Violence and Reproductive Health: Current Knowledge and Future Research Directions

Objectives: Despite the scope of violence against women and its importance for reproductive health, very few scientific data about the relationship between violence and reproductive health issues are available. Methods: The current knowledge base for several issues specific to violence and reproductive health, including association of violence with pregnancy, pregnancy intention, contraception use, pregnancy terminations, and pregnancy outcomes, are reviewed and suggestions are provided for future research. Results: Despite the limitations of current research and some inconclusive results, the existing research base clearly documents several important points: (1) violence occurs commonly during pregnancy (an estimated 4%–8% of pregnancies); (2) violence is associated with unintended pregnancies and may be related to inconsistent contraceptive use; and (3) the research is inconclusive about the relationship between violence and pregnancy outcomes. Conclusions: Improved knowledge of the risk factors for violence is critical for effective intervention design and implementation. Four areas that need improvement for development of new research studies examining violence and reproductive-related issues include (1) broadening of study populations, (2) refining data collection methodologies, (3) obtaining additional information about violence and other factors, and (4) developing and evaluating screening and intervention programs. The research and health care communities should act collaboratively to improve our understanding of why violence against women occurs, how it specifically affects reproductive health status, and what prevention strategies may be effective.     

Exposure to Partner,Family, and Community Violence: Gang-Affiliated Latina Women and Risk of Unintended Pregnancy

While teen pregnancy rates appear to be declining in the USA overall, the rate of decline among young Latinas has been less than other ethnic groups. Among the myriad factors associated with elevated pregnancy rates, for Latina girls living in the inner city, exposure to gang and community violence may be a critical context for increased pregnancy risk. This study explores the relationship between gang involvement and reproductive health, and the pathways through which childhood, family, and relationship violence exposure may lead to unintended pregnancy. Interviews of 20 young adult Latinas with known gang involvement in Los Angeles County were audiotaped, transcribed, and coded for key themes related to violence exposure and reproductive health. Limited access to reproductive health care compounded by male partner sexual and pregnancy coercion, as well as physical and sexual violence, emerged in the interviews. Exposures to interparental domestic violence, childhood physical and sexual abuse, and gang violence were prominent and closely associated with unhealthy and abusive intimate relationships. Adverse childhood experiences and exposure to partner, family, and community violence impact the reproductive lives and choices of young Latina women in gangs. These findings may guide targeted pregnancy prevention efforts among urban gang-affiliated Latinas as well as encourage the integration of sexual violence prevention and reproductive health promotion within gang violence intervention programs.     

Sexual Violence and Reproductive Health

Sexual violence is a significant public health problem, and has been linked to adverse effects on women's physical and mental health. Although some advances in the research have been made, more scientific exploration is needed to understand the potential association between sexual violence and women's reproductive health, and to identify measures that could be implemented in reproductive health care settings to assist women who have experienced sexual violence. Three general areas needing further study include (1) expansion of the theoretical frameworks and analytic models used in future research, (2) the reproductive health care needs of women who have experienced sexual violence, (3) and intervention strategies that could be implemented most effectively in reproductive health care settings.     

Spousal Abuse Against Women and Its Consequences on Reproductive Health: A Study in the Urban Slums in Bangladesh

Objectives: Spousal violence is common and results in costly problems both for society and for the reproductive health of women. Despite the recognition that violence may be associated with serious consequences for women's reproductive health, our understanding of the relationship between the two remains limited. In this study, we assessed the association between spousal violence and women's reproductive health. Methods: Data from an interviewer-administered questionnaire assessing socioeconomic, demographic, behavioral profiles, and spousal violence-related information was collected from 496 women. Subjects were chosen from eight randomly selected urban slums from four metropolitan cities. Results: Spousal violence was significantly higher amongst the group of less educated women who had been in several marriages; indicating that the social and behavioral traits of women act as catalysts for spousal violence. Abusive husbands also had been married several times and were more likely to be addicted to alcohol or drugs. This demonstrates that the behavioral traits of husbands were also responsible for spousal violence. Spousal violence injuries adversely affect the health and well-being of women. More than three-quarters of physically violated women suffered injuries as a result of this violence. About 50% of these injuries were minor and about 10% serious. Sexual violence adversely affected women's health; more than 80% of sexually violated women complained of pelvic pain, more than 50% reported reproductive tract infections, and more than 50% reported symptoms of irritable bowel syndrome. Abused women suffered from gynecological problems at the time of pregnancy significantly more than non-abused women (p<0.05) and abused women suffered from reproductive tract infections significantly more than non-abused women (p<0.01). Abusive husbands suffered from sexually transmitted diseases (STD) significantly more than non-abusive husbands (p<0.05). Abused women used contraception significantly less than non-abused women (p<0.01). Logistic regression analysis suggested that spousal violence was the most important contributing factor for reproductive health problems in women. Conclusions: The findings of this study may enhance our understanding of the impact of spousal violence against women and their reproductive health and therefore highlight the importance of spousal violence prevention measures. Increasing the awareness and understanding of the relationship between violence against women and reproductive health could be achieved if lawyers, researchers, clinicians, practitioners, and government workers from multiple disciplines and agencies worked together.     

Violence Against Women and Reproductive Health: Toward Defining a Role for Reproductive Health Care Services

Since a large proportion of U.S. women receive reproductive health care services each year, reproductive health care settings offer an important opportunity to reach women who may be at risk of or experiencing intimate partner violence (IPV). Although screening women for IPV in clinical health care settings has been endorsed by national professional associations and organizations, scientific evidence suggests that opportunities for screening in reproductive health care settings are often missed. This commentary outlines what is known about screening and intervention for IPV in clinical health care settings, and points out areas that need greater attention. The ultimate goal of these recommendations is to increase the involvement of reproductive health care services in sensitive, appropriate, and effective care for women who may be at risk of or affected by IPV.     

Women,war, and reproductive health in developing countries

Globally, millions of people are affected by war and conflicts every year. However, women have increasingly suffered the greatest harm by war in more different ways than men. We conceptualize a reproductive rights approach toward examining the effects of war on women’s reproductive health in developing countries. Given the rising concerns of exclusion to adequately address women’s rights, sexual and gender-based violence, and post-conflict accountability, we specifically focus on the limitations of the Minimum Initial Service Package, a UN-sponsored reproductive health service program in conflict zones while offering a broad reproductive rights-based conceptual lens for examining reproductive health care services in war-torn areas. In addition, we discuss the roles social workers may play at both micro and macro levels in war-torn areas to bring about both short term and long term gains in women’s reproductive health.     

Screening for Intimate Partner Violence in Reproductive Health Centers: An Evaluation Study

This study compared rates of intimate partner violence reports on a new, empirically-developed screening tool completed by 385 women in 2007 to those from an older tool completed by 420 women in 2006. Data were obtained from randomly selected medical charts across three health center locations, which were part of the same reproductive health care organization. Chi-square analyses were conducted to test associations between demographic characteristics and partner violence reports. Multiple regression analyses were used to compare odds ratios of disclosure by type of screening tool, adjusting for associated demographic factors associated with partner violence reports. Women completing the old and new tools were similar across all demographic characteristics. After adjusting for age and center location, women completing the new screening form were more than 2.5 times as likely to report any partner violence. When analyzed by mutually exclusive violence history categories, women completing the new screening form were over 2.5 times as likely to report past or current violence and over 4 times as likely to report experiencing both past and current violence. Findings suggest that implementing empirically developed brief screening tools for partner violence in reproductive health settings may elicit more disclosures from patients than more traditional tools.     

Questioning gender norms with men to improve health outcomes: Evidence of impact

Abstract

This article describes a review of 58 evaluation studies of programmes with men and boys in sexual and reproductive health (including HIV prevention, treatment, care and support); father involvement; gender-based violence; maternal, newborn and child health; and gender socialisation more broadly. While few of the programmes go beyond the pilot stage, or a relatively short-term timeframe, they offer compelling evidence that well-designed programmes with men and boys can lead to positive changes in their behaviours and attitudes related to sexual and reproductive health; maternal, newborn and child health; their interaction with their children; their use of violence against women; their questioning of violence with other men; and their health-seeking behaviour. The evidence indicates that programmes that incorporate a gender-transformative approach and promote gender-equitable relationships between men and women are more effective in producing behaviour change than narrowly focused interventions, as are programmes which reach beyond the individual level to the social context.     

商丘市医务人员工作场所暴力与工作能力的相关分析

目的探讨医务人员遭受工作场所暴力和工作能力之间的关系,为预防工作场所暴力的发生、提高工作能力提供依据。方法采用工作场所暴力量表(WVS)和工作能力指数量表(WAI)对河南省商丘市507名医务人员遭受工作场所暴力的情况和工作能力进行了调查,并用自制表格调查所有研究对象的一般情况。结果30~44岁年龄组医务人员工作场所暴力得分高于45岁及45岁以上年龄组,护士组工作场所暴力得分高于医生和医技人员组(P<0·05);文化程度为初中及以下者工作能力得分比其他文化程度者低(P<0·05);遭受工作场所暴力与工作能力呈负相关,相关系数为-0·250(P<0·01);多因素分析表明,在控制了其它因素后,遭受工作场所暴力是工作能力下降的危险因素,其OR值为8·44。结论遭受工作场所暴力对医务人员的工作能力有影响,应采取措施预防和控制工作场所暴力的发生。     

Reproductive health and intimate partner violence

The article examines the relationship between reproductive health and intimate partner violence. Through the conference conducted by the Centers for Disease Control and Prevention, along with other government agencies and private organizations, it has been demonstrated that while there is an increased awareness of intimate partner violence as a public health issue, there has been limited research on the potential association of violence to women's reproductive health. Furthermore, there are few consistent findings that can be used to aid in the development and evaluation of effective interventions to reduce intimate partner violence as part of an overall strategy of improving women's reproductive health. Most recent information suggests potential associations between violence and a variety of reproductive health indicators, such as sexually transmitted diseases and HIV, birth outcomes, and unintended pregnancies. However, the nature of these associations remains unclear and requires further investigation.     

Making sense of domestic violence intervention in professional health care

Intervening in domestic violence in the health care and social service settings is a complex and contested issue. In this qualitative, multidisciplinary study, the barriers to but also the possibilities for health care professionals in encountering victims of violence were scrutinised. The focus was on omissions in service structure and practices. The data consisted of six focus group interviews with nurses, physicians, social workers and psychologists in specialist health care (n = 30) conducted in Finland in 2009. The aim was to explore professionals' processes of making sense of violence interventions and the organisational practices of violence interventions. Four types of framing of the domestic violence issue were identified: (i) practical frame, (ii) medical frame, (iii) individualistic frame and (iv) psychological frame. Each frame consisted of particular features relating to explaining, structuring or dismissing the question of domestic violence in health care settings. The main themes included the division of responsibilities and feasibility of treatment. All four frames underlie the tendency for healthcare professionals to arrive at sense-making practices where it is possible to focus on fixing the injuries and consequences of domestic violence and bypassing the issue of violence as the cause of symptoms and injuries. The results indicate that developing successful practices both in identifying survivors of domestic violence and in preventing further victimisation requires a broad understanding of the effects of domestic violence and the challenges for health care professionals in dealing with it. New perspectives are needed in creating adequate practices both for victims of violence seeking help and for professionals working with this issue. Strong support at the organisational level and established practices throughout the fields of health and social care are the key elements in building a responsible approach to domestic violence.     

Male reproductive control of women who have experienced intimate partner violence in the United States

Women who have experienced intimate partner violence (IPV) are consistently found to have poor sexual and reproductive health when compared to non-abused women, but the mechanisms through which such associations occur are inadequately defined. Through face-to-face, semi-structured in-depth interviews, we gathered full reproductive histories of 71 women aged 18–49 with a history of IPV recruited from a family planning clinic, an abortion clinic and a domestic violence shelter in the United States. A phenomenon which emerged among 53 respondents (74%) was male reproductive control which encompasses pregnancy-promoting behaviors as well as control and abuse during pregnancy in an attempt to influence the pregnancy outcome. Pregnancy promotion involves male partner attempts to impregnate a woman including verbal threats about getting her pregnant, unprotected forced sex, and contraceptive sabotage. Once pregnant, male partners resort to behaviors that threaten a woman if she does not do what he desires with the pregnancy. Reproductive control was present in violent as well as non-violent relationships. By assessing for male reproductive control among women seeking reproductive health services, including antenatal care, health care providers may be able to provide education, care, and counseling to help women protect their reproductive health and physical safety.     

关注男性生殖健康发展生殖保健服务

分析和探讨生殖健康研究领域中对男性关注不足的问题和加强中国男性生殖保健服务的策略和对策。通过比较女性生殖保健服务,发现男性生殖保健服务的提供明显不足。目前的生殖保健多是建立在妇幼保健服务的背景上,服务对象多为女性和青少年,少有为男性提供生殖保健服务或方便男性就医的机构。男性对生殖保健服务的利用也明显不足。因此,应该关注男性生殖健康,把开展男性生殖保健服务作为生殖健康领域未来的一项重要任务,积极营造促进男性生殖健康的社会氛围,探索为男性及其家庭提供生殖保健服务的适宜途径。     

Access to health care, reproductive health and disability: a large scale survey in Sierra Leone

This is the first study to compare health status and access to health care services between disabled and non-disabled men and women in urban and peri-urban areas of Sierra Leone. It pays particular attention to access to reproductive health care services and maternal health care for disabled women. A cross-sectional study was conducted in 2009 in 5 districts of Sierra Leone, randomly selecting 17 clusters for a total sample of 425 households. All adults who were identified as being disabled, as well as a control group of randomly selected non-disabled adults, were interviewed about health and reproductive health. As expected, we showed that people with severe disabilities had less access to public health care services than non-disabled people after adjustment for other socioeconomic characteristics (bivariate modelling). However, there were no significant differences in reporting use of contraception between disabled and non-disabled people; contrary to expectations, women with disabilities were as likely to report access to maternal health care services as did non-disabled women. Rather than disability, it is socioeconomic inequality that governs access to such services. We also found that disabled women were as likely as non-disabled women to report having children and to desiring another child: they are not only sexually active, but also need access to reproductive health services. We conclude that disparity in access to government-supported health care facilities constitutes a major and persisting health inequity between persons with and without disabilities in Sierra Leone. Ensuring equal access will require further strengthening of the country's health care system. Furthermore, because the morbidity and mortality rates of pregnant women are persistently high in Sierra Leone, assessing the quality of services received is an important priority for future research.     

An Exploration of Maternal Intimate Partner Violence Experiences and Infant General Health and Temperament

Objectives While the women’s health consequences of intimate partner violence have received much research attention, less is known about how maternal abuse experiences affect infant health and well-being. Existing studies have also been unable to examine specific types of intimate partner violence such as psychological aggression, physical abuse, and sexual coercion. This secondary data analysis explored the prevalence, patterns, and types of intimate partner violence within a large cohort of mothers and explored the relationship between maternal intimate partner violence experiences and infant’s general health and temperament at 1 year of age. Methods Existing data were drawn from the Fragile Families and Child Wellbeing study which collected data through surveys conducted shortly after the infant’s birth (baseline) and at 1 year of age (follow-up). Records from 4,141 mothers recruited from 75 hospitals, in 20 cities, in the US were used. Bivariate and multivariate regression analyses were conducted. Results Results show high rates of intimate partner violence. Maternal reports of any intimate partner violence at baseline or follow-up were both significantly associated with increased odds of less than excellent infant general health and difficult temperament. Independent examination of psychological, physical, and sexual abuse revealed differential relationships between the types of intimate partner violence and infant health outcomes. Conclusions Results from this study contribute to our understanding of the infant health threats associated with maternal intimate partner violence experiences. Additional research addressing the complex relationship between maternal abuse experiences and infant health and specific intervention implications is warranted.     

A systematic review of microfinance and women’s health literature: Directions for future research

While growing evidence suggests that microfinance is an effective approach for improved women’s health, a significant gap remains in our understanding. The objective of this review is to synthesise the findings from published literature focused on microfinance and health issues particularly affecting women, including HIV/AIDS, reproductive health, mental health, and violence. Forty-one articles that examine the impact of microfinance participation on women’s health were identified through a systematic search of electronic databases, coded using a structured abstraction form, and synthesised. Review results indicate that the impact of microfinance on women’s health is an area in great need of research and publication attention. Varied quality and reporting in the identified articles restricted the ability to draw concrete conclusions regarding the relationship between microfinance participation and women’s health, but led to the identification of current gaps in existing published research. Future research should work to address the recommendations provided in order to offer additional evidence to better understand the use of microfinance programming as a structural intervention to improve women’s health.     

家庭暴力对流动人口已婚育龄妇女性与生殖健康的影响

目的：了解丈夫的身体暴力或性暴力对流动人口已婚育龄妇女性与生殖健康的影响。方法：在上海市某中心城区采用以社区为基础的多阶段整群抽样方法对符合条件的流动人口已婚育龄妇女进行问卷调查,共收回有效问卷958份。结果：曾经或最近1年遭受过身体暴力或性暴力的对象有不良妊娠结局、曾经或最近1年有生殖道感染症状、性生活不和谐、曾经感到缺乏性欲和最近1年感到缺乏性欲的比例显著高于同一时期从未遭受过任何暴力的对象。Logistic回归分析发现,遭受过身体暴力或性暴力的对象有不良妊娠结局、生殖道感染、妇科疾病、性生活不和谐和缺乏性欲的危险性是未遭受过任何暴力对象的2.05～4.79倍。结论：身体暴力或性暴力对流动人口已婚育龄妇女的性与生殖健康状况有显著影响。     

Exposure to community violence and depressive symptoms: Examining community,family, and peer effects among public housing youth

Exposure to community violence is an epidemic problem that causes debilitating effects on youth mental health. However, the relationships between violence exposure and youth mental health remain unclear when examining co-occurring socioecological risk and protective factors. The purpose of this study is to clarify the observed gaps in knowledge by utilizing structural equation modeling (SEM) to examine the mediating role of community violence exposure on the relationship between perceived neighborhood risk factors, parental behaviors, and peers on depressive symptoms in a sample of urban youth in low-income public housing communities (n = 320). Results indicate that community violence exposure and exposure to delinquent peers mediates the effects of perceived neighborhood risk and parenting behaviors on depressive symptoms. These findings suggest that while interventions that limit exposure to community violence and delinquent peers could reduce depressive symptoms, interventions that reduce community violence are essential to improve youth mental health.     

Examining how neighborhood disadvantage influences trajectories of adolescent violence: a look at social bonding and psychological distress

BACKGROUND: To understand how neighborhoods influence the development of youth violence, we investigated intrapersonal mediators of the relationship between neighborhood disadvantage and youth violence trajectories between ages 11 and 18. The hypothesized mediators included indicators of social bonding (belief in conventional values, involvement in school activities, religious engagement, and commitment to traditional goals) and psychological distress. METHODS: The sample (N = 5118) was 50% female and 52% Caucasian. Data from a 5‐wave panel study spanning ages 11 to 18 were analyzed using sex‐stratified multilevel growth curves. RESULTS: Neighborhood disadvantage was associated with higher levels of violence perpetrated by girls, lower belief in conventional values for both girls and boys, less commitment to traditional goals by girls, and higher levels of psychological distress reported by girls. Sobel tests identified 3 significant mediators of the effects of neighborhood disadvantage on girls' violence trajectories: belief in conventional values, commitment to traditional goals, and psychological distress. The only significant mediator of the relationship between neighborhood disadvantage and boys' violence trajectories was belief in conventional values. The effects of neighborhood disadvantage on violence trajectories were not fully mediated; in fact, results suggested that suppression effects, or inconsistent mediation, may exist. CONCLUSIONS: The results emphasize the importance of both contextual and intrapersonal attributes in understanding the development of violence among school‐aged youth. Early school‐based and community‐level prevention initiatives that promote social bonding and address mental health needs may help reduce the impact of youth violence, particularly for girls.