Cross-Sectional Analysis of Contextual Factors Associated With Sexual Violence Against Children and Youth in Low- and Middle-Income Countries.

Sexual violence (SV) against children and youth is a global problem. Minimal evidence exists on how contextual factors, such as those at the community or societal levels, influence the prevalence of SV in low- and middle-income countries (LMICs). Data from the Violence against Children and Youth Surveys in Cambodia, Colombia, Côte d'Ivoire, El Salvador, Kenya, Mozambique, and Nigeria (nmale = 9,245; nfemale = 10,022) were merged with the Out of the Shadows Index (OOSI), a global index of national child protection efforts developed by Economist Impact. Age- and sex-stratified sequential fixed effects random intercepts models assessed associations between cluster-level community-aggregated attitudes and OOSI indicators with forced sexual initiation (FSI), lifetime non-consensual sexual touching (NCST), and lifetime SV. We found that aggregated harmful attitudes about women and men at the community-level were associated with FSI among females (adjusted odds ratio (aOR) = 4.43, p =< .001), and NCST (aOR = 2.86, p < .001), and SV (aOR = 2.70, p < .001) among males. Aggregated community attitudes supportive of intimate partner violence were significantly associated with lifetime SV among females (aOR = 2.09, p < .001) and males (aOR = 3.16, p < .001), and NCST (aOR = 3.10, p < .001) among males. The OOSI legal indicator was associated with lower prevalence of NCST (aOR = 0.94, p =< .001) and SV (aOR = 0.94, p =< .001) among males, and NCST among females aged 13 to 17 years (aOR = 0.96, p = .009). Community attitudes are associated with youth experiences of SV, and protective national legislation is associated with a lower risk of youth experiencing SV in LMICs. National policies and programs that alter these factors have the potential to help prevent SV among children and youth.