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PURPOSE Domestic violence is prevalent among women using primary health care services in Lebanon and has a negative effect on their health, yet physicians are not inquiring about it. In this study, we explored the attitudes of these women regarding involving the health care system in domestic violence management. METHODSWe undertook a qualitative focus group study. Health care professionals in 6 primary health care centers routinely screened women for domestic violence using the HITS (Hurt, Insult, Threaten, Scream) instrument. At each center, 12 women who were screened (regardless of the result) were recruited to participate in a focus group discussion.RESULTS Most of the 72 women encouraged involvement of the health care system in the management of domestic violence and considered it to be a "socially accepted way to break the silence." Women expected health care professionals to have an "active conscience"; to be open minded, ready to listen, and unhurried; and to respect confi dentiality. Additionally, they recommended mass media and community awareness campaigns focusing on family relationships to address domestic violence.CONCLUSIONS Addressing domestic violence through the health care system, if done properly, may be socially acceptable and nonoffensive even to women living in conservative societies such as Lebanon. The women in this study described characteristics of health professionals that would be conducive to screening and that could be extrapolated to the health care of immigrant Arab women. Ann Fam Med 2012;10:213-220. doi:10.1370/afm.1336. INTRODUCTIOND omestic violence is prevalent worldwide and associated with considerable morbidity and mortality.1,2 Women exposed to domestic violence are more likely to have physical symptoms, poor pregnancy outcomes, sexually transmitted infections, and elective abortions. [3][4][5][6] Such consequences lead to poorer physical and mental health, more hospitalizations, greater use of outpatient care for acute problems, and less preventive care. [7][8][9][10] Although numerous medical associations, governmental agencies, and advocacy groups recommend routinely screening for or inquiring about domestic violence, 11,12 many physicians, even in developed countries, do not follow these recommendations 13 for various reasons, including lack of knowledge, inadequate training, and fear of offending patients. 14 Several studies have been conducted in developed countries to identify women's attitudes toward routine screening and disclosure of domestic violence in health care settings. A systematic review of 20 peer-reviewed quantitative studies concluded that 43% to 85% of female respondents were in favor of universal screening for intimate partner violence. 213 HE A LT H C A R E A ND D O MES T IC VIOL ENCEincluding victims of violence, would actually endorse screening for such violence under certain conditions: assurance of privacy, a nonjudgmental clinician, and provision of a rationale for the purpose of the screen. 16In addition, female patients in the Unite...

Objectives: To determine the factors associated with domestic violence against pregnant Palestinian refugee women residing in Lebanon and currently using the United Nation Relief and Work Agency's (UNRWA) primary healthcare services. Methods: This was a cross-sectional study conducted at a polyclinic of primary healthcare of the UNRWA in South Lebanon during the years 2005-2006. The sample was 351 pregnant women who were 15-42 years of age and not accompanied by their husbands or relatives. All women were invited by the midwife to participate in the study during their visit to the clinic for their first checkup or during a follow-up visit. The Abuse Assessment Screen instrument was used to screen for past and recent history of physical and emotional abuse among the participants. Results: Domestic violence was significantly associated with education, gestational age, fear of husband or someone else in the house, and unintended pregnancy. The odds of abuse for women with an elementary or lower education were 6.86 (95% CI 1.2-38.1) and for women with an intermediate or secondary education 6.84 (95% CI 1.4-33.3) compared with women with a university education. The odds of abuse during pregnancy for women whose husbands did not desire their pregnancy were 3.80 (95% CI 1.5-9.7) compared with other women. Conclusions: Domestic violence against women in Lebanon was associated with educational level, gestational age, fear of husband or someone else in the house, and unintended pregnancy.

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The purpose of this paper is to describe trends in fertility and fertility change in the West Bank and Gaza Strip during the years 1968-1992, with a particular focus on the recent rise in fertility. The paper is based primarily on vital registration data. The findings show that the fertility transition has been well underway in the West Bank since 1985, with a lull during the Intifada period. No indication of a fertility transition in the Gaza Strip was found. An examination of the age pattern of fertility reveals that Palestinian fertility has been increasingly shifting toward younger ages, with a particular concentration in the age group 15-24 during the Intifada period. A decomposition analysis of the fertility rates shows that the recent rise in fertility is essentially due to changes in marital structure, but also to increased fertility within marriage among younger women. No evidence of increased fertility among older women is found. Some implications of the findings are discussed.