Understanding and Preventing Gender-based Intimate Partner Violence among West African Immigrants of Washington State, USA Community-based Participatory Research

Children Witnessing Domestic and Family Violence: A Widespread Occurrence during the Coronavirus Disease 2019 (COVID-19) Pandemic

The pandemic paradox: The consequences of COVID‐19 on domestic violence

Despite decades of feminist efforts to educate the community about, and improve responses to, domestic violence, men’s violence against women remains a significant social and human rights issue in our society. In Australia, it is estimated that at least one in five women have experienced violence by a current or previous partner and almost every week a woman is killed by a current or former partner. Public and legal discourses about domestic violence continue to misunderstand women’s experiences of violence, frequently simplifying these to a mere question of ‘why doesn’t she leave’ the abusive relationship. Such narratives fail to account for the complicated nature of women’s lived realities, their decision-making and the family violence system. This thesis provides a more complete view of the contextual circumstances in which women separate. This thesis engages with scholarship from a range of disciplines including criminology, sociology, psychology and social work. It draws upon in-depth, semi-structured interviews with 12 women to explore their lived experiences of separating from an abusive, intimate male partner in Victoria, Australia. A unique contribution of this thesis is it contextualises women’s experiences of separating from a violent partner and the supports available to them by bringing together the stories of women and the perspectives of 19 support workers gathered via in-depth interviews and focus groups. This research highlights that understanding the dynamics of coercive control is important in recognising the significant limits placed on women’s agency when separating from a violent partner. The narratives reflect how women seek to gain ‘control in the context of no control’ by managing safety and survival via varied strategic, concealed and calculated measures aimed at reducing the escalated risk of violence associated with separation. Interactions with informal and formal supports can empower women to resist their coercively controlling partners or, alternatively, extend experiences of gendered power, control and trauma when the violence and women’s decision-making are dismissed. Overstretched and underfunded support services along with punitive social security and legal systems also place profound barriers on women gaining adequate, timely and ongoing support. The thesis makes a significant contribution to interdisciplinary knowledge about the social dynamics of women leaving violent relationships in contemporary Australia. Importantly, the stories captured in this thesis are also significant in informing public discourse about the complexities of women’s experiences when separating, along with the need for policy and practice to foster an empowering approach to support and respect women’s decision-making.

<b>PB-PG-0712-28011 – NIHR Research for Patient Benefit Programme – Final report</b><br /> <br /> <b>Project title: </b>Learning from women’s experiences: improving our understanding of the physical, psychological and emotional health impacts of domestic violence and abuse (DVA), help-seeking trajectories and outcomes<br /> <br /> <b>Authors:&nbsp;</b><br /> Dr Maggie Evans - NHS Bristol CCG&nbsp;&nbsp;<br /> ProfessorGene Feder - University of Bristol<br /> Dr Fiona Duxbury - Blackbird Leys Health Centre<br /> Dr Helen Salisbury - University of Oxford<br /> Professor Sue Ziebland - University of Oxford<br /> <br /> <b>Plain language summary</b><br /> <br /> It is estimated that 1 in 4 women experience Domestic Violence and Abuse (DVA) during their lifetime and may approach multiple agencies before they get help. On average women try to leave abusive relationships 7 or 8 times, but may encounter repercussions from their partner and difficulty in disclosing their situation to family members, friends, health care or other professionals. This can lead to extreme social isolation. We aimed to develop a web-based resource which gives real-life accounts of women's experiences of DVA and their outcomes. This may help to increase the options for women in an abusive relationship, suggest ways to improve their self-care, where to seek help and how to make plans to leave.<br /> <br /> We conducted in-depth video- and audio-taped interviews with 40 women across the UK, with a range of ages and ethnic backgrounds, who have experienced DVA, asking about the impacts on their physical and mental health, their help-seeking experiences, outcomes and any barriers experienced. The interviews are being used to develop (i) a web-based resource for women experiencing DVA, family members and friends, as part of www.healthtalkonline.org. (ii) a training resource for medical and allied health and social care professionals. Participants were recruited through Patient and Public Involvement groups, advertisements in the media, a dedicated website and specialist third sector agencies. Women were interviewed at a safe location by an experienced female researcher.<br /> <br /> We were very careful to ensure participants’ safety. Women who felt uncomfortable about videos or audio-recordings being available online are represented by actors, and real names of people and places are deleted.<br /> We found consistent themes in the women’s narratives, which have been written up as Topic Summaries for the website. For example, the data provide new insights into the experience of Coercive Control which is now a criminal offence but is poorly understood. We found new insights into the difficulties and dangers faced by women who want to leave an abusive relationship, which counter the often asked question: ‘Why didn’t you just leave’. We also found that women themselves were so isolated and controlled in the abusive relationship that they generally did not understand that they were experiencing DVA. Our study highlights the need for wide-ranging education into the reality of DVA, which will be part of the dissemination process.<br /> <br /> <b>Keywords</b><br /> Domestic Violence, Domestic Abuse, Women's Narratives, Women's Help-seeking, Women's Health, Qualitative study, Website study.<br /> <br /> <b>Summary of research findings</b><br /> <br /> Methods<br /> <br /> We recruited a purposive sample of 40 women across the UK who have experienced DVA. They had a range of ages and ethnic backgrounds. Women were recruited via DVA support agencies, patients at GP practices which operate the IRIS model for the identification and referral of women to DVA support agencies, a website set up for our study, twitter and FaceBook.<br /> <br /> Women were interviewed in a safe, convenient location using a topic guide that covered all aspects of their experience of DVA. Interviews were video- and/or audio- recorded. Women could chose the form in which clips of their interview will appear on the website, either video, audio, written or spoken by an actor. Three women decided not to have their data included on the website. All participants had the opportunity to check and give approval for the use of their interview data, making deletions if they wished to.<br /> <br /> Interviews were transcribed, anonymised and the data were entered into NVIVO software. The research team carried out a thematic analysis which was used as the basis for writing 27 Topic Summaries for the website, illustrated by clips from the interviews. These summaries represent the full range of women’s experiences of DVA, and reflect the most important themes. The topic summaries and associated clips are being processed by the technical team at the DiPEx charity in order for them to appear on the website. All video and audio tapes will be professionally edited.<br /> Some of the participants, DVA professionals and GPs, along with the research team formed an Advisory Panel that met twice during the study, to comment on the process and to advise on the content of the proposed Topic Summaries. They evaluated the material that had been prepared by the research team in June 2016 and, as a result, major changes were made to the format and content of the Topic Summaries, feedback that was valuable in developing the finished product.<br /> <br /> Key Findings<br /> <br /> We found consistent themes in the women’s narratives, which formed the Topic Summaries for the website. For example, the data provide new insights into the experience of Coercive Control which is now a criminal offence but is poorly understood. We found new insights into the difficulties and dangers faced by women who want to leave an abusive relationship, which counter the often asked question: ‘Why didn’t you just leave’.<br /> <br /> Women's narratives confirmed the devastating impacts of DVA on their mental health and also on that of their children, impacts that did not stop when the relationship ended. Specialized therapy may be needed to help women and their families recover from the trauma of DVA, and yet women's accounts reveal a widespread lack of understanding or appropriate support across a range of key professionals in healthcare, the police and children's services including CAFCASS.<br /> <br /> We also discovered a number of significant barriers to women in seeking help, which form a Topic on the website entitled ‘Obstacles to seeking help’. Women across all educational levels revealed a lack of knowledge about DVA, so they were not able to understand their partner’s behaviour. Women described being manipulated into believing their partner’s behaviour was their fault and therefore they had no ‘right’ to ask for help.<br /> <br /> Other constraints to asking for help included a deep fear amongst women that they might lose custody of their children if their home situation was known about by professionals. Women also said that it was hard for them to open up to anybody about their experiences and urged professionals, family and friends to ask more questions but to be non-judgmental. The very real repercussions in terms of violence from their partner when a woman left was highlighted in the interviews and underlines the need for greater support at this time. For many women, getting a place in a women’s refuge was impossible owing to lack of availability and the need to be eligible for public funding. This was particularly difficult for first generation migrant women.<br /> <br /> Our study highlights the need for wide-ranging education into the reality of DVA, which will be part of the dissemination process. Our participants frequently experienced being let down by, for example, the police who had, in the participants’ view, little understanding of DVA beyond physical violence.<br /> <br /> Expected impact<br /> <br /> The study will be published online as part of the award-winning website www.healthtalkonline.org, a growing resource that specialises in disseminating qualitative studies of experiences of health and illness. The impact of a website is difficult to measure. The site currently covers over 70 health conditions and receives over 5 million hits per month. Following the launch of the DVA module, which is likely to be in March 2017, we will undertake dissemination work to maximise potential impact. We will receive regular bulletins of the number of hits per page from the website charity, so that we can monitor usage over time.<br /> <br /> We plan to expand on dissemination and impact measurement following the launch which will include a Press release and media coverage. We are working closely with Women’s Aid to facilitate dissemination. The DVA module will be introduced on the website by some video clips from key informants in the field of DVA. We have made an introductory video of Jenni Murray, Patron of Women’s Aid and presenter of Radio 4 Woman's Hour. Radio 4 has been covering DVA in the last two years through a storyline in the radio series ‘The Archers’ and Women’s Hour has made several reports on the topic. We hope to use this forum to advertise the website module.&nbsp;<br /> <br /> We have already taken steps to include findings and video clips in teaching modules for medical students and in academic and non-academic conferences and events. Clips and data from the DVA module will be incorporated in the training for the IRIS model for GPs and other staff in primary care (see www.irisdomesticviolence.org.uk). We hope that the range of topics addressed in the DVA module will strengthen the likelihood that primary health care and other commissioners will commission IRIS and other DVA resources. Small cards and/or posters giving the web address of the DVA module will be available to be distributed to interested parties, for example GP practices, hospitals, police stations, DVA agencies, other public places. Attempts till be made to disseminate into other professional areas such as the training of police or the education of young people. One potential method for doing this is to create a piece of ‘verbatim theatre’ in which actors speak the words of women survivors of DVA, taken from their narratives, and developed into a piece of theatre. We plan to apply for funding for dissemination and impact assessment work.<br /> <br /> The balance of the grant (under &pound;4,000) will be retained for 12 calendar months so that we can undertake planned dissemination work, which will include professionals' study and information days and attending international conferences about DVA (please see spreadsheet for details).<br /> <br /> Conclusions<br /> <br /> A resource such as the www.healthtalk.org&nbsp; module about DVA could be used in a variety of health care, social care and educational settings, to increase public and professional understanding of DVA. Most of the women said that, had they known about DVA in all its various forms, they might not have stayed so long in an abusive relationship, and they would have sought help earlier.<br /> <br /> A positive outcome was the number of women who experienced support from other survivors of DVA. For many women, simply talking to someone else who understood, was the beginning of their own journey away from abuse. Providing and evaluating information, resources and training to facilitate women in setting up and advertising peer support groups could be valuable future research proposals.<br /> <br /> <br /> <b>Patient and public involvement</b><br /> <br /> Working with our PPI group of women survivors of DVA has been essential to the success of the study. I feel strongly that PPI representation should not be tokenistic, such as one or two PPI members on a steering group that mainly comprises academics and other professionals, which will enable only the more confident or articulate to participate. I also resist the move towards the 'semi-professionalisation' of PPI members that I see in evidence around me, whereby individuals with a particular illness condition are recruited because of current or past professional skills that are relevant to the research rather than for their personal experience of the condition that is being studied. I have witnessed formal application forms and interviews for PPI positions, which I wholly disagree with. Our role as professionals is to objectify the condition under study and as far as PPI members are concerned it is important to prioritise their subjective experiences, not their confidence or articulate-ness or professional skills.<br /> <br /> With this in mind, we recruited a group of women survivors, some of whom had worked with us on previous studies, and who met regularly during the lifetime of the study. Meetings were held at the University, pre-paid taxis were booked to enable women to attend, lunch was provided and shopping vouchers of &pound;20 were provided in appreciation of their time and contribution. Four members of this group volunteered to join the project Advisory Panel that also included professionals from Women's Aid, the local DVA agency, the IRIS programme, GPs with expertise in DVA and the core research team.<br /> <br /> PPI members were involved in developing the funding application, helping to prioritise the research aims and develop the methodology. They provided important insights into issues of confidentiality and safety in terms of recruitment, data collection and use of the data on the website. When funding was secured, PPI members assisted in the development of participant information resources, commenting on the design and wording of all research documents such as participant information sheets, consent forms and topic guides. We agreed to implement a safety button on each page that instantly closes the website down should a woman be disurbed while One innovation that arose from this process was the design and use of a coloured flyer which was widely disseminated. It showed a woman's face with speech bubbles asking key questions to identify DVA. This was used as the initial stage of recruitment, before the full information sheets were provided. Another example was the agreement to include a safety button on each page that quickly closes the website down if a woman is disturbed while accessing the site.<br /> <br /> We held two Advisory Panel meetings during the lifetime of the study, which were lengthy working sessions. All members were sent data in advance and invited to comment. At the second of the two meetings, we drafted the Topic Summaries for the website and we had a very lively meeting following which I changed the focus of the data analysis in line with the feedback from the survivors. Drawing on their own experience they were able to steer the way in which the data was analysed, so that we reduced the emphasis on some topics and expanded others. One example of this is the use of a large amount of data in the interviews relating to the effects of DVA on children, some very long-term, and women's struggles to get help and support for their children. We had not originally processed this data as it seemed to take the focus off the women and we also feel that we have enough data on children to potentially write another healthtalk module! However,&nbsp; all the women felt that impact on children was one of their prime concerns. When we analysed the data we realised that the impact on children was both a reason for women to stay in an abusive relationship and also a reason for women to get away. Although the analysis and processing of this data provided a lot of extra work, we feel that the module is better as a result. Our panel representative from the HERG unit at Oxford (which leads the research for the website) commented that it was one of the best, well attended and inclusive meetings she had attended.<br /> <br /> The PPI women continue to be involved, some have offered to proof-read the material for the website, others are personally attending conferences and meetings to speak about their experiences of DVA and their experiences as research advisors. When the module is ready, we will involve PPI women in a short evaluation and checking, followed by the&nbsp; launch. We will continue to consult and involve the women in our dissemination plans.<br /> <br /> <b>Data sharing statement</b><br /> See link <a href="https://www.nihr.ac.uk/documents/nihr-position-on-the-sharing-of-research-data/12253">[https://www.nihr.ac.uk/documents/nihr-position-on-the-sharing-of-research-data/12253</a>] for the NIHR position of the sharing of research data.&nbsp; The NIHR strongly supports the sharing of data in the most appropriate way, to help deliver research that maximises benefits to patients and the wider public, the health and care system and which contributes to economic growth in the UK.&nbsp; All requests for data should be directed to the award holder and managed by the award holder.<br /> <br /> <b>Disclaimer</b><br /> This project is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0712-28011). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.<br /> <br /> This project was carried out between September 2014 and November 2016 . This final report has not been peer-reviewed. The report was examined by the Programme Director at the time of submission to assess completeness against the stated aims.

&lt;p&gt;&lt;b&gt;Binegativity is a term used to refer to the negative stereotypes attributed to bisexual people. Examples include promiscuity, attention seeking, and/or going through a phase. Despite the success of the LGBTQ+ movement in improving social equality for gay and lesbian individuals, bisexual negative stereotypes and stigma are prevalent in both heterosexual and LGBTQ+ communities. They are problematic because they erase bisexual identities, rendering bisexual people voiceless, feeling rejected and alone in their experiences. This isolation impacts the magnitude of the social problems that this group disproportionally face. &lt;/b&gt;&lt;/p&gt; &lt;p&gt;Indeed, figures in Aotearoa New Zealand and worldwide indicate that intimate partner abuse (IPA) is more prevalent amongst bisexual women and young people in comparison to any other sexual orientation, age or gender. The limited research with bisexual women shows that bi-erasure and young age impacts women’s experiences of IPA from a male intimate partner and their help seeking behaviour. However, the mechanisms involved are not understood by society or support services, and require further research. This qualitative study aimed to address this gap by exploring the role of bisexuality and young age on the abuse and helpseeking experiences of six bisexual young women who were in an intimate relationship with a man. The transcripts of six semi-structured interviews with women were analysed. All identified as bisexual and were aged between 15 to 20 years when they first entered into an intimate relationship with their male partner. Interpretative Phenomenological Analysis (IPAN) was used to understand how the women made sense and meaning of their experiences, as interpreted by the current researcher. Four themes were identified: 1) Developing Relationship IQ; 2) Progression of Control and Abuse; 3) Unspoken Bisexuality; and 4) Help Seeking Barriers. Collectively, the themes encapsulate the unspoken nature of bisexuality and bi-erasure in society showing how it exacerbates control and abuse in IPA, and adding further barriers to helpseeking for bisexual people. Furthermore, it is clear that young people’s knowledge of IPA and available support services impacts their ability to helpseek, as does the lack of understanding of bisexuality by services and service workers. &lt;/p&gt; &lt;p&gt;Findings suggest an urgent need for policy and practice to implement robust relationship education in schools and for research to further explore the role of bisexuality in IPA, drawing out bisexuality from under the LGBTQ+ umbrella. &lt;/p&gt; &lt;p&gt; “I call myself bisexual because I acknowledge that I have in myself the potential to be attracted romantically and/or sexually to people of more than one sex and/or gender not necessarily at the same time not necessarily in the same way and not necessarily to the same degree” – Robyn Ochs&lt;/p&gt;

&lt;p&gt;Despite men and women experiencing similar prevalence rates of intimate partner abuse (IPA) victimisation, the abuse of men by female intimate partners is under-acknowledged. Further, the nature of this experience - including the maintenance of these abusive relationships - is under-researched. This inadequate response to men’s experiences is largely due to gender-focussed conceptualisations of IPA, whereby IPA is viewed as both a product and tool of the patriarchal foundations of many societies, which encourage men to assert and maintain their dominance over women. Due to these conceptualisations, the majority of past IPA research has been dedicated to women’s experiences of victimisation. Moreover, the majority of what is known about men’s experiences of IPA victimisation has come from quantitative research, which has provided surface-level statistics and descriptions. Recent qualitative studies have found themes related to the maintenance of these relationships. Yet, the need for an in-depth analysis of how abusive relationships where men are victimised are maintained is apparent. This qualitative study addressed this gap by exploring men’s experiences of the maintenance of their abusive intimate relationship through the analysis of 13 interviews with men in Aotearoa New Zealand who have experienced IPA victimisation from a female partner. The men were aged 36 to 66, and most were European (77%), while two were Māori, and one was Indian. Reflexive Thematic Analysis was employed using an approach that was inductive (data-focussed), semantic (addressing intended meaning), and realist (building knowledge based on directly intended meanings). Four themes were identified that spoke to the men’s experiences of the maintenance of their abusive intimate relationships. The first theme described The Skewed View of the Abuse, which consisted of five subthemes: 1) Delayed Recognition of the Abuse, 2) Ignoring the Abuse, 3) Feeling Responsible for the Abuse, 4) Justification of the Abuse, and 5) Partner’s Denying the Abuse and Passing Blame. The second theme identified, The Dilemma of Staying or Leaving, consisted of two subthemes: 1) Benefits of Staying, and 2) Negative Consequences of Leaving. The third theme described The Barriers to Help-seeking and was comprised of five subthemes: 1) Limited Support Networks, 2) Unsure Where to Disclose, 3) Reluctance to Disclose, 4) Poor Mental Health, and, 5) Feeling Helpless. The fourth and final theme, The Suboptimal Influence of Others, comprised three subthemes: 1) Passively Unhelpful People, 2) Actively Unhelpful People. The findings convey how the men’s abusive intimate relationships are maintained from their perspective and identify factors that may keep men stuck within them such as the lack of education about men’s experiences of abuse and how to leave such relationships by the men themselves, their whānau, and even professionals. The findings add to in-depth understandings of why men become stuck in abusive intimate relationships and indicate a strong need for ongoing research to identify and implement the necessary changes to policy and practice to improve early interventions for affected men.&lt;/p&gt;

Background Healthcare disparities among racial and ethnic groups have been well documented across all aspects of clinical healthcare, and disparities in attainment of preventive services are particularly prevalent. African immigrants may be particularly susceptible to factors that contribute to healthcare disparities but little is known about this population. The purpose of this study was to assess patient-provider concordance and trust of health care providers among West African immigrants in the US. In addition, we explored the relationship between these variables and the prostate cancer (CaP) screening behavior of participants. Methods Data collection was part of a global study of prostate cancer in West African men. A study questionnaire was used to collect data from West African male immigrants in the US between the ages of 35 and 70 years. Survey scales for this study included country of birth, years since immigration, patient–provider concordance, trust of healthcare provider, attitude and cues towards CaP screening (PSA and DRE), and CaP screening history. Results There were 38 African immigrants from Cameroon, Nigeria, Sierra Leone, and Ghana. Participants’ average age was 46.2 years and they had spent an average of 13.9 years in the US. Most of the participants (over 60%) stated that they had no preference in regards to their provider race, ethnicity or gender. Over 70% indicated that their physician was of different ethnicity and race while 50% indicated that their physician was of a different gender. Furthermore, most respondents noted that they trusted their physicians with health decisions. However, 61% and 68% of participants did not complete PSA or DRE testing, respectively. Most stated that they did not discuss the advantages or disadvantages of prostate cancer screening with their physicians, noting they mostly received cues to getting tested from reading information, radio, and/or TV. Conclusion Although health disparities can be explained by socioeconomic status such as lack of insurance and various other observable impediments to accessing health care, others barriers persist. It is important to explore other contributing factors such as patient-physician relationships. This study suggests that patient-provider concordance may not be a priority. Emphasis should be placed on encouraging physician-initiated discussion on CaP screening. Unfortunately, current physician guidelines do not stress CaP screening and fail to account for the documented increased risk and early onset of CaP in Black men. Citation Format: Nissa Askins, Ruth Agaba, Oluwaseyi Adeniji, Adaora Ezeani, Ernest Kaninjing, Folakemi Odedina, Catherine Badejo, Anthonia Sowunmi, Omolara Fatiregun, Ayo Salako, A. A Popoola, Mohammed Faruk, Emeka Iweala, Iya Bassey, Chidiebere Ogo, O. P. Oluwole, H. A. Nggada, Paul Jibrin, Ifeoma Okoye, Abidemi Omonisi, Iheanyi Okpala, A Adeniji, Toye Adeniji. Patient and provider concordance and trust in providers among West African Immigrants: Findings from the CaPTC Familial Cohort Study [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D034.

Male victims of domestic abuse (DA) face a number of barriers to seeking help from their abusive relationships. Though available research has focussed primarily on exploring many of these challenges, few suggestions have been made on how to reduce or resolve them. It is necessary to establish a comprehensive plan to affect change at multiple levels in society in order to improve outcomes for this under-served population. This paper begins with a literature review examining in detail the many reasons why male victims of DA may refuse to seek help in an abusive relationship. Using the main key words, male victims combined with several common phrases related to the phenomenon of abuse including domestic abuse, domestic violence, and intimate partner violence, the review revealed several common reasons that male victims of DA refuse to seek help. These reasons include refusal or reluctance to view their experiences as abuse, hesitancy to identify with victimizing language, lack of available supportive services, embarrassment, shame, loss of masculinity, fear of being judged or disbelieved by others, fear of police response, and devotion to their family. Based on this review, a list of suggestions by the author is provided for changes that can be made to counter these barriers and improve male help-seeking. These suggestions are comprised of four broad themes: increasing public awareness, addressing the unique needs of male victims of DA, improving training for service providers, and increasing funding for services targeted to male victims of DA. A section exploring some of the unique concerns of gay, bisexual, and transgender men is included. International trends in the development and provision of services for male victims show that while increasing attention is being given to this vulnerable population, there are still significant gaps in available supports.

Emergency Department–Based Study of Risk Factors for Acute Injury From Domestic Violence Against Women

When George Zimmerman fatally shot Trayvon Martin in a Florida suburb, the event stirred national attention and outrage toward Florida’s Stand Your Ground laws. Much publicity focused on how the law essentially legalizes racial profiling by excusing defendants who kill racial minorities based on “reasonable” fear. While these ideas convey significant truths about pervasive societal problems, focusing on only one horrendous case as a platform to abolish, or substantially limit, Stand Your Ground laws overlooks the adverse effects such abolition would have on women who respond to domestic violence. Domestic violence is a serious and widespread problem in our society. Women continue to endure severe abuse at the hands of their intimate partners. Given the barriers to safe retreat, it is reasonable for many women to choose to remain in such relationships. Regardless of whether a woman in an abusive † The author will receive a law degree from the University of California, Berkeley, School of Law (Boalt Hall) in 2015. As a law student, the author took the Domestic Violence Law course and participated in the Domestic Violence Practicum at Berkeley Law. She spent a summer at The Law Foundation of Silicon Valley, where she provided legal assistance to underserved minority populations. She spent the following summer at the Santa Clara County Alternate Defender’s Office, where she served clients who were adversely affected by domestic violence, gender biases, and the severely imbalanced criminal justice system. She is grateful to Nancy Lemon, John and Elizabeth Boalt Lecturer, whose Domestic Violence seminar provided the impetus for this piece, and who provided valuable feedback and suggestions. She is also grateful to editorial team of the Berkeley Journal of Gender, Law & Justice for excellent editorial assistance. JACKSON MACRO 2-6 (DO NOT DELETE) 2/12/2015 5:16 PM NO GROUND ON WHICH TO STAND 155 partnership decides to end the relationship, there may come a point when the abuser attacks her with enough force to threaten her life, forcing her to use deadly force to protect herself. When this happens, Stand Your Ground laws are often implicated both in prosecutorial decisions and in legal defenses. Such laws can be important tools for women to assert self-defense successfully. Some might argue that such justifiable killing is adequately covered under basic selfdefense principles, and hence, there is no need for further privilege to stand one’s ground. However, certain affirmative “stand your ground” laws can provide protection from prosecution so the defendant is not vulnerable to the fact finder’s analysis of whether the lethal response was “reasonable” under the circumstances. Both judges and jurors analyze “objective” reasonableness through biased lenses. These biases include male normativity, stereotypes, myths about domestic abuse, and the tendency to blame the victim. Such biases disadvantage women, and, in particular, survivors of domestic abuse. It is time to revise Stand Your Ground laws with this vulnerable population in mind. The most just way for this law to operate is to grant immunity from criminal prosecution for those who defend themselves in their home against abusive cohabitants, and to develop a statutory presumption of fear in a defendant who has endured a history of domestic abuse. INTRODUCTION 156 I. BACKGROUND ON THE RIGHT TO “STAND YOUR GROUND,” AND THEORIES FOR WHY WOMEN IN ABUSIVE RELATIONSHIPS DO JUST THAT 160 A. American Law Births the Self-Defense Doctrine, Creates the Duty to Retreat Exception, and Limits This with the “Castle Doctrine” 160 B. Expansion of the Right to Stand Your Ground: Beyond the Home, the Presumption of Fear, and Prosecutorial Immunity ....... 161 C. “Battered Woman’s Syndrome” and Survivor Theory: Competing Frameworks for Understanding Domestic Violence and Why Women in an Abusive Relationships May Not Retreat .. 162 D. “Why Doesn’t She Just Leave?” (Separation Assault and the Lack of Resources) 165 II. HOW STAND YOUR GROUND LAWS AFFECT SURVIVORS OF DOMESTIC VIOLENCE WHO KILL THEIR ABUSERS AS THE ONLY MEANS FOR PROTECTING THEIR LIVES 168 A. The Application of Stand Your Ground Laws to Women Who Defend Against an Attack from a Cohabitant 168 B. Do Affirmative Stand Your Ground Laws Effectively Shield Survivors of Domestic Violence from Unjustified Prosecution? ... 171 C. If Prosecuted, Fact Finders’ Implicit Gender Biases Deprive Battered Defendants of Equal Treatment Under the Law 173 D. Fact Finders’ Victim-Blaming Mentality Grossly Distorts Their JACKSON MACRO 2-6 (DO NOT DELETE) 2/12/2015 5:16 PM 156 BERKELEY JOURNAL OF GENDER, LAW & JUSTICE Understanding of “The Circumstances” of the Homicide 175 III. PROPOSED SOLUTIONS: THE RIGHT TO STAND YOUR GROUND IN YOUR HOME OR PLACE OF DWELLING, AND IMMUNITY FROM PROSECUTION 176 A. Stand Your Ground Laws Should Grant Immunity So Survivors of Domestic Violence Do Not Become “Defendants” 176 B. The Law Should Permit Battered Defendants to Benefit from Stand Your Ground Laws Regardless of the Attacker’s Property Rights 177 C. When There Is a History of Abuse Documented by the Decedent’s Behavior Towards the Defendant, the Law Should Create a Rebuttable Presumption of Fear 178 D. Response to Potentially Adverse Effects of the Proposed Statutory Changes 179 CONCLUSION 180

BackgroundThe number of African immigrants in the United States grew 40‐fold between 1960 and 2007, from 35 355 to 1.4 million, with a large majority from West Africa. This study sought to examine the prevalence of cardiovascular disease (CVD) risk factors and global CVD risk and to identify independent predictors of increased CVD risk among West African immigrants in the United States.Methods and ResultsThis cross‐sectional study assessed West African (Ghanaian and Nigerian) immigrants aged 35–74 years in the Baltimore–Washington metropolitan area. The mean age of participants was 49.5±9.2 years, and 58% were female. The majority (95%) had ≥1 of the 6 CVD risk factors. Smoking was least prevalent, and overweight or obesity was most prevalent, with 88% having a body mass index (in kg/m2) ≥25; 16% had a prior diagnosis of diabetes or had fasting blood glucose levels ≥126 mg/dL. In addition, 44% were physically inactive. Among women, employment and health insurance were associated with odds of 0.09 (95% CI 0.033–0.29) and 0.25 (95% CI 0.09–0.67), respectively, of having a Pooled Cohort Equations estimate ≥7.5% in the multivariable logistic regression analysis. Among men, higher social support was associated with 0.90 (95% CI 0.83–0.98) lower odds of having ≥3 CVD risk factors but not with having a Pooled Cohort Equations estimate ≥7.5%.ConclusionsThe prevalence of CVD risk factors among West African immigrants was particularly high. Being employed and having health insurance were associated with lower CVD risk in women, but only higher social support was associated with lower CVD risk in men.

BackgroundViolence against women is now widely recognized as a serious human right abuse, and an important public health problem with substantial consequences physical, mental, sexual, and reproductive health. Data on systematic review of domestic violence are needed to support policy and program recommendations. Therefore, the overall purpose of this systematic review was to assess magnitude of domestic violence against women and associated factors in Ethiopia.MethodsStudies systematically reviewed in Federal Democratic Republic of Ethiopia from 2000 to 2014. Systematic review was employed on published research works from databases such as Pubmed, popline, Hinari, and Google using key words. We also consulted public health experts. Community based studies with a study population (15–49 years) were included for review. Thirteen peer reviewed papers and two consecutive Ethiopian demographic and health surveys (2005 and 2011) were included to the systematic review. Twenty seven available in open access journals were retrieved and assessed based on the criteria’s such as community based study, cross sectional study design, clearly report prevalence and associated factors were included in the systematic review work. Finally, 15 papers were included in this review.ResultsLifetime prevalence of domestic violence against women by husband or intimate partner among 10 studies ranged from 20 to 78 %. The lifetime domestic physical violence by husband or intimate partner against women ranged from 31 to 76.5 %. The life time domestic sexual violence against women by husband or intimate partner ranged from 19.2 to 59 %. The mean life time prevalence of domestic emotional violence was 51.7 %. Significant number of women experienced violence during their pregnancy period. Domestic violence against women significantly associated with alcohol consumption, chat chewing, family history of violence, occupation, religion, educational status, residence and decision making power.ConclusionDomestic violence against women was relatively high in different parts of Ethiopia. Domestic violence has direct relationship with sociodemographic characteristics of the victim as well as perpetrator. Therefore, appropriate health promotion information activities needed to tackle associated factors of domestic violence against women or to prevent and control the problem to save women from being victim.

This Campbell systematic review examines the effectiveness of women's economic self‐help groups (ESHG) on individual women empowerment in low‐and middle‐income countries. It also examines the mechanisms that empower women through female participants' experiences of ESHG membership. The review summarises findings from 23 quantitative studies and 11 qualitative studies. The vast majority of these studies was conducted in South Asia. ESHG have positive effects on women's economic and political empowerment, as well as social empowerment ‐ such as, women's family size decision‐making power and social mobility. There is no quantitative evidence to indicate positive effects on women's psychological empowerment. However, the qualitative studies suggest that women participating in ESHG perceive themselves as psychologically empowered. ESHG with a training component, such as financial and business education or life skills training, have a larger effect than programs that do not involve training. Important mechanisms which facilitate empowerment are gaining financial skills (economic empowerment); gaining the capability to speak in front of others, access to household decision‐making (psychological empowerment); improved networks and the experience of mutual support from and solidarity with fellow group members (social empowerment); and access to wider social participation combined with an increased understanding of political contexts and individual rights (political empowerment). There is no evidence of increased levels of domestic violence. Qualitative data indicate that ESHG may decrease domestic violence as women gain respect from their partners, families and access to household decision‐making. Few qualitative studies report experiences of disappointment, mistrust and stigma among women who attended ESHG. ESHGs do not reach the poorest citizens. The ‘poorest of the poor’ do not participate for economic and religious reasons, and mechanisms of self‐selection. Plain language summary Motivation: Self‐help groups (SHGs) are implemented around the world to empower women, supported by many developing country governments and agencies. A relatively large number of studies purport to demonstrate the effectiveness of SHGs. This is the first systematic review of that evidence. Approach: We conducted a systematic review of the effectiveness of women's economic SHG programs, incorporating evidence from quantitative and qualitative studies. We systematically searched for published and unpublished literature, and applied inclusion criteria based on the study protocol. We critically appraised all included studies and used a combination of statistical meta‐analysis and meta‐ethnography to synthesize the findings based on a theory of change. Findings from quantitative synthesis: Our review suggests that economic SHGs have positive effects on various dimensions of women's empowerment, including economic, social, and political empowerment. However, we did not find evidence for positive effects of SHGs on psychological empowerment. Our findings further suggest there are important variations in the impacts of SHGs on empowerment that are associated with program design and contextual characteristics. Findings from qualitative synthesis: Women's perspectives on factors determining their participation in, and benefits from, SHGs suggest various pathways through which SHGs could achieve the identified positive impacts. Evidence suggested that the positive effects of SHGs on economic, social, and political empowerment run through the channels of familiarity with handling money and independence in financial decision making, solidarity, improved social networks, and respect from the household and other community members. In contrast to the quantitative evidence, the qualitative synthesis suggests that women participating in SHGs perceive themselves to be psychologically empowered. Women also perceive low participation of the poorest of the poor in SHGs due to various barriers, which could potentially limit the benefits the poorest could gain from SHG membership. Findings from integrated synthesis: Our integration of the quantitative and qualitative evidence suggests there is no evidence for adverse effects of women's SHGs on the likelihood of domestic violence. Women's perspectives in the qualitative research indicate that even if domestic violence occurs in the short term, in the long term the benefits from SHG membership may mitigate the initial adverse consequences of SHGs on domestic violence. Executive Summary BACKGROUND Women bear an unequal share of the burden of poverty globally due to societal and structural barriers. One way that governments, development agencies, and grassroots women's groups have tried to address these inequalities is through women's SHGs. This review focuses on the impacts of SHGs with a broad range of collective finance, enterprise, and livelihood components on women's political, economic, social, and psychological empowerment. OBJECTIVES The primary objective of this review was to examine the impact of women's economic SHGs on women's individual‐level empowerment in low‐ and middle‐income countries using evidence from rigorous quantitative evaluations. The secondary objective was to examine the perspectives of female participants on their experiences of empowerment as a result of participation in economic SHGs in low‐and middle‐income countries using evidence from high‐quality qualitative evaluations. We conducted an integrated mixed‐methods systematic review that examined data generated through both quantitative and qualitative research methods. SEARCH METHODS We searched electronic databases, grey literature, relevant journals and organization websites and performed keyword hand searches and requested recommendation from key personnel. The search was conducted from March 2013–February 2014. SELECTION CRITERIA We included studies conducted from 1980–January 2014 that examined the impact of SHGs on the empowerment of and perspectives of women of all ages in low‐ and middle‐income countries, as defined by the World Bank, who participated in SHGs in which female participants physically came together and received a collective finance and enterprise and/or livelihoods group intervention. To be included in the review, quantitative studies had to measure economic empowerment, political empowerment, psychological empowerment or social empowerment. We also examined adverse outcomes including intimate partner violence, stigma, disappointment, and reduced subjective well‐being. We included quantitative studies with experimental designs using random assignment to the intervention and quasi‐experimental designs with non‐random assignment (such as regression discontinuity designs, “natural experiments,” and studies in which participants self‐select into the program). In addition, we included qualitative studies that explored empowerment from the perspectives of women participants in SHGs using in‐depth interviews, ethnography/participant observation, and focus groups. DATA COLLECTION AND ANALYSIS We systematically coded information from the included studies and critically appraised them. We conducted statistical meta‐analysis from the data extracted from quantitative experimental and quasi‐experimental studies, and used meta‐ethnographic methods to synthesize the textual data extracted from the women's quotes in the qualitative studies. We then integrated the findings from the qualitative synthesis with those from the quantitative studies to develop a framework for assessing how economic SHGs might impact women's empowerment. RESULTS We included a total of 23 quantitative and 11 qualitative studies in the final analysis. Initially, we reviewed 3,536 abstracts from electronic database searches and 351 abstracts from the gray literature searches. We found that women's economic SHGs have positive statistically significant effects on various dimensions of women's empowerment, including economic, social and political empowerment ranging from 0.06‐0.41 SD. We did not find evidence for statistically significant effects of SHGs on psychological empowerment. We also did not find statistical evidence of adverse effects of women's SHGs. Our integration of the quantitative and qualitative evidence indicates that SHGs do not have adverse consequences for domestic violence. Our synthesis of women's perspectives on factors determining their participation in, and benefits from SHGs suggests various pathways through which SHGs could achieve the identified positive impacts on empowerment. Women's experiences suggested that the positive effects of SHGs on economic, social, and political empowerment run through several channels including: familiarity with handling money and independence in financial decision making; solidarity; improved social networks; and respect from the household and other community members. Our synthesis of the qualitative evidence (key informant interviews and focus groups) also indicates that women perceive there to be low participation of the poorest of the poor in SHGs, as compared to less poor women. IMPLICATIONS FOR POLICY, PRACTICE AND RESEARCH</jats

Domestic or intimate partner violence is alarmingly prevalent, and, for victims, a major contributor to depression, anxiety, and other forms of mental illness. Psychological problemsandpsychiatric syndromesoften are the antecedents of domestic violence for the perpetrator and also can be risk factors for becoming a victim. Remarkably, the two dominant mental health fields, psychiatry and clinical psychology—the ones charged with investigating and attending to the mind, brain, andbehavior—are largelyabsent fromdomestic violence research and intervention. More than one in three women and at least one in four men have been the victim of rape, physical violence, or stalking by an intimate partner (1). However, women are far more likely than men to experience severe sexual and physical violence from apartnerortobekilledbyone(1,2). IntheUnitedStates, intimate partnerhomicidesmakeupbetween40%and50%ofallmurders of women (3). Domestic violence crosses geographic and socioeconomic stratification, although studies indicate that lowerincomewomen in rural communities experience higher rates of violence and, specifically, sexual abuse (4, 5). Victims suffer from dramatic rates of depression, anxiety, and posttraumatic stress disorder,aswellassubstanceabuseandsuicidality(6–8).Arecent study based on a representativeU.S. sample ofmore than 25,000 adults indicatedthatnewonsetsofmajormentalhealthproblems were more than twice as common among those exposed to domestic violence in the past year than among nonvictims (9). Millionsofchildren—asmanyas 15million, according to some estimates—witness domestic violence each year (10). For male children there is a 1,000% greater risk of reproducing this violence in their own spousal relationships (11). A recent epidemiologic study found prior domestic violence victimization to bemore strongly associatedwith domestic violence perpetration than any other factor (12). Despite its prevalence in the general population, domestic violence is underrepresented in our consulting rooms in part because victims, and especially perpetrators, rarely voluntarily self-identifyorseektreatment(8, 13, 14).Shame,guilt, anddenial are obvious deterrents. These factors are often compounded by a sense of futility resulting from learned helplessness, and a profound unraveling of self-esteem (15). More practical considerations include fears for personal security, economic codependence, and the concerns that disclosure will trigger social services engagement, particularly child protection (8). Finally, disclosure represents a potential threat to the continuance of a romantic relationship, which, though abusive, involves emotional investment. Without experience handling domestic violence situations, clinicians can feel ill-prepared and deskilled, lacking knowledge about referral sources, emergent threats of bodily harm, and the accompanying legal and ethical obligations. This lack of presentation in clinical settings contributes to a “don’t ask” scenario (8). Since 1986, numerous medical institutions have advocated for domestic violence screening inroutinemedicalcare(16, 17); in2001, theAmerican Psychiatric Association followed suit. That same year, the AmericanPsychologicalAssociation’s IntimatePartner Abuse and Relationship Violence Working Group launched a curriculumon domestic violence but appears to have done little to foster relevant training in clinical interventions. Domestic violence is an exceptionally challenging clinical situation. Those in domestic violence relationships areat risk for repeating this experience, and likely have abuse or exposure to it in their backgrounds (11, 18), adding immense complexity to treatment. Thework presents unique challenges, including safety planning and patients’minimization of abuse, which may induce feelings of helplessness in the context of significant urgency anddanger (19–21). There noware targeted treatments for domestic violence intervention, such as Seeking Safety (22) and Child-Parent Psychotherapy (23), though few psychologists and psychiatrists are trained in them. Of course the question of how clinically to respond to perpetrators is a complicated one, independentof thenecessary legal consequences.However, treatment and prevention programs are emerging, such as the Melissa Institute for Violence Prevention and Treatment. Beyond the “professional counter-transference” is possibly a more personal one. Aggression is a fundamental human impulse, and violence a socially unacceptable manifestation of it. Underlying any violent interaction is the universal human struggle with aggression and its myriad complex antecedents: family and developmental history; self-esteem; power dynamics; fear of abandonment and humiliation; emotional regulation; impulse control; and the capacity for empathy, guilt, and remorse. The possibility that domestic

Wife beating is one of the most common forms of violence against women by husbands or other intimate male partners. Although violence against women is pervasive, there are only few studies documenting the magnitude of the problem especially among the working class. The civil service comprises of persons from all socio-economic levels and different backgrounds. They act in advisory capacity and assist those responsible for making state policy Thus, 431 civil servants of the Oyo State government service were interviewed using a 44-item self-administered questionnaire. Results revealed that prevalence of wife beating was 31.3%. Ninety one (42.5%) men had been perpetrators, while 44 (23.5%) women had been victims. Consuming alcohol and growing up in an environment where parents fight publicly were significantly associated (p < 0.05) with men beating their wives; while being young, unmarried and a parental background of fighting was significantly associated with women being beaten (p < 0.05). Female respondents justified reasons for various types of domestic violence, including beating, more than the males (p < 0.05). Younger respondents had significantly worse attitudes (p < 0.05), while married and educated respondents had better attitude (p < 0.05). "Not wanting the children to suffer" (60.7%) and "hoping that partner will change" (28.8%) were reasons given for remaining in abusive relationships. There is an urgent need for education of the women on their rights, sensitisation of the men on gender-based violence and punishment for perpetrators. Supportive care and counselling services should also be provided for victims of violence.