Associations of forms of intimate partner violence with low birth weight in India: findings from a population-based Survey

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.

Magnitude of self-reported intimate partner violence against pregnant women in Ghana's northern region and its association with low birth weight

BACKGROUND

Low birth weight (LBW) rates are high in the northern region of Ghana, as is tolerance for intimate partner violence (IPV). However, the relationship between the two incidents has not been established. This study assessed the magnitude of IPV against pregnant women and its association with LBW in the northern region of Ghana.

METHODS

A cross-sectional study was conducted among 402 postnatal women from five public health care facilities in the Tamale Metropolitan Area, northern Ghana. Data were collected electronically during face-to-face interviews. Validated methods were used to determine IPV exposure during pregnancy and birth weight. Multivariable logistic regression was used to identify the independent association between prenatal exposure to IPV and LBW.

RESULTS

Of the 402 women, 46.5% (95% CI: 41.7, 51.4) experienced IPV during their most recent pregnancy. Of these, 34.8% were psychologically abused, 24.4% were sexually abused, and 6.7% were physically abused. Prenatal IPV exposure was found to be significantly associated with birth weight. Low birth weight was twice as likely among exposed women as among unexposed women (AOR = 2.42; 95% CI: 1.12, 5.26, p < 0.05). Low birth weight risk was also higher among women with anaemia in the first trimester (AOR = 3.47; 95% CI: 1.47, 8.23, p < 0.01), but was lower among women who made at least four antenatal care visits before delivery (AOR = 0.35; 95% CI: 0.14, 0.89, p < 0.05) and male newborns (AOR = 0.23; 95% CI: 0.11, 0.49, p < 0.001).

CONCLUSION AND RECOMMENDATION

IPV during pregnancy is prevalent in the research population, with psychological IPV being more widespread than other kinds. Women who suffered IPV during pregnancy were more likely to have LBW than those who did not. It is essential to incorporate questions about domestic violence into antenatal care protocols. In particular, every pregnant woman should be screened for IPV at least once during each trimester, and those who have experienced violence should be closely monitored for weight gain and foetal growth in the study setting to avert the LBW associated with IPV. In the northern region of Ghana, the number of babies born with low birth weight is high, as is the number of adults who are willing to put up with intimate partner violence. However, there has not been any proof that these two incidents are connected. This study looked at how frequently intimate partner violence occurs among pregnant women and how it is linked to low birth weight in northern Ghana's Tamale Metropolitan Area. A cross-sectional study was conducted with 402 postnatal women from five public health care facilities in the study setting. Information on exposure to intimate partner violence during pregnancy and the birth weight of babies was collected electronically during face-to-face interviews. The study found that of the 402 women, 46.5% had experienced violence by an intimate partner during their most recent pregnancy. Out of these, 34.8% were abused psychologically, 24.4% were abused sexually, and 6.7% were abused physically. Women who were abused were more likely than those who were not to have babies with low birth weight. We concluded that intimate partner violence is common during pregnancy in the study setting and that more women suffered psychological intimate partner violence than other types of violence. Intimate partner violence during pregnancy was linked to low birth weight in the study setting. It is important for antenatal care plans to include questions about intimate partner violence. In particular, every pregnant woman should be assessed for intimate partner violence at least once during each trimester for monitoring.

Risk of adverse newborn outcomes among women who experienced physical and psychological intimate partner abuse during pregnancy in Ghana's northern region

Background

Intimate partner violence (IPV) is common worldwide. However, the health effects of exposure to IPV during pregnancy are significantly more severe. We investigated the relationship between exposure to IPV during pregnancy and the risk of preterm and low birthweight births among women in Ghana's northern region.

Methods

We recruited 402 postnatal women aged 15-49 years from five selected public health facilities in the Tamale Metropolis of the northern region of Ghana. Using Kobo Collect, information on a wide range of factors, including exposure to IPV during the last pregnancy and pregnancy outcomes, was collected electronically. Multiple logistic regression analyses were conducted in Stata to determine the associations between prenatal exposure to IPV and binary measures of gestational age at birth and birthweight.

Results

Overall, 35.1% (95% CI: 30.5, 39.9) of the respondents experienced IPV during their recent pregnancy; 6.7% (95% CI: 4.6, 9.6) experienced physical IPV; and 34.8% (95% CI: 30.3, 39.6) experienced psychological IPV. The prevalence of preterm and low birthweight deliveries was 18.9% (95% CI: 15.4, 23.1) and 9.0% (95% CI: 6.5, 12.2), respectively. Prenatal exposure to IPV was linked to poor newborn outcomes by multivariable binary regression models. Women who suffered IPV during their last pregnancy were three times more likely to deliver low birthweight babies (AOR = 3.12: 95% CI: 1.42, 6.84). Exposed women were also about twice as likely to deliver prematurely, although this association was not statistically significant (AOR = 1.81; 95% CI: 0.97, 3.38).

Conclusion

Exposure to IPV during pregnancy increases a woman's risk of delivering prematurely and having a low birthweight baby. IPV screening should be a regular part of ANC, so that pregnant women who are experiencing IPV can be monitored and supported to avoid adverse outcomes for their babies.

Negotiating Autonomy: The Linkages between Intimate Partner Violence, Women’s Paid Work Status and Birth Outcomes

Maternal and child health is severely impacted by adverse birth outcomes leading to a public health concern. A whole host of socioeconomic factors are instrumental in determining birth outcomes. Importantly, there is an intricate relationship between women’s autonomy, the perpetration of intimate partner violence in households, women’s paid work status and their consequent impact on birth outcomes. Noting this, we ask how intimate partner violence and women’s work status interact and how women’s ‘autonomy’ is negotiated to mitigate adverse birth outcomes such as miscarriage, abortion, stillbirth, low birth weight and preterm birth. We use the nationally representative NFHS-5 data for India and use multiple correspondence analyses to create an index of women’s autonomy, and multinomial logistic regression has been used to determine the relation. Women’s working status in association with the perpetration of intimate partner violence contributes significantly to adverse birth outcomes. The study found that mitigation of adverse birth outcomes, which is necessary for bringing about improvements in maternal and child health, is contingent on a multiplicity of social factors, which requires redressal in association to ensure a reduction in adverse birth outcomes.

Factors Associated with Low Birthweight in Low-and-Middle Income Countries in South Asia

Child with Low Birth Weight (LBW) has a higher risk of infant mortality, learning difficulties in childhood due to stunted growth and impaired neurodevelopment, is more likely to develop heart diseases and diabetes in adulthood. This study aimed to evaluate the latest demographic and health surveys (DHSs) across multiple countries in South Asia to determine the factors associated with LBW among these countries. Latest available DHS data across Afghanistan (2015, n = 29,461), Bangladesh (2018, n = 20,127), Nepal (2016, n = 12,862), and Pakistan (2018, n = 15,068) were analysed. Complex survey adjusted generalized linear models were fitted to investigate the association of birth weight with sociodemographic and decision-making factors. Pakistan had the highest proportion of LBW at 18% followed by Afghanistan and Bangladesh at around 14% and Nepal had the lowest (13%). Children born in Pakistan were more likely to have LBW children than Afghanistan (AOR = 2.17, 95% CI = 1.49-3.14). Mothers living in rural areas (AOR = 0.77, 95% CI = 0.61-0.97), with highly educated partners and belonging to richer families were less susceptible to having child with LBW. To reduce 30% LBW in-line with the World Health Organisation's 2025 goal, policymakers in SA should focus on women in urban areas with low-educated partners belonging to poor households to ease LBW burden.

He hurts her womb: Physical-sexual violence and pregnancy complications among women in Afghanistan

Background: Though some studies show the association between intimate partner violence and pregnancy complications in developed countries, the association remains understudied in less developed and low-income settings. This study examines the association of physical and sexual violence with pregnancy complications among women in Afghanistan.

Methods: This study used the data from the 2015 Afghanistan Demographic and Health Survey (AfDHS). The analysis included 7229 women aged between 15 and 49 and used logistic regression to show the association of physical and sexual violence with pregnancy compilations. The analysis controlled for some potential variables and followed complex survey design factors such as strata, clusters, and survey weights.

Results: Fully adjusted regression model shows that the women who experienced physical violence were 21% (adjusted odds ratio [OR]=1.21; confidence interval [CI]=0.98, 1.50; P <0.1) more likely to endure pregnancy complications compared to those who did not face the violence. Likewise, the women experiencing sexual violence were 89% (adjusted OR=1.89; CI=1.37, 2.62; P <0.01) higher to face pregnancy complications than those who did not face any of sexual violence. More specifically, physically and sexually violated women were highly prey to the complications that increased with the increment of the violence.

Conclusion: This study adds that policymakers may formulate policies for ensuring 3C (caring couple counselling) by readdressing couple relationships, raising gender rights and awareness, providing reproductive health literacy, and increasing mental health awareness during pregnancy.