Screening in the Prenatal Period for Intimate Partner Violence and History of Abuse: A Survey of Edmonton Obstetrician/Gynaecologists

Objective

This study sought to understand how obstetrician gynaecologists (OB/GYNs) in Edmonton, Alberta screen prenatal patients for intimate partner violence (IPV). It also aimed to explore attitudes, beliefs, and perceptions regarding IPV and identify barriers to screening for IPV. Institutional protocols, resources, and support available to clinicians and patients were also reviewed.

Similarity and Differences in Sexual Violence Against Adolescents and Adult Women: The Need to Focus on Adolescent Victims

Study ObjectiveTo explore whether there are differences in characteristics, clinical findings and management in cases of sexual violence in adolescent and adult women.DesignRetrospective study.SettingSVSeD–Service for Sexual and Domestic Violence, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy.ParticipantsFemale victims of sexual violence aged 10 years and older. Two study groups were analysed: an adolescent group and an adult group.InterventionsNone; this was an observational study.Main Outcome MeasuresCharacteristics of the perpetrator, time spent between the episode of sexual violence and the access to SVSeD, presence of genital and/or extragenital injuries; tests for sexually transmitted diseases, spermatozoa research; and toxicological screening;ResultsAdolescent victims of sexual violence requested help later than the adult victims. The majority of the perpetrators were well known to the victims in both groups. In both groups, we observed genital injuries in 1 of 3 patients. We found a strong association between the presence of genital injuries and a positive screening test for sexually transmitted diseases, in particular with regard to the adolescent victims.ConclusionAdolescents’ delayed disclosure of sexual violence may affect the ability to properly manage these crimes. Prevention programs and public awareness campaigns should be implemented to highlight the importance of a prompt disclosure after sexual assault has occurred. Gynecologists should be made increasingly aware of this delicate issue, to better assist victims of sexual violence, especially adolescent victims.     

Intimate partner violence and repeat induced abortion in Italy: A cross sectional study

Abstract

Objective To investigate the impact of intimate partner violence (IPV) on the risk of repeat induced abortion (RIA), we compared IPV history among women with and without previous induced abortion (IA).

Methods All consecutive women aged 18 years or more requiring IA in 12 Italian abortion clinics were eligible for inclusion in the study. They were asked to fill in an anonymous, self-developed questionnaire assessing sociodemographic data and their history of different types of violence and related risk factors.

Results The analysis included 1030 women, 624 (60.6%) of whom reported a previous IA. Past or current IPV was reported by 19.3%: 7.0% reported sexual violence, 11.3% physical abuse and 12.1% psychological abuse. Past or current IPV was reported by 22.3% of women with RIA and 14.8% of those undergoing their first IA (adjusted odds ratio 1.57, 95% confidence interval 1.07–2.30; p = 0.02). When we considered sexual, psychological and physical abuse separately, we found that any kind of abuse was more frequent in women with RIA than in women with no previous IA.

Conclusion This study underlines the impact of IPV on the risk of RIA and suggests the need for screening for IPV among women requiring abortion, in order to identify women at risk of RIA and to improve their general and reproductive health.

Chinese Abstract

摘要：

目的：为了研究亲密伴侣暴力对反复人工流产的影响,我们比较了既往有亲密伴侣暴力病人有无反复流产史。

方法：在意大利12所堕胎诊所需要行人工流产术的所有的18周岁及以上的妇女符合此研究的纳入标准,她们需要填写一份匿名的、自主研发的问卷,调查研究社会人口数据和既往的暴力性质及与此相关的影响因素。

结果：共有1030人纳入研究,其中的624（60.6%）既往有过人工流产史。目前的研究表明亲密伴侣暴力的发生率为19.3%,其中7.0%为性暴力,11.3%躯体虐待,12.1%为心理暴力。目前的研究提出,既往有过人工流产史的妇女中发生亲密伴侣暴力的概率是22.3%,第一次行人工流产的妇女中亲密伴侣暴力的发生率是14.8%（调整后OR=1.57,95%CI 1.07-2.30,P=0.02）。当我们将性、躯体、心理的虐待分开来考虑,发现不同形式的虐待在既往有人工流产史的妇女中的发生频率均高于在初次行人工流产的妇女的发生频率。

结论：这项研究强调了亲密伴侣暴力对反复人工流产的影响,建议在妇女需要行人工流产时调查有无亲密伴侣暴力的存在,从而识别有无反复人工流产的危险因素,并提高妇女的健康及生殖健康。

关键词：亲密伴侣暴力,人工流产, 流行病学,危险因素,性虐待     

Current Evidence on Perinatal Home Visiting and Intimate Partner Violence

Objective: To describe current evidence on home visiting interventions for pregnant or postpartum women with specific intimate partner violence assessment and content.
Data Sources: Online bibliographic databases including PubMed, CINAHL Plus, and Web of Science and a hand search of bibliographies of relevant articles.
Study Selection: Original research and intervention studies were included that contained (a) a well-described prenatal and/or postpartum home visitation; (b) an assessment of perinatal intimate partner violence; and (c) quantitative data describing health outcomes for the women and their infants.
Data Extraction: The search yielded 128 articles, and 8 relevant articles met all of the inclusion criteria. Nonresearch, nonintervention, and international articles were excluded.
Data Synthesis: No perinatal home visiting interventions were designed to address intimate partner violence. Programs that screened for intimate partner violence found high rates, and the presence of intimate partner violence limited the ability of the intervention to improve maternal and child outcomes.
Conclusions: Perinatal home visitation programs likely improve pregnancy and infant outcomes. Home visiting interventions addressing intimate partner violence in nonperinatal population groups have been effective in minimizing intimate partner violence and improving outcomes. This suggests that perinatal home visiting programs adding specific intimate partner violence interventions may reduce intimate partner violence and improve maternal and infant health. Continued rigorous research is needed.     

Gender-Related Differences in Associations Between Sexual Abuse and Hypersexuality

BackgroundIndividuals with histories of sexual abuse may be more likely to experience sexual-related problems including hypersexuality, but gender-related differences remain unclear.AimThis online study examined sexual abuse history and hypersexuality by gender among 16,823 Hungarian adults, adjusting for age, sexual orientation, relationship status, education, employment status, and residence.MethodsAn online questionnaire on one of the largest Hungarian news portals advertised this study examining sexual activities in January 2017. 3 categorizations of age-related sexual abuse were examined: child sexual abuse (CSA) occurring at age 13 and earlier (compared to no abuse), adolescent/adult sexual abuse (AASA; compared to no abuse), and CSA and AASA (CSA/AASA; compared to one age-related category of abuse or the other).OutcomesThe outcome variable, hypersexuality, was examined as a continuous variable due to the low prevalence of clinical hypersexuality in this sample. 3 multivariate linear regression analyses adjusting for covariates aimed to predict hypersexuality from each category of abuse, along with gender and its interaction with each category.ResultsIn all models, younger age, non-heterosexual sexual orientation, male gender, single relationship status, less than full-time work, and living in a capital city were associated with hypersexuality, and education was not a significant predictor. CSA, AASA, and CSA/AASA predicted hypersexuality in both men and women. There was a significant interaction between CSA/AASA and gender, such that the relationship between CSA/AASA and hypersexuality was stronger in men than in women.Clinical TranslationSexual abuse at each developmental time-point may influence hypersexuality among men and women, although the cumulative impact of CSA and AASA on hypersexuality may be particularly relevant among men.Strengths & LimitationsThis is one of the largest studies to examine gender-related differences in the relationship between sexual abuse and hypersexuality. Nevertheless, our study is cross-sectional, and longitudinal work is needed to determine how sexual abuse affects children, adolescents, and adults throughout their lives.ConclusionDevelopmental impacts of sexual abuse may be considered in a gender-informed fashion in order to develop and optimize effective prevention and treatment strategies for hypersexuality.Slavin MN, Blycker GR, Potenza MN, et al. Gender-Related Differences in Associations Between Sexual Abuse and Hypersexuality. J Sex Med 2020;17:2029–2038.     

Intimate partner violence (IPV) and preeclampsia among Peruvian women

OBJECTIVE: Mounting evidence supports the view that intimate partner violence (IPV) is an important cause of maternal mortality. Some, but not all, prior studies suggest that IPV is associated with increased risks of maternal medical conditions such as hypertensive disorders of pregnancy which are leading causes of maternal mortality worldwide. We assessed the relation between IPV and risk of preeclampsia among Peruvian women. STUDY DESIGN: We conducted a case-control study at two large hospitals in Lima, Peru. Preeclampsia cases were 339 women with pregnancy-induced hypertension and proteinuria (i.e., preeclampsia). Controls were 337 normotensive women. Information concerning women's exposure to physical and emotional violence during pregnancy was collected during in-person interviews conducted after delivery and while patients were in hospital. Odds ratios (OR) and 95% confidence intervals (CI) were estimated from logistic regression models. RESULTS: The prevalence of IPV was 43.1% among cases and 24.3% among controls. Compared with those reporting never exposure to IPV during pregnancy, women reporting any exposure had a 2.4-fold increased risk of preeclampsia (OR=2.4; 95% CI: 1.7-3.3). The association was strengthened slightly after adjusting for maternal age, parity and pre-pregnancy adiposity (OR=2.7; 95% CI: 1.9-3.9). Emotional abuse in the absence of physical violence was associated with a 3.2-fold (95% CI: 2.1-4.9) increased risk of preeclampsia. Emotional and physical abuse during pregnancy was associated with a 1.9-fold increased risk of preeclampsia (95% CI: 1.1-3.5). CONCLUSIONS: IPV among pregnant women is common and is associated with an increased risk of preeclampsia. These data support recent calls for coordinated global health efforts to prevent violence against women.     

Dating Violence in Adolescence: Implications for Girls’ Sexual Health

Adolescents in the United States are too often involved in relationships characterized by coercion and violence. An emerging body of research suggests that dating violence is linked with other health risks in adolescent relationships, particularly sexual risk behavior. The confluence of risks conferred by dating violence and sexual risk behavior are particularly acute for adolescent girls. Adolescent gynecology providers need to understand the nature of dating violence in adolescence and the ways in which dating violence and sexual risk behavior are mutually influential. This article reviews the literature on the links between dating violence and sexual risk in adolescent girls’ relationships. The prevalence, risk factors, and consequences of dating violence in adolescence are discussed, followed by a review of the research linking dating violence and sexual risk, with a focus on common mechanisms underlying these relationship risk behaviors. The review concludes with implications for screening, prevention, intervention, and future directions for research.     

Protection of sexual and reproductive health rights: Addressing violence against women

Violence against women is recognized as a global public health and human rights problem in need of urgent attention. It affects women's health, including their sexual and reproductive health, and their human rights. While progress has been made in the last 15 years, there is still a long way to go. International human rights law and public health provide tools to governments and non-governmental actors to ensure women a life free from violence and its consequences. Health policies and services need to address violence more systematically and health providers must take action. At a minimum, they should be informed and able to respond appropriately to violence, providing appropriate care and referral to other services. Equally, if not more important, is to provide support to interventions that prevent violence against women from happening in the first place.     

Effects of an Interprofessional Student-Led Sexual Education Program on Self-Efficacy and Attitudes About Sexual Violence in Youths in Juvenile Detention

Study ObjectiveWe aim to explore the impact of an interprofessional graduate student−led sexual education curriculum on sexual self-efficacy, perceived importance of sexual consent, and willingness to intervene against sexual violence in the high-risk population of detained youths.Design, Setting, and ParticipantsMedical, nursing, social work, and physician assistant students implemented a 3-session, comprehensive sexual health curriculum for detained youths (n = 253).Interventions and Main Outcome MeasuresThe curriculum from Son et al (2017) was adapted to include a more targeted curriculum on consent and safe relationships. Youths completed pre- and postintervention assessments that evaluated their sexual self-efficacy and violence-related beliefs and behaviors.ResultsDetained youths completing the curriculum showed statistically significant increases in the sexual self-efficacy (P < .001), view of the importance of consent (P < .001), and willingness to intervene (P = .0027). The subset of male individuals and adolescents aged 17-19 years achieved statistically significant improvement in each category; adolescents aged 12-14 years did not. Female participants showed statistically significant improvement in sexual self-efficacy scores only.ConclusionsThe curriculum addressing topics of consent and sexual violence was effective in improving detained youths’ belief in their ability to safely navigate a sexual encounter and their attitudes toward sexual assault. Additional research on gender- and age-specific programming and the long-term impact on sexual health risk behaviors is needed.     

Intimate partner and nonpartner violence against pregnant women in rural Haiti

OBJECTIVE: To examine the association between violence experienced by pregnant Haitian women in the previous 6 months and pregnancy-related symptom distress. METHODS: A total of 200 women seeking prenatal care at community health dispensaries in the Artibonite Valley were interviewed. RESULTS: Over 4 in 10 women (44.0%) reported that they had experienced violence in the 6 months prior to interview; 77.8% of these women reported that the violence was perpetrated by an intimate partner. Those who experienced intimate partner violence reported significantly greater pregnancy-related symptom distress (beta=0.23, P=0.001). No significant differences between violence perpetrated by family members or others and reporting of symptoms were observed (beta=0.06, P=0.38). CONCLUSION: The findings indicate the need to integrate violence screening, resources, and primary prevention into prenatal care in rural Haiti.     

Association between adolescent marriage and marital violence among young adult women in India

Objective

To assess whether a history of adolescent marriage (< 18 years) places women in young adulthood in India at increased risk of physical or sexual marital violence.

Methods

Cross-sectional analysis was performed on data from a nationally representative household study of 124 385 Indian women aged 15-49 years collected in 2005-2006. The analyses were restricted to married women aged 20-24 years who participated in the marital violence (MV) survey module (n = 10 514). Simple regression models and models adjusted for participant demographics were constructed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between adolescent marriage and MV.

Results

Over half (58%) of the participants were married before 18 years of age; 35% of the women had experienced physical or sexual violence in their marriage; and 27% reported such abuse in the last year. Adjusted regression analyses revealed that women married as minors were significantly more likely than those married as adults to report ever experiencing MV (adjusted OR 1.77; 95% CI, 1.61-1.95) and in the last 12 months (adjusted OR 1.51; 95% CI, 1.36-1.67).

Conclusions

Women who were married as adolescents remain at increased risk of MV into young adulthood.     

Intimate partner violence and women's reproductive health

Intimate partner violence is common among women, with an estimated 30% of all women globally likely to experience physical or sexual violence by a husband, intimate partner or ex-partner. While most prevalence estimates are based on consideration of physical or sexual violence, IPV can also encompass psychological, financial or social abuse. Although influenced by multiple factors at the societal, community, and relationship levels, the behaviour of individuals (the abusive partner) often results from the desire to have power and control over a woman's actions. The presence of past or current IPV in a woman's life can have profound implications for all aspects of her reproductive health, and healthcare providers need to have the skills to identify IPV, and provide appropriate support and referrals as required.     

Abuse of women and children in a Philippine community.

This retrospective study describes the demographic profiles, types of injuries and characteristics of abusers of 1354 women and children survivors of domestic violence who sought medical care from the obstetrics and gynecology resident and attending staff in the Women and Children Protection Unit in Vicente Sotto Memorial Medical Center from 1 January 1997 to 31 December 1998. Thirty-nine percent of these patients were sexually abused; their peak age was 11-20 years. Almost 75% of sexual abusers were from outside of the household. The highest incidence of physical abuse occurred in ages 26-35 years. Seventy-five percent of this form of abuse was in the home and perpetrated by husbands and live-in partners. Our data add to the expanding literature demonstrating the existence of family violence throughout the world. The role of our Protection Unit in responding to the victims of family violence is in keeping with the responsibilities and the ethical obligations all obstetrician-gynecologists have to the safety, physical and psychological needs of the women they serve.     

Intimate partner violence and sexually transmitted disease symptoms in a national sample of married Bangladeshi women.

OBJECTIVES: To assess associations of intimate partner violence (IPV) with women's sexually transmitted disease (STD) symptoms, and to clarify biological and behavioral mechanisms underpinning heightened STD rates among abused women. METHODS: A cross-sectional investigation of married couples (n=2865) sampled via the Bangladesh Demographic Health Survey. RESULTS: Over one third (38%) of married Bangladeshi women experienced physical or sexual IPV in the 12 months preceding the survey. Victimization was bivariately associated with vaginal irritation/discharge, pelvic pain during intercourse, genital sores/ulcers, and vaginal discharge with odor (OR 1.39-2.09). IPV demonstrated an independent effect on vaginal irritation with discharge (adjusted OR 1.34) and vaginal discharge with odor (adjusted OR 2.08) after accounting for STD exposure (i.e., husbands' recent STD). CONCLUSIONS: IPV elevates married Bangladeshi women's STD symptoms beyond the risk represented by husbands' STD alone, suggesting that high rates of STD among abusive men and the context of violence itself both relate to abused women's STD risk.