Mandatory Reporting in the Context of Home Visitation Programs: Intimate Partner Violence and Children's Exposure to Intimate Partner Violence

The mandatory reporting of intimate partner violence (IPV) is a controversial issue that is receiving increased attention. A related concern is whether children's exposure to IPV constitutes child maltreatment, making it reportable to child protective services. These issues have been relatively unexplored within the context of home visitation programs. A secondary analysis of qualitative data collected from community stakeholders, clients, and home visiting nurses in the Nurse-Family Partnership program was carried out. Participants' perceptions about mandatory reporting of IPV and reporting of children's exposure to IPV are highlighted. Emergent themes and implications for research, practice, and policy are discussed.     

Intimate Partner Violence and Contraception among Adolescent Girls and Young Women: A Longitudinal Analysis of the Girl Power-Malawi Cohort

PurposeIn sub-Saharan Africa, sexually active adolescent girls and young women (AGYW) experience high rates of intimate partner violence (IPV) and low levels of contraceptive use, but the effect of IPV on contraceptive use is not well understood.MethodsIn the Girl Power-Malawi study, AGYW aged 15-24 were recruited from 4 health centers in Lilongwe, Malawi, and followed for 1 year. At baseline, AGYW were assessed for IPV using the modified Conflict Tactics Scale. AGYW reported contraceptive method use at 6 and 12 months, characterized as barrier, non-barrier, or any modern method. Modified Poisson regression was implemented to estimate risk ratios (RRs) and 95% confidence intervals (CIs) to examine the effect of IPV on contraceptive use.ResultsOne thousand AGYW were enrolled, and 954 non-pregnant participants were included. Baseline prevalence of IPV with the most recent partner was 35.5% (physical), 46.2% (sexual), and 76.9% (emotional). Baseline IPV did not affect contraceptive use at 6 months (aRR [95% CI]: physical 0.98 [0.91-1.05]; sexual 1.00 [0.94-1.07]; emotional 1.03 [0.94-1.12]) or 12 months (physical 0.95 [0.89-1.02]; sexual 0.96 [0.90-1.02]; emotional 0.98 [0.91-1.05]). None of the 3 IPV categories affected contraceptive use when the outcome was restricted to either barrier or non-barrier methods.ConclusionsIn this cohort, IPV was not a key driver of contraceptive use in longitudinal analyses. Interventions are needed to address the alarming rates of IPV in this population, but addressing IPV alone might be insufficient to address low contraceptive use, and multifaceted youth-friendly health services might be necessary.     

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.     

The Prevalence of Intimate Partner Violence Among Women and Teenagers Seeking Abortion Compared With Those Continuing Pregnancy

ObjectiveTo determine the prevalence of intimate partner violence (IPV) among women and teenagers seeking termination of pregnancy compared with those continuing with pregnancy.MethodsAll women who presented for elective termination of pregnancy at a family planning clinic between June 2001 and January 2003 were invited to participate. This study was conducted by means of face-to-face interviews with clinic nurses. The control group was composed of women who were continuing with pregnancy.ResultsIn total, 1003 women were interviewed, including 350 at the family planning clinic (elective abortion [EA] group) and 653 women at the perinatal clinic (continuing pregnancy [CP] group). For women in the EA group, the probability of being a victim of IPV in the past year (including psychological, physical, and/or sexual abuse) was almost three times higher than for women in the CP group (25.7% vs. 9.3%, P < 0.0001), and the risk of being a victim of physical and/or sexual IPV in the past year was almost four times higher (7.1% vs. 1.8%, P < 0.0001). Women in the EA group had also more often been victims of violence in their lifetime (41.1% vs. 29.1%, P = 0.0001). The principal factors predictive of having been a victim of physical and/or sexual IPV in the past year were being single, separated, divorced, or widowed, and being in a relationship that was in difficulty or breaking down. In the multivariate analysis adjusted for confounding factors, age was rarely a significant factor.ConclusionThe high prevalence rates of IPV among women seeking elective abortion justifies routine assessment for IPV during pre-abortion visits. Physicians have access to tools that will help them to identify IPV and to be proactive regarding this important issue.     

Comparative Analyses of Stressors Experienced by Rural Low-Income Pregnant Women Experiencing Intimate Partner Violence and Those Who Are Not

Objective: To describe the daily lives of rural pregnant women who smoked during pregnancy, with a focus on their sources of stress and the compounding effects of intimate partner violence.
Design: A qualitative study using content analysis of research nurses' telephone logs from a large smoking cessation randomized controlled trial ( N =695) in which 33% of the sample ( n =227) experienced intimate partner violence in the past year.
Participants: Fifty pregnant women, 25 who had experienced intimate partner violence in the past year and 25 who had never experienced intimate partner violence, were randomly selected from those who received a nurse-delivered telephone intervention for smoking cessation ( n =345). The mean age of the sample was 22 years, and the majority were White and living in a married-like relationship.
Results: Women experiencing intimate partner violence discussed certain stressors significantly more often than nonabused women. These stressors included finances, lack of social support, legal issues, transportation issues, and abuse by the intimate partner and others.
Conclusion: Health care providers need to recognize that intimate partner violence creates a stress, which can compound the stressors of pregnancy and poverty in rural areas. Offering these women a chance to talk about their lives can help them not only to locate necessary resources, but also to break down the barriers of isolation.     

Intimate Partner Violence: Relationships Between Alexithymia,Depression, Attachment Styles,and Coping Strategies of Battered Women

IntroductionOne of the most common forms of violence against women is the intimate partner violence (IPV). This term includes physical, sexual, and emotional abuse and controlling behaviors by an intimate partner.AimThis exploratory study investigates the relationship between alexithymia, adult attachment styles, depression, and coping strategies in a group of female victims of IPV and a control group.MethodsParticipants were 80 female victims of IPV with an age range from 18 years to 54 years (mean 31.62; standard deviation 9.81). The control group included 80 women with no history of IPV with an age range from 19 years to 37 years (mean 25.05; standard deviation 3.67).Main Outcome MeasuresWe administered the following self‐report questionnaires: (i) 20‐Item Toronto Alexithymia Scale (TAS‐20); (ii) Coping Orientation Problems Experienced; (iii) Beck Depression Inventory (BDI)‐II; and (iv) Attachment Style Questionnaire (ASQ).ResultsCompared with control group, the IPV group showed higher mean scores on TAS‐20 (52.9 vs. 41.1, P < 0.001) and BDI‐II (19.50 vs. 9.95, P < 0.001). In both groups, we found significant correlations between BDI‐II and TAS‐20 total scores (P < 0.001) and between BDI‐II and the following dimensions of ASQ: confidence (P < 0.001), discomfort with closeness (P = 0.002), relationships as secondary (P < 0.001), need for approval (P < 0.001), and preoccupation with relationships (P < 0.001). Differently from the control group, in the IPV group, social support correlated significantly and positively (P < 0.001) with the dimension preoccupation with relationships on ASQ, but not with the secure attachment style.ConclusionsIn comparison to the control group, alexithymia, depressive symptoms, and an insecure attachment style were negatively correlated with the ability to cope with stress for women in the IPV group. Craparo G, Gori A, Petruccelli I, Cannella V, and Simonelli C. Intimate partner violence: Relationships between alexithymia, depression, attachment styles, and coping strategies of battered women. J Sex Med 2014;11:1484–1494.     

Sexting and Young Adolescents: Associations with Sexual Abuse and Intimate Partner Violence

Study ObjectiveTo explore whether sexting by young adolescent girls and boys is associated with adverse life experiences including exploitative or violent sexual relationships.Design and SettingCross-sectional, anonymous survey of a convenience sample of minor adolescents younger than age 18 years recruited while waiting for care in clinics affiliated with a children's hospital in a low-resource, high-poverty, urban community.ParticipantsFive hundred fifty-five adolescents aged 14-17 years, 63% girls and 37% boys.Main Outcome MeasuresWe measured sexting by asking, “Have you ever sent a sexually suggestive or naked picture of yourself to another person through text or e-mail?” The survey also measured risk behaviors, sexual abuse, intimate partner violence (IPV), and arrest and included a validated depression scale.ResultsMean age was 15.6 ± 1.1 years; 59% were Hispanic, 28% were black; 44% of girls and 46% of boys ever had sex; 24% of girls and 20% of boys ever sent a sext. More girls than boys reported sexual abuse (16% vs 3%; P < .01), IPV victimization (15% vs 7%; P < .01), and depression (33% vs 17%; P < .01). More boys than girls reported arrest (15% vs 7%; P < .01). Independent associations with sexting for girls were: ever had sex (odds ratio [OR], 4.59; 95% confidence interval [CI], 2.29-9.19; P < .001); sexual abuse (OR, 3.81; 95% CI, 1.80-8.05; P < .001); IPV victim (OR, 2.72; 95% CI, 1.11-6.62; P < .05), and for boys: ever had sex (OR, 4.26; 95% CI, 1.47-12.32; P < .01); sexual abuse (OR, 38.48; 95% CI, 1.48-999.46; P < .05); IPV perpetration (OR, 16.73; 95% CI, 1.64-170.75; 95% CI, P < .05), as well as cannabis use, older age, other race, and arrest.ConclusionFor young adolescents, sexting is independently associated with exploitative and abusive sexual relationships including sexual abuse and IPV with similarities and differences in predictors of sexting for girls and boys.