Patrizia Romito

Women's health after childbirth: a longitudinal study in France and Italy.

Objective To describe the prevalence of various symptoms five months and twelve months after childbirth in two European countries, according to employment, financial difficulties and relationship with partner.

Social context and drivers of intimate partner violence in rural Kenya: Implications for the health of pregnant women

More than half of rural Kenyan women experience intimate partner violence (IPV) in their lifetime. Beyond physical consequences, IPV indirectly worsens maternal health because pregnant women avoid antenatal care or HIV testing when they fear violent reprisal from partners. To develop an intervention to mitigate violence towards pregnant women, we conducted qualitative research in rural Kenya. Through eight focus group discussions, four with pregnant women and four with male partners, and in-depth interviews with service providers, we explored the social context of IPV using an ecological model. We found that women experienced physical and sexual IPV, but also economic violence such as forced exile from the marital home or losing material support. Relationship triggers of IPV included perceived sexual infidelity or transgressing gender norms. Women described hiding antenatal HIV testing from partners, as testing was perceived as a sign of infidelity. Extended families were sometimes supportive, but often encouraged silence to protect the family image. The broader community viewed IPV as an intractable, common issue, which seemed to normalise its use. These results resonate with global IPV research showing that factors beyond the individual – gender roles in intimate partnerships, family dynamics and community norms – shape high rates of violence.

Unemployment and psychological distress one year after childbirth in France

STUDY OBJECTIVE To analyse the relation between unemployment and the psychological distress of mothers one year after childbirth. DESIGN Multicentric survey concerning births occurring between September 1993 and July 1994. SETTING In France: two maternity units in the Parisian area and one in Champagne-Ardennes, in the east of France, comprising both urban and rural areas. PARTICIPANTS Primipara and secondipara women were interviewed three times: at birth by a face to face interview, five months and 12 months after the birth, by postal questionnaires, with a 83% response rate for the two postal questionnaires. The analysis includes 632 women who answered all three stages of the survey. MEASUREMENTS Psychological distress was mainly assessed one year after birth by the 12-item General Health Questionnaire. RESULTS After adjustment for unwanted pregnancy, marital conflicts, marital status, hospitalisation of the baby during the last year, lack of confiding relationship, depressive or anxious troubles before pregnancy, age, educational level and parity, unemployed women had an excess of psychological distress compared with employed women (OR = 1.87; 95%CI = 1.12, 3.13). The ratios for housewives were very close to those of employed women. Among the unemployed women, 60% had recently been without a job, since a few months before or after the birth. An excess of psychological distress among unemployed compared with employed women was observed in all social groups defined by the current or last occupation, but with various extents. Psychological distress was specially linked to the employment status in the group of women with the more qualified occupations. CONCLUSION Even after a birth, when women are very much involved in their maternal role, those seeking a job have worse mental health than those in a stable situation, either employed or housewives. In France, the unemployment rate among young women is high. It is specially important that social regulations protecting employment during and after pregnancy are adequately applied. Employers, legislators, such as medical doctors, have to be aware to this situation.

Watching Pornography Gender Differences, Violence and Victimization. An Exploratory Study in Italy

The aims of this article are to analyze exposure to pornography, its content, and the associations between victimization and pornography in a sample of 303 students (49.2% female). The questionnaire included questions on pornography exposure, psychological and physical family violence, and sexual violence. Almost all male students and 67% of female students had ever watched pornography; 42% and 32%, respectively, had watched violence against women. Female students exposed to family psychological violence and to sexual violence were significantly more likely to watch pornography, especially violent pornography than those who had not been exposed. No such association was found among male students.

Responses to and Resources for Intimate Partner Violence Qualitative Findings From Women, Men, and Service Providers in Rural Kenya

Intimate partner violence (IPV) is reported by one in three women globally, but the prevalence is much higher in East Africa. Though some formal and informal resources do exist for women experiencing IPV, data suggest that disclosure, help seeking, and subsequent utilization of these resources are often hindered by sociocultural, economic, and institutional factors. This article explores actions taken by victims, available support services, and barriers to the utilization of available IPV resources by pregnant women in rural Nyanza, Kenya. Qualitative data were collected through nine focus group discussions and 20 in-depth interviews with pregnant women, partners or male relatives of pregnant women, and service providers. Data were managed in NVivo 8 using a descriptive analytical approach that harnessed thematic content coding and in-depth grounded analysis. We found that while formal resources for IPV were scarce, women utilized many informal resources (family, pastors, local leaders) as well as the health facility. In rare occasions, women escalated their response to formal services (police, judiciary). The community was sometimes responsive to women experiencing IPV but often viewed it as a “normal” part of local culture. Further barriers to women accessing services included logistical challenges and providers who were undertrained or uncommitted to responding to IPV appropriately. Moreover, the very sanctions meant to address violence (such as fines or jail) were often inhibiting for women who depended on their partners for financial resources. The results suggest that future IPV interventions should address community views around IPV and build upon locally available resources—including the health clinic—to address violence among women of childbearing age.

A Community-Supported Clinic-Based Program for Prevention of Violence against Pregnant Women in Rural Kenya

Objective. Pregnant women are especially vulnerable to adverse outcomes related to HIV infection and gender-based violence (GBV). We aimed at developing a program for prevention and mitigation of the effects of GBV among pregnant women at an antenatal clinic in rural Kenya. Methods. Based on formative research with pregnant women, male partners, and service providers, we developed a GBV program including comprehensive clinic training, risk assessments in the clinic, referrals supported by community volunteers, and community mobilization. To evaluate the program, we analyzed data from risk assessment forms and conducted focus groups (n = 2 groups) and in-depth interviews (n = 25) with healthcare workers and community members. Results. A total of 134 pregnant women were assessed during a 5-month period: 49 (37%) reported violence and of those 53% accepted referrals to local support resources. Qualitative findings suggested that the program was acceptable and feasible, as it aided pregnant women in accessing GBV services and raised awareness of GBV. Community collaboration was crucial in this low-resource setting. Conclusion. Integrating GBV programs into rural antenatal clinics has potential to contribute to both primary and secondary GBV prevention. Following further evaluation, this model may be deemed applicable for rural communities in Kenya and elsewhere in East Africa.

Mothers' experience of breastfeeding

Abstract Forty-four French primiparae were interviewed in a longitudinal study of the transition to motherhood. Quantitative and qualitative data were gathered. Only results concerned with feeding topics are presented. When pregnant, 75 per cent of women wanted to breastfeed: social and demographic variables did not clearly differentiate between prospective breast-and bottle-feeders. After the birth and during the hospital stay, one third of the mothers who had wanted to breastfeed had difficulties linked to an operative birth or to the staffs behaviour and, at five weeks postpartum, had switched to the bottle. At that time, 41 per cent of mothers were breastfeeding. Results indicate that they had more difficulties than bottle-feeders: their babies woke up more often to be fed in the night; they had fewer outings without the baby; their husbands helped less in baby-care; they resumed sexual relationship later and were more often depressed. In spite of that, many of them also expressed great pleasure and ...

Violence in the Lives of Women in Italy Who Have an Elective Abortion

BACKGROUND Violence is an important health problem for pregnant women, with numerous studies showing that it may compromise maternal and infant health. Many women who seek an elective abortion (EA) live in difficult personal and social circumstances, in which violence often has a central role, yet few studies have analyzed the relationships between violence and having an EA. OBJECTIVES To analyze the role of family and partner violence among women seeking an EA, exploring the role of womens age, and controlling for sociodemographic factors. METHODS An unmatched, case-control study was carried out in the Trieste Public Hospital, including all consecutive EAs (n=445) and live births (n=438). With an anonymous questionnaire, we collected information on sociodemographic characteristics, current violence (psychological, physical, and sexual) perpetrated by a partner or by other family members, and past violence. RESULTS Compared with postpartum women, EA women were significantly more likely to report any type of current and past violence. Among women younger than 30 years old, adjusting for relevant social factors, partner psychological violence and family violence were strongly associated with EA, whereas among women 30 years old or older, there was no association with partner and family violence after adjustment. CONCLUSION These results highlight the role of violence in the lives of women, especially younger women, seeking an abortion, and the need for sensitive screening for partner and family violence among these women. Health professionals should be able to recognize violence among women seeking an EA and to support them.

Factors Associated with Exposure to Violent or Degrading Pornography among High School Students.

The purpose of this study was to analyze pornography exposure in a sample of 702 Italian adolescents (46% males; mean age = 18.2, SD = 0.8). Among male students, 11% were not exposed, 44.5% were exposed to nonviolent material, and 44.5% were exposed to violent/degrading material. Among female students, 60.8% were not exposed, 20.4% were exposed to nonviolent material, and 18.8% were exposed to violent/degrading material. Among males, adjusted odds ratio (AdjOR) of exposure to violent/degrading pornography were higher if using alcohol, having friends who sell/buy sex, and taking sexual pictures. Females who were victims of family violence, attending technical/vocational schools, and taking sexual pictures had higher AdjOR of watching violent pornography; smoking and having friends who sell/buy sex were associated with both nonviolent and violent/degrading exposure. Exposure to violent/degrading pornography is common among adolescents, associated with at-risk behaviors, and, for females, it correlates with a history of victimization. School nurses have a pivotal role in including discussions about pornography in interventions about relationships, sexuality, or violence.

Violence and women's psychological distress after birth: An exploratory study in italy

Our aim in conducting this study was to analyze the relationships between violence and maternal psychological distress 8 months after a birth, taking into account other important psychosocial factors, known to be associated both with violence and with new mothers’ mental health. A total of 352 women responded to a questionnaire after the birth at a maternity hospital in northern Italy, and 292 also participated in a telephone interview 8 months later. We evaluated psychological distress with the General Health Questionnaire (GHQ), and partner and family violence with a 28-item scale. Eight months postpartum, 5% of women showed high psychological distress; 10% were currently experiencing violence from the partner or another family member. After adjustment for covariates, the odds ratio for depressive symptoms was 13.74 for women experiencing violence. We believe that these results provide support for the important role of violence in postpartum maternal psychological distress.