Prevalence of intimate partner violence among women seeking termination of pregnancy compared to women seeking contraceptive counseling.

OBJECTIVE: To estimate the prevalence of intimate partner violence (IPV) among women seeking termination of pregnancy (TOP) in comparison to women seeking contraceptive counseling. DESIGN: Case-control study. SETTING: Family planning unit, Uppsala University Hospital. POPULATION: Women seeking TOP (n = 635) and women seeking contraceptive counseling (n = 591) answered a self-administered questionnaire regarding experience of IPV. In addition, the women were interviewed by specially trained staff. METHOD: Comparisons were made between the two groups and between those who had previously undergone TOP and those who had never done so with experience of IPV as the main outcome measure. Multivariate logistic regression was used to adjust for age, education and occupation. RESULTS: In total, 29% of women seeking TOP and 22% of women seeking contraceptive counseling reported experience of violence. Women seeking TOP were more likely to report physical violence [adjusted odds ratio (aOR) = 1.6, 95% confidence interval (CI) 1.2-2.1] and experience of violence during the past year (aOR = 2.3, 95% Cl 1.1-4.8). Women who had ever undergone TOP were also more likely to report IPV compared with women with no history of TOP (aOR = 1.7, 95% CI 1.3-2.3). Among women with repeated TOP, 51% reported experience of IPV. CONCLUSION: Women seeking TOP reported to a greater extent experience of IPV. However, women seeking contraceptive counseling also had a high prevalence of violent experiences. These results stress the importance of caregivers approaching both groups of women with questions about IPV to identify exposed women and offer them help.

Prevalence of experiences of partner violence among female health staff: relevance to awareness and action when meeting abused women patients.

BACKGROUND: As violence against women is a prevalent phenomenon, it is quite likely that health workers have experienced such violence. Prevalence among female health staff of emotional, physical and sexual abuse inflicted by a current or previous male partner as well as awareness of violence within the family of origin or among acquaintances were studied. Whether such experiences were associated with practice and knowledge concerning care of abused women was also examinated. METHODS: Questionnaires were distributed to randomly selected female health care workers at a Swedish hospital. Response rate was 68% (588 participating). Bivariate and multivariate analyses were performed. MAIN FINDINGS: Emotional, physical and sexual abuse by a current or previous male partner was reported by 23.5%; abuse within family or among acquaintances by 22.1%. Associations between personal experience of violence and aspects of practice and knowledge in bivariate comparisons did not remain significant in binary logistic regression analyses, with one exception. Those with awareness of violence within the family or among acquaintances met abused women more frequently. Training was positively associated with all aspects of care and knowledge. CONCLUSION: The prevalence rate of intimate partner violence (23.5%) among female health staff was high and not unlike that of the Swedish female population in general. Training is of greater importance than personal experience of violence in the context of practice and knowledge when meeting abused women as patients. Hence, men's violence against women should be included in professional education and in in-service training.

Midwives' experiences of routine antenatal questioning relating to men's violence against women.

OBJECTIVE: to describe and use the experience gained by antenatal-care midwives who routinely questioned pregnant women about personally experienced violence. DESIGN: qualitative, using focus-group discussions. SETTING: antenatal care in a city in south-central Sweden. STUDY POPULATION: 21 midwives. DATA COLLECTION AND ANALYSIS: the midwives participated in any one of five focus-group discussions held by the same moderator and observer. The discussions were audiotaped, transcribed verbatim and analysed using qualitative content analysis. FINDINGS: the importance of routine questioning about violence was emphasised in all groups. Midwives felt they had failed in their duty when women were not questioned. The two main obstacles to such questioning were the delicacy of the subject and the routine of inviting the partner to all visits. The perceived delicacy underlined the need to devise a natural setting for the questioning. The midwives wanted to connect questions about abuse with related subjects routinely established in early pregnancy. As the partner was invited to every visit, it was not practicable to establish a procedure whereby the assessment was connected with a particular visit. Other obstacles included the following: time constraints, oversight, a preconceived notion of who might be a victim of abuse and language difficulties. The midwives emphasised the importance of training, easy access to support for abused women, and personal counselling for midwives. They described their role as raising awareness of the problem of male violence, reducing the shame of being abused, informing, giving emotional support and mediating help. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: in order to ensure that the establishment of experience of violence is a routine enquiry in antenatal care, midwives must have a reasonable opportunity of carrying out such questioning. A routine that offers each woman a private consultation will ease the questioning and save time and distress.

Lifetime prevalence of sexual abuse in a Swedish pregnant population.

BACKGROUND: Our primary purpose was to determine the prevalence of sexual abuse in a non-selected pregnant population. We also endeavored to establish the age at which the abuse had occurred and the identity of the perpetrator and to analyze in sexually abused vis-à-vis non-abused women, various socio-economic and clinical variables. METHODS: Over a period of 6 months, all women registered at antenatal clinics in Uppsala, Sweden, were questioned by their midwives regarding exposure to sexual abuse. Data from antenatal records were used to compare abused with non-abused women concerning socio-economic characteristics, previous ill health, reproductive history, pregnancy complications, and pregnancy outcome. Continuous variables were compared using the Student's t-test or the Mann-Whitney U-test and categorical variables using the chi-square test or Fisher's exact test. RESULTS: Of 1038 women assessed, 84 (8.1%) reported that at some time in their life they had been forced to participate in or subjected to sexual activity against their will. In most cases the perpetrator was someone the woman knew. When compared with non-victims, those abused were more likely to report general health problems, especially gynecologic ill health and surgery, pulmonary disease/asthma, and/or psychiatric care. However, no differences were found regarding pregnancy outcome. CONCLUSIONS: It was found that one pregnant woman in 12 had reported sexual abuse at some time in their life. To midwives and obstetricians who work closely both physically and emotionally with pregnant women, an awareness of the extent of the problem and of possible sequelae is essential.