Providing sanctuary for battered women: Nicaragua's casas de la mujer

Effectiveness of secondary and tertiary prevention for violence against women in low and low-middle income countries: a systematic review

BACKGROUND

Violence against women (VAW) is a major problem worldwide, with one in three women experiencing violence in their lifetime. While interventions to prevent violence (primary prevention) are extremely important, they can take many years. This review focuses on secondary and tertiary prevention interventions that address the needs of survivors of violence and aim to prevent recurrence. This review also focuses on studies taking place in low and low-middle income countries, where rates of VAW are highest.

METHODS

Searches of peer-reviewed and grey literature took place from March-June 2016 through databases (Embase, CINAHL, WHO Global Index Medicus, Medline, PsychINFO, Web of Science, Cochrane Library, Applied Social Sciences Index and Abstracts and Sociological Abstracts) and by consulting experts in the field. Only primary research was eligible for inclusion and studies had to focus on secondary or tertiary prevention for survivors of VAW in low or low-middle income countries. All study designs were eligible, as long as the study examined client-related outcome measures (e.g., incidence of violence, health outcomes or client satisfaction). Data were extracted and quality of the studies was assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies and a qualitative quality assessment tool developed by Mays and Pope. Due to the low number of results and heterogeneity of the study populations and outcomes, a narrative synthesis was conducted and evidence was summarized.

RESULTS

One thousand two hundred fifteen studies were identified through the search strategy and 22 of these met the eligibility criteria. Overall, the evidence for interventions is weak and study limitations prevent definitive conclusions on what works. There is some evidence that interventions targeting alcohol use, both among perpetrators and survivors, may be effective at reducing VAW through secondary prevention, and that psychotherapy might be effective for survivors of non-partner sexual violence through tertiary prevention. Finally, some evidence exists for crisis centres increasing survivors' access to services (through both secondary and tertiary prevention), however, assessment of their impact on future VAW are needed.

CONCLUSIONS

Though some interventions for survivors of VAW have shown evidence of effectiveness, further research is needed, especially high-quality studies with quantitative outcome data.

Considering the Interplay of Cultural Context and Service Provision in Intimate Partner Violence

This qualitative study explored how the cultural context of intimate partner violence affected accessibility to mainstream services for one immigrant group: Haitian women. Analysis of the data revealed two major themes. First, the nature and context of intimate partner violence in the Haitian immigrant community contribute to Haitian women’s reluctance to seek services as well as their overall vulnerability to intimate partner violence. Second, mainstream services are largely inaccessible to Haitian women. The authors conclude with suggestions for overcoming cultural barriers through education, increasing cultural competency of mainstream services, and creating alternative community-based services.

The supportive process for ending intimate partner violence after pregnancy: the experience of Nicaraguan women

This grounded theory study found that Nicaraguan mothers exposed to intimate partner violence (IPV) during pregnancy eventually acted to protect their children and themselves. They experienced ending abuse as an empowerment process characterized by a cognitive change in women's attitudes toward partner abuse and the emergence of help-seeking strategies that lead to ending violence with or without ending the relationship. This process was facilitated by a supportive environment that challenged abusive behaviors as well as being asked about abuse during their last pregnancy. Although environmental changes can facilitate ending abuse, Nicaragua's public institutions must be strengthened to reach women in need.

Bridging Prevention and Health: Exploring Community Perceptions of Intimate Partner Violence in Rural Honduras

This qualitative study rooted in community-based participatory research principles utilized semi-structured interviews with 2 focus groups (n=9) with female healthcare volunteers (FCVs) and 3 male key informants who were community leaders (MCLs). The study aimed to examine how a rural Honduran community defines and responds to intimate partner violence (IPV) in order to lay the foundation for future interventions. Based on grounded theory, the authors assessed for common themes across transcripts. Authors found that a number of participants denied the existence of IPV. Perspectives on the causes and definitions of IPV varied between FCVs and MCLs. All participants affirmed the need for intervention and many participants mentioned healthcare and legal systems as potential venues to ameliorate IPV. The results highlight potentially important differences between FCV and MCL perspectives that may inform future interventions. Findings suggest health-care workers can play a role in IPV prevention and intervention in rural Honduras.

Domestic violence against women in Egypt--wife beating and health outcomes

Research has consistently demonstrated that a woman is more likely to be abused by an intimate partner than by any other person. Many negative health consequences to the victims have been associated with domestic violence against women. Data from the 1995 Egyptian Demographic and Health Survey, a nationally representative household survey, were analyzed for 6566 currently married women age 15-49 who responded to both the main questionnaire and a special module on women's status. Multivariate logistic regressions were used to examine the association of ever-beating, beating in past year or frequency of beatings in past year with contraceptive use, pregnancy management, and report of health problems. Thirty-four percent of women in the sample were ever beaten by their current husband while 16% were beaten in the past year. Ever-beaten women were more likely to report health problems necessitating medical attention as were women beaten in the past year compared to never-beaten women. Regarding reproductive health, higher frequency of beating was associated with non-use of a female contraceptive method, while ante-natal care (ANC) by a health professional for the most recent baby born in the past year was less likely among ever-beaten women (OR = 0.17, p < 0.05). Unexpectedly, among professional ANC patients, those ever-abused were more likely to make four or more visits (OR = 36.54, p < 0.05). In Egypt as elsewhere around the world, wife beating is related to various negative health outcomes. Women's programmes must take domestic violence into account if they want to better address the needs of a non-negligible proportion of their target population.

The neural correlates of mate competition in dominant male rhesus macaques

BACKGROUND

Male sexual jealousy provoked by threatened exclusive access to a female mate is a frequently reported motive in cases involving spousal abuse. Dominant male rhesus macaques also respond aggressively to threats to mating exclusivity.

METHODS

Nine dominant male monkeys were injected with [(18)F]-fluorodeoxyglucose ([(18)F]-FDG) and then exposed to one of two conditions: a "challenge" condition in which they witnessed a potential sexual interaction between their female consort and a rival male, and a control condition in which the consort was present without the rival male. After the brain uptake period for [(18)F]-FDG, dominant males were sedated, blood samples were drawn, and regional cerebral glucose metabolism was measured with positron emission tomographic imaging.

RESULTS

Males that showed larger increases in plasma testosterone in the challenge condition showed more aggression and greater activation in the central gray matter of the midbrain, a brain area rich in androgen receptors. The challenge condition was associated with activation in both right superior temporal sulcus and right amygdala, which might relate to increased social vigilance and anxiety, respectively.

CONCLUSIONS

Sexual jealousy in male humans is also often accompanied by vigilance behavior and anxiety and might recruit a similar neural network to that described here.

Culturally appropriate care for pregnant Latina women who are victims of domestic violence

Latina women who are pregnant and experiencing domestic violence face many barriers to accessing care and finding culturally appropriate services. These barriers are entwined in a complex web of social, cultural, economic, political, and legal issues. Leininger's cultural care model is presented as a framework to discuss culturally appropriate assessment of Latina women in various health care settings. Recommendations are made for the role of nurses in primary prevention interventions at the individual and community levels.

Women's strategic responses to violence in Nicaragua

STUDY OBJECTIVE

To describe the responses of women in León, Nicaragua to partner abuse and identify contextual factors associated with the use of certain coping mechanisms and the likelihood of permanent separation.

DESIGN

Cross sectional population-based survey.

SETTING

León, Nicaragua.

PARTICIPANTS

188 women 15-49 years of age who had experienced physical partner abuse, out of 488 women interviewed.

MAIN RESULTS

66% of women defended themselves effectively from abuse either physically or verbally. Forty one per cent of women had left home temporarily because of violence and 20% had sought help outside the home. Women experiencing severe abuse were more likely to leave or seek help, whereas women with less severe abuse were more able to defend themselves effectively. Seventy per cent of women eventually left abusive relationships. Help seeking and temporary separations increased the likelihood of a permanent separation, whereas women who defended themselves and were able to stop the violence, at least temporarily, were more likely to remain in abusive relationships.

CONCLUSIONS

Women in Nicaragua use a variety of methods in order to overcome physical partner abuse. Temporary leaving and help seeking are critical steps in the process of leaving a violent relationship. However, many women indicated that they did not receive support for their situation. More interventions are needed to help women recognise and deal with violence, as well as strengthening the community support networks available to abused women.

Enduring love: a grounded formal theory of women's experience of domestic violence

Using a grounded formal theory approach, 13 qualitative research reports were analyzed with the goal of synthesizing a middle-range theory of women's responses to violent relationships. The combined sample numbered 282 ethnically and geographically diverse women ages 16-67. Within cultural contexts that normalized relationship violence while promoting idealized romance, these women dealt with the incongruity of violence in their relationships as a basic process of enduring love. In response to shifting definitions of their relationship situations, many women moved through four phases, which began with discounting early violence for the sake of their romantic commitment ("This is what I wanted"), progressed to immobilization and demoralization in the face of increasingly unpredictable violence that was endured by the careful monitoring of partner behavior and the stifling of self ("The more I do, the worse I am"), shifted to a perspective that redefined the situation as unacceptable ("I had enough"), and finally moved out of the relationship and toward a new life ("I was finding me"). Variations in the manifestation and duration of these phases were found to be linked to personal, sociopolitical, and cultural contexts.

Wife abuse among women of childbearing age in Nicaragua

OBJECTIVES

This study measured the prevalence, frequency, and severity of physical wife abuse and its risk factors in León, Nicaragua.

METHODS

A cross-sectional survey was conducted with a representative sample of 488 women 15 to 49 years of age.

RESULTS

The lifetime prevalence of spousal violence was 52% among ever-married women (n = 360). Spousal violence was significantly positively associated with poverty, parity, urban residence, and history of violence in the husband's family. No significant associations were found between spousal violence and women's age, education, marital dependency, or occupation.

CONCLUSIONS

Wife abuse constitutes a major public health problem in Nicaragua, requiring urgent measures for prevention and treatment for victims.

Women's experiences of abuse: a review of qualitative research

This article reviews qualitative research published within the past 15 years based on women's first person accounts of their abuse experiences. Battered women's accounts of their experiences in abusive relationships aid in understanding why they stay, how they cope, and how others can help. Women's views of the emotional consequences of battering, the process of leaving, and the impact of social systems and community resources were consistent. Other themes in the literature were abuse in pregnancy, women who fight back, substance use, sex after beatings, family origins, and women who are elderly, minority, or from other cultures. Future research is needed on minority and affluent women, as well as the role of batterer's patriarchal attitudes and religious beliefs. Practice suggestions include expanding screening and parent education to pediatricians' offices and schools.