Search

In January, 2016, the Board of Directors of the American Professional Society on the Abuse of Children approved a position paper on allegations of child maltreatment and intimate partner violence in divorce/parental relationship dissolution. This commentary describes the range of dynamics that can lead to allegations of interpersonal violence in divorce/relationship dissolution, outlines the process employed in developing the position paper, and provides a description of the contents of the position paper.

In Canada, diverse people face violence and abuse at alarming rates as a result of their gender, perceived gender, or gender expression. This phenomenon is referred to as gender-based violence (GBV). Gender-based violence has many manifestations, including sexual assault, femicide, and intimate partner violence (IPV), as well as dowry-related violence, early or forced marriage and pregnancy, female genital mutilation, elder abuse, human trafficking, sexual harassment, cyber abuse, and many other forms, both visible and invisible. Crucially, GBV does not simply occur in the context of inter-personal relationships or as the result of perpetration by ‘bad men’; rather, GBV is a systemic issue that seizes upon and operates through longstanding pathologies and power dynamics—patriarchy, racism, colonialism, and transphobia to name few—rendering diverse people more vulnerable to victimization on the basis of their identity. Strategies, policies, and programs focused on ensuring victims and survivors can achieve economic security will form a vital component of any serious plan to address GBV. On this point there is notable consensus. Less agreement exists, however, when debate begins on the question of which strategies, policies, and programs ought to be implemented. In this discussion paper, we weigh in on this debate through an evaluation of an economic security tool over which there has been much fanfare in recent years: the basic income model. Two questions guide our analysis: (1) to what extent could a basic income disrupt the material conditions and forms of oppression which drive GBV, and thus reduce both risk and prevalence? and (2) to what extent would basic income be an effective support for those encountering/recovering from various forms of GBV? Our analysis is driven by two definitional assumptions about economic security and basic income. That is, we consider economic security to be a state in which criteria for financial security, stability, and continuity are fulfilled, and conceive of basic income as a class of policies that share principles of simplicity, respect, economic security, and social inclusion.

For more than 20 years, the American College of Physicians (ACP) has advocated for the need to address firearm-related injuries and deaths in the United States. Yet, firearm violence continues to be a public health crisis that requires the nation's immediate attention. The policy recommendations in this paper build on, strengthen, and expand current ACP policies approved by the Board of Regents in April 2014, based on analysis of approaches that the evidence suggests will be effective in reducing deaths and injuries from firearm-related violence.

In this position paper, the American College of Physicians (ACP) examines the challenges women face in the U.S. health care system across their lifespans, including access to care; sex- and gender-specific health issues; variation in health outcomes compared with men; underrepresentation in research studies; and public policies that affect women, their families, and society. ACP puts forward several recommendations focused on policies that will improve the health outcomes of women and ensure a health care system that supports the needs of women and their families over the course of their lifespans.

This article examines the place of gendered relationships between parents with regard to child protection work in England, and the effects of this on mothers who are abused by their male partners. These areas are discussed within an emotionally, socially, and politically charged set of issues concerning to what extent the State should intervene, why, and how between parents and their children in terms of parental rights and child protection. In this way, the article examines fault lines in the Western world’s ideology of the family, and concepts and realities of parental, mothers’ and children’s rights. In examining dominant and competing discourses on parental rights in child protection work, the case is made for the need to disaggregate concepts and approaches away from parental rights per se, to viewing the possibility of needing to see fathers and mothers needs and rights as at times being in conflict. This becomes particularly problematic in relation to mothers’ rights to their own protection from abuse, and how this relates to professional interventions when both the mother and the children are being abused. It considers the need to acknowledge and foreground taking account of how the mother and child(ren) are experiencing the abuse, not how society and professionals might like to view the situation by way of an idealized view of families through a particular ideological lens.

We find a significant negative relationship between stock returns during the week and the reported incidence of domestic violence during the weekend. Our findings suggest that wealth shocks caused by the stock market can affect stress levels within families, escalate arguments, and trigger violence. The effect of stock returns on reported domestic violence is primarily attributable to negative returns, and the incidence of domestic violence increases with the magnitude of loss. The effect also increases with local stock market participation. Using Google search volumes as an alternative proxy for the incidence of domestic violence yields similar results.

Nearly 2 million women are assaulted by a partner or ex-partner each year in the United States (Tjaden and Thoennes 2000). Intimate partner violence is a complex social problem rooted in structural gender inequality, but that affects individual women in different ways (e.g. Crenshaw, 1991; Stark 2008). Battered women actively seek help in ending the violence from both formal and informal sources (e.g. Campbell et al. 1998; Stark 2008; Sullivan and Bybee 1999). As part of this process, many battered women will apply for a protection order against their batterer; nearly 1 million such orders are issued every year (Tjaden and Thoennes 2000). This article reviews the research on the effectiveness of such orders, including access and enforcement, and provides suggestions for further research and policy improvements.

Undocumented-immigrant battered women in the borderlands have been pushed and pulled across the U.S.-Mexico border seeking socioeconomic advancement, maintenance of sociocultural ties, and physical security for themselves and their children. Legality and illegality play a central role in the lives of these women due to a combination of factors, such as how immigration policies linked to the needs of corporate capitalism have led to the creation of the “undocumented” population in the U.S. Southwest. Based on ethnographic research on battering among immigrants in Phoenix, Arizona, we bring a domestic violence perspective to immigration policy and an immigration perspective to domestic violence research to trace how battering contributes to illegality and how immigration policies contribute to men’s battering. We explore how border crossing and criminality can constitute survival as well as battering strategies and reflect on the place of kin and family in how immigrant women from Mexico struggle simultaneo...

Dans cet article, nous examinons le cas de Mme A., une citoyenne américaine d'origine pakistanaise dont le mari, selon les termes de son visa, devait retourner pour deux ans au Pakistan. Mme A. demandait aux Services de l'Immigration d'accorder une dérogation à son mari afin qu'il reste aux États-Unis, au motif qu'elle ne supporterait pas d'être séparée de lui pendant deux ans. Nous présentons brièvement les principes de l'évaluation psychologique dans les procédures d'immigration, un domaine nouveau d'expertise psycholégale, ainsi qu'une biographie de Mme A. Celle-ci met en évidence les dangers qu'elle encourrerait au Pakistan et les multiples violences dont elle a été victime. Nous présentons l'examen psychologique de Mme A. en insistant sur l'apport du Rorschach (SI) dans l'évaluation de l'impact et de l'étendue de son traumatisme psychologique. Nous mettons en lumière la pertinence du Rorschach dans l'évaluation du traumatisme dans des contextes psycholégaux.

In her 1903 polemic The Home: Its Work and Influence, Charlotte Perkins Gilman thundered, ‘This power of home-influence we cannot fail to see, but we have bowed to it in blind idolatry as one of unmixed influence, instead of studying with jealous care that so large a force be wisely guarded and restrained.’1 Her point, throughout The Home, as well as her phenomenally successful Women and Economics (1898) and her feminist utopian novel Herland (1915), was that the middle-class home in Gilded-Age America was by no means a benign institution, and that claiming otherwise was both erroneous and pernicious. Combining sexual companionship, child-rearing, and economic dependence, the nineteenth-century middle-class American home turned women into slavish drudges, and men into selfish tyrants, yet, rather than criticizing or seeking to alter the system itself, she argued, society at large repeatedly blamed individual wives, husbands, children, even specific houses, for the ills found within it. Gilman therefore urged that drunkenness, infidelity, domestic violence, infant and maternal mortality and illness, juvenile delinquency, and psychological disorders such as neurasthenia should not be seen as symptoms of the moral degeneracy of those who display such behavioral problems. Instead, the home itself needed to be totally reconceived and reformed, along socialist and collectivist, rather than individualist and capitalist, lines.

The emergency room (ER) represents the main system entry for crises-based health care visits. It is estimated that 2% to 10% of children visiting the ER are victims of child abuse and neglect (CAN). Therefore, ER personnel may be the first hospital contact and opportunity for CAN victims to be recognised. Early diagnosis of CAN is important, as without early identification and intervention, about one in three children will suffer subsequent abuse. This educational paper provides the reader with an up-to-date and in-depth overview of the current screening methods for CAN at the ER. Conclusion: We believe that a combined approach, using a checklist with risk factors for CAN, a structured clinical assessment and inspection of the undressed patient (called ‘top–toe’ inspection) and a system of standard referral of all children from parents who attend the ER because of alcohol or drugs intoxication, severe psychiatric disorders or with injuries due to intimate partner violence, is the most promising procedure for the early diagnosis of CAN in the ER setting.

With attention focussed on child abuse and measures for child protection in many countries around the world, efforts have been made to understand something of the nature and dimensions that lie behind abuse. Now the time has come to look at domestic violence in its other manifestations - not only parent to child as in child abuse, but also husband to wife or cohabiter to cohabiter. What, however, has been missing from this widening of concerns has been a focus on parental behaviour toward their children which involves the use of physical punishment in child rearing but which may fall short of the legal definition of abuse. This gap is about to be considered with the emergence in Australia of the EPOCH campaign in which Oz Child is to be a leading participant.

Reviews the book, "Elder Abuse: Selected Papers from the Prague World Congress on Family Violence" edited by E. Podnieks, J.I. Kosberg, and A. Lowenstein (2005). The 'Prague Papers', as this collection has become known, consists of ten contributions on various aspects of elder abuse by international experts. The papers cover topics from the prevention of financial abuse and recognition of elder abuse in faith communities, international variations in the definition and reliable detection of elder abuse, to the vulnerability of older women. The reader will find plenty of new developments presented here, although the studies reported are relatively modest and have not had access to larger-scale research resources. Papers of special interest call for greater awareness of abuse of grandparents by grandchildren. However, given examples of threats, defiance and sometimes serious acts of violence, it leaves little doubt that, as vulnerable children need protection, so do vulnerable adults need the same opportunities for frank disclosure, support and protection from harm. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

This paper argues that the gendered impact of COVID-19 has both visible and hidden dimensions, and both immediate effects linked with lockdowns and longer-term effects that are likely to emerge sequentially in time and affect recovery. Much of the existing feminist literature on the impact of COVID-19 has neglected these complexities and focused mainly on care work and domestic violence. This has diverted attention away from other key concerns such as livelihood loss, food and nutritional insecurity, indebtedness, rising poverty, and the low resilience of most women in developing economies. Even care work and domestic violence have complex facets that tend to be missed. Using examples from India, the paper outlines the kinds of gendered effects we might expect, the extent to which these have been traced in existing surveys, and the data gaps. It also highlights the potential of group approaches in enhancing women’s economic recovery and providing social protection from the worst outcomes of the pandemic—approaches that could guide us towards effective policy pathways for ‘building back better.’

Purpose We aimed to explore the relationship between common mental disorders (CMDs), food insecurity and experiences of domestic violence among pregnant women attending public sector midwife obstetric units and basic antenatal care clinics in Cape Town during the COVID-19 lockdown. Methods Perinatal women, attending 14 healthcare facilities in Cape Town, were enrolled in the study during baseline data collection before the COVID-19 lockdown. During the lockdown period, fieldworkers telephonically contacted the perinatal women who were enrolled in the study and had provided contact details. The following data were collected from those who consented to the study: socio-demographic information, mental health assessment, food insecurity status and experiences of domestic violence. Poisson regression was used to model the associations of a number of risk factors with the occurrence of CMDs. Results Of the 2149 women enrolled in the ASSET study, 885 consented to telephonic interviews. We found that 12.5% of women had probable CMDs and 43% were severely food insecure. Psychological distress increased significantly during the lockdown period, compared to before the COVID-19 outbreak. Using multivariate Poisson regression modelling, we showed that the risk of CMDs was increased in women who were severely food insecure or who experienced psychological or sexual abuse. Conclusions This study provides evidence of the effect of the COVID-19 lockdown on the mental health status of perinatal women living in low-resource settings in Cape Town and highlights how a crisis such as the COVID-19 lockdown amplifies the psycho-social risk factors associated with CMDs in perinatal women.

This short paper has the objective of making the case for more investment to explore the use of data-driven technology to predict, prevent and pursue criminal harms against women. The paper begins with an overview of the contemporary scale of the issues, and the current problem of recording data on serious violent and sexual offending against women, before moving on to consider the current status and strength of positive obligations under UK human rights law to protect victims of intimate partner violence. The paper then looks at some examples of how data tech can augment policing of serious criminal harms against women, before turning to consider some of the legal problems concerning potential bias, inaccuracies and transparency that can dog 'predictive policing' in particular. Finally, a conclusion is offered up which explores the degree to which investment and exploration of the predictive policing of intimate partner violence must be pursued at the same time as better oversight mechanisms are also developed for the use of machine learning technology in public protection roles, since the two emphases go hand in hand.

Summary Background Gender-based violence affects 35–45% of women worldwide, mostly coming from domestic violence. A good screening procedure in clinical practice is useful, but WHO does not advise universal screening, recommending further research. Aim (i) To report the frequency of domestic violence cases among admissions to the Emergency Room of a major Italian Hospital in 2020, including during complete ‘Lockdown’ period; (ii) to document acute and chronic health effects of domestic violence and (iii) to asses usefulness of the WHO screening as a tool for uncovering cases which would otherwise remain hidden. Design and methods A database containing all the information recorded for each of 19 160 patients in the Emergency Room was constructed by a keyword search (‘violence’, ‘assault’, ‘trauma’) to filter the data and retrieve cases of violence in the period between 1 January and 2 June 2020. The self-administered questionnaire of the WHO Multi-country Study on Women’s Health and Domestic Violence against Women was used in women referred to the emergency room for any cause, excluding trauma. Results A recent history of domestic violence was disclosed by 22.67%, after completing the WHO questionnaire. Of those not participating in the survey, diagnosis of domestic violence was only 0.6% (128/19 160). Conclusion Power of detection of domestic violence by the WHO questionnaire is very high, while the frequency of occurrence of these events in this population was considerable. Seemingly, it elicits the responsiveness to the topic of the volunteer interviewees. Its use should be firmly recommended, reasonably, while Covid-19 pandemic is affecting health, rights and response.

Community processes to address fractured social relationships and well‐being remain the least examined dimensions in studies of legacies of civil wars. This article addresses these limitations by analyzing how the wartime and postwar generations have negotiated the legacies of the civil war (1976–1992) in a farming economy region in Mozambique. Based on a 14‐year (2002–2015) study of community courts in Mozambique, we analyzed the types of social conflicts and the associations with gender, age, risk factors, self‐described health impairments, and the timing of farming activities. We identified n = 3,456 participants and found that perennial sources of disputes were related to family formation and maintenance, defamation, accusations of perpetration of serious civil wartime violations, mistrust, debts, and domestic violence. Furthermore, conflict relations were associated with gender, age, risk factors, and health problems. This study concludes that civil wars have lasting multifaceted legacies, but generational tensions, availability of community institutions, and economic resources shape social relationships and well‐being outcomes while averting revenge cycles among civilian war survivors.

Coronavirus (COVID‐19) pandemic has created an unprecedented loss and disruptions over all across the world. From developed to developing, no country has been spared from its brunt. In this paper, we have analyzed the implications of COVID‐19 on the economy and society of India so far. An impact assessment on the basis of available lietrature is made on all the three sectors—primary, secondary and service sector along with the impact on migrants, health, poverty, job losses, informal sector, environment, and so forth. The all sectors of the economy has been disproportionately affected and even within a sector, there is a disproportionate loss. The societal impacts are dire too with job losses, mental illness, increased domestic violence, and so forth. Some positive effects can be seen in terms of improved air quality, water quality, wildlife but the sustainability of such impact is conditional upon post‐COVID and people's habits and future policies related to the environment.

Introduction Worldwide every third women is exposed to physical and/or sexual violence and pregnancy is no safe period for the women. The aim was to elucidate midwives experience of violence-exposed pregnant women who had been referred to a prenatal ward and were hospitalized. Methods An inductive qualitative method was used with four focus-group interviews performed with sixteen midwives working at in-hospital prenatal ward. The data were analyzed with content analysis. Results Three categories emerged. 'Professional area of responsibility', the midwives working at in-hospital prenatal ward considered it was the responsibility of the midwives working at antenatal care to ask routinely in order to detect violence-exposed women. Signs of help-seeking were based on the pregnant woman's behavior. Suspicion of intimate-partner violence was based on gut feeling. 'Conditions for support', the midwives strived to support pregnant women who were already identified as violence-exposed or if they had a suspicion that the pregnant woman was in a relationship where intimatepartner violence occurred. 'Barriers for giving support', both the work-place layout and routines constituted a barrier. The midwives own emotional state could affect her handling of the situation. Conclusions The midwives working in-hospital considered it the responsibility of the midwives at antenatal healthcare to identify these women. The midwives had limited experience in dealing with violence-exposed pregnant women but recognized a number of signs and symptoms that could cause suspicion. They felt uncomfortable in the situation and expressed a need for both education and an action plan.

This study explores how social work professionals at women’s shelters in Sweden experience, understand, and are responding to domestic violence under the impact of the COVID-19 pandemic. A qualitative longitudinal research design was employed, and multiple semi-structured interviews were conducted with 14 professionals at women’s shelters over a period of one year. The results are presented in three overall themes; (a) professional challenges due to increased needs, (b) professionals’ adjustments to new circumstances, and (c) professionals’ attributions regarding client barriers to help seeking. The results show diverse and changing experiences among the professionals as the pandemic progressed. Clients and professionals have shared the same collective trauma associated with the pandemic, which has affected the professionals’ understanding of and response to domestic violence. The professionals understand both clients and themselves as being more vulnerable and susceptible to risk under these new circumstances. Social work adjustments focused on maintaining contact, reducing risk and prioritizing safety, which had both positive and negative consequences for both clients and professionals. The study concludes that the professionals coped with the uncertainty they experienced during the pandemic by relying on both their previous knowledge and work experience of domestic violence and their experience of sharing trauma with clients.

Reflecting international patterns, Aboriginal people in Victoria are more likely to gamble and to experience gambling harm than non-Indigenous Victorians. This paper describes experiences of gambling reported by 50 Aboriginal people interviewed in regional Victoria in 2016 and 2017 as part of studies initiated by two Aboriginal community-controlled organisations. Data were analysed using social practice theory (SPT) and coded to the elements of ���meaning���, ���material���, ���competence���, and ���temporality���. Across each element we identified highly contradictory experiences. Gambling held meaning as an opportunity for community gatherings but was also regarded as a cause of domestic violence, conflict, isolation and shame. Materially, the venues that offered gambling were experienced by many Aboriginal people as safe and welcoming, but at the same time gambling produced a damaging affective sense of addiction for some. Gambling was a competency that some people valued and taught to children, but it was also seen as undermining cultural practices. While Aboriginal people were historically denied access to licensed venues offering commercial gambling, many participants now found opportunities to gamble inescapable. The intermingling of benefits and harms described above supports the need for a multi-faceted response to gambling in Aboriginal communities, which includes harm reduction as well as supply restriction and treatment. Some experiences of gambling related by our participants reflected those reported also by non-Indigenous Australians, while others were differently nuanced. Because SPT is used to understand collectively-shared practices, it facilitates the identification of gambling interventions at the level of the community, as recommended by our research participants.

Intimate partner violence (IPV) is an important public health concern with higher prevalence among women. Community health workers (CHWs) are trusted frontline public health workers that bridge gaps between communities and healthcare services. Despite their effectiveness in delivering services and improving outcomes for different chronic conditions, there is a dearth of understanding regarding CHW management of IPV. The purpose of this study is to examine knowledge, attitudes, practices, and readiness to manage IPV among a sample of CHWs (n = 152). Participants completed an online version of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS), which was modified for CHW practice. Psychometrics of the newly adapted tool, along with empirical relationships between knowledge, attitudes, and readiness to manage IPV were examined. Most sub-scales yielded moderate to high reliability (0.70

Background The popularity of mobile health (mHealth) technology has resulted in the development of numerous apps for almost every condition and disease management. mHealth and eHealth solutions for increasing awareness about, and safety around, intimate partner violence are no exception. These apps allow women to control access to these resources and provide unlimited, and with the right design features, safe access when these resources are needed. Few apps, however, have been designed in close collaboration with intended users to ensure relevance and effectiveness. Objective The objective of this paper is to discuss the design of a suite of evidence-based mHealth and eHealth apps to facilitate early identification of unsafe relationship behaviors and tailored safety planning to reduce harm from violence including the methods by which we collaborated with and sought input from a population of intended users. Methods A user-centered approach with aspects of human-centered design was followed to design a suite of 3 app-based safety planning interventions. Results This review of the design suite of app-based interventions revealed challenges faced and lessons learned that may inform future efforts to design evidence-based mHealth and eHealth interventions. Conclusions Following a user-centered approach can be helpful in designing mHealth and eHealth interventions for marginalized and vulnerable populations, and led to novel insights that improved the design of our interventions.

Research on the topic of poor perinatal mental health in South America is scarce. Nevertheless, studies have shown that it is not uncommon, and that it is linked to women's experience of sexual and intimate partner violence and to inequality, poverty and low educational attainment. High-quality research in large samples with rigorous methodology is a priority, so that data from this region may be compared and analysed in systematic reviews. The links with intimate partner violence need to be explored. Risk and protective factors must be investigated with a strong intercultural perspective. Service integration needs to be implemented. This will require improvements in the availability, accessibility and quality of obstetric and mental health services. There is a need for targeted evidence-based interventions for women and children at risk that incorporate a strong gender and rights perspective.

One method in mitigating the impact of COVID-19 is that of contact tracing. It is estimated that in the US, 35,000-100,000 contact tracers will be hired (and trained) to talk to recently-infected individuals, understand who they have exposed to the virus, and encourage those exposed to self-quarantine. The Center for Disease Control recommends the use of motivational interviewing (MI) by contact tracers to encourage compliance with contact tracing/quarantine. Contact tracers need to sensitively communicate with COVID-19-exposed individuals who may also be experiencing other issues caused by the pandemic, such as anxiety, depression, grief, anger, intimate partner violence, health problems, food insecurity, and/or unemployment. Social workers are particularly prepared to address the mental health and other psychosocial problems that may be encountered in the tracing process. This article describes contact tracing, its use in other diseases, the role of MI, psychosocial issues that contact tracers may encounter, and how social work can respond to these needs. A sample dialogue of contact tracing using MI is presented with a discussion of the content and skills used in the process.

Purpose Threatening or obscene messaging is repeated, unwanted texts, emails, letters or cards experienced by the recipient as threatening or obscene, and causing fear, alarm or distress. It is rarely examined as an aspect of intimate partner violence. We describe the prevalence of exposure to threatening/obscene messaging from a current or ex-partner; characteristics of victims; and associations with other forms of violence and abuse, mental disorder, self-harm, and suicidality. Methods Cross-sectional probability-sample survey of the general population in England aged 16 + . Multivariable regression modelling tested associations between receipt of threatening/obscene messaging and current common mental disorder, past-year self-harm and suicidality. Results Threatening/obscene messages were received from a current/ex-partner by 6.6% (95%CI: 5.9–7.3) of adults who had been in a relationship; 1.7% received these in the past year. Victims were more likely to be female, under 35, single or divorced, socioeconomically disadvantaged, and to have experienced other forms of sexual and partner violence and abuse. Those who received threatening/obscene messages in the past year were more likely to experience common mental disorder (adjusted odds ratio 1.89; 1.01–3.55), self-harm (2.31; 1.00–5.33), and suicidal thoughts (2.00; 1.06–3.78). Conclusion Threatening/obscene messaging commonly occurs in the context of intimate partner violence. While often occurring alongside sexual and physical violence, messaging has an additional association with mental disorder and suicidality. Routine enquiry in service settings concerning safety, including those working with people who have escaped domestic violence, should ask about ongoing contact from previous as well as current partners. This should include asking about messaging, as well as other forms of potentially technology-enabled abuse which may become increasingly common.

Choking/strangulation during sex is prevalent among young adults, with one study finding that 58% of women college students had ever been choked during sex. However, no qualitative study has examined women’s experiences with choking/strangulation during sex outside of intimate partner violence. The purpose of our qualitative interview study was to investigate women’s experiences with choking and/or being choked during partnered sex. Through in-depth interviews with 24 undergraduate and graduate women students ages 18 to 33, we sought to understand how women communicate about choking, their learning about and initiation into choking, their feelings about being choked and choking others, as well as consent and safety practices used in relation to choking. We found that women had first learned about choking through diverse sources including pornography, erotic stories, magazines, social media, friends, and partners. While all 24 women had been choked during sex, only 13 of 24 had ever choked a partner. They described having engaged in choking with men as well as women and with committed as well as more casual partner types. Participants described consensual and non-consensual choking experiences. While many women enjoyed choking, others did it largely to please their sexual partner. Women described different methods and intensities of having been choked. Although very few had ever sought out information on safety practices or risk reduction, and only some had established safe words or safe gestures with partners, participants consistently expressed a belief that the ways in which they and their partner(s) engaged in choking were safe.

Background: Violence and other adversities commonly co-occur, yet are usually investigated individually. The primary objectives of this paper are to investigate: (i) the relationship between maternal exposure to violence (including childhood abuse and intimate partner violence) and postpartum mental and physical health; and (ii) the extent to which exposure to violence and poor maternal mental and physical health are associated with children's emotional-behavioral difficulties. Methods: Prospective pregnancy cohort (n = 1507) followed up to 4 year postpartum. Validated measures used: Composite Abuse Scale; Edinburgh Postnatal Depression Scale, SF-36, Child Maltreatment History Self Report; Strengths and Difficulties Questionnaire. Logistic regression was used to investigate associations between maternal childhood abuse, intimate partner violence (IPV), maternal health and child emotional and behavioral difficulties at age 4. Outcomes: Two out of five women (41%) reported abuse in childhood, and almost one in three (29%) reported IPV during the first four years of motherhood. Women reporting both physical and sexual childhood abuse had markedly raised odds of IPV and poor physical and mental health at all time points (pregnancy, first year postpartum and four year postpartum). For the index child, violence exposures (maternal childhood abuse or IPV) and poor maternal physical or mental health were associated with higher odds of emotional/behavioral difficulties at age four. In multivariable models (adjusted for child gender and maternal age), cumulative exposures (multiple violence exposures or poor maternal mental or physical health at multiple time points) each independently added to increased odds of emotional-behavioral difficulties. Children of mothers who reported a history of childhood abuse but were not exposed to IPV had odds of difficulties similar to children of mothers not reporting any violence exposure, suggesting resilient outcomes where violence experiences are not repeated in the next generation. Interpretation: The clustering of risk (child and adult violence experiences) and the accumulation of risk within families (IPV, poor maternal health, child difficulties) highlight the need for effective early intervention to limit or ameliorate the impact of violence across the lifespan, and to break the intergenerational cycle of disadvantage. Keywords: Intimate partner violence, Child abuse, Intergenerational, Maternal health, Family violence, Child outcomes

Background The high global prevalence of intimate partner violence (IPV) and its association with poor physical and mental health underscore the need for effective primary prevention. We previously developed Ghya Bharari Ekatra (GBE), a couples-based primary prevention intervention for IPV among newly married couples residing in slum communities in Pune, India. Objective Through this pilot study, we aimed to explore the acceptance, safety, feasibility, and preliminary efficacy of GBE. Methods Between January and May 2018, we enrolled and assigned 20 couples to receive GBE plus information on IPV support services and 20 control couples to receive information on IPV support services alone. The GBE intervention was delivered over 6 weekly sessions to groups of 3 to 5 couples by lay peer educators in the communities in which the participants resided. Intervention components addressed relationship quality, resilience, communication and conflict negotiation, self-esteem, sexual communication and sexual health knowledge, and norms around IPV. Outcome evaluation included exit interviews with participants and peers to examine acceptance and feasibility challenges and baseline and 3-month follow-up interviews to examine change in IPV reporting and mental health (by women) and alcohol misuse (by men). The process evaluation examined dose delivered, dose received, fidelity, recruitment, participation rate, and context. Results Half (40/83) of the eligible couples approached agreed to participate in the GBE intervention. Retention rates were high (17/20, 85% across all 6 sessions), feedback from exit interviews suggested the content and delivery methods were very well received, and the community was highly supportive of the intervention. The principal feasibility challenge involved recruiting men with the lowest income who were dependent on daily wages. No safety concerns were reported by female participants over the course of the intervention or at the 3-month follow-up. There were no reported physical or sexual IPV events in either group, but there were fewer incidents of psychological abuse in GBE participants (3/17, 18%) versus control participants (4/16, 25%) at 3-month follow-up. There was also significant improvement in the overall mental health of female intervention participants and declines in the control participants (change in mean General Health Questionnaire-12 score: –0.13 in intervention vs 0.13 in controls; P=.10). Conclusions GBE has high acceptance, feasibility, and preliminary efficacy in preventing IPV and improving mental health among women. Next steps include refining the intervention content based on pilot findings and examining intervention efficacy through a large-scale randomized trial with longer follow-up. Trial Registration ClinicalTrials.gov NCT03332134; https://clinicaltrials.gov/ct2/show/NCT03332134. Clinical Trials Registry of India CTRI/2018/01/011596; http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=21443 International Registered Report Identifier (IRRID) RR2-10.2196/11533