Association between adolescent marriage and marital violence among young adult women in India

Objective

To assess whether a history of adolescent marriage (< 18 years) places women in young adulthood in India at increased risk of physical or sexual marital violence.

Methods

Cross-sectional analysis was performed on data from a nationally representative household study of 124 385 Indian women aged 15-49 years collected in 2005-2006. The analyses were restricted to married women aged 20-24 years who participated in the marital violence (MV) survey module (n = 10 514). Simple regression models and models adjusted for participant demographics were constructed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between adolescent marriage and MV.

Results

Over half (58%) of the participants were married before 18 years of age; 35% of the women had experienced physical or sexual violence in their marriage; and 27% reported such abuse in the last year. Adjusted regression analyses revealed that women married as minors were significantly more likely than those married as adults to report ever experiencing MV (adjusted OR 1.77; 95% CI, 1.61-1.95) and in the last 12 months (adjusted OR 1.51; 95% CI, 1.36-1.67).

Conclusions

Women who were married as adolescents remain at increased risk of MV into young adulthood.     

Impact of the RHANI Wives intervention on marital conflict and sexual coercion

Objective

To assess the effects of the RHANI (Reducing HIV among Non-Infected) Wives intervention on marital conflict and intimate partner violence (IPV) in urban India.

Methods

A 2-armed cluster-randomized controlled trial (7 intervention, 6 control clusters) of the RHANI Wives intervention was conducted with 220 women contending with a history of IPV and/or husband’s drunken behavior. Participants were surveyed at baseline and 4.5-month follow-up. Outcome measures included marital conflict (arguments with husband in past 3 months), marital IPV (physical or sexual violence from husband in past 3 months), and marital sexual coercion (husband forcing sex at last sex). Intention-to-treat logistic generalized linear mixed models were used to determine intervention impact.

Results

One-third (35.0%) of participants reported physical or sexual abuse from their husband in the past 3 months, and 58.6% reported that their husband was drunk in the past 30 days. Intention-to-treat analyses indicated time × treatment reductions in marital conflict (risk ratio [RR] 0.4; 90% confidence interval [CI], 0.1–0.9; P = 0.06) and marital sexual coercion (RR 0.2; 90% CI, 0.05–0.9; P = 0.08), but not IPV.

Conclusion

The findings suggest the potential utility of this intervention in reducing marital conflict and sexual coercion among women in urban India.ClinicalTrials.gov: NCT01592994.     

Physical,sexual, and psychological violence in a gynaecological–psychosomatic outpatient sample: Prevalence and implications for mental health

Objective

The main objective was to assess the prevalence of physical, sexual, or psychological violence in a cohort of patients with gynaecological symptoms who presented at a psychosomatic outpatient clinic. We assessed differences in prevalence rates of gynaecological symptoms and mental health problems in women with and without a history of experiencing violence.

Study design

We performed a cohort study of women (n = 424) who attended a psychosomatic–gynaecological outpatient clinic during a 6-year-period of time. Information about lifetime victimization, mental health status, and socio-demographic characteristics were systematically obtained through semi-structured interviews. Psychiatric diagnoses were made using questions adapted to the structured interview for DSM-IV.

Results

Some form of violence was reported by 39.9%. Of the total sample, physical violence was reported in 25.2%, sexual violence in 13.0%, and psychological violence in 23.8%. Of those with a history of experiencing violence, 26.1% experienced two different kinds of violence, and 14.8% were victims of all three kinds of violence. Perpetrators of physical and psychological violence were, predominantly, the partner or the father. With respect to sexual violence, perpetrators were exclusively male, including family members or friends in more than 80% of all cases. Women with a history of experiencing violence suffered significantly more often from major depressive disorders (29.6%) than those without a history of experiencing violence (16.5%) (p < .002). Post-traumatic stress disorder (PTSD) was significantly more frequent in women with a history of experiencing violence (7.1%) (p < .001).

Conclusions

We found a high lifetime prevalence of different forms of violence toward women in our sample. Perpetrators were most often male family members, highlighting the impact of domestic violence. Our study provides evidence that women who attend a psychosomatic unit should be cautiously screened for a potential history of traumatic violent experiences.     

Domestic violence against infertile women in a Turkish setting

Objective

To investigate the prevalence of domestic violence against infertile women in a Turkish setting.

Methods

A total of 122 women with primary infertility attending an obstetrics and gynecology outpatient clinic were interviewed using the Abuse Assessment Screen questionnaire to investigate their experiences of domestic violence.

Results

In total, 41 (33.6%) women had experienced domestic violence because of their infertility. Of these women, 32 (78%) had experienced domestic violence for the first time in the relationship with the current partner following diagnosis of female factor infertility. The percentage of nonabused and abused infertile women who were mostly satisfied with their sexual lives was 56.87% and 29.2%, respectively (P < 0.05).

Conclusion

Routine screening for domestic violence in infertility clinics is necessary to give affected women an opportunity to access appropriate health care and support services.     

Prevalence and risk factors for domestic violence against infertile women in an Iranian setting

Objective

To determine the prevalence of and risk factors for domestic violence against women with female factor infertility in an Iranian setting.

Methods

In this cross-sectional survey conducted from August 1, 2009 to January 31, 2010, 400 women with primary infertility attending Valiasr Reproductive Health Research Center in Tehran, Iran, were interviewed using the Revised Conflict Tactics Scales questionnaire (CTS₂). This instrument was developed to investigate the presence domestic violence.

Results

A total of 247 women (61.8%) reported having experienced domestic violence because of their infertility. The most common type of violence was psychological (n = 135 [33.8%]), followed by physical (n = 56 [14%]) and sexual (n = 32 [8%]), with 24 women (6%) reporting injuries. All women reported their husbands to be the perpetrators.

Conclusion

Domestic violence against infertile women is a considerable yet unreported problem. Clinicians should identify the abused women and provide them with medical care and supportive counseling.     

Trends and determinants of pregnancy-related domestic violence in a referral center in southern Nigeria

Objective

To describe the trend and identify associated risk factors for pregnancy-related domestic violence.

Methods

In a cross-sectional study of 502 women attending the sixth week postnatal clinic in a tertiary hospital in urban Nigeria, participants completed semi-structured questionnaires on experience of domestic violence before and during pregnancy, and in the puerperium. Multivariate logistic regression was used to assess risk factors associated with experiencing violence.

Results

The prevalence of domestic violence was 43.5% during the 12 months before the pregnancy, 28.3% during the pregnancy, and 4% in the puerperium. Psychological violence was the commonest form of violence experienced. All forms of violence were least common in the puerperium. Experience of violence in the 12 months before pregnancy (P < 0.0001, odds ratio 274.34 [95% CI, 66.4-1133.8]), HIV seropositivity (P = 0.02, odds ratio 2.81 [95% CI, 1.2-6.5]), and regular alcohol intake (P < 0.0001, odds ratio 11.60 [95% CI, 3.8-35.1]) significantly increased the likelihood of experiencing domestic violence.

Conclusion

Pregnancy-related domestic violence is an important health problem in this community in southern Nigeria. Experience of violence before the pregnancy, HIV infection, and regular alcohol consumption are risk factors.     

A cross-sectional survey on gender-based violence and mental health among female urban refugees and asylum seekers in Kampala,Uganda

Objective

To assess gender-based violence and mental health outcomes among a population of female urban refugees and asylum seekers.

Methods

In a questionnaire-based, cross-sectional study conducted in 2010 in Kampala, Uganda, a study team interviewed a stratified random sample of female refugees and asylum seekers aged 15–59 years from the Democratic Republic of Congo and Somalia. Questionnaires were used to collect information about recent and lifetime exposure to sexual and physical violence, and symptoms of depression and post-traumatic stress disorder (PTSD).

Results

Among the 500 women selected, 117 (23.4%) completed interviews. The weighted lifetime prevalences of experiencing any (physical and/or sexual) violence, physical violence, and sexual violence were 77.5% (95% CI 66.6–88.4), 76.2% (95% CI 65.2–87.2), and 63.3% (95% CI 51.2–75.4), respectively. Lifetime history of physical violence was associated with PTSD symptoms (P < 0.001), as was lifetime history of sexual violence (P = 0.014). Overall, 112 women had symptoms of depression (weighted prevalence 92.0; 95% CI 83.9–100) and 83 had PTSD symptoms (weighted prevalence 71.1; 95% CI 59.9–82.4).

Conclusion

Prevalences of violence, depression, and PTSD symptoms among female urban refugees in Kampala are high. Additional services and increased availability of psychosocial programs for refugees are needed.     

Development of an evidence-based domestic violence guideline: supporting perinatal women-centred care in Japan

Objective

to develop an evidenced-based, women-centred care clinical guideline designed to assist midwives and other health-care providers in Japanese hospitals, clinics and midwifery offices, in identifying and supporting potential or actual perinatal victims of domestic violence.

Design

systematic review and critical appraisal of extant research; structured assessment of clinical guideline development.

Method

systematic and comprehensive literature search. Appraisal of Guidelines for Research and Evaluation (AGREE) was used to assess the guideline development for purposes of assuring methodological quality.

Findings

electronic searches of medical and nursing databases between February and December 2003 retrieved 2392 articles. Selected as evidence were 157 articles yielding 28 recommendations aligned to clinical assessment questions.

Key conclusions

using expert consensus and external reviews, recommendations were generated that provided the at-risk perinatal group with the best possible practice available to prevent further harm.

Implications for practice

the evidenced-based clinical guideline fosters a supportive environment for educating health-care providers on domestic violence, and to improve clinic access for at-risk perinatal women. Information on domestic violence and a negotiated midwife–client safety plan can be initiated for potential or actual victims of domestic violence, and is achieved through understanding the risks of the woman and her fetus or baby, while respecting the woman's intention.     

Psychiatric evaluation of women who were assisted at a university referral center in Campinas,Brazil, following an experience of sexual violence

Objective

To present the sociodemographic characteristics and psychiatric symptoms of women who have been raped.

Methods

Between 2006 and 2010, a retrospective study was conducted of 468 women who underwent psychiatric evaluation at a university referral center in Brazil after an experience of sexual violence.

Results

The women had a mean age of 24.1 years; were predominantly white, unmarried, childless, and employed; had 9–11 years of education; and had a religion. Rape was the first sexual intercourse for 124 (26.8%) of 462 for whom data were available; 53 (13.6%) of 389 had a personal history of sexual violence and 29 (8.0%) of 361 had a family history. No psychiatric symptoms were reported in 146 (32.9%) of 444 women, mild/short-term symptoms were reported in 107 (24.1%), and a psychiatric diagnosis was made for 191 (43.0%). Psychiatric comorbidity was seen in 59 (12.6%) women, and 174 (38.0%) received pharmacologic treatment. All follow-up consultations were attended by 215 (45.9%) of 468 women; 166 (35.5%) attended some, and 87 (18.6%) attended only one during the 6-month follow-up period.

Conclusion

The frequency and severity of psychiatric symptoms and mental disorders among women who have been raped highlights the importance of mental health monitoring.     

Mental health impacts of reproductive coercion among women in Côte d’Ivoire

Objective

To assess the independent associations of partner-perpetrated reproductive coercion, intimate partner violence (IPV), in-law reproductive coercion, and in-law abuse with recent probable post-traumatic stress disorder (PTSD), and to test their relationship with PTSD symptoms when controlling for the other types of abuse among partnered women in rural Côte d’Ivoire.

Methods

Cross-sectional analyses were conducted using logistic generalized estimating equations, which accounted for village-level clustering. Data were drawn from baseline data from a randomized controlled trial among 24 villages in rural Côte d’Ivoire (n = 953 partnered women). Three adjusted models were used to test associations of reproductive coercion and abuse with probable PTSD.

Results

Partner-perpetrated reproductive coercion was experienced by 176 (18.5%) women. In model 3, which accounted for the co-occurrence of abuses, partner-perpetrated reproductive coercion (odds ratio [OR] 2.3; 95% confidence interval [CI], 1.4–3.9) and partner-perpetrated IPV (OR 1.7; 95% CI, 1.1–2.7) were the most significant predictors of past-week probable PTSD (P < 0.05).

Conclusion

Reproductive coercion may be a significant contributor to poor mental health. The mental health impacts of reproductive coercion and IPV should be considered within psychosocial programming for rural Ivorian communities to address the full range of traumatic experiences that may have been experienced by women.     

Disclosure and police reporting of intimate partner violence postpartum: a pilot study

Objective

intimate partner violence is a significant health problem. Fear of retaliation and shame may prevent women from telling anyone about the violence. This study investigated the prevalence of disclosure and police reporting of intimate partner violence during the first year postpartum.

Design

a prospective longitudinal Swedish cohort study based on information from 2563 women who answered a postal questionnaire in early pregnancy and 12 months postpartum.

Findings

of 52 women who had been exposed to violence by their partner during the first year postpartum, four (8%) had filed a police report while 19 (37%) had not told anyone about the violence. All single women in the study had disclosed the violence to a friend, a relative or filed a police report.

Key conclusions

few women file a police report when they are being hit by their partner during the year after childbirth. Many women do not tell anyone that they have been hit.

Implications for practice

these data may encourage health professionals to undertake sensitive questioning about violence, giving an opening for support.     

Domestic abuse: Black and minority-ethnic women's perspectives

Background

domestic abuse affects one in three women in the UK and can have long-term consequences for those concerned and their families. Guidelines suggest that all women should be asked about domestic abuse, and the Department of Health has suggested ways of supporting this issue. Health-care professionals could find themselves with a woman who cannot speak English, and may require the support of an interpreter. Current guidelines are not suitable for Black and minority-ethnic women, and midwives may not have enough cultural awareness to support these women.

Aim

to interview bilingual women in the community to explore: (1) how domestic abuse is viewed in their culture; and (2) who should be questioning women about this sensitive issue.

Method

a qualitative phenomenological study using semi-structured interviews with non-pregnant bilingual workers within the local community.

Findings

women's lives were influenced by their in-laws and family, status, attitudes to marriage arrangements and gossiping in the community. All of these factors affected disclosure.

Conclusions

health-care professionals must understand that women take serious measures to hide the fact that they are victims of abuse in order to preserve family honour. Divulging information to interpreters or relatives is a problem because of lack of confidentiality and gossiping in the community.     

Abortion care for adolescent and young women

Background

Unintended pregnancy among adolescents (10–19 years) and young women (20–24 years) is a global public health problem. Adolescents face challenges in accessing safe abortion care.

Objective

To determine, via a systematic data review, whether abortion care for adolescent and young women differs clinically from that for older women.

Methods

In a comprehensive data review, the Cochrane Central Register of Controlled Trials, MEDLINE, and POPLINE databases were searched from the earliest data entered until November 2012. Randomized controlled trials and observational studies comparing effectiveness, safety, acceptability, and long-term sequelae of abortion care between adolescent/young women and older women were identified. Two reviewers independently extracted data, and the Cochrane guidelines and Newcastle–Ottawa Scale were used for quality assessment.

Results

In total, there were 25 studies including 346 000 women undergoing first- and second-trimester medical abortion, vacuum aspiration, or dilation and evacuation. Effectiveness and overall complications were similar among age groups. However, younger women had an increased risk for cervical laceration and a decreased risk of uterine perforation and mortality. Satisfaction and long-term depression were similar between age groups. Except for less uptake of intrauterine devices among adolescents, age did not affect post-abortion contraception.

Conclusions

Evidence from various healthcare systems indicates that abortion is safe and efficacious among adolescent and young women. Clinical services should promote access to safe abortion for adolescents.     

DNA extraction from filter-paper spots of vaginal samples collected after sexual violence

Objective

To detect the presence of male DNA in vaginal samples collected from survivors of sexual violence and stored on filter paper.

Methods

A pilot study was conducted to evaluate 10 vaginal samples spotted on sterile filter paper: 6 collected at random in April 2009 and 4 in October 2010. Time between sexual assault and sample collection was 4–48 hours. After drying at room temperature, the samples were placed in a sterile envelope and stored for 2–3 years until processing. DNA extraction was confirmed by polymerase chain reaction for human β-globin, and the presence of prostate-specific antigen (PSA) was quantified. The presence of the Y chromosome was detected using primers for sequences in the TSPY (Y7/Y8 and DYS14) and SRY genes.

Results

β-Globin was detected in all 10 samples, while 2 samples were positive for PSA. Half of the samples amplified the Y7/Y8 and DYS14 sequences of the TSPY gene and 30% amplified the SRY gene sequence of the Y chromosome. Four male samples and 1 female sample served as controls.

Conclusion

Filter-paper spots stored for periods of up to 3 years proved adequate for preserving genetic material from vaginal samples collected following sexual violence.     

Midwives' awareness and experiences regarding domestic violence among pregnant women in southern Sweden

Objective

to explore midwives' awareness of and clinical experience regarding domestic violence among pregnant women in southern Sweden.

Design

an inductive qualitative design, using focus groups interviews.

Setting

midwives with experience of working in antenatal care (ANC) units connected to two university hospitals in southern Sweden. Participants 16 midwives recruited by network sampling and purposive sampling, divided into four focus groups of three to five individuals.

Findings

five categories emerged: ‘Knowledge about ‘the different faces’ of violence’, perpetrator and survivor behaviour, and violence-related consequences. ‘Identified and visible vulnerable groups’, ‘at risk’ groups for exposure to domestic violence during pregnancy, e.g. immigrants and substance users. ‘Barriers towards asking the right questions’, the midwife herself could be an obstacle, lack of knowledge among midwives as to how to handle disclosure of violence, fear of the perpetrator and presence of the partner at visits to the midwife. ‘Handling the delicate situation’, e.g. the potential conflict between the midwife's professional obligation to protect the pregnant woman and the unborn baby who is exposed to domestic violence and the survivor's wish to avoid interference. ‘The crucial role of the midwife’, insufficient or non-existent support for the midwife, lack of guidelines and/or written plans of action in situations when domestic violence is disclosed. The above five categories were subsumed under the overarching category ‘Failing both mother and the unborn baby’ which highlights the vulnerability of the unborn baby and the need to provide protection for the unborn baby by means of adequate care to the pregnant woman.

Key conclusions and implication for practice

avoidance of questions concerning the experience of violence during pregnancy may be regarded as a failing not only to the pregnant woman but also to the unprotected and unborn baby. Nevertheless, certain hindrances must be overcome before the implementation of routine enquiry concerning violence during pregnancy. It is important to develop guidelines and a plan of action for all health-care personnel at antenatal clinics as well as to provide continuous education and professional support for midwives in southern Sweden.     

Relación entre los valores de hemoglobina materna anteparto y los resultados perinatales

Objective

To evaluate the association between maternal hemoglobin levels and perinatal outcomes.

Subjects and methods

Seven hundred twenty-eight pregnant women attended in the Hospital Universitario de Canarias, Tenerife (Spain) between January and April 2004 were studied. The women were divided into three groups: women with anemia (n = 61), women with normal hemoglobin levels (n = 587) and those with hemoconcentration (n = 80).An observational retrospective study was performed. Perinatal outcomes were compared among the groups studied and the possible correlations among hemoglobin levels and perinatal variables were analyzed.

Results

A significant quadratic relationship was found between maternal hemoglobin levels and both gestational age at delivery and birthweight. Multiple regression analysis showed that these variables were independent predictors of maternal hemoglobin concentration.

Conclusions

Gestational age at delivery and birthweight were lower in both the anemia and hemoconcentration groups. Maternal anemia is associated with a higher risk of having a small-forgestational- age neonate regardless of the risk of preterm delivery.     

Epidemiologic profile of women presenting to the National Hospital of Niamey,Niger for vaginal fistula repair

Objective

To describe the epidemiologic profile of women with vaginal fistulas presenting to the surgical mission trips of the International Organization for Women and Development (IOWD) at the National Hospital of Niamey, Niger.

Methods

In a cross-sectional retrospective study, data were assessed from a database of women who attended the IOWD at the National Hospital of Niamey, Niger, from October 2003 to April 2009. The database was compiled from the history and physical examination forms for each patient visit.

Results

During the study period, there were 1323 data entries and 896 initial patient visits. Overall, 580 women presented with obstetric fistulas. The median age was 29 years; the mean age at marriage was 16 years; 73.7% were married. The median age at first delivery was 18 years; the mean number of past full-term pregnancies was 3; the mean parity was 4. Vaginal (66.3%) or cesarean (27.7%) delivery was a common predisposing factor for developing an obstetric fistula. Overall, 97.4% of women labored for 24 hours or more; 75.4% delivered in hospital; 82.9% had a stillbirth.

Conclusion

Women presenting to the IOWD for fistula repair have specific epidemiologic characteristics. Better understanding of these characteristics might help to formulate future public health programs for fistula prevention.     

Prevalence and correlates of intimate partner violence among women attending HIV voluntary counseling and testing in northern Tanzania, 2005-2008

Objective

To investigate the prevalence and correlates of intimate partner violence (IPV) among women at an HIV voluntary counseling and testing (VCT) center in northern Tanzania.

Methods

In a cross-sectional study, the lifetime history of IPV experienced by women attending an HIV VCT center in Moshi, Tanzania, from June 2005 to January 2008 was assessed. Bivariate and ordered logistic regression analyses were performed to identify risk factors for IPV.

Results

Of 2436 enrolled women, 432 (17.7%) reported IPV during their lifetime. Older, unemployed, and less-educated women, and those with children were more likely to have experienced IPV (P < 0.05). IPV exposure differed by marital status (P < 0.001). Adjusting for sociodemographics, the odds ratio of IPV was 1.51 (95% confidence interval [CI] 1.10-2.07) for married women and 2.25 (95% CI 1.63-3.10) for divorced women, compared with single women. HIV prevalence did not differ by IPV exposure or severity; however, 22.4% of single women who had experienced IPV were HIV seropositive, compared with 15.1% of women with no experience of IPV (P = 0.041).

Conclusion

Given that IPV represents both a risk factor for and a consequence of HIV infection, VCT sites are an appropriate and accessible venue for IPV screening and counseling in resource-poor settings.