Association between spousal emotional abuse and reproductive outcomes of women in India: findings from cross-sectional analysis of the 2005-2006 National Family Health Survey

Marital violence affects reproductive health and pregnancy outcomes in Northeast India

BACKGROUND

As per the National Family Health Survey (NFHS-4, 2015-16) report, 40% of women aged 15-49 in India experienced intimate partner violence (IPV), with emotional abuse significantly associated with negative reproductive health (RH) outcomes.

METHODS

The study uses secondary data from the NFHS-4 and conducts statistical analysis based on information gathered from 8766 married women aged 15-49 years in Northeast India. Bivariate analysis followed by multiple logistic regression analysis is performed to understand the relationship between IPV and its effects on women's RH.

RESULTS

The findings indicate that ever-married women in Northeast India have faced physical violence (25.1%), sexual violence (11.8%), emotional abuse (6.4%) and severe violence (5.3%). Among all women who participated in the study, 6.9% had experienced non-live births, 4.2% miscarriages, 2.4% abortions, 0.3% stillbirths, 16.9% terminated pregnancies and 2.1% sexually transmitted infections (STI). Sexually abused women (SAW) showed higher likelihoods of non-live births, STIs, miscarriages, abortions and pregnancy terminations. SAW had a 65% higher risk of miscarriages, while those experiencing physical violence had a 64% increased risk of abortions.

CONCLUSION

IPV significantly impacts women's RH in Northeast India. This study presents evidence from surveys on sexual and RH among married women affected by IPV in Northeast India.

Linkages between maternal experience of intimate partner violence and child nutrition outcomes: A rapid evidence assessment

BACKGROUND

A strong evidence base indicates that maternal caregivers' experience of intimate partner violence [IPV] impacts children's health, cognitive development, and risk-taking behaviors. Our objective was to review peer-reviewed literature describing the associations between a child's indirect exposure to IPV and corresponding nutrition outcomes, with a particular focus on fragile settings in low and middle-income countries [LMICs].

METHODS

We conducted a rapid evidence assessment to synthesize quantitative associations between maternal caregivers' IPV experience and children's nutrition/growth outcomes (birthweight, feeding, and growth indicators). We included peer-reviewed research, published in English or Spanish after the year 2000, conducted in fragile settings in LMICs.

RESULTS

We identified 86 publications that fit inclusion criteria. Amongst all associations assessed, a maternal caregiver's experience of combined forms of IPV (physical, sexual and emotional) or physical IPV only, were most consistently associated with lower birthweight, especially during pregnancy. Women of child-bearing age, including adolescents, exposed to at least one type of IPV showed a decreased likelihood of following recommended breastfeeding practices. Lifetime maternal experience of combined IPV was significantly associated with stunting among children under 5 years of age in the largest study included, though findings in smaller studies were inconsistent. Maternal experience of physical or combined IPV were inconsistently associated with underweight or wasting in the first five years. Maternal experience of sexual IPV during pregnancy appeared to predict worsened lipid profiles among children.

CONCLUSION

Maternal caregivers' experience of IPV is significantly associated with low birthweight and suboptimal breastfeeding practices, whereas studies showed inconsistent associations with child growth indicators or blood nutrient levels. Future research should focus on outcomes in children aged 2 years and older, investigation of feeding practices beyond breastfeeding, and examination of risk during time periods physiologically relevant to the outcomes. Programmatic implications include incorporation of GBV considerations into nutrition policies and programming and integrating GBV prevention and response into mother and child health and nutrition interventions in LMIC contexts.

Interparental Coercive Control and Child and Family Outcomes: A Systematic Review

Coercive control (CC) is a core facet of intimate partner violence (IPV) and involves asserting power, dominance, and control over another person. Although the adverse impacts of childhood exposure to interparental IPV have been well documented, the outcomes of childhood exposure to interparental CC have not been systematically examined. This study aimed to address this gap by reviewing available empirical evidence on interparental CC and child and family outcomes. Articles were identified by searching electronic databases using keywords relating to CC, children and parents, and child wellbeing outcomes. The final review included 51 studies that reported on adverse outcomes pertaining to parenting and family relationships (k = 29), child internalizing and externalizing problems (k = 7), social-emotional development (k = 5), and physical/health development (k = 17). Specifically, studies reported that CC was associated with increased parental psychopathology, poorer family functioning, harsher parenting and higher levels of child abuse, strained parent-child relationships, children used as tools and co-victims of CC, increased risk of child internalizing and externalizing problems, limited socializing opportunities, increased bullying, poorer perinatal outcomes, limited access to healthcare, and increased risk of child mortality. Evidence identified CC as a unique contributor to adverse child wellbeing outcomes, independent of exposure to IPV more broadly. Results indicated that the impacts of childhood exposure to CC are complex, far reaching, and, in some cases, devastating. The limitations of the findings, as well as implications for practice, policy, and research are discussed.

Is there an association between intimate partner violence and the prevalence of cervical cancer screening in Jordan?

BACKGROUND

Major health inequalities exist surrounding the utilisation of cervical cancer screening services globally. Jordan, a low- and middle-income country, has poor screening rates (15.8%), with barriers to accessing services, including lack of education. Emerging studies demonstrate that intimate partner violence (IPV) impacts reproductive health decisions. As a large proportion of Jordanian women have reported experiencing IPV, this study examines the association between IPV and cervical cancer screening in Jordan, the first of its kind using national-level data.

METHODS

Using Jordan's Demographic Health Survey 2017-18, cervical cancer screening awareness and self-reported screening were estimated in participants who answered questions on IPV (n = 6679). After applying sample weights, Heckman's two-stage probit model determined the association of awareness and utilisation of cervical cancer screening with experience of IPV, adjusting for the socio-economic factors.

RESULTS

Of the women with privacy to answer the IPV module, 180 (3.4%) were found to be victims of sexual violence, 691 of physical violence (12.6%) and 935 (16.2%) of emotional violence. Women subjected to sexual violence were less likely to admit to having awareness of a Pap smear test; however, this did not impact screening rates. Victims of emotional violence were more likely to be screened than non-victims. No association between physical violence and cervical cancer screening was found.

CONCLUSIONS

A significant association between cervical screening awareness and IPV demonstrates that cancer screening policies must consider IPV among women to improve screening awareness. The paper further sheds light on the paradoxical association between emotional violence and screening. It is acknowledged this situation may be far worse than reported, as women without autonomy were unlikely to answer IPV questions that may endanger them-targeted surveys on cervical cancer screening warrant further investigation.

Panorama of Intimate Partner Violence Against Women in Brazil and its Association With Self-Perception of Health: Findings From a National Representative Survey

Intimate partner violence (IPV) is a challenge in Brazil. The country holds one of the highest rates of femicide in the world, most of which are preceded by IPV. We conducted a cross-sectional study with 34,334 women, aged 18 to 59 years, from the 2019 Brazilian National Health Survey to analyze the prevalence of IPV and its subtypes among the Brazilian adult women in the last 12 months, encompassing their health consequences and the use of health services resulting from IPV. We also used logistic regression models to estimate the association of sociodemographic characteristics and self-perceived health status with IPV. The prevalence of IPV among Brazilian adult women in the last 12 months was 7.6% (95% confidence interval [CI] [7.0, 8.2]). Women aged 18 to 39 years, not married, and with income of up to 1 minimum wage (MW), had higher odds of suffering IPV. Among those who reported health consequences due to IPV, 69% reported psychological consequences, and 13.9% sought health care, mostly in primary or secondary health care services in the Brazilian Unified Health System (41.9%). Regarding the self-perceived health variables, women who reported eating problems (odds ratio [OR]  =  1.29; [1.01, 1.65]), lack of interest/absence of pleasure (OR  =  1.41; [1.11, 1.79]), depressive feelings (OR  =  1.39; [1.03, 1.88]), feeling of failure (OR = 1.75; [1.36, 2.24]), and suicidal thoughts (OR = 1.73; [1.25, 2.41]) had greater odds of reporting IPV compared to those who did not report these same perceptions. The results show that younger, divorced or single, low-income women with eating problems and mental health disorders were more likely to suffer IPV. IPV often led to health problems, and many abused women sought support from public health services. Health professionals must be trained to identify and care for these women, thereby acting as allies in preventing and reducing IPV.

Maternal exposure to intimate partner violence and uptake of maternal healthcare services in Ethiopia: Evidence from a national survey

Background

Women exposed to Intimate Partner Violence (IPV) often do not utilize maternal health care optimally both because of stigma and other social problems. The current study aims to explore an association between maternal healthcare seeking and violence exposure among Ethiopian women and to assess if educational attainment and wealth status moderate this association.

Methods

The analyses included 2836 (weighted) currently married women with one live birth. We focus on the five years preceding the 2016 Ethiopian Demographic and Health Survey (EDHS) who participate, in the domestic violence sub-study. Exposure was determined by maternal reports of physical, emotional, sexual IPV or any form of IPV. The utilization of antenatal care (ANC) and place of delivery were used as proxy outcome variables for uptake of skilled maternal healthcare utilization. Women’s education attainment and wealth status were selected as potential moderators, as they can enable women with psychological and financial resources to counteract impact of IPV. Multilevel logistic regression analyses were used to explore the association between spousal IPV and maternal health outcomes. Moderation effects by education and wealth status were tested, and the data stratified. Using statistical software Stata MP 16.1, the restricted maximum likelihood method, we obtained the model estimates.

Results

About 27.5% of the women who reported exposure to any form of IPV had a health facility delivery. While 23.4% and 22.4% visited four or more antenatal care services among mothers exposed to emotional IPV and sexual IPV, respectively. After adjusting for potential confounding factors, only the association between maternal exposure to emotional IPV and adequate use of ANC was statistically significant (OR = 0.73, (95% CI:0.56–0.95)). But we found no significant association between IPV and utilization of health facility delivery. Some moderation effects of education and wealth in the association between IPV and maternal healthcare service utilization outcome were found.

Conclusion

Exposure to emotional IPV was associated with poor uptake of maternal health care service utilization for married Ethiopian women. While developing interventions to improve women’s maternal healthcare service use, it is crucial to consider the effects of socio-economic variables that moderate the association especially with the intersection of IPV.

Physical violence against women by their intimate partner during pregnancy and its relationship with breastfeeding

Abstract Objectives: to estimate the association between physical violence against women by their intimate partner during pregnancy and breastfeeding. Methods: the data source is the 2010 National Demographic and Health Survey (DHS) conducted in Colombia, and 11,416 mother-child dyads were analysed. The relationship between physical violence against women by their partner during pregnancy and breastfeeding indicators was carried out using the weighted propensity score from the Inverse Probability of Treatment Weighting (IPTW). Variables for adjustment were selected through the Directed Acyclic Diagram (DAG) and performed a sensitivity analysis to identify the strength of hidden bias. Results: according to the data, 6.4% (730) of the women suffered physical violence by their partner during their pregnancy. The median time of exclusive breastfeeding was 1.0 month. No statistically significant relationship was observed with any of the breastfeeding indicators analysed: exclusive breastfeeding (OR=1.17; CI95%=0.82-1.67); breastfeeding at any time (OR=1.61; CI95%=0.58-2.60); and initiation of breastfeeding (OR=1.07; CI95%=0.74-1.2) Conclusion: although the association between violence against women committed during pregnancy and breastfeeding indicators was not found, the suboptimal breastfeeding practices and high prevalence of violence against women by the partner are two major public health issues in Colombia. Prenatal care professionals can change this scenario by identifying women exposed to intimate partner violence and offering tailored support for breastfeeding practices.

Domestic Violence and Sterilization Skew in India: An Instrumental Variable Analysis

The objective of this study was to assess the prevalence of domestic violence in ever-married women in India and analyze the relationship between domestic violence and use of female sterilization as contraception. We analyzed data from the National Family Health Survey 2005-2006 (NFHS3). The Domestic Violence Module of the survey included abuse experiences and reproductive health outcomes of ever-married women aged 15 to 49 years (n = 69,704). The main outcome of interest was female sterilization and domestic violence experience was the main independent variable. Covariates in our multivariate regression models were guided by the socioecological model for domestic abuse. We estimated a reference linear probability model for the dichotomous outcome. We also employed an instrumental variables procedure to strengthen causal inference under such potential sources of bias as measurement error in reporting domestic violence and omitted variables. The reference model showed an increase of 2.1 percentage points (p < .001) in the probability of female sterilization associated with exposure to domestic violence. After correcting the estimate for the measurement error and omitted variable bias, we found that domestic violence was associated with an increase in female sterilization by 6.4 percentage points (p < .001), which is 18% higher than the rate of sterilization among non-victims. In conclusion, our findings imply that domestic violence may lead abuse victims to opt for female sterilization as contraception. Domestic violence is a significant obstacle to efficient contraceptive use. Programs directed toward violence prevention should work conjointly with family planning programs in India.

Intimate partner violence and breastfeeding: a systematic review

OBJECTIVE

The association between intimate partner violence (IPV) and breastfeeding is unclear. We conducted a systematic review to summarise the evidence of breastfeeding outcomes following exposure to IPV.

DESIGN

Systematic review.

METHODS

We searched for published studies without study design or language restrictions (up to July 2019) in the following databases: PubMed, Embase, SCOPUS and The Global Health Library. Studies assessing various breastfeeding outcomes (initiation, duration and exclusive breastfeeding) in women exposed to IPV in any form (physical, psychological or sexual) and at any stage (1 year pre-pregnancy, during or post-pregnancy) were included. Two authors independently selected the studies and conducted the quality appraisal by use of the Newcastle-Ottawa Scale. Results were summarised taking precision and quality into account.

RESULTS

A total of 16 studies (participants n=414 393) were included and they adjusted for a total of 48 different confounders. The majority of studies were cross-sectional (n=11) and most studies were judged to be fair/low quality. Four out of seven studies found that IPV exposure shortened breastfeeding duration (adjusted ORs/aORs=0.22 (95% CI: 0.05-0.85), 1.18 (95% CI: 1.01-1.37), 5.92 (95% CI: 1.72-27.98), 1.28 (95% CI: 1.18-1.39)). Further, 5/10 studies found that IPV led to early termination of exclusive breastfeeding (aORs=1.53 (95% CI: 1.01-23.1), 0.83 (95% CI: 0.71-0.96), 1.35 (95% CI: 1.07-1.71), 0.17 (95% CI: 0.07-0.4), 1839 (95% CI: 1.61-2911)) and 2/6 studies found that IPV significantly reduced breastfeeding initiation (aORs=2.00 (95% CI: 1.2-3.3), 0.81 (95% CI: 0.7-0.93)).

CONCLUSION

IPV exposure appears to associate negatively with some breastfeeding outcomes. Individual patient data meta-analysis is required to quantify the magnitude of the association for specific IPV-outcome combinations. More high-quality studies and definition of core confounders are warranted.

PROSPERO REGISTRATION NUMBER

CRD42019129353.

The mediation effect of contraceptive use and women's autonomy on the relationship between intimate partner violence and unintended pregnancy in Ethiopia

Background

Intimate partner violence (IPV) affects one in every three women globally. Previous studies have revealed that women’s experiences of different forms of IPV are significantly associated with a higher rate of unintended pregnancy, reduced uptake of contraception, and reduced ability to make decisions regarding their fertility. The aim of this study was to investigate whether previously observed relationships between IPV and unintended pregnancy in Ethiopia are mediated by contraceptive use and women’s autonomy.

Methods

This study was performed using nationally representative data from the 2016 Ethiopian Demographic and Health Survey (EDHS). A subsample of married women of reproductive age reporting a pregnancy within the 5 years preceding 2016 and who participated in the domestic violence sub-study of the survey were included in analyses. Logistic regression models, together with the product of coefficients method, were used to estimate direct and mediated effects.

Results

Twenty six percent of participants reported an unintended pregnancy in the 5 years preceding the survey. Sixty-four percent reported having ever experienced IPV (a composite measure of physical, sexual, emotional abuse, and partner controlling behaviour). After adjusting for potential confounding factors, unintended pregnancy was significantly positively associated with reporting sexual IPV, emotional IPV, IPV (a composite measure of physical, sexual, or emotional abuse), and multiple partner controlling behaviour. However, IPV (as a composite of all four forms), physical IPV, and partner control (single act) were not significantly associated with unintended pregnancy. Women’s autonomy, but not contraception use, had a significant partial mediation effect in the relationships between some forms of IPV and unintended pregnancy. Women’s autonomy mediated about 35, 35, and 43% of the total effect of emotional IPV, IPV (physical, sexual, and/or emotional), and multiple partner control on unintended pregnancy respectively.

Conclusion

Women’s autonomy appears to play a significant role in mediating the effect of IPV on unintended pregnancy in Ethiopia. Maternal health service interventions in Ethiopia could incorporate measures to improve women’s decision-making power to reduce the negative reproductive health effects of IPV.

Intimate partner violence against women and its association with pregnancy loss in Ethiopia: evidence from a national survey

Background

Intimate partner violence (IPV) is major public health problem that affects many dimensions of women’s health. However, the role of IPV on women’s reproductive health in general and pregnancy loss in particular, is largely unknown in Ethiopia. Therefore, this study investigated the association between IPV and pregnancy loss in Ethiopia.

Methods

A retrospective analysis of nationally representative data from the 2016 Ethiopian Demographic and Health Survey (EDHS) was conducted. Married women of reproductive age (15–49 years) who participated in the domestic violence sub-study of the survey were included in the analysis. Adjusted odds ratios were estimated using multilevel logistic regression models to represent the association of IPV with outcome variable.

Results

Among 4167 women included in the analysis, pregnancy loss had been experienced by 467 (11.2%). In total, 1504 (36.1%) participants reported having ever experienced any form of IPV, with 25.1, 11.9, and 24.1% reporting physical, sexual and emotional IPV respectively. A total of 2371 (56.9%) women had also experienced at least one act of partner controlling behaviour. After adjusting for potential confounders, a significant association was observed between IPV (a composite measure of physical, sexual and emotional abuse) and pregnancy loss (Adjusted Odds Ratio (AOR) 1.54, 95% Confidence Interval (CI): 1.12, 2.14). The odds of pregnancy loss were also higher (AOR 1.72, 95% CI: 1.06, 2.79) among women who had experienced multiple acts of partner controlling behaviours, compared with women who had not experienced partner controlling behaviours. The intra-class correlation coefficient (ICC) indicated that pregnancy loss exhibits significant between-cluster variation (p < 0.001); about 25% of the variation in pregnancy loss was attributable to differences between clusters.

Conclusion

IPV against women, including partner controlling behaviour, is significantly associated with pregnancy loss in Ethiopia. Therefore, there is a clear need to develop IPV prevention strategies and to incorporate IPV interventions into maternal health programs.