Perpetrators of intimate partner sexual violence: are there unique characteristics associated with making partners have sex without a condom?

This study examined correlates of making an intimate partner engage in unprotected sex among perpetrators of sexual violence. Based on the Confluence Model, we hypothesized that power and impersonal sex motives would be higher among perpetrators who made a dating partner have unprotected sex. Among a subsample of 78 male college students, significant differences were found for acceptance of verbal pressure, positive attitudes about casual sex, frequency of sexual intercourse, and physical injuries to dating partners. These findings highlight the importance of integrating theories and interventions directed at sexual assault and sexual risk reduction.     

Intimate partner violence and women's contraceptive use

Intimate partner violence has been hypothesized as a factor associated with women's risk for problems in contraception use or access. This article explores differences in contraceptive use between abused and nonabused women, using a case-control study of 225 women. Women experiencing physical and emotional abuse were more likely to report not using their preferred method of contraception in the past 12 months compared with nonabused women (OR = 1.9; 95% CI = 1.0 to 3.7). Health care providers need to consider how intimate partner violence may influence their patients' use of contraceptives, which has implications for the high risk of unintended pregnancies among abused women.     

Contraceptive use and associations with intimate partner violence among a population-based sample of New Zealand women

AIM: To outline the use of contraception among a representative sample of New Zealand women, and explore associations with intimate partner violence (IPV), and contraception and condom use. METHODS: Face-to-face interviews were conducted with a random sample of 2790 women who had ever had sexual intercourse, aged 18-64 years old in two regions (urban and rural) in New Zealand. Analyses were conducted using logistic regression and Wald chi(2) tests. RESULTS: Almost all women had used contraception at some point in their life, and almost one half of all women 18-49 years were currently using methods of contraception. Contraceptive use and methods varied significantly by location. Women who had ever experienced IPV were significantly more likely to report having ever used contraception, compared with women who had not experienced IPV (91% vs 85.2%). While having a partner who refused to use or tried to stop women from using a method of contraception was rare, it was significantly more common among women who had ever experienced IPV (5.4% vs 1.3%). CONCLUSIONS: Most women have used contraception at some point. Women who have ever experienced IPV were: more likely to have used contraception than women who have not experienced IPV, and to have had partners who refused to use condoms or prevented women from using contraception. Partner refusal may be a key indicator of IPV. These findings emphasise the importance of family violence screening at routine health consultations.     

The effects of advance provision of emergency contraception on adolescent women's sexual and contraceptive behaviors

CONTEXT: Advance provision of emergency contraception (EC) may increase timely access and improve effectiveness, but the impact on adolescent sexual and contraceptive behaviors is not known. OBJECTIVE: To determine whether adolescents given advance EC have higher sexual and contraceptive risk-taking behaviors compared to those obtaining it on an as-needed basis. DESIGN AND SETTING: Randomized trial conducted at urban, hospital-based adolescent clinic in Pittsburgh, PA, from June 1997 to June 2002. PARTICIPANTS: 301 predominantly minority, low-income, sexually active adolescent women, age 15-20 years, not using long-acting contraception. INTERVENTIONS: Advance EC vs instruction on how to get emergency contraception. OUTCOME MEASURES: Self-reported unprotected intercourse and use of condoms, EC, and hormonal contraception ascertained by monthly 10-minute telephone interviews for 6 months post-enrollment. Reported timing of EC use after unprotected intercourse. RESULTS: At both 1- and 6-month followup interviews, there were no differences between advance EC and control groups in reported unprotected intercourse within the past month or at last intercourse. At 6 months, more advance EC participants reported condom use in the past month compared to control group participants (77% vs 62%, P=0.02), but not at last intercourse (advance EC 83% vs control 78%, P=0.34). There were no significant differences by group in hormonal contraception use reported by advance EC or control groups in the past month (44% vs 53%, P=0.19) or at last intercourse (48% vs 58%, P=0.20). At the first followup, the advance group reported nearly twice as much EC use as the control group (15% vs 8%, P=0.05) but not at the final followup (8% vs 6%, P=0.54). Advance EC group participants began their EC significantly sooner (11.4 hours vs 21.8 hours, P=0.005). CONCLUSIONS: Providing advance EC to adolescents is not associated with more unprotected intercourse or less condom or hormonal contraception use. In the first month after enrollment, adolescents provided with advance EC were nearly twice as likely to use it and began EC sooner, when it is known to be more effective.     

Paradoxical adolescent reproductive decisions

OBJECTIVE: To determine why teenagers who say they do not plan to parent if they become pregnant fail to use contraceptives consistently enough to avoid conceiving by default. METHODS: A racially diverse group of 333 inadequately contracepting, nulligravida teens, 45 (13.5%) of whom did not plan to parent if they became pregnant was studied. Participants completed scales assessing traditional teen pregnancy risk factors, deterrents to contraceptive use, expectations about the effect of pregnancy, the desire to remain non-pregnant, and sexual behavior. RESULTS: Teens who said they would not parent if pregnant were less apt to report boyfriends who wanted them to conceive (RR=0.7; 95% CI=0.5-0.9) and deterrents to contraceptive use (RRs around: 0.6; 95% CI: 0.3-0.9) and more apt to anticipate that childbearing would negatively impact their lives (RR: 1.9; 95% CI: 1.6-2.2), to want to remain non-pregnant (RR: 2.2; 95% CI: 1.8-2.4), and to have used contraception at last sexual intercourse (RR: 1.8; 95% CI: 1.3-2.4). In the group that did not intend to parent the only difference between those who had and had not used contraception at last intercourse was their willingness to plan for sexual activity (OR: 4.6; 95% CI: 1.3-16.7). CONCLUSION: This study suggests that further progress toward preventing unwanted teen pregnancies might be made by dispelling the notion that for young, unmarried women, unplanned sexual intercourse is preferable to planned sexual intercourse.     

The relationship between males' attitudes to partner violence and use of contraceptive methods in Turkey

Interventions have been carried out to improve the reproductive health and status of women in Turkey. However, these efforts are limited due to lack of male involvement. Lifestyle risks such as partner violence need to be evaluated in terms of any effects on the use of contraception. Data collected from interviews of married women and their husbands for the 1998 Turkish Demographic and Health Survey and 1971 husbands were included in the study. The percentage of husbands who were against partner violence was 20.4%. However, 22 (0.9%) husbands had an attitude toward the use of violence against their wives. The frequency of contraceptive use was increased from the group of men who had unfavorable attitudes towards violence to the group of men who had favorable attitudes. A similar trend was found in the percentages of condom use for men, with multiple factors influencing contraceptive use. The study suggests that further investigations are needed for couple-related issues to improve the status of women in the community and to empower women for sexual health.     

Suicidal ideation and the prevalence of intimate partner violence against women in rural western China

This study examined the extent of the association between intimate partner violence (IPV) and suicidal ideation in a rural county in Western China. A sample of 1,771 women participated in the study. The lifetime prevalence of physical assault, psychological aggression, and sexual coercion was 34%, 68%, and 4%, respectively. The preceding-year prevalence of physical assault and psychological aggression was 8% and 32%, respectively. The prevalence of lifetime suicidal ideation was 15.9%, and 3.3% of the women had suicidal ideation during the preceding week. Physical abuse victims were at more than four times greater risk of having suicidal ideation than those who had not suffered physical assault.     

The relationship between males' attitudes to partner violence and use of contraceptive methods in Turkey.

Interventions have been carried out to improve the reproductive health and status of women in Turkey. However, these efforts are limited due to lack of male involvement. Lifestyle risks such as partner violence need to be evaluated in terms of any effects on the use of contraception. Data collected from interviews of married women and their husbands for the 1998 Turkish Demographic and Health Survey and 1971 husbands were included in the study. The percentage of husbands who were against partner violence was 20.4%. However, 22 (0.9%) husbands had an attitude toward the use of violence against their wives. The frequency of contraceptive use was increased from the group of men who had unfavorable attitudes towards violence to the group of men who had favorable attitudes. A similar trend was found in the percentages of condom use for men, with multiple factors influencing contraceptive use. The study suggests that further investigations are needed for couple-related issues to improve the status of women in the community and to empower women for sexual health.     

Recent and past intimate partner abuse and HIV risk among young women

OBJECTIVE: To examine the associations between past intimate partner abuse experienced during adolescence (verbal and physical), recent intimate partner abuse (verbal, physical, and sexual), and HIV risk (as indicated by lack of condom use) for sexually active young adult women in relationships with male partners. DESIGN: Secondary data analysis of waves II and III of the National Longitudinal Study of Adolescent Health (Add Health). SETTING: The Add Health Study is a longitudinal, in-home survey of a nationally representative sample of adolescents. SAMPLE: Analyses involved 2,058 sexually active young adult women. MAIN OUTCOME MEASURES: HIV risk was measured by consistent condom use over the past 12 months. RESULTS: Physical and verbal abuse experienced in adolescence were associated with physical/verbal abuse experienced in young adulthood. Young, sexually active women experiencing no abuse in their relationships were more likely to consistently use condoms in the past 12 months than were their abused counterparts. CONCLUSION: A causal pathway may exist between prior abuse, current abuse, and HIV risk.     

Intimate partner violence and women's reproductive health

Intimate partner violence (IPV) is common among women. An estimated 30% of all women globally report having experienced physical or sexual violence by a husband, intimate partner or ex-partner. It is important for those working in reproductive health settings to be aware that sexual assault can occur in the context of relationships. IPV can also include reproductive and sexual coercion. Reproductive coercion includes behaviours that interfere with contraception use and/or pregnancy, while sexual coercion includes behaviours related to pressuring or coercing a person to have sex without using physical force. Past or current IPV in a woman's life can have profound implications for her reproductive and general health, and healthcare providers need to have the skills to identify IPV, and provide appropriate support and referrals as required.     

SEXUAL HEALTH,REPRODUCTIVE HEALTH,SEXUAL COERCION,AND PARTNER ABUSE INDICATORS IN A CANADIAN OBSTETRICS AND GYNAECOLOGY OUTPATIENT POPULATION

OBJECTIVES: to assess prevalence and correlates of sexual health, reproductive health, sexual coercion, and partner abuse in a Canadian obstetrics and gynaecology outpatient population, and to determine whether women who report concerns in these areas have ever discussed them with their physicians. METHODS: a self-administered questionnaire was completed by 409 women (93.8% response rate) attending two hospital-based obstetrics and gynaecology outpatient clinics in a mid-size Canadian city. RESULTS: significant, prevalent, and clinically neglected sexual health, reproductive health, sexual coercion, and partner abuse concerns were reported, including: chronic and troubling dyspareunia (37%), dysmenorrhea (47%), and premenstrual syndrome (57%), infrequent breast self-examination (53%), inconsistent contraceptive use despite the desire not to conceive (41%), inconsistent condom use among those with multiple sexual partners (82%), sexual dysfunction (76% reported at least one sexual function concern), and a history of sexual coercion (23%) and physical partner abuse (19%). Only a small minority of women who reported sexual or reproductive health or sexual coercion or partner abuse concerns had ever discussed these concerns with their physician. CONCLUSION: these findings provide an empirical profile of significant and prevalent, but clinically neglected, women's health concerns. The findings suggest the need for increased clinical attention to the range of problems surveyed.     

Sexual violence in women's lives. Findings from the Women's Safety Project,a community-based survey

This paper presents a community-based study, which aims to determine the interconnections between women's experiences of sexual abuse in childhood, sexual assault in adulthood, and physical assault in intimate relationships in Toronto, Canada. An in-depth face-to-face interview was conducted with 420 women who comprised the random sample of the women living in Toronto, Canada. Findings on the prevalence and effects of various forms of sexual abuse and violence revealed that 97.6% of the woman interviewed reported that they personally experienced some form of sexual violation. Sexual abuse in childhood (including incest), sexual assault, sexual harassment, and physical assault in intimate relationships were documented. Among the findings were that one-fourth of the women in the sample were physically assaulted by a male intimate, one-half of the women reported being raped or almost raped, and nearly half of the respondents reported experiencing some kind of sexual abuse before reaching age 16.     

Prevalence of family violence amongst women attending an abortion clinic in New Zealand

AIMS: To measure the prevalence of family violence reported by women seeking a termination of pregnancy (TOP). METHODS: A cross sectional survey involving consecutive women at one Health Waikato abortion clinic. Participants completed a self-administered questionnaire in private counselling rooms. RESULTS: Sixty-two of the 125 women invited to participate did so (response rate: 49.6%). The reported lifetime prevalence of physical or sexual abuse was 50.8%. The reported lifetime prevalence of physical abuse was 43.3% and that of sexual abuse was 32.2%. The reported prevalence of physical abuse within the last year was 13.3%, and of sexual abuse within the last year was 8.5%. Of women reporting a lifetime history of physical abuse, 69% reported that her partner was the perpetrator/one of the perpetrators of abuse. CONCLUSIONS: The study demonstrated a high prevalence of family violence amongst women attending an abortion clinic. Consideration should be given to screening for family violence in abortion clinics in New Zealand. Screening should be accompanied by the provision of appropriate information and support for women with family violence issues.     

北京市无痛人工流产育龄妇女接受流产服务的现状调查

目的:了解选择行无痛人工流产术的育龄妇女接受流产服务的现状。方法:采用分层随机抽样的方法在北京市18个区县中抽取6个区县的18家开展计划生育技术服务的医疗机构,在门诊对早孕后选择终止妊娠的育龄妇女进行问卷调查。结果:在至少有1次流产史的1 005例行无痛人工流产调查对象中,前次流产有49.2%的人选择了无痛人工流产,在前次流产时有77.9%接受了避孕宣传教育,只有50.1%获得了避孕药具,前次流产告知流产后需避孕者其流产后首次性生活避孕的比例明显高于未告知者,而且提供避孕宣传教育服务与流产的地点有关。本次流产83.6%为意外妊娠,外地户籍、大学或大专学历、收入>3 000元、丈夫或性伴年龄<25岁的育龄妇女选择无痛人工流产的比例较高,选择无痛人工流产的育龄妇女中有29.0%存在高危因素,仅有61.9%被告知无痛人工流产可能发生并发症。结论:无痛人工流产育龄妇女高危流产的比例较高,其流产前、后获得的知识和信息不足,应开展多种形式的生殖健康知识宣传教育,落实避孕措施,减少非意愿妊娠。     

Disclosure and health-seeking behaviour following intimate partner violence before and during pregnancy in Flanders, Belgium: a survey surveillance study

OBJECTIVES: The objectives were to estimate the prevalence of physical and sexual intimate partner violence (IPV) among a regional sample of the general obstetric population as the lifetime prevalence, as the 1-year period prevalence before pregnancy, and as the prevalence during the index pregnancy; to assess the rates of disclosure and help-seeking behaviour with IPV; and to determine the acceptability of screening for IPV. STUDY DESIGN: A multi-centred survey surveillance study was carried out among pregnant women attending five large hospitals in the province of East Flanders, Belgium as a regional probability sample of the general obstetric population. Data were collected through an anonymous, written questionnaire that included the Abuse Assessment Screen and additional questions on the circumstances of the most recent episode of physical or sexual violence, on disclosure and help-seeking behaviour, on reporting assault to the police, and on the acceptability of routine screening for IPV. RESULTS: The sampling frame consisted of 1362 women who received the questionnaire at the antenatal service during a 2-month study period, of which 537 (mean age 29.4 years, S.D. 4.09) returned the envelope (response rate 39.4%). The lifetime prevalence of IPV was estimated to be 10.1% (95% CI 7.7-13.0%) and the period prevalence of IPV during pregnancy and/or in the year preceding pregnancy 3.4% (95% CI 2.1-5.4%). There was a significant difference in the reported lifetime prevalence of IPV between women attending with a partner and those who came to the prenatal visit unattended by their partner in particular (6.8% versus 13.9%, p=0.010). Overall, only 19.2% (23 out of 120) and as few as 6.6% (4 out of 61) of the victims of physical and sexual abuse respectively sought medical care by consulting a general practitioner, gynaecologist, or an emergency department. Routine screening for IPV by a general practitioner or gynaecologist was found to be largely acceptable. CONCLUSIONS: In our highly medicalised society, women experiencing partner violence rarely disclose abuse to the widely available health care services, unless they are directly asked about it, which appears an acceptable practice. Hence, there is a definite need to improve women's awareness regarding abuse and their help-seeking behaviour at a public health level.     

Coerced sexual intercourse within marriage: a clinic-based study of pregnant Palestinian refugees in Lebanon

This study examines the correlates of forced sexual intercourse among pregnant refugee women attending an antenatal clinic in Sidon, Lebanon. A total of 349 pregnant women were interviewed during a clinic visit for a prenatal check-up during the months of June and July 2005. The Abuse Assessment Screen was used to identify cases of abuse. The outcome variable was whether the woman was forced to have sexual intercourse during the past year. One-quarter of women (26.2%) reported having forced sexual intercourse. Associations between forced sexual intercourse and sociodemographic risk factors were assessed using odds ratios from logistic regression models. Low educational levels and reported fear of husband were significant risk factors for sexual abuse, adjusting for other relevant variables. Age, parity, length of marriage, place of residence, undesired pregnancy, gestational age, consanguinity, and physical violence during last year were not associated with forced sexual intercourse.     

Forgetting hormonal contraceptive methods: expert opinion about their daily management in clinical routine practice

Many guidelines regarding the daily management of regular oral hormonal contraceptive methods have been proposed worldwide. Some of them may even appear to be conflicting. The search for the maximal contraceptive protection leads to a low acceptance of these guidelines, probably because of their complexity and their apparent discrepancy. We are deeply convinced that simplicity and pragmatism of guidelines should pave the way to both their better acceptance and compliance and, consequently, to their improved real-life effectiveness. We have considered physiology and pharmacodynamics before proposing the following rules for an effective management of hormonal contraceptive failures. We conclude that the risk of unwanted pregnancy is higher in case of a unique contraception misuse/a delayed start during the first week of the contraceptive cycle (or in case of multiple days of contraceptive misuses during the following weeks) for a combined contraception or at every cycle day for a non anti-ovulatory progestin only contraception. In such risky situations, we firmly recommend the restart of the regular contraceptive method and the use of condoms for the following 72 hours, provided no sexual intercourse has occurred during the past 5 days before the contraceptive failure. If sexual intercourse has occurred during the past 5 days before the contraceptive failure, we firmly recommend the intake of an emergency contraception, ulipristal acetate, the restart the regular contraceptive method and in this case, the use of condoms for, at least, the following 7 days.     

Contraceptive use in a sample of young Danish females

During the period April 1984-February 1985, 4 test samples of totally 380 young Danish women aged 16-20 years old were invited to interview about contraception and sexual behaviour. The response rate was 75.3%. There were 208 (74.0%) who had had sexual debut. Median age was estimated to 16.8 years. At first intercourse 168 (80.8%) used contraception, 36.5% used condom and 36.1% oral contraception (OC). Among teenage-girls with sexual debut before 15 years old 32.5% were unprotected against pregnancy. At the time of the interview 64.4% did use contraception. The most frequently used contraceptive device was OC (46.6%). Teenage-girls changed the contraceptive method from condom to OC after sexual debut. A small proportion of sexually active girls (8%) did not use contraception neither at first intercourse nor at the moment.