Abortion withdrawal of sexual violence pregnancy: the role of the sex offender / Desistência do abortamento de gestação decorrente de violência sexual: o papel do agressor sexual

INTRODUCTION: Unwanted pregnancy is a serious consequence for women who experience sexual violence. Although deciding on abortion is frequent in these cases, there is not much information on women who give up abortion in this circumstanceOBJECTIVE: To analyse the associated factors in abortion withdrawal of sexual violence pregnancyMETHODS: A cross-sectional epidemiological study with a convenience sample of adolescents and women with pregnancy due to sexual violence and requesting legal abortion between August 1994 and December 2012, at Hospital Pérola Byington, São Paulo, Brazil. Pregnant women who gave up abortion after receiving the procedure approval were included and, in another group, pregnant women who completed the abortion. The variables were selected from a digitized database and analyzed using SPSS 15.0 software. The outcome was abortion withdrawal. The study variables were age; low education level; gestational age; color/black ethnicity; not being united; declare religion; serious threat from the aggressor; known offender; and residence of the aggressor. Odds ratios with 95% confidence intervals were calculated. The analysis used Wald's chi-square test (χ2W) and logistic regression with variable of interest defined as the known aggressor. The research was approved by the Research Ethics Committee of the Federal University of São Paulo, Opinion No. 6767RESULTS: The study included 941 women, 849 (90.2%) who had an abortion and 92 (9.8%) who gave up after being approved. Age ranged from 10-46 years, mean 23.2 ± 7.9 years, gestational age 4-22 weeks, average 11.9 ± 4.5 weeks. Among those who gave up abortion, 12.0% were <14 years old; 50.0% had gestational age ≥ 13 weeks; 50.0% had low education; 14.2% were black; 90.2% single; 85.9% declared to have religion; 50.0% were threatened; 12.0% of the cases occurred at the perpetrator's residence and 53.3% of the victims were raped by known perpetrators. In logistic regression, the only significant variable was the known perpetrator, increasing the victim's chance of giving up abortion twiceCONCLUSION: The known sex offender has influenced the woman or adolescent's decision to give up legal abortion

INTRODUÇÃO: A gravidez forçada é uma grave consequência para mulheres que sofrem violência sexual. Embora decidir pelo aborto seja frequente nestes casos, há escassa informação sobre as mulheres que desistem de realizar ao aborto nessa circunstânciaOBJETIVO: Analisar os fatores associados na desistência do abortamento de gestação decorrente de violência sexualMÉTODO: A cross-sectional epidemiological study com amostra de conveniência de adolescentes e mulheres com gravidez decorrente de violência sexual e solicitação de aborto legal entre agosto de 1994 e dezembro de 2012, no Hospital Pérola Byington, São Paulo, Brasil. Foram incluídas gestantes que desistiram de realizar o aborto após receberem aprovação do procedimento e, em outro grupo, as gestantes que concluíram o aborto. As variáveis foram selecionadas de banco de dados digitalizado e analisadas em software SPSS 15.0. O desfecho foi desistência do aborto. As variáveis de estudo foram a idade, baixa escolaridade; idade gestacional; cor/etnia negra; não estar unida; declarar religião; grave ameaça do agressor; agressor conhecido; e residência do agressor. Foram calculadas as razões de chances (Odds Ratio) com intervalo de confiança de 95%. A análise utilizou teste de qui-quadrado de Wald (χ2W) e regressão logística com variável de interesse definida como o agressor conhecido. A pesquisa recebeu aprovação do Comitê de Ética e Pesquisa da Universidade Federal de São Paulo, Parecer nº 6767RESULTADOS: O estudo contou com 941 mulheres, sendo 849 (90,2%) que realizaram o aborto e 92 (9,8%) que desistiram após receberem aprovação. A idade variou de 10-46 anos, média 23,2±7,9 anos, com idade gestacional de 4-22 semanas, média 11,9±4,5 semanas. Entre as que desistiram do aborto, 12,0% tinham idade < 14 anos; 50,0% apresentaram idade gestacional ≥ 13 semanas; 50,0% tinham baixa escolaridade; 14,2% eram negras; 90,2% solteiras; 85,9% declararam ter religião; 50,0% sofreram ameaça; 12,0% dos casos ocorreram na residência do agressor e 53,3% das vítimas foram violentadas por agressores conhecidos. Na regressão logística, a única variável significante foi o agressor conhecido, aumentando em duas vezes a chance da vítima de desistir do abortoCONCLUSÃO: O agressor sexual conhecido exerceu influência na decisão da mulher ou adolescente de desistir do aborto legal

Partner violence in married women.

Introduction: Violence against women is the highest in Australia, Canada, Israel and South Africa and women make up 40 to 70% of homicide victims. Forced marriage is still practiced in the parts of South Asia, East Asia and Africa and among immigrants to the West from these regions. The objectives of the study were to explore and compare the violence in the married women living in urban and rural areas Material and methods: The study adopted a comparative research approach. The study was conducted on married women of age group between 16-40 years. The population comprised of 60 married women (30 subjects each from urban and rural areas respectively) was drawn by convenient sampling technique. Data was collected through interview, by using socio demographic proforma and structured intimate partner violence questionnaire. Data was analyzed by using descriptive and inferential statistics. Results: The overall prevalence of violence among women was high. There was no significant difference between rural and urban area with respect to psychological and physical violence. The findings showed that majority of violence in urban area women were more than the rural area women. Conclusion: Women are more frequent victims of violence. Violence is a universal phenomenon, so effective actions should be taken to stop intimate partner violence at no time.

Mujeres violentadas durante el embarazo y el parto: experiencias de parteras en Jalisco, México / Abused women during pregnacy and childbirth : experience from midwives in Jalisco, Mexico

OBJETIVO: explorar la experiencia y perspectiva de parteras con mujeres violentadas durante el embarazo y el parto en Jalisco, México. METODOLOGIA: se llevó a cabo un estudio cualitativo en zona rural de Jalisco, México, entre mayo y octubre de 2011 con 24 parteras, utilizando la entrevista individual, modalidad historia de vida pautada y la asamblea participativa regional como técnicas de indagación; posteriormente, los discursos fueron analizados bajo el modelo actancial semiótico. RESULTADOS : familiaridad de las parteras con la violencia hacia la mujer durante el embarazo y el parto, atribuida principalmente a aspectos de género y ruralidad; señalan al binomio violencia-embarazo como factor de riesgo para presentar problemas obstétricos, siendo la violencia física la que más encuentran y a la pareja como principal agresor. Resalta su capacidad de diálogo y escucha activa en identificación de violencia. Refieren posibilidad de ser escuchadas en la generación de acciones frente a este problema. DISCUSION:necesidad de asumir una postura política estatal sobre la partería, que permita reconocer su papel en la sociedad y la posibilidad de incorporarlas en las acciones que hacen frente al problema de la violencia, y valorar los elementos propios de su ejercicio en la detección y manejo de estas mujeres.

OBJECTIVE:to explore the experiences and perspectives that a group of midwives from Jalisco, Mexico had with women who were abused during pregnancy and childbirth . METHODOLOGY: a qualitative study was conducted in a rural zone of Jalisco, Mexico, between May and October 2011 with 24 midwives. The techniques used to obtain the data were: individual interviews, life history, and the participatory regional assembly. After collecting the discourses, these were analyzed using the semiotic actantial model. RESULTS:the midwives are familiar with the violence exercised against women during the pregnancy and birth process; this is mainly attributed tolocation- and sex-related aspects,which in turn shows the combination of pregnancy and violence as a risk factor for obstetrical problems. In addition, physical violence was the most common type of abuse, and the woman’s partner was the main aggressor. Finally, the midwives’ ability to speak, listen and identify the cases of violence is worth mentioning. CONCLUSION: it is necessary to assume a political stance on midwives that would help recognize their goal in society and incorporate them into any actions taken to stop domestic violence while valuing the midwives’ efforts to identify and aid thesemothers.

¿Violencia episódica o terrorismo íntimo? Una propuesta exploratoria para clasificar la violencia contra la mujer en las relaciones de pareja / Episodic violence or intimate terrorism? An exploratory proposal to classify violence against women in the context of intimate couple relationships

Introduction The concern of this paper comes from a reflection on the phenomenon of violence against women in the context of intimate couple relationships. Even though studies dealing with the issue tend to focus on the presence of physical violence, it should not be forgotten that in the same relationships several types of emotional and sometimes sexual violence may co-exist. Violent men intentionally aim to create a threatening climate against women. To do so, they resort to devaluations, insults, threats, maltreatment, shouting, contempt, intolerance, humiliations, jealousy and accusations. Nevertheless, women are often unaware of many of them given the social tolerance towards overall abuse and the lack of institutional alternatives. There are, however, some difficulties to operationalize these behaviours. It is particularly difficult to measure the characteristic pattern followed by these relationships as this may involve very subtle forms of violence. Likewise, results obtained in the physical and psychological dimensions are usually kept as separate areas or they are presented at best in a mixed form to show the prevalences from the different surveys carried out. This article is a theoretical and statistical exercise aimed at constructing a typology of male violence against women. Its starting point is a proposal posing that in heterosexual relationships two types of violence are present. The first one may be called episodic violence, where one or both members of the couple carry out some violent act without the desire to control or dominate the other partner. In the other one, defined as intimate terrorism, the man acts out with the clear purpose of exerting both a violent and non-violent control and dominion over the woman's actions, thoughts, and emotions. Although it is certainly arguable, it might be interesting to analyze this classification for it is risky to suppose that there are couple relationships where a symmetry in the use of violence exists both on the part of men and women -that is, that women are as violent as men. It is risky because it distorts violence's gender nature by presupposing that the same behaviour may be exerted with the same physical and symbolic strength and that it will have similar consequences. However, we think it is worth taking it into account as a starting point for this analysis. To do so, a database derived from a study conducted among a sample of women attending general medical consultation was used. The main analysis axis was the indicator of having experienced a physically violent behaviour on the part of the partner during the last year. This was related to five emotional violence dimensions which represent different modalities as to their intentionality and impact. The groups thus formed were analyzed considering some variables which were previously regarded as associated to this form of violence, including demographic features, and some other features related to household income participation and the distribution of household keeping chores in the women's families. Specific features regarding the violent relationship, such as the motives behind the physical violence episodes and the role played by alcohol abuse on the part of the male partner in these episodes, were also considered. Method A database derived from a transversal ex post facto study conducted with a 345-women sample attending first-time or subsequent medical attention in a first level institution was analyzed. A structured questionnaire made up of different areas was applied. The following areas were included in this study: 1. Socio-demographic variables from each woman, her male partner and her family. 2. A violence severity scale containing 22 different types of physically violent behaviours from men against women, and 36 emotional violence types. A previous analysis of the latter showed five conceptually congruous dimensions: Devaluation, Threatening behaviours, Intimidation, Hostility, and Abusive expectations. 3. Features of both the relationship and the violent episodes. 4. Alcohol abuse on the part of the partner. To construct the typology, women who had experienced at least one physical violence attack by their partners during the last twelve months were classified, regardless of the frequency and severity of such behaviour. With this sub-sample, a multidimensional escalation analysis was performed with the five emotional violence dimensions reported and these were considered as <>. Decisions were then taken as to the configuration obtained and the women were classified in three groups considering both the presence and severity of the physical violence experienced and the frequency of the different forms of emotional violence. Based on these groups classification, variance and chi square analysis were carried out with the variables selected to observe whether these effectively differentiated the women from each group. Results The resulting emotional violence dimensions allowed us to obtain a typology of the sub-sample of women who had experienced physical violence (30% of the total). With this, three groups were formed: 1. episodic physical violence, including women who did not report any threats nor intimidation or devaluation (12.5%); 2. intimidating physical violence, including women who reported threats and intimidation and some or no devaluation (12.5%), and 3. intimate terrorism, which refers to women who suffered very frequent threats and intimidations together with occasional to frequent devaluations (5%). The latter is the highest risk group. Women belonging to this group were older (35 years) than those from the other two groups and so were their partners (40 years). They reported having more children and having lived longer with the abusing partner. Three out of each five had a paid job, mainly informal, and took charge of the money income responsibility of their households. Male partners were the main income providers only in 40% of the instances. Role genders in these families were very traditional as the male partners seldom helped with household keeping cores. Male partners had alcohol abuse-related problems and, in fact, one out of each three got aggressive when he had had any alcohol. The main reasons behind physical violence were male drunkenness, jealousy, and women protecting their offspring. At the other end are the women we classified in the episodic violence group. These were the youngest in the study even when compared to non-abused and intimidating violence victims. These women and their couple's household income participation, and the family members' participation in household keeping cores were similar to those in the no violence group. Their partners had also used alcohol in a comparable amount to that of the intimidating violence group. The main reasons underlying physical violence were male anger and male jealousy, and drunkenness to a lesser degree. Conclusions A considerable amount of women, nearly one out of each three, had experienced some form of physical violence in their couple relationship during the last year, and one out of each five had suffered violence in an abusive context of threats, intimidation and devaluation. Given this, it is important to focus on any type of physical violence as a part of a primary preventive perspective.

El presente trabajo es un ejercicio teórico y estadístico para construir una tipología de la violencia masculina hacia la mujer. Parte de una propuesta que plantea que en las relaciones heterosexuales ocurren dos tipos de violencia física. Uno de éstos puede denominarse violencia episódica, donde uno o ambos integrantes de la pareja realizan algún acto violento sin que esté presente el deseo de controlar o dominar al otro integrante. En el otro, definido como terrorismo íntimo, el hombre actúa con una clara intención de ejercer un control y dominio tanto violentos como no violentos sobre las conductas, pensamientos y emociones de la mujer. Los grupos construidos se analizan según algunas variables que previamente se ha considerado que se pueden asociar con esta forma de violencia, como las características demográficas, las características relacionadas con la participación económica y la distribución de las labores domésticas en las familias de las mujeres y las características específicas de la relación violenta, en particular el uso de alcohol por parte de la pareja. Método Se analizó una base de datos derivada de un estudio transversal y ex post facto realizado con una muestra de 345 mujeres que asistieron a atención médica de primera vez o subsecuente a una institución del primer nivel en el Distrito Federal. Para construir la tipología, se eligió a las mujeres que habían sufrido al menos una manifestación de violencia física por su pareja en los últimos 12 meses, y se realizó un análisis de escalamiento multidimensional a partir de cinco dimensiones de la violencia emocional. Con base en la clasificación de grupos, se realizaron análisis de varianza y de chi cuadrada con variables demográficas, y otras que la bibliografía ha reportado como relevantes. Resultados Un 30% de las mujeres había sufrido algún episodio de violencia física en el último año. Éstos se clasificaron de la siguiente manera: 1. con violencia física episódica, que incluye a aquellas que no reportaron amenazas, ni intimidación y devaluación (12.5% de la población total); 2. violencia física intimidatoria, que incluye mujeres que reportaron amenazas e intimidación y poca o ninguna devaluación (12.5% de la población total); y 3. terrorismo íntimo, referido a mujeres que sufrieron amenazas e intimidaciones muy frecuentes junto con una devaluación que va de <> a <> (5% de la población total). Este último grupo es el de más alto riesgo; las mujeres que lo integraron fueron de mayor edad que las de los otros grupos, al igual que sus parejas. Reportaron tener más hijos y más años de vivir con el maltratador, en promedio 18. Tres de cada cinco mujeres tenía un trabajo remunerado, en su mayoría de manera informal, y llevaban la responsabilidad económica del hogar, así como la carga de las actividades domésticas. Sus parejas tenían un consumo de alcohol problemático; de hecho, uno de cada tres se ponía agresivo al ingerirlo. Conclusiones No encontramos relaciones físicamente violentas libres de violencia emocional, ya que, aun cuando la violencia episódica ocurrió sin manifestaciones de amenazas, intimidación y devaluación, las mujeres sí reportaron comportamientos hostiles y expectativas abusivas de parte de sus parejas. Los resultados obtenidos en torno a las variables sociodemográficas, las relacionadas con la participación económica y con las actividades domésticas de las mujeres y sus familiares, y el consumo de alcohol, pueden utilizarse para elaborar un instrumento breve que permita la detección de mujeres en situación de alto riesgo de violencia de pareja. Además, permiten reflexionar en la necesidad de plantear políticas públicas estructurales para enfrentar este problema, como la creación de empleos dignos y bien remunerados para las mujeres. Destaca igualmente la importancia de contar con programas que aborden el consumo de alcohol y la violencia en los hombres, considerando ambos aspectos como ejes de la construcción de la masculinidad tradicional.

Impact of domestic violence: a study in communities of Bangkok Metropolitan, Thailand

Introduction: Domestic violence, now a national health concern, has pervasive effects at both individual and social levels. The objective of this study was to survey the prevalence of DV, the characteristics and the impact of the violence among married women living in the slum communities of metropolitan Bangkok, Thailand. Methods: A cross-sectional survey was carried out. A total of 580 married women aged 15 years and above were randomly sampled from seven slum communities in Bangkok. Information on age, education, occupation, income, family size, alcohol use, and experience of DV were collected. Results: The prevalence of DV was 27.2%. Most of the violent episodes were triggered either by factors related to personal characteristic of the couples, such as bad temper (89.9%) and being grumpy (83.5%), or circumstantial factors, such as financial problems (74.7%) and suspicion of adultery (28.5%). Twelve per cent of the abuse episodes were moderate violence, and 34.2% was severe violence. The impacts of victims of violence included mental, family, and social problems. The mental impacts, e.g., anxiety, stress and nervousness were found in 79.1%. Others were sad, unhappy, and depressed at 68.4%. Of those, 50.3% could not control their emotion, got angry easily, and threw things. Other important mental episodes were that they wanted to harm others or revenge at 19% and injured themselves or committed suicide at 17.1%. The last was negative attitude about sex at 12.2%. Conclusion: DV is common in slum communities and highly related to socioeconomic status, personality characteristics, and alcohol consumption of the couples.

Impact of domestic violence: a study in communities of Bangkok Metropolitan, Thailand

Introduction: Domestic violence, now a national health concern, has pervasive effects at both individual and social levels. The objective of this study was to survey the prevalence of DV, the characteristics and the impact of the violence among married women living in the slum communities of metropolitan Bangkok, Thailand. Methods: A cross-sectional survey was carried out. A total of 580 married women aged 15 years and above were randomly sampled from seven slum communities in Bangkok. Information on age, education, occupation, income, family size, alcohol use, and experience of DV were collected. Results: The prevalence of DV was 27.2%. Most of the violent episodes were triggered either by factors related to personal characteristic of the couples, such as bad temper (89.9%) and being grumpy (83.5%), or circumstantial factors, such as financial problems (74.7%) and suspicion of adultery (28.5%). Twelve per cent of the abuse episodes were moderate violence, and 34.2% was severe violence. The impacts of victims of violence included mental, family, and social problems. The mental impacts, e.g., anxiety, stress and nervousness were found in 79.1%. Others were sad, unhappy, and depressed at 68.4%. Of those, 50.3% could not control their emotion, got angry easily, and threw things. Other important mental episodes were that they wanted to harm others or revenge at 19% and injured themselves or committed suicide at 17.1%. The last was negative attitude about sex at 12.2%. Conclusion: DV is common in slum communities and highly related to socioeconomic status, personality characteristics, and alcohol consumption of the couples.