Prevalence of domestic violence during pregnancy and related risk factors: a cross-sectional study in southern Sweden

The Consequences of A History of Violence on Women's Pregnancy and Childbirth in the Nordic Countries: A Scoping Review

Violence against women (VAW) is a global challenge also in the childbearing period. Despite high gender equality, there is a high prevalence of VAW in the Nordic countries. This scoping review aims to explore predictors for and consequences of a history of violence on women's pregnancy and childbirth in the Nordic countries, including women's experience of the impact of violence and the interventions used to detect, address consequences, and prevent further violence. The framework by Arksey and O'Malley was followed, and English, Finnish, Icelandic, Norwegian, Danish, and Swedish literature was included. The population was women aged ≥18 residing in the Nordic countries during the perinatal period. Eight databases were searched: MEDLINE, CINAHL, PubMed, PsycINFO, Web of Science, ASSIA, Social Services-, and Sociological abstracts. There was no limitation of the search time frame. The initial screening resulted in 1,104 records, and after removing duplicates, 452 remained. Finally, 61 papers met the inclusion criteria. The results covering the past 32 years indicated that childbearing women with a history of violence are at greater risk of common complaints and hospitalization during pregnancy, fear of childbirth, Cesarean section, breastfeeding difficulties, and physical and mental health problems. While extensive research was found on the associations between a history of and current violence and outcomes related to pregnancy, there was a lack of intervention studies and studies from Finland. Efforts must be made to scientifically test the methods used to reduce and treat the adverse effects of a history of violence and prevent further violence.

Prevalence and severity of physical intimate partner violence during pregnancy among adolescents in eight sub-Saharan Africa countries: A cross-sectional study

Globally, intimate partner violence (IPV) is highly prevalent, with adolescents being particularly vulnerable, especially during pregnancy. This study examines the prevalence and severity of physical IPV among pregnant adolescents in sub-Saharan Africa (SSA). We analyzed data from Demographic Health Surveys collected between 2017-2021 from eight SSA countries, involving 2,289 ever-pregnant adolescents aged 15-19. Physical IPV during pregnancy was defined as experiencing physical harm while pregnant by a husband, former partner, current boyfriend, or former boyfriend. Severity of physical IPV included experiences such as kicking, choking, weapon threats, and serious injuries. Logistic regression analysis was conducted, with results presented as unadjusted and adjusted odds ratios with 95% confidence intervals. The prevalence of physical IPV during pregnancy among adolescents in the eight SSA countries ranged from 2.9% to 12.6%, with 5.6% experiencing severe lifetime physical IPV and 6.3% severe physical injuries. We found a strong association between physical IPV during pregnancy and severe lifetime physical IPV (aOR: 6.8, 95% CI: 4.5-10.4) and severe injuries (aOR: 9.2, 95% CI: 6.0-14.2), even after adjusting for covariates. Physical IPV during pregnancy is common among adolescents in SSA and is associated with severe physical lifetime IPV. Addressing this issue in low-resource settings requires collaborative efforts among community stakeholders, health system practitioners, and policymakers to protect vulnerable adolescent girls during pregnancy.

The burden of prenatal and early life maternal substance use among children at risk of maltreatment: A systematic review

ISSUES

Although maternal substance use is a known risk factor for child maltreatment, evidence on the scale of substance use is needed to inform prevention responses. This systematic review synthesised prevalence estimates of maternal substance use during pregnancy and early life among children at risk of maltreatment. Ovid, Pubmed, CINAHL, PsychInfo and ProQuest databases were searched. We included observational studies that sampled children at risk of maltreatment in high-income countries and reported information on maternal substance use during pregnancy and/or the child's first year of life. We extracted study characteristics and data to calculate prevalence, assessed risk of bias and conducted a narrative synthesis; there were insufficient comparable populations or outcomes to quantitatively synthesise results.

KEY FINDINGS

Thirty five of 14,084 titles were included. Fifteen studies had adequately sized and representative samples to estimate prevalence. Maternal substance use prevalence ranged from 2.4% to 40.6%. Maternal substance use was highest among infants referred to child protection at birth (40.6%) and children in out-of-home care (10.4% to 37.2%). Prevalence was higher when studies defined substance use more broadly and when maternal substance use was ascertained from both child and mother records.

IMPLICATIONS

Supportive, coordinated responses to maternal substance use are needed from health and child protection services, spanning alcohol and other drug treatment, antenatal and postnatal care.

CONCLUSIONS

Prenatal and early life maternal substance use is common among child maltreatment populations, particularly among younger children and those with more serious maltreatment.

An Umbrella Review of the Literature on Perinatal Domestic Violence: Prevalence, Risk Factors, Possible Outcomes and Interventions

Perinatal domestic violence (P-DV) is a common form of violence experienced by women and is associated with adverse impacts on their own physical and mental health and that of their offspring. Illuminating the risk factors for, potential effects of, and promising interventions to reduce P-DV is essential for informing policies to tackle P-DV and mitigate its negative impacts. This umbrella review of recent high-quality systematic reviews and meta-analyses of worldwide research on P-DV provides a systematic synthesis of current knowledge relating to the prevalence, risk factors for, possible outcomes of and interventions to reduce and prevent P-DV. 13 reviews identified through systematic searches of computerised databases, manual search and expert consultation met our inclusion criteria (i.e. English systematic reviews and/or meta-analyses that were from recent 10 years, focused on women exposed to P-DV, assessed risk factors, possible outcomes and/or interventions, and were of fair to high methodological quality). Our results suggest that while there is a growing understanding of risk factors and possible outcomes of P-DV, this knowledge has thus far not been translated well into effective interventions. P-DV intervention programmes that have been subject to rigorous evaluation are mostly relatively narrow in scope and could benefit from targeting a wider range of maternal and child wellbeing outcomes, and perpetrator, relationship and community risk factors. The overall quality of the evidence syntheses in this field is reasonable; however, future studies should involve multiple reviewers at all key stages of systematic reviews and meta-analyses to help enhance reliability.

Intimate partner violence during pregnancy - Prevalence and associations with women's health: A cross-sectional study

OBJECTIVE

Intimate partner violence (IPV) against women occurs in all settings. Exposure to intimate partner violence, especially during pregnancy, is associated with serious adverse health outcomes and is recognized as a global health issue.

AIM

To describe the prevalence of physical, psychological, and sexual intimate partner violence among pregnant women in Sweden during current pregnancy, and to investigate potential associations between exposure and sociodemographic characteristics and health.

METHODS

Between October and December 2020, a cross-sectional survey study was conducted at 35 midwifery clinics in Stockholm, Sweden.

RESULTS

The questionnaire was answered by 3399 pregnant women. The results showed that 2.1% of the women reported exposure to intimate partner violence during pregnancy, with exposure to psychological violence being most common (1.8%), followed by exposure to physical violence (0.6%) and sexual violence (0.1%). Exposure to intimate partner violence was significantly associated with living situation and depressive symptoms, as well as education, country of birth, and employment status.

CONCLUSION

Exposure to intimate partner violence occurs even during pregnancy and it is crucial to identify pregnant women exposed to intimate partner violence in order to inform clinical practice and to provide adequate support. More research is needed to develop screening instruments to detect violence against pregnant women.

Multilevel analysis of factors for intimate partner violence during pregnancy in Gammo Goffa Zone, South Ethiopia: A community based study

Background

Intimate partner violence during pregnancy is a public health problem that can affect both maternal and fetal life. However, its prevalence and associated factors have not been well studied and understood in Ethiopia. Hence, this study was conducted to assess the individual and community-level factors associated with intimate partner violence during pregnancy in Gammo Goffa Zone, South Ethiopia.

Methods

A community-based cross-sectional study was conducted among 1,535 randomly selected pregnant women from July to October 2020. Data were collected using an interviewer-administered, standardized WHO multi-country study questionnaire and analyzed using STATA 14. A two level mixed-effects logistic regression model was used to identify factors associated with intimate partner violence during pregnancy.

Results

The prevalence of intimate partner violence during pregnancy was found to be 48% (95% CI: 45–50%). Factors affecting violence during pregnancy were identified at the community and individual levels. Access to health facilities (AOR = 0.61; 95% CI: 0.43, 0.85), women feeling isolated from the community (AOR= 1.96; 95% CI: 1.04, 3.69), and strict gender role differences (AOR= 1.45; 95% CI: 1.03, 2.04) were among higher-level factors found to be significantly associated with intimate partner violence during pregnancy. Low decision-making power was found to increase the odds of experiencing IPV during pregnancy (AOR= 2.51; 95% CI: 1.28, 4.92). Similarly, maternal education, maternal occupation, living with the partner's family, current pregnancy intended by the partner, dowry payment, and presence of marital conflict were among the individual- level factors found to increase the odds of experiencing intimate partner violence during pregnancy.

Conclusions

The prevalence of intimate partner violence during pregnancy was high in the study area. Both individual and community-level factors had significant implications on maternal health programs related to violence against women. Socio-demographic and socio-ecological characteristics were identified as associated factors. Since it is a multifaceted problem, special emphasis has to be given to multi-sectoral approaches involving all responsible bodies to mitigate the situation.

Cultural Sensitivity in Interventions Aiming to Reduce or Prevent Intimate Partner Violence During Pregnancy: A Scoping Review

Intimate partner violence (IPV) around the time of pregnancy is a recognized global health problem. Ethnic minorities and immigrant pregnant women experiencing IPV require culturally responsive health services. The aim of this scoping review was to identify aspects of cultural sensitivity in interventions to prevent or reduce IPV among ethnic minorities and immigrant pregnant women in high-income countries. Eight databases were searched in November 2019. Any type of scientific research, quantitative, qualitative, or mixed methods studies regarding interventions against IPV among pregnant women were considered for inclusion. Resnicow et al.'s definition of cultural sensitivity was used to identify aspects of cultural sensitivity. Ten papers relating to nine interventions/studies met our inclusion criteria. These studies, which included randomized controlled trials, a mixed methods study, a program evaluation, and a longitudinal study, were conducted in Australia, Belgium, Norway, and the United States. Aspects of surface cultural sensitivity, including the translation of intervention content into the language of the target group(s) and the involvement of bilingual staff to recruit participants, were identified in eight studies. Deep structure aspects of cultural sensitivity were identified in one study, where the intervention content was pretested among the target group(s). Results that could be related to the culture-sensitive adaptions included successful recruitment of the target population. Three studies were planning to investigate women's experiences of interventions, but no publications were yet available. This scoping review provides evidence that culturally sensitive interventions to reduce or prevent IPV among immigrant pregnant women are limited in number and detail.

Interpersonal Violence Around Pregnancy Experienced by Rural and Urban Canadian Women: Correlates and Selected Health Outcomes

Interpersonal violence around pregnancy is of increasing global public health concern affecting both women themselves and their children. The primary aim of this study is to explore and identify potential correlates of such violence and to examine maternal and birth outcomes subsequent to that violence in a nationally representative sample of urban and rural women in Canada. The data are from the Maternity Experiences Survey (MES), a Canadian population-based postcensus survey administered to 6,421 Canadian mothers in 2006. Survey participants were 15 years and older and had given birth to a singleton and continued to live with their infant at the time of the survey. The survey response rate was 78%. Multivariable logistic regression analyses were used in the analysis with adjustments made for confounding variables. The study findings indicated that living in an urban environment was associated with an increased risk of interpersonal violence experience around the time of pregnancy (OR = 1.31, 95% CI: 1.03-1.66). In addition, being aboriginal, young, unmarried, economically disadvantaged, a nonimmigrant, and having more than four pregnancies, as well as cigarette smoking, alcohol drinking and drug use before the pregnancy were correlated with interpersonal violence around pregnancy. Maternal interpersonal violence experiences were also associated with postnatal depression and stressful life events among both urban and rural mothers. However, maternal interpersonal violence experiences were only associated with preterm birth among rural mothers but not among urban mothers. The present study highlights the need to implement effective interventions for women experiencing interpersonal violence around pregnancy due to its potential impact on maternal and newborn's physical and mental health. Screening and intervention should be targeted high-risk women particularly those who are indigenous, young, unmarried, nonimmigrants, of lower socioeconomic status, and manifesting high risk health behaviors.

Antenatal depression and the association of intimate partner violence among a culturally diverse population in southeastern Norway: A cross-sectional study

INTRODUCTION

Antenatal depression and intimate partner violence (IPV) are independently associated with adverse short- and long-term health effects for women and their children. The main aim of the study was to investigate the prevalence of antenatal depression and the association between symptoms of antenatal depression and physical, emotional and sexual abuse in a culturally diverse population attending antenatal care.

METHODS

A cross-sectional study was conducted with 1812 culturally diverse pregnant women from Safe Pregnancy, a randomized controlled trial to test the effect of an intimate partner violence intervention for abused women in southeastern Norway.

RESULTS

More than one in ten women (14%) reported symptoms of antenatal depression. Women with symptoms of antenatal depression were significantly younger and single, had lower educational level, more limited economic resources and were more likely to use tobacco and to report negative experiences regarding alcohol consumption, including that of her partner, compared to women with no symptoms of depression. A total of 15.4% of the women reported experiences of some form of IPV during their lifetime. Most women reported previous experiences of IPV rather than recent experiences. Women with a history of IPV were significantly more likely to report symptoms of antenatal depression, after adjusting for confounding factors (AOR=1.96; 95% CI: 1.35–2.83).

CONCLUSIONS

Women who reported symptoms of antenatal depression were significantly more likely to have experienced physical, emotional and sexual IPV than women with no history of IPV. It is important to identify women at risk of antenatal depression in order to offer appropriate services during pregnancy.

The Prevalence of Violence Against Women During Pregnancy and After Delivery in Saudi Arabia: A Cross-Sectional Study

Introduction

Violence against pregnant women has become a public health issue and a violation of human rights. The World Health Organization (WHO) defines violence as any act (physical or verbal) that causes physical or psychological harm. Obstetric violence committed by healthcare providers can lead to significant health consequences harming both mother and child. During pregnancy, violence is more frequent than some obstetric complications that are routinely recorded or screened. Therefore, this study aims to assess the prevalence of violence against women during pregnancy and labor, and postpartum.

Materials and methods

In this cross-sectional study, our study population consisted of women who have experienced pregnancy and labor in the Najd region. We used both face-to-face and online questionnaires that evaluated the knowledge and practice outcomes of women who have experienced violence during labor, in addition to the behavior of healthcare providers toward these women.

Results

In our analysis of demographic data, we found a significant association between age and having experienced violence before/during birth. Most women who experienced violence were between 25 and 45 years old (p=0.002). Furthermore, the history analysis revealed a significant association between follow-up regularity and violence experiences (p=0.010). Nursing students delivered most women (71%), and they did not provide information regarding the women’s rights or procedures. Of the respondents, 39.6% did not feel comfortable and were afraid of the healthcare providers’ words, phrases, or behaviors.

Conclusion

Our study concluded that many women experience violence committed by healthcare providers before, during, and after labor without realizing it. As a result of the ignorance of their rights, violence is more prevalent among these women. As a recommendation, to expand on the rights, women organizations should dedicate more efforts and throw campaigns to raise the awareness of violence among other women.

Risk for partners' depression and anxiety during pregnancy and up to one year postpartum: A longitudinal cohort study

INTRODUCTION

Families may benefit from increased focus on partner emotional well-being during pregnancy and the perinatal period. Our aim was to explore the risk for depression and anxiety during pregnancy and one year postpartum in relation to partners' self-reported health, sense of coherence, social support, and lifestyle factors.

METHODS

This is a longitudinal cohort study using three questionnaires that were answered twice during pregnancy and at one year postpartum. Participants (n=532) were recruited between April 2012 and September 2013, and follow-up was between April 2012 and March 2015, in Sweden.

RESULTS

In late pregnancy, 8.9% of the prospective partners were at high risk for depression and 8.3% one year postpartum. An increased risk for depression was found amongst those reporting 'fair or very poor' sexual satisfaction and those reporting 'fair or very poor' health during pregnancy and postpartum. High anxiety was reported by 10.8% during late pregnancy and 12.4% one year postpartum. Partners who were unemployed, had financial difficulties, and who scored low on a Sense of Coherence scale, showed significantly higher anxiety in late pregnancy and postpartum. Social support has a significant and positive impact concerning signs of depression and anxiety, both during pregnancy and postpartum.

CONCLUSIONS

More than 10% of partners in this study showed depressive symptoms and anxiety, indicating a problem in need of attention by stakeholders. Strengthening social support is of greatest importance. It is time for the introduction of family-focused care aimed at prevention of depression and anxiety, and maintenance of family well-being.

Pathways Linking Intimate Partner Violence and Postpartum Depression Among Jewish and Arab Women in Israel

Intimate partner violence (IPV) is a major risk factor for postpartum depression (PPD), with 9% to 28% of PPD cases reporting IPV at some point in their lives. Yet little is known about how these phenomena are associated. We asked, "What direct and indirect pathways link IPV to PPD in women belonging to different ethnic-national groups in Israel?" We recruited a stratified sample of Jewish and Arab women, 18 to 48 years old and 6 months postpartum, during their visits to maternal and child health clinics. We computed path analyses to identify both direct and indirect predictors linking IPV frequency and PPD in a stratified sample of Jewish (n = 807) and Arab (n = 248) women. The overall rate of PPD was estimated at 10.3%, whereas the rate of IPV for the total sample was 36%. We identified a direct link between IPV and PPD. IPV also appeared to have an equivalent, indirect effect on PPD via greater chronic stress and reduced social support. IPV was greater and social support was lower for Arab women, who also reported higher PPD, independent of sociodemographic differences between ethnic groups (i.e., education, occupation). Of note, an unplanned pregnancy appeared to increase the risk of both IPV and PPD. Our findings suggest that complex pathways link IPV to PPD and that indirect effects of IPV are equivalent to its direct effects on postpartum women. These findings contribute to a growing international body of research showing the significant effects of IPV on health and well-being. The factors we identified as directly and indirectly associated with PPD might inform interventions to identify and treat PPD.

Worldwide Prevalence of Intimate Partner Violence in Pregnancy. A Systematic Review and Meta-Analysis

Background: Intimate partner violence (IPV) affects outcomes of mothers and their offspring. This systematic review collated the worldwide literature on the prevalence rates of different types of IPV in pregnancy.

Methods: Two reviewers independently identified cross sectional and cohort studies of IPV prevalence in pregnancy in online databases (PubMed, WOS and Scopus), selected and extracted data [participants' country, study quality, measurement tool (validation and purpose) and rates of IPV in pregnancy]. We considered a high quality study if it had a prospective design, an adequate sampling method, a sample size estimation, a response rate > 90%, a contemporary ascertainment of IPV in the index pregnancy, and a well-developed detailed IPV tool. We performed random effects meta-analysis and explored reasons for heterogeneity of rates.

Results: One hundred fifty-five studies were included, of which 44 (28%) met two-thirds of the quality criteria. Worldwide prevalence of physical (126 studies, 220,462 participants), psychological (113 studies, 189,630 participants) and sexual (98 studies, 155,324 participants) IPV in pregnancy was 9.2% (95% CI 7.7–11.1%, I² 95.9%), 18.7% (15.1–22.9%, I² 98.2%), 5.5% (4.0–7.5%, I² 93.4%), respectively. Where several types of IPV were reported combined, the prevalence of any kind of IPV (118 studies, 124,838 participants) was 25.0% (20.3, 30.5%, I² 98.6%). IPV rates varied within and between continents, being the highest in Africa and the lowest in Europe (p < 0.001). Rates also varied according to measurement purpose, being higher for diagnosis than for screening, in physical (p = 0.022) and sexual (p = 0.014) IPV.

Conclusions: IPV prevalence in pregnancy varies across countries, with one-quarter of mothers exposed on average globally. Routine systematic antenatal detection should be applied worldwide.

Systematic Review Registration: identifier: CRD42020176131.

Exploring Intimate Partner Violence Before, During, and After Pregnancy in Bangladesh

Intimate partner violence (IPV) against pregnant or postpartum women is known to have multiple detrimental effects on women and their children. Although results from past research suggest much continuity in trajectories of IPV, it is unclear whether pregnancy interrupts or augments these patterns. Little is known about how physical, sexual, and psychological IPV change and overlap throughout a woman's transition to parenthood. Relying on population-based data, this study examines the prevalence, co-occurring nature, and the changing patterns of physical, sexual, and psychological IPV before, during, and after pregnancy in Bangladesh. Cross-sectional survey data were collected between October 2015 and January 2016 in the Chandpur District of Bangladesh from 426 new mothers, aged 15 to 49 years, who were in the first 6 months postpartum. IPV was assessed with a validated set of survey items. The frequencies of different types of IPV victimization according to the period of occurrence were calculated separately and in a cumulative, co-occurring manner. The prevalence of physical IPV before, during, and after pregnancy was 52.8%, 35.2%, and 32.2%, respectively. The comparative figures for psychological IPV were 67.4%, 65%, and 60.8%, and for sexual IPV were 21.1%, 18.5%, and 15.5%, respectively. The results demonstrate a notable continuity in IPV victimization before, during, and after pregnancy. Psychological IPV is the only type to exhibit a significant reduction during and after pregnancy, compared with before pregnancy, but it commonly overlaps with physical IPV, which shows a significant change during pregnancy and little change in the postpartum period. At the same time, pregnancy and childbirth offer little protection against IPV for women in relationships characterized by psychological or sexual victimization, both of which commonly overlap with physical IPV. Results reinforce the need to conduct routine screening during pregnancy to identify women with a history of IPV and to offer necessary help and support.

Prevalence of Intimate Partner Violence Among Intimate Partners During the Perinatal Period: A Narrative Literature Review

Intimate partner violence (IPV) affects individuals and families from all backgrounds, regardless of their ethnicity, socio-economic status, sexual orientation, or religion. Pregnancy and childbirth could be a time of vulnerability to violence because of changes in physical, emotional, social, and economic demands and needs. Prevalence of IPV against women during the perinatal period is increasingly researched and documented. However, evidence on IPV prevalence among intimate partners as well as on the course of IPV over the perinatal period is scarce. The purpose of this review was to provide a narrative synthesis of the existing literature regarding the prevalence estimates of IPV among intimate partners over the perinatal period. Through this review, we also gained better insight into associated factors, as well as the various forms of IPV. Of the 766 studies assessing prevalence estimates identified, 86 were included, where 80 studies focused on unidirectional IPV (i.e., perpetrated by men against women) and six studies investigated bidirectional IPV (i.e., IPV perpetrated by both partners). Most of the included studies reported lower overall prevalence rates for unidirectional IPV postpartum (range: 2-58%) compared to pregnancy (range: 1.5-66.9%). Psychological violence was found to be the most prevalent form of violence during the entire perinatal period. Studies on bidirectional IPV mostly reported women's perpetration to be almost as high as that of their partner or even higher, yet their findings need to be interpreted with caution. In addition, our results also highlighted the associated factors of IPV among partners, in which they were assimilated into a multi-level ecological model and were analyzed through an intersectional framework. Based on our findings, IPV is found to be highly prevalent during the entire perinatal period and in populations suffering from social inequalities. Further research exploring not only the occurrence, but also the motivations and the context of the bidirectionality of IPV during the perinatal period may facilitate better understanding of the detrimental consequences on partners and their families, as well as the development of effective intervention strategies. Public health prevention approaches intervening at optimal times during the perinatal period are also needed.

Maternal Smoking and Hospital Treatment During Pregnancy

INTRODUCTION

Previous research suggests that young maternal age, smoking, hospitalization during a previous pregnancy, and poor self-rated health could be risk factors for prenatal hospitalization.

METHODS

The objective of this retrospective observational register study was to investigate if maternal smoking during pregnancy is associated with mother's need for hospital treatment during pregnancy. The study population consists of all singleton pregnancies (n = 961 127) in 1999-2015 in Finland. Information on maternal smoking was received from the Medical Birth Register in three classes: nonsmoker, quit smoking in the first trimester, and continued smoking throughout the pregnancy. These data were linked with the Hospital Discharge Register data and analyzed according to ICD-10 chapters.

RESULTS

10.7% of women continued to smoke after the first trimester. After adjusting for confounding factors women in both smoking groups had more hospital treatment compared with nonsmokers. Especially outpatient treatment was more common among mothers who continued to smoke compared to those who quit smoking in the first trimester in several ICD-10 chapters. Compared to non-smokers, aOR for mental and behavioral disorders (F00-F99) was 2.14 (95% confidence interval 2.00-2.30) in the quit smoking group and 3.88 (3.71-4.06) in the continued smoking group. Similarly, aOR for respiratory diseases (J00-J99) was 1.26 (1.15-1.39) and 1.61 (1.52-1.71), respectively and aOR for genitourinary diseases (N00-N99) was 1.10 (1.03-1.17) and 1.29 (1.23-1.35), respectively. Some similar findings were made also in inpatient care. Some similar findings were made also in inpatient care.

CONCLUSIONS

Women who smoke during pregnancy seem to require more hospital care for various reasons. These findings emphasize the importance of actions for smoking cessation during pregnancy and women should be encouraged to quit as early as possible.

IMPLICATIONS

Maternal smoking during pregnancy is associated with greater rates of both outpatient and inpatient hospital care during pregnancy. Women who quit smoking had a similar risk for hospital care during pregnancy with nonsmokers in certain diagnosis chapters, which is very motivational and could be used as an informational tool in prenatal clinics to encourage smoking cessation as it is never too late to quit smoking during pregnancy.

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.

User-Involvement in the Development of a Culturally Sensitive Intervention in the Safe Pregnancy Study to Prevent Intimate Partner Violence

Intimate partner violence (IPV) during pregnancy has negative health impacts on the woman and the fetus. There is a lack of evidence supporting effective interventions to prevent IPV during pregnancy. This user-involvement study was conducted to get feedback on a culturally sensitive, tablet intervention containing questions about violence and safety-behaviors and a video promoting safety behaviors. This resulted in important feedback on the intervention content. Our findings show that women are in favor of disclosing IPV via a tablet. They suggested ways to address barriers for disclosure, such as safeguarding anonymity and creating a trustful relationship with the midwife.

Midwives experiences of meeting pregnant women who are exposed to Intimate-Partner Violence at in-hospital prenatal ward: A qualitative study

INTRODUCTION

Worldwide every third women is exposed to physical and/or sexual violence and pregnancy is no safe period for the women. The aim was to elucidate midwives experience of violence-exposed pregnant women who had been referred to a prenatal ward and were hospitalized.

METHODS

An inductive qualitative method was used with four focus-group interviews performed with sixteen midwives working at in-hospital prenatal ward. The data were analyzed with content analysis.

RESULTS

Three categories emerged. 'Professional area of responsibility', the midwives working at in-hospital prenatal ward considered it was the responsibility of the midwives working at antenatal care to ask routinely in order to detect violence-exposed women. Signs of help-seeking were based on the pregnant woman's behavior. Suspicion of intimate-partner violence was based on gut feeling. 'Conditions for support', the midwives strived to support pregnant women who were already identified as violence-exposed or if they had a suspicion that the pregnant woman was in a relationship where intimatepartner violence occurred. 'Barriers for giving support', both the work-place layout and routines constituted a barrier. The midwives own emotional state could affect her handling of the situation.

CONCLUSIONS

The midwives working in-hospital considered it the responsibility of the midwives at antenatal healthcare to identify these women. The midwives had limited experience in dealing with violence-exposed pregnant women but recognized a number of signs and symptoms that could cause suspicion. They felt uncomfortable in the situation and expressed a need for both education and an action plan.

Birth outcomes in a Swedish population of women reporting a history of violence including domestic violence during pregnancy: a longitudinal cohort study

Background

Victimisation of women is encountered in all countries across the world, it damages the mental and physical health of women. During pregnancy and the postpartum period, women are at a greater risk of experiencing violence from an intimate partner. The aim of this study was to explore childbirth outcomes in a Swedish population of women reporting a history of violence including domestic violence during pregnancy.

Methods

A longitudinal cohort design was used. In total, 1939 pregnant women ≥18 years were recruited to answer two questionnaires, both questionnaires were administered in the early and late stages of their pregnancy. The available dataset included birth records of 1694 mothers who gave birth between June 2012 and April 2014. Statistical analyses included descriptive statistics, T-test and bivariate logistic regression.

Results

Of 1694 mothers 38.7% (n = 656) reported a history of violence and 2% (n = 34) also experienced domestic violence during pregnancy. Women who were single, living apart from their partner, unemployed, smoked and faced financial distress were at a higher risk of experiencing violence (p = 0.001). They also had significant low scores on the SOC-scale and high EDS-scores ≥13 (p = 0.001) when compared to women without a history of violence (p = 0.001). Having a history of violence increased the woman’s risk of undergoing a caesarean section (OR 1.33, 95% CI 1.02–1.70). A history of emotional abuse also significantly increased the risk of having a caesarean section irrespective of whether it was a planned or an emergency caesarean section (OR 1.50, 95% CI 1.09–2.06). Infants born to a mother who reported a history of violence, were at significant risk of being born premature < 37 weeks of gestation compared to infants born by mothers with no history of violence (p = 0,049).

Conclusions

A history of violence and/or exclusively a history of emotional abuse has a negative impact on childbirth outcomes including caesarean section and premature birth. Therefore, early identification of a history of or ongoing violence is crucial to provide women with extra support which may have positive impact on her birth outcomes.

Prevalence of intimate partner violence against women and associated factors in Ethiopia

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 globally. Violence against women in Ethiopia is widely acknowledged to be of great concern from human rights, economic and health perspective. The aim of this study was to assess the prevalence of intimate partner violence (IPV) against women and associated factors in Ethiopia.

Method

The data was obtained from 2016 Ethiopia Demographic and Health Survey which is the fourth survey conducted in Ethiopia as part of the worldwide project. The sample was selected using a stratified; two-stage cluster sampling design and the data was analyzed using logistic regression model.

Result

A total of 4714 ever-married women in reproductive age who reported their experience of spousal violence were considered from nine regional states and two city administratives. Over 30% of study participants were subjected to IPV. Living in rural areas, divorced, primary and secondary education, 25–39 years old, being poor are found to be predictors of IPV against women in Ethiopia.

Conclusion

The prevalence of IPV was found high in Ethiopia and government and any concerned bodies should design appropriate strategy and work hard to tackle the problem. There is a need of giving special attention for women living in rural area, women from poor family and 25–39 years old women to decrease the burden of IPV.

Development of the Intimate Partner Violence During Pregnancy Instrument (IPVPI)

Background: Intimate partner violence (IPV) during pregnancy can lead to negative consequences for both the mother and offspring. Although IPV is recognized as a worldwide public health issue, its prevalence is considered to be underestimated because cases are likely underreported, suggesting that there might be unmeasured IPV. The aim of this study was to develop an instrument to detect IPV in pregnant women.

Methods: A total of 6,590 women in Aichi prefecture, Japan, who took part in a 3 or 4 month infant health checkup program, participated in the study. Questionnaires assessing history of IPV during pregnancy (physical abuse and verbal abuse), maternal characteristics, partner's characteristics, and household characteristics were mailed to women before, or distributed at, the checkup. Women returned the questionnaires to the checkup sites or mailed them back to the health centers. A prediction model for history of IPV was then generated using potential risk factors selected based on the literature.

Results: Among 6,530 women who responded to either question on IPV during pregnancy (response rate = 67.3%), the rate of participants who experienced any IPV during pregnancy was 11.1% (physical IPV = 1.2%; verbal IPV = 10.8%). Multiple logistic regression analyses showed that maternal age (<25 years old), multiparity, history of artificial abortion, negative feelings when the pregnancy was confirmed (e.g., confused), having no one to provide support during pregnancy, having relationship problems with their partner, paternal smoking during pregnancy, and difficult financial status were associated with any abuse from the partner. Based on the analysis, the Intimate Partner Violence during Pregnancy Instrument (IPVPI) was developed, comprising of eight questions to detect unmeasured IPV in pregnant women, and showed moderate predictive power (area under receiver operating characteristic curve = 0.719, 95% confidence interval: 0.698 to 0.740) ranging from 0 to 16 with a cut-off point of 2 (sensitivity = 79.5%, specificity = 47.1%).

Conclusion: The IPVPI, which allows to ask indirect questions rather that asking directly about experience of IPV, might be helpful to detect unmeasured IPV in pregnant women in fields of primary healthcare and obstetrics. Further research longitudinal studies are needed to improve the sensitivity and specificity of the IPVPI.

Depressive symptoms during pregnancy and postpartum in women and use of antidepressant treatment - a longitudinal cohort study

Objective

The aim of this study was to investigate whether women, who reported “symptoms of depression” during pregnancy and up to 1.5 years postpartum, who reported domestic violence or not, were treated with antidepressant medication.

Patients and methods

A prospective longitudinal cohort study recruited primi- and multiparous women (n=1,939). The Edinburgh Postnatal Depression Scale (EPDS), the NorVold Abuse Questionnaire, and a questionnaire about medication during pregnancy were distributed and administered three times, during early pregnancy, late pregnancy, and the postpartum period. Antidepressant medication was compared between women with EPDS scores <13 and EPDS scores ≥13 as the optimal cutoff for symptoms of depression.

Results

EPDS scores ≥13 were detected in 10.1% of the women during the whole pregnancy, of those 6.2% had depressive symptoms already in early pregnancy and 10.0 % during the postpartum period. Women with EPDS scores ≥13 and non-exposure to domestic violence were more often non-medicated (P<0.001). None of the women with EPDS scores ≥13 exposed to domestic violence had received any antidepressant medication, albeit the relationship was statistically nonsignificant.

Conclusion

Pregnant women who experienced themselves as having several depressive symptoms, social vulnerability, and even a history of domestic violence, did not receive any antidepressant treatment during pregnancy nor postpartum. This study shows the importance of detecting depressive symptoms during early pregnancy and a need for standardized screening methods.

Lifestyle factors, self-reported health and sense of coherence among fathers/partners in relation to risk for depression and anxiety in early pregnancy

BACKGROUND

Father's health is important for mothers and unborn/newborn children and knowledge about expectant fathers' health in relation to lifestyle and psychosocial aspects is essential.

AIMS

To determine sociodemographic and lifestyle factors, self-reported health and sense of coherence among fathers and partners in relation to their risk for depression and anxiety in early pregnancy.

METHODS

A cross-sectional design, descriptive statistics, chi-squared analysis, T-test, binary logistic regression, multiple logistic regression with OR and 95% CI were used.

RESULTS

A total of 532 prospective fathers/partners constituted the cohort (mean age 31.55, SD 5.47 years). Nearly, one in ten (9.8%) had a statistically high risk for depression; mainly those who were unemployed (p = 0.043), had financial distress (0.001), reported 'very or fairly bad' health (p = 0.002), had a 'very or fairly bad' sexual satisfaction (p = 0.006) and scored low on the SOC scale (p < 0.001). They smoked more often (p = 0.003) were hazardous users of alcohol (p = 0.001) and slept with difficulties (p = 0.001). Those with sleeping difficulties were 5.7 times more likely to have several symptoms of depression (p = 0.001). Hazardous users of alcohol and smokers had 3.1 respectively 3.0 times higher risk for depression (p = 0.001 respectively 0.003). The single strongest risk factor was a low score on the SOC-scale which gave 10.6 (AOR 10.6; 95% CI 5.4-20.6) higher risk for depression. High-anxiety 'just now' was reported by 8.9% and 'in general' by 7.9%, and those who had sleeping difficulties reported 'very or fairly bad' health (p < 0.001).

CONCLUSIONS

Allocating more resources and introducing more family-focused care with depression and anxiety screening in early pregnancy for both expecting parents at antenatal care should be strongly considered by actors and policymakers, as this is a step in maintaining a family's well-being.

Profiling Pregnant Women at Risk for Domestic Violence in Jamaica: A Pilot Study

Background:

Domestic violence (DV) is recognized as a priority in maternity care. Data on the prevalence and profile of women experiencing DV during pregnancy are limited in Jamaica. This baseline study has identified the prevalence and provided a profile of pregnant women who are at risk for DV in Kingston, Jamaica.

Method:

A descriptive cross-sectional study was done in 2014. A total of 185 randomly selected pregnant women attending the antenatal clinic completed a self-administered questionnaire. The data were analyzed using SPSS. The study was approved by our local ethical boards and all ethical considerations were adhered to.

Results:

The study identified a prevalence rate of 41% (n= 75/182) which includes all types of DV during pregnancy. Those at risk were 23–29 years old, single (66.6%), employed (44%), had primary education (66.6%), and had unplanned pregnancies (65%). The majority of respondents (98%) were willing to disclose DV, but the clinic does not provide them the opportunity. Only 11% (8/75) reported that they sought professional help.

Conclusion:

This study adds to the body of knowledge on the prevalence of DV and notes that it is high among pregnant women attending the antenatal clinic. The findings can guide the development of a DV screening protocol to identify and treat pregnant women and train health practitioners in Jamaica.

The prevalence of sexual violence during pregnancy in Iran and the world: a systematic review and meta-analysis

Background:

Domestic violence during pregnancy is a public health crisis, because it affects both mother ‎and fetus simultaneously, resulting in irreversible consequences for mothers and their ‎newborns. This study was performed to determine the prevalence of sexual violence during ‎pregnancy in the world and Iran as meta-analysis.‎

Methods:

This study is a meta-analysis on the prevalence of sexual violence during pregnancy ‎in the world and Iran that was conducted on Persian and English published articles up to ‎‎2015. To this end, through searching the information by key words and their compounds at SID, Medlib, Irandoc, Google scholar, Pubmid, ‎ISI, Iranmedex, Scopus and Magiran, all related articles ‎were extracted independently by two trained researchers. The results of studies ana-lyzed using ‎the STATA and Spss16 software.‎

Results:

In the initial searching of 167 articles, 33 articles related to Iran, 40 articles related to ‎other parts of the world and totally 73 articles met inclusion criteria for study. The prevalence ‎of sexual violence during pregnancy were estimated in the world 17% (CI95%:15% -18%) and ‎in Iran 28% (CI95%: 23% -32%).The prevalence of sexual violence during pregnancy in Iran is ‎‎11 percent more than the world.‎

Conclusions:

According to the present meta-analysis results, the prevalence of sexual violence ‎during pregnancy in Iran is high. Given that sexual violence during pregnancy causes damage to ‎the mother and infant, it is recommended that the relevant authorities with the implementation ‎of intervention and educational programs reduce the prevalence of sexual violence during ‎pregnancy.‎

Breastfeeding in the context of domestic violence-a cross-sectional study

AIMS

To determine the differences in breastfeeding among women who did and did not experience domestic violence during pregnancy and postpartum in a Swedish context. In addition, to identify possible differences regarding breastfeeding between groups with or without a history of violence. Further, determine the relationship between exclusive breastfeeding and symptoms of depression.

BACKGROUND

History of violence may increase the risk of depression and a decrease in, or cessation of, breastfeeding.

DESIGN

The study has a cross-sectional design.

METHODS

Data were collected prospectively from March 2012 - May 2015. A cohort of 731 mothers answered a questionnaire from a larger project (1.5 years postpartum).

RESULTS

Breastfeeding was reported by 93.7% of participants. Women exposed to domestic violence during pregnancy and/or postpartum (4.5%) were just as likely to breastfeed as women who had not reported exposure to domestic violence. There were no statistically significant differences between the groups with or without a history of violence regarding exclusive breastfeeding. Women reporting several symptoms of depression breastfed exclusively to a lesser extent compared with women who had a few symptoms of depression.

CONCLUSION

Domestic violence did not influence breastfeeding prevalence or duration. Breastfeeding did not differ in women with or without a history of violence. Symptoms of depression influenced duration of exclusive breastfeeding. Beyond recognizing women who are exposed to violence, it is important to identify and to support pregnant women and new mothers with symptoms of depression as their health and the health of their infants depends on the mothers' mental well-being.

The degree of suffering among pregnant women with a history of violence, help-seeking, and police reporting

OBJECTIVES

To explore the degree of self-reported suffering following violent incidents and the prevalence of police reporting as well as other help-seeking behaviour among women in early pregnancy with history of violence.

STUDY DESIGN

A cross-sectional design. 1939 pregnant women≥18years were recruited prospectively between March 2012 and September 2013 in south-west Sweden. Of those, 761 (39.5%) reported having a history of violence, and they comprised the cohort investigated in the present study. Descriptive statistics, Chi-square analysis, and T-test were used for the statistical calculations.

RESULTS

More than four of five women (80.5%) having a history of emotional abuse (n=374), more than half (52.4%) having history of physical abuse (n=561), and almost three of four (70.6%) who experienced sexual abuse (n=302) reported in the early second trimester of their pregnancy that they still suffered from their experience. Of those women who had experienced emotional, physical, and sexual abuse, 10.5%, 25.1%, and 18.0%, respectively, had never disclosed their experiences to anyone. At most, a quarter of the abused women had reported a violent incident to the police.

CONCLUSIONS

All midwives and other actors who meet women with experience of abuse need to have increased knowledge about the long-term consequences of all types of abuse. Increased routine questioning of pregnant women about history of violence would help to prevent experiences of violence from affecting pregnancy and childbirth negatively and facilitate the provision of help and support.

Prevalence of intimate partner violence and its association with symptoms of depression; a cross-sectional study based on a female population sample in Sweden

Background

Intimate Partner Violence (IPV) is the most common type of violence targeting women. IPV includes acts of physical aggression, sexual coercion, psychological abuse and controlling behaviors and these forms of violence often coexist in the same relationship. Living with IPV is associated with serious mental health outcomes such as depression and depressive symptoms. Few population based studies from Sweden have investigated the relationship between different forms of IPV and women’s depressive symptoms and even fewer used controlling behavior as an independent variable in such studies. The aim of this study was therefore to assess the prevalence of exposure to IPV in terms of controlling behavior, sexual, and physical violence and their association with self-reported symptoms of depression in a female population based sample.

Methods

The cross-sectional, population based sample contained 573 women aged 18–65 years randomly selected in Sweden. Five self-reported symptoms that define depression in the Diagnostic and Statistical Manual of Mental Disorders were assessed. Physical and sexual violence were inquired about using the World Health Organization’s (WHO) Violence Against Women Instrument (VAWI), while controlling behavior was assessed with the Controlling Behavior Scale (CBS). Associations between different forms of IPV and symptoms of depression were estimated by crude and adjusted odds ratio (OR) with 95% confidence intervals (CI).

Results

Bivariable associations revealed that women exposed to controlling behavior, had higher OR of depressive symptoms compared to unexposed women (OR 2.43; 95% CI 1.63–3.63). Women exposed to physical and sexual violence had also a higher OR of depressive symptoms (OR 3.78; 95% CI 1.99–7.17 and OR 5.10; 95% CI 1.74–14.91 respectively). After adjusting for socio-demographic and psychosocial covariates, all three forms of IPV showed statistically significant associations with self-reported symptoms of depression.

Conclusions

A strength with this study is the analysis of controlling behavior and its association with self-reported symptoms of depression in a female population based sample. Exposure to controlling behavior, physical and sexual violence by an intimate partner were clearly associated with women’s self-reported symptoms of depression.

Domestic violence among antenatal attendees in a Kathmandu hospital and its associated factors: a cross-sectional study

BACKGROUND

Domestic violence during pregnancy is a public health problem which violates human rights and causes an adverse effect on both maternal and fetal health. The objectives of the study were to assess the prevalence of domestic violence among the pregnant women attending the antenatal clinic, to explore the associated factors, and to identify the perpetrators of domestic violence.

METHODS

A descriptive cross-sectional study was conducted among 404 pregnant women in their third trimester of pregnancy. Convenient sampling was used to select the study population. Data collection tools consisted of questionnaires on socio-demographic characteristics of the woman and her spouse, social support, and the woman's attitude towards domestic violence, along with her experiences of psychological, physical, and sexual violence. Domestic violence was assessed using a questionnaire adapted from a World Health Organization multi-country study on women's health and life experiences. Relationships between domestic violence and the various factors were determined by bivariate analysis using a chi-square test. Binary logistic regression with 95% confidence interval and adjusted odds ratio were then applied to assess the factors independently associated with domestic violence.

RESULTS

More than one-quarter (27.2%) of the pregnant women had experienced some form of violence. The most common form of violence was sexual violence (17.3%), followed by psychological violence (16.6%) and physical violence (3.2%). Husbands within the age group 25-34 years (AOR = 0.38), women married for 2-5 years (AOR = 0.42) and who had one or two children (AOR = 0.32) were negatively associated with domestic violence. Whereas the presence of husband's controlling behavior (AOR = 1.88) and experience of violence before the current pregnancy (AOR = 24.55) increased the odds of experiencing violence during pregnancy. The husband was the major perpetrator in all type of violence.

CONCLUSIONS

Domestic violence is common among pregnant women attending an antenatal clinic. It indicates a need for routine screening during antenatal visits to identify women experiencing violence and thus provide support services, thereby preventing them from adverse health consequences.

Increasing prevalence and incidence of domestic violence during the pregnancy and one and a half year postpartum, as well as risk factors: -a longitudinal cohort study in Southern Sweden

BACKGROUND

Domestic violence is a global health problem as well as a violation against human rights. The aim of this study was to explore prevalence and incidence of domestic violence during pregnancy and 1 to 1.5 years postpartum as well as to explore the history of violence among new mothers in the southwestern region of Sweden. In addition, the aim was to explore the association between domestic violence postpartum and possible risk factors.

METHODS

This is a longitudinal cohort-study including pregnant women ≥ 18 years of age. Total 1939 pregnant women were recruited to the study and requested to answer three questionnaires (QI-III) during pregnancy and postpartum. Statistical analysis were descriptive statistics, logistic regression and multiple regression with Odds ratios (OR) and 95 % confidence intervals (95 % CI).

RESULTS

The response rate for those who received the Q-III (n = 755) at a Child Welfare Center was almost 97 % (n = 731). When all three questionnaires were answered the prevalence of domestic violence during pregnancy irrespective of type or severity was reported by 2.5 % (n = 40/1573). At 1 to 1.5 years postpartum the prevalence of domestic violence had increased to 3.3 % (n = 23/697). The incidence was 14 per 1000 women during pregnancy and 17.2 per 1000 women postpartum. The strongest risk factor for domestic violence reported at1-1.5 years postpartum was a history of violence whereby all of the women (n = 23) who had revealed their exposure to domestic violence postpartum also reported a history of violence (p < 0.001). Being single/living apart gave a 12.9 times higher risk for domestic violence postpartum (AOR 12.9; 95 % CI: 4.5-37.1). Having several symptoms of depression and a low score on the SOC-scale gave a 3.5 and 3.0 times higher risk respectively (AOR 3.5; 95 % CI: 1.2-10.4) and (AOR 3.0; 95 % CI 1.1-8.3).

CONCLUSION

Domestic violence increases as the pregnancy develops and postpartum. A history of violence and being single/living apart may be strong indicators for domestic violence during pregnancy as well as postpartum. Also, having symptoms of depression are associated with domestic violence both during pregnancy and postpartum. Collaboration between health care providers at Antenatal and Welfare centres is essential.

Pregnant women's preference for cesarean section and subsequent mode of birth - a six-country cohort study

INTRODUCTION

The rate of cesarean section (CS) for non-medical reasons has risen and it is a concern for health care. Women's preferences may vary across countries for psychosocial or obstetric reasons.

METHODS

A prospective cohort study of 6549 women in routine antenatal care giving birth in Belgium, Iceland, Denmark, Estonia, Norway or Sweden. Preference for mode of birth was self-reported in mid-pregnancy. Birth outcome data were collected from hospital records.

RESULTS

A CS was preferred by 3.5% of primiparous women and 8.7% of the multiparous women. Preference for CS was associated with severe fear of childbirth (FOC), with a negative birth experience in multiparous women and with depressive symptoms in the primiparous. Women were somewhat more prone to prefer a cesarean in Iceland, odd ratio (OR) 1.70 (1.02-2.83), adjusted for age, education, depression, FOC, history of abuse, previous cesarean and negative birth experience. Out of the 404 women who preferred CS during pregnancy, 286 (70.8%) delivered by CS, mostly for a medical indication. A total of 9% of the cesareans in the cohort had a non-medical indication only.

CONCLUSIONS

Women's preference for CS often seems to be due to health concerns. Both medical and psychological factors need to be addressed in antenatal counseling. Obstetricians need to convey accurately to women the risks and benefits of CS in her specific case. Maternity professionals should identify and explore psychosocial reasons for women's preferences.

Prevalence and incidence of domestic violence during pregnancy and associated risk factors: a longitudinal cohort study in the south of Sweden

Background

Domestic violence during pregnancy is not only a severe public health issue that jeopardizes maternal and foetal health but also violates human rights. The aim was to explore the prevalence and incidence of domestic violence among pregnant women, in the southwestern region of Scania in Sweden, and their experience of a history of violence. In addition, to explore the association between domestic violence during pregnancy and possible risk factors.

Methods

This is a longitudinal cohort-study including pregnant women ≥18 years of age, registered at antenatal care when pregnant. A cohort of 1939 pregnant women answered Questionnaire I (QI) in gestational week 13 (mean 12.8 week, SD 5.11). Response rate of Questionnaire II (QII) in gestation week 34 (mean 33.9 week, SD 2.2) was 78.8 % (n = 1527). Statistical analysis was descriptive statistics, logistic regression and multiple regression with Odds ratios (OR) and 95 % confidence intervals (95 % CI).

Results

Both QI and QII were completed by 77.8 % (n = 1509) of the women and 44.3 % (n = 668) reported a lifetime experience of abuse irrespective of type, severity or perpetrator. Also, 5.1 % (n = 77) reported some experience of abuse past year. Prevalence of domestic violence during pregnancy was 2.0 % (n = 29) and the incidence was 7.3 new cases per 1000 women. The strongest risk factor for domestic violence, during early and late pregnancy, was history of violence whereby all women who disclosed exposure had also reported history of violence (p < 0.001). To be single/living apart gave 8.4 times more risk associated with domestic violence during pregnancy (AOR 8.4; 95 % CI: 2.2–32.6). Having several symptoms of depression and lack of sleep gave 3.8 times more risk respectively (AOR 3.8; 95 % CI: 1.1–13.6) and (AOR 3.8; 95 % CI 1.1–12.9).

Conclusions

Pregnant women with a history of violence as well as being single/living apart and/or having several symptoms of depression during pregnancy should be alerts for clinical working midwives and obstetricians. Further, this is important knowledge for health care providers to develop or upgrade guidelines and plans of action for pregnant women exposed to violence.

Incidence of Domestic Violence Against Pregnant Females After the Great East Japan Earthquake in Miyagi Prefecture: The Japan Environment and Children's Study

OBJECTIVE

This study aimed to clarify the correlation between the 2011 Great East Japan Earthquake and domestic violence (DV) against pregnant females after the disaster in Miyagi Prefecture, an area damaged by the earthquake and tsunami.

METHODS

We analyzed 7600 pregnant females from June to December 2011. The incidence of physical and mental DV and the proportions in the inland, north coastal, and south coastal areas of Miyagi Prefecture and nationwide were calculated, and a chi-square test was conducted for comparison. The risk factors for DV were estimated with multivariate logistic regression analyses on a prefecture-wide basis.

RESULTS

The incidence levels for physical DV were found to be 5.9% in the north coastal area, which was significantly higher than in the inland area (1.3%, P=0.0007) and nationwide (1.5%, P<0.0001). There were no significant differences in the incidence of mental DV between the 3 areas in Miyagi Prefecture (inland 15.2%, north coast 15.7%, and south coast 18.8%) or nationwide (13.8%). Experiencing disease or injury in someone close and changes in the family structure were significantly associated with mental DV in Miyagi Prefecture.

CONCLUSION

Continuous monitoring and support for pregnant females may be necessary to address this issue in disaster-affected areas. (Disaster Med Public Health Preparedness. 2017;11:216-226).

Violência doméstica na gravidez

Resumo Objetivo: Caracterizar violência doméstica na gravidez. Métodos: Estudo transversal, exploratório e analítico da violência doméstica com 385 mulheres atendidas em maternidade pública. Testes de Qui-Quadrado de Pearson e Exato de Fisher foram utilizados para verificar associações e considerados significantes resultados p<0,05. Dados das características sociodemográficas das mulheres, parceiros e familiares e itens do “Abuse Assessment Screen- AAS” foram coletados. Resultados: A violência doméstica acometeu 36,9% das mulheres em algum momento da vida e 34,6% na gravidez. As prevalências foram para violência psicológica (97,1%), física (48,7%) e sexual (4,9%) e oparceiro foi o principal agente. Houve associação significante da violência doméstica com religião protestante (p=0,0022), ausência de planejamento da gravidez (p=0,0196), baixa renda familiar (p=0,0215) e hábito do etilismo do parceiro (p=0,0002). Conclusão: A violência doméstica deve ser investigada sistematicamente na gravidez, com atenção especial nas grávidas protestantes, sem planejamento da gravidez e as mulheres cujos parceiros são etilistas.

Pregnancy intendedness and the association with physical, sexual and emotional abuse - a European multi-country cross-sectional study

BACKGROUND

Unintended pregnancies are common and when not resulting in a termination of pregnancy may lead to unintended childbirth. Unintended pregnancies are associated with increased health risks, also for women for whom pregnancy continues to childbirth. Our objective was to present the prevalence of unintended pregnancy in six European countries among pregnant women attending routine antenatal care, and to investigate the association with a history of physical, sexual and emotional abuse.

METHODS

A prospective cross-sectional study, of 7102 pregnant women who filled out a questionnaire during pregnancy as part of a multi-country cohort study (Bidens) with the participating countries: Belgium, Iceland, Denmark, Estonia, Norway and Sweden. A validated instrument, the Norvold Abuse Questionnaire (NorAq) consisting of 10 descriptive questions measured abuse. Pregnancy intendedness was assessed using a single question asking women if this pregnancy was planned. Cross-tabulation, Chi-square tests and binary logistic regression analysis were used.

RESULTS

Approximately one-fifth (19.2 %) of all women reported their current pregnancy to be unintended. Women with an unintended pregnancy were significantly younger, had less education, suffered economic hardship, had a different ethnic background from the regional majority and more frequently were not living with their partner. The prevalence of an unintended pregnancy among women reporting any lifetime abuse was 24.5 %, and 38.5 % among women reporting recent abuse. Women with a history of any lifetime abuse had significantly higher odds of unintended pregnancy, also after adjusting for confounding factors, AOR for any lifetime abuse 1.41 (95 % CI 1.23-1.60) and for recent abuse AOR 2.03 (95 % CI 1.54-2.68).

CONCLUSION

Women who have experienced any lifetime abuse are significantly more likely to have an unintended pregnancy. This is particularly true for women reporting recent abuse, suggesting that women living in a violent relationship have less control over their fertility.