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The exceptionalism of abortion in public health education, due to social stigma, politicization, and lack of training, contributes to misinformation, policies unjustified by rigorous science, lack of access to person-centered health care, and systemic pregnancy-related inequities. Now that abortion access has vanished for large portions of the United States, following the Supreme Court decision in "Dobbs v. Jackson Women's Health Organization" ("JWHO"), health educators must work to eliminate abortion-related silos, destigmatize abortion education, and bring comprehensive sexual and reproductive health information and evidence to the many audiences that will require it. We discuss consequences of abortion exceptionalism in health education for the public, health care providers, pregnant people, and health professionals in training--and opportunities to better and more accessibly provide sexual and reproductive health education to these audiences.

Intimate partner violence (IPV) is a challenge in Brazil; the country is ranked 6th globally for femicide and one in four women experience physical and/or sexual IPV in their lifetimes. Safety decision aids (SDA) are tools for women experiencing IPV. Building upon previously developed and tested online SDA tools, we intend to adapt an SDA tool for use in Brazil. The purpose of this study was to examine the feasibility of a technology-based SDA to support Brazilian women living with IPV, tailored for the Brazilian context. Our participatory-action research approach built upon research between 2018 and 2019 at the House of the Brazilian Woman (HBW) of Curitiba, Brazil, a cross-sectoral one-stop center (OSC) providing comprehensive care for IPV survivors. Field research included observation, field notes, and in-depth interviews with twenty-eight (n = 28) participants (HBW staff and survivors). The results were grouped into four main thematic categories: advantages; uncertainties; barriers; and suggestions. The triangulated results showed that the majority of participants considered the SDA feasible, highlighting flexibility and confidentiality; information about IPV; and access to resources for formal help-seeking as advantages of the tool. Participants also expressed uncertainties about SDA's ability to increase women's safety and its accessibility for the most vulnerable. They made suggestions for improvement to meet the unique needs of Brazilian women. This study provided evidence on the potential of an SDA tailored for use within a comprehensive program of women survivors in Brazil. This step was crucial to inform the future implementation and evaluation., Author(s): Marcos Claudio Signorelli [sup.1] , Vera Lucia Costa da Silva [sup.2] , Dabney P. Evans [sup.3] , Sandra Marques Prado [sup.4] , Nancy Glass [sup.5] Author Affiliations: (1) grid.20736.30, [...]

Purpose The purpose of this mixed-methods triangulation study was to assess the face validity and comprehension of a femicide risk assessment tool, the Danger Assessment-Brazil (DA-Brazil) among women seeking care in a one stop center for abused women in Curitiba, Brazil. Our secondary aim was to assess professionals' perceptions of feasibility for using the DA-Brazil in the same setting. Method Fifty-five women experiencing relationship violence completed the instrument and participated in cognitive interviews about their experience; professionals attending survivors were also interviewed. Results The vast majority of women described the DA-Brazil instrument as being easy to comprehend (n = 41, 73.2%). Nearly half of participants (n = 26, 46.4%) had some kind of question regarding the DA-Brazil calendar, a tool to visualize abuse frequency and severity. Queries aligned with five categories: recollection of dates, scale, relationship status, terminology, and discomfort. Professionals reported that the DA-Brazil instrument would support referral decision-making. Conclusion The overall face validity and comprehension of the DA-Brazil appears to be high. The majority of challenges were around the calendar activity. Professional perceptions of the DA-Brazil suggest a high degree of feasibility for its use in Brazilian healthcare settings. In order for the DA-Brazil to effectively be administered with facilitated support there is a need for training on the best use of the instrument. Accurate assessment of femicide risk is critical in a country like Brazil with high rates of femicide. The DA-Brazil provides a valid assessment of femicide risk and has the potential to trigger early intervention for those at risk., Author(s): Dabney P. Evans [sup.1] , Casey D. Xavier Hall [sup.2] [sup.3] , Raiza Wallace Guimarães da Rocha [sup.4] , Sandra Marques Prado [sup.5] , Marcos C. Signorelli [sup.4] Author [...]

This study sought to understand the effects of COVID-19, including movement-related restrictions such as shelter-in-place, quarantine, and isolation orders, on intimate partner violence (IPV) from the perspective of health care providers (HCPs) working at a public hospital in Atlanta, Georgia. From November 2020 to May 2021, we conducted 12 interviews. Three themes emerged: (1) HCPs perceived that COVID-19 movement-related restrictions likely exacerbated IPV; (2) HCPs encountered many practice-oriented and community barriers in IPV care provision during COVID-19; and (3) HCPs suggested process and partnership improvements for IPV response. These findings can inform future pandemic preparedness including improved communication, improved IPV screening and follow-up, and strengthened hospital-community partnerships. [ABSTRACT FROM AUTHOR]

This cross-sectional study is the first to describe the prevalence of violence and poly-victimisation among 310 female sex workers (FSWs) who were cisgender in Haiphong, Viet Nam. An adapted version of the WHO-Multi-Country Study on Violence against Women Survey Instrument was administered to assess physical, sexual, economic and emotional forms of violence perpetrated by an intimate partner, paying partner/client, and/or others (e.g. relatives, police, strangers and other FSWs) during adulthood. The ACE-Q scale was administered to assess adverse childhood experiences (ACEs) before age 18 years. Our findings showed that FSWs are exposed to high rates of multiple forms of violence by multiple perpetrators. For any male client-perpetrated violence (CPV), lifetime prevalence was 70.0%, with 12-month prevalence 61.3%. Lifetime prevalence of male intimate partner violence (IPV) was 62.1%, and the 12-month prevalence was 58.2%. Lifetime and prior 12-month prevalence of physical and/or sexual violence by other perpetrators (OPV) was 18.1% and 14.2%, respectively. Sixty-five percent of FSWs reported at least one type of ACE. Overall, 21.6 percent of FSWs reported having experienced all three forms of violence (IPV, CPV and OPV) in their lifetime. Policy and programme recommendations for screening and prevention of violence are needed in this setting. [ABSTRACT FROM AUTHOR]

Dobbs v. Jackson Women's Health continues a trajectory of U.S. Supreme Court jurisprudence that undermines the normative foundation of public health — the idea that the state is obligated to provide a robust set of supports for healthcare services and the underlying social determinants of health. Dobbs furthers a longstanding ideology of individual responsibility in public health, neglecting collective responsibility for better health outcomes. Such an ideology on individual responsibility not only enables a shrinking of public health infrastructure for reproductive health, it facilitates the rise of reproductive coercion and a criminal legal response to pregnancy and abortion. This commentary situates Dobbs in the context of a long historical shift in public health that increasingly places burdens on individuals for their own reproductive health care, moving away from the possibility of a robust state public health infrastructure. [ABSTRACT FROM AUTHOR]

Dobbs v. Jackson Women’s Health continues a trajectory of U.S. Supreme Court jurisprudence that undermines the normative foundation of public health — the idea that the state is obligated to provide a robust set of supports for healthcare services and the underlying social determinants of health. Dobbs furthers a longstanding ideology of individual responsibility in public health, neglecting collective responsibility for better health outcomes. Such an ideology on individual responsibility not only enables a shrinking of public health infrastructure for reproductive health, it facilitates the rise of reproductive coercion and a criminal legal response to pregnancy and abortion. This commentary situates Dobbs in the context of a long historical shift in public health that increasingly places burdens on individuals for their own reproductive health care, moving away from the possibility of a robust state public health infrastructure. [ABSTRACT FROM AUTHOR]

Purpose: The frequency of intimate partner violence (IPV) is much lower in males than females. Data regarding IPV-related injuries patterns and characteristics in males are scant. The purpose of this study was to characterize and compare patterns of IPV-related head and neck injuries between men and women.Materials and Methods: This cross-sectional study reviewed cases of IPV at Grady Memorial Hospital in Atlanta, Georgia from January 2016 to August 2019. The study sample was collected from electronic medical records by identifying IPV subjects using a natural language processing algorithm and then cross-referencing the trauma registry to identify patients who sustained head and neck injuries. The primary analyses of interest were to measure the association between gender and the following covariates: age, race, insurance status, setting of injury, day of injury, social history, report of physical abuse, mechanism of injury, injury location, brain injuries, soft tissue injuries, facial fractures, other associated injuries, Glasgow Coma Scale, Injury Severity Score, hospital length of stay, intensive care unit length of stay, and discharge status. Univariate and bivariate analyses were calculated. Statistical significance was P < .05.Results: One hundred fifty six patients met inclusion criteria. There were 120 (76.9%) female patients with a mean age of 34.5 years (range, 16 to 67 years). There were 36 (23%) male patients with a mean age of 43.8 years (range, 18 to 77 years). Women were statistically more likely than men to have government-subsidized insurance (47 [39.2%] vs 7 [19.4%]; P = .03), positive alcohol exposure (27 [22.5%] vs 19 [52.8%]; P = .0001), positive illicit drugs toxicology screen (25 [20.8%] vs 13 [36.1%]; P < .02), report physical abuse (24 [20%] vs 0; P = .004), have subarachnoid hemorrhage (14 [11.7%] vs 0; P = .04), and/or lower extremity injuries (39 [32.5%] vs 5 [13.9%]; P = .03).Conclusion: Males tend not to report physical abuse; this behavior contributes to IPV under-reporting in males. [ABSTRACT FROM AUTHOR]

The Danger Assessment (DA) is a widely-used risk assessment instrument designed to help women understand their risk of femicide. Currently, no validated tool exists in Brazilian Portuguese. The purpose of this study was to conduct a cross-cultural adaptation of the DA for use in the Brazilian context as a precursor to validation and broader testing among women in Brazil. This study describes a community participatory approach for translation and cultural adaptation of the DA from European to Brazilian Portuguese that engages the target population in the process. Using a three-step process, a final version of the DA-Brazil instrument was developed. [ABSTRACT FROM AUTHOR]

Intimate femicide perpetrators are rarely studied despite their important role as drivers of violence. This paper analyzes the explanatory narratives of men who intentionally killed their female intimate partners in Buenos Aires, Argentina. Twenty-four interviews were conducted with 12 participants. Data were analyzed using Atlas.Ti and an inductive thematic coding strategy. Two dimensions—frequency of physical violence in the relationship and locus of explanation—were used to identify four narrative archetypes: victim, redemption, extraordinary, and outburst. Greater attention should be paid to perpetrator life trajectories and narratives including the gender and violence discourses that shape explanations for perpetration. [ABSTRACT FROM AUTHOR]

Health care providers (HCPs) who directly interact with women play a critical role in intimate partner violence (IPV) prevention and response. The aim of this study was to identify the structural and interpersonal barriers to IPV response among HCPs working in public health clinics in Santo André, Brazil. Eligible participants included all HCPs providing direct care to individuals at three public health clinics. Participants self-administered an adapted Knowledge, Attitudes, and Practices survey on IPV. Data were analyzed using Epi Info 7 and SAS 9.4. 114 HCPs completed surveys. Less than half of HCPs (41%, n = 34) reported ever having asked a woman about abuse in the past year. HCPs who perceived fewer barriers were more likely to report asking about IPV. The top three reported barriers to asking women about IPV included the following: few opportunities for one-on-one interaction (77%, n = 65), a lack of privacy (71%, n = 60), and fear of offending women (71%, n = 60). Fewer providers who perceived the barriers of lack of privacy asked about IPV (50.8%, n = 33 compared with 84.2%, n = 16; p <.05); less providers who perceived few opportunities for private patient interactions asked about IPV (48.3%, n = 29 compared with 75.0%, n = 18; p <.05). Our results support the need for a systems approach of institution-wide reforms altering the health care environment and avoiding missed opportunities in IPV screening and referring women to appropriate resources or care. Two of the most frequently reported barriers to asking IPV were structural in nature, pointing to the need for policies that protect privacy and confidentiality. Within the Brazilian context, our research highlights the role of HCPs in the design and implementation of IPV interventions that both strengthen health systems and enable providers to address IPV. [ABSTRACT FROM AUTHOR]

Fetal "heartbeat" bills have become the anti-abortion legislative measure of choice in the US war on sexual and reproductive health and rights (SRHR). In 2019, Georgia House Bill 481 (HB 481) passed by a narrow margin banning abortions upon detection of embryonic cardiac activity, as early as six weeks gestation. The purpose of this study was to distinguish and characterise the arguments and tactics used by legislators and community members in support of Georgia's early abortion ban. Our data included testimony and debate from House Health and Human Services and the Senate Science and Technology Committees; data were transcribed verbatim and coded in MAXQDA 18 using a constant comparison method. Major themes included: the use of the "heartbeat" as an indicator of life and therefore personhood; an attempt to create a new class of persons – fetuses in utero – entitled to legal protection; and arguments to expand state protections for fetuses as a matter of state sovereignty and rights. Arguments were furthered through appropriation by misrepresenting medical science and co-opting the legal successes of progressive movements. Our analysis provides an initial understanding of evolving early abortion ban strategy and its tactics for challenging established legal standards and precedent. As the battle over SRHR wages on, opponents of abortion bans should attempt to understand, deconstruct, and analyse anti-abortion messaging to effectively combat it. These data may inform their tactical strategies to advance sexual and reproductive health, rights, and justice both in the US context and beyond. [ABSTRACT FROM AUTHOR]

Because little is known about the mental health status of Syrian refugees in the United States, we conducted a survey among a convenience sample of those resettled in Atlanta between March 2011 and 2017. Though home visits, we delivered a questionnaire including standardized instruments (HSCL25 and PTSD-8) to assess symptoms of anxiety, depression and Posttraumatic Stress Disorder. We found high rates of anxiety (60%), depression (44%) and Posttraumatic Stress Disorder (84%) symptoms; however, only 20% of participants had seen a mental health professional. Reported reasons for not seeking professional help were lack of transportation and access to information. Findings of this survey indicate the high burden of mental health symptoms and the need for services to the study population. A longitudinal study with a larger sample size would improve the understanding of mental health needs and resilience factors of Syrian refugees resettled in the US. [ABSTRACT FROM AUTHOR]

Introduction. The purpose of this study was to examine the perceptions of institutional policies and practices for the prevention of and response to gender inequities as experienced by female faculty working in the health sciences at a US research university. Methods. Data from the institution's Faculty Campus Climate Survey (n = 260 female faculty) were coupled with qualitative interviews (n = 14) of females in leadership positions, exploring campus climate, and institutional policies and practices aimed at advancing women. Results. Two-thirds (59%) of the female faculty respondents indicated witnessing sexual harassment and 28% reported experiencing sexual harassment. Several organizational themes emerged to address this problem: culture, including cultural change, transparency, and accountability. Conclusions. The findings reveal the ways in which university culture mimics the larger societal context. At the same time, the distinct culture of higher education processes for recruitment, career advancement - specifically tenure and promotion - are identified as important factors that require modifications in support of reductions in gender inequalities. [ABSTRACT FROM AUTHOR]

Negative health outcome and its relationship with length and severity of Childhood Sexual Abuse is well established in the literature. Until recently, this literature consisted disproportionately of studies of adults recalling past events. For guidelines for the treatment of childhood survivors, research focused on child victims may be more relevant. We aim to characterize factors related to long-term and severe sexual abuse among children in São Paulo, Brazil. We conducted a cross-sectional study of children up to the age of ten, referred to a specialty program on sexual abuse between 2004 and 2013. Length and severity of the abuse were tested for associations with variables related to the abuse using a Chi-square test, followed by the Poisson regression with robust variance for prevalence ratio. Most children experienced abuse were reliant on relatives or friends for housing (45%). The time between abuse and reporting was longer when the perpetrator lived in the same household as the child and when abuse was reported by a relative or friend. Abuse was more frequent among female children, but longer and more severe in males. A lack of independent housing, parents' education and social stigma facilitated childhood sexual abuse by delaying reporting among our sample. [ABSTRACT FROM AUTHOR]

This statement arose from discussions during the Global Health Fieldwork Ethics Workshop held in Atlanta, Georgia, USA in April 2018, co-sponsored by Agnes Scott College, The Taskforce for Global Health, and Emory University Rollins School of Public Health. As participants from a wide range of academic and global health implementation organizations discussed ethics challenges in fieldwork settings, it became clear that gender-based violence was an issue of vast importance that has not been adequately considered for global health fieldworkers and participants. This statement highlights key themes on gender-based violence that emerged from our discussions and calls for further action. [ABSTRACT FROM AUTHOR]

This article uses a case study design to explore attempted intimate femicide in metropolitan São Paulo, Brazil. We conducted 30 in-depth interviews with adult women on community and personal relationship experiences, health-care services, and national legislation about violence against women. Through a thorough transcript review, we identified two participants, Maria* and Raquel*, whose intimate partners attempted to kill them. We used a modified grounded theory approach to code the entire sample, and further analysed these transcripts to identify missed opportunities for intervention in both the prevention of- and responses to intimate partner violence (IPV), and the antecedents of attempted intimate femicide. Both women had normalized experiences of violence, and experienced psychological abuse prior to the attempted intimate femicide. Social and familial networks were sources of shame for Raquel and support for Maria. Neither woman expressed confidence in law enforcement's ability to protect women and girls from IPV. These cases illustrate the need for multi-tiered interventions to prevent femicide in Brazil, which boasts one of the highest global female homicide rates. Although antifemicide laws exist, better mechanisms are needed to integrate health, legal and social services for IPV and femicide prevention. In addition, community- and interpersonallevel interventions that counteract the Brazilian 'culture of violence' and machismo may provide support for at-risk women and girls. [ABSTRACT FROM AUTHOR]