Conservative, Pragmatic, and Progressive Ulama: Religion-Based Gender Ideology and Intimate Partner Violence in Indonesia (Study at Jakarta Province, Central Java Province and Jogjakarta Province)

A Longitudinal Investigation of Intimate Partner Violence Among Mothers With Mental Illness

Severe mental illness, substance use, and intimate partner violence have emerged as major intersecting public health problems that adversely and disproportionately impact the lives of women in the United States. This longitudinal study investigated the demographic and clinical correlates of intimate partner violence in a sample of 324 mothers with severe mental illness. A secondary analysis of longitudinal data was conducted by using multiple logistic regression. Participants were part of a longitudinal, community-based study of mothers with severe mental illness, which was aimed at understanding how these mothers viewed motherhood. The women were interviewed initially at baseline (interviews were conducted between 1995 and 1996) and then about 20 months later at follow-up (interviews were conducted between 1997 and 1998). At follow-up the prevalence rate of intimate partner violence was 19%. Multiple logistic regression analyses showed a significant positive relationship between alcohol and drug misuse at baseline and intimate partner violence at follow-up, indicating that women with a co-occurring diagnosis of a substance use disorder (dual diagnosis) were more likely than women without such a diagnosis to report intimate partner violence. The number of lifetime psychiatric hospitalizations and the number of symptoms related to psychiatric disability exhibited at baseline were positively associated with intimate partner violence at follow-up, and age was inversely associated with intimate partner violence. Mental health professionals serving mothers with mental health problems need to be aware of and prepared to assess the significant correlation between these intersecting public health problems in order to influence successful interventions. Particular attention must be given to the special treatment needs related to dual diagnosis and victimization and the impact of these factors on this vulnerable population.

BackgroundWe were interested in finding out if the very low antenatal VCT acceptance rate reported in Mbale Hospital was linked to intimate partner violence against women. We therefore set out to i) determine the prevalence of intimate partner violence, ii) identify risk factors for intimate partner violence and iii) look for association between intimate partner violence and HIV prevention particularly in the context of the prevention of mother-to-child transmission of HIV programme (PMTCT).MethodsThe study consisted of a household survey of rural and urban women with infants in Mbale district, complemented with focus group discussions with women and men. Women were interviewed on socio-demographic characteristics of the woman and her husband, antenatal and postnatal experience related to the youngest child, antenatal HIV testing, perceptions regarding the marital relationship, and intimate partner violence. We obtained ethical approval from Makerere University and informed consent from all participants in the study.ResultsDuring November and December 2003, we interviewed 457 women in Mbale District. A further 96 women and men participated in the focus group discussions. The prevalence of lifetime intimate partner violence was 54% and physical violence in the past year was 14%. Higher education of women (OR 0.3, 95% CI 0.1–0.7) and marriage satisfaction (OR 0.3, 95% CI 0.1–0.7) were associated with lower risk of intimate partner violence, while rural residence (OR 4.4, 95% CI 1.2–16.2) and the husband having another partner (OR 2.4, 95% CI 1.02–5.7) were associated with higher risk of intimate partner violence. There was a strong association between sexual coercion and lifetime physical violence (OR 3.8, 95% CI 2.5–5.7). Multiple partners and consumption of alcohol were major reasons for intimate partner violence. According to the focus group discussions, women fear to test for HIV, disclose HIV results, and request to use condoms because of fear of intimate partner violence.ConclusionIntimate partner violence is common in eastern Uganda and is related to gender inequality, multiple partners, alcohol, and poverty. Accordingly, programmes for the prevention of intimate partner violence need to target these underlying factors. The suggested link between intimate partner violence and HIV risky behaviours or prevention strategies calls for further studies to clearly establish this relationship.

Women's greatest risk of violence in the Democratic Republic of Congo (DRC) may come from an intimate partner, but few studies have analyzed context-specific risk and protective factors for intimate partner violence (IPV) in the DRC. This study analyzed data from the most recent Demographic and Health Survey (DHS) in Congo to assess risk and protective factors for IPV and the role of women's status, a factor implicated in prior IPV research. Using a sample of 1,821 married or cohabiting women between the ages of 15 and 49, four logistic regression models tested relationships between physical, sexual, emotional, or any violence and independent variables of interest. Results indicated that 68.2% of respondents had experienced at least one of the three types of IPV. An attitude of acceptance toward spousal violence was associated with increased risk for physical and emotional IPV. Women who were the only wife of their husband were half as likely to experience IPV compared with women whose husbands had other wives or women who did not know their husbands' marital status. Partner's use of alcohol was associated with nearly doubled risk for both physical and sexual IPV. The study's results indicate that IPV occurs frequently and is justified as acceptable by many women in the DRC. Findings suggest that awareness-raising campaigns may be a helpful intervention and that partner characteristics should be considered when assessing women's risk for IPV.

BackgroundChild and forced marriage have negative health consequences including increased risk of intimate partner violence (IPV) for women and girls. War and humanitarian crises may impact decision-making around marriage and risks of IPV for displaced populations. A qualitative study was conducted among Somali refugees in Dollo Ado, Ethiopia to understand the interplay of factors that contribute to IPV and to inform an intervention. This secondary analysis aims to explore the influence of displacement on marital practices and associated IPV risk.MethodsInterviews and focus group discussions were conducted in 2016 in Dollo Ado, Ethiopia, among Somali women and men living in Bokolmayo refugee camp, host community members, non-governmental staff and service providers, stakeholders, and community and religious leaders (N = 110). Data were transcribed, translated to English, and coded and analyzed thematically using Dedoose software and a codebook developed a priori.ResultsFindings reveal numerous displacement-related factors that led to perceived shifts in marital practices among refugees, including reductions in child and forced marriages. NGO awareness-raising programs and Ethiopian laws prohibiting child marriage as well as increased access to education for girls were reported to have contributed to these changes, despite continued economic hardship and high perceived risk of non-partner sexual violence within the camp and host community. Polygamy was also perceived to have decreased, primarily due to worsening economic conditions. Forced marriage, polygamy and dowry were reported to contribute to physical IPV, and sexual IPV was reported as common in all types of marital unions. However, there was no evidence that changes in these marital practices contributed to any perceived declines in IPV within this context.ConclusionSafe access to education for girls should be prioritized in humanitarian settings. Interventions to address child and forced marriage should address gender and social norms. Intimate partner violence prevention programming should include specialized content taking into account marital practices including child and forced marriage and polygamy. Laws recognizing sexual IPV within marital relationships are needed to reduce sexual IPV.

The role of the extended family in women's risk of intimate partner violence in Jordan

As a wicked problem, intimate partner violence (IPV) is complex, multi-dimensional and global. It is influenced by intersecting social, environmental, and political factors. Therefore, it requires a multifaceted response to minimize the health, economic and social burdens associated with experiences of violence. Given the complexity of the problem of IPV, a 'one size fits all' approach to assessment and response is no longer sufficient. Our efforts must now be focused on advancing nurses' skills to deliver care that is tailored to meet the diverse needs of women and other groups at disproportionate risk of IPV. These nurse-led interventions then need to be strategically implemented and sufficiently resourced within care contexts, where cultural, physical and emotional safety are prioritized. In this Special Issue we use selected examples of the included articles to illustrate how internationally, nurses are leading the development, evaluation, and implementation of healthcare responses to identify and respond to individuals experiencing IPV. However, because of the complexity and tenacity of the problem of IPV, we cannot stand still. Nursing needs to evolve and adapt. With this in mind, we focus on advances in the following areas: improving nurse education on IPV; person-centred and trauma-and violence-informed care; healthcare organization's initiatives to tackling IPV. Global estimates are that one in three women will experience IPV or non-partner sexual violence at least once in their lifetime (World Health Organization, 2021) and that interpersonal violence is associated with negative and serious reproductive, physical and mental health outcomes. In a study to determine the prevalence of dating violence (a risk indicator for future IPV) among nursing students enrolled at a university in Spain, Barroso-Corroto et al. (2023) reported that 53.2% of nursing students had experienced dating violence in the last year, with the same number perpetrating violence, including cyberviolence, against their partner. Given the high prevalence of IPV, we can postulate with a high degree of certainty that all nurses will provide care to a survivor of violence during their career or be a survivor themselves. Yet nursing students and practicing nurses remain woefully unprepared to ask about, and more critically to provide comprehensive nursing care in response to IPV disclosures. In two studies of nursing students from Thailand (Udmuangpia, 2023) and Saudi Arabia (Shaqiqi & Innab, 2023), many participants (40–75%) reported not receiving IPV education; and even in the presence of positive intentions, attitudes or knowledge to ask about IPV, participants consistently reported low perceptions about their intentions to ask, or preparedness to manage IPV disclosures. It is imperative that organizations responsible for the accreditation of nursing education programs develop entry-to-practice competencies for the nursing care of individuals who experience interpersonal trauma across the life course. Moreover, educational opportunities for nursing students and practicing nurses must advance beyond the provision of single workshops focused on the epidemiology and health consequences of IPV. Instead, there need to be comprehensive and regular opportunities to engage in opportunities for skill development, practice and reflection. In their integrative review of community nurse-led interventions to identify and respond to domestic abuse in the postnatal period, one of the key training recommendations proposed by Drake and Murphy Tighe (2023) is for the provision of training that includes refresher updating, supervision, and ongoing mentorship. Nursing needs to move on from a focus on identifying strategies and barriers to recognize or 'screen' for IPV. We know enough about the problem. It is imperative now that the spotlight is on how to create safe environments that facilitate disclosures and appropriate responses that meet the individual needs of people who have a history of past or current IPV. In all care contexts, when individuals disclose experiences of IPV, all nurses need to be prepared to provide the first-line response of LIVES (Listen, Inquire about needs, Validate, Enhance safety and support) as recommended by the World Health Organization (2014). However, there will be certain contexts where a homogenous response to an IPV disclosure is not sufficient, and nurses must have the knowledge and skills to provide care that is tailored to the needs of a specific population. This needs to reflect the type(s) of IPV experienced and include interventions to promote safety, as well as address the health effects of IPV. In this Special Issue, we are pleased to include articles that deepen our understanding of the prevalence, risk indicators and experiences of violence among diverse populations. Awareness and identification of populations at disproportionate risk for IPV are critical for providing person-centred responses to individuals' health and social needs within healthcare contexts. Using data from the Pregnancy Risk Assessment Monitoring System (United States), in a cross-sectional sample of 43,837 individuals with a live birth, respondents with disabilities had 2.6 times the odds of experiencing IPV before pregnancy and 2.5 times the odds of experiencing IPV during pregnancy, compared to individuals in the perinatal period without disabilities (Alhusen et al., 2023). In a systematic review to examine the relationship between IPV exposure and women with breast and gynaecologic cancers, Sheikhnezhad et al. (2023) highlight that women with these types of cancer are at the greatest risk of psychological IPV and that maintaining a relationship with the perpetrator negatively influenced their use and access to treatment and quality of life during treatment. In addition to recognizing violence perpetrated against women and children, nurses have a responsibility to understand the types of IPV experienced by people from sexual and gender minority populations. In a qualitative descriptive study, Choi et al. (2023) provide a rich and in-depth analysis of the varied types of sexual violence, including chemsex, stealthing and image-based violence, as experienced by Chinese men who have sex with men who use dating 'apps' in Hong Kong. Acceptance or 'normalization' of sexual violence, along with experiences of stigmatization and discrimination, provides insights on how experiences of violence subsequently influence their health behaviours, including reticence to obtain HIV post-exposure prophylaxis (Choi et al., 2023). Nurses' understanding that experiences of different types of IPV necessitates different nursing responses is also critical. In their commentary on nurses' experiences in identifying and responding to IPV among gay and bisexual men, Callan et al. (2023) challenge the profession to recognize that applying heterosexual paradigms to capture different experiences/types of abuse in gay and bisexual populations may be problematic, and that differential tools and tailored responses are needed. Individual nurses cannot be expected to practice within a vacuum. Comprehensive organizational support is essential for ensuring that IPV training initiatives are sustained and that nursing approaches to IPV assessment and intervention are implemented and consistently delivered. In Spain, Maquibar Landa et al. (2023) explain that the enactment of the 'Andalusion Protocol for Healthcare Response to Gender Based Violence' has enabled the establishment of a supportive legal framework and health system to address IPV, and that this has created a care context where nurses are able to implement evidence-informed practices for caring for women who have experienced IPV. At a practical level, organizational support should at minimum consist of an investment of time and resources to provide nurses with high-quality reflective and clinical supervision, the identification of IPV practice 'champions' to role model best practices, the development and implementation of care pathways, protocols and the establishment of partnerships between service organization to facilitate interagency referrals (Drake & Murphy Tighe, 2023; Jack et al., 2023). With strong leadership and organizational support, nurses are better able to provide the person-centred and trauma-and violence-informed nursing care that are required. We consider it important that nurses move beyond the often-standard processes of identifying IPV and then referring onto other specialized supports, to delivering interventions that address the social or health effects associated with exposure to violence or traumatic stress. In home visitation programmes, where nurses provide health promotion supports and services to pregnant individuals or families with young children, findings from a systematic review and qualitative meta-synthesis, indicate that nurses have specialized roles in conducting risk assessments to inform the development of tailored safety plans, promoting child safeguarding and coordinating services (Adams et al., 2023). Researchers in nursing and health services are actively engaged in developing and evaluating new interventions to address the health effects associated with violence exposure. For pregnant women who have experienced IPV, the provision of 12 sessions of trauma-and violence-informed cognitive behavioural therapy by a clinical nurse specialist is showing promise as an intervention to identify potential triggers in pregnancy, develop appropriate coping strategies and advocate for their needs to best cope with their stressors and pain (Mantler et al., 2023). Similarly, for nurses working with perpetrators of violence, a nurse-led, 15-session videoconference-delivered cognitive behavioural group therapy is also showing promise as an intervention where participants report high levels of satisfaction and completion (Nesset et al., 2023). For women who receive care after non-fatal strangulation in an emergency department, forensic nurse examiners have a critical role in assessing symptoms and injuries, communicating diagnoses, validating patient experiences and ensuring a thorough and objective documentation of their findings (Patch et al., 2023). By its very nature, a wicked problem is difficult to solve, but nursing makes a considerable contribution to addressing IPV. The articles in this Special Issue attest to the cutting-edge work happening within the profession and we are delighted to showcase such work within JAN. However, if nursing is to continue to make the required strides and impacts, we have highlighted the imperative to improve nursing education on IPV and for nursing care to be person-centred and trauma-and violence-informed. We have also called for healthcare organizations to provide the resources and infrastructure that are required to support nursing's contribution to tackling IPV. All authors agreed the parameters of the editorial and were involved with the handling of the submitted manuscripts. SJ led on the analysis of the included articles and preparation of the first draft of the manuscript. CB-J edited the manuscript and agreed on the final version. None. There was no funding to support this work. The authors declare no conflicts of interest.

Intimate partner violence (IPV) during pregnancy is known to have multiple detrimental consequences for the woman and potentially for her unborn child. However, little is known about the nature and extent of IPV during pregnancy, particularly in developing countries, which compromises efforts to address the problem. Relying on population-based data, this article examines the extent, patterns, and correlates associated with physical, sexual, and psychological IPV during pregnancy in Bangladesh. Cross-sectional survey data were collected between October 2015 and January 2016 from 426 new mothers, aged 15 to 49 years, who were in the first 6 months postpartum. IPV was assessed with a validated set of survey items. Multivariate logistic regression analyses were conducted to evaluate correlates associated with different types of IPV. Overall, 66.4% of women experienced any IPV during pregnancy. The prevalence of physical, sexual, and psychological IPV was 35.2%, 18.5%, and 65%, respectively. These forms of IPV often overlap, particularly physical and psychological IPV. Pregnant women who report limited social support and have controlling husbands are at significantly increased risk for all three types of IPV during pregnancy. Women who cling to traditional gender roles and those with low self-esteem exhibit increased risk for physical and psychological IPV during pregnancy. Psychological IPV during pregnancy is also correlated with low decision-making autonomy and childhood exposure to violence. Women whose husband's demand a dowry at marriage are at increased risk of sexual IPV during pregnancy. Results reinforce the need to conduct routine screening during pregnancy to identify women with a history of IPV and to be able to offer help and support. The findings also reinforce calls for gender equity and women's equal access to family and social resources thereby increasing women's social support networks, their self-esteem, and autonomy, and reducing their risk of IPV during pregnancy.

Intimate Partner Violence

Heavy drinking couples in which one (i.e., discordant heavy drinking) or both (i.e., concordant heavy drinking) partners drink alcohol heavily are at greater risk for intimate partner violence (IPV) than couples in which neither partner drinks heavily (i.e., concordant nonheavy drinking). Additionally, the risk for IPV is particularly high among discordant as compared to concordant heavy drinking couples. Despite the fact that individuals who drink heavily often also use other drugs, the extent to which couples' use of other drugs interacts with heavy drinking patterns remains unknown. The current study examined differences in psychological and physical IPV perpetration as a function of couples' heavy drinking and other drug use patterns. The sample included 337 couples in which at least one partner reported a history of heavy drinking and IPV in the current relationship. Results of dyadic path models showed that concordant drug using couples who engaged in either discordant or concordant heavy drinking were at greater risk for male- and female-perpetrated psychological IPV compared to concordant nondrug using couples (regardless of heavy drinking) and concordant nonheavy drinking couples (regardless of drug use). Associations between heavy drinking and other drug use patterns on physical IPV perpetration were not statistically significant. These findings show that a pattern of concordant drug use paired with discordant or concordant heavy drinking places couples at particularly high risk for psychological IPV. Clinicians working with couples affected by IPV may benefit from paying attention to the dyadic dynamics of heavy drinking, other drug use, and IPV.

Adverse childhood experiences (ACEs) are associated with an increased risk of depression and intimate partner violence (IPV). Social support and partner support may help explain this association. Few researchers have focused on Chinese immigrant women, who are less likely than native-born women to seek help for mental health challenges and IPV. The purpose of this study was to examine the mediation effects of social and partner support on the relationship between (a) ACEs and (b) depressive symptoms and IPV among Chinese immigrant women living in the United States. This is a secondary analysis of data from 475 Chinese immigrant women recruited online. Depressive symptoms, IPV, ACEs, perceived social support, and perceived partner support were measured cross-sectionally. Mediation analyses were conducted to test the mediating role of social and partner support on the associations between ACEs and depressive symptoms and IPV. Social support and partner support fully mediated the relationship between ACEs and depressive symptoms. However, partner support only partially mediated the relationship between ACEs and IPV. ACEs indirectly affect depressive symptoms by undermining both general perceptions of support and perceived partner support. The findings of this study underscore the critical influence of a lack of partner support in mediating the effects of ACEs on Chinese immigrant women's risk of IPV. Promoting strong existing support networks, creating new support resources, and improving partner relationships are important targets for interventions to mitigate the effects of ACEs on depression and IPV in Chinese immigrant women.

Adolescent Adverse Childhood Experiences and Risk of Adult Intimate Partner Violence

Background: Intimate partner violence (IPV) is the primary cause of serious injury and the second leading cause of death among women of reproductive age in Canada. Alberta has one of the highest rates of IPV in Canada. Health systems play a crucial role in providing services for IPV. It is widely recommended to integrate IPV services into trauma services to improve outcomes for patients admitted with severe IPV injuries. For example, having a dedicated IPV expert, such as a peer advocate worker or social worker on the trauma team, will help patients experiencing IPV get the support they need to avoid further harm. Approach: The University of Alberta Hospital (UAH) has a large trauma population at risk for IPV and is currently without a standardized screening protocol, resources to appropriately screen, and trained IPV personnel to provide resources for safety planning, mental health support, and referral to community-based IPV services. Our team has collected evidence on effective IPV screening practices and identified the determinants of successfully implementing integrated IPV response services in trauma care. We gathered qualitative feedback from trauma providers and IPV survivors to design a comprehensive screening program that includes a dedicated IPV expert on the trauma team, referral to community-based resources, and educational sessions for hospital staff delivered by community IPV collaborators. Results: Consistent with a social-ecological analysis and implementation science, we identified the factors that would enable the successful implementation of integrated IPV services at the UAH trauma service. In the wider community context, we have engaged with community agencies and Indigenous knowledge experts, including the UAH Indigenous Liaison, to develop a referral protocol to community-based IPV resources that is sensitive to survivors needs, particularly within specific cultural groups such as Indigenous patients. Within the UAH trauma service itself, our site champion, a trauma surgeon, has engaged UAH leadership to support the initiative. We propose hiring a peer advocate worker to administer IPV screening using a validated screening tool. Having dedicated personnel to support screening, assessment, and referral addresses trauma providers time constraints and capacity to respond to IPV. At the micro level, the peer-advocate worker will establish rapport with patients, assess risk and protective factors, educate patients about IPV, and provide direct connections to community resources and follow-up. Implications: We investigated the factors that impact the successful implementation of an integrated IPV program at the UAH trauma service. These factors guided the development of an IPV screening and referral program at the UAH trauma service, and we have submitted a funding proposal to support its implementation. Our research advances knowledge aligned with the nine pillars of integrated care, namely, supporting an integrated workforce for IPV response in the health system and promoting survivor-centred care by improving trauma patients connection to IPV resources and community supports. Peer-advocate workers also support care coordination around patient needs and preferences. For the healthcare system, breaking the cycle of violence can reduce trauma recidivism and repeat presentations to hospitals for acute injuries and potentially prevent death from ongoing IPV.

While IPV is often studied as a predictor of housing insecurity, few U.S. studies explore how different forms of housing instability may contribute to intimate partner violence (IPV) risk. Using a mixed-methods approach and a cross-sectional design, this study examined the association between four housing instability domains and IPV among a sample of tenants that had either experienced eviction or were at high risk for eviction. Tenants in Harris and Travis counties (Texas, USA) completed an online survey (n = 1085; March–July 2024). Housing instability was assessed across four domains: homelessness, lease violations, utility hardship, and poor housing quality. IPV was measured using the Hurt, Insult, Threaten, Scream Screener. Covariate-adjusted logistic regression models suggest indicators within the four housing instability domains were associated with IPV risk. Within the homelessness domain, experiences with lifetime homelessness (AOR = 1.92, 95%CI 1.61–2.28), in the past 12 months living in unconventional spaces (AOR = 2.10, 95%CI 1.92–2.29), and moving in with others (AOR = 1.20, 95%CI 1.06–1.36) were associated with IPV. Within the lease violations domain, missed rent payments (AOR = 1.69, 95%CI 1.68–1.71) and non-payment lease violations (AOR = 2.50, 95%CI 2.29–2.73) in the past 12 months were associated with IPV. Utility shutoffs (AOR = 1.62, 95%CI 1.37–1.91) and unsafe housing (AOR = 1.65, 95%CI 1.31–2.09) in the past 12 months were associated with IPV. Homelessness, housing-related economic hardships and substandard living conditions predict an elevated risk of IPV.

To investigate if pregnancy/perinatal status (PS) modifies the risk of Intimate Partner Violence (IPV). This cross-sectional study used data from the 2019 Brazilian National Health Survey (PNS), a population-based study. A sample of 26,006 women (18-49 years) answered a questionnaire assessing sociodemographic, reproductive history and IPV (psychological and physical/sexual) in the last 12 months. PS was classified into 3 groups: nulliparous, pregnant or <18 months postpartum, and ≥18 months postpartum. Logistic regression models were used to obtain crude and adjusted Odds Ratios (ORs) and 95% Confidence Intervals (CIs) for the association between PS and IPV category. All analyses were weighted. The prevalence of IPV psychological and physical/sexual was 7.9% (95% CI [7.2, 8.7]) and 3.6% [3.0, 4.3], respectively. PS was significantly associated with psychological IPV. Compared to nulliparous women, those with ≥ 18 months postpartum had a 60% higher chance of experiencing psychological IPV (OR: 1.60, [1.09, 2.36]), while pregnant women or those <18 months postpartum had even higher chances (OR: 1.94, [1.17, 3.23]). In contrast, PS was not significantly associated with physical/sexual IPV. Pregnant and postpartum women had a higher risk of psychological IPV, but not of physical/sexual IPV. Preventive and management strategies for psychological IPV in this group are recommended.