* abbeymae@email.unc.edu Abigail M. HatcherID1,2*, Sabrina Page3,4, Lele Aletta van EckID2, Isabelle Pearson4,
Rebecca Fielding-Miller5, Celine Mazars6, Heidi Sto¨cklID3,4 1 Galling’s School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North
Carolina, United States of America, 2 School of Public Health, Faculty of Health Sciences, University of the
Witwatersrand, Johannesburg, South Africa, 3 Institute for Medical Information Processing, Biometry, and
Epidemiology, Ludwig-Maximilians-University, Munich, Germany, 4 Department of Global Health and
Development, London School of Hygiene and Tropical Medicine, London, United Kingdom, 5 Herbert
Wertheim School of Public Health, University of California, San Diego, San Diego, California, United States of
America, 6 Independent Researcher, Paris, France a1111111111
a1111111111
a1111111111
a1111111111
a1111111111 a1111111111
a1111111111
a1111111111
a1111111111
a1111111111 Systematic review of food insecurity and
violence against women and girls: Mixed
methods findings from low- and middle-
income settings Abigail M. HatcherID1,2*, Sabrina Page3,4, Lele Aletta van EckID2, Isabelle Pearson4,
Rebecca Fielding-Miller5, Celine Mazars6, Heidi Sto¨cklID3,4 Abigail M. HatcherID1,2*, Sabrina Page3,4, Lele Aletta van EckID2, Isabelle Pearson4,
Rebecca Fielding-Miller5, Celine Mazars6, Heidi Sto¨cklID3,4 Abstract Citation: Hatcher AM, Page S, Aletta van Eck L,
Pearson I, Fielding-Miller R, Mazars C, et al. (2022)
Systematic review of food insecurity and violence
against women and girls: Mixed methods findings
from low- and middle-income settings. PLOS Glob
Public Health 2(9): e0000479. https://doi.org/
10.1371/journal.pgph.0000479 Violence against women and girls (VAWG) is a global human rights and public health con-
cern. Food insecurity is a sign of severe poverty, and likely to heighten women’s vulnerability
to VAWG and men’s perpetration of it. However, the extent of the association and the multi-
ple pathways between food insecurity and VAWG are not well understood. We systemati-
cally assessed peer reviewed quantitative and qualitative literature to explore this in low-
and middle-income countries. Fixed effects meta-analysis was used to synthesize quantita-
tive evidence. Qualitative data was analyzed using thematic analysis. From a search of 732
titles, we identified 23 quantitative and 19 qualitative or mixed-methods peer-reviewed man-
uscripts. In a meta-analysis of 21 cross-sectional studies with 20,378 participants, food inse-
curity was associated with doubled odds of reported VAWG (odds ratio [OR] = 2.38, 95%
confidence interval [CI] = 1.82–3.10). This finding was consistent for both women’s experi-
ence or male perpetration of VAWG. Qualitative and mixed-methods papers offered insight
that underlying conditions of inequitable gender norms, economic deprivation, and social
isolation frame both food insecurity and VAWG. Food insecurity may trigger survival behav-
iors due to household stress and lack of meeting expected gender roles, which leads to
VAWG. VAWG exposure may lead to food insecurity if women are more impoverished after
leaving a violent household. Potential protective factors include financial stability, the
involvement of men in VAWG programming, transformation of gender norms, and support-
ing women to develop new networks and social ties. Strong evidence exists for a relation-
ship between food security and VAWG. Future funding should target causal directions and
preventive options through longitudinal and interventional research. Strategies to ensure
households have access to sufficient food and safe relationships are urgently needed to pre-
vent VAWG. Editor: Palash Chandra Banik, Bangladesh
University of Health Sciences, BANGLADESH
Received: April 18, 2022
Accepted: August 17, 2022
Published: September 14, 2022 Editor: Palash Chandra Banik, Bangladesh
University of Health Sciences, BANGLADESH PLOS GLOBAL PUBLIC HEALTH PLOS GLOBAL PUBLIC HEALTH Search strategy We searched five databases (PubMed, Web of Science, CINAHL, Global Health, and PsycInfo)
from January 2000 through to July 2021. A full search strategy included key words and Medical
Subject Headings (MESH) terms around the four constructs (S1 Text): food insecurity,
VAWG, NOT plants or animals and LMIC settings. Funding: The authors received no specific funding
for this work. Competing interests: The authors have declared
that no competing interests exist. Competing interests: The authors have declared
that no competing interests exist. Emerging evidence suggests food insecurity may be one factor related to VAWG. Food
insecurity is defined as having uncertain or limited availability of nutritionally adequate food
or the inability to acquire safe, acceptable foods [6]. Beyond sheer hunger from insufficient
food intake, food insecurity also includes poor dietary quality and worry or anxiety over secur-
ing food supplies [7]. It can incorporate social and psychological elements of shame or status
in a community. In 2019, an estimated 1.3 billion people lacked regular access to food [8], and
this number is likely to have increased since the SARS Cov-2 pandemic (Covid-19) [9]. Food
security is also worsening due to global climate change, with droughts leading to insufficient
agricultural output [10]. Being food insecure seems to be related to women’s exposure to violence, though the pathways
for this are poorly understood. Meinzen-Dick and colleagues posit that safety from VAWG
improves women’s household bargaining power, thereby improving food security [11]. Hatcher
et al. theorized that food insecurity leads to VAWG perpetration by prompting conflict, relation-
ship control, and causing increased alcohol intake [12]. Cash transfer trials have found that elimi-
nating food insecurity may reduce household conflict and improve decision-making [13]. It is
plausible that a bidirectional relationship between these two conditions may exist. The evidence on food insecurity and VAWG has yet to be brought together systematically. The gaps around the links between food insecurity and VAWG as well as potential solutions
are crucial to fill if we are to inform future programs and sustainable development goals. Methods We conducted a mixed-methods systematic review. Using the quantitative evidence, we per-
formed a meta-analysis to estimate the effect of the association between food insecurity and
VAWG in populations living in low- and middle-income countries (LMIC). We analyzed the
qualitative evidence using thematic analysis and synthesized the qualitative and mixed meth-
ods evidence to explore the drivers of food insecurity and VAWG, with an emphasis on possi-
ble pathways linking these conditions. The methodology for this systematic review was
developed in line with the Preferred Reporting Items for Systematic Reviews and Meta-
Analyses (PRISMA) [9]. Editor: Palash Chandra Banik, Bangladesh
University of Health Sciences, BANGLADESH Received: April 18, 2022
Accepted: August 17, 2022
Published: September 14, 2022 Peer Review History: PLOS recognizes the
benefits of transparency in the peer review
process; therefore, we enable the publication of
all of the content of peer review and author
responses alongside final, published articles. The
editorial history of this article is available here:
https://doi.org/10.1371/journal.pgph.0000479 Copyright: © 2022 Hatcher et al. This is an open
access article distributed under the terms of the
Creative Commons Attribution License, which
permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited. Data Availability Statement: Quantitative data is
included within the manuscript (Table 1 and Fig 2). 1 / 18 PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0000479
September 14, 2022 PLOS GLOBAL PUBLIC HEALTH Introduction The World Health Organization estimates that globally, one in four women experience violence
against women (VAWG) in their lifetime [1]. In sub-Saharan Africa, 44% of women experience
VAWG from an intimate partner and one in six experience non-partner violence [2]. VAWG
forms a persistent health crisis, leading to a high burden of injury, mental illness, physical
decline, and mortality [3, 4]. VAWG is also a human rights travesty that circumvents govern-
mental and bilateral commitments and undermines Sustainable Development Goals [5]. PLOS GLOBAL PUBLIC HEALTH Systematic review of food insecurity and violence against women Eligibility criteria Inclusion and exclusion criteria were constructed and applied to all results that came up rela-
tive to the search terms. The search terms can be found in S1 Text. Studies were limited to
original research published in peer-reviewed journals in the English language in low-and 2 / 18 PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0000479
September 14, 2022 PLOS GLOBAL PUBLIC HEALTH Systematic review of food insecurity and violence against women middle-income countries. The review included quantitative, qualitative, and mixed methods
interventional or observational study designs. Studies must have also reported the association between food insecurity and VAW among
adult populations, defined as aged 15 and above, with the study setting in a LMIC based on
current World Bank rating. Food insecurity is defined as the situation in which an individual
or household has difficulties accessing sufficient, safe, culturally appropriate and nutritious
food to meet dietary requirements and preferences for a healthy life due to lack of money or
other resources [4]. Qualitative studies were included if they used focus groups and/or inter-
views to assess experiences with food insecurity and access [13]. Studies were excluded if they
did not include a food insecurity measure as an exposure for VAWG or if they did not assess
food insecurity and VAWG together. Study selection followed a three-step process: title and abstract review, full text review, and
quality appraisal. First, multiple authors (AMH, SP, LvE, IP) reviewed all identified study titles
and abstracts using a double-blind process. Duplicates and studies that did not meet the inclu-
sion criteria were removed. The same authors independently assessed the full papers of those
abstracts that met the eligibility criteria. Finally, the authors conducted a quality appraisal on all full texts using the Newcastle–
Ottawa Scale (NOS) for observational studies [14]. NOS is a tool to assess the quality of non-
randomized studies to be used in a systematic review. Each study is judged with a ‘star system’
on three points: the selection of the study groups, the comparability of the groups, and the
ascertainment of the exposure or outcome. At each stage of the process, reviewers assessed discrepancies and garnered input from the
senior authors (CM and HS) until a consensus was reached. Finally, the three authors manu-
ally searched the reference lists of the included articles for further key studies that could poten-
tially be included in the analysis. Data abstraction. Eligibility criteria The following data was extracted and summarized in tables: citation;
year of publication; country; study design and sampling; characteristics of the study population;
outcomes (VAWG type); measures used (for food insecurity and VAWG). When available,
adjusted odds ratios (aOR) and similar estimates (e.g. relative risk, hazard ratio) with confidence
intervals were extracted. Additionally, count data was extracted in a two-by-two table to be
interpreted as an odds ratio. When count data was not presented in the published manuscript,
authors were contacted by email to invite them to share a simple two-by-two table. Data analysis. Quantitative outcomes were extracted into an Excel table. Pooled unad-
justed odds ratio (OR) estimates were calculated using random effects meta-analysis metan
command in STATA 12.0 [15]. Sub-analyses were conducted to assess meta-analytic findings
by sex (experience among women or perpetration by men), VAWG type (physical vs. sexual
vs. emotional), and geography of study setting. Qualitative data were thematically coded by summarizing themes from each included quali-
tative paper [16]. These themes were grouped inductively by three researchers (AMH, CM,
SP). We highlighted any geographical or methodological gaps in the current literature. In a
section on mixed-methods findings, we explored what the current literature says around
mechanisms on why food insecurity and IPV might be related? Here we drew upon available
quantitative data that highlights mediators or directionality between the two conditions. Study characteristics Our original search yielded 742 titles. Including seven papers found by contacting authors in
the field, a total of 38 papers were included in the systematic review (Fig 1). 3 / 18 PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0000479
September 14, 2022 PLOS GLOBAL PUBLIC HEALTH Systematic review of food insecurity and violence against women Our search identified 23 studies that examined the quantitative association between food
insecurity and VAWG (Table 1). The majority of studies (n = 20) examined VAWG experience
among women, while five studies looked at men’s VAWG perpetration. Studies were pub-
lished from 2012–2020 and were conducted in Africa (Cote d’Ivoire, Ethiopia, Kenya, Liberia,
South Africa, Eswatini, Uganda), Asia (Afghanistan, Bangladesh, Khazakstan, Nepal), and
Original Search
PubMed: 206
Web of Science: 271
PsychInfo / Global Health: 265
Duplicates: 188
Title / Abstract Screening: 554
Excluded: 487
• Review articles
• Case report
• Non-peer reviewed 
• Animal research
• Plant research
Full Text Review: 67
Excluded:
• Lacked predictor (food inse-
curity): 2
• Lacked outcome (VAWG): 6
• Paper unavailable: 3
• No data presented (review 
or think piece):4
• No association examined: 
10
Included: 38
Quant: IPV Victimization: 19
Quant: IPV Perpetration: 5
Qualitative:15
• Intervention trials: 7
Excluded:
• not in SSA: 5
Programme Review: 2
AIM 1
AIM 1
AIM 2
AIM 3
Fig 1. Study selection flow diagram. https://doi.org/10.1371/journal.pgph.0000479.g001 Original Search
PubMed: 206
Web of Science: 271
PsychInfo / Global Health: 265 Duplicates: 188 Title / Abstract Screening: 554 Full Text Review: 67 Programme Review: 2
AIM 3 Included: 38 Qualitative:15
AIM 2 Quant: IPV Perpetration: 5
AIM 1 Quant: IPV Victimization: 19
AIM 1 Fig 1. Study selection flow diagram. https://doi.org/10.1371/journal.pgph.0000479.g001 https://doi.org/10.1371/journal.pgph.0000479.g001 Our search identified 23 studies that examined the quantitative association between food
insecurity and VAWG (Table 1). The majority of studies (n = 20) examined VAWG experience
among women, while five studies looked at men’s VAWG perpetration. Studies were pub-
lished from 2012–2020 and were conducted in Africa (Cote d’Ivoire, Ethiopia, Kenya, Liberia,
South Africa, Eswatini, Uganda), Asia (Afghanistan, Bangladesh, Khazakstan, Nepal), and PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0000479
September 14, 2022 4 / 18 PLOS GLOBAL PUBLIC HEALTH Systematic review of food insecurity and violence against women Table 1. Quantitative studies included in systematic review. PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0000479
September 14, 2022 Study characteristics Author
Year
Country
Group
Study
type
Sample
size
Food
insecurity
Measure
VAWG
Measure
Time
period
Type of
VAW
Analysis
Adjusted
outcome
Control variables
Andarge,
2018
Ethiopia
Women
cross-
sectional
737
Food
insecurity
food insecurity
experience
scale
IPV
experience
WHO
Instrument
12
months
Phys,
Sex,
Emot
Logistic
Regression
aOR = 6.59
(4.54–9.57)
age of woman,
partner age
difference,
decision-making
Barnett
2019
South
Africa
Pregnant
women
cross-
sectional
992
Food
insecurity
USDA
Household
Food Security
Scale
IPV
experience
WHO
Instrument
12
months
Phys,
Sex,
Emot
Logistic
Regression
aOR
(emotional)
= 1.60 (1.04
to 2.46)
income,
education,
community,
childhood
trauma, stressful
life events,
depression,
distress
de Moraes
2016
Brazil
Women
cross-
sectional
845
Food
insecurity
Brazilian
version of
Household
Food
insecurity
Access Scale
(HFIAS)
IPV
experience
Revised
conflict tactic
scale
12
months
Phys,
Psych
Path
Analysis
adjusted
outcome
data not
presented
Diamond-
Smith,
2019
Nepal
Women
cross-
sectional
3373
Food
insecurity
Household
Food
insecurity
Access Scale
(HFIAS)
IPV
experience
Demographic
Health Survey
items
12
months
Phys,
Sex,
Emot
Logistic
Regression
aOR = 2.48
(1.52–4.04)
age, education,
ethnicity,
geographic
region, household
head, living with
partner,
occupation,
alcohol,
household wealth
Field,
2018
South
Africa
Pregnant
women
cross-
sectional
376
Food
insecurity
Household
Food Security
survey module
IPV
experience
Revised
conflict tactic
scale
6
Months
Phys,
Sex,
Emot
Logistic
Regression
aOR = 2.43
(1.50–4.57)
age, relationship
type, social
support, past
abuse, mental
health
Fielding-
Miller,
2015
Swaziland
Pregnant
women
cross-
sectional
405
Food
insecurity
7 items
IPV
experience
WHO
Instrument
12
months
Phys /
Sex
Logistic
Regression
adjusted
outcome
data not
presented
Fielding-
Miller,
2020
Swaziland
Young,
university
women
cross-
sectional
372
Food
insecurity
7 items
Sexual assault
Sexual
experience
Survey Short
Form
12
months
Sexual
Logistic
Regression
aOR = 2.43
(1.50–4.57)
ever had a child,
bursary as
support,
childhood abuse
exposure
Fong
2016
Cote
d’Ivoire
Women
cross
sectional
68
Food
insecurity
HFIAS
IPV
experience
unknown
12
months
Logistic
Regression
aOR = 8.36
(2.29–30.57)
children, marital
status
Gibbs,
2018
Afghanistan
Women
cross
sectional
935
Food
insecurity
Household
Hunger Scale
(HHS)
IPV
experience
WHO
Instrument
12
months
Phys,
Emot
Multinomial
Regression
aRRR = 1.13
(1.03–1.25)
age, cluster,
education,
ethnicity, gender
attitudes,
childhood
trauma, earnings,
polygyny, family
violence,
depression,
disability
(Continued)
PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0000479
September 14, 2022
5 / 18 5 / 18 PLOS GLOBAL PUBLIC HEALTH Systematic review of food insecurity and violence against women Author
Year
Country
Group
Study
type
Sample
size
Food
insecurity
Measure
VAWG
Measure
Time
period
Type of
VAW
Analysis
Adjusted
outcome
Control variables
Gibbs,
2018
South
Africa
Young
women
and men
in
informal
settings
cross
sectional
1357
Food
insecurity
HHS
IPV
perpetration/
experience
WHO
Instrument
12
months
Phys /
Sex
Logistic
Regression
aoR
(women) =
1.84 (1.08–
3.14) aOR
(men) = NS;
age, education,
intervention arm,
relationship
status, quarreling,
controlling
behaviours,
alcohol use,
depressive
symptoms
Gilbert,
2019
Khazakstan
Male
migrant
workers
cross-
sectional
1342
Food
insecurity
Single item
IPV
perpetration
Revised
conflict tactic
scale
6
Months
Phys /
Sex
Logistic
Regression
aOR
(external
migrant) =
4.37 (1.72–
11.07)
age, marital
status, children,
religion, ever in
jail, childhood
sexual abuse,
alcohol, social
support,
depression
Hatcher,
2019
South
Africa
Men in
informal
settings
cross
sectional
2006
Food
insecurity
HHS
IPV
perpetration
WHO
Instrument
12
months
Phys /
Sex
Logistic
Regression
aOR = 2.18
(1.75, 2.54)
migrancy,
eduction, age,
unemployment
Jewkes,
2019
Afghanistan
Women
cross-
sectional
1462
Food
insecurity
3 items
IPV
experience
WHO
Instrument
12
months
Physical
Multinomial
Regression
adjusted
outcome
data not
presented
Logie,
2019
Uganda
Displaced
young
women
cross-
sectional
233
Food
insecurity
Single item
IPV
experience
3 Items
12
months
Phys,
Sex,
Emot
Multinomial
Regression
aOR (>1
type VAWG)
= 7.15 (1.32,
38.89)
age, relationship
status, mobile
phone ownership,
depression,
childhood
violence,
transactional sex,
sexual
relationship
power,
community safety
Naved
2018
Bangladesh
Women
cross-
sectional
800
Food
insecurity
3 items
IPV
experience
WHO
Instrument
12
months
Phys /
Sex
Logistic
Regression
aOR (phys)
= 3.78 (1.29–
11.19)
Age, education,
children, income,
savings,
household
contribution,
acceptance of
IPV, control or
fights by husband
Orindi
2020
Kenya
Young
women
cross-
sectional
Hunger
Single item
IPV
experience
WHO
Instrument
6
months
Phys,
Sex,
Emot
Logistic
Regression
aOR (phys)
= 1.38 (1.01–
1.89)
age, intervention
arm, site, marital
status, in school,
religion, sexually
active
(Continued)
LOS Global Public Health | https://doi.org/10.1371/journal.pgph.0000479
September 14, 2022 6 / 18 PLOS GLOBAL PUBLIC HEALTH Systematic review of food insecurity and violence against women Author
Year
Country
Group
Study
type
Sample
size
Food
insecurity
Measure
VAWG
Measure
Time
period
Type of
VAW
Analysis
Adjusted
outcome
Control variables
Regassa
2012
Ethiopia
Women
cross-
sectional
1094
Food
insecurity
HFIAS
IPV
experience
WHO
Instrument
12
months
Phys,
Sex,
Emot
Logistic
Regression
aOR = 2.18
(1.75, 2.54)
age, age
difference,
marital status,
education,
literacy, religion,
household size,
alcohol use
Rahman,
2013
Bangladesh
Women
cross-
sectional
3861
Chronic
undernutrition
BMI<18.5Kg/
m2
IPV
experience
Revised
conflict tactic
scale
12
months
Phys /
Sex
Logistic
Regression
aOR = 1.22
(1.04–1.43)
age, education,
decision-making
autonomy,
occupation,
religion,
residence,
number of
household
members, ever
use of
contraception
and respondent’s
height
Ribeiro-
Silva,
2016
Brazil
Poor
families
cross-
sectional
1019
Food
insecurity
Brazilian
HFIAS
IPV
perpetration
Revised
conflict tactic
scale
12
months
Physical
Logistic
Regression
aPR (minor
violence) =
1.23 [1.12,
1.35]
economic status,
income,
agglomeration
and education
level
Schneider,
2018
South
Africa
Pregnant
women
cross-
sectional
425
Food
insecurity
HFIAS
IPV
experience
2 item
quesionnairre
3
Months
Phys /
Sex
Bivariate
adjusted
outcome
data not
presented
Shai,
2019
Nepal
Migrant
workers
cross-
sectional
357
Hunger
Single item
IPV
perpetration/
experience
WHO
Instrument
12
months
Phys,
Sex,
Emot
Logistic
Regression
aOR (older
women) =
1.77 (1.11–
2.81) aOR
(men) = NS
age, depression,
mother-in-law
relationship
Swahn,
2015
Uganda
Young
women
cross-
sectional
313
Hunger
Single item
Sexual assault
Youth risk
behaviour
survey,
12
months
Sexual
Logistic
Regression
aOR = 3.73
[1.92, 7.22]
age, alcohol. Measurement Overall, measurement of food insecurity and VAWG in included studies was of high quality. Most studies used self-reported measures to assess food insecurity (with one study objectively
assessing malnutrition by measuring body mass index [17]). All studies used self-reported
measures of VAWG. While self-reports represent the state of art for food insecurity and
VAWG research, there are clear limitations in reporting bias for this type of measure, such as
underreporting and social desirability bias. Multiple studies used comprehensive measures of food security. The Household Food Inse-
curity Access Scale (HFIAS) and the Brazilian Food Insecurity Scale (BFIS) measure constructs
of quality and quantity of food supply as well as anxiety around food supply. Four studies used
HFIAS [18–21] and two used BFIS [22, 23]. Another strong measure is the USDA Household
Food Security Scale [24]. Three papers used 3-items of HFIAS related to household hunger
(called the Household Hunger Scale [HHS]) [12, 25, 26]. Several studies used a single item to
assess food insecurity [27–31], which may increase the risk of misclassification. Measurement of VAWG varied but a majority used validated scales that assessed between 9
to 14 behaviourally-specific actions to classify whether violence occurred or not. Tools
included the World Health Organization multi-country study instrument [12, 20, 24–26, 29,
30, 32–35], the Revised Conflict Tactics Scale [17, 22, 23, 27, 36, 37], the Sexual Experiences
Survey [33], and the Demographic Health Survey Domestic Violence module [18]. Three stud-
ies used non-validated 1 to 3 single item questions asking participants whether they experi-
enced any physical or sexual intimate partner? violence [21, 28, 31]. Ethical considerations of studies Many studies included an explanation of the ethical procedures undertaken if a participant dis-
closed experience of or perpetration of VAWG. While this was not a focus of the review, it is
important to note that this ethical section is required by most experimental trial reporting and
represents best-practice in the violence research field. Study characteristics Loneliness
Willie,
2018
Liberia
Pregnant
women
cross-
sectional
195
Food
insecurity
1 item from
Harvard
Trauma
Questionnaire
IPV
experience
Revised
conflict tactic
scale
Lifetime
Phys /
Sex
Logistic
Regression
aOR = 2.55
[1.32, 4.94]
age, education,
employment,
relationship
status, children
https://doi.org/10.1371/journal.pgph.0000479.t001
LOS Global Public Health | https://doi.org/10.1371/journal.pgph.0000479
September 14, 2022 7 / 18 PLOS GLOBAL PUBLIC HEALTH Systematic review of food insecurity and violence against women South America (Brazil). All included studies were cross-sectional reports. Of the 18 qualitative
and mixed-methods papers included in the synthesis, 9 took place in sub-Saharan Africa, 4 in
Asia, and 2 in Latin America (Table 1). Meta-analytic findings The meta-analysis included 21 studies with relevant bivariate data (Table 2). Overall, the rela-
tionship between food security and VAWG was significant (Fig 2). Being food insecure dou-
bled the odds that a participant reported VAWG exposure (odds ratio [OR] = 2.38, 95%
confidence interval [CI] = 1.82–3.10). [
]
)
When examined by sex, the meta-analytic findings stay consistent (Fig B1 in S1 Fig). Stud-
ies examining women’s VAWG reporting found that food insecurity more than doubles the
odds of them experiencing VAWG (OR = 1.98, 95%CI = 1.79–2.18). If men are food insecure,
they report roughly double the odds of perpetrating VAWG (OR = 1.90, 95%CI = 1.63–2.22). Results vary somewhat by VAWG type, though this should be tempered by the limited
number of studies in each category (Fig B2 in S1 Fig). When studies measured VAWG as “any
physical, sexual or emotional form of violence”, food insecurity more than doubled the odds of
violence (OR = 2.27, 95%CI = 1.89–2.72). When studies measured it as “physical violence
only”, the association was similar and slightly stronger (OR = 2.55, 95%CI = 2.17–3.01). By
contrast, using a measure of “any physical and/or sexual violence” led to 70% increased odds
of VAWG (OR = 1.70, 95%CI = 1.55–1.87). The number of studies included in “sexual only”
(n = 2) or “physical and/or emotional” (n = 1) VAWG were too small to be interpreted, though
both were above three-fold odds. When examined by sex, the meta-analytic findings stay consistent (Fig B1 in S1 Fig). Stud-
ies examining women’s VAWG reporting found that food insecurity more than doubles the
odds of them experiencing VAWG (OR = 1.98, 95%CI = 1.79–2.18). If men are food insecure,
they report roughly double the odds of perpetrating VAWG (OR = 1.90, 95%CI = 1.63–2.22). Results vary somewhat by VAWG type, though this should be tempered by the limited
number of studies in each category (Fig B2 in S1 Fig). When studies measured VAWG as “any
physical, sexual or emotional form of violence”, food insecurity more than doubled the odds of
violence (OR = 2.27, 95%CI = 1.89–2.72). When studies measured it as “physical violence
only”, the association was similar and slightly stronger (OR = 2.55, 95%CI = 2.17–3.01). By
contrast, using a measure of “any physical and/or sexual violence” led to 70% increased odds
of VAWG (OR = 1.70, 95%CI = 1.55–1.87). Association between food insecurity and VAWG Eighteen studies examined the association between food insecurity and VAWG experience among
women. The majority of these studies were among adult women in the general population. Five
studies were conducted among women aged 18+ [26, 28, 29, 31, 33] and four among pregnant adult
women [21, 36, 37]. Shai et al. examined migrant workers [30], while Naved et al. conducted
research among factory workers [35]. The young women Logie et al. interviewed were displaced by
migration [28]. Every study reporting adjusted associations of food insecurity and VAWG experi-
ence among women found statistically significant results. The odds ratios ranged from 1.22 to 8.36,
suggesting that the two conditions are significantly and strongly associated in cross-sectional data. Five studies included measures of men’s perpetration of VAWG [12, 23, 26, 27, 30]. Four
studies were among adult men in the general population, though Gibbs et al. conducted
research among adult men aged 18–30. Gibbs et al. and Hatcher et al. conducted research in
informal, urban settings [26] while Gilbert et al. and Shai et al. focused on migrant communi-
ties [27, 30]. Three studies reported significant associations between food insecurity and
VAWG perpetration by men [12, 23, 27]. The adjusted odds ratios for studies reporting a sig-
nificant association ranged from 2.18–4.37. The two studies in South Africa and Nepal that did 8 / 18 PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0000479
September 14, 2022 PLOS GLOBAL PUBLIC HEALTH Systematic review of food insecurity and violence against women not report a significant association presented no data on the adjusted relationship between
food insecurity and VAWG perpetration [26, 30]. https://doi.org/10.1371/journal.pgph.0000479.t002 Meta-analytic findings The number of studies included in “sexual only”
(n = 2) or “physical and/or emotional” (n = 1) VAWG were too small to be interpreted, though
both were above three-fold odds. The meta-analytic results vary slightly by region (Fig B3 in S1 Fig). African studies show a
stronger association between the two conditions (OR = 2.17, 95%CI = 1.97–2.39) compared to
Asian studies (OR = 1.86, 95%CI = 1.67–2.09). In terms of timeframe (Fig B4 in S1 Fig), studies
conducted before El Nino in 2016 show a weaker association between food insecurity and Table 2. Qualitative and mixed-methods studies included in systematic review. Author
Year
Country
Population group
Data collection method
Sample size
1
Ager,
2018
Uganda
Women, Men, Boys and girls
Focus Groups
64 Groups
2
Bellows,
2015
Georgia & South Africa
States
Case study
n/a
3
Bonatti,
2019
Tanzania
Men, Women
Survey/ Workshop
333
4
Buller
2016
Ecuador
Men, Women
Qual interviews + Focus Groups
48 IDIs; 8 FGDs
5
Buller
2018
Global
Peer-review publications
Lit Review
n/a
6
Cardoso,
2016
Coˆte d’Ivoire,
Men and Women
Focus group
91
7
Davis,
2018
Zambia
Men and Women
Survey
204
8
Derose,
2017
Dominican Republic
Women with HIV
Qual interviews
30
9
Deuba,
2016
Nepal
Pregnant women
Qual interviews
20
10
De Moraes
2016
Brazil
Women
Quantitative
849
11
Fielding-Miller
2019
Eswatini
Women victims of VAWG
Qual interviews
20
12
Hatcher
2019
South Africa
Men
Quantitative
2604
13
Lemke,
2003
South Africa
Men and Women
Qual interviews
166
14
Lentz,
2019
South Asia
Women
Qual interviews
134
15
Meinzen-Dick
2019
Global
Peer-review publications
Lit Review
n/a
16
Miller,
2011
Uganda
Women & Men
Qual interviews
41
17
Roy
2019
Bangladesh
Women
Qual interviews
not stated
18
Sethuraman,
2006
South India
Women & children
Focus group
820
19
Zakaras
2017
Kenya
Women & Men
Qual interviews
54
htt
//d i
/10 1371/j
l
h 0000479 t002 Table 2. Qualitative and mixed-methods studies included in systematic review. Table 2. Qualitative and mixed-methods studies included in systematic review. Meta-analytic findings PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0000479
September 14, 2022 9 / 18 PLOS GLOBAL PUBLIC HEALTH Systematic review of food insecurity and violence against women I-V Overall  (I-squared = 87.6%, p = 0.000)
Shai   men
Swahn
Field
Gilbert
author
Schneider
Andarge
Shai  women
Rahman
Regassa
Gibbs  women
Fielding-Miller
Jewkes / Gibbs
Hatcher
Naved
Fielding-Miller
Logie
Gibbs  men
D+L Overall
Willie
2019
2015
2018
2019
year
2018
2018
2019
2013
2012
2018
2020
2019
2019
2018
2015
2019
2018
2018
1.95 (1.80, 2.12)
2.90 (0.31, 27.03)
5.35 (3.02, 9.46)
2.63 (1.48, 4.68)
2.23 (1.43, 3.49)
OR (95% CI)
1.22 (0.63, 2.36)
6.41 (4.53, 9.06)
1.82 (0.83, 3.99)
1.32 (1.15, 1.53)
1.80 (1.25, 2.61)
3.01 (2.00, 4.55)
3.09 (1.83, 5.21)
3.10 (2.16, 4.47)
2.05 (1.71, 2.47)
4.72 (1.79, 12.43)
1.82 (1.21, 2.74)
0.89 (0.55, 1.44)
1.20 (0.82, 1.76)
2.38 (1.82, 3.10)
5.68 (3.24, 9.95)
100.00
0.14
2.08
2.04
3.39
(I-V)
%
1.56
5.64
1.10
33.06
4.95
3.99
2.48
5.10
19.97
0.72
4.06
2.96
4.61
Weight
2.15
1.95 (1.80, 2.12)
2.90 (0.31, 27.03)
5.35 (3.02, 9.46)
2.63 (1.48, 4.68)
2.23 (1.43, 3.49)
OR (95% CI)
1.22 (0.63, 2.36)
6.41 (4.53, 9.06)
1.82 (0.83, 3.99)
1.32 (1.15, 1.53)
1.80 (1.25, 2.61)
3.01 (2.00, 4.55)
3.09 (1.83, 5.21)
3.10 (2.16, 4.47)
2.05 (1.71, 2.47)
4.72 (1.79, 12.43)
1.82 (1.21, 2.74)
0.89 (0.55, 1.44)
1.20 (0.82, 1.76)
2.38 (1.82, 3.10)
5.68 (3.24, 9.95)
100.00
0.14
2.08
2.04
3.39
(I-V)
%
1.56
5.64
1.10
33.06
4.95
3.99
2.48
5.10
19.97
0.72
4.06
2.96
4.61
Weight
2.15
 
 
1
.037
1
27
Fig 2. Meta-analysis of cross-sectional studies of relationship between food security and violence against women and girls. al studies of relationship between food security and violence against women and girls. . Meta-analysis of cross-sectional studies of relationship between food security and violence against women and girls. Fig 2. Meta-analysis of cross-sectional studies of relationship between food security and violence against women and girls. Fig 2. Meta-analysis of cross-sectional studies of relationship between food security and violence agai https://doi.org/10.1371/journal.pgph.0000479.g002 https://doi.org/10.1371/journal.pgph.0000479.g002 VAWG (OR = 1.51, 95%CI = 1.33–1.70). Studies conducted after the El Nino year show a
stronger association between the two conditions (OR = 2.38, 95%CI = 2.18–2.61). Meta-analyses were visually inspected for potential publication bias through funnel
plots and Egger’s test for small-study effects (S2 Fig). There was no evidence of publication
bias (p = 0.09). Qualitative and mixed-methods findings on common drivers and their
pathways The analysis of qualitative and mixed-methods findings suggests that the relationship between
food insecurity and VAWG is underpinned by entrenched poverty and gender-inequitable
norms. The following describes how the pathways of economic deprivation, alcohol use, and
underlying drivers of violence such as gender norms and social ties lead to an increase of 10 / 18 PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0000479
September 14, 2022 PLOS GLOBAL PUBLIC HEALTH Systematic review of food insecurity and violence against women Relationship
Social
Mental health decline:
• trauma
• depression
Food Insecurity
Malnutrition 
Hunger 
Inability to 
ﬁ nd food in 
acceptable 
ways
Few social 
support networks
Emotional 
reactivity
Isolation
Aggression
Violence
against
Women & Girls
Rigid gendered beliefs
• decision-making
• food practices
• men control resources 
Individual
Alcohol as coping 
strategy to
• mask hunger
Alcohol misuse and 
dependence
Risky partnerships or early marriage to secure food
Threats to masculinity:
• low libido
• loss of breadwinner role
• women gaining agency
Women have limited access 
to land, property, credit
Relationship 
conﬂ ict
Quarreling
Unequal
sexual power
Chronic stress
Gender power dynamics:
Fig 3. Conceptual framework of pathways between food insecurity and VAWG. https://doi org/10 1371/journal pgph 0000479 g003 Violence
against
Women & Girls Fig 3. Conceptual framework of pathways between food insecurity and VAWG. https://doi.org/10.1371/journal.pgph.0000479.g003 VAWG, through routes of individual, relationship, and social behaviours. These potential
pathways are highlighted in Fig 3. Individual pathways. Poor mental health that results from trauma or chronic stress,
especially due to food insecurity, also plays a role in perpetrating VAWG. Among men who
are experiencing food insecurity depression seems to be an important pathway leading to
VAWG perpetration [28]. Several papers presented the idea that “If the house is not peaceful,
food is not eaten” [38]. One mechanism for this may be the psychological distress caused by
VAWG exposure. Women reported not eating food because of stress and fear of violence
caused by their husband’s behaviour [39, 40]. y
Alcohol use may be a maladaptive coping mechanism of being food insecure [12]. Stress
and alcohol use depletes psychological resources required to enact self-control over the violent
act. Alcohol use may further entrench household conflict if household income is used to buy
alcohol instead of purchasing food necessities [41]. Alcohol misuse by men may be related to
over-compensating among men who fail to meet the role of provider [42]. Relationship pathways. PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0000479
September 14, 2022 Qualitative and mixed-methods findings on common drivers and their
pathways Food insecurity can cause women to engage in risky survival
behaviours, such as resorting to exploitative transactional sex to meet food needs [38, 41, 43,
44]. In post-conflict settings in Uganda, families sometimes arrange marriages for younger
women in their family to secure access to resources, placing the girls at higher risk of violence
[38]. Women themselves may strategically chose abusive relationships as an alternative to
being without food [39, 41, 43]. Quarrelling within the household manifests through conflict over resource allocation [38,
45, 46]. In many settings, men are in a position to control assets and may spend household
income on non-food items, including to buy alcohol [45]. Quarrels are also caused by the gen-
eral stress induced by the lack of food, which compromises the family well-being [46]. If food
insecurity is caused by a man losing his job, the financial burden can create relationship con-
flict and VAWG [41]. 11 / 18 PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0000479
September 14, 2022 PLOS GLOBAL PUBLIC HEALTH Systematic review of food insecurity and violence against women Food insecurity can alter gender power dynamics in the household. A woman may take on
work outside the home to supplement household earnings or men may leave the home to look
for work [45]. In either instance of a deepening of traditional roles or a subversion of typical
roles, a woman may be at higher risk and further exposed to VAWG [47]. Men may feel their
identity as providers are threatened, which can lead to unhealthy coping strategies such as
abusing alcohol, taking on multiple partners, or perpetrating VAWG [42, 43]. Women’s gen-
dered position as sexually accessible can be compromised if food insecurity leads to a loss of
libido [43, 46]. Disempowerment caused by poverty limits the ability of women to circumvent
the norms that make them more vulnerable to malnourishment [48]. Food practices are also gendered, where being a “woman at the table” means eating later or
accessing lower quantity or quality of food. In some settings, women were required to eat after
the man and the children, leading some to suggest that women can be exposed to a sort of
“food-related violence” [41, 45]. When male partners determine how much money can be allo-
cated to food purchases, their control over women’s access to nutrition may similarly be
viewed as a form of economic violence [40]. Qualitative and mixed-methods findings on common drivers and their
pathways This pattern may explain why studies looking at
intra-household malnutrition find that women suffer more than men from under-nutrition
[43]. Ager suggested that some women “preferred being beaten [if] children can eat”, confirm-
ing that strict norms around the ability of women to care for children were sometimes priori-
tized over individual safety [38, 41]. Social pathways. Social ties seem crucial to empower women, but these are challenging
to maintain in the context of food insecurity [48–50]. In a study among HIV positive people,
lack of food was leading to VAWG partly due to disruptions in social networks due to HIV-
related stigma, which distanced people from sources of food support [50]. Material resources of land, property and credit can be protective for women. When wid-
ows inherit land or other assets, this could lead to increased food security and prevent women
from engaging in sexual relationships for food and other goods, as show in [country x] [44]. Women involved in farming cooperatives report improved social assets (networking), human
assets (capacity building) and natural assets (access to land) [41]. Other types of empowerment
included women’s improved decision making [47], managing resources (incl through access
to credit) [44] or by attending nutritional sessions or saving groups [13, 42]. In one program
in South Africa, there was a new acceptance that there could be a number of income earners in
the household and therefore also several decision-makers [48]. Indeed, access to networks is
one of the pathways through which successful interventions seem to reduce violence [13, 48,
51]. PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0000479
September 14, 2022 Discussion Evidence from published literature suggests that food insecurity and VAWG are deeply inter-
twined. In meta-analysis of more than 20,000 participants we found food insecurity is associ-
ated with more than double the odds of experiencing or perpetrating VAWG. This finding is
consistent across various types of VAWG assessed, study region, and publication timeframe
(pre vs. post-El Nino). Food insecurity seems to similarly impact women’s exposure to VAWG
and men’s perpetration of this type of violence. Growing evidence pinpoints why and how food security and VAWG are related. We identi-
fied a robust, if relatively small, body of qualitative and mixed methods studies in LMICs. Together, these findings inform a conceptual ecological framework capturing individual, rela-
tionship, and social levels. At the individual level, hunger and lack of nutrition can inhibit
mental health or lead to maladaptive coping via alcohol use. At the relationship level, economic
stress and household conflict over resources can threaten gender roles, aligning with past 12 / 18 PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0000479
September 14, 2022 PLOS GLOBAL PUBLIC HEALTH Systematic review of food insecurity and violence against women (non-systematic) literature reviews [52]. Socially there is an overlap with rigid gender norms
that confine women to community positions without access to land, credit/savings, or other
material resources. Because food insecurity further isolates women, this has grave implications
for their ability to respond to VAWG. Our evidence synthesis suggests interventions aiming to improve food security and safety
for women and girls can operate along three pathways: Addressing mental health and alcohol,
shifting power dynamics within the household, and women’s social empowerment through
material resources and networks. These three layers fit well with promising VAWG prevention
intervention research from LMICs. For example, among men, addressing mental health and
alcohol misuse seems to be a promising way to limit VAWG perpetration [53–55]. Cash trans-
fers that offer financial stability show promise in reducing couple conflict and household stress
[13, 42, 46, 47]. Improving food security may enhance the quality of the couple’s relationship
in general, and sexual intimacy in particular [46]. An important caveat is the potential for food security interventions to increase VAWG if
they lead to backlash by male partners of female participants. If men feel that women have bet-
ter access to household resources and livelihood opportunities, they may feel their masculinity
being threatened and retaliate with violence [47]. Limitations The systematic review had several limitations. Papers were only reviewed in English, which
limits our ability to draw from papers from all LMIC settings. It is plausible that a larger review
inclusive of Spanish and Portuguese language publications would be in a better position to
assess the association in that region as only few studies were included that were conducted in
Latin America. Because we focused on peer-reviewed literature, we underrepresent perspec-
tives from reports or other grey literature. This may be an acceptable shortcoming for meta-
analytic outcomes, but they represent a potentially important gap in our qualitative and mixed
methods result. The quantitative studies also used different scales to measure food insecurity
and VAWG. It is important to note here that two South American studies included in our
review were not included in meta-analysis due to methodologic differences in reporting (and
authors were not able to provide additional data by email). We did not abstract information
from the studies around research ethics, but given the sensitive nature of the research topics
this might be an important area for future reviews to examine more closely. Discussion Evidence on the frequency of this backlash is
not consistent though and recent reviews have not identified it in relation to food insecurity
[56–58]. Further, it is plausible that coupling food insecurity provisions with gender empower-
ment programming may help to reduce or prevent male backlash [47]. PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0000479
September 14, 2022 Next steps for research, policy, and practice There is, to date, little evidence of directionality. Since completion of this review, one longitu-
dinal study among men in South Africa suggests food insecurity leads to later VAWG perpe-
tration add reference. The authors found no quantitative association between VAWG
perpetration and later food insecurity, though it is plausible that data from women survivors
might have distinct findings. The included literature relied on a heterosexual framing of pub-
lished findings in LMICs. Violence against LGBTIQ communities is higher than in other pop-
ulations and follows similar patterns of power and control as heterosexual relationships,
suggesting food insecurity may be an important dynamic to explore in these samples. There are major gaps in understanding how policy and broader political forces shape the
food security and VAWG intersection. For example, the effect of climate change is likely to be
monumental, yet no extant literature, to our knowledge, exists on climate change, food and PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0000479
September 14, 2022 13 / 18 PLOS GLOBAL PUBLIC HEALTH Systematic review of food insecurity and violence against women VAWG. There is emerging information about Covid-19 and VAWG as well as around Covid-
19 and food security. However, we are unaware of publications that combine these three inter-
secting conditions. There is also a lack of data around how these issues affect young people, a
crucial oversight since adolescents and young adults represent a growing proportion of LMIC
citizenry. VAWG. There is emerging information about Covid-19 and VAWG as well as around Covid-
19 and food security. However, we are unaware of publications that combine these three inter-
secting conditions. There is also a lack of data around how these issues affect young people, a
crucial oversight since adolescents and young adults represent a growing proportion of LMIC
citizenry. Evidence for efficacious strategies that jointly target food insecurity and VAWG prevention
is limited. This gap is crucial to fill, since these two social drivers of health are highly prevalent
in many LMIC communities. Multiple programming approaches have the potential to be sus-
tainable, scalable and cost-effective, but these have limited research demonstrating their effi-
cacy. For example, Gender Action and Learning, a community-based methodology adopted
by large-scale organizations such as Oxfam and IFAD, adds gender reflections and visioning
exercises to agricultural and financial planning trainings. Next steps for research, policy, and practice Gender Champions, a program
implemented by Catholic Relief Services, conducts three home visits and implements ‘safe
spaces’ where women and men can discuss common issues. Social Analysis and Action in
Food and Nutrition Security, implemented by Care in more than 20 countries, asks commu-
nity members to take practical steps to address gender, discrimination, or social norms
through analysis-action-reflection. According to qualitative or anecdotal evidence, each of
these programs seem to improve attitudes about VAWG and decision-making for women,
lead to more equitable household division of labour, and offer better economic opportunities. However, none of these has been tested rigorously using experimental study designs, highlight-
ing the importance of funding for research around food and safer relationships programming. It terms of strategies going forward, programming should be framed as focused on family
well-being to benefit households (rather than programming to transform gender). Women’s
empowerment should be an implicit strategy of the intervention, even if this is not necessarily
highlighted during community onboarding. Additionally, improving networks and social ties
could be a promising strategy for promoting resilience for both food and violence prevention. Existing innovations in the field should be accompanied by rigorous evidence generation. This
can be accomplished by adding VAWG and food security to ongoing trials, carefully evaluat-
ing scale-up activities in quasi-experimental design, and funder requirements for practice-
based research that includes effectiveness findings. Conclusion This review synthesizes the evidence base on food insecurity and VAWG, and finds these two
conditions are statistically and qualitatively related. Both women’s experience of VAWG and
male perpetration of VAWG are doubled when participants disclose food insecurity. The
bidirectionality of these conditions is highlighted in emerging qualitative findings that (1) food
insecurity may lead to household stress or tension around gender roles, and/or (2) VAWG
exposure may lead to food insecurity if women are more impoverished after leaving a violent
household. The review identifies promising strategies for addressing food insecurity and
VAWG concurrently: financial stability, gender-transformative approaches, and supporting
women’s social ties. Global goals to improve nutrition, achieve gender equity, and reduce
household poverty will only be accomplished if food security and safer relationships are placed
at the forefront of policy and funding decisions in the coming years. S1 Text. Search terms for PubMed, Web of Science, PsycInfo.
(DOCX) Supporting information S1 Text. Search terms for PubMed, Web of Science, PsycInfo. (DOCX) 14 / 18 PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0000479
September 14, 2022 PLOS GLOBAL PUBLIC HEALTH Systematic review of food insecurity and violence against women Author Contributions Conceptualization: Abigail M. Hatcher, Sabrina Page, Celine Mazars, Heidi Sto¨ckl. Data curation: Abigail M. Hatcher, Lele Aletta van Eck, Rebecca Fielding-Miller. Formal analysis: Abigail M. Hatcher, Sabrina Page, Isabelle Pearson, Celine Mazars. Investigation: Abigail M. Hatcher, Sabrina Page, Celine Mazars, Heidi Sto¨ckl. Methodology: Abigail M. Hatcher, Sabrina Page, Rebecca Fielding-Miller. Project administration: Abigail M. Hatcher, Lele Aletta van Eck, Celine Mazars. l Project administration: Abigail M. Hatcher, Lele Aletta van Eck, Celine Mazars. Resources: Celine Mazars. Software: Abigail M. Hatcher. Supervision: Heidi Sto¨ckl. Validation: Abigail M. Hatcher, Sabrina Page, Isabelle Pearson. Visualization: Abigail M. Hatcher. Visualization: Abigail M. Hatcher. Writing – original draft: Abigail M. Hatcher, Celine Mazars. Writing – review & editing: Abigail M. Hatcher, Sabrina Page, Lele Aletta van Eck, Isabelle
Pearson, Rebecca Fielding-Miller, Celine Mazars, Heidi Sto¨ckl. 7.
Bickel G, Nord M, Price C, Hamilton W, Cook J. Guide to Measuring Household Food Security, Revised
2000. Alexandria, VA: U.S. Department of Agriculture, Food and Nutrition Service, 2000 March, 2000.
Report No. PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0000479
September 14, 2022 Systematic review of food insecurity and violence against women Systematic review of food insecurity and violence against women 8. United Nations. United Nations Food Issue. Geneva: UN, 2020. 9. World Bank. Food security and COVID-19. Washington D.C.: World Bank, 2021. 11. Meinzen-Dick R, Quisumbing A, Doss C, Theis S. Women’s land rights as a pathway to poverty reduc-
tion: Framework and review of available evidence. Agricultural Systems. 2019; 172:72–82. 12. Hatcher AM, Sto¨ckl H, McBride R-S, Khumalo M, Christofides N. Pathways from food insecurity to inti-
mate partner violence perpetration among peri-urban men in South Africa. American Journal of Preven-
tive Medicine. 2019; 56(5):765–72. https://doi.org/10.1016/j.amepre.2018.12.013 PMID: 30905482. 13. Buller AM, Hidrobo M, Peterman A, Heise L. The way to a man’s heart is through his stomach?: a mixed
methods study on causal mechanisms through which cash and in-kind food transfers decreased inti-
mate partner violence. BMC Public Health. 2016; 16:488. Epub 2016/06/10. https://doi.org/10.1186/
s12889-016-3129-3 PMID: 27278935; PubMed Central PMCID: PMC4898371. 14. Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale
(NOS) for assessing the quality of nonrandomised studies in meta-analyses [Feb 18 2022]. Available
from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. 15. Harris R, Bradburn M, Deeks J, Harbord R, Altman D, Sterne J. Metan: fixed-and random-effects meta-
analysis. Stata journal. 2008; 8(1):3. 16. Kiger M, Varpio L. Thematic analysis of qualitative data. Medical Teacher. 2020; 131. 17. Rahman M, Nakamura K, Seino K, Kizuki M. Intimate partner violence and chronic undernutrition
among married Bangladeshi women of reproductive age: are the poor uniquely disadvantaged? Eur J
Clin Nutr. 2013; 67(3):301–7. Epub 2012/12/13. https://doi.org/10.1038/ejcn.2012.202 PMID:
23232590. 18. Diamond-Smith N, Conroy AA, Tsai AC, Nekkanti M, Weiser SD. Food insecurity and intimate partner
violence among married women in Nepal. Journal of Global Health. 2019; 9(1). https://doi.org/10.7189/
jogh.09.010412 WOS:000476640500037. PMID: 30774941 19. Fong S, Gupta J, Kpebo D, Falb K. Food insecurity associated with intimate partner violence among
women in Abidjan, Cote d’Ivoire. International Journal of Gynecology & Obstetrics. 2016; 134(3):341–2. https://doi.org/10.1016/j.ijgo.2016.03.012 WOS:000382594100025. PMID: 27344532 20. Regassa N. Intimate partners violence in Southern Ethiopia: Examining the prevalence and risk factors
in the Sidama zone. International Journal of Sociology and Anthropology. 2012; 4(1):13–22. 21. Schneider M, Baron E, Davies T, Munodawafa M, Lund C. Patterns of intimate partner violence among
perinatal women with depression symptoms in Khayelitsha, South Africa: a longitudinal analysis. Global
Mental Health. 2018; 5. https://doi.org/10.1017/gmh.2018.1 WOS:000430014700001. PMID:
29868233 22. References 1. Sardinha L, Maheu-Giroux M, Sto¨ckl H, Meyer SR, Garcı´a-Moreno C. Global, regional, and national
prevalence estimates of physical or sexual, or both, intimate partner violence against women in 2018. The Lancet. 2022; 399(10327):803–13. 2. Muluneh MD, Stulz V, Francis L, Agho K. Gender based violence against women in Sub-Saharan africa:
a systematic review and meta-analysis of cross-sectional studies. International journal of environmental
research and public health. 2020; 17(3):903. https://doi.org/10.3390/ijerph17030903 PMID: 32024080 3. Collaborators GBDRF. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a
systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396(10258):1223–49. Epub 2020/10/19. https://doi.org/10.1016/S0140-6736(20)30752-2 PMID: 33069327; PubMed Central
PMCID: PMC7566194. 4. Sandoval GA, Marinho F, Delaney R, Pinto IV, Lima CMD, Costa RM, et al. Mortality risk among
women exposed to violence in Brazil: a population-based exploratory analysis. Public Health. 2020;
179:45–50. Epub 2019/11/15. https://doi.org/10.1016/j.puhe.2019.09.019 PMID: 31726400. 5. Garcı´a-Moreno C, Amin A. The sustainable development goals, violence and women’s and children’s
health. Bulletin of the World Health Organization. 2016; 94(5):396. https://doi.org/10.2471/BLT.16. 172205 PMID: 27147771 6. Radimer KL, Olson CM, Greene JC, Campbell CC, Habicht JP. Understanding hunger and developing
indicators to assess it in women and children. Journal of Nutrition Education. 1992; 24(1 suppl.):36S–
44S. 7. Bickel G, Nord M, Price C, Hamilton W, Cook J. Guide to Measuring Household Food Security, Revised
2000. Alexandria, VA: U.S. Department of Agriculture, Food and Nutrition Service, 2000 March, 2000. Report No. 15 / 18 PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0000479
September 14, 2022 PLOS GLOBAL PUBLIC HEALTH PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0000479
September 14, 2022 Medicine. 2019; 96(1):83–95. https://doi.org/10.1007/s11524-018-0312-0 WOS:000460479400011.
PMID: 30232690 28. 28. Logie CH, Okumu M, Mwima S, Hakiza R, Irungi KP, Kyambadde P, et al. Social ecological factors
associated with experiencing violence among urban refugee and displaced adolescent girls and young
women in informal settlements in Kampala, Uganda: a cross-sectional study. Conflict and Health. 2019;
13(1). https://doi.org/10.1186/s13031-019-0242-9 WOS:000512760100001. PMID: 31867053 29. Orindi BO, Maina BW, Muuo SW, Birdthistle I, Carter DJ, Floyd S, et al. Experiences of violence among
adolescent girls and young women in Nairobi’s informal settlements prior to scale-up of the DREAMS
Partnership: Prevalence, severity and predictors. PLoS One. 2020; 15(4):e0231737. Epub 2020/04/23. https://doi.org/10.1371/journal.pone.0231737 PMID: 32320405; PubMed Central PMCID:
PMC7176122. 30. Shai N, Pradhan GD, Chirwa E, Ratna S, Abhina A, Kerr-Wilson A. Factors associated with IPV victimi-
sation of women and perpetration by men in migrant communities of Nepal. PLoS ONE. 2019; 14(7):
e0210258–e. https://doi.org/10.1371/journal.pone.0210258 PMID: 31361743. Publication Type: Jour-
nal Article. Language: English. Number of References: 58 ref. Subject Subsets: Rural Development. 31. Swahn MH, Dill LJ, Palmier JB, Kasirye R. Girls and Young Women Living in the Slums of Kampala:
Prevalence and Correlates of Physical and Sexual Violence Victimization. Sage Open. 2015; 5(2). https://doi.org/10.1177/2158244015580853 WOS:000369476900040. 32. Andarge E, Shiferaw Y. Disparities in Intimate Partner Violence among Currently Married Women from
Food Secure and Insecure Urban Households in South Ethiopia: A Community Based Comparative
Cross-Sectional Study. Biomed Research International. 2018. https://doi.org/10.1155/2018/4738527
WOS:000446035600001. PMID: 30327777 33. Fielding-Miller R, Shabalala F, Masuku S, Raj A. Epidemiology of Campus Sexual Assault Among Uni-
versity Women in Eswatini. Journal of Interpersonal Violence. 2015. https://doi.org/10.1177/
0886260519888208 WOS:000498353000001. PMID: 31738110 34. Jewkes R, Corboz J, Gibbs A. Violence against Afghan women by husbands, mothers-in-law and sib-
lings-in-law/siblings: Risk markers and health consequences in an analysis of the baseline of a rando-
mised controlled trial. Plos One. 2019; 14(2). https://doi.org/10.1371/journal.pone.0211361
WOS:000458026000022. PMID: 30730914 35. Naved RT, Al Mamun M, Parvin K, Willan S, Gibbs A, Yu M, et al. Magnitude and correlates of intimate
partner violence against female garment workers from selected factories in Bangladesh. Plos One. 2018; 13(11). https://doi.org/10.1371/journal.pone.0204725 WOS:000449379500008. PMID:
30403674 36. Willie TC, Kershaw TS, Callands TA. Examining relationships of intimate partner violence and food
insecurity with HIV-related risk factors among young pregnant Liberian women. Aids Care-Psychologi-
cal and Socio-Medical Aspects of Aids/Hiv. 2018; 30(9):1156–60. https://doi.org/10.1080/09540121. 2018.1466983 WOS:000438096400012. PMID: 29682990 37. Field S, Onah M, van Heyningen T, Honikman S. PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0000479
September 14, 2022 Systematic review of food insecurity and violence against women de Moraes CL, Marques ES, Reichenheim ME, Ferreira MD, Salles-Costa R. Intimate partner violence,
common mental disorders and household food insecurity: an analysis using path analysis. Public Health
Nutrition. 2016; 19(16):2965–74. https://doi.org/10.1017/S1368980016001178
WOS:000411255200011. PMID: 27211890 23. Ribeiro-Silva RdC Fiaccone RL, Barreto ML Santana MLP, Santos SMCd Conceic¸ão-Machado MEPd,
et al. The association between intimate partner domestic violence and the food security status of poor
families in Brazil. Public Health Nutrition. 2016; 19(7):1305–11. https://doi.org/10.1017/
S1368980015002694 PMID: 26411418. Language: English. Entry Date: 20170117. Revision Date:
20190921. Publication Type: journal article. 24. Barnett W, Pellowski J, Kuo C, Koen N, Donald KA, Zar HJ, et al. Food-insecure pregnant women in
South Africa: a cross-sectional exploration of maternal depression as a mediator of violence and trauma
risk factors. BMJ Open. 2019; 9(3):e018277. Epub 2019/03/15. https://doi.org/10.1136/bmjopen-2017-
018277 PMID: 30867198; PubMed Central PMCID: PMC6429723. 25. Gibbs A, Corboz J, Jewkes R. Factors associated with recent intimate partner violence experience
amongst currently married women in Afghanistan and health impacts of IPV: a cross sectional study. Bmc Public Health. 2018; 18. https://doi.org/10.1186/s12889-018-5507-5 WOS:000431863200006. PMID: 29724222 26. Gibbs A, Jewkes R, Willan S, Washington L. Associations between poverty, mental health and sub-
stance use, gender power, and intimate partner violence amongst young (18–30) women and men in
urban informal settlements in South Africa: A cross-sectional study and structural equation model. Plos
One. 2018; 13(10). https://doi.org/10.1371/journal.pone.0204956 WOS:000446342400071. PMID:
30281677 27. Gilbert L, Michalopoulos L, Ma X, Jiwatram-Negron T, Terlikbayeva A, Primbetova S, et al. How Do
Risk Environment Factors Influence Perpetration of Partner Violence among Male Migrant and Non-
migrant Market Workers in Central Asia? Journal of Urban Health-Bulletin of the New York Academy of PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0000479
September 14, 2022 16 / 18 PLOS GLOBAL PUBLIC HEALTH Systematic review of food insecurity and violence against women Medicine. 2019; 96(1):83–95. https://doi.org/10.1007/s11524-018-0312-0 WOS:000460479400011. PMID: 30232690 Medicine. 2019; 96(1):83–95. https://doi.org/10.1007/s11524-018-0312-0 WOS:000460479400011. PMID: 30232690 Medicine. 2019; 96(1):83–95. https://doi.org/10.1007/s11524-018-0312-0 WOS:000460479400011.
PMID: 30232690 Domestic and intimate partner violence among preg-
nant women in a low resource setting in South Africa: a facility-based, mixed methods study. Bmc Wom-
ens Health. 2018; 18. https://doi.org/10.1186/s12905-018-0612-2 WOS:000437353700001. PMID:
29973182 38. Ager A, Bancroft C, Berger E, Stark L. Local constructions of gender-based violence amongst IDPs in
northern Uganda: analysis of archival data collected using a gender-and age-segmented participatory
ranking methodology. Conflict and Health. 2018; 12. https://doi.org/10.1186/s13031-018-0140-6
WOS:000424798800001. PMID: 29445418 39. Deuba K, Mainali A, Alvesson HM, Karki DK. Experience of intimate partner violence among young
pregnant women in urban slums of Kathmandu Valley, Nepal: a qualitative study. BMC Women’s
Health. 2016; 16(11):1–10. https://doi.org/10.1186/s12905-016-0293-7 PMID: 26945755. Language:
English. Entry Date: 20180726. Revision Date: 20180726. Publication Type: journal article. 40. Sethuraman K, Lansdown R, Sullivan K. Women’s empowerment and domestic violence: the role of
sociocultural determinants in maternal and child undernutrition in tribal and rural communities in South
India. Food Nutr Bull. 2006; 27(2):128–43. Epub 2006/06/22. https://doi.org/10.1177/
156482650602700204 PMID: 16786979. 41. Lentz EC, Narayanan S, De A. Last and least: Findings on intrahousehold undernutrition from participa-
tory research in South Asia. Social Science & Medicine. 2019; 232:316–23. https://doi.org/10.1016/j. socscimed.2019.05.024 WOS:000474677900032. PMID: 31125800 42. Davis LM, Kostick KM. Balancing risk, interpersonal intimacy and agency: perspectives from margina-
lised women in Zambia. Culture Health & Sexuality. 2018; 20(10):1102–16. https://doi.org/10.1080/
13691058.2018.1462889 WOS:000452278400005. PMID: 29764308 17 / 18 PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0000479
September 14, 2022 PLOS GLOBAL PUBLIC HEALTH Systematic review of food insecurity and violence against women 43. Cardoso L, Gupta J, Shuman S, Cole H, Kpebo D, Falb K, et al. What Factors Contribute to Intimate
Partner Violence Against Women in Urban, Conflict-Affected Settings? Qualitative Findings from Abi-
djan, Coˆte d’Ivoire. Journal of Urban Health. 2016; 93(2):364–78. https://doi.org/10.1007/s11524-016-
0029-x PMID: 27000124. Language: English. Entry Date: 20180724. Revision Date: 20191121. Publi-
cation Type: journal article. 44. Miller CL, Bangsberg DR, Tuller DM, Senkungu J, Kawuma A, Frongillo EA, et al. Food Insecurity and
Sexual Risk in an HIV Endemic Community in Uganda. Aids and Behavior. 2011; 15(7):1512–9. https://
doi.org/10.1007/s10461-010-9693-0 WOS:000295271200024. PMID: 20405316 45. Bonatti M, Borba J, Schlindwein I, Rybak C, Sieber S. "They Came Home Over-Empowered": Identify-
ing Masculinities and Femininities in Food Insecurity Situations in Tanzania. Sustainability. 2019; 11
(15). https://doi.org/10.3390/su11154196 WOS:000485230200201. 46. Zakaras JM, Weiser SD, Hatcher AM, Weke E, Burger RL, Cohen CR, et al. Medicine. 2019; 96(1):83–95. https://doi.org/10.1007/s11524-018-0312-0 WOS:000460479400011.
PMID: 30232690 A Qualitative Investigation
of the Impact of a Livelihood Intervention on Gendered Power and Sexual Risk Behaviors Among HIV-
Positive Adults in Rural Kenya. Archives of Sexual Behavior. 2017; 46(4):1121–33. https://doi.org/10. 1007/s10508-016-0828-x WOS:000401837400026. PMID: 27507020 47. Buller AM, Peterman A, Ranganathan M, Bleile A, Hidrobo M, Heise L. A mixed-method review of cash
transfers and intimate partner violence in low-and middle-income countries. The World Bank Research
Observer. 2018; 33(2):218–58. 48. Lemke S, Vorster HH, van Rensburg NS, Ziche J. Empowered women, social networks and the contri-
bution of qualitative research: broadening our understanding of underlying causes for food and nutrition
insecurity. Public Health Nutr. 2003; 6(8):759–64. Epub 2003/12/03. https://doi.org/10.1079/
phn2003491 PMID: 14641946. 49. Bellows AC, Lemke S, Jenderedjian A, Scherbaum V. Violence as an Under-Recognized Barrier to
Women’s Realization of Their Right to Adequate Food and Nutrition: Case Studies From Georgia and
South Africa. Violence against Women. 2015; 21(10):1194–217. https://doi.org/10.1177/
1077801215591631 WOS:000360412000002. PMID: 26139694 50. Derose KP, Payan DD, Fulcar MA, Terrero S, Acevedo R, Farias H, et al. Factors contributing to food
insecurity among women living with HIV in the Dominican Republic: A qualitative study. Plos One. 2017;
12(7). https://doi.org/10.1371/journal.pone.0181568 WOS:000406370000037. PMID: 28742870 51. Roy S, Hidrobo M, Hoddinott J, Koch B, Ahmed A. Can transfers and behavior change communication
reduce intimate partner violence four years post-program? Experimental evidence from Bangladesh. IFPRI—Discussion Papers. Washington; USA: International Food Policy Research Institute; 2019. 52. Kerr-Wilson A. Rigorous global evidence Review of interventions to prevent violence against women
and girls. What Works to Reduce Violence? Programme, 2020. 53. Nadkarni A, Weobong B, Weiss HA, McCambridge J, Bhat B, Katti B, et al. Counselling for Alcohol
Problems (CAP), a lay counsellor-delivered brief psychological treatment for harmful drinking in men, in
primary care in India: a randomised controlled trial. Lancet (london, england). 2017; 389(10065):186-
95. https://doi.org/10.1016/S0140-6736(16)31590-2 PMID: 27988144. 54. Patel V, Weobong B, Weiss HA, Anand A, Bhat B, Katti B, et al. The Healthy Activity Program (HAP), a
lay counsellor-delivered brief psychological treatment for severe depression, in primary care in India: a
randomised controlled trial. Lancet. 2017; 389(10065):176–85. Epub 2016/12/19. https://doi.org/10. 1016/S0140-6736(16)31589-6 PMID: 27988143; PubMed Central PMCID: PMC5236064. 55. Murray LK, Kane JC, Glass N, Skavenski van Wyk S, Melendez F, Paul R, et al. Effectiveness of the
Common Elements Treatment Approach (CETA) in reducing intimate partner violence and hazardous
alcohol use in Zambia (VATU): A randomized controlled trial. PLoS Med. 2020; 17(4):e1003056. PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0000479
September 14, 2022 Medicine. 2019; 96(1):83–95. https://doi.org/10.1007/s11524-018-0312-0 WOS:000460479400011.
PMID: 30232690 Epub
2020/04/18. https://doi.org/10.1371/journal.pmed.1003056 PMID: 32302308; PubMed Central PMCID:
PMC7164585. 56. Collaborative TP. “Evidence Brief: Cash Transfers and Intimate Partner Violence: Findings from a
Review of Quantitative and Qualitative Studies in Low- and Middle-Income Countries. 2019. 57. UN Women, Social Development Direct. Poverty Reduced, RESPECT: Preventing Violence against
Women Strategy Summary. 2020. 58. Gibbs A, Bishop K. Combined Economic Empowerment and Gender-Transformative Interventions, Evi-
dence Review Pretoria: What Works to Prevent Violence, SAMRC, 2019. 18 / 18