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Intimate partner violence in Nicaragua: studies on ending abuse, child growth, and contraception
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Intimate partner violence (IPV) is a pervasive, worldwide public health problem and one of the most common violations of human rights. The aim of this thesis were twofold: (i) to study the process and factors related to ending of IPV of Nicaraguan women and (ii) to examine to what extent IPV exposure is associated with the child linear growth and women’s contraceptive use after pregnancy.

Methods: Data were collected from a panel study which followed 398 women who were inquired about their IPV exposure during pregnancy and at follow-up a median of 43 months after delivery. Three hundred seventy five of their children were available for anthropometric assessment. Thirteen in-depth interviews were conducted with women exposed to physical/sexual IPV during pregnancy but not at follow-up. For analysis both quantitative and qualitative methodologies were used.

Results: Women experienced four patterns of abuse: never abused, ending abuse, continued abuse, and new abuse. Of the women who experienced any IPV before or during pregnancy, 59% (95% CI 52-65%) reported no abuse at follow-up (135/229).  Women exposed to a continued abuse pattern and those exposed to any IPV, emotional or physical IPV at follow-up had higher odds of reversible contraceptive use. Further, exposure to any IPV and controlling behavior by a partner during pregnancy impaired the index child linear growth. Girls whose mothers had low social resources during pregnancy were the most affected. Women felt that being inquired about IPV while pregnant contributed to process of ending the abuse.

Ending IPV was experienced as a process with three phases: “I came to a turning point,” “I changed,” and the “Relationship ended or changed.” Successful strategies to ending abuse mainly involved utilizing informal networks. Ending IPV did not always mean ending the relationship. IPV awareness, severity of the abuse, and economic independence were individual factors associated with ending of abuse. At the relationship level, diminishing or no exposure to controlling behavior by their partner was a key element. At the community level, a supportive and less tolerant to IPV environment as well as exposure to IPV inquiry during pregnancy facilitated the process of ending abuse.

Conclusion: The study found that IPV exposure is associated with the children’s linear growth and women’s reversible contraceptive use. In addition, it is clear that gender norms regarding IPV are not static and that they play an important role in facilitating the process ending the abuse by increasing abused women’s access to emotional and material support. Our results emphasize the relevance of improving public services response to IPV.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2011. , 43 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1411
Keyword [en]
Intimate partner violence, IPV, child growth, contraception, pregnancy, Nicaragua, ending abuse
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
URN: urn:nbn:se:umu:diva-43390ISBN: 978-91-7459-169-9OAI: oai:DiVA.org:umu-43390DiVA: diva2:413391
Public defence
2011-05-20, Sal 135, Allmänmedicin, by 9A, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2011-04-29 Created: 2011-04-28 Last updated: 2013-02-05Bibliographically approved
List of papers
1. Ending intimate partner violence after pregnancy: findings from a community-based longitudinal study in Nicaragua
Open this publication in new window or tab >>Ending intimate partner violence after pregnancy: findings from a community-based longitudinal study in Nicaragua
2009 (English)In: BMC Public Health, ISSN 1471-2458, Vol. 9, 350- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Although reducing intimate partner violence (IPV) is a pervasive public health problem, few longitudinal studies in developing countries have assessed ways to end such abuse. To this end, this paper aims to analyze individual, family, community and societal factors that facilitate reducing IPV.

METHODS: A longitudinal population-based study was conducted in León, Nicaragua at a demographic surveillance site. Women (n = 478) who were pregnant between 2002 and 2003 were interviewed, and 398 were found at follow-up, 2007. Partner abuse was measured using the WHO Multi-country study on women's health and domestic violence questionnaire. Women's socio demographic variables, perceived emotional distress, partner control, social resources, women's norms and attitudes towards IPV and help-seeking behaviours were also assessed. Ending of abuse was defined as having experienced any abuse in a lifetime or during pregnancy but not at follow-up. Crude and adjusted odds ratios were applied.

RESULTS: Of the women exposed to lifetime or pregnancy IPV, 59% reported that their abuse ended. This finding took place in a context of a substantial shift in women's normative attitudes towards not tolerating abuse. At the family level, no or diminishing partner control [ORadj 6.7 (95%CI 3.5-13)] was associated with ending of abuse. At the societal level, high or improved social resources [ORadj 2.0 (95%CI 1.1.-3.7)] were also associated with the end of abuse.

CONCLUSION: A considerable proportion of women reported end of violence. This might be related to a favourable change in women's norms and attitudes toward gender roles and violence and a more positive attitude towards interventions from people outside their family to end abuse. Maintaining and improving social resources and decreasing partner control and isolation are key interventions to ending abuse. Abuse inquiring may also play an important role in this process and must include health care provider's training and a referral system to be more effective. Interventions at the community level are crucial to reducing partner violence.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-30568 (URN)10.1186/1471-2458-9-350 (DOI)19765299 (PubMedID)
Available from: 2010-01-08 Created: 2010-01-08 Last updated: 2015-04-29Bibliographically approved
2. The supportive process for ending intimate partner violence after pregnancy: the experience of nicaraguan women
Open this publication in new window or tab >>The supportive process for ending intimate partner violence after pregnancy: the experience of nicaraguan women
2012 (English)In: Violence against Women, ISSN 1077-8012, E-ISSN 1552-8448, Vol. 18, no 11, 1257-1278 p.Article in journal (Refereed) Published
Abstract [en]

This grounded theory study found that Nicaraguan mothers exposed to intimate partner violence (IPV) during pregnancy eventually acted to protect their children and themselves. They experienced ending abuse as an empowerment process characterized by a cognitive change in women's attitudes toward partner abuse and the emergence of help-seeking strategies that lead to ending violence with or without ending the relationship. This process was facilitated by a supportive environment that challenged abusive behaviors as well as being asked about abuse during their last pregnancy. Although environmental changes can facilitate ending abuse, Nicaragua's public institutions must be strengthened to reach women in need.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-64352 (URN)10.1177/1077801212470549 (DOI)23334814 (PubMedID)
Available from: 2013-01-24 Created: 2013-01-24 Last updated: 2015-04-29Bibliographically approved
3. Intimate partner violence, maternal social resources, and early child growth: a community-based cohort study in Nicaragua
Open this publication in new window or tab >>Intimate partner violence, maternal social resources, and early child growth: a community-based cohort study in Nicaragua
(English)Article in journal (Refereed) Submitted
Identifiers
urn:nbn:se:umu:diva-43386 (URN)
Available from: 2011-04-28 Created: 2011-04-28 Last updated: 2013-02-05Bibliographically approved
4. Questions about IPV should be part of contraceptive counseling: findings from a community-based longitudinal study in Nicaragua
Open this publication in new window or tab >>Questions about IPV should be part of contraceptive counseling: findings from a community-based longitudinal study in Nicaragua
(English)Article in journal (Refereed) Submitted
Identifiers
urn:nbn:se:umu:diva-43387 (URN)
Available from: 2011-04-28 Created: 2011-04-28 Last updated: 2013-02-05Bibliographically approved

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