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Bright M, Amendola A, Roussos-Ross D. Maternal Mortality Review Committees should take a closer look at homicide deaths. Am J Obstet Gynecol 2024; 231:143-146. [PMID: 38565477 DOI: 10.1016/j.ajog.2024.02.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/09/2024] [Accepted: 02/26/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Melissa Bright
- Center for Violence Prevention Research, Gainesville, FL.
| | | | - Dikea Roussos-Ross
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL
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2
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Musa-Maliki AU, Duma SE. Barriers to routine screening for intimate partner violence during pregnancy in Nigeria. Heliyon 2024; 10:e30504. [PMID: 38742052 PMCID: PMC11089367 DOI: 10.1016/j.heliyon.2024.e30504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 05/16/2024] Open
Abstract
Background The benefits of routine screening for intimate partner violence (IPV) among pregnant women include early identification, prompt management, referral of IPV victims, and creating awareness about IPV. Despite these benefits, the practice of routine screening of IPV remains limited in midwifery settings in low-income countries. The purpose of this study is to identify and describe midwives' perspectives of the barriers in conducting routine screening of IPV for pregnant women in northern Nigeria. Methods A case study qualitative descriptive design was used to collect data from ten midwives in the antenatal clinic of a tertiary hospital. Non-participant observation and individual face-to-face semi-structured interviews were used as data collection methods. Thematic data analysis was carried out using Yin's five stage analytical cycle. Findings Three themes, with related subthemes, emerged from the data: (i) The theme of "Internal" barriers to IPV screening has four subthemes; midwives' personal discomfort in asking IPV- related questions, perceived mistrust of midwives by pregnant women, midwives' own perceptions of IPV as a personal matter, and midwives' lack of skills to screen for IPV. (ii) "External" barriers to IPV screening subsumes three subthemes: antenatal card related barriers, workload related barriers, and protocol barriers. (iii) "Structural" barriers to IPV screening have two subthemes: lack of space for privacy and lack of resources for managing pregnant women who have experienced IPV. Conclusion Knowing the barriers to midwives' screening practices is important because it may help in the development of contextually relevant and acceptable screening guidelines for midwives in Nigeria. Education and training of midwives will eliminate the internal barriers while the external barriers will need the intervention of hospital authorities and government to eliminate their effects on screening.
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Affiliation(s)
| | - Sinegugu E. Duma
- School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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3
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Huang RS, Spence AR, Abenhaim HA. Non-Obstetric Maternal Mortality Trends by Race in the United States. Matern Child Health J 2024; 28:895-904. [PMID: 38147278 DOI: 10.1007/s10995-023-03862-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES Public health interventions to reduce maternal mortality have largely focused on obstetric causes of death. However, previous studies have noted that non-obstetrics factors, such as motor vehicle accidents, substance overdoses, homicides, and suicides, may account for a large proportion of maternal deaths. The study objective was to examine trends in maternal deaths from non-obstetric causes across races in the United States (US). METHODS A population-based cross-sectional study was conducted on 80,710,348 live births using data from the "Birth Data" and "Mortality Multiple Cause" files compiled by the Centers for Disease Control and Prevention from 2000 to 2019. The annual incidence of maternal deaths attributed to non-obstetric causes (/100,000 live-births) during pregnancy and up to 42 days postpartum were calculated across racial groups. Then the effects of race on the risk of non-obstetric maternal mortality and temporal changes over the study period were examined using logistic regression models. RESULTS From 2000 to 2019, a total 7,334 women died during pregnancy, childbirth, and within 42 days postpartum from non-obstetric causes, representing 34.5% (7,334/21,241) of all maternal mortality. Of non-obstetric deaths, 31.3% were caused by transport accidents and 27.3% by accidental poisoning. American Indian women were found to have the highest risk of non-obstetric maternal mortality (OR 2.20,95% CI 1.90-2.56), and 46.1% (176/382) of all deaths among pregnant American Indian women were caused by non-obstetric complications. Risk of non-obstetric maternal mortality increased overall during the 20-year study period, with a greater increase among Black (1.15, 1.13-1.17) and American Indian women (1.17, 1.13-1.21). CONCLUSION Non-obstetric causes of death have become increasingly prevalent in the US, especially in American Indian women. Novel interventions to address these non-obstetric factors should especially target American Indian women to improve maternal outcomes.
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Affiliation(s)
- Ryan S Huang
- Division of Experimental Medicine, McGill University, Montreal, QC, Canada
| | - Andrea R Spence
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Haim A Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, 5790 Cote-Des Neiges, Pav. H 325, Montreal, QC, H3S 1Y9, Canada.
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4
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Wei X, Wang W, Law YW, Zhang H. The Impacts of Intimate Partner Violence on Postpartum Depression: An Updated Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2024; 25:1531-1550. [PMID: 37480328 DOI: 10.1177/15248380231188068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
The associations between intimate partner violence (IPV) and postpartum depression (PPD) have been well established in previous reviews. However, none has explored potential differences between IPV subtypes or exposure times, which could help healthcare providers recognize the adverse impacts of various IPV subtypes and conduct comprehensive IPV screening. This study aimed to estimate the impacts of overall IPV and its subtypes (physical, psychological, and sexual) on PPD using an updated meta-analysis and to examine the potential role of IPV exposure time and regional income levels. Four English databases (Medline, PsycINFO, PubMed, and Web of Science) and two Chinese databases (China National Knowledge Infrastructure [CNKI] and Wanfang Database) were systematically searched. We included 76 studies with 388,966 samples. Random-effects models were used to pool the odds ratios (ORs) across studies. Overall, IPV and its subtypes had statistically significant impacts on PPD (overall: OR = 2.50, physical: OR = 2.31, psychological: OR = 2.22, sexual: OR = 1.75). A higher impact of IPV on PPD was observed in middle- and low-income regions (OR = 3.01) than in high-income regions (OR = 1.92). IPV during pregnancy (OR = 2.73) had a greater impact on PPD than lifetime IPV (OR = 2.24). This study provides updated evidence for the significant impact of IPV and its subtypes and exposure time on PPD. Women at risk of exposure to physical IPV, especially during pregnancy, are in urgent need of support to reduce the risk of PPD.
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Affiliation(s)
- Xinyi Wei
- The University of Hong Kong, Pokfulam, Hong Kong
| | | | - Yik Wa Law
- The University of Hong Kong, Pokfulam, Hong Kong
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5
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Decker H, Schwab M, Shao S, Kaki D, Melhado C, Cuschieri J, Bongiovanni T. Screening for Intimate Partner Violence in Trauma: Results of a Quality Improvement Project. J Surg Res 2024; 295:376-384. [PMID: 38064979 DOI: 10.1016/j.jss.2023.11.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Intimate partner violence (IPV) is common, especially among patients presenting with traumatic injury. We implemented an IPV screening program for patients admitted after trauma. We sought to determine whether specific demographic or clinical characteristics were associated with being screened or not screened for IPV and with IPV screen results. METHODS Retrospective cohort study evaluating all patients admitted after trauma from July 2020-July 2022 in an Adult Level 1 Trauma Center. RESULTS There were 4147 admissions following traumatic injury, of which 70% were men and 30% were women. The cohort was 46% White, 20% Asian, 15% Black, and 17% other races. Twenty-three percent were Hispanic or Latino/a. Seventy-seven percent were admitted for blunt injuries and 16% for penetrating injuries. Thirteen percent (n = 559) of the cohort was successfully screened for IPV. Screening rates did not differ by gender, race, or ethnicity. After adjustment for demographic and clinical factors, patients admitted to the intensive care unit were significantly less likely to be screened. Of the screened patients, 30% (165) screened positive. These patients were more commonly Hispanic or Latino/a, insured by Medicaid and presented with a penetrating injury. There were no differences in injury severity in patients who screened positive versus those who screened negative. CONCLUSIONS There are significant barriers to universal screening for IPV, including injury acuity, in patients admitted following trauma. However, the 30% rate of positive screens for IPV in patients admitted following trauma highlights the urgent need to understand and address barriers to screening in trauma settings to enable universal screening.
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Affiliation(s)
- Hannah Decker
- Department of Surgery, University of California at San Francisco, San Francisco, California.
| | - Marisa Schwab
- Department of Surgery, University of California at San Francisco, San Francisco, California
| | - Shirley Shao
- Department of Surgery, University of California at San Francisco, San Francisco, California
| | - Dahlia Kaki
- Department of Surgery, University of California at San Francisco, San Francisco, California
| | - Caroline Melhado
- Department of Surgery, University of California at San Francisco, San Francisco, California
| | - Joseph Cuschieri
- Department of Surgery, University of California at San Francisco, San Francisco, California
| | - Tasce Bongiovanni
- Department of Surgery, University of California at San Francisco, San Francisco, California
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6
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Nuwabaine L, Kawuki J, Amwiine E, Asiimwe JB, Sserwanja Q, Gatasi G, Donkor E, Atwijukiire H. Sexual violence and associated factors among women of reproductive age in Rwanda: a 2020 nationwide cross-sectional survey. Arch Public Health 2023; 81:112. [PMID: 37331931 PMCID: PMC10278278 DOI: 10.1186/s13690-023-01109-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/15/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Sexual violence against women is a global public health issue with both short- and long-term effects on the physical and mental health of women. This study aimed to determine the prevalence of sexual violence and its associated factors among women of reproductive age in Rwanda. METHODS We used secondary data from the 2020 Rwanda Demographic and Health Survey of 1,700 participants, who were selected using multistage stratified sampling. Multivariable logistic regression was conducted to explore factors associated with sexual violence using SPSS (version 25). RESULTS Of the 1,700 women of reproductive age, 12.4% (95%CI: 11.0-14.1) had experienced sexual violence. Justified beating (AOR = 1.34, 95%CI: 1.16-1.65), not having health insurance (AOR = 1.46, 95%CI: 1.26-2.40), not being involved in healthcare decision-making (AOR = 1.64, 95%CI: 1.99-2.70), having a husband/partner with primary (AOR = 1.70, 95%CI: 5.47-6.21) or no education (AOR = 1.84, 95%CI: 1.21-3.37), as well as having a husband/partner who sometimes (AOR = 3.37, 95%CI: 1.56-7.30) or often (AOR = 12.87, 95%CI: 5.64-29.38) gets drunk were positively associated with sexual violence. However, women from male-headed households (AOR = 0.52, 95%CI: 0.29-0.92) were less likely to experience sexual violence. CONCLUSIONS There is a need to demystify negative culturally-rooted beliefs favouring sexual violence, such as justified beating, as well as increase efforts to promote women's empowerment and healthcare access. Moreover, engaging men in anti-sexual violence strategies is paramount to addressing male-related issues that expose women to sexual violence.
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Affiliation(s)
- Lilian Nuwabaine
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
| | - Joseph Kawuki
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Earnest Amwiine
- Faculty of Medicine, Mbarara University of Science & Technology, Mbarara, Uganda
| | | | | | - Ghislaine Gatasi
- Key Laboratory of Environmental Medicine Engineering, School of Public Health, Southeast University, 210009 Nanjing, Jiangsu Province China
| | - Elorm Donkor
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Hartwell M, Keener A, Robling K, Enmeier M, Sajjadi NB, Greiner B, Price J. Associations of intimate partner violence and maternal comorbidities: a cross-sectional analysis of the Pregnancy Risk Assessment Monitoring System. J Osteopath Med 2023:jom-2023-0018. [PMID: 36943903 DOI: 10.1515/jom-2023-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/06/2023] [Indexed: 03/23/2023]
Abstract
CONTEXT Intimate partner violence (IPV) occurs when an intimate partner inflicts physical, sexual, and/or emotional assault with coercive control and is a traumatic experience with repercussions that can be exacerbated when a woman is pregnant. While screening for IPV during pregnancy is recommended to occur regardless of risk, less than 50% of pregnant women are screened. OBJECTIVES Identifying clinical factors commonly associated with IPV during pregnancy may improve screening rates, thus our primary objective was to examine associations between IPV and maternal comorbidities. METHODS We conducted a cross-sectional analysis of the Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8 spanning 2016 through 2019. Bivariate and multivariable logistic regression was utilized to calculate adjusted odds ratios (AORs) to determine associations between IPV and diabetes, anxiety, hypertension, depression, asthma, polycystic ovary syndrome (PCOS), and thyroid disease. RESULTS More than 40% of women experiencing IPV reported a history of depression or anxiety. The occurrence of IPV was higher among women with depression (AOR 3.48, CI 3.14-3.85), anxiety (AOR 2.98, CI 2.64-3.37), hypertension (AOR 1.21, CI 1.02-1.44), and asthma (AOR 1.37; CI 1.17-1.59) than women without those respective conditions, but not among diagnoses of diabetes, PCOS, or thyroid disorders. CONCLUSIONS Our findings show that pregnant individuals reporting having experienced IPV were more likely to report having certain comorbidities compared to those who did not report experiencing IPV. Given the low rates of screening, knowing clinically relevant associations may increase screening sensitivity among clinicians and, in turn, increase the likelihood that individuals experiencing IPV receive supportive care.
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Affiliation(s)
- Micah Hartwell
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
- Oklahoma State University College of Osteopathic Medicine, Tahlequah, OK, USA
| | - Ashley Keener
- College of Osteopathic Medicine, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Kristyn Robling
- Oklahoma State University College of Osteopathic Medicine, Tahlequah, OK, USA
| | - Mackenzie Enmeier
- Oklahoma State University College of Osteopathic Medicine, Tahlequah, OK, USA
| | - Nicholas B Sajjadi
- College of Osteopathic Medicine, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Benjamin Greiner
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Jameca Price
- Department of Obstetrics and Gynecology, University of Oklahoma School of Community Medicine, Tulsa, OK, USA
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8
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Nacev EC, Greene MZ, Taboada MP, Ehrenthal DB. Factors Influencing Provider Behavior Around Delivery of Preconception Care. Matern Child Health J 2022; 26:1567-1575. [PMID: 35435579 PMCID: PMC9295340 DOI: 10.1007/s10995-022-03411-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Despite growing consensus about the clinical value of preconception care (PCC), gaps and disparities remain in its delivery. This study aimed to examine the factors influencing behavior of health care providers around PCC in outpatient clinical settings in the United States. METHODS Twenty health care providers who serve people of reproductive age were interviewed using semi-structured interviews. Data was coded based on a modified Theoretical Domains Framework and analyzed using deductive content analysis. RESULTS We interviewed eight family medicine physicians, four obstetricians/gynecologists, seven nurse practitioners, and one nurse midwife. Overall, we found a wide variety in practices and attitudes towards PCC. Barriers and challenges to delivering PCC were shared across sites. We identified six themes that influenced provider behavior around PCC: (1) lack of knowledge of PCC guidelines, (2) perception of lack of preconception patient contact, (3) pessimism around patient "compliance," (4) opinion about scope of practice, (5) clinical site structure, and (6) reliance on the patient/provider relationship. CONCLUSIONS FOR PRACTICE Overall, our findings call for improved provider understanding of PCC and creative incorporation into current health care culture and practice. Given that PCC-specific visits are perceived by some as outside the norm of clinical offerings, providers may need to incorporate PCC into other encounters, as many in this study reported doing. We amplify the call for providers to understand how structural inequities may influence patient behavior and the value of standardized screening, within and beyond PCC, as well as examination of implicit and explicit provider bias.
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Affiliation(s)
- Erin C Nacev
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA.
| | - Madelyne Z Greene
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Mireya P Taboada
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - Deborah B Ehrenthal
- Departments of Obstetrics and Gynecology and Population Health, University of Wisconsin-Madison, Madison, WI, USA
- Social Science Research Institute, Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
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9
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Andreu-Pejó L, Chillerón MJV, González Chordá VM, Mena-Tudela D, Cervera-Gasch A. An integrative review of the literature on screening for gender-based violence during pregnancy: barriers, facilitators, and tools. Nurs Health Sci 2022; 24:564-578. [PMID: 35726481 PMCID: PMC9543014 DOI: 10.1111/nhs.12967] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/11/2022] [Accepted: 06/16/2022] [Indexed: 11/28/2022]
Abstract
An integrative review of the literature has been developed to explore barriers and facilitators in screening for gender‐based violence in pregnant women and identify available tools for this screening. Studies were identified via a systematic search on the PubMed, CINAHL Plus (Cumulative Index of Nursing and Allied Health Literature Complete), Scopus, and LILACS (Latin American and Caribbean Health Sciences Literature) databases and a manual reverse reference search to obtain literature published between 2015 and 2020. The methodology followed the recommendations made by Whittemore & Knafl. The quality of studies was evaluated using the Critical Skills Appraisal Program tool. Twenty‐three of the 4202 articles fulfilled the inclusion criteria. The principal barriers identified were lack of training for professionals (mainly nurses and midwives), lack of support policies, and lack of human and material resources. The main facilitators were to increase professional training programs on case detection, availability of effective instruments, and greater investment in resources to guarantee safety and referral of cases. With regard to the available tools, the Abuse Assessment Screen (AAS) continues to be the most widely used, although others such as the Humiliation, Afraid, Rape, and Kick questionnaire (HARK) could be suitable for antenatal care settings.
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Affiliation(s)
- Laura Andreu-Pejó
- Nursing Department, University Jaume I, Castellón, Spain.,Health Research Institute of Aragon, Zaragoza, Spain
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10
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Wallace M, Gillispie-Bell V, Cruz K, Davis K, Vilda D. Homicide During Pregnancy and the Postpartum Period in the United States, 2018-2019. Obstet Gynecol 2021; 138:762-769. [PMID: 34619735 PMCID: PMC9134264 DOI: 10.1097/aog.0000000000004567] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/12/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the national pregnancy-associated homicide mortality ratio, characterize pregnancy-associated homicide victims, and compare the risk of homicide in the perinatal period (pregnancy and up to 1 year postpartum) with risk among nonpregnant, nonpostpartum females aged 10-44 years. METHODS Data from the National Center for Health Statistics 2018 and 2019 mortality files were used to identify all female decedents aged 10-44 in the United States. These data were used to estimate 2-year pregnancy-associated homicide mortality ratios (deaths/100,000 live births) for comparison with homicide mortality among nonpregnant, nonpostpartum females (deaths/100,000 population) and to mortality ratios for direct maternal causes of death. We compared characteristics and estimated homicide mortality rate ratios and 95% CIs between pregnant or postpartum and nonpregnant, nonpostpartum victims for the total population and with stratification by race and ethnicity and age. RESULTS There were 3.62 homicides per 100,000 live births among females who were pregnant or within 1 year postpartum, 16% higher than homicide prevalence among nonpregnant and nonpostpartum females of reproductive age (3.12 deaths/100,000 population, P<.05). Homicide during pregnancy or within 42 days of the end of pregnancy exceeded all the leading causes of maternal mortality by more than twofold. Pregnancy was associated with a significantly elevated homicide risk in the Black population and among girls and younger women (age 10-24 years) across racial and ethnic subgroups. CONCLUSION Homicide is a leading cause of death during pregnancy and the postpartum period in the United States. Pregnancy and the postpartum period are times of elevated risk for homicide among all females of reproductive age.
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Affiliation(s)
- Maeve Wallace
- Mary Amelia Center for Women's Health Equity Research, Department of Social, Behavioral, and Population Science, Tulane University School of Public Health and Tropical Medicine, the Department of Obstetrics and Gynecology, Ochsner Baptist Medical Center, and the National Birth Equity Collaborative, New Orleans, Louisiana
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11
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Miller CJ, Adjognon OL, Brady JE, Dichter ME, Iverson KM. Screening for intimate partner violence in healthcare settings: An implementation-oriented systematic review. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2:10.1177/26334895211039894. [PMID: 36712586 PMCID: PMC9881185 DOI: 10.1177/26334895211039894] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background Intimate partner violence (IPV) is a population health problem affecting millions of women worldwide. Screening for IPV within healthcare settings can identify women who experience IPV and inform counseling, referrals, and interventions to improve their health outcomes. Unfortunately, many screening programs used to detect IPV have only been tested in research contexts featuring externally funded study staff and resources. This systematic review therefore investigated the utility of IPV screening administered by frontline clinical personnel. Methods We conducted a systematic literature review focusing on studies of IPV screening programs for women delivered by frontline healthcare staff. We based our data synthesis on two widely used implementation models (Reach, Effectiveness, Adoption, Implementation and Maintenance [RE-AIM] and Proctor's dimensions of implementation effectiveness). Results We extracted data from 59 qualifying studies. Based on data extraction guided by the RE-AIM framework, the median reach of the IPV screening programs was high (80%), but Emergency Department (ED) settings were found to have a much lower reach (47%). The median screen positive rate was 11%, which is comparable to the screen-positive rate found in studies using externally funded research staff. Among those screening positive, a median of 32% received a referral to follow-up services. Based on data extraction guided by Proctor's dimension of appropriateness, a lack of available referral services frustrated some efforts to implement IPV screening. Among studies reporting data on maintenance or sustainability of IPV screening programs, only half concluded that IPV screening rates held steady during the maintenance phase. Other domains of the RE-AIM and Proctor frameworks (e.g., implementation fidelity and costs) were reported less frequently. Conclusions IPV is a population health issue, and successfully implementing IPV screening programs may be part of the solution. Our review emphasizes the importance of ongoing provider trainings, readily available referral sources, and consistent institutional support in maintaining appropriate IPV screening programs. Plain language abstract Intimate partner violence (IPV) is a population health problem affecting millions of women worldwide. IPV screening and response can identify women who experience IPV and can inform interventions to improve their health outcomes. Unfortunately, many of the screening programs used to detect IPV have only been tested in research contexts featuring administration by externally funded study staff. This systematic review of IPV screening programs for women is particularly novel, as previous reviews have not focused on clinical implementation. It provides a better understanding of successful ways of implementing IPV screening and response practices with frontline clinical personnel in the context of routine care. Successfully implementing IPV screening programs may help mitigate the harms resulting from IPV against women. Findings from this review can inform future efforts to improve implementation of IPV screening programs in clinical settings to ensure that the victims of IPV have access to appropriate counseling, resources, and referrals.
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Affiliation(s)
- Christopher J Miller
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Omonyêlé L Adjognon
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA,Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - Julianne E Brady
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA,Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - Melissa E Dichter
- VA Center for Health Equity Research and Promotion (CHERP), Crescenz VA Medical Center, Philadelphia, PA, USA,School of Social Work, Temple University, Philadelphia, PA, USA
| | - Katherine M Iverson
- Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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12
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Miller JM, Rensing S. Integrating National Violent Death Reporting System Data into Maternal Mortality Review Committees. J Womens Health (Larchmt) 2021; 30:1573-1579. [PMID: 34379991 DOI: 10.1089/jwh.2021.0058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: With the Maternal Mortality Review Information Application (MMRIA) data system, the Centers for Disease Control and Prevention (CDC), alongside Maternal Mortality Review Committees (MMRCs), are developing comprehensive and uniform data collection to eradicate preventable maternal deaths. However, MMRIA is primarily focused on pregnancy-related deaths, and not pregnancy-associated deaths. Currently, the National Violent Death Reporting System Restricted Access Data (NVDRS-RAD) on pregnancy-associated homicides and suicides are not included in MMRIA and by extension the work of most MMRCs. This study examined the NVDRS-RAD data from 2014 to 2017 and argues that the data for pregnancy-associated maternal deaths should be integrated into the work of MMRCs. Methods: A secondary data analysis of the NVDRS-RAD from 2014 to 2017 was conducted. Pregnancy-associated mortality was identified using data available within the NVDRS-RAD and categorized according to period of pregnancy and manner of death. Descriptive statistics and risk ratios were calculated. Chi-square tests were also calculated. Results: The results indicate that pregnancy and the postpartum period show increased risk for homicide and suicide. Pregnant women were found to be five times more likely to die by homicide than their nonpregnant peers who died by violent means. The relationships between periods of pregnancy and manner of death were all found to be significantly associated although the association was weak. Conclusions: Integrating National Violent Death Reporting System data on pregnancy-associated deaths into MMRIA would improve the efficacy of MMRCs and address the intertwined risk factors driving the racial disparities of the United States' maternal mortality rate.
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Affiliation(s)
- Jennifer M Miller
- Department of Kinesiology, Kansas State University, Manhattan, Kansas, USA
| | - Susan Rensing
- Department of Gender, Women, and Sexuality Studies, Kansas State University, Manhattan, Kansas, USA
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Hooker L, Taft A. Who is Being Screened for Intimate Partner Violence in Primary Care Settings? Secondary Data Analysis of a Cluster Randomised Trial. Matern Child Health J 2021; 25:1554-1561. [PMID: 33954881 DOI: 10.1007/s10995-021-03136-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To assess sociodemographic differences in postpartum women screened for intimate partner violence and who disclosed to their Maternal and Child Health nurses. METHODS Secondary analyses of survey data from women participating in a cluster randomised trial. The trial tested a nurse-designed, enhanced violence screening model-versus routine screening among eight community nurse clinics in Melbourne, Australia. Self-completion anonymous surveys were sent to all clinic attendees who had given birth in the previous eight months. We measured intimate partner violence with the Composite Abuse Scale and other sociodemographic variables. Multivariable logistic regression was used to analyse characteristics of screened versus unscreened women and those who did or did not disclose. RESULTS 91 clinics (163 nurses) participated in the trial. 2621/10,472 (25%) women responded to the survey. Notable characteristics, such as level of intimate partner violence (AdjOR 1.14, CI 0.94-1.40), parity (AdjOR 1.13, CI 0.94-1.35), education (AdjOR 1.20 CI 0.91-1.58) and being born in Australia (AdjOR 0.94, CI 0.86-1.03) made no significant difference to screening. However, nurses were significantly less likely to screen women with a lower income than those with a higher one (AdjOR 0.59, CI 0.40-0.87) with a dose response relationship. Women on the lowest levels of income were significantly more likely to disclose abuse (AdjOR 3.06, CI 1.02-9.17), indicating missed opportunities for nurses to provide timely care. CONCLUSIONS FOR PRACTICE Despite being required to screen all women, nurses are almost twice as likely to screen more affluent women, who would be less likely to be experiencing or disclose intimate partner violence.
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Affiliation(s)
- Leesa Hooker
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, 3086, Australia. .,Rural Department of Nursing and Midwifery, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, 3550, Australia.
| | - Angela Taft
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, 3086, Australia
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Román-Gálvez RM, Martín-Peláez S, Martínez-Galiano JM, Khan KS, Bueno-Cavanillas A. Prevalence of Intimate Partner Violence in Pregnancy: An Umbrella Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E707. [PMID: 33467538 PMCID: PMC7830915 DOI: 10.3390/ijerph18020707] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/07/2021] [Accepted: 01/13/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Intimate partner violence (IPV) is a public health concern, especially during pregnancy, and needs to be urgently addressed. In order to establish effective actions for the prevention of IPV during pregnancy, authorities must be aware of the real burden of IPV. This review aimed to summarize the existing evidence about IPV prevalence during pregnancy worldwide. METHODS A review of reviews was carried out. All published systematic reviews and meta-analyses published until October 2020 were identified through PubMed, Scopus, and Web of Science. The main outcome was the IPV prevalence during pregnancy. RESULTS A total of 12 systematic reviews were included in the review, 5 of them including meta-analysis. The quality of the reviews was variable. Physical IPV during pregnancy showed a wide range (1.6-78%), as did psychological IPV (1.8-67.4%). CONCLUSIONS Available data about IPV prevalence during pregnancy were of low quality and showed high figures for physical and psychological IPV. The existing evidence syntheses do not capture the totality of the worldwide disease burden of IPV in pregnancy.
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Affiliation(s)
- Rosario M. Román-Gálvez
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Granada, 18071 Granada, Spain;
- Unidad Asistencial Churriana de la Vega, Servicio Andaluz de Salud, Churriana de la Vega, 18194 Granada, Spain
| | - Sandra Martín-Peláez
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Granada, 18071 Granada, Spain; (K.S.K.); (A.B.-C.)
- Instituto de Investigación Biosanitaria de Granada IBS, 18014 Granada, Spain
| | - Juan Miguel Martínez-Galiano
- Department of Nursing, University of Jaén, 23071 Jaén, Spain;
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Khalid Saeed Khan
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Granada, 18071 Granada, Spain; (K.S.K.); (A.B.-C.)
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Aurora Bueno-Cavanillas
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Granada, 18071 Granada, Spain; (K.S.K.); (A.B.-C.)
- Instituto de Investigación Biosanitaria de Granada IBS, 18014 Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
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When Home Is Not Safe for Mothers. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2020.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Johnson DM, Tzilos Wernette G, Miller TR, Muzik M, Raker CA, Zlotnick C. Computerized intervention for reducing intimate partner victimization for perinatal women seeking mental health treatment: A multisite randomized clinical trial protocol. Contemp Clin Trials 2020; 93:106011. [PMID: 32305456 PMCID: PMC7254924 DOI: 10.1016/j.cct.2020.106011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/09/2020] [Accepted: 04/14/2020] [Indexed: 11/15/2022]
Abstract
Intimate partner victimization (IPV) is a significant social and public health problem among perinatal women. Research suggests that 21% to 33% of perinatal women report IPV and there is an enormous amount of morbidity associated with IPV. Moreover, IPV places women at high risk for several psychiatric disorders, which transforms the perinatal period from an already challenging process into a potentially overwhelming one. Further, IPV and untreated mental illness during the perinatal period pose a dual risk of adverse physical and emotional outcomes for women and their developing fetus/infant. Given the high rates of IPV among women who seek mental health treatment, mental health clinics compared to other medical settings are more effective sites for focused case finding and intervention. Our team has successfully tested an innovative, computerized intervention, Strength for U in Relationship Empowerment (SURE). SURE is a brief, interactive program consistent with motivational interviewing and incorporates empowerment strategies. The proposed multisite randomized clinical trial (N = 186) will test whether SURE relative to control is associated with reduced IPV, greater positive affect and well-being, and greater perceived emotional support. We will also evaluate the role of theoretical mediators of empowerment and self-efficacy. Finally, we will estimate the resources needed and costs to deliver SURE, as well as the incremental cost effectiveness of SURE compared with treatment as usual. If SURE is found to be efficacious and cost effective, it can be easily integrated into clinical care and will fill a critical gap for a vulnerable, high-risk population.
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Affiliation(s)
- Dawn M Johnson
- Department of Psychology, University of Akron, Akron, OH 44325-4301, USA.
| | - Golfo Tzilos Wernette
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ted R Miller
- Pacific Institute for Research and Evaluation, Calverton, MD, USA; School of Public Health, Curtin University, Perth, WA, Australia
| | - Maria Muzik
- Department of Psychiatry, Obstetrics & Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Christina A Raker
- Division of Research, Women and Infant's Hospital, Providence, RI, USA
| | - Caron Zlotnick
- Department of Medicine, Women and Infant's Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
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