Prevalence of physical intimate partner violence in the first six months after childbirth in the city of Rio de Janeiro, Brazil

Perceptions of Brazilian women at a public obstetric outpatient clinic regarding domestic violence: a qualitative study

OBJECTIVE

The aim was to explore women's perceptions of violence, its causes, manifestations, consequences and responses to prevent and confront domestic violence against women in Brazilian society.

DESIGN

We conducted a qualitative study with individual, semistructured interviews. We used thematic analysis and discussed the data considering the ecological framework.

SETTING

The study was conducted in an antenatal and postnatal care service in the Brazilian National Health System. Data collection was conducted in October 2022.

PARTICIPANTS

The sample selection was intentional and sampling was conducted according to the data saturation criterion. Twelve women who attended an antenatal and postnatal care service were interviewed. The participants reported different experiences of domestic and family violence throughout their lives.

RESULTS

Based on the analysis, four themes were identified: (1) between the public and the private spheres: violence against women and its manifestations, causes and particularities; (2) factors that increase vulnerability; (3) protection system and support network: strengths and weaknesses; and (4) alternatives for the prevention and elimination of violence.

CONCLUSIONS

The perceptions of Brazilian women during pregnancy and the postpartum period regarding domestic violence included a multifaceted view of violence. The women's discourse demonstrated the difficulties that they faced in interrupting the cycle of violence and accessing support networks.

Implementation of postpartum care for women in primary care in the South of Brazil

Abstract Objectives: to determine the implementation level and analyze favorable and unfavorable aspects of operationalization women’s care in postpartum period in primary care. Methods: evaluation study of the normative type, performed through a multiple case study in three cities in the South States in Brazil, with a collection of primary and secondary data. The implementation level (classification: satisfactory, partial, incipient, and critical) was determined by the Matriz de Análise e Julgamento (Analysis and Judgment Matrix), consisted of the dimensions of management and execution, and the respective sub-dimensions. Thematic and imbricated analysis of the cases were performed. Results: postpartum care was incipient in the management dimension for all the cases, with a higher implementation level for the “care coordination and intersectorality mechanisms” (partial) sub-dimension. In the execution dimension in case 3 was partially implemented, and the others were incipient. The breastfeeding sub-dimension had a higher implementation level for all the cases, and the longitudinality, mental health and reproductive planning sub-dimensions had a lower implementation level. Care in relation to domestic violence and mental health occurred unsystematically, and reproductive planning focused on hormonal contraceptive methods. Conclusion: management does not provide ideal conditions for healthcare professionals’ performance; and, in the execution dimension are not incorporated as the main necessity in the health care practice in women’s health.

Prevalence of Intimate Partner Violence Among Intimate Partners During the Perinatal Period: A Narrative Literature Review

Intimate partner violence (IPV) affects individuals and families from all backgrounds, regardless of their ethnicity, socio-economic status, sexual orientation, or religion. Pregnancy and childbirth could be a time of vulnerability to violence because of changes in physical, emotional, social, and economic demands and needs. Prevalence of IPV against women during the perinatal period is increasingly researched and documented. However, evidence on IPV prevalence among intimate partners as well as on the course of IPV over the perinatal period is scarce. The purpose of this review was to provide a narrative synthesis of the existing literature regarding the prevalence estimates of IPV among intimate partners over the perinatal period. Through this review, we also gained better insight into associated factors, as well as the various forms of IPV. Of the 766 studies assessing prevalence estimates identified, 86 were included, where 80 studies focused on unidirectional IPV (i.e., perpetrated by men against women) and six studies investigated bidirectional IPV (i.e., IPV perpetrated by both partners). Most of the included studies reported lower overall prevalence rates for unidirectional IPV postpartum (range: 2-58%) compared to pregnancy (range: 1.5-66.9%). Psychological violence was found to be the most prevalent form of violence during the entire perinatal period. Studies on bidirectional IPV mostly reported women's perpetration to be almost as high as that of their partner or even higher, yet their findings need to be interpreted with caution. In addition, our results also highlighted the associated factors of IPV among partners, in which they were assimilated into a multi-level ecological model and were analyzed through an intersectional framework. Based on our findings, IPV is found to be highly prevalent during the entire perinatal period and in populations suffering from social inequalities. Further research exploring not only the occurrence, but also the motivations and the context of the bidirectionality of IPV during the perinatal period may facilitate better understanding of the detrimental consequences on partners and their families, as well as the development of effective intervention strategies. Public health prevention approaches intervening at optimal times during the perinatal period are also needed.

[Postpartum care for women in primary care: building an assessment model]

Postpartum care for women in primary healthcare (PHC) is important for reducing their morbimortality, but there is no clearly described theory on such care, and the assessment studies are rare. This study aimed to develop and systematize an assessment model for women's postpartum care in PHC, verifying it evaluability. An evaluability study was performed using a Brazilian and international literature review, review of national documents, and interviews with stakeholders. Such evidence backed the elaboration of an assessment model that was validated in a consensus workshop. The data were analyzed with thematic analysis. The study elaborated the program's theory, in which postpartum care in PHC ideally takes place with a comprehensive approach to the woman's physical, psychological, emotional, and social needs, considering the individuality of women with liveborn children or in situations of fetal/neonatal death, initiating prenatal care and continuity in the postpartum period, and with the involvement of spouses and other family members. The program's theory established the program's contextualization and logical design, with objectives, targets, activities, outputs, results, and impact, previously not explained systematically in the literature and documents. Postpartum care was found to be evaluable through an implementation analysis, and the program's theory was defined, with the potential for use by various stakeholders at both the national and international levels to implement and/or improve comprehensive postpartum care for women.

Sheltered adolescents’ background of exposure to violence and distressful experiences

ABSTRACT Objectives: to analyze the exposure to violence and distressful experiences lived by adolescents in institutional shelters in the city of Rio de Janeiro (previous to their admittance). Methods: a cross-sectional study carried out in public institutional shelter units, with a sample of 72 adolescents aged between 12 and 18 years. Data on sociodemographic aspects, family relationships and distressful experiences were obtained by means of the Parcours Amoureux des Jeunes instrument, validated for use in Brazil. Statistical analysis included estimates of prevalence and 95% confidence intervals. Results: high magnitudes of distressful experiences and overlapping abuses lived by adolescents were observed, especially violent events (72.2%), social exclusion (59.1%), and sexual harassment (48.6%). Conclusions: the study shows that adolescents under institutional sheltering come from a background of severe and frequent distressful experiences. These took place in multiple environments: family (prior to their institutional reception), community, and group.

Propriedades Psicométricas de uma Medida de Abuso Psicológico na Parceira

O abuso psicológico é caracterizado pela degradação e pelo controle do parceiro que levam ao desrespeito entre eles.Objetivou-se reunir evidências de validade da Escala de Abuso Psicológico na Parceira (EAP-P) em mulheres brasileiras. O estudo foi dividido em dois. Do Estudo 1, participaram 303 mulheres e realizaram-se análise fatorial exploratória e consistência interna. Os achados corroboraram para uma estrutura bifatorial: estratégias diretas do abuso psicológico e estratégias indiretas do abuso psicológico, com alfas iguais a .92 e .89, respectivamente. Do Estudo 2, participaram 380 mulheres, com a realização de análise confirmatória, e avaliaram-se os parâmetros dos itens mediante a Teoria deResposta ao Item (TRI). Os resultados apontaram que o modelo bifactor apresentou melhores índices de ajuste, além de bons índices de confiabilidade composta de .90 e variância média extraída (.51 e .50), e indicaram, através da TRI, boa capacidade de avaliar a porção central do contínuo de abuso psicológico. A eap-p se apresentou como um instrumento válido e consistente para detectar e medir a violência psicológica em mulheres.

Lifetime prevalence of intimate partner violence against women in an urban Brazilian city: A cross-sectional survey

Background

Intimate partner violence is a global health burden that disproportionately affects women and their health outcomes. Women in Brazil are also affected by interpersonal violence. We aimed to estimate the lifetime prevalence of three forms of interpersonal violence against women (IPVAW) and to identify sociodemographic factors associated with IPVAW in one urban Brazilian city.

Methods

Using a cross-sectional design, we interviewed women aged ≥18 years in the urban Brazilian city, Maringá, who currently have or have had an intimate partner. The 13-item WHO Violence Against Women instrument was used to ask participants about their experiences with intimate partner violence, categorized into psychological, physical and sexual violence. We estimated associations between IPVAW and sociodemographic characteristics using generalized linear models.

Results and conclusions

Of the 419 women who were enrolled and met inclusion criteria, lifetime prevalence of IPVAW was 56%. Psychological violence was more prevalent (52%) than physical (21%) or sexual violence (13%). Twenty-eight women (6.4%) experienced all three forms of IPVAW. Women were more likely to experience violence if they were employed, did not live with their partner or had 4 or more children. Educational level, household income, age and race were not significantly associated factors. Our findings highlight a high prevalence of IPVAW in a community in southern Brazil.