Faculty Bibliography

INTRODUCTION: Bellevue Hospital's Program For Survivors of Torture (PSOT) sees patients applying for asylum from developing countries with limited access to contraception. The objective of this study is to examine contraceptive knowledge and use among a population of asylum candidates, in order to better understand their contraceptive educational needs.
METHOD(S): An observational study was conducted using a cross-sectional structured interview questionnaire. IRB approval and patient informed consent were obtained. Data were collected from 55 participants as part of a larger research study to assess histories, perceptions, and gynecological needs of immigrant female survivors of torture. Data analysis was conducted via REDCap.
RESULT(S): Sixty-three percent of participants did not want to get pregnant within the next year, but only 32% of them were using any form of effective contraception. The only effective method of contraception that a majority (53%) of participants had been taught to use were oral contraceptive pills (OCPs) and only 36% had knowledge about long-acting reversible contraceptives (LARCs). Comparatively, 75% knew how to use the rhythm method. Prior use of LARCs, OCPs, and noneffective methods were 9%, 31%, and 63%, respectively.
CONCLUSION(S): A majority of the immigrant women in this study did not want to get pregnant in the next year, but a minority had knowledge about effective contraceptive options outside of OCPs, and an even fewer had knowledge about LARCs. The discrepancy of usage between non-effective methods of contraception and effective methods suggests providers who see patients entering the American healthcare system should provide education on effective contraceptive options

This article describes the Engage, Motivate, Protect, Organize, self-Worth, Educate, Respect (EMPOWER) Clinic for Survivors of Sex Trafficking and Sexual Violence located at Gouverneur Health in New York, New York, as a model for integrated gynecologic and psychiatric care of survivors of sexual and gender-based violence. Although patients with a history of sexual trauma often have critical health needs that persist long after the traumatic event, most existing services for survivors of sexual violence focus solely on the provision of acute care immediately after the violence has occurred. There are very few clinics in the United States dedicated to managing the significant long-term medical consequences and sequelae of sexual violence in a trauma-informed setting. We report on best practices for the provision of trauma-sensitive medical care to this patient population based on those employed at the EMPOWER Clinic. In particular, we outline some of the unique considerations for treating survivors relating to taking a patient history, conducting the physical and gynecologic examinations, ensuring confidentiality, and managing legal issues. Finally, we reflect on the challenges faced in sustaining the EMPOWER Clinic and the importance of the existence of a clinic dedicated to this specific population.

According to the World Health Organization, female genital cutting affects millions of girls and women worldwide, particularly on the African continent and in the Middle East. This paper presents a plausible, albeit hypothetical, clinical vignette and then explores the legal landscape as well as the ethical landscape physicians should use to evaluate the adult patient who requests re-infibulation. The principles of non-maleficence, beneficence, justice, and autonomy are considered for guidance, and physician conscientious objection to this procedure is discussed as well. Analyses of law and predominant principles of bioethics fail to yield a clear answer regarding performing female genital cutting or re-infibulation on an adult in the United States. Physicians should consider the patient's physical, mental, and social health when thinking about female genital cutting and should understand the deep-rooted cultural significance of the practice.

Objectives: To describe demographic, gynecological, and psychiatric characteristics of survivors of gender-based violence seeking routine gynecological care in New York City. Method: Data was available for for 200 patients of the EMPOWER Clinic for Survivors of Sex Trafficking and Sexual Violence, a New York City gynecology clinic with co-located psychiatric services. Patients may have seen the gynecologist, psychiatrist, or both. Data were abstracted from the medical records of patients' gynecology and psychiatry intake visits. Results: The EMPOWER Clinic patients are mostly from Latin America (33%), Africa (32%) and Asia (10%). Of the 200 enrolled patients, A quarter (25%) have a history of female genital cutting (FGC), and over a third (39%) have a history of sex trafficking. Over a quarter (28%) had a previous induced abortion, and 9% had a forced abortion. Nearly a quarter of patients (23%) report a history of sexually transmitted disease and 12% have had an abnormal Papanicolaou smear. Of patients who were connected to a psychiatrist, a majority were diagnosed with major depressive disorder (79%) and/or post-traumatic stress disorder (90%). Conclusions: EMPOWER patients hail from all over the world, and have experienced forms of SGBV such as sex trafficking and FGC. They have important gynecologic and mental health history and needs

Objectives: To explore female survivors of torture's attitudes towards the benefits of female genital cutting (FGC), its religious significance, and whether this practice should be continued. Method: An observational study was conducted using a cross-sectional structured interview questionnaire and retrospective chart review for women in the Bellevue Hospital Program for Survivors of Torture. Data on FGC were collected as part of research to assess histories, perceptions, and gynecological needs of immigrant female survivors of torture. Results: Of the 44 women interviewed, 41 had heard of FGC. Respondents identified as Christian (37%), Muslim (33%) or Catholic (19%), and most were from Africa (75%). Thirty percent of respondents had experienced FGC. Most believed women receive no benefits from FGC (89%), it should be discontinued (94%), FGC has no effect on premarital sex (67%), and their religion does not require it (81%). Perceived benefits included preventing premarital sex (15%) and religious approval (6%), while benefits of not undergoing FGC included increased sexual pleasure (69%), avoiding pain (66%) and fewer medical problems (63%). Conclusions: The vast majority of women interviewed who were familiar with and/or have undergone FGC believe this practice offers no benefits to women, is not required by their religion and should be discontinued

Objectives: To determine how frequently survivors of sex trafficking interacted with the healthcare system during the time in which they were being trafficked, and if they were identified as survivors in the healthcare setting. Method: Women were included if they were eighteen years or older, had a history of sex trafficking, received care at the EMPOWER Clinic for Survivors of Sex Trafficking and Sexual Violence, and provided informed consent for participation. Participants were administered a structured interview via phone or in person asking whether they had obtained healthcare in a formal or informal setting during the trafficking period, and whether any healthcare provided did or could have detected the trafficking situation. Results: Half (50%) of participants saw a doctor or other healthcare provider during trafficking, but 25% of these visits were informal providers. Most (75%) of participants were accompanied by their trafficker on their first visit, while 25% were alone during their visit. Only 8% of participants believed their doctor might have suspected they were being trafficked. No participants were identified as trafficked in the healthcare setting. Conclusions: While screening for trafficking in the healthcare setting may detect some victims, many do not see a formal healthcare provider, and detection may be complicated by the presence of the trafficker at many of the visits

Objectives: To define sugar dating. To identify gaps in medical and sociological research on the sugar dating phenomenon in the United States. Method: Databases searched were PubMed, PsychInfo, ProQuest: Gender Watch, and EBSCO Host. Search terms utilized were: sugar daddy/daddies, sugar baby/babies, transactional sex, sugar mommy/mommies/aunties, sugar arrangement, sugar dating, sex work, mediated intimacy, instrumental intimacy, compensated dating, and gift for sex. Articles were included if the terms sugar daddy/mommy/baby, arrangement, or sugar dating were used or if the subject matter described a relationship that involved an exchange of goods for some form of intimacy, but was not described as prostitution. Results: Of the 12,718 articles gathered, a total of 24 articles met the inclusion criteria. Sugar dating can be defined as an arrangement in which intimacy is commodified and exchanged between a "sugar baby" and a wealthier, "sugar daddy/mommy." Of the relevant articles, 13 (54%) were academic articles from various countries in Africa. Two American journals reported on the motives behind sex work akin to sugar dating. Seven (29%) articles were published from U.S. mass media sites rather than academic journals. No research on sugar dating has been published in indexed medical or sociological journals within the United States. Conclusions: There is a lack of published medical and sociological research from the United States on the sugar dating phenomenon. Further research is needed to elucidate prevalence of sugar dating in the United States, sugar babies' conceptual framework participation, demographic factors associated with those who participate in sugar dating, the mental and physical health risks associated with sugar dating, and how sugar arrangements are negotiated