Violence against women in life: study among Primary Care users

A National Study on Psychological Violence in Brazil: Differences by Sex and Skin Color

Violence is a global public health problem that affects especially the most vulnerable people. The aim was to analyze the prevalence of psychological violence in the Brazilian population and inequalities according to sex and skin color. This was a cross-sectional study in which the database of the National Health Survey 2019 was used. Psychological violence was considered present when an individual answered yes to at least one of the five variables investigated: In the last 12 months, has anyone (a) offended you, humiliated you, or ridiculed you in front of other people?; (b) yelled at you or called you names?; (c) used social media or cell phones to threaten, offend, curse, or expose your images without your consent?; (d) threatened to hurt you or hurt someone important to you?; and (e) destroyed something of yours on purpose? The independent variable was skin color. The crude prevalence ratio (PR) was determined by Poisson regression. All analyses were stratified by sex. Of the 88,531 respondents, 41,662 were males and 46,869 were females. The prevalence of the presence of psychological violence was 19% in women and 15.6% in men. Men and women with black/brown/yellow/indigenous skin color were 20% and 15% more likely to suffer one or more items of psychological violence, respectively, than men and women with white skin color (PR = 1.20; 95% CI [1.11, 1.30] and PR = 1.15; 95% CI [1.08, 1.23]). Psychological violence occurred predominantly against females and individuals with black/brown/yellow/indigenous skin color. There were notable inequalities in the exposure to this type of violence that need to be considered when making plans to address this problem. The findings emphasize the relevance of constantly reviewing political and social constructions to promote a reduction of inequalities.

Association between perceived stress and history of intimate partner violence throughout life and during the COVID-19 pandemic

Introduction

Intimate Partner Violence (IPV) is a significant public health issue, characterized by being a highly stressful experience for its victims. The relationship between IPV and stress creates a harmful cycle with broad health implications, affecting individuals and society at large. Despite its significance, there's a noticeable lack of research on this topic, especially regarding IPV throughout one's life and during the pandemic.

Objective

To verify the association between perceived stress and the history of intimate partner violence throughout life and during the COVID-19 pandemic.

Materials and methods

Analytical cross-sectional epidemiological study with a sample of 1,086 women. Sociodemographic information and violence history, assessed using the World Health Organization Violence Against Women (WHO VAW STUDY), along with perceived stress measured by the short version of the Perceived Stress Scale (PSS), were collected. The sampling process unfolded through multiple stages. For bivariate analyses, the t-test and ANOVA were performed, whereas for multivariate analyses simple and multiple linear regression were performed. The software Stata® version 15.1 and R® were used.

Results

Women who reported having suffered intimate partner violence throughout their lives had higher means of stress (18.49), with an average increase of 4 points without adjustments and 3.5 points after adjustments for sociodemographic variables. Similarly, during the COVID-19 pandemic (19.01), stress increased by an average of 3.3 points, which was reduced to 2.8 points after adjustments.

Conclusion

The results indicate an association between intimate partner violence and an increase in women's perceived stress, both throughout life and during the pandemic. The importance of preventive approaches, promoting gender equality and preventing IPV from the early stages of life is highlighted. In addition, they underscore the urgency of evidence-based interventions of a comprehensive nature to deal with this complex issue in a careful and effective manner. The cross-sectional nature of this study limits the inference of causality, and an additional limitation is acknowledged concerning information bias. This bias relates to the multifaceted issues surrounding the concept of violence, potentially influencing the accuracy of participants' information and complicating the measurement of violence.

Prevalence and factors associated with recurrent violence in a southeastern Brazilian state: Cross-sectional study

Violence is a serious public health problem and its repetitive character points to a chronic phenomenon and its insertion in the daily lives of victims. To identify the frequency of repeat violence reported in adults in a Brazilian state and its association with the characteristics of the victim, the aggressor, and the aggression. This is an epidemiological cross-sectional study conducted with data from the notifications of violence recorded in the Notifiable Diseases Information System in Espírito Santo, Brazil from 2011 to 2018. Bivariate analysis was performed using Pearson Chi-Squared test and the multivariate Poisson regression, using a widely used hierarchical model, with the victim's characteristics in the first level and the aggressor's characteristics and the occurrence in the second level. In the multivariate analysis, the variables that obtained P  < .2 in the bivariate analysis were included in the model, keeping those with P  < .05. Data were expressed by prevalence ratio (PR), with confidence intervals of 95%. During the period, 9933 cases of violence were registered in the adult population, referring to 1061 notifications of male adults and 8872 notifications of female adults. The prevalence of repeat violence was 56.7% (95% CI: 56.0 - 57.5). It was more prevalent among women (PR: 1.73; 95% CI: 1.63 - 1.83), in the age groups over 40 years (PR: 1.12; 95% CI: 1.08 - 1.16), black and mixed-race ( P : 1.04; 95% CI: 1.01 - 1.07), and with a partner ( P : 1.09; 95% CI: 1.05 - 1.12). Victims with disabilities or disorders suffered 34% more from this problem (95% CI: 1.29 - 1.38) and lived in urban or peri-urban areas (PR: 1.16; 95% CI: 1.10 - 1.23). As for the aggressors, they were under 25 years of age (PR: 1.06; 95% CI: 1.02 - 1.11), of both sexes (PR: 1.32; 95% CI: 1.06 - 1.64), and were the victim's intimate partner (PR: 3.91; 95% CI: 3.25 - 4.71). The aggressions had only 1 perpetrator (PR: 1.17; 95% CI: 1.07 - 1.28) and occurred in the residence (PR: 1.33; 95% CI: 1.26 - 1.41). Repeat violence showed high frequency among notifications and was associated with characteristics of the victim, aggressor, and event. The results point to a phenomenon present in the daily life of communities that is potentially capable of negatively impacting the different areas of the subjects lives. Studies on the subject are important to understand the phenomenon and implement strategic actions to confront it.

Risk of Femicide and Quality of Life Assessment of Women Victims of Intimate Partner Violence in Campinas, São Paulo, Brazil

Background

Violence against women is a public priority issue for epidemiological and public health sciences. Severe consequences of violence affect the quality of life of women victims. The objective of this study was to quantify the impact in the quality of life of the strengthening group in women victims of intimate partner violence who attend a reference violence center in Campinas, São Paulo, Brazil.

Method

Quasi-experimental before and after the study was designed. The danger assessment and WHOQOL-BREF scales were applied at admission, after 3 and 6 months. Descriptive and statistical analysis of the variables was carried out to verify the difference between the measurements in the quality of life domains.

Results

Seventy-eight victims of intimate partner violence participated in the study. The most prevalent violence was psychological (96.2%), physical (79.5%), and moral (67.7%). Three months after participating in the strengthening group, there was an improvement in the 4 domains of quality of life, significantly in the psychological (p = 0.032 ) and physical (p = 0.006 ) domains. More than half of the participants were classified at the extreme level of risk of femicide (51.3%). The study was stopped early because of the restrictions of the COVID-19 pandemic.

Conclusion

With the available data collected, the strengthening group proved to be a strategy that positively impacts the quality of life of women victims of intimate partner violence.

Patterns of abuse of elderly people in Brazil: analysis of notifications

This study aimed to describe the characteristics of elderly people abuse notifications by gender and to assess notification patterns according to gender. We analyzed data from the Brazilian Information System for Notificable Diseases (SINAN) in 2017. We carried out a descriptive analysis of victim characteristics, violence, and the probable perpetrator according to gender. Pearson's χ2 test was used to assess the significance between groups. Then, we verified the main relationships between the studied characteristics and the victim's gender by simple correspondence analysis (SCA). Thus, 17,311 cases/suspicions of elderly people abuse were notified, corresponding to 7.2% of the total number of violence notifications. Of these victims, 50.4% were white, 42.3% were married, and 17.2% had a disability/disorder; 76.9% occurred at home, 62.8% included physical violence, and 49.5% were cases of repeated violence. Most perpetrators were men (62%), and violence by two or more perpetrators was observed in 62.8% of the cases. SCA evidenced inequalities in older adults' gender, which proved to be higher among women. Physical violence was the most common among younger and old individuals, whereas neglect/abandonment tended to occur more frequently among the oldest individuals, and was most often committed by daughters. In sum, this study demonstrated evidence of gender-based violence, especially among older adults. Disability proved to be an essential characteristic for neglect/abandonment in older adults. In this context, policies are needed to reduce gender inequalities and implement a care network for older adults who are victims of violence.

Analysis of femicide cases in Campinas, SP, Brazil, from 2018 to 2019 through the ecological model of violence

Lethal violence against women is a complex and multidimensional phenomenon in which a wide number of factors intersect and converge to make a femicide happen at a specific time and place. The main factors that contributed to the occurrence of femicides in the city of Campinas were identified from January 2018 to December 2019. Interviews were conducted with family members, friends, neighbors, witnesses, and health agents about 24 femicides using the verbal autopsy technique. The autopsies were supplemented, when possible, with information from the media and clinical autopsy reports. For the data analysis process, narratives of the cases were carried out, recovering the most important aspects of the verbal autopsies and organizing the factors found in the four levels of the ecological model of violence used by the World Health Organization: individual, relational, community, and social. The analysis was structured in categories following a deductive approach. Starting from particular cases delimited in time (2018 and 2019) and in space (municipality of Campinas) it is expected to understand the phenomenon of femicide in its broadest dimension.

Analysis of femicide cases in Campinas, SP, Brazil, from 2018 to 2019 through the ecological model of violence

Abstract Lethal violence against women is a complex and multidimensional phenomenon in which a wide number of factors intersect and converge to make a femicide happen at a specific time and place. The main factors that contributed to the occurrence of femicides in the city of Campinas were identified from January 2018 to December 2019. Interviews were conducted with family members, friends, neighbors, witnesses, and health agents about 24 femicides using the verbal autopsy technique. The autopsies were supplemented, when possible, with information from the media and clinical autopsy reports. For the data analysis process, narratives of the cases were carried out, recovering the most important aspects of the verbal autopsies and organizing the factors found in the four levels of the ecological model of violence used by the World Health Organization: individual, relational, community, and social. The analysis was structured in categories following a deductive approach. Starting from particular cases delimited in time (2018 and 2019) and in space (municipality of Campinas) it is expected to understand the phenomenon of femicide in its broadest dimension.

Sexual Violence and Low Rates of HIV Post-exposure Prophylaxis Access Among Female Sex Workers in Brazil

Female sex workers (FSW) are disproportionately affected by sexual violence (SV) and HIV. Social and structural barriers limit their access to post-exposure prophylaxis (PEP). Respondent-driven sampling survey in 12 Brazilian cities among 4188 FSW aimed to estimate the rates of SV and factors associated with access to PEP use among FSW who experienced SV. The prevalence of SV was 26.3% (1199). Of the 1199, 7.5% sought out healthcare and used PEP, 19% sought out healthcare, but did not use PEP, and 73.5% did not seek out healthcare after SV. Factors associated with PEP use included PEP awareness, participation in HIV/STI prevention workshops, and disclosure of FSW status in healthcare services. Although Brazil has a PEP program free of charge, it is not readily accessible, even for FSW who seek out healthcare. The development of effective strategies to link FSW to HIV preventive services is urgently needed.

Violence Against Women During COVID-19 Pandemic: A Comparative Study from a Turkish Emergency Department

OBJECTIVE

Violence against women (VAW) is a major public health problem and a violation of women's human rights. The coronavirus disease 2019 (COVID-19) pandemic has worsened gender inequality, resulting in a heightened incidence of VAW. This study aims to assess the characteristics of women who admit to the emergency department (ED), both before the pandemic and during the pandemic. The secondary aim is to compare the frequencies of violence cases between periods.

METHODS

By single-center, retrospective, and cross-sectional design, the periods of April 10 - December 31, 2020 and April 10 - December 31, 2019 were compared. The outcomes of the study were the daily ED admission numbers of both sexes, the prevalence of VAW cases in the ED, as well as sociodemographic and clinical variables of the women who were exposed to violence.

RESULTS

During the pandemic period, number of VAW cases in the ED increased 13% and the ratio of VAW cases to all ED admissions tripled compared to the pre-pandemic period. Women exposed to VAW were more likely to be without social insurance, injured in the trunk part of their body, and having a life-threatening injury in the pandemic period. In both periods, women were attacked by an intimate partner, dominantly (42.6% and 54.1%, respectively). In addition, among all admissions of adults to the ED, women's percentage decreased while men's admission ratios increased during the pandemic period. Admissions to ED declined 47.7% during the COVID-19 pandemic compared to the year before.

CONCLUSION

Cases of VAW tend to increase during the pandemic, and health care settings should be well-organized to respond to survivors.

Intimate partner violence during pregnancy: a focus on partner characteristics

This study analyzes the association between violence against women during pregnancy and intimate partner socioeconomic and behavioral characteristics. We conducted an analytical cross-sectional study with 327 postpartum women admitted to a maternity hospital in a city in Espírito Santo, Brazil using a questionnaire to collect data on intimate partner socioeconomic and behavioral characteristics. Intimate partner violence was assessed using questions based on the World Health Organisation instrument "Violence against Women (WHO VAW STUDY)". Associations were tested using crude and adjusted Poisson regression. The prevalence of psychological violence during pregnancy was higher among women whose partners consumed alcohol, refused to use condoms, and were not the infant's biological father. Physical violence was associated with women whose partners did not work and refused to use condoms. The prevalence of sexual violence during pregnancy was more than nine times higher among women with partners who refused to use condoms. The findings demonstrate that antenatal care is an opportune time to approach partners about health care and address violence. It is necessary to promote the utilization of health services by men in order to address risk factors for violence during pregnancy.

Intimate partner violence during pregnancy: a focus on partner characteristics

Abstract This study analyzes the association between violence against women during pregnancy and intimate partner socioeconomic and behavioral characteristics. We conducted an analytical cross-sectional study with 327 postpartum women admitted to a maternity hospital in a city in Espírito Santo, Brazil using a questionnaire to collect data on intimate partner socioeconomic and behavioral characteristics. Intimate partner violence was assessed using questions based on the World Health Organisation instrument “Violence against Women (WHO VAW STUDY)”. Associations were tested using crude and adjusted Poisson regression. The prevalence of psychological violence during pregnancy was higher among women whose partners consumed alcohol, refused to use condoms, and were not the infant’s biological father. Physical violence was associated with women whose partners did not work and refused to use condoms. The prevalence of sexual violence during pregnancy was more than nine times higher among women with partners who refused to use condoms. The findings demonstrate that antenatal care is an opportune time to approach partners about health care and address violence. It is necessary to promote the utilization of health services by men in order to address risk factors for violence during pregnancy.

Theater on the scene in the teaching-learning process to approach violence against women: experience report

ABSTRACT Objective Report the construction, organization and presentation of a play with an approach to violence against womens. Method This is an experience report about the use of theater in the teaching-learning process to approach violence against womens. The activity was developed from April to November 2019, being elaborated in three stages: (1) Construction of the script; (2) Essays and organization and (3) Presentation. Data were analyzed through thematic categorical analysis, presented in a descriptive way, emerging four thematic categories and six subcategories, discussing them according to the relevant literature. Results It highlights the importance of using this educational technology to favor the teaching-learning process, from the construction to the presentation of the play, enabling undergraduates encouragement to creativity, strengthening of social relations, criticality, respect and the capacity for agreement, by providing opportunities for the development of essential skills for professional practice, collective coexistence and transdisciplinary work. Conclusionan and implications for practice The experience was considered successful, as it constituted an educational strategy that enabled undergraduates to develop crucial skills for recognizing and assisting to women in situations of violence.

Vulnerabilidades associadas à violência contra a mulher antes do ingresso no sistema prisional

RESUMO Objetivo: analisar as vulnerabilidades individuais e sociais de mulheres privadas de liberdade para violência sofrida antes da entrada no sistema prisional. Método: estudo transversal analítico, realizado com 272 internas de uma unidade prisional feminina, na Região Metropolitana de Fortaleza, Ceará. Foram aplicados dois instrumentos: formulário para análise de informações sociodemográficas e da violência sofrida previamente à entrada no presídio e o Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), que analisou o histórico do uso de substâncias psicoativas. Resultados: 44,5% das mulheres sofreram violência. A maior parte da amostra total apresentava idade entre 18 e 29 anos, com filhos, baixa escolaridade e renda, início precoce da vida sexual e histórico de uso de drogas ilícitas. A idade entre 18 e 29 anos mostrou ser fator protetor da violência (OR = 0,632). Uso de cocaína e crack (p = 0,002), anfetaminas e êxtase (p = 0,018) aumenta a chance de violência de 2,2 a 3,3 vezes. Conclusão: aspectos das dimensões individuais e sociais da vulnerabilidade estão associadas à ocorrência de violência em mulheres internas do sistema prisional feminino. Estratégias efetivas necessitam ser traçadas com base nas vulnerabilidades, para prevenir violência contra a mulher.

Vulnerabilities associated with violence against women before entering the prison system

OBJECTIVE

to analyze the individual and social vulnerabilities of women deprived of their liberty for violence suffered before entering the prison system.

METHOD

an analytical crosssectional study, carried out with 272 inmates of a female prison unit, in the Metropolitan Region of Fortaleza, Ceará. We applied two instruments: a form to analyze sociodemographic information and the violence suffered prior to entering the prison and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), which analyzed the history of psychoactive substance use.

RESULTS

44.5% of women suffered violence. Most of the total sample was between 18 and 29 years old, with children, low education and income, early onset of sexual life and history of illicit drug use. Age between 18 and 29 years proved to be a protective factor against violence (OR = 0.632). Cocaine and crack use (p =0.002), amphetamines and ecstasy (p =0.018) increase the chance of violence by 2.2 to 3.3 times.

CONCLUSION

aspects of the individual and social dimensions of vulnerability are associated with the occurrence of violence in women in the female prison system. Effective strategies need to be designed based on vulnerabilities to prevent violence against women.

Teatro em cena no processo ensino-aprendizagem para abordagem da violência contra mulheres: relato de experiência

RESUMO Objetivo relatar a construção, organização e apresentação de peça teatral com abordagem acerca da violência contra mulheres. Método trata-se de relato de experiência acerca da utilização do teatro no processo ensino-aprendizagem para abordagem da violência contra mulheres. A atividade foi desenvolvida nos meses de abril a novembro de 2019, sendo elaborada em três etapas: (1) Construção do roteiro; (2) Ensaios e organização e (3) Apresentação. Os dados foram analisados mediante análise categorial temática e apresentados de forma descritiva, emergindo quatro categorias temáticas e seis subcategorias, discutindo-os conforme a literatura pertinente. Resultados evidencia-se a importância de utilização dessa tecnologia educativa para favorecer o processo ensino-aprendizagem, desde a construção até a apresentação da peça, possibilitando, aos graduandos, estímulo à criatividade, fortalecimento das relações sociais, criticidade, respeito e a capacidade de pactuação ao oportunizar o desenvolvimento de competências imprescindíveis para o exercício profissional, convivência coletiva e trabalho transdisciplinar. Conclusão e implicações para a prática a vivência foi considerada exitosa, pois constitui estratégia educativa que possibilitou, aos graduandos, desenvolvimento de aptidões cruciais para o reconhecimento e a assistência às mulheres em situação de violência.

Prevalence of exposure to violence among adults - Brazil, 2019

OBJECTIVE

To estimate the prevalence of exposure to violence, characterizing its magnitude, types and occurrence in the adult population in Brazil.

METHODS

Cross-sectional study with data from the National Health Survey conducted in 2019. The prevalence of violence in the last 12 months and respective 95% confidence intervals (95%CI) were estimated according to sociodemographic variables. Crude prevalence ratios were estimated by Poisson regression.

RESULTS

The prevalence of exposure to violence among adults in Brazil was 18.3% (95%CI 17.8-18.8), with a significantly higher frequency among women (19.4%; 95%CI 18.7-20.0), in the 18-29 age group (27.0%; 95%CI 25.7-28.4), in self-declared black people (20.6%; 95%CI 19.3-21.9) and mixed race (19.3%; 95%CI 18.6-20.1) and among inhabitants of the Northeast region (18.7%; 95%CI 18.0-19.5). Among the victims of violence, 15.6% (95%CI 14.2-17.0) sought health care, of which (91.2%; 95%CI 88.1-93.6) were attended. The most reported types of violence were: psychological (17.4%; 95%CI 16.9-17.9), physical (4.1%; 95%CI 3.9-4.4) and sexual (0.8%; 95%CI 0.7-0.9). Men were more exposed to violence with the use of firearms or sharp targets, while women were the predominant victims for all other types and mechanisms of violence. The aggressor most cited was the intimate partner, the most frequent place of occurrence of violence being the residence and public streets/places.

CONCLUSION

In Brazil, violence affected one in five adults. Women, young people and people with black skin were the population segments most exposed to violence, which should be a priority in prevention actions.