Gender-based violence and absent fathers: a scoping review protocol.

INTRODUCTION: Gender-based violence (GBV) and absent fathers are two epidemics that affect women and children in sub-Saharan Africa. However, the understanding of the complex links between GBV and absent fathers is currently inadequate. The aim of the study is to provide an overview of documented evidence that links GBV and absent fathers as well as identifies areas that require systematic review and where more primary research is needed. METHODS AND ANALYSIS: The search strategy for this scoping review study will involve electronic databases including: Academic Search Premier, Ingenta, Kluwer Online, PsycARTICLES (EBSCO), PsycINFO (EBSCO), Social Work Abstracts and Sociological Collection. The studies will be mapped in 2 stages: stage 1 will map studies descriptively by focus and method; stage 2 will involve additional inclusion criteria, quality assessment and data extraction undertaken by two reviewers in parallel. A thematic analysis of the studies will be carried out to extract relevant outcomes using NVIVO. DISCUSSION: We anticipate finding a large number of studies on GBV diagnostic interventions in sub-Saharan Africa which, once summarised, will be useful to guide future research. The protocol for the scoping review has been registered in PROSPERO. DISSEMINATION: The study will be disseminated electronically and in print. It will also be presented to conferences related to GBV, Father Connections and Children's Health. PROSPERO REGISTRATION NUMBER: CRD42015022094. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Introduction

Empirical evidence suggests that the prevalence of gender-based violence (GBV) is high around the world.1 2 Findings of the WHO's multicountry study revealed that between 13% and 61% of ever partnered women have experienced an array of lifetime physical violence.2 The WHO3 further reports that intimate partner violence (IPV) is the most common form of GBV. This form of violence comprises physical, sexual and emotional abuse and controlling behaviour by a current or former intimate partner or spouse.4

Studies show that GBV disproportionally affects women and children, and that it is mainly perpetrated by men.1 5 Authors argue that GBV mostly arises from the unequal power relationships between men and women, and has a devastating impact on the lives of the victims, mainly women and children.6 GBV negatively impacts the physical, mental and sexual health of the victims, as well as the social and economic aspects of their lives.2 7 For example, there is emerging evidence that GBV may result in children growing up without their biological fathers.8

There is a paucity of literature on father absence in Africa.9 Published data suggest that between 30% and 50% of South African children grow up without their biological fathers, with black African children being the most affected.10 Father absence is a term that is rarely defined in the literature.9 However, studies have shown that ‘fathers can be absent in the lives of their children fully, partially, economically and emotionally’.11 The term ‘father absence’ in this study refers to biological fathers who are absent in the lives of their children due to disappearance in the early stages of the child's life or those who are known to be alive or perceived to be alive but, since the early stages of the child's life, have been emotionally and economically absent leading to children feeling neglected or abandoned.11 Studies report varying reasons for father absence, and Nduna and Jewkes12 suggest that the rape of a woman by a stranger may lead to father absence in direct ways, as a father may be genuinely unknown to the mother. Other studies show that in cases of denied paternity or unacknowledged pregnancies, the mother may have no confidence in introducing the alleged father to his child, leading to father absence.13–15 Furthermore, qualitative studies conducted in South Africa show that domestic violence may lead to a marriage or relationship break-up leading to father absence.16 17 It is well documented in the literature that children who grow up with an absent biological father tend to display more behavioural problems and often experience more life trauma and distress compared to children who grow up residing with both parents.9 However, little is known about whether and how father absence predisposes children who grow up with absent biological fathers to GBV. Notwithstanding this, evidence from a few studies conducted in South Africa suggests that young people who grew up with absent fathers tend to be treated differently (compared to other children who have involved fathers) in their maternal homes, or often suffer physical, sexual and emotional abuse perpetrated by significant people in their lives (eg, maternal uncles, aunts and/or maternal grandparents). However, it is currently not known how prevalent this is in South Africa.

While there is scant literature on this topic in South Africa, mounting evidence suggests that growing up with an absent father is a risk factor for GBV perpetration by boys/men.18 Studies have demonstrated that men who perpetrate violence against women are likely to be those who did not co-reside with their biological fathers, had poor father–son relations or did not even know their fathers.19 Other studies have shown that girls with absent fathers are likely to have poor heterosexual adjustment, dissatisfying and violent sexual relationships.20

The literature and evidence above suggest that GBV and absent fathers might be two epidemics that excessively affect women and children in South Africa. However, the understanding of the complex links between GBV and absent fathers is currently inadequate. This underscores the need for research to explore the links between these two phenomena and build knowledge around this area. The main aim of the study is to provide an overview of documented evidence that suggests a link between GBV and absent fathers in sub-Saharan Africa, as well as identifies areas that require systematic review and where more primary research is needed. In order to fulfil the above aim, the following objectives will guide the study:

To review evidence that the absent father phenomenon leads to perpetration of GBV by boys and men.

To examine evidence that the absent father phenomenon contributes to GBV victimisation of girls.

To examine evidence that the absent father phenomenon contributes to GBV victimisation of boys.

To determine evidence that GBV leads to absent fathers in children's lives.

The main research question: is there a link between GBV and absent fathers?

Research subquestions are as follows:

Is there evidence that the absent father phenomenon leads to perpetration of GBV by boys and men?

Is there evidence that the absent father phenomenon contributes to GBV victimisation of girls?

Is there evidence that the absent father phenomenon contributes to GBV victimisation of boys?

Is there evidence that GBV leads to absent fathers in children's lives?

Eligibility of research question

Materials and methods

This scoping review protocol has been registered and published in the PROSPERO international prospective register of systematic reviews. It is registered under the following number: CRD42015022094

Study selection

Peer-reviewed studies and grey literature that addresses the research question will be included in the search. An electronic search of the database of all studies with various study designs will be included, as well as the grey literature. Furthermore, when necessary, expert opinions will be sought. The databases that will be used to search for literature include: Academic Search Premier, Ingenta, Kluwer Online, PsycARTICLES (EBSCO), PsycINFO (EBSCO), Social Work Abstracts and Sociological Collection.

Data extraction

The research team will carry out a narrative review or analytical method to extract background or process oriented information from each included study through the following process (see figure 1):

Figure 1

A flow chart showing phases of the literature search for extraction of the most specific literature for the review.

Collectively developing the data-charting form and determining the variables and themes to extract in order to answer the research question.

Updating charting data.

Two independent reviewers will extract data from all eligible studies in duplicate using a standardised and piloted data abstraction spreadsheet. A third reviewer will be consulted if necessary to reach consensus. Bibliographic details, study design, number of participants, intervention(s), comparison(s), study setting, funding source and conclusions for the primary and secondary outcomes of interest will be extracted. Information specific to the father's absence, description of the intervention (GBV) and geographic location of the study will also be extracted. Quality appraisal will not be performed on studies included in this scoping review study.

A thematic analysis will be carried out collectively by researchers to extract relevant outcomes using NVIVO

Inclusion and exclusion criteria (see table 1) were developed to ensure a sufficient level of comparability across GBV in families and communities raising children in the absence of fathers and those raising children in the presence of fathers.

Table 1

A framework for determination of the eligibility of the review question

Criteria	Determinants
	The population for this study will be children raised without, and with no connection to, their biological fathers. Children who are orphans or institutionalised will be excluded from this study. An orphaned child is defined as a young person below the age of 18 years whose biological parents have died. The death of both biological parents could confound the links between GBV and absent fathers.An institutionalised child is defined as a young person below the age of 18 years who has been placed in an institution (eg, children's shelter or orphanage). The intervention (ie, professional support, place of safety or protection, or provision of other critical services) of the institution on children placed in such institutions could muddle the links between GBV and the absent father.
	Absence of fathers, gender-based violence
	Children raised with connection to their fathers
	Gender-based violence, father absence
Study setting	Sub-Saharan AfricaWhile we have largely cited literature from South Africa in this protocol, owing to the paucity of literature on father absence in Africa, we propose to extend the scope of this review to include studies from other sub-Saharan countries. The rationale for extending the review to sub-Saharan Africa is to increase the pool of studies to include in this scoping review study. Furthermore, we believe that countries in the sub-Saharan region are not too dissimilar in terms of socioeconomic status and social dynamics that lead to father absence.

GBV, gender-based violence; PICOS, Population, Intervention, Comparisons, Outcomes, Study setting.

Inclusion criteria

Evidence published in the English language.

Evidence from published relevant interventions and studies in sub-Saharan Africa.

Studies with focus on families with children with absent fathers.

Research reporting on intervention with children 18 years of age and younger.

Literature published from January 1990 up to June 2015

Review articles including: peer-reviewed journal articles, systematic reviews, scoping reviews, meta-analysis and rapid reviews.

Grey literature including: government and non-governmental organisation reports and academic dissertations.

Full reports of studies including: qualitative, quantitative and mixed methods studies will be considered.

All study designs will be considered including cross-sectional qualitative and quantitative studies, randomised controlled trials, and quasi-experimental designs and pilot studies.

Exclusion criteria

Evidence from countries outside sub-Saharan Africa will be excluded because the cultures and nature of GBV may be substantially different from our target group.

Evidence from conflict or post-conflict settings (see definitions below) will be excluded as causes or circumstances under which fathers become absent during and/or immediately after conflict may be different in nature when equated to those dynamics in non-conflict settings.

Evidence where the impact of fathers' absence could not be differentiated from the impact of a broader interference/intervention.

Non-English publications will be excluded.

Studies published before January 1990 and after June 2015.

Studies with no focus on children.

Studies reporting father absence due to incarceration.

Studies reporting father absence due to death.

Studies reporting father absence due to travel for long duration for work but involved in child's life.

Studies on orphaned and institutionalised children.

During the keyword search (see table 2), keywords will be combined into a phrase including Boolean (AND, OR) terms, a sample as demonstrated below (as this will be an iterative process and will be documented in the analysis and write-up):

Table 2

Electronic search record

Date	Keyword searched	Search engine used	Number of publications retrieved

(‘Gender-based violence’ OR ‘Domestic Violence’ OR ‘Intimate partner violence’ OR ‘Partner Violence’ OR ‘Spousal violence’ OR ‘Dating violence’ OR ‘Child sexual abuse’ OR ‘Violence against women’ AND ‘Father absence’ OR ‘Absent and unknown fathers’ OR ‘Absent but known fathers’ OR ‘Absent and undisclosed fathers’ OR ‘Unknown and deceased fathers’ OR ‘Known but physically absent fathers’ OR ‘Uninvolved fathers’ OR ‘Father not co-residing’)

All researchers will keep an updated record of the number of publications identified and date during each session of the literature search using table 2 below.

Collating, summarising and reporting results

The principal aim of this study is to scope the existing evidence and summarise the findings as presented across articles. The research team will meet to carry out a thematic analysis of the studies and provide an overview of all the data reviewed. This process will include the following steps: First, the bibliographic details, study design, number of participants, intervention(s), comparison(s), study setting and funding source of the included studies will be examined. Second, results of the studies on perpetration of GBV by boys and men, GBV victimisation of girls, GBV victimisation of boys, on evidence whether GBV leads to absent fathers, and on whether father absence leads to GBV will be coded by all authors independently. When all the included studies have been explored and coded, authors will come together and interrogate the resulting themes and critically examine their relationship to the research question. Further to this, the study team will scrutinise the meanings of the findings as they relate to the overall aim of the study, and discuss the implications for future research, practice and policy.

Discussion

The proposed scoping review will generate findings that will aid in describing the links between GBV and absent fathers in sub-Saharan Africa. While this area has received little research attention, emerging evidence from South Africa suggests that children who grow up with absent fathers may be at an increased risk of experiencing various forms of GBV in their lives. However, the understanding of the links between GBV and absent fathers is currently inadequate. For example, there is little understanding on how prevalent the abuse of children with absent fathers is, what the factors are that lead to abuse, and what the nature is of the relationship between GBV and absent fathers. This review will enable the authors to answer these questions and further elucidate what is known and unknown about the links between these phenomena in the sub-Saharan region.

Specific targeted research on absent fathers and its effect on the psychological and social health of children in sub-Saharan Africa is still in its infancy. Until now, we are not aware of any review or empirical studies that have been conducted in sub-Saharan Africa to specifically look at the question addressed in the current proposal. As such, the findings of this review will contribute to knowledge on this topic area and impact practice, policy and research in the area of father connections, fatherhood and child health.

Owing to contextual dynamics, we resolved to exclude literature and studies from other regions of Africa. We perceive that the causes and circumstances that lead to father absence in conflict or post-conflict settings, for example, may be different in nature when compared to those factors in politically stable countries. As such, we argue that if we include literature and studies from politically unstable countries, we risk distorting the findings on the links between GBV and absent fathers in this review. Also, emotional absence while co-residing with the father is not considered as this is a different form of absence. The study will also exclude incarcerated fathers and institutionalised children as the disconnection to fathers may result in factors other than GBV. A similar reasoning was applied to the exclusion of orphaned children.

Results from this scoping review will be useful to policymakers, academics, researchers and programme implementers who work with families and children in sub-Saharan Africa, and other similar settings. Evidence generated in this scoping review will be a critical base on which primary prevention strategies may be built. Furthermore, this work will be critical in identifying research gaps in the father connections literature, as well as highlight areas where primary empirical work and systematic reviews are required. Academics in higher institutions of learning in South Africa have increasingly pointed to the need for methodical approaches of reviewing literature by postgraduate students, as such approaches offer a systematic way of reviewing and synthesising the literature and enhance the quality of the outputs. Thus, the methodology described in this scoping review protocol will be essential for teaching purposes at higher institutions of learning in South Africa and elsewhere. Findings of this review will become pertinent to researchers as evidence for the need for more work in this area and used to justify the need to fund this work.

Strengths and limitations of this study

The study will only include literature published in English. Therefore, studies published in other languages will be missed. To the best of our knowledge, the research area of father absence is relatively new in Africa; as such, there may be little published work that directly or indirectly looks at the links between GBV and father absence. While this may be a possible limitation in terms of the amount of data for this scoping review study, it may be an important finding of this study and a basis for calling for more research on this area.

Definition of key terms

GBV: Gender-based violence will include intimate partner violence, non-intimate partner violence, domestic violence, BUT will exclude gender-based violence that occurs in crisis situations (eg, conflict or post-conflict settings).

GBV: Means sexual, emotional, physical and economical violence, BUT excludes sexual harassment

VAW: Violence against women will include “any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life.”21

IPV: Intimate partner violence will include “any range of sexually, psychologically, and physically coercive acts used against adult and adolescent women by current or former male intimate partners”.22

Child abuse: will include “all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power”.23

Father: For the purpose of this paper, when referring to fathers, we mean biological fathers. Social fathers will be excluded.

Absent father: Will either be those alive and either known or unknown to the child.

Victimisation: Any subjectively reported or objectively measured experiences of gender-based violence within or outside relationships or interactions.

Perpetration: Will include men who have perpetrated GBV against women and girls and other men in the contexts of intimate relationships or non-intimate relationships, including those who perpetrate such violence against infants, children and lesbian, gay, bisexual and transgender populations.

Perpetrators: Will include anyone who has been reported to have perpetrated abuse on children whose fathers are absent.

Conflict settings: Are countries where armed conflict between opposing groupings is still ongoing. For the purpose of this study, a country is defined as a conflict setting even if the conflict was concentrated in a particular area at the time the study was conducted.

Post-conflict settings: Are settings where open fighting or warfare between opposing groupings has come to an end. For the purpose of this study, a country is defined as a conflict setting even if the conflict was concentrated in a particular area at the time the study was conducted.