The association between intimate partner violence and low birth weight and preterm delivery in eastern Ethiopia: Findings from a facility-based study

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.

Intimate partner violence and antenatal care utilization predictors in Uganda: an analysis applying Andersen's behavioral model of healthcare utilization

BACKGROUND

Optimal utilization of antenatal care (ANC) services improves positive pregnancy experiences and birth outcomes. However, paucity of evidence exists on which factors should be targeted to increase ANC utilization among women experiencing intimate partner violence (IPV) in Uganda.

OBJECTIVE

To determine the independent association between IPV exposure and ANC utilization as well as the predictors of ANC utilization informed by Andersen's Behavioral Model of Healthcare Utilization.

METHODS

We analyzed 2016 Uganda Demographic and Health Survey data that included a sample of 1,768 women with children aged 12 to 18 months and responded to both ANC utilization and IPV items. Our outcome was ANC utilization, a count variable assessed as the number of ANC visits in the last 12 months preceding the survey. The key independent variable was exposure to any IPV form defined as self-report of having experienced physical, sexual and/or emotional IPV. Covariates were grouped into predisposing (age, formal education, religion, problem paying treatment costs), enabling (women's autonomy, mass media exposure), need (unintended pregnancy, parity, history of pregnancy termination), and healthcare system/environmental factors (rural/urban residence, spatial accessibility to health facility). Poisson regression models tested the independent association between IPV and ANC utilization, and the predictors of ANC utilization after controlling for potential confounders.

RESULTS

Mean number of ANC visits (ANC utilization) was 3.71 visits with standard deviation (SD) of ± 1.5 respectively. Overall, 60.8% of our sample reported experiencing any form of IPV. Any IPV exposure was associated with lower number of ANC visits (3.64, SD ± 1.41) when compared to women without IPV exposure (3.82, SD ± 1.64) at p = 0.013. In the adjusted models, any IPV exposure was negatively associated with ANC utilization when compared to women with no IPV exposure after controlling for enabling factors (Coef. -0.03; 95%CI -0.06,-0.01), and healthcare system/environmental factors (Coef. -0.06; 95%CI -0.11,-0.04). Predictors of ANC utilization were higher education (Coef. 0.27; 95%CI 0.15,0.39) compared with no education, high autonomy (Coef. 0.12; 95%CI 0.02,0.23) compared to low autonomy, and partial media exposure (Coef. 0.06; 95%CI 0.01,0.12) compared to low media exposure.

CONCLUSION

Addressing enabling and healthcare system/environmental factors may increase ANC utilization among Ugandan women experiencing IPV. Prevention and response interventions for IPV should include strategies to increase girls' higher education completion rates, improve women's financial autonomy, and mass media exposure to improve ANC utilization in similar populations in Uganda.

Associations between intimate partner violence and adverse birth outcomes during pregnancy: a systematic review and meta-analysis

Background

Intimate partner violence (IPV) has been associated with an elevated risk of multiple adverse birth outcomes, yet little is known about how specific IPV influences adverse birth outcomes. The aim of this study was to examine the association between IPV during pregnancy and adverse birth outcomes (i.e., preterm birth, low birth weight, and stillbirth).

Methods

Systematic searches were conducted using four databases: EMBASE, Web of Science, PubMed, and CINAHL for observational studies published from 1 January 2011 to 31 August 2021. Two reviewers independently carried out the literature search, study selection, data extraction, assessment of the study, and risk of bias assessment; disagreements were resolved by a third reviewer. A random-effect model was used to calculate the odds ratio (OR) with a 95% confidence interval (CI) for preterm birth, low birth weight, and stillbirth. I² statistic accompanied by chi-square p-value was used to assess heterogeneity, and funnel plot and Peter's test were used to assess publication bias.

Results

In total, 23 studies met the inclusion criterion. IPV was associated with preterm birth (OR = 1.84; 95% CI: 1.37-2.49; I² = 88%), low birth weight (OR = 2.73; 95% CI: 1.66-4.48; I² = 95%), and stillbirth (OR = 1.74; 95% CI: 0.86-3.54; I² = 64%). We attained comparable results among all specific IPV including physical, sexual, emotional, and mixed.

Conclusion

Intimate partner violence and specific IPV during pregnancy were significantly associated with adverse birth outcomes, especially for physical IPV. An urgent need for greater action to prevent or intervene in IPV during pregnancy is warranted.

Systematic review registration

CRD42021282936, https://www.crd.york.ac.uk/prospero/.

Policy to Decrease Low Birth Weight in Indonesia: Who Should Be the Target?

The study aimed to analyze the target of the policy to decrease low birth weight (LBW) in Indonesia. This cross-sectional study used a sample of live births in last five years preceding the survey of birth weight. Data collection took place from July to September 2017. The weighted sample size was 17,848 participants. The variables analyzed included residence, age, marital status, education, employment, parity, and wealth. The study employed binary logistic regression in the final stage to determine the target of policy regarding LBW. The results showed that women in urban areas were 1.200 times more likely to deliver babies with LBW than women in rural areas. All age groups were less likely to deliver babies with LBW than those aged 45-49. The study also found all marital statuses had a lower likelihood of providing babies with LBW than those who had never been in a marriage. Women of all education levels had a greater risk of giving birth to babies with LBW than women with higher education levels. Unemployed women had 1.033 times more chances of delivering babies with LBW than employed women. Primiparous women were 1.132 times more likely to give birth to babies with LBW than multiparous women. Overall, the women in all wealth status categories had a higher probability of delivering babies with LBW than the wealthiest groups. The study concluded that policymakers should target women who live in urban areas, are old, have never been married, have low education, and are unemployed, primiparous, and poor to decrease LBW cases in Indonesia.

Intimate partner violence during pregnancy and adverse birth outcomes in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Intimate partner violence is a significant public health issue that affects maternal and neonatal health worldwide. Several studies have been conducted to investigate the prevalence of intimate partner violence during pregnancy as well as the factors that contribute to it. As a result, the purpose of this study was to determine the impact of intimate partner violence on birth outcomes.

METHODS

International databases including Scopus, PubMed, Google Scholar, Embase, and CINAHL were used to search primary studies. The quality and strength of the included studies were evaluated using the Newcastle-Ottawa Scale quality assessment tool. The studies heterogeneity and publication biases were assessed using I2 statistics and Egger's regression test. The Meta-analysis was carried out using STATA version 16 software.

RESULTS

A total of nine hundred and fifty-eight articles were retrieved from various databases, and seventeen articles were included in the review. The pooled prevalence of intimate violence during pregnancy in Ethiopia was 32.23% (95% CI 28.02% -36.45%). During pregnancy, intimate partner violence was a significant predictor of low birth weight (AOR: 3.69, 95%CI 1.61-8.50) and preterm birth (AOR: 2.23, 95%CI 1.64-3.04).

CONCLUSION

One in every three pregnant women experiences intimate partner violence. Women who experienced intimate partner violence during their pregnancy are more likely to experience adverse outcomes such as premature delivery and low birth weight infants.

Birth weight was associated with maternal exposure to intimate partner violence during pregnancy in southern Ethiopia: A prospective cohort study

Introduction

Birth weight is defined as the first weight of the newborn, ideally measured soon after birth. A recent Ethiopian survey estimated that 48% of births took place in health facilities. Data for women exposed to intimate partner violence (IPV) may be lacking in official statistics because these women may prefer to deliver at home, where data from non-institutional births, including reporting of birth weights, are not routinely recorded.

Objective

The aim of this study was to investigate the association between maternal exposure to IPV during pregnancy and birth weight in a community in the Wondo Genet district of southern Ethiopia.

Methods

We carried out a community-based prospective cohort study from February to December 2017. We followed up with 505 pregnant women and their newborns until after delivery. An interview about partner violence was done during pregnancy at home when enrolled. Field assistants who visited the homes measured the birth weight of each baby in grams. Twins and late birth weight measurements were excluded. Factors associated with birth weight were assessed by multiple linear regression.

Results

Birth weight was assessed within 48 h for 477 (94.5%) newborns and between 48 and 72 h for an additional 28 (5.5%). There were 365 (72.3%) institutional deliveries. In an adjusted regression analysis (IPV adjusted for socio-economic status), birth weight was 203 g lower (B -203 95% CI -320 to -87) among newborns of women exposed to IPV than among the unexposed. Birth weight was also lower in girls than in boys, in newborns delivered at home rather than in a health facility, and in babies with a younger gestational age.

Conclusion

Maternal exposure to IPV during pregnancy was associated with lower baby birth weights. Antenatal clinics should consider routinely identifying IPV-exposed women, and identifying babies with lower birth weights at home is an important indicator.