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Exploring links between domestic violence, depression and reproductive health

abused womanIt's no surprise that domestic violence has effects that ripple outward in a victim's life, beyond physical traces of abuse. Research into just what those effects are can help physicians provide better counseling and treatment, and two new studies show striking correlations between domestic violence, mental illness, and contraception use.

The first study, published in Depression and Anxiety, enrolled a nationally representative sample of more than 1,000 mothers with no previous history of depression, and assessed them over 10 years. It was headed by Isabelle Ouellet-Morin, PhD, researcher at the University of Montreal. Thirty-three percent of the women reported being the victim of violence from their partner, and these women had a twofold increase in their risk of suffering from new-onset depression (after controlling for childhood maltreatment, socioeconomic deprivation, antisocial personality, and young motherhood). Compared with women who had never been victims of violence, women who were abused both in childhood and adulthood were 4-7 times more likely to suffer from depression. The results were similar for psychotic symptoms.

Louise Arseneault, PhD, co-author and professor of developmental psychology at Kings College London, is quoted in PsychCentral:

Health professionals need to be very aware of the possibility that women who experience mental health problems may also be the victims of domestic violence and vice versa. Given the prevalence of depression in these victims, we need to prevent these situations and take action. These acts of violence do more than leave physical damage; they leave psychological scars as well.

The second study, published in PLOS One and headed by Lauren Maxwell, PhD student at McGill University, synthesizes research on how domestic violence impacts reproductive health. The research included in the study primarily took place in the U.S., as well as in India, South Africa, Zimbabwe and Nicaragua. It found that women who are abused by their partner (or ex-partner) are much less likely to use contraception, particularly condoms, instead preferring contraceptives that don't require negotiation with a partner. This makes them particularly vulnerable to contracting infections. In African countries, women who experience partner violence are three times more likely to contract HIV than women who do not, according to the World Health Organization.

Maxwell, as quoted in a McGill press release, says:

When talking to abused women, I had often heard them mention they were opting for contraception methods their male partner could not refuse. I wanted to know whether, across countries, women who experience intimate partner violence are less able to use contraception, which might explain why rates of abortion and HIV transmission are higher among women abused by their partners.

What is notable about the study is its conclusiveness: As noted in the release, it suggests that there is a causative relationship between intimate partner violence and reproductive health, not just a correlation.

The implications for training health-care providers are evident - with this knowledge in mind, they can appropriately include/exclude men from conversations about contraception and better recognize abusive situations.

Previously: Lobbying congress on bill to stop violence against women, Preventing domestic violence and HIV in Uganda and Stanford sociologists gathering info on contraception use
Photo by European Parliament

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