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    <recommendedItem id="20100101_19_266"
                     title="Domestic Abuse May Affect Reproductive Freedom (CME/CE)"
                     score="0.004"
                     href="http://www.medpagetoday.com/PrimaryCare/DomesticViolence/tb/18120?impressionId=1265741210071"
                     
      &lt;p&gt;In some abusive relationships, men may use strategies to force women to become pregnant, including sabotaging their birth control, researchers reported.&lt;/p&gt;
&lt;p&gt;In a cross-sectional study of women treated at five family clinics across northern California, about 20% of women said that their partner tried to coerce them into having a child, Elizabeth Miller, MD, of the University of California Davis, and colleagues reported online in the journal &lt;em&gt;Contraception&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Beyond outright coercion, abusive partners also engaged in birth control sabotage, for example, poking holes in condoms and flushing birth control pills down the toilet.&lt;/p&gt;
&lt;p&gt;&quot;It was stunning to have this many women seeking reproductive health services saying, &apos;this has happened to me,&apos;&quot; Miller said.&lt;/p&gt;
&lt;p&gt;To investigate a possible link between domestic violence and forced pregnancy, the researchers conducted a survey of 1,278 women ages 16 to 29 who sought care at the five family planning clinics in northern California.&lt;/p&gt;
&lt;p&gt;More than half of the women surveyed  --  53%  --  reported physical or sexual partner violence.&lt;/p&gt;
&lt;p&gt;Approximately a third of the women who reported partner violence also reported pregnancy coercion or birth control sabotage.&lt;/p&gt;
&lt;p&gt;Altogether, the effect of both partner violence and reproductive control nearly doubled a woman&apos;s odds of unintended pregnancy (OR 1.99, 95% CI 1.11 to 3.58).&lt;/p&gt;
&lt;p&gt;Both pregnancy coercion and birth control sabotage were separately associated with unintended pregnancy as well (OR 1.83, 95% CI 1.36 to 2.46 and OR 1.58, 95% CI 1.14 to 2.20, respectively).&lt;/p&gt;
&lt;p&gt;&quot;The findings suggest that pregnancy coercion and birth control sabotage may be an aspect of partner violence that, given its relevance to reproductive health, should be identified by providers in clinical settings,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;Among the reasons men would want their partners to bear children: &quot;It ranges from things like wanting to leave a legacy, to a straightforward desire for attachment, to having absolute control over her body,&quot; Miller said. &quot;There are all of these elements to it.&quot;&lt;/p&gt;
&lt;p&gt;Aisha Mays, MD, director of the Teen and Young Adult Clinic at San Francisco General Hospital who was not involved in the study, said pregnancy coercion is a growing problem that has been around for &quot;quite some time&quot; but is just now being recognized as a major health issue.&lt;/p&gt;
&lt;p&gt;&quot;It&apos;s about power and control,&quot; Mays said. &quot;It&apos;s another way of saying, &apos;this girl&apos;s taken, this girl&apos;s mine.&apos;&quot;&lt;/p&gt;
&lt;p&gt;Mays said she has seen cases in which a young mother who has a child with another partner will be forced by her new boyfriend to have another baby with him.&lt;/p&gt;
&lt;p&gt;It&apos;s also a way for males to make their partners more dependent on them, according to Amy Bonomi, PhD, MPH, of Ohio State University.&lt;/p&gt;
&lt;p&gt;&quot;Women in abusive relationships are sometimes forced to bear children as a means to keep them dependent on their partner and sometimes as a means to justify additional  --  and sometimes more severe  --  abuse,&quot; Bonomi said.&lt;/p&gt;
&lt;p&gt;Miller said the findings emphasize the need for family planning clinics to provide intervention programs to combat both reproductive control and partner violence.&lt;/p&gt;
&lt;p&gt;Key strategies include advising women about &quot;invisible&quot; forms of birth control such as injectable and intrauterine contraceptives, as well as easy access to emergency contraception.&lt;/p&gt;
&lt;p&gt;&quot;If we can identify that reproductive control is going on,&quot; Miller said, &quot;we can offer the woman methods for birth control that the partner can&apos;t mess with.&quot;&lt;/p&gt;
&lt;p&gt;Mays added that physicians and counselors should talk about women&apos;s empowerment with regard to reproduction during reproductive health visits.&lt;/p&gt;
&lt;p&gt;&quot;It tends to be left out,&quot; Mays said. &quot;We talk about getting the prescription [for birth control] and its side effects. But we really need to have a discussion around whether the girl is feeling ready for sex.&quot;&lt;/p&gt;
&lt;p&gt;The study was limited by its cross-sectional design, which &quot;precludes conclusions concerning temporality regarding associations observed among pregnancy coercion, birth control sabotage, and intimate partner violence with unintended pregnancy.&quot; Miller et al said additional studies are needed to clarify the chronology of reproductive control and partner violence, and how those factors might combine to affect risk for unintended pregnancy.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by grants from the National Institute of Child Health and Human Development, a UC Davis Health System Research Award, and a Building Interdisciplinary Research Centers in Women&apos;s Health award.&lt;/p&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_236"
                     title="Prenatal Counseling Reduces Domestic Violence (CME/CE)"
                     score="0.001"
                     href="http://www.medpagetoday.com/OBGYN/DomesticViolence/tb/18085?impressionId=1265741210071"
                     
      &lt;p&gt;Pregnant African-American women who received counseling to improve their physical and psychological health and safety were less likely to be the victims of domestic violence during pregnancy and postpartum, a new study found.&lt;/p&gt;
&lt;p&gt;Women who received the cognitive and behavioral integrated intervention were less likely to experience recurrent episodes of intimate partner violence victimization (OR 0.48, 95% CI 0.29 to 0.80), according to a report in the Jan. 21 issue of &lt;em&gt;Obstetrics &amp;amp; Gynecology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Counseled women who had reported previous minor intimate partner violence were significantly less likely to experience further episodes during pregnancy (OR 0.48, 95% CI 0.26 to 0.86) and after they gave birth (OR 0.56, 95% CI 0.34 to 0.93).&lt;/p&gt;
&lt;p&gt;Furthermore, counseled women were less likely to give birth very preterm (&amp;lt;33 weeks gestation) than mothers who received no counseling (1.5% versus 6.6% respectively; &lt;em&gt;P&lt;/em&gt;=0.03), and the babies of counseled women had a longer mean gestational age at delivery.&lt;/p&gt;
&lt;p&gt;&quot;A relatively brief intervention during pregnancy had discernible effects on intimate partner violence and pregnancy outcomes,&quot; Michele Kiely, DrPH, of Eunice Kennedy Shriver National Institute of Child Health and Human Development, and colleagues wrote.&lt;/p&gt;
&lt;p&gt;&quot;Screening for intimate partner violence as well as other psychosocial and behavioral risks and incorporating similar interventions in prenatal care is strongly recommended.&quot;&lt;/p&gt;
&lt;p&gt;Intimate partner violence is a pattern of assault and coercion that includes the threat or infliction of physical, sexual, or psychological abuse.&lt;/p&gt;
&lt;p&gt;Approximately 4.8 million episodes of intimate partner violence occur every year in the U.S. in women 18 years and older, according to the CDC.&lt;/p&gt;
&lt;p&gt;Victims are at higher risk for a range of psychobehavioral and health problems, including complications during pregnancy and adverse pregnancy outcomes, such as preterm delivery and low birth weight.&lt;/p&gt;
&lt;p&gt;Kiely and colleagues set out to determine whether a cognitive behavioral intervention administered during pregnancy could reduce intimate partner violence and improve birth outcomes in a population of African-American residents of Washington, DC.&lt;/p&gt;
&lt;p&gt;Of the 1,044 women enrolled in the study between July 2001 and October 2003, 521 were randomly assigned to receive the intervention and 523 to receive usual care. At an initial interview, 336 of the women reported intimate partner violence victimization in the past year, evenly divided between the intervention group and usual care.&lt;/p&gt;
&lt;p&gt;The women in the intervention group received individually tailored counseling and information that addressed the problems they reported.&lt;/p&gt;
&lt;p&gt;The counselors provided information about the types of abuse and the cycle of violence and assessed the level of danger to which the women were exposed.&lt;/p&gt;
&lt;p&gt;They discussed preventive options the women might consider, such as filing a protection order, and the development of a safety plan. The women also received a list of community resources and information on the health risks of smoking and how to cope with depression.&lt;/p&gt;
&lt;p&gt;The complete intervention included eight prenatal sessions delivered during routine prenatal care visits, and researchers conducted follow-up interviews over the phone with the women.&lt;/p&gt;
&lt;p&gt;They found that women in the intervention group who had previously experienced severe intimate partner violence showed a significant reduction in episodes after giving birth (OR 0.39, 95% CI 0.18 to 0.82) and that women who experienced physical violence specifically showed significant reductions by their first follow-up prenatal visit (OR 0.49, 95% CI 0.27 to 0.91) and postpartum (OR 0.47, 95% CI 0.27 to 0.82).&lt;/p&gt;
&lt;p&gt;&quot;There is evidence that this intervention for pregnant African-American women reduced intimate partner violence victimization during pregnancy and improved pregnancy outcome,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;&quot;If generalizable, our results should encourage healthcare providers and third party payers to go beyond screening for psychosocial and behavioral risks to providing services during prenatal care to address such risks. The potential cost savings associated with reduction of births within the highest risk category may be substantial.&quot;&lt;/p&gt;
&lt;p&gt;The authors cautioned that the study was not designed to test whether the intervention was effective at reducing adverse pregnancy outcomes but rather focused on reducing psychobehavioral risks.&lt;/p&gt;
&lt;p&gt;They also noted that only 59% of the women in the intervention group completed all eight sessions, indicating that as a group they were only modestly committed to participating in the program.&lt;/p&gt;
&lt;p&gt;Further improvements to the intervention strategy could be made to address other issues, such as alcohol and drug use, they wrote. &quot;Had we addressed these, we might have been even more successful,&quot; they concluded.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Center on Minority Health and Health Disparities.&lt;/p&gt;&lt;p&gt;The authors reported no financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_6_894"
                     title="Men Common Victims of Domestic Violence"
                     score="-0.005"
                     href="