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.     

Factors associated with intimate partner violence by a former partner by immigration status and length of residence in Canada

PurposeWe examined intimate partner violence (IPV) by a former partner among Canadian-born and immigrant women by length of residence in Canada.MethodsData from a 2009 national, population-based, telephone survey were used to determine the prevalence of and factors associated with any type of IPV (emotional, financial, physical, and/or sexual) by a former partner with whom there had been contact in the previous 5 years among immigrant women 0 to 19 years in Canada, 20 or more years or longer in Canada, and Canadian-born women (n = 1681).ResultsOf immigrant women in Canada for 0 to 19 years, 41.6% had experienced IPV by a former partner; for immigrant women in Canada for 20 or more years or longer, 60.6%, and Canadian-born women, 61.5% (P = .0423). In a logistic regression model adjusted for age and other sociodemographic characteristics, immigrant women in Canada for 0 to 19 years were less likely than Canadian-born women to experience any IPV (odds ratio, 0.266; 95% confidence interval, 0.130–0.544). There was no difference in the occurrence of any IPV between immigrant women in Canada 20 or more years or longer and Canadian-born women.ConclusionsHigh rates of any IPV by a former partner were found for both Canadian-born and immigrant women. Within immigrant communities, specific prevention campaigns should address the high risk of experiencing IPV at later stages of resettlement.     

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.     

Discursos profesionales sobre la violencia del compañero íntimo: implicación en la atención de las mujeres inmigrantes en España

Objective1) to examine the discourses of professionals involved in the care of female victims of intimate partner violence (IPV), with emphasis on how they describe the immigrant women, the perpetrators and their own responsibility of care; and 2) to compare these discourses with the other professions involved in caring for these women (social services, associations and police and justice).MethodsQualitative study based on semi-structured interviews with 43 professionals from social services, associations and the police and judicial systems. A discourse analysis was carried out to identify interpretive repertoires about IPV, immigrant women and their aggressors, their culture and professional practices.ResultsFour interpretive repertoires emerged from professional discourses: “Cultural prototypes of women affected by IPV”, “Perpetrators are similar regardless of their culture of origin”, “Are victims credible and the perpetrators responsible?” and “Lack of cultural sensitivity of professionals in helping immigrant women in abusive situations”. These repertoires correspond to preconceptions that professionals construct about affected women and their perpetrators, the credibility and responsibility they attribute to them and the interpretation of their professional roles.ConclusionsThe employment of IPV-trained cultural mediators in the services responsible for caring for the female victims, together with cultural training for the professionals, will facilitate the provision of culturally sensitive care to immigrant female victims of intimate partner violence.     

Use of medical care, police assistance, and restraining orders by women reporting intimate partner violence--Massachusetts, 1996-1997

Approximately 1.5 million women in the United States are physically or sexually assaulted by an intimate partner (IP) each year (1). The Woman Abuse Tracking in Clinics and Hospitals (WATCH) Project at the Massachusetts Department of Public Health analyzed data from the 1996 and 1997 Behavioral Risk Factor Surveillance System (BRFSS) in Massachusetts to 1) estimate the percentage of women aged 18-59 years experiencing intimate partner violence (IPV) who used medical care, police assistance, and restraining orders during the preceding 5 years, 2) determine where women experiencing IPV went for medical care, and 3) examine the overlap in use of these three services. This report describes the results of these analyses, which indicate that a higher percentage of women aged 18-59 years use police assistance rather than obtain a restraining order or seek medical care.     

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.     

Inadequacy of cervical cancer screening among urban recent immigrants: a population-based study of physician and laboratory claims in Toronto, Canada

OBJECTIVE: In Canada, Pap smears are recommended from 18 to 69. Self-reported socioeconomic gradients in screening have been documented in North America but there have been few direct measures of Pap smear use among immigrants or socially disadvantaged groups. Our purpose was to investigate whether socioedemographic factors are related to cervical cancer screening in Toronto, Canada. METHOD: Pap smears were identified using fee and laboratory codes in Ontario physician service claims for 3 years (2000-2002 inclusive) for women aged 18-66. Area-level socioeconomic factors were derived from the 2001 census. At the individual level, recent registrants for health coverage, over 80% of whom are expected to be recent immigrants, were identified as women first registering after January 1, 1993. RESULTS: Among 724,584 women, 55.4% had Pap smears within 3 years. Recent immigration, visible minority, foreign language, low income and low education were all associated with significantly lower area rates. Recent registrants had much lower rates than non-recent registrants (36.9% versus 60.9%). CONCLUSION: Pap smear rates in Toronto fall below those dictated by evidence-based practice. Recent registrants, a largely immigrant group, have particularly low rates. Efforts to improve coverage need to emphasize women who recently immigrated and those with socioeconomic disadvantage.     

Immigrant women family caregivers in Canada: implications for policies and programmes in health and social sectors

Migration has become a profound global phenomenon in this century. In Canada, uncoordinated policies, including those related to immigration, resettlement, employment, and government funding for health and social services, present barriers to immigrant women caregivers. The purpose of this paper is to share relevant insights from individual and group interviews with immigrant women family caregivers, service providers and policy influencers, and discuss these in relation to immigration, health and social policy, and programme trends in Canada. The present authors conducted individual interviews with immigrant women family caregivers (n = 29) in phase 1, followed by two group interviews with women family caregivers (n = 7), and two group interviews with service providers and policy-makers (n = 15) in phase 2. Using an inductive approach, the authors employed thematic content data analysis. Immigrant women experienced barriers to health and social services similar to Canadian-born family caregivers, particularly those who have low incomes, jobs with limited flexibility and heavy caregiving demands. These immigrant women family caregivers avoided certain formal services for a variety of reasons, including lack of cultural sensitivity. However, their challenges were compounded by language, immigration and separation from family in the home country. The identified barriers to support reinforce the importance of modifying and expanding policies and programmes affecting immigrant women's ability to care for family members with illnesses or disabilities within the context of Canadian society. Participants recommended changes to policies and programmes to deal with information, transportation, language, attitudinal and network barriers. The various barriers to services and programmes which were experienced by immigrant women caregivers underscore the importance of reviewing policies affecting immigration, caregiving, and access to health and social services. Intersectoral collaboration among agencies is essential to reduce the barriers identified in the present study, and to establish services which are linguistically and culturally appropriate.     

Estado de salud y violencia contra la mujer en la pareja

Objective

To describe the prevalence of intimate partner violence (IPV) in Spain in the last year and at some point during the lifetime, to determine health status in women according to whether they had experienced IPV or not, and to analyze the individual variables associated with IPV in Spain.

Methods

A cross-sectional study was performed of the database, Macrosurvey on Gender Violence in Spain 2011. This database includes data on 7,898 women older than 18 years old. The dependent variables were IPV-last year, IPV-ever in life. Covariates consisted of sociodemographic characteristics, socioeconomic status, maternal experience of IPV, social support, and self-care. The measure of association used was the OR with its 95% confidence interval (95% CI).

Results

A total of 3.6% of women had experienced IPV-last year and 12.2% ever in life. Female victims of IPV had poorer health than women who had not experienced IPV. Immigrant women living in Spain for 6 years or more were more likely to experience IPV-ever in life than Spanish women [OR (95% CI): 1.95 (1.50, 2.53)]. An interaction was found between nationality and the existence of children under 18 years old. Among women with children under 18 years old, immigrant women were more likely to experience IPV-last year than Spanish women [OR (95% CI): 1.99 (1.25, 3.17)]. Other variables associated with IPV were age, low socioeconomic status, low social support and having a mother who had experienced IPV.

Conclusions

In Spain, some women have a higher probability of experiencing IPV. The variables associated with greater vulnerability to IPV should be taken into account when implementing measures to prevent or alleviate IPV.     

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.     

Cultural Background and Socioeconomic Influence of Immigrant and Refugee Women Coping with Postpartum Depression

Postpartum depression is a serious condition that can have long lasting traumatic effects on women and their families. Until recently postpartum depression research has focused more on the population as a whole rather than refugee and immigrant women. Informed by Kleinman’s explanatory model and the postcolonial feminist perspective, 30 immigrant and refugee women were interviewed to find out what factors influenced them in seeking postpartum care and what strategies would be helpful in prevention and treatment of postpartum depression. We found that the immigrant and refugee women in our sample: (a) were influenced by both cultural background and socioeconomic factors in seeking support and treatment; (b) were influenced by cultural differences and social stigma when making decisions about health care practices; and (c) employed numerous coping strategies to deal with postpartum depression. Recommendations are provided for more culturally appropriate and equitable mental health care services for immigrant and refugee women living in Canada.     

How do women in Spain deal with an abusive relationship?

OBJECTIVES: To determine the different responses adopted by women in Spain who are victims of intimate partner violence (IPV); identify the different sociodemographic profiles associated with each response; analyse the factors contributing to adopting a response; and study the association between the different types of response and the different types of IPV. DESIGN: Cross sectional study. SETTING: 23 volunteer general practices in Spain. PARTICIPANTS: 1402 randomly selected women. MAIN OUTCOME MEASURE: Women's response to IPV: none, partner separation, reporting the case to the police, seeking help from healthcare professionals and seeking help from associations for battered women. RESULTS: Lifetime prevalence of any type of IPV (physical, psychological, and/or sexual) was 32%. Sixty three per cent of abused women took some kind of action to overcome IPV. Women who separated from their partners were mostly younger, with a smaller number of children and higher income and educational levels, compared with those abused women who reported the abuse to the police or sought help from healthcare professionals or associations for battered women. Independent factors associated with presenting a response to IPV were: being separated/divorced/widowed, having social support, having experienced IPV frequently, and having experienced physical and psychological abuse (compared with psychological abuse alone). Women who experienced the three types of abuse were also more likely to respond to violence. CONCLUSIONS: Identifying the factors that have an influence on the response adopted by abused women allows us to better understand the support needed by them to abandon an abusive relationship.     

Tobacco use among immigrant and nonimmigrant adolescents: individual and family level influences

PurposeTo identify individual and family level characteristics that might explain differences in rates of tobacco use among immigrant and nonimmigrant adolescents.MethodsData for analysis come from a probability sample of 5401 adolescents aged 12–18 years participating in the Ontario Health Survey (OHS). Three groups were compared: (a) adolescents born in Canada to Canadian-born parents (n = 3886), (b) adolescents born in Canada to immigrant parents (n = 1233), and (c) adolescents born outside of Canada (n = 282). Discrete, multilevel logistic regression was used in the analysis.ResultsAdolescents born outside of Canada report the lowest rates of tobacco use, despite greater economic hardship. A negative association emerges between family socioeconomic status and tobacco use among adolescents born in Canada but not among adolescents born outside of Canada. Immigrant youth are less likely to affiliate with peers who smoke and are more likely to come from families where parents do not smoke: these differences partially explain the decreased rates of tobacco use among immigrant adolescents.ConclusionsAlthough subject to greater economic hardship, immigrant youth are less likely to engage in tobacco use. Protective factors associated with immigrant family life, such as lower rates of parental tobacco use and less exposure among immigrant adolescents to peers who smoke, may counteract some of the negative effects of poverty and social hardship. Future research should begin to address the processes that lead to adaptive outcomes among adolescents from immigrant families, despite greater exposure to social disadvantage.     

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.     

Inequalities in mental health care and social services utilisation by immigrant women

Background: The basic assumption of public health policy forimmigrants is that they ought to have equal access to healthservices compared to other population groups In Dutch society.However, little research is done on the actual use of mentalhealth services by immigrants and literature seems to indicateinequalities in services utilisation by immigrant women. Methods:This study was conducted in Amsterdam, The Netherlands. Dataon service utilisation were drawn from patient registers andcame from care providers who were asked to keep up registrationfor some time to count the number of immigrant women referredto and in treatment. Results: Surinamese, Antillean, Turkishand Moroccan women made considerably less use of mental healthcare services than native-born women. On the other hand, immigrantwomen more frequently used social work facilities and womencrisis intervention centres. Overall, they consulted the latterorganizations nearly 1.5 times more frequently than mental healthcare services. The differences in service utilisation betweenthe four immigrant groups are also discussed. Conclusions: Thisstudy explores the reasons for the ethnic differences in serviceutilisation. It argues that cultural and supply factors arelargely responsible for the ethnic differences in use of mentalhealth services. The differential use of social services ismainly ascribed to the socioeconomic status of the women concerned.The results imply that a care policy may improve the accessibilityof mental health services for immigrant women. The most promisingmeasure is by employing more ethnic and bilingual care providers.     

Influence of Maternal Birthplace on Postpartum Health and Health Services Use

This study examined differences in health status, rates of postpartum depression, perceptions of health services, unmet service needs, and barriers to service use among women born in and outside of Canada at 6 weeks following postpartum discharge from hospital. A secondary analysis of data gathered for a longitudinal cross-sectional survey of postpartum health and service use was conducted. Data from participants recruited from two urban hospitals were used for this analysis (n = 1,045). Analyses examined differences between women born in and outside of Canada. Immigrant women were significantly more likely to experience fair/poor postpartum health status and risk for postpartum depression. Immigrant women were also more likely to rate community health services as fair/poor, and were less likely to be able to get care for emotional health problems. Postpartum health services need to be responsive and accessible in order to meet the needs of immigrant women.     

Health Care Utilization and Costs Associated with Physical and Nonphysical-Only Intimate Partner Violence

Objective. To estimate health care utilization and costs associated with the type of intimate partner violence (IPV) women experience by the timing of their abuse.
Methods. A total of 3,333 women (ages 18–64) were randomly sampled from the membership files of a large health plan located in a metropolitan area and participated in a telephone survey to assess IPV history, including the type of IPV (physical IPV or nonphysical abuse only) and the timing of the abuse (ongoing; recent, not ongoing but occurring in the past 5 years; remote, ending at least 5 years prior). Automated annual health care utilization and costs were assembled over 7.4 years for women with physical IPV and nonphysical abuse only by the time period during which their abuse occurred (ongoing, recent, remote), and compared with those of never-abused women (reference group).
Results. Mental health utilization was significantly higher for women with physical or nonphysical abuse only compared with never-abused women—with the highest use among women with ongoing abuse (relative risk for those with ongoing abuse: physical, 2.61; nonphysical, 2.18). Physically abused women also used more emergency department, hospital outpatient, primary care, pharmacy, and specialty services; for emergency department, pharmacy, and specialty care, utilization was the highest for women with ongoing abuse. Total annual health care costs were higher for physically abused women, with the highest costs for ongoing abuse (42 percent higher compared with nonabused women), followed by recent (24 percent higher) and remote abuse (19 percent higher). Women with recent nonphysical abuse only had annual costs that were 33 percent higher than nonabused women.
Conclusion. Physical and nonphysical abuse contributed to higher health care utilization, particularly mental health services utilization.     

Out of Africa: Coping Strategies of African Immigrant Women Survivors of Intimate Partner Violence

We explored the coping behaviors of 15 immigrant African survivors of intimate partner violence (IPV) in the United States. Similarities and differences in coping strategies between African and other immigrant women were noted. Results from the qualitative analysis are that African immigrant survivors utilized multiple coping strategies including beliefs in spirituality and divine retribution, a future orientation, and a sense of self-efficacy. Acceptance/ endurance of abuse, which they believe was “normal” in male/ female relationships; minimization of the abuse; and avoidant behaviors and thoughts also were used. Informal and formal support/help seeking, and knowledge of available services empowered women. Implications for policy, practice, and future research are discussed.     

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.     

Intimate partner violence screening and counseling in the health care setting: Perception of provider-based discussions as a strategic response to IPV

Intimate partner violence (IPV) affects women worldwide, and is addressable in the health care setting not only via screening, but also through provider-based counseling and referral to legal or social services, as appropriate. We conducted a study in Pennsylvania (USA) examining factors associated with receipt of IPV screening and women's perceptions of counseling discussions as a strategic response. We found that women with past-year IPV were more likely to receive screening (aOR: 2.0, 95%CI: 1.2,3.5) and to consider counseling discussions to be a strategic response to IPV exposure (aOR: 2.7, 95%CI: 1.008,7.2) than women with a more distant history of IPV. Scholars and clinicians may learn that, especially for women with a recent history of IPV, screening may provide a conduit to meaningful counseling discussions and referrals that women view as a helpful strategy in responding to IPV.