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Abstract：
OBJECTIVE: Violence against women is a widespread public health concern with severe effects to women\'s sexual and reproductive health, including higher risks for miscarriage or stillbirth, unintended pregnancy and induced abortion. This study examined the association between women exposure to physical violence, psychological violence and sexual and reproductive health outcomes (contraceptive use, miscarriage or stillbirth and abortion) in Germany.
METHODS: This study used a cross-sectional research design to analyze data on violence against women and sexual and reproductive health (SRH) outcomes collected through the German Health Interview and Examination Survey for Adults, Wave 1, between 2008 and 2011 (n = 3149 women, aged 18-64 years). Multivariable logistic regression models were used to assess the association between experiences of violence among women and the presence of sexual and reproductive health outcomes, considering the influence of socio-demographic and health-related factors (age, marital status, socioeconomic status, social support, number of children, alcohol consumption, health status, chronic conditions).
RESULTS: Three associations remained significant (p<0.05) in fully-adjusted models: (i) exposure to physical violence by a parent or caregiver and birth control pill utilization (aOR, adjusted Odds Ratio, 95% CI: 1.36, 1.02-1.81) (ii) exposure to physical violence since the age of 16 and miscarriage or stillbirth (aOR, 95%CI: 1.89, 1.17-3.04); and (iii) exposure to psychological violence by a parent or caregiver and abortion (aOR, 95%CI: 1.87, 1.30-2.70).
CONCLUSIONS: The results suggest that adult German women who experienced physical or psychological violence since the age of 16, including violence perpetrated by a parent or caregiver, were more likely to report miscarriage or stillbirth and abortion. Direct assessment of violence experiences against women should be conducted by healthcare professionals in clinical encounters, particularly by obstetrics and gynaecological specialists, for the prevention of women´s adverse sexual and reproductive health outcomes. Furthermore, violence should be treated as a major public health concern and addressed through a multisectoral approach, involving the healthcare and educational sectors, researchers and relevant policymakers.
METHODS: This study used a cross-sectional research design to analyze data on violence against women and sexual and reproductive health (SRH) outcomes collected through the German Health Interview and Examination Survey for Adults, Wave 1, between 2008 and 2011 (n = 3149 women, aged 18-64 years). Multivariable logistic regression models were used to assess the association between experiences of violence among women and the presence of sexual and reproductive health outcomes, considering the influence of socio-demographic and health-related factors (age, marital status, socioeconomic status, social support, number of children, alcohol consumption, health status, chronic conditions).
RESULTS: Three associations remained significant (p<0.05) in fully-adjusted models: (i) exposure to physical violence by a parent or caregiver and birth control pill utilization (aOR, adjusted Odds Ratio, 95% CI: 1.36, 1.02-1.81) (ii) exposure to physical violence since the age of 16 and miscarriage or stillbirth (aOR, 95%CI: 1.89, 1.17-3.04); and (iii) exposure to psychological violence by a parent or caregiver and abortion (aOR, 95%CI: 1.87, 1.30-2.70).
CONCLUSIONS: The results suggest that adult German women who experienced physical or psychological violence since the age of 16, including violence perpetrated by a parent or caregiver, were more likely to report miscarriage or stillbirth and abortion. Direct assessment of violence experiences against women should be conducted by healthcare professionals in clinical encounters, particularly by obstetrics and gynaecological specialists, for the prevention of women´s adverse sexual and reproductive health outcomes. Furthermore, violence should be treated as a major public health concern and addressed through a multisectoral approach, involving the healthcare and educational sectors, researchers and relevant policymakers.
摘要：
目的：对妇女的暴力行为是一个广泛的公共卫生问题，对妇女的性健康和生殖健康造成严重影响，包括更高的流产或死产风险，意外怀孕和人工流产。这项研究调查了女性遭受身体暴力之间的关系，心理暴力和性健康和生殖健康结果(避孕药具的使用，流产或死产和流产)在德国。
方法：本研究采用横断面研究设计，分析通过德国成人健康访谈和检查调查收集的关于暴力侵害妇女行为以及性健康和生殖健康(SRH)结果的数据，第一波，2008年至2011年(n=3149名女性，18-64岁)。使用多变量逻辑回归模型来评估女性暴力经历与性健康和生殖健康结果之间的关联。考虑到社会人口统计学和健康相关因素的影响(年龄，婚姻状况,社会经济地位,社会支持,儿童数量,酒精消费,健康状况,慢性疾病)。
结果：在完全调整的模型中，三个关联仍然显着（p<0.05）：（i）父母或照顾者对身体暴力的暴露以及避孕药的使用（aOR，调整后的赔率比，95%CI：1.36，1.02-1.81）（ii）自16岁起遭受身体暴力和流产或死产（aOR，95CI：1.89，1.17-3.04）；以及（iii）父母或照顾者和堕胎的心理暴力（aOR，95CI：1.87，1.30-2.70）。
结论：结果表明，自16岁起遭受身体或心理暴力的德国成年妇女，包括父母或照顾者的暴力行为，更有可能报告流产或死产和流产。对妇女的暴力经历的直接评估应由医疗保健专业人员在临床中进行，特别是妇产科专家，预防妇女不良的性健康和生殖健康结果。此外，暴力应被视为主要的公共卫生问题，并通过多部门方法加以解决，涉及医疗保健和教育部门，研究人员和相关政策制定者。
方法：本研究采用横断面研究设计，分析通过德国成人健康访谈和检查调查收集的关于暴力侵害妇女行为以及性健康和生殖健康(SRH)结果的数据，第一波，2008年至2011年(n=3149名女性，18-64岁)。使用多变量逻辑回归模型来评估女性暴力经历与性健康和生殖健康结果之间的关联。考虑到社会人口统计学和健康相关因素的影响(年龄，婚姻状况,社会经济地位,社会支持,儿童数量,酒精消费,健康状况,慢性疾病)。
结果：在完全调整的模型中，三个关联仍然显着（p<0.05）：（i）父母或照顾者对身体暴力的暴露以及避孕药的使用（aOR，调整后的赔率比，95%CI：1.36，1.02-1.81）（ii）自16岁起遭受身体暴力和流产或死产（aOR，95CI：1.89，1.17-3.04）；以及（iii）父母或照顾者和堕胎的心理暴力（aOR，95CI：1.87，1.30-2.70）。
结论：结果表明，自16岁起遭受身体或心理暴力的德国成年妇女，包括父母或照顾者的暴力行为，更有可能报告流产或死产和流产。对妇女的暴力经历的直接评估应由医疗保健专业人员在临床中进行，特别是妇产科专家，预防妇女不良的性健康和生殖健康结果。此外，暴力应被视为主要的公共卫生问题，并通过多部门方法加以解决，涉及医疗保健和教育部门，研究人员和相关政策制定者。
