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Scott SE, Jenkins G, Mickievicz E, Saladino J, Rick AM, Levenson R, Chang JC, Randell KA, Duplessis V, Miller E, Ragavan M. Creating Healing-Centered Spaces for Intimate Partner Violence Survivors in the Postpartum Unit: Examining Current Practices and Desired Resources Among Health Care Providers and Postpartum People. J Womens Health (Larchmt) 2024; 33:204-217. [PMID: 37971822 PMCID: PMC10880269 DOI: 10.1089/jwh.2023.0347] [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: 11/19/2023] Open
Abstract
Background: Intimate partner violence (IPV) has negative health impacts for pregnant people and their infants. Although inpatient postpartum units offer an opportunity to provide support and resources for IPV survivors and their families, to our knowledge, such interventions exist. The goal of this study is to explore (1) how IPV is currently discussed with postpartum people in the postpartum unit; (2) what content should be included and how an IPV intervention should be delivered; (3) how best to support survivors who disclose IPV; and (4) implementation barriers and facilitators. Materials and Methods: We used individual, semistructured interviews with postpartum people and health care providers (HCPs). Interview transcripts were coded and analyzed using an inductive-deductive thematic analysis. Results: While HCPs reported using a variety of practices to support survivors, postpartum people reported that they did not recall receiving resources or education related to IPV while in the inpatient postpartum unit. While HCPs identified a need for screening and disclosure-driven resource provision, postpartum people identified a need for universal IPV resource provision in the postpartum unit to postpartum people and their partners. Participants identified several barriers (i.e., staff capacity, education already provided in the postpartum unit, and COVID-19 pandemic) and facilitators (i.e., continuity of care, various HCPs) to supporting survivors in the postpartum unit. Conclusion: The inpatient postpartum unit is a promising setting to implement an intervention to support IPV survivors and their infants. Future research and intervention development should focus on facilitating universal education and promoting resource provision to IPV survivors.
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Affiliation(s)
- Sarah E Scott
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Genelle Jenkins
- Division of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Erin Mickievicz
- Division of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jackie Saladino
- Division of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anne-Marie Rick
- Division of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Judy C Chang
- Department of Obstetrics, Gynecology & Reproductive Sciences, and Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kimberly A Randell
- Division of Emergency Medicine, Children's Mercy, Kansas City, Missouri, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
- Department of Pediatrics, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | | | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Maya Ragavan
- Division of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Branjerdporn G, Clonan T, Boddy J, Gillespie K, O’Malley R, Baird K. Australian women's perspectives of routine enquiry into domestic violence before and after birth. BMC Pregnancy Childbirth 2023; 23:44. [PMID: 36658549 PMCID: PMC9854157 DOI: 10.1186/s12884-023-05345-7] [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: 08/13/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Peripartum women are vulnerable to experiencing intimate partner violence (IPV). Interactions with health practitioners during maternity care provide a unique opportunity to detect and respond to women who are experiencing IPV. The aim of this study was to explore women's experiences of IPV screening at an Australian maternity service. METHODS Qualitative methodology was used in this cross-sectional study. In-depth semi-structured interviews were conducted with women with IPV who attended an Australian maternity service. Thematic analysis was used to identify codes and themes. RESULTS The nine women expressed three major themes, and six sub-themes, surrounding clinician approaches (communication and support, asking about IPV, and following disclosure), system considerations (fear of child safety involvement, continuity of care, and environmental considerations), and education. All participants supported screening and highlighted beneficial or detrimental approaches to screening and care, and recommendations for improvement. CONCLUSION This research points to the benefit of trauma-informed frameworks in hospitals to support women experiencing IPV.
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Affiliation(s)
- Grace Branjerdporn
- grid.413154.60000 0004 0625 9072Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD 4215 Australia
| | - Tanya Clonan
- grid.1022.10000 0004 0437 5432Griffith University, Southport, Australia
| | - Jennifer Boddy
- grid.1022.10000 0004 0437 5432Griffith University, Southport, Australia
| | - Kerri Gillespie
- grid.413154.60000 0004 0625 9072Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD 4215 Australia
| | | | - Kathleen Baird
- grid.117476.20000 0004 1936 7611University of Technology Sydney, Sydney, Australia
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Multilevel analysis of factors associated with perinatal intimate partner violence among postpartum population in Southern Ethiopia. Sci Rep 2022; 12:19013. [PMID: 36347930 PMCID: PMC9643427 DOI: 10.1038/s41598-022-23645-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 11/03/2022] [Indexed: 11/10/2022] Open
Abstract
Violence around pregnancy is critical in nature and major public health problem worldwide. Thus, the present study aims to determine the extent of perinatal partner violence and to identify its individual and community-level factors among postpartum women in Southern Ethiopia. A total of 1342 postpartum women nested in 38 'Kebles' (clusters) were enumerated using multistage-clustered sampling techniques for multilevel analysis. Different parameters were computed for model comparison and model fitness. The overall prevalence of intimate partner violence before, during, and/or after pregnancy was estimated to be 39.9% [95% CI 36.9-44.5]. About 18% of women reported continuous abuse over the perinatal period. Postpartum women who live in rural areas [adjusted odds ratio (AOR) = 2.46; 95% CI 1.21-5.01], or in neighborhoods with high IPV favoring norms [AOR = 1.49; 95%CI 1.01-2.20], high female literacy [AOR = 2.84; 95%CI 1.62-5.01], high female autonomy [AOR = 2.06; 95%CI 1.36-3.12], or in neighborhoods with lower wealth status [AOR = 1.74; 95%CI 1.14-2.66] were more likely to encounter PIPV. The complex patterns of interplaying factors operating at different levels could put pregnant or postpartum women at higher risk of IPV victimization. Therefore, policies that prioritize the improvement of contextual factors, particularly norms toward IPV and women's empowerment are likely to be the most effective interventions.
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Abota TL, Gashe FE, Deyessa N. Perinatal intimate partner violence and postpartum contraception timing among currently married women in Southern Ethiopia: A multilevel Weibull regression modeling. Front Public Health 2022; 10:913546. [PMID: 36339168 PMCID: PMC9627296 DOI: 10.3389/fpubh.2022.913546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/30/2022] [Indexed: 01/22/2023] Open
Abstract
Background Adopting contraception on time is a critical intervention for postpartum women, but violence exposure around pregnancy may interfere with postpartum contraceptive use behaviors. Hence, this study aimed to investigate the time duration of the first modern contraceptive adoption and its individual-and community-level predictors among postpartum women in the Wolaita zone, South Ethiopia. Methods A community-based prospective follow-up study was conducted among 1,292 postpartum women nested in 38 "Kebles" (clusters) using multistage-clustered sampling techniques. A multilevel Weibull regression model was employed to investigate predictors of time-to-method initiation after childbirth using STATA Version 14. Kaplan-Meier curve and Wilcoxon log-rank test were used to estimate time-to-modern contraceptive use across different variables. All variables with p-values <0.05 were considered for multivariate analysis. Adjusted time ratios (ATR) with 95 % CI were computed using Weibull accelerated failure time models. Results Of the respondents, 62% (95% CI: 59.1-64.5) had started the first modern contraception within a year after childbirth. The restricted mean survival time-to-postpartum modern contraceptive use was 6.28 months. Being a rural dweller (aTR: 1.44; 95% CI: 1.06-1.99) and living in the middle household wealth quintiles (aTR: 1.10; 95% CI: 1.02-1.19) predicted longer time duration to adopt first modern contraception by 44 and 10%, respectively. The women from the community with a high early marriage (aTR: 1.14; 95% CI: 1.01-1.28) took longer time to initiate modern postpartum methods. Furthermore, women who had no history of perinatal abuse took less time than those who had a history of abuse to start postpartum contraception (aTR: 0.71; 95% CI: 0.66-0.78). Conclusion Rural residence, poor household wealth status, history of perinatal abuse, and a high rate of early marriage in the community are predicted to lengthen the time duration to start modern postpartum contraception. Thus, community-level women's empowerment, particularly among rural women and integration of intimate partner violence screening into family planning counseling throughout the continuum of care will likely to improve postpartum contraception timing.
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Affiliation(s)
- Tafesse Lamaro Abota
- College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
- Department of Epidemiology and Biostatistics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fikre Enqueselassie Gashe
- Department of Epidemiology and Biostatistics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Negussie Deyessa
- Department of Epidemiology and Biostatistics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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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: 1] [Impact Index Per Article: 0.5] [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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Wishart D, Cruz Alvarez C, Ward C, Danner S, O'Brian CA, Simon M. Racial and Ethnic Minority Pregnant Patients with Low-Income Experiences of Perinatal Care: A Scoping Review. Health Equity 2021; 5:554-568. [PMID: 34909522 PMCID: PMC8665802 DOI: 10.1089/heq.2021.0017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose: The maternal mortality ratio for the United States (US) has consistently risen over recent decades. This mortality is especially pronounced within minority populations who experience a maternal mortality and morbidity rate that are much higher than their non-Hispanic white counterparts. Qualitative data are critical in gaining true insight from minority pregnant and postpartum persons. Such data should serve as the basis for building interventions and programs that seek to eradicate perinatal inequities. This review examines the qualitative literature on racial and ethnic minority pregnant patients with low income and their experiences during perinatal care (PNC) to identify recurrent themes that can be addressed through targeted interventions. Methods: PubMed, CINAHL, and Web of Science databases were searched for qualitative studies on racial and ethnic minority pregnant patients with low income and their experiences during PNC. Twenty-two articles were included for analysis. Thematic synthesis was performed to identify categories and recurring themes in each article. Results: Five major categories were identified as consistent experiences of pregnant patients with PNC clinicians: support, education, connection, communication, and trust. Of these, clinician support was the most consistently coded category. Eighteen of the 23 articles discussed tangible support patients had received from their clinicians, such as care coordination and referrals to support services. The second most coded category was education, which was represented in 16 articles. Education was mostly represented negatively as lack of adequate perinatal care education given during the perinatal period. Finally, the categories of connection, communication, and trust were represented by 18, 17, and 17 articles, respectively. Conclusions: These qualitative studies provided specific examples of what racial and ethnic minority pregnant patients with low income deemed positive and negative during the perinatal period and outline ways that these experiences can be improved. Future studies can take the experiences reported in this review to help inform interventions to improve patient experiences and health outcomes that minority persons face in the perinatal period.
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Affiliation(s)
- Danielle Wishart
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cindy Cruz Alvarez
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Carmenisha Ward
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sankirtana Danner
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Catherine A O'Brian
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Melissa Simon
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
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Goldstein BL, Briggs-Gowan M, Grasso DJ. The effects of Intimate Partner Violence and a history of Childhood Abuse on Mental Health and Stress during Pregnancy. JOURNAL OF FAMILY VIOLENCE 2021; 36:337-346. [PMID: 34113060 PMCID: PMC8186840 DOI: 10.1007/s10896-020-00149-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Maternal adverse childhood experiences (ACEs) and intimate partner violence (IPV) are temporally distinct risk factors that negatively impact mothers and their offspring. Risk associated with ACEs and IPV begin during pregnancy, a period of increased physical and psychological demands. The current study examined a person-centered method to empirically identify profiles of pregnant women based on type and severity of ACEs and past-year IPV. Profiles were then differentiated on psychosocial functioning indicators. METHODS A primarily Latinx, low socioeconomic sample of women (n = 225) completed measures assessing ACEs and past-year IPV, perceived and experienced stress, emotion regulation, and trauma-related symptoms during their third trimester. Latent profile analysis (LPA) was used to identify unique profiles of women based on seven dimensional indicators reflecting threat- and deprivation-based ACEs and IPV. RESULTS A 4-class solution best fit the data: (1) low probability of ACEs or IPV (64.9%), (2) childhood neglect-only (20.4%), (3) childhood abuse/neglect (10.2%), and (4) polytrauma characterized by a combination of childhood abuse, neglect, and IPV (4.4%). Women with the "childhood abuse/neglect" or "polytrauma" profiles reported more stress and symptoms than women with the "low exposure" profile. Women in the "childhood neglect-only" profile were generally similar to women in the "low exposure" profile, but did report greater difficulties in emotion regulation. CONCLUSIONS These results suggest that childhood abuse and IPV, exposure types involving threat, are potent correlates of stress, emotion regulation, and mental health difficulties during pregnancy. However, exposure characterized by deprivation alone generally did not increase difficulties.
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Affiliation(s)
| | | | - Damion J Grasso
- Department of Psychiatry, University of Connecticut School of Medicine
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Byrnes L. Perinatal mood and anxiety disorders: findings from focus groups of at risk women. Arch Psychiatr Nurs 2019; 33:149-153. [PMID: 31753221 DOI: 10.1016/j.apnu.2019.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/20/2019] [Accepted: 08/25/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Lorraine Byrnes
- University of Hawaii Manoa, 2825 McCarthy Mall, Webster Hall 414, Honolulu, HI 96822, United States of America.
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