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The Mount Sinai Journal of Medicine,... 2011Intimate partner violence--physical, psychological, or sexual abuse of women perpetrated by intimate partners--is one of the most common forms of violence against women,... (Review)
Review
Intimate partner violence--physical, psychological, or sexual abuse of women perpetrated by intimate partners--is one of the most common forms of violence against women, and is associated with adverse women's reproductive and maternal health outcomes. We review the opportunities for addressing intimate partner violence by the health system, examine promising approaches, and outline future challenges for developing effective health-systems responses to violence. Evidence shows that women seldom approach support services in response to violence, but do seek health care at some point in their lives. In fact, women's utilization of reproductive-health services in particular has been increasing globally. These services have a broad reach and represent an important opportunity to engage in violence prevention. Although health systems-based responses to intimate partner violence have emerged, rigorous evaluations to guide program planning and policy efforts to reduce violence are limited. Programs in the United States have expanded from improving individual provider prevention practices to instituting system-wide changes to ensure sustainability of these practices. Developing-country program responses, though limited, have been system-wide and multisectoral right from the start. Our review highlights 3 challenges for developing and expanding health-systems responses to violence. First, interventions should focus on creating a supportive environment within the health system and strengthening linkages across health care and allied sectors. Second, rigorous evaluations of health sector-based interventions are needed for a sound evidence base to guide programmatic and policy decisions. Finally, research is needed to identify the entry points for engaging men on violence prevention, and to examine the feasibility and effectiveness of such interventions.
Topics: Delivery of Health Care; Female; Global Health; Health Services; Humans; Public Health; Spouse Abuse
PubMed: 21598270
DOI: 10.1002/msj.20259 -
The British Journal of General Practice... Apr 2006Intimate partner abuse is very common among female patients in family practice. In general, doctors overlook the possibility of partner abuse. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Intimate partner abuse is very common among female patients in family practice. In general, doctors overlook the possibility of partner abuse.
AIM
To investigate whether awareness of intimate partner abuse, as well as active questioning, increase after attending focus group and training, or focus group only.
DESIGN OF STUDY
Randomised controlled trial in a stratified sample.
SETTING
Family practices in Rotterdam and surrounding areas.
METHOD
A full-training group (n = 23), a group attending focus group discussions alone (n = 14), and a control group (n = 17) were formed. Data were collected with incident reporting of every female patient (aged >18 years) that was suspected of, or presented, partner abuse during a period of 6 months. The primary outcome measure was the number of reported patients; the secondary outcome measure was the number of patients with whom the GP had non-obvious reasons to suspect/discuss abuse.
RESULTS
Comparison of the full-training group (n = 87 patients) versus the control group (n = 14 patients) resulted in a rate ratio of 4.54 (95% confidence interval [CI] = 2.55 to 8.09, P <0.001); the focus group only group (n = 30 cases) versus control group: rate ratio of 2.2 (95% CI = 1.14 to 4.26, P = 0.019); full-training versus the focus group only group: rate ratio of 2.19 (95% CI = 1.36 to 3.52, P = 0.001). Comparison of the fulltraining group with the untrained groups for awareness of partner abuse in case of non-obvious signs resulted in: odds ratio 5.92 (95% CI = 2.25 to 15.62, P <0.01) all corrected for sex, district, practice setting, working part/full-time, experience, and age of the doctor.
CONCLUSIONS
Training was the most significant determinant to improve awareness and identification of intimate partner abuse. Active questioning increased, especially where there were non-obvious signs. The focus group on its own doubled the awareness of partner abuse.
Topics: Adult; Attitude of Health Personnel; Clinical Competence; Education, Medical, Continuing; Family Practice; Female; Focus Groups; Humans; Male; Middle Aged; Netherlands; Physician-Patient Relations; Socioeconomic Factors; Spouse Abuse
PubMed: 16611512
DOI: No ID Found -
PloS One 2015Intimate partner violence (IPV) is an important global public health problem. While there is a growing literature on the association between IPV and women's reproductive... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Intimate partner violence (IPV) is an important global public health problem. While there is a growing literature on the association between IPV and women's reproductive health (RH) outcomes, most studies are cross-sectional-which weakens inference about the causal effect of IPV on women's RH. This systematic review synthesizes existing evidence from the strongest study designs to estimate the impact of IPV on women's use of contraception.
METHODS
We searched 11 electronic databases from January of 1980 to 3 December 2013 and reviewed reference lists from systematic reviews for studies examining IPV and contraceptive use. To be able to infer causality, we limited our review to studies that had longitudinal measures of either IPV or women's use of contraception.
RESULTS
Of the 1,574 articles identified by the search, we included 179 articles in the full text review and extracted data from 12 studies that met our inclusion criteria. We limited the meta-analysis to seven studies that could be classified as subject to low or moderate levels of bias. Women's experience of IPV was associated with a significant reduction in the odds of using contraception (n = 14,866; OR: 0.47; 95% CI: 0.25, 0.85; I2 = 92%; 95% CII2: 87%, 96%). Restricting to studies that measured the effect of IPV on women's use of partner dependent contraceptive methods was associated with a reduction in the heterogeneity of the overall estimate. In the three studies that examined women's likelihood of using male condoms with their partners, experience of IPV was associated with a significant decrease in condom use (OR: 0.48; 95% CIOR: 0.32, 0.72; I2 = 51%; 95% CII2: 0%, 86%).
CONCLUSIONS
IPV is associated with a reduction in women's use of contraception; women who experience IPV are less likely to report using condoms with their male partners. Family planning and HIV prevention programs should consider women's experiences of IPV.
Topics: Contraception; Cross-Sectional Studies; Female; Humans; Interpersonal Relations; Male; Odds Ratio; Sexual Partners; Spouse Abuse; Women's Health
PubMed: 25693056
DOI: 10.1371/journal.pone.0118234 -
BMJ (Clinical Research Ed.) May 2014To examine the effectiveness of screening for intimate partner violence conducted within healthcare settings to determine whether or not screening increases... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To examine the effectiveness of screening for intimate partner violence conducted within healthcare settings to determine whether or not screening increases identification and referral to support agencies, improves women's wellbeing, decreases further violence, or causes harm.
DESIGN
Systematic review and meta-analysis of trials assessing effectiveness of screening. Study assessment, data abstraction, and quality assessment were conducted independently by two of the authors. Standardised estimations of the risk ratios and 95% confidence intervals were calculated.
DATA SOURCES
Nine databases searched up to July 2012 (CENTRAL, Medline, Medline(R), Embase, DARE, CINAHL, PsycINFO, Sociological Abstracts, and ASSIA), and five trials registers searched up to 2010.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Randomised or quasi-randomised trials of screening programmes for intimate partner violence involving all women aged ≥ 16 attending a healthcare setting. We included only studies in which clinicians in the intervention arm personally conducted the screening, or were informed of the screening result at the time of the consultation, compared with usual care (or no screening). Studies of screening programmes that were followed by structured interventions such as advocacy or therapeutic intervention were excluded.
RESULTS
11 eligible trials (n=13,027) were identified. In six pooled studies (n=3564), screening increased the identification of intimate partner violence (risk ratio 2.33, 95% confidence interval 1.39 to 3.89), particularly in antenatal settings (4.26, 1.76 to 10.31). Based on three studies (n=1400), we detected no evidence that screening increases referrals to domestic violence support services (2.67, 0.99 to 7.20). Only two studies measured women's experience of violence after screening (three to 18 months after screening) and found no reduction in intimate partner violence. One study reported that screening does not cause harm.
CONCLUSIONS
Though screening is likely to increase identification of intimate partner violence in healthcare settings, rates of identification from screening interventions were low relative to best estimates of prevalence of such violence. It is uncertain whether screening increases effective referral to supportive agencies. Screening does not seem to cause harm in the short term, but harm was measured in only one study. As the primary studies did not detect improved outcomes for women screened for intimate partner violence, there is insufficient evidence for screening in healthcare settings. Studies comparing screening versus case finding, or screening in combination with therapeutic intervention for women's long term wellbeing, are needed to inform the implementation of identification policies in healthcare settings.
Topics: Adult; Female; Humans; Mass Screening; Referral and Consultation; Social Support; Spouse Abuse; Women's Health Services
PubMed: 24821132
DOI: 10.1136/bmj.g2913 -
Journal of Interpersonal Violence Apr 2005The past two decades have seen an explosion in research in the fields of violence and trauma and behavior genetics. These two fields came into direct conflict when... (Review)
Review
The past two decades have seen an explosion in research in the fields of violence and trauma and behavior genetics. These two fields came into direct conflict when Lisabeth Fisher DiLalla and Irving I. Gottesman outlined a fundamental conceptual limitation of trauma and violence research: that rather than being causal, the well-documented relationship between exposure to trauma or violence and later negative outcomes could be explained by gene-environment correlation. In the past decade, researchers have addressed this limitation by studying the effects of trauma and violence using genetically informative designs. This report briefly discusses the gains made from this research approach and the promising future for genetically informative trauma and violence research.
Topics: Female; Genetic Predisposition to Disease; Humans; Male; Models, Psychological; Research Design; Risk Factors; Sex Offenses; Sexual Partners; Social Environment; Spouse Abuse; Stress Disorders, Post-Traumatic; United States
PubMed: 15722508
DOI: 10.1177/0886260504267759 -
Public Health Reports (Washington, D.C.... 2006In this article, the authors consider the empirical status of batterer intervention programs (BIPs) for male perpetrators of intimate partner violence (IPV). Recent... (Review)
Review
In this article, the authors consider the empirical status of batterer intervention programs (BIPs) for male perpetrators of intimate partner violence (IPV). Recent reviews have reported only small average effect sizes for BIPs, with the small number of randomized trials showing little benefit of BIP attendance in preventing future abuse. The most widely adopted BIP intervention model has little empirical justification to support this dominance, yet states with standards governing the content of BIPs often mandate this approach as a contingency for state funding. Little data exist concerning the moderators and mediators of BIP effects on IPV recidivism, and a variety of factors threaten to impede future design advancements, including "turf" battles regarding the causes of IPV and limited funding outlets. Given this discouraging summary, the authors argue that research efforts concerning BIP effectiveness should borrow the design strategies and programmatic research efforts that have proven successful in psychotherapy research, in which significant advances have been made with regard to the evaluation and validation of empirically supported treatments for a wide variety of mental health problems. They conclude by calling for a new generation of IPV researchers to work across professional boundaries in a multidisciplinary manner to design the sophisticated evaluation studies that funding agencies would readily support, and that would provide the substantive answers to the many IPV-related public health questions that remain.
Topics: Battered Women; Behavioral Research; Biomedical Research; Female; Gender Identity; Humans; Interprofessional Relations; Male; Psychotherapy; Sexual Partners; Spouse Abuse
PubMed: 16827438
DOI: 10.1177/003335490612100405 -
Gaceta Sanitaria 2004The present study aims to review the problem of intimate partner violence, as well as its causes and consequences. It will also specifically analyze the role of health... (Review)
Review
The present study aims to review the problem of intimate partner violence, as well as its causes and consequences. It will also specifically analyze the role of health professionals. In opposition to the classical epidemiological view of risk factors, Heise proposes an ecological framework to study violence against women. This framework analyzes the interplay among the personal, situational and sociocultural factors that combine to cause abuse. Regarding the frequency of intimate partner violence in Spain, in January 2003 there were 2.519 formal complaints and 69 women died between January and November 2003. No geographical patterns in mortality or the incidence of formal complaints of intimate partner violence or among the provinces with the highest incidence of formal complains and those with highest mortality were observed. The only national survey published in Spain was performed by the Women's Institute in 1999, which reported a prevalence of domestic violence of 9.2%. A frequency of 22.8% was found in a primary health care center in Granada. Health services can play a key role in helping victims of domestic violence, since most women contact the health services at some time in their lives. Professionals in administrative or managerial positions can contribute to raising awareness of this health problem, which is one of the main causes of poor health and disability. Evidently, beyond consciousness-raising and early detection campaigns, public health strategies should be designed to prevent this serious health problem the causes of which can be changed.
Topics: Battered Women; Cultural Characteristics; Female; Humans; Socioeconomic Factors; Spouse Abuse; Women's Health; Women's Health Services
PubMed: 15171840
DOI: 10.1157/13061990 -
Acta Medica Iranica May 2016In some relationships, pregnancy is a risk factor for intimate partner violence (IPV). We present a case of a 34-year-old, 28-week-pregnant woman who was admitted to the...
In some relationships, pregnancy is a risk factor for intimate partner violence (IPV). We present a case of a 34-year-old, 28-week-pregnant woman who was admitted to the emergency department with multiple traumas due to IPV. Her husband had hit her with a power cable after abusing methamphetamine. There were multiple ecchymoses and lacerations on her body. On questioning, the patient revealed a low socioeconomic status. The couple had been married for five years, and the abuse began 11 months earlier, after the husband became addicted to methamphetamines. In this instance of abuse, the husband was suspicious of the wife's pregnancy and believed that the child had been fathered by another man. Her husband's methamphetamine abuse had resulted in previous incidences of non-physical IPV, but, in the present incident, the combination of abuse coupled with partner jealousy resulted in physical abuse. During admission, there were no significant changes to the patient's health, and the fetus was deemed to be healthy and unharmed. After discharge, the patient decided to divorce her abusive husband. Screening and counseling for interpersonal and domestic violence is especially recommended during pregnancy to protect the mother and her fetus. In Iranian civil law, IPV is regarded as "osr-o-haraj" or severe and intolerable hardship, and women may cite it as grounds for divorce in cases such as spousal drug addiction and certain forms of spousal abuse. When intimate partner assault is repeated and petition for khula is presented to the courts, the court can order the man to divorce his wife and, if he refuses, the court judge can grant the khula without the husband's consent.
Topics: Adult; Female; Humans; Incidence; Iran; Male; Pregnancy; Pregnancy Complications; Risk Factors; Spouse Abuse; Substance-Related Disorders
PubMed: 27309485
DOI: No ID Found -
Journal of Women's Health (2002) Jan 2015The effects of intimate partner violence (IPV) on maternal and neonatal outcomes are multifaceted and largely preventable. During pregnancy, there are many opportunities...
The effects of intimate partner violence (IPV) on maternal and neonatal outcomes are multifaceted and largely preventable. During pregnancy, there are many opportunities within the current health care system for screening and early intervention during routine prenatal care or during episodic care in a hospital setting. This article describes the effects of IPV on maternal health (e.g., insufficient or inconsistent prenatal care, poor nutrition, inadequate weight gain, substance use, increased prevalence of depression), as well as adverse neonatal outcomes (e.g., low birth weight [LBW]), preterm birth [PTB], and small for gestational age [SGA]) and maternal and neonatal death. Discussion of the mechanisms of action are explored and include: maternal engagement in health behaviors that are considered "risky," including smoking and alcohol and substance use, and new evidence regarding the alteration of the hypothalamic-pituitary-adrenal axis and resulting changes in hormones that may affect LBW and SGA infants and PTB. Clinical recommendations include a commitment for routine screening of IPV in all pregnant women who present for care using validated screening instruments. In addition, the provision of readily accessible prenatal care and the development of a trusting patient-provider relationship are first steps in addressing the problem of IPV in pregnancy. Early trials of targeted interventions such as a nurse-led home visitation program and the Domestic Violence Enhanced Home Visitation Program show promising results. Brief psychobehavioral interventions are also being explored. The approach of universal screening, patient engagement in prenatal care, and targeted individualized interventions has the ability to reduce the adverse effects of IPV and highlight the importance of this complex social disorder as a top priority in maternal and neonatal health.
Topics: Adult; Female; Humans; Infant Welfare; Infant, Newborn; Maternal Welfare; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Prenatal Care; Spouse Abuse; United States; Young Adult
PubMed: 25265285
DOI: 10.1089/jwh.2014.4872 -
PloS One 2020Pakistan and other developing countries need to address disparities in maternal health care and factors associated with it. This justifies tracking the progress on two...
Utilization of maternal healthcare services in women experiencing spousal violence in Pakistan: A comparative analysis of 2012-13 and 2017-18 Pakistan Demographic Health Surveys.
BACKGROUND
Pakistan and other developing countries need to address disparities in maternal health care and factors associated with it. This justifies tracking the progress on two important indicators 'spousal violence' and 'maternal health care utilization' to improve maternal health and achieve Sustainable Development Goals (SDGs) for these nations.
OBJECTIVE
The objective of this study is to compare the data from the latest two Demographic Health Surveys of Pakistan to identify trends in prevalence of various forms of spousal violence and maternal healthcare utilization and to determine the predictive role of spousal violence in poor maternal health.
METHODS
We conducted a retrospective analysis of nationally representative data from the 2012-13 and 2017-18 PDHS. The data used in this analysis is from the domestic violence module and core women's questionnaire. Spousal violence and sociodemographic background were predictor variables. Terminated pregnancy, number of pregnancy losses, number of antenatal visits for last birth and institutional delivery for last birth were taken as indicators of maternal health. Logistic regression analysis was conducted to test for association between maternal health indicators and various forms of spousal violence after controlling for sociodemographic variables.
RESULTS
Almost one quarter of women experienced physical and emotional violence as revealed by both surveys. Binary analysis revealed that all forms of spousal violence significantly associate with maternal health variables in both surveys. The comparison of results on logistic regression analysis showed that odd ratios were relatively higher for 2012-13 as compared to 2017-18 PDHS. Logistic regression analysis from 2017-18 data showed that experience of less severe physical violence (OR = 1.26; 95% CI, 1.08-1.47), severe physical violence (OR = 1.41; 95% CI, 1.09-1.83), sexual violence (OR = 1.39; 95% CI, 1.02-1.89), physical violence during pregnancy (OR = 1.37; 95% CI, 1.07-1.76) augment the risk of terminated pregnancy. Emotional violence decreases the likelihood for institutional delivery (OR = 0.64; 95% CI, 0.45-0.93) and above than four antenatal visits (OR = 0.54; 95% CI, 0.37-0.79).
CONCLUSIONS
Strategies to prevent spousal violence should be at the core of maternal health programs because health sector provides a platform to challenge social norms and promote attitudes that disapprove spousal violence which are essential for promoting gender equality, women empowerment (SDG 3) and improve maternal health (SDG 5).
Topics: Adolescent; Adult; Demography; Facilities and Services Utilization; Female; Humans; Maternal Health Services; Middle Aged; Pakistan; Socioeconomic Factors; Spouse Abuse
PubMed: 32976544
DOI: 10.1371/journal.pone.0239722