Atendimento de urgência de mulheres grávidas em decorrência de violência sexual: características e tendências observadas em 20 anos / Emergency care for women due to sexual assault: characteristics and tendency observed for 20 years

Objetivo: O atendimento médico de urgência (AMU) é fundamental na prevenção e na redução de agravos da violência sexual (VS), como o uso de anticoncepção de emergência (AE). O objetivo deste estudo é analisar 20 anos de AMU após VS entre gestantes decorrente de estupro. Métodos: Estudo transversal com 2.816 mulheres entre 1999 e 2018. Considerou-se buscar ou não o AMU após a VS e dados sociodemográficos. Analisou-se por dispersão de dados e curva exponencial de tendência. Resultados: O AMU ocorreu em 188 casos (6,7%). Neste grupo, não se prescreveu AE em 31 (16,5%) mulheres. Não houve diferença significativa nos dados sociodemográficos. Os extremos de variação dos percentuais para quem buscou AMU foram de 16,1%, em 1999, e de 2%, em 2010, com queda da linha de tendência exponencial (R2 = 0,4667). Conclusão: Não houve associação com características sociodemográficas e a queda expressiva dos percentuais de gestações sugere, indiretamente, melhora da eficácia dos serviços de saúde em prover a AE.(AU)

Objective: Emergency medical care (EMC) is essential in the prevention and reduction of sexual assault (SA), including the use of emergency contraception (EC). The aim of this study is to analyze 20 years of EMC after SA in pregnant women due to rape. Methods: Cross-sectional study with 2,816 women between 1999 and 2018. It was considered to seek or not EMC after SA and sociodemographic data. Statistical analysis was performed by data dispersion and exponential trend curve. Results: EMC occurred in 188 cases (6.7%). In this group, EC was not prescribed in 31 (16.5%). There was no significant difference in sociodemographic data. The extremes of percentage variation for those seeking EMC were 16.1% in 1999, and 2% in 2010, with a drop in the exponential trend line (R2 = 0.4667). Conclusion: There was no association with sociodemographic characteristics and the significant drop in the percentage of pregnancies indirectly suggests an improvement in the effectiveness of health services in providing EC.(AU)

Dependence in adult relationships: Latent classes of relational dependence and associated outcomes in women exposed to intimate partner abuse.

OBJECTIVE: Studies applying a betrayal trauma theory (BTT) framework to adult abuse have measured dependence by asking about the closeness of the victim-offender relationship. However, women's experiences of dependence may vary even in close victim-offender relationships, such as in the case of abuse perpetrated by intimate partners. This investigation assessed whether subgroups of women who were abused by intimate partners could be identified based on dependence characteristics. Further, we evaluated whether high-dependence subgroups were more likely to experience outcomes associated with BTT. METHOD: Using latent class analysis (LCA), we examined classes of dependence in a non-treatment-seeking community sample of 236 women who reported intimate partner abuse (IPA) to police. The validity of the dependence classes was evaluated from a BTT perspective using the classes to predict empirically supported betrayal-trauma outcomes. RESULTS: Low-, medium-, and high-dependence subgroups emerged when dependence characteristics were analyzed using LCA. As hypothesized, greater dependence was linked with increased likelihood of women maintaining the relationship with the offender, higher self-report dissociation scores, and greater service disengagement. Counter to study hypotheses, dependence subgroups were unrelated to women's revictimization and self-reported memory for the target IPA incident 12 months later. CONCLUSION: Findings suggest that dependence can vary even in close adult relationships. Further, we identified links between dependence subgroups and outcomes predicted by BTT. Implications for BTT research and IPA victim support and intervention are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Violence against Women in a Slum Area in Helwan, Cairo, Egypt: A Community Based Survey.

BACKGROUND: Violence against women (VAW) is a major global public health problem with serious consequences. We aimed to estimate the prevalence of VAW aged 18-45 yr in a slum area in Helwan, Cairo, to assess their knowledge and perspective regarding VAW, and to assess their help-seeking practice in response to violence. STUDY DESIGN: Cross-sectional design. METHODS: This community based survey was carried out among 657 women in a slum area in Helwan, Cairo, Egypt in 2018. Data about the women's knowledge about VAW, exposure to different forms of violence and their frequency, women's perspective towards violence, and their healthcare-seeking behavior on exposure to violence were collected using an interviewing questionnaire. RESULTS: The prevalence of exposure to at least one type of intimate partner violence (IPV) was 59.1% with psychological violence ranking 1st followed by physical violence. Most women exposed to IPV reported that they have never asked for healthcare upon exposure to violence. One third had good knowledge. Most had favorable perspective against VAW. CONCLUSION: Most women suffered some kind of violence. They, however, did not seek help most of the time.

Validation of the scale for assessing the psychological vulnerability and its association with health of intimate partner violence victims in Chinese young adult population.

The Women's Experience with Battering (WEB) scale is a self-report instrument that uses a 10-item Likert-type scale to measure IPV victims' cognitive and affective experience of battering. This study aimed to validate the Chinese version of the WEB scale using gender-neutral questions, Experience of Battering Scale (Chinese) (EBS-C), to assess the psychological vulnerability of victims of intimate partner violence (IPV). The study adopted a range of methods, including translation and back translation, expert reviews, cognitive debriefing, and test-retest reliability assessment. The EBS-C was validated in a purposive convenience sample of 718 Chinese-speaking participants (male = 362; female = 356) aged 18-24 (mean age = 21.4) in Hong Kong. The results of CFA showed a good model fit: CFI = .97, TLI = .96, RMSEA = .05, SRMR = .03. The EBS-C was also found to be significantly associated with the Revised Conflict Tactics Scales (CTS2; r = .13-.17, p < .01), depression (BDI-II: r = .15, p < .01), anxiety (GAD-7: r = .17, p < .01), interpersonal support (ISEL-12: r = -.27, p < .01), relationship satisfaction (RAS: r = -.36, p < .01), and self-esteem (RSES: r = -.22, p < .01). The study demonstrated the EBS-C to be a reliable and valid measure for assessing the psychological vulnerability of IPV victims. It is thus useful for identifying the risks such individuals face by assessing their experience of fear, danger, and disempowerment in the intimate relationship relative to abusive incident-based measures alone. The EBS-C will also be useful for developing effective treatments to address the psychological vulnerability resulting from IPV and will facilitate cross-cultural comparative research aimed at enriching our knowledge of IPV victimization.

Differences in the acceptance of wife abuse among ethnic minority Garo and Santal and mainstream Bengali communities in rural Bangladesh.

Studies on wife abuse in Bangladesh predominantly include the mainstream Bengali population, although there are at least 27 ethnic minority communities including a few 'female-centered' matrilineal groups living in the country. This study explored ethnic differences in the attitudinal acceptance of wife abuse among matrilineal ethnic minority Garo, patrilineal ethnic minority Santal, and mainstream patriarchal Bengali communities in rural Bangladesh. Adopting a cross-sectional design, the study included 1,929 women and men randomly selected from 24 Garo, Santal, and Bengali villages. Multivariate Poisson regression was performed to predict the number of contextual events, where the respondents attitudinally endorsed wife abuse. Of the sample, 33.2% were from Garo, 33.2% from Santal, and 33.6% from the Bengali communities. The acceptance of wife abuse was high in the sample; specifically, 34.1% of the respondents accepted physical wife abuse, 67.5% accepted emotional abuse, and 71.6% accepted any abuse (either physical or emotional) at least on one contextual reason provided in a 10-item scale. The mean for accepting any abuse was 3.0 (SD = 2.8), emotional abuse 2.3 (SD = 2.2), and physical abuse 0.8 (SD = 1.4). The study showed that the rates of accepting any abuse and physical abuse were respectively 16% and 56% lower among Garo as well as 14% and 33% lower among Santal than that of the Bengali community. Data also revealed that individual level factors like younger age, higher education, prestigious occupation as well as family level factors such as higher income, female mobility, and female family authority were inversely associated with the acceptance of wife abuse in the sample. It appears that the gender regime of a society has a great influence on the attitudes toward wife abuse. We argue that a comprehensive socio-cultural transformation of the patriarchal societies into a gender equal order is imperative for the prevention of widespread wife abuse in the country.

SAFE: an eHealth intervention for women experiencing intimate partner violence - study protocol for a randomized controlled trial, process evaluation and open feasibility study.

BACKGROUND: Intimate partner violence (IPV) affects almost one in three women worldwide. However, disclosing violence or seeking help is difficult for affected women. eHealth may represent an effective alternative to the standard support offers, which often require face-to-face interaction, because of easy accessibility and possibility of anonymous usage. In the Netherlands we are developing SAFE, an eHealth intervention for female victims of IPV, which will be evaluated in a randomized controlled trial and a process evaluation, followed by an open feasibility study to assess real-world user data. METHODS/DESIGN: The randomized controlled trial is a two-arm parallel design comparing an intervention arm and a control group. The groups both have access to eHealth but differ in the offer of interactive features compared to static information. Both groups complete questionnaires at three or four time points (baseline, three months, six months, 12 months) with self-efficacy at 6 months as the primary outcome, measured with the General Self-Efficacy (GSE) scale. The process evaluation consists of quantitative data (from the website and from web evaluation questionnaires) and qualitative data (from interviews) on how the website was used and the users' experiences. DISCUSSION: eHealth has the potential to reach a large number of women who experience IPV. The internet-based design can lower access barriers and encourage help-seeking behavior ultimately reducing the lag time between subjective awareness and protective action. TRIAL REGISTRATION: Trial registered on 15 August 2017 at the Netherlands Trial Register NL7108 (NTR7313).

What can we learn from studying control arms of randomised VAW prevention intervention evaluations: reflections on expected measurement error, meaningful change and the utility of RCTs.

Background: Randomised controlled trials (RCTs) are a gold standard for evaluations in public health, economics and social sciences, including prevention of violence against women (VAW). They substantially reduce bias, but do not eliminate measurement error. Control arms often show change, but this is rarely systematically examined.Objective: We present a secondary analysis of data from the control arms of evaluations of VAW prevention programming to understand measurement variance over time, factors that may systematically impact this and make recommendations for stronger trial design and interpretation.Methods: We examine data from six RCTs and one quasi-experimental study, all of which used comparable measures. We look at change over time among control participants in prevalence of physical intimate partner violence (IPV), sexual IPV, and severe physical/sexual IPV, by participants' gender and study design (cohort vs. repeat cross-sectional).Results: On average, repeated assessments of past year IPV varied by 3.21 (95%Cis 1.59,4.83) percentage points for the studies with no active control arms. The prevalence at endline, as a proportion of that at baseline, on average differed by 17.7%. In 10/35 assessments from 4/7 studies, the difference was more than 30%. We did not find evidence of the Hawthorne effect or repeat interview bias as explanations. Our findings largely supported non-differential misclassification (measurement error) as the most likely error and it was a greater problem for men.Conclusions: Control arms are very valuable, but in VAW research their measures fluctuate. This must be considered in sample size calculations. We need more rigorous criteria for determining trial effect. Our findings suggest this may be an absolute change in prevalence of 7% and proportionate change of 0.4 or more (especially for studies in populations with lower IPV prevalence (<20%)). More elaborate pre-defined outcomes are necessary for determining impact (or possible harms) of VAW prevention interventions.

Cambodian Remarried Women Are at Risk for Domestic Violence.

Divorce rates continue to rise, especially in urban centers, which in turn contributes to increasing numbers of women who remarry. While remarriage is one of the only options for survival for divorced women, especially those from low socioeconomic status, remarriage also brings with it increased stressors of financial strain and the strain of blended families. This study tested the hypothesis that remarried women compared with first-time married and divorced women are at increased risk for domestic violence. The sample was drawn from the Cambodia Demographic and Health Survey, consisting of 1,560 women with the average age of 31.64. Results showed that 20% of women reported emotional violence and 14%, physical violence. Based on hierarchical multiple regressions, this study found that remarried women were more likely to experience physical and emotional abuse than women in their first marriage or women who remain divorced/not in union. Further interaction analyses showed that domestic violence varies depending on place of residence, number of children younger than 5 years, partners' education, and wealth index. Rural residents who were in poorest and poorer groups and urban residents in their poorer and middle groups of their wealth index showed high risk of domestic violence. Remarried women with two or three children younger than 5 years showed highest risk of domestic violence. Additional three-way interaction analysis revealed that remarried women residing in rural/urban areas with a spouse having no education and/or primary level of education were at highest risk of domestic violence. The study lends support to the structural role of the power of male dominance on women's social and emotional well-being. This study suggested that to reduce men's perceived domination, structural intervention that includes implementing gender-responsive curriculum in formal education, as well as strengthening domestic violence law enforcement would help reduce domestic violence against women.

Using a Developmental-Relational Approach to Understand the Impact of Interpersonal Violence in Women Who Struggle with Substance Use.

Substance use among women is a major public health concern. This review article takes a developmental-relational approach to examine processes through which early relational trauma and violence in relationships may lead to substance use. We examine how early exposure to violence in relationships can impact neurological development, specifically through interference with physiological mechanisms (e.g., the hypothalamic-pituitary-adrenal axis), brain structure and functioning (e.g., the hippocampus and prefrontal cortex), and neuropsychological development (e.g., executive functioning and emotion regulation) across the lifespan. Further, we discuss the impact of exposure to violence on the development of relational capacity, including attachment, internal working models, and subsequent interpersonal relationships across the lifespan, and how these developmental pathways can lead to continued problematic substance use in women.

Social network analysis to characterize women victims of violence.

BACKGROUND: In Europe, it is estimated that one third of women had experienced at least one physical or sexual violence after their 15. Taking into account the severe health consequences, the Emergency Department (ED), may offer an opportunity to recognize when an aggression is part of the spectrum of violence. This study applies Social Network analysis (SNA) to ED data in the Lazio region with the objective to identify patterns of diagnoses, within all the ED accesses of women experiencing an aggression, that are signals for gender-based violence against women. We aim to develop a risk assessment tool for ED professionals in order to strength their ability to manage victims of violence. METHODS: A cohort of 124,691 women aged 15-70 with an ED visit for aggression between 2003 and 2015 was selected and, for each woman, the ED history of diagnoses and traumas was reconstructed. SNA was applied on all these diagnoses and traumas, including also 9 specific violence diagnoses. SNA community detection algorithms and network centrality measures were used to detect diagnostic patterns more strongly associated to violence. A logistic model was developed to validate the capability of these patterns to predict the odds for a woman of having an history of violence. Model results were summed up into a risk chart. RESULTS: Among women experiencing an aggression, SNA identified four communities representing specific violence-related patterns of diagnoses. Diagnoses having a central role in the violence network were alcohol or substance abuse, pregnancy-related conditions and psychoses. These high-risk violence related patterns accounted for at most 20% of our cohort. The logistic model had good predictive accuracy and predictive power confirming that diagnosis patterns identified through the SNA are meaningful in the violence recognition. CONCLUSIONS: Routine ED data, analyzed using SNA, can be a first-line warning to recognize when an aggression related access is part of the spectrum of gender-based violence against women. Increasing the available number of predictors, such procedures may be proven to support ED staff in identifying early signs of violence to adequately support the victims and mitigate the harms.

Mediated representations of violence against women in the mainstream news in Australia.

BACKGROUND: How the mainstream news media report violence against women is significant if levels of violence are to be reduced and ultimately eliminated. Media reporting is an important indicator through which to measure progress towards shifting social and cultural norms that reinforce or challenge the place of violence against women in our society. The current study, therefore, aimed to establish a baseline picture of the extent and nature of reporting of violence against women by the mainstream Australian news media. METHODS: Descriptive and content analysis of media reports on violence against women that were collected over four months in three states of Australia. Reports were from newspapers, broadcast (television and radio) and online news sites. RESULTS: Coverage of violence against women in the mainstream news media was extensive. Explicitly situating violent experiences for women within a broader social context was infrequent. Few news reports included information for women on where to seek help. Additionally, news reports rarely elevated the voices of survivors, advocates and other experts, with a disproportionate emphasis on law enforcement, political and criminal justice perspectives. CONCLUSIONS: Despite readiness among journalists and readers to engage in news about violence against women, reporting that promotes public understanding of the issue is not always the norm.

Psycho-social profile of battered women in Galicia, Spain: Distress as a result of intimate partner violence and child abuse.

In Spain, a country of great cultural diversity, there is an increasing demand for psychosocial care for victims of gender-based violence. The objective is to describe the psychosocial profile of these women residing in the Autonomous Community of Galicia. In a sample (n = 40) of victims of intimate partner violence, it was found a high incidence of PTSD, depression, and low self-esteem associated with greater severity of PTSD and depression. A prolonged relationship increases the types of violence experienced, which is associated with particular psychosocial conditions that are analyzed quanti-qualitatively in order to recommend interventions consistent with the problems detected.

Mixed methods assessment of women's risk of intimate partner violence in Nepal.

BACKGROUND: Intimate partner violence (IPV) is a significant public health issue that affects one in three women globally and a similarly large number of women in Nepal. Although important policy and programmatic steps have been taken to address violence against women in Nepal over the past decade, there is still a gap on IPV research in Nepal, particularly with regard to social norms. METHODS: This mixed-methods study used in-depth interviews with women and their husbands as well as baseline survey data from a cluster randomized trial testing a primary prevention intervention for IPV to examine the prevalence and risk factors for IPV. Baseline survey data included 1800 women from Nawalparasi, Chitwan, and Kapilvastu districts in Nepal. Multivariate regression was used to identify risk and protective factors for exposure to physical and / or sexual IPV in the prior 12 months. Case-based analysis was used to analyze one of 18 pairs of in-depth interviews to examine risk and protective factors within marriages. RESULTS: Of 1800 eligible participants, 455 (25.28%) were exposed to IPV. In multivariate analyses, low caste, wife employment, income stress, poor marital communication, quarrelling, husband drunkenness, exposure to IPV as a child, in-law violence, and gender inequitable normative expectations were associated with IPV. The selected case interview represented common themes identified in the analysis including the wife's exposure to violence as a child, husband alcohol use, and marital quarrelling. CONCLUSIONS: Gender inequitable norms in the community and the intergenerational transmission of attitudes and behaviors supportive of IPV are important to address in intervention measures.

Exposure to domestic violence and abuse and consultations for emergency contraception: nested case-control study in a UK primary care dataset.

BACKGROUND: Evidence of an association between exposure to domestic violence and abuse (DVA) and use of emergency contraception (EC) is lacking in the UK. AIM: To quantify the association between exposure to DVA and consultations for EC in general practice. DESIGN AND SETTING: Nested case-control study in UK general practice. METHOD: Using the Clinical Practice Research Datalink, the authors identified all women all women aged 15-49 years registered with a GP between 1 January 2011 and 31 December 2016. Cases with consultations for EC (n = 43 570) were each matched on age and GP against four controls with no consultations for EC (n = 174 280). The authors calculated odds ratios (ORs) and 95% confidence intervals (CIs) for the association between exposure to DVA in the previous year and consultations for EC. Covariates included age, ethnicity, socioeconomic status, pregnancy, children, alcohol misuse, and depression. RESULTS: Women exposed to DVA were 2.06 times more likely to have a consultation for EC than unexposed women (95% CI = 1.64 to 2.61). Women aged 25-39 years with exposure to DVA were 2.8 times more likely to have a consultation for EC, compared with unexposed women (95% CI = 2.08 to 3.75). The authors found some evidence of an independent effect of exposure to DVA on the number of consultations for EC (OR 1.48, 95% CI = 0.99 to 2.21). CONCLUSION: A request for EC in general practice can indicate possible exposure to DVA. Primary care consultation for EC is a relevant context for identifying and responding to DVA as recommended by the World Health Organization and National Institute for Health and Care Excellence guidelines. DVA training for providers of EC should include this new evidence.

[Sexual violence against women in Tunisia]. / Violence sexuelle exercée sur les femmes en Tunisie.

BACKGROUND: Sexual violence exists everywhere in the world. It depends mainly on the cultural and religious norms conveyed in the various societies. This is a neglected area of research. Available data are insufficient, especially in Arab-Muslim context. METHODS: In this paper, we comprehensively review the scientific literature in order to clarify the cultural, religious and legal aspects of the concept of sexual violence against women in Tunisia, and ask the question of the urgent need to put in place strategies to counter this problem. RESULTS: The National Office for Family and Population published in 2011 the results of the national survey on violence against women in Tunisia, including data on sexual violence and its impact on women's health and well-being. According to this survey, 14.2% of women reported having been sexually abused by an intimate partner during their lifetime and 9.0% reported having experienced it during the last 12 months. One out of every six Tunisian women has been the victim of a sexual violence in a conjugal setting. More men than women legitimized violence against women in contexts where family control, especially conjugal control, is exercised over them. In a study examining the impact of culture and religion on experiences and sexual practice of women in Tunisian society, the majority of respondents thought that sexuality in women was a religious duty and that they do not have the right to refuse their husbands or to rebel. Thus, women would be doubly sanctioned having neither the right to express their desire nor not to respond to their husband's desire. A survey of a representative sample of Tunisian women found that 56.9% of the participants reported being victims of domestic violence, particularly sexual violence (10.7%) consisting mainly of rape and sodomy, at least once in their lifetime. This survey showed that those victims expressed dissatisfaction with overall quality of life. Moreover, contrary to Western literature, sexual violence was the least reported form of violence by teenage girls in Tunisian schools. Indeed, cultural values of modesty, virginity and honor are socially much more demanded for girls, in Arab countries in general, reinforcing staggering silence and inaction around violence experienced by school-aged adolescents. In Tunisian society, the cultural "solution" to rape wants the woman to marry her rapist which safeguards her family's integrity by legitimizing the union. CONCLUSION: Sexual violence has detrimental effects on female victims' physical and mental health. Even if the information on this form of violence is not easy to obtain in our environment, and that rates of subjects reporting sexual violence in their lifetimes are not important, the problem of sexual violence must be considered as a public health problem requiring urgent interventions and a greater institutional will.