Interpersonal and structural contexts of intimate partner violence among female sex workers in conflict-affected northern Uganda

Intimate partner violence (IPV) is the most prevalent form of violence against women, yet remains under-researched among sex workers in sub-Saharan Africa. We explored the interpersonal and structural determinants of recent IPV among female sex workers in northern Uganda. This analysis drew on data from a community-based cross-sectional study (conducted May 2011–January 2012), involving 379 female sex workers in Gulu, northern Uganda. Using logistic regression and multivariable modeling, we examined the correlates of recent male-perpetrated physical or sexual IPV. Of 379 women with noncommercial partners, 59 percent reported having experienced recent moderate/severe physical or sexual IPV. Reporting recent client violence (adjusted odds ratio (AOR): 3.67; 95 percent confidence interval [CI]: 2.31–5.83), doing what their partner wanted (AOR: 2.46; 95 percent CI: 1.46–4.13), and forced sexual debut (AOR: 1.92; 95 percent CI: 1.20–3.05) were independently associated with moderate/severe IPV; recent police arrest and/or incarceration were/was marginally significantly associated with IPV (AOR: 2.25; 95 percent CI: 0.86–5.88, p = 0.097). Greater odds of IPV among sex workers were associated with recent workplace violence, forced sexual debut, and gendered power dynamics favoring male partner control. Programs and policies promoting the safety and health of marginalized women and addressing gender dynamics and violence are needed.     

Social Support and Employment Status Modify the Effect of Intimate Partner Violence on Depression Symptom Severity in Women: Results from the 2006 Behavioral Risk Factor Surveillance System Survey

BackgroundDepression and intimate partner violence (IPV) are significant health issues for U.S. women. Interaction effects between IPV and other psychosocial factors on the severity of depressive symptoms have not been fully explored. This study assessed effect modification, that is, how IPV interacts with sociodemographics, psychosocial factors and health risk behaviors, on the severity of depressive symptoms in women.MethodsWe utilized cross-sectional data from female respondents (n = 16,106) of the 2006 Behavioral Risk Factors Surveillance Survey. Sociodemographics, psychosocial variables, and health risk behaviors determined to be significantly associated with depression were tested for interaction effects with IPV. Weighted ordinal logistic regression and predicted probabilities illustrated the effect of IPV status on depressive symptom severity, stratified by interaction effects.ResultsRecent and lifetime IPV exposure were associated with more severe depressive symptoms compared with no IPV exposure. IPV history interacted with employment status and social support on the severity of depressive symptoms in women. Overall, any IPV exposure was associated with more severe depressive symptoms among women with low social support and unemployment, although the effect of recent (versus lifetime) IPV was most pronounced among women with high social support or employed women.ConclusionsSocial support and employment status interact with IPV on the severity of depressive symptoms in women. Therefore, social support or workplace interventions designed to improve depressive symptoms should examine IPV history.     

Resilience and Resources Among South Asian Immigrant Women as Survivors of Partner Violence

This study explored resilience among South Asian (SA) immigrant women who were survivors of intimate partner violence (IPV). Eleven women participated in in-depth interviews. Thematic analysis was conducted using constant comparison. We identified five cross-cutting themes: resources before and after the turning-point (i.e. decision to confront violence), transformations in self, modification of social networks, and being an immigrant. Women drew upon their individual cognitive abilities, social support, and professional assistance to move beyond victimization. All women modified their social networks purposefully. The changes in individual-self included an increased sense of autonomy, positive outlook, and keeping busy. The changes in collective-self occurred as women developed a stronger feeling of belonging to their adopted country. This hybrid identity created a loop of reciprocity and a desire to contribute to their community. Women were cognizant of their surmountable challenges as immigrants. SA immigrant women IPV survivors sought multiple resources at micro, meso and macro levels, signifying the need for socio-ecological approaches in programs and policies along with inter-sectoral coordination to foster resilience.     

Changes in Incidents and Payment Methods for Intimate Partner Violence Related Injuries in Women Residing in the United States, 2002 to 2015

BackgroundViolence in interpersonal relationships is a substantial health and social problem in the United States and is associated with a myriad of immediate and long-term physical, behavioral, and neurocognitive impairments. The present study sought to determine the incidence of U.S. emergency department (ED)-attended intimate partner violence (IPV) from 2002 to 2015 and examine the differences in payment sources before and after implementation of the Affordable Care Act.MethodsWe analyzed ED visits among female patients aged 15 years or older between 2002 and 2015 from the National Hospital Ambulatory Medical Care Survey. Using International Classification of Disease, Ninth Revision, Clinical Modification, codes from patient visit records, we classified each ED visit to determine the frequency and estimate the relative proportion and national frequency of IPV visits. We explored bivariate and multivariate associations between IPV-related injuries with age, race, ethnicity, method of payment, and region, noting changes over time.ResultsBetween 2002 and 2015, female patients visited EDs an estimated 2,576,417 times for IPV-related events, and the proportion of ED visits for IPV increased during that time period. The percentage of ED visits for IPV-related events did not differ significantly by region, race, or ethnicity. Compared with women 25–44 years of age, women aged 65 to 74 (odds ratio, 0.15; 95% confidence interval, 0.05–0.43; p < .001) and 75 years and older (odds ratio, 0.20; 95% confidence interval, 0.08–0.53; p = .001) were less likely to visit an ED for IPV. Women were more likely to pay for IPV-related services out-of-pocket (i.e., self-pay) (odds ratio, 1.85; 95% confidence interval, 1.24–277; p = .003) before the enactment of the Affordable Care Act.ConclusionsThe increase in the percentage of IPV-related ED claims paid by private insurance suggests that the Affordable Care Act may have increased women's willingness and ability to seek medical attention for IPV-related injuries and disclose IPV as the source of injuries.     

Disorganization Theory,Neighborhood Social Capital,and Ethnic Inequalities in Intimate Partner Violence between Arab and Jewish Women Citizens of Israel

We draw on social disorganization (SD) theory and social capital to examine the impact of neighborhood environment on the ethnic gap in intimate partner violence (IPV) between Arab and Jewish women in Israel. We linked census data on neighborhood socioeconomic status (SES) to national data we gathered in 2014–2015 on 1401 women (436 Arab, 965 Jewish) age 16–48. Women were interviewed while visiting 65 maternal and child health clinics throughout Israel. We used General Estimated Equation (GEE) multivariate logistic regression models to adjust for clinic cluster effects and estimated the contribution of neighborhood collective efficacy, problems, relative socioeconomic status (SES), bridging and linking social capital, and social support to explaining ethnic inequalities in IPV, while adjusting for women’s socioeconomic and socio-demographic characteristics. We found that any IPV is higher among Arab compared to Jewish women (odds ratio (OR) and 95% confidence intervals (CI) = 4.19 (2.72,6.42)). Collective efficacy and social group membership (bridging social capital) had no effect on the ethnic inequality in any IPV and types of IPV. Women’s active participation in social groups (linking social capital), higher social support, and living in neighborhoods with relative SES similar to the ethnic group average) had a protective effect from any IPV and physical IPV. Neighborhood problems were associated with increased any IPV and physical IPV. In the final model, the ethnic gap in IPV was reduced but not eliminated (OR (95%CI) = 3.28 (2.01, 5.35). Collective efficacy did not explain the ethnic gap in IPV, while women’s active participation (linking social capital) had a protective effect from IPV. Given the protective nature of women’s activism in this population, future research should investigate how this might be incorporated into solutions to IPV. In addition, reducing neighborhood problems, improving neighborhood SES, and increasing social support might help reduce IPV among Arab women, thus decreasing the ethnic gap in IPV.     

Intimate partner violence during pregnancy: best practices for social workers

Intimate partner violence (IPV) during pregnancy is a major problem in the United States, with estimates that 3 percent to 17 percent of women experience violence during the perinatal period. Research indicates that IPV during pregnancy is associated with serious, negative health outcomes for the mother and her unborn child. As such, many researchers have suggested that pregnancy offers a unique window for IPV intervention, particularly for social workers in health-care settings. Although assessing for IPV more generally has received increased attention in the social work literature, there is a lack of information about the specific needs for pregnant women. Thus, the purpose of this article is to provide a focused literature review on the scope and impact of IPV during pregnancy and to identify best practices for social workers for intervention and prevention.     

Intimate partner violence injuries--Oklahoma, 2002

Intimate partner violence (IPV) is a serious public health problem in the United States and a common cause of injury. Prevalence rates of IPV vary by the surveillance methods and definitions used. National data from the 1995 National Violence Against Women Survey indicate that 22.1% of women and 7.4% of men experience IPV during their lifetimes and that 1.3% of women and 0.9% of men experience IPV annually. IPV results in an estimated 4.1 billion dollars each year in direct medical and mental health-care costs, including 159 million dollars in emergency department (ED) treatments for IPV physical assaults. IPV might constitute as much as 17% of all violence-related injuries treated in EDs. To determine the magnitude of the IPV problem in Oklahoma, including IPV-related injuries and medical service utilization, researchers analyzed injury surveillance data from ED medical records and data from the Oklahoma Women's Health Survey (OWHS). This report summarizes the findings, which indicated that, during 2002 in Oklahoma, approximately 16% of all ED visits for assaults were for IPV injuries, including 35% of assault visits among females and 3% of assault visits among males. In addition, results of the OWHS for 2001-2003 indicated that 5.9% of surveyed Oklahoma women aged 18-44 years sustained an IPV injury during the preceding year. Overall, IPV resulted in a substantial number of injuries, particularly to women, many of whom required treatment in EDs. Medical recognition and documentation of IPV are important for identification of persons in need of services.     

Help-seeking rates for intimate partner violence (IPV) among Canadian immigrant women

We examined rates of help seeking for intimate partner violence (IPV) among recent (0-9 years in Canada) and non-recent (10+ years in Canada) immigrant women. Data from a national, cross-sectional, telephone survey were used. Help-seeking variables included disclosure of IPV, reporting IPV to police, use of social services subsequent to IPV, and barriers to social service use. Recent immigrant women, compared with non-recent immigrant women, were significantly more likely to report IPV to police and less likely to use social services. Findings have important implications for prevention and detection of IPV in immigrant communities and in future research.     

Help-Seeking Rates for Intimate Partner Violence (IPV) Among Canadian Immigrant Women

We examined rates of help seeking for intimate partner violence (IPV) among recent (0–9 years in Canada) and nonrecent (10+ years in Canada) immigrant women. Data from a national, cross-sectional, telephone survey were used. Help-seeking variables included disclosure of IPV, reporting IPV to police, use of social services subsequent to IPV, and barriers to social service use. Recent immigrant women, compared with nonrecent immigrant women, were significantly more likely to report IPV to police and less likely to use social services. Findings have important implications for prevention and detection of IPV in immigrant communities and in future research.     

Intimate Partner Violence around the Time of Pregnancy and Postpartum Contraceptive Use

ObjectivesWe sought to examine postpartum contraceptive use among women who reported physical intimate partner violence (IPV) during or within 12 months before pregnancy compared with women who did not report physical IPV and to identify factors associated with nonuse of contraception among women who reported physical IPV.MethodsData were obtained from women with a recent live birth from 2012 to 2015 who participated in the Pregnancy Risk Assessment and Monitoring System. We described characteristics of women and postpartum contraceptive use by method effectiveness (most effective [female sterilization, male sterilization, intrauterine device, implant], moderately effective [injectable, pill, patch, ring], less effective [condoms, natural family planning, withdrawal, other]) or no method, stratified by reported physical IPV. Multivariable logistic regression was used to examine characteristics associated with nonuse of contraception among women who reported physical IPV.ResultsThe proportion of women using most or moderately effective contraception was similar for women reporting and not reporting physical IPV. Less effective contraceptive use was lower among women who reported physical IPV (13.9%) than those who did not report physical IPV (25.1%) (p < .001). Nonuse was higher among women who reported physical IPV (33%) than those who did not report physical IPV (21%) (p < .001). Having no health insurance at the time of survey and experiencing traumatic stress within 12 months before delivery were associated with nonuse of contraception among women who reported physical IPV.ConclusionsThe higher proportion of contraception nonuse among women who reported physical IPV indicates a potential unmet need for contraception among this vulnerable population. Recommended screening for IPV and counseling about the full range of contraceptive methods should begin during pregnancy and continue through the postpartum period.     

Intimate partner violence among midlife and older women: a descriptive analysis of women seeking medical services

Although intimate partner violence (IPV) may occur throughout a woman's life course, there has been a paucity of research on the experiences of victimization among midlife and older women. This article examines both the prevalence of IPV among a sample of women ages 50 to 64 (N=620), who were recruited at an emergency department and primary care clinics in an urban setting, and the associated factors for the subsample of these women who reported IPV (n=34). More than 5 percent of the women reported experiencing some form of abuse by their partners within the past two years. Bivariate analyses comparing victims and nonvictims indicate that higher proportions of women who reported abuse had received public assistance and had a recent history of homelessness. In addition, victims of IPV reported higher frequencies of HIV risk factors than did nonvictims, including having a partner who insisted on sex without a condom, having sex with a man they knew or suspected was an IV drug user, and experiencing symptoms or receiving a diagnosis or treatment for a sexually transmitted infection. Significantly higher percentages of abused women reported being tested for HIV and being HIV seropositive. Implications of the findings for social workers are discussed.     

Intimate Partner Violence and Health Care-Seeking Patterns Among Female Users of Urban Adolescent Clinics

To assess the prevalence of intimate partner violence (IPV) and associations with health care-seeking patterns among female patients of adolescent clinics, and to examine screening for IPV and IPV disclosure patterns within these clinics. A self-administered, anonymous, computerized survey was administered to female clients ages 14–20 years (N = 448) seeking care in five urban adolescent clinics, inquiring about IPV history, reasons for seeking care, and IPV screening by and IPV disclosure to providers. Two in five (40%) female urban adolescent clinic patients had experienced IPV, with 32% reporting physical and 21% reporting sexual victimization. Among IPV survivors, 45% reported abuse in their current or most recent relationship. IPV prevalence was equally high among those visiting clinics for reproductive health concerns as among those seeking care for other reasons. IPV victimization was associated with both poor current health status (AOR 1.57, 95% CI 1.03–2.40) and having foregone care in the past year (AOR 2.59, 95% CI 1.20–5.58). Recent IPV victimization was associated only with past 12 month foregone care (AOR 2.02, 95% CI 1.18–3.46). A minority (30%) reported ever being screened for IPV in a clinical setting. IPV victimization is pervasive among female adolescent clinic attendees regardless of visit type, yet IPV screening by providers appears low. Patients reporting poor health status and foregone care are more likely to have experienced IPV. IPV screening and interventions tailored for female patients of adolescent clinics are needed.     

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.     

Intimate Partner Violence Among Mothers of Sick Newborns in Ghana

Intimate partner violence (IPV) is a major public health problem estimated to affect 15%–71% of women worldwide. We sought to elicit IPV risks among mothers of sick newborns in Ghana. As part of a broader study on postpartum depression, we conducted semistructured surveys of 153 women in a mother–baby unit, assessing demographics, depression, social support, and IPV with the present partner. Forty-six percent of mothers reported some form of violence, mostly emotional (34%), followed by physical (17%), and sexual (15%). The study highlights the frequency of perinatal IPV and the associated risk factors of depression and poor social support.     

Process of forgiveness in the recovery of Chinese women survivors of intimate partner violence: Empowerment,transformation, and integration

Forgiveness has been found one substantial element in the recovery for women survivors from intimate partner violence following the termination of the abusive relationship. To further investigate the details of forgiveness in this specific context, the present study explored the process of forgiveness using grounded theory. In-depth and semi-structured interviews were conducted with 25 Chinese women survivors of IPV. The findings suggest that forgiveness is a strength-based process including empowerment, transformation, and integration phases. In the empowerment phase, survivors obtain strength at the intrapersonal, behavioural, and interpersonal levels. In the transformation phase, survivors complete cognitive transformation for their IPV experiences and emotional transformation towards former partners. In the integration phase, survivors—now freed from the past—reflect upon and apply the changes they have undergone. Two trajectories in the process were found. One trajectory is going through stages sequentially and the other trajectory is experiencing back and forth between empowerment and transformation stages before moving into the integration stage. The study's findings broaden our knowledge of the strength-based forgiveness process that women survivors of IPV undergo during recovery. Practitioners and policymakers could develop programmes and policies that support forgiveness by holistically facilitating their recovery and empowerment like assistance in dealing with life difficulties and promoting their reconnection with social networks. To improve the transferability and validity of the findings, the forgiveness of survivors of IPV could be explored in a diverse sample (e.g., survivors with low educational background or live in the rural area).     

A national survey of attitudes toward intimate partner violence among married women in Kazakhstan,Kyrgyzstan, and Tajikistan: Implications for health prevention and intervention

Attitudes toward intimate partner violence (IPV) can affect the prevalence of IPV, response of victims’ to IPV (e.g., whether to seek help), and the response of professionals (e.g., police, social workers, health care professionals) to IPV. Knowledge about IPV-related attitudes is essential for developing effective social work and violence-related programs. Using data from the 2005–2006 Multiple Indicator Cluster Surveys, this study examines attitudes toward IPV and socio-demographic predictors of these attitudes among married women in Kazakhstan, Kyrgyzstan, and Tajikistan. Women were asked whether they approved of a husband beating his wife: if she goes out without telling him, neglects their children, argues, refuses to have sex, and burns food. The prevalence of IPV acceptance for at least one of the five reasons varied from 12.3% in Kazakhstan to 45.3% in Kyrgyzstan and 74.5% in Tajikistan. Women who were less educated, members of Asian ethnic groups, resided in middle-class urban areas, and lived in specific regions were more likely to accept IPV. Few age differences that emerged indicated that young women were more approving of IPV. Proactive efforts are needed to confront attitudes about gender roles and IPV in Tajikistan and Kyrgyzstan.     

Measuring the impact of intimate partner violence on the health of women in Victoria, Australia

OBJECTIVE: Using burden of disease methodology, estimate the health risks of intimate partner violence (IPV) among women in Victoria, Australia. METHODS: We calculated population attributable fractions (from survey data on the prevalence of IPV and the relative risks of associated health problems in Australia) and determined health outcomes by applying them to disability-adjusted life year estimates for the relevant disease and injury categories for Victoria, Australia for 2001. FINDINGS: For women of all ages IPV accounted for 2.9% (95% uncertainty interval 2.4-3.4%) of the total disease and injury burden. Among women 18-44 years of age, IPV was associated with 7.9% (95% uncertainty interval 6.4-9.5%) of the overall disease burden and was a larger risk to health than risk factors traditionally included in burden of disease studies, such as raised blood pressure, tobacco use and increased body weight. Poor mental health contributed 73% and substance abuse 22% to the disease burden attributed to IPV. CONCLUSION: Our findings suggest that IPV constitutes a significant risk to women's health. Mental health policy-makers and health workers treating common mental health problems need to be aware that IPV is an important risk factor. Future research should concentrate on evaluating effective interventions to prevent women being exposed to violence, and identifying the most appropriate mental health care for victims to reduce short- and long-term disability.     

The association between length of stay in Canada and intimate partner violence among immigrant women

OBJECTIVE: We examined the prevalence of intimate partner violence (IPV) among recent (0-9 years) and nonrecent (>/= 10 years) immigrant women in Canada to determine whether differences in IPV were associated with length of stay in Canada. METHODS: We analyzed data from the 1999 General Social Survey, a national cross-sectional telephone survey. We used weighted logistic regression analysis to examine the effect of length of stay in Canada on IPV and controlled for socio-cultural and other factors associated with IPV. RESULTS: The crude prevalence of IPV was similar among recent and nonrecent immigrant women. However, after adjustment, the risk for IPV was significantly lower among recent immigrant women compared with nonrecent immigrant women. Country of origin, age, marital status, and having an activity limitation (physical/mental disability or health problem) also were associated with a higher risk for IPV. CONCLUSIONS: Our findings have important implications for both prevention and detection of IPV among immigrant women.     

Identifying risk and protective factors related to depressive symptoms among Northern Plains American Indian women cancer survivors

Cancer is the leading cause of death among American Indian and Alaska Native (AIAN) women, and depressive symptoms have been linked to higher mortality, but research on depressive symptoms among AIAN cancer patients has been scant. The purpose of this exploratory study was, using the Framework of Historical Oppression, Resilience, and Transcendence, to examine risk and protective factors related to depressive symptoms in American Indian (AI) women cancer survivors. We examined the relationships of adverse childhood experiences (ACE), perceived health status, resilience, and social support with depressive symptoms in Northern Plains AI women cancer survivors. We used a cross-sectional design with purposive sampling of 73 female cancer survivors (aged 18 years or older) between June 2014 and February 2015. Hierarchical multiple regression was used to test three sets of variables in relation to depressive symptoms: (1) sociodemographics, (2) risk factors (ACE and perceived health), and (3) protective factors (psychological resilience and social support). Approximately 47 percent of participants had probable depressive symptoms. Depressive symptoms were inversely associated with perceived health, psychological resilience, and social support. These results support bolstering existing social support among AI cancer patients and survivors as well as prevention and intervention efforts that strengthen resilience.