Gender

1. Gender and reproductive health behaviour
and Intimate partner violence
BME YEAR 3 Intake 2020/2023
GROUP 7
MEMBERS:
• BIGIRWENKYA WAMARA MOSES 20/U/21984/HTG
• LAKWECH FILDER 20/U/22157/HTG
• NAKAWUNGU JUDITH 20/U/21969/HTG
• INUAT DANIEL 20/U/21981/HTG
• MUHAHIRYA JOTHAM 20/U/21965/HTG
Date: 5/5/2023

2. Introduction
Gender
• Defined as a description of roles, activities and responsibilities
assigned to men and women in a given society, culture, community or
time.
• They are expectations of people from someone, because either they
are female or male.
• Men and women are expected to perform the fixed roles assigned to
them by the society. It is a learned process and can be changed.

3. Reproductive Health
DESCRIPTION
• Reproductive health is a state of complete physical, mental and social
well-being in all matters relating to the reproductive system.
• It implies that people are able to have a satisfying and safe sex life,
the capability to reproduce, and the freedom to decide if, when, and
how often to do so.

4. SEX
• Sex refers to the biological characteristics that define humans as male
or female.
• Sexual health is a state of physical, emotional, mental and social
wellbeing in relation to sexuality.
• It is not merely the absence of disease , dysfunction or infirmity.

5. Components of Reproductive Health
• The three components of reproductive health are
• family planning,
• sexual health, and
• maternal health.

6. Family planning
• Family planning: is the ability of an individual or couple to decide
when to have children how many children they desire in a family and
how to space their children.
• This can include fertility testing, general health checkups, pregnancy
testing and counselling.

7. Sexual health
Definition: Sexual health is a state of physical, emotional, mental and
social well-being related to sexuality; it is not merely the absence of
disease, dysfunction or infirmity. Sexual health requires a positive and
respectful approach to sexuality and sexual relationships, as well as the
possibility of having pleasurable and safe sexual experiences, free of
coercion, discrimination and violence. For sexual health to be attained
and maintained, the sexual rights of all persons must be respected,
protected and fulfilled (WHO, 2002).

8. Cont…
Sexual health involves testing for sexually transmitted infections (STIs)
and HIV, sexual education, counselling, preventative contraception and
emergency contraception.

9. Maternal health
• Maternal health refers to the health of women before and during
pregnancy (prenatal and antenatal care), during childbirth, and after
pregnancy (postnatal care.)
• This might include newborn screenings for illnesses, newborn
immunization, counselling for postnatal depression and support
services after a miscarriage.

10. Intimate partner violence
Definition
Intimate partner violence refers to behavior by an intimate partner or
ex-partner that causes physical, sexual or psychological harm, including
physical aggression, sexual coercion, psychological abuse and
controlling behaviors.

11. Sexual violence
Sexual violence is any sexual act, attempt to obtain a sexual act, or
other act directed against a person’s sexuality using coercion, by any
person regardless of their relationship to the victim. It includes rape,
defined as the physically forced or otherwise coerced penetration of
the vulva or anus with a penis, other body part or object.

12. Scope of the problem
The first report of the “WHO Multi-country study on women’s health
and domestic violence against women” (2005) in 10 mainly developing
countries found that, among women aged 15–49:
• Between 15% women in Japan and 71% women in Ethiopia reported physical
and/or sexual violence by an intimate partner in their lifetime;
• The first sexual experience for many women was reported as forced – 17% in
rural Tanzania, 24% in rural Peru, and 30% in rural Bangladesh.

13. Statistics on intimate partner violence
• A recent analysis of WHO with the London School of Hygiene and
Tropical Medicine and the Medical Research Council, based on
existing data from over 80 countries.
• This Study found that:
• Globally 35% of women have experienced either physical and/or sexual
intimate partner violence or non-partner sexual violence.
• Most of this violence is intimate partner violence.
• Worldwide, almost one third (30%) of all women who have been in a
relationship have experienced physical and/or sexual violence by their
intimate partner, in some regions this is much higher.
• Globally as many as 38% of all murders of women are committed by intimate
partners.

14. Statistics cont…
• According to the Uganda demographic health survey 2006 report on
instances of violence against women (VAW), 54% are located in the
urban areas showing that the phenomenon cuts across the rural
urban divide.
• The majority of the violence against women is committed by an
intimate partner.
• Two thirds of women who have experienced physical violence since
age fifteen say that an intimate partner committed violence against
them, while 16% of women reported having experienced physical
violence during pregnancy with women in rural being three times
more likely than urban women to experience violence during
pregnancy. (UBOS, 2012).

15. Risk factors for IPV :
Perpetration
• Childhood maltreatment and witnessing of domestic violence
• Multiple types of IPV (engaging in an IPV type increases likelihood of other
types)
• Marital dissatisfaction
• Illicit drug use and alcoholism
• Traditional gender and sex role ideology perpetrator
• Implicit attitudes condoning violence
• Physical health issues: Insomnia, gastrointestinal issues
• Mental health issues: Personality disorders, depression
Insecure/disorganized attachment style (Alexander et al, 2003)

16. Risk factors for IPV
Victimization
• Childhood maltreatment and witnessing of domestic violence
• Mental health issues: Personality disorders, depression, dissociative
disorders
• Economic disempowerment
• Youth: 80% of female sexual assault victims are under 25
• Insecure/disorganized attachment style
• Predictors of escalation in abusive relationships:
• Female victims perpetrating violence toward male perpetrators
• Partner threats to harm and/or kill (CDC, 2011)

17. Risk factors cont…
IPV and identity
Race
• Institutionalized racism (criminal justice system)
• “Traitor” to community
Gender identity
• Male and transgender victims
Religion
• Taboo of divorce
Sexual orientation
• ‘’Outness” of victim v. perpetrator. (To be ‘’out’’ means that people know
about a person's gender identity or history, sexual orientation, or both)
• Female perpetrators

18. Risk factors for IPV cont….
• Income level
• Financially dependent on perpetrator
• Difficult to access resources
• Immigration status
• Fear of deportation
• Need to report perpetrator/assist in prosecution to receive visa Language
abilities
• Disability
• Dependent on perpetrator for survival
• Lack of resources

19. Types of IPV
According to the USA’s CDC:
1. Physical violence: is defined as the intentional use of physical force with
the potential to cause death, disability, injury or harm. Physical violence
includes, but is not limited to:
• scratching, pushing, shoving, throwing, grabbing, biting, choking,
shaking, poking, hair-pulling, slapping, punching, hitting, burning,
use of a weapon (gun, knife or other object), and use of restraints
or one's body, size, or strength against another person.
• Physical violence also includes coercing other people to commit
any of the above acts.

20. 2. Sexual violence
It is divided into three categories:
a) Use of physical force to compel a person to engage in a sexual act
against his or her will, whether or not the act is completed
b) An attempted or completed sex act involving a person who is
unable to understand the nature or condition of the act, to decline
participation, or to communicate unwillingness to engage in the sexual
act (e.g. because of illness, disability, or the influence of alcohol or
other drugs, or due to intimidation or pressure).

21. Cont…
c) Abusive sexual contact, including intentionally touching directly or
through the clothing, of the genitalia, anus, groin, breast, inner thigh,
or buttocks of any person against his or her will, or of any person who
is unable to understand the nature or condition of the act, to decline
participation, or to communicate unwillingness to engage in the sexual
act (e.g. because of illness, disability, or the influence of alcohol or
other drugs, or due to intimidation or pressure).

22. 3. Threat of physical and sexual violence
• The use of words, gestures, or weapons to communicate the intent to
cause death, disability, injury, or physical harm.
• Also the use of words gestures or weapons to communicate the
intent to compel a person to engage in sex acts or abusive sexual
contact when the person is either unwilling or unable to consent.

23. 4. Psychological/ emotional violence
• Trauma to the victim caused by acts, threats of acts, coercive tactics
when there has also been prior physical or sexual violence, or prior
threat of physical or sexual violence. Psychological/emotional abuse
can include but is not limited to: humiliating a person; controlling
what the person can and cannot do; withholding information from
the person; getting annoyed if the person disagrees;

24. Psychological abuse cont…
• Deliberately doing something to make the person feel diminished
(e.g. less smart, less attractive); deliberately doing something to make
the person feel embarrassed; isolating the person from friends and
family; prohibiting access to transportation or telephone; denying
access to money and other resources; threatening loss of custody of
children; and, smashing objects or destroying property.

25. assessment
1. Revised Conflict Tactics Scale (CTS2)
• Assesses perpetration and victimization type/severity/frequency, and negotiation
• More often used in research, but appropriate for clinical practice
2. Timeline Follow back Spousal Violence Interview (TLFB-SV)
• Daily calendar method documenting typology and frequency of violence
3. Proximal Antecedents to Violent Episodes (PAVE) Scale
• Context and functions of IPV incidents
4. Guidelines
• Screen IPV separately with each partner
• Complete a lethality assessment to determine appropriate services
• Screen IPV again later, as it may initially be denied due to shame, fear, and guilt
• If IPV is identified, creating a safety plan is crucial

26. Treatment:
perpetration
• Treatment as usual: Duluth Model/Derivative
• Grounded in theory of patriarchal dominance
• Goal = behavior change via psycho-education and in-group processing
and modeling of healthy relationships and conflict resolution
• Limited effectiveness, likely due to lack of addressing comorbid
psychiatric and substance abuse issues and trauma history

27. Treatment Cont…
• Couples therapy
• Only recommended with situational common-couple violence, rather then
character-logical violence perpetrated by one partner
• Behavioral couples therapy shown to be effective with substance using couples
• Multi-couple group therapy
• Demonstrated success with mild to moderate situational common-couple
violence
• Group therapy
• Batterer/abuser intervention programs
• Most effective if comorbid psychiatric and substance use issues are addressed
• Demonstrated success utilizing CBT and MI modalities and in conjunction with
individual therapy

28. Consequences of IPV
• Health consequences of intimate partner and sexual violence include
serious short- and long-term physical, mental, sexual and
reproductive health problems for women.
• They also affect their children, and lead to high social and economic
costs for women, their families and societies. Such violence can:
• Have fatal outcomes like homicide or suicide.
• Lead to injuries, with 42% of women who experience intimate partner
violence reporting an injury as a consequence of this violence

29. Consequences IPV Cont…
• IPV can lead to unintended pregnancies, induced abortions, gynaecological
problems, and sexually transmitted infections, including HIV.
• The WHO 2013 analysis found that women who had been physically or
sexually abused were 1.5 times more likely to have a sexually transmitted
infection and, in some regions, HIV, compared to women who had not
experienced partner violence.
• They are also twice as likely to have an abortion

30. Consequences of IPV cont…
• violence in pregnancy also increases the likelihood of miscarriage,
stillbirth, pre-term delivery and low birth weight babies.
• The same 2013 study showed that women who experienced intimate
partner violence were 16% more likely to suffer a miscarriage and
41% more likely to have a pre-term birth.
• These forms of violence can lead to depression, post-traumatic stress
and other anxiety disorders, sleep difficulties, eating disorders, and
suicide attempts.
• The 2013 analysis found that women who have experienced intimate
partner violence were almost twice as likely to experience depression
and problem drinking

31. Health effects
• Health effects can also include headaches, back pain, abdominal pain,
gastrointestinal disorders, limited mobility and poor overall health.
• Sexual violence, particularly during childhood, can lead to increased
smoking, drug and alcohol misuse, and risky sexual behaviours in later
life.
• It is also associated with perpetration of violence (for males) and
being a victim of violence (for females).

32. Impact of IPV on children
• Children who grow up in families where there is violence may suffer a
range of behavioural and emotional disturbances.
• These can also be associated with perpetrating or experiencing
violence later in life.
• Intimate partner violence has also been associated with higher rates
of infant and child mortality and morbidity (through, for example
diarrheal disease or malnutrition)

33. Social and economic costs of IPV
• The social and economic costs of intimate partner violence are
enormous and have ripple effects throughout society.
• Women may suffer isolation, inability to work, loss of wages, lack of
participation in regular activities and limited ability to care for
themselves and their children.

34. Preventive and protective factors for IPV
• Preventing child maltreatment, including witnessing of domestic violence
• Promoting flexible gender roles, egalitarian relationships, non-violence, and feminist identity
• Treating comorbid substance use and psychiatric disorders
• Training physical and mental health care providers to
• a) identify the effects of IPV on patients presenting to treatment and
• b) accurately and appropriately assess IPV
• Targeted education about intimate partner violence, sexual assault, and healthy relationships
• Economic independence, vocational opportunities, affordable housing
• Social supports (Backus & Mahalik, 2011)

35. REFERENCES
American psychiatric Association. (2013). Diagnostic and statistical manual of
mental disorders (5th ed.).
Alexander & Warner, 2003; Eckhardt & Crane, 2014; Heise & Garcia-Moreno,
2002; Singh et al., 2014; Stith et al., 2004; Tjaden & Thoennes, 2000;
Whitfield et al., 2003;)
CDC, 2011; Goodman & Epstein, 2007; Stith et al., 2004; ; Tjaden &
Thoennes, 2000; Whitfield et al., 2003.
Backus & Mahalik, 2011; Easton, 2013; Goodman & Epstein, 2007;
McCloskey & Grigsby, 2005
UBOS & ICF International Inc. (2012). Uganda Demographic and Health
Survey 2011. Kampala Uganda: UBOS and Claverton, Maryland: ICF
International Inc.