Unintended pregnancy and intimate partner violence around pregnancy in a population-based study

Association between intimate partner violence and pregnancy intention: evidence from the Peruvian demographic and health survey

BACKGROUND

Intimate partner violence (IPV) in Peru represents a significant public health challenge. IPV can influence women's reproductive and social behaviors, undermining fertility control, and exacerbating unintended pregnancies. Our objective was to assess the association between IPV and pregnancy intention among Peruvian women of reproductive age.

METHODS

We conducted a secondary analysis of Peru's 2020 Demographic and Family Health Survey data. The independent variable in this study was IPV against women, which includes psychological IPV, sexual IPV, and physical IPV. If a respondent experienced any of these three forms of IPV, the IPV variable was labeled as "yes"; if none were present, it was labeled as "no". The dependent variable was pregnancy intention (no vs. yes). We utilized a generalized linear model (GLM) from the Poisson family with a log link function to assess the relationship between IPV occurrences (total and each IPV type) and pregnancy intention. We report crude and adjusted prevalence ratios (aPR) with 95% confidence intervals (95%CI).

RESULTS

We analyzed data from 8466 women aged 15 to 49. The prevalence of any IPV was 49.6% (psychological IPV: 45.8%; physical IPV: 22.2%; and sexual IPV: 4.3%). Exposure to physical IPV (aPR: 1.05; 95% CI: 1.03-1.07), psychological IPV (aPR: 1.04; 95% CI: 1.02-1.06), and sexual IPV (aPR: 1.09; 95% CI: 1.04-1.13), as well as a history of any IPV (aPR: 1.05; 95% CI: 1.02-1.07), were associated with a higher probability of not intending to become pregnant. This association persisted after adjusting for confounders like age, marital status, educational attainment, education level of the child's father, place of residence, wealth, ethnicity, and parity.

CONCLUSION

One in two Peruvian women reported experiencing IPV. An association was observed between IPV exposure and a higher probability of not holding an intention to become pregnant.

Barriers Faced by Australian and New Zealand Women When Sharing Experiences of Family Violence with Primary Healthcare Providers: A Scoping Review

Despite the Australian Government's attempts to reduce domestic violence (DV) incidences, impediments within the social and health systems and current interventions designed to identify DV victims may be contributing to female victims' reluctance to disclose DV experiences to their primary healthcare providers. This scoping review aimed to provide the state of evidence regarding reluctance to disclose DV incidents, symptoms and comorbidities that patients present to healthcare providers, current detection systems and interventions in clinical settings, and recommendations to generate more effective responses to DV. Findings revealed that female victims are reluctant to disclose DV because they do not trust or believe that general practitioners can help them to solve their issues, and they do not acknowledge that they are in an abusive relationship, and are unaware that they are in one, or have been victims of DV. The most common symptoms and comorbidities victims present with are sleep difficulties, substance use and anxiety. Not all GPs are equipped with knowledge about comorbidities signalling cases of DV. These DV screening programs are the most prominent intervention types within Australian primary health services and are currently not sufficiently nuanced nor sensitive to screen with accuracy. Finally, this scoping review provides formative evidence that in order for more accurate and reliable data regarding disclosure in healthcare settings to be collected, gender power imbalances in the health workforce should be redressed, and advocacy of gender equality and the change of social structures in both Australia and New Zealand remain the focus for reducing DV in these countries.

Unintended pregnancy among U.S. military active duty servicemembers: Estimates for 2018 and trends since 2005

OBJECTIVES

To evaluate the prevalence of and factors associated with unintended pregnancy in the past 12 months among women and men in the United States (U.S.) military in 2018, as well as trends in unintended pregnancy between 2005 and 2018.

STUDY DESIGN

This was a cross-sectional study using the 2018 Department of Defense Health Related Behaviors Survey of active duty servicemembers. We selected a stratified random sample from members of all military service branches and used weighted logistic regression models to identify associated independent factors. A 9.6% weighted response rate to the online survey resulted in 16,806 active duty servicemembers analyzed; 4993 women aged 17 to 44 years and 11,813 men aged 17 to 45+ years. We used data from five independent surveys: 2005, 2008, 2011, 2015, and 2018 to examine trends over time.

RESULTS

A total of 5.6% (95% CI: 4.5%-6.7%) of servicewomen reported unintended pregnancy and 2.4% (95% CI: 1.9%-2.9%) of servicemen reported to have caused unintended pregnancy. Unintended pregnancy was associated with contraception nonuse, younger age, and being either married or cohabiting.

CONCLUSION

The decrease in prevalence of unintended pregnancy among U.S. servicemembers since 2005 mirrors the general U.S.

POPULATION

Differing contraception policies during basic training across military services may influence rates of unintended pregnancy. Unintended pregnancies place a large burden on the military healthcare system, as the majority of women serving in the military are of reproductive age, and thus require care before, during, and for years after giving birth.

IMPLICATIONS

Unintended pregnancy among U.S. military servicewomen relatively mirrors that seen in the U.S.

POPULATION

Contraceptive policies affect unintended pregnancy throughout servicemembers' duration of service. As they are more likely to live in states which restrict access to abortion services, servicewomen with unintended pregnancy may face increased obstacles to care.

Design and study of psychometric properties of the Community Attitude to Abortion Scale (CAAS) with the Chilean population: Autonomy and Stigma

Introduction

Attitudes toward abortion are related to structural, cultural, and direct gender-based violence. This violence can affect women's mental, physical and reproductive health. Therefore, it is essential to know the nature of community attitudes toward abortion. Since we currently do not have an instrument that measures attitudes towards abortion in Chile, we set the objective of this study to design the Community Attitude to Abortion Scale (CAAS) and analyze its psychometric properties in a Chilean community population.

Methods

This work is an instrumental design study. Using a sampling of panelists by sociodemographic quotas, we obtained a sample of 1,223 participants with a mean age of 36.7 years (SD = 13.56).

Results

As a result, we obtained a scale of 18 items and two correlated factors, Autonomy and Stigma. This structure fits better as an Exploratory Structural Equations Model (ESEM). Both factors have excellent internal consistency. In addition, we obtained evidence of concurrent and discriminant validity: The scores on the factors of the Universal Religious Involvement Scale (I-E12) correlated negatively with Autonomy and positively with Stigma; participants with low levels of identification with a right-wing political orientation, with high levels of identification with a leftwing, pro-feminist, pro-LGBTQ +, and pro-euthanasia political orientation, obtained higher mean scores on Autonomy and lower on Stigma.

Discussion

The CAAS is an adequate tool for use with the Chilean community population, with evidence of consistency and validity. La CAAS is the first tool to measure attitudes to abortion in this country.

Landscaping the evidence of intimate partner violence and postpartum depression: a systematic review

OBJECTIVE

To assess the evidence of the association between exposure to intimate partner violence (IPV) and postpartum depression. IPV during pregnancy can have immediate and long-term physical and mental health consequences for the family. Therefore, it has been hypothesised that IPV may affect the risk of developing postpartum depression.

METHODS

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, Global Health Library, Scopus and Google scholar were searched for published studies without restrictions on language, time or study design (up to May 2020). Studies were included if they assessed postpartum depression using the Edinburg Postnatal Depression Scale (cut-off≥10), among women who had been exposed to IPV (emotional, physical and/or sexual abuse). The quality of studies was judged according to the Newcastle-Ottawa scale.

RESULTS

A total of 33 studies were included in the review (participants n=131 131). The majority of studies found an association between exposure to IPV and the development of signs of postpartum depression. Overall, studies measured both exposure and outcome in various ways and controlled for a vast number of different confounders. Thirty percent of the studies were set in low-income and lower-middle-income countries while the rest were set in upper-middle-income and high-income countries and the association did not differ across settings. Among the studies reporting adjusted OR (aOR) (n=26), the significant aOR ranged between 1.18 and 6.87 (95% CI 1.12 to 11.78). The majority of the studies were judged as 'good quality' (n=20/33).

CONCLUSION

We found evidence of an association between exposure to IPV and the development of signs of postpartum depression. Meta-analysis or individual patient data meta-analysis is required to quantify the magnitude of the association between IPV and postpartum depression.

PROSPERO REGISTRATION NUMBER

CRD42020209435.

The association between marital violence and reproductive and sexual health outcomes of women: A multi-country study of South Asia

In this study, we examined the relationship between marital violence(MV) and reproductive and sexual health outcomes of women of Bangladesh, India, Nepal and Pakistan. The lifetime MV inflicted by husbands on their wives was highest at 53% in Bangladesh, India(37%), Pakistan(28%) and Nepal(28%) respectively. Overall, our results in this study suggest that MV perpetrated by husbands on their wife is significantly associated with unintended pregnancy, pregnancy termination, current use of any modern contraceptive methods and sexually transmitted infections, but inconsistent associations are appeared across countries. Lifetime sexual violence and physical-sexual force were significantly and positively associated with unintended pregnancy and pregnancy termination respectively, whereas, all types of MV were significantly and positively related with the symptom of sexually transmitted diseases in the women. Appropriate measures should be undertaken to combat Violence against women(VAW) and necessary services should be provided to the victimized women to uphold their reproductive and sexual rights.

Intimate partner violence and the association of pregnancy intendedness - A cross-sectional study in southeastern Norway

OBJECTIVES

Unintended pregnancy in the context of intimate partner violence (IPV) is a public health issue. It is associated with increased health risks for women and their children. Our objective was to investigate the association between unintended pregnancy and emotional, physical and sexual IPV in a multi-cultural population attending routine antenatal care.

STUDY DESIGN

A prospective cross-sectional study of 1788 pregnant women who filled out a questionnaire during pregnancy as part of a randomized controlled trial conducted in southeastern Norway.

MAIN OUTCOME MEASURES

Pregnancy intendedness was measured by asking women if their pregnancy was planned or not. The Abuse Assessment Screen and the Composite Abuse Scale R-SF, consisting of descriptive questions, were used to measure IPV. Chi-square tests, a Mann-Whitney U test, and binary logistic regression analysis were used.

RESULTS

Almost one in five women (17.4%) reported that their current pregnancy was unintended. Women with unintended pregnancy were significantly younger, had lower educational backgrounds, more limited economic resources and were more likely to be non-native Norwegian speakers. A total of 15.3% of the women reported some experience of IPV in their lifetime. These women were significantly more likely to experience an unintended pregnancy than women who had not experienced IPV, after adjusting for confounding factors: AOR = 1.74 (95% CI [1.23-2.47]).

CONCLUSIONS

Women who had experienced IPV were significantly more likely to have an unintended pregnancy than women who had not experienced IPV. It is of major importance to identify those women and offer appropriate services during pregnancy.

Prevalence, Risk Factors and Effects of Domestic Violence Before and During Pregnancy on Birth Outcomes: An Observational Study of Literate Omani Women

BACKGROUND

Domestic violence against women before and/or during pregnancy is a concerning public health issue. It has a deleterious impact on both the mother and the baby.

AIM

The aim of this study is to identify the prevalence and predictors of emotional and physical domestic violence during three periods (lifelong, one year before pregnancy and during pregnancy). Moreover, it evaluates the effects of domestic violence on the outcomes of pregnancy, including miscarriages, birth weight of the baby, gestational age at delivery, and mode of delivery.

METHODOLOGY

This is a prospective observational study of literate pregnant women, attending four primary health-care centers in Muscat, from 1st April 2019 to 31st March 2020. Subjects with twin pregnancies were excluded from the study. The validated Arabic NorVold Domestic Abuse Questionnaire (NORAQ) was used to determine the prevalence of emotional and physical domestic violence. The recruited subjects were re-evaluated for birth outcomes at 2-4 weeks postpartum.

RESULTS

A total of 960 women participated in the study, with the mean age of 30.3 ± 5.4 years. Overall, experiences of lifelong domestic violence were reported by 161 women (16.8%), and the prevalence rate declined substantially in the one-year period preceding pregnancy and during pregnancy, 2.7% and 1.6%, respectively. Women who reported any type of domestic violence one year before pregnancy were at a higher risk of experiencing it again during pregnancy. A multivariate analysis of the obtained data revealed a strong association between physical domestic violence one year before pregnancy and unplanned pregnancy. Subjects with lifelong domestic violence reported higher rates of depression, insomnia, and somatic symptoms. No significant association was found between domestic violence, across any periods, and birth outcomes.

CONCLUSION

The rates of domestic violence are relatively lower during pregnancy and one year before pregnancy compared to those of the lifelong period among Omani women. A significant association was found between domestic violence and depression, insomnia, somatic symptoms, and unplanned pregnancy. Screening for domestic violence during the perinatal period, using high-quality surveys, is of utmost importance.

Controversial Issues of Abortion License According to Religious and Jurisprudential Laws in Iran: A Systematic Review

Background :

Increase in the number of unwanted pregnancies has been considered to be among the health indices of the society. A large number of children, illegitimate children, and undesirable fetal gender might increase the prevalence of illegal abortions.

Objective:

The present study aimed to investigate the abortion license according to religious and jurisprudential laws in Iran.

Methods:

In this review, the related articles were found through searching of PubMed, Scopus, Google Scholar, SID, and Magiran databases as well as Muslim authorities’ sites using the following keywords: ethics, religious, abortion, and Islamic jurists’ fatwas, without any time limitations.

Results:

The majority of Islamic jurisprudents have considered abortion to be forbidden and nonreligious at any stage of development in case there is no justifiable reason. In case of fetal anomalies or threats to the mother’s life, abortion is allowed, based on the jurisprudential law (al-'usr wa el-haraj) and written permission by the department of forensic medicine. However, abortion is not permitted after ensoulment to the fetus, according to all scholars, with the exception of a few jurisprudents.

Conclusion:

The prohibition of abortion, in the view of most jurists, is not an absolute issue and might include exceptions. According to jurisprudential laws (al-'usr wa el-haraj), the prohibition of abortion has been abolished. Harassment and conflict in maternal-fetal life can also provide a license for abortion.

Poor antenatal care attendance is associated with intimate partner violence: Multivariate analysis of a pregnancy cohort

OBJECTIVE

Intimate partner violence (IPV) is a common, neglected public health problem and pregnancy is a period of vulnerability. We evaluated the relationship of attendance for antenatal care with the experience of psychological and physical IPV.

STUDY DESIGN

We established a cohort of 779 consecutive mothers who received antenatal care and gave birth in 15 public hospitals, Andalusia, Spain. Trained midwives gathered IPV data using the Index of Spouse Abuse validated in the Spanish language (score ranges: 0-100, higher scores reflect more severe IPV; cut-offs: physical IPV = 10, psychological IPV = 25). Less than eight visits defined the threshold for poor antenatal care attendance. Multivariate logistic regression estimated crude (COR) and adjusted odds ratios (AOR), with 95% confidence intervals (CI), of the relationship between antenatal care attendance and psychological and physical IPV, controlling for socio-demographic and other pregnancy characteristics.

RESULTS

Response rate was 92.2%. Poor antenatal clinic attendance, observed in 76 (9.8%) women, was associated with both physical IPV (n = 26, 39% vs 9%; COR = 6.2, 95%CI = 2.7-14.3; AOR = 3.3, 95%CI = 1.1-9.4) and psychological IPV (n = 149, 20% vs 8%; COR = 2.9, 95%CI = 1.7-4.8; AOR = 1.6, 95%CI = 0.9-3.1), though the latter was not significant in multivariate analysis.

CONCLUSION

Women with a poor antenatal care attendance have higher risk of suffering physical IPV during pregnancy. Clinicians should be vigilant about the risk of IPV in mothers with poor attendance for antenatal care.

Imaging of Violence Against the Elderly and the Women

Emergency department assessment is a critical opportunity to identify elder abuse and violence against women, which represent a growing problem, requiring the attention of health care systems. Elder abuse is most frequently perpetrated by family members because of the higher levels of stress, burnout, and financial problems affecting the caregivers that can even lead to deadly consequences. Intimate partner violence is defined as physical, sexual, or psychological harm caused to another by a current or former partner or spouse, and can range from a single acute hit to chronic battering, varying in frequency and severity. Radiologists have a critical role in detecting those injury findings suggestive of abuse and violence. When appropriate, additional information about the social circumstances in which an injury took place, linked with imaging findings, may also be helpful in diagnosing abuse. The purpose of this article is to highlight the role of diagnostic imaging in the detection of lesions compatible with domestic abuse in elderly patients and women, and to allow the recognition of the alterations most frequently associated with this type of violence.