Manisha Joshi

Intersections of Harm and Health A Qualitative Study of Intimate Partner Violence in Women's Lives

Eight focus groups of women with recent exposure to intimate partner violence (IPV) were conducted to elicit womens descriptions of how IPV affects their health. Their shared narratives reveal a complex relationship with three main points of intersection between IPV and health: IPV leading to adverse health effects; IPV worsening already compromised health; and womens illness or disability increasing dependency on abusive partners, thereby lengthening the duration of IPV exposure. Women describe bidirectional and cyclical ways through which IPV and health intersect over time. Service providers, including physicians, need to better understand the myriad ways that abuse affects womens health.

“Do You Know What It Feels Like to Drown?” Strangulation as Coercive Control in Intimate Relationships

Strangulation is a unique and particularly gendered form of nonfatal intimate partner violence, affecting 10 times as many women as men. Medical research documents multiple negative health outcomes of such victimization, and in the past decade nearly 30 U.S. states have enacted laws making nonfatal strangulation a felony. We extended prior work by using grounded theory in a qualitative study to explore women’s experiences of, thoughts about, and reactions to being strangled. Each of the 17 mostly well-educated and African American domestic violence shelter residents had been strangled at least once by an intimate partner; most had survived multiple strangulations. Despite other severe abuse and a high level of fear, all were shocked that their partner strangled them. Participants reported an intense sense of vulnerability when they recognized during the assault how easily they could be killed by their partner. Nonetheless, they seemed to think of strangulation, not as a failed murder attempt, but as a way to exert power. Efforts to extricate themselves from a “choking” largely failed and resistance resulted in an escalation of the violence. Moreover, strangulation is difficult to detect which, as participants observed, makes it especially useful to the abuser. The aftereffects permeated the relationship such that strangulation need not be repeated in order for her to be compliant and submissive, thus creating a context of coercive control.

“I Didn't Know I Could Turn Colors”: Health Problems and Health Care Experiences of Women Strangled by an Intimate Partner

Strangulation is a unique and particularly pernicious form of intimate partner violence. To increase the relatively little that is known about strangulation survivors, focus groups and interviews were conducted as part of a practice–research engagement with a domestic violence shelter. All of the participants had been strangled and, among them, almost all were strangled multiple times. The loss of consciousness was common. Participants associated “choking” with use of body parts and “strangling” with use of objects. Although some minimized the assault, most considered strangulation to be serious and reported a variety of medical conditions following the assault. Few sought medical care. Of those who did, few disclosed the assault, or were asked about strangulation, which commonly resulted in misdirected treatment. Implications for improving detection and treatment are discussed.

Knowing a Sexual Assault Victim or Perpetrator A Stratified Random Sample of Undergraduates at One University

Rape awareness and prevention programs are common on college campuses and a potentially useful way to reach large numbers of young adults. One largely unexamined potential mediator or moderator of program effectiveness is the personal knowledge of student audiences. In this study, we assess the prevalence of knowing a victim and, notably, a perpetrator of sexual assault. A stratified random sample of 2,400 undergraduates was recruited for an online survey about sexual assault. A total of 53.5% participated and yielded a sample representative of the student body. Sixteen questions were modified from the Sexual Experiences Survey to assess whether participants knew a victim of any one of eight types of sexual assault. Findings indicate that students begin college with considerable personal knowledge of sexual assault victimization and perpetration. Nearly two thirds (64.5%) reported that they know one or more women who were a victim of any one of eight types of sexual assault, and over half (52.4%) reported that they know one or more men who perpetrated any of the types of sexual assault. Most students reported knowing victims and perpetrators of multiple types of assault. Knowledge varied substantially by gender and ethnicity. Students’ preexisting personal knowledge should be included in assessments of program effectiveness and, ideally, in program design.

A Systematic Review of the Epidemiology of Nonfatal Strangulation, a Human Rights and Health Concern

We reviewed the literature on the epidemiology of nonfatal strangulation (also, albeit incorrectly, called choking) by an intimate partner. We searched 6 electronic databases to identify cross-sectional, primary research studies from 1960 to 2014 that reported national prevalence estimates of nonfatal strangulation by an intimate partner among community-residing adults. Of 7260 identified references, 23 articles based on 11 self-reported surveys in 9 countries met the inclusion criteria. The percentage of women who reported ever having been strangled by an intimate partner ranged from 3.0% to 9.7%; past-year prevalence ranged from 0.4% to 2.4%, with 1.0% being typical. Although many epidemiological surveys inquire about strangulation, evidence regarding its prevalence is scarce. Modifying or adding a question to ongoing national surveys, particularly the Demographic and Health Surveys, would remedy the lack of data for low- and middle-income countries. In addition, when questions about strangulation are asked, findings should be reported rather than only combined with other questions to form broader categories (e.g., severe violence). Such action is merited because of the multiple negative short- and long-term sequelae of strangulation.

Intimate Partner Violence at the Scene: Incident Characteristics and Implications for Public Health Surveillance.

Using data that, to our knowledge, have not been used before for this purpose, we examined 9,231 opposite-sex intimate partner violence (IPV) calls for law enforcement assistance recorded in the Compstat system of a large U.S. city. Although women were the predominant victims, injuries were documented more often for men. Only about 1% of incidents were considered a restraining order violation, although many orders were active in the city at the time. The data appeared to be of good quality and just a few changes in recording procedures would increase Compstat’s usefulness for public health in U.S. cities.

A national survey of attitudes toward intimate partner violence among married women in Kazakhstan, Kyrgyzstan, and Tajikistan: implications for health prevention and intervention

ABSTRACT Attitudes toward intimate partner violence (IPV) can affect the prevalence of IPV, response of victims’ to IPV (e.g., whether to seek help), and the response of professionals (e.g., police, social workers, health care professionals) to IPV. Knowledge about IPV-related attitudes is essential for developing effective social work and violence-related programs. Using data from the 2005–2006 Multiple Indicator Cluster Surveys, this study examines attitudes toward IPV and socio-demographic predictors of these attitudes among married women in Kazakhstan, Kyrgyzstan, and Tajikistan. Women were asked whether they approved of a husband beating his wife: if she goes out without telling him, neglects their children, argues, refuses to have sex, and burns food. The prevalence of IPV acceptance for at least one of the five reasons varied from 12.3% in Kazakhstan to 45.3% in Kyrgyzstan and 74.5% in Tajikistan. Women who were less educated, members of Asian ethnic groups, resided in middle-class urban areas, and lived in specific regions were more likely to accept IPV. Few age differences that emerged indicated that young women were more approving of IPV. Proactive efforts are needed to confront attitudes about gender roles and IPV in Tajikistan and Kyrgyzstan.

Intimate Partner Violence Among Female Service Members and Veterans: Information and Resources Available Through Military and Non-Military Websites

With the expansion of women’s roles in the military, the number of female service members and veterans has increased. Considerable knowledge about intimate partner violence (IPV) in civilian couples exists but little is known about IPV among female service members and veterans. Prevalence rates of IPV range from 17% to 39% for female service members, and 21.9% to 74% for veterans. Most service members and veterans indicated using the Internet at least occasionally and expressed willingness to seek information about services via the Internet. Informed by data, we conducted a systematic review of military (Army, Navy, Air Force, and Marine Corps) and non-military (Veterans Affairs and Google) websites to explore the availability and presentation of information and resources related to IPV. The websites search revealed a variety of resources and information available, and important differences between sites with regard to what and how information is presented. Implications for practice and further research are discussed.

Language of Sexual Violence in Haiti: Perceptions of Victims, Community-level Workers, and Health Care Providers

Non-partner sexual violence (NPSV), an important risk factor for HIV, is of global public health significance and understudied. The 2010 earthquake interacted syndemically with structural factors to increase sexual violence and HIV risk for women in Cité Soleil, Haiti. We used an exploratory sequential qualitative design and Grounded Theory to investigate language/terminology for NPSV, victims and perpetrators, and health effects of NPSV on victims, in four focus groups: Health care providers (HCPs) (n=3; n=8), community advocates (n=8), and victims (n=8). Crucial differences exist among stakeholders: HCPs prefer French and possess different explanatory models of illness from victims, who provided more extensive and explicit descriptions (e.g., “strangled like a chicken,” “tuyo”/“faucet”/“flooding” for gang rapes). Victims also reported purposeful injury to their external and internal genitalia, signaling STI/HIV risk. Reconciling within-culture differences between victims and HCPs can inform screening, diagnosis, treatment, follow-up and delivery of relevant interventions.

Assessing the Development of Cultural Proficiency Among Upper-Level Social Work Students

ABSTRACT Graduate social work pedagogy is challenging to diverse faculty and students who work with diverse clients, often in international practice. We discuss the development, outcomes, and assessment of an assignment designed to stimulate students’ research on proverbs as cultural resources for practice and to promote attainment of six competencies related to diversity and social justice of the Council on Social Work Education’s Educational Policy and Accreditation Standards. We used procedures from grounded theory and Atlas.ti to analyze 40 student papers. More than 70% of papers reflected students’ mastery of three competencies, suggesting the assignment was insufficient to ensure attainment of all six competencies and signaling errors in the structure of the assignment and in the rubric. Ensuring students’ achievement of the competencies requires careful design and assessment of assignments and deliberate, structured assessment of the assignment outcomes.