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Mercier O, Fu SY, Filler R, Leclerc A, Sampsel K, Fournier K, Walker M, Wen SW, Muldoon K. Interventions for intimate partner violence during the perinatal period: A scoping review: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1423. [PMID: 39010852 PMCID: PMC11247475 DOI: 10.1002/cl2.1423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
Background Intimate partner violence (IPV) is a prevalent global health problem. IPV that occurs before pregnancy often continues during the perinatal period, resulting in ongoing violence and many adverse maternal, obstetrical, and neonatal outcomes. Objectives This scoping review is designed to broadly capture all potential interventions for perinatal IPV and describe their core components and measured outcomes. Search Methods We conducted a search for empirical studies describing IPV interventions in the perinatal population in June 2022. The search was conducted in MEDLINE, EMBASE, PsycInfo, CINAHL, Cochrane Central Register of Controlled Trials, Web of Science, Applied Social Sciences Index & Abstracts, ClinicalTrials.gov and MedRxiv. Hand searching of references from select articles was also performed. Selection Criteria Included studies described an intervention for those experiencing IPV during the perinatal period, including 12 months before pregnancy, while pregnant or in the 12 months post-partum. The search encompassed January 2000 to June 2022 and only peer-reviewed studies written in either English or French were included. Included interventions focused on the survivor exposed to IPV, rather than healthcare professionals administering the intervention. Interventions designed to reduce IPV revictimization or any adverse maternal, obstetrical, or neonatal health outcomes as well as social outcomes related to IPV victimization were included. Data Collections and Analysis We used standard methodological procedures expected by The Campbell Collaboration. Main Results In total, 10,079 titles and abstracts were screened and 226 proceeded to full text screening. A total of 67 studies included perinatal IPV interventions and were included in the final sample. These studies included a total of 27,327 participants. Included studies originated from 19 countries, and the majority were randomized controlled trials (n = 43). Most studies were of moderate or low quality. Interventions included home visitation, educational modules, counseling, and cash transfer programs and occurred primarily in community obstetrician and gynecologist clinics, hospitals, or in participants' homes. Most interventions focused on reducing revictimization of IPV (n = 38), improving survivor knowledge or acceptance of violence, knowledge of community resources, and actions to reduce violence (n = 28), and improving maternal mental health outcomes (n = 26). Few studies evaluated the effect of perinatal IPV interventions on obstetrical, neonatal or child health outcomes. Authors' Conclusions The majority of intervention studies for perinatal IPV focus on reducing revictimization and improving mental health outcomes, very few included obstetrical, neonatal, and other physical health outcomes. Future interventions should place a larger emphasis on targeting maternal and neonatal outcomes to have the largest possible impact on the lives and families of IPV survivors and their infants.
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Affiliation(s)
- Olivia Mercier
- Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
| | - Sarah Yu Fu
- Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Rachel Filler
- Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
| | - Alexie Leclerc
- Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
| | - Kari Sampsel
- Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
- Department of Emergency MedicineThe Ottawa HospitalOttawaOntarioCanada
| | - Karine Fournier
- Health Sciences LibraryUniversity of OttawaOttawaOntarioCanada
| | - Mark Walker
- Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
- Department of Global Health and InternationalizationUniversity of OttawaOttawaOntarioCanada
- Department of Obstetrics and GynecologyUniversity of OttawaOttawaOntarioCanada
- Department of Obstetrics, Gynecology and Newborn CareThe Ottawa HospitalOttawaOntarioCanada
| | - Shi Wu Wen
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
- Department of Obstetrics and GynecologyUniversity of OttawaOttawaOntarioCanada
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Katherine Muldoon
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
- Department of Obstetrics and GynecologyUniversity of OttawaOttawaOntarioCanada
- Children's Hospital of Eastern OntarioOttawaOntarioCanada
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Sabloak T, Ryan I, Nahi S, Eucalitto P, Simon MA, Premkumar A. Intimate Partner Violence Detected during Abortion-Related Visits: A Systematic Review of Screenings and Interventions. Am J Perinatol 2024; 41:1697-1705. [PMID: 38365213 DOI: 10.1055/s-0044-1779746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
OBJECTIVE To perform a systematic review of screening tools and interventions focused on reducing adverse health outcomes associated with intimate partner violence (IPV) at abortion-related visits. STUDY DESIGN Studies were eligible if they included individuals seeking pregnancy options health care services in the United States, screening for or implementation of an intervention for IPV, and were published in English after the year 2000. The primary outcomes were to summarize screening tools, interventions studied, and if interventions led to individuals being connected to IPV-related resources. Secondary outcomes included patient responses to the IPV-related interventions and any other outcomes reported by the studies (PROSPERO #42021252199). RESULTS Among 4,205 abstracts identified, nine studies met inclusion criteria. The majority (n = 6) employed the ARCHES (Addressing Reproductive Coercion in Health Settings) tool for identification of IPV. Interventions included provider-facilitated discussions of IPV, a safety card with information about IPV and community-based resources, and referral pathways to directly connect patients with support services. For the primary outcome, IPV-related interventions were shown to better inform patients of available IPV-related resources as compared to no intervention at all. For the secondary outcomes, screening and intervening on IPV were associated with improvements in patient perception of provider empathy (i.e., caring about safety) and safer responses by patients to unhealthy relationships. CONCLUSION Screening for and intervening on IPV at abortion-related visits are associated with positive outcomes for patient safety and the patient-provider relationship. However, data on effective tools for identifying and supporting these patients are extremely limited. This review emphasizes the unmet need for implementation and evaluation of IPV-specific interventions during abortion-related clinical encounters. KEY POINTS · The abortion visit offers a crucial setting to address IPV among a highly affected population.. · This study reviews others that analyzed interventions and associated outcomes for IPV at abortion-related visits.. · Appropriate interventions for IPV can improve patient-provider relationships and connect patients to essential resources..
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Affiliation(s)
- Thwisha Sabloak
- Northwestern University Feinberg School of Medicine, Department of Obstetrics and Gynecology, Chicago, Illinois
| | - Isa Ryan
- Northwestern University Feinberg School of Medicine, Department of Obstetrics and Gynecology, Chicago, Illinois
| | - Skylar Nahi
- Northwestern University Feinberg School of Medicine, Department of Obstetrics and Gynecology, Chicago, Illinois
| | - Patrick Eucalitto
- Northwestern University Feinberg School of Medicine, Department of Obstetrics and Gynecology, Chicago, Illinois
| | - Melissa A Simon
- Northwestern University Feinberg School of Medicine, Department of Obstetrics and Gynecology, Chicago, Illinois
| | - Ashish Premkumar
- The University of Chicago Pritzker School of Medicine, Department of Maternal Fetal Medicine, Chicago, Illinois
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Pearson E, Paul D, Menzel J, Shakhider MAH, Konika RA, Uysal J, Silverman JG. Effectiveness of the Addressing Reproductive Coercion in Health Settings (ARCHES) intervention among abortion clients in Bangladesh: a cluster-randomized controlled trial. EClinicalMedicine 2024; 73:102699. [PMID: 39040882 PMCID: PMC11260591 DOI: 10.1016/j.eclinm.2024.102699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 07/24/2024] Open
Abstract
Background The Addressing Reproductive Coercion in Health Settings (ARCHES) intervention trains existing providers to address reproductive coercion (RC) and intimate partner violence (IPV) within routine family planning counseling. This study evaluated the effectiveness of a single ARCHES counseling session as adapted for use with abortion clients in Bangladesh. Methods In this cluster-randomized controlled trial conducted between January 2019 and January 2021, health facilities with an abortion clinic with infrastructure for private counseling and onsite violence support services were eligible. Six facilities in Bangladesh met inclusion criteria, and matched pairs randomization with parallel assignment and a 1:1 allocation ratio was used to randomize three facilities to ARCHES and three facilities to control, which implemented standard counseling. Blinding was not possible as providers in intervention facilities participated in a three-day ARCHES training. Participants were abortion clients aged 18-49 years who could provide safe recontact information and be interviewed privately. The primary outcome was past three-month modern contraceptive use without interruption or interference. The trial was registered on clinicaltrials.gov (NCT03539315) on 29 May 2018. Findings A total of 1492 intervention participants and 1237 control participants were enrolled. Available data were analyzed at each follow-up period: 1331 intervention and 1069 control participants at the three-month follow-up, and 1269 intervention and 1050 control participants at the twelve-month follow-up. ARCHES was associated with higher likelihood of modern contraceptive use at the three-month follow-up (adjusted RR = 1.08, 95% CI: 1.06-1.10) and the twelve-month follow-up (adjusted RR = 1.06, 95% CI: 1.02-1.10). ARCHES was also associated with decreased incident pregnancy, decreased IPV, and increased knowledge of IPV support services. Interpretation The ARCHES intervention is effective in increasing post-abortion modern contraceptive use and decreasing incident pregnancy and IPV among abortion clients in Bangladesh. Implementation of ARCHES should be considered in facilities with sufficient privacy for counseling. Funding Society of Family Planning (#SFPRF11-07) and Ipas.
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Affiliation(s)
- Erin Pearson
- Ipas, Chapel Hill, NC, USA
- Center on Gender Equity and Health, Department of Medicine, University of California, San Diego, CA, USA
| | | | - Jamie Menzel
- Ipas, Chapel Hill, NC, USA
- Center on Gender Equity and Health, Department of Medicine, University of California, San Diego, CA, USA
| | | | | | - Jasmine Uysal
- Center on Gender Equity and Health, Department of Medicine, University of California, San Diego, CA, USA
| | - Jay G. Silverman
- Center on Gender Equity and Health, Department of Medicine, University of California, San Diego, CA, USA
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Chatterji S, Johns NE, Ghule M, Begum S, Averbach S, Battala M, Raj A. Assessing the impact of CHARM2, a family planning program on gender attitudes, intimate partner violence, reproductive coercion, and marital quality in India. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003220. [PMID: 38771823 PMCID: PMC11108161 DOI: 10.1371/journal.pgph.0003220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 04/17/2024] [Indexed: 05/23/2024]
Abstract
Using a two-armed cluster randomised controlled trial, CHARM2 (Counselling Husbands to Achieve Reproductive health and Marital equity), a 5-session gender equity and family planning intervention for couples in rural India, showed an impact on family planning outcomes in primary trial analyses. This study examines its effects on gender-equitable attitudes, intimate partner violence, reproductive coercion, and marital quality. We used multilevel mixed-effects models to assess the intervention impact on each outcome. Both male (aIRR at 9 months: 0.64, C.I.: 0.45,0.90; aIRR at 18 months: 0.25, C.I.: 0.18,0.39) and female (aIRR at 9 months: 0.57, C.I.: 0.46,0.71; aIRR at 18 months: 0.38, C.I.: 0.23,0.61) intervention participants were less likely than corresponding control participants to endorse attitudes accepting physical IPV at 9- and 18-month follow-ups. Men in the intervention, compared to those in the control condition, reported more gender-equitable attitudes at 9- and 18 months (ß at 9 months: 0.13, C.I.: 0.06,0.20; ß at 18 months: 0.26, C.I.: 0.19,0.34) and higher marital quality at the 18-month follow-up (ß: 0.03, C.I.: 0.01,0.05). However, we found no effects on women's experiences of IPV, reproductive coercion, or marital quality. CHARM2 shows promise in improving men's and women's attitudes towards gender equality and male perceptions of marital quality. Still, IPV and reproductive coercion reductions may require more intensive programming than that provided within this 5-session model focused on family planning.
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Affiliation(s)
- Sangeeta Chatterji
- School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Nicole E. Johns
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Mohan Ghule
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Shahina Begum
- ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India
| | - Sarah Averbach
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, San Diego, California, United States of America
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California San Diego, San Diego, California, United States of America
| | | | - Anita Raj
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, San Diego, California, United States of America
- Newcomb Institute, Tulane University, New Orleans, Louisiana, United States of America
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
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Grace KT, Glass NE, Miller E, Alexander KA, Holliday CN, Decker MR. Birth Control Sabotage Motivation and Measurement: A Mixed-Methods Analysis among Latina Women. Violence Against Women 2024; 30:1634-1655. [PMID: 36567608 PMCID: PMC10290727 DOI: 10.1177/10778012221145292] [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] [Indexed: 12/27/2022]
Abstract
Reproductive coercion (RC) is a type of intimate partner violence that includes birth control sabotage (BCS). We explored the perceived intent behind BCS to refine RC measurement, using a mixed-methods design with a clinic-based sample of Latina women (13 interviews; 482 surveys). Women perceived partners used BCS for reasons beyond pregnancy promotion. Specifically, 16.8% of participants reported any past-year RC; this decreased to 9.5% when asked if their partner used BCS with the sole intent of getting them pregnant. RC measures and assessment should separate behavior from intent in BCS questions to not underestimate the prevalence and to guide clinical response.
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Affiliation(s)
- Karen Trister Grace
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nancy E Glass
- Johns Hopkins University, School of Nursing, Baltimore, MD, USA
| | - Elizabeth Miller
- Division of Adolescent Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | | | | | - Michele R Decker
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
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Alsina E, Browne JL, Gielkens D, Noorman MAJ, de Wit JB. Interventions to Prevent Intimate Partner Violence: A Systematic Review and Meta-Analysis. Violence Against Women 2024; 30:953-980. [PMID: 37475456 PMCID: PMC10845820 DOI: 10.1177/10778012231183660] [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] [Indexed: 07/22/2023]
Abstract
Intimate partner violence (IPV) remains a global health and human rights problem. This systematic review assesses the effects of preventive interventions on the occurrence of IPV experience or perpetration. Twenty-six studies published between January 1, 2008 and March 31, 2022 were included, contributing 91 effect sizes. Multilevel meta-analysis showed a protective pooled effect (risk ratio = 0.85, 95% CI [0.77, 0.99]). Interventions (also) including men were more effective than interventions for women only. No other moderators were found. Findings underscore that various IPV prevention interventions are now available that can improve the health and rights of women in diverse settings.
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Affiliation(s)
- Ema Alsina
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joyce L. Browne
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Desi Gielkens
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
| | - Maaike A. J. Noorman
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
| | - John B.F. de Wit
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
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Chen W, Hammett JF, Stewart RJD, Kirwan M, Davis KC. Receipt of Coercive Condom Use Resistance: A Scoping Review. JOURNAL OF SEX RESEARCH 2024; 61:399-413. [PMID: 37158996 PMCID: PMC10632542 DOI: 10.1080/00224499.2023.2204297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Condom use resistance (CUR) refers to practices used to obtain unprotected sex with a partner who wishes to use a condom. Coercive CUR is a manipulative and aggressive form of CUR, which is associated with detrimental mental, physical, and sexual health consequences. This review synthesizes quantitative evidence on the prevalence and correlates of experiencing coercive CUR. A systematic approach, including title, abstract, and full-text review, was used to identify relevant empirical studies. Thirty-seven articles met the inclusion criteria. Prevalence of experiencing coercive CUR ranged from 0.1% to 59.5%. Significant correlates of receiving coercive CUR included interpersonal violence, sexually transmitted infection (STI) diagnosis, emotional stress, and drug use. Importantly, vulnerable populations (e.g., racial/ethnic minorities, men who have sex with men, sex workers) and people with low perceived control and resistive efficacy (i.e., the ability to say "no") had an increased likelihood of experiencing coercive CUR. Methodological weaknesses in the current literature include a lack of longitudinal studies and studies that examine the effectiveness of interventions, as well as failure to use consistent measures and include samples of men and sexual minorities. Future research should address these limitations. Intervention and prevention strategies should prioritize populations that are at greater risk for experiencing coercive CUR to achieve better health equity outcomes.
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Affiliation(s)
- Weiqi Chen
- Edson College of Nursing and Health Innovation, Arizona State University
| | - Julia F Hammett
- Edson College of Nursing and Health Innovation, Arizona State University
| | - Robin J D Stewart
- Edson College of Nursing and Health Innovation, Arizona State University
| | - Mitchell Kirwan
- Edson College of Nursing and Health Innovation, Arizona State University
| | - Kelly Cue Davis
- Edson College of Nursing and Health Innovation, Arizona State University
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Huber-Krum S, Bornstein M, D'Angelo D, Narasimhan S, Zapata LB, Tsukerman K, Ruvalcaba Y. Contraceptive Sabotage and Contraceptive Use at the Time of Pregnancy: An Analysis of People with a Recent Live Birth in the United States. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:11954-11979. [PMID: 37515538 PMCID: PMC10989733 DOI: 10.1177/08862605231190346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
Contraceptive sabotage and other forms of intimate partner violence (IPV) can interfere with contraceptive use. We used 2012 to 2015 Pregnancy Risk Assessment Monitoring System data from 8,981 people residing in five states who reported that when they became pregnant, they were not trying to get pregnant. We assessed the relationships between ever experiencing contraceptive sabotage and physical IPV 12 months before pregnancy (both by the current partner) and contraceptive use at the time of pregnancy using multivariable logistic regression. We also assessed the joint associations between physical IPV 12 months before pregnancy and ever experienced contraceptive sabotage with contraceptive use at the time of pregnancy. Few people ever experienced contraceptive sabotage (1.8%; 95% confidence interval [CI]: 1.4, 2.3) or physical IPV 12 months before pregnancy (2.8%; 95% CI: 2.3, 3.3). In models adjusted for age, race/ethnicity, marital status, education, and state of residence, ever experiencing contraceptive sabotage was associated with contraceptive use at the time of pregnancy (adjusted odds ratio [aOR]: 1.73; 95% CI: 1.06, 2.82), but not with physical IPV 12 months before pregnancy (aOR: 0.69; 95% CI: 0.46, 1.02). When examining the joint association, compared to not ever experiencing contraceptive sabotage or physical IPV 12 months before pregnancy, ever experiencing contraceptive sabotage was significantly related to contraceptive use at the time of pregnancy (aOR: 1.72; 95% CI: 1.00, 2.95). However, it was not associated with experiencing physical IPV 12 months before pregnancy (aOR: 0.68; 95% CI: 0.45, 1.04) or with experiencing both contraceptive sabotage and physical IPV 12 months before pregnancy (aOR: 1.21; 95% CI: 0.42, 3.50), compared to not ever experiencing contraceptive sabotage or physical IPV 12 months before pregnancy. Our study highlights that current partner contraceptive sabotage may motivate those not trying to get pregnant to use contraception; however, all people in our sample still experienced a pregnancy.
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Affiliation(s)
- Sarah Huber-Krum
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Denise D'Angelo
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Lauren B Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kara Tsukerman
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Yanet Ruvalcaba
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
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Uysal J, Boyce SC, Undie CC, Liambila W, Wendoh S, Pearson E, Johns NE, Silverman JG. Effects of a clinic-based reproductive empowerment intervention on proximal outcomes of contraceptive use, self-efficacy, attitudes, and awareness and use of survivor services: a cluster-controlled trial in Nairobi, Kenya. Sex Reprod Health Matters 2023; 31:2227371. [PMID: 37594312 PMCID: PMC10443967 DOI: 10.1080/26410397.2023.2227371] [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] [Indexed: 08/19/2023] Open
Abstract
This study was undertaken to evaluate the effect of a reproductive empowerment contraceptive counselling intervention (ARCHES) adapted to private clinics in Nairobi, Kenya on proximal outcomes of contraceptive use and covert use, self-efficacy, awareness and use of intimate partner violence (IPV) survivor services, and attitudes justifying reproductive coercion (RC) and IPV. We conducted a cluster-controlled trial among female family planning patients (N = 659) in six private clinics non-randomly assigned to ARCHES or control in and around Nairobi, Kenya. Patients completed interviews immediately before (baseline) and after (exit) treatment and at three- and six-month follow-up. We use inverse probability by treatment weighting (IPTW) applied to difference-in-differences marginal structural models to estimate the treatment effect using a modified intent-to-treat approach. After IPTW, women receiving ARCHES contraceptive counselling, relative to controls, were more likely to receive a contraceptive method at exit (86% vs. 75%, p < 0.001) and had a significantly greater relative increase in awareness of IPV services at from baseline to three- (beta 0.84, 95% CI 0.13, 1.55) and six-month follow-up (beta 0.92, 95% CI 0, 1.84) and a relative decrease in attitudes justifying RC from baseline to six-month follow-up (beta -0.34, 95% CI -0.65, -0.04). In the first evaluation of a clinic-based approach to address both RC and IPV in a low- or middle-income country (LMIC) context, we found evidence that ARCHES contraceptive counselling improved proximal outcomes related to contraceptive use and coping with RC and IPV. We recommend further study and refinement of this approach in Kenya and other LMICs.Plain Language Summary Reproductive coercion (RC) and intimate partner violence (IPV) are two forms of gender-based violence that are known to harm women's reproductive health. While one intervention, ARCHES - Addressing Reproductive Coercion in Health Settings, has shown promise to improve contraceptive use and help women cope with RC and IPV in the United States, no approach has been proven effective in a low- or middle-income country (LMIC) context. In the first evaluation of a reproductive empowerment contraceptive counselling intervention in an LMIC setting, we found that ARCHES contraceptive counselling, relative to standard contraceptive counselling, improved proximal outcomes on contraceptive uptake, covert contraceptive use, awareness of local violence survives, and reduced attitudes justifying RC among women seeking contraceptive services in Nairobi, Kenya. Distal outcomes will be reported separately. Findings from this study support the promise of addressing RC and IPV within routine contraceptive counselling in Kenya on women's proximal outcomes related to contraceptive use and coping with violence and coercion and should be used to inform the further study of this approach in Kenya and other LMICs.
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Affiliation(s)
- Jasmine Uysal
- Predoctoral fellow, Center on Gender Equity and Health, Department of Medicine, Division of Infectious Disease and Global Public Health, University of California, San Diego, CA, USA
| | - Sabrina C. Boyce
- Postdoctoral fellow, Center on Gender Equity and Health, Department of Medicine, Division of Infectious Disease and Global Public Health, University of California, San Diego, CA, USA
| | - Chi-Chi Undie
- Senior Associate, Population Council, Nairobi, Kenya
| | | | - Seri Wendoh
- Global Lead for Gender & Inclusion, International Planned Parenthood Federation, London, UK
| | - Erin Pearson
- Research Scientist, Center on Gender Equity and Health, Department of Medicine, Division of Infectious Disease and Global Public Health, University of California, San Diego, CA, USA
| | - Nicole E. Johns
- Data Analyst, Center on Gender Equity and Health, Department of Medicine, Division of Infectious Disease and Global Public Health, University of California, San Diego, CA, USA
| | - Jay G. Silverman
- Professor of Medicine and Global Public Health, Center on Gender Equity and Health, Department of Medicine, Division of Infectious Disease and Global Public Health, University of California, San Diego, CA, USA
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Olaniyan A, Hawk M, Mendez DD, Albert SM, Jarlenski M, Chang JC. Racial Inequities in Drug Tests Ordered by Clinicians for Pregnant People Who Disclose Prenatal Substance Use. Obstet Gynecol 2023; 142:1169-1178. [PMID: 37769307 DOI: 10.1097/aog.0000000000005385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/06/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE To measure racial inequities in drug testing among pregnant people during the first prenatal visit based on their drug use disclosure pattern. METHODS We used data from a cohort study of patient-clinician communication patterns regarding substance use in first prenatal visits from February 2011 to August 2014. We assessed racial differences (Black-White) in the receipt of urine toxicology testing, stratifying on patients' drug use disclosure to the clinician. RESULTS Among 341 study participants (205 Black [60.1%] and 136 White [39.9%] participants), 70 participants (33 Black [47.1%] and 37 White [52.9%] participants) disclosed drug use, and 271 participants (172 Black [63.5%] and 99 White [36.5%] participants) did not disclose drug use during their first obstetric visit. Of 70 participants who disclosed drug use, 50 (28 Black [56.0%] and 22 White [44.0%] White) had urine drug testing conducted. Black pregnant patients who disclosed drug use were more likely to be tested for drugs than their White counterparts in the adjusted regression analysis (adjusted odds ratio [aOR] 8.9, 95% CI 1.3-58.6). Among the 271 participants who did not disclose drug use, 38 (18 Black [47.4%] and 20 White [52.6%] participants) had urine drug testing conducted. For those who did not disclose drug use, the adjusted model showed no statistically significant differences in urine drug testing by patients' race (aOR 0.7, 95% CI 0.3-1.6). CONCLUSION When pregnant people disclosed drug use, clinicians were more likely to order urine drug testing for Black pregnant people compared with their White counterparts, suggesting clinician racial bias. Current practice patterns and protocols such as urine drug testing in pregnancy care deserve review to identify and mitigate areas of potential clinician discrimination.
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Affiliation(s)
- Abisola Olaniyan
- Department of Behavioral and Community Health Sciences, the Department of Epidemiology, and the Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, the Center for Innovative Research on Gender Health Equity, University of Pittsburgh, and the Department of Medicine and the Department of Obstetrics, Gynecology, & Reproductive Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Warling A, Treder KM, Brandi K, Kumar B, Fay KE. An Ecological Model of Reproductive Coercion. J Midwifery Womens Health 2023; 68:697-701. [PMID: 37531176 PMCID: PMC11090065 DOI: 10.1111/jmwh.13555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/13/2023] [Indexed: 08/03/2023]
Affiliation(s)
| | - Kelly M. Treder
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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Pearson E, Uysal J, Menzel J, Undie CC, Odwe G, Liambila W, Silverman JG. Evaluating a scalable ARCHES (Addressing Reproductive Coercion in Health Settings) model in government health facilities in Uasin Gishu county, Kenya: study protocol for a cluster-randomized controlled trial. Reprod Health 2023; 20:155. [PMID: 37848916 PMCID: PMC10583405 DOI: 10.1186/s12978-023-01697-7] [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] [Received: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Since 2013, the World Health Organization has recommended that reproductive coercion (RC) and intimate partner violence (IPV) be addressed within reproductive health services and, in 2018, the Lancet Commission on Sexual and Reproductive Health and Rights found that RC and IPV were significant contributors to unmet need for family planning (FP) and unintended pregnancy. In Kenya, the Ministry of Health (MOH) has made reduction of unintended pregnancy and gender-based violence a primary objective. Despite this need and guidance, no clinic-based intervention models outside of the U.S. (apart from the one described here) have demonstrated efficacy to improve FP use and reduce IPV or RC thereby reducing unintended pregnancy. ARCHES (Addressing Reproductive Coercion in Health Settings) is a brief, clinic-based intervention delivered by existing FP providers aiming to: (1) Increase women's ability to use FP without interference, (2) Provide a safe and supportive environment for IPV disclosure and referral to support services, and (3) Improve quality of FP counseling, including addressing RC and IPV. The objective of this study is to generate evidence on scaling integrated FP services (including FP, RC, and IPV) in public sector health facilities in Uasin Gishu county, Kenya via adaptation and implementation of ARCHES in partnership with the Kenya MOH. METHODS A cluster-randomized controlled trial paired with concurrent implementation science assessments will test effectiveness of the ARCHES model, adapted for scale by the Kenya MOH, in reducing unintended pregnancy. Female FP clients aged 15-49 years at selected sites will complete baseline surveys (immediately prior to receiving care), immediately post-visit exit surveys, and 6-month follow-up surveys. Provider surveys will assess changes in gender-equitable attitudes and self-efficacy to address violence reported by their clients. Costs associated with scaling ARCHES will be tracked and utilized in combination with results of the effectiveness trial to assess costs and cost-effectiveness relative to the standard of care. DISCUSSION This study will provide evidence of the effectiveness of a facility-based intervention to address RC and IPV within public sector FP services at scale, as adapted and implemented in Uasin Gishu county, Kenya. Trial registration Trial registered on 28 September 2023 with clinicaltrials.gov NCT06059196.
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Affiliation(s)
- Erin Pearson
- Center On Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - Jasmine Uysal
- Center On Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Jamie Menzel
- Center On Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Chi-Chi Undie
- Population Council Kenya, Avenue 5, 3rd Floor, Rose Avenue, Nairobi, Kenya
| | - George Odwe
- Population Council Kenya, Avenue 5, 3rd Floor, Rose Avenue, Nairobi, Kenya
| | - Wilson Liambila
- Population Council Kenya, Avenue 5, 3rd Floor, Rose Avenue, Nairobi, Kenya
| | - Jay G Silverman
- Center On Gender Equity and Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
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13
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Brown RB, Miller-Walfish S, Scott S, Ali A, Marjavi A, Miller E, McGuier EA. Cross-sector collaboration in Project Catalyst: Creating state partnerships to address the health impact of intimate partner violence. Prev Med Rep 2023; 33:102204. [PMID: 37223578 PMCID: PMC10201862 DOI: 10.1016/j.pmedr.2023.102204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 05/25/2023] Open
Abstract
Intimate Partner Violence and Human Trafficking are major public health problems with myriad health and social consequences. This paper describes a federal initiative in the United States to formalize cross-sector collaborations at the state-level and encourage practice and policy changes intended to promote prevention and improve health and safety outcomes for Intimate Partner Violence/Human Trafficking (IPV/HT) survivors. Project Catalyst Phases I and II (2017-2019) engaged six state leadership teams, consisting of leaders from each state's Primary Care Association, Department of Health, and Domestic Violence Coalition. Leadership teams received training and funding to disseminate information on trauma-informed practices to health centers and integrate IPV/HT considerations into state-level initiatives. At the beginning and end of Project Catalyst, participants completed surveys assessing the status of their collaboration and project goals (e.g., number of state initiatives involving IPV/HT, number of people trained). All domains of collaboration increased from baseline to project end. Largest improvements were seen in 'Communication' and 'Process & Structure,' both of which increased by more than 20% over the course of the project. 'Purpose' and 'Membership Characteristics' increased by 10% and 13%, respectively. Total collaboration scores increased 17% overall. Each state made substantial efforts to integrate and improve responses to IPV/HT in community health centers and domestic violence programs, and integrated IPV/HT response into state-level initiatives. Project Catalyst was successful in facilitating formalized collaborations within state leadership teams, contributing to practice and policy changes intended to improve health and safety for IPV/HT survivors.
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Affiliation(s)
| | | | - Sarah Scott
- Department of Pediatrics, University of Pittsburgh School of Medicine, USA
| | | | | | - Elizabeth Miller
- Department of Pediatrics, University of Pittsburgh School of Medicine, USA
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14
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Wood SN, Thomas HL, Thiongo M, Guiella G, Bazié F, Onadja Y, Mosso R, Fassassi R, Gichangi P, Decker MR. Intersection of reproductive coercion and intimate partner violence: cross-sectional influences on women's contraceptive use in Burkina Faso, Côte d'Ivoire and Kenya. BMJ Open 2023; 13:e065697. [PMID: 37164455 PMCID: PMC10173961 DOI: 10.1136/bmjopen-2022-065697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVES Among nationally representative cross-sections of women in need of contraception from Burkina Faso, Côte d'Ivoire and Kenya, we aimed to: (1) examine the intersection of past-year physical/sexual intimate partner violence (IPV), emotional IPV and reproductive coercion (RC) and (2) assess the impact of physical/sexual IPV, emotional IPV and RC on women's contraceptive use outcomes, including current contraceptive use, method type and covert use. DESIGN The present analysis uses cross-sectional female data collected in Burkina Faso (December 2020-March 2021), Côte d'Ivoire (October-November 2021) and Kenya (November-December 2020). SETTINGS Burkina Faso, Côte d'Ivoire and Kenya PARTICIPANTS: Analytical samples were restricted to partnered women with contraceptive need who completed a violence module (Burkina Faso n=1863; Côte d'Ivoire n=1105; Kenya n=3390). PRIMARY AND SECONDARY OUTCOME MEASURES The exposures of interest-past-year emotional IPV, physical/sexual IPV and RC-were assessed using abridged versions of the Revised Conflict and Tactics Scale-2 and Reproductive Coercion Scale, respectively. Outcomes of interest included current contraceptive use, contraceptive method type (female controlled vs male compliant), and covert contraceptive use, and used standard assessments. RESULTS Across sites, 6.4% (Côte d'Ivoire) to 7.8% (Kenya) of women in need of contraception experienced RC; approximately one-third to one-half of women experiencing RC reported no other violence forms (31.7% in Burkina Faso to 45.8% in Côte d'Ivoire), whereas physical/sexual IPV largely occurred with emotional IPV. In multivariable models, RC was consistently associated with covert use (Burkina Faso: aOR 2.84 (95% CI 1.21 to 6.64); Côte d'Ivoire: aOR 4.45 (95% CI 1.76 to 11.25); Kenya: aOR 5.77 (95% CI 3.51 to 9.46)). Some IPV in some settings was also associated with covert use (emotional IPV, Burkina Faso: aOR 2.99 (95% CI 1.56 to 5.74); physical/sexual, Kenya: aOR 2.35 (95% CI 1.33 to 4.17)). CONCLUSIONS Across settings, covert use is a critical strategy for women experiencing RC. Country policies must recognise RC as a unique form of violence with profound implications for women's reproductive health.
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Affiliation(s)
- Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Haley L Thomas
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mary Thiongo
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
| | - Georges Guiella
- Institut Supérieur des Sciences de la Population, Ouagadougou, Centre, Burkina Faso
| | - Fiacre Bazié
- Institut Supérieur des Sciences de la Population, Ouagadougou, Centre, Burkina Faso
| | - Yentéma Onadja
- Institut Supérieur des Sciences de la Population, Ouagadougou, Centre, Burkina Faso
| | - Rosine Mosso
- Ecole Nationale Superieure de Statistique et d'Economie Appliquee, Abidjan, Côte d'Ivoire
| | - Raimi Fassassi
- Ecole Nationale Superieure de Statistique et d'Economie Appliquee, Abidjan, Côte d'Ivoire
| | - Peter Gichangi
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
- Technical University of Mombasa, Mombasa, Kenya
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
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15
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Cheng Y, Rogers C, Boerma CJ, Botfield JR, Estoesta J. Clinician views and experiences with reproductive coercion screening in a family planning service. Sex Health 2023; 20:71-79. [PMID: 36690449 DOI: 10.1071/sh22143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/15/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Reproductive coercion refers to behaviour that interferes with a person's reproductive autonomy, such as contraceptive sabotage, pregnancy coercion, controlling a pregnancy outcome or forced sterilisation. Routine screening for reproductive coercion, together with clinician education, was implemented at a family planning service in New South Wales, Australia, in December 2018. A study was undertaken to explore the views and experiences of clinicians in undertaking reproductive coercion screening at this service. METHODS Clinicians were invited to complete an online survey and interview to discuss their understanding of reproductive coercion and their views and experiences of undertaking reproductive coercion screening. Descriptive and thematic content analysis was conducted. RESULTS Clinicians deemed reproductive coercion screening to be relevant and important in family planning services. Key barriers to reproductive coercion screening and responding to disclosures included time constraints and limited appropriate referral pathways. Ongoing education and training with resources such as a decision-support tool on reproductive coercion screening and management, as well as effective multi-disciplinary collaboration, were identified as strategies to improve the screening program. CONCLUSIONS Findings from our study highlight that clinicians' perceived reproductive coercion screening as a relevant and important component of sexual and reproductive healthcare. Ongoing reproductive coercion education, training and support would ensure the competency and confidence of clinicians undertaking screening. Identifying appropriate referral pathways with multi-disciplinary collaboration (involving clinicians, social workers, support workers and psychologists) would support clinicians in undertaking screening and responding to disclosures of reproductive coercion in Australian health care settings which provide family planning and sexual and reproductive health services.
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Affiliation(s)
- Yan Cheng
- Family Planning NSW, 8 Holker Street, Newington, NSW 2127, Australia
| | - Claire Rogers
- Family Planning NSW, 8 Holker Street, Newington, NSW 2127, Australia
| | - Clare J Boerma
- Family Planning NSW, 8 Holker Street, Newington, NSW 2127, Australia
| | | | - Jane Estoesta
- Family Planning NSW, 8 Holker Street, Newington, NSW 2127, Australia
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16
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Huang C, Hill A, Miller E, Soudi A, Flick D, Buranosky R, Holland CL, Hawker L, Chang JC. "Are You Safe at Home?": Clinician's Assessments for Intimate Partner Violence at the Initial Obstetric Visit. Violence Against Women 2023; 29:185-201. [PMID: 36474434 PMCID: PMC10704346 DOI: 10.1177/10778012221142915] [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] [Indexed: 12/12/2022]
Abstract
Few studies have empirically examined patient-clinician conversations to assess how intimate partner violence (IPV) screening is performed. Our study sought to examine audio-recorded first obstetric encounters' IPV screening conversations to describe and categorize communication approaches and explore associations with patient disclosure. We analyzed 247 patient encounters with 47 providers. IPV screening occurred in 95% of visits: 57% used direct questions, 25% used indirect questions, 17% repeated IPV screening later in the visit, 11% framed questions with a reason for asking, and 10% described IPV types. Patients disclosed IPV in 71 (28.7%) visits. There were no associations between disclosure and any categories of IPV screening.
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Affiliation(s)
- Cecilia Huang
- Long Beach Memorial Family Medicine Residency Program, Long Beach, CA, USA
| | - Amber Hill
- Department of Pediatrics, CS Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Abdesalam Soudi
- Department of Linguistics, University of Pittsburgh Dietrich School of Arts and Sciences, Pittsburgh, PA, USA
| | - Diane Flick
- The Primary Health Network - Behavioral Health Operations, Sharon, PA, USA
| | - Raquel Buranosky
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Cynthia L. Holland
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lynn Hawker
- Women’s Center and Shelter of Greater Pittsburgh, Pittsburgh, PA, USA
| | - Judy C. Chang
- Magee-Women’s Research Institute and Department of Obstetrics, Gynecology and Reproductive Sciences; Division of General Internal Medicine, Department of Medicine; Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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17
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Wood SN, Thomas HL, Guiella G, Bazié F, Mosso R, Fassassi R, Akilimali PZ, Thiongo M, Gichangi P, Oumarou S, OlaOlorun FM, Omoluabi E, Khanna A, Kibira SPS, Makumbi F, Decker MR. Prevalence and correlates of reproductive coercion across ten sites: commonalities and divergence. Reprod Health 2023; 20:22. [PMID: 36707833 PMCID: PMC9881347 DOI: 10.1186/s12978-023-01568-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/13/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Reproductive coercion (RC) is a type of abuse where a partner asserts control over a woman's reproductive health trajectories. Recent research emphasizes that RC experiences may differ within and across low- and middle-income countries (LMICs), as compared to higher income contexts, given social pressures surrounding childbearing. To date, nationally representative surveys have lacked comprehensive measures for RC, leading to gaps in understanding its prevalence and risk factors. Across eight LMICs (10 sites), we aimed to (1) validate the RC Scale; (2) calculate prevalence of RC and specific behaviors; and (3) assess correlates of RC. METHODS This analysis leverages cross-sectional Performance Monitoring for Action (PMA) data collected from November 2020 to May 2022. Analyses were limited to women in need of contraception (Burkina Faso n = 2767; Côte d'Ivoire n = 1561; Kongo Central, Democratic Republic of Congo (DRC) n = 830; Kinshasa, DRC n = 846; Kenya n = 4588; Kano, Nigeria n = 535; Lagos, Nigeria n = 612; Niger n = 1525; Rajasthan, India n = 3017; Uganda n = 2020). Past-year RC was assessed via five items adapted from the original RC Scale and previously tested in LMICs. Confirmatory factor analysis examined fit statistics by site. Per-item and overall prevalence were calculated. Site-specific bivariate and multivariable logistic regression examined RC correlates across the socioecological framework. RESULTS Confirmatory factor analysis confirmed goodness of fit across all sites, with moderate internal consistency (alpha range: 0.66 Cote d'Ivoire-0.89 Kinshasa, DRC/Lagos, Nigeria). Past-year reported prevalence of RC was highest in Kongo Central, DRC (20.3%) and lowest in Niger (3.1%). Prevalence of individual items varied substantially by geography. Polygyny was the most common RC risk factor across six sites (adjusted odds ratio (aOR) range: 1.59-10.76). Increased partner education levels were protective in Kenya and Kano, Nigeria (aOR range: 0.23-0.67). Other assessed correlates differed by site. CONCLUSIONS Understanding RC prevalence and behaviors is central to providing woman-centered reproductive care. RC was most strongly correlated with factors at the partner dyad level; future research is needed to unpack the relative contributions of relationship power dynamics versus cultural norms surrounding childbearing. Family planning services must recognize and respond to women's immediate needs to ensure RC does not alter reproductive trajectories, including vulnerability to unintended pregnancy.
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Affiliation(s)
- Shannon N. Wood
- grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E4009, Baltimore, MD 21205 USA ,grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Haley L. Thomas
- grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E4009, Baltimore, MD 21205 USA
| | - Georges Guiella
- grid.463389.30000 0000 9980 0286Institut Supérieur des Sciences de la Population (ISSP/University of Ouagadougou), Ouagadougou, Burkina Faso
| | - Fiacre Bazié
- grid.463389.30000 0000 9980 0286Institut Supérieur des Sciences de la Population (ISSP/University of Ouagadougou), Ouagadougou, Burkina Faso
| | - Rosine Mosso
- grid.508476.80000 0001 2107 3477Ecole Nationale Superieure de Statistique et Appliquee d’Abidjan (ENSEA), Abidjan, Côte d’Ivoire
| | - Raimi Fassassi
- grid.508476.80000 0001 2107 3477Ecole Nationale Superieure de Statistique et Appliquee d’Abidjan (ENSEA), Abidjan, Côte d’Ivoire
| | - Pierre Z. Akilimali
- grid.9783.50000 0000 9927 0991Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Mary Thiongo
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
| | - Peter Gichangi
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya ,grid.449703.d0000 0004 1762 6835Technical University of Mombasa, Mombasa, Kenya ,grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Sani Oumarou
- Institut National de la Statistique du Niger, Niamey, Niger
| | - Funmilola M. OlaOlorun
- grid.9582.60000 0004 1794 5983College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Elizabeth Omoluabi
- grid.8974.20000 0001 2156 8226University of the Western Cape, Cape Town, South Africa
| | - Anoop Khanna
- grid.464858.30000 0001 0495 1821Indian Institute of Health Management Research, Sanganer, Jaipur, India
| | - Simon Peter Sebina Kibira
- grid.464858.30000 0001 0495 1821Indian Institute of Health Management Research, Sanganer, Jaipur, India
| | - Fredrick Makumbi
- grid.11194.3c0000 0004 0620 0548Makerere University School of Public Health, Kampala, Uganda
| | - Michele R. Decker
- grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E4009, Baltimore, MD 21205 USA ,grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA ,grid.21107.350000 0001 2171 9311Johns Hopkins School of Nursing, Baltimore, USA
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18
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Grace KT, Miller E. Future directions for reproductive coercion and abuse research. Reprod Health 2023; 20:5. [PMID: 36593505 PMCID: PMC9809032 DOI: 10.1186/s12978-022-01550-3] [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: 09/15/2022] [Accepted: 12/12/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Reproductive coercion and abuse (RCA) is a form of intimate partner violence (IPV) in which people with the capacity for pregnancy experience coercive behaviors that threaten their reproductive autonomy. Behaviors that constitute RCA include contraceptive control/sabotage, pregnancy pressure, and controlling the outcome of a pregnancy. Several areas of RCA study have emerged: associations with IPV, health outcomes resulting from RCA, and demographic and contextual factors associated with experiencing RCA. Current research in these areas is summarized and placed in a global context, including sexual and gender minority groups, use of RCA (exploring perpetration), RCA interventions, RCA in women with disabilities, and the question of whether people assigned male at birth can be RCA victims. CONCLUSION Areas for future exploration include evolving interpretations of pregnancy intention in the setting of fewer options for abortion, RCA in people with disabilities and multiple levels of marginalization, including sexual and gender minorities; intersections between RCA and economic abuse in the context of efforts at economic justice; and community-centered approaches to intervention and prevention.
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Affiliation(s)
- Karen Trister Grace
- grid.22448.380000 0004 1936 8032School of Nursing, College of Public Health, George Mason University, 4400 University Drive, Mailstop 3C4, Fairfax, VA 22030 USA
| | - Elizabeth Miller
- grid.21925.3d0000 0004 1936 9000Adolescent and Young Adult Medicine, University of Pittsburgh, 120 Lytton Avenue, Pittsburgh, PA 15213-1481 USA
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19
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Wood SN, Dozier JL, Karp C, Desta S, Decker MR, Shiferaw S, Seme A, Yirgu R, Zimmerman LA. Pregnancy coercion, correlates, and associated modern contraceptive use within a nationally representative sample of Ethiopian women. Sex Reprod Health Matters 2022; 30:2139891. [PMID: 36469634 PMCID: PMC9728127 DOI: 10.1080/26410397.2022.2139891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Partner-perpetrated pregnancy coercion inhibits women's reproductive autonomy. However, few studies have quantified pregnancy coercion and its effects on women's health within low- and middle-income countries. Among a national sample of Ethiopian women, this study aimed to: (1) assess the prevalence of past-year pregnancy coercion and explore regional differences; (2) identify correlates; (3) examine the relationship between pregnancy coercion and modern contraceptive use. Analyses utilise cross-sectional data from Performance Monitoring for Action (PMA)-Ethiopia, a nationally representative sample of females aged 15-49 conducted from October to November 2019. Past-year pregnancy coercion was assessed via five items and analysed dichotomously and categorically for severity. Among women in need of contraception, bivariate and multivariable logistic regression examined associations between variables of interest, per aim, accounting for sampling weights and clustering by enumeration area. Approximately 20% of Ethiopian women reported past-year pregnancy coercion (11.4% less severe; 8.6% more severe), ranging from 16% in Benishangul-Gumuz to 35% in Dire Dawa. Increasing parity was associated with decreased odds of pregnancy coercion. Among women in need of contraception, experience of pregnancy coercion was associated with a 32% decrease in odds of modern contraceptive use (aOR = 0.68; 95% CI: 0.53-0.89); when disaggregated by severity, odds decreased for most severe pregnancy coercion (aOR = 0.59; 95% CI = 0.41-0.83). Results indicate that partner-perpetrated pregnancy coercion is prevalent across diverse regions of Ethiopia, and most severe forms could interrupt recent gains in contraceptive coverage and progress to sexual and reproductive health and rights. Providers must be aware of potential contraceptive interference and address coercive influences during contraceptive counselling.
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Affiliation(s)
- Shannon N Wood
- Assistant Scientist, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jessica L Dozier
- PhD Student, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Celia Karp
- Assistant Scientist, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Selamawit Desta
- Director of Survey Operations, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michele R Decker
- Bloomberg Professor of American Health, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Women’s Health and Rights Program Director, Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Joint Professor, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Solomon Shiferaw
- Associate Professor, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Assefa Seme
- Associate Professor, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Robel Yirgu
- Associate Professor, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Linnea A Zimmerman
- Assistant Professor, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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20
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Wright EN, Anderson J, Phillips K, Miyamoto S. Help-Seeking and Barriers to Care in Intimate Partner Sexual Violence: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2022; 23:1510-1528. [PMID: 33685295 DOI: 10.1177/1524838021998305] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Intimate partner sexual violence (IPSV) is a prevalent phenomenon, yet an under-researched topic. Due to the complex nature of balancing love and fear, individuals who experience IPSV have unique needs and face unique barriers to seeking care. The purpose of this systematic review was to examine the literature on help-seeking and barriers to care in IPSV. Articles were identified through PubMed, CINAHL, PsycINFO, and Web of Science. Search terms included terms related to IPSV, intimate partner violence (IPV), domestic violence, sexual assault, and rape. The review was limited to the United States, and articles that were included needed to specifically measure or identify sexual violence in an intimate relationship and analyze or discuss IPSV in relation to help-seeking behaviors or barriers to care. Of the 17 articles included in this review, 13 were quantitative studies and four were qualitative studies. Various definitions and measurements of IPSV across studies included in this review make drawing broad conclusions challenging. Findings suggest that experiencing IPSV compared to experiencing nonsexual IPV (i.e., physical or psychological IPV) may increase help-seeking for medical, legal, and social services while decreasing help-seeking for informal support. Help-seeking can also reduce risk of future IPSV and decrease poor mental health outcomes. Barriers to seeking care in IPSV included social stigma, fear, and difficulty for individuals in identifying IPSV behaviors in their relationships as abuse. More inclusive research is needed among different populations including men, non-White individuals, nonheterosexual, and transgender individuals. Suggestions for research, practice, and policies are discussed.
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Affiliation(s)
- Elizabeth N Wright
- College of Nursing, 8082The Pennsylvania State University, University Park, PA, USA
| | - Jocelyn Anderson
- College of Nursing, 8082The Pennsylvania State University, University Park, PA, USA
| | - Kathleen Phillips
- College of Nursing, 8082The Pennsylvania State University, University Park, PA, USA
| | - Sheridan Miyamoto
- College of Nursing, 8082The Pennsylvania State University, University Park, PA, USA
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21
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Wood SN, Yirgu R, Karp C, Tadesse MZ, Shiferaw S, Zimmerman LA. The impact of partner autonomy constraints on women's health-seeking across the maternal and newborn continuum of care. EClinicalMedicine 2022; 53:101715. [PMID: 36345400 PMCID: PMC9636056 DOI: 10.1016/j.eclinm.2022.101715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/07/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Gendered health inequities impede women's reproductive autonomy over the life course. Pregnancy is a critical time point for assessing inequities and partners are integral actors in the achievement or impediment of women's and children's health during this time. METHODS Among a nationally representative cohort of Ethiopian women 5-9 weeks postpartum with data collected from October 2019-September 2020, this study aimed to 1) understand the prevalence and interplay of partner-related autonomy constraints (intimate partner violence (IPV), reproductive coercion (RC), lack of encouragement from seeking antenatal care (ANC), and lack of encouragement from seeking postnatal care (PNC), and 2) examine the impact of autonomy constraints on the maternal and newborn health (MNH) continuum of care. FINDINGS Sixty percent of women experienced a partner-related autonomy constraint prior to or during pregnancy. Approximately 20% of women were not encouraged to seek antenatal care and postpartum care, respectively, whereas fewer women experienced IPV during pregnancy (12.3%) and RC (11.0%). Less than one in five women completed the MNH continuum of care. Lack of encouragement of ANC and PNC were associated with decreased care-seeking at every point across the MNH continuum of care. Lack of encouragement of ANC (aOR = 0.45; p = 0.05) and of PNC (aOR = 0.16; p < 0.001) were associated with reductions in completing the continuum. INTERPRETATION Partner engagement, interventions, and messaging are critical to enhance MNH care-seeking behaviors. FUNDING This work was supported, in whole, by the Bill & Melinda Gates Foundation [INV 009466]. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission.
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Affiliation(s)
- Shannon N. Wood
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Corresponding author. 615 N. Wolfe Street Room E4009, Baltimore, MD, 21205, USA.
| | - Robel Yirgu
- Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | - Celia Karp
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Meseret Zelalem Tadesse
- Maternal, Child, and Nutrition Directorate, Ethiopia Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Solomon Shiferaw
- Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | - Linnea A. Zimmerman
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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22
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Anderson JC, Richter RK, Hawk M, Egan J, Miller E, Lampe K, Van Dusen CR, Chugani CD. Exploring Definitions of Consent and Healthy Relationships Among College Students with Disabilities: "I think it's fuzzy". JOURNAL OF FAMILY VIOLENCE 2022; 37:1353-1366. [PMID: 36300014 PMCID: PMC9590619 DOI: 10.1007/s10896-021-00322-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 06/16/2023]
Abstract
Purpose College students with disabilities (SWDs) experience elevated rates of sexual violence and intimate partner violence compared with their non-disabled peers. While tailored interventions for these pressing health issues are needed, current research lacks investigation into how SWDs conceptualize relevant key concepts, such as consent and healthy relationships. Method This descriptive qualitative study explored these concepts through semi-structured interviews with college SWDs (n=49), 18-24 years old, in Pennsylvania and West Virginia. Results The results culminated in six rich, descriptive themes addressing: 1) interpersonal and intrapersonal skills necessary for relationship health; 2) normalization of unhealthy treatment by a partner due to manipulation, denial, and love for the partner; 3) how dichotomous definitions of consent interfere with practical application in lived experiences; 4) how active consent can be both facilitated and hindered within the context of a romantic relationship; 5) perceptions that healthcare providers aim to elicit disclosures of abuse rather than initiate a discussion about relationship health; and 6) students' reticence to disclose abuse to healthcare providers due to mistrust and fear over loss of agency. Conclusions These results contradict historic narratives that SWDs do not have the same sexual and relationship beliefs and experiences as other students and highlight the perspectives of this marginalized population. Implications for campus prevention programming and healthcare practices include incorporating intersections of disability and violence, discussing the nuances of consent and substance use, and creating conversations about relationship health that are transparent, non-judgmental, and include a broad range of types of abuse.
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Affiliation(s)
| | | | - Mary Hawk
- Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health
| | - James Egan
- Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health
| | - Elizabeth Miller
- Department of Pediatrics, University of Pittsburgh School of Medicine
| | - Kelli Lampe
- Counseling Academic Unit, Oregon State University
- University Counseling Center, Division of Student Affairs, University of Pittsburgh
| | | | - Carla D. Chugani
- Department of Pediatrics, University of Pittsburgh School of Medicine
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23
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Wood SN, Kennedy SR, Akumu I, Tallam C, Asira B, Zimmerman LA, Glass N, Decker MR. Understanding the Link Between Reproductive Coercion and Covert Use of Contraception as a Safety Strategy for Women Experiencing Violence in Nairobi's Urban Informal Settlements. Violence Against Women 2022; 29:1343-1367. [PMID: 36000323 DOI: 10.1177/10778012221108422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This mixed-methods study examined the relationship between reproductive coercion (RC) and covert contraceptive use among intimate partner violence survivors in Nairobi, Kenya. Quantitative analyses utilize baseline data from the myPlan Kenya trial (n = 321). Purposive in-depth interviews (IDIs) (n = 30) explored women's reproductive safety strategies. Multinomial analyses indicated increased covert use and decreased overt use compared to nonuse, for women experiencing RC; logistic models similarly report increased odds of covert use with RC experience. Qualitative data contextualize women's reasons for use and challenges faced. Integration of reproductive safety strategies into family planning and violence services can improve the safe use of contraception.
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Affiliation(s)
- Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Irene Akumu
- Mashinani Department, Ujamaa-Africa, Nairobi, Kenya
| | | | - Ben Asira
- Mashinani Department, Ujamaa-Africa, Nairobi, Kenya
| | - Linnea A Zimmerman
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nancy Glass
- Johns Hopkins School of Nursing, Baltimore, MD, USA.,Department of International Health, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Global Health, 15851Johns Hopkins University, Baltimore, MD, USA
| | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins School of Nursing, Baltimore, MD, USA.,Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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24
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Korab-Chandler E, Kyei-Onanjiri M, Cameron J, Hegarty K, Tarzia L. Women's experiences and expectations of intimate partner abuse identification in healthcare settings: a qualitative evidence synthesis. BMJ Open 2022; 12:e058582. [PMID: 35835525 PMCID: PMC9289017 DOI: 10.1136/bmjopen-2021-058582] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To explore women's experiences and expectations of intimate partner abuse (IPA) disclosure and identification in healthcare settings, focusing on the process of disclosure/identification rather than the healthcare responses that come afterwards. DESIGN Systematic review and meta-synthesis of qualitative studies DATA SOURCES: Relevant studies were sourced by using keywords to search the databases MEDLINE, EMBASE, CINAHL, PsychINFO, SocINDEX and ASSIA in September 2021. ELIGIBILITY CRITERIA Studies needed to focus on women's views about IPA disclosure and identification in healthcare settings, use qualitative methods and have been published in the last 5 years. DATA EXTRACTION AND SYNTHESIS Relevant data were extracted into a customised template. The Critical Appraisal Skills Programme checklist for qualitative research was used to assess the methodological quality of included studies. A thematic synthesis approach was applied to the data, and confidence in the findings was appraised using The Confidence in the Evidence from Reviews of Qualitative research methods. RESULTS Thirty-four studies were included from a range of healthcare settings and countries. Three key themes were generated through analysing their data: (1) Provide universal education, (2) Create a safe and supportive environment for disclosure and (3) It is about how you ask. Included papers were rated overall as being of moderate quality, and moderate-high confidence was placed in the review findings. CONCLUSIONS Women in the included studies articulated a desire to routinely receive information about IPA, lending support to a universal education approach that equips all women with an understanding of IPA and options for assistance, regardless of disclosure. Women's suggestions for how to promote an environment conducive to disclosure and how to enquire about IPA have clear implications for clinical practice.PROSPERO registration numberCRD42018091523.
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Affiliation(s)
| | - Minerva Kyei-Onanjiri
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jacqueline Cameron
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kelsey Hegarty
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Family Violence Prevention, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Laura Tarzia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Family Violence Prevention, The Royal Women's Hospital, Parkville, Victoria, Australia
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25
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Anderson JC, Feinstein Z, Edwards C, Jones KA, Van Dusen C, Kehr V, Burrell C, Coulter RW, Miller E, Chugani CD. Provider perspectives on implementing a student health and counseling center intervention for sexual violence. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1363-1371. [PMID: 32721195 PMCID: PMC7855319 DOI: 10.1080/07448481.2020.1797752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/20/2019] [Accepted: 02/29/2020] [Indexed: 06/11/2023]
Abstract
Objective: To describe provider experiences with implementation of the GIFTSS (Giving Information for Trauma Support and Safety) intervention. Participants: Health and counseling center staff from participating campuses attended trainings between August 2015 and August 2016. Interviews were conducted between May and August 2017. Methods: Providers (n = 230) completed surveys prior to and six months following a 3-hour training on the intervention. Structured phone interviews were conducted with a purposively selected subset of 14 providers. Results: Overall, staff found the intervention acceptable. Implementation barriers noted were time and competing patient priorities. Providers noted variation based on patient and visit characteristics. Clinic commitment, particularly in adopting strategies for universal dissemination of the GIFTSS card, was seen as helpful. Conclusion: Implementation of a brief trauma-informed intervention in campus health and counseling centers was feasible and acceptable to most providers. Opportunities to change organizational culture regarding ensuring adequate time and safety for patients are discussed.
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Affiliation(s)
- Jocelyn C. Anderson
- University of Pittsburgh School of Medicine, Department of Pediatrics and UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
- Pennsylvania State University, College of Nursing, State College, PA
| | - Zoe Feinstein
- University of Pittsburgh School of Medicine, Department of Pediatrics and UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
| | | | - Kelley A. Jones
- University of Pittsburgh School of Medicine, Department of Pediatrics and UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
| | - Courtney Van Dusen
- University of Pittsburgh School of Medicine, Department of Pediatrics and UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
| | - Vanessa Kehr
- University of Pittsburgh School of Medicine, Department of Pediatrics and UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
| | | | - Robert W.S. Coulter
- University of Pittsburgh School of Medicine, Department of Pediatrics and UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
- University of Pittsburgh Graduate School of Public Health, Department of Behavioral and Community Health Sciences, Pittsburgh, PA
| | - Elizabeth Miller
- University of Pittsburgh School of Medicine, Department of Pediatrics and UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
| | - Carla D. Chugani
- University of Pittsburgh School of Medicine, Department of Pediatrics and UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
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26
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Uysal J, Stockman JK, Miller E, Rocha-Jimenez T, Rangel GM, Mercado AP, Servin AE. "At Least I Didn't Get Raped": A Qualitative Exploration of IPV and Reproductive Coercion among Adolescent Girls Seeking Family Planning in Mexico. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP4740-NP4761. [PMID: 33183147 PMCID: PMC8113348 DOI: 10.1177/0886260520959571] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Adolescent girls who report intimate partner violence (IPV) are at an increased risk of experiencing reproductive coercion (RC); both these forms of gender-based violence (GBV) are associated with unintended pregnancy. Yet little is known about these experiences among adolescent girls in Mexico. Qualitative data were collected as part of formative research for the adaptation of an evidence-based intervention to address RC and IPV in community health centers in Tijuana, Mexico. From September, 2017 to January, 2018, adolescent girls aged 16 to 20 years old (n = 20) seeking voluntary family planning (FP) services were identified and recruited from two publicly funded community health centers. We conducted semi-structured, in-depth interviews and analyzed the transcripts using inductive and deductive techniques. Participants in this sample commonly described experiencing IPV and RC (including pregnancy coercion and contraceptive sabotage), which many girls reported resulted in unintended pregnancy. Further, participants' narratives and general lack of knowledge on how to cope with IPV or RC illuminated the acceptability of offering GBV prevention intervention within FP clinics serving this population. Findings highlight an urgent need to prevent IPV and RC, and reduce risk for unintended pregnancy among adolescent girls in this region and the potential of FP clinics to serve as a safe space for intervention delivery. Findings contribute to the limited qualitative evidence from Mexico, describing adolescent girl's experiences of IPV and RC, strategies for preventing pregnancy in the context of RC, and opportunities for support from FP providers.
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Affiliation(s)
- Jasmine Uysal
- University of California, San Diego (UCSD), La Jolla, CA, USA
| | | | - Elizabeth Miller
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Gudelia M. Rangel
- U.S.-Mexico Border Health Commission, Tijuana, Baja California, Mexico
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27
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Ragavan MI, Barral RL, Randell KA. Addressing Adolescent Relationship Abuse in the Context of Reproductive Health Care. Semin Reprod Med 2022; 40:146-154. [PMID: 34996120 PMCID: PMC9885502 DOI: 10.1055/s-0041-1741519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Adolescent relationship abuse (ARA) is a significant public health issue that includes physical, sexual, psychological and cyber abuse, reproductive coercion, and/or sexual exploitation within an intimate relationship in which one or both partners is a minor. ARA is associated with numerous negative outcomes that include all domains of health. Many negative outcomes of ARA are related to reproductive and sexual health (RSH); thus, reproductive health care providers must be equipped to recognize and address ARA. This article will review the epidemiology and outcomes of ARA, followed by a discussion of means to robustly address ARA in health care settings. We recommend a strengths-based approach that promotes healthy adolescent relationships, connects adolescents experiencing ARA to harm reduction resources, and equips adolescents to serve as a resource for their peers.
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Affiliation(s)
- Maya I. Ragavan
- Division of General Academic Pediatrics, University of Pittsburgh/Children’s Hospital Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Romina L. Barral
- Division of Adolescent Medicine, Children’s Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA; University of Kansas School of Medicine, Kansas City, KS, USA
| | - Kimberly A. Randell
- Division of Emergency Medicine, Children’s Mercy Kansas City; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA; University of Kansas School of Medicine, Kansas City, KS, USA
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28
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Raj A, Ghule M, Johns NE, Battala M, Begum S, Dixit A, Vaida F, Saggurti N, Silverman JG, Averbach S. Evaluation of a gender synchronized family planning intervention for married couples in rural India: The CHARM2 cluster randomized control trial. EClinicalMedicine 2022; 45:101334. [PMID: 35274093 PMCID: PMC8902598 DOI: 10.1016/j.eclinm.2022.101334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/27/2022] [Accepted: 02/16/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Despite calls for gender transformative family planning interventions to increase male engagement and female reproductive agency, there is limited research involving rigorous evaluation of the integration of these approaches. CHARM2 (counseling Husbands and wives to Achieve Reproductive Health and Marital Equity) builds upon a prior three-session male engagement intervention by integrating female-focused sessions emphasizing women's choice and agency (i.e., gender synchronization). We hypothesized that CHARM2 participants will be more likely to report marital contraceptive use and communication and women's contraceptive agency, and less likely to report unintended pregnancy, relative to participants in the control condition. METHODS We conducted a two-armed cluster randomized controlled trial evaluating the effects of CHARM2 on marital contraceptive use, communication, decision-making; women's contraceptive agency, and pregnancy among young married couples in rural Maharashtra, India (ClinicalTrials.gov #NCT03514914, complete). 40 geographic clusters, defined based on the catchment areas of subcenter health facilities (the most proximal level of community health care within India's public health system) were randomized to control (n = 20) and intervention (n = 20). We assigned all participants within that geographic cluster to the corresponding cluster treatment condition; participants, investigators, and study staff were not masked to treatment assignment. Eligibility criteria included wife aged 18-29, couple residing together for at least six months with no plan for migration, and neither spouse sterilized or infertile. The CHARM2 intervention included five provider-delivered sessions on gender equity and family planning, two delivered in parallel to husbands and wives separately by gender-matched providers, and one final joint session, delivered within the four months subsequent to baseline survey. We conducted surveys and pregnancy testing at baseline and 9-month and 18-month follow-up. We used difference-in-differences multilevel mixed effects logistic regressions to assess CHARM2 effects on marital contraceptive use and communication, and women's contraceptive agency; we used single time point mixed effects logistic regressions for pregnancy outcomes. All analyses used an intention-to-treat approach. FINDINGS 1201 couples were recruited between September 2018 and June 2019; 600 intervention and 601 control. All couples were included in outcome analyses. Full couple retention was 90·2% (n = 1083) at 9-month follow-up and 90·5% (n = 1087) at 18-month follow-up. Modern contraceptive use was higher among intervention participants at 9-month but not 18-month follow-up (9-month adjusted ratio of odds ratio [AROR] 1·5, 95% CI 1·03-2·3; 18-month AROR 0·8, 95% CI 0·4-1·4). Communication (9-month AROR 1·9, 95% CI 1·0-3·6; 18-month AROR 2·7, 95% CI 1·5-4·8) and agency (9-month AROR 5·1, 95% CI 1·2-22·4; 18-month AROR 8·1, 95% CI 1·4-48·2) both improved at both time points. There was no significant difference in pregnancy between groups over the 18-month period (AOR 0·8, 95% CI 0·7-1.1) However, for women who expressed fertility ambivalence at baseline, unintended pregnancy was marginally less likely among intervention participants (47% vs 19%) (p = 0·07). There were no reported adverse events. INTERPRETATION The CHARM2 intervention offers a scalable model to improve contraceptive use, communication, and agency and possibly decrease unplanned pregnancies for couples in rural India.
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Affiliation(s)
- Anita Raj
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093, United States
- Department of Education Studies, University of California, 3350 La Jolla Village Dr, San Diego, CA 92161, United States
- Corresponding author at: Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093, United States.
| | - Mohan Ghule
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093, United States
| | - Nicole E. Johns
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093, United States
| | - Madhusudana Battala
- Population Council, Zone 5A, Ground Floor, India Habitat Center, Lodi Road, New Delhi 110003, India
| | - Shahina Begum
- Department of Biostatistics, ICMR-National Institute for Research in Reproductive Health, J.M Street, Parel, Mumbai 400012, India
| | - Anvita Dixit
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093, United States
- Joint Doctoral Program in Public Health (Global Health Track), University of California San Diego/San Diego State University, UC San Diego 9500 Gilman Dr., La Jolla, CA 92093-0725, USA
| | - Florin Vaida
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093, United States
- Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Niranjan Saggurti
- Population Council, Zone 5A, Ground Floor, India Habitat Center, Lodi Road, New Delhi 110003, India
| | - Jay G. Silverman
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093, United States
| | - Sarah Averbach
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093, United States
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego School of Medicine, 9300 Campus Point Drive #7433, La Jolla, CA 92037, USA
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29
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Grace KT, Decker MR, Alexander KA, Campbell J, Miller E, Perrin N, Glass N. Reproductive Coercion, Intimate Partner Violence, and Unintended Pregnancy Among Latina Women. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:1604-1636. [PMID: 32486886 PMCID: PMC8162928 DOI: 10.1177/0886260520922363] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Reproductive coercion (RC) describes a range of behaviors that restrict reproductive autonomy including pregnancy coercion, birth control sabotage, and controlling the outcome of a pregnancy. RC is associated with pregnancies that are mistimed and unwanted (i.e., unintended). Past research demonstrates that Latina women have higher risk for RC and for unintended pregnancy. This cross-sectional descriptive study with Latina women (n = 482) examined prevalence and risk factors for RC, evaluated the association of RC and unintended pregnancy among women with a past-year pregnancy, and explored use of safety and harm reduction strategies. A tablet survey was administered to women attending a community health center, between the ages of 15 and 45, who self-identified as Latina and who had a dating or sexual partner in the past year. Approximately one in six (16.8%) experienced past-year RC and risk factors included younger age (adjusted odds ratio [AOR] = 0.95, 95% confidence interval [CI] = [0.91, 1.00], p = .038) and concurrent intimate partner violence (IPV; AOR = 4.47, 95% CI = [2.06, 9.70], p < .001). IPV questions were specific to the partner involved with RC behaviors. For the 185 participants who reported a past-year pregnancy, RC was associated with lower pregnancy planning scores (β = -.27, 95% CI = [-0.41, -0.13], p < .001). The combination of experiencing RC and IPV appeared particularly potent in lowering pregnancy planning scores (β = -.15, 95% CI = [-0.29, 0.00], p = .052). Approximately 10.6% of participants engaged in harm reduction strategies, most commonly ending an unhealthy or abusive relationship (6.1%) and using less detectable methods of contraception so that partners would not find out (3.4%). The study articulates the risk of RC and its intersection with IPV and unintended pregnancy for Latina women. Providers working with racially and ethnically marginalized women have an important role in promoting safety and harm reduction strategies that include offering less detectable methods of contraception and support in leaving unhealthy and abusive relationships.
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Affiliation(s)
| | - Michele R Decker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Nancy Perrin
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Nancy Glass
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
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30
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Bonar EE, DeGue S, Abbey A, Coker AL, Lindquist CH, McCauley HL, Miller E, Senn CY, Thompson MP, Ngo QM, Cunningham RM, Walton MA. Prevention of sexual violence among college students: Current challenges and future directions. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:575-588. [PMID: 32407244 PMCID: PMC7666108 DOI: 10.1080/07448481.2020.1757681] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 03/25/2020] [Accepted: 04/13/2020] [Indexed: 06/02/2023]
Abstract
Objective Preventing sexual violence among college students is a public health priority. This paper was catalyzed by a summit convened in 2018 to review the state of the science on campus sexual violence prevention. We summarize key risk and vulnerability factors and campus-based interventions, and provide directions for future research pertaining to campus sexual violence. Results and Conclusions: Although studies have identified risk factors for campus sexual violence, longitudinal research is needed to examine time-varying risk factors across social ecological levels (individual, relationship, campus context/broader community and culture) and data are particularly needed to identify protective factors. In terms of prevention, promising individual and relational level interventions exist, including active bystander, resistance, and gender transformative approaches; however, further evidence-based interventions are needed, particularly at the community-level, with attention to vulnerability factors and inclusion for marginalized students.
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Affiliation(s)
- Erin E Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah DeGue
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Antonia Abbey
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Ann L Coker
- Department of Obstetrics & Gynecology, School of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Christine H Lindquist
- Division for Applied Justice Research, RTI International, Research Triangle Park, North Carolina, USA
| | - Heather L McCauley
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh & Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Charlene Y Senn
- Department of Psychology and Women's & Gender Studies Program, University of Windsor, Windsor, Ontario, Canada
| | - Martie P Thompson
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Quyen M Ngo
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Rebecca M Cunningham
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Maureen A Walton
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan, USA
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Greenbaum J. Child Labor and Sex Trafficking. Pediatr Rev 2021; 42:639-654. [PMID: 34850175 DOI: 10.1542/pir.2020-001396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Regardless of their practice setting or subspecialty, pediatricians are likely to encounter children who have experienced sex or labor trafficking or who are at risk for exploitation. Only 24.1% of health professionals in one study reported receiving previous training on human trafficking; after a brief presentation on the topic, 39.6% indicated that they knew or suspected they had cared for a trafficked person in the past 3 months. Trafficked and exploited children can present with myriad physical or mental health conditions; most have experienced repeated, significant trauma; and few are likely to spontaneously disclose their exploitative situation. As a result, clinicians face challenges in recognizing and appropriately responding to potential human trafficking. Knowledge of common risk factors and potential indicators of exploitation can assist the pediatrician in recognizing affected and at-risk youth. However, health professionals report that existing training tends to focus on general information about trafficking, with relatively little time spent discussing the specifics of the trauma-informed approach to patient interactions. Given the critical importance of building patient trust, empowering patients to share their concerns, and engaging them in their own care and safety planning, this article focuses on the practical aspects of working with trafficked and exploited children. A brief overview of human trafficking is followed by an extensive discussion of rights-based, culturally sensitive, trauma-informed strategies for interacting with vulnerable patients.
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Affiliation(s)
- Jordan Greenbaum
- International Centre for Missing and Exploited Children, Alexandria, VA.,Institute on Healthcare and Human Trafficking, Stephanie V. Blank Center for Safe and Healthy Children, Children's Healthcare of Atlanta, Atlanta, GA
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Abota TL, Gashe FE, Kabeta ND. Postpartum Women's Lived Experiences of Perinatal Intimate Partner Violence in Wolaita Zone, Southern Ethiopia: A Phenomenological Study Approach. Int J Womens Health 2021; 13:1103-1114. [PMID: 34803406 PMCID: PMC8598125 DOI: 10.2147/ijwh.s332545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/28/2021] [Indexed: 01/10/2023] Open
Abstract
Objective Perinatal intimate partner violence affects the health and safety of postpartum women and their infants. However, it has not been well recognized and addressed in the study setting. Hence, this study aimed to explore postpartum women's lived experiences of perinatal intimate partner violence and its contributing factors in Wolaita Zone, Southern Ethiopia. Methods A phenomenological study approach was used to explore postpartum women's lived experiences of perinatal partner violence from January to March 2020. A total of twenty-two postnatal women and five health extension workers (HEWs) were interviewed. Interviews were audio-recorded, transcribed verbatim in local languages, and then translated into English. Data were analyzed thematically, using deductive and inductive coding. The consolidated criteria for reporting qualitative research (CORE-Q) checklist was followed to report the findings. Results Results indicated that postpartum women had experienced recurrent violence before, during, and after pregnancy from their husbands, with 16 out of 22 women being subjected to perinatal intimate partner violence. A majority of the participants delineated their exposure to perinatal physical violence next to perinatal psychological violence. Many of the interviewed women noted that violence during pregnancy was exacerbated and increased during postpartum. Moreover, the interviewees revealed that some partners were not only a serious threat to their wives, but also their infants during the postpartum period. Four of the participants stated that their newborns were hit and thrown by their father and became unconscious. Participants linked husbands' perinatal violence with suspicion about the newborn, male-child preference, partner infidelity and jealousy, contraceptives usage, alcohol consumptions, indifference to shortages on household necessities, improper parenting, and financial problems. Conclusion This study highlights that postpartum women are experiencing continuous and severe forms of perinatal IPV in the study setting. Thus, community-level interventions that minimize perinatal partner violence against postnatal women and their infants are needed.
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Affiliation(s)
- Tafesse Lamaro Abota
- Department of Nursing, College of Health Sciences, Mizan-Tepi University, Mizan-Aman, South West Ethiopia.,School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Negussie Deyessa Kabeta
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Cheng Y, Wilson EG, Botfield JR, Boerma CJ, Estoesta J, Peters LJ, McGeechan K. Outcomes of routine screening for reproductive coercion in a family planning service. Sex Health 2021; 18:349-357. [PMID: 34606741 DOI: 10.1071/sh21079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/12/2021] [Indexed: 11/23/2022]
Abstract
Background Reproductive coercion (RC) occurs when a person's autonomous decision-making regarding reproductive health is compromised by another. RC screening, that is, the use of routine, non-invasive screening questions asked of service users/clients, is one strategy that can be used to assess for RC. Routine screening for RC was implemented within Family Planning NSW clinical consultations in December 2018. A cross-sectional study was undertaken to review the outcomes of screening to better understand the situation of RC among women accessing family planning services. Methods A retrospective review of clinical consultation data of eligible women attending Family Planning NSW clinics in 2019 was undertaken. Descriptive analysis was conducted and modified Poisson regression was used to estimate prevalence ratios and assess associations between binary outcomes and client characteristics. Results Of 7943 women eligible for RC screening, 5497 were screened (69%) and 127 women (2.3%) disclosed RC. RC was more likely to be disclosed among clients who were unemployed, had a disability or had more than one visit within 1 year. Conclusions Sexual and reproductive health clinicians, in particular, are well placed to conduct RC screening. However, they must have adequate training and access to resources to implement screening and respond to women who disclose RC.
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Affiliation(s)
- Yan Cheng
- Family Planning NSW, 328-336 Liverpool Road, Ashfield, NSW 2131, Australia
| | - Eleanor G Wilson
- Family Planning NSW, 328-336 Liverpool Road, Ashfield, NSW 2131, Australia
| | - Jessica R Botfield
- Family Planning NSW, 328-336 Liverpool Road, Ashfield, NSW 2131, Australia
| | - Clare J Boerma
- Family Planning NSW, 328-336 Liverpool Road, Ashfield, NSW 2131, Australia
| | - Jane Estoesta
- Family Planning NSW, 328-336 Liverpool Road, Ashfield, NSW 2131, Australia
| | - Leslie James Peters
- Family Planning NSW, 328-336 Liverpool Road, Ashfield, NSW 2131, Australia; and The University of Sydney, Sydney, NSW, Australia
| | - Kevin McGeechan
- Family Planning NSW, 328-336 Liverpool Road, Ashfield, NSW 2131, Australia; and The University of Sydney, Sydney, NSW, Australia
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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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Alexander KA, Sanders RA, Grace KT, Thorpe RJ, Doro E, Bowleg L. "Having a Child Meant I had a Real Life": Reproductive Coercion and Childbearing Motivations Among Young Black Men Living in Baltimore. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP9197-NP9225. [PMID: 31195889 PMCID: PMC6911027 DOI: 10.1177/0886260519853400] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Despite disproportionate health outcome disparities experienced by Black women, reproductive coercion (RC), a range of behaviors to promote unwanted pregnancy and childbearing motivations among poor young Black men are underexamined in current empirical literature. We aimed to describe perceptions of RC behaviors and childbearing motivations among poor young Black men in Baltimore City. We recruited a convenience sample of young Black men aged 18 to 25 (N = 25). Data were collected using semi-structured interviews and demographic surveys. Thematic analysis was guided by Miller's Traits-Desires-Intentions-Behaviors (TDIB) framework. According to survey data (N = 23), mean age was 22 (2.1). Majority of participants reported sexual relationships with one person (74%; n = 17), almost half (48%; n = 12) were biological fathers, and six (26%) participants reported using RC toward an intimate partner; three (13%) reported experiencing RC behaviors from a female partner. According to qualitative interviews (N = 25), participants described perceived women-partner motivations for RC as entrapment. Childbearing motivations were influenced by (a) legacies and bonding and (b) escaping/correcting the past. Childbearing desires included (a) love feelings and intimacy and (b) good father. Childbearing intentions included (a) resistance to medical interventions and (b) preparation. Perceptions of RC and childbearing motivations reflected desires from participants to fulfill cultural expectations for conventional masculinity and enhance personal dreams for fatherhood. Although some perceptions and behavior patterns aligned with previous studies, RC was relatively rare in this sample. Findings demonstrated nuanced antithesis to stereotypical notions of young Black men and fatherhood. Provision of reproductive care for young men and their sexual partners should include discussions about RC, pregnancy motivations, and healthy sexual communication strategies.
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Affiliation(s)
| | | | | | - Roland J. Thorpe
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior, and Society, Baltimore, Maryland, USA
| | - Elizabeth Doro
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Lisa Bowleg
- The George Washington University, Department of Psychology, Washington, D.C., USA
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Swan LE, Hales T, Ely GE, Auerbach SL, Agbemenu K. Validation of the short-form reproductive coercion scale with Appalachian women. Contraception 2021; 104:265-270. [DOI: https:/doi.org/10.1016/j.contraception.2021.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
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Bagwell-Gray ME, Thaller J, Messing JT, Durfee A. Women's Reproductive Coercion and Pregnancy Avoidance: Associations With Homicide Risk, Sexual Violence, and Religious Abuse. Violence Against Women 2021; 27:2294-2312. [PMID: 34165023 DOI: 10.1177/10778012211005566] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This survey study explores patterns of reproductive coercion (RC) and pregnancy avoidance (PA) among women recruited from domestic violence shelters in the southwestern United States (N = 661). Two logistic regression models assessed the demographic, relationships, and violence characteristics associated with RC and PA. Younger, African American, and Hispanic women were more likely to experience RC. Homicide risk, sexual intimate partner violence (IPV), and religious abuse were associated with RC, and RC and homicide risk were associated with PA. We discuss implications of the associations between RC and PA and their links to religious abuse, sexual IPV, and homicide risk.
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Affiliation(s)
| | | | - Jill T Messing
- Arizona State University, Phoenix, AZ, and Tempe, AZ, USA
| | - Alesha Durfee
- Arizona State University, Phoenix, AZ, and Tempe, AZ, USA
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Mthembu J, Mabaso M, Reis S, Zuma K, Zungu N. Prevalence and factors associated with intimate partner violence among the adolescent girls and young women in South Africa: findings the 2017 population based cross-sectional survey. BMC Public Health 2021; 21:1160. [PMID: 34134666 PMCID: PMC8210348 DOI: 10.1186/s12889-021-11183-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 06/01/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Evidence indicate that intimate partner violence (IPV) is disturbingly high among South African adolescent girls and young women (AGYW). Understanding prevalence and risk factors for IPV among these emerging adults is critical for developing appropriate interventions to prevent adverse health outcomes later in life. This study investigates the prevalence and factors associated with lifetime physical IPV experience among AGYW, aged 15-24 years, using the South African national HIV prevalence, incidence, behaviour and communication survey conducted in 2017. METHODS The data used in this secondary analysis was obtained from a cross-sectional, population-based household survey data, conducted using a multi-stage stratified random cluster sampling approach. Multivariate stepwise backward logistic regression modelling was used to determine factors associated with IPV. RESULTS Of 716 AGYW that responded to the two commonly answered questions on IPV, 13.1% (95% CI: 9.6-17.6) indicated that they experienced IPV. The odds of reporting experiences of IPV were significantly lower among AGYW residing in high SES households [AOR = 0.09 (95% CI: 0.02-0.47), p = 0.004] than low SES households, and those residing in rural informal/tribal areas [AOR = 0.01 (95% CI: 0.00-0.22), p = 0.004] than urban areas. AGYW experiencing IPV had higher odds of reporting psychological distress compared to their counterparts [AOR = 4.37 (95% CI, 0.97-19.72), p = 0.054]. CONCLUSION The findings highlight the need for targeted structural and psychosocial interventions in low SES households and especially in urban areas.
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Affiliation(s)
- Jacqueline Mthembu
- grid.417715.10000 0001 0071 1142Human and Social Capabilities Division, Human Sciences Research Council, Pretoria, South Africa ,grid.19006.3e0000 0000 9632 6718University of California, Los Angeles, USA
| | - Musawenkosi Mabaso
- grid.417715.10000 0001 0071 1142Human and Social Capabilities Division, Human Sciences Research Council, Durban, South Africa
| | - Sarah Reis
- United Nations Population Fund, Pretoria, South Africa
| | - Khangelani Zuma
- grid.417715.10000 0001 0071 1142Human and Social Capabilities Division, Human Sciences Research Council, Pretoria, South Africa ,grid.11951.3d0000 0004 1937 1135School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Nompumelelo Zungu
- grid.417715.10000 0001 0071 1142Human and Social Capabilities Division, Human Sciences Research Council, Pretoria, South Africa ,grid.49697.350000 0001 2107 2298Department of Psychology, University of Pretoria, Pretoria, South Africa
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Kalra N, Hooker L, Reisenhofer S, Di Tanna GL, García-Moreno C. Training healthcare providers to respond to intimate partner violence against women. Cochrane Database Syst Rev 2021; 5:CD012423. [PMID: 34057734 PMCID: PMC8166264 DOI: 10.1002/14651858.cd012423.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) includes any violence (physical, sexual or psychological/emotional) by a current or former partner. This review reflects the current understanding of IPV as a profoundly gendered issue, perpetrated most often by men against women. IPV may result in substantial physical and mental health impacts for survivors. Women affected by IPV are more likely to have contact with healthcare providers (HCPs) (e.g. nurses, doctors, midwives), even though women often do not disclose the violence. Training HCPs on IPV, including how to respond to survivors of IPV, is an important intervention to improve HCPs' knowledge, attitudes and practice, and subsequently the care and health outcomes for IPV survivors. OBJECTIVES To assess the effectiveness of training programmes that seek to improve HCPs' identification of and response to IPV against women, compared to no intervention, wait-list, placebo or training as usual. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and seven other databases up to June 2020. We also searched two clinical trials registries and relevant websites. In addition, we contacted primary authors of included studies to ask if they knew of any relevant studies not identified in the search. We evaluated the reference lists of all included studies and systematic reviews for inclusion. We applied no restrictions by search dates or language. SELECTION CRITERIA All randomised and quasi-randomised controlled trials comparing IPV training or educational programmes for HCPs compared with no training, wait-list, training as usual, placebo, or a sub-component of the intervention. DATA COLLECTION AND ANALYSIS We used standard methodological procedures outlined by Cochrane. Two review authors independently assessed studies for eligibility, undertook data extraction and assessed risks of bias. Where possible, we synthesised the effects of IPV training in a meta-analysis. Other analyses were synthesised in a narrative manner. We assessed evidence certainty using the GRADE approach. MAIN RESULTS We included 19 trials involving 1662 participants. Three-quarters of all studies were conducted in the USA, with single studies from Australia, Iran, Mexico, Turkey and the Netherlands. Twelve trials compared IPV training versus no training, and seven trials compared the effects of IPV training to training as usual or a sub-component of the intervention in the comparison group, or both. Study participants included 618 medical staff/students, 460 nurses/students, 348 dentists/students, 161 counsellors or psychologists/students, 70 midwives and 5 social workers. Studies were heterogeneous and varied across training content delivered, pedagogy and time to follow-up (immediately post training to 24 months). The risk of bias assessment highlighted unclear reporting across many areas of bias. The GRADE assessment of the studies found that the certainty of the evidence for the primary outcomes was low to very low, with studies often reporting on perceived or self-reported outcomes rather than actual HCPs' practices or outcomes for women. Eleven of the 19 included studies received some form of research grant funding to complete the research. Within 12 months post-intervention, the evidence suggests that compared to no intervention, wait-list or placebo, IPV training: · may improve HCPs' attitudes towards IPV survivors (standardised mean difference (SMD) 0.71, 95% CI 0.39 to 1.03; 8 studies, 641 participants; low-certainty evidence); · may have a large effect on HCPs' self-perceived readiness to respond to IPV survivors, although the evidence was uncertain (SMD 2.44, 95% CI 1.51 to 3.37; 6 studies, 487 participants; very low-certainty evidence); · may have a large effect on HCPs' knowledge of IPV, although the evidence was uncertain (SMD 6.56, 95% CI 2.49 to 10.63; 3 studies, 239 participants; very low-certainty evidence); · may make little to no difference to HCPs' referral practices of women to support agencies, although this is based on only one study (with 49 clinics) assessed to be very low certainty; · has an uncertain effect on HCPs' response behaviours (based on two studies of very low certainty), with one trial (with 27 participants) reporting that trained HCPs were more likely to successfully provide advice on safety planning during their interactions with standardised patients, and the other study (with 49 clinics) reporting no clear impact on safety planning practices; · may improve identification of IPV at six months post-training (RR 4.54, 95% CI 2.5 to 8.09) as in one study (with 54 participants), although three studies (with 48 participants) reported little to no effects of training on identification or documentation of IPV, or both. No studies assessed the impact of training HCPs on the mental health of women survivors of IPV compared to no intervention, wait-list or placebo. When IPV training was compared to training as usual or a sub-component of the intervention, or both, no clear effects were seen on HCPs' attitudes/beliefs, safety planning, and referral to services or mental health outcomes for women. Inconsistent results were seen for HCPs' readiness to respond (improvements in two out of three studies) and HCPs' IPV knowledge (improved in two out of four studies). One study found that IPV training improved HCPs' validation responses. No adverse IPV-related events were reported in any of the studies identified in this review. AUTHORS' CONCLUSIONS Overall, IPV training for HCPs may be effective for outcomes that are precursors to behaviour change. There is some, albeit weak evidence that IPV training may improve HCPs' attitudes towards IPV. Training may also improve IPV knowledge and HCPs' self-perceived readiness to respond to those affected by IPV, although we are not certain about this evidence. Although supportive evidence is weak and inconsistent, training may improve HCPs' actual responses, including the use of safety planning, identification and documentation of IPV in women's case histories. The sustained effect of training on these outcomes beyond 12 months is undetermined. Our confidence in these findings is reduced by the substantial level of heterogeneity across studies and the unclear risk of bias around randomisation and blinding of participants, as well as high risk of bias from attrition in many studies. Further research is needed that overcomes these limitations, as well as assesses the impacts of IPV training on HCPs' behavioral outcomes and the well-being of women survivors of IPV.
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Affiliation(s)
- Naira Kalra
- Gender Innovation Lab, Office of the Chief Economist, Africa Region, World Bank, Washington, DC, USA
| | - Leesa Hooker
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Australia
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Sonia Reisenhofer
- College of Science, Health & Engineering, La Trobe University, Bundoora, Australia
| | - Gian Luca Di Tanna
- Statistics Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Claudia García-Moreno
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Validation of the short-form reproductive coercion scale with Appalachian women. Contraception 2021; 104:265-270. [PMID: 33930381 DOI: 10.1016/j.contraception.2021.04.024] [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: 10/23/2020] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the psychometric properties of the short-form Reproductive Coercion Scale among a sample of Appalachian women. STUDY DESIGN We recruited a purposive sample of Appalachian women, using targeted Facebook ads to collect data via an online survey in fall 2019. We randomly split our sample into two independent samples and used exploratory factor analysis on sample 1 (N = 314) and confirmatory factor analysis on sample 2 (N = 314) in order to cross-validate our findings. RESULTS Findings indicated that the short-form Reproductive Coercion Scale is a valid and reliable instrument to assess reproductive coercion among this sample of Appalachian women. Our findings indicated that, in this Appalachian sample, the reduced, five-item Reproductive Coercion Scale measured a unidimensional construct and was not comprised of the multiple dimensions of pregnancy coercion and condom manipulation. As expected, intimate partner violence and pregnancy fatalism were significantly and positively associated with reproductive coercion while religious affiliation and insurance status were not significantly associated with reproductive coercion. These findings help build construct validity for the short-form Reproductive Coercion Scale with this sample. CONCLUSION While pregnancy coercion and condom manipulation are often considered independent reproductive coercion factors, the current study indicates that, in this Appalachian sample, the short-form Reproductive Coercion Scale measures a single latent reproductive coercion factor. IMPLICATIONS While pregnancy coercion and condom manipulation are often considered independent reproductive coercion factors, the current study indicates that, in this Appalachian sample, the short-form Reproductive Coercion Scale measures a single latent reproductive coercion factor. Additional research may be needed to confirm the factor structure of the short-form Reproductive Coercion Scale across populations and geographic conditions.
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Willie TC, Alexander KA, Caplon A, Kershaw TS, Safon CB, Galvao RW, Kaplan C, Caldwell A, Calabrese SK. Birth Control Sabotage as a Correlate of Women's Sexual Health Risk: An Exploratory Study. Womens Health Issues 2021; 31:157-163. [PMID: 33218751 PMCID: PMC8005431 DOI: 10.1016/j.whi.2020.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 09/15/2020] [Accepted: 10/12/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION To explore associations between birth control sabotage, a form of reproductive coercion, and women's sexual risk among women attending family planning health centers. Data were collected from a 2017 cross-sectional online survey of 675 women who attended Connecticut Planned Parenthood centers. Participants reported birth control sabotage; sexual risk (i.e., inconsistent condom use during vaginal and anal sex in the past 6 months, lifetime sexually transmitted infection diagnosis, lifetime exchange sex [trading sex for money, drugs, or other goods], and multiple sexual partners in the past 6 months); and sociodemographics. Bivariate and multivariable logistic regression models were used to examine associations between birth control sabotage and women's sexual risk. RESULTS One in six women (16.4%; n = 111) reported experiencing birth control sabotage. Women who reported birth control sabotage had a greater odds of ever having an sexually transmitted infection (adjusted odds ratio, 2.18; 95% confidence interval, 1.31-3.60; p = .003), ever engaging in exchange sex (adjusted odds ratio, 2.77; 95% confidence interval, 1.17-6.53; p = .020), and having multiple sexual partners in the past 6 months (adjusted odds ratio, 1.96; 95% confidence interval, 1.21-3.18; p = .006). CONCLUSIONS Our findings demonstrate increased engagement in sexual risk taking among women who reported birth control sabotage compared with women did not.
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Affiliation(s)
- Tiara C Willie
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Kamila A Alexander
- Department of Community Public Health Nursing, Johns Hopkins School of Nursing, Baltimore, Maryland
| | - Amy Caplon
- Division of Cancer Control and Populations Sciences, National Cancer Institute, Rockville, Maryland
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Cara B Safon
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Rachel W Galvao
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Clair Kaplan
- Planned Parenthood of Southern New England, New Haven, Connecticut
| | - Abigail Caldwell
- Planned Parenthood of Southern New England, New Haven, Connecticut
| | - Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC
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42
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Paterno MT, Draughon Moret JE, Paskausky A, Campbell JC. Exploring Reproductive Coercion in Relationship Contexts Among Young Adult, Primarily African American Women at Three Women's Health Clinics. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP2248-2271NP. [PMID: 29460674 DOI: 10.1177/0886260518756116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Understanding reproductive coercion experiences in marginalized populations is important to assist in tailoring care and services. Reproductive coercion is consistently associated with intimate partner violence (IPV), engaging in sexual risk-taking, and is more commonly reported among non-White women. We conducted a secondary analysis of data from a mixed methods study to examine reproductive coercion in relationship contexts among a sample (N = 130) of young adult, primarily African American women recruited from three women's health clinics; 12 also participated in an in-depth interview. Thirty-six women (27.7%) reported reproductive coercion in the past year. Past-year reproductive coercion was associated with relationship trust, (t(128) = -3.01, p = .003), and past-year IPV (Fisher's exact test, p = .005). In the best-fit model, odds of past-year reproductive coercion increased by 4% with each one-point increase in relationship trust score (indicating reproductive coercion increased with lower trust; adjusted odds ratio [AOR] = 1.04; 95% confidence interval [CI] = [1.00, 1.08]), and by more than 4 times with past experience of IPV (AOR = 4.74; 95% CI = [1.07, 20.86]). Qualitative analysis revealed women's awareness of reproductive coercion whether or not they personally experienced it. Those who experienced reproductive coercion identified it as a form of abuse and additionally described experiences of pressure to conceive from the partner's family. Our results support routine screening for IPV and reproductive coercion. Furthermore, the intersection of partner reproductive coercion with family pressure related to reproductive decision making should be explored to better inform clinical interventions.
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Wood SN, Kennedy SR, Akumu I, Tallam C, Asira B, Hameeduddin Z, McGready J, Zimmerman LA, Kennedy CE, Glass N, Decker MR. Reproductive Coercion among Intimate Partner Violence Survivors in Nairobi. Stud Fam Plann 2020; 51:343-360. [PMID: 33336831 DOI: 10.1111/sifp.12141] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Reproductive coercion (RC), or partner interference in reproductive decisions, limits women's autonomy. Little is known about RC behaviors and measurement in low- and middle-income countries (LMICs). In this mixed-methods study, we examined the transferability of the US-developed RC Scale to the Kenyan context. Through community-based sampling, recent intimate partner violence (IPV) survivors were recruited from Nairobi's informal settlements. We conducted quantitative analyses (n = 327) to assess the transferability of RC measures via exploratory factor analysis and used descriptive statistics to examine prevalence and continuous metrics. We conducted in-depth interviews (IDIs; n = 30) to contextualize results. Psychometric analyses indicated a two-factor solution comprising pregnancy coercion and condom manipulation (alpha = 0.86). Eighty-two percent of IPV survivors reported experiencing RC (pregnancy coercion = 76.6 percent; condom manipulation = 59.5 percent). IDIs highlighted women's multiple, severe RC experiences; experiences described in IDIs were largely consistent with quantitative findings. We found the RC Scale was transferable to this LMIC context, where IPV survivors face prevalent, severe RC and would benefit from linkage to woman-centered support services.
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Affiliation(s)
- Shannon N Wood
- Shannon N. Wood, Linnea A. Zimmerman, Zaynab Hameeduddin, Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. Contact Author
| | - S Rachel Kennedy
- S. Rachel Kennedy, Johns Hopkins School of Nursing, Baltimore, USA
| | - Irene Akumu
- Irene Akumu, Catherine Tallam, Ben Asira, Mashinani Department, Ujamaa-Africa, Nairobi, Kenya
| | - Catherine Tallam
- Irene Akumu, Catherine Tallam, Ben Asira, Mashinani Department, Ujamaa-Africa, Nairobi, Kenya
| | - Ben Asira
- Irene Akumu, Catherine Tallam, Ben Asira, Mashinani Department, Ujamaa-Africa, Nairobi, Kenya
| | - Zaynab Hameeduddin
- Shannon N. Wood, Linnea A. Zimmerman, Zaynab Hameeduddin, Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. Contact Author
| | - John McGready
- John McGready, Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Linnea A Zimmerman
- Shannon N. Wood, Linnea A. Zimmerman, Zaynab Hameeduddin, Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. Contact Author
| | - Caitlin E Kennedy
- Caitlin E. Kennedy, Department of International Health, Johns Hopkins School of Public Health, Baltimore, USA
| | - Nancy Glass
- S. Rachel Kennedy, Johns Hopkins School of Nursing, Baltimore, USA.,Caitlin E. Kennedy, Department of International Health, Johns Hopkins School of Public Health, Baltimore, USA.,Nancy Glass, Johns Hopkins School of Nursing, Baltimore, USA.,Department of International Health, Johns Hopkins School of Public Health, Baltimore, USA.,Center for Global Health, Johns Hopkins University, Baltimore, USA
| | - Michele R Decker
- Shannon N. Wood, Linnea A. Zimmerman, Zaynab Hameeduddin, Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. Contact Author.,S. Rachel Kennedy, Johns Hopkins School of Nursing, Baltimore, USA.,Michele R. Decker, Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Johns Hopkins School of Nursing, Baltimore, USA.,Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Hill AL, Zachor H, Miller E, Talis J, Zelazny S, Jones KA. Trauma-Informed Personalized Scripts to Address Partner Violence and Reproductive Coercion: Follow-Up Findings from an Implementation Randomized Controlled Trial Study. J Womens Health (Larchmt) 2020; 30:604-614. [PMID: 33211607 DOI: 10.1089/jwh.2020.8527] [Citation(s) in RCA: 5] [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: Intimate partner violence (IPV) and reproductive coercion impact women seeking care at family planning (FP) clinics. Interventions to facilitate patient-provider conversations about healthy relationships are needed. We sought to determine the added effect of providing psychoeducational messages to patients compared with tailored provider scripts alone on sexual and reproductive health outcomes at 4-6 months. Materials and Methods: We randomized participants to Trauma-Informed Personalized Scripts (TIPS)-Plus (provider scripts +patient messages) or TIPS-Basic (provider scripts only) at four FP clinics. Eligible patients included English-speaking females aged 16-29 years. Data were collected at initial visits (T1) and 4-6 months (T2) on IPV, reproductive coercion, fear, condom and other contraceptive use, self-efficacy, harm reduction behaviors, and knowledge/use of IPV-related services. We compared frequencies and summary scores between baseline and follow-up with McNemar's test of paired proportions and Signed Rank-Sum, respectively. We compared the difference in differences over time by treatment arm using two-sample t-tests, and used linear, logistic, and ordinal logistic regression to compare intervention effects at follow-up. Results: Two hundred forty patients participated (114 TIPS-Plus, 126 TIPS-Basic), 216 completed follow-up. We detected no differences in outcomes between treatment arms. Between T1 and T2, we observed overall reductions in mean summary scores for reproductive coercion (T1 = 0.08 ± 0.02, T2 = 0.02 ± 0.01, p = 0.028) and increases in contraceptive use (69.6%-87.9%, p < 0.001), long-acting reversible contraceptives (8.3%-20.8%, p < 0.001), and hidden methods (20%-38.5%, p < 0.001). Conclusions: We show no added benefit of patient-activation messages compared with provider scripts alone. Findings suggest potential utility of provider scripts in addressing reproductive coercion and contraceptive uptake (Trial Registration No. NCT02782728).
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Affiliation(s)
- Amber L Hill
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Hadas Zachor
- Department of Psychiatry and Behavioral Science, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Janine Talis
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Kelley A Jones
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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CJEM Debate Series: #DomesticViolence - We should routinely screen for domestic violence (intimate partner violence) in the emergency department. CAN J EMERG MED 2020; 21:701-705. [PMID: 31771690 DOI: 10.1017/cem.2019.358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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46
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Todahl J, Nekkanti A, Schnabler S. Universal Screening and Education: A Client-Centered Protocol for Normalizing Intimate Partner Violence Conversation in Clinical Practice. JOURNAL OF COUPLE & RELATIONSHIP THERAPY 2020. [DOI: 10.1080/15332691.2020.1835595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Jeff Todahl
- Counseling Psychology and Human Services Department, University of Oregon, Eugene, Oregon, USA
| | - Akhila Nekkanti
- Counseling Psychology and Human Services Department, University of Oregon, Eugene, Oregon, USA
| | - Simone Schnabler
- Center for the Prevention of Abuse and Neglect, University of Oregon, Eugene, Oregon, USA
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47
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Fernandes ETBS, Ferreira SL, Ferreira CSB, Santos EA. Autonomy in the reproductive health of quilombolas women and associated factors. Rev Bras Enferm 2020; 73:e20190786. [PMID: 32965428 DOI: 10.1590/0034-7167-2019-0786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 05/24/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Identify the level of reproductive autonomy of quilombola women and associate it with sociodemographic characteristics and aspects of sexual and reproductive health. METHODS Cross-sectional census study carried out in quilombola communities in a municipality in Bahia. Data was collected through questionnaires from the National Health Survey and the Reproductive Autonomy Scale, applied to quilombola women who agreed to participate. Descriptive statistics procedures were used and associations were made between reproductive autonomy scores and sociodemographic and reproductive characteristics. RESULTS The average total score for reproductive autonomy was 2.06. An association was found between the "decision-making" score and marital status. The score for "total reproductive autonomy" was associated with the use of contraceptive method. CONCLUSION The reality of the study participants converges with the literature regarding the interference of sociodemographic and reproductive factors in the reproductive autonomy of black women.
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Rosenbaum JE, DiClemente RJ. Reproductive coercion sometimes works: evaluating whether young African-American women who experience reproductive coercion or birth control sabotage are more likely to become pregnant. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2020; 20:265-282. [PMID: 32837268 PMCID: PMC7384393 DOI: 10.1007/s10742-020-00213-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/11/2020] [Accepted: 07/15/2020] [Indexed: 11/30/2022]
Abstract
Men engaging in reproductive coercion may coerce, force, or deceive female partners into pregnancy. This study evaluates whether the 3-month incidence of pregnancy is higher among women reporting reproductive coercion than similar women reporting no reproductive coercion. We tested this hypothesis in longitudinal data from a sample of African-American women ages 18–24 recruited from community settings in Atlanta, Georgia, US, in 2012–2014 (n = 560). Participants were surveyed at baseline, 3 months, 6 months, 9 months, and 12 months. To reduce selection bias, we used full matching on 22 baseline variables related to demographics, economic power, risky alcohol use, and gender-based power inequality. We used logistic regression in the matched sample with outcome pregnancy 3 months later, controlling for baseline fertility intentions (n = 482, n = 458, n = 452 at respectively 3, 6, 9 months). At 3 months, 15% of women reported reproductive coercion. At 6 months, 11.3% of women reporting coercion were pregnant vs. 4.6% of matched women reporting no coercion (p = 0.06). Women reporting coercion had 3 times the odds of pregnancy as matched women reporting no coercion (AOR 2.95, 95% CI (1.16, 6.98), p = 0.02). Among women pregnant after coercion, only 15% wanted to be pregnant then or sooner. Women reporting reproductive coercion are at greater risk of unwanted or mistimed pregnancies, and the semen exposure that caused these pregnancies could also transmit STI/HIV. Clinicians should screen patients for reproductive coercion; consider using semen exposure biomarkers such as PSA or Yc-PCR to identify condom sabotage or stealthing; and refer women experiencing reproductive coercion to supportive services.
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Affiliation(s)
- Janet E Rosenbaum
- Department of Epidemiology and Biostatistics, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY 11203 USA.,Department of Social and Behavioral Sciences, College of Public Health, New York University, New York, NY USA
| | - Ralph J DiClemente
- Department of Epidemiology and Biostatistics, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY 11203 USA.,Department of Social and Behavioral Sciences, College of Public Health, New York University, New York, NY USA
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49
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Haberland N, Ndwiga C, McCarthy K, Pulerwitz J, Kosgei R, Mak’anyengo M, Peltz A, Wong VJ, Kalibala S. Addressing Intimate Partner Violence and Power in Intimate Relationships in HIV Testing Services in Nairobi, Kenya. AIDS Behav 2020; 24:2409-2420. [PMID: 32026250 PMCID: PMC7395047 DOI: 10.1007/s10461-020-02801-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Intimate partner violence (IPV) undermines women’s uptake of HIV services and violates their human rights. In a two-arm randomized controlled trial we evaluated a short intervention that went a step beyond IPV screening to discuss violence and power with women receiving HIV testing services during antenatal care (ANC). The intervention included training and support for HIV counselors, a take-home card for clients, and an on-site IPV counselor. One third (35%) of women (N = 688) reported experiencing IPV in the past year; 6% were living with HIV. Among women experiencing IPV, program participants were more likely to disclose violence to their counselor than women receiving standard care (32% vs. 7%, p < 0.001). At second ANC visit, intervention group women were significantly more likely to report that talking with their counselor made a positive difference (aOR 2.9; 95% CI 1.8, 4.4; p < 0.001) and felt more confident in how they deserved to be treated (aOR 2.7; 95% CI 1.7, 4.4; p < 0.001). Exploratory analyses of intent to use ARVs to prevent mother-to-child transmission and actions to address violence were also encouraging.
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50
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Decker MR, Wood SN, Hameeduddin Z, Kennedy SR, Perrin N, Tallam C, Akumu I, Wanjiru I, Asira B, Frankel A, Omondi B, Case J, Clough A, Otieno R, Mwiti M, Glass N. Safety decision-making and planning mobile app for intimate partner violence prevention and response: randomised controlled trial in Kenya. BMJ Glob Health 2020; 5:bmjgh-2019-002091. [PMID: 32675229 PMCID: PMC7368487 DOI: 10.1136/bmjgh-2019-002091] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/10/2020] [Accepted: 03/15/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Intimate partner violence (IPV) threatens women’s health and safety globally, yet services remain underdeveloped and inaccessible. Technology-based resources exist, however, few have been adapted and tested in low-resource settings. We evaluate the efficacy of a community-partnered technology solution: culturally and linguistically adapted version of the myPlan app, a tailored safety decision-making and planning intervention, administrated by trained lay professionals. Methods This randomised, controlled, participant-blinded superiority trial compares safety-related outcomes at baseline, immediate post intervention and 3-month follow-up among women at risk of and experiencing IPV in Nairobi, Kenya. Women were randomised (1:1 ratio) to: (1) myPlan Kenya (intervention); or (2) standard IPV referrals (control). Primary outcomes were safety preparedness, safety behaviour and IPV; secondary outcomes include resilience, mental health, service utilisation and self-blame. Results Between April 2018 and October 2018, 352 participants (n=177 intervention, n=175 control) were enrolled and randomly assigned; 312 (88.6%, n=157 intervention, n=155 control) were retained at 3 months. Intervention participants demonstrated immediate postintervention improvement in safety preparedness relative to control participants (p=0.001). At 3 months, intervention participants reported increased helpfulness of safety strategies used relative to control participants (p=0.004); IPV reduced in both groups. Among women reporting the highest level of IPV severity, intervention participants had significant increase in resilience (p<0.01) compared with controls, and significantly decreased risk for lethal violence (p<0.01). Conclusions Facilitated delivery of a technology-based safety intervention appropriately adapted to the context demonstrates promise in improving women’s IPV-related health and safety in a low-resource, urban setting. Trial registration number Pan African Clinical Trial Registry (PACTR201804003321122).
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Affiliation(s)
- Michele R Decker
- Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA .,Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.,Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shannon N Wood
- Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Zaynab Hameeduddin
- Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - S Rachel Kennedy
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Nancy Perrin
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | | | | | | | | | - Ariel Frankel
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - James Case
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Amber Clough
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | | | | | - Nancy Glass
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.,International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Center for Global Health, Johns Hopkins University, Baltimore, Maryland, USA
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