Men's reproductive coercion of women: prevalence, experiences, and coping strategies-a mixed method study in urban health facilities in León, Nicaragua.

BACKGROUND: Reproductive coercion (RC) is a common form of violence against women. It can take several expressions aiming at limiting women's reproductive autonomy. Thus, the frequency and how reproductive coercion can be resisted must be investigated. There is limited research regarding RC in Latin America. Therefore, this study aimed to measure RC prevalence and associated factors and to explore the women experiences and coping strategies for RC. METHODS: A convergent mixed-methods study with parallel sampling was conducted in Nicaragua. A quantitative phase was applied with 390 women 18-35 years old attending three main urban primary health care facilities. Lifetime and 12 months of exposure to RC behaviors including pregnancy promotion (PP) and contraceptive sabotage (CS) were assessed. Poisson regression with a robust variance estimator was used to obtain adjusted prevalence rate ratios and 95% Confidence Intervals (CIs). In addition, seven in-depth interviews were collected and analyzed using qualitative content analysis. RESULTS: Ever RC prevalence was 17.4% (95% CI, 13.8-21.6) with similar proportions reporting ever experiencing PP (12.6%, 95% CI 9.4-16.3) or ever experiencing CS (11.8%, 95% CI 8.7-15.4). The prevalence of last twelve months RC was slightly lower (12.3%, 95% CI, 9.2-16.0) than above. Twelve months PP (7.4%, 95% CI 5.0-10.5) and CS (8.7%, 95% CI 6.1-12.0) were also similar. Women's higher education was a protective factor against ever and 12 months of exposure to any RC behaviors by a current or former partner. Informants described a broad spectrum of coping strategies during and after exposure to RC. However, these rarely succeeded in preventing unintended pregnancies or regaining women's long-term fertility autonomy. CONCLUSIONS: Our facility-based study showed that men's RC is a continuous phenomenon that can be enacted through explicit or subtle behaviors. Women in our study used different strategies to cope with RC but rarely succeeded in preventing unintended pregnancies or regaining their long-term fertility autonomy. Population-based studies are needed assess this phenomenon in a larger sample. The Nicaraguan health system should screen for RC and develop policies to protect women's reproductive autonomy.

Touch perceptions across skin sites: differences between sensitivity, direction discrimination and pleasantness.

Human skin is innervated with different tactile afferents, which are found at varying densities over the body. We investigate how the relationships between tactile pleasantness, sensitivity and discrimination differ across the skin. Tactile pleasantness was assessed by stroking a soft brush over the skin, using five velocities (0.3, 1, 3, 10, 30 cm s(-1)), known to differentiate hedonic touch, and pleasantness ratings were gained. The ratings velocity-profile is known to correlate with firing in unmyelinated C-tactile (CT) afferents. Tactile sensitivity thresholds were determined using monofilament force detection and the tactile discrimination level was obtained in the direction discrimination of a moving probe; both tasks readily activate myelinated touch receptors. Perceptions were measured over five skin sites: forehead, arm, palm, thigh and shin. The assessment of tactile pleasantness over the skin resulted in a preference for the middle velocities (1-10 cm s(-1)), where higher ratings were gained compared to the slowest and fastest velocities. This preference in tactile pleasantness was found across all the skin sites, apart from at the palm, where no decrease in pleasantness for the faster stroking velocities was seen. We find that tactile sensitivity and discrimination vary across the skin, where the forehead and palm show increased acuity. Tactile sensitivity and discrimination levels also correlated significantly, although the tactile acuity did not relate to the perceived pleasantness of touch. Tactile pleasantness varied in a subtle way across skin sites, where the middle velocities were always rated as the most pleasant, but the ratings at hairy skin sites were more receptive to changes in stroking velocity. We postulate that although the mechanoreceptive afferent physiology may be different over the skin, the perception of pleasant touch can be interpreted using all of the available incoming somatosensory information in combination with central processing.