Violence Against Women: Representations, Interpretations, and Education.

Cultural representations of violence against women have been mystified, eroticized, and depicted as heroic, camouflaging, and trivializing acts of violence as a societal norm for thousands of years. This themed issue invites people to re/claim identities and power, and enter into a global cultural discourse connected with cross-disciplinary channels and creative work.

Experiences of violence among adolescent girls and young women in Nairobi's informal settlements prior to scale-up of the DREAMS Partnership: Prevalence, severity and predictors.

INTRODUCTION: We sought to estimate the prevalence, severity and identify predictors of violence among adolescent girls and young women (AGYW) in informal settlement areas of Nairobi, Kenya, selected for DREAMS (Determined Resilient Empowered AIDS-free, Mentored and Safe) investment. METHODS: Data were collected from 1687 AGYW aged 10-14 years (n = 606) and 15-22 years (n = 1081), randomly selected from a general population census in Korogocho and Viwandani in 2017, as part of an impact evaluation of the "DREAMS" Partnership. For 10-14 year-olds, we measured violence experienced either in the past 6 months or ever using a different set of questions from those used for 15-22 year-olds. Among 15-22 year-olds we measured prevalence of violence, experienced in the past 12 months, using World Health Organization (WHO) definitions for violence typologies. Predictors of violence were identified using multivariable logit models. RESULTS: Among 606 girls aged 10-14 years, about 54% and 7% ever experienced psychological and sexual violence, respectively. About 33%, 16% and 5% experienced psychological, physical and sexual violence in the past 6 months. The 10-14 year old girls who engaged in chores or activities for payment in the past 6 months, or whose family did not have enough food due to lack of money were at a greater risk for violence. Invitation to DREAMS and being a non-Christian were protective. Among 1081 AGYW aged 15-22 years, psychological violence was the most prevalent in the past year (33.1%), followed by physical violence (22.9%), and sexual violence (15.8%). About 7% experienced all three types of violence. Severe physical violence was more prevalent (13.8%) than moderate physical violence (9.2%). Among AGYW aged 15-22 years, being previously married/lived with partner, engaging in employment last month, food insecure were all risk factors for psychological violence. For physical violence, living in Viwandani and being a Muslim were protective; while being previously married or lived with a partner, or sleeping hungry at night during the past 4 weeks were risk factors. The odds of sexual violence were lower among AGYW aged 18-22 years and among Muslims. Engaging in sex and food insecurity increased chances for sexual violence. CONCLUSIONS: Prevalence of recent violence among AGYW is high in this population. This calls for increased effort geared towards addressing drivers of violence as an early entry point of HIV prevention effort in this vulnerable group.

When Bigger Is Better: Household Size, Abuse Injuries, Neglect, and Family Response in Novosibirsk, Russia.

Although previous research has demonstrated larger households to be at higher risk of physical abuse and neglect of children, we argue that unilateral conceptualization of larger households as a risk factor is inappropriate. Application of resource dilution theory must capture the possibility that larger families may have more members with both the agency and will to intervene against child maltreatment. We hypothesized a negative interaction between household size and protective informal social control by family members in predicting abuse injuries and neglect. A three-stage probability proportional to size cluster sample representative of Novosibirsk, Russia, was collected from 306 cohabiting couples. One parent in each household was interviewed. A focal child was selected using most recent birthday. When responses limited to families with minor children (below age 18) were selected, 172 families remained in the data. Physical abuse and neglect were measured using the Conflict Tactics Scales (CTS). Protective informal social control by family members was measured using the Informal Social Control of Child Maltreatment (ISC_CM) Scale. Models were tested using random effects regression and logistic regression. Nearly 7% of focal children were injured in the last year, 10% were neglected. Consistent with previous research, protective informal social control was associated with lower odds of injury and fewer instances of neglect. The significant negative interaction between household size and protective control is consistent with the idea that larger households may be protective when adult family members intervene against maltreatment to protect children. Replication and further investigation of protective ISC_CM in Western populations is much needed. Future research should not conceptualize or measure household size as a unilateral risk factor.

Intimate partner violence and associated factors among pregnant women attending antenatal care service in Debre Markos town health facilities, Northwest Ethiopia.

BACKGROUND: Intimate partner violence is a thoughtful public health concern and human rights violation towards pregnant women for it has a significant negative health effect on the life of both the mother and her fetus. However, there is a scanty of information about the extent of intimate partner violence during pregnancy in Ethiopia, particularly in the study area. Therefore, the current study was conducted to determine the prevalence of intimate partner violence among pregnant women attending antenatal care and identify associated factors that cause it. METHODS: An institution based cross-sectional study was conducted on 409 pregnant women who were attending antenatal care service in Debre Markos town from March 17, 2018 -April 28, 2018. Systematic random sampling technique was used to select study participants. A pre-tested structured questionnaire was used to collect the data. Bivariable and Multivariable logistic regression models were done. Adjusted odds ratio with 95% confidence interval was used to identify factors associated with intimate partner violence during pregnancy. RESULTS: The prevalence of intimate partner violence during current pregnancy was found to be 41.1% (95% confidence interval (CI): 36.0-46.0). Of this, the prevalence of psychological, physical, and sexual violence was 29.1%, 21%, 19.8% respectively. Lower educational status of partners (AOR = 3.26, 95%CI: 1.45-7.36), rural residency (AOR = 4.04, 95%CI: 1.17-13.93), frequent alcohol abuse by partner (AOR = 4.79, 95% CI: 2.08-11.04), early initiation of antenatal care (AOR = 0.44, 95% CI: 0.24-0.81), the age of women between 17-26 years (Adjusted odds ratio (AOR) = 0.21, 95%CI: 0.09-0.49),choice of partner by the women only (AOR = 3.26,95% CI:1.24-8.57) were statistically significant factors associated with intimate partner violence towards pregnant women. CONCLUSIONS: In this study, the prevalence of intimate partner violence during pregnancy is found to be high. As a result, interventions that would address the above mentioned factors need to be implemented.

Violence against women: Affecting factors and coping methods for women.

OBJECTIVE: To determine women's exposure to domestic violence, it's affecting factors and coping methods. METHODS: The descriptive, cross-sectional study was conducted from September to December 2017 and comprised married women living in Kesan, a district in the Turkish province of Edirne. A self-generated questionnaire was used to gather sociodemographic data and women's exposure to domestic violence. SPSS 16 was used to analyse data. RESULTS: Of the 586 subjects, 321(55%) were aged up to 40 years, while 265(45%) were aged 41 years or more. Domestic violence was reported by 156(26.6%) women. Beating ranked first among physical violence behavior reported by 83(14.2%) subjects. Name-calling and yelling ranked first among verbal violence behaviour reported by 118(20.1%). Keeping women at a certain distance rankedfirst among emotional violence behaviour, reported by 95(16.2%). Not purchasing the fundamental needs of the home ranked first among the economic violence behaviour, reported by 38(6.5%). Finally, 14(2.4%) reported being physically forced to engage in a sexual act, which ranked first among sexual violence behaviour. From among the women abused, 114(66.7%) women said violence occurred because of the instant anger of their partners, and 69(44.2%)said they did not apply to any officialinstitution for help. CONCLUSIONS: Women preferred to remain silent about domestic violence. There is a need to introduce urgent prevention programmes to end domestic violence.

The impact of a statewide trauma-informed child welfare initiative on children's permanency and maltreatment outcomes.

This article presents findings of a state-wide trauma informed child-welfare initiative with the goal of improving well-being, permanency and maltreatment outcomes for traumatized children. The Massachuetts Child Trauma Project (MCTP), funded by the Administration of Children and Families, Children's Bureau was a multi-year project implementing trauma-informed care into child welfare service delivery. The project's implementation design included training and consultation for mental health providers in three evidence-based treatments and training of the child-welfare workforce in trauma-informed case work practice. The learning was integrated between child-welfare and mental health with Trauma Informed Leadership Teams which included leaders from both systems and the greater community. These teams developed incremental steps toward trauma-informed system improvement. This study evaluated whether MCTP was associated with reductions in child abuse and neglect, improvements in placement stability, and higher rates of permanency during the first year of implementation. Children in the intervention group had fewer total substantiated reports of maltreatment, including less physical abuse and neglect than the comparison group by the end of the intervention year. However, children in the intervention group had more maltreatment reports (substantiated or not) and total out-of-home placements than did their counterparts in the comparison group. Assignment to MCTP, however, was not associated with an increase in kinship care or adoption. Overall, the results are promising in reinforcing the importance of mobilizing communities toward improvements in child-welfare service delivery.

Victim voice in reenvisioning responses to sexual and physical violence nationally and internationally.

Internationally and in the United States many victims of sexual assault and domestic violence are unserved, underserved, or ill-served, especially those from the most vulnerable populations. Programs developed in the United States are routinely exported to developing countries but often without success. Notably, the failures seen internationally resemble those in the United States and are related to structural and attitudinal-cultural factors. Many victims do not disclose, and if they do seek services, they often report that available options mismatch their objectives, present accessibility challenges, disempower their pursuit of justice, and fail to augment needed resources. A deeper understanding of obstacles to effective service provision is needed if the United States is to continue to be an international partner in victim response and violence prevention. This article builds on what is known about service delivery challenges in U.S. programs to envision a path forward that concomitantly accommodates anticipation of shrinking resources, by (a) reviewing illustrative services and feedback from victims about utilizing them; (b) examining structural inequalities and the intersections of personal and contextual features that both increase vulnerability to victimization and decrease accessibility and acceptability of services; (c) advocating for reintroduction of direct victim voice into response planning to enhance reach and relevance; and (d) reorienting delivery systems, community partnerships, and Coordinated Community Response teams. The authors suggest as the way forward pairing direct victim voice with open-minded listening to expressed priorities, especially in vulnerable populations, and designing services accordingly. Through a process that prioritizes adaptation to diverse needs and cultures, U.S models can increase desirability, equity, and thrift at home as well as enhance international relevance. (PsycINFO Database Record

Justice or Injustice: a History and Critique of the New York State Justice Center for the Protection of People with Special Needs.

The creation of the New York State Justice Center for the Protection of People with Special Needs ("Justice Center") was announced with great fanfare in 2013. Its goal is laudable: strengthening and standardizing "the safety net for vulnerable persons, adults and children alike, who are receiving care from New York's human service agencies and programs." Its jurisdiction is broad: covering residential and non-residential programs and provider agencies that come within the purview of six state oversight agencies, namely, the Office of Mental Health, the Office for People with Developmental Disabilities, the Office of Alcohol and Substance Abuse Services, the Office of Children and Family Services, the Department of Health, and the State Education Department. Its powers are comprehensive: investigating allegations of abuse, neglect, and significant incidents, and disciplining individuals and agencies pursuant to administrative authority. In addition, it can prosecute crimes of neglect and abuse pursuant to criminal prosecutorial authority. Given that over 270,000 vulnerable children and adults live in residential facilities overseen by the state and that numerous other individuals receive services from "day programs operated, licensed[,] or certified by the state[,]" the creation of the Justice Center is consistent with New York's history of oversight of vulnerable individuals. The state has overseen various state and municipal programs and private organizations that have addressed the needs of vulnerable individuals practically since New York's first poorhouse opened in 1736. The development of that oversight has been a series of responses to perceived deficiencies of an existing system, and the creation of the Justice Center is, much in the same way, a response to a 2011 study commissioned by the Governor to examine the treatment and care of vulnerable adults. The Justice Center's jurisdiction reflects a departure, however, from traditional oversight. State administrative and regulatory review has been carried out by specialized state agencies established during the late nineteenth and twentieth centuries to address specific categories of individuals receiving care and treatment according to their needs. Residential and day treatment programs, as well as their custodians and employees, have been disciplined for abuse and neglect in accordance with state regulations created by these agencies. Criminal prosecutions have also been referred to county district attorneys. The Justice Center unites all specialized agencies, all vulnerable individuals with diverse needs, and all custodians and employees trained to meet those needs under one additional layer of uniform rules and regulations, with potential administrative discipline, civil liability, and criminal prosecution also under the same umbrella. This article explores the history of state oversight in New York and the departure represented by the Justice Center. This article first traces the early history of oversight. It then discusses the role of the Commission on Quality of Care for the Mentally Disabled, an antecedent organization similar to the Justice Center. Next, it examines the Justice Center itself. Last, this article concludes with some reflections on the Center.

Applying a participatory approach to the promotion of a culture of respect during childbirth.

Disrespect and abuse (D&A) during facility-based childbirth is a topic of growing concern and attention globally. Several recent studies have sought to quantify the prevalence of D&A, however little evidence exists about effective interventions to mitigate disrespect and abuse, and promote respectful maternity care. In an accompanying article, we describe the process of selecting, implementing, and evaluating a package of interventions designed to prevent and reduce disrespect and abuse in a large urban hospital in Tanzania. Though that study was not powered to detect a definitive impact on reducing D&A, the results showed important changes in intermediate outcomes associated with this goal. In this commentary, we describe the factors that enabled this effect, especially the participatory approach we adopted to engage key stakeholders throughout the planning and implementation of the program. Based on our experience and findings, we conclude that a visible, sustained, and participatory intervention process; committed facility leadership; management support; and staff engagement throughout the project contributed to a marked change in the culture of the hospital to one that values and promotes respectful maternity care. For these changes to translate into dignified care during childbirth for all women in a sustainable fashion, institutional commitment to providing the necessary resources and staff will be needed.

Mitigating disrespect and abuse during childbirth in Tanzania: an exploratory study of the effects of two facility-based interventions in a large public hospital.

BACKGROUND: There is emerging evidence that disrespect and abuse (D&A) during facility-based childbirth is prevalent in countries throughout the world and a barrier to achieving good maternal health outcomes. However, much work remains in the identification of effective interventions to prevent and eliminate D&A during facility-based childbirth. This paper describes an exploratory study conducted in a large referral hospital in Dar es Salaam, Tanzania that sought to measure D&A, introduce a package of interventions to reduce its incidence, and evaluate their effectiveness. METHODS: After extensive consultation with critical constituencies, two discrete interventions were implemented: (1) Open Birth Days (OBD), a birth preparedness and antenatal care education program, and (2) a workshop for healthcare providers based on the Health Workers for Change curriculum. Each intervention was designed to increase knowledge of patient rights and birth preparedness; increase and improve patient-provider and provider-administrator communication; and improve women's experience and provider attitudes. The effects of the interventions were assessed using a pre-post design and a range of tools: pre-post questionnaires for OBD participants and pre-post questionnaires for workshop participants; structured interviews with healthcare providers and administrators; structured interviews with women who gave birth at the study facility; and direct observations of patient-provider interactions during labor and delivery. RESULTS: Comparisons before and after the interventions showed an increase in patient and provider knowledge of user rights across multiple dimensions, as well as women's knowledge of the labor and delivery process. Women reported feeling better prepared for delivery and provider attitudes towards them improved, with providers reporting higher levels of empathy for the women they serve and better interpersonal relationships. Patients and providers reported improved communication, which direct observations confirmed. Additionally, women reported feeling more empowered and confident during delivery. Provider job satisfaction increased substantially from baseline levels, as did user reports of satisfaction and perceptions of care quality. CONCLUSIONS: Collectively, the outcomes of this study indicate that the tested interventions have the potential to be successful in promoting outcomes that are prerequisite to reducing disrespect and abuse. However, a more rigorous evaluation is needed to determine the full impact of these interventions.

Risk factors for men's lifetime perpetration of physical violence against intimate partners: results from the international men and gender equality survey (IMAGES) in eight countries.

This paper examines men's lifetime physical intimate partner violence (IPV) perpetration across eight low- and middle-income countries to better understand key risk factors that interventions can target in order to promote gender equality and reduce IPV. We use data from men (n = 7806) that were collected as part of the International Men and Gender Equality Survey (IMAGES) in Bosnia and Herzegovina, Brazil, Chile, Croatia, Democratic Republic of Congo (DRC), India, Mexico, and Rwanda. Results show that there is wide variation across countries for lifetime self-reported physical violence perpetration (range: 17% in Mexico to 45% in DRC), men's support for equal roles for men and women, and acceptability of violence against women. Across the sample, 31% of men report having perpetrated physical violence against a partner in their lifetime. In multivariate analyses examining risk factors for men ever perpetrating physical violence against a partner, witnessing parental violence was the strongest risk factor, reinforcing previous research suggesting the inter-generational transmission of violence. Additionally, having been involved in fights not specifically with an intimate partner, permissive attitudes towards violence against women, having inequitable gender attitudes, and older age were associated with a higher likelihood of ever perpetrating physical IPV. In separate analyses for each country, we found different patterns of risk factors in countries with high perpetration compared to countries with low perpetration. Findings are interpreted to identify key knowledge gaps and directions for future research, public policies, evaluation, and programming.

L'efficacité d'outils d'évaluation du risque d'abus physique envers les enfants / The effectiveness of tools for assessing the risk of physical abuse of children

INTRODUCTION: Au Québec, en 2007, l'introduction de la notion de risque sérieux en matière de négligence, d'abus sexuel et d'abus physique dans la Loi sur la protection de la jeunesse rend compte de l'ampleur croissante de la récurrence de ces types de maltraitance. Dans les services de protection de la jeunesse (SPJ), cela se manifeste, entre autres, par de nouveaux signalements, une réévaluation de cas, de nouvelles allégations fondées et le placement successif d'enfants en dehors du foyer familial. Le parcours cyclique entre les services de première ligne - centres de santé et de services sociaux (CSSS) - et les services de deuxième ligne - centres jeunesse (CJ) - destinés aux enfants ayant vécu ou à risque de revivre une ou plusieurs situations d'abus physique rend compte de ce phénomène qui préoccupe les autorités responsables de ces services. Dans l'optique d'améliorer la pratique d'évaluation, de favoriser une meilleure gestion du risque et de mieux cibler la clientèle afin de lui offrir des services adaptés selon les ressources disponibles, l'Association des centres jeunesse du Québec (ACJQ) a présenté une demande à l'Institut national d'excellence en santé et en services sociaux (INESSS) afin de repérer un ou des outils d'évaluation du risque d'abus physique envers les enfants. Par définition, un outil d'évaluation du risque d'abus physique est composé d'une série de questions qui sert à évaluer, avec plus de précision et de cohérence que le seul jugement professionnel, les enfants à risque de subir des sévices corporels pouvant compromettre leur santé et leur sécurité. Un tel outil devrait répondre à la fois aux critères d'efficacité théorique (fiabilité, validité), sur le plan scientifique, et aux critères d'efficacité pratique (utilité et applicabilité dans les milieux d'intervention). L'INESSS a donc produit, en collaboration avec le Centre jeunesse de Québec ­ Institut universitaire (CJQ-IU), le présent avis, qui vise à répondre aux quatre questions suivantes: 1) Quelle est l'efficacité reconnue, sur le plan scientifique, des outils d'évaluation du risque d'abus physique envers les enfants? 2) Ces outils dont l'efficacité est reconnue sont-ils utiles à la prise décision au moment d'évaluer des enfants qui font l'objet d'un signalement ou d'un nouveau signalement pour un risque d'abus physique? 3) Comment ces outils dont l'efficacité est reconnue s'intègrent-ils au contexte d'intervention? 4) Ces outils dont l'efficacité est reconnue sont-ils adaptables au contexte légal québécois? MÉTHODOLOGIE: Une revue systématique de la littérature scientifique couvrant les années 2003 à 2013 a été réalisée afin de répondre à la première question. Les réponses à la deuxième et à la troisième question s'appuient sur une revue de la littérature grise, et la tenue de groupes de discussion focalisée auxquels ont participé 21 personnes, soit des intervenants, des agents de liaison et des gestionnaires de CSSS et de CJ du Québec. La quatrième question a été débattue avec les membres du comité de suivi du projet et commentée par des experts indépendants. RÉSULTATS: La revue systématique a permis de recenser 21 études qui présentent des résultats sur l'efficacité théorique de 7 outils d'évaluation du risque d'abus physique envers les enfants. Utilisés à l'étape d'évaluation de la situation de l'enfant, ces outils sont les suivants : AAPI-2 (Adult Adolescent Parenting Inventory-2), C-CAPS (Cleveland Child Abuse Potential Scale), CAPI (Child Abuse Potential Inventory), CFRA (California Family Risk Assessment), CFRAT (Colorado Family Risk Assessment Tool), FRAAN (Family Risk Assessment of Abuse and Neglect) et OFRA (Ontario Family Risk Assessment). Il est à noter que la majorité des études recensées ne porte pas uniquement sur le risque d'abus physique, et sur sa récurrence, puisque la prédiction englobe l'abus en général et, parfois, la négligence. Ces outils sont de deux types : 1) des outils d'évaluation structurée du risque de type contextuel, qui s'appuient sur le consensus, issu de la littérature et des conseils d'experts, au sujet des facteurs et des conditions jugés le plus fortement associés à la récurrence de la maltraitance; 2) des outils statistiques de type actuariel, qui font appel à des méthodes statistiques permettant de déterminer et de pondérer les principaux facteurs associés à l'occurrence et à la récurrence de sévices corporels infligés aux enfants (résultats d'intérêt). CONCLUSIONS: La demande adressée à l'INESSS par 'ACJQ consistait à déterminer et à évaluer l'efficacité, sur le plan scientifique, d'outils d'évaluation du risque d'abus physique envers les enfants. Les données scientifiques provenant de 21 études de validation d'outils d'évaluation du risque d'abus physique et parfois, de la négligence parmi les familles à risque ayant déjà commis ces actes ont été analysées. Par la suite, les données provenant de 9 publications qui traitent de l'efficacité pratique de ce type d'outils ont permis de cerner un certain nombre de préoccupations qui ont été abordées lors de groupes de discussion focalisée auxquels ont participé des intervenants, des agents de liaison et des gestionnaires en provenance de CSSS ou de CJ du Québec. Enfin, une délibération des membres du comité de suivi en vue de produire le présent avis a permis d'évaluer la possibilité d'adapter un outil de ce type au contexte légal québécois. En réponse à la question 1, qui porte sur l'efficacité théorique (fiabilité, validité) de ce type d'outil, l'INESSS conclut ce qui suit: -à l'exception de l'outil CAPI (Child Abuse Potential Inventory), les outils évalués ne permettent pas de distinguer les différents types d'abus (physique, sexuel ou psychologique); -aucun des outils évalués ne satisfait à la fois aux critères d'une bonne fiabilité et d'une bonne validité. La fiabilité des outils CAPI et FRAAN (Family Risk of Abuse and Neglect) est bonne. La validité de l'outil CFRA (California Family Risk Assessment) est jugée adéquate. Sa version adaptée, l'outil OFRA (Ontario Family Risk Assessment) est en usage en Ontario; -aucun des outils recensés ne permet de prédire si les parents (ou leurs conjoints) vont commettre (à nouveau) un abus physique envers leur enfant ou non; les outils actuariels, qui tiennent compte de la présence de facteurs de risque associés à l'abus physique, sont plus efficaces (fiabilité, validité) que les outils contextuels pour évaluer le niveau de risque d'abus physique ou sa récurrence; -lorsqu'il fait partie d'un système d'évaluation intégré, tel que le SDM (Structure Decision Making) conçu par le CRC (Children's Research Center) du National Council on Crime and Delinquency (NCCD), l'outil actuariel fournit une meilleure évaluation du risque d'abus physique que lorsqu'il est utilisé seul. Étant donné la présence d'autres outils d'aide à la décision dans les établissements visés, il y aurait lieu d'examiner comment il peut s'insérer parmi ceux déjà en place.