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Pakistan has a significant occurrence of both consanguineous marriages and intimate partner violence (IPV), which may be interlinked. The practice of consanguineous marriages could potentially influence women to rationalize and accept instances of IPV. Such attitudes perpetuate a culture of violence against women, creating difficulties for victims to reject or escape from it. Pakistan has high prevalence rate of consanguineous marriages and IPV. However, no research has been done to explain the difference in acceptance of IPV between women in consanguineous and non-consanguineous marriages. This study used Pakistan Demographic and Health Survey data and applied association tests, logistic regression, and the Fairlie decomposition analysis. The Fairlie decomposition helps us identify the relative contribution of different socioeconomic factors in the inequalities in IPV between the two types of marriages. Five dimensions of wife-beating justification are used as outcome variables. Age, education, and empowerment of women, husband education, woman witness parental violence, region, place of residence, and household wealth status are used as independent variables. The logistic regression results indicated that women in consanguineous marriages of younger age and who witnessed parental violence are more likely to justify wife-beating than those who belong to wealthy households and enjoy more empowerment. Compared to the Punjab province, women residing in Sindh and Baluchistan are less likely and in the Khyber Pakhtunkhwa province are more likely to justify wife-beating. The Fairlie decomposition analysis shows that household wealth status, woman education, and empowerment are the main contributors in explaining the gap between the wife-beating justification of the two groups. The IPV gap can be reduced up to 77% if the distribution of women in different wealth quantiles of the consanguineous marriage group is identical to the non-consanguineous marriage group. Furthermore, woman education level is the second highest contributor. Consanguineous marriages are a prevalent cultural practice in Pakistan and are associated with several negative health and social outcomes. Addressing this issue requires a sustained and comprehensive effort by the government, civil society, and international partners, with a particular focus on women from poor households with less education., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interests with respect to the authorship and/or publication of this article.

Intimate partner violence against women (IPV) has devastating effects on the healthcare and well-being of women and their children. Physical, psychological, and social consequences, a worse perception of their own health, and loss of quality of life are well-documented, while aftereffects persist in time even after the end of abuse. Psychological consequences of abuse last longer and are more serious. IPV also affects sons and daughters, disabled people, family, and the attacker himself. Many health problems, both physical and mental, that lead women to go to healthcare services in search of help have an origin in the violence they experience. Treatment of the symptoms without awareness of its relation to such violence favours medicalization, iatrogenesis, and chronification. Psychological violence poses a threat that is invisible, subtle, cumulative, and difficult to detect; it is, however, the most destructive., (Copyright © 2024 The Authors. Publicado por Elsevier España S.L.U. All rights reserved.)

Background: Violence against women is considered a fundamental violation of their human rights. According to the world health organization (WHO), one-third of women worldwide experience some form of intimate partner violence (IPV). This study aimed to investigate the relationship between dowry demand, perception of wife-beating, decision-making on work and household purchases and physical, sexual, and emotional violence against married adolescent girls in India by using a large dataset., Methods: Data from the Understanding the lives of adolescents and young adults (UDAYA) project survey were used in this study. The final sample size included 4893 married adolescent girls. Descriptive statistics and bivariate analyses were performed to examine preliminary results. Multivariate logistic regression analysis was used to analyze the associations between dowry demand, perception of wife-beating, decision-making and types of IPV., Results: The prevalence of emotional, physical, and sexual violence among married adolescent girls were 28.6%, 22.9%, and 26.1%, respectively. Approximately 44% of married adolescent girls have experienced some form of violence (emotional, physical, or sexual). The likelihood of experiencing violence was 3.64 times more likely among adolescent girls who reported that dowry was demanded by their in-laws than their counterparts [aOR: 3.64; CI: 3.05-4.35]. Moreover, married girls who justified wife-beating were more likely to face any violence than their counterparts [aOR: 1.56; CI: 1.28-1.90]. Similarly, adolescent girls whose work decisions were made by others had higher odds of experiencing any violence than those who decided their work themselves/jointly with others [aOR: 1.34; CI: 1.07-1.68]. The odds of any violence were higher among adolescent girls whose decisions on household purchases were made by others compared to those who decided to make purchases themselves or jointly with others [aOR: 1.37; CI: 1.09-1.71]., Conclusions: The findings revealed significant associations between dowry-demand, justification of wife-beating, decision making power and IPV among married adolescent girls, and suggest policies that help reduce violence related to the predominantly practiced dowry system in the country, and programs aimed at educating adolescent married girls about their rights against violence and empowering them to retain equal decision-making power within their families and reduce their vulnerability to domestic violence., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Srivastava et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study examines domestic violence perpetrated by wives against husbands in Palestine, utilizing structured interviews with 53 married participants. Findings reveal prevalent female-perpetrated domestic violence, often involving mutual conflict initiation. External stressors and power dynamics significantly influence behaviors, reflecting situational pressures and control issues. Verbal abuse and emotional manipulation are widespread, indicating covert and challenging violence dynamics. Responses to violence vary, suggesting barriers to accessing support systems. Effective conflict resolution is crucial to address ongoing relationship challenges. The study underscores the multifaceted nature of domestic violence, emphasizing the need to address underlying psychological factors and promote healthier relationship dynamics. Based on the study's findings, actionable recommendations include educational outreach, customized support services, legal advocacy initiatives, community engagement projects, professional development activities, and sustained research efforts to promote positive societal change., Competing Interests: Declaration of competing interest The author declares no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

A systematic review was conducted to examine the factors that put women at risk of domestic violence in Nepal. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), PubMed, Cochrane, MEDLINE, CINAHL, and PsycINFO were searched supplemented by searching of the reference list manually. Of the 143 studies identified 24 were included in the final review. Search strategy was developed, and studies were included if they considered female participants (age 15-49 years) in heterosexual relationship, with exposure of different factors and whose outcomes were the magnitude of any form of violence (physical, sexual, and emotional/psychological). The Mixed Methods Appraisal Tool was used to assess the quality of the studies included. The findings are categorized based on the four levels of the ecological framework. At the individual level, the alcohol consumption level of husband, education level of both women and men, women's age at the time of marriage and childhood exposure to violence were found to be highly prevalent risk factors. At the relationship level, most prevalent risk factors were controlling husband and decision-making capacity of women. At the community level, belonging to underprivileged community or low caste system and living in Terai region were the risk factors. At the societal level, patriarchal belief and norms supporting violence were the risk factors. The complex nature of violence against women in Nepal requires culturally sensitive interventions along with organized efforts from the local and intra government to improve the status of Nepalese women at all levels of the ecological framework., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The study aimed to qualitatively explore the relationship between intimate partner violence and early marriage, focusing on the psychological and physical health issues faced by married women in rural Pakistan. Specifically, it investigated how resilience moderates the effects of early marriage, physical health problems, intimate partner abuse, and psychological issues. Using an intrinsic qualitative approach, the research involved interviews with 20 household heads, 62 husbands, and 40 wives in Sindh province. The findings indicated significant differences related to early marriage, intimate partner abuse, physical health issues, stress, anxiety, and depression. The results align with other South Asian studies, highlighting early marriage as a major risk factor for physical health issues and intimate partner violence. Additionally, the study underscores the widespread nature of violence as a social problem affecting married couples' health in Pakistan., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2024.)

Background: Violence against women is a critical public health issue that adversely affects physical and mental health, contributing to injuries, chronic conditions, and mental health disorders. This study addresses the gap in understanding the relationship between spousal violence with maternal functioning and mental health in postpartum mothers., Methods: This Prospective study was conducted on 316 postpartum women who gave birth in Al-Zahra and Taleghani Educational Treatment Centers in Tabriz, Iran, from June 2023 to October 2023. Participants were selected using convenience sampling and followed up for 6-8 weeks. The data were collected using the Revised Conflict Tactics Scale (CTS2), the Edinburgh Postnatal Depression Scale (EPDS), the Postpartum Specific Anxiety Scale (PSAS), and the Barkin Index of Maternal Functioning (BIMF). A general linear model, adjusted for individual, social, and obstetric variables, was used to determine the relationship between domestic violence, maternal functioning, depression and anxiety., Results: Most women (84%) experienced one or more types of intimate partner violence (IPV), including psychological, physical, or sexual abuse. About one-third (32.9%) reported psychological abuse, 21.2% physical violence, 49.4% sexual coercion, and 6.3% reported injuries. The adjusted general linear model showed that the mean depression score was lower in individuals without any experience of violence compared to those who had experienced any violence (β: -1.75; 95% CI: -3.40 to -0.10; p = 0.038). The mean depression score was significantly higher in homemakers compared to employed individuals (β = 3.53; 95% CI = 1.22 to 5.84, p = 0.003). The mean maternal functioning score was significantly higher in those who had not experienced mild physical violence compared to those who had (β = 2.94; 95% CI = 0.34 to 5.55, p = 0.027). The mean anxiety score was lower in individuals with high income (β: -3.38; 95% CI: -5.73 to -1.04; p = 0.005) and moderate income (β: -2.21; 95% CI: -4.35 to -0.07; p = 0.043) compared to those with low income., Conclusion: The findings reveal a high prevalence of violence, particularly sexual coercion, significantly affecting maternal functioning and mental health. Socioeconomic factors also play a crucial role in postpartum mental health. These results highlight the urgent need for enhanced prevention efforts and targeted interventions that consider the socio-economic context and specific forms of violence., (© 2024. The Author(s).)

Since it was first published in 1995, the Spousal Assault Risk Assessment (SARA) Guide has become one of the most used and researched intimate partner violence (IPV) risk measures worldwide. Yet, no recent review has formally and systematically established the psychometric properties of this measure. Furthermore, the third version of the SARA (SARA-V3) was published in 2015, with no psychometric critique to date. This review aimed to provide an inclusive and exhaustive literature review of all psychometric properties (i.e., predictive validity, convergent validity, internal consistency, and inter-rater) of the SARA, including V3. A systematic search of 17 databases was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Academic journals, book chapters, and gray literature were included but conference presentations were not. To be included studies had to report a psychometric property of any version of the SARA and be composed of individuals having committed IPV. The search identified 28 records published between 1997 and 2022. Results showed that although the literature on the SARA is mostly positive, it is much more varied in terms of both results and research quality than its widespread implementation might suggest. Most studies were conducted using case files in a research context with non-diverse samples, undermining ecological validity. Results for convergent and predictive validity were mostly positive. However, reliability statistics were under-researched and showed poorer results. Lastly, little research has gone into validating the SARA-V3, with what is available suggesting poorer reliability and validity than its predecessor. Practitioners are cautioned against transitioning to the newer version before further validation research has occurred., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: As per the National Family Health Survey (NFHS-4, 2015-16) report, 40% of women aged 15-49 in India experienced intimate partner violence (IPV), with emotional abuse significantly associated with negative reproductive health (RH) outcomes., Methods: The study uses secondary data from the NFHS-4 and conducts statistical analysis based on information gathered from 8766 married women aged 15-49 years in Northeast India. Bivariate analysis followed by multiple logistic regression analysis is performed to understand the relationship between IPV and its effects on women's RH., Results: The findings indicate that ever-married women in Northeast India have faced physical violence (25.1%), sexual violence (11.8%), emotional abuse (6.4%) and severe violence (5.3%). Among all women who participated in the study, 6.9% had experienced non-live births, 4.2% miscarriages, 2.4% abortions, 0.3% stillbirths, 16.9% terminated pregnancies and 2.1% sexually transmitted infections (STI). Sexually abused women (SAW) showed higher likelihoods of non-live births, STIs, miscarriages, abortions and pregnancy terminations. SAW had a 65% higher risk of miscarriages, while those experiencing physical violence had a 64% increased risk of abortions., Conclusion: IPV significantly impacts women's RH in Northeast India. This study presents evidence from surveys on sexual and RH among married women affected by IPV in Northeast India., (© The Author(s) 2024. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Despite domestic violence and related homicides perpetrated by partners and/or in-laws being a significant public health problem in India, there are no reliable and valid instruments to identify and intervene with women in domestic violence relationships. Continued domestic violence can escalate to severe, near-lethal, or lethal violence or homicide. The Danger Assessment (DA) is a risk assessment instrument designed to assess the likelihood of severe, near-lethal, or lethal violence in abusive relationships. However, the DA is not designed to determine the risk of future severe, near-lethal, or lethal violence by in-laws. In-law abuse plays a significant role in domestic violence-related homicides in India and other countries with similar cultural norms. This study addressed this gap by developing the Danger Assessment for in-laws (DA-L) to assess risk from in-laws, alongside the Danger Assessment for Women in India (DA-WI) to assess risk from partners. The study also examined the psychometric properties of the DA-L and DA-WI. Longitudinal data from 150 women in India were used to measure the reliability and validity of the two versions of the DA. The original DA items and additional risk items were examined using relative risk ratios for their relationship with severe violence at three-month follow-ups. Predictive validity was tested with the receiver operating characteristic curve. The study resulted in reliable and valid measures (11 items DA-L and 26-items DA-WI) of risk. The versions of the DA can be useful for practitioners in India and those working with Indian women in the US and other countries. The DAs can be used for identifying women in domestic violence relationships who are at risk for future severe domestic violence and guide the provision of tailored safety plans., (© 2024. The Author(s).)

Racial disparities in criminal justice outcomes are widely observed. In Canada, such disparities are particularly evident between Indigenous and non-Indigenous persons. The role of formal risk assessment in contributing to such disparities remains a topic of interest to many, but critical analysis has almost exclusively focused on actuarial or statistical risk measures. Recent research suggests that ratings from other common tools, based on the structured professional judgment model, can also demonstrate racial disparities. This study examined risk assessments produced using a widely used structured professional judgment tool, the Spousal Assault Risk Assessment Guide-Version 3, among a sample of 190 individuals with histories of intimate partner violence. We examined the relationships among race, risk factors, summary risk ratings, and recidivism while also investigating whether participants' racial identity influenced the likelihood of incurring formal sanctions for reported violence. Spousal Assault Risk Assessment Guide-Version 3 risk factor totals and summary risk ratings were associated with new violent charges. Indigenous individuals were assessed as demonstrating more risk factors and were more likely to be rated as high risk, even after controlling for summed risk factor totals and prior convictions. They were also more likely to recidivate and to have a history of at least one reported act of violence that did not result in formal sanctions. The results suggest that structured professional judgment guidelines can produce disparate results across racial groups. The disparities observed may reflect genuine differences in the likelihood of recidivism, driven by psychologically meaningful risk factors which have origins in deep-rooted systemic and contextual factors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Previous studies exploring the influential factors associated with attitudinal acceptance of wife abuse (AAWA) did not widely focus on the relation between women's social mobility (WSM) and different dimensions of AAWA in rural Bangladesh. This current study examined the association between WSM and different dimensions of AAWA in the context of socio-cultural differences among the Bengali, the Santal, and the Garo ethnic communities in rural Bangladesh. Adopting a cross-sectional design, 1,929 married men and women were randomly included in the study from 8 Bengali, 8 Santal, and 8 Garo villages where 50.2% were women and 49.8% were men. Of the sample, 33.2% Garo, 33.2% Santal, and 33.6% Bengali participants were included in this study. Data revealed that 45.5% of women had low social mobility and the prevalence of different dimensions of AAWA was high and varied among the study communities. We used descriptive statistics, chi-square, and binary logistic regression analysis to estimate the association. The multivariate binary logistic regression analysis results revealed that the likelihood of attitudinal acceptance of overall abuse, psychological abuse, physical abuse, abuse on disobeying family obligation, and abuse on challenging male authority were significantly lower for the respondents who belonged to families where women enjoyed high mobility compared to those who belonged to families where WSM was low. This study also showed that the Bengali and the Santal participants were more likely to accept different dimensions of AAWA compared to the Garos. This study suggests that WSM should be considered in policy-making and implementing interventions to reduce the different dimensions of AAWA in rural Bangladesh., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interests with respect to the authorship, funding, and/or publication of this article.

Background: Violence, a notable human rights concern, has a public health impact across the globe. The study aimed to determine the prevalence and determinants of domestic violence among ever-married women aged 18-49 years in India., Methods: Secondary data analysis with National Family Health Survey 5, 2019-21 data (NFHS-5) was conducted. The complex sampling design of the survey was accounted-for during analysis. The primary outcome was domestic violence. Prevalence was reported with 95% confidence interval (CI). Prevalence ratio was reported to provide the factors associated with domestic violence using Poisson regression., Results: About 63 796 ever-married women aged 18-49 years covered under domestic violence module of NFHS-5 survey were included. Prevalence of domestic violence (12 months preceding the survey) was 31.9% (95% CI: 30.9-32.9%). Physical violence (28.3%) was the most common form followed by emotional (14.1%) and sexual violence (6.1%). Women with low education, being employed, husband being uneducated or with coercive behavior had significantly higher prevalence of domestic violence., Conclusions: One-third of the reproductive age-group women were facing some form of domestic violence. Target group interventions like violence awareness campaigns, women supportive services and stringent law enforcement should be implemented to eliminate domestic violence by year 2030., (© The Author(s) 2023. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Violence against women is a serious human rights violation. While much attention has been given to the prevalence and prevention of physical, sexual and emotional violence, one crucial dimension is to date less well understood: economic abuse against women. This paper presents rich qualitative data on economic abuse against women in India to improve the understanding of economic abuse in a lower-middle income setting and to assess how economic abuse interacts with socio-cultural factors such as patrilocality, patriarchal gender norms and limited acceptance of female employment., Methods: We conducted 13 focus group discussions (FGDs) in the states Maharashtra and Rajasthan. FGDs were conducted with married working (for income) and non-working women, husbands and mothers-in-law. Discussions were recorded, transcribed verbatim and translated to English. Transcripts were coded using thematic analysis and emerging themes were discussed among all authors., Results: Women suffered from four distinct forms of economic abuse. Economic control emerged as the most prevalent theme, amplified by women's marginalisation from financial decision-making in the household. Discussions further alluded to employment sabotage, which husbands commonly justified by not wanting their wives to neglect their duties at home. A third category was women's economic exploitation, expressed by husbands taking their salaries, accumulating debt in their wife's name, and using their wife's wedding endowments for own purposes. A last category was husbands' refusal to financially contribute to necessary household expenses, which hindered investments in children's education and adequate coping with health emergencies. We identified important linkages with other forms of domestic abuse., Conclusion: Economic abuse has the potential to trap women in abusive relationships. Effective interventions to reduce economic abuse and economically empower women such as financial inclusion programmes are urgently needed. Stricter penalisation of dowry-related violence and spousal abuse is also required., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The purpose of the current qualitative descriptive study was to describe the experiences of women who have endured intimate partner abuse using the theoretical framework of posttraumatic growth (PTG). Women ( N = 14) who reported emotional and/or physical abuse by their male partners were interviewed. Five themes were identified: Acknowledging the Abusive Relationship ; Fear of Him: Threats, Control, Pain, and Isolation ; Accepting Support: Grabbing the Life Preserver ; Rediscovering Myself: Digging Deep ; and Appreciating Life and Helping Others . Findings have practical implications for nurses who are in pivotal positions to educate and influence others about the possibility of PTG following partner abuse. Nurses can help women find their way through this trauma and teach others about coping, healing, and recovery. [ Journal of Psychosocial Nursing and Mental Health Services, 61 (8), 34-41.].

Domestic violence is a serious, complex, public health problem, which is more common than many physicians realize. Although certain characteristics may be associated with the victim and perpetrator, they have limited value in identification or prediction of partner violence. Any woman may be a victim and any man, a perpetrator; therefore, universal screening for partner abuse is encouraged. The medical and psychological consequences of domestic violence are often of tragic proportion, for both the woman and her children. Unfortunately, unless asked directly and in a supportive fashion, many women will remain silent and continue to be victimized., (© 1998 American Osteopathic Association.)

Background: Sexual and physical violence against disabled individuals is widespread and linked to negative public health and social outcomes. The real-world prevalence of abuse in women with multiple sclerosis (MS) has not been well studied., Objectives: To explore abuse prevalence in a real-world cohort of females with MS attending an academic MS Center., Methods: Prospective and retrospective abuse data were confidentially collected during neurology clinic visits and extracted from medical records for women attending an academic MS Center. Self-reported and provider-documented prevalence of abuse experiences were correlated with socio-economic and disease-specific factors., Results: In total, 200 women completed prospective questionnaires, and 121 non-overlapping independent health records were retrospectively reviewed. Mean age ( SD ) was 49.055 (11.39). Seventy-six (38%) reported lifetime abuse incidents; 15% were abused within the previous year. Intimate partners were the most likely verbal ( p ⩽ 0.01)) and physical ( p = 0.04) abuse perpetrators. Neurologic disability correlated with greater likelihood of verbal abuse ( p = 0.021) in prospective cohort. There was no billing or encounter documentation for any form of abuse., Conclusion: Intimate partner violence is common in women with MS, correlates with neurologic disability, and is underreported by the health system. Future research needs to focus on abuse detection and mitigation strategies.

Intimate partner violence survivors ( N  = 122) reported on formal help-seeking before and after their male partners enrolled in a Relationship Violence Intervention Program (RVIP). At baseline, only 20% of survivors had ever received domestic abuse (DA) counseling. DA counseling was more common among survivors with more extensive partner abuse exposures, and for black women residing in suburban versus urban communities. New help-seeking was associated with survivor perceptions of the abusive partner's stage of change. RVIP impact may be enhanced through culturally sensitive survivor outreach that is responsive to a broad range of needs and includes repeated contact over time.

Prior research suggests that economic abuse and work sabotage are common tactics for abusers and (ex)partner stalkers. This study examines the context and timing (i.e., during the relationship or during separation) of work harassment among women stalked by abusive (ex)partners among victims who did ( n =271) and who did not ( n =302) experience work losses (significant problems at work or loss of work due to the abuse/stalking) and whether work losses and non-work related resource losses were associated with current mental health symptoms. Results showed that almost half of the women in the study reported they experienced work losses because of their abusive (ex)partner. Women with work losses experienced more work harassment particularly during periods of separation. Women who experienced work losses also experienced more work harassment, separation attempts, economic control, coercive control, physical and sexual abuse, higher fear levels, and a higher number of non-work related resource losses compared to women who did not report experiencing work losses. Women with work losses experienced more symptoms of current depression, anxiety, and Post-Traumatic Stress Disorder. Further, in the multivariate analysis, non-work related resource losses were significantly and uniquely associated with current mental health symptoms. In conclusion, women being stalked by abusive (ex)partners are at significant risk of resource losses, and those losses have long term impacts on mental health suggesting that safety planning for stalking victims should include plans to protect resources as well as physical safety.

Introduction: Intimate partner violence (IPV) is a distressing reality worldwide. Victims of IPV usually experience long-term mental health disorders and maladjustments in their daily lives., Aims: To examine the prevalence of depression, anxiety, and post-traumatic stress disorder in female victims of IPV that participated in a public mental health care program, and to analyze the relationships between the type of IPV exposure, its psychological consequences, and daily life adjustment., Method: Up to 164 female victims of IPV referred by their primary care doctors to the Adult Mental Health Casntre of Sant Cugat del Vallès (Barcelona) between 2010 and 2016 were evaluated using several tests (Index of Spouse Abuse - ISA, Beck Depression Inventory - BDI-II, Sate-Trait Anxiety Inventory - STAI, the Maladjustment Scale - MS, and the Severity Symptom Scale for Post-traumatic Stress Disorder - EGS)., Results: Of the 164 referred women, 102 (62.2%) agreed to participate (mean age 44.98 years, range 19-71) and 73% scored above the cut-off point in the physical IPV dimension (ISA). Moreover, 73% had depression symptoms, 77% trait anxiety, and 87% state anxiety altered scores. Prevalence of post-traumatic stress disorder was also high (87%). IPV interfered significantly in all the aspects of the daily lives of 92% of the sample., Conclusions: The participants of the study experienced many psychological symptoms and a high level of interference with all aspects of their daily lives. These consequences were of similar magnitude amongst victims of emotional abuse compared to those who suffered physical violence.

Background: Individuals in violent intimate relationships are at a high risk of sustaining both orthopaedic fractures and traumatic brain injury (TBI), and the fracture clinic may be the first place that concurrent intimate partner violence (IPV) and TBI are recognized. Both IPV and TBI can affect all aspects of fracture management, but prevalence of TBI and comorbid TBI and IPV is unknown., Questions/purposes: (1) What are the previous-year and lifetime prevalence of IPV and TBI in women presenting to an outpatient orthopaedic fracture clinic? (2) What are the conditional probabilities of TBI in the presence of IPV and the reverse, to explore whether screening for one condition could effectively identify patients with the other? (3) Do patients with TBI, IPV, or both have worse neurobehavioral symptoms than patients without TBI and IPV?, Methods: The study was completed in the fracture clinic at a community Level 1 trauma center in Southern Ontario from July 2018 to March 2019 and included patients seen by three orthopaedic surgeons. Inclusion criteria were self-identification as a woman, age 18 years or older, and the ability to complete forms in English without assistance from the person who brought them to the clinic (for participant safety and privacy). We invited 263 women to participate: 22 were ineligible (for example, they were patients of a surgeon who was not on the study protocol), 87 declined before hearing the topic of the study, and data from eight were excluded because the data were incomplete or lost. Complete data were obtained from 146 participants. Participants' mean age was 52 ± 16 years, and the most common diagnosis was upper or lower limb fracture. Prevalence of IPV was calculated as the number of women who answered "sometimes" or "often" to direct questions from the Woman Abuse Screening Tool, which asks about physical, emotional, and sexual abuse in the past year or person's lifetime. The prevalence of TBI was calculated as the number of women who reported at least one head or neck injury that resulted in feeling dazed or confused or in loss of consciousness lasting 30 minutes or less on the Ohio State University Traumatic Brain Injury Identification Method, a standardized procedure for eliciting lifetime history of TBI through a 3- to 5-minute structured interview. Conditional probabilities were calculated using a Bayesian analysis. Neurobehavioral symptoms were characterized using the Neurobehavioral Symptom Inventory, a standard self-report measure of everyday emotional, somatic, and cognitive complaints after TBI, with total scores compared across groups using a one-way ANOVA., Results: Previous-year prevalence of physical IPV was 7% (10 of 146), and lifetime prevalence was 28% (41 of 146). Previous-year prevalence of TBI was 8% (12 of 146), and lifetime prevalence was 49% (72 of 146). The probability of TBI in the presence of IPV was 0.77, and probability of IPV in the presence of TBI was 0.36. Thus, screening for IPV identified proportionately more patients with TBI than screening for TBI, but the reverse was not true. Neurobehavioral Symptom Inventory scores were higher (more symptoms) in patients with TBI only (23 ± 16) than those with fractures only (12 ± 11, mean difference 11 [95% CI 8 to 18]; p < 0.001), in those with IPV only (17 ± 11) versus fractures only (mean difference 5 [95% CI -1 to -11]; p < 0.05), and in those with both TBI and IPV (25 ± 14) than with fractures only (mean difference 13 [95% CI 8 to 18]; p < 0.001) or those with IPV alone (17 ± 11, mean difference 8 [95% CI -1 to 16]; p < 0.05)., Conclusion: Using a brief screening interview, we identified a high self-reported prevalence of TBI and IPV alone, consistent with previous studies, and a novel finding of high comorbidity of IPV and TBI. Given that the fracture clinic may be the first healthcare contact for women with IPV and TBI, especially mild TBI associated with IPV, we recommend educating frontline staff on how to identify IPV and TBI as well as implementing brief screening and referral and universal design modifications that support effective, efficient, and accurate communication patients with TBI-related cognitive and communication challenges., Level of Evidence: Level II, prognostic study., Competing Interests: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request., (Copyright © 2022 by the Association of Bone and Joint Surgeons.)

Background: There is a high prevalence of substance use disorders, especially among men, in Iran and is associated with a high burden on families. We aimed to systematically review the association between illicit drug use and spouse and child abuse in Iran., Method: Comprehensive terms were used to search three international databases (ISI, Medline, and Scopus) and a national database of Scientific Information Database up to September 2019. The retrieved citations were screened based on the eligibility criteria and then data were extracted, and the risk of bias was assessed by two independent investigators. Data were analyzed using random-effects model to estimate pooled odds ratios ( OR s) and the heterogeneity of studies., Results: The search yielded 18 articles that met the inclusion criteria. Illicit substance use in husbands was associated with increased odds of current violence ( OR = 3.50; 95% CI [2.09, 5.86]), current physical violence ( OR = 5.41; 95% CI [3.50, 8.35]), current psychological violence ( OR = 6.20; 95% CI [3.74, 10.30]), and current sexual violence ( OR = 7.23; 95% CI [4.06, 12.87]) against spouse. In studies on child abuse, the odds of current physical child abuse by parents who used an illicit substance was 3.88 times (95% CI [1.50, 10.01]) higher than parents who did not use any illicit substance., Conclusion: The results of the current study showed that illicit substance use is associated with an increased risk of spouse and child abuse. This is an important social and health consequence of drug use and should be addressed in all drug control plans.

Despite being a human rights violation, child marriage still takes place across the globe. Prior scholarship has shown early marriage to be associated with an increased risk of intimate partner violence (IPV). Drawing on data from the nationally representative Demographic and Health Surveys-conducted in developing and transitional nations where rates of child marriage tend to be higher-the current study provides a cross-national examination of individual-, community-, and national-level predictors of child marriage and their association with physical and emotional IPV. The sample of ever married women includes 281,674 respondents across 46 developing and transitional nations. Findings reveal the prevalence of child marriage was largely consistent with worldwide estimates. Over half of the sample (59.97%) were over the age of 18 when they married and about 1 in 10 women were married at age 14 or younger. A later age at marriage, measured continuously, was associated with lower odds of physical and emotional IPV. When considering the 18 and over cutoff traditionally used to operationalize child marriage, the odds of physical and emotional IPV were lower for women who married over the age of 18 than women who were 14 and younger when they married. However, there was a confounding effect when considering age at marriage as 18 and over when community-level predictors were not included in the model estimating physical abuse. This underscores the need to consider the nested nature of respondents' experiences. Further, national legislation that protects against child marriage was not associated with risk of physical or emotional IPV. However, population size increased the odds of physical IPV and lowered the odds of emotional IPV. Such findings can be interpreted in light of opportunity theory and provide direction for prevention and intervention programming.

Objective Personality disorders and intimate partner violence (IPV) are two problems recognized as major public health issues associated with serious individual and societal repercussions. Several studies have documented the links between borderline personality disorder (BPD) and IPV; however, we know very little about the specific pathological traits contributing to IPV. The study aims to document the phenomenon of IPV committed and suffered in persons with BPD and to draw profiles from the personality facets of the DSM-5 Alternative Model for Personality Disorders (AMPD). Method One hundred and eight BPD participants (83.3% female; Mage = 32.39, SD = 9.00) referred to a day hospital program following a crisis episode completed a battery of questionnaires including the French versions of the Revised Conflict Tactics Scales, evaluating physical and psychological IPV committed and suffered, and the Personality Inventory for the DSM-5- Faceted Brief Form, evaluating 25 pathological facets of personality. Results Among the participants, 78.7% report having committed psychological IPV, while 68.5% have been victims, which is more than the estimates published by the World Health Organization (27%). In addition, 31.5% would have committed physical IPV, while 22.2% would have been victims. IPV appears to be bidirectional since 85.9% of participants who are perpetrators of psychological IPV also report suffering from it and 52.9% of participants who are perpetrators of physical IPV report being also victims. Nonparametric group comparisons indicate that Hostility, Suspiciousness, Duplicity, Risk-Taking, and Irresponsibility facets distinguish physically and psychologically violent participants from nonviolent participants. High results on Hostility, Callousness, Manipulation, and Risk-taking facets characterize participants who are victims of psychological IPV, while an elevation in Hostility, Withdrawal, Avoidance of intimacy, and Risk-taking facets and a low result on the Submission facet distinguish participants who are victims of physical IPV from non-victims. Regression analyzes show that the Hostility facet alone explains a significant variance in the results of IPV perpetrated, while the Irresponsibility facet contributes substantially to the variance of the results of IPV experienced. Conclusion Results show the high prevalence of IPV in a sample of persons with BPD, as well as its bidirectional nature. Beyond the diagnosis of BPD, certain specific facets of the personality (including Hostility and Irresponsability) make it possible to target persons at greater risk of committing and suffering from psychological and physical IPV.

Violence against women is now widely recognized as an important public health problem, owing to its health consequences. Domestic violence generally refers to violence against women that generally takes place in the matrimonial home, which includes physical, emotional, sexual as well as economical violence occurring in the adult relationship. Domestic violence has negative impact on the demographic outcome of a country or region, which includes the health and health seeking behavior of women. The present study is an attempt to investigate the socioeconomic factors that would significantly influence domestic violence in the northeastern region of India. The northeastern region of India comprises of eight states, including Manipur and Sikkim, which are reported having the highest and the least prevalence of domestic violence in the whole country according to NFHS-4. Considering these reports and having a different socioeconomic setup as compared to other states in the mainland India, we selected the region for the current study. Data from NFHS-4 conducted during 2015-16 is being employed for the present study. Findings show that education of women, wealth, women's working status, religion, parity of women, and husband's alcohol use are some of the significant covariates that might have influenced domestic violence. The overall prevalence of physical, emotional, sexual, and severe physical violence among women of northeastern India are 24.7%, 11.8%, 6.4%, and 5.3%, respectively. Logistic regression analysis computes the relative risks of categorical variables via the odds ratios. Those women who got higher education and are in upper wealth quintiles have less risk of experiencing domestic violence as compared to women in lower education and lower wealth quintile in northeastern India. There is no rural urban difference in experiencing domestic violence in the region.

Introduction: Violence against women is a significant health and legal problem and has been declared as a health priority by the World Health Organization. The most common type of violence against women is domestic violence, more prevalent against women with disabilities than other women. Multiple sclerosis (MS) is a debilitating neurological disease and has experienced sudden growth in Iran. This study aimed to investigate the prevalence of domestic violence and its various types (psychological, economic, physical, and sexual) experienced by women with MS., Methods: In this cross-sectional study, 275 married women with MS were selected using convenience sampling. After obtaining informed consent and reviewing the inclusion and exclusion criteria, the Domestic Violence against Women Questionnaire developed by Mohseni Tabrizi et al. was completed by the participants on a self-report basis. The results were analyzed using SPSS software version 16. To analyze data, statistical tests including chi-square and Fisher exact tests for univariate analysis and logistic regression, were employed., Results: The mean age of participants was 37.12 ± 8.48 years. Domestic violence in different forms of psychological, economic, physical, and sexual violence was present in 53.1%, 63%, 33.6%, and 20.4% of participants, respectively. Economic violence (33.8%) was the highest, and sexual violence (5.1%) was the lowest rate of severe violence among participants. There was a significant relationship between the overall rate of domestic violence and the variables including income (P = 0.013), spouse's income (P = 0.001), participant's job (P = 0.036) and participant's education (P = 0.001). In logistic regression, the overall rate of domestic violence was higher in participants with education less than a diploma than in participants with a diploma (P = 0.014) and participants with a university education (P = 0.016)., Conclusion: According to the results, providing opportunities such as promoting the social status of women, fulfilling the rights of women with disabilities and debilitating diseases such as MS in society is recommended. Additionally, educating men about the negative impact of domestic violence on the current and future status of the family seems necessary. Providing counseling facilities on various forms of violence, especially domestic violence, for women with MS, is also recommended., (© 2022. The Author(s).)

There is increasing concern about the impact of the COVID-19 pandemic and the lockdown's social and economic consequences on gender-based violence. This study aimed to assess the impact of the COVID-19 pandemic on gender-based violence by comparing the prevalence of spousal violence against women before and during the COVID-19 related lockdown periods. This study was conducted in the Kurdistan Region of Iraq using a self-administered online questionnaire survey after the COVID-19 lockdown period in June 2020. Data were collected from a sample of 346 married women about the occurrence, frequency, and forms of spousal violence before and during the lockdown period. Significant increases in violence were observed from the pre-lockdown period to the lockdown period for any violence (32.1% to 38.7%, p = .001), emotional abuse (29.5% to 35.0%, p = .005), and physical violence (12.7% to 17.6%, p = .002). Regarding emotional abuse, humiliation (24.6% to 28.3%, p = .041) and scaring or intimidation (14.2% to 21.4%, p < .001) significantly increased during the lockdown. For physical violence, twisting the arm or pulling hair (9.0% to 13.0%, p = .004) and hitting (5.2% to 9.2%, p = .003) significantly increased during the lockdown. Forcing to have sexual intercourse also significantly increased during lockdown (6.6% to 9.5%., p = .021). The concerned authorities and women's rights organizations should collaborate to enhance the prevention of violence against women. An effective prevention strategy should emphasize recognizing and acknowledging the extent of the problem, raising awareness about the problem and the available resources to address it, and ensuring social and economic stability. Lessons learned about the increased prevalence of spousal violence against women during the COVID-19 pandemic and the need to adopt appropriate strategies to prevent and address it will be valuable for similar future crises.

Domestic violence (DV), also commonly referred to as intimate partner violence or spousal abuse, is a global public health issue that affects the physical, psychological, sexual, and reproductive health of women. We examined the sociocultural factors associated with the attitude toward DV perpetrated against women in Afghanistan. We used data from the 2015 Afghanistan Demographic and Health Survey, consisting of an ever-married sample of 29,461 women and 10,760 men aged 15 to 49 years. Our dependent variable, attitude toward DV, was determined from responses on acceptance of wife-beating in five scenarios, and the group of socio cultural factors was selected based on evidence from previous studies. Our main analytical method was logistic regression, using the survey design. Our findings indicated that factors such as an increase in years of education and living in a wealthier household reduce the likelihood of acceptance of DV among men and women. Ethnicity was also associated with the attitude toward DV, but the magnitude varied across ethnic groups and gender. Furthermore, an increase in age and living in the urban area were associated with nonjustification of DV among women, but not among men. On the other hand, frequent exposure to the media increases the likelihood of acceptance of DV among men, but not for women. The result of the present study suggests that there are economic, social, and cultural aspects to the attitude toward DV among men and women in Afghanistan. Therefore, policies designed at changing the socio cultural perception of the people are of importance in other to bring about a change in attitude, and even combat the prevalence of DV.

There has been increased interest in the subjective experiences of participants of community partner abuse intervention programs (PAIPs). In the context of high attrition rates, qualitative research is needed to understand the factors associated with sustained engagement and dropout. Using a community nonmandated PAIP, the current study is a rare investigation of the experiences of both completers and noncompleters. We explored the differences between completers' and noncompleters' perceptions of the treatment process, the reasons for sustained program engagement, and the perceived outcomes of treatment. Semi-structured interviews were completed with 14 participants: nine completers and five noncompleters. The majority of participants were referred by children's social care and were unemployed at the time of interview. The interviews were conducted by research staff independent from the treatment-providing organization. Three themes emerged from the data: (a) Treatment as Challenging Yet Enlightening, (b) the Importance of a Well-timed and Safe Therapeutic Environment, and (c) Improved Emotional Self-Management Due to Treatment. Results highlighted how structured individualized sessions, underpinned by a strong therapeutic alliance with facilitators, helped participants increase their interpersonal problem-solving and communication skills. The study reinforced the importance of developing a therapeutic alliance and providing structured individualized treatment characterized by flexibility and accessibility. Noncompletion was perceived as related to known risk factors and treatment readiness. Therefore, it may be beneficial to employ screening measures to monitor these factors. Future research should use larger, more diverse samples to further investigate subjective experiences of PAIP completers and, particularly, noncompleters to enhance the limited literature in this area.

Religion has long been recognized as a powerful tool capable of shaping the lives of people in many societies. In this study, we draw insights from discursive psychology to explore the influence of religious beliefs and practices on the perpetration of husband-to-wife abuse and the entrapment of victims in Ghana. Semi-structured focus group discussions and in-depth individual interviews were conducted with 40 participants, comprising 16 (60%) perpetrators (men), 16 (60%) victims (women), and eight (20%) key informants from rural and urban Ghana. Participants' discursive accounts suggest that both perpetrators and victims invoke religious instructions on gender norms to legitimize male authority over women in marriage. While perpetrators construct husbands' conjugal authority over their wives in terms of prescriptive religious norms, victims construct their entrapment in abusive relationships in terms of proscriptive theology of divorce in the bible. The double-edged role of religion in providing both motivational and inhibitory support for wife abusers is also discussed.

Background: Reproductive coercion and abuse is a major public health issue, with significant effects on the health and well-being of women. Reproductive coercion and abuse includes any form of behaviour that intentionally controls another person's reproductive choices. The aim of this qualitative evidence synthesis is to explore women's experiences of reproductive coercion and abuse globally, to broaden understanding of the different ways reproductive coercion and abuse is perpetrated, perceived and experienced across settings and socio-cultural contexts., Method: We searched Medline, CINAHL and Embase for eligible studies from inception to 25th February 2021. Primary studies with a qualitative study design that focused on the experiences and perceptions of women who have encountered reproductive coercion and abuse were eligible for inclusion. Titles and abstracts, and full texts were screened by independent reviewers. We extracted data from included studies using a form designed for this synthesis and assessed methodological limitations using CASP. We used Thomas and Harden's thematic analysis approach to analyse and synthesise the evidence, and the GRADE-CERQual approach to assess confidence in review findings., Results: We included 33 studies from twelve countries in South Asia, the Asia Pacific, North America, South America, Africa and Europe. Most studies used in-depth interviews and focus group discussions to discuss women's experiences of reproductive coercion and abuse. Reproductive coercion and abuse manifested in a range of behaviours including control of pregnancy outcome, pregnancy pressure or contraceptive sabotage. There were a range of reasons cited for reproductive coercion and abuse, including control of women, rigid gender roles, social inequalities and family pressure. Women's different responses to reproductive coercion and abuse included using covert contraception and feelings of distress, anger and trauma. Across contexts, perpetration and experiences of reproductive coercion and abuse were influenced by different factors including son preferences and social exclusion., Conclusions: We reflect on the importance of socio-cultural factors in understanding the phenomenon of reproductive coercion and abuse and how it affects women, as well as how the mechanisms of power and control at both individual and societal levels work to perpetuate the incidence of reproductive coercion and abuse against women., Competing Interests: The authors declare that they have no competing interests.

Background: Childhood diarrhea remains a major public health problem in sub-Saharan Africa (SSA). Women empowerment reduces child mortality, and wife beating attitude is one of the indicators of women empowerment. There is a dearth of evidence about wife beating attitudes and childhood diarrhea in SSA. Therefore, the present study aimed to examine the association between attitude towards wife beating and diarrhea among under-five children., Methods: We used Demographic and Health Surveys from 25 countries in SSA that were conducted between 2010 and 2020. Using Stata version 14 software, we carried out the analysis on 153,864 children under five. Bivariate and multivariate logistic regression analyses were applied, and the results were presented using adjusted odd ratios (aOR) at 95% confidence interval (CI)., Results: The pooled results show that 71.4% of married women disagreed with wife beating. About 20.5% of under-five children of married women had diarrhea. Childhood diarrhea varied from highest prevalence in Chad (27.9%) to the lowest prevalence in Sierra-Leone (8.5%). The study showed lower odds of diarrhea among children of married women who disagreed with wife beating (aOR = 0.66 95% CI; 0.54-0.80) compared to children of married women who agreed with wife beating. Moreover, the study results show that women's age (35-39 years-aOR = 0.48, 95% CI; 0.31-0.74, 40-44 years-aOR = 0.57, 95% CI; 0.35-0.93, 45-49 years-aOR = 0.35, 95% CI; 0.16-0.79) was negatively associated with childhood diarrhea, while husband's education (primary school-aOR = 1.36, 95% CI; 1.05-1.77), parity (ever born 3-4 children-aOR = 1.36, 95% CI; 1.09-1.70, and 5+ children-aOR = 1.56, 95% CI; 1.14-2.12), and religion (Muslim-aOR = 3.56, 95% CI; 1.44-8.83) were positively associated with diarrhea among under-five children., Conclusions: The study shows association between women attitude towards wife beating and childhood diarrhea. Therefore, empowering women, especially young women by increasing awareness about domestic violence, their rights, and empowering them through education and economic advancement need to be considered in order to reduce childhood diarrhea. Moreover, fertility control or birth spacing and working closely with religious leaders are important factors to consider in reducing childhood diarrhea., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Betregiorgis Zegeye et al.)

Background: In April 2020, the United Nations predicted that the COVID-19 pandemic will have a 'calamitous' impact on the lives of women. This was based on concerns about an upsurge in Intimate Partner Violence (IPV) arising from increased opportunities for relational conflict due to forced co-existence and therefore additional time spent with abusive partners., Aim: Research has shown an increase in IPV during times of crisis. The COVID-19 pandemic has generated unprecedented circumstances and stress, and opportunities to do research to understand whether the COVID-19 pandemic impacted on IPV experiences were limited. Thus, the present study aimed to understand women's experiences of being in and leaving an abusive relationship during the COVID-19 pandemic., Methods: Individual, telephonic interviews were conducted with 16 women living in domestic violence shelters within three Provinces during South Africa's lockdown period., Results: Findings reveal that the public health measures implemented by the South African Government to curb the spread of the virus, may have placed vulnerable groups at increased risk of violence. Specifically, lockdown likely magnified the risk for escalation of abuse in families already experiencing IPV prior to COVID-19. The study highlights an IPV and COVID-19 relationship, showing that the gender insensitive pandemic control measures, such as stay at home orders and travel restrictions, likely placed women at risk of increased abuse. Given the recurrency of COVID-19 epidemic waves, attention must be given to gender disparities or many South African women may experience worse outcomes., Conclusion: This study reminds us that being ordered to stay at home is not always the safest option for women and thus, in a country with one of the highest levels of GBV, it becomes imperative to ensure that IPV safeguards are integrated into COVID-19 measures. It also becomes evident that COVID-19 requires enhanced ways of responding by paying attention to gender disparities., Competing Interests: The authors have declared that no competing interests exist.

Evidence from demographic and health surveys in various countries and Ethiopia too showed that more women are generally believed to justify intimate partner violence (IPV) than men do. An attitude that justifies IPV is one of the factors affecting victimization and perpetration from IPV. However, women's justification about the violence and factors affecting the justification are not well documented, particularly by addressing household factors such as household food conditions. Therefore, the present study aims to fill this gap among married women of childbearing age so that evidence can be drawn for holistic interventions. A community-based cross-sectional study was conducted among 696 currently married women of childbearing age (15-49) by using a multistage cluster sampling technique to obtain the women from 11 kebeles (the smallest administrative unit in the government structure of Ethiopia) of Arba Minch town, Southern Ethiopia. Data were collected using a pretested and structured questionnaire. Logistic regression was performed using IBM SPSS version 20. The odds ratio with its 95% confidence interval was used to show the degree of association between the outcome variable and explanatory variables. Nearly two-thirds (59.5%) of the study women justified wife-beating in at least one of the five conditions. A higher odds of justification of wife-beating was observed among women whose marriage was arranged by any other person than the couples themselves, from food-insecure households, with a family size of 5 and above, in the age group of 30-39 years, and whose partner was in the age range of 31-39 years. In contrast, lower odds of justification of wife-beating was observed among women having an age difference of 10 or more years with their partner and those in a household wealth index of middle and higher category. Despite great efforts in realizing gender equality in the country, a higher proportion of women were having the attitude that justifies wife-beating in the five conditions specified to them. Interventions targeting the improvement of women's attitude towards wife-beating should target against the traditional norms of arranged marriage, improve household food conditions, and decrease family size., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Eshetu Andarge et al.)

This paper examines the scope and characteristics of male-to-female intimate partner violence in southern rural Chiapas, Mexico, and its association with depression and anxiety symptoms, highlighting the role of partner controlling behaviors. Participants were selected by random sampling. One-hundred and forty-one women >15 years participated in the study. Data was obtained through an adapted version of the National Survey of the Dynamics of Household Relationships (ENDIREH) intimate partner violence scale, the Patient Health Questionnaire-9 for depression symptoms and the Generalized Anxiety Disorder-7 for anxiety symptoms. Quantitative results indicated a 66.4% lifetime prevalence of physical and/or sexual IPV among ever-partnered women 15 years or older (95% CI: 57.5-74.5%). Forty percent (95% CI: 32.0-49.7%) of them reported having experienced physical and/or sexual violence with high partner control (HC-IPV), and 25.8% (95% CI: 18.5-34.3%) reported having experienced physical and/or sexual violence with low or moderate partner control (MC-IPV). Lifetime experience of HC-IPV was significantly associated with moderate-severe depression symptoms (RR = 5.8) and suicidality (RR = 2.08). While partner alcohol abuse was associated with a 3.06 times higher risk of lifetime physical and/or sexual IPV, 30.9% of women mentioned that their partners were never drunk when violence occurred. Interestingly, high partner alcohol abuse was more frequent among women who reported HC-IPV compared to MC-IPV. Implications for global mental health practice are discussed., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Though there are several interventions evaluated over the past 25 years, significant knowledge gaps continue to exist regarding the effective prevention of sexual violence. This study explored the socio-economic and context-specific distinctive characteristics of husbands and wives on sexual autonomy and unwanted sexual experiences of currently married women in India., Methodology: We have utilized the recent round of National Family Health Survey (NFHS-4, 2015-16) data for this exploration. The NFHS-4 survey had adopted a stratified two-stage sample design to reach out to the survey households. A total of 63,696 couples are included in the analysis comprising of women of 15-49 years age and men of 15-54 years age. Multivariate techniques have been applied to understand the adjusted effects of socio-economic and demographic variables on control over their sexuality and sexual violence., Results: Uneducated women married to uneducated men experienced more sexual violence and had less control over their sexuality than the other categories. The adjusted multivariate logistic model shows that educated husbands were significantly more likely to exercise control over their educated wives' sexuality (AOR = 0.88; CI:0.78-0.99). Women having older husbands were significantly less likely to be having no-control over own sexuality (AOR = 0.89; CI:0.83-0.95) and experienced sexual violence (AOR = 0.81; CI:0.70-0.95). Women having comparatively more-educated husbands were significantly less likely to experience sexual violence (AOR = 0.62; CI:0.47-0.81). Muslim women were significantly more likely to have no control overown sexuality. SC/ST women were significantly more likely to experience sexual violence (28%)., Conclusions: This study highlights the factors associated with control over one's sexuality and preponderance to sexual violence: age, education, spouse working status, wealth status, husband's alcohol consumption, women autonomy, decision-making, and freedom for mobility. This study suggests that empowering women with education, creating awareness regarding reproductive health, and addressing their socio-economic needs to help them achieve autonomy and derive decision-making power., Competing Interests: The authors have declared that no competing interests exist.

This study examined how different forms of childhood family victimization are associated with the attitudinal (not actual action) refusal of wife abuse among women and men in rural Bangladesh. It included 1,929 randomly selected married women and men. Of the sample, 31.3% (Men = 49.3%, Women = 13.5%) attitudinally refused overall wife abuse, 38.5% (Men = 53.2%, Women = 23.8%) refused emotional abuse, 67.0% (Men = 82.5%, Women = 51.6%) refused physical abuse, 78.0% (Men = 88.6%, Women = 67.4%) refused abuse on wife's disobeying family obligations, and 32.3% (Men = 50.3%, Women = 14.6%) refused abuse on challenging male authority. Multivariate logistic regression revealed that the odds ratio (ORs) of the attitudinal refusal of overall wife abuse were 1.75 (p = .041) for the childhood non-victims of emotional abuse and 2.31 (p < .001) for the victims of mild emotional abuse, compared to the victims of severe emotional abuse. On the other hand, the ORs of the overall refusal of abuse were 1.84 (p = .031) for the non-victims of physical abuse and 1.29 (p = .465) for the victims of mild physical abuse, compared to the childhood victims of severe physical abuse. Data further revealed that the childhood non-victimization of physical abuse increased all types of attitudinal refusal of wife abuse, e.g., emotional abuse, physical abuse, abuse on disobeying family obligations, and abuse on challenging male authority. Compared to the childhood experiences of severe emotional abuse, data also indicated that childhood exposure to mild emotional abuse might increase the attitudinal refusal of wife abuse on a few issues, e.g., abuse on disobeying family obligations, abuse on challenging male authority, and physical abuse. It appeared that childhood experiences of family victimization greatly influence different types of attitudinal refusal of wife abuse. We argue that the issue of childhood victimization should be brought to the forefront in the discourse. We recommend that state machinery and social welfare agencies should expend significant efforts to stop child abuse within the family and in other areas of society in rural Bangladesh., Competing Interests: The authors have declared that no competing interests exist.

During the first months of the COVID-19 pandemic, governments instituted a series of measures to control the spread of the virus. The measures were widely believed to increase women's risk of violent victimization, most of which is by an intimate partner. We examined help-seeking during this period in a large U.S. city and used an interrupted time series analysis to assess the effects of three government interventions on domestic violence and sexual assault hotline calls and on "911" calls regarding domestic violence, assault, and rape. Declaration of an emergency appeared to reduce victim calls to the rape crisis hotline and the few "911" calls about rape. School closure was associated with a reduction in "911" calls about assault and rape and victim calls to the domestic violence hotline. Implementation of stay-at-home orders was associated with a gradual increase in domestic violence hotline calls. Although "911" calls regarding assault fell by nearly half, calls to police for domestic violence were unchanged. In sum, there was a decrease in help-seeking for sexual assault and assault in general but not for domestic violence during the initial phases of the COVID-19 outbreak. The analysis underscores the importance of distinguishing between the violence itself, calls to police, and calls to helplines when claims are made about changes over time in violence against women. The opportunities and constraints for each can differ widely under usual circumstances, circumstances that were altered by public health interventions related to the pandemic.

Compared to young men, Ugandan young women are disproportionately impacted by HIV. Childhood transactional sex may contribute to this disparity. Using data from the 2015 Uganda Violence Against Children Survey, we used logistic regression models to assess the association between childhood transactional sex and negative outcomes. Among 18-24-year-old young women who had sex prior to 18 (n = 982), those who ever engaged in transactional sex had 5.9 times [adjusted odds ratio (AOR); confidence interval (CI): 1.6-22.2] higher odds of having multiple sexual partners in the past year; 5.2 times (AOR; CI: 2.1-12.9) higher odds of infrequent condom use in the past year; 3.0 times (AOR; CI: 1.2-7.9) higher odds of hurting themselves intentionally; and 3.2 times (AOR; CI: 1.3-7.7) higher odds of having attitudes justifying spousal abuse than young women who never engaged in transactional sex. Interventions for transactional sex and HIV in Uganda should consider prioritizing prevention, harm-reduction and continued investment in adolescent girls' and young women's futures., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Intimate Partner Violence is a global public health problem. Attitude towards wife-beating is a major determinant of both intimate partner violence perpetration and victimization. However, little is known about the attitudes of Ghanaian young people towards wife-beating. The objectives of this study were to assess young people's attitudes towards wife-beating, and identify salient factors influencing young people's acceptance of wife-beating., Methods: Data used in this study were obtained from the 2014 Ghana Demographic and Health Survey. The survey was nationally representative and provides estimates for population and health indicators across the former ten regions of Ghana, including rural and urban areas. Data were analyzed with Stata/SE version 16., Results: We found that 32% of young women and 19% of young men accepted wife-beating. Among young women, acceptance of wife-beating was significantly influenced by younger age, wealth index, low educational status, religion, the region of residence, ethnicity, frequency of reading newspaper and frequency of listening to radio (p < 0.05). Among young men, acceptance of wife-beating was significantly influenced by wealth index, the region of residence and frequency of reading newspaper (p < 0.05)., Conclusion: This study demonstrates that a substantial proportion of young people in Ghana accept wife-beating. Young women were more likely to accept wife-beating compared to young men. Acceptance of wife-beating was influenced by socio-demographic and behavioral factors. Efforts to end violence against women and girls in Ghana should focus on promoting girl education, economic empowerment of women and public education on laws that prohibit Intimate Partner Violence., Competing Interests: The authors have declared that no competing interests exist

In HIV prevention trials, male partners have influenced women's ability to adhere to investigational products, including antiretroviral (ARV) containing vaginal rings. Validated scales can be useful tools to systematically measure complex constructs, such as those related to male partner engagement. Although multiple scales exist to assess physical, psychological and sexual violence within intimate relationships, fewer scales focus on supportive behaviors within these relationships. Our intervention involved development of a Healthy Relationship Assessment Tool (HEART) that assessed both positive and negative aspects of male partner involvement in women's HIV prevention. We identified and refined 127 potential items, representing intimate partner violence, agency and social support. A structured survey, including potential items and other sociodemographic and behavioral variables was administered to former microbicide trial and non-trial participants. We conducted an exploratory factor analysis (EFA) to identify a reduced set of constructs and items to screen women who might experience social harms or benefits from vaginal ring use. We examined associations between constructs and with other survey variables to assess content and construct validity. In a subset of 10 women who participated in the survey and qualitative interviews, we used qualitative data to predict survey scores. We retained five constructs with theoretical relevance and good-to-strong reliability for the tool, including: Traditional Values; Partner Support; Partner Abuse & Control; Partner Resistance to HIV Prevention; and HIV Prevention Readiness. Predicted associations between HEART constructs, and correspondence between participants' qualitative data and HEART scores were generally correct, while those between constructs and other sociodemographic variables were more mixed. Initial validation of the HEART tool was promising. The tool will be used during the CHARISMA pilot study at the Johannesburg MTN 025/HOPE site and validated as part of a randomized controlled trial of CHARISMA within a PrEP demonstration project. Beyond clinical trial settings, HEART could assist PrEP or antiretroviral treatment (ART) providers with an easy-to-administer tool to identify risk and tailor risk reduction, empowerment and adherence counseling for microbicides, PrEP or ART related services., Competing Interests: The authors have declared that no competing interests exist.

Background: Women, especially those who marry as children, experience various forms and degrees of exclusion and discrimination. Early marriage is a harmful traditional practice that continues to affect millions around the world. Though it has declined over the years, it is still pervasive in developing countries. In Ethiopia, Amhara National Regional State (or alternatively Amhara region) hosts the largest share of child-brides in the country. This study aimed at assessing the effects of early marriage on its survivors' life conditions - specifically, empowerment and household decision-making - in western Amhara., Methods: This study employed community-based cross-sectional study design. It adopted mixed method approach - survey, in-depth interview and focus group discussion (FGD) - to collect, analyse and interpret data on early marriage and its effects on household decision-making processes. The survey covered 1278 randomly selected respondents, and 14FGDs and 6 in-depth interviews were conducted. Statistical procedures - frequency distribution, Chi-square, logistic regression - were used to test, compare and establish associations between survey results on women empowerment for two groups of married women based on age at first marriage i.e., below 18 and at/after 18. Narratives and analytical descriptions were integrated to substantiate and/or explain observed quantitative results, or generate contextual themes., Results: This study reported that women married at/after 18 were more involved in household decision-making processes than child-brides. Child-brides were more likely to experience various forms of spousal abuse and violence in married life. The study results illustrated how individual-level changes, mainly driven by age at first marriage, interplay with structural factors to define the changing status and roles of married women in the household and community., Conclusion: Age at first marriage significantly affected empowerment at household level, and women benefited significantly from delaying marriage. Increase in age did not automatically and unilaterally empowered women in marriage, however, since age entails a cultural definition of one's position in society and its institutions. We recommend further research to focus on the nexus between the household and the social-structural forms that manifest at individual and community levels, and draw insights to promote women's wellbeing and emancipation.

Generally, South Asian Muslim communities reject dating and view it as shameful. Despite this, many South Asian Muslims still engage in dating. These traditional norms, however, remain influential and a part of the cultural context in which dating abuse occurs. This exploratory study examines South Asian Muslims' perceptions of how cultural norms forbidding dating and constructing it as shameful may affect women's experiences of dating abuse. Findings indicate these cultural norms may prompt fear of parental and community reactions to dating as well as strong relationship attachment. These then have implications for disclosure, help seeking, and ending abusive relationships.

The coronavirus disease 2019 (COVID-19) pandemic created a situation of general distress. Although the focus has been initially more on the physical health during the pandemic, mental health concerns linked to the lockdown have quickly risen. This study aims to assess the effect of the COVID-19-related lockdown on Tunisian women's mental health and gender-based violence. An online survey was conducted, using the Depression Anxiety and Stress Scales (DASS-21) and the Facebook Bergen Addiction Scale (FBAS). We chose a female-exclusive social group on Facebook and used the snowball sampling method. A total of 751 participants originating from all the Tunisian regions completed the questionnaire. More than half of the participants (57.3%) reported extremely severe distress symptoms, as per the DASS-21. Those who had a history of mental illness and who were allegedly abused during lockdown were found to have more severe symptoms of depression, anxiety, and stress. Around 40% of women reported problematic social media use. Violence against women also reportedly increased significantly during the lockdown (from 4.4 to 14.8%; p < 0.001). Psychological abuse was the most frequent type of violence (96%). Women who had experienced abuse before the lockdown were at an increased risk of violence during lockdown (p < 0.001; OR = 19.34 [8.71-43.00]). To our knowledge, this is the first study that evaluates the acute impact of COVID-19 on mental health and violence against women in Tunisia, Africa, and the Arab world. It may be a sound basis for developing a more effective psychological intervention aimed at women in these regions.

Intimate partner violence (IPV) is associated with various health issues, which may be explained by hypothalamic-pituitary-adrenal (HPA) axis dysfunction. There is a lack of research examining hair cortisol concentrations as a biomarker of HPA function alterations in the context of IPV with consideration to women's resilience. The study assessed whether IPV severity and resilience are associated with hair cortisol concentrations among Saudi women. This cross-sectional explanatory design used a convenience sample of 156 Saudi women from health care settings. A structured interview that included self-reported responses was performed, and hair samples were collected. The samples were analyzed using a salivary ELISA kit. The result showed a significant difference in hair cortisol concentration between women who have experienced IPV and women who have not experienced IPV. As well, controlling for depressive and post-traumatic stress disorder, IPV severity (β = -.281, 95 % CI = -.046 to -.003) and resilience (β = -.225, 95 % CI = -.038 to -.005) were significant predictors of lower hair cortisol concentrations. The effect of IPV severity on cortisol levels as a biomarker of HPA axis function could explain the poor health conditions among IPV survivors. This study highlights that IPV victimization leads to physiological changes and that hair cortisol is an indicator of women's health status., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: To identify the prevalence of violence during pregnancy and the association with the socioeconomic, behavioral and clinical characteristics of pregnant women., Methods: Cross-sectional study in a low-risk maternity hospital in the municipality of Cariacica, Espírito Santo. A total of 330 puerperal women were interviewed from August to October 2017. Information on socioeconomic, behavioral, reproductive and clinical characteristics, as well as life experiences, was collected through a questionnaire. To identify the types of violence, the proper World Health Organization instrument was used. Gross bivariate and multivariate analysis was performed and adjusted for Poisson regression with robust variance., Results: Prevalence was 16.1% (95%CI 2.5-20.4) for psychological violence, 7.6% (95%CI 5.1-11.0) for physical violence and 2.7% (95%CI 1.4-5.2) for sexual violence. Psychological violence remained associated with age, family income, beginning of sexual life, disease in pregnancy, desire to interrupt pregnancy and number of partners. Physical violence was associated with schooling, beginning of sexual life and disease in pregnancy. Sexual violence remained associated with marital status and desire to interrupt pregnancy (p < 0.05)., Conclusions: Psychological violence by an intimate partner was the most prevalent among pregnant women. Women that were younger, had lower income and less schooling, who started their sexual life before the age of 14 and who wished to interrupt pregnancy, experienced violence more frequently during pregnancy.

Amid the coronavirus disease 2019 (COVID-19) pandemic, there has been an alarming rise in domestic violence worldwide. Factors believed to be fueling this escalation in domestic violence include increasing social confinement at home during lockdowns and mounting stress levels from unemployment that have resulted from the economic uncertainties of these times. This contribution explores some of the challenges faced by physicians in clinically assessing victims of domestic violence during the COVID-19 era. One such challenge is the increased reliance on telemedicine during the pandemic, a medium of communication that offers a narrower clinical view of patients than is what is usually provided by an in-person examination. In this contribution, we offer suggestions on how best to screen for domestic violence, whether through telemedicine or during an in-person encounter. The history and physical findings that suggest domestic violence are reviewed along with recommendations on how to make the clinical examination more sensitive and compassionate to the needs of the victims. One of the authors of this contribution (L.C.H.) is herself a survivor of domestic violence and has courageously shared, in these pages, details of her harrowing near murder by an abusing husband. From this case history, it is hoped that readers will gain wider insights into what domestic violence means from the perspective of a victim and how we can better help save victims from this widespread and devastating social problem., Competing Interests: Declaration of competing interest The authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grant; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patient-licensing arrangements), or non-financial interest (such as personal relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Intimate partner violence (IPV) is a significant national and global public health concern, with COVID-19 pandemic increasing IPV and associated health issues. Immigrant women may be disproportionately vulnerable to IPV-related health risks during the pandemic. Using qualitative in-depth interviews, we explored the perspectives of service providers ( n   =   17) and immigrant survivors of IPV( n   =   45) on the impact of COVID-19 on immigrant women, existing services for survivors and strategies needed needed to enhance women's health and safety. Participants reported issues such as increased IPV and suggested strategies (e.g. strengthening virtual platforms). The findings could be informative for providers in national and international settings.

Objective: This cross-sectional study evaluates the association between physical intimate partner violence (IPV) and frequencies of drinking and volume consumed in six different contexts among a sample of urban emergency department (ED) patients., Method: We obtained survey data from 1,037 married, cohabiting, or partnered patients (53% female; 50% Hispanic; 29% African American) at a Northern California safety-net hospital. Past-year physical IPV was measured with the Revised Conflict Tactics Scale. We asked patients about frequency of drinking and usual number of drinks consumed at bars, restaurants, homes of friends or relatives, own home, public places such as street corners or parking lots, and community centers or large events. Gender-stratified dose-response models were estimated for frequencies of IPV perpetration and victimization, with adjustment for sociodemographic and psychosocial factors, marijuana use, and spouse/partner problem drinking., Results: None of the women's context-based frequency and volume measures were associated with frequency of IPV victimization. Women's volume of alcohol consumed at home was associated positively with frequency of their IPV perpetration (β = .008, SE = .003, p < .01), and volume consumed in public places was associated negatively with this outcome (β = -.023, SE = .010, p < .05). Among men, none of the context-based frequency and volume measures were associated with frequency of either IPV outcome. Spouse/partner's problem drinking was associated with each gender's IPV victimization, and with IPV perpetration by men., Conclusions: Frequency of drinking and volume consumed in specific contexts do not substantively contribute to frequency of IPV perpetration or victimization in this sample of urban ED patients.

Screening for intimate partner violence is recommended by the medical community. This study investigated obstetrician-gynecologists' intimate partner violence screening patterns and physician and patient factors associated with screening. Four hundred obstetricians-gynecologists completed the Physician Readiness to Manage Intimate Partner Violence Survey between December 2014 and July 2015. Their patients completed the Patient Safety and Satisfaction Survey. Hierarchical generalized linear modeling analyzed physician and patient variables related to the likelihood of being screened. Forty-four physicians responded. The viable patient response rate was 81.3 percent ( n = 894) of patients from included physicians. Less than half (43.2 percent) of physicians reported screening during annual exams. There was a statistically significant difference for patient race/ethnicity ( p < .03) and the number of previous doctor visits ( p < .03) with not being screened. These patient-level variables accounted for approximately 68.3 percent of the variance screening odds. There was no significant difference ( p < .10) between physicians' perceived preparation, knowledge, and attitudes for not being screened. The hierarchical generalized linear modeling analysis showed a trend for physicians with a high-perceived preparation for screening was related to initial visits. This study identified that obstetrician-gynecologists do not routinely screen for IPV and race/ethnicity and number of visits are factors in screening for intimate partner violence.