Developing and validating the Nepalese Abuse Assessment Screen (N-AAS) for identifying domestic violence among pregnant women in Nepal

This study culturally adapted and validated a Nepalese version of the Abuse Assessment Screen (AAS) tool for identifying domestic violence among pregnant women in Nepal, creating the Nepalese Abuse Assessment Screen (N-AAS). International and national topic experts reviewed the initial N-AAS version using the Delphi method, and pregnant women participated in cognitive interviews, providing feedback on the N-AAS as user experts. Subsequent pre-testing of a comprehensive questionnaire, which included the translated version of the N-AAS, occurred in two tertiary care hospitals using an electronic format known as Color-Coded Audio Computer-Assisted Self-Interview (C-ACASI). The study assessed the content validity index, compared the concurrent validity of the N-AAS with the gold standard interview, estimated the prevalence of domestic violence from two hospitals, and calculated the Kappa coefficient. The reliability of the entire questionnaire was also evaluated through a test-retest analysis, with content validity rated as "good to excellent" by topic and user experts and high test-retest reliability (91.2-98.9%), indicating consistency across questionnaires completed at two different time points, with 12% of participants reporting any form of violence. The N-AAS demonstrated ≥91.7% specificity for all forms of abuse, accurately identifying non-abuse cases. In addition, moderate to excellent sensitivity was observed for emotional abuse (52.5%) and physical abuse since marriage (50%), while sensitivity for physical abuse in the past 12 months was 100%. Thus, the N-AAS demonstrated reliable test-retest results with a good Kappa coefficient and specificity, as well as showing excellent sensitivity for detecting recent physical abuse and moderate sensitivity for detecting emotional abuse and physical abuse since marriage. Because cultural context often leads women to normalize and tolerate abuse from spouses and family members and women are thus reluctant to report abuse, the results imply that the N-AAS can serve as a valuable screening tool for domestic abuse in antenatal care settings in Nepal.

The association between intimate partner violence and breastfeeding practices in Cameroon: An analysis from demographic and health survey of 2018

Intimate partner violence is a major public health concern around the world. While its degrading effects on maternal health are well documented, it is not clear establishing a link with child health outcomes, especially on breastfeeding practices. Therefore, this paper aims to analyze the association between Intimate partner violence and breastfeeding practices in Cameroon using data from the 2018 demographic and health survey. Intimate partner violence is apprehended from its three dimensions (physical, emotional and sexual violence), and the two key breastfeeding practices are considered: early initiation to breastfeeding within an hour of delivery for children under 24 months of age, and exclusive breastfeeding during 24 h preceding the mother's interview for children under 6 months. The results of descriptive statistics suggest that 51.91 % (n = 1704) of mothers whose infants between 0 and 23 months of age who acquired early initiation to breastfeeding and 39.61 % (n = 484) of mothers whose infants between 0 and 5 months of age practiced exclusive breastfeeding. The estimated results of the logistic regression model suggest that emotional violence and sexual violence were significantly associated with low chances of early initiation to breastfeeding (OR: 0.675; 95 % CI: 0.528, 0.864; p < 0.05; OR: 0.741; 95 % CI: 0.525, 1.046; p < 0.1), which is not the case with physical violence which has no significant association. No dimension of Intimate partner violence was associated with exclusive breastfeeding, independently or with control for infant, maternal and household characteristics. We further performed robustness analysis, and the findings suggest that the associations are robust to consider another measure of Intimate partner violence and the duration of maternity leave. Thus, to improve breastfeeding practices, in particular early initiation to breastfeeding, public decision-makers should strengthen the fight against domestic violence by emphasizing sexual and emotional violence. This paper provides a benchmark for several future investigations that could discuss other breastfeeding practices and the policy challenges towards the length of maternity leave.

States' Abortion Laws Associated With Intimate Partner Violence-Related Homicide Of Women And Girls In The US, 2014-20

Women who are pregnant or recently gave birth are significantly more likely to be killed by an intimate partner than nonpregnant, nonpostpartum women of reproductive age, implicating the risk of fatal violence conferred by pregnancy itself. The rapidly increasing passage of state legislation has restricted or banned access to abortion care across the US. We used the most recent and only source of population-based data to examine the association between state laws that restrict access to abortion and trends in intimate partner violence-related homicide among women and girls ages 10-44 during the period 2014-20. Using robust difference-in-differences ecologic modeling, we found that enforcement of each additional Targeted Regulation of Abortion Providers (TRAP) law was associated with a 3.4 percent increase in the rate of intimate partner violence-related homicide in this population. We estimated that 24.3 intimate partner violence-related homicides of women and girls ages 10-44 were associated with TRAP laws implemented in the states and years included in this analysis. Assessment of policies that restrict access to abortion should consider their potential harm to reproductive-age women through the risk for violent death.

Intimate partner violence and associated factors among married adolescent girls and young women in the pastoralist community of South Ethiopia: is intimate partner violence associated with cultural phenomena?

Background

Violence against women is a major public health problem that affects the physical, sexual, mental, and social wellbeing of more than one-third of all women worldwide. Hence the purpose of this study was to determine the prevalence of physical and sexual intimate partner violence (IPV) and associated factors among married adolescent girls and young women (AGYW) belonging to the pastoralist community of Dassenech district, South Omo Zone, South Ethiopia.

Methods

A community-based cross-sectional survey was conducted among married AGYW in the Dassenech district from March 1, 2022, to April 1, 2022. A multi-stage sampling technique was adopted to select 545 participants. The data were collected using pre-tested and standardized WHO multi-country study tools. A binary logistic regression model was fitted to identify the independent predictors of physical and sexual intimate partner violence. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to measure the effect size, and finally, a p-value<0.05 was considered statistically significant.

Results

The prevalence of physical IPV among AGYW belonging to the pastoralist community of Dassenech district was 44.1% (95% confidence interval (CI): 40%, 48%) and that of sexual IPV was 39.3% (95% CI: 35%, 43%). The husband only deciding for the household (AOR = 11.36; 95% CI: 6.97, 18.53), the father performing the Dimi cultural ceremony (AOR = 3.70; 95% CI: 2.22, 6.14), and frequent quarrels (AOR = 2.06; 95% CI: 1.07, 3.99) are significantly associated with physical IPV. Both partners drinking alcohol (AOR = 3.47; 95% CI: 1.94, 6.20), the husband only deciding for the household (AOR = 11.23; 95% CI: 6.91, 18.27), and frequent quarrels (AOR = 2.29; 95% CI: 1.15, 4.56) were factors significantly associated with sexual IPV.

Conclusion

Physical and sexual intimate partner violence is a significant public health problem in the study area. Therefore, interventional measures to change the attitude of cultural leaders, providing education to married men and women on risky sexual behavior, and empowering women need to be prioritized to prevent the occurrence of this problem.

Someone you can count on: Examining the mediating effect of social support on economic abuse and depression

The aim of this study was to examine whether social support mediated the relationship between economic abuse, a form of intimate partner violence, and mental health, specifically depression, among pregnant women. This cross-sectional study used a sample of 193 pregnant women living in the United States who participated in an online Qualtrics panel survey in January 2021. Hayes Process Macro was used to assess a mediation model. Economic abuse was associated with increased odds of depressive sympto ms and fewer perceived social supports. Social support mediated the relationship between economic abuse and depression. Implications for research, policy, and practice are discussed. Notably, research focused on economic abuse and efforts to respond to it need to pay particularly close attention to the role that social supports may play in survivor's overall well-being, as well as the impact that economic abuse may have on survivors' perceptions of social support. This may be particularly true for pregnant women experiencing economic abuse for whom social support-related interventions have yielded positive health outcomes.

Intimate partner violence during pregnancy in COVID-19 pandemic: a cross-sectional study from South-west of Iran

BACKGROUND

Intimate partner violence (IPV) against pregnant women can cause several complications for the mother and her baby, which are life-threatening. Thus, we aimed to find the prevalence of IPV and its associated factors in pregnant women in Shiraz, Iran.

METHODS

This cross-sectional study was conducted among pregnant mothers in Shiraz between July 2020 and January 2021. The questionnaire consisted of four parts: demographic data, socio-economic status (SES), obstetric and medical history, and questions about IPV. Univariate analysis was performed using Chi-square, McNemar, or Fisher's exact test, and variables with p-value < 0.20 were included in Logistic regression. The odds ratio and CI 95% for variables with p-value < 0.05 were considered statistically significant.

RESULTS

The overall prevalence of IPV was 93.1% among 830 pregnant women in Shiraz. Psychological violence was the most prevalent type (92.9%), followed by sexual (11%) and physical (7.7%) violence. High SES (OR = 3.21, (CI:1.61-6.41)) was the only risk factor for overall violence, and the age group, 30-34, was a risk factor for physical violence. Mother-desired pregnancy (OR = 26 (Cl:0.09-0.79)) and father-desired pregnancy (OR = 0.91, (CI:0.22-3.80)) were protective factors against physical and sexual violence, respectively. Furthermore, Psychological violence and sexual violence increased during COVID-19 Pandemic (P.value < 0.05).

CONCLUSION

According to the obtained results, the prevalence of IPV during pregnancy in Shiraz was very concerning, especially psychological violence. Improving conflict-solving skills among family members and addressing economic problems could be considered by health policymakers when designing interventional programs and policies to reduce IPV during pregnancy.

Alarming Trends of Cesarean Section-Time to Rethink: Evidence From a Large-Scale Cross-sectional Sample Survey in India

BACKGROUND

Cesarean section (CS) delivery rate has increased significantly both globally and in India, thereby posing a burden on overstretched health systems.

OBJECTIVE

This study plans to understand the factors associated with CS rate with an objective to (1) analyze the trends of CS delivery from 1998-99 to 2019-21 and (2) understand the proximate determinants of CS deliveries in India.

METHODS

Analysis of secondary data (National Family Health Survey) of a nationally representative sample of 230,870 women (year 2019-21) was undertaken to explore the trends, distribution, and determinants of CS deliveries in India and within states. Multivariable analyses were performed to determine the proximate variables associated with CS and elective CS. The relative interaction effect of confounding factors, such as number of antenatal care (ANC) visits, place of residence, and wealth status, on cesarean delivery was assessed. A composite index was generated using trust, support, and intimate partner violence variables (termed the partner human capital index [PHI]) to study its influence on CS deliveries, with a low PHI indicating abusive partner and a high PHI indicating supportive partner. Statewise spatial distribution of the most significantly associated factors, namely, wealth quintile and ANC checkups, were also analyzed.

RESULTS

The overall prevalence of CS was 21.50% (49,634/230,870) which had risen from 16.72% (2312/13,829) in 1998-99. The adjusted odds of CS deliveries were significantly higher among women who were highly educated (odds ratio [OR] 7.30, 95% CI 7.02-7.60; P<.001), had 4 or more ANC visits (OR 2.28, 95% CI 2.15-2.42; P<.001), belonging to the high-wealth quintile (OR 7.87, 95% CI 7.57-8.18; P<.001), and from urban regions. Increasing educational level of the head of the household (OR 3.05, 95% CI 2.94-3.16; P<.001) was also found to be a significant determinant of CS deliveries. The odds of selection of elective and emergency CS were also significantly higher among women from richer families (OR 1.66, 95% CI 1.25-2.21; P<.001) and those belonging to Christian religion (OR 1.67, 95% CI 1.14-2.43; P=.008). Adjusting the cesarean delivery by PHI, the odds of outcome were significantly higher among women with moderate and high PHI compared with those with low PHI (OR 1.46, 95% CI 1.36-1.56 and OR 1.61, 95% CI 1.49-1.74, respectively; P<.001 for both). The interaction effect result reiterates that women with more than 4 ANC checkups, high PHI, and belonging to the richer wealth quintile were more likely to undergo cesarean delivery (OR 22.22, 95% CI 14.99-32.93; P<.001) compared with those with no ANC visit, low PHI, and poorest women.

CONCLUSIONS

The increasing trend of CS deliveries across India is raising concerns. Better education, wealth, and good support from the partner have been incriminated as the contributory factors. There is a need to institute proper monitoring mechanisms to assess the need for CS, especially when performed electively.

Factors associated with experiencing lifetime intimate partner violence among pregnant displaced women living in refugee camps in Erbil, Iraq

According to the World Health Organization, intimate partner violence (IPV) affects 35% of women worldwide and 40% of pregnant women, often resulting in maternal and infant death and harm. Displaced persons are at higher risk of abuse compared to the general population. While few studies have explored IPV in Iraq, research from Erbil, Iraq showed nearly 60% of women reported experiencing IPV in their lifetime. No publications examining IPV among displaced women in Iraq exist. Considering the severe impacts of IPV in pregnancy and the associated risks for IPV among women in refugee camps, this paper presents the first analysis of prevalence and factors associated with lifetime IPV among displaced pregnant women in two Iraqi refugee camps. Thirteen percent of women reported experiencing any abuse and experiencing IPV was associated with receiving fewer years of schooling (p = 0.04), not having a private doctor (p = 0.002), attending the first prenatal visit during the third trimester (p = 0.03), feeling pressure to have a child (p = 0.003), knowing someone who was physically injured by their husband (p = 0.05), experiencing suicidal ideation (p = 0.02), and being worried about harming one's baby (p = 0.02). Policy and programme recommendations for screening and prevention of IPV in resource-limited settings are provided.

Income Inequality and Pregnancy-Associated Homicide in the US: A Longitudinal, State-Level Analysis

Pregnancy-associated homicide remains an understudied yet critical issue. Using restricted use mortality files provided by the National Center for Health Statistics and the National Violent Death Reporting System, annual state-level pregnancy-associated homicide ratios were estimated as the count of deaths divided by the number of live births. The exposure, the state Gini index, was categorized into tertiles to compare states by levels of income inequality. In the final adjusted longitudinal linear model, those who experienced the greatest amount of income inequality had a significant 1.28 per 100,000 homicide rate when compared to the lowest income inequality tertile.

Contexto y Dinámicas de Atención Prenatal para Mujeres con Violencia de Pareja

Introducción: Las mujeres tienen necesidades en salud que varían de acuerdo con el curso de vida y la violencia de pareja íntima. Objetivo: identificar las características del contexto en el cual se brinda la atención prenatal a las mujeres identificadas con violencia de pareja. Materiales y Métodos: estudio cualitativo con el diseño de etnografía y observación participante focalizada. Realizado en las sesiones del curso de preparación para el parto y en salas de espera de cinco instituciones de salud en Cali, Colombia. Resultados: se identificaron tres dimensiones que sobre el contexto de atención: (a) El Ambiente donde se brinda la Atención, (b) Relaciones de poder y (c) Dinámicas de la atención. Los resultados muestran un contexto tradicional en la atención prenatal con predominio de un modelo biomédico. Discusión: Los hallazgos muestran la complejidad de la atención en las instituciones de salud y un contexto tradicional en la atención prenatal con predominio de un modelo biomédico. Conclusión: en el encuentro de las mujeres con el personal de salud no se identifica la violencia de pareja que sufren las mujeres, puesto que, la relación se ve medida por: desconocer necesidades, relaciones verticales, el poder y la comunicación no asertiva. Para la adopción de acciones de apoyo y acompañamiento, es necesario, reconocer la importancia de una atención en salud con enfoque de perspectiva de género, diferencial, e interseccional. Además, en favor de la autonomía y la dignidad de las mujeres se debe fortalecer la cultura del respeto y de empatía hacia las usuarias.

Prevalence, Patterns, and Determinants of Intimate Partner Violence Experienced by Women Who Are Pregnant in Sanma Province, Vanuatu

Violence perpetrated by an intimate partner (IPV) is an important human rights and public health problem worldwide and when experienced during pregnancy is of special concern due to the harmful impact on maternal and child health. Women living in Vanuatu, and especially Sanma Province, experience high rates of IPV, however little is known about their experiences of violence when pregnant. The aim was to describe the prevalence, patterns and determinants of IPV among women who are pregnant in Sanma Province, Vanuatu. A cross-sectional survey was used. All healthy adult women attending Northern Provincial Hospital antenatal clinic from late May to late July 2019 were eligible and invited to participate. Psychological, physical and sexual IPV and controlling behaviours were assessed with a modified version of the World Health Organization Violence Against Women Instrument administered as an individual interview. Descriptive statistics were used to analyse prevalence and patterns of IPV and logistic regression models to identify determinants. Of 214 women who expressed interest in participating, 192 women contributed data. Overall 64.2% of women had experienced any IPV during their lifetime and 42.2% had experienced IPV during their current pregnancy. Experience of co-occurrence of violence types was common, and it was more common for IPV to continue than to cease during pregnancy. Factors which increased likelihood of experiencing IPV included being employed, occupying a lower socioeconomic position, having a partner who was unemployed or used alcohol or illicit substances at least once a week. IPV, in all its forms, is a common problem faced by women who are pregnant and living in Vanuatu.

Pregnant women’s unmet need to communicate with a health professional during the SARS-CoV-2 pandemic lockdown in France: The Covimater cross-sectional study

During the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic lockdown, communication between pregnant women and health professionals may have become complicated due to restrictions on movement and saturated health services. This could have impacts on pregnancy monitoring and women’s wellbeing. We aimed to i) describe the unmet need of pregnant women living in France to communicate with health professionals about the pandemic and their pregnancy during the lockdown, ii) assess the socio-demographic, medical and contextual factors associated with this unmet need. The Covimater cross-sectional study, conducted in July 2020, includes data on 500 adult women’s experiences of pregnancy during the first lockdown period in France (i.e., from March to May 2020). The women, all residents in metropolitan France, answered a web-based questionnaire about their conversations with health professionals during the lockdown, as well as their social and medical characteristics. A robust variance Poisson regression model was used to estimate crude or adjusted prevalence ratios (aPRs) for their unmet need to communicate with health professionals about the pandemic and their pregnancy. Forty-one percent of participants reported an unmet need to communicate with a health professional during the lockdown, mainly about the risk of transmitting SARS-CoV-2 to their baby and the consequences for the latter. Factors associated were: i) being professionally inactive (aPR = 1.58,CI95%[(1.14–2.21]), ii) having an educational level below secondary school diploma (1.38,[1.05,-1.81]), iii) having experienced serious arguments/violence (2.12,[1.28–3.52]), iv) being very worried about the pandemic (1.41,[1.11–1.78]), v) being primiparous (1.36,[1.06–1.74]) and vi) having had pregnancy consultations postponed/cancelled by health professionals during the lockdown (1.35,[1.06–1.73]). These results can be used to develop targeted strategies that ensure pregnant women are able to i) communicate with health professionals about the potential impact of the SARS-CoV-2 pandemic on their pregnancy, and ii) access up-to-date and reliable information on the consequences of SARS-CoV-2 for themselves and their child.

Safe Pregnancy intervention for intimate partner violence: a randomised controlled trial in Norway among culturally diverse pregnant women

Background

Intimate partner violence (IPV) during pregnancy is a global health problem with adverse consequences for mothers, infants and families. We hypothesise that information about IPV and safety behaviours during pregnancy has the potential to increase quality of life and the use of safety behaviours and prevent IPV.

Methods

A multicentre randomised controlled trial among culturally diverse pregnant women in Norway, to test the effect of a tablet-based video intervention about IPV and safety behaviours. Women attending routine antenatal check-ups alone (baseline) were screened for violence (Abuse Assessment Screen) by responding to questions on a tablet, and randomised (1:1) by computer to receive an intervention or a control video. The intervention video presented information about IPV and safety behaviours. The controls viewed a video promoting healthy pregnancy in general. Outcome measures were assessed three months post-partum: The World Health Organization Quality of Life-BREF, the Composite Abuse Scale on violence during the last 12 months and use of safety behaviours based on a 15-item checklist. A general linear model for repeated measures was used to examine the intervention’s effect. The analyses were conducted by intention to treat.

Results

Among 1818 eligible women, 317 reported IPV and were randomised to an intervention (157) or a control group (160). A total of 251 (79.2%) women completed the follow-up questionnaire: 120 (76.4%) in the intervention group and 131 (81.9%) in the control group. At follow-up, 115 (45.8%) women reported a history of IPV. Few women (n = 39) reported IPV during the last 12 months. No differences in quality-of-life domains and overall quality of life and health were found between the intervention and the control groups. We detected no differences between the use of safety behaviours or IPV frequency and severity during the last 12 months.

Conclusion

Our intervention did not improve women’s quality of life, use of safety behaviours or exposure to violence. Nevertheless, a tablet-based tool may motivate women experiencing IPV to seek help and support. More research is needed regarding tablet-based interventions for women experiencing IPV, particularly culturally sensitive interventions.

Trial registration

NCT03397277 registered in clinicaltrials.gov on 11/01/2018.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04400-z.

Prevalence and associated factors of intimate partner violence among pregnant women attending health care facilities, Northern Ethiopia: comparative cross-sectional study

Intimate partner violence (IPV) is a major public health problem. While it is high among pregnant women in Ethiopia, the cases are under-reported, and the true extent of the issue is uncertain. The study is intended to determine the prevalence and determinants of IPV among pregnant women seeking antenatal care (ANC). A comparative cross-sectional survey was conducted in healthcare facilities, Northern Ethiopia, in 2019. A sample of 324 pregnant women visiting ANC service was selected by systematic sampling. Binary logistic regression was conducted to identify significant determinants. The prevalence of IPV during pregnancy was 36.3%. Lack of formal schooling, rural life, husband's additional sexual partners, lack of shared decisions, and partners' alcohol intake were identified as a predictor of IPV. It is important to consider raising awareness, enhancing women's decision-making abilities, and educating women. Furthermore, partner involvement should be addressed to minimize violence against women in the community.IMPACT STATEMENTWhat is already known on this subject? Intimate partner abuse (IPV) is a global public health problem as well as a significant violation of human rights, and Ethiopia has the world's highest rates of physical and sexual IPV. The immediate effect of IPV during pregnancy (sexually transmitted infections (STI), intrauterine growth retardations (IUGR), preterm labour, miscarriage, abortion, antepartum haemorrhage, perinatal death) was known.What do the results of this study add? Even though the outcome of IPV among pregnant women was recognised, the underlying factors of the violence were not well understood. As a result, this research will contribute to our understanding of the determinants of IPV among pregnant women.What are the implications of these findings for clinical practice and/or further research? In this research, we revealed that the majority of the determinants of IPV among pregnant women were linked to their husband's behaviour, and that women's decision-making capacity and educational level were also root causes of the violence. Therefore, Women empowerment and partner participation during antenatal care would offer outstanding feedback to reduce partner violence. Aside from that, more research in family health would provide in-depth knowledge about the root cause of the violence.

Impact of the SARS-CoV-2 pandemic and first lockdown on pregnancy monitoring in France: the COVIMATER cross-sectional study

BACKGROUND

In the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, consultations and pregnancy monitoring examinations had to be reorganised urgently. In addition, women themselves may have postponed or cancelled their medical monitoring for organisational reasons, for fear of contracting the disease caused by SARS-CoV-2 (COVID-19) or for other reasons of their own. Delayed care can have deleterious consequences for both the mother and the child. Our objective was therefore to study the impact of the SARS-CoV-2 pandemic and the first lockdown in France on voluntary changes by pregnant women in the medical monitoring of their pregnancy and the associated factors.

METHODS

A cross-sectional study was conducted in July 2020 using a web-questionnaire completed by 500 adult (> 18 years old) pregnant women during the first French lockdown (March-May 2020). A robust variance Poisson regression model was used to estimate adjusted prevalence ratios (aPRs).

RESULTS

Almost one women of five (23.4%) reported having voluntarily postponed or foregone at least one consultation or pregnancy check-up during the lockdown. Women who were professionally inactive (aPR = 1.98, CI95%[1.24-3.16]), who had experienced serious disputes or violence during the lockdown (1.47, [1.00-2.16]), who felt they received little or no support (1.71, [1.07-2.71]), and those who changed health professionals during the lockdown (1.57, [1.04-2.36]) were all more likely to have voluntarily changed their pregnancy monitoring. Higher level of worry about the pandemic was associated with a lower probability of voluntarily changing pregnancy monitoring (0.66, [0.46-0.96]).

CONCLUSIONS

Our results can guide prevention and support policies for pregnant women in the current and future pandemics.

Exploring factors associated with pregnant women's experiences of material hardship during COVID-19: a cross-sectional Qualtrics survey in the United States

BACKGROUND

The COVID-19 pandemic has exacerbated the financial insecurity of women and their families globally. Some studies have explored the impact of financial strain among pregnant women, in particular, during the pandemic. However, less is known about the factors associated with pregnant women's experiences of material hardship.

METHODS

This cross-sectional study used a non-probability sample to examine the factors associated with pregnant women's experiences of material hardship during the COVID-19 pandemic. In January 2021, 183 pregnant women living in the United States participated in an online Qualtrics panel survey. In addition to socio-demographic characteristics, individuals were asked about their finances and predictors of financial well-being, mental health symptoms, and intimate partner violence (IPV) experiences. Chi-square analysis and one-way ANOVA were used to examine whether women's experiences with material hardship and associated factors differed by income level (i.e., less than $20,000; $20,000 to $60,000; more than $60,000). Ordinary least squares regression was used to calculate unadjusted and adjusted estimates.

RESULTS

Study findings showed that the majority of women in the sample experienced at least one form of material hardship in the past year. Individuals with an annual household income less than $20,000 reported the highest average number of material hardships experienced (M = 3.7, SD = 2.8). Compared to women with household incomes less than $20,000, women with incomes of more than $60,000 reported significantly fewer material hardships, less financial strain, and higher levels of financial support, economic self-efficacy, and economic-self-sufficiency. Women with incomes of $60,000 or more also reported significantly lower levels of psychological abuse, and a smaller percentage met the cut-off for anxiety. Economic self-sufficiency, financial strain, posttraumatic stress disorder, and economic abuse were all significantly associated with material hardship.

CONCLUSIONS

A contribution of this study is that it highlights the significant, positive association between economic abuse, a unique form of IPV, and material hardship among pregnant women during the pandemic. These findings suggest the need for policy and practice interventions that help to ameliorate the financial insecurity experienced by some pregnant women, as well as respond to associated bidirectional vulnerabilities (e.g., mental health symptoms, experiences of IPV).

Postpartum Depressive Symptoms as a Mediator Between Intimate Partner Violence During Pregnancy and Maternal-Infant Bonding in Japan

Studies show that experiencing intimate partner violence (IPV) during pregnancy is related to poor maternal-infant bonding. However, the mechanisms underlying this relationship are unclear. This article aims to examine whether maternal postpartum depressive (PPD) symptoms mediate the association between pregnancy IPV and maternal-infant bonding, and whether the relationship differs by maternal-infant bonding subscales-lack of affection, anger/rejection. A survey was conducted among women who participated in a postpartum health check-up program in Aichi prefecture, Japan (N = 6,590) in 2012. We examined whether experiences of emotional and physical IPV were related to maternal-infant bonding and whether PPD symptoms mediated this relationship. Path analysis showed that emotional and physical IPV were associated with PPD symptoms, and PPD symptoms predicted poor bonding. The total effect of emotional IPV on poor bonding was significant, showing a marginally significant direct effect and statistically significant indirect effect. The total effect of physical IPV on poor bonding was not statistically significant. Emotional IPV was significantly associated with both lack of affection and anger/rejection bonding subscales, which were similarly mediated by PPD symptoms. Findings revealed a modest indirect association between IPV, emotional IPV in particular, and poor maternal-infant bonding, which was mediated by PPD symptoms. While prevention of IPV is the ultimate goal, the treatment of PPD symptoms among women who experience IPV during pregnancy may improve maternal-infant bonding and mitigate cross-generational effects of IPV. Identifying opportunities for detection of IPV and PPD symptoms, as well as prevention and early intervention, may improve maternal-infant bonding.

Firearm Relinquishment Laws Associated With Substantial Reduction In Homicide Of Pregnant And Postpartum Women

Homicide is a leading cause of death among women who are pregnant and up to one year postpartum in the United States. Most incidents are perpetrated by an intimate partner with a firearm. Some states have implemented laws that prohibit firearm possession by perpetrators of domestic violence and, in some instances, include explicit statutory language mandating relinquishment of firearms once a person has become prohibited from possessing them. We examined the impact of these policies on state-level rates of homicide among pregnant and postpartum women during the period 2011-19. We found that state laws prohibiting possession of firearms and requiring relinquishment of firearms by people convicted of domestic violence-related misdemeanors were associated with substantial reductions in homicide of pregnant and postpartum women. State policy makers should consider further strengthening domestic violence-related firearm regulations and their enforcement to prevent homicide of pregnant and postpartum women.

Child Sexual Abuse as Lifespan Trauma Within the Context of Intimate Partner Violence: Experiences of Caribbean Women

Background: There is a dearth of research which explores sexual abuse from perspectives of Caribbean women, despite its high prevalence in the region. While sexual violence is universal, tackling it requires a deep understanding of the contextual specificities in which it arises and of the intersections of gender with other sources of oppression and marginalisation. It also calls for the recognition that intimate partner violence against women is not separate from, but linked to violence against girls, not only because both are forms of gender-based violence but because together they speak to its historical, persistent and accumulative effects. Methods: In-depth intensive interviews were carried out with 35 women from Barbados and Grenada, aged 18-60 years who had experienced intimate partner violence under one of the following circumstances: during pregnancy (n = 15), as a woman a with disability (n = 8), as a woman living with HIV (n = 12). Interviews were digitally recorded, transcribed and thematically analyzed. Results: The participants experienced multiple forms of violence within their relationships, often concurrently. Twenty-one of the women had been subject to sexual violence and of these, 19 had experienced sexual abuse as children; these experiences were viewed as interconnected and bolstered by the high level of violence-acceptance reported within communities. Women were subject to different forms of control by their partners depending upon prevailing discourses related to their circumstances (as pregnant, disabled, or HIV positive); being 'vulnerable' was synonymous with having one's agency as an independent, autonomous person constrained and little external help was available. Conclusion: The study identified a clear chain of sexual behaviors, each of which fuel different layers of the problem: the prevalence of early sexualization of children is associated with the prevalence of child sexual abuse; child sexual abuse is pervasive in large part, because of the normalisation and social acceptance of violence against women and girls; "cultural" normalcy, in turn, fuels attitudes which contribute to sexual violence against women and women in especially vulnerable circumstances face additional risks. Integrated policy, which tackles these as interconnected issues is called for.

Women's Attitude and Its Influence on Violence During Pregnancy in Northern State of Peninsular Malaysia: Cross-Sectional Study

The objective of this study was to determine the prevalence of men's violence against pregnant women and whether it is influenced by women's attitude. A cross-sectional study was carried out in a hospital in northern state of Peninsular Malaysia. A total of 1,200 postnatal women aged 18 years and above who had been admitted to the hospital were recruited in the study. Universal sampling was performed, and participants were interviewed face-to-face by using a validated Malay version of WHO Women's Health and Life Experiences Questionnaire. The main outcome measures in the study were emotional, physical or sexual violence. The study results showed that more than one third of women (35.9%; confidence interval [CI] = [0.33, 0.39]) had experienced any type of violence during pregnancy with the commonest was psychological violence (29.8%; CI = [0.27, 0.32]) followed by physical (12.9%; CI = [0.11, 0.15]) and sexual violence (9.8%; CI = [0.08, 0.12]). Women who were drug users, had an exposure to violence during childhood, had higher parity, and had inadequate antenatal care were at greater risk. Agree that husband is justified to hit his wife in certain conditions and agree that women has a right to refuse sex in certain conditions were among violence-supporting attitudes. It can be concluded that men's violence against pregnant women is extremely prevalent. Sensitive assessment, attitude modification, and intervention (primary, secondary, and tertiary) are of great value in combating men's violence against pregnant women.

Intimate partner violence and maternal health services utilization: evidence from 36 National Household Surveys

Background

High rates of maternal mortality and intimate partner violence (IPV) are both major worldwide health challenges. Evidence from single-country samples suggests that IPV may be an important risk factor for low utilization of maternal health services, but there is little large-scale evidence on this association. This paper evaluates whether IPV is a risk factor for low utilization of maternal health services in a large cross-country sample, and also compiles evidence on the relative effects of different forms of IPV.

Methods

We analyze the association between intimate partner violence and utilization of maternal health care, using a dataset compiling all Demographic and Health Surveys that report data on intimate partner violence. Using data on 166,685 women observed in 36 countries between 2005 and 2016, we estimate logistic regression models to analyze the relationship between lifetime experience of IPV and utilization of antenatal care (ANC), facility delivery care, and postnatal care. We estimate both unadjusted models and models adjusted for geographic and sociodemographic characteristics that are generally correlated with utilization of maternal health care (including age, education, number of children, wealth status, marital status, and urbanity).

Results

Lifetime experience of any IPV is associated with decreased use of maternal health services in a broad sample of births observed in lower and middle-income countries: in particular, the utilization of four or more ANC visits, the number of ANC visits, and the utilization of facility care at birth. This association remains statistically significant even after adjusting for country of residence, subnational region of residence, and additional individual-level covariates; however, there is no statistically significant association between experience of any IPV and postnatal care. The only form of IPV significantly associated with care utilization is physical IPV.

Conclusions

Women experiencing physical intimate partner violence show lower levels of utilization of maternal health services in a large sample of developing and middle-income countries. Given that reduced utilization of maternal health services is correlated with maternal and neonatal health outcomes, this pattern suggests that IPV prevention may be an important component of interventions targeting enhanced maternal and neonatal health.

Violence against pregnant women in the experience of the rape centre of Turin: Clinical and forensic evaluation

Pregnant women can be victims of violence: as a matter of fact, far from being a protective factor, pregnancy can trigger or worsen episodes of abuse. Studies conducted by the WHO highlight that its incidence fluctuates between 1% and 28%. Therefore violence during pregnancy is endemic all over the world and involves all social strata. We analysed 113 medical records concerning pregnant women (average age 27.9 ± 6.0 years, 80 foreigners), who turned to the Centro Soccorso Violenza Sessuale, one of the two Italian Rape Centre, in Turin between January 1st, 2005 and December 31st, 2017. Fifty-three women were visited in the first trimester, 41 in the second, and 16 in the third, while 3 during the puerperium. The current partner was accused to be the abuser by the 84.4% of the Italian women and by the 69.2% of the foreigners. Sixty-eight women suffered multiple forms of violence, while 98 suffered only physical violence, and 3 reported only sexual abuse. According to 20 women, violent episodes increased during pregnancy. The clinical history of these women was characterized by some recurrent physical symptoms, such as pelvic pain, abdominal pain, facial pain and headache and 54 women presented injuries (abrasions and ecchymosis). Our results confirm that violence in pregnancy is a social and public health problem. Therefore it is important that the health personnel should be prepared not only to care for women seeking help, but above all its better preparation could also identify victims of violence, which do not report abuse.

Prevalence and Factors Associated With Intimate Partner Violence Among Young Women Aged 15 to 24 Years in India: A Social-Ecological Approach

Intimate partner violence (IPV) is a critical public health issue that has reached epidemic proportions. Research investigating IPV among young women in India using large-scale population data is lacking. This study examined the prevalence and factors associated with IPV among women aged 15 to 24 years in India through a social-ecological approach. This cross-sectional study analyzed data from the National Family Health Survey, a population-based survey conducted in India from 2005 to 2006. The past-year prevalence of emotional, physical, and sexual forms of IPV, among ever-married women aged 15 to 24 years were computed. Multivariate logistic regression was conducted to evaluate the association of factors at various levels of the social-ecological framework with the past-year experience of emotional, physical, sexual, and any form of IPV. The past-year prevalence of IPV among women aged 15 to 24 years (n = 16,285) was 29%. Physical IPV was the most common, affecting 23% in the past year. The past-year prevalence of sexual IPV among women aged 15 to 24 years at 9.5% was higher than older women. Individual factors significantly associated with the past-year experience of all forms of IPV were the young age at first marriage, parental IPV, and ever had a terminated pregnancy. At the relationship level, husband's controlling behaviors, his consumption of alcohol, and experience of violence from other family members were positively associated with all forms of IPV in the past year. Poverty and acceptance of IPV increased the women's odds of experiencing IPV. IPV was associated with multiple factors occurring at all levels of the social-ecological framework. Actions to prevent and eliminate IPV in India demand multidisciplinary and collaborative efforts that are tailored specifically for adolescents and young women. It is imperative to protect the girls and young women from IPV; it protects the future of India.

The Intersection of Maternal Morbidity and Mortality and Intimate Partner Violence in the United States

Background:

In the United States, rates of maternal morbidity and mortality (MMM) are high compared with other high-income countries and are characterized by significant racial/ethnic disparities. Typically, research on MMM focuses on obstetrical problems. Less research examines the role of intimate partner violence (IPV). Maternal health, IPV, and their intersection are linked with the impacts of social determinants of health.

Objective:

We sought to understand the intersection of MMM and IPV in the United States, particularly data issues that hinder research in this area and the resulting knowledge gaps.

Methods:

We identified major articles of interest regarding maternal morbidity and mortality and IPV in the United States and drafted a mini review based on relevant information.

Results:

Despite the prevalence of IPV during pregnancy, the intersection of maternal health and IPV has not been widely reviewed or discussed.

Conclusion:

There are a number of limitations in surveillance activities and data collection that underestimate the impact of IPV on MMM. Importantly, women who die by homicide or suicide— which in many cases is linked with IPV—are not counted as pregnancy-related deaths in the United States under the current definition. Establishing separate panels of local experts in maternal health or maternal mortality review committees (MMRCs) that are dedicated to examining violent deaths and use of the Maternal Mortality Review Information Application system would likely improve data accuracy of pregnancy-associated deaths. Based on the literature reviewed and limitations of current data, there are significant knowledge gaps on the effects of IPV and maternal health.

Effectiveness of ICT-based intimate partner violence interventions: a systematic review

BACKGROUND

Intimate Partner Violence is a "global pandemic". Meanwhile, information and communication technologies (ICT), such as the internet, mobile phones, and smartphones, are spreading worldwide, including in low- and middle-income countries. We reviewed the available evidence on the use of ICT-based interventions to address intimate partner violence (IPV), evaluating the effectiveness, acceptability, and suitability of ICT for addressing different aspects of the problem (e.g., awareness, screening, prevention, treatment, mental health).

METHODS

We conducted a systematic review, following PRISMA guidelines, using the following databases: PubMed, PsycINFO, and Web of Science. Key search terms included women, violence, domestic violence, intimate partner violence, information, communication technology, ICT, technology, email, mobile, phone, digital, ehealth, web, computer, online, and computerized. Only articles written in English were included.

RESULTS

Twenty-five studies addressing screening and disclosure, IPV prevention, ICT suitability, support and women's mental health were identified. The evidence reviewed suggests that ICT-based interventions were effective mainly in screening, disclosure, and prevention. However, there is a lack of homogeneity among the studies' outcome measurements and the sample sizes, the control groups used (if any), the type of interventions, and the study recruitment space. Questions addressing safety, equity, and the unintended consequences of the use of ICT in IPV programming are virtually non-existent.

CONCLUSIONS

There is a clear need to develop women-centered ICT design when programming for IPV. Our study showed only one study that formally addressed software usability. The need for more research to address safety, equity, and the unintended consequences of the use of ICT in IPV programming is paramount. Studies addressing long term effects are also needed.

Nursing research on intimate partner violence in China: A scoping review

Intimate partner violence (IPV) is a serious public health issue, and nurses have the potential to screen, navigate to interventions, and provide support, but responses to IPV differ greatly in mainland China, Hong Kong, Macao, and Taiwan. We conducted a scoping review to examine the nursing literature on IPV in the above four regions in China. We conducted a comprehensive search of 11 Chinese and English databases from database inception to January 31, 2020, for eligible papers including empirical studies, reviews, reports, and expert opinion articles. We hand searched references lists and other studies published by the first and corresponding authors of included articles. Two reviewers independently screened articles and extracted data, and three reviewers cross-checked the extracted results. We also conducted quality appraisal for applicable empirical studies. A total of 58 Chinese-language and 63 English-language articles were included, 58 from Taiwan, 44 from Hong Kong, 13 from mainland China, and six from institutions outside China, but none from Macao. The quantitative and qualitative studies described the prevalence and complex nature of IPV, comparable to non-nursing and international studies. Nurse-led advocacy and Qigong (traditional Chinese mind-body health practice) interventions showed promise for improving mental health in women in Hong Kong. There was a low level of knowledge and preparedness to respond to IPV among Chinese nurses, especially in mainland China. Mixed methods studies in Hong Kong and Taiwan as complex designs were generally well-conducted. Nursing case reports from Taiwan uniquely supplemented the evidence base. In Hong Kong and Taiwan, varying designs were used to study various facets of IPV, targeting victims, nurses and other key stakeholders. In mainland China and Macao, IPV research was limited in quantity, quality, and diversity. As more research in the area of IPV is needed, factors influencing nursing research on IPV also merit investigation, while taking into consideration socio-economic-political-cultural factors.

Intimate partner violence among postpartum women at a teaching hospital in Nigeria's Federal Capital City: pattern and materno-fetal outcomes

Background

Intimate partner violence is an important public health and human rights issue. Previous studies have considered intimate partner violence in pregnancy mainly among pregnant women attending antenatal clinics thereby missing out a few who may encounter this problem in late pregnancy or just before delivery. This study had the objective of ascertaining the prevalence, pattern of intimate partner violence, and associated materno-fetal outcomes.

Method

This was a cross-sectional study conducted between January 2017 and June 2017 among postpartum mothers at a Nigerian Teaching Hospital just before being discharged home. The abuse assessment score was adapted and used to interview women regarding possible intimate partner violence experiences within the past 1 year and during the pregnancy after obtaining written consent.

Results

Out of 349 postpartum women interviewed, 102/349 (29.2%) experienced intimate partner violence in the past 1 year, while 18/349 (5.2%) of intimate partner violence occurred in the index pregnancy. Sexual partners were the main perpetuators of intimate partner violence, 67/102 (65.7%), while 35/102 (34.3%) were by someone else other than their sexual partners. Among those abused in the current pregnancy, 10/18 (55.6%) were abused once and the remaining 8/18 (44.4%) were abused more than once. Intimate partner violence was associated with higher chances of cesarean section (p = 0.001), increased risk of lesser birth weight babies (p = 0.014), and maternal complications in pregnancy (p = 0.030).

Conclusion

The prevalence of intimate partner violence in pregnancy in Abuja is high with associated poor materno-fetal outcomes. Enforcing existing legislations and screening for intimate partner violence during routine antenatal care may help reduce its prevalence and ensure a positive pregnancy experience for Nigerian women.

Associations between recent intimate partner violence and receipt and quality of perinatal health services in Uttar Pradesh

BACKGROUND

India suffers some of the highest maternal and neonatal mortality rates in the world. Intimate partner violence (IPV) can be a barrier to utilization of perinatal care, and has been associated with poor maternal and neonatal health outcomes. However, studies that assess the relationship between IPV and perinatal health care often focus solely on receipt of services, and not the quality of the services received.

METHODS AND FINDINGS

Data were collected in 2016-2017 from a representative sample of women (15-49yrs) in Uttar Pradesh, India who had given birth within the previous 12 months (N = 5020), including use of perinatal health services and past 12 months experiences of physical and sexual IPV. Multivariate logistic regression models assessed whether physical or sexual IPV were associated with perinatal health service utilization and quality. Reports of IPV were not associated with odds of receiving antenatal care or a health worker home visit during the third trimester, but physical IPV was associated with fewer diagnostic tests during antenatal visits (beta = -0.30), and fewer health topics covered during home visits (beta = -0.44). Recent physical and recent sexual IPV were both associated with decreased odds of institutional delivery (physical IPV AOR 0.65; sexual IPV AOR 0.61), and recent sexual IPV was associated with leaving a delivery facility earlier than recommended (AOR = 1.87). Neither form of IPV was associated with receipt of a postnatal home visit, but recent physical IPV was associated with fewer health topics discussed during such visits (beta = -0.26).

CONCLUSIONS

In this study, reduced quantity and quality of perinatal health care were associated with recent IPV experiences. In cases where IPV was not related to care receipt, IPV remained associated with diminished care quality. Additional study to understand the mechanisms underlying associations between IPV and care qualities is required to inform health services.

The Influence of Intimate Partner Violence on Pregnancy Symptoms

The current literature contains few studies conducted on the effects of intimate partner violence (IPV) on pregnancy symptoms. Does being subjected to IPV during pregnancy increase the incidence of pregnancy-related symptoms? The aim of the present study was to explore the impact of IPV on pregnancy-related symptoms. The study was conducted as comparative, descriptive, and cross-sectional research with a total of 370 participants. Data were collected using the Domestic Violence Against Women Screening Form, the Pregnancy Symptoms Inventory (PSI), and a descriptive questionnaire. The types of IPV the women in the study had experienced during pregnancy were, in order of frequency, verbal abuse (31.1 %; n = 115), economic abuse (25.9 %; n = 96), physical violence (8.4 %; n = 31), and sexual abuse (5.9%; n = 22). The PSI scores for the pregnant women subjected to physical violence related to gastrointestinal system symptoms (p < .05), cardiovascular system symptoms (p < .05), mental health symptoms (p = 0), neurological system symptoms (p < .05), urinary system symptoms (p < .01), and tiredness or fatigue (p = 0); their total PSI scores (p = 0) were significantly higher statistically than those of women who did not experience physical violence during pregnancy. The scores of the pregnant women subjected to sexual abuse related to mental health symptoms (p < .05), and their total PSI scores (p < .05) were significantly higher than those of women who did not experience sexual abuse. The scores of the pregnant women subjected to economic abuse related to tiredness or fatigue (p < .01) and their mental health symptom scores (p < .05) were significantly higher than those of women who did not experience economic abuse. Our results showed that women subjected to IPV during pregnancy experienced a higher incidence of pregnancy symptoms.

The Safe Pregnancy study - promoting safety behaviours in antenatal care among Norwegian, Pakistani and Somali pregnant women: a study protocol for a randomized controlled trial

BACKGROUND

Intimate partner violence (IPV) around the time of pregnancy is a recognized global health problem with damaging consequences. However, little is known about the effect of violence assessment and intervention during pregnancy. We hypothesise that routine enquiry about IPV during pregnancy, in combination with information about IPV and safety behaviours, has the potential to increase the use of these behaviours and prevent and reduce IPV.

METHODS

The Safe Pregnancy study is a randomised controlled trial (RCT) to test the effectiveness of a tablet-based intervention to promote safety behaviours among pregnant women. Midwives include women who attend routine antenatal care. The intervention consists of a screening questionnaire for violence and information about violence and safety behaviours through a short video shown on a tablet. The materials are available in different languages to ensure participation of Norwegian, Urdu, Somali and English-speaking women. Eligible women answer baseline questions on the tablet including the Abuse Assessment Scale (AAS). Women who screen positive on the AAS will be randomized to an intervention video that contains information about violence and safety behaviours and women in the control group to a video with general information about a healthy and a safe pregnancy. All women receive information about referral resources. Follow up will be at three months post-partum, when the woman attends the maternal and child health centre (MCHC) for the baby's check-up. Outcome measures are: Use of safety behaviours and quality of life (primary outcomes), prevalence of violence, mental health measures and birth outcomes (secondary outcomes). Intention to treat analysis will be performed.

DISCUSSION

The project will provide evidence on whether enquiry about violence and a short video intervention on a tablet is effective and feasible to prevent or reduce harm from IPV among women who attend antenatal care.

TRIAL REGISTRATION

This study is registered in ClinicalTrials.gov. Identifier: NCT03397277 (Registered 11th January 2018).

Predictors of psychological distress in low-income mothers over the first postpartum year

Up to 25% of postpartum women experience psychological distress including stress, depressive, or anxiety symptoms during the postpartum period. The purpose of this study was to explore the extent to which social determinants of health and allostatic load score, a 10-item index of biologic measures of chronic stress, predict psychological distress in low-income pregnant women over the first postpartum year. We conducted a secondary data analysis of the Child Community Health Research Network data set. The psychological distress outcome variables were perceived stress (n = 842), depression ( n = 845), and anxiety ( n = 846) symptoms, all measured categorically over the first year postpartum (T1:1 month, T2: 24-29 weeks, and T3: 50-65 weeks). Our predictors were social determinants of health (e.g., demographics, maternal hardship, percent poverty level, interpersonal violence, and food security) and allostatic load score. Generalized linear mixed models were used to determine which predictors were significantly associated with psychological distress symptoms across the first postpartum year. Interpersonal violence was a statistically significant risk factor for stress, depression, and anxiety symptoms over the first year postpartum. Other significant risk factors included low-income level, nativity, and perceived food security. Receiving food stamps was a significant protective factor for stress symptoms. The significance of risk factors for psychological distress, both modifiable and nonmodifiable, can be used as potential targets for further research, screening, and intervention. Future work should explore why and in what conditions these risk factors vary over time.

Domestic Violence in Pregnant Women: A Study Conducted in the Postpartum Period of Adolescents and Adults

The aim of this study was to estimate the prevalence of domestic violence in adolescent and adult mothers who were admitted to obstetrics services centers in Brazil and to identify risk factors of domestic violence and any adverse obstetric and perinatal outcomes. Researchers used standardized interviews, the questionnaire Abuse Assessment Screen, and a review of patients' medical records. Descriptive statistical analyses were also used. The prevalence of domestic violence among all participants totaled 40.1% (38.5% of adolescents, 41.7% of adults). Factors associated with domestic violence during pregnancy were as follows: a history of family violence, a greater number of sexual partners, and being a smoker. No statistically significant association was found for adverse obstetric and perinatal outcomes. Results showed that, in Vitória, Espírito Santo, Brazil, pregnancy did not protect a woman from suffering domestic violence.

Intimate partner violence during pregnancy and adverse birth outcomes: a case-control study

BACKGROUND

Intimate partner violence is a common phenomenon in Ethiopia families. About 81% of women believed that a husband is justified in beating his wife. About 30-60% of families were affected by their intimates. Women suffer physical, emotional, sexual and economic violence by their intimate partners. It often remains either for the sake of family secrecy, cultural norms or, due to fear, shame and community's reluctance on domestic affair and social stigma.The objective of this study is to examine the association between intimate partner violence during pregnancy and adverse birth outcomes.

METHODS

A hospital based unmatched case control study was conducted in four zonal hospitals of Tigray region. A total of 954 study participants (318 cases and 636 controls) were taken. Systematic sampling was used to select the cases and controls. Ethical clearance was obtained throughout the study period.

RESULT

Out of 954 interviewed mothers, 389 (40.8%) had experienced intimate partner violence during their index pregnancy period. More than two third (68.6%) of cases had been exposed to intimate partner violence. Multivariable logistic regression analysis showed that, women exposed to intimate partner violence during pregnancy were three times more likely to experience low birth weight (AOR = 3.1; CI 95% [1.470,6.618]) and preterm birth (AOR = 2.5; CI 95% [2.198-2.957]). It was observed that women who had been exposed to physical violence during pregnancy were five times more likely to experience low birth weight (AOR = 4.767; CI 95% [2.515, 9.034]) and preterm birth (AOR = 5.3; CI 95%: 3.95-7.094).

CONCLUSION AND RECOMMENDATION

It was found that the risk of preterm birth and low birth weight was increased when the pregnant women were exposed to more than one type of intimate partner violence and physical violence during pregnancy. Therefore, Efforts to address maternal and newborn health need to include issues of violence against women.

Marital Rape and HIV Risk in Uganda: The Impact of Women's Empowerment Factors

This study used Uganda Demographic Health Survey data (2011) to examine the role of women's empowerment in reducing HIV risk among married women who experienced sexual violence in Uganda. The sample size was 8,674 ever-married women aged 15-49 years. Significant differences were revealed for marital rape, women's empowerment variables, and reducing HIV risk according to sociodemographic characteristics. Women's labor force participation partially mediated the relationship between sexual violence and reducing HIV risk, but decision making did not. Findings highlight the need for the development and implementation of policies and programs to address marital rape and reduce HIV risk within institutions of marriage.

Early Childhood Victimization and Physical Intimate Partner Violence During Pregnancy: A Developmental and Person-Oriented Approach

Intimate partner violence (IPV) victimization during pregnancy is a major public health concern, yet little is known about how risk factors for IPV during pregnancy may depend on whether women have histories of victimization dating back to early childhood (ages 0-5 years). This study examined whether risk factors for physical IPV victimization during pregnancy (a pregnancy that was not planned and prenatal substance use) differed for women with versus without early childhood victimization. Participants were 236 ethnically diverse, low-income biological mothers ( M = 30.94 years; 50.0% Latina, 16.9% Caucasian, 13.1% African American, and 16.9% multiracial) of children aged 0 to 6 years. Mothers were classified into four groups based on whether they had experienced early childhood victimization and physical IPV victimization during pregnancy with the target child. Multinomial logistic regressions, controlling for demographic characteristics, examined whether a pregnancy not planned and prenatal substance use predicted group membership. Compared to mothers with early victimization only, mothers with both early childhood victimization and physical IPV during pregnancy were more than 3 times as likely to report that their pregnancy with the target child was not planned. In follow-up analyses, mothers with early victimization and physical IPV during pregnancy also reported higher lifetime parity than mothers with physical IPV during pregnancy but no early victimization. Early childhood victimization may place women on a risk pathway to physical IPV during pregnancy, particularly if the pregnancy is not planned. Prevention and policy efforts should screen women for early childhood victimization to understand risks for physical IPV during pregnancy.

An Intimate Partner Violence Prevention Intervention in a Nurse Home Visitation Program: A Randomized Clinical Trial

BACKGROUND

Intimate partner violence (IPV) is a significant public health problem with many negative consequences, particularly for pregnant women. This randomized trial investigated the effectiveness of an IPV preventive intervention embedded within the Nurse Family Partnership (NFP) program.

MATERIALS AND METHODS

Participants enrolled over a 20-month period and were interviewed at baseline and 1- and 2-year follow-up. Eligibility criteria included first pregnancy, eligible for the nutrition program Women, Infants, and Children (WIC), English or Spanish speaking, and at least 15 years of age. All women initially referred and screened were randomized to either intervention (NFP+) or control (NFP only) condition. The final sample consisted of 238 women completing baseline assessments; retention was 81% at 2-year follow-up.

RESULTS

Analyses indicated that there were no main effects: the intervention affected participants differently depending on their baseline experience with IPV. For physical violence victimization, an interaction between baseline victimization and treatment was found; the intervention reduced victimization at 1 year (and approached significance at 2 years), but only among women who had not experienced past-year physical victimization at baseline. For sexual violence victimization, another interaction emerged; women in the intervention group were more likely to report sexual violence victimization at 2-year follow-up, but only among participants who had reported sexual victimization at baseline. The only effect on IPV perpetration was psychological perpetration at 2-year follow-up; again, the treatment effect was moderated by baseline perpetration. The intervention reduced psychological perpetration for participants who were nonperpetrators at baseline, but had no effect on those reporting perpetration.

CONCLUSIONS

Overall, findings suggest that the intervention was effective in reducing some forms of violence among those not experiencing IPV at baseline, but was ineffective or potentially harmful for those already experiencing IPV.

Exposure to domestic violence influences pregnant women's preparedness for childbirth in Nepal: A cross-sectional study

OBJECTIVE

This study aimed to evaluate if domestic violence affected women's ability to prepare for childbirth. Birth preparedness and complication readiness (BP/CR) includes saving money, arranging transportation, identifying a skilled birth attendant, a health facility, and a blood donor before childbirth. During data collection, Nepal experienced two earthquakes and therefore it was possible to examine associations between domestic violence, women's BP/CR and effects of the earthquakes.

METHODS

Women who were between 12 and 28 weeks of gestation participated in a descriptive cross-sectional study at a hospital antenatal clinic in Nepal, where they completed a structured questionnaire on sociodemographic characteristics, obstetric history, experiences of domestic violence, and BP/CR. The 5-item Abuse Assessment Screen was used to assess prevalence of domestic violence, and a questionnaire on safe motherhood obtained from Jhpiego was used to assess BP/CR status. The participants self-completed the questionnaire on a tablet computer. Those who reported at least three out of five BP/CR activities were considered prepared for childbirth.

RESULTS

A total of 1011 women participated in the study: 433 pre-earthquakes and 578 post-earthquakes. With respect to BP/CR, 78% had identified a health facility for childbirth and 65% had saved money prior to childbirth. Less than 50% had identified a birth attendant to assist with the delivery, transportation to a health facility, or arranged for a potential blood donor. Prior to the earthquakes, 38% were unprepared; by contrast, almost 62% were not prepared after the earthquakes. A significant association was found between exposure to violence and not being prepared for childbirth (AOR = 2.3, 95% CI: 1.4-3.9). The women with increased odds of not being prepared for childbirth were illiterate (AOR = 9.9, 95% CI:5.7-17), young (AOR = 3.4, 95% CI:1.6-7.2), from the most oppressed social classes (AOR = 3.0, 95% CI:1.2-7.6), were married to illiterate husbands (AOR = 2.5, 95% CI:1.2-5.2), had attended fewer than four antenatal visits (AOR = 2.0, 95% CI: 1.4-2.6), had low incomes (AOR = 1.7, 95% CI:1.1-2.9) or lived in rural settings (AOR = 1.5, 95% confidence interval CI:1.2-2.1).

CONCLUSION

The paper identifies vulnerable women who require extra care from the health system, and draws attention to the need for interventions to reduce the harmful effects of domestic violence on women's preparations for childbirth.

Intimate Partner Violence, Small for Gestational Age Birth and Cigarette Smoking in the Pregnancy Risk Assessment Monitoring System

BACKGROUND

Exposure to intimate partner violence (IPV) in the perinatal period is associated with obstetric complications, poor maternal mental health, neonatal complications, and increased risk of infant mortality and morbidity. Less is known about how IPV may influence small for gestational age (SGA) birth.

MATERIALS AND METHODS

Data were obtained for 231,081 United States mothers who delivered neonates from 2004 to 2011 and completed the Pregnancy Risk Assessment Monitoring System survey 2-9 months after delivery. Weighted descriptive statistics and multivariate logistic regression models were used.

RESULTS

IPV in the year before or during pregnancy was related to SGA bivariately (odds ratio 1.39, 95% confidence interval [CI] 1.28, 1.51), and after adjustment for demographic and obstetric factors, this association attenuated after further adjustment for perinatal smoking patterns, (adjusted odds ratio [aOR] 1.06, 95% CI 0.97, 1.15). Compared with nonabused women, women experiencing perinatal IPV were more than twice as likely to smoke before pregnancy (aOR 2.34, 95% CI 2.19, 2.49), and nearly 1.5 times as likely to report sustained smoking into the last 3 months of pregnancy (aOR 1.45, 95% CI 1.32, 1.59). In turn, among prepregnancy smokers, sustained smoking was associated with delivery of a SGA neonate (aOR 1.87, 95% CI 1.72, 2.03), fully attenuating the association of perinatal IPV with SGA.

CONCLUSION

Women who experienced perinatal IPV were significantly more likely to smoke prepregnancy and sustain smoking into the last 3 months of pregnancy. Through behavioral and physiological pathways, smoking cessation may be uniquely challenging for women experiencing IPV, yet critical to address clinically to mitigate risk for SGA.

Gender, Migration, and Exclusionary Citizenship Regimes: Conceptualizing Transnational Abandonment of Wives as a Form of Violence Against Women

Based on life history narratives of 57 women in India and interviews with 21 practitioners, we document the neglect, abuse, and instrumental deprivation of women's rights through the process of transnational abandonment. While gendered local sociocultural milieus and economic norms contribute to these harms, they are crucially enabled and sustained by transnational formal-legal frameworks. Widening the explanatory lens for understanding domestic violence beyond the family and community, we argue that in a globalized world, (inter)state policies serve to construct these women as a subordinate category of citizens-"disposable women"-who can be abused and abandoned with impunity.

Prevalence of intimate partner violence (IPV) during pregnancy in China: A systematic review and meta-analysis

Background

Intimate partner violence (IPV) is the most common form of violence against women worldwide. IPV during pregnancy is an important risk factor for adverse health outcomes for women and their offspring. However, the prevalence of IPV during pregnancy is not well understood in China. The objective of this study was to estimate the pooled prevalence of IPV during pregnancy in China using a systematic review and meta-analysis.

Methods

Systematic literature searches were conducted in PubMed, Web of Science, CNKI, Wanfang, Weipu and CBM databases to identify relevant articles published from the inception of each database to January 31, 2016 that reported data on the prevalence of IPV during pregnancy in China. The Risk of Bias Tool for prevalence studies was used to assess the risk of bias in individual studies. Owing to significant between-study heterogeneity, a random-effects model was used to calculate the pooled prevalence and corresponding 95% confidence interval, and then univariate meta-regression analyses were performed to investigate the sources of heterogeneity. Subgroup analysis was conducted to explore the risk factors associated with IPV during pregnancy.

Results

Thirteen studies with a total of 30,665 individuals were included in this study. The overall pooled prevalence of IPV during pregnancy was 7.7% (95% CI: 5.6–10.1%) with significant heterogeneity (I² = 97.8%, p < 0.001). The results of the univariate meta-regression analyses showed that only the variable “sample source” explained part of the heterogeneity in this study (p < 0.05). The characteristics “number of children” and “unplanned pregnancy” were determined as risk factors for experiencing violence during pregnancy.

Conclusions

The prevalence of IPV during pregnancy in China is considerable and one of the highest reported in Asia, which suggests that issues of violence against women during pregnancy should be included in efforts to improve the health of pregnant women and their offspring. In addition, a nationwide epidemiological study is needed to confirm the prevalence estimates and identify more risk factors for IPV during pregnancy.

Effects of Socioeconomic Status and Social Support on Violence against Pregnant Women: A Structural Equation Modeling Analysis

Few studies have used structural equation modeling to analyze the effects of variables on violence against women. The present study analyzed the effects of socioeconomic status and social support on violence against pregnant women who used prenatal services. This was a cross-sectional study based on data from the Brazilian Ribeirão Preto and São Luís birth cohort studies (BRISA). The sample of the municipality of São Luís (Maranhão/Brazil) consisted of 1,446 pregnant women interviewed in 2010 and 2011. In the proposed model, socioeconomic status was the most distal predictor, followed by social support that determined general violence, psychological violence or physical/sexual violence, which were analyzed as latent variables. Violence was measured by the World Health Organization Violence against Women (WHO VAW) instrument. The São Luis model was estimated using structural equation modeling and validated with 1,378 pregnant women from Ribeirão Preto (São Paulo/Brazil). The proposed model showed good fit for general, psychological and physical/sexual violence for the São Luís sample. Socioeconomic status had no effect on general or psychological violence (p>0.05), but pregnant women with lower socioeconomic status reported more episodes of physical/sexual violence (standardized coefficient, SC = -0.136; p = 0.021). This effect of socioeconomic status was indirect and mediated by low social support (SC = -0.075; p<0.001). Low social support was associated with more episodes of general, psychological and physical/sexual violence (p<0.001). General and psychological violence indistinctly affected pregnant women of different socioeconomic status. Physical/sexual violence was more common for pregnant women with lower socioeconomic status and lower social support. Better social support contributed to reduction of all types of violence. Results were nearly the same for the validation sample of Ribeirão Preto except that SES was not associated with physical/sexual violence.

A mixed methods assessment of barriers to maternal, newborn and child health in gogrial west, south Sudan

Background

Health conditions for mothers, newborns, and children in South Sudan are among the worst worldwide. South Sudan has the highest rate of maternal mortality in the world and despite alarming statistics, few women and children in South Sudan have access to needed healthcare, especially in rural areas. The purpose of this study was to understand the barriers to maternal, newborn and child health in Gogrial West, Warrap State, South Sudan, one of the most underdeveloped states.

Methods

A randomized household quantitative study and supplemental qualitative interviews were employed in 8/9 payams in Gogrial West, Warrap, South Sudan. Interviews were conducted with randomly selected female household members (n = 860) who were pregnant or had children less than 5 years of age, and men (n = 144) with a wife having these characteristics. Non-randomized qualitative interviews (n = 72) were used to nuance and add important socio-cultural context to the quantitative data. Analysis involved the estimation of weighted population means and percentages, using 95% confidence intervals and considering p-values as significant when less than 0.05, when comparisons by age, age of marriage, wife status and wealth were to be established.

Results

Most women (90.8%) and men (96.6%) did not want contraception. Only 1.2% of women aged 15–49 had met their need for family planning. On average, pregnant women presented for antenatal care (ANC) 2.3 times and by unskilled providers. Less than half of households had a mosquito net; fewer had insecticide treated nets. Recognition of maternal, newborn and child health danger signs overall was low. Only 4.6% of women had skilled birth attendants. One quarter of children had verifiable DPT3 immunization. Five percent of men and 6% of women reported forced intercourse. Overall men and women accept beatings as a norm.

Conclusion

Barriers to care for mothers, infants and children are far more than the lack of antenatal care. Maternal, newborn and child health suffers from lack of skilled providers, resources, distance to clinics. A lack of gender equity and accepted negative social norms impedes healthy behaviors among women and children. The paucity of a peer-reviewed evidence base in the world’s newest country to address the overwhelming needs of the population suggests these data will help to align health priorities to guide programmatic strategy for key stakeholders.

Factors associated with physical violence against pregnant women from São Luís, Maranhão State, Brazil: an approach using structural equation modeling

Abstract: The factors associated with physical violence against pregnant women were analyzed in a cross-sectional study of 1,446 pregnant women from a prenatal cohort who were interviewed in 2010 and 2011 in São Luís, Brazil. In the initial model, socioeconomic status occupied the most distal position, determining sociodemographic factors, social support and the behavioral factors that ultimately determined physical violence, which was investigated as a latent variable. Structural equation modeling was used in the analysis. Pregnant women who were from more disadvantaged backgrounds (p = 0.027), did not reside with intimate partners (p = 0.005), had low social support (p < 0.001) and had a high number of lifetime intimate partners (p = 0.001) reported more episodes of physical violence. Low social support was the primary mediator of the effect of socioeconomic status on physical violence. The effect of marital status was mainly mediated by a high number of lifetime intimate partners.

Testing a counselling intervention in antenatal care for women experiencing partner violence: a study protocol for a randomized controlled trial in Johannesburg, South Africa

BACKGROUND

Intimate partner violence (IPV) during or before pregnancy is associated with many adverse health outcomes. Pregnancy-related complications or poor infant health outcomes can arise from direct trauma as well as physiological effects of stress, both of which impact maternal health and fetal growth and development. Antenatal care can be a key entry point within the health system for many women, particularly in low-resource settings. Interventions to identify violence during pregnancy and offer women support and counselling may reduce the occurrence of violence and mitigate its consequences.

METHODS

Following a formative research phase, a randomized controlled trial will be conducted to test a nurse-led empowerment counselling intervention, originally developed for high-income settings and adapted for urban South Africa. The primary outcome is reduction of partner violence, and secondary outcomes include improvement in women's mental health, safety and self-efficacy. The study aims to recruit 504 pregnant women from three antenatal clinics in Johannesburg who will be randomized to the nurse-led empowerment arm (two 30-min counselling sessions) or enhanced control condition (a referral list) to determine whether participants in the intervention arm have better outcomes as compared to the those in the control arm.

DISCUSSION

This research will provide much needed evidence on whether a short counselling intervention delivered by nurses is efficacious and feasible in low resource settings that have high prevalence of IPV and HIV.

TRIAL REGISTRATION

The study was registered in the South African Clinical Trials Registry (DOH-27-0414-4720) on 11 August 2014 and in the ISRCTN Registry ( ISRCTN35969343 ) on 23 May 2016).

The Consequences of Intimate Partner Violence on Health: A Further Disaggregation of Psychological Violence-Evidence From Spain

Using a nationally representative sample of 10,171 women, this study examines the association between current and previous intimate partner violence and current health status. Current physical or sexual violence was associated with the highest likelihood of reporting health outcomes, followed by current emotional or economic abuse. Current controlling behavior increased the odds of reporting poor health whereas previous controlling behavior has less effect on current health. Controlling behavior alone often is the first expression of mistreatment. If health professionals could identify violence at this early stage, long-term effects on women's health could be minimized. The implications for health of the cumulative effects of violence and of its timing are discussed.