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Making the Connection: Bridging Public Health and Domestic and Sexual Violence Prevention

Making the Connection: Bridging Public Health and Domestic and Sexual Violence Prevention. Long Term Goals of Project Connect. Improved health and safety for women and kids Early identification, response to abuse in public health programs

allen-cooley
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Making the Connection: Bridging Public Health and Domestic and Sexual Violence Prevention

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  1. Making the Connection: Bridging Public Health and Domestic and Sexual Violence Prevention

  2. Long Term Goals of Project Connect Improved health and safety for women and kids Early identification, response to abuse in public health programs Interventions to decrease risk for poor health outcomes Decrease in coercion and violence

  3. Program Goals Continued Move the discussion away from violence as a criminal justice issue alone To an integrated approach to health, wellness and safety

  4. Why focus on Reproductive and Maternal Child Health? Violence increases risk for: • Unplanned pregnancy • STI’s including HIV • Poor pregnancy outcomes: (Low birth weight babies miscarriage, prematurity) • Maternal depression • Rapid repeat pregnancy

  5. MAGNITUDE OF THE PROBLEM: U.S. 24.8% of women 7.6% of men • Lifetime prevalence of having been raped and/or physically assaulted by a current or former partner: Tjaden & Thoennes, 2000

  6. WHAT WE KNOW 1 in 4(25%) U.S. women and 1 in 5(20%) U.S. teen girls report ever experiencing physical and/or sexual IPV. CDC Morbidity and Mortality Weekly Report, February 2008; Silverman et al, 2001

  7. Bergman & Brismar, 1991; Bonomi et al, 2007; Campbell & Lewandowski, 1997; Campbell & Alford, 1989; Chapman JD, 1989; Dienemann et al, 2000; Domino & Haber, 1987; Plichta, 1996 Health problems associated with a history of forced sex by an intimate partner include: • Chronic headaches • Depression • Pelvic inflammatory disease • Vaginal and anal tearing • Bladder infections • Sexual dysfunction • Pelvic pain • Gynecological problems

  8. Most Important Reason of all? WOMEN WHO TALKED TO THEIR HEALTH CARE PROVIDER ABOUT THE ABUSE WERE: WOMEN WHO TALKED TO THEIR HEALTH CARE PROVIDER ABOUT THE ABUSE WERE: ~4 times more likely to use an intervention ~2.6 times more likely to exit the abusive relationship McCloskey et al, 2006 McCloskey et al, 2006 ~4 times more likely to use an intervention 2.6 times more likely to exit the abusive relationship

  9. Adolescent girls in physically abusive relationships were 3.5 times more likely to become pregnant than non-abused girls. DATING VIOLENCE AND TEEN PREGNANCY Roberts et al, 2005

  10. KNOWLEDGE ISN’T ENOUGH Under high levels of fear for abuse, women with high STI knowledge were more likely to use condoms inconsistently than nonfearful women with low STI knowledge. Ralford et al, 2009

  11. Like the first couple of times, the condom seems to break every time. You know what I mean, and it was just kind of funny, like, the first 6 times the condom broke. Six condoms, that's kind of rare I could understand 1 but 6 times, and then after that when I got on the birth control, he was just like always saying, like you should have my baby, you should have my daughter, you should have my kid.” 17 yr. old female who started Depo-Provera without partner’s knowledge MALE PARTNER PREGNANCY INTENTION AND CONDOM MANIPULATION “ Miller, et al, 2007

  12. IPV PERPETRATORS AND SEXUAL RISK BEHAVIORS Men who perpetrated IPV in the past year were more likely to report: • Inconsistent or no condom use during vaginal and anal sexual intercourse • Forcing sexual intercourse without a condom Raj et al, 2006

  13. TEEN BIRTH CONTROL SABOTAGE Among teen mothers on public assistance who experienced recent IPV: • 66% experienced birth control sabotage by a dating partner • 34% reported work or school related-sabotage by their boyfriend. Raphael, 2005

  14. “I was on the birth control, and he ended up getting mad and flushing it down the toilet, so I ended up getting pregnant.” “ Miller, et al, 2007

  15. ADOLESCENT RAPID REPEAT PREGNANCY Adolescent mothers who experienced physical abuse within three months after delivery were nearly twice as likely to have a repeat pregnancy within 24 months. Raneri & Wiemann, 2007

  16. 3X HIGHER The risk of being a victim of IPV in the past year was nearly for women seeking an abortion compared to women who were continuing their pregnancies. Bourassa & Berube, 2007

  17. SEXUALLY TRANSMITTED INFECTIONS AND INTIMATE PARTNER VIOLENCE More than one-third (38.8%) of adolescent girls tested for STI/HIV have experienced dating violence. DECKER ET AL, 2005

  18. DATING VIOLENCE AND CONDOM USE Teen girls who are abused by male partners are 3x as likely to become infected with STI/HIV Women and girls who are victims of IPV are 4xas likely to be infected with HIV Men and boys who are abusive to female partners are 3xas likely to have an STI (Decker, 2005; Silverman, 2007)

  19. Elements of Reproductive Coercion Includes: Birth Control Sabotage--Active interference with contraceptive method Examples: • Hiding, withholding or destroying birth control pills • Breaking condoms on purpose or taking them off • Not with drawing when that was agreed upon method of contraception • Pulling out vaginal rings • Tearing off contraceptive patches

  20. Elements of Reproductive Coercion Include: Pregnancy Pressure-- Involves behaviors that are intended to pressure a partner to become pregnant when she does not wish to be pregnant Examples: • "I will leave you if you don’t get pregnant" • "I will hurt you if you don’t become pregnant"

  21. Pregnancy Coercion— Involves threats or acts of violence if a woman does not comply with the perpetrators wishes regarding the decision of whether to terminate or continue the pregnancy Elements of Reproductive Coercion Include:

  22. Enhanced IPV/SA Assessment • Assessment specific to sexual and reproductive health and relevant to visit • Normalizing IPV/SA experiences and connecting those experiences to reproductive health • Outcome: Increased awareness and recognition of abusive behaviors including reproductive control

  23. Resource: Reproductive Health Safety Card • Asks key questions • Used as a prompt for staff and a safety card for patients • Order at endabuse.org/health

  24. Harm Reduction Counseling Specific to sexual and reproductive health, for example: • Birth control that your partner doesn’t have to know about (IUD, Implanon) • Emergency contraception • STI partner notification in clinic vs. at home • Safety planning regarding partner violence

  25. Educate clients that family planning clinic is safe place for women to connect to such resources Normalize use of referral resources Outcome: Increased awareness and utilization of IPV/SA victimization services Supported Referral Family planning counselors may help client contact relevant resources • Annotated referral list for violence related community resources • Names of staff, Spanish speaking, bus lines

  26. Thank you! • Questions? • Contact: • Surabhi Kukke • skukke@tcfv.org • 512-685-6317 • www.tcfv.org

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