Together to end violence against women in Tanzania: Results of a pilot cluster randomized controlled trial to evaluate preliminary effectiveness of interpersonal and community level interventions to address intimate partner violence

ABSTRACT

In Tanzania, women suffer high rates of intimate partner violence (IPV). We conducted a pilot cluster randomised controlled trial to test the feasibility, acceptability and preliminary effectiveness of IPV prevention interventions targeting men and communities in nine villages randomly assigned to one of three study arms (n = 450 couples). In the Control Group, women participated in savings groups while male partners received no intervention. In Intervention Group 1, women participated in savings groups and men participated in peer-groups addressing gender relations and IPV prevention. In Intervention Group 2, women participated in savings groups, men participated in peer-groups, and community leaders facilitated dialogues on similar topics. Recruitment was completed within one month with 95% retained in the intervention and 81% retained in the endline survey. Acceptability was high, with men participating in 82% of peer-group session hours. More men in Interventions 1 (24%) and 2 (19%) disagreed with wife-beating compared to men in the Control (13%); and more men reported non-perpetration of IPV in Interventions 1 (16%) and 2 (14%) compared to the Control (?2%). Findings suggest a fully powered RCT may detect significant reductions in men’s justification and use of IPV, paving the way for evidence-based violence prevention programming.

Trial registration: ClinicalTrials.gov identifier: NCT02434796.     

Vulnerabilities for Abuse Among Women with Disabilities

Sexuality and Disability - Research findings reveal that women with disabilities experience rates of emotional, physical, and sexual abuse that are comparable to, if not greater than, women without...     

Intimate Partner Violence,Parental Divorce,and Child Custody: Directions for Intervention and Future Research*

Abstract: Joint custody and cooperative coparenting are often unsafe for women who leave violent partners. Although certain legal protections are available, more work is needed to understand and address abused women's needs in this context. This study provides divorce scholars and practitioners with information on the interface between separation/divorce and intimate partner violence. We review existing research, policies, and programs and propose directions for intervention and research that center around the unique needs of these families.     

Validity of the Brief Inpatient Screen for Intimate Partner Violence Among Adult Women

Background: Identifying intimate partner violence in healthcare settings is becoming the standard of care. The Brief Inpatient Screen was designed to assess recent emotional, physical, and sexual abuse in a general inpatient medical-surgical setting and compared to the Composite Abuse Scale. Methods: Researchers matched “cases” (inpatients screening Brief Inpatient Screen-positive) to up to four “controls” (inpatients screening Brief Inpatient Screen-negative). Forty-six female hospital inpatients ages 18–64 years completed a self-administered survey. The sensitivity and specificity of the Brief Inpatient Screen and its subscales were compared to the Composite Abuse Scale. Researchers examined the performance of the Brief Inpatient Screen when used as a verbal screen versus an anonymous written screen. Results: Twelve of 46 participants (26%) had a positive screen. Compared to the Composite Abuse Scale, the overall sensitivity and specificity of the verbal Brief Inpatient Screen were 52.6% (95% CI 28.9–75.6) and 92.6% (95% CI 75.7–99.1), respectively. The written Brief Inpatient Screen showed improved sensitivity overall (68.4%, 95% CI 43.5–87.4) for the most severe intimate partner violence. Subscale analysis revealed greater sensitivity for emotional and severe combined intimate partner violence. Conclusions: The verbal Brief Inpatient Screen, when compared to the Composite Abuse Scale, was limited in its ability to identify intimate partner violence. An anonymous written format improved sensitivity. Future research should optimize intimate partner violence screening among inpatients.     

Prevalence and correlates of physical,psychological, and sexual intimate partner violence in Bolivia

Despite increasing awareness that domestic violence is a major public health problem, existing studies focus on physical and sexual violence and give little attention to psychological violence. This study uses data from the 2008 Bolivia Demographic and Health Surveys (BDHS) to examine the prevalence and correlates of physical, sexual, and psychological intimate partner violence in Bolivia. The results show that psychological intimate partner violence is extremely common (affecting nearly one in two women) and often occurs in addition to physical violence. While physical, psychological and sexual intimate partner violence have several common predictors, there are factors that only affect some types of violence. Common risk factors include urban residence, respondent's employment status and having witnessed interparental violence in childhood. Although marital status is not a risk factor for physical violence, unmarried cohabitation is a strong risk factor for psychological intimate partner violence. Our findings highlight the need for research to assess the potential consequences of psychological intimate partner violence, particularly for women's mental health.     

Disability,Gender and Intimate Partner Violence: Relationships from the Behavioral Risk Factor Surveillance System

Research on women with disabilities has found that the most common perpetrators of violence were current or former intimate partners (Young et al. Arch. Phys. Med. Rehabil. 78, S34–S38, 1997; Riddington, Beating the “odds”: Violence and Women with Disabilities (Position Paper 2). 1989). This article examines intimate partner sexual and physical abuse experienced by women with disabilities compared to women without disabilities and men with and without disabilities through chi square analysis and regression analysis using data from the 2005 Behavioral Risk Factor Surveillance System (BRFSS). Results show that women with disabilities experienced almost twice the rate of all forms of abuse compared to the other populations. Variables increasing the likelihood of abuse include being female, disabled, not employed, uncoupled and younger age. Implications for future research, screening and intervention for rehabilitation professionals are discussed.     

Informal support for women and intimate partner violence: the crucial yet ambivalent role of neighbours in urban India

Women who experience intimate partner violence often rely on informal support to mitigate intimate partner violence's health effects. Yet there is little known about who gives the support and how it is provided. This paper explores from whom and how low-income women experiencing domestic violence in urban India seek informal support. In South Asia, women's reliance on kin for support is culturally valued, yet the urban social context makes it more likely that they will access such support from non-kin when they experience intimate partner violence. The paper draws on observations and interviews with 10 families collected over 14 months of in-depth ethnographic research in one Delhi slum community. Using a case study approach to explore women's responses to violence longitudinally, it was possible to track how women drew on support. Results show that even as women sought emotional support and direct intervention from their neighbours to deal with their domestic violence, they restricted these relationships, faced stigma, and emphasised the need to protect their families. Understanding the informal, but deeply ambivalent, systems of social support that women engage to deal with intimate partner violence is a first step toward strengthening such networks, a key recommendation to stem the health impacts of domestic violence.     

‘Yarn about it’: Aboriginal Australian women’s perceptions of the impact of routine enquiry for intimate partner violence

Aboriginal women globally are disproportionately affected by intimate partner violence (IPV) and face additional barriers to help-seeking. It is crucial that interventions for IPV are made safe for Indigenous women, given inflated rates of statutory intervention and widespread institutional racism. As part of a larger study of antenatal IPV screening, we interviewed 12 Aboriginal Australian women about the perceived impact of an antenatal IPV routine enquiry intervention. Seven women reported positive impact, and five women reported the absence of positive impact. Qualitative comparative analysis was used to map pathways to perceived impact. Cultural safety – the practice of countering tendencies in health care that undermine safety – was a key condition for positive impact. Others included: (i) continuity of care; (ii) asking about abuse without judgement and with care; and (iii) support and validation. Absence of these factors also typified pathways for nil positive impact. Naming the abuse, a sense of connection, unburdening, taking steps to safety and enabling informed care were all reported benefits. Two women reported explicitly negative impacts: one noted a sense of intrusion, and the other, disengagement from the health service. Interventions for IPV have the potential to benefit Indigenous women where cultural safety is prioritised.     

Intimate Partner Violence in Interracial and Monoracial Couples

This study, using a nationally representative sample, investigated intimate partner violence (IPV) in interracial and monoracial relationships. Regression analyses indicated that interracial couples demonstrated a higher level of mutual IPV than monoracial White couples but a level similar to monoracial Black couples. There were significant gender differences in IPV, with women reporting lower levels of victimization than men. Regarding relationship status, cohabiting couples demonstrated the highest levels of IPV, and dating couples reported the lowest levels. Regarding interactions among couple racial composition, relationship status, and respondents' gender, an interaction between racial composition and relationship status was found. Implications for practitioners and directions for future research are discussed.     

Domestic violence against women in India: A systematic review of a decade of quantitative studies

Domestic violence (DV) is prevalent among women in India and has been associated with poor mental and physical health. We performed a systematic review of 137 quantitative studies published in the prior decade that directly evaluated the DV experiences of Indian women to summarise the breadth of recent work and identify gaps in the literature. Among studies surveying at least two forms of abuse, a median 41% of women reported experiencing DV during their lifetime and 30% in the past year. We noted substantial inter-study variance in DV prevalence estimates, attributable in part to different study populations and settings, but also to a lack of standardisation, validation, and cultural adaptation of DV survey instruments. There was paucity of studies evaluating the DV experiences of women over age 50, residing in live-in relationships, same-sex relationships, tribal villages, and of women from the northern regions of India. Additionally, our review highlighted a gap in research evaluating the impact of DV on physical health. We conclude with a research agenda calling for additional qualitative and longitudinal quantitative studies to explore the DV correlates proposed by this quantitative literature to inform the development of a culturally tailored DV scale and prevention strategies.     

Victim Help Seeking: Differences Between Intimate Terrorism and Situational Couple Violence

Abstract: Research indicates that two major forms of partner violence exist, intimate terrorism (IT) and situational couple violence (SCV). The current study (N= 389) used a subgroup of women who responded to the Chicago Women’s Health Risk Study to examine whether type of violence experienced is differentially related to formal (e.g., police, medical agencies, counseling) and informal (e.g., family, friends/neighbors) help seeking. IT victims were more likely to seek each type of formal help but were equally or less likely to seek informal help. Findings can inform both family violence research and the development and implementation of social service programs.     

Barriers to Screening for Intimate Partner Violence

Background: Health care providers play a vital role in the detection of intimate partner violence among their patients. Despite the recommendations for routine intimate partner violence screening in various medical settings, health care providers do not routinely screen for intimate partner violence. The authors wanted to identify barriers to intimate partner violence screening and improve the understanding of intimate partner violence screening barriers among different health care providers. Methods: The authors conducted a systematic review to examine health care providers' perceived barriers to screening for intimate partner violence. By grouping the studies into two time periods, based on date of publication, they examined differences in the reported barriers to intimate partner violence screening over time. Results: The authors included a total of 22 studies in this review from all examined sources. Five categories of intimate partner violence screening barriers were identified: personal barriers, resource barriers, perceptions and attitudes, fears, and patient-related barriers. The most frequently reported barriers included personal discomfort with the issue, lack of knowledge, and time constraints. Provider-related barriers were reported more often than patient-related barriers. Conclusions: Barriers to screening for intimate partner violence are numerous among health care providers of various medical specialties. Increased education and training regarding intimate partner violence is necessary to address perceptions and attitudes to remove barriers that hinder intimate partner violence screening by health care providers.     

Associations Between Perceptions and Involvement in Neighborhood Violence and Intimate Partner Violence Perpetration Among Urban,African American Men

Violence disproportionately affects African American men and their communities. Research is needed to inform programming efforts to reduce racial/ethnic disparities in violence exposure, involvement, and victimization. The current study examined involvement in and perceptions of neighborhood violence and relation to perpetration of intimate partner violence (IPV) among a sample of urban, African American men. Participants of this cross-sectional study were sexually active African American men (n = 703) between the ages of 18 and 65 years, recruited from urban community health centers. Age-adjusted logistic regression models were used to assess associations between neighborhood violence variables and perpetration of IPV. In age-adjusted logistic regression models, involvement with street violence in the previous 6 months (Odds Ratio (OR) = 3.0; 95% Confidence Interval (CI): 1.9–4.6), ever being involved with gangs (OR = 2.0; 95% CI: 1.3–3.2), and perceptions/beliefs that violence occurs in one’s neighborhood (ORs = 2.0–3.1) were found to be significantly associated with IPV perpetration. Findings demonstrate that involvement in neighborhood violence as well as perceptions/beliefs that violence occurs in one’s neighborhood are associated with increased likelihood of IPV perpetration among urban, African American men. While socioeconomics and substance use contribute to high rates of these forms of violence, the relation between these forms of violence and perpetration of IPV was significant beyond the influences of these factors. Findings suggest that future violence prevention and treatment efforts will be most successful by addressing multiple forms of violence.     

The macro-level drivers of intimate partner violence: New evidence from a multilevel dataset

This study uses multi-level regression analysis to determine the impact of macro-level drivers on intimate partner violence (IPV). It argues that we need to look beyond the usual, individual-level risk factors in order to understand why women experience abuse at the hands of their intimate partners. Using Demographic and Health Survey data from 40 developing countries, this paper demonstrates that socio-economic development, beliefs and laws play an important role in explaining IPV.     

Six Months After Routine Screening for Intimate Partner Violence: Attitude Change,Useful and Adverse Effects

This evaluative study measured self-reported changes in abuse-related measures six months after routine screening for intimate partner violence. Participants were 122 women who disclosed abuse and 241 who did not report abuse, screened in antenatal, substance abuse, and mental health services according to an existing standardized protocol used in New South Wales, Australia. Six months after initial screening, abused women were more likely to report increased agreement with a number of attitudes relating to abuse, in particular that being hurt by a partner affects a woman's health and that health services should ask about abuse. The proportion reporting current abuse was significantly lower after six months. While 6% (7/119) reported negative emotional reactions, 34% (41/120) reported useful effects—most frequently re-evaluating their situation and reducing isolation. Women who had experienced abuse, but elected not to disclose it reported similar effects. The results of this study lend support to the use of protocols for asking about abuse and responding to disclosures of abuse.