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THE CATHOLIC UNIVERSITY OF AMERICA Thai Abused Women Living in a Shelter: The Process of Becoming a Mother A DISSERTATION Submitted to the Faculty of the School of Nursing Of The Catholic University of America In Partial Fulfillment of the Requirements For the Degree Doctor of Philosophy © Copyright All Rights Reserved By Natthapat Buaboon Washington, D.C. 2013 Thai Abused Women Living in a Shelter: The Process of Becoming a Mother Natthapat Buaboon Ph.D. Director: Dr. Patricia McMullen Ph.D., JD, CNS, CRNP, Ordinary Professor and Dean Becoming a mother (BAM) is a period that is challenging for women. Unfortunately, violence directed toward the mother and infant may serve as a barrier to attainment of the maternal role. The purpose of this study was to describe the process of BAM as reported by Thai abused mothers who are living in shelters by using grounded theory methodology. A purposive sampling procedure was employed to recruit Thai abused mothers who lived in four non-profit, charitable shelters in Thailand. A total of 21 participants, who were Thai and between 18 to 33 years of age, had resided in a shelter for two to ten months were interviewed. Four phases were reported: “Preparing to Be a Mother” described the process of BAM, noting that it began outside the shelter during pregnancy. Participant’s babies were a main factor that empowered them to get away from their abusive relationship, seek assistance, and prepare for their maternal role. “Struggling to Be a Good Mother”, the second theme of the process, reflected personal, environmental, and financial problems experienced and the strategies they used to better cope with their situation. The third theme, “Making Progress”, referred to behaviors that promoted a positive maternal role and mother-baby interaction. The final theme, “Being a Good Mother on their Own terms”, reflected how they achieved the role of being a good mother. They described that they needed to stand on their own feet, go back into the world, and provide a better life to their baby by placing the baby up for adoption. Results indicated that Thai mothers who lived in shelters were faced with high levels of tension and lived with limited resources. Despite these challenges, they still defined themselves as successful mothers, even if, this definition of being a good mother was different from the idealized mother. Thai policy makers and health care providers should incorporate the findings of this study into social policy and healthcare services for this vulnerable group. Such measures may include: (1) enacting laws which hold fathers at least partially responsible for child support; (2) encouraging services that minimize the stigma such women report; (3) offering more flexibility in terms of when women must participate in shelter activities; (4) ensuring adequate educational or job training programs for women who experience DV; and (5) establishing systems where mothers who place their child up for adoption or foster care are able to maintain a relationship with their infant. This dissertation by Natthapat Buaboon fulfills the dissertation requirement for the doctoral degree in Nursing approved by Patricia McMullen Ph.D., JD, CNS, CRNP, Ordinary Professor and Dean, as Director, and by Barbara Moran, Ph.D, CNM, and Janice B. Griffin Agazio, Ph.D, CRNP, RN as readers Patricia McMullen Ph.D, JD, CNS, CRNP,Director Barbara Moran, Ph.D, CNM , Reader Janice B. Griffin Agazio, Ph.D, CRNP, RN, Reader ii Dedication To my family: Wilas; Nupian; Dussadee Buaboon; and Jiranat Rajchaleewong who always give me unconditional love. To my professor: Patricia McMullen, Barbara Moran, and Janice B. Griffin Agazio who provided their enthusiastic support and devoted their times for my study. To my friends and my colleagues at School of nursing, Thammasat University, Thailand, who help me pursue my dream, support me, so I could complete this project. To The National Science and Technology development Agency, that offered scholarship and To all participants who shared their tough experiences with me, without them I could not finish my research. iii Table of Content Page DEDCATION iii LIST OF TABLES vii LIST OF FIGURE viii CHAPTER I. INTRODUCTION Background of the Study 1 Statement of purpose 9 Statement of research question 9 Definition of Terms 9 Assumptions 16 Limitations 17 Significance 17 II. REVIEW OF THE LITERATURE Overview of Thailand 18 Socio-cultural factors affecting becoming a mother in Thai abused women. 20 Domestic Violence and Pregnancy 22 Abused women living in a shelter 27 The theoretical framework of becoming a mother 29 Becoming a mother in Thailand 31 iv Page III. METHODOLOGY Research Design 33 Theoretical perspective: Grounded theory method 34 Participants 40 Research Setting 41 Protection of Human Subjects 42 Research Procedure 43 Data Analysis 45 Establishing Trustworthiness 45 Limitations 47 Summary 48 IV. PRESENTATION OF FINDINGS Demographic Characteristics of the Participants and Their Families 49 Development of the Conceptual Categories 55 The four Phases of the Process of Becoming a Mother: Preparing to be a Mother 60 Struggling to be a good mother 69 Making Progress 86 Being a good mother on my own terms 93 Summary 96 v page V. SUMMARY, DISCUSSION OF THEFINDINGS, C0NCLUSION, AND RECOMENDATIONS Summary of the Findings 99 Relationship of Findings to Existing Research 111 Implications for Nursing Research, Practice, Education, and Policy Maker 120 Recommendation for Future Research 121 Conclusion 122 APPENDICES Inform Consent form 125 Study Instruments 132 Flyer 137 REFERENCES 140 vi LIST OF TABLES Table Page 1. Demographic Characteristics of Participants 51 2. Demographic Characteristics of Participants’ Partners 53 3. Demographic Characteristics of Participants’ Babies 54 4. Sample of Transcribed Interview with Recorded Codes 57 5. Cluster of Substantive Codes and Conceptual Categories 59 Explaining the Process of Becoming a mother 6. Properties and Indicators of the Second Phase 70 of the Process of Becoming a Mother: Struggle with Being a Mother vii LIST OF FIGURE Figure Page 1. The Process of becoming a Mother in Thai Abused Mothers Living in Shelters. 97 viii 1 Running head: The Process of becoming a Mother 1 Chapter 1 Introduction Background of the Study Domestic violence against women is a serious human rights issue and remains a significant health care issue in all parts of the world. Various terms are used to describe domestic violence including intimate partner violence, spousal abuse, domestic violence, courtship violence, battering, marital rape, date rape, and dating violence. The United Nations defines violence against women as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life (World Health Organization, 2012).” Consequently, domestic violence can consist of physical abuse, sexual abuse, emotional abuse, economic abuse, or psychological abuse that has an influence on women or family members Violence against women and domestic violence are mostly committed by men and occurs regardless of race, age, socioeconomic status, religious or cultural background, or mental or physical ability (WHO, 2012). Currently, domestic violence has been reported in newspapers, on television, and by researchers: however, these reports may underestimate actual levels of domestic violence (Friends of Women, 2007). Statistics on domestic violence vary, but recent estimates have indicated that 22 million U.S. women have been assaulted in their lifetime. 63.84% of these women were abused by a current or former intimate partner (National Intimate Partner and Sexual Violence Survey, 2011). About one out of every four women will face 1 Running head: The Process of becoming a Mother 2 domestic abuse in her lifetime and 1.3 million women are sufferers of domestic violence each year (U.S. Conference of Mayors, 2008). Violence can increase in frequency and intensity during pregnancy and child bearing (Chatchawanwit, 2008). In Thailand, all types of violence against women have increased (The government public relation department, 2008). The majority of cases of violence against women are committed by partners. From 2003 to 2006, the incidence of intimate partner violence (IPV) reported in five major Thai newspapers were 184, 386, 603, and 561 respectively (Friends of Women, 2007). It has been hypothesized that reasons for the increase in violence against Thai women is attributable to such factors as poverty and alcohol consumption (Aekplakorn and Kongsakon, 2007: Thai Government Public Relations Department, 2008). From the findings of Aekplakorn and Kongsakon (2007), they conducted a cross-sectional survey in 580 married women from seven slum communities in Bangkok. The result found that 27.2 % were abused by their intimate partner abuse. The variables associated with partner violence conflicts included financial problems (OR 1.97, 95 percent CI 1.20-3.22) and regular alcohol consumptions (OR 3.72, 95 percent CI 2.02-6.89). Moreover, the Thai government has launched the national campaign to stop violence against women and to draw the society’s attention of domestic abuse. In the past, Most Thai people perceived that domestic violence was family problems. It should be hidden only in their families and abused women were embarrassed to speak up for their rights. Throughout this campaign, many public and private organizations have arranged activities to societal awareness of the problem of violence against women. This campaign also helps to encourage women to speak out about this problem and promote Thai people to change their attitudes (Thai Running head: The Process of becoming a Mother 3 Government Public Relations Department, 2008). Domestic violence is not a family problem. All Thais must aware this problem and help to stop any kind of abuse. Despite this program has launched, the prevalence of IPV in Thailand still rises every day.