Investigating the relationship between women's experience of intimate partner violence and utilization of maternal healthcare services in India

Barriers to Seeking Healthcare Services After Sexual Assault: A Scoping Review

BACKGROUND

Sexual violence by an intimate partner or by a stranger remains highly prevalent in the United States. Yet, the use of post-sexual-assault health care is still underutilized. Persons in vulnerable populations such as immigrants, LGBTQIA+, and Black women may experience additional barriers to care.

OBJECTIVE

We sought to determine the extant research in this area, the methodologies used, and whether specific barriers exist for seeking sexual assault services. We sought to understand if barriers differed for vulnerable populations.

INCLUSION CRITERIA

Peer-reviewed literature published before September 2023, written in English, conducted in the United States, and that included survivors of sexual violence and explored barriers to seeking care postassault (i.e., sexual assault nurse examiners) were included in the review.

METHODS

Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews protocols were followed. PubMed, Scopus, CINAHL, PsycINFO, and PTSDpubs databases were used to identify literature that met the inclusion criteria, from which we selected 14 publications.

RESULTS

Much of the literature employed qualitative or mixed methods designs. Several studies focused on underserved minority groups, including immigrant women, Black women, and homeless youth. Common barriers existed on the intrapersonal, interpersonal, organizational, community, and societal levels.

CONCLUSION

The literature provided substantive context for the multilevel barriers, all contributing to survivors remaining silent rather than seeking much-needed help. Although there is a need for additional research on barriers to sexual assault services specifically, the extant research supports strengthening multilevel, alternative approaches to deliver much-needed services.

Impact evaluation of invisible intimate partner violence on maternal healthcare utilization in Pakistan

INTRODUCTION

Existing research has shown that intimate partner violence (IPV) may hinder maternal access to healthcare services, thereby affecting maternal and child health. However, current studies have ignored whether emotional intimate partner violence (EV) could negatively affect maternal healthcare use. This study aims to evaluate the impact of invisible IPV on maternal healthcare utilization in Pakistan.

METHODS

We analyzed nationally representative data from the Pakistan Demographic and Health Survey database from 2012-2013 and 2017-2018. Exposure to physical intimate partner violence (PV) and EV was the primary predictor. Based on women's last birth records, outcomes included three binary variables indicating whether women had inadequate antenatal care (ANC) visits, non-institutional delivery, and lack of postnatal health check-ups. A logistic regression model was established on weighted samples.

RESULTS

Exposure to EV during pregnancy was significantly associated with having inadequate ANC visits (aOR = 2.16, 95% CI: 1.06 to 4.38, p = 0.033) and non-institutional delivery (aOR = 2.24, 95% CI: 1.41 to 3.57, p = 0.001). Lifetime exposure to EV was associated with increased risks of inadequate ANC visits (aOR = 1.48, 95% CI: 1.00 to 2.19, p = 0.049). Lifetime exposure to low-scale physical intimate partner violence (LSPV) (adjusted OR (aOR) = 1.73, 95% CI: 1.29 to 2.31, p < 0.001) was associated with increased risks of having no postnatal health check-ups.

CONCLUSIONS

Pregnant women who experienced EV and LSPV are at greater risk of missing maternal healthcare, even if the violence occurred before pregnancy. Therefore, in countries with high levels of IPV, early screening for invisible violence needs to be integrated into policy development, and healthcare providers need to be trained to identify EV and LSPV.

Overlooked impact of less severe physical violence on antenatal care visits: Findings from South Asia

Background

In South Asia, women often experience intimate partner violence (IPV) and have limited access to maternal health services (MHS). However, the effects of IPV on antenatal care (ANC) visits remain unclear. This study aimed to examine the impact of IPV of different forms and severities on ANC visits in South Asia.

Methods

This cross-sectional study used the latest available data from demographic and health surveys conducted in Bangladesh, India, Afghanistan, Nepal, Maldives, and Pakistan. The study sampled 4467 women who had given birth within the past 12 months and were interviewed for IPV. IPV was measured by binary variables indicating the presence of physical violence (PV), categorised into less severe (LSPV) and severe physical violence (SPV), emotional violence (EV), and sexual violence (SV). ANC utilization was measured using binary variables indicating whether respondents had any, at least four, or at least eight ANC visits, as recommended by World Health Organization (WHO). Logistic regressions adjusted for survey weights were used to assess associations between ANC utilization and exposure to IPV during pregnancy and lifetime.

Results

The prevalence of LSPV, SPV, EV, and SV during pregnancy were 14.5%, 4.4%, 11.6%, and 4.1%. LSPV experience during pregnancy was associated with decreased likelihoods of at least four ANC visits (odds ratio (OR) = 0.55; 95% confidence interval (CI) = 0.40-0.76) and eight ANC visits (OR = 0.53; 95% CI = 0.31-0.90). Results of lifetime exposure to IPV followed similar patterns. Lifetime exposure to LSPV was associated with decreased likelihoods of at least four ANC visits (OR = 0.55; 95% CI = 0.41-0.74) and eight ANC visits (OR = 0.47; 95% CI = 0.29-0.77).

Conclusion

This study highlights the negativities of LSPV on the frequency of women seeking ANC visits. Policies are necessary to identify women at risk of the often-overlooked LSPV early and provide protective interventions to promote maternal health in South Asia.

Child Marriage and Problems Accessing Healthcare in Adulthood: Evidence from India

The association between child marriage and the access to or utilization of maternal and antenatal healthcare has been widely studied. However, little is known about child brides' access to healthcare for illnesses later in life. Using data on 496,283 married women aged 18 to 49 years from the India National Family and Health Survey 2015-2016, we developed an 11-point composite score (ranging from 0 to 10) outlining the extent of problems accessing healthcare, as follows: (i) no/little problem (score 0 to 2), (ii) some problems (score 3 to 6), and (iii) big problems (score 7 to 10). The differences between child brides and their peers married as adults were assessed by the relative risk ratios obtained from multinomial logistic regressions. The adjusted risk of having "some problems" and "big problems" accessing healthcare relative to "no/little problem" for child brides was found to be 1.22 (95% CI: 1.20-1.25) and 1.26 (95% CI: 1.22-1.29) times that of those married as adults, respectively. These findings highlight the disproportionate barriers to healthcare access faced by women married as children compared to women married as adults and the need for further research to inform policies regarding effective public health interventions to improve healthcare access.

Intimate partner violence as a predictor of antenatal care services utilization in Rwanda

Background

Although compelling evidence shows that exposure to intimate partner violence (IPV) during pregnancy is detrimental to both physical and mental health of the victims and their fetuses, studies on negative impact of IPV on antenatal care (ANC) services utilization are scarce.

Methods

The aim of the current study was to determine the impact of IPV exposure on ANC services utilization indicators such as (i) initiation of care within the first 3 months of pregnancy, (ii) receipt of at least four ANC visits and (iii) receipt of care from skilled providers among reproductive age women in Rwanda. This study used the data from the 2014–15 Rwanda Demographic and Health Survey. Multiple logistic regression was used to estimate the effects of physical and sexual IPV on the ANC services utilization indicators.

Results

Among married women living with their partners with at least one child aged 5 years or under (N = 5116), 17% of them reported physical violence, 22.8% reported psychological violence and 9.2% reported sexual violence. We found that there was a significant negative relationship between physical IPV and both early ANC and sufficient ANC. Women who had experienced physical violence by their partners during the preceding 12 months were less likely to receive more than four ANC visits, (O.R = 0.61, CI = 0.417–0.908) and they were less likely to attend the first ANC visits within the first 3 months (O.R = 0.656, CI = 0.445–0.967).

Conclusion

In this study, the prevalence of IPV still remains high and there is evidence that it does have significant impact on ANC. Therefore, the results provide support for continued efforts to reduce intimate partner violence, through the improvement of screening for IPV during ANC visits.

Trends and correlates of intimate partner violence experienced by ever-married women of India: results from National Family Health Survey round III and IV

BACKGROUND

The study aims to estimate the prevalence of Intimate partner violence (IPV) in India, and changes observed over a decade as per the nationally representative datasets from National Family Health Surveys (NFHS) Round 3 and 4. We also highlight various socio-demographic characteristics associated with different types of IPV in India. The NFHS round 3 and 4 interviewed 124,385, and 699,686 women respondents aged 15-49 years using a multi-stage sampling method across 29 states and 2 union territories in India. For IPV, we only included ever-married women (64,607, and 62,716) from the two rounds. Primary outcomes of the study was prevalence of the  ever-experience of different types of IPV: physical, emotional, and sexual violence by ever-married women aged 15 to 49 years. The secondary outcome included predictors of different forms of IPV, and changes in the prevalence of different types of IPV compared to the previous round of the NFHS survey.

RESULTS

As per NFHS-4, weighted prevalence of physical, sexual, emotional, or any kind of IPV ever-experienced by women were 29.2%, 6.7%, 13.2%, and 32.8%. These subtypes of IPV depicted a relative change of - 14.9%, - 30.2%, - 11.0%, - 15.7% compared to round 3. Significant state-wise variations were observed in the prevalence. Multivariate  binary logistic regression analysis highlighted women's and partner's education, socio-economic status, women empowerment, urban-rural residence, partner's controlling behaviours as major significant predictors of IPV.

CONCLUSIONS

Our study findings suggest high prevalence of IPV with state-wise variations in the prevalence. Similar factors were responsible for different forms of IPV. Therefore, based on existing evidences, it is recommended to offer adequate screening and counselling services for the couples, especially in health-care settings so that they speak up against IPV, and are offered timely help to prevent long-term physical and mental health consequences.