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A Closer Look: Q&A with An-Sofie Van Parys

An-Sofie Van Parys

Intimate Partner Violence during Pregnancy and Parenting:  A Systematic Review of Interventions

An-Sofie Van Parys is a doctoral candidate at the International Centre For Reproductive Health at Universiteit Gent in Belgium. She received her Bachelor’s in Midwifery and a Master’s in Social and Cultural Sciences as well as a Master’s in Family and Sexuologic Sciences. Van Parys and a research team conducted a systematic review of IPV interventions.  After reading this publication, we followed up with Van Parys to discuss her findings and to get a sense of how this field is evolving.

1. What interventions are the most successful in targeting intimate partner violence during pregnancy?

In reviewing these interventions for intimate partner violence (IPV), we found that the most effective programs were typically those that took place in the home — addressing the problem where it is rooted. These programs tend to handle the problem with a multi-level approach, focusing on substance use, mental health, and other issues that contextualize the IPV. Hospital and medical center programs tend to have a more narrow scope that mainly targets the violence.

2. Which programs, if any, worked with the partners of the women?

One program located in Hawaii — Reducing Maternal Intimate Partner Violence, part of the Hawaii Healthy Start Home Visitation Program — addressed both partners in their intervention.  For me, this is a matter of ideology and whether or not the women are solely viewed as victims. By addressing the partners together, the program has the ability to empower both partners to understand the roles that each play in their relationship and family, and how they can effect change in their own lives.

3.  How well did the articles and programs address comorbidities associated with IPV, such as substance use disorders and higher incidence of HIV infection?

Most of the interventions we analyzed were selected because of their focus on both IPV and pregnancy.  Some of the interventions approached the work by addressing the multiplicity of factors that affect intimate partner violence, such as mental health, but others did not. Engaging women around substance use or living with HIV required more capacity than most organizations had.

4. Given that psychological violence is the most difficult type of violence to measure, what are some promising measures that were used by the programs reviewed?

Most of the studied interventions utilized validated violence scales to measure IPV. The scale that is mostly used to screen for violence in a pregnant population is the Abuse Assessment Screen (McFarlane et al., 1992). Unfortunately, this scale has significant limitations in that there is no measure of psychological violence/abuse and limited questions regarding sexual violence. The scale that is considered the gold standard is called the Conflict Tactics Scale (Straus et al, 1996). The shortest version of this scale has 20 items, which makes it difficult to use in a daily clinical environment. The advantage of this scale, however, is that it measures violence in both directions, implicating both partners. TheWHO Multi-country Study on Women’s Health and Life Experiences has been validated in many countries and provides many questions, which lends itself to cultural and regional adaptation.

Recently, the field has taken up the question of how we determine what constitutes a good outcome irrespective of these measurements. Merely relying on the absence of IPV does not address the complexity of the problem and is, therefore, probably too narrow of an indicator of “success.” Mental well-being, in tandem with measurements of violence, gets at long-term outcomes in a way that violence measures on their own cannot.

5. How did these programs vary in both training and outcomes? What could they learn from one another to offer more comprehensive interventions for IPV during and after pregnancy?

All providers in the interventions we analyzed were specifically trained and supervised utilizing an IPV-specific curriculum. These providers, however, could all benefit from booster sessions, whereby intervention skills are strengthened. Violence is a difficult subject to broach. Years ago, questions regarding smoking, alcohol/drug use were similarly avoided and considered too invasive to ask. It’s my hope that we will destigmatize IPV and normalize questions concerning an individual’s experience with violence. In the two intervention models we analyzed, paraprofessionals (typically, trained  members of the community) and home-visiting nurses were able to intervene with very different outcomes, given their different training. In this study, the nurses were specifically trained to address IPV, while the paraprofessionals were not. While the women who worked with the nurses saw a marked decrease in violence, those who worked with the paraprofessionals tended to have higher quality-of-life outcomes. This may suggest that these two types of models could borrow from one another to offer the most comprehensive of interventions.

6. What effect do you hope this review will have for researchers and providers?

I hope this work makes clear the lack of, and need for, multi-level interventions that address mental health in its relation to violence, as well as psychological violence, independently. Additionally, I urge providers and researchers to extend the services to both parents and their children. By continuing to accept the framework of  “gender-based violence,” we reiterate the dynamic of the father and mother as perpetrator and victim, respectively. By de-emphasizing the woman’s status as a victim, we can open the conversation to address and mitigate the many types of violence that can exist in a relationship and family.

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