Parenting Among Mothers Who Experienced Child Sexual Abuse: A Qualitative Systematic Review

Stigmatizing and inaccessible: The perspectives of female sex workers on barriers to reproductive healthcare utilization - A scoping review

AIM

To systematically map the extent, range and nature of qualitative studies that explored female sex workers' own perspectives on barriers to accessing reproductive healthcare services.

DESIGN

A scoping review of the literature utilizing Arksey and O'Malley's method.

DATA SOURCES/REVIEW METHODS

A search of the electronic databases MEDLINE/ PubMed, PsycNET, Sociological Abstracts, ProQuest, ScienceDirect, HeinOnline, Scopus, Web of Science and Google Scholar was conducted for items published in English between 2001 and 2021.

RESULTS

Twenty-one studies were included in the review, the majority of which were conducted in lower-middle-income countries. RHC themes studied were diverse, with a few more studies focusing on STI/HIV, contraceptive use and pregnancy than those focusing on childbirth and postnatal care. The findings indicate barriers in four main domains: socio-legal barriers, health services-related barriers, interpersonal barriers and personal history-related barriers. Stigma was a major multifaceted barrier.

CONCLUSION

Female sex workers experience exclusion in utilizing reproductive healthcare services globally. As such, healthcare services are advised to adopt a nonjudgemental approach, to enhance physical accessibility and to train nurses and other healthcare professionals on reproductive health needs of female sex workers. Finally, knowledge production processes on the RHC of FSW should adopt a holistic view of FSW, by exploring their needs and barriers related to childbirth and maternity care and by including the perspectives of FSW in high-income countries.

IMPACT

The review offered an in-depth understanding of female sex workers' own perspectives regarding needs and barriers in utilizing reproductive healthcare services. Findings indicated socio-legal barriers, health services-related barriers, interpersonal barriers and personal history-related barriers. The review could inform the training of nurses and other healthcare professionals in reproductive healthcare services globally. Researchers should adopt a holistic view of female sex workers, by exploring their family planning needs, including barriers related to childbirth, maternity and postpartum care.

REPORTING METHOD

We adhered to the EQUATOR guidelines PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation.

Understanding the Narratives of Child Sexual Abuse

This qualitative study consisted of in-depth, retrospective interviews with participants over the age of 18 who experienced child sexual abuse. Through narrative analysis, study findings shed light on three overall findings: the perception of memories, the perception of grooming, and the perception of the lived lives of child sexual abuse survivors. Findings suggest that the narratives elicited from the participants included current views but also past experiences and anticipation about the future, including individual and societal levels of meaning. These narratives are furthermore entangled and inexorably linked - temporally, culturally, generationally, materially, and emotionally - and the results are thus presented from a holistic perspective. Study findings help explain the complex dimensions concerning the lived experiences of child sexual abuse. As such, this research speaks to the field of social and health care practitioners working with children and families facing the complex phenomenon of child sexual abuse.

The public's knowledge about child sexual abuse influences its perceptions of prevention and associated policies

BACKGROUND

Child sexual abuse (CSA) prevention requires efforts from all members of society.

OBJECTIVE

The current study aimed to examine factors associated with (1) perceptions of CSA as unpreventable and (2) support for policies to prevent CSA and to punish people who perpetrated CSA. We focused on the roles of knowledge and misperceptions about child sexual abuse.

PARTICIPANTS AND SETTING

We collected survey data online from a large (N = 5068), nationally representative sample of adults in the United States.

RESULTS

Analyses revealed factors promoting perceptions of CSA as unpreventable. Support for or against policies that aim to prevent CSA or to punish perpetrators of CSA were associated with individual factors such as older age (B = 0.08, -0.13), Republican political affiliation (B = 0.10, 0.07), and misperceptions about CSA (B = 0.15, 0.06).

CONCLUSIONS

Findings highlight malleable factors that could be targeted to collectivize calls for CSA prevention and to promote support for effective policies to prevent CSA. In particular, ensuring accurate knowledge about CSA, and collective responsibility and government efficacy specific to CSA prevention, were identified as helping shape views of CSA as preventable.

"I Was Trying to Be the Mother to Her That I Didn't Have": Mothers' Experiences of Child Sexual Abuse and Intergenerational Maltreatment

Child sexual abuse (CSA) can have lasting negative impacts on one's sense of safety and trust, ultimately affecting the quality of relationships, and increasing the likelihood of future victimization experiences. The present study provides a qualitative description of the themes that were generated through interviews conducted with 23 mothers who experienced CSA (dis)continuity (12 continuity, 11 discontinuity). The mothers described a variety of experiences related to parent-child and romantic relationships and parenting behaviors, which could be further researched and targeted by interventions to reduce the risk of intergenerational cycles of maltreatment.

Interventions from pregnancy to two years after birth for parents experiencing complex post-traumatic stress disorder and/or with childhood experience of maltreatment

BACKGROUND

Acceptable, effective and feasible support strategies (interventions) for parents experiencing complex post-traumatic stress disorder (CPTSD) symptoms or with a history of childhood maltreatment may offer an opportunity to support parental recovery, reduce the risk of intergenerational transmission of trauma and improve life-course trajectories for children and future generations. However, evidence relating to the effect of interventions has not been synthesised to provide a comprehensive review of available support strategies. This evidence synthesis is critical to inform further research, practice and policy approaches in this emerging area.

OBJECTIVES

To assess the effects of interventions provided to support parents who were experiencing CPTSD symptoms or who had experienced childhood maltreatment (or both), on parenting capacity and parental psychological or socio-emotional wellbeing.

SEARCH METHODS

In October 2021 we searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers, together with checking references and contacting experts to identify additional studies.

SELECTION CRITERIA

All variants of randomised controlled trials (RCTs) comparing any intervention delivered in the perinatal period designed to support parents experiencing CPTSD symptoms or with a history of childhood maltreatment (or both), to any active or inactive control. Primary outcomes were parental psychological or socio-emotional wellbeing and parenting capacity between pregnancy and up to two years postpartum.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed the eligibility of trials for inclusion, extracted data using a pre-designed data extraction form, and assessed risk of bias and certainty of evidence. We contacted study authors for additional information as required. We analysed continuous data using mean difference (MD) for outcomes using a single measure, and standardised mean difference (SMD) for outcomes using multiple measures, and risk ratios (RR) for dichotomous data. All data are presented with 95% confidence intervals (CIs). We undertook meta-analyses using random-effects models.

MAIN RESULTS

We included evidence from 1925 participants in 15 RCTs that investigated the effect of 17 interventions. All included studies were published after 2005. Interventions included seven parenting interventions, eight psychological interventions and two service system approaches. The studies were funded by major research councils, government departments and philanthropic/charitable organisations. All evidence was of low or very low certainty. Parenting interventions Evidence was very uncertain from a study (33 participants) assessing the effects of a parenting intervention compared to attention control on trauma-related symptoms, and psychological wellbeing symptoms (postpartum depression), in mothers who had experienced childhood maltreatment and were experiencing current parenting risk factors. Evidence suggested that parenting interventions may improve parent-child relationships slightly compared to usual service provision (SMD 0.45, 95% CI -0.06 to 0.96; I2 = 60%; 2 studies, 153 participants; low-certainty evidence). There may be little or no difference between parenting interventions and usual perinatal service in parenting skills including nurturance, supportive presence and reciprocity (SMD 0.25, 95% CI -0.07 to 0.58; I2 = 0%; 4 studies, 149 participants; low-certainty evidence). No studies assessed the effects of parenting interventions on parents' substance use, relationship quality or self-harm. Psychological interventions Psychological interventions may result in little or no difference in trauma-related symptoms compared to usual care (SMD -0.05, 95% CI -0.40 to 0.31; I2 = 39%; 4 studies, 247 participants; low-certainty evidence). Psychological interventions may make little or no difference compared to usual care to depression symptom severity (8 studies, 507 participants, low-certainty evidence, SMD -0.34, 95% CI -0.66 to -0.03; I2 = 63%). An interpersonally focused cognitive behavioural analysis system of psychotherapy may slightly increase the number of pregnant women who quit smoking compared to usual smoking cessation therapy and prenatal care (189 participants, low-certainty evidence). A psychological intervention may slightly improve parents' relationship quality compared to usual care (1 study, 67 participants, low-certainty evidence). Benefits for parent-child relationships were very uncertain (26 participants, very low-certainty evidence), while there may be a slight improvement in parenting skills compared to usual care (66 participants, low-certainty evidence). No studies assessed the effects of psychological interventions on parents' self-harm. Service system approaches One service system approach assessed the effect of a financial empowerment education programme, with and without trauma-informed peer support, compared to usual care for parents with low incomes. The interventions increased depression slightly (52 participants, low-certainty evidence). No studies assessed the effects of service system interventions on parents' trauma-related symptoms, substance use, relationship quality, self-harm, parent-child relationships or parenting skills.

AUTHORS' CONCLUSIONS

There is currently a lack of high-quality evidence regarding the effectiveness of interventions to improve parenting capacity or parental psychological or socio-emotional wellbeing in parents experiencing CPTSD symptoms or who have experienced childhood maltreatment (or both). This lack of methodological rigour and high risk of bias made it difficult to interpret the findings of this review. Overall, results suggest that parenting interventions may slightly improve parent-child relationships but have a small, unimportant effect on parenting skills. Psychological interventions may help some women stop smoking in pregnancy, and may have small benefits on parents' relationships and parenting skills. A financial empowerment programme may slightly worsen depression symptoms. While potential beneficial effects were small, the importance of a positive effect in a small number of parents must be considered when making treatment and care decisions. There is a need for further high-quality research into effective strategies for this population.

What Can We Learn About the Others Present During Incidents of Child Abuse?: Key Lessons and Future Directions Based on a Scoping Review

Child abuse (CA) is a global problem that has received attention from policymakers, researchers, and practitioners. The majority of studies have focused on the phenomenon's epidemiology and consequences, alongside groundbreaking writing on victims and perpetrators. The concept of others who are present during the abuse is understudied and underdeveloped, despite its vital importance in better understanding children's experiences as well as their disclosure. The current study was designed to spotlight the phenomenon of others' presence, beyond the victims and perpetrators, during child abuse incidents. The current literature review was guided by a scoping review strategy. The results revealed scant empirical data, with only 15 studies meeting the inclusion criteria of the study. The articles that met the inclusion criteria addressed other people's presence during CA incidents, were published in peer-reviewed journals, and were written in the English language. These articles' analyses addressed the relations of the survivors with these others, pointing mainly to two identities: accidental bystanders who are not familiar with the child and family members of the child. The results provided a glance into the process that accidental bystanders go through during the abuse and the meaning of their presence for those who are family members. The perceptions and experiences of the children themselves with respect to the presence of the others during the abuse are noticeably lacking. The key conclusion from the current scoping review pinpoints the urgent need to advance the empirical knowledge on the presence of others during incidents of child abuse, especially others who are familiar to the children and are a significant part of their lives. The conceptualization of this phenomenon has the potential to better adapt prevention and intervention efforts in the field of child abuse.

'There Were Moments We Wished She Could Just Die': The Highly Gendered Burden of Nodding Syndrome in Northern Uganda

Nodding Syndrome (NS) occurs within a wide spectrum of epilepsies seen in onchocerciasis endemic areas of sub-Saharan Africa. It has debilitating consequences on affected individuals and increases the socio-economic, physical and psychological burden on care-givers and their households, diminishing their standing within the community. Social science research on the disproportionate burden of the disease on females is limited. Based on ethnographic research over 3 years in northern Uganda, we explored the burden of being ill and care-giving for persons with NS from a gendered perspective. We found that NS-affected females were at greater risk of physical and psychological abuse, sexual violence, unwanted pregnancies, sexually transmitted infections and stigma, in a context of deteriorating socio-economic conditions. Primary care-givers of the NS-affected, mostly women, struggled to make ends meet and were subjected to stigma and abandonment. Targeted interventions, including legal protection for affected females, stigma reduction, and psycho-social and financial support are needed.

The role of maternal child maltreatment history and unsupportive emotion socialization in the intergenerational transmission of emotion regulation difficulties

BACKGROUND

Maternal mental health problems and poor parenting are thought to account for the intergenerational transmission of poor outcomes to offspring of mothers who have experienced child maltreatment.

OBJECTIVE

Given that emotion regulation (ER) difficulties have been linked to adult psychopathology and maladaptive parenting, the goal of the present study was to examine the mechanisms through which a maternal history of child maltreatment, and subsequent difficulties with ER, might contribute to unsupportive emotion socialization and the intergenerational transmission of ER difficulties.

PARTICIPANTS AND SETTING

Mothers and their young adult children (aged 18-25) were recruited from across Canada to participate in an online study (N = 185 dyads).

METHODS

Mothers responded to questionnaires assessing their child maltreatment histories and ER difficulties. Young adults retrospectively reported on their mothers' emotion socialization behaviours in adolescence as well as their own difficulties with ER.

RESULTS

A moderated mediation analysis revealed that mothers who endorsed more types of child maltreatment were described as using more unsupportive contingencies, but only in the context of high levels of maternal ER difficulties. The indirect effect of maternal child maltreatment on young adults' ER difficulties was only significant for mothers with high levels of ER difficulties. More specifically, maternal difficulties with impulse control and emotional clarity contributed to more unsupportive contingencies.

CONCLUSIONS

Mothers who have experienced multiple forms of child maltreatment may be more likely to struggle with ER and engage in unsupportive emotion socialization behaviours, which may increase the risk of emotional difficulties in their children. Survivors of child maltreatment should have access to interventions that promote ER skills to improve their own well-being and to prevent the transmission of ER difficulties to future generations.

'We experienced lack of understanding in the healthcare system'. Experiences of childhood sexual abuse survivors of the childbearing process, health and motherhood

BACKGROUND

Childhood sexual abuse (CSA) has widespread and long-lasting impact on women's lives and health. Increased knowledge and deeper understanding are needed of survivors' experiences of the childbearing process, health and motherhood.

METHODS

In this phenomenological study, 16 in-depth interviews were conducted with nine female CSA survivors. The interviews were recorded, transcribed verbatim and thematically analysed.

RESULTS

The overarching theme of the study is: 'more understanding is needed', which refers to the participants' experience that greater understanding is needed from health professionals of the long-term effects of CSA on childbearing women. Most of the women had suffered from poor health, especially chronic pain associated with fibromyalgia and gynaecological diseases. All of them had suffered mental health consequences particularly anxiety, depression and PTSD. The majority had experienced flashbacks to the violence and disassociation. Many had experienced miscarriages, had deviations from normal pregnancies and births, such as prolonged labour, caesarean sections, induction of labour, vacuum extraction, bleeding and exaggerated pregnancy problems, such as great nausea and pelvic pain. All but one had a negative experience in one of their births. All of them had experienced a lack of understanding in the healthcare system, perceived abuse of power and felt vulnerable in those situations. All of them had a strong need for a sense of control and participation in decision-making in the childbearing process. Most of them had experienced problems in bonding with their children and some have had difficulties touching them. All of them were in dire need of protecting their children from potential violence and many expressed a tendency to overprotect them.

CONCLUSIONS

Healthcare professionals need to have more knowledge and greater understanding of how healthcare services can be improved so that CSA survivors can have a better experience of the childbearing process.

Growing Older in the Shadow of Childhood Intra-Familial Sexual Abuse: Women's Reflections on Parenthood Experiences Throughout the Life Course

BACKGROUND AND OBJECTIVES

The long-term effect of intra-familial sexual abuse for the survivors' parenting, rarely focuses on older women who are mothers of adult children. The aim of the present study was to explore the parenthood experiences of aging women survivors of intra-familial sexual abuse, using the life-course perspective as a conceptual framework.

RESEARCH DESIGN AND METHODS

Interpretive phenomenological analysis was used to analyze the narratives of 19 older women survivors of intra-familial sexual abuse.

RESULTS

The narratives revealed four themes: (1) "How did I raise those kids? I really don't know": Early parenthood experiences of aging women incest survivors; (2) "This is a true gift they are giving me now": Revealing the IFSA secret to the adult children; (3) "Is it possible to say that something good came out of it?": Adult children as a victory over incest experiences; and (4) "When my granddaughter was born, I suddenly felt that I couldn't go near her": Grandparenting in the shadow of incest memories.

DISCUSSION AND IMPLICATIONS

Aging seems to open up a new avenue for parent-child relationships in the shadow of the parent's traumatic past, allowing reframing of parenthood in later life and demonstrating the power of parenthood as a source of healing in the lives of sexual abuse victims.

A systematic review of the effectiveness of interventions designed for mothers who experienced child sexual abuse

BACKGROUND

Past experiences of child sexual abuse (CSA) have been shown to have a pernicious effect on the parenting behaviors of mothers. As a result, interventions have been developed to address these effects. However, a systematic synthesis of the effectiveness of such interventions has not been conducted.

OBJECTIVE

To conduct a systematic review of existing literature on interventions that have been developed and evaluated for mothers who experienced CSA.

METHODS

Studies were located through a sensitive search strategy in nine academic databases and search engines, and through handsearching reference lists of included studies and their subsequent citations. Two authors independently completed screening, full text review, data extraction, and quality appraisal.

RESULTS

Searches revealed a paucity of literature, with four intervention studies located. All four interventions consisted of therapy, with three of these interventions using a group-based format. One of the included intervention studies used reiki as an adjunct to therapy. Decreases in negative mental health symptoms were reported through both validated measures and interviews. No validated measures to assess parenting were used in any intervention, though some qualitative results indicated changes in parenting. Qualitative results also suggested that most mothers were satisfied with the interventions. Studies were of limited quality - none used a randomized trial design, and only one a control group.

CONCLUSIONS

Given the limitations of the identified intervention studies for mothers who experienced CSA, there is a clear need to develop evidence-based interventions for this population given the unique detrimental effects of CSA on parenting. Avenues for future intervention development are discussed.

A mixed methods investigation of the association between child sexual abuse and subsequent maternal parenting

BACKGROUND

Child sexual abuse (CSA) is associated with a number of pernicious outcomes, including adverse parenting outcomes among mothers who experienced CSA (M_CSA). Despite the large literature on these outcomes, gaps and uncertainties in the literature exist. Specifically, while previous literature has shown that some M_CSA have their parenting negatively affected by CSA, others do not, and potential mechanisms explaining these variations, such as mental health and characteristics of the CSA experience, have not been fully explored.

OBJECTIVES

To investigate (1) how M_CSA believe their CSA experiences have affected their parenting, if at all; (2) what factors may be contributing to these perceived effects; and (3) what resources or intervention components M_CSA believe they need to cope with their experiences.

PARTICIPANTS AND SETTING

Participants were M_CSA primarily from the UK and the Republic of Ireland.

METHODS

M_CSA were recruited through partner organizations specializing in parenting, child abuse, and mental health to complete an online survey with both qualitative and quantitative components. Qualitative data were thematically synthesized and subgroup analyses were conducted.

RESULTS

M_CSA reported that their CSA experiences most affected their desire to protect their child from experiencing abuse. Additionally, breastfeeding, child-rearing practices, the mother-child relationship, and perceptions of motherhood and the child were reported to be affected.

CONCLUSIONS

Given that M_CSA have reported their CSA experiences to negatively affect several aspects of parenting, evidence-based interventions are needed. Participant concerns regarding parenting and suggestions made by participants in this study for interventions may aid in intervention development.