Recent reproductive coercion and unintended pregnancy among female family planning clients

Objective

Reproductive coercion (RC) — birth control sabotage and coercion by male partners to become pregnant and to control the outcome of a pregnancy — has been associated with a history of both intimate partner physical and sexual violence (IPV) and unintended pregnancy among females utilizing reproductive health services. The temporal nature of associations of RC and unintended pregnancy (distinct from the impact of IPV), however, has remained less clear.

Study Design

A survey was administered to females aged 16–29 years seeking care in 24 rural and urban family planning clinics in Pennsylvania (n= 3539).

Results

Five percent of respondents reported RC in the past 3 months, and 12% reported an unintended pregnancy in the past year. Among those who reported recent RC, 21% reported past-year unintended pregnancy. Compared to women exposed to neither condition, exposure to recent RC increased the odds of past-year unintended pregnancy, both in the absence of a history of IPV [adjusted odds ratio (AOR) 1.79, 1.06–2.03] and in combination with a history of IPV (AOR 2.00, 1.15–3.48); history of IPV without recent RC was also associated with unintended pregnancy (AOR 1.80, 1.42–2.26).

Conclusions

Findings indicate the temporal proximity of the association of RC and unintended pregnancy, with recent RC related to past-year unintended pregnancy, both independently and in combination with a history of IPV. Recent RC is relatively prevalent among young women using family planning clinics and is associated with increased risk for past-year unintended pregnancy even in the absence of IPV.

Implications

Recent RC and a history of IPV are prevalent among female family planning clients, particularly younger women, and these experiences are each associated with unintended pregnancy. Pregnancy prevention counseling should include not only assessment for physical and sexual partner violence but also specific inquiry about RC.     

The role of intimate partner violence, race, and ethnicity in help-seeking behaviors

Objective . Women experiencing intimate partner violence (IPV) have multiple health and social service needs but many, especially Hispanic, women may not access these resources. This research sought to examine the relationship between IPV and health and social services utilization (help-seeking behaviors), with a focus on racial and ethnic disparities.

Design . Case-control study from an urban US emergency department population in which cases (women with IPV) and controls (women without IPV) were frequency matched by age group and race/ethnicity. Logistic regression analyses were performed to examine the relationship between IPV and help-seeking behaviors and between help-seeking behaviors and race/ethnicity among abused women. In addition, a stratified analysis was conducted to examine the relationship between acculturation and help-seeking behaviors among Hispanic women.

Results . The sample included 182 cases and 147 controls. Among the health services, alcohol program, emergency department, and hospital utilization were significantly increased among IPV victims compared to non-victims after taking demographic and substance use factors into account. Similarly, IPV victims were more likely to access social/case worker services and housing assistance compared to non-victims. Specific help-seeking behaviors were significantly associated with race and ethnicity among IPV victims, with non-Hispanic white and black women more likely to use housing assistance and emergency department services and black women more likely to use police assistance compared to Hispanic women. Among all Hispanic women, low acculturation was associated with decreased utilization of social services overall and with any healthcare utilization, particularly among abused women.

Conclusions . Social service and healthcare workers should be alerted to and screen for IPV among all clients. The need for increased outreach and accessibility of services for abused women in Hispanic communities in the USA should be addressed, with cultural and language relevance a key component of these efforts.     

A family planning clinic partner violence intervention to reduce risk associated with reproductive coercion

Background

This study examined the efficacy of a family-planning-clinic-based intervention to address intimate partner violence (IPV) and reproductive coercion.

Study Design

Four free-standing urban family planning clinics in Northern California were randomized to intervention (trained family planning counselors) or standard of care. English-speaking and Spanish-speaking females ages 16–29 years (N=906) completed audio computer-assisted surveys prior to a clinic visit and 12–24 weeks later (75% retention rate). Analyses included assessment of intervention effects on recent IPV, awareness of IPV services and reproductive coercion.

Results

Among women reporting past-3-months IPV at baseline, there was a 71% reduction in the odds of pregnancy coercion among participants in intervention clinics compared to participants in the control clinics that provided standard of care. Women in the intervention arm were more likely to report ending a relationship because the relationship was unhealthy or because they felt unsafe regardless of IPV status (adjusted odds ratio=1.63; 95% confidence interval=1.01–2.63).

Conclusions

Results of this pilot study suggest that this intervention may reduce the risk for reproductive coercion from abusive male partners among family planning clients and support such women to leave unsafe relationships.     

Detecting intimate partner violence during pregnancy: awareness-raising indicators for use by primary healthcare professionals

BACKGROUND: Given the deleterious consequences of intimate partner violence (IPV) for gestation, it is important to promote a more effective and amicable approach that engenders greater receptiveness, stimulates more open communication and, ultimately, facilitates addressing the problem. In this regard, active primary care professionals need to be educated about the different profiles of violence found in domestic environments. The aim of this study is to make the identification of those subgroups of pregnant women most likely to be living in IPV situations both practical and simple. Its ultimate goal is to give healthcare professionals who work directly with the public the tools to anticipate such events. To this end, this study presents a profile of IPV during pregnancy according to different characteristics observed among primary health service users. METHODS: Five hundred and twenty-seven women who carried children to term in Rio de Janeiro were interviewed. A Portuguese version of the Revised Conflict Tactics Scale (CTS2) was used to detect IPV. Several sociodemographic factors, life habits and reproductive health characteristics of pregnant women and their partners were scrutinized. Prevalence projections by subgroup were obtained using a multinomial logit model. RESULTS: The projected prevalences for negotiation, psychological violence, minor physical violence and severe physical violence were, respectively, 0.1% [95% confidence interval (CI) 0.0-0.6], 2.6% (95%CI 0.7-6.9), 7.0% (95%CI 1.7-18.5) and 90.3% (95%CI 77.2-96.8) for the extreme scenario, i.e. women <20 years of age, non-White, living in house with inadequate garbage disposal, previous history of abortion, reporting fear of someone, reporting lack of affective social support, and reporting drug use by woman or spouse. In the absence of these characteristics, the projected prevalences were 51.3% (95%CI 38.5-64.6), 40.0% (95%CI 28.5-51.9), 7.6% (95%CI 4.2-12.7) and 1.1% (95%CI 0.3-2.4), respectively. CONCLUSION: This study found that knowledge of certain characteristics of pregnant women who attend health services can alert professionals to the high probability of IPV, facilitating early identification of the problem and subsequent implementation of proactive measures.     

Intimate partner violence and depression among Whites, Blacks, and Hispanics

PURPOSE: To examine the relationship between intimate partner violence and depression. METHODS: A household probability sample of Whites (n=616), Blacks (n=377), and Hispanics (n=592) age 18 or older was interviewed in 1995. The response rate was 85%. Logistic analysis is used to identify predictors of depression. RESULTS: Among men, Black (OR=.29; 95% CI, 0.13-.65) and Hispanic (OR=0.4; 95% CI, 0.2-0.8) ethnicity were protective against depression. Factors of risk for men included victimization by female to male partner violence (OR=4.04; 95% CI, 1.15-14.11), unemployment (OR=7.65; 95% CI, 1.59-16.39), and living in a high-unemployment neighborhood (OR=4.6; 95% CI, 1.86-11.37). Among women, the predictors are perpetration of moderate (OR=4.08; 95% CI, 1.33-12.47) or severe (OR=6.57; 95% CI, 1.76-24.52) female to male partner violence, and impulsivity (OR=1.82; 95% CI, 3.87-20.71). CONCLUSIONS: Knowledge from surveys using general population samples is important for developing prevention interventions in the community. Because predictors of depression in these samples are both individual and contextual at neighborhood level, prevention interventions to be effective must address not only individual factors of risk but also structural conditions in the environment where individuals live.     

Common mental disorders and intimate partner violence in pregnancy

OBJECTIVE

To investigate the association between common mental disorders and intimate partner violence during pregnancy.

METHODS

A cross sectional study was carried out with 1,120 pregnant women aged 18-49 years old, who were registered in the Family Health Program in the city of Recife, Northeastern Brazil, between 2005 and 2006. Common mental disorders were assessed using the Self-Reporting Questionnaire (SRQ-20). Intimate partner violence was defined as psychologically, physically and sexually abusive acts committed against women by their partners. Crude and adjusted odds ratios were estimated for the association studied utilizing logistic regression analysis.

RESULTS

The most common form of partner violence was psychological. The prevalence of common mental disorders was 71.0% among women who reported all form of violence in pregnancy and 33.8% among those who did not report intimate partner violence. Common mental disorders were associated with psychological violence (OR 2.49, 95%CI 1.8;3.5), even without physical or sexual violence. When psychological violence was combined with physical or sexual violence, the risk of common mental disorders was even higher (OR 3.45; 95%CI 2.3;5.2).

CONCLUSIONS

Being assaulted by someone with whom you are emotionally involved can trigger feelings of helplessness, low self-esteem and depression. The pregnancy probably increased women`s vulnerability to common mental disorders     

Association of physical violence by an intimate partner around the time of pregnancy with inadequate gestational weight gain

Intimate partner violence has been previously examined in relation to a variety of pregnancy, labor and delivery outcomes. We evaluated whether women who experienced physical violence by their intimate partners around the time of pregnancy were less likely to achieve weight gain according to the US Institute of Medicine (IOM) guidelines. A cross-sectional study was conducted using the 2000-2006 Oklahoma Pregnancy Risk Assessment Monitoring Survey (PRAMS) data for post-partum women, 20 years and older. Physical violence perpetrated by an intimate partner before and/or during pregnancy was prevalent in nearly 6.5% of women. Weight gain was adequate in 38.8%, deficient in 28.4% and excessive in 32.8% of these women, respectively. After adjusting for maternal age, marital status, education, pregnancy intention, stressful life events, third-trimester use of tobacco and alcohol and gestational age at delivery, physical violence by an intimate partner around the time of pregnancy was positively but non-significantly associated with excessive (but not deficient) gestational weight gain. After stratifying by age group, positive and significant associations between physical violence by an intimate partner around the time of pregnancy and inadequate gestational weight gain were observed only among women 35 years and older. With the exception of mothers ≥ 35 years of age, deficient and excessive gestational weight gains were not significantly related to experiences with physical violence by an intimate partner prior to delivery. Prospective cohort studies are needed to establish whether other forms of violence, including emotional and sexual abuse, can affect gestational weight gain and whether gestational weight gain can mediate the effect of physical, sexual and emotional abuse on pregnancy, labor and delivery outcomes.     

Unperceived intimate partner violence and women's health

Objective

Women who experience intimate partner violence (IPV) often do not perceive themselves as abused. This study sought to estimate the health effects of unperceived IPV (uIPV), taking violence-free women as the reference, and to compare the effects of uIPV with those of perceived IPV (pIPV).

Method

We performed a cross-sectional population study through telephone interviews of 2835 women aged 18 to 70 years living in the region of Madrid and having an ongoing intimate partner relationship or contact with a former partner in the preceding year. Based on 26 questions from the Conflict Tactics Scale-1 and the Enquête Nacional sur les Violences envers les Femmes en France and the question “Do you feel abused by your partner?” a variable was constructed in three categories, namely, the absence of IPV, uIPV and pIPV. Using logistic regression, we analyzed the association between health problems, medication use, health-service utilization and IPV (perceived and unperceived) vis-à-vis the absence of IPV.

Results

There were 247 cases of uIPV and 96 of pIPV (prevalences of 8.8% and 3.4%, respectively). The multivariate analysis showed that a substantial number of the outcomes explored were associated with uIPV, pIPV, or both. The highest odds ratios (ORs) were obtained for depression (Patient Health Questionnaire-9 ≥ 10) (uIPV: OR 3.4, 95% CI 2.4-3.8; and pIPV: 4.1, 95%CI 2.5-6.8). In most problems, the ORs did not significantly differ between the two types of IPV.

Conclusions

uIPV is 2.6 times more frequent than pIPV and is associated with at least as many health problems as pIPV.     

Unwanted pregnancy,pregnancy loss,and other risk factors for intimate partner violence in the Democratic Republic of the Congo

The Democratic Republic of the Congo (DRC) has one of the highest rates of violence against women in the world; however, few studies have focused on this issue. In this study, we assessed the interrelationship among intimate partner violence (IPV), unintended pregnancy, pregnancy loss, and other sociodemographic factors in the DRC. Our analyses were based on data from the DRC demographic and health survey, conducted from November 2013 to February 2014. We constructed generalized estimating equation models to analyze the data from a sample of 5,120 married women. Our results showed that having a husband or partner who exhibited controlling behaviors, women who justified wife-beating, having a mother who had experienced IPV, and having a husband or partner who consumed alcohol were positively associated with IPV, whereas decision-making autonomy among women was negatively associated with IPV. In the community, the proportion of women who had experienced IPV and that of those who had completed secondary or higher education were positively and negatively associated with any IPV type, respectively. In addition, emotional IPV and any IPV type were positively associated with pregnancy loss. Our results indicate the necessity of implementing programs targeting gender equality at both individual and community levels.     

Associations of intimate partner violence with unintended pregnancy and pre-pregnancy contraceptive use in South Asia

ObjectiveTo assess associations of intimate partner violence (IPV) with pregnancy intendedness and pre-pregnancy contraceptive use among pregnant women in South Asia.Study designCross-sectional analyses were conducted using the most recent Demographic and Health Surveys from Bangladesh, India and Nepal for married, pregnant women aged 15–49 years who responded to IPV assessments specific to current marriage (N= 4738). Adjusted logistic and multinomial regression analyses were conducted with pooled data to assess associations of IPV ever (sexual only, physical only, sexual plus physical or none) with the outcomes of pregnancy intendedness (wanted, mistimed or unwanted) and pre-pregnancy contraceptive use (no, traditional or modern) for the current pregnancy.ResultsIPV was not associated with a mistimed or unwanted pregnancy. Sexual IPV was associated with pre-pregnancy modern contraceptive use (aOR=2.32, 95% CI=1.24, 4.36); sexual plus physical IPV was associated with pre-pregnancy traditional contraceptive use (aOR=1.85, 95% CI=1.12, 3.07). Post hoc analysis of reasons for pre-pregnancy contraceptive discontinuation revealed that women with a history of IPV, particularly sexual IPV, had higher prevalence of contraceptive failure (sexual only, 37.3%; sexual plus physical, 30.9%; physical only, 22.6%; no IPV, 13.6%).ConclusionPregnant women who experienced sexual IPV from husbands were more likely to use contraceptives pre-pregnancy but had no reduced risk unintended pregnancy, possibly due to higher rates of pre-pregnancy contraceptive failure among those with this history. These findings suggest that victims of sexual IPV are able to acquire and use family planning services but require more support to sustain effective contraceptive use.ImplicationsFamily planning services are reaching women affected by sexual IPV, and programs should be sensitive to this concern and the heightened vulnerability to contraceptive failure these women face. Long-acting reversible contraception could be beneficial by allowing women to have greater reproductive control in situations of compromised sexual autonomy.     

中国北方城市妇女妊娠前、妊娠期及产后家庭暴力的调查

目的 探讨妊娠前、妊娠期及产后针对妇女的家庭暴力发生的现况以及相关的影响因素。方法 在天津市、河南省、辽宁省以及陕西省，采用分层整群抽样及面对面调查的方法，选择32个区，对有6～18月龄小儿的妇女进行调查，以了解她们妊娠前、妊娠期和产后家庭暴力的情况。采用SPSS软件进行分析。结果 中国北方部分地区妊娠前、妊娠期和产后家庭暴力总的发生率为12．6％，其中性暴力的发生率最高(8．0％)，心理暴力的发生率最低(3．5％)，躯体暴力发生率居中(5．6％)。妊娠前、妊娠期和产后家庭暴力的发生率分别为9．1％、4．3％和8．3％。进一步分析显示妊娠前发生家庭暴力则预示着妊娠期、产后很可能发生家庭暴力。单因素分析发现与家庭暴力相关的因素有：妇女和配偶的受教育程度低、结婚时间长、体力劳动者、个人月收入低、吸烟、饮酒。还发现妇女见到周围有人挨丈夫打的及夫妻关系不好者，发生家庭暴力的可能性大。结论 中国北方城市家庭暴力的发生率较高，应该引起足够的重视。对医务人员进行广泛深入的培训，以增强他们对家庭暴力的认识和反应，以及了解如何进行筛查和管理家庭暴力案例。     

Disability and intimate partner violence: A cross-sectional study from Mwanza,Tanzania

BackgroundWomen with disabilities are at heightened risk of experiencing intimate partner violence [IPV], although the mechanisms through which disability acts as a risk factor for IPV are not clear.ObjectiveWe analyzed cross-sectional data (n = 867) from Wave 3 of the MAISHA longitudinal study, conducted in Mwanza, Tanzania, to i) describe the levels of disability and IPV amongst women, and ii) to assess the association between level and type of disability and IPV experience.MethodsIPV was assessed using the WHO Multi-Country study instrument. Levels of disability (none, mild and severe) were categorized based on responses to the Washington Group Short Set questions. We fitted logistic regression models to determine the risk of experiencing each type of IPV according to disability level and type of disability.ResultsWe found significant associations between mild and severe disability and different types of IPV. For example, in multivariate analyses controlling for socio-demographic variables, women reporting severe disability were significantly more likely to report physical and/or sexual IPV, sexual IPV. controlling behaviors, economic IPV, and severe IPV, whereas for mild disability compared to no disability, physical and/or sexual IPV, sexual IPV, and economic IPV were significantly more likely to be reported. Cognitive disability was a significant correlate of all forms of IPV apart from physical IPV.ConclusionsOur findings that specific types of disability and not others were associated with an elevated risk of IPV exposure indicate the need for nuanced measurement and analysis of the association between disability and IPV.     

Contraceptive Prevalence and Consulting Service in Women with Systemic Lupus Erythematosus: A Cross-Sectional Study

BackgroundSystemic lupus erythematosus (SLE), often affects women of childbearing age. Family planning consultation is a major aspect of medical care in these patients because of the risk of disease activation and poor pregnancy and fetal outcomes. The aim of the present study was to evaluate contraceptive prevalence and consulting service in women with SLE.MethodsIn a cross-sectional study, a total of 144 female patients with SLE, ages 15–50, who were presented to rheumatology clinics in Sari, north of Iran, were evaluated. The study was conducted between March 2019 and May 2020. Patients'' clinico-demographic profile and fertility information were obtained. Disease activity and damage were assessed by the systemic lupus erythematosus disease activity (SLEDAI) and Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (SDI).ResultsOne hundred and forty-four SLE patients of childbearing age participated in this study. From 102 patients with the possibility of pregnancy, 36(35.2%) received contraceptive consultations in last year. Withdrawal was the most prevalent contraceptive method (41.7%), followed by permanent (11.8%), and barrier methods (9%). There were no significant differences in age, disease duration, marriage duration, SDI or SLEDAI scores between the women who received or not received contraceptive counseling (P>0.05).ConclusionMany SLE patients did not receive adequate information about contraception, and it may be associated with many adverse effects on disease activity and pregnancy outcomes. Therefore, contraceptive consultation as an important aspect of patient''s management is strongly suggested.     

Community level effects of gender inequality on intimate partner violence and unintended pregnancy in Colombia: testing the feminist perspective

Violence against women, especially by intimate partners, is a serious public health problem that is associated with physical, reproductive, and mental health consequences. The effect of intimate partner violence on women's ability to control their fertility and the mechanisms through which these phenomena are related merit further investigation. Building on findings from a previous analysis in which a statistically significant relationship between intimate partner violence and unintended pregnancy in Colombia was found, this analysis examines the effect of gender inequality on this association using data from the 2000 Colombian Demographic and Health Survey. Specifically, the objective of this analysis is to explore whether gender inequality (as measured by women's autonomy, women's status, male patriarchal control, and intimate partner violence) in municipalities partially explains the association between intimate partner violence and unintended pregnancy in Colombia. Results of logistic regression analysis with multi-level data show that living in a municipality with high rates of male patriarchal control significantly increased women's odds of having an unintended pregnancy by almost four times. Also, living in a municipality with high rates of intimate partner violence increased one's odds of unintended pregnancy by more than 2.5 times, and non-abused women living in municipalities with high rates of intimate partner violence were at a significantly increased risk of unintended pregnancy. In addition, abused women living in a municipality with high personal female decision-making autonomy had more than a fourfold increased risk of having an unintended pregnancy. These findings demonstrate the need for reproductive health programs to target areas at particularly high risk for unintended pregnancy by reducing intimate partner violence and gender inequality.