Factors associated with 'honour killing' in Afghanistan and the occupied Palestinian Territories: Two cross-sectional studies.

'Honour killing', the murder of women to preserve family reputation, is well recognised but infrequently systematically researched. This paper has three hypotheses. First, in families where women report an 'honour killing' there is more violence against women and girls, second these women are more likely to report more patriarchal gender attitudes than others, and third these families are exposed to higher levels of poverty. We asked (n = 1461) women enrolled in a trial in Afghanistan, and (n = 535) in a population-based sample in the occupied Palestinian Territories (oPT) if there had ever been an 'honour killing' in their family. In Afghanistan, 2.3% (n = 33), and the oPT 7.7% (n = 41), reported this. We built separate multivariable logistic regression models for each country, and for married and unmarried women in each country. Among Afghan married women, 'honour killing' was associated with borrowing because of hunger (adjusted odds ratio [aOR]8.71, 95%CI 2.27-33.40), easier access to money in emergency (aOR11.39, 95%CI 3.05-42.50), and violence within the family; intimate partner violence (IPV) (aOR3.73, 95%CI 1.12-12.36), and IPV and mother-in-law violence (aOR10.52, 2.60-42.56). For unmarried women in Afghanistan, 'honour killing' was associated with easier access money in an emergency (aOR4.06, 95%CI 0.85-19.37), household violence (hit by parent or sibling, or parent and sibling [aOR5.47, 95%CI 0.82-36.70; aOR7.37, 95%CI 1.24-43.86, respectively]); more childhood traumas (aOR1.24, 1.11-1.38), and more patriarchal personal gender attitudes (aOR1.24, 1.00-1.54). In the oPT experiencing IPV (aOR3.07, 1.02-9.23) and borrowing and experiencing IPV (aOR5.89, 1.84-18.79) were risks for married women. For unmarried women borrowing because of hunger was associated with higher risk (aOR2.33, 95%CI 1.18-4.85). Despite limitations-specifically the potential women were reporting the same 'honour killing'-our analysis suggests 'honour killings' are associated with violence, patriarchy, and poverty. Research is needed for the prevention of 'honour killing', which must address the root causes. Trial Registration: ClinicalTrials.gov NCT03236948.