‘Sometimes all she wants is a kind word’: Social support as mitigator of intimate partner violence in Santo André, Brazil Pubblico
Manders, Olivia C. (Fall 2018)
Abstract
In Brazil, an estimated 13.5 women have experienced physical or sexual violence (Instituto Avon, 2013). In 2010, more than 80% of reported cases were perpetrated by intimate partners (Agência Patricia Galvão). Between 2009 and 2013, cases of reported violence against women doubled in the municipality of Santo André, São Paulo. The objective of this study was to characterize the role of social support in mediating women’s experience of intimate partner violence (IPV). We performed a secondary analysis of 30 individual in-depth interviews conducted with female patients visiting three public health clinics in Santo André, Brazil. Using a modified grounded theory approach, we used deductive and inductive strategies. For this study, the first author read all interviews and applied codes using the senior author’s codebook. The first author then reviewed data coded as ‘social support’, created new sub-codes based on source and type of support mentioned, applied them to the data and analyzed them thematically. MAXQDA 11 software (VERBI GmbH, Berlin, Germany) was used for all data analyses. A subset of 23 interviews was used for this study.
Interviewees described personal experiences with IPV and those of friends, neighbors and relatives. In sorting the sources and types of support women described offering and receiving, we identified functions of these exchanges that helped describe the effect of support on women’s experience of IPV. From this, we developed a disclosure model that helps explain the process of abuse disclosure. Consistent with other studies, women sought informal support when abuse was verbal or emotional, and progressively accessed more substantive support from both informal and formal sources as their situations became life-threatening or intolerable. A primary trigger for women to activate support to leave their relationships was concern about setting a bad example for their children. This overcame the desire to maintain the family unit intact and the fear of stigma attached to leaving. Most women cited accessing help from their mothers, who then helped them access formal support. Survivors expressed preference for discussing IPV with psychologists rather than clinicians, but most said they would like providers to ask. Several indicated counseling sessions should be available at clinics to help adolescent girls as well as women.
These findings suggest interventions targeting women experiencing emotional or verbal abuse may prevent relationships from advancing to physical. Targeted interventions addressing social norms around gender roles, and improving communication skills in adolescents and young couples may address some of the issues that result in IPV. School and community-based interventions that address social norms and promote positive relationships developed by Promundo and others have yielded positive results among adolescent and adult men in Brazil. Court-mandated, psychologist-led group sessions have helped male abusers modify their views on gender roles and improve their ability to communicate, and have helped women develop self-esteem. Leveraging existing interventions led by formal sources of support that teach communication, interpersonal relationships, and parenting skills could help break generational cycles of violence in these communities.
Table of Contents
Chapter 1: Introduction ..................................................................................................................... 1
Introduction and Rationale .................................................................................................... 1
Purpose .................................................................................................................................. 2
Objectives ............................................................................................................................. 3
Significance........................................................................................................................... 3
Chapter 2: Comprehensive Review of the Literature ....................................................................... 5
Introduction ........................................................................................................................... 5
Violence Against Women ..................................................................................................... 5
Intimate Partner Violence ..................................................................................................... 6
Violence Against Women Laws in Brazil ............................................................................ 7
National Policies and Social Services ................................................................................... 9
Women’s Specialized Police Services ................................................................................... 9
Single Unified Health System (SUS) ................................................................................... 10
Women’s Services Network (REAM) .................................................................................. 10
Social Support ..................................................................................................................... 11
Research on social support in Brazil ................................................................................... 13
Santo André, São Paulo ...................................................................................................... 15
Social Norms ....................................................................................................................... 17
Summary ............................................................................................................................. 18
Chapter 3: Manuscript..................................................................................................................... 20
Contribution of the Student ................................................................................................. 21
Title Page ............................................................................................................................ 22
Abstract ............................................................................................................................... 24
Introduction ......................................................................................................................... 25
Methods............................................................................................................................... 27
Background ......................................................................................................................... 27
Parent Study ........................................................................................................................ 27
Study Sites ........................................................................................................................... 27
Data Collection ................................................................................................................... 28
Instruments .......................................................................................................................... 28
Interview process ................................................................................................................ 29
Data Management and Analysis ......................................................................................... 29
Study ethics ......................................................................................................................... 30
Present Study: A secondary data analysis of social support among participants .............. 31
Data Analysis ...................................................................................................................... 31
Process ................................................................................................................................ 34
Study ethics ......................................................................................................................... 34
Results ................................................................................................................................. 35
Social Support Study Population Demographics ................................................................ 35
IPV in the study population ................................................................................................ 36
Social support in the study population ................................................................................ 38
Sources of social support .................................................................................................... 38
Types of social support ....................................................................................................... 39
Prayer moderates IPV for Evangelical women .................................................................. 40
Venting has a moderating effect on how women experience IPV ....................................... 41
Women report abuse when they need instrumental help .................................................... 43
Experienced-based Counsel ................................................................................................ 43
Women are selective with whom they discuss IPV.............................................................. 44
Women compartmentalize healthcare provider roles ......................................................... 45
Barriers to accessing social support................................................................................... 47
Consequences to challenging social norms ........................................................................ 48
Discussion ........................................................................................................................... 49
Mothers are a pathway to formal sources of support ......................................................... 51
The Role of REAM in providing support to survivors......................................................... 51
The role of social support as mediator of women’s ability to address IPV ........................ 52
Moderating effects of Social Support on the experience of IPV ......................................... 52
The protective effects of social support on the experience of IPV ...................................... 53
Social support had rehabilitative effects on the experience of IPV .................................... 54
Social Norms and IPV ......................................................................................................... 55
Conclusion ...................................................................................................................................... 57
References ....................................................................................................................................... 60
Conclusions ..................................................................................................................................... 66
Public Health Implications and Future Research ................................................................ 66
Appendices ...................................................................................................................................... 68
Appendix I: In-depth Interview Guide (English Version) .................................................. 68
Appendix II: In-depth Interview Guide (Portuguese Version) ........................................... 72
References ....................................................................................................................................... 77
Table of Tables and Figures
Figure 1. Parent Study Application of Dahlberg and Krug’s Social Ecological Model………….30
Figure 2. Disclosure Model……………………………………………………………………….38
Table 1. Social Support Analysis Codebook……………………………………………………...33
Table 2. Study Population demographics…………………………………………………………36
Table 3. Study population by age, perpetrator, type of abuse, current living status, and role of survivor and/or support provider (n=23)………………………………………………………….37
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