Faculty Bibliography

Background: The United States has an estimated 400,000 residing survivors of torture. The Program for Survivors of Torture (PSOT) at Bellevue Hospital is the only comprehensive torture treatment center in New York City. PSOT offers both medical and mental health treatment to its clients, who are ethnically diverse. There has to date been no comprehensive assessment of the gynecological needs of this population. This study affords a novel opportunity to investigate reproductive health needs of women who have experienced torture. Methods: This is a cross-sectional descriptive study conducted through structured interviews. All women enrolling in PSOT were eligible for inclusion. Data was collected in a REDCap database and analyzed using Stata v14. Outcomes were evaluated using descriptive statistics. Outcomes of interest include obstetric history, contraceptive knowledge and use, and prevalence of prior gender based violence (GBV) and female genital cutting (FGC). Findings: The majority (71.4%) were French-speaking West Africans. All participants reported prior experience of GBV; perpetrators were more likely to be from outside the family (64.3%), but violence from an intimate partner (35.0%) or family member (33.3%) was also common. Prior sexual violence and history of FGC was reported in 66.7% and 25.0% of subjects, respectively. The mean gravidity was 2.1 pregnancies (SD = 1.1) and, of those who have been pregnant (64.3%), 77.8% reported having received antenatal care at some point in pregnancy. While 85.7% reported any prior pregnancy-related complications, 57.1% of them reported seeking medical attention. Current contraception use was only reported in 15.4%, even though over half of women expressed a desire to delay pregnancy (spacers). Moreover, among all spacers, current use of contraception (28.6%) is lower than past use (78.6%). Participants had a better basic knowledge of traditional contraceptive methods (77.5%) compared to modern ones (56.1%). Interpretation: This is the first comprehensive review of gynecologic needs of survivors of torture in NYC. Prior history of GBV is common. It appears that while many have had prenatal care, overall knowledge and use of contraception in this population is very low compared to the general population