Prevalence of family violence amongst women attending an abortion clinic in New Zealand

AIMS: To measure the prevalence of family violence reported by women seeking a termination of pregnancy (TOP). METHODS: A cross sectional survey involving consecutive women at one Health Waikato abortion clinic. Participants completed a self-administered questionnaire in private counselling rooms. RESULTS: Sixty-two of the 125 women invited to participate did so (response rate: 49.6%). The reported lifetime prevalence of physical or sexual abuse was 50.8%. The reported lifetime prevalence of physical abuse was 43.3% and that of sexual abuse was 32.2%. The reported prevalence of physical abuse within the last year was 13.3%, and of sexual abuse within the last year was 8.5%. Of women reporting a lifetime history of physical abuse, 69% reported that her partner was the perpetrator/one of the perpetrators of abuse. CONCLUSIONS: The study demonstrated a high prevalence of family violence amongst women attending an abortion clinic. Consideration should be given to screening for family violence in abortion clinics in New Zealand. Screening should be accompanied by the provision of appropriate information and support for women with family violence issues.     

Sexual abuse during childhood and adolescence as predictors of HIV-related sexual risk during adulthood among female sexual partners of injection drug users

This study explores the relationship of sexual abuse during childhood and adolescence with HIV-related sexual risk behaviors during adulthood among female sexual partners of injection drug users. It analyzed data that was gathered between 1990 and 1993, which included a sample of 2794 women from the US, Mexico, and Puerto Rico. 6 HIV-related sexual risk behaviors that occurred during the month prior to interview were examined; namely, number of sexual partners, number of drug-injecting sexual partners, number of sexual intercourse while high on alcohol and/or other drugs, number of times trading sex for drugs and/or money, proportion of all sexual acts involving protection, and overall HIV-related sexual risk. The results showed that more than one-third of the women (36.3%) experienced some form of sexual abuse during childhood, whereas 34.4% reported that they had been abused sexually during adolescence; 1 in 5 women (18.4%) stated being abused during both periods. The results further indicate that there is a strong link between sexual abuse victimization early in life and involvement later in life in HIV-related sexual risk behaviors. It was found out that certain forms of sexual abuse, such as forced exposure and touching of one's sexual parts were more strongly related than other forms of sexual abuse to subsequent involvement in HIV-related sexual behaviors.     

Husband's control and sexual coercion within marriage: findings from a population-based survey in Egypt

This article examined sexual coercion within marriage in Egypt. Using cross-sectional survey data from a representative sample of married Egyptian women (N = 5,240), associations between forced intercourse and husband's control, as well as other relevant sociodemographic factors, were assessed through binary logistic regression models. The lifetime prevalence of forced intercourse was 6.2% and 4.6% during the past year, and husband's control was significantly associated with forced intercourse during a woman's lifetime (odds ratio = 3.5) and past year (odds ratio = 2.8). Interventions addressing gender patriarchy and men's control may decrease incidence of sexual coercion in Egypt and similar contexts.     

上海流动人口已婚育龄妇女家庭暴力发生情况及与不良妊娠结局关系的研究

目的:了解上海流动人口已婚育龄妇女家庭暴力的发生情况、种类构成、表现形式和发生频率及与不良妊娠结局的关系。方法:在上海市某中心城区采用以社区为基础的多阶段整群抽样方法对符合条件的流动人口已婚育龄妇女进行问卷调查。结果:共收回有效问卷958份。调查对象曾经遭受的总家庭暴力发生比例为40.0%,以精神暴力最为常见,其次为控制行为和身体暴力,性暴力的发生比例相对较低。在遭受过家庭暴力的对象中,约33.3%的对象同时遭受2种以上的暴力。精神暴力、身体暴力和性暴力最常见的形式分别是"故意瞪眼睛或摔东西吓唬/恐吓"、"粗暴地推/撞/拖"和"采用非暴力手段逼迫同房",且最近一年这3种暴力形式发生次数≥2次的比例分别达60.5%、63.6%和72.2%。曾经遭受身体暴力或性暴力的对象死胎和自然流产发生比例显著高于未遭受过任何暴力者(P0.05)。结论:流动人口已婚育龄妇女的家庭暴力发生情况不容乐观,且会导致受暴妇女死胎和自然流产发生率增加,应采取措施降低其发生比例,以保护妇女的权益。     

Sexual behavior and activity in Chinese pregnant women

OBJECTIVE: To evaluate sexual activities, attitudes, and complications related to intercourse among Chinese pregnant women and to study their source of the information. METHODS: This was a prospective cross-sectional study. Two hundred and ninety-eight Chinese pregnant women were recruited. Pregnant women completed a self-administered questionnaire anonymously. Their sexual experience and sexuality were analyzed and compared among trimesters. Multiple logistic regression was used to assess the association of various factors with a number of outcomes concerning the sexuality in pregnancy. RESULTS: Ninety-three percent of the pregnant women reported an overall reduction in their sexual activities during pregnancy. Among these activities, vaginal intercourse significantly decreased in the third trimester. Besides gestation, advanced maternal age and nulliparity were independent factors associated with the reduction of vaginal intercourse (P < 0.001). Moreover, over 60% of the women, as well as more than 40% of their partners, had reduction in sexual desire and enjoyment during pregnancy. Over 80% of the women and their partners worried about the adverse effects of sexual activity on the fetus. However, less than 12% of them experienced complications after coitus during pregnancy. Among them, only 9.4% discussed sexuality with their doctors and half of them raised up this topic by themselves. CONCLUSION: Chinese pregnant women had less sexual activities and desire during pregnancy. Culture, inadequate knowledge, and excessive anxiety are likely the important factors for the marked reduction in sexuality in Chinese couples. Medical staffs should take a proactive role in providing more information to relieve their anxiety.     

Contributions of physical and sexual abuse to women's experiences with chronic pelvic pain

OBJECTIVE: To examine the roles of physical and sexual abuse in women with chronic pelvic pain using multi-dimensional pain assessment and to compare the chronic pelvic pain experiences of women with physical abuse to those of women with sexual abuse. STUDY DESIGN: Structured questionnaires were used to measure self-reported abuse, pain severity, psychological distress, physical functioning, interpersonalfunctioning, and coping in 63 women attending a tertiary care gynecologic clinic for diagnosis and treatment of chronic pelvic pain. RESULTS: Women with chronic pelvic pain who reported abuse demonstrated significantly more psychological distress than did women who reported no abuse, but there were no differences in pain severity, physical functioning, interpersonal functioning or coping. Women with physical abuse reported more overall psychological distress, depression, anxiety and somatization than women who reported no physical abuse. Women who reported sexual abuse showed more overall psychological distress and anxiety than women who reported no sexual abuse. While physical abuse was more consistently associated with psychological distress than was sexual abuse, both types of abuse were risk factors for distress. CONCLUSION: These results suggest that both physical and sexual abuse are associated with psychological distress in women with chronic pelvic pain but not with other domains of pain experience. Additional research to improve identification and treatment of women with both chronic pelvic pain and abuse is indicated.     

Effects of domestic violence on preterm birth and low birth weight

BACKGROUND: Domestic violence is increasingly recognized as a potentially modifiable risk factor for adverse pregnancy outcomes. This study was conducted to evaluate the relationship between abuse during pregnancy or within the last year and low birth weight and preterm birth. METHODS: From 1997 to 2001, 3149 low income, relatively low-risk pregnant women (82% African-American) participated in this prospective study. The Abuse Assessment Screen, a validated screening tool, which assesses emotional, physical or sexual abuse, injuries due to physical abuse and physical abuse in the index pregnancy, was filled out by 3103 women. RESULTS: Of the women screened, 26.6% reported emotional abuse, 18.7% reported physical abuse in the past year and 10.3% women reported being beaten, bruised, threatened with a weapon or being permanently injured. Abuse during pregnancy was reported by 5.9% of the women. Low birth weight and preterm birth occurred in 10.9% and 10.2% of the pregnant women, respectively. Logistic regression analyzes indicated that injury due to physical abuse within the past year was significantly associated with both preterm birth [adjusted odds ratio (AOR) = 1.6, 95% confidence interval (CI) = 1.1-2.3] and low birth weight (AOR = 1.8, 95% CI = 1.3-2.5) after adjusting for other covariates. The mean birth weight of infants born to women who were injured due to physical abuse was significantly lower (-75.2 g, p = 0.04) than the mean birth weight of infants of women who were not injured. CONCLUSION: These results indicate that in our population, injuries resulting from physical abuse are associated with both low birth weight and preterm birth.     

Prenatal behavioral risk screening by computer in a health maintenance organization-based prenatal care clinic

Cigarette smoking, alcohol and drug abuse, and stressful life events are significant contributors to prematurity and low birth weight in the United States. Identification and treatment of pregnant women with these risk factors require obtaining complete and accurate psychosocial histories. The purpose of this study was to determine whether a computer interview developed by our staff is appropriate for assessing behavioral risk factors for adverse pregnancy outcomes and for educating pregnant women about healthy behaviors during pregnancy. This computer interview asks about pregnant patients' perceived life stressors, diet, use of cigarettes and alcohol, and abuse of drugs. The study population consisted of 201 medically insured Hispanic and non-Hispanic white women attending a health maintenance organization--based prenatal clinic. Almost all subjects rated the computer interview favorably. Medical record reviews were conducted to compare participants' reports of cigarette, alcohol, and drug use obtained from paper-and-pencil interviews with behaviors reported during the computer interview. Although self-reported rates of smoking did not differ between the two interview techniques, a much higher percentage of women reported alcohol and drug use during the computer interview. Study participants scored significantly higher on a test measuring knowledge of the effects of stress, diet, and substances of abuse on pregnancy than did a control group. Results demonstrated the potential value of computer-interactive software programs for assessing high-risk behaviors among pregnant women in this population and educating them about healthy behaviors during pregnancy.     

Prevalence of sexual abuse among women seeking gynecologic care in Germany

OBJECTIVE: To estimate the prevalence of sexual abuse among patients seen for gynecologic care in Germany. METHODS: A short anonymous questionnaire was distributed to 1157 women attending a gynecologic outpatient clinic at a large urban teaching hospital. Data collected using the questionnaire included patient characteristics, sexual abuse history, and screening practices. Women who reported that they had been abused were asked if they had ever discussed the issue with their gynecologist. RESULTS: A total of 1075 questionnaires were returned, for a response rate of 92.9%. Almost half (n = 479 [44.6%]) of the women surveyed reported that they had been the subject of unwanted sexual attention. One fifth (n = 216 [20.1%]) had been forced to engage in sexual activities: 6.8% in childhood, 10.3% during adolescence, 6.4% as an adult, and 3.5% across more than one stage. Thirteen women (6%) reported having discussed the abuse with their gynecologist. Sixty-six (30.5%) were too afraid to raise the issue, and 119 (55.1%) stated it was not relevant to their care. Only one woman (0.5%) reported that her gynecologist had asked about sexual abuse. CONCLUSION: Despite the high prevalence of sexual abuse among women seeking gynecologic care, routine screening does not appear to be part of standardized practice.     

The prevalence of violence investigated in a pregnant population in Sweden

All women registered for antenatal care within a Swedish municipality during a 6-month period were assessed regarding acts of violence. The Abuse Assessment Screen was used on two occasions during pregnancy, and once between 4 and 20 weeks after delivery. The efficacy of repeated interviews was investigated, and characteristics of abused and non-abused women were compared. The participation rate was 93% (1038 women). Physical abuse by a close acquaintance or relative during or shortly after pregnancy was reported by 1.3%, and by 2.8% when the year preceding pregnancy was included. The lifetime prevalence of emotional, physical or sexual abuse was 19.4%. Repeated questioning increased the detection of abuse. Women abused during pregnancy reported more preceding ill-health and more elective abortions than non-abused women. Intervention against sexual violence has been on the political agenda in Sweden for several decades. Even so, physical abuse is a risk factor comparable in frequency to obstetric complications such as gestational diabetes and pre-eclampsia. Routines need to be established to make questioning about violence an integral part of the standardized screening for risk factors during pregnancy.     

The invisible wounds: the occurrence of psychological abuse and anxiety compared with previous experience of physical abuse during the childbearing year.

The aim of this study was to measure the prevalence, effects and character of psychological abuse in women visiting antenatal clinics. A standardized questionnaire based on four different established scales (PMWI, SVAW, TSC-33, and STAI) was used to estimate the frequency of psychological, physical and sexual abuse, anxiety and depression. In the study 207 pregnant Swedish born women married to or cohabiting with Swedish born men were consecutively chosen from three different antenatal clinics from the city of G?teborg, Sweden. Personal interviews were conducted in connection to their regular visit to the antenatal clinic, ranging from the first to the third trimester. Fifty-one (24.5%) women out of 207 reported threats and/or acts of violence during the last year according to the Severity of Violence Against Women Scale (SVAW). There was 89.4% who had experienced dominance/isolation according to the Psychological Maltreatment of Women Inventory (PMWI) and 44.4% of the women reported emotional/verbal abuse. Occupational status, but not age income or education, was found to be significantly correlated to physical violence, dominance/isolation and to emotional/verbal factor according to Psychological Maltreatment of Women Inventory (PMWI). Threats of moderate violence' and 'serious violence' were strongly correlated to physical violence (correlation coefficient 0.9433 and 0.9405, respectively). Sexual abuse demonstrated a high correlation to physical violence and emotional/verbal factor. The results indicate that sexual violence is highly represented in the abusive relationship and also that depression and anxiety in the childbearing year may be caused by domestic violence. This study emphasises the importance of incorporating screening for threats and actual acts of psychological, physical and sexual abuse into routine care for women, enabling health care providers to identify high-risk patients and improve quality of care.     

Risk factors for hepatitis B infection during pregnancy in a Nigerian obstetric population.

We aimed to assess the risk factors for hepatitis B infection among pregnant women in Enugu, southeast Nigeria. This was a prospective case-control study of risk factors for hepatitis B surface antigen positivity among pregnant women seen in two tertiary health institutions in Enugu, southeast Nigeria. It was carried out over an 8-month period, January - August 2005. Of the 1,499 pregnant women attending the antenatal clinic, 4.6% (n = 69) were seropositive for hepatitis B surface antigen. A total of 35 (50.7%) HBsAg positive women and 71 negative controls were interviewed. The risk factors for HBsAg were present in 71% (n = 25) of the positive cases, while only 27% (n = 19) of the negative cases had risk factors. The significant risk factors for HBsAg positivity were higher mean parity, higher number of sexual partners since sexual debut, polygamy and previous positive history of sexually transmitted diseases (STD) (p < 0.05). The two groups did not differ with respect to presence of tattoo or scarification marks, positive history of jaundice or contact with a jaundiced patient, previous blood transfusion or contact with blood products, intravenous drug abuse or sharing personal instruments (p > 0.05). Screening pregnant women for hepatitis B infection on the basis of presence of risk factors may not effective. Universal antenatal screening for HBsAg, health education aimed at reducing risk factors and immunisation of all newborn and those at risk of hepatitis B is advocated.     

The prevalence of emotional abuse in gynaecology patients and its association with gynaecological symptoms

AIM: To determine the lifetime prevalence of emotional abuse in a population of women attending a gynaecology outpatient clinic and also to investigate whether women who reported emotional abuse were more likely to complain of certain gynaecological symptoms. SETTING: A gynaecology outpatient clinic in a North of England Hospital. METHODS: Anonymous confidential questionnaire given to women. RESULTS: Nine hundred and twenty consecutive women were included, 825 questionnaires were returned (90% response rate). The prevalence of emotional abuse was 24% (198/825). Emotional abuse is four times less common in women over 50 years old. Of the fifteen presenting symptoms reported by the women, referral for termination of pregnancy, cervical smear abnormality, worry about cancer and urinary incontinence were significantly more common in the group who reported emotional abuse. The women with emotional abuse also had significantly more consultations; however, the duration of their symptoms was not significantly different. CONCLUSION: The prevalence of emotional abuse in a group of women attending the gynaecology outpatient clinic in a North of England Hospital was 24%. Women who are subjected to emotional abuse tend to have more consultations and are more likely to complain of certain symptoms.     

Prevalence of physical and sexual abuse before and during pregnancy among Swedish couples

BACKGROUND: To estimate the prevalence of threats and actual acts of physical and sexual abuse during pregnancy. METHODS: Two hundred and seven pregnant Swedish women married to or cohabiting with Swedish men were randomly selected from three antenatal clinics in the city of G?teborg, Sweden. A standardized questionnaire was used for personal interviews about the women's experience of physical and sexual abuse by a husband or a boyfriend at some point in the past, during the last year and during current pregnancy. RESULTS: Twenty-seven point five percent of the women reported that they had been exposed to physical violence at some point in the past by their husband/boyfriend. Twenty-four and a half percent of the women had experienced some form of threat, physical or sexual violence during the last year. At some time (once or more) during their current pregnancy, the proportions of women who had been exposed to the following categories of violence, were as follows: 14.5%-symbolic violence, 14.5%-threats of mild violence, 2.9%-threats of moderate violence, 2.9%-threats of serious violence, 11%-mild violence, 4.3%-minor violence, 2.4%-moderate violence, 4.3%-serious violence and 3.3%-sexual violence. CONCLUSIONS: This study demonstrates that a considerable number of women had experienced threats, physical and sexual abuse during pregnancy. There is an obvious need for screening of experience of domestic violence among pregnant women to enhance the safety of women and their unborn babies.     

The prevalence of domestic violence in pregnant women

Objective To determine the prevalence of domestic violence in a population of pregnant women.
Design Questionnaire survey.
Setting Antenatal booking clinic in a north of England hospital.
Population Five hundred consecutive women were included.
Methods Anonymous confidential questionnaire to women who were not accompanied by their partners.
Main outcome measures Disclosure of a past history of physical, emotional or sexual abuse.
Results Four hundred and seventy-five questionnaires were returned (95% response rate). The prevalence of domestic violence was 17%. Domestic violence was highest in the age group 26–30 years and boyfriends were the main perpetrators. Punching and slapping were the most common pattern of violence, and 10% of women experiencing domestic violence had had forced sexual activity.
Conclusion The prevalence of domestic violence in a cohort of pregnant women in the north of England was 17%. Consideration should be given for routine screening for domestic violence in pregnancy to institute effective intervention strategies.     

Sexual violence among pregnant women in India

AIM: To discover the extent of sexual violence during pregnancy, its correlation to various variables and effects, and to consider future possibilities for creating awareness in health providers, health seekers and communities for prevention. METHODS: Two thousand pregnant women were interviewed using a semi-structured, pre-designed, pre-tested questionnaire with some open-ended questions in the local language. RESULTS: Of 2000 women, 1959 (97.95%) reported that they had had sex with their partners during the current pregnancy. Of the 2000, 615 (30.7%) women had not wished to have sex during the pregnancy, but had been forced to do so. CONCLUSION: Women suffer with recurrent marital rape during pregnancy with considerable after effects. This sexual violence takes place irrespective of education or socioeconomic status.     

Abuse disclosure in privately and medicaid-funded pregnant women

Disclosure of abuse by pregnant women can vary depending on whether the woman is assessed directly by a trained interviewer versus written questionnaires, and if she is asked repeatedly during the course of pregnancy. One thousand pregnant women were enrolled in a randomized clinical trial designed to assess the effects of a nursing case management intervention on the mental and physical well-being of pregnant women experiencing or at risk for abuse. Thirteen percent of the total study participants reported current abuse and/or abuse within the past year, with only 2% of those reporting that the abuse occurred during pregnancy. The incidence of reported abuse was much higher among Medicaid-funded women (28.9%) than privately insured women (8.7%). Regardless of source of payment, women reporting abuse were significantly younger, less educated, nonwhite with lower income, and had significantly higher stress and lower self-esteem than women not reporting abuse. A high incidence of women reporting intimate partner violence described being choked on the Danger Assessment Screen (34%). We strongly urge that choking be added to routine screening questions used during pregnancy and that the Danger Assessment tool is used for further evaluation of women who screen positive. In addition, we believe another barrier to reporting abuse was fear of being reported to child protective services, contributing to the overall low rate of abuse disclosure.     

Correlation between sexual abuse and somatization in women with somatic and nonsomatic chronic pelvic pain.

After a comprehensive clinical and psychological evaluation, 99 women with pelvic pain of at least 6 months' duration and normal findings at laparoscopy were divided into two groups, including 47 women with probable somatic causes of pain (group 1) and 52 women without identifiable somatic abnormality (group 2). Women without identifiable somatic abnormality (group 2) were younger, had higher mean somatization scores, and reported an earlier mean age at first intercourse, a higher number of total sexual partners, and a higher prevalence of sexual abuse before the age of 20. Within group 2 (nonsomatic pain) but not within group 1, mean somatization scores were significantly higher among women with a history of sexual abuse than among women with a negative history. When analyzed as risks for nonsomatic pelvic pain, the positive predictive value of both a history of sexual abuse and a high somatization score was 78% (relative risk compared with that of women with zero or one risk factor, 2.1; p less than 0.0001). These data suggest that the psychosocial profile of women with nonsomatic pelvic pain differs from that of women with somatic pelvic pain and that previous sexual abuse is a significant predisposing risk for somatization and non-somatic chronic pelvic pain.