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Violence Against Women: G lobal Maternal/Reproductive Health Burden and Promising Solutions

This study highlights the global burden of violence against women on maternal and reproductive health, presenting promising interventions such as CHANCE and a family planning-based program to reduce reproductive coercion. The findings emphasize the link between VAW and poor pregnancy outcomes and child health, offering actionable strategies for improvement. Rigorous assessments, adaptations, and scalability of interventions are crucial for sustainable impact.

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Violence Against Women: G lobal Maternal/Reproductive Health Burden and Promising Solutions

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  1. Violence Against Women:Global Maternal/Reproductive Health Burden and Promising Solutions Jay G. Silverman, Ph.D. Professor Of Medicine And Global Health Co-Director, Program on Gender Inequities and Global Health

  2. State of Knowledge andExamples of Promising Programs • Prevalence of IPV - 25%-75% (Garcia-Moreno et al., 2006) • Control of Conception • Health During Pregnancy • Pregnancy Outcomes • Infant and Child health • Promising Programs

  3. State of Knowledge:VAW and Control of Conception • Contraception - Married women less likely to adopt, Abusive men less likely to use(Stephenson et al., 2008; Decker et al., 2011) • Pregnancy coercion – 83% more likely (Miller and Silverman et al., 2010) • Unintended pregnancy - 46% to 69% increased risk(Pallitto et al, 2012; Cripe et al., 2008; Silverman et al, 2007) • Abortion - 61% to 2.7 times more likely • Repeat Abortion – 2.2 to 3.4 times more likely (Pallitto et al., 2012; Nguyen et al., 2012; Silverman et al, 2010)

  4. State of Knowledge:VAW and Poor Pregnancy Health • First trimester antenatal care – 34-53% less likely (Koski et al 2011; Silverman et al., forthcoming) • Health during pregnancy • No weight gain - 95% more likely(Silverman et al., forthcoming) • Preeclampsia – 47% to2.7 times more likely (Sanchez et al., 2008; Silverman et al., forthcoming) • PROM - 62% to 2.1 times more likely(Silverman et al., 2005, forthcoming)

  5. State of Knowledge:VAW and Poor Pregnancy Outcomes • Poor pregnancy outcomes Miscarriage – 1.8 times more likely (Silverman et al., 2007) • Preterm delivery –37% to 2.0 times more likely(Silverman et al., 2006; Sanchez et al., 2013) • Maternal Mortality?

  6. State of Knowledge:VAW and Child Health • Low Birth Weight - 17% to 3.9 times more likely (Valledares et al, 2002; Silverman et al., 2006, forthcoming) • Diarrheal Disease and Acute Respiratory Infection – 38% to 65% more likely(Silverman et al., 2009, forthcoming) • Malnutrition and Stunting - 34% to 36% more likely(Ackerman and Subramanian, 2008; Rico et al., 2011; Salazar et al., 2012 - only for girls) • Infant Death - 15% to 85% more likely(Jejeebhoy, 1998; Koenig et al, 2010; Rico et al., 2011; Silverman et al, 2011 – only for girls)

  7. Counseling Households to Improve Antenatal Care, Nutrition, Communication and Equity:CHANCE • Partners: Indian NIRRH and Population Council • Government-funded health promotion includes multiple household visits by CHWs • CHANCE expands model by: • including husbands and in-laws • integrating negative health impacts of husband violence and household maltreatment • (3) 20-30 minute education/counseling visits over six weeks integrated into standard gov’t programs

  8. CHANCE Pilot • Improved • Utilization of antenatal care • Marital communication with husbands re: pregnancy) • Reduced • Fear of husbands • Household maltreatment (e.g., increased access to nutrition and rest) • Violence from husbands against pregnant women • 2-arm cluster RCT, N=240 families(NICHD/ICMR:Pending) 

  9. Ending Reproductive CoercionA Family Planning-based Program • Training of existing FP counselors • Provide brief intervention within SoC to: • Recognize connections between VAW and reproductive control • Reduce harm via strategic contraception • Connect to available VAW services • RCT results (N=906, 12 mo. follow-up; NICHD): • 71% reduced risk of pregnancy coercion • 63% increase in leaving a relationship re: abuse(Miller and Silverman et al., 2011)

  10. VAW is a major factor in maternal/reproductive health.Interventions can reduce VAW and improve maternal and child outcomes.Rigorously Assess, Adapt and Scale

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