• Association Between Maternal Experience of Intimate Partner Violence and Under-5 Child Health in Egypt, Jordan, Pakistan, and Afghanistan

      Motawi, Basant; Hirshon, Jon Mark (2022)
      Background : Intimate partner violence (IPV) is the most common type of violence experienced by women globally. The Middle East has some of the highest IPV prevalence worldwide, in particular, Afghanistan, Egypt, Jordan and Pakistan with prevalence ranging from 39% to 87%. The relationship between IPV and childhood morbidity is not well understood. Nonetheless, poor child health outcomes have been linked to homes with IPV. There also is a general lack of research that considers childcare practices when examining the relationship between IPV and child health. The study aims to investigate the association between maternal exposure to IPV and under-5 childhood morbidity taking into account childcare practices. Study Design: Secondary data analysis utilizing data from Demographic and Health Surveys collected in the 2015, 2014, 2017-2018 and 2017-2018 for Afghanistan, Egypt, Jordan, and Pakistan respectively. The study examined the association between IPV and under-5 years childhood morbidity in Afghanistan, Egypt, Jordan, and Pakistan, taking into account the mediating effect of childcare practices. The IPV exposure was assessed through the DHS domestic violence module while the outcome was defined as diarrhea, fever, or ARI experience by the child in the two weeks preceding the survey. Results: The study identified several contextual and individual level factors associated with IPV. Younger, less educated women, with less educated husbands, who are less wealthy and have more children were more likely to experience IPV. The study identified a strong association between IPV and under-5 child illness signs in Afghanistan (OR 2.32, 95 % CI 2.05-2.63) , Egypt (OR 2.02, 95 % CI 1.65-2.48) and Jordan (OR 2.08, 95 % CI 1.54- 2.83).This relationship was not observed in Pakistan (OR 1.17, 95 % CI 0.93-1.47).Childcare practices were found to have no mediation effect on the association between IPV and child illness. Conclusion: The study provides evidence that IPV is a major public health problem affecting not only women, but also their children. Our finding supports designing IPV interventions that integrate IPV screening into routine neonatal care and childcare visits. This approach will not only contribute to monitoring and prevention of IPV but could also reduce child morbidity.
    • The Interplay of Home Visitors’ Personal and Professional Identities in Effectively Screening and Supporting Women around Sensitive Topics

      Burruss-Cousins, Karen M.; DeForge, Bruce R.; 0000-0003-3665-1211 (2022)
      Home visiting programs provide information, support, resources, and tools that empower new parents to promote positive maternal and child health outcomes. During home visits, there is a unique opportunity to screen for intimate partner violence (IPV), reproductive coercion, and unintended pregnancy with women in unguarded settings (i.e., the women’s homes) while providing ongoing services via a therapeutic relationship. Using individual interviews and a deliberative discussion focus group, the current study examined the research question, to what degree do home visiting staff members’ personal and professional identities impact their ability to effectively screen and support pregnant women and new mothers around the topics of unintended pregnancy and intimate partner violence including reproductive coercion? Interviews and a deliberative discussion focus group were conducted virtually with staff members from Healthy Families America (HFA) programs in Maryland. Six major themes emerged from the interviews and focus group: personal versus professional experience, therapeutic alliance building, keeping families engaged, use of supervision, addressing intimate partner violence/reproductive coercion in families, and home visiting in the time of a health pandemic. Participants shared how their personal and professional identities helped shape their perceptions of their roles within the home visiting field including the terms, its meaning, and the expectations of that role. The findings suggest that home visitors need additional training around reproductive health since they routinely interact with pregnant women and new mothers who are at-risk for poor pregnancy-related health outcomes that may be due to the lack of control or intention related to reproduction. Participants expressed general knowledge, comfort, safety plan creation, and resource linking around the issue of IPV. Participants had received extensive training on administering the Relationship Assessment Tool (RAT), which is the IPV screener for HFA. However, relatively few program recipients endorsed that their HFA program recipients are experiencing IPV using the RAT. Therefore, HFA staff would benefit from advanced level training utilizing more clinical skills around the topic of IPV including advanced screening skills.