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Not all women who fear violence because of using or discussing contraceptives are necessarily at risk of actual abuse. In fact, some studies suggest that many men may be more accepting of family planning than most women suspect (Gallan 1986). But communication in marriage is often so limited that women have no idea of their partner’s view of family planning but assume that it mirrors the cultural norm-frequently that men want large families and distrust women who use birth control. The discrepancy between women’s perceptions and reality also speaks to the way that violence induces fear by example.
Even in countries where birth control is generally accepted, violence can restrict a women’s ability to exercise reproductive and sexual autonomy. In a representative survey of women in Texas, more than 12 percent of the 1,539 respondents reported having been sexually abused by a husband, ex-husband, boyfriend, or ex-boyfriend after the age of 18. Of those 187 women, 12.3 percent stated that they had been prevented from using birth control and 10.7 percent that they had been forced to get pregnant against their will (Grant, Preda, and Martin 1989).
Studies from the United States suggest that sexual victimization may play an indirect role in perpetuating unwanted pregnancy. In a community based, random survey of women in Los Angeles, Wyatt, Gutherie, and Notgrass (1992) found that women who were sexually abused in childhood were 2.4 times more likely to be sexually revictimized during adulthood; revictimized women, in turn, had a significantly higher rate of unintended and aborted pregnancies than non-revictimized women.
Boyer and Fine’s (1992) study of adolescent mothers in Washington State, discussed above in the section on the health effects of child and adolescent sexual abuse, suggests that there an: links between childhood sexual abuse and unwanted pregnancy among teenage women. Noting that concerted effort to improve teenagers’ access to contraception and sex education had failed to reduce the rate of adolescent pregnancy in the United States over the past 20 years, the authors suggest that a “key factor in the conundrum of adolescent high-risk sexual behavior and adolescent pregnancy” (1992, p. 11) may be unresolved issues around early sexual victimization.
Effect on std and aids prevention.
Not surprisingly, male violence can impede women’s ability to protect themselves from HIV and other sexually transmitted diseases (STDs). Violence can increase a woman’s risk through nonconsensual sex or by limiting her willingness or ability to get her partner to use a condom. In many cultures suggesting condom use is even more threatening than raising birth control in general, because condoms are widely associated with promiscuity, prostitution, and disease. A woman’s act of bringing up condom use can be perceived as insinuating her infidelity or implicitly challenging a male partner’s right to conduct outside relationships. Either way, it may trigger a violent response (Worth 1989).
An AIDS prevention strategy based solely on “negotiating.” condom use assumes an equity of power between men and women that simply does not exist in many relationships. Even in consensual unions, women often lack control over their sexual lives. A study of home-based industrial workers in Mexico, for example, found that wives’ bargaining power in marriage was lowest with regard to decisions about whether and when to have sexual intercourse (Beneria and Roldan 1987). Studies of natural family planning in the Philippines, Peru, and Sri Lanka and of sexual attitudes among women in Guatemala report forced sex in marriage, especially when men arrive home drunk (Liskin 1981; Lundgren and others 1992_. The summary of the Guntemalan study’s focus groups observes that “it is clear from the replies the women gave. that being forced through violence to have sex by their partner is not an uncommon experience for Guatemalan women” (Lundgren and others 1992, p. 34).
For women who live with violent or alcoholic partners the possibility of coercive sex is even more pronounced. In the United States 10 to 14 percent of married women report being physically forced to have sex against their will, but among battered women the prevalence of coercive intercourse is at least 40 percent (Campbell and Alford 1989). In Bolivia and Puerto Rico 58 percent of battered wives report being sexually assaulted by their partner (ISIS International 1988), and in Colombia the reported rate is 46 percent (PROFAMILIA 1992). Given the percentage of women around the world who live with physically abusive partners, sexual coercion within consensual unions is probably common.
Childhood sexual abuse also puts individuals at increased risk of STDs, including AIDS, through the responses it generates in victims. Several studies link a history of sexual abuse with a high risk of entering prostitution (Finkelhor 1987; James and Meyerding 1777). Researchers from Brown University found that men and women who had been raped or forced to have sex during their childhood or adolescence were four times more likely than non-abused people to have worked in prostitution (Zierler and others 1991). They were also twice as likely to have multiple partners in any single year and to engage in casual sex with partners they did not know. Women survivors of childhood sexual assault were twice as likely to be heavy consumers of alcohol and nearly three times more likely to become pregnant before age 18. These behaviors did not translate directly into higher rates of HIV among women, but men who had experienced childhood sexual abuse were twice as likely to be HIV-positive as men who had not. The higher prevalence of HIV among male survivors could not be explained by a history of intravenous drug use.
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