Working with abused older women from a feminist perspective

Domestic violence in older families is often referred to not as family violence but as elder abuse. This chapter will begin by discussing how perceptions of this type of violence impact informal and formal interventions. The prevalence and etiology of domestic violence are described, along with how the joint forces of ageism and sexism affect older female victims. National, state, and local efforts to prevent and remediate the abuse of older women are also covered. In conclusion, the author presents implications for working with groups and individual abused older women from a feminist perspective.     

Experiences with obstetric violence among healthcare professionals and students in Spain: A constructivist grounded theory study

BackgroundObstetric violence appears to be a worldwide concern and is defined as a type of gender-based violence perpetrated by health professionals. This violence undermines and harms women’s autonomy. In Spain, 38.3 % of women have identified themselves as victims of this type of violence.AimTo explore current information and knowledge about obstetric violence within the Spanish healthcare context, as well as to develop a theoretical model to explain the concept of obstetric violence, based on the experiences of healthcare professionals (midwives, registered nurses, gynaecologists and paediatricians) and nursing students.MethodsA constructivist grounded theory study was conducted at Jaume I University in Spain between May and July 2021, including concurrent data collection and interpretation through constant comparison analysis. An inductive analysis was carried out using the ATLAS.ti 9.0 software to organise and analyse the data.ResultsTwenty in-depth interviews were conducted, which revealed that healthcare professionals and students considered obstetric violence a violation of human rights and a serious public health issue. The interviews allowed them to describe certain characteristics and propose preventive strategies. Three main categories were identified from the data analysis: (i) characteristics of obstetric violence in the daily routine, (ii) defining the problem of obstetric violence and (iii) strategies for addressing obstetric violence. Participants identified obstetric violence as structural gender-based violence and emphasised the importance of understanding its characteristics. Our results indicate how participants’ experiences influence their process of connecting new information to prior knowledge, and they provide a connection to specific micro- and macro-level strategic plans.DiscussionDespite the lack of consensus, this study resonates with the established principles of women and childbirth care, but also generates a new theoretical model for healthcare students and professionals to identify and manage obstetric violence based on contextual factors. The term ‘obstetric violence’ offers a distinct contribution to the growing awareness of violence against women, helps to regulate it through national policy and legislation, and involves both structural and interpersonal gender-based abuse, rather than assigning blame only to care providers.ConclusionsObstetric violence is the most accurate term to describe disrespect and mistreatment as forms of interpersonal and structural violence that contribute to gender and social inequality, and the definition of this term contributes to the ongoing awareness of violence against women, which may help to regulate it through national policy and legislation.     

An exploration of Australian midwives’ knowledge of intimate partner violence against women during pregnancy

BackgroundIntimate partner violence is recognised as a global public health issue. Living with intimate partner violence results in poorer health status with reduced quality of life and higher utilisation of health services. Increased awareness, education and training, and an understanding of multi-agency collaboration are vital in order for health practitioners to respond to women experiencing partner violence and abuse. Midwives are well placed to identify, provide immediate support, and refer women onto appropriate support agencies but may lack appropriate education, training or support.AimTo investigate midwives’ knowledge of intimate partner violence against women during pregnancy.MethodsAn online survey link was distributed through the Australian College of Midwives. The survey included personal, professional and practice details, and 25 questions that tested knowledge about intimate partner violence.Findings152 midwives completed the online questionnaire. Knowledge scores ranged from 27 to 48 (out of a possible 50), with the mean total score of 42.8 (SD = 3.3). Although 60% of participants scored 48, two-thirds did not know about the risks and signs of intimate partner violence. One-third of the midwives did not know about age risks associated with intimate partner violence. Around 25% incorrectly believed that perpetrators are violent because of alcohol or drug use. Nearly 90% (88%) of participants had some education or training about intimate partner violence. Those with some training achieved higher knowledge scores than those with no formal training (Mann–Whitney U = 1272, p = 0.003).ConclusionParticipating midwives generally reported a high level of knowledge about intimate partner violence but held misconceptions about risks and characteristics of perpetrators of violence. These knowledge gaps may adversely affect their ability to identify women at risk of violence. Education about intimate partner violence was associated with improved knowledge. Future training and education on intimate partner violence should target identified knowledge gaps.     

Strengthening resources for midlife and older rural women who experience intimate partner violence

ABSTRACT

Little is known about midlife and older women who experience intimate partner violence living in rural places and their resource needs. Guided by a strengths perspective, we provided insights into resources that midlife and older women use, or would like to use, in their journey in leaving an abusive partner. Eight women who had left an abusive partner participated in a face-to-face interview. They drew on a wide variety of paid and unpaid resources, while each woman had a unique set of resources that contributed to her being able to make such a significant life transition. It is clear that we need to have a variety of formal and informal resources available to older women experiencing intimate partner violence (IPV) in rural places, and new forms of resources need to be developed. Our results also indicate that increased efforts are needed in improving both public and professional education regarding older rural women and IPV.     

Risk factors of severity of abuse against older women in the home setting: A multinational European study

ABSTRACT

This article examines the ecological risk factors of abuse against older women. Data from 2,880 older women were randomly collected in five European countries (Austria, Belgium, Finland, Lithuania, and Portugal) using a standardized questionnaire. Results indicate that overall 30.1 % older women had at least one experience of abuse in the past year. The findings demonstrate that a single emphasis on personal risk factors (e.g., health, coping) is important but too simple: Abuse is multifaceted and is embedded in environmental (e.g., loneliness, household income) as well as macrocultural contexts (e.g., old age dependency ratio).     

Private violence/private transport: the role of means of transport in women’s mobility to escape from domestic violence in England and Wales

ABSTRACT

This article highlights a gendered and forced mobility which has been under-recognised in the literature on mobility. It explores the hidden relocations of women (often with children) due to intimate partner abuse; presenting findings from mixed methods research on women’s journeys to escape domestic violence, including analysis of over 80 journey segments made by 20 women within England and Wales, and from abroad. Focusing on means of transport, the research found that under a third of journey segments were made by public transport, and these tended to be longer distances; that journeys by disabled women were more likely to be by private transport, and that journeys from rural areas were more likely to be with the assistance of others. Thematic analysis of interviews at different stages of women’s journeys is used to explore their experiences of different means of transport in terms of degrees of control and agency, in terms of losing or retaining personal possessions on the move; and in highlighting the role of others’ assistance in compounding or counteracting the implications of abuse. Women’s domestic violence journeys are thereby contextualised within wider mobilities research, uncovering the inequalities and implications of this hidden internal displacement in the UK.     

Widowhood and Spirituality: Coping Responses to Bereavement

SUMMARY

Nearly half of women age 65 or older are widows and nearly 70% of these women live alone. Because older women are three times more likely than their male counterparts to be widowed, widowhood has been labeled a primarily female phenomenon. This review article has two aims: (a) to discuss the impact of widowhood on the lives of older women and (b) to discuss how religion and spirituality may be used as coping methods for conjugal loss. After reviewing the literature the authors conclude that older women use religious coping as well as religious and spiritual beliefs and behaviors to facilitate positive adjustment to the loss of a spouse.     

Posttraumatic Stress Disorder and Older Women

SUMMARY

This article examines the literature related to the identification and treatment of posttraumatic stress disorder in older women. From this review, several key findings emerge. Consistent in the research literature is the fact that American women are more at risk for PTSD than are men as a result of the high frequency of sexual and domestic physical abuse that women experience. Studies on older women and PTSD indicate that older women are under-diagnosed and are more typically perceived as suffering from depression, anxiety or poor physical health. It was found consistently that older women who present with age-related stressors may not be asked about earlier trauma history or it may not be understood within the context of trauma-related variables. In several research studies, trauma history was often not identified either as a result of current assessment practice or because women from certain age cohorts did not disclose trauma-related data to health professionals. Key researchers emphasize the necessity of clinicians, staff and medical personnel to attend to the historical variables present in trauma histories of older women. Researchers underscore the importance of understanding the impact of early and repeated trauma, especially interpersonal trauma, on the physical health and social functioning of older women–even though a significant amount of time may have elapsed since exposure. These findings indicate that further study of PTSD in older women is warranted. The paper concludes with a discussion of assessment and treatment options.     

Transforming mental health services to address gender disparities in depression risk factors

ABSTRACT

Depression in older women is a significant and growing problem. Women who experience life stressors across the life span are at higher risk for developing depression than their male counterparts. Research has focused primarily on identifying and reducing the symptoms of depression for the general aging population, disregarding gender-specific differences in the foundational causes of depression. This article examines how women’s unique experiences influence the development of depression and highlights how the current mental health system could better meet older women’s needs by moving from a gender-neutral model to one that emphasizes women’s experiences.     

The experiences of pregnant women attending a specialist service and using methamphetamine

BackgroundPregnant women attending the Specialist Drug and Alcohol Service in Perth use methamphetamine as their primary drug of choice. This is the only tertiary service for pregnant and postnatal women with complex Alcohol and Other Drug Use in Western Australia. It is a midwifery-led multidisciplinary team. Many of the women struggle with addiction, polysubstance use, co-occurring mental health, family and domestic violence, complex trauma and fear of Child Protection and infant removal. Therefore, the aim of this study was to understand the impact of methamphetamine use of pregnant women attending the service and explore and highlight the potential barriers to engagement and follow-up.MethodsA qualitative study informed by phenomenological methods was undertaken using semi-structured interviews with 20 women with methamphetamine use attending the service in order to explore and understand the experience of using methamphetamine in pregnancy and the postpartum period. A thematic analysis was undertaken with data from the women in the study (n = 20) to identify key themes.ResultsKey themes that emerged from the women’s experiences detail their resilience and experience with methamphetamine and the impact that methamphetamine has on their life. A key concern for women regarding methamphetamine use and engagement with specialist services was the welfare of their child(ren). Agencies charged with child protection was a barrier to treatment because women feared disclosure of methamphetamine use would result in loss of child custody. Themes highlighted the multiple layers of adversities, and trauma from childhood to adulthood including, co-occurring drug use, mental health and life histories of trauma (abuse, violence, and neglect; intergenerational trauma; intergenerational drug and alcohol use, and child removal), the omnipresence of methamphetamine, and the impact on pregnancy and mothering.ConclusionWe conclude that understanding the experiences of women and the impact methamphetamine use has on their life is paramount to providing effective and appropriate care to support pregnant women in a trauma-informed and woman-centred approach. Poor engagement in pregnancy care for women with methamphetamine use has significant impacts on mother and infant.     

The magnitude of the problem of obstetric violence and its associated factors: A cross-sectional study

BackgroundIn recent years, the concept of obstetric violence has become visible among women and professionals, but its prevalence and the factors with which it is related in our healthcare environment are unknown.AimTo determine the prevalence of obstetric violence in the Spanish healthcare system and identify the associated factors.MethodsA cross-sectional observational study was conducted during 2019 and included 899 women who had given birth in the last 12 months. An online questionnaire was distributed through midwives and women associations in Spain. The questionnaire included sociodemographic, clinical, and assistance practices variables. The primary outcome variable was obstetric violence and its verbal, physical, and psycho-affective types. Crude odds ratios (OR) and adjusted OR (ORa) were estimated using binary logistic regression.ResultsObstetric violence was reported by 67.4% (606) of the women; 25.1% (226) verbal, 54.5% (490) physical, and 36.7% (330) psycho-affective. Overall obstetric violence was observed more frequently in women who attended maternal education programme (ORa 1.56, 95% CI 1.05–2.32), those who presented a birth plan but it was not respected (ORa 2.82, 95% CI 1.27–6.29), those who received regional analgesia (ORa 1.61, 95% CI 1.13–2.30), those who required an urgent caesarean section (ORa 3.46, 95% CI 1.79–6.69), underwent an episiotomy (ORa 3.34, 95% CI 2.21–5.38), and whose newborn was admitted to an intensive care unit (ORa 2.73, 95% CI: 1.21–6.15). The presentation of a birth plan was observed as protective factors, and the possibility of skin-to-skin (ORa 0.34, 95% CI 0.18–0.62) and felt respected (ORa 0.61, 95% CI 0.43–0.85).ConclusionsTwo out of three women perceive having suffered obstetric violence during childbirth. Practices such as skin-to-skin contact, and the use of respected birth plans, were protective factors against obstetric violence.     

Care Arrangement Choices for Older Widows: Decision Participants' Perspectives

SUMMARY

This research examines how a wide range of care arrangement decisions for frail older women are made. Interviews were conducted with 11 older women (ten of whom are widows), nine of their family members, and six professional service providers. Maintaining the older woman's independence was identified as a major theme. While all decision participants identified it as an explicit or implicit decision-making goal, their meanings of independence were different. The older women's meanings were flexible, changing in response to changes in their physical condition and need for assistance. Adult children tended to identify their mothers as independent when they did not actually need assistance, or when they received help from other sources (e.g., home health care). Professional service providers were inclined to define independence narrowly, as avoiding nursing home placement. Minor themes associated with independence include responsibility, reciprocity, and the family's importance in maintaining independence. These themes help to clarify the complex dynamics that take place during care arrangement decisions and explain how care arrangement choices are made.     

Perinatal psychosocial assessment of women of refugee background

BackgroundWomen of refugee background may be particularly vulnerable to perinatal mental illness, possibly due to increased exposure to psychosocial stressors associated with their forced migration and post-resettlement adjustment.AimThis study aimed to compare psychosocial risk factors reported by women of refugee background receiving maternity services at a public hospital, to those reported by Australian-born women in the same hospital. It further aimed to examine the referrals offered, and accepted, by the women of refugee background reporting psychosocial risk factors for perinatal mental illness.MethodsA retrospective hospital record review was conducted to compare the antenatal and postnatal psychosocial risk factors of 100 women of refugee background and 100 Australian-born women who gave birth at a public hospital in Victoria between 1 July 2015 and 30 April 2016, and who had completed the Maternity Psychosocial Needs Assessment.FindingsWomen of refugee background were more likely than Australian-born women to report financial concerns and low social support at antenatal assessment, but were less likely to report prior mental health problems than Australian-born women at either assessment point. Both groups reported low rates of family violence compared to published prevalence rates. Of the women of refugee background assessed antenatally, 23% were offered referrals, with 52% take-up. Postnatally, 11.2% were offered referrals, with 93% take-up.Discussion/conclusionThis study showed elevated rates of psychosocial risk factors among women of refugee background, however, possible under-reporting of mental health problems and family violence raises questions regarding how to assess psychosocial risk factors with different cultural groups. Lower antenatal referral take-up suggests barriers to acceptance of referrals may exist during pregnancy.     

Defying,producing, and overlooking stereotypes? The complexities of mobilizing “grandmotherhood” as political strategy

ABSTRACT

This article explores the Canadian Grandmothers to Grandmothers Campaign, a mobilization of older women responding to the effects of HIV/AIDS in sub-Saharan Africa. Based on interviews, participant observation, and archival work, this article looks at how and to what effect “grandmotherhood,” as discourse, was mobilized and deployed, in fluid and fractured ways, in order to increase members’ credibility as global social justice actors and build their solidarity with African women. These mobilizations functioned to uphold essentialist notions of what being a grandmother means, while also challenging stereotypes of older women as frail and disengaged.     

Korean Older Intimate Partner Violence Survivors in North America: Cultural Considerations and Practice Recommendations

While literature on elder abuse has expanded, elder abuse by intimate partners has been less investigated. Even less is known about intimate partner violence among older Koreans living in North America. This article identifies important cultural considerations for individuals helping the Korean older adult community, beginning with the definition of intimate partner violence in this community and barriers to leaving that include traditional views of the East Asian self. Current practice interventions are discussed and recommendations for future practice such as healing han, the accumulated suffering from years of abuse, are suggested. The ultimate goal of this paper is to expand awareness in order to develop the best culturally competent prevention and intervention practice for Korean older intimate partner violence survivors in North America.     

The Red Hat Society®: Exploring the Role of Play,Liminality, and Communitas in Older Women's Lives

ABSTRACT

There is an extensive literature on play. Yet, the role of play in older adults' lives has received limited attention. Strikingly absent is research on play and older women. Missing from the literature is how older women use play as a liminal context for social interaction and communitas. This is odd because by 2030 one in four American women will be over the age of sixty-five. The primary purpose of this study is to explore the roles of play, liminality, and communitas in older women's lives. The focus is the Red Hat Society®, a social group for women over age 50 that fosters play and fun. Using qualitative interviews with focus groups and participant observation of a regional Red Hat Society® event, the study highlights some of the strengths and weaknesses of current conceptualizations of play, liminality, and communitas.     

Midwives and sexual violence: A cross-sectional analysis of personal exposure,education and attitudes in practice

BackgroundAround one in three women experience sexual violence during their lifetime. They may need trauma-sensitive maternity care that takes sexual trauma triggers into account. Midwives are similarly likely to have experienced sexual violence in their lifetime. It is unknown whether midwives with a personal sexual violence history have a different professional approach to the topic than their colleagues without such history.AimTo explore whether midwives with a personal sexual violence history are more likely to have received or need education about sexual violence and whether they approach sexual violence differently in practice.MethodsAn exploratory online survey was conducted amongst practicing midwives in high resource countries. Odds ratios were calculated for differences between midwives with and without a personal sexual violence history.FindingsOf the 288 participating midwives, 48.6% disclosed a personal sexual violence history. Midwives with a personal sexual violence history showed higher uptake of post-graduate education (OR 2.05, 95% CI 1.23–3.44), more accurate prevalence estimation (OR 3.42, 95% CI 2.10–5.57) and more confidence to identify sexual violence history (OR 1.94, 95% CI 1.19–3.15). We found no differences in requiring future education, screening practices, other aspects of confidence or time and discomfort barriers.ConclusionsAs fellow survivors, midwives with a personal sexual violence history have a unique standpoint towards sexual violence in maternity care practice that may make them more sensitive to the issue.     

The Importance of Fairness and Equity for the Marital Satisfaction of Older Women

ABSTRACT

In all societies, people are concerned with social justice. “It's just not right” is a fairly common lament. In these two studies, we interviewed 240 older women, who ranged in age from 50 to 82. We found that most older women (85%) considered their marriages to be fair and equitable. Older women were less concerned about existing inequities than their younger peers. Nonetheless, they were somewhat concerned with how rewarding and how fair and equitable their relationships were perceived to be. Those who felt over-benefited, for example, felt more guilty than did their less advantaged peers; those who felt under-benefited felt far more angry than did their privileged peers. Stressful life events—such as the arrival of children, retirement, serious illness, or the awareness impending death—often brought to awareness long simmering resentments over issues of fairness.