Women with disabilities' experience with physical and sexual abuse: review of the literature and implications for the field

Measurement of violence against women and disability: protocol for a scoping review

INTRODUCTION

Violence against women is a serious threat to women's health and human rights globally. Disability has been associated with increased risk of exposure to different forms of violence, however, there are questions concerning how best to measure this association. Research on understanding the association between violence and disability among women has included incorporating short disability measures into violence against women prevalence surveys. The potential to improve understanding of interconnections between violence and disability by measuring violence within disability-focused research is underexplored. The scoping review described here focuses on three areas of measurement of violence against women and disability: (1) measurement of violence within the context of disability-focused research, (2) measurement in research focused on the intersection of disability and violence and (3) measurement of disability in the context of research focused on violence against women. Specifically, we aim to map definitions, measures and methodologies in these areas, globally.

METHODS AND ANALYSIS

For our scoping review, we will conduct searches for quantitative studies of disability-focused research which use measures of violence against women, and measures of disability in research focused on violence against women, in 11 online databases. Two authors will independently review titles and abstracts retrieved through the search strategy. We will search for grey literature, search the websites of National Statistics Offices for all countries to identify any national or subnational disability research and consult with experts for input. Data extraction will be conducted independently by one author and reviewed by another author, and data will be analysed and synthesised using a thematic synthesis approach.

ETHICS AND DISSEMINATION

Ethics approval was not sought as no primary data is being collected. Findings will be disseminated through a publication in a peer-reviewed journal, through coordinated dissemination to researchers, practitioners, data users and generators and through various working groups and networks on violence against women and disability.

How do programmes to prevent intimate partner violence among the general population impact women with disabilities? Post-hoc analysis of three randomised controlled trials

INTRODUCTION

Women with disabilities experience higher rates of intimate partner violence (IPV) than women without disabilities. There remains limited evidence about whether IPV prevention interventions for the general population have benefits for women with disabilities that compare to those for women without disabilities. Using data from IPV prevention randomised controlled trials in diverse locations (Rwanda, South Africa and Afghanistan), we assess whether outcomes differed by disability status.

METHODS

We assessed disability at baseline in three IPV prevention trials. We performed post-hoc analysis of intervention impacts at endline (22 or 24 months post-baseline) stratified by disability status at study baseline and tested an interaction term for disability at baseline by intervention arm for three sets of outcomes: (1) past year experiences of physical, sexual and severe IPV; (2) economic and livelihood outcomes; and (3) health, mental health and substance use outcomes.

RESULTS

At baseline between 17.7% and 26.2% of women reported being disabled. For IPV prevention, in seven out of eight tests across three studies, women with and without disabilities had similar outcomes. For economic, health and substance use outcomes, there was more variation, with women with disabilities reporting both better and worse outcomes than women without disabilities; however there was no clear pattern in these differential results.

CONCLUSION

IPV prevention programmes targeting general populations can prevent IPV among women with disabilities participants with benefits that mirror those for women without disabilities. Benefits for participants with and without disabilities on secondary programme outcomes related to economic empowerment and health may be more varied and should be explicitly monitored.

Sexual abuse in people with spinal cord damage

Objectives: There are few studies of sexual abuse in people with spinal cord damage (SCD). Objective of this study was to determine the prevalence and impact of sexual abuse in SCD. Design: Survey (web and paper-based). Setting: Australia (August 2013-June 2014). Participants: People with SCD (n = 136); able-bodied controls (n = 220). Interventions: None. Outcome measures: Spinal Cord Injury Secondary Conditions Scale, International SCI Quality of Life Basic Dataset, and the Physical Disability Sexual and Body Esteem scale. Questions regarding demographic and clinical characteristics, sex, sexual orientation, relationship status, disability, sexual interest and satisfaction, and sexual abuse. Results: Most SCD participants were male (n = 92, 67%), the average age was 46 years (SD = 14) and they were median of 11 years (IQR 4-21) after SCD. Of these, 19% (n = 26) reported sexual abuse. Females were much more likely to report being abused (odds ratio 3.3, 95%CI 1.5-7.4; χ²=10.9, P = 0.001). Participants reporting sexual abuse were younger (P = 0.01) and more likely to have been abused before their SCD (69%). There was no significant difference between those with SCD who reported sexual abuse and those who did not regarding their quality of life as a whole (P > 0.1). There was no difference regarding the reporting of sexual abuse between able-bodied and those with SCD (P = 0.1). Conclusion: Sexual abuse was relatively common and was not associated with an adverse relationship with the covariates assessed. Further research is needed to better determine the prevalence of sexual abuse in people with SCD and its impact.

Users of rehabilitation services in 14 countries and territories affected by conflict, 1988-2018

OBJECTIVE

To analyse the demographic and clinical characteristics of people attending physical rehabilitation centres run or supported by the International Committee of the Red Cross in countries and territories affected by conflict.

METHODS

Of 150 such rehabilitation centres worldwide, 38 use an electronic patient management system. We invited all 38 centres to participate. We extracted de-identified data from 1988 to 2018 and categorized them by sex, age, country or territory and reason for using rehabilitation services.

FINDINGS

Thirty-one of the 38 rehabilitation centres in 14 countries and territories participated. We included data for 287 274 individuals. Of people using rehabilitation services, 61.6% (176 949/287 274) were in Afghanistan, followed by 15.7% (44 959/287 274) in Cambodia. Seven places had over 9000 service users each (Afghanistan, Cambodia, Gaza Strip, Iraq, Myanmar, Somalia and Sudan). Overall, 72.6% (208 515/287 274) of service users were male. In eight countries, more than half of the users were of working age (18-59 years). Amputation was the most common reason for using rehabilitation services; 33.3% (95 574/287 274) of users were people with amputations, followed by 13.7% (39 446/287 274) with cerebral palsy. The male predominance was greater in the population aged 18-34 years (83.1%; 71 441/85 997) and in people with amputations (88.6%; 84 717/95 574) but was evident across all places, age groups and health conditions.

CONCLUSION

The considerably lower attendance of females at the rehabilitation centres highlights the need to understand the factors that affect the accessibility and acceptability of rehabilitation for women and girls in conflict settings.

"I Tell Them What I Can Feel and How Far My Legs Can Bend": Optimizing Sexual Satisfaction for Women With Spina Bifida

BACKGROUND

There is a high reported rate of sexual dysfunction among women with spina bifida, but little is known about the etiology of this or how sexual satisfaction could be improved.

AIM

To identify, through the words of women with spina bifida, perceived causes of diminished sexual satisfaction and recommendations to optimize partnered sexual encounters.

METHODS

In this qualitative study, we conducted semi-structured individual interviews with 22 women with spina bifida (median age 26.5 years, range 16-52 years) who have had a romantic partner. Using Grounded Theory, interviews were independently coded by 3 reviewers. Disagreements were resolved by consensus.

OUTCOMES

We identified overlapping themes of issues women experienced during sexual intimacy and strategies they learned to improve sexual encounters.

RESULTS

7 salient themes emerged from the data: (i) fear of rejection with resulting difficulty setting boundaries and the risk of coercion; (ii) conflict between spontaneity and self-care in sexual encounters; (iii) worry about incontinence during sex; (iv) trial and error in learning optimal sexual positions; (v) decreased genital sensation; (vi) safety considerations; and (vii) sharing advice with other women with spina bifida.

CLINICAL IMPLICATIONS

As sexual satisfaction is influenced by physical features as well as psychological, interpersonal, and sociocultural factors, optimizing sexual satisfaction of women with spina bifida is best managed with a holistic approach utilizing a biopsychosocial model.

STRENGTHS & LIMITATIONS

The sample included women with a diverse range of functional impairments. Women were forthright with their comments and thematic saturation was reached. Recruitment was primarily from a single Midwestern institution, which may have limited sampled perspectives.

CONCLUSION

While women with spina bifida encounter challenges during sexual encounters, strategies focused on improving communication with partners and addressing specific physical considerations can potentially enhance their sexual experiences. Streur CS, Schafer CL, Garcia VP, et al. "I Tell Them What I Can Feel and How Far My Legs Can Bend": Optimizing Sexual Satisfaction for Women With Spina Bifida. J Sex Med 2020;17;1694-1704.

Occupational Deprivation Among Female Survivors of Intimate Partner Violence Who Have Physical Disabilities

IMPORTANCE

Women with disabilities face a heightened risk of intimate partner violence (IPV) compared with those without disabilities. The damaging impact of IPV compromises the ability of survivors with disabilities to competently and independently engage in daily occupations.

OBJECTIVE

To examine the impact of occupational deprivation on survivors of IPV who have physical disabilities.

DESIGN

The findings presented in this article are part of a larger qualitative study. Semistructured interviews were conducted over the course of 18 mo, primarily focusing on questions related to four areas: abuse experience and risk assessment, use and nonuse of self-protective strategies, necessary support services, and impact of disability in relation to these phenomena.

SETTING

A nonresidential domestic violence agency serving people with disabilities located in New York City.

PARTICIPANTS

Twenty-five women with physical disabilities receiving services from a domestic violence agency that specializes in assisting people with disabilities.

RESULTS

The findings reported here focus on educational, vocational, financial, and physical barriers to occupational engagement faced by IPV survivors with disabilities.

CONCLUSION AND RELEVANCE

The occupational deprivation experienced by IPV survivors with disabilities can entrap women in abusive relationships, preventing them from independently supporting themselves and their children. Occupational therapy practitioners can provide education and interventions that increase their ability to live independently.

WHAT THIS ARTICLE ADDS

This article provides a novel consideration of how occupational therapy practitioners can help survivors with disabilities escape IPV through occupational engagement.

After Disclosure: A Research Protocol to Respond to Disclosures of Abuse and Sexual Violence in Research With Adults With Intellectual Disabilities

People with intellectual disabilities (ID) have high lifetime risk of abuse and assault, including sexual violence. As adults with ID participate in research, researchers must be prepared for disclosures of past or current abuse. In collaboration with our state's protective agency, we developed a protocol for responding effectively to disclosures of sexual violence from adult research participants with ID. We completed a literature review clarifying best practices for responding to disclosures of abuse by adults with ID. The literature focused on various professionals but we were unable to find evidence clarifying researchers' roles in responding to sexual violence. Working with our state protective services agency, we adapted these practices to develop protocols and an algorithm for responding to disclosure, as well as materials for participants. Our protocol for abuse reporting considers all members of the research team to be mandated reporters, emphasizes informed consent, and details specific steps for responding to disclosures of abuse in the context of research. It represents a collaboration between academic researchers and community partners. Research participation by people with ID may represent an opportunity for disclosure of past or current abuse, and therefore, it is imperative that researchers are equipped to respond effectively. Policy-level responses to prevent abuse and enable justice are also needed; however, ensuring that researchers respond systematically and effectively to disclosures is crucial to the ethical conduct of research with a vulnerable population. We anticipate that the frequency with which researchers will need to use this protocol will depend on the nature of their research. In practice, we recommend including this protocol as part of the overall study protocol and submitting it for Institutional Review Board (IRB) approval. Future research to test our protocol in the field is recommended.

"If Everyone Else Is Having This Talk With Their Doctor, Why Am I Not Having This Talk With Mine?": The Experiences of Sexuality and Sexual Health Education of Young Women With Spina Bifida

INTRODUCTION

Women with spina bifida are sexually active, but most never discuss this topic with providers.

AIM

To determine what women with spina bifida understand about their sexual health, how they learned about it, what questions they have, and their experiences with their sexuality.

METHODS

For this qualitative study, women with spina bifida ages 16 and older without marked developmental delay were individually interviewed. 25 women with spina bifida participated (mean age 27.1 years, range 16-52). Interviews were independently coded for themes by 3 reviewers, using Grounded Theory, with disagreements resolved by consensus.

MAIN OUTCOME MEASURES

We identified overlapping themes regarding the women's perception and experience of their sexuality and sexual health education.

RESULTS

17 of the 25 (68%) participants had been or were currently sexually active. 5 themes emerged regarding their understanding of their sexuality and their sexual experiences: (i) being perceived as asexual, (ii) sources for sex education, (iii) need for spina bifida-specific sex education, (iv) impact of spina bifida-specific features on sexual encounters, and (v) perceived relationship between low sexual self-confidence and risk for sexual assault.

CLINICAL IMPLICATIONS

Women with spina bifida are sexual beings, but they are perceived as asexual by providers, which prevents them from getting adequate sexual health education and leaves them with misconceptions and unanswered questions, as well as vulnerable to sexual abuse.

STRENGTH & LIMITATIONS

The strengths of this study include the diversity of women interviewed, including their age, severity of disability, and experiences with their sexuality, as well as the ability to reach thematic saturation. The limitation of this study is that most women received treatment at a single Midwestern tertiary referral center in the United States.

CONCLUSION

Including sexual health discussions in the usual care of women with spina bifida is critical to enhancing their sexual confidence and experience and preventing sexual abuse. Streur CS, Schafer CL, Garcia VP, et al. "If Everyone Else Is Having This Talk With Their Doctor, Why Am I Not Having This Talk With Mine?": The Experiences of Sexuality and Sexual Health Education of Young Women With Spina Bifida. J Sex Med 2019;16:853-859.

Disability, sexual orientation, and the mental health outcomes of intimate partner violence: A comparative study of women in the U.S

BACKGROUND

Research on disabled non-heterosexual women's post-intimate partner violence mental health outcomes-such as anxiety, depression, suicidal ideation, and alcohol use-is lacking.

OBJECTIVE

To examine the impact of the intersection of disability and sexual orientation on women's post-intimate partner violence mental health outcomes: including difficulty sleeping, missing school or work, or reporting some post-traumatic stress disorder symptomology and a self-reported subjective measure of overall wellbeing.

METHODS

Data come from the National Intimate Partner and Sexual Violence Survey (2010). A series of chi-square analyses were conducted (applying standardized sample weights and adjusting standard errors for both clustering and stratification for survey data).

RESULTS

Bisexual women are significantly more likely than straight women to report being disabled prior to victimization, but all disabled women-regardless of sexual orientation-are equivalently likely to rate their mental health as poor and/or actively experience difficulty sleeping, difficulty going to work or school, and/or PTSD.

CONCLUSIONS

Aligned with previous work, this study finds that bisexual women are significantly more likely than straight women to be disabled prior to experiencing all forms of intimate partner violence; and that disabled women, generally, are significantly more likely than not-disabled women to experience the negative mental health consequences of that violence. However, contrary to previous work, there are no sexual orientation disparities in said mental health outcomes among disabled women. Clinically, it is important for health care providers to be aware of the significant impact of intimate partner violence on the disabled women they regularly provide care to.

Intimate Partner Violence among Women with Disabilities in Uganda

Violence against women with disabilities is pervasive, yet a paucity of research examines intimate partner violence (IPV) experienced by women with disabilities in low- and middle-income countries. The purpose of this study is to document the prevalence and consequences of IPV exposure among Ugandan women with disabilities. Cross sectional data from the 2011 and 2016 Uganda Demographic and Health Surveys (UDHS) were used to study married and/or partnered women aged 15⁻49 who answered specific questions about lifetime intimate partner violence (N = 8592). Univariate and multivariate logistic regression models were used to investigate the relationship between disability, IPV, and indicators of maternal and child health. Compared to women without disabilities, women with disabilities were more likely to experience lifetime physical violence (odds ratio (OR) 1.4, p < 0.01), sexual violence (OR = 1.7, p < 0.01), and emotional abuse (1.4, p < 0.01) after controlling for sociodemographic and household characteristics. Study findings suggest that women with disabilities in Uganda may experience increased risk for IPV compared to women without disabilities, with concomitant risks to their health and the survival of their infants. Further research examining the prevalence and correlates of IPV in low- and middle-income countries is needed to address the needs and rights of women with disabilities.

In pursuit of intimacy: disability stigma, womanhood and intimate partnerships in South Africa

Notions of womanhood inculcate naturalised ideologies of femininity, sexuality, motherhood and caregiving. The paper asks how disability stigma intersects with womanhood to characterise intimate partnerships in South Africa. In-depth interviews with 30 women with a range of disabilities were conducted in informal settlements in Cape Town. Findings suggest that disability stigma may hamper attainment of normative womanhood and sexual relationships for women with disabilities in South Africa. Limited opportunities to meet potential partners, hegemonic gender expectations and restricted sexual and physical contact shape their intimate partnerships. However, women with disabilities also challenge ableist constructs of normalcy and discredit negative images of disabled womanhood. Because of this, theoretical models of intimate partner violence should consider the influence of disability on constructions of sexuality and norms in intimate partnerships. Building on women with disabilities' stigma-avoidance strategies will help facilitate better relationship outcomes. Social norms interventions with broader society, communities, women with disabilities and their partners, family and carers can help destabilise assumptions that women with disabilities are unable to have long-lasting and fulfilling sexual and intimate partnerships. Moreover, accessible and relevant sexuality education and information on relationships, intimate partner violence, maternal and sexual and reproductive health care can ensure healthy and safe intimate partnerships for women with disabilities.

Prevalence and sequelae of self-reported and other-reported sexual abuse in adults with intellectual disability

BACKGROUND

Sexual victimisation is an important problem that affects millions of people around the world, especially those with some kind of disability. The aim of this study was to determine the prevalence of self-reported and documented sexual abuse in people with mild or moderate intellectual disability and to analyse the sequelae that such experiences can have on their psychosocial health.

METHODS

The sample consisted of 360 adults (50% men and 50% women) between 18 and 55 years of age (M = 39.87; standard deviation = 10.55).

RESULTS

The prevalence of sexual abuse is 6.10% when it is self-reported (9.4% in women and 2.8% in men) and 28.6% when it is reported by professionals (27.8% in women and 29.4% in men). People who self-report cases of abuse present poorer quality of life, more negative attitudes towards sex and a lower capacity to identify situations that entail a risk of sexual abuse. Individuals who have suffered documented cases of abuse are more likely to present encopresis, social isolation, self-harm and a higher number of suicide attempts.

CONCLUSIONS

Our results evidence the need to have access to all sources of information so as to be able to obtain prevalence figures that match the real situation and to perform a proper analysis of the sequelae.

Additional Layers of Violence: The Intersections of Gender and Disability in the Violence Experiences of Women With Physical Disabilities in South Africa

South Africa has unprecedented levels of violence and many South African women are exposed to violence during their lifetime. This article explores how gender and disability intersect in women's experiences of violence during their lifetime. Repeat in-depth qualitative interviews with 30 physically disabled women in Cape Town reveal that women with physical disabilities are exposed to various forms of violence, and shows how their impairments shape their violence experiences. The most common forms of violence women with disabilities experience are psychological violence, financial abuse, neglect, and deprivation, with disability stigma playing a central role and contributing to how women with disabilities are exploited and dehumanized. Constructions of women as asexual shape their sexual relationships and experiences of sexual violence. This article identifies that women with disabilities are more at risk and experience additional layers of violence than women without disabilities. These additional risks and layers of violence need to be recognized and inform interventions to prevent and respond to violence against women with disabilities in the country. Prevention of violence against women with physical disabilities in South Africa needs to address the role of disability stigma that shapes the types of violence they experience, change gender norms, and create accessible and safe environments and economic empowerment opportunities.

Implementation of intimate partner violence education for adolescents with spina bifida

OBJECTIVE

Intimate partner violence (IPV) prevention among adolescent patients with disability is needed, yet rarely discussed in the clinical setting. This study evaluated the feasibility of implementing a brief educational training based on an evidence-based IPV intervention in a pediatric spina bifida clinic. Frequency of IPV discussion was assessed through evaluation of patient feedback and provider surveys.

METHODS

Adolescent patients with spina bifida aged 12-21 completed after visit surveys before (N= 13) and after the provider training (N= 21). Primary outcomes included frequency of provider discussion about IPV and receipt of patient safety cards. Chi-square tests compared patient feedback prior to and two months following the education session. Provider knowledge and attitude changes were assessed with pre-post surveys.

RESULTS

More patients discussed IPV with providers following the education session compared to baseline (p= 0.03). Provider feedback, both immediately and at two months after the education session showed increased awareness of IPV, comfort with assessment, disclosure, and referral to resources.

CONCLUSIONS

The educational intervention increased provider comfort with addressing IPV within a specialty clinical setting. The frequency of IPV communication significantly increased as compared to baseline, patients reported the discussions were beneficial, and providers reported greater comfort discussing IPV and referring patients to resources.

Associating disabilities, school environments, and child victimization

Inclusive education has become one of the key policy objectives for the education for children with disabilities in recent decades. However, its effectiveness in promoting happy school life among those children has been questioned. In this study, we aimed to provide a detailed profile of the associations between disabilities and child victimization, and to examine the effects of school environments on those associations. We conducted a cross-sectional survey with a sample of 4114 school-aged children (6-18 years), who were receiving primary or secondary education in Hong Kong in 2016-2017. Children's experiences of 7 types of victimization in the past year, status of disabilities, type of school attending, and other demographic factors were captured with questionnaire completed by the children or their parents. Apart from descriptive statistics, we conducted logistic regression analyses to examine the associations between disabilities, types of school, and child victimization. Children with ADHD, internalizing disorder, autistic spectrum disorder, and restrictions in body movement were at higher risks of victimization while other types of disabilities were not. Children attending special schools were at lower risks of victimization, while children with disabilities who had been placed in ordinary schools for inclusive education were at higher risks of most types of victimization when compared to children without disabilities. Our findings suggested an important role of the school environments on the associations between disabilities and victimization. When placed in a protective environment, children with disabilities could even be less vulnerable to victimization than those without disabilities.

Prevalence and psychological sequelae of sexual abuse among individuals with an intellectual disability: A review of the recent literature

The impact of sexual abuse among those with an intellectual disability is an area in need of further research. The current article provides an in-depth narrative review of the sexual abuse literature relevant to individuals with an intellectual disability. The 29 articles included in this study focused on (a) the prevalence of sexual abuse, (b) the risk factors associated with this population, and (c) the psychological impact of abuse. The findings confirmed that children and adults with an intellectual disability are at a higher risk of sexual abuse than nondisabled peers. Research regarding risk factors is equivocal, with a range of possible factors indicated. Similarly, evidence suggests that there is no single diagnostic trajectory when dealing with the sequelae of sexual abuse among those with an intellectual disability. The article concludes by discussing recommendations for future research and development of policy around this area.

Sexual assaults in individuals with visual impairment: a cross-sectional study of a Norwegian sample

OBJECTIVE

To examine the prevalence of sexual assaults among individuals with visual impairment (VI) compared with the general population and to investigate the association between sexual assault and outcomes of self-efficacy and life satisfaction.

DESIGN

Cross-sectional interview-based study conducted between February and May 2017.

PARTICIPANTS

A probability sample of adults with VI (≥18 years) who were members of the Norwegian Association of the Blind and Partially Sighted. A total of 736 (61%) members participated, of whom 55% were of female gender. We obtained norm data for sexual assaults from a representative survey of the general Norwegian population.

OUTCOME MEASURES

Sexual assaults (Life Event Checklist for DSM-5), self-efficacy (General Self-Efficacy Scale) and life satisfaction (Cantril's Ladder of Life Satisfaction).

RESULTS

The prevalence of sexual assaults (rape, attempted rape and forced into sexual acts) in the VI population was 17.4% (95% CI 14.0 to 21.4) among women and 2.4% (95% CI 1.2 to 4.7) among men. For women, the VI population had higher rates of sexual assaults across age strata than the general population. For men, no significant differences were found. In the population of people with VI, the risk of sexual assault was greater for those having other impairments in addition to the vision loss. Individuals with VI who experienced sexual assaults had lower levels of self-efficacy (adjusted relative risk (ARR): 0.18, 95% CI 0.05 to 0.61) and life satisfaction (ARR: 0.31, 95% CI 0.19 to 0.50) than others.

CONCLUSIONS

The risk of experiencing sexual assault appears to be higher in individuals with VI than in the general population. Preventive measures as well as psychosocial care for those who have been exposed are needed.

Supporting female survivors of intimate partner violence with disabilities: Recommendations for social workers in the emergency department

Intimate partner violence (IPV) is a pervasive problem with grave consequences. Women with disabilities are among the most vulnerable groups disproportionately affected, with higher IPV rates than either women without disabilities or men with disabilities. The emergency department (ED) in particular affords a gateway into health services for female survivors of IPV, placing ED social workers in a prime position to observe potential signs of IPV and connect survivors to further assistance. This article explores the critical role ED social workers can fill in addressing the needs of female survivors of IPV with disabilities. We begin by providing background on the characteristics of IPV among women with disabilities, followed by a discussion of the opportunities and challenges inherent to assessing and intervening with survivors. We conclude by outlining recommendations for working with female survivors of IPV with disabilities in EDs, using our previous research on the topic as a guide.

The Interface Between Violence, Disability, and Poverty: Stories From a Developing Country

People with disabilities are vulnerable to multiple forms of violence in their everyday lives, including structural violence, deprivation, and physical, emotional, and sexual exploitation. Despite increasing reports of violence against people with disabilities, little is known about this phenomenon, especially in the context of poverty. Furthermore, the various types of violence have traditionally been studied in isolation, which has led to a limited understanding of the nature and persistence of violence in society, and has affected our understanding of the relationship between different forms of violence. In this article, we explore the relationship between violence, disability, and poverty among people living in a rural area of South Africa. Thirty adults with a variety of disabilities living in 12 rural villages in the Mpumalanga Province of South Africa participated in the study. Each of the participants was provided with an opportunity to tell their life story. Narrative inquiry and participant observation were used to explore the ways in which violence pervades the participants' everyday experiences. Results were analyzed using thematic analysis and suggest that in the context of poverty, it is impossible to separate the experience of disability from the experience of violence. Structural violence was shown to underpin all other forms of interpersonal violence, making persons with disabilities vulnerable to additional forms of exploitation, and serve to further isolate people with disabilities from society, compromising both health and human rights. The findings suggest that an understanding of contextual factors is fundamental to understanding the relationship between violence and disability.

Promises of protection? Article 16 of the Convention on the Rights of Persons with Disabilities and gender-based violence in South Africa

Article 16 of the Convention on the Rights of Persons with Disabilities (CRPD) guarantees persons with disabilities freedom from exploitation, violence and abuse. This article explores the current status of implementation of article 16 in South Africa, with specific reference to the legislative framework underpinning protection from exploitation, violence and abuse. This investigation is done specifically in the context of gender-based violence, which remains a cause of great concern in this country.

The sexuality of young women with intellectual and developmental disabilities: A neglected focus in the American foster care system

Youths with intellectual and developmental disabilities (ID/DD) are overrepresented in the American foster care system and experience heightened rates of pregnancy compared to their nondisabled peers. Yet limited information is known about sexually active or pregnant young women with ID/DD in foster care. Consequently, important healthcare needs of this population are not adequately addressed. This article explores sexuality education and sexual healthcare for female adolescents in foster care with ID/DD and recommends practice guidelines to support and prepare their emergent sexual development.

Intimate partner violence in women with disabilities: perception of healthcare and attitudes of health professionals

PURPOSE

Intimate partner violence (IPV) is a major social problem and public health issue, but we still have a relatively small amount of data about partner violence in women with disabilities. The main objective of this study was to understand the experiences of women with disabilities who are or have been abused by their partners and to explore the knowledge, views and training requirements of primary care professionals.

METHOD

Qualitative study using semi-structured interviews with women with disabilities who had experienced IPV (n = 14), and focus groups with healthcare professionals (n = 16).

RESULTS

Women with disabilities suffer specific forms of abuse. Because they depend on the people around them to take action, they are subordinate and this can prolong the abuse. The healthcare staff frequently mentioned that it is often difficult to notice that women with disabilities are being abused. Their lack of training about disabilities and gender-based violence makes them less sure of their ability to identify and deal with any possible cases of abuse.

CONCLUSIONS

The difficulties described by the women interviewed are broadly speaking the same as those described by the healthcare professionals consulted. A number of suggestions for improvements are provided based on the results found. Implications for Rehabilitation The rehabilitation of abused disabled women implies that women perceive the health system as a resource to resolve their situation. Healthcare professionals should be trained on how to detect, treat and communicate with disabled women who experience partner violence. Is needed to establish a comprehensive system of coordination between services involved in caring for abused women and with disabilities.

Effectiveness of IMPACT:Ability to Improve Safety and Self-Advocacy Skills in Students With Disabilities-Follow-Up Study

BACKGROUND

Research shows that individuals with disabilities are more likely to experience abuse than their peers without disabilities. Yet, few evidenced-based abuse prevention interventions exist. This study examines whether positive outcomes identified previously in an evaluation of IMPACT:Ability were maintained 1 year later.

METHODS

A survey measuring safety and self-advocacy knowledge, confidence, and behaviors among special education high-school students was administered 12 months post-training. Paired samples t-tests were used to compare baseline to follow up and postsurvey to follow up and repeated measures analyses were conducted to test the effect of time across the 3 time points (baseline, post, and 1-year follow up) (N = 47).

RESULTS

Follow-up study participants had a range of disabilities, just over half were boys, and most were either black or Latino/Hispanic. Difference between scores at baseline and follow-up for all the measures of interest represented gains from baseline. Statistically significant post-training improvements in participants' safety and self-advocacy knowledge and confidence were maintained 1-year later.

CONCLUSIONS

These results provide additional support for the case that IMPACT:Ability is a promising safety and self-advocacy training program for diverse groups of students with disabilities.

Experience of domestic violence routine screening in Family Planning NSW clinics

BACKGROUND

This study reviewed implementation of the Domestic Violence Routine Screening (DVRS) program at Family Planning NSW and outcomes of screening to determine the feasibility of routine screening in a family planning setting and the suitability of this program in the context of women's reproductive and sexual health.

METHODS

A retrospective review of medical records was undertaken of eligible women attending Family Planning NSW clinics between 1 January and 31 December 2015. Modified Poisson regression was used to estimate prevalence ratios and assess association between binary outcomes and client characteristics.

RESULTS

Of 13440 eligible women, 5491 were screened (41%). Number of visits, clinic attended, age, employment status and disability were associated with completion of screening. In all, 220 women (4.0%) disclosed domestic violence. Factors associated with disclosure were clinic attended, age group, region of birth, employment status, education and disability. Women who disclosed domestic violence were more likely to have discussed issues related to sexually transmissible infections in their consultation. All women who disclosed were assessed for any safety concerns and offered a range of suitable referral options.

CONCLUSION

Although routine screening may not be appropriate in all health settings, given associations between domestic violence and sexual and reproductive health, a DVRS program is considered appropriate in sexual and reproductive health clinics and appears to be feasible in a service such as Family Planning NSW. Consistent implementation of the program should continue at Family Planning NSW and be expanded to other family planning services in Australia to support identification and early intervention for women affected by domestic violence.

Exploring the Experiences of Abuse of College Students With Disabilities

Intimate partner violence and sexual assault of college students has garnered increased attention and publicity. Current studies have focused primarily on general campus populations with little to no attention to students with disabilities. While studies suggest the rate of abuse of individuals with disabilities is similar or higher compared to the general population, there remains a lack of focus on this issue. Individuals with disabilities are at particularly high risk for abuse, both through typical forms of violence (physical, sexual, emotional, and economic) and those that target one's disability. In an effort highlight and explore this issue further, an exploratory study was conducted to learn the rates of abuse among university students who have identified as having a disability. This is a cross-sectional survey of 101 students of students with disabilities from a large northeastern public university. Experiences of abuse were measured through the use of the Abuse Assessment Screen- Disability (AAS-D) scale. Students were asked about experiences of physical, sexual, psychological, and disability related abuse within the last year and help seeking behaviors when an incident of abuse occurred. We found that 22 % of participants reported some form of abuse over the last and nearly 62% (n= 63) had experienced some form of physical or sexual abuse before the age of 17. Those who were abused in the past year, 40% reported little or no knowledge of abuse-related resources and only 27% reported the incident. Authors discuss implications results have for programs and policies on campus for individuals with disabilities.

Risk factors associated with domestic abuse directed at adults with disabilities in South Korea

BACKGROUND

Most research on domestic abuse and disability has focused on women with disabilities, while research on abuse against men with disabilities and their risk factors is virtually non-existent.

OBJECTIVE

The purpose of this research is to understand domestic abuse experienced by people with disabilities by investigating its prevalence and risk factors.

METHOD

This research used the National Survey on Persons with Disabilities (2011). Using a stratified sampling method, 5259 respondents were identified to make up the final sample. Ordered logistic regression was used to verify risk factors for abuse.

RESULTS

Risk factors for women with disabilities are age, educational attainment level, ADL, experiences of discrimination, awareness of disability discrimination, external support, and satisfaction with number of friends. Risk factors for men with disabilities are region, experiences of discrimination, awareness of disability discrimination, external support, and satisfaction with number of friends. For both women and men with disabilities, more experience of discrimination, greater awareness of disability discrimination, less external support, and less satisfaction with number of friends are associated with a higher likelihood of having experiences of abuse. Men with disabilities living in rural areas have a higher risk of abuse than those living in cities. Younger women, women with lower educational attainment, and those with lower physical functioning are more likely to have experienced abuse.

CONCLUSIONS

Based on these findings, the authors make recommendations designed to protect people with disabilities from domestic abuse.

Disability and Risk of Recent Sexual Violence in the United States

OBJECTIVES

To examine the relative prevalence of recent (past 12 months) penetrative and nonpenetrative sexual violence comparing men and women with and without a disability.

METHODS

Data are from the 2010 National Intimate Partner and Sexual Violence Survey, a national telephone survey of US adults, and includes an expansive measure of sexual violence victimization. A total of 9086 women and 7421 men completed the telephone survey in 2010.

RESULTS

Compared with persons without a disability, persons with a disability were at increased risk for recent rape for women (adjusted odds ratio = 3.3; 95% confidence interval = 1.6, 6.7), and being made to penetrate a perpetrator for men (adjusted odds ratio = 4.2; 95% confidence interval = 1.6, 10.8). An estimated 39% of women raped in the 12 months preceding the survey had a disability at the time of the rape. For women and men, having a disability was associated with an increased risk of sexual coercion and noncontact unwanted sexual experiences.

CONCLUSIONS

In this nationally representative sample, men and women with a disability were at increased risk for recent sexual violence, compared to those without a disability.

Ethnoracial Variation in Women's Exposure to Intimate Partner Violence

While intimate partner violence (IPV) has been acknowledged as a national public health concern, little research exists that directly assesses differential exposure to IPV for distinct ethnoracial groups. The current study compared the rate, severity, and type of IPV exposure across samples of White, African American, and Latina women (N = 180). Participants reported rates of exposure to violence on measures of physical assault, psychological aggression, injury, and sexual coercion; each subscale contained items denoting both mild and severe levels of violence. Multiple regression analyses indicated that women's frequency of exposure to sexual coercion, and severe and injurious violence significantly differed based on participants' ethnoracial identification, such that Latina women experienced disproportionate levels of violence relative to White and African American peers. Mothers' monthly income, level of education, general health, and relationship status also emerged as significant predictors of violence exposure. Results support the development of culturally sensitive adaptations of IPV interventions, targeting not only Latina populations but also women who are single, low-income, and educationally underserved.

Intimate Partner Victimization Among College Students With and Without Disabilities: Prevalence of and Relationship to Emotional Well-Being

Prior research indicates that both college students and individuals with disabilities are at an increased risk of experiencing intimate partner victimization (IPV). However, little is known about IPV risk and its relationship to emotional well-being among the intersection of these two populations. Utilizing a sample of approximately 20,000 college students from the American College Health Association's (ACHA) National College Health Assessment II (NCHA II), this study focuses on this overlooked intersection by examining IPV among college students with disabilities. Multivariate binary logistic regression models were used to estimate the relationship among disability, IPV, and emotional well-being. College students with disabilities were approximately twice as likely to experience IPV than their counterparts without disabilities. Students with mental disabilities and multiple disability types were found to have the greatest likelihood of experiencing IPV. Victims with disabilities were more likely than victims without disabilities to report experiencing depression symptoms, self-harm behavior, and stress. Recommendations for reducing and preventing IPV among a college student population are discussed.

Accessibility and Responsiveness Review Tool: community agency capacity to respond to survivors with disabilities

For persons with disabilities who have experienced trauma in the forms of abuse and violence, options for accessible and trauma-informed services are often limited. Using a self-assessment and planning process, disability service providers and victim/survivor service providers are able to strategize ways of addressing the needs of survivors with disabilities. The Accessibility and Responsiveness Review Tool (Review Tool) incorporates the principles of universal design and trauma-informed practices into an agency-wide discussion tool leading to increases in knowledge, reduction in barriers, and overall improved programs for survivors with disabilities. Results of agencies that participated in the Review Tool process are presented.

Factors Contributing to Sexual Violence at Selected Schools for Learners with Mild Intellectual Disability in South Africa

BACKGROUND

This paper reports part of the findings of a study which exposed sexual violence in schools for learners with mild intellectual disability in South Africa. Special attention was paid on factors contributing to such a problem.

METHODS

Data were collected using focus groups and individual interviews with 16 learners with mild intellectual disability at two special schools in South Africa. This was followed by individual interviews with the school nurse and social worker, and an analysis of schools' books of incidents.

RESULTS

Factors contributing to sexual violence at schools for learners with mild intellectual disability included: (i) peer pressure, (ii) concealment of reported incidents of sexual violence, (iii) unsupervised areas linked to schools and (iv) arranged relationships.

CONCLUSION

The following suggestions are put forth: (i) awareness programmes, (ii) sensitization of teachers about the consequences and prevention of sexual violence, (iii) boundaries within which the arranged relationship occurs, (iv) intensification of sexuality education and (v) supervision around the school premises.

The association between disability and intimate partner violence in the United States

PURPOSE

Prior research has shown that people with disabilities are at greater risk of intimate partner violence (IPV) victimization. This study seeks to examine the link between disability and IPV in a nationally representative sample of U.S. women and men. Also, by establishing that disability preceded recent IPV victimization, this study allows for a more thorough understanding of whether people with disabilities are at greater risk of victimization subsequent to having a disability.

METHODS

Data were analyzed from the 2010 National Intimate Partner and Sexual Violence Survey, an ongoing, national random digit dial telephone survey of U.S. adults. Estimates of age-adjusted 12-month IPV prevalence by disability status were calculated.

RESULTS

Compared to women without a disability, women with a disability were significantly more likely to report experiencing each form of IPV measured, which includes rape, sexual violence other than rape, physical violence, stalking, psychological aggression, and control of reproductive or sexual health. For men, significant associations were found with respect to stalking and psychological aggression by an intimate partner.

CONCLUSIONS

The results suggest that people with a disability are at greater risk of victimization and that primary and secondary prevention efforts might be targeted to those with a disability.

Genito-anal injury patterns and associated factors in rape survivors in an urban province of South Africa: a cross-sectional study

Background

The prevalence of genito-anal injuries in rape survivors varies significantly and the factors associated with the absence of injuries are not well understood. This plays a major role in the conviction of cases as the absence of injury is equated with a lack of assault. In such cases, health care providers face major challenges in presenting and defending their findings. The aim of this paper is to describe the absence of genito-anal injuries by site in a group of rape survivors and to identify factors associated with the absence of these injuries.

Methods

In a cross-sectional study rape cases reported to the police in one province in South Africa were randomly sampled using a two stage sampling procedure. Data were obtained on the survivor, the circumstances of the rape and the findings of the medicolegal examination. Descriptive statistics were conducted for the prevalence of genito-anal injuries by site and logistic regression models were built to identify factors associated with the absence of genito-anal injuries for all survivors and those reported to be virgins.

Results

In the sample of 1472 women injuries ranged from 1% to 36%. No significant injuries were reported for 749 (51%) survivors. In the multivariable model there was a significantly lower odds of having no injuries in survivors who were virgins, those raped by multiple perpetrators and those examined by a doctor with additional qualifications. In the model for survivors who were virgins, those with disabilities had a greater odds of having no injuries while those between the ages of 8 and 17 years had a lower odds of having no injuries compared to survivors below four years of age.

Conclusions

This study found that being a virgin, multiple perpetration rape and the examiner’s qualifications were significantly associated with the absence of genito-anal injuries. Health providers should thus be aware that in all other respects there was no difference in survivors who had injuries and those who did not. It is important to reiterate the message that the presence of injuries does not necessarily prove that rape occurred nor does the absence disprove the fact.

Effectiveness of the IMPACT:Ability program to improve safety and self-advocacy skills in high school students with disabilities

BACKGROUND

Individuals with disabilities experience higher rates of abuse than the nondisabled. Few evidence-based prevention interventions have been published despite a need for such work. This study evaluated

IMPACT

Ability, a safety and self-advocacy training for individuals with cognitive and/or physical disabilities.

METHODS

A quasi-experimental design was used to assess change in safety and self-advocacy knowledge, confidence, and behaviors among special education high school students in Boston, MA. Instruments were interviewer-administered at 3 time points. Analysis of covariance (ANCOVA) was used to compare change between the intervention (N = 21) and wait-list (N = 36) groups. Repeated measures analysis was used to test change in the complete sample (N = 57).

RESULTS

Students were diverse (58% males, 82% nonwhite) with a range of disabilities. Significantly greater improvement in key outcomes, including safety and self-advocacy knowledge, confidence, and behavior, were observed in intervention students compared to the wait-list group. Results in the complete sample showed evidence of further improvements in students' sense of safety and general self-efficacy.

CONCLUSIONS

These findings are encouraging given the effects were demonstrated in a heterogeneous urban population.

IMPACT

Ability may be an effective safety and self-advocacy training for students with disabilities. Further research will be required to determine effectiveness within particular subpopulations of students.

Access and utilisation of maternity care for disabled women who experience domestic abuse: a systematic review

Background

Although disabled women are significantly more likely to experience domestic abuse during pregnancy than non-disabled women, very little is known about how maternity care access and utilisation is affected by the co-existence of disability and domestic abuse. This systematic review of the literature explored how domestic abuse impacts upon disabled women’s access to maternity services.

Methods

Eleven articles were identified through a search of six electronic databases and data were analysed to identify: the factors that facilitate or compromise access to care; the consequences of inadequate care for pregnant women’s health and wellbeing; and the effectiveness of existing strategies for improvement.

Results

Findings indicate that a mental health diagnosis, poor relationships with health professionals and environmental barriers can compromise women’s utilisation of maternity services. Domestic abuse can both compromise, and catalyse, access to services and social support is a positive factor when accessing care. Delayed and inadequate care has adverse effects on women’s physical and psychological health, however further research is required to fully explore the nature and extent of these consequences. Only one study identified strategies currently being used to improve access to services for disabled women experiencing abuse.

Conclusions

Based upon the barriers and facilitators identified within the review, we suggest that future strategies for improvement should focus on: understanding women’s reasons for accessing care; fostering positive relationships; being women-centred; promoting environmental accessibility; and improving the strength of the evidence base.

Violence against people with disability in England and Wales: findings from a national cross-sectional survey

Background

The recent World Report on Disability highlighted violence as a leading cause of morbidity among disabled people. However, we know little about the extent to which people with disability experience different violence types, and associated health/economic costs. The recent introduction of disability measures into the England&Wales victimization survey provided an opportunity to address this gap.

Methods and Findings

Analysis of the 2009/10 British Crime Survey (BCS), a nationally representative cross-sectional survey of 44,398 adults living in residential households in England&Wales. Using multivariate logistic regression, we estimated the relative odds of being a victim of past-year violence (physical/sexual domestic or non-domestic violence) in people with disability compared to those without, after adjusting for socio-demographics, behavioural and area confounders. 1256/44398(2.4%) participants had one or more disabilities including mental illness (‘mental illness’) and 7781(13.9%) had one or more disabilities excluding mental illness (‘non-mental disability’). Compared with the non-disabled, those with mental illness had adjusted relative odds (aOR) of 3.0(95% confidence interval (CI) 2.3–3.8) and those with non-mental disability had aOR of 1.8(95% CI: 1.5–2.2) of being a victim of past-year violence (with similar relative odds for domestic and non-domestic violence). Disabled victims were more likely to suffer mental ill health as a result of violence than non-disabled victims. The proportion of violence that could be attributed to the independent effect of disability in the general population was 7.5%(CI 5.7–9.3%), at an estimated cost of £1.51 billion. The main study limitation is the exclusion of institutionalised people with disability.

Conclusions

People with disability are at increased risk of being victims of domestic and non-domestic violence, and of suffering mental ill health when victimized. The related public health and economic burden calls for an urgent assessment of the causes of this violence, and national policies on violence prevention in this vulnerable group.

Assessment and psychotherapy with women experiencing intimate partner violence: integrating research and practice

Intimate partner violence (IPV) is a serious, pervasive problem; however, professional literature focused on psychotherapy for women experiencing IPV is limited. This article delineates reasons why there is a dearth of literature on this topic. It then provides guidelines for assessment and practice, focusing on issues and approaches unique to women experiencing IPV. For assessment, the therapist should gather information on the type of IPV the client experiences, the relationship dynamics involved, and the availability of the client's social support network. Discussion of the client's developmental history, including any history of child maltreatment and violence in early dating relationships is also relevant. Assessment of the client's current mental health functioning is essential and will include a consideration of common psychological sequelae that can result from IPV. Treatment should include safety planning as well as reducing minimization of the abuse. In addition, treatment should address potential IPV-related emotion dysregulation and splitting.