Related factors of violence against women with infertility: A systematic review study based on an ecological approach

Effectiveness of mindful self-compassion therapy on psychopathology symptoms, psychological distress and life expectancy in infertile women treated with in vitro fertilization: a two-arm double-blind parallel randomized controlled trial

OBJECTIVES

Infertility is a prominent problem affecting millions of couples worldwide. Recently, there has been a hightened emphasis on elucidating the subtle linkages between infertility treatment leveraging assisted reproductive technology and the complex realm of psychological challenges, as well as efforts in implementation of psychological interventions.The Mindful Self-Compassion (MSC) program seeks to improve self-compassion, compassion for others, mindfulness, and life satisfaction while reducing depression, anxiety, and stress. In the current study, an MSC intervention was performed on infertile women (IW) undergoing in vitro fertilization (IVF) to assess the effectiveness of this intervention in reducing psychological distress and psychopathological symptoms and enhancing life expectancy.

METHODS

Fifty-seven IW undergoing IVF were randomly allocated to two groups: MSC (n = 29) or treatment as usual (TAU; n = 28). Participants in MSC met once a week for two hours for eight weeks and attended a half-day meditation retreat. The Synder's Hope questionnaire and the Revised 90-Symptom Checklist (SCL-90-R) were used as the primary outcome measures. Data were obtained before the intervention, immediately after the intervention, and two months post-intervention. Repeated measures of ANCOVA and paired t-tests in all assessment points were used to compare the MSC and the TAU groups in outcomes.

RESULTS

In the MSC group, hopelessness, anger-hostility, anxiety, interpersonal sensitivity difficulties, and depression were significantly reduced compared with the TAU group, and those improvements persisted at the two-month follow-up. Reliable change index revealed that the MSC group's gains were both clinically significant and durable.

CONCLUSIONS

MSC can facilitate higher life satisfaction and mental well-being for IW undergoing IVF by reducing psychological distress, psychopathological symptoms, and hopelessness. These encouraging findings call for more research into the effectiveness of mindfulness-based therapies in addressing psychological problems among IW undergoing IVF.

A review of the challenges of screening for domestic violence against women from the perspective of health professionals

BACKGROUND

Domestic violence has a significant effect on women's reproductive, physical, and mental health, and it is a significant threat to everyone's health, so that, it sometimes leads women to commit suicide. Although many of these women will refer to receive medical care due to domestic violence, few of them are identified by health care providers. The present study aimed to review the challenges of screening for domestic violence against women from the perspective of health professionals.

MATERIALS AND METHOD

This study is a scoping review. The study was performed in five stages, which include (1) designing the research question, (2) searching and extracting research-related studies in national and international databases such as PubMed, Scopus, Web of Science, Embase, Magiran, Scientific Information Database (SID), IranDoc and Google Scholar search engine, from inception to March 2021, (3) selecting related studies, (4) scheduling and summarizing data and information, and (5) reporting the results.

RESULTS

Out of 411 articles reviewed, 10 article met our inclusion criteria and were included. According to the results of the studies, barriers of screening for domestic violence can be classified into three areas, which include barriers related to employees (lack of knowledge and training, lack of time to conduct screening, lack of staff confidence, client judgment, and lack of security and comfort for asking related questions and forgetting employees), barriers related to the client and the prevailing culture in the society (tolerating and not reporting domestic violence, fear of spouse due to high power of men in society, fear of losing children and life, and racial and cultural issues) and barriers related to the organization (lack of necessary support from the organization, lack of funding from the organization, lack of protocol).

CONCLUSION

Considering the high number of barriers of detecting women affected by the domestic violence, this study could be used in program designation, and implementation of effective interventions to remove barriers of domestic violence screening. Health care providers can use the results of this review to prepare educational packages according to their cultural background to improve understanding and women's cooperation in the domestic violence prevention and screening programs.

Prevalence of intimate partner violence against infertile women in low-income and middle-income countries: a systematic review and meta-analysis

Background

Infertility and intimate partner violence (IPV) are of serious concern globally, yet the prevalence of IPV against infertile women has not been quantified at the regional or global level. We aimed to estimate the prevalence of IPV against infertile women and its variation in low-income and middle-income countries (LMICs).

Methods

We did a systematic literature search of 11 databases for articles published between database inception and Sept 30, 2021, and performed meta-analyses to estimate the pooled prevalence and 95% CI of IPV against infertile women in LMICs. We used subgroup analyses and meta-regressions to explore variation in the prevalence by study period (2010 and before vs after 2010), study region (Africa, west Asia, south Asia, and east Asia), type of infertility (primary or secondary), risk of bias (high, moderate, or low), sample size (continuous variable), and measuring tools (the modified Abuse Assessment Screen, the WHO Violence Against Women instrument, or the revised Conflict Tactics Scales). This study is registered with PROSPERO, CRD42021248448.

Findings

Of 2661 references identified (2637 via database searches and 24 via secondary searches), 120 full-text articles were reviewed, and we identified 30 relevant studies conducted in nine LMICs between 2000 and 2019. 25 studies met the inclusion criteria for meta-analysis, with a total sample size of 7164 participants. The 12-month prevalence of IPV among infertile women was 36·0% (95% CI 20·4–55·2), compared with a lifetime prevalence of 47·2% (31·7–63·3). The most common type of IPV was psychological violence, with a prevalence of 24·6% (11·3–45·6) over 12 months and 51·5% (38·8–64·0) over a lifetime (slightly higher than the pooled overall rate due to different data sources), respectively; followed by physical violence (11·9% [5·2–25·1] and 20·2% [12·1–31·7]); sexual violence (8·7% [2·6–25·0] and 11·5% [6·1–20·7]); and economic coercion (2·6% [0·4–13·7] and 9·8% [5·7–16·5]). Significant variations of lifetime prevalence estimates were presented by study period (R²=39·46%), region (R²=50·95%), and measuring tools (R²=54·27%).

Interpretation

A high prevalence of IPV against infertile women is evident despite heterogeneity across studies. IPV screening, counselling, and structural interventions should be tailored to address this urgent issue at multiple levels of society.

Funding

China Medical Board and WHO.

Determinants of domestic violence among women of reproductive age (15-49 years) in Quetta, Balochistan-a mixed-method protocol

BACKGROUND

Worldwide, domestic violence (DV) is a cause of death and disability among women aged 15-49 years. In Pakistan, DV appears in different forms, and only 3.2% of women report any DV. There are various factors associated with DV against women. The data are sparse for the Balochistan province due to the under-reporting and scattered population. This research study aims to determine the factors associated with DV and the types of violence among women of reproductive age. Also, to understand the perspective of community leaders and healthcare workers (HCWs) for developing interventions for DV prevention against women of reproductive age in Quetta Balochistan.

METHODS AND ANALYSIS

A sequential explanatory mixed-method (quantitative study followed by qualitative) study design will be used to fulfil the study's objectives. Women of reproductive age (15-49 years), both married and unmarried, local residents, community leaders and community HCWs of Quetta Balochistan, will be made part of the study. A structured questionnaire will be used as the quantitative tool. Focus group discussions will be conducted using a semistructured guide for the qualitative data collection. The multivariable logistic regression analysis will be performed for the quantitative part. P value ≤0.05 will be considered significant. In the qualitative part, data will be transcribed, and recurrent themes/subthemes will be developed to understand the perspective and opinion regarding DV prevention.

ETHICS AND DISSEMINATION

Ethical Approval was taken from Aga Khan University, Karachi, Pakistan. Informed written consent will be obtained from all participants. The article will be published after data collection and analysis in the journal to disseminate the results.

Violence and sexual dysfunction among infertile Egyptian women

OBJECTIVE

To evaluate domestic violence and sexual dysfunction in infertile women.

MATERIALS AND METHODS

We recruited women complaining of infertility (primary or secondary infertility). A control group of fertile women attending the outpatient clinic for any concern was recruited. Domestic violence was evaluated using the Arabic validated NorVold Domestic Abuse Questionnaire (NORAQ). Female sexual function was evaluated using the Arabic validated female sexual function index.

RESULTS

There was no significant difference between both groups in rates of exposure to violence (p-value 0.830). Primary infertility was a significant contributing factor in infertile women's exposure to violence (p-value 0.001). All the studied population had female sexual dysfunction, with more dysfunction was reported by the infertile women (total score 18.87 ± 5.92, 19.51 ± 5.42, p-value 0.072). They differed significantly in arousal (2.83 ± 1.33, 3.13 ± 1.29, p-value 0.001) and satisfaction (3.98 ± 1.27, 4.28 ± 1.28, p-value 0.003) which were impaired in infertile women.

CONCLUSIONS

The recruited infertile women were exposed to violence. Emotional abuse was the most common reported type of violence. Sexual dysfunction was reported in the entire studied population with no significant difference relating to fertility.

The relationship between gender perception levels and infertility distress of infertile women in a university hospital, Turkey

Purpose

This study was conducted to analyze the correlation between gender perception and infertility distress of infertile women.

Design/methodology/approach

This was a descriptive-analytical study conducted with 255 women receiving treatment in the in vitro fertilization unit of a medical faculty hospital in Turkey. Study data were collected using sociodemographic questions as well as the Perception of Gender Scale (PGS) and the Infertility Distress Scale (IDS).

Findings

It was found that the PGS mean score was 69.65 and the IDS mean score was 53.1. It was determined that there was a negative, moderate and significant correlation between gender perception and infertility distress levels of women in the infertility treatment process (r = −0.263, p < 0.001).

Originality/value

As a result of the study, a negative, moderate, significant correlation was detected between gender perception and infertility distress.

Prevalence and risk factors for domestic violence among infertile Egyptian women: a cross-sectional study

Objective: Domestic violence (DV) is an important social and public health problem affecting women globally. This study aims to assess the prevalence and risk factors of DV among infertile Egyptian women. Patients and methods: A cross-sectional hospital-based study included infertile women attending the outpatient gynaecological clinic in a tertiary University hospital was carried out between September 2017 and October 2018. After obtaining ethical approval, 304 infertile women were enrolled in the study and investigated using an interview questionnaire of Infertile Women's Exposure to Violence Determination Scale (IWEVDS). The questionnaire was examined for accuracy after translation into the Arabic language. Results: The infertile women's reported DV resulted in an average total score on the IWEVDS of 73 ± 17. The top three domains with the highest scales were DV, punishment and exposure to traditional practices domains with scale 20.84 ± 7.67, 18.25 ± 4.15 and 14.63 ± 3.18 points, respectively. Using Multivariable linear regression analysis, we found that the best-fitting predictors for this scale were the wife's age (p = .001), residency (p = .033), previous intracytoplasmic sperm injection (ICSI) (p = .016), divorce threatens (p = .022) and fear from husband (p = .026). Conclusions: Infertile Egyptian women are at an increased risk of DV. The most common forms of DV are psychological violence and verbal abuse.

Effectiveness of two guided self-administered interventions for psychological distress among women with infertility: a three-armed, randomized controlled trial

STUDY QUESTION

What is the effect of two guided self-administered interventions on psychological distress in women undergoing IVF or ICSI?

SUMMARY ANSWER

A brief mindfulness intervention significantly reduced depression and improved sleep quality, while the gratitude journal intervention showed no significant effect on any outcome variables.

WHAT IS KNOWN ALREADY

Mindfulness and gratitude journal interventions have been found to be beneficial in reducing negative affect and improving well-being. However, there are very few mental health professionals who implement such interventions in low- and middle-income countries. Therefore, two guided self-administered interventions for women with infertility were designed to help them cope with their psychological distress.

STUDY DESIGN, SIZE, DURATION

A three-armed, randomized controlled trial was designed to evaluate the mindfulness and gratitude journal interventions for women undergoing IVF/ICSI. Between May 2016 and November 2017, at the reproductive center in a public hospital, 234 women were randomly assigned to the brief mindfulness group (BMG, n = 78), gratitude journal group (GJG, n = 78) or control group (CG, n = 78). The inclusion criteria were being a woman undergoing her first cycle of IVF, having at least junior middle school education and having no biological or adopted children.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Female infertility patients (n = 346) were approached, and 112 did not meet the inclusion criteria. All three randomized groups completed questionnaires on the day of down-regulation (T1), the day before embryo(s) transfer (T2), and 3 days before the pregnancy test (T3). The BMG completed four sessions and listened to a 20-minute audio daily, including guided mindfulness breathing and body scan. The GJG completed four sessions and wrote three gratitude journals daily. The CG received routine care. A generalized estimating equation was used in an intention-to-treat analysis. The primary outcome was depression. Secondary outcomes were anxiety, sleep quality, infertility-related stress, mindfulness and gratitude.

MAIN RESULTS AND THE ROLE OF CHANCE

Participants of the BMG showed decreased depression (mean difference (MD) = −1.69, [−3.01, −0.37], d = 0.44) and improved sleep quality (MD = −1.24, [−1.95, −0.39], d = 0.43) compared to the CG, but the effect was not significant for anxiety, Fertility Problem Inventory totals, mindfulness, gratitude scores or pregnancy rates. The BMG showed a significant reduction in depression and improvement in sleep quality between T1 and T2, a continuous significant reduction between T1 and T3 and no reduction between T2 and T3. There were no significant effects on any of the variables for the GJG.

LIMITATIONS, REASONS FOR CAUTION

The inclusion criteria may result in bias because some participants with low education were excluded and only women with infertility were included. A low compliance rate occurred in the gratitude journals group. Moreover, men were not included in this study. Further research should consider including spouses of the target population.

WIDER IMPLICATIONS OF THE FINDINGS

The brief mindfulness intervention was beneficial in decreasing depression and improving sleep quality. Implementation of guided self-administered mindfulness could make the psychological counseling service more accessible for patients with infertility in resource-poor settings. The efficiency and feasibility of the gratitude journal intervention needs to be investigated further.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by the National Social Science Foundation (17BSH054). The authors have no conflicts of interest.

TRIAL REGISTRATION NUMBER

ChiCTR-IOR-16008452.

TRIAL REGISTRATION DATE

9 May 2016

DATE OF FIRST PATIENT’S ENROLMENT

15 May 2016.