Jay G. Silverman

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.

Pregnancy coercion, intimate partner violence and unintended pregnancy ☆

BACKGROUND Reproductive control including pregnancy coercion (coercion by male partners to become pregnant) and birth control sabotage (partner interference with contraception) may be associated with partner violence and risk for unintended pregnancy among young adult females utilizing family planning clinic services. STUDY DESIGN A cross-sectional survey was administered to females ages 16-29 years seeking care in five family planning clinics in Northern California (N=1278). RESULTS Fifty-three percent of respondents reported physical or sexual partner violence, 19% reported experiencing pregnancy coercion and 15% reported birth control sabotage. One third of respondents reporting partner violence (35%) also reported reproductive control. Both pregnancy coercion and birth control sabotage were associated with unintended pregnancy (AOR 1.83, 95% CI 1.36-2.46, and AOR 1.58, 95% CI 1.14-2.20, respectively). In analyses stratified by partner violence exposure, associations of reproductive control with unintended pregnancy persisted only among women with a history of partner violence. CONCLUSIONS Pregnancy coercion and birth control sabotage are common among young women utilizing family planning clinics, and in the context of partner violence, are associated with increased risk for unintended pregnancy.

Health status and health care use of Massachusetts women reporting partner abuse

BACKGROUND Studies indicate that women abused by their intimate partners are at increased risk for a number of health problems and have increased rates of health care utilization. However, these findings are based mainly on studies using clinic or health plan populations. In this study, we examined the association between intimate partner abuse (IPA) and health concerns and health care utilization in a population-based sample of adult women. METHODS We analyzed data on 2043 women aged 18 to 59 who participated in the 1998 Massachusetts Behavioral Risk Factor Surveillance System (BRFSS), a population-based health survey that included questions on IPA. IPA was defined as experiencing physical violence by, fear of, or control by an intimate partner. Consequences of IPA and self-rated health status and health care utilization of women experiencing IPA were examined. RESULTS A total of 6.3% of Massachusetts women aged 18 to 59 reported IPA during the past year. Women experiencing IPA were more likely than other women to report depression, anxiety, sleep problems, suicidal ideation, disabilities, smoking, unwanted pregnancy, HIV testing, and condom use. Women experiencing IPA were less likely to have health insurance, but received routine health care at similar rates as other women. CONCLUSIONS These results indicate that women in the general population experiencing IPA are at increased risk for several serious emotional and physical health concerns. Most of these women are in routine contact with health care providers. These findings also suggest that the BRFSS may provide a valuable mechanism for tracking state-based IPA prevalence rates over time.

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.

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.

Violence against wives, sexual risk and sexually transmitted infection among Bangladeshi men

Objective: To assess the relationship between men’s reported violence against wives and their sexual risk behaviours and sexual health. Design, setting and participants: Cross-sectional analyses of a survey of a nationally representative household-based sample of married men in Bangladesh (n = 3096). Main outcome measure(s): Physical and sexual violence against wives during the previous 12 months was assessed and examined for relations to men’s extramarital sexual behaviours and sexually transmitted infection (STI) symptoms or diagnosis during this same period, as well as to men’s disclosure of such infection to wives and condom use while infected. Results: More than 1 in 3 (36.84%) married Bangladeshi men reported physically and/or sexually abusing their wives in the past year. Men perpetrating such violence were more likely to report both premarital and extramarital sex partners (ORadjs 1.80–3.45; 95% CI 1.20 to 8.23); those reporting physical violence were more likely to report STI symptoms or diagnosis in the past year (ORadjs 1.68–2.52; 95% CI 1.24 to 3.73). Men perpetrating physical violence and contracting an STI were somewhat more likely to fail to disclose infection status to wives (ORadj 1.58; 95% CI 0.93 to 2.70) than infected men not reporting such abuse. Conclusions: Violence against wives is common among Bangladeshi men. Men who perpetrate such abuse represent increased risk regarding their wives’ sexual health because they are more likely to both participate in extramarital sexual behaviour and contract an STI compared with non-abusive husbands. Given the growing epidemic of HIV infection among monogamous South Asian women based on intercourse with infected non-monogamous husbands, research and intervention regarding men’s violence in marriage and implications of such behaviour for women’s sexual health should be prioritised.