Intimate partner violence in urban Pakistan: prevalence, frequency, and risk factors

Economic costs of perinatal depression and anxiety in a lower middle income country: Pakistan

BACKGROUND

Women's mental health during the perinatal period is a major public health problem in Pakistan. Many challenges and competing priorities prevent progress to address the large treatment gap. Aim To quantify the long-term impacts of untreated perinatal depression and anxiety in economic terms, thus highlighting its overall burden based on country-specific evidence.

METHODS

Cost estimates were generated for a hypothetical cohort of women giving birth in 2017, and their children. Women and children experiencing adverse events linked to perinatal mental health problems were modelled over 40 years. Costs assigned to adverse events included were those linked to losses in quantity and quality-of-life, productivity, and healthcare-related expenditure. Present values were derived using a discount rate of 3 %. Data were taken from published cohort studies, as well as from sources of population, economic and health indicators.

RESULTS

The total costs were $16.5 billion for the cohort and $2680 per woman giving birth. The by far largest proportion referred to quality-of-life losses ($15.8 billion). Productivity losses and out-of-pocket expenditure made up only a small proportion of the costs, due to low wages and market prices. When the costs of maternal suicide were included, total costs increased to $16.6 billion.

LIMITATIONS

Important evidence gaps prevented the inclusion of all cost consequences linked to perinatal mental health problems.

CONCLUSIONS

Total national costs are much higher compared with those in other, higher middle-income countries, reflecting the excessive disease burden. This study is an important first step to inform resource allocations.

Supportive Interventions of Chinese Police in Domestic Violence: Do Officer Knowledge and Training Matter?

Policing domestic violence (DV) poses significant challenges in China due to cultural, legal, and organizational complexities. Policing DV in China favors mediation over assertive interventions, complicating law enforcement's role. While previous research has focused on coercive interventions by Chinese police, there is limited information on non-coercive, supportive approaches. This study investigates the relationship between police officers' knowledge and training regarding the Anti-DV law and their willingness to provide supportive services to DV victims in China. It also considers various individual and organizational factors. The data used in this study are derived from the Policing DV in China project, with a sample of 1,353 respondents who had experience dealing with DV cases within the past 3 years. The study focuses on three dependent variables representing supportive approaches to DV cases: Referral, Counseling, and Protection orders. Independent variables include officers' knowledge of the Anti-DV law and agency training. Control variables include the use of body-worn cameras (BWC) and attitudes toward Violence Tolerance, Male Dominance, and Gender Equality. Additionally, demographic variables, working environment, length of service, and police rank are considered. The analytical approach involves a three-step strategy, incorporating descriptive, bivariate analyses, and regression analyses. The results are interpreted using odds ratios and average marginal effects, and statistical software such as SPSS by IBM and R by Open-Source Model is utilized for data analysis. Key findings indicate that more than half of the officers referred intimate partner violence survivors to shelters and assisted victims in filing protection orders. Counseling practices varied across provinces and between male and female officers. Agency training and the use of BWC were positively associated with non-coercive and supportive approaches, while knowledge of the DV Act, male dominance score, and gender equality score did not predict the use of such approaches. Demographic characteristics, including police rank, length of service, and province of employment, influenced the utilization of non-coercive and supportive approaches. This study examines the challenges faced by Chinese police officers when responding to DV cases and their willingness to provide supportive interventions. The study highlights the complexities surrounding the initiation of protection orders due to officers' legal knowledge and discretion. The study emphasizes the importance of police support in addressing DV in China and the role of agency training in promoting non-coercive responses. It highlights regional variations in police support and underscores the need for addressing disparities in service provision across different provinces.

Intimate partner violence among women in Togo: a generalised structural equation modeling approach

OBJECTIVE

This study aimed to assess the magnitude and identify associated factors with intimate partner violence (IPV) in Togo.

DESIGN

Cross-sectional study.

SETTING

Togo.

PARTICIPANTS

Women of reproductive age (15-49 years).

PRIMARY OUTCOME

Intimate partner violence.

METHODS

This study used data from the 2013 Togolese Demographic and Health Survey. A total of 4910 married or partnered women were included. A Generalised Structural Equation Model (GSEM) was performed to identify significant factors associated with IPV. Results of the GSEM were reported as adjusted ORs (aOR) with their corresponding 95% CIs.

RESULTS

The pooled prevalence of IPV was 35.5% (95% CI: 34.2% to 36.8%). Emotional violence and physical violence were the most reported forms of IPV (29.7% and 20.2%, respectively), while sexual violence was the least common, with a prevalence of 7.5%. Additionally, the results indicated that the following factors related to women, men and households were significantly associated with IPV in Togo: ethnicity, region, religion, wealth index, working status, age at the first union, having attitudes toward wife-beating, participation in household decision-making, education level, alcohol use and controlling behaviour.

CONCLUSION

IPV is a complex and multifactorial phenomenon in Togo. The Togo government as well as women's human rights organisations should consider these factors when designing IPV programmes.

Associations between sexual violence and women's sexual self-consciousness

Background

Sexual violence is a global public health problem that has serious and multiple consequences for the victims' health.

Objective

This study was conducted to determine associations between sexual violence and women's sexual self-consciousness.

Methods

In the analytical cross-sectional study, 340 eligible married women of reproductive age who have been referred to comprehensive health centers of Rasht, participated. Simple random sampling followed by cluster sampling was used to reach eligible study participants. The data collection tool was a three-part questionnaire including a demographic information form, sexual violence questionnaire, and sexual self-consciousness scale.

Results

More than 66% of the participants in this study were exposed to sexual violence by their current spouses/partners. The highest prevalence of sexual violence was in the dimension of unwillingness to have sex (49%), and the lowest in the verbal dimension was 2.1%. Participants were 4.11 ± 5.18. There was a significant positive correlation between the total score of sexual violence and the total score of sexual self-consciousness of participants (P <0.001, r = 469).

Conclusion

According to the findings, there is a significant positive correlation between SSC and sexual violence, so prevention policies for sexual violence should be focused on skill-based programs and empowering women.

Factors and consequences associated with intimate partner violence against women in low- and middle-income countries: A systematic review

Intimate Partner Violence (IPV) is a global public health issue, with notably high prevalence rates observed within Low-and Middle-Income Countries (LMICs). This systematic review aimed to examine the risk factors and consequences associated with IPV against women in LMICs. Following PRISMA guidelines, we conducted a systematic review using three databases: Web of Science, ProQuest Central, and Scopus, covering the period from January 2010 to January 2022. The study included only peer-reviewed journal articles in English that investigated IPV against women in LMICs. Out of 167 articles screened, 30 met the inclusion criteria, comprising both quantitative and mixed-method studies. Risk factors of IPV were categorised as: demographic risk factors (23 studies), family risk factors (9 studies), community-level factors (1 studies), and behavioural risk factors (14 studies), while consequences of IPV were categorised as mental health impacts (13 studies), physical impacts (5 studies), and societal impacts (4 studies). In this study, several risk factors were identified including lower levels of education, marriage at a young age, poor wealth indices, rural residential areas, and acceptance of gender norms that contribute to the prevalence of IPV in LMICs. It is essential to address these factors through effective preventive policies and programs. Moreover, this review highlights the necessity of large-scale, high-quality policy-driven research to further examine risk factors and consequences, ultimately guiding the development of interventions aimed at preventing IPV against women in LMICs.

Application of Virginia Henderson's Theory Within an Intimate Partner Violence Scenario

The practice column focuses on incorporating a nursing theoretical framework into nursing care in a clinical scenario involving intimate partner violence. Accordingly, as exemplified by utilizing Virginia Henderson's theory, there is guidance to define, focus, and evaluate nursing care in these multifaceted clinical cases.

Exploring the relationship between intimate partner violence during pregnancy and stillbirths

INTRODUCTION

The relationship between intimate partner violence (IPV) in pregnancy and stillbirths is poorly understood. We aimed to determine if there was any association between stillbirths and IPV during pregnancy.

METHODS

A community-based, matched, case-control study was conducted in 2014, nested within the Maternal and Newborn Health Registry of the Global Network for Women's and Children's Health Research in Pakistan. Using a WHO questionnaire, IPV in pregnancy was ascertained from 256 cases (women with stillbirths) and 539 controls (women with live births), individually matched on parity. Multivariable conditional logistic regression analysis assessed the association of IPV in pregnancy ending in stillbirths compared to those with live births.

RESULTS

The effect of physical and psychological IPV was modified by maternal age. Among women 25-34 years old with stillbirths, the odds of experiencing physical IPV in pregnancy were four times greater than those with live births, after controlling for confounders [odds ratio 4.1 (95% CI: 1.5, 11.2)]. A negative association was observed between psychological IPV in pregnancy and stillbirths among women younger than 25 years, and no association was observed between sexual IPV during pregnancy and stillbirths.

CONCLUSION

Study results show that women 25-34 years of age with stillbirths were four times more likely to experience physical IPV during pregnancy. Further studies replicating the effect modification of IPV by maternal age are warranted.

Intimate partner violence against women in Southern Punjab, Pakistan: A phenomenological study

BACKGROUND

Intimate Partner Violence (IPV) refers to behavior by an intimate partner that can cause physical, sexual, or psychological harm; is a common global public health issue requiring immediate attention. IPV is the most common form of violence in rural areas of Punjab, Pakistan.

METHODS

This qualitative phenomenological study collected 46 in-depth interviews from married women who experienced IPV in the rural areas of South Punjab. A semi-structured interview guide was used for data collection. These women were selected through a snowball sampling technique from October 2018 to March 2019. Researchers accessed the study setting with the help of gatekeepers (Lady Health Workers and Village Heads). The interviews were audio-recorded in the local language (Saraiki) and were translated into English. The data were analyzed using the thematic inductive analysis technique.

RESULTS

The study has presented multifaceted factors of IPV by using the socio-ecological framework in rural areas of South Punjab, Pakistan. The current study introduced culturally contextualized terminologies of "protection," "physical submissiveness," "mental delicacy," and "social security". For married women, culturally embedded terms became the primary cause of IPV. In addition, the study also highlighted some of the cultural terminologies (such as run-mureed, watta-satta, beghairat, izzat, etc.) that are ubiquitous in the local context that sometimes intensifies IPV in the family and community sphere. Furthermore, the study discussed how gender-based inequalities trigger a status quo that ultimately creates power discrimination between spouses, which perpetuates violence in the domestic context.

CONCLUSIONS

Gender-prejudiced roles and expectations imposed by orthodoxy, misinterpretations of Islamic teachings, and dominant patriarchy can be contested through awareness campaigns among the public, and gender sensitization drives among public institutions of police and judiciary. Education and employment-based can lead to women's empowerment and help to challenge the orthodox anti-feminist societal norms and the role of kinship-based networks in the family and community sphere.

Intimate-partner violence and its association with symptoms of depression, perceived health, and quality of life in the Himalayan Mountain Villages of Gilgit Baltistan

Study objectives

We aimed to estimate the prevalence of intimate partner violence (IPV) and associated risk factors in married women in rural villages of Gilgit Baltistan in Pakistan.

Methods

A cross-sectional design to assess the magnitude and factors associated with IPV in a random sample of 789 married women aged 18–49 years. A World Health Organization screening instrument was used to assess the presence of IPV in the previous 12 months. A locally validated instrument was adopted to identify self-reported symptoms of major depression according to the DSM IV. Trained nurses obtained socio-demographic and reproductive history through structured interviews. Bivariate and multivariable logistic regression analyses were used to estimate prevalence and identify significant predictors of IPV.

Results

The mean age of the participants was 38.3 years (SD: ±12.8). The prevalence of IPV in women was 22.8% (95% Confidence Interval: 20.0–25.9), 18.5% in pregnant women (95% CI: 11.7–27.9) and significantly associated with depression in 55.1% of IPV cases. Husband education level (college/higher) (Adjusted Odds Ratio: 0.40; 95%CI: 0.22–0.70) and high household income (AOR: 0.44; 95% CI: 0.29–0.68) were protective against IPV. Increase in age (AOR;1.02; 95% CI: 1.01–1.02) and poor relationship with mother-in-law increased the risk of IPV (AOR = 2.85; 95% CI: 1.90–4.28). IPV was positively associated with symptoms of depression (AOR = 1.97; 95% CI:1.39–2.77), poor perceived quality of life (AOR = 3.54; 95% CI: 1.90–6.58) and poor health (AOR = 2.74; 95% CI: 1.92–3.92).

Conclusion

IPV is substantial public health burden significantly associated with depressive symptoms, poor perceived health and the quality of life.

Examining Sexual Crime Severity in China: A General-specific Model on Sex Offending Against Adults

Sexual violence severity has long been viewed as a critical factor of sex offending. However, the criminological viewpoints on sexual violence severity have not received much attention, especially in the Chinese context. By integrating general-criminogenic (inhibitory mechanisms) and specific sex offending (learning mechanisms and contextual factors) perspectives, the current study links the propositions of social control (bonds) theory, self-control theory, differential association theory, and the integrated theory of sex offending, proposing a general-specific model for sexual violence severity. Survey data was collected from 250 Chinese offenders who committed sexual offenses against adults. The mediation analysis found that deviant peer association fully mediates the effects of social control and low self-control on sexual violence severity. The moderation analysis showed that substance abuse exaggerates the impact of deviant peer association on sexual violence severity, while sex purchasing mitigates this relationship. This general-specific model may expand our current understanding of sexual violence severity from both criminological and psychological perspectives.

Prevalence and related factors of intimate partner violence among married women in Garmsar, Iran

BACKGROUND

Intimate partner violence (IPV) is the most common type of domestic violence often used by men against their wives. Due to the destructive and widespread social and health consequences of IPV, the present study aimed to investigate the prevalence and related factors of IPV among married women in Garmsar, Iran.

METHODS

Using multi-stage clusters sampling method, this cross-sectional study included 400 married women in Garmsar, Iran. The data collection process was conducted during October and December 2019 using a researcher-made questionnaire. The content validity of the questionnaire was confirmed using content validity ratio (CVR) and content validity index (CVI) indicators (0.85 and 0.88, respectively). Also, the reliability was confirmed by examining the internal consistency and obtaining a score of 0.93 for Cronbach's alpha. Descriptive and analytical statistics were performed using t-test, analysis of variance (ANOVA), and Tukey's post-hoc test.

RESULTS

Most participants were in the age range of 20-40 years (mean age: 34.9 years). The overall exposure of women to IPV was 56.11%. In addition, the most prevalent types of IPV included legal (24%), social (24%), financial (22%), verbal (16%), physical (13%), emotional (12%), and sexual (11%). The effective factors on the prevalence of IPV included number of children, education level, occupation, and age (P less than 0.05).

CONCLUSIONS

We witnessed that women living in Garmsar faced different types of IPV and their overall exposure to this phenomenon was higher than the national and global average. To resolve the problem, the following measurements are recommended: a careful investigation of the reasons for the spread of IPV, implementing interventions based on reliable evidence, and serious cooperation of the experts and relevant governmental and non-governmental institutions, particularly citizens.

Frequency, Types, and Manifestations of Partner Sexual Violence, Non-Partner Sexual Violence and Sexual Harassment: A Population Study in Spain

Background: This study analyzes the frequency and sociodemographic characteristics associated with sexual violence by a partner/ex-partner (PSV), someone other than a partner or ex-partner (NPSV), or sexual harassment (SH). Methods: The study is based on the 2019 Macro-survey of Violence against Women conducted by the Spanish Ministry of Equality among a sample of 9568 women age 16 or more years. Odds Ratios were calculated and multinomial logistic regression analyses were performed. Results: Forty-four women had suffered some kind of sexual violence over their lifetime, 9.2% had experienced PSV, 6.5% NPSV and 40.4% SH. More than 7% of women had been raped by a partner and 2.2% by another man. In the three groups, violence was associated with lower age and having a certified disability. NPSV and SH were significantly associated with a higher education and internet use. In NPSV, 9.2% of cases were reported to the police and 3.9% were reported to the courts. In SH, 91.7% of women told a family member or a close friend and 4.2% reported it to the police or the courts. Conclusions: A greater emphasis needs to be placed on reporting sexual violence in its various forms. Rape within intimate partnerships ought to be investigated and studied in greater depth.

Gender-based Structural Stigma and Intimate Partner Violence Across 28 Countries: A Population-based Study of Women Across Sexual Orientation, Immigration Status, and Socioeconomic Status

Reducing structural drivers of intimate partner violence (IPV), including gender inequity in education, employment, and health, surrounding women worldwide represents a clear public health priority. Within countries, some women are at disproportionate risk of IPV compared to other women, including sexual minority women, immigrant women, and women in poverty. However, limited research has assessed women's IPV risk and related circumstances, including police involvement following IPV experiences and IPV-related worry, across sexual orientation, immigration status, and socioeconomic status in a population-based survey of women across countries. Further, few studies have examined IPV against minority women as a function of gender-based structural stigma. This study aimed to determine whether gender-based structural stigma is associated with IPV and related circumstances among European women; examine minority-majority IPV disparities; and assess whether structural stigma is associated with IPV disparities. We used the population-based 2012 Violence Against Women Survey (n = 42,000) administered across 28 European Union countries: 724 (1.7%) identified as sexual minority, 841 (2.0%) as immigrant, and 2,272 (5.4%) as living in poverty. Women in high gender-based structural stigma countries had a greater risk of past-12-month IPV (AOR: 1.18, 95% CI = 1.04, 1.34) and IPV-related worry (AOR: 1.09, 95% CI = 1.04, 1.15) than women in low structural stigma countries. All minority women were at disproportionate risk of IPV and IPV-related worry compared to majority women. Associations between gender-based structural stigma and IPV and related circumstances differed across minority status. Country-level structural stigma can possibly perpetuate women's risk of IPV and related circumstances. Associations between structural stigma and IPV and related circumstances for sexual minority women, immigrant women, and women in poverty call for research into the IPV experiences of minority populations across structural contexts.

Empowerment and IPV in Married Women of Reproductive Age: Evidence from Pakistan Demographic Health Survey 2017-2018

The study was an attempt to identify demographic, household, and women empowerment factors that predicted emotional, physical, and sexual violence in ever-married women of reproductive age (15-49 years, n = 3,965) in Pakistan by performing secondary analysis on Pakistan Demographic and Health Survey, 2017-2018. The analysis was done using SPSS (v.22) and binary and multivariate logistic regression techniques were performed for analyses. The analysis found that 30.2% of women experienced emotional, 24.1% reported less severe physical, 6.5% experienced severe physical, and 4.3% experienced sexual violence, respectively. The multivariate analysis found that husband's age, education, wealth, and alcohol consumption were significant predictors of intimate partner violence (IPV). Additionally, womens' age, education, and number of children also significantly predicted IPV. With respect to empowerment variables, ownership of house was a significant predictor of less severe physical violence, ownership of property significantly predicted emotional violence, and autonomy in household purchase decisions was significantly related to severe physical violence. The control on husband's income as a measure of empowerment significantly predicted all four types of IPV. Belief in patriarchy also turned out to be an important factor in determining emotional and less severe physical violence. The study concludes that women empowerment in household context can prevent less serious forms of violence but to hinder serious forms of violence, interventions at family and community level will be required.

A 10-year retrospective analysis of intimate partner violence patients in the emergency department

BACKGROUND

Intimate partner violence (IPV) is an important human rights problem faced by one in three women worldwide. The aim of this study is to evaluate the demographic, trauma, and radiological characteristics of patients admitted to a tertiary emer-gency department due to IPV.

METHODS

Sociodemographic characteristics (age, gender, education level, and marital status), trauma characteristics (severity, type, and location), radiological imaging findings (radiography, computed tomography, and magnetic resonance imaging) of patients diagnosed with IPV were evaluated.

RESULTS

In the study, 1225 patients were evaluated, and 98.7% of them were women (mean age 35 [IQR: 17] years). Of the pa-tients, 63.1% were high school and university graduates. The rate of married women was 74.6%. No relationship was found between gender, age, educational status, and marital status (p>0.05). Most of the traumas were minor (85.4%) and blunt (81.9%) trauma, and the most common types of trauma were kicking (49.9%) and punching (47.3%). It was found that the most frequently affected areas of the patients were the head and neck (76.7%), and the frequency of pelvic trauma was high in male patients (p<0.05). The most com-mon bone fracture was nasal (40.5%) followed by ulna fractures (14.5%). The left-sided diaphyseal fractures were the most common in patients exposed to IPV. In our study, the frequency of mortality was 12.9%, and it was found to be significantly higher in males (p<0.05).

CONCLUSION

Female patients are more frequently exposed to IPV. Specific injury characteristics can be detected in patients diagnosed with IPV and old fractures detected in these patients should alert the clinician about IPV.

Cross-sectional study on knowledge, attitude and prevalence of domestic violence among women in Kaduna, north-western Nigeria

BACKGROUND

Domestic violence is a global issue of public health concern with detrimental effects on women's physical, mental and social well-being. There is a paucity of community-based studies assessing the knowledge and attitude of women towards domestic violence in Nigeria.

OBJECTIVE

To assess knowledge, attitudes, prevalence and associated factors of domestic violence among women in a community in Kaduna, Nigeria.

DESIGN

A descriptive cross-sectional study.

SETTING

A selected community in Kaduna South Local Government Area in Kaduna State.

PARTICIPANTS

In total, 170 women aged 15-49 years participated in the study.

PRIMARY AND SECONDARY OUTCOME MEASURES

The outcomes were knowledge, attitude and prevalence of domestic violence.

RESULTS

The mean age of the respondents was 28.7+7.9 years. A total of 113 (66.5%) respondents had high level of knowledge about domestic violence with 114 (67.1%) having non-tolerant attitudes towards domestic violence. The lifetime prevalence and 12-month prevalence of domestic violence were 47.1% and 35.3%, respectively. The results of logistic regression identified the educational status of women as a significant predictor of knowledge of domestic violence (adjusted OR (aOR)=0.32; 95% CI 0.15 to 0.68), while marital status (aOR=0.21; 95% CI 0.05 to 0.96), occupation of women (aOR=2.49; 95% CI 1.13 to 5.49), their tolerance of wife beating (aOR=0.33; 95% CI 0.15 to 0.72) and their partners' consumption habit of alcohol/substance use (aOR=7.91; 95% CI 3.09 to 20.27) were identified as significant predictors of the women's experience of domestic violence.

CONCLUSION

Domestic violence was relatively high among women. Though a majority had high level of knowledge about domestic violence, a significant third had tolerant attitudes towards it. Appropriate health interventions need to be implemented by governmental and relevant stakeholders to target negative attitudes and address associated factors of domestic violence against women.

Assessing Demographics-Based Differences in Attitude Toward Honor Killings

The current study has been conducted to explore demographics-based differences in assessing attitudes toward honor killing. The scale used to measure attitudes is a newly developed indigenous measure. The scale consists of two subscales as follows: (a) affirmation of honor killing and (b) deterrence of honor killing. The sample comprised 695 individuals (248 males and 447 females) with ages ranging from 18 to 55 years (M = 25.89, SD = 8.10). The sample was collected from the federal capital city of Pakistan and various cities of Punjab (Pakistan). The results of the study found nonsignificant gender differences in the attitudes toward honor killings. Furthermore, people living in rural setups showed more affirmation than people living in urban setups. Likewise, older adults showed more affirmation to honor killing than adults of younger age groups. Finally, participants belonging to a joint/extended family system were more affirmative and had acceptance toward honor killing than those who belonged to nuclear families. Hence, the findings of the current study suggest that demographic variables play a role in determining and shaping the attitudes and beliefs of individuals regarding the phenomenon of honor killing.

Women's Status and its Association With Home Delivery: A Cross-Sectional Study Conducted in Khyber-Pakhtunkhwa, Pakistan

INTRODUCTION

Home delivery is a predominant driver of maternal and neonatal deaths in developing countries. Despite the efforts of international organizations in Pakistan, home childbirth is common in the remote and rural areas of Khyber Pakhtunkhwa province. We studied women's position within the household (socio-economic dependence, maternal health decision making, and social mobility) and its association with the preference for home delivery.

METHODS

We conducted a cross-sectional household survey among 503 ever-married women of reproductive age (15-49 years), who have had childbirth in the last twelve months or were pregnant (more than 6 months) at the time of the interview. A two-stage cluster sampling technique has been used for recruitment. Descriptive and bivariate analyses have been conducted. A binary logistic regression model was calculated to present odds ratios and corresponding 95% confidence intervals for factor associated with home delivery.

RESULTS

An inferior status of women, restrictions in mobility and limited power in decision making related to household purchases, maternal health care, and outdoor socializing are contributing factors of home delivery. Furthermore, women having faced intimate partner violence were much more likely to deliver at home (OR = 2.66, 95% CI: 1.83.3.86, p < 0.001).

DISCUSSION

We concluded that women are in a position with minimal authority in decision making to access and deliver the baby in any health facility. We recommend that the government should ensure the availability of health facilities in nearby locations to increase institutional deliveries in the study area.

Intimate partner violence among ever-married Afghan women: patterns, associations and attitudinal acceptance

Intimate partner violence (IPV) is one of the most prevalent forms of violence that women suffer globally. Women in Afghanistan have been exposed to high levels of IPV which coincided with high levels of conflict during more than four decades. We cross-sectionally examined the Afghanistan Demographic and Health Survey responses of 21,234 ever-married Afghan women. We first performed the frequency distribution analysis to determine the prevalence of IPV and the basic socio-demographic characteristics of the participants. Subsequently we examined the relationship between the independent and dependent variables followed by the bivariate and survey versions of logistic regression analyses. We report odds ratios in order to depict the strength and direction of the associations between the IPV and selected independent variables. P-values less than 0.05 were considered statistically significant. The analyses showed that 55.54% of Afghan women experienced some form of physical, emotional, or sexual violence by their intimate partners during the recall period partners. The most common form of IPV found was physical violence (50.52%). Factors such as being exposed to inter-parental violence (respondent woman's father physically abused her mother) (adjusted OR= 3.69, CI= 3.31-4.10) and respondent's acceptance of IPV (aOR= 1.85, 1.51-2.26) were associated with increased exposure to IPV. Having a spouse with at least a primary education (aOR= 0.76, CI= 0.64-0.91) or a respondent with at least a primary education (aOR= 0.82, CI= 0.68-0.98) was associated with lower exposure to reported IPV. The lifetime experience of IPV occurs to a high extent among Afghan women, and several socio-demographic factors have predisposing attributes. IPV policy formulation and strategizing may benefit from considering these factors.

Intimate partner violence among reproductive-age women with chronic mental illness attending a psychiatry outpatient department: cross-sectional facility-based study, Addis Ababa, Ethiopia

OBJECTIVE

To determine the prevalence of intimate partner violence (IPV), and associated factors, in reproductive-aged women attending psychiatric outpatient departments.

DESIGN

Cross-sectional facility-based study.

SETTING

Outpatient psychiatric clinics of public hospitals in Addis Ababa.

PARTICIPANTS

Reproductive aged women with chronic mental illness (CMI) who attended follow-up in psychiatric outpatient clinics.

PRIMARY AND SECONDARY OUTCOME MEASURES

The data were collected using a multi-culturally validated instrument from randomly sampled women with CMI. Multiple logistic regression was used to identify factors independently associated with IPV.

RESULT

Four hundred and twenty-two women who were attending the psychiatric outpatient clinics took part in the study. The majority of participants 62.0% (95% CI 56.1 to 68.8) experienced IPV at least once in their lifetime. The most common form of IPV experienced by women was emotional violence (60%; 95% CI 55.0 to 64.7). One hundred and eighty-six (44.1%; (95% CI 39.3 to 48.8)) respondents experienced physical or sexual violence during the last year. A history of divorce (Adjusted Odds Ratio [AOR]=5.64; 95% CI 2.75 to 11.56) and having a mental illness for more than 5 years (AOR=2.23; 95% CI 1.26 to 3.93) were associated with any form of IPV.

CONCLUSION

The high prevalence of IPV among women attending psychiatric outpatient services highlights the need to routinely inquire about IPV and develop effective strategies to prevent it among this vulnerable group.

Applying Socioecological Framework to Acid Attack Violence: An Exploration of Inhabitant Factors

This study focused on the phenomenon of acid attack violence by using the socioecological framework. It explored the personal, relational, institutional, and cultural factors that contribute toward the act of acid violence. By using the qualitative research design, 15 in-depth interviews were conducted from acid victims. Thematic analysis was used to analyze the data. The main themes under the framework of social ecology focused on certain inhabitant aspects such as prevailing poverty, forced marriages, conflicting relationships, lack of social support, the falsified religious interpretation of violence, lack of medical assistance, and poor response of law enforcement agencies. This lack of social support is extended at an institutional level as well as where rehabilitative help and response were absent. This study concluded the complexity and interdependence of all levels factors contribute to the act of acid violence. Moreover, it emphasized the need to develop a biopsychosocial approach to address the issue.

The Role of Social Norm in Acceptability Attitude of Women Toward Intimate Partner Violence in Punjab, Pakistan

Intimate partner violence (IPV) is a public health and human rights issue with the social and economic impacts felt by women. Punjab is a male-dominated society, where partner violence is generally accepted as a cultural norm and viewed as normal behavior within a marriage. It stems from attitudes that partner violence is a private matter and usually a justifiable response to misbehavior on the part of the wife. The focus of the current study is to investigate the impact of this cultural norm in acceptability attitude of women toward IPV in Punjab province. A large-scale sample size of more than 46,000 from Multi-Indicator Cluster Survey (MICS) 2018 has been used. The impact of the cultural norm on the wife-beating attitude has been investigated in five dimensions: wife going out without telling him, neglecting the children, arguing with him, refusing to have sex with him, and burning the food. The logistic regression results indicate that wife-beating is accepted as a community norm. It has been found that if wife-beating is accepted by community, then the individual female is more than 3 times more likely to consider it justifiable in all five dimensions. The other important factors are education level, household wealth, ethnicity, media exposure, and wife-husband age difference. The level of education of women plays the most important role in rejecting the wife-beating norm, as an increase in level of education is associated with an increase in the probability of rejecting the wife-beating. So, the current study suggests that there is a dire need to increase the female education level to overcome this issue.

Prevalence and Predictors of Violence Against Women in Pakistan

Violence against Pakistani women occurs at an alarming prevalence that reflects a significant risk to the health of women and families. Understanding violence against women in Pakistan comes with methodological and cultural complexities. Many of the studies examining prevalence and predictors of violence against women tend to utilize convenience samples contributing to the possibility of an inflated prevalence. Due to the patriarchal family structure and cultural context, domestic violence is normalized resulting in extremely low reporting rates. The present study utilizes a sample of ever-married Pakistani women collected across five provinces to shed light on the prevalence and predictors of women that experience domestic violence (emotional or physical abuse). Data were obtained from the 2012-2013 Pakistan Demographic and Health Survey including a large sample of Pakistani women from five provinces (Sindh, Punjab, Balochistan, Khyber Pakhtunkhwa, and Gilgit Baltistan). Binary Linear regressions were conducted to examine how intrinsic variables (age, education, region, urban/rural, type of marital relationship, and wealth) predicted experiencing emotional or physical abuse from one's husband within the past year. Approximately, 20% of women endorsed experiencing physical violence and 28% endorsed experiencing emotional violence. Results found that educational level, wealth, and type of marital relationship were associated with a higher likelihood of experiencing some form of physical or emotional violence. Implications from this study support policy interventions aimed at education within the family, linking women with resources, and continued investment in the education of young women. Interventions would be best targeted in low wealth regions with a special emphasis on rural areas.

Prevalence of Emotional and Physical Intimate Partner Violence Among Married Women in Pakistan

Intimate partner violence (IPV) affects millions of women across the world, and Pakistan is no exception. However, there is wide variance in reported frequencies worldwide and even within the same population. No standardized representative national and subnational estimates were available for IPV in Pakistan. We analyzed 3,666 ever-married women (15-49 years), from the most recent Pakistan Demographic and Health Survey (PDHS; 2012-2013), to determine the prevalence of emotional and physical violence among women in Pakistan and its major subpopulations. The Conflicts Tactics Scale (CTS) was used to ascertain violence. Furthermore, we examined the socioeconomic and demographic characteristics, which have the potential to increase the risk of emotional and physical violence. Weighted multivariate logistic regression was carried out to determine the association of IPV with the potential risk factors using Stata version 13.0. The prevalence of emotional and physical violence was, respectively, 36.4% (95% confidence interval [CI]: [33.8, 39.1]) and 18.4% (95% CI: [16.4, 20.6]) in Pakistan. The frequency of emotional and physical violence was highest in Khyber Pakhtunkhwa (KPK; 54.9% and 36.4%) followed by Balochistan (50.0% and 25.5%), Punjab (35.9% and 15.8%), and Sindh (24.7% and 13.3%) provinces. The prevalence of any form of violence (emotional or physical or both) was higher in rural than in urban areas (45.2% vs. 30.6%). Higher age of the husband and lower socioeconomic status were associated with emotional violence in KPK. Furthermore, alcohol intake by husbands and lower educational status of women or their husbands were associated with greater risk of emotional and physical violence across the provinces. IPV is high in Pakistan and large variations exist in the prevalence of violence across the provinces. The predictors of emotional and physical violence included occupation and education of the husband, alcohol intake, woman's occupation, and wealth index. Further studies are needed to explore the underlying factors of violence and reasons for variation across different regions in the country for contextual interventions.

Prevalence and Sociodemographic Predictors of Intimate Partner Violence Against Women in El Salvador

Violence against women is currently one of the major problems in El Salvador. However, the country lacks existing data to address this issue. The recent coming into effect of the Ley Especial Integral para una Vida Libre de Violencia para las Mujeres (LEIV) [Comprehensive Law for a Life Free of Violence Against Women] urgently calls for the dimensions of the problem to be understood. The aim of this study is to determine the prevalence of physical, sexual, emotional, and controlling violence, which Salvadoran women aged 15 to 64 years suffer at the hands of their current partners or ex-partners, and the association of such violence with sociodemographic factors. The target population of the study is composed of Salvadoran women aged 15 to 64, from which a representative sample of 1,274 women was obtained. The results reveal that 54.4% of Salvadoran women reported having suffered some type of physical, sexual, or psychological violence during their lives. Psychological control (41.2%) was the most frequent form of violence, followed by emotional violence (39%), physical violence (22.5%), and sexual violence (13.3%). Women's number of children, marital status, and age were the main factors associated with violence. This study provides information needed to develop victim care measures and training programs for professionals. The study also provides evidence of the impact of public policies and prevention programs already in place.

Is Attitudinal Acceptance of Violence a Risk Factor? An Analysis of Domestic Violence Against Women in Pakistan

Violence against women (VAW) is a grave problem in Pakistan, and women from all socioeconomic groups are vulnerable to domestic violence in varying degrees. It is argued that patriarchal definition of gender roles may reinforce the internalized inferiority of women. So, it may not be a mere coincidence that a large number of women in Pakistan justify VAW for various reasons. The objectives of this article are threefold: (a) to identify the drivers of VAW, (b) to see if women's attitudinal acceptance of violence is causally linked with observed violence against women, and (c) to see if attitudinal acceptance of violence mediates between the socioeconomic status of women and observed violence. We used data from the Pakistan Demographic and Health Survey (PDHS) 2012-13. The sample consisted of 3,265 ever married women aged between 15 and 49 years who were interviewed for domestic violence. We used multivariate logit regression analysis to identify the drivers of VAW and used the Karlson-Holm-Breen (KHB) method for mediation analysis. We found that women's attitudinal acceptance of violence, their childhood experience of violence in their parental household, the education of both husband and wife, and some occupation types significantly predicted their experience of spousal violence. In addition, we found that women's attitudinal acceptance of violence mediated the relationships between socioeconomic factors (education and wealth status) and VAW. The significance of the study lies in the fact that it highlights the need to modify the perceptions of violence through change in educational policy. Among multiple other factors, an increase in the economic status of women is an effective hedge against the risk of spousal violence.

Gynaecological morbidities among married women and husband's behaviour: Evidence from a community-based study

AIM

To determine the association between gynaecological morbidities and IPV among married women specifically, with attention to the attitudes of the husband and the degree of satisfaction in a marital relationship.

DESIGN

Cross-sectional study design.

METHODS

Data were collected using face-to-face interviews with married women aged 15-49 years, living in selected communities. Information was collected on demographic characteristics, gynaecological morbidities and IPV using a self-developed tool. Descriptive and inferential statistics were used to analyse the data.

RESULTS

Logistic Regression showed a significant association between physical violence and burning micturition, increased urinary frequency, constant dribbling of urine, genital ulcers, lower abdominal pain, vaginal discharge and painful coitus (OR: 1.41-1.84). A significant association between sexual and psychological abuse was also found with burning micturition (OR: 1.41) and dribbling of urine (OR: 0.12). Since gynaecological morbidities can have a serious effect on the psychological, physical well-being, and the social status of women in Pakistan; effective interventions are imperative in dealing with their symptoms and decreasing their emergence.

Knowledge, Attitude, and Practices of Dental Practitioners Regarding Domestic Violence in Pakistan

Domestic violence is a complex social issue worldwide that includes a wide range of physical, sexual, psychological, economic, or emotional trauma to a child or adult. A large proportion of domestic violence cases remain unreported or undocumented. Dentists can play an important role in identifying and reporting these cases, but no such local study is available assessing the dental practitioners' attitudes and knowledge of evaluating physical abuse in Pakistan. The objective of this study was to assess the knowledge and practices of dental practitioners of Pakistan about domestic violence. This cross-sectional study was carried out over 2 months, among 330 dentists across Pakistan, selected by convenience sampling technique. Data was collected via a pre-validated online questionnaire, filled anonymously after taking informed consent. The survey questionnaire collected data about dentists' demographics, awareness, and experiences about domestic violence cases via close-ended questions. Only 10.6% of participating dentists received formal training in the management of domestic violence cases. Approximately 55% of participants knew that physical abuse should be reported in all circumstances; however, half of them could not accurately identify the legal authorities where suspected cases should be reported. Only 20% of the participating dentists had ever suspected a case of physical abuse and 30% of those actually reported it to legal authorities. Participants characterized fear of anger from relatives as the most significant barrier toward reporting suspected cases. The analysis revealed that Pakistan's dentists lack adequate knowledge regarding domestic violence in terms of identification, relevant physical signs/symptoms, and social indicators. Dentists of Pakistan had insufficient knowledge about the identification, management, and reporting of domestic violence cases. However, formal training and dentists' qualification were positively associated with overall awareness and practices regarding domestic violence case management.

More than individual factors; is there any contextual effect of unemployment, poverty and literacy on the domestic spousal violence against women? A multilevel analysis on Indian context

PURPOSE

Despite successful enactment of Domestic Violence act, 2005 in India to protect Indian women from any kind of domestic violation offence, the decline trend of prevalence of spousal violence against women still remains low. The study aims to explain the factors associated with spousal violence against women through a multilevel modeling framework.

METHOD

We used multilevel logistic regression model, basically here we carried out two-level random intercept model where the data base is used from National Family Health survey 2015-16 data for the fulfillment of our study objectives. A total 34,921 women, who were selected for 2015-16 domestic violence modules by NFHS, were included in this present study.

RESULTS

Result of multilevel logistic regression model showed that women who were belonged to poorest economic background, lived in rural areas, had low level of education or no education were at more risk in experiencing violence from their husband. Factors as large family size with more children in a household have a significant positive association with the prevalence of spousal violence against women. In case of higher level contextual variables unemployment, poverty has a crucial effect for upbringing spousal violence where higher literacy rate of a region has a strength that can reduce the probability of violence against women.

CONCLUSIONS

The Govt. promptness as a collective responsibility to enhance educational facilities for men and women, create employment opportunities and take policies for overall economic and societal development, these may change the individual perception of a person to cause the spousal violence against women.

Community stakeholders' perspectives regarding acceptability of a life skills building intervention to empower women in Pakistan

Violence against women (VAW) is a major determinant in the assessment of a women's mental health. Many interventions have addressed strategies to reduce VAW, however, little information is available regarding effectiveness in the local context, particularly the role of men in women's empowerment. In Pakistan, a qualitative approach was undertaken in all four of its provinces to describe the community residents', both men and women, perceptions regarding the acceptability of a proposed life skills building (LSB) intervention involving men's engagement with regards to women's empowerment and VAW. Eighteen focus group discussions were conducted with men and women from locales within each province of Pakistan, averaging 6-10 participants per group. Fourteen key informant interviews were conducted with community stakeholders. The analysis identified three major themes: family life and male engagement, LSB training as an empowerment tool, and operationalization of the proposed LSB intervention. The proposed LSB intervention was well accepted by the participants with a strong urge to engage men in receiving the LSB training sessions. Men's engagement has been identified as an important element to facilitate women's empowerment. Participants suggested that these sessions should be held for two and a half hours per week within the community public spaces. In addition, these sessions should be based on an interactive approach. The focus of these sessions should include ideas surrounding positive relationships and economic skills building. Moreover, men's engagement will help to reduce VAW and improve the mental health of women in a patriarchal country like Pakistan.

Community stakeholders' views on reducing violence against women in Pakistan

BACKGROUND

Nearly half of the women experience violence across their lifespan in all the provinces of Pakistan at an alarming rate. Despite knowing the prevalence, there has been meager progress in developing strategies to combat violence at individual, family, or community level. Many interventions suggested in other countries have been pilot tested but the effects of those interventions had been limited. Therefore, the aim of this study is to understand the voices of stakeholders to reduce Violence Against Women (VAW) and to explore the possible community-based strategies that could be implemented in Pakistan.

METHODS

A total of 14 Key Informant Interviews (KIIs) and 18 Focus Group Discussions (FGDs) were held across all four provinces of Pakistan. Participants were purposefully recruited and all the interviews were audio-recorded. Transcriptions were open coded and content analysis was done to emerge codes, categories and themes. Ethical approval was obtained from Aga Khan University Ethics Review Committee.

RESULTS

Three major themes emerged on community members and stakeholders' views on VAW: a) community's perception of VAW b) the repercussions of VAW, and c) multiple voices regarding strategies to reduce VAW. Participants voiced the need of standing against the status quo, role of awareness and education: regarding capacity building skills, promotion of women rights and women empowerment through Life Skills Based Education (LSBE) through national health works program, has been proposed as an innovative strategy to reduce VAW.

CONCLUSIONS

The responsibility to bring about a substantial change in behavior and attitudes must begin with engaging men in all the interventions that aim to reduce violence. Since, VAW is very much linked with the cultural norms, so, without community stakeholder's involvement and participation it could never be reduced. Keeping the existing socio-cultural dynamics in mind, the need of time is to design and implement innovative interventions that are culturally and contextually appropriate and can be expanded across the country.

Prevalence and risk factors of domestic violence and its impacts on women's mental health in Gilgit-Baltistan, Pakistan

Objective:

To assess the prevalence of domestic violence, associated risk factors, and its impacts on women’s mental health in Gilgit-Baltistan (GB), Pakistan.

Methods:

This is a sequential explanatory strategy that is a mixed-method research design was conducted at Department of Behavioral Sciences, Karakoram International University Gilgit from January 2017 to June 2018 on 160 married women. Quantitative data were collected using Karachi domestic violence screening scale and mental health inventory and qualitative data were collected through interview guides. Descriptive and inferential statistical techniques were applied to analyze quantitative data while qualitative data were analyzed using thematic analysis.

Results:

Married women in GB reported higher levels of domestic violence (88.8%; psychological (69.4%), physical (37.5%) & sexual (21.2%). Abused women reported lower levels of mental health (t=3.19, p=0.00); psychological wellbeing (t=2.03, p=0.04), general positive affect (t=2.09, p=0.03), and life satisfaction (t=2.39, p=0.01) and higher levels of psychological distress (t=3.27, p=0.00), anxiety (t=3.06, p=0.00), depression (t=2.60, p=0.01), and loss of emotional/behavioral control (t=3.05, p=0.00) as compared to non-abused women. Risk factors behind domestic violence were identified as; poverty, the influence of in-laws, second marriage, stepchildren, forceful intimate relationships, husband’s irresponsibility, and addiction, and handicapped children.

Conclusions:

We found higher level of domestic violence, associated risk factors, and poor mental health of abused women in GB.

Empowerment and Intimate Partner Violence in Pakistan: Results From a Nationally Representative Survey

Using empowerment theory, the current study examines antecedents of lifetime experience of intimate partner violence, intimate partner violence experienced in the last 12 months, emotional violence, and husbands' controlling behaviors toward their wives in Pakistan. Using data from a subsample of 658 women from the nationally representative Pakistan Demographic and Health Survey 2012-2013, this study examined whether empowerment variables, such as household decision-making power, economic decision-making power, and adherence to patriarchy, operationalized as justification of wife beating, contribute to intimate partner violence using logistic regression analyses. Results indicate that adherence to patriarchal norms, household decision-making power, and higher education was found to be associated with lifetime prevalence of intimate partner violence. Adherence to patriarchal norms, economic decision-making power, and higher education was found significantly associated with intimate partner violence in the past 12 months. Adherence to patriarchal norms was significantly associated with experiencing emotional violence as well as controlling behaviors by husbands. In conclusion, women's adherence to patriarchal norms is a reflection of the patriarchal society in which they live; indeed, this was found to be the most important predictor of women's experience of intimate partner violence, when different types of violence were assessed. Implications for social work practice are discussed.

Predictors of Intimate Partner Homicide in a Sample of Portuguese Male Domestic Offenders

Intimate partner homicide (IPH) is a major social problem, and it is important to determine the predictors of this violent behavior. The purpose of this study was to examine the differences between intimate partner violence (IPV) and IPH and to identify the variables that predict IPH. The sample was composed of 35 perpetrators of IPH, who were compared with 137 perpetrators of IPV. The data were collected using the Spousal Abuse Risk Assessment. The data suggest that IPH presents different dynamics from IPV. Being older, exhibiting suicidal and/or homicidal ideation/intent, and the use of weapons and/or credible threats of death substantially increase a man's risk of committing IPH. Inversely, not being single, violating conditional release, and being victimized in childhood decrease the likelihood of committing IPH. These findings reinforce the assumption that IPV and IPH have both commonalities and differences and challenge the view that IPV and IPH are different phenomena and that intimate partner murder is an inexplicable event. Implications for preventing IPV and IPH are discussed.

Cohort Profile: Perinatal depression and child socioemotional development ; the Bachpan cohort study from rural Pakistan

PURPOSE

This is a prospective pregnancy-birth cohort designed to investigate the effects of depression on socioemotional development of children. Perinatal depression is a risk factor for poor child development and for many it has a recurring chronic course. Thus, the exposure to depression can continue through the early years of the child with detrimental developmental outcomes.

PARTICIPANTS

Between October 2014 and February 2016, we recruited 1154 pregnant women from a rural subdistrict of Pakistan. Data include longitudinal and repeated measures of maternal psychosocial measures and child growth, cognitive and socioemotional measures. Follow-up include mother-child dyad assessments at 3rd, 6th, 12th, 24th and 36th months of child age. All these follow-ups are community based at the household level. We have competed baseline assessment.

FINDINGS TO DATE

Of the eligible dyads, we followed 885 (76.6%), 929 (91%) and 940 (93.3%) at 3, 6 and 12 months post-childbirth. We include a subsample mother-child dyad DNA and inflammatory biomarkers, 73 and 104, respectively.

FUTURE PLANS

While we continue to do 24-month and 36-month follow-up assessments, we plan to follow these mother-child dyads up to the age of 7-8 years with some children being exposed to at least 1 year of school environment. Investigators interested in learning more about the study can contact (jmaselko@unc.edu) and (siham.sikander@hdrfoundation.org).

What Difference Does Peace Make? Intimate Partner Violence and Violent Conflict in Northern Ireland

This article investigates how the transition from violent conflict to peaceful political settlement has shaped intimate partner violence (IPV) in Northern Ireland focusing on three issues, which are policing, paramilitarism, and firearms. It does so on the basis of comparative analysis of interview findings with more than 100 women victims of IPV from across Northern Ireland conducted at two junctures: first in 1992 during a period of violent conflict, and later in 2016 at a time of enduring peace. The findings trace the changes that have occurred across these areas and highlight any problems that remain in the post-conflict environment.

Prevalence of intimate partner violence and reproductive health outcomes among Afghan refugee women in Iran

Refugee women are at high risk of experiencing high level of Intimate Partner Violence (IPV) and its negative impacts. We conducted a cross-sectional population-based household survey with refugees in a settlement in the city of Semnan, Iran, from 2016 to 2017. Afghan refugee women (n = 188) with ages between 15 and 49 years were recruited for the survey. Overall, about 79.8% of the participants reported to have experienced a form of IPV in the past 12 months. IPV exposure is associated with a negative reproductive health outcome. The high prevalence of IPV found among refugee women in the present research and its strong links with poor reproductive health outcomes, underline the urgent need for the development and testing of appropriate interventions in refugee settlements.

Prevalência e fatores associados da violência sexual contra a mulher: revisão sistemática

La revisión se propuso identificar en la literatura la prevalencia y factores asociados con la violencia sexual (VS) contra las mujeres adolescentes y adultas. Se revisaron estudios poblacionales, publicados entre 2011 y 2016, en inglés, portugués y español, en las bases de datos PubMed/Medline, Lilacs y SciELO. Los estudios fueron descritos y analizados, detallando sus características e informaciones sobre prevalencia y factores asociados a la VS. Entre los 3 002 artículos encontrados, de acuerdo con los criterios de inclusión, 15 estudios fueron objetos de esta revisión. La mayoría de los estudios se concentran en Asia y África, que también presentan las mayores prevalencias de VS. El grupo de edad predominante fue de 15 a 49 años. Se observó una gran variación de la prevalencia de VS entre los países. Con respecto a la VS cometida por una persona íntima, ésta varió del 1 % en Alemania al 92 % en Zimbabue. En cuanto a los factores asociados, se destacan la baja escolaridad, la juventud, las condiciones de salud mental y la salud sexual y reproductiva, así como el uso de alcohol y otras drogas. La revisión muestra la necesidad de profundizar en estudios sobre la violencia sexual, para contribuir a las políticas públicas, a detener la violencia contra las mujeres y la equidad de género.

The Biopsychosocial Sphere of Women Victims of Violence: A Systematic Review

Objetivo: Identificar la contribución de la investigación desarrollada a una esfera biopsicosocial de mujeres víctimas de violencia y el significado atribuido a estas experiencias en sus vidas. Método: Revisión integradora realizada en los bases de datos MEDLINE / PubMed y LILACS, que cubre los años de 2009 a 2015. Resultados: Se seleccionaron y analizaron 18 estudios, con los criterios de selección siendo las razones dadas por las mujeres para permanecer con un compañero violento, las razones para no buscar ayuda para romper el ciclo de violencia o el significado atribuido a esta experiencia en sus vidas, incluyendo el significado religioso, ético y moral, así como el sufrimiento derivado de la experiencia. Discusión: Las intervenciones llevadas a cabo en las instituciones de salud permiten el desarrollo de estratificaciones para hacer frente a este problema. Una denuncia presentada por una esposa contra su atacante demuestra una ruptura temprana en el ciclo de violencia. Conclusión: Los resultados evidencian aspectos que pueden ayudar a mejorar la calidad de la salud de estas mujeres y muestran la importancia de la investigación para apoyar las prácticas en el cuidado de las mujeres víctimas de la violencia.

Domestic violence against women: representations of health professionals

OBJECTIVE

to analyze the representations about domestic violence against women, among health professionals of Family Health Units.

METHOD

qualitative study based on the Theory of Social Representations. Data were collected by means of evocations and interviews, treating them in the Ensemble de Programmes Pemettant L'Analyse des Evocations software - EVOC and content analysis.

RESULTS

nurses, physicians, nursing technicians and community health agents participated. The evocations were answered by 201 professionals and, of these, 64 were interviewed. The central core of this representation, comprised by the terms "aggression", "physical-aggression", "cowardice" and "lack of respect", which have negative connotations and were cited by interviewees. In the contrast zone, comprised by the terms "abuse", "abuse-power", "pain", "humiliation", "impunity", "suffering", "sadness" and "violence", two subgroups were identified. The first periphery contains the terms "fear", evoked most often, followed by "revolt", "low self-esteem" and "submission", and in the second periphery "acceptance" and "professional support".

CONCLUSION

this is a structured representation since it contains conceptual, imagetic and attitudinal elements. The subgroups were comprised by professionals working in the rural area and by those who had completed their professional training course in or after 2004. These presented a representation of violence different from the representation of the general group, although all demonstrated a negative connotation of this phenomenon.

[Characteristics of sexual violence against adolescent and adult women reported by the public health services in Santa Catarina State, Brazil]

Sexual violence against women is a form of gender violence and both a severe human rights violation and public health problem. This ecological, descriptive, and temporal series study aims to analyze sexual violence against pre-adolescent, adolescent, and adult females in Santa Catarina State, Brazil, based on data from the Information System for Notifiable Diseases, in order to describe the characteristics of cases of sexual violence perpetrated against women, reported by health professionals from 2008 a 2013. A total of 15,508 cases of violence were reported, including 2,010 cases of sexual violence (12.9%). Cases of violence totaled 950 reports in the 10 to 14 year bracket (47.3%), 450 in the 15 to 19 year bracket (22.4%), and 610 (30.3%) in women 20 years or older (adults). Adolescent females suffered violence by a single aggressor, at home, at night, with vaginal penetration, and with greater tendency to repeated assault and pregnancy as a result. For females 10 to 14 and 15 to 19 years of age, the aggressors were unknown in 32.9% and 33.1% of the reports, respectively. Adult women were sexually assaulted either at home or on public byways, at night or in the early morning hours, by a single aggressor, with vaginal penetration in more than half of the cases, with more physical injuries, and with more subsequent suicide attempts. The information should contribute to awareness-raising of policymakers, health professionals, researchers, and health field professors concerning the importance of reporting violence in order to help develop interventions to prevent such violence against women.

Risk factors associated with current intimate partner violence at individual and relationship levels: a cross-sectional study among married rural migrant women in Shanghai, China

OBJECTIVE

To identify individual and relationship risk factors associated with current intimate partner violence (IPV) against married rural migrant women in Shanghai, China.

DESIGN

Cross-sectional survey.

SETTING

Two subdistricts of one administrative district, Shanghai, China.

PARTICIPANTS

A total of 958 married rural migrant women of reproductive age were selected using a community-based two-stage cluster sampling method in April and May of 2010.

OUTCOME MEASURES

Data were collected using a modified questionnaire based on an instrument from the WHO Multi-country Study on Women's Health and Domestic Violence against Women. Adjusted odds ratio (AOR) and 95% CI from a multivariable logistic regression model were estimated to identify individual and relationship risk factors associated with different types of violence in the past 12 months.

RESULTS

Women's low financial autonomy was associated with all types of violence (AORs ranged from 1.98 to 7.89, p<0.05). Quarrelling with husband was a very strong risk factor (AORs >6, p<0.05) for both emotional violence and any violence. Experience of job change in the past year (AOR=4.03, 95% CI 1.57 to 10.35) and history of husband being abused (AOR=4.67, 95% CI 2.17 to 7.69) were strongly associated with physical or sexual violence.

CONCLUSION

Women's low financial autonomy and unstable employment status at an individual level, quarrelling with husband and history of husband beaten by family members at a relationship level were identified as the most robust risk factors for IPV among married rural migrant women. Efforts to prevent IPV among this population should be made to involve both women and their husbands, with a focus on improving financial autonomy and employment status of women, promoting problem-solving and interaction skills of the couples and changing their knowledge and attitudes towards gender norms and IPV.

Chinese Women's Experience of Intimate Partner Violence: Exploring Factors Affecting Various Types of IPV

Using a sample of 553 married and divorced women in a large city in southern China, this study tested the effects of demographic characteristics, risk behaviors, patriarchal ideology, and personal mentality and skills on women's experience of physical violence, psychological violence, controlling behavior, and sexual abuse. Divorced women were more likely than married women to experience all types of IPV. Risk behaviors were consistently related to IPV incidents, whereas the impact of patriarchal ideology and personal mentality and skills was equivocal. Limitations of the study and implications for future research and policy are discussed.

Injury patterns and health outcomes among pregnant women seeking emergency medical care in Kumasi, Ghana: Challenges and opportunities to improve care

INTRODUCTION

In high-income countries, injury is the most common cause of non-obstetric death among pregnant women. However, the injury risk during pregnancy has not been well characterized for many developing countries including Ghana. Our study described maternal and fetal outcomes after injury at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, and identified associations between the prevalence of poor outcomes and maternal risk factors.

METHODS

We conducted a cross-sectional study to identify pregnant women treated for injury over a 12-month period at KATH in Kumasi, Ghana. Descriptive statistics were used to characterize the population. We identified the association between poor outcomes and maternal risk factors using multivariable Poisson regression.

RESULTS

There were 134 women with documented pregnancy who sought emergency care for injury (1.1% of all injured women). The leading injury mechanisms were motor vehicle collision (23%), poisoning (21%), and fall (19%). Assault was implicated in 3% of the injuries. Eleven women (8%) died from their injuries. The prevalence of poor fetal outcomes: fetal death, distress or premature birth, was high (61.9%). One in four infants was delivered prematurely following maternal injury. After adjusting for maternal and injury characteristics, poor fetal outcomes were associated with pedestrian injury (adjusted prevalence ratio (aPR) 2.5, 95% CI 1.5-4.6), and injury to the thoraco-abdominal region (aPR 2.1, 95% CI 1.4-3.3).

CONCLUSIONS

Injury is an important cause of maternal morbidity and poor fetal outcomes. Poisoning, often in an attempt to terminate pregnancy, was a common occurrence among pregnant women treated for injury in Kumasi. Future work should address modifiable risk factors related to traffic safety, prevention of intimate partner violence, and prevention of unintended pregnancies.

Domestic violence and its associated factors among married women of a village development committee of rural Nepal

Background

Violence against women is a global public health problem occurring in multitude of contexts and domestic violence is considered to be the most pervasive one. Poor enforcement of policies, limitation of researches and expertise in this field largely accounts for persistence of this problem and nature of domestic violence and its associated factors are poorly understood.

Objectives

This research aimed to estimate the magnitude of different forms of domestic violence and identify its associated factors.

Methods

Community based cross sectional study was conducted among 355 married women of reproductive age group of Kusheshwor, Sindhuli, Nepal. The questionnaire adapted from the World Health Organization Multi-Country Study was used for the face to face interviews. Occurrence of current domestic violence was used as outcome variable in logistic regression. Descriptive and multivariate analysis were performed in order to assess the magnitude of domestic violence and to identify its associated factors respectively.

Results

Self-reported lifetime prevalence of physical violence was 29.6 % and past year prevalence was 15.2 %, while corresponding figures for sexual violence were 6.8 and 2.3 %, and for psychological violence were 31.0 and 18.3 %. Lifetime domestic violence was 38.6 % while in past 12 months, prevalence was 23.1 %. Furthermore, 12.4 % of women were experiencing all forms of violence concurrently. Women with controlling husband and having poor mental health were found to be at higher risk of domestic violence.

Conclusions

Domestic violence is still rampant in our society with several forms of violence occurring together. In a country like Nepal, differentials power in relationship and poor mental health was found to be positively associated with violent episodes. This study highlights the infringement of women rights which can be the cause for serious public health consequences.