IntroductionWe assessed whether the Women for Women International (WfWI) economic and social empowerment programme could reduce women’s experiences of intimate partner violence (IPV) and depression in Afghanistan.MethodsWe conducted a two-arm individually randomised controlled trial in six urban and peri-urban communities. Communities were selected by WfWI for being conflict affected and showing signs of economic vulnerability (eg, little or no education, living in extreme poverty). Individual eligibility were female, aged 18–49, able to consent to participate and one woman per household. At 22 months, three primary outcomes were assessed: past year physical IPV experience; past year severe IPV experience; depressive symptoms. There was no blinding to arms. We conducted an intention-to-treat analysis, controlling for age. We also conducted qualitative interviews at endline, analysed using thematic analysis.Results1461 women (n=933 married) were recruited and randomised. Retention at endline was n=1210 (82%). Primary outcomes were in the hypothesised direction, but showed no significant impacts: physical IPV (adjusted OR (aOR) 0.88 (0.62 to 1.23)), severe IPV (aOR 0.75 (0.50 to 1.11)) and depressive symptoms (β −0.35 (−1.19 to 0.48)). Women reported reduced food insecurity (β −0.48 (−0.85 to –0.12)), higher earnings (β 3.79 (0.96 to 6.61)) and savings (β 11.79 (9.95 to 13.64)). Women reported less gender-inequitable attitudes (β −0.89 (−1.15 to –0.62)), more household decision-making (β 0.35 (−0.04 to 0.74)) and increased mobility (aOR 1.78 (1.27 to 2.50)). Twenty-eight in-depth interviews were conducted.ConclusionThe intervention did not impact IPV or depression. The intervention did improve livelihoods, create more gender-equitable relationships and increase women’s mobility. Translating these gains into IPV and depression reduction is critical.Trial registration numberNCT03236948, registered 2 August 2017.

BackgroundIntimate Partner Violence (IPV) is the most common form of violence in conflict and post-conflict settings, but there are few evaluations of interventions to prevent IPV in such settings.MethodsThe Women for Women International (WfWI) intervention is a year-long combined economic and social empowerment intervention for marginalized women survivors of conflict. Primarily, it seeks to support women to achieve four key outcomes: women earn and save money; women improve their health and well-being; women influence decisions in their homes and communities; women connect to networks for support. The organization recognizes Violence Against Women and Girls (VAWG) as a significant barrier to women’s empowerment and expects to see reduction in VAWG, and specifically IPV, as part of building women’s social and economic empowerment. This program is being quantitatively evaluated through an individually randomized control trial amongst women in Afghanistan, with a 24-month follow up. A comparison of baseline characteristics of participants is also included as well as a discussion of implementation of the baseline research.DiscussionThere is a high demand amongst Afghan women for such interventions, and this posed challenges in completing the randomization and baseline. In addition, the complex security situation in Afghanistan also posed challenges. However, despite these issues, recruitment was successfully achieved and the arms were balanced on socio-demographic measures. The evaluation will contribute to the limited evidence base on interventions to prevent IPV in conflict-affected settings.Trial registrationNCT03236948. Registered 28 July 2017, retrospectively registered.

Efficient process of litigation of medical errors is key to ensure fair, speedy, and accessible justice system. The conditions for establishing medical negligence are similar in both legal systems. These conditions include the duty of care, breach of that duty of care, the damages, and establishing causation. A culture of litigation and compensation is growing in UK and Saudi Arabia; however the cost of medical claims and awarded compensations are much more in UK compared to Saudi Arabia. In Saudi Arabia, there is a need for more transparency in the documentation and publication of litigated medical errors. In addition, there is a need to introduce interventions to shorten the duration of litigation in both legal systems. Financial caps on awarded compensation and caps on expert and legal fees are potential strategies to control the cost of medical errors which seem to work well in the Saudi model.

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