Anita Raj

Violence Against Immigrant Women: The Roles of Culture, Context, and Legal Immigrant Status on Intimate Partner Violence

Intimate partner violence against immigrant women is at epidemic proportions, but research has only recently begun to address the concern. A review of the legal, medical, and social science research literature reveals little data, but that which exist demonstrate that immigrant womens cultures, contexts, and legal status (a) increase vulnerability for abuse, (b) are used by batterers to control and abuse immigrant women, and (c) create barriers to women seeking and receiving help. Data also reveal that immigrant culture and context offer resiliency factors through which programs and policy can be used to better serve these populations.

On the Margin: Power and Women's HIV Risk Reduction Strategies

HIV risk and prevention research has failed to investigate adequately the effects of gender-related factors such as relationship power, sexual communication, abuse, and gender roles on womens abilities to engage in protective actions. We propose that womens HIV risk from heterosexual transmission is embedded in the context of gender, race/ethnicity, and class oppression. This context has central implications for interpersonal relationship factors relevant to womens HIV risk. We suggest a framework for understanding womens HIV risk within the context of oppression and the role of power in intimate sexual relationships. Three common dynamics of oppression are considered: (1) Silencing, (2) Violence and Fear of Violence, and (3) Internalized Oppression. These dynamics are based on characteristics of oppression discussed in the work of Jean Baker Miller on gender, Hussain Bulhan on race, and Paulo Freire on class. These dynamics are discussed in the context of findings reported in this journal issue and those of other authors. Finally, the discussion identifies common patterns across studies, as well as areas of disagreement and directions for future research and public health prevention efforts.

Intimate partner violence and unwanted pregnancy, miscarriage, induced abortion, and stillbirth among a national sample of Bangladeshi women

Objective  To estimate (1) lifetime prevalence of physical and sexual victimisation from husbands among a national sample of Bangladeshi women, (2) associations of unwanted pregnancy and experiences of husband violence, and (3) associations of miscarriage, induced abortion, and fetal death/stillbirth and such victimisation.

Prevalence of child marriage and its effect on fertility and fertility-control outcomes of young women in India: a cross-sectional, observational study

BACKGROUND Child marriage is a substantial barrier to social and economic development in India, and a primary concern for womens health. We assessed the prevalence of child marriage-ie, before 18 years of age-in young adult women in India, and the associations between child marriage and womens fertility and fertility-control outcomes. METHODS Data from the National Family Health Survey-3 (2005-06) were limited to a sample of Indian women aged 20-24 years (n=22 807), of whom 14 813 had been or were presently married (ever-married). Prevalence of child marriage was estimated for the whole sample. We used regression models adjusted for demographics, and models adjusted for demographics and duration of marriage to estimate odds ratios (ORs) for the associations between child marriage and both fertility and fertility-control outcomes, in the ever-married subsample. FINDINGS 44.5% of women aged 20-24 years were married before age 18 years, 22.6% were married before age 16 years, and 2.6% were married before age 13 years. Child marriage was significantly associated with no contraceptive use before first childbirth (adjusted OR 1.37 [95% CI 1.22-1.54]), high fertility (three or more births) (7.40 [6.45-8.50]), a repeat childbirth in less than 24 months (3.00 [2.74-3.29]), multiple unwanted pregnancies (2.36 [1.90-2.94]), pregnancy termination (1.48 [1.34-1.63]), and female sterilisation (6.68 [5.78-7.60]). The association between child marriage and high fertility, a repeat childbirth in less than 24 months, multiple unwanted pregnancies, pregnancy termination, and sterilisation all remained significant after controlling for duration of marriage. INTERPRETATION Increased enforcement of existing policies is crucial for prevention of child marriage. Improved family-planning education, access, and support are urgently needed for women married as children, their husbands, and their families to reduce the high fertility and poor fertility-control outcomes of this practice. FUNDING US National Institutes of Health and Indian Council of Medical Research.

Adverse consequences of intimate partner abuse among women in non-urban domestic violence shelters

OBJECTIVE This study examined the health consequences of having experienced both sexual and physical abuse relative to women experiencing physical abuse but not sexual abuse. METHODS A cross-sectional study was conducted among 203 women seeking refuge in battered womens shelters. Controlling for sociodemographics, logistic regression analyses were conducted to assess the consequences of experiencing both sexual and physical abuse. RESULTS Compared to women experiencing physical abuse, women experiencing both sexual and physical abuse were more likely to have a history of multiple sexually transmitted diseases (STDs) in their abusive relationships, have had an STD in the past 2 months, be worried about being infected with HIV, use marijuana and alcohol to cope, attempt suicide, feel as though they had no control in their relationships, experience more episodes of physical abuse in the past 2 months, rate their abuse as more severe, and be physically threatened by their partner when they asked that condoms be used. CONCLUSIONS Given the prevalence of adverse health outcomes, domestic violence shelters could counsel women to avoid using alcohol/drugs as a coping strategy, educate women about alternative healthy coping strategies, counsel women about methods of STD prevention that they can control, and provide STD screening and treatment.

Perpetration of Intimate Partner Violence Associated With Sexual Risk Behaviors Among Young Adult Men

OBJECTIVE We assessed the association between intimate partner violence (IPV) perpetration and sexual risk behaviors and fatherhood (having fathered children) among young men. METHODS Sexually active men aged 18 to 35 years who visited an urban community health center and who reported having sexual intercourse with a steady female partner during the past 3 months (N = 283) completed a brief self-administered survey about sexual risk behaviors, IPV perpetration, and demographics. We conducted logistic regression analyses adjusted for demographics to assess associations between IPV and sexual risk behaviors and fatherhood. RESULTS Participants were predominantly Hispanic (74.9%) and Black (21.9%). Participants who reported IPV perpetration during the past year (41.3%) were significantly more likely to report (1) inconsistent or no condom use during vaginal and anal sexual intercourse, (2) forcing sexual intercourse without a condom, (3) having sexual intercourse with other women, and (4) having fathered 3 or more children. CONCLUSION IPV perpetration was common among our sample and was associated with increased sexual risk behaviors. Urban community health centers may offer an important venue for reaching this at-risk population.

The Relationship Between Sexual Abuse and Sexual Risk Among High School Students: Findings from the 1997 Massachusetts Youth Risk Behavior Survey

Objective: To assess whether adolescents with a history of sexual abuse were more likely than those with no such history to engage in sexual risk behaviors. Methods: Data for this study were obtained through the 1997 Massachusetts Youth Risk Behavior Survey, a self-report questionnaire administered to a representative sample of 9th through 12th graders (N = 4014) to assess a variety of adolescent risk behaviors. Only sexually experienced adolescents (n = 1610; female = 779, male = 831) were included in the present study. Logistic regression models were constructed to examine the relationship of sexual abuse history to sexual risk behaviors. Adolescents were considered as having a history of sexual abuse if they reported ever having had sexual contact against their will. Results: Almost one- third of sexually experienced adolescent girls (30.2%) and one-tenth (9.3%) of adolescent boys reported a history of sexual abuse. After controlling for related demographics and risk behaviors, sexually abused female students were significantly more likely than those without such a history to have had earlier first coitus (OR = 2.2, 95%CI = 1.46–3.47), to have had three or more sex partners ever (OR = 2.5, 95%CI = 1.71–3.68), and to have been pregnant (OR = 1.9, 95%CI = 1.21–2.92). Sexually abused male students were significantly more likely than those without such a history to have ever had multiple partners (OR = 3.2, 95%CI = 1.56–6.57), to have had multiple sex partners in the past 3 months (OR = 2.9, 95%CI = 1.71–3.68), and to have engaged in sex resulting in pregnancy (OR = 3.4,95%CI = 1.53–7.34). Conclusion: Both adolescent girls and boys with a history of sexual abuse report greater sexual risk-taking than those without such a history. However, although sexual abuse is more prevalent among girls than boys, the impact of sexual abuse on sexual risk appears to be even greater for boys. Programs addressing both sexual abuse and sexual risk must be made available to all adolescents.

Dating Violence and Sexually Transmitted Disease/HIV Testing and Diagnosis Among Adolescent Females

Objective.Previous studies demonstrate significant associations between dating-violence victimization and sexual risk behaviors among adolescent girls; however, a relationship between dating violence and actual sexually transmitted disease (STD)/HIV testing and diagnosis has yet to be investigated among a representative sample. The present study assesses associations between dating violence and STD/HIV testing and diagnosis among a representative sample of sexually active adolescent girls. Methods.Data from 9th- to 12th-grade female students completing the 1999 and 2001 Massachusetts Youth Risk Behavior Surveys and reporting having ever had sexual intercourse (N = 1641) were examined. Odds ratios for STD/HIV testing and diagnosis that were based on experiences of dating violence and adjusted for STD/HIV risk behaviors and demographics were calculated. Results.More than one third (38.8%) of adolescent girls tested for STD or HIV and more than half (51.6%) of girls diagnosed with STD/HIV reported experiencing dating violence. Compared with nonabused girls, girls who experienced both physical and sexual dating violence were 3.0 times more likely to have been tested for STD and HIV, and 2.6 times more likely to report an STD diagnosis. Conclusions.After adjusting for STD/HIV risk behaviors, dating violence remains significantly associated with STD/HIV testing and diagnosis among sexually active adolescent girls.

Immigrant South Asian Women at Greater Risk for Injury From Intimate Partner Violence

Intimate partner violence and intimate partner violence–related homicide disproportionately affect immigrant women.1–6 South Asian women residing in the United States appear to be at particularly high risk for intimate partner violence, with 40% reporting intimate partner violence in their current relationship in a recent study.3 Other research indicates that immigration-related social isolation, often resulting from the absence of both family in the United States and community support for intimate partner violence victims, and lack of awareness of intimate partner violence services prevent battered South Asian women from seeking help.3,7–13 These findings suggest that factors related to immigration may place South Asian immigrant women at increased risk for intimate partner violence. The purpose of the current study was to assess the relations between immigration-related factors and intimate partner violence among a sample of South Asian women residing in the United States.

WOMEN'S SEXUAL HEALTH: THE NEED FOR FEMINIST ANALYSES IN PUBLIC HEALTH IN THE DECADE OF BEHAVIOR

Womens sexual health is directly affected by womens low status in society. This low status, and subsequent lack of sexual autonomy not only increases risk for sexual health problems, it also decreases ability to obtain treatment and support when a sexual health concern arises. This has clearly been demonstrated in the HIV epidemic within the U.S. Earlier in the epidemic, women were simply ignored by public health research and practice. Once they could no longer be ignored, they were blamed and viewed as vectors. Current seroprevalence rates among men reveal that women are not significant vectors. In contrast, rates among women indicate that infection from men is the primary mechanism by which women are contracting HIV, and male-controlled sexual decision-making, male partner violence against women, and histories of sexual assault all contribute to increased HIV risk for women. Once infected, women are not given the support and resources they need as mothers and caretakers of HIV-positive partners and/or children. These findings are especially true for marginalized women such as women of color, poor women, women addicted to alcohol or drugs, and women who exchange sex for drugs or money. Findings from this review demonstrate the need for feminist approaches in understanding and addressing this issue in the Decade of Behavior. Such approaches must include an understanding of the needs of diverse women. An empowerment approach is needed to better contend with the sexual health needs of women; this must include the goal of ensuring womens control of their own bodies.