

Physical violence (n=336)

27 (17.9)

26 (14.1)

53 (15.8)

0.338

Perpetrator of physical violence (n=53)

       

Boyfriend

16 (59.3)

11 (42.3)

27 (50.9)

0.217

Female family member

6 (22.2)

5 (19.2)

11 (20.8)

0.788

Other male family member

2 (7.4)

6 (23.1)

8 (15.1)

0.111

Female friend of family

1 (3.7)

2 (7.7)

3 (5.7)

0.530

Someone at school

3 (11.1)

0 (0.0)

3 (5.7)

0.080*

Stranger

1 (3.7)

1 (3.8)

2 (3.8)

0.978

Mother

0 (0.0)

1 (3.8)

1 (1.9)

0.304

Other

1 (3.7)

2 (7.7)

3 (5.7)

0.530

Sexual violence (n=334)

10 (6.7)

4 (2.2)

14 (4.2)

0.039**

Perpetrator of sexual violence (n=14)

       

Boyfriend

5 (50.0)

4 (100.0)

9 (64.3)

0.078

Stranger

1 (10.0)

0 (0.0)

1 (7.1)

0.512

Male friend of family

1 (10.0)

0 (0.0)

1 (7.1)

0.512

Other

2 (20.0)

0 (0.0)

2 (14.3)

0.334

If forced sex, ever gang raped (n=11)

1 (14.3)

0 (0.0)

1 (9.1)

0.428

Any physical or sexual non-partner violence (n=333)

35 (23.5)

32 (17.4)

67 (20.1)

0.167

Ever been physically injured as a result of violence (n=107)

5 (10.0)

6 (10.5)

11 (10.3)

0.929

Ever sexually exploited (n=334)

3 (2.0)

8 (4.3)

11 (3.3)

0.247

Any lifetime violence victimization (n=333)

89 (55.3)

100 (52.4)

189 (53.7)

0.584

*Marginally significant

Table 5 Lifetime experiences of violence among national and stateless men in Cote d'Ivoire

 

National

Stateless

Total

 
 

(N=104)

(N=117)

(N=221)

 

n (%)

n (%)

n (%)

p-value

Exposure to violence

Mother ever hit father (n=130)

4 (4.9)

1 (2.0)

5 (3.8)

0.405

Father ever hit mother (n=129)

17 (21.0)

3 (6.3)

20 (15.5)

0.025

Ever saw or heard violence (n=21)

15 (88.2)

3 (75)

18 (85.7)

0.496

Divorced/separated due to violence (n=111)

5 (7.7)

2 (4.3)

7 (6.3)

0.721

Childhood violence

       

Physical child abuse (n=215)

47 (47.0)

54 (47.0)

101 (47.0)

0.995

Perpetrator of physical child abuse (n=101)

   

Other female family member

11 (23.4)

19 (35.2)

30 (29.7)

0.196

Other male family member

10 (21.3)

12 (22.2)

22 (21.8)

0.909

Father

12 (25.5)

9 (16.7)

21 (20.8)

0.273

Someone from the community

7 (14.9)

12 (22.2)

19 (18.8)

0.347

Someone from another community

5 (10.6)

9 (16.7)

14 (13.9)

0.382

Someone at school

11 (23.4)

3 (5.6)

14 (13.9)

0.010**

Teacher

8 (17.0)

1 (1.9)

9 (8.9)

0.008**

Male friend of family

3 (6.4)

6 (11.1)

9 (8.9)

0.405

Stranger

1 (2.1)

5 (9.3)

6 (5.9)

0.130

Street gang

1 (2.1)

1 (1.9)

2 (2.0)

0.921

Soldier/ Militia

1 (2.1)

1 (1.9)

2 (2.0)

0.921

Stepfather

0 (0.0)

1 (1.9)

1 (1.0)

0.348

Other

2 (4.3)

4 (7.4)

6 (5.9)

0.504

Sexual child abuse (n=212)

6 (6.1)

11 (9.7)

17 (8.0)

0.326

Perpetrator of sexual child abuse (n=17)

     

Someone from another clan

0 (0.0)

2 (18.2)

2 (11.8)

0.266

Other male family member

1 (16.7)

1 (9.1)

2 (11.8)

0.643

Other female family member

1 (16.7)

2 (18.2)

2 (11.8)

0.643

Male friend of family

0 (0.0)

3 (27.3)

3 (17.6)

0.21

Stranger

0 (0.0)

1 (9.1)

1 (5.9)

0.446

Female friend of family

2 (33.3)

1 (9.1)

3 (17.6)

0.21

Other

3 (50.0)

2 (18.2)

5 (29.4)

0.169

Any child physical or sexual abuse (n=215)

50 (50.0)

56 (48.7)

106 (49.3)

0.849

Ever been injured as result of child physical/sexual abuse (n=103)

16 (32.7)

17 (31.5)

33 (32.0)

0.899

Ever received healthcare for injury (among those with injuries; n=34)

No

11 (64.7)

11 (64.7)

22 (64.7)

0.801

Yes, always

1 (5.9)

2 (11.8)

3 (8.8)

 

Yes, sometimes

5 (29.4)

4 (23.5)

9 (26.5)

 

Violence victimization in adulthood (ages 15 and older)

   

Physical violence (n=211)

22 (22.2)

23 (20.5)

45 (21.3)

 

Perpetrator of physical violence (n=45)

       

Someone from another clan

3 (13.6)

13 (56.5)

16 (35.6)

0.003**

Other male family member

5 (22.7)

3 (13.0)

8 (17.8)

0.396

Soldier/ Militia

3 (13.6)

2 (8.7)

5 (11.1)

0.598

Teacher

5 (22.7)

0 (0.0)

5 (11.1)

0.015**

Male friend of family

2 (9.1)

2 (8.7)

4 (8.9)

0.963

Female family member

2 (9.1)

1 (4.3)

3 (6.7)

0.524

Street gang

0 (0.0)

2 (8.7)

2 (4.4)

0.157

Stranger

1 (4.5)

1 (4.3)

2 (4.4)

0.974

Father

1 (4.5)

0 (0.0)

1 (2.2)

0.301

Police

0 (0.0)

1 (4.3)

1 (2.2)

0.323

Female friend of the family

1 (4.5)

0 (0.0)

1 (2.2)

0.301

Other

1 (4.5)

2 (8.7)

3 (6.7)

0.577

Sexual violence (n=214)

       

Perpetrator of sexual violence (n=9)

       

Wife/Partner

1 (20.0)

3 (75.0)

4 (44.4)

0.099*

Female family member

3 (60.0)

0 (0.0)

3 (33.3)

0.058*

Someone from another clan

1 (20.0)

0 (0.0)

1 (11.1)

0.343

Stranger

0 (0.0)

1 (25.0)

1 (11.1)

0.236

Community leader

1 (20.0)

0 (0.0)

1 (11.1)

0.343

Any physical or sexual violence (n=211)

26 (26.3)

26 (26.2)

52 (24.6)

0.608

Ever injured from non-partner violence (n=51)

7 (26.9)

7 (28.0)

14 (27.5)

0.931

*Marginally significant

Table 6. Perpetration of intimate and non-partner violence among stateless and national men in Cote d'Ivoire

 

National

(N = 104)

Stateless

(N = 117)

Total

 

n (%)

n (%)

n (%)

p-value

Intimate Partner Violence

       

Lifetime physical IPV perpetration (n=220)

18 (17.3)

15 (12.9)

33 (15.0)

0.364

Partner pregnant at time when participant forced her to her to have sex (n=21)

1 (9.1)

1 (10.0)

2 (9.5)

0.620

Lifetime sexual IPV perpetration (n=202)

13 (13.3)

20 (19.2)

33 (16.3)

0.252

Lifetime physical or sexual IPV perpetration (n=221)

27 (26.0)

29 (24.8)

56 (25.3)

0.841

Partner ever been injured as a result of violence (n=26)

0 (0.0)

1 (3.7)

1 (1.9)

0.322

Non-Partner Violence

       

Ever physically hurt a woman (n=214)

8 (8.1)

3 (2.6)

11 (5.1)

0.071*

Ever forced sex with another woman (n=215)

0 (0.0)

3 (2.6)

3 (1.4)

0.107

Ever forced/pressured a woman into sex exchange (n=215)

     

no

97 (98)

113 (97.4)

210 (97.7)

0.389

yes, to have sex with me

1 (1.0)

3 (2.6)

4 (1.9)

yes, to have sex with someone else

1 (1.0)

0 (0.0)

1 (0.5)

If forced sex exchanged…

       

benefited financially (n=5)

0 (0.0)

1 (33.3)

1 (20.0)

0.361

made her travel to another area (n=75)

       

Lifetime non-partner violence perpetration (n=18)

8 (7.7)

6 (5.1)

14 (6.3)

0.435

Victim ever injured due to violence/abuse (n=18)

0 (0.0)

0 (0.0)

0 (0.0)

N/A

Victim ever went to safe shelter (n=16)

1 (12.5)

1 (12.5)

2 (12.5)

1.00

Victim reported violence/abuse to someone (n=15)

3 (42.9)

1 (12.5)

4 (26.7)

0.185

Ever threatened victim to prevent reporting (n=13)

0 (0.0)

1 (12.5)

1 (7.7)

0.411

Any lifetime non-partner violence victimization

8 (7.7)

6 (5.1)

14 (6.3)

0.435

*Marginally significant

     
             

Table 7. General health among male and female stateless and national populations in Cote d'Ivoire

 

Females

Males

 

National

Stateless

Total

 

National

Stateless

Total

 

(N =161 )

(N =191 )

(N =104 )

(N =117 )

n (%)

n (%)

n (%)

p-value

n (%)

n (%)

n (%)

p-value

General Health Rating (women, n=337; men, n=214)

             

Excellent/good

112 (74.7)

143 (76.5)

255 (75.7)

0.657

72 (72.7

95 (82.6)

167 (78.0)

0.081*

Fair

25 (16.7)

25 (13.4)

50 (14.8)

19 (19.2)

10 (8.7)

29 (13.6)

Poor/very poor

13 (8.7)

19 (10.2)

32 (9.5)

8 (8.1)

10 (8.7)

18 (8.4)

Hospitalized within the past year because of sickness (women, n=335; men, n=211)

15 (10.1)

17 (9.1)

32 (9.6)

0.774

15 (15.2)

5 (4.5)

20 (9.5)

0.008*

Health problems during the past month (women, n=336; men, n=210)

32 (21.3)

42 (22.6)

74 (22.0)

0.784

26 (26.8)

26 (23.0)

52 (24.8)

0.525

Depression (women, n=302; men, n=156)

28 (21.7)

41 (23.7)

69 (22.8)

0.683

15 (19.7)

20 (25.0)

35 (22.4)

0.431

Greatest challenges in accessing healthcare:

               

Getting permission to go to the doctor (women, n=337; men, n=215)

11 (7.4)

25 (13.4)

36 (10.7)

0.078*

3 (3.0)

15 (12.9)

18 (8.4)

0.009**

Problems getting money needed for advice/treatment (women, n=337; men, n=214)

75 (50.0)

136 (72.7)

211 (62.6)

48 (48.5)

85 (73.9)

133 (62.1)

Problems with distance to health facility (women, n=337; men, n=215)

42 (28.0)

66 (35.3)

108 (32.0)

0.154

20 (20.2)

44 (37.9)

64 (29.8)

0.005**

Problems not wanting to go alone (women, n=337; men, n=215)

18 (12.0)

51 (27.3)

69 (20.5)

0.001

6 (6.1)

26 (22.4)

32 (14.9)

0.001**

Concern about deportation ( women, n=337; men , n=215)

2 (1.3)

74 (40.2)

76 (22.8)

0 (0.0)

46 (39.7)

46 (21.4)

Frequency of alcohol consumption (women, n=343; men, n=215)

           

Never

114 (74.0)

142 (75.1)

256 (74.6)

0.592

45 (45.0)

68 (59.1)

113 (52.6)

0.060*

17 (11.0)

25 (13.2)

42 (12.2)

16 (16.0)

9 (7.8)

25 (11.6)

Few times per week/daily

23 (14.9)

22 (11.6)

45 (13.1)

39 (39.0)

38 (33.0)

77 (35.8)

Frequency of partner's alcohol consumption (women, n=216; men, n=111)

           

Never

46 (48.9)

65 (53.3)

111 (51.4)

0.610

53 (77.9)

33 (76.7)

86 (77.5)

0.933

15 (16.0)

14 (11.5)

29 (13.4)

5 (7.4)

4 (9.3)

9 (8.1)

Few times per week/daily

33 (35.1)

43 (35.2)

76 (35.2)

10 (14.7)

6 (14.0)

16 (14.4)

~cutoff based on 75th percentile; *Marginally significant

         

1. Blitz, B. and M. Lynch, Statelessness And Citizenship: A Comparative Study on the Benefits of Nationality. 2011, Cheltenham: Edward Elgar Publishing.

2. Blitz, B., Statelessness, protection and equality, R.S. Centre, Editor. 2009, Oxford Department of International Development, University of Oxford.

3. Vu, A., et al., The Prevalence of Sexual Violence among Female Refugees in Complex Humanitarian Emergencies: a Systematic Review and Meta-analysis. PLoS Curr, 2014. 6.

4. Wirtz, A., et al., Development of a screening tool to identify female survivors of gender-based violence in a humanitarian setting: qualitative evidence base from research among refugees in Ethiopia. Conflict and health, 2013. 7(13).

5. Wirtz, A.L., et al., Comprehensive development and testing of the ASIST-GBV, a screening tool for responding to gender-based violence among women in humanitarian settings. Confl Health, 2016. 10: p. 7.

6. Wirtz, A.L., et al., Gender-based violence in conflict and displacement: qualitative findings from displaced women in Colombia. Confl Health, 2014. 8: p. 10.

7. Asgary, R., E. Emery, and M. Wong, Systematic review of prevention and management strategies for the consequences of gender-based violence in refugee settings. International health, 2013. 5(2): p. 85-91.

8. UNHCR, Stateless Populations in West Africa and Statelessness Risk Factors. 2013, UNHCR,.

9. U.S. Department of State, 2013 Human Rights Report: Cote D'Ivoire. 2014, United States Government.: Washington DC.

10. International Organization for Migration, Cote D'Ivoire Facts and Figures 2013: Switzerland.

11. UNHCR, UNHCR Regional Representation Final Mission Report: Cote D'Ivoire (28 April - 11 May 2013). 2013, UNHCR,.

12. Dickson, M. and L. Bingham, Evaluation of Evidence Supporting Legal Argument in Côte d’Ivoire. 2011, Open Society Justice Initiative.

13. African Development Bank Group, Côte d’Ivoire: Emerging From Conflict Gender-based Component of a Multi-Sector Support Project. 2013.

14. Gupta, J., et al., Associations between Exposure to Intimate Partner Violence, Armed Conflict, and Probable PTSD among Women in Rural Côte d’Ivoire. PLoS One, 2014. 9(5): p. e96300.

15. Annan, J. and M. Brier, The risk of return: intimate partner violence in northern Uganda's armed conflict. Social science & medicine, 2010. 70(1): p. 152-9.

16. Clark, C.J., et al., The role of the extended family in women's risk of intimate partner violence in Jordan. Social science & medicine, 2010. 70(1): p. 144-51.

17. Falb, K.L., et al., Recent abuse from in-laws and associations with adverse experiences during the crisis among rural Ivorian women: Extended families as part of the ecological model. Glob Public Health, 2013. 8(7): p. 831-844.

18. UNHCR, Guidance document on measuring stateless populations, Statelessness Unit, Editor. 2011, United Nations High Commissioner for Refugees,: Geneva.

19. Committee, I.S., Guidelines for Integrating Gender-Based Violence Interventions in Humanitarian Action: Reducing risk, promoting resilience and aiding recovery. 2015, Inter-Agency Standing Committee

.

20. Bernard, H.R., Research methods in anthropology: Qualitative and quantitative approaches. 2011: Rowman Altamira.

21. Strauss, A. and J. Corbin, Basics of qualitative research. 1990, Newbury Park, CA: Sage.

22. Claudia García-Moreno, H.A.F.M.J., Mary Ellsberg, Lori Heise, Charlotte Watts, WHO Multi-country Study on Women’s Health and Domestic Violence against Women: Initial results onprevalence, health outcomesand women’s responses. 2005, World Health Organization: Geneva, Switzerland.

23. Fleming, P.J., et al., Risk Factors for Men’s Lifetime Perpetration of Physical Violence against Intimate Partners: Results from the International Men and Gender Equality Survey (IMAGES) in Eight Countries. PLoS ONE, 2015. 10(3): p. e0118639.

24. Fulu, E., et al., Prevalence of and factors associated with male perpetration of intimate partner violence: fi ndings from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacific. Lancet Glob Health, 2013. 1: p. e187–207.

25. Fulu, E., et al., Why do some men use violence against women and how can we prevent it? Quantitative findings from the United Nations multi-country study onf men and violence in Asia and the Pacific. 2013, UNDP, UNFPA, UN Women, UNV,: Bangkok.

26. Mollica, R., et al., MEASURING TRAUMA, MEASURING TORTURE: Instructions and Guidance on the utilization of the Harvard Program in Refugee Trauma’s Versions of The Hopkins Symptom Checklist-25 (HSCL-25) & The Harvard Trauma Questionnaire (HTQ) 2004, Harvard Medical School: Cambridge.

Distribution channels: Human Rights


EIN Presswire does not exercise editorial control over third-party content provided, uploaded, published, or distributed by users of EIN Presswire. We are a distributor, not a publisher, of 3rd party content. Such content may contain the views, opinions, statements, offers, and other material of the respective users, suppliers, participants, or authors.