Reproductive coercion is a behavior that interferes with the autonomous decision-making of a woman, with regard to reproductive health. It may take the form of birth control sabotage, pregnancy ...coercion, or controlling the outcome of a pregnancy. The objectives of this article are to address the questions: (1) What is known about reproductive coercion, its prevalence, and correlates? (2) What strategies do women use to preserve their reproductive autonomy when experiencing reproductive coercion? (3) What interventions are effective to decrease reproductive coercion? In this review of 27 research studies, 12 contained findings regarding the general phenomenon of reproductive coercion and 19 contained findings about at least one component of reproductive coercion. Additionally, 11 studies contained findings related to the intersection of intimate partner violence (IPV) and reproductive coercion, 6 presented data on strategies women use to resist reproductive coercion, and 3 included intervention data. Variation in measurement makes synthesis of prevalence and correlate data challenging. The reviewed literature presents reproductive coercion as a phenomenon that disproportionately affects women experiencing concurrent IPV, women of lower socioeconomic status, single women, and African American, Latina and multiracial women. Women who experience reproductive coercion were found to present frequently for certain health services. Most data on reproductive coercion are descriptive, and there is need for further research to examine the co-occurrence with related phenomena such as IPV and unintended pregnancy. More research is also needed on the strategies women use to resist reproductive coercion as well as interventions aimed at survivors and perpetrators of reproductive coercion and health-care providers who encounter them.
Violence against women perpetrated by an intimate partner (IPV) is prevalent in low- and middle-income countries (LAMIC). The aim was to describe the attitudes of women and men towards perpetration ...of physical violence to women by an intimate partner, in a large group of low- and middle-income countries.
We used data from Round Four of the UNICEF Multiple Indicator Cluster Surveys. Attitudes towards IPV against women were assessed by a study-specific scale asking if 'wife beating' is justified in any of five circumstances. Overall, data from 39 countries (all had data from women and 13 countries also had data from men) were included in the analyses. The proportions of women who held attitudes that 'wife-beating' was justified in any of the five circumstances varied widely among countries from 2.0% (95% CI 1.7;2.3) in Argentina to 90.2% (95% CI 88.9;91.5) in Afghanistan. Similarly, among men it varied from 5.0% (95% CI 4.0;6.0) in Belarus to 74.5% (95% CI 72.5;76.4) in the Central African Republic. The belief that 'wife-beating' is acceptable was most common in Africa and South Asia, and least common in Central and Eastern Europe and Latin America and the Caribbean. In general this belief was more common among people in disadvantaged circumstances, including being a member of a family in the lowest household wealth quintile, living in a rural area and having limited formal education. Young adults were more likely to accept physical abuse by a man of his intimate partner than those who were older, but people who had never partnered were less likely to have these attitudes.
Violence against women is an international priority and requires a multicomponent response. These data provide evidence that strategies should include major public education programs to change attitudes about the acceptability of IPV against women, and that these should be addressed to women and girls as well as to boys and men.
Intimate Partner Violence (IPV) is a global pandemic and many have been victims of it long before Covid-19. International organizations have documented an increase in IPV reports during the current ...pandemic, raising awareness of the potential causes for such an increase. Reflecting on risk factors associated with IPV, and the underlying need of the perpetrators to exert control over the victims, it becomes increasingly important to understand how the current policies of social distancing, self-isolation, and lockdown can precipitate episodes of IPV. Furthermore, access to specialized services and health care can be compromised, and health care professionals face new challenges and demands imposed by the pandemic while managing IPV cases. This article begins by examining the main risk factors more commonly associated with IPV in the literature. It proceeds by reflecting on how these risk factors may be exacerbated during the Covid-19 pandemic, which can explain the increased number of reports. Finally, it emphasizes the new challenges faced by health care professionals, while assisting IPV victims during the pandemic and provides possible recommendations on actions to implement during and beyond the Covid-19 pandemic to prevent such cases.
•Intimate Partner Violence cases increase during emergencies.•An increase in IPV cases has been reported during the Covid-19 pandemic.•IPV has been related to numerous risk factors.•Risk factors for IPV can be exacerbated during the Covid-19 pandemic.•Health care professionals face new challenges managing IPV cases during the Covid-19 pandemic.
The current worldwide outbreak of COVID-19 has changed the modus operandi of all segments of society. While some pandemic-related stressors affect nearly everyone, many especially affect women. ...Purpose: To review what is known about the pandemic’s effect on women’s mental health, what makes them more predisposed to vulnerabilities and adverse impacts, and strategies for preventing and treating these mental health consequences in the female population during specific stages across the lifespan. Methods: The authors performed a narrative review in combination with their observations from clinical experience in the field of women’s mental health and reproductive psychiatry. Articles on women’s mental health and COVID-19 up to May 30, 2020, were searched using the electronic PubMed and PsychInfo databases, as well as publications by major health entities (e.g., World Health Organization, Centers for Disease Control and Prevention, the United Nations) and press releases from prime communication outlets (e.g., National Public Radio). Results and conclusions: Women who are pregnant, postpartum, miscarrying, or experiencing intimate partner violence are at especially high risk for developing mental health problems during the pandemic. Proactive outreach to these groups of women and enhancement of social supports could lead to prevention, early detection, and prompt treatment. Social support is a key protective factor. Similarly, parenting may be substantially more stressful during a pandemic. Gender disparities may be accentuated, particularly for employed women or single parents, as women are disproportionately responsible for the bulk of domestic tasks, including childcare and eldercare.
Mixed-gender couples presenting for couple therapy are at 2-3 times higher risk for physical intimate partner violence (IPV) than community couples. However, it is unclear if this elevation of ...relative risk is the same in the general population because relationship distress and treatment-seeking are often confounded. We used archival data from three representative U.S. civilian samples and one representative U.S. Air Force sample to test the hypothesis that clinically significant relationship distress is associated with increased risk of various forms of IPV. In these community samples, those in mixed-gender distressed relationships were at 2-3 times higher risk than those in nondistressed relationships for any physical IPV during the past year and at 3-6 times higher risk for clinically significant psychological and physical IPV during the past year. Given that the increase in IPV risk is similar for individuals in distressed community relationships and therapy-seeking relationships, the prior findings of the elevated rates of IPV in clinical samples are unlikely to be due to therapy-seeking. Although epidemiological risk involves statistical, not causal, associations, the increased co-occurrence of IPV in distressed mixed-gender couples fits with numerous theories of IPV and has implications for both screening and future research.
Internationally, intimate partner violence (IPV) cohorts have demonstrated associations with depression and anxiety. However, this association has not yet been described in a UK population, nor has ...the association with serious mental illness (SMI).
To explore the relationship between IPV exposure and mental illness in a UK population.
We designed a retrospective cohort study whereby we matched 18 547 women exposed to IPV to 74 188 unexposed women. Outcomes of interest (anxiety, depression and SMI) were identified through clinical codes.
At baseline, 9174 (49.5%) women in the exposed group had some form of mental illness compared with 17 768 (24.0%) in the unexposed group, described as an adjusted odds ratio of 2.62 (95% CI 2.52-2.72). Excluding those with mental illness at baseline, 1254 exposed women (incidence rate 46.62 per 1000 person-years) went on to present with any type of mental illness compared with 3119 unexposed women (incidence rate 14.93 per 1000 person-years), with an aIRR of 2.77 (95% CI 2.58-2.97). Anxiety (aIRR 1.99, 95% CI 1.80-2.20), depression (aIRR 3.05, 95% CI 2.81-3.31) and SMI (aIRR 3.08, 95% CI 2.19-4.32) were all associated with exposure to IPV.
IPV remains a significant public health issue in the UK. We have demonstrated the significant recorded mental health burden associated with IPV in primary care, at both baseline and following exposure. Clinicians must be aware of this association to reduce mental illness diagnostic delay and improve management of psychological outcomes in this group of patients.
The aim of this article was to conduct a rapid critical review of the literature about the relationship between violence against women (VAW) and the current COVID-19 pandemic.
After the screening ...process, a total of 42 articles were considered. Our review confirmed that the “stay at home” policies to contrast the pandemic have increased the problem of VAW, creating a “shadow pandemic within the pandemic”, as it was called by the United Nations. However, rigorous studies estimating the relationship between VAW and COVID-19 pandemic are scarce; most of the articles are commentaries, letters, editorials, and most of the published data derives from social media, internet, anecdotal evidence and helplines reports.
Health care systems should promote further investigations into the relation between VAW and COVID-19, to identify creative solutions to provide clinical care and forensic services for victims of VAW.
We assessed the impact of a personal agency-based training for refugee women and their male partners on their economic and social empowerment, rates of intimate partner violence (IPV), and ...non-partner violence (NPV).
We conducted an individually randomized controlled trial with 1061 partnered women (aged 18-45) living in a refugee camp in Rwanda. Women received two days of training, and their partners received one day of training. The follow-up survey where all relevant outcomes were assessed was carried out at 6-9 months post-intervention.
At follow up, women in the intervention arm were more likely to report partaking in income generating activities (aIRR 1.27 (1.04-1.54), p < 0.05) and skill learning (aIRR 1.59 (1.39-1.82), p < 0.001) and reported a reduction in experience of physical or sexual NPV in the past six months (aIRR 0.65 (0.39-1.07), p < 0.09). While improved, no statistically significant impacts were seen on physical or sexual IPV (aIRR 0.80 (0.58-1.09), p = 0.16), food insecurity (β 0.98 (0.93 to 1.03), p = 0.396), or clean cookstove uptake (aIRR 0.95 (0.88 to 1.01), p = 0.113) in the past six months. We found statistically significant reduction in physical and sexual IPV amongst those experiencing IPV at baseline (aIRR 0.72 (0.50 to 1.02), p < 0.07). Small improvements in self-efficacy scores and our indicator of adapting to stress were seen in the intervention arm. Some challenges were also seen, such as higher prevalence of probable depression and/or anxiety (aIRR 1.79 (1.00-3.22), p = 0.05) and PTSD (aIRR 2.07 (1.10-3.91), p < 0.05) in the intervention arm compared to the control arm.
Our findings echo previous research showing personal agency training can support economic well-being of women. We also find potentially promising impacts on gender-based violence. However, there is some evidence that integration of evidence-based mental health support is important when enhancing agency amongst conflict-affected populations.
The trial was registered with ClinicalTrials.gov, Identifier: NCT04081441 on 09/09/2019.
Intimate partner violence is widespread and represents an obstacle to human freedom and a significant public health concern. Poverty alleviation programs and efforts to economically “empower” women ...have become popular policy options, but theory and empirical evidence are mixed on the relationship between women's empowerment and the experience of violence. We study the effects of a successful poverty alleviation program on women's empowerment and intimate partner relations and violence from 2009 to 2011. In the first experiment, a cluster-randomized superiority trial, 15 marginalized people (86% women) were identified in each of 120 villages (n = 1800) in Gulu and Kitgum districts in Uganda. Half of villages were randomly assigned via public lottery to immediate treatment: five days of business training, $150, and supervision and advising. We examine intent-to-treat estimates of program impact and heterogeneity in treatment effects by initial quality of partner relations. 16 months after the initial grants, the program doubled business ownership and incomes (p < 0.01); we show that the effect on monthly income, however, is moderated by initial quality of intimate partner relations. We also find small increases in marital control (p < 0.05), self-reported autonomy (p < 0.10), and quality of partner relations (p < 0.01), but essentially no change in intimate partner violence. In a second experiment, we study the impact of a low-cost attempt to include household partners (often husbands) in the process. Participants from the 60 waitlist villages (n = 904) were randomly assigned to participate in the program as individuals or with a household partner. We observe small, non-significant decreases in abuse and marital control and large increases in the quality of relationships (p < 0.05), but no effects on women's attitudes toward gender norms and a non-significant reduction in autonomy. Involving men and changing framing to promote more inclusive programming can improve relationships, but may not change gender attitudes or increase business success. Increasing women's earnings has no effect on intimate partner violence.
Research from high-income countries shows that witnessing intimate partner violence (IPV) between caregivers is experienced by up to a third of all children and is related to poor mental health ...outcomes. Much less is known about the burden of witnessing IPV in low- and middle-income countries.
This study seeks to explore the magnitude of witnessing IPV between caregivers, its association with other types of violence and the relationship between witnessing IPV in the past and current mental distress.
Representative data from the Violence against Children Surveys (VACS) from Cambodia (N = 2373), Malawi (N = 2147) and Nigeria (N = 4098) are employed.
Logistic regression was applied to assess the association between witnessing IPV in childhood and mental distress in adulthood.
Between 22.4 % and 34.3 % of participants witnessed IPV between their caregivers during childhood. Respondents who witnessed IPV had higher odds of mental distress, compared to those who did not witness IPV in Cambodia (OR 2.73 2.02, 3.72 for females, OR 2.38 1.67, 3.41 for males) and Malawi (OR 2.48 1.43, 4.28 for females, OR 1.66 1.11, 2.48 for males). In Nigeria only male respondents who witnessed IPV had higher odds of mental distress (OR 2.12 1.60, 2.80), but females had no significant association (OR 0.91 0.68, 1.20).
The findings highlight the association of negative mental health consequences faced by children living in households with intimate partner violence for selected low- and middle-income countries. Children’s exposure to IPV should be considered when providing support to survivors of IPV. Special considerations should be made to provide culturally and resource-appropriate support.
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