Prevalence of rape-related pregnancy as an indication for abortion at two urban family planning clinics

Sexually Transmitted Infection/Human Immunodeficiency Virus, Pregnancy, and Mental Health-Related Services Provided During Visits With Sexual Assault and Abuse Diagnosis for US Medicaid Beneficiaries, 2019

BACKGROUND

Centers for Disease Control recommends that the decision to provide sexually transmitted infection (STI)/human immunodeficiency virus (HIV) testing and presumptive treatment to patients who report sexual assault and abuse (SAA) be made on an individual basis.

METHODS

The 2019 Centers for Medicare & Medicaid Services national Medicaid data set was used. The SAA visits were identified by International Classification of Diseases 10th Revision Clinical Modification (O9A4 for pregnancy-related sexual abuse, T74.2 for confirmed sexual abuse, and Z04.4 for alleged rape). The initial SAA visit was defined as the patient's first SAA-related visit. Medical services were identified by International Classification of Diseases 10th Revision Clinical Modification codes, Current Procedural Terminology codes, and National Drug Code codes.

RESULTS

Of 55,113 patients at their initial SAA visits, 86.2% were female; 63.4% aged ≥13 years; 59.2% visited emergency department (ED); all STI/HIV tests were provided in ≤20% of visits; presumptive gonorrhea and chlamydia treatment was provided in 9.7% and 3.4% of visits, respectively; pregnancy test was provided in 15.7% of visits and contraception services was provided in 9.4% of visits; and diagnosed anxiety was provided in 6.4% of visits. Patients who visited ED were less likely to have STI testing and anxiety than those visited non-ED facilities, but more likely to receive presumptive treatment for gonorrhea, testing for pregnancy, and contraceptive services. About 14.2% of patients had follow-up SAA visits within 60 days after the initial SAA visit. Of 7821 patients with the follow-up SAA visits within 60 days, most medical services provided were chlamydia testing (13.8%), gonorrhea testing (13.5%), syphilis testing (12.8%), HIV testing (14.0%); diagnosed anxiety (15.0%), and posttraumatic stress disorder (9.8%).

CONCLUSIONS

Current medical services during SAA visits for Medicaid patients are described in this evaluation. More collaboration with staff who handle SAA will improve SAA-related medical services.

Patient satisfaction with Sexual Assault Nurse Examiner services and post-assault resource utilization at a university health center and emergency department

Objective: Describe a model for incorporating campus-based Sexual Assault Nurse Examiner (SANE) services. Describe differences in patient satisfaction and utilization of follow-up resources between patients seeking SANE services at a university health center (UHC) compared to an emergency department (ED). Participants: Patients seeking SANE services at the UHC or ED of a large Midwestern university from January 2016-April 2018. Fifty-eight participants completed a satisfaction survey, including 28 students. Twenty-eight participants completed a follow-up survey, including 15 students. Methods: A Qualtrics survey assessed: 1) satisfaction following the SANE exam and 2) use of follow-up services 4-6 weeks later. Descriptive analyses, exact logistic regressions, and OLS regressions were calculated. Results: There were no differences in satisfaction, services received, or follow-up services accessed between patients at the UHC and ED, including between students. Conclusions: Campus-based SANE services meet the expectations of survivors and do not differ significantly from services at the ED.

Medical and psychological consequences of rape among survivors during armed conflicts in northeast Ethiopia

BACKGROUND

Rape is the most common act of violence against women during wartime which is considered interpersonal, social and political violence because survivors usually suffer from stigma and discrimination in the community. Sexual violence is a serious threat to women's health. The psychological and medical consequences of rape during the conflict period are not well documented. Therefore, this study investigated the psychological and medical consequences of rape among survivor in the northern Ethiopia conflict, which occurred since 2020-2022.

METHODS

A retrospective cross-sectional survey supplemented with a qualitative data was conducted among survivors of rape recorded until June 2022. Health institutions that provide maternal and child health services in the study area were included. All rape victims who received medical care following the incident were included. Victims who were found in active war areas or rape care recorded before wartime were excluded. To understand the experience of raped women's psychological consequences related to sexual assault we conducted 23 in-depth interviews. Thematic analysis was used to conduct qualitative interpretation.

RESULTS

The mean age of the participants was 31.66 (SD ± 20.95) years. One-third of 92(33.9%) of the survivors were diagnosed positive for sexually transmitted infections. Chlamydia 54(58.4%) and HIV 32(34.8%) were the most frequently diagnosed infections. Among the rape survivors, one-tenth 29(10.7%) of them were positive for pregnancy, and induced abortion was done for 13 (44.8%) women who got pregnant due to sexual assault. The armed groups not only have sexual interests but inhumane individuals and consider rape as their way of expressing abjection to civilians. Survivors of raped women are confronted with social rejection and exclusion in the community that aggravates the traumatic process. Because of shame and fear, rape survivors often do not seek help but have to be offered support proactively. The victims claimed that they didn't able to return to their previous life and considered their future in peril.

CONCLUSION

Conflict has a multidimensional devastating life effect, especially on women's health. The victims experienced many physical and psychological consequences. Hence, resolving conflicts with peaceful discussion has numerous benefits for civilians.

Violence and sexually transmitted infections in pregnancy

OBJECTIVE

To synthesize the knowledge produced in studies about the association between violence and STI during pregnancy.

METHODS

In this systematic review, we conducted basic activities of identification, compilation, and registration of the trials. The instruments of data collection were studies that investigated, explicitly, relationships between violence, gestation, and STI, from July 2012 to July 2017, using PubMed, Cochrane Library, SciELO, and LILACS.

RESULTS

In all, 26 articles were chosen to form the basis of the analysis of this study. The relationship between violence and STI was observed in 22 of the 26 studies, and in eight of them, the violence was practiced during the gestation period. In two studies, there was no evidence of this relationship. In one study, the lack of care for STI was attributed to the unpreparedness of health professionals. Mental disorders were cited as resulting from STI in three articles and in another as a result of violence. One study found more frequent violence against adolescents, while two others cited gestation as a protective factor.

CONCLUSIONS

IPV combines characteristics that have a different expression when the woman is in the gestational period. The literature points to a relationship between IPV against women and the presence of STI. The monitoring of pregnancy, whether in the prenatal or postpartum period, offers unique opportunities for the health professional to identify situations of violence and thus provide assistance.