Obstetrician-gynecologist and patient factors associated with intimate partner violence screening in a clinical setting

ABSTRACT

Screening for intimate partner violence is recommended by the medical community. This study investigated obstetrician-gynecologists’ intimate partner violence screening patterns and physician and patient factors associated with screening. Four hundred obstetricians-gynecologists completed the Physician Readiness to Manage Intimate Partner Violence Survey between December 2014 and July 2015. Their patients completed the Patient Safety and Satisfaction Survey. Hierarchical generalized linear modeling analyzed physician and patient variables related to the likelihood of being screened. Forty-four physicians responded. The viable patient response rate was 81.3 percent (n = 894) of patients from included physicians. Less than half (43.2 percent) of physicians reported screening during annual exams. There was a statistically significant difference for patient race/ethnicity (p < .03) and the number of previous doctor visits (p < .03) with not being screened. These patient-level variables accounted for approximately 68.3 percent of the variance screening odds. There was no significant difference (p < .10) between physicians’ perceived preparation, knowledge, and attitudes for not being screened. The hierarchical generalized linear modeling analysis showed a trend for physicians with a high-perceived preparation for screening was related to initial visits. This study identified that obstetrician-gynecologists do not routinely screen for IPV and race/ethnicity and number of visits are factors in screening for intimate partner violence.     

Male reproductive control of women who have experienced intimate partner violence in the United States

Women who have experienced intimate partner violence (IPV) are consistently found to have poor sexual and reproductive health when compared to non-abused women, but the mechanisms through which such associations occur are inadequately defined. Through face-to-face, semi-structured in-depth interviews, we gathered full reproductive histories of 71 women aged 18–49 with a history of IPV recruited from a family planning clinic, an abortion clinic and a domestic violence shelter in the United States. A phenomenon which emerged among 53 respondents (74%) was male reproductive control which encompasses pregnancy-promoting behaviors as well as control and abuse during pregnancy in an attempt to influence the pregnancy outcome. Pregnancy promotion involves male partner attempts to impregnate a woman including verbal threats about getting her pregnant, unprotected forced sex, and contraceptive sabotage. Once pregnant, male partners resort to behaviors that threaten a woman if she does not do what he desires with the pregnancy. Reproductive control was present in violent as well as non-violent relationships. By assessing for male reproductive control among women seeking reproductive health services, including antenatal care, health care providers may be able to provide education, care, and counseling to help women protect their reproductive health and physical safety.     

湖南省孕产妇亲密伴侣暴力发生及影响因素研究

目的了解孕产妇在孕前和妊娠期亲密伴侣暴力(intimate partner violence,IPV)的发生情况,探索和识别影响亲密伴侣暴力发生的因素.方法通过湖南省某妇幼保健院产科门诊招募孕妇进行问卷调查,内容包括一般人口学特征,家庭条件,妊娠经历,社会支持和亲密伴侣暴力经历.结果本次回收有效问卷510份,共113例...     

Trends and risk factors associated with the perpetration of physical intimate partner violence by women in Haiti, 2000-2012

ABSTRACT

Trends in the proportion of women reporting ever having perpetrated physical intimate partner violence (IPV) and factors associated with such IPV in Haiti between 2000 and 2012 were analyzed. We used datasets from Haitian couples in the 2000, 2005, and 2012 Demographic and Health Surveys. Physical IPV was assessed by the Conflict Tactics Scale. Trends were tested with the Cochrane–Armitage test. Women’s and spouses’ factors associated with physical IPV perpetration by women were estimated using binomial multivariable regressions. In 2000, 2005 and 2012, 3.5%, 3.4% and 3.2% women, respectively, reported perpetrating physical IPV (p for trend = 0.732). Factors associated with physical IPV by women included exposure to any IPV [Adjusted prevalence ratio (APR): 9.37; 95% Confidence Interval (CI): 5.05–17.38], living with a male partner who had a genital ulcer in the year preceding the survey [APR: 2.92; 95% CI: 1.11–7.65], living with a male partner who drank alcohol [APR: 2.58; 95% CI: 1.42–4.69], and having witnessed her father beating her mother during childhood [APR: 2.08; 95% CI: 1.14–3.81]. Exposure to IPV and history of genital ulcer in husbands/partners were the important factors associated with perpetration of physical IPV by women in Haiti over a 10-year period.     

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.     

亲密关系中男性躯体施暴行为影响因素分析

目的 从生态理论的角度,探讨影响亲密伴侣暴力中男性躯体施暴行为的相关因素。方法 采用分层整群方便抽样的方法,在新疆地区对900名18~65岁有过婚恋经历的人群进行横断面调查的基础上,采用1：1匹配对照研究设计,以132名亲密关系中男性施暴者为研究组,132名非施暴者作为对照组,采用一般情况调查表、简版冲突策略量表（CTS2）、人格诊断问卷（PDQ-4+）进行问卷调查。结果 单因素分析结果显示,受教育程度（χ²=13.67,P=0.03）、最近1年工作状况（χ²=10.70,P=0.01）、儿时目睹父亲打母亲（χ²=7.02,P=0.03）、儿时经历父亲忽视（χ²=9.34,P=0.01）、伴侣间相处方式（χ²=7.96,P=0.02）、婚外情（χ²=12.11,P=0.01）、个性因素（χ²=11.00,P=0.00）、社区对IPV的态度（χ²=10.79,P=0.01）、对伴侣实施行为控制（χ²=18.18,P=0.00）及经济控制（χ²=61.88,P=0.00）是亲密关系暴力（IPV）中男性躯体施暴行为的危险因素;结合专业解释,将个体对IPV的态度（χ²=7.45,P=0.06）与上述10个因素作为自变量进行多因素配对logistic回归分析,结果显示,无固定工作（OR=7.51,95%CI=1.51~37.23）、儿时经历父亲忽视（OR=3.74,95%CI=1.59~8.79）、对亲密伴侣暴力持赞同态度（OR=5.7,95%CI=1.50~21.10）及对伴侣实施经济控制（OR=10.64,95%CI=4.02~28.14）为男性实施躯体暴力行为的危险因素。结论 无固定工作、儿时经历父亲忽视、对暴力持赞同的态度、对伴侣有经济控制行为是男性实施躯体暴力的主要危险因素。     

Opportunities and obstacles to screening pregnant women for intimate partner violence during antenatal care in Zimbabwe

Pregnancy offers an opportunity for midwives to recognise and respond to women experiencing intimate partner violence (IPV). However, most antenatal care interventions have been conducted in private specialist services in high-income countries and do not address the structural and cultural realities of developing country settings. We report on an exploratory qualitative study conducted in antenatal public health facilities in Harare, Zimbabwe, involving six in-depth interviews with midwives and seven FGDs with 64 pregnant and postpartum women. Recorded interviews were transcribed verbatim and analysed using thematic content analysis. We found that identifying and responding to IPV in antenatal care is hampered by inadequate human, financial and infrastructural resources as well as poor support of gender-based violence training for midwives. Midwives had divergent views of their role, with some perceiving IPV as a non-clinical, social and domestic problem that does not require their attention, while others who had been sensitised to the problem felt that it could easily overwhelm them. A comprehensive response to IPV by midwives would be difficult to achieve in this setting but sensitised midwives could respond to cues to violence and ultimately assist abused women in culturally sensitive and appropriate ways.     

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.     

Bidirectional intimate partner violence: Evidence from a list experiment in Kenya

Intimate Partner Violence (IPV) continues to be a major public health concern that can both respond to economic policies and affect economic outcomes. Few studies regarding IPV, however, take a gender inclusive approach towards its identification. Using a sample of both men and women from rural Kenya, we are the first, to our knowledge, to conduct a list experiment with cohabiting married couples to identify the prevalence of physical violence on both men and women. We find that 14 percent of respondents agree with the statement “my spouse regularly hits me”. In contrast to other survey evidence that uses direct elicitation, we find no differences in the prevalence of male-to-female and female-to-male violence. We provide supporting evidence that bidirectional IPV accounts for the lack of gender differences. A complete understanding of the typology of IPV can be crucial for policies seeking IPV reduction.     

Experience of intimate partner violence among women and men attending general practices in Dublin,Ireland: A cross-sectional survey

This cross-sectional study examined women's and men's reported experience of intimate partner violence in general practice in the greater Dublin region. A high prevalence of reported experience of controlling behaviour and violent incidents was found. Although the reported prevalence of both was higher in men, women were more likely to have reported fear of a partner and a severe level of violence.

Conclusion: The findings demonstrate that intimate partner violence is a major problem among the men and women surveyed.     

Why place and space matter for intimate partner violence survivors’ mental wellbeing and communities in Northeastern Uganda

ABSTRACT

The context of place matters for mental health. Employing a feminist framework, this study used key informant interviews and focus group discussions in May 2012 with 77 conflict-affected adults, children, and adolescents in Northeastern Uganda to understand the relation of place and the symbolic space of family to IPV survivors’ mental wellbeing to shape intervention possibilities. Using Grounded Theory methods, narratives identified numerous negative mental health experiences, such as having a disturbed mind, associated with inhabiting a violent domestic space. Place-associated qualities interacted with the symbolic space of the family to impede women’s ability to enhance the safety of their domestic space, discourage separation, and encourage reunification in the case of separation, all of which related to negative mental health experiences. Interventions should not assume that IPV survivors’ exposure to violence has terminated and look beyond mental health as an individual outcome.     

Unwanted pregnancy,pregnancy loss,and other risk factors for intimate partner violence in the Democratic Republic of the Congo

The Democratic Republic of the Congo (DRC) has one of the highest rates of violence against women in the world; however, few studies have focused on this issue. In this study, we assessed the interrelationship among intimate partner violence (IPV), unintended pregnancy, pregnancy loss, and other sociodemographic factors in the DRC. Our analyses were based on data from the DRC demographic and health survey, conducted from November 2013 to February 2014. We constructed generalized estimating equation models to analyze the data from a sample of 5,120 married women. Our results showed that having a husband or partner who exhibited controlling behaviors, women who justified wife-beating, having a mother who had experienced IPV, and having a husband or partner who consumed alcohol were positively associated with IPV, whereas decision-making autonomy among women was negatively associated with IPV. In the community, the proportion of women who had experienced IPV and that of those who had completed secondary or higher education were positively and negatively associated with any IPV type, respectively. In addition, emotional IPV and any IPV type were positively associated with pregnancy loss. Our results indicate the necessity of implementing programs targeting gender equality at both individual and community levels.     

Prevalence and factors associated with intimate partner violence against women in The Gambia: a population-based analysis

ABSTRACT

Although intimate partner violence (IPV) against women is prevalent in sub-Saharan Africa, studies that investigated factors associated with IPV among Gambian women are limited. In this study, we examined the prevalence and factors associated with the different forms of IPV against Gambian women. We used a sample of 3,116 currently married women age (15 ~ 49 years) from The Gambia Demographic and Health Survey 2013. Logistic regression models were used to examine factors associated with Physical Violence (PV), Sexual Violence (SV), and Emotional Violence (EV). Over 40% (n = 1,248) of women reported at least one form of IPV. The prevalence of PV, SV and EV was 20.6%, 4.3%, and 15.1% respectively. Women married at age 18 ~ 24 (adjusted Odds Ratio [aOR]_SV = 1.55), lived with 3 ~ 4 (aOR_PV = 1.69; aOR_EV = 2.10) and ≥5 (aOR_PV = 1.77; aOR_EV = 2.64) children, witnessed parental violence (aOR_PV = 1.66; aOR_SV = 2.75; aOR_EV = 2.25), partner’s primary education (aOR_PV = 1.76), accused of unfaithfulness (aOR_PV = 2.42; aOR_SV = 3.62; aOR_EV4.10), and partner’s alcohol consumption (aOR_PV = 2.56; OR_SV = 3.91; aOR_EV = 2.82) are more likely to report IPV. Conversely, women who lived in Kerewan area (aOR_PV = 0.43; aOR_SV = 0.38; aOR_EV = 0.50), had high income (aOR_PV = 0.65), Wolof (aOR_PV = 0.68) and Jola (aOR_PV = 0.65) ethnicity and unemployed (aOR_PV = 0.59; aOR_SV = 0.56) were less likely to report IPV. Interventions to prevent IPV should focus on education on its effects, and programs that reject sociocultural practices as determinants of IPV.     

Women's perceptions of how pregnancy influences the context of intimate partner violence in Germany

Intimate partner violence during pregnancy is receiving increased attention because of its high prevalence and health effects. Still, little is known about women's perceptions on how their pregnancy influences the context in which intimate partner violence occurs. We conducted 19 in-depth interviews with women who had experienced intimate partner violence around the time of pregnancy. Women clearly perceived pregnancy as a turning point, because it created new expectations and a feeling of being overwhelmed. This led to violence by reducing women's acceptance of their partner's unemployment, alcohol abuse and lack of relationship commitment, or by increasing women's vulnerability because they felt too young to raise a child alone. Pregnancy also led to violence by bringing back childhood memories or by taking attention away from their partners. Understanding how pregnancy influences the context in which intimate partner violence occurs is important to provide abused, pregnant women with the services they need.     

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).     

The impact of violence against women on reproductive health and child mortality in Timor‐Leste

Objectives: To determine differences in reproductive health and infant and child mortality and health between abused and non‐abused ever‐married women in Timor‐Leste. Methods: Secondary data analysis of Timor‐Leste Demographic Health Survey (1,959 ever‐married women aged 15–49 years). Associations with violence estimated using multinomial logistic regression adjusted for sociodemographic variables and age of first intercourse. Results: Overall, 45% of ever‐married women experienced violence: 34% reported physical only and 11% reported combined physical, sexual and/or emotional violence. Compared to non‐abused women, women reporting physical violence only were more likely to use traditional contraception (AdjOR 2.35, 95%CI 1.05–5.26) or report: a sexually transmitted infection (AdjOR 4.46, 95%CI 3.27–6.08); a pregnancy termination (AdjOR 1.42, 95%CI 1.03–1.96); a child who had died (AdjOR 1.30, 95%CI 1.05–1.60), a low birth weight infant (AdjOR 2.08, 95%CI 1.64–2.64); and partially vaccinated children (AdjOR 1.35, 95%CI 1.05–1.74). Women who reported combined abuse were more likely to report: a sexually transmitted infection (AdjOR 3.51, 95%CI 2.26–5.44); a pregnancy termination (AdjOR 1.95, 95%CI 1.27–3.01); few antenatal visits (AdjOR 1.76 95%CI 1.21–2.55); and a child who had died (AdjOR 1.45, 95%CI 1.06–2.00). Conclusions: Violence exposes women to poor reproductive health, infant and child mortality and poor infant and child health. Implications: Preventing and reducing violence against women should improve women and children's health outcomes in Timor‐Leste.     

Applying international human rights laws to promote wellness within the community: On diminishing intimate partner violence in the context of western Belize

Abstract

In 1992, Belize passed the Domestic Violence Act to criminalise intimate partner violence within its borders, and in 1996, it ratified the Convention of Belém do Pará to pledge its allegiance to eradicate all forms of gender-related violence on the American continents. Despite these legal commitments to human rights, and several decades of work by activists to diminish the phenomenon, such legislation is seldom enforced in Belize and domestic violence remains a reality for over half of the women in the country. Condoned by culturally relevant gender hierarchies, this prevalence furthermore contributes to public wellness-related concerns, such as both major and minor external injuries, and also an accelerated spread of HIV/AIDS as well as non-fatal sexually transmitted diseases (STDs). In this article, I will address the specific problems which hinder such legislative enforcement and further complicate the administration of health services within one local context, and I will highlight several strategies which advocates are newly striving to employ to help mitigate the situation.     

Community-level correlates of intimate partner violence against women globally: a systematic review

Intimate partner violence (IPV) against women is a problem facing women around the world, one that has implications for women's health and well-being. The relationship between communities and the occurrence of IPV is an expanding area of research. Although a large number of community characteristics have been examined in relation to IPV, the research as a whole lacks a coherent theoretical focus or perspective. In this systematic review, we provide a comprehensive synthesis of the evidence regarding the community-level correlates of IPV against women. In our review of peer-reviewed research published between January 1, 1990 and January 31, 2011, we identify key community-level correlates, detect gaps, and offer recommendations for future research. Recognizing a difference in approach between U.S. and non-U.S. based research and an over-reliance on a primarily urban, U.S.-based perspective on communities and IPV, we advocate for a global perspective that better reflects the social and economic fabric of communities around the world. Specifically, future research should focus on the most promising, but currently under-studied, community-level correlates of IPV against women, namely gender inequality, gender norms, and adapted measures of collective efficacy/social cohesion.