Intimate partner violence during pregnancy and maternal and child health outcomes: a scoping review of the literature from low-and-middle income countries from 2016 - 2021

Intimate Partner Violence Against Women Before, During, and After Pregnancy: A Meta-Analysis

Intimate partner violence (IPV) against pregnant women negatively impacts women's and infants' health. Yet inconsistent results have been found regarding whether pregnancy increases or decreases the risk of IPV. To answer this question, we systematically searched for studies that provided data on IPV against women before pregnancy, during pregnancy, and after childbirth. Nineteen studies met our selection criteria. We meta-analyzed the nineteen studies for the pooled prevalence of IPV across the three periods and examined study characteristics that moderate the prevalence. Results showed the pooled prevalence estimates of IPV were 21.2% before pregnancy, 12.8% during pregnancy and 14.7% after childbirth. Although these findings suggest a reduction in IPV during pregnancy, our closer evaluation of the prevalence of IPV after childbirth revealed that the reduction does not appear to persist. The prevalence of IPV increased from 12.8% within the first year after childbirth to 24.0% beyond the first year. Taken together, we should not assume pregnancy protects women from IPV, as IPV tends to persist across a longer-term period. Future studies are needed to investigate if IPV transits into other less obvious types of violence during pregnancy. Moderator analyses showed the prevalence estimates significantly varied across countries by income levels and regions.

Risk of adverse perinatal outcomes with violence in pregnancy

PURPOSE

To examine the association between physical, sexual, or physiological harm in pregnancy and perinatal outcomes in a large, contemporary birth cohort.

METHODS

This retrospective cohort study used California-linked vital statistics and hospital discharge data from 2016 to 2020. We included singleton, non-anomalous births with a gestational age of 23-42 weeks. Violence in pregnancy was identified using International Classification of Disease, Tenth Revision (ICD-10) codes. Chi-square tests and multivariable Poisson regression models were used to evaluate associations of violence in pregnancy with perinatal outcomes.

RESULTS

A total of 1,728,478 pregnancies met inclusion criteria, of which 3,457 (0.2%) had reported violence in pregnancy. Compared to those without violence in pregnancy, individuals who experienced violence had an increased risk of non-severe hypertensive disorders (aRR = 1.36, 95% CI 1.22, 1.51), preeclampsia with severe features (aRR = 1.34; 95% CI 1.11, 1.61), chorioamnionitis (aRR = 1.68; 95% CI 1.48, 1.91), anemia (aRR = 1.59; 95% CI 1.50, 1.68), antepartum hemorrhage (aRR = 2.17; 95% CI 1.19, 3.95), and postpartum hemorrhage (aRR = 1.65; 95% CI 1.48, 1.85). Violence in pregnancy was also associated with increased risk of Apgar score < 7 at 5 min (aRR = 1.37; 95% CI 1.11, 1.71) and neonatal hypoglycemia (aRR = 1.26; 95% CI 1.07, 1.48).

CONCLUSION

Violence experienced in pregnancy is associated with an increased risk of adverse perinatal outcomes. Understanding how universal screening and early recognition of violence in pregnancy may reduce disparities in maternal morbidity for this understudied population is critical.

Antepartum Intimate Partner Violence: Development of a Risk Prediction Model

Objectives: To explore socio-behavioral, clinical, and imaging findings associated with antepartum intimate partner violence (IPV) and aid in risk stratification of at-risk individuals. Methods: We analyzed electronic medical records during indexed pregnancies for 108 pregnant patients who self-reported antepartum IPV (cases) and 106 age-matched pregnant patients who did not self-report antepartum IPV (controls). Sociodemographic, clinical, and radiology data were analyzed via chi-squared and Fisher's exact tests with p < 0.05 as the threshold for significance. Stepwise logistic regression was applied to derive a risk prediction model. Results: The proportion of cases reporting emotional IPV (76% vs. 52%) and/or physical IPV (45% vs. 31%) during pregnancy significantly increased from prior to pregnancy. Cases were significantly more likely to report prepregnancy substance use (odds ratio [OR] = 2.60; 95% confidence interval [CI]: 1.13-5.98), sexually transmitted infections (OR = 3.48; 95%CI: 1.64-7.37), abortion (OR = 3.17; 95%CI: 1.79, 5.59), and preterm birth (OR = 5.97; 95%CI: 1.69-21.15). During pregnancy, cases were more likely to report unstable housing (OR = 5.26; 95%CI: 2.67-10.36), multigravidity (OR = 2.83; 95%CI: 1.44-5.58), multiparity (OR = 3.75; 95%CI: 1.72-8.20), anxiety (OR = 3.35; 95%CI: 1.85-6.08), depression (OR = 5.58; 95%CI: 3.07-10.16), substance use (OR = 2.92; 95%CI: 1.28-6.65), urinary tract infection (UTI) (OR = 3.26; 95%CI: 1.14-9.32), intrauterine growth restriction (OR = 10.71; 95%CI: 1.35-85.25), and cesarean delivery (OR = 2.25; 95%CI: 1.26-4.02). Cases had significantly more OBGYN abnormalities on imaging and canceled more radiological studies (OR = 5.31). Logistic regression found housing status, sexually transmitted infection history, preterm delivery history, abortion history, depression, and antepartum UTI predictive of antepartum IPV. The risk prediction model achieved good calibration with an area under the curve of 0.79. Conclusions: This study identifies significant disparities among patients experiencing antepartum IPV, and our proposed risk prediction model can inform risk assessment in this setting.

Intimate Partner Violence and Antenatal Depression Among Underserved Pregnant Women

Introduction: Few studies have examined the associations of intimate partner violence (IPV) exposure during pregnancy and types of IPV with antenatal depression among underserved pregnant women. Methods: Data came from participants from a Healthy Start program in South Carolina between 2015 and 2019 (n = 1,629). The first two questions in the Woman Abuse Screening Tool (WAST) were used to measure IPV exposure, that is, having a problematic relationship with their partner. Those who had IPV exposure were assessed with six additional questions of the WAST. Principal component analysis was conducted on the 8-item WAST data to identify underlying types of IPV exposure. Antenatal depression was defined as the Center for Epidemiologic Studies Depression scores ≥16. Results: Participants were racially diverse (71% black, 21% white) with 85% Medicaid recipients. Nearly 12% of participants reported IPV exposure and 30% reported antenatal depression. The odds of having IPV exposure were higher among unmarried women, those with less than a high school education, and those who lacked family support. The odds of having antenatal depression were 2.5 times higher (95% CI: 1.9-3.5) among women with IPV exposure. After controlling for covariates, a one-point increase in the scores for psychological IPV (Factor 1) or a problematic relationship (Factor 3) was associated with increased odds of antenatal depression. Conclusion: This is one of the first studies to estimate the prevalence of IPV exposure using a proxy measure (a problematic relationship) among underserved U.S. pregnant women. Its positive association with antenatal depression suggests the utility of screening for a problematic relationship using a two-item WAST and providing assistance to those with IPV exposure.

Domestic Violence in Pregnancy during the Pandemic Era: a Systematic Review

INTRODUCTION

Women, and mainly pregnant ones, have been always highly vulnerable to domestic violence/intimate partner violence (DV/IPV) throughout their lives. Covid-19 pandemic brought new unprecedented living conditions that raised the rates of DV during pregnancy. Investigating the association between Covid-19 and DV in pregnant women may help government and community groups seeking to reduce DV/IPV in vulnerable populations in order to better understand the prevalence of this phenomenon and its associated factors and thus find ways to ensure control and stop domestic violence, as the society and health care systems are still disorganized in the way they deal with the DV against pregnant women.

AIM

The aim of this study is to investigate the state of DV in pregnant women during the Covid-19 pandemic and to present the incidence rates of domestic violence as well as the possible consequences that can occur for both women and newborns, while also highlighting risk factors connected to Covid-19 that increase DV and attempting to see if there is a way to prevent and address DV through a systematic review of the available literature.

METHODS

We searched Google Scholar, Medline and PubMed for relevant articles published between 2019-2023. Out of the total number of 772 returned articles, only 25 were included in the present review after excluding all those which failed to meet one of the critical criteria.

RESULTS

We identified four themes linked to DV during pregnancy in the pandemic era, including the incidence of negative consequences for mother and fetus, Covid-19-associated factors, interventions and solutions. Also, prevalence of DV was found to be higher than before the pandemic. DV/IPV was linked to Covid-19 factors such as lockdown and quarantine, causing spouses to spend more time together, economic strains from loss of incomes and reduced incomes, unintended pregnancies and limited access to healthcare services for antenatal and prenatal clinics and support. The adverse effects of DV/IPV on pregnant women and the fetus include miscarriages, still births, abortions, early fetal loss, maternal anxiety and depression as well as poor development of the child after birth, among others. Critical interventions to manage DV/IPV during the pandemic include, to name just a few, better screening systems during the pandemic, public awareness, maintenance of support and healthcare systems and connections.

CONCLUSIONS

Covid-19 created circumstances and measures that increased the risk and incidence of DV/IPV in pregnant women, which led to a higher prevalence of the phenomenon. Sustainable systems can help reduce DV/IPV against women and, in particular women at-risk, such as pregnant ones. Therefore, some interventions, including screening mechanisms and public awareness, healthcare support and interconnections, need to be maintained and strengthened during times of crisis, such as the pandemic, to curb mitigate DV/IPV.

Nurse informaticists' role in promoting health equity

ABSTRACT

Nurse informaticists (NIs) play a pivotal role in addressing health-related social needs through integrating technology into electronic health records. NIs navigate regulatory landscapes, emphasizing screening for social determinants of health during hospital encounters. This article underscores NIs' strategic contributions to optimizing data collection, supporting health equity, and utilizing innovative technologies to bridge gaps in healthcare outcomes.

The Impact of Maternal Interpersonal Violent Trauma and Related Psychopathology on Child Outcomes and Intergenerational Transmission

PURPOSE OF REVIEW

This review aims to outline some consequences that maternal history of trauma with and without related psychopathology, such as posttraumatic stress symptoms (PTSS), can have on their children's development and functioning. It then addresses mechanisms through which intergenerational transmission of interpersonal violence (IPV) and related psychopathology may occur.

RECENT FINDINGS

Findings include the effects of maternal IPV experience and related psychopathology on child social-emotional and biologically-based outcomes. This includes increased developmental disturbances and child psychopathology, as well as physiological factors. Secondly, the review focuses on psychobiological mechanisms by which maternal experience of IPV and related psychopathology likely trigger intergenerational effects. Maternal IPV and related psychopathology can have a negative impact on several areas of their child's life including development, interactive behavior, psychopathology, and physiology. This transmission may partially be due to fetal and perinatal processes, genetic and epigenetic effects, and interactions with their parents.

Association of intimate partner violence with offspring growth in 32 low- and middle-income countries: a population-based cross-sectional study

Intimate partner violence (IPV) against women presents a major public health challenge, especially in low-income and middle-income countries (LMICs), and its relationship with poor offspring growth is emerging but remains understudied. This study aimed to explore the impact of maternal exposure to IPV on offspring growth based on different approaches in LMICs. We conducted a population-based cross-sectional study using the most recent Demographic and Health Surveys from 32 LMICs; 81,652 mother-child dyads comprising women aged from 15 to 49 years with children aged 0 to 59 months were included. We applied logistic regression models to explore the independent and cumulative relationship between IPV, including emotional, physical, and sexual IPV, with poor child growth status, including stunting and wasting; 52.6% of mothers were under the age of 30 years with a 36% prevalence of any lifetime exposure to IPV. Maternal exposure to any IPV increased the odds of stunting, but only physical and sexual IPV were independently associated with an increased risk of stunting. Three different types of IPV exhibited a cumulative effect on stunting. Maternal exposure to physical IPV was significantly associated with an increased risk of wasting. Significant associations between maternal exposure to emotional IPV with offspring stunting and physical IPV with wasting were only observed in children aged 0 to 36 months. IPV against women remains high in LMICs and has adverse effects on offspring growth. Policy and program efforts are needed to prioritize the reduction of widespread physical and sexual IPV and to mitigate the impact of such violence.

Predictors for the utilization of community support systems against intimate partner violence among married women living with HIV in southwestern Uganda-A cross sectional study

BACKGROUND

Intimate partner violence (IPV) disproportionately affects married women living with HIV (MWLHIV), resulting in undesirable human rights, socio-economic, mental, maternal, and child health consequences. Community Support systems against Violence (CoSaV) are widely available and promising public and voluntary resources for the prevention and mitigation of IPV but are poorly investigated. We set out to identify the predictors for the utilization of the CoSaV among the MWLHIV.

METHODS

This was a quantitative cross-sectional study conducted among 424 consecutively sampled MWLHIV attending the Antiretroviral Therapy (ART) clinic at Kabale Regional Referral Hospital in southwestern Uganda in April 2021. Using an interviewer-administered questionnaire, data were collected on the participant's socio-demographic characteristics, exposure to IPV, awareness about the CoSaV, perceptions about the quality, accessibility and challenges in accessing the CoSaV and the utilization. Modified Poisson regression model was used to identify the predictors for the utilization of CoSaV using the Statistical Package for Social Sciences (SPSS) version 23.0.

RESULTS

The mean age of the 424 participants in the study was 39.5 ± 10.2 years. More than half of the participants 51.9% (220/424) reported exposure to any IPV. Utilization of any CoSaV was found to be above average at 58.3% among the participants. The formal support (police, local government leaders, health workers and counselors) were more frequently utilized compared to the informal support (family, relatives and friends). Utilization of any CoSaV was higher among the women who were aware of the CoSaV and also those who were exposed to violence. Accessibility was identified as an independent predictor for utilization of any CoSaV.

CONCLUSIONS

Intimate partner violence (IPV) was prevalent among MWLHIV in southwestern Uganda. However, the utilization of any CoSaV was suboptimal. The formal CoSaV were more frequently utilized than the informal support systems. Accessibility was an independent predictor for utilization of any CoSaV. There is need to improve access in order to increase the utilization of the CoSaV and contribute to the attainment of sustainable development goal 5.2.1 and end violence against women.

"We decided together": a qualitative study about women with HIV navigating infant-feeding decisions with the father of their children

BACKGROUND

The World Health Organization (WHO) recommends that women with HIV breastfeed for a minimum of one year. In contrast, United Kingdom (UK) guidelines encourage formula feeding, but breastfeeding can be supported under certain circumstances. Infant-feeding decisions often involve personal and social networks. Currently, little research addresses how individuals with HIV in high-income countries navigate infant-feeding decisions with the father of their children.

METHODS

Semi-structured remote interviews were conducted with UK-based individuals with a confirmed HIV positive diagnosis who were pregnant or one-year postpartum, and two partners. Using purposive sampling, pregnant and postpartum participants were recruited through HIV NHS clinics and community-based organisations, and where possible, fathers were recruited via them. Data were analysed using thematic analysis and organised using NVivo 12.

RESULTS

Of the 36 women interviewed, 28 were postpartum. The majority were of Black African descent (n = 22) and born outside the UK. The key factors in women navigating HIV and infant-feeding discussions with respect to their baby's father were the latter's: (1) awareness of woman's HIV status; (2) relationship with the woman; (3) confidence in infant-feeding decision; (4) support and opinion about woman's infant-feeding intentions. Most women made a joint decision with biological fathers when in a long-term (> one year) relationship with them. Single women tended not to discuss their infant-feeding decision with the father of their child, often for safety reasons.

CONCLUSION

Women in ongoing relationships with the father of their child valued their support and opinions regarding infant-feeding. In contrast, single women chose not to involve the father for reasons of privacy and safety. Clinical teams and community-based organisations should support mothers in discussing infant-feeding decisions regardless of relationship status. When appropriate, they should also support discussions with their partners, but remain sensitive to circumstances where this may put women at risk.

Assessment of the COVID-19 Pandemic's Impact on Physical Intimate Partner Violence Against Pregnant Women in Ankara (Turkey): A Hospital-Based Study

Purpose

A significant increase in physical intimate partner violence (IPV) cases has been reported from many countries during the COVID-19 pandemic, and particularly during lockdown periods. The current study's objectives are to define the COVID-19 pandemic's impact on physical IPV against pregnant women in Ankara.

Patients and Methods

During the one-year pre-pandemic and two-year pandemic, records of patients who sent by the judicial authorities to the Obstetrics and Gynecology Emergency Room (ER) at Ankara City Hospital were reviewed, and pregnant women who had been subjected to IPV were identified.

Results

Of pregnant women 19.1% in the pre-pandemic period, 29.4% in the first year and 51.5% in the second year of the pandemic period exposed to IPV. The mean age of IPV victims was 28.8 ± 6.5 years. Most ER applications were in the evening hours (48.5%), and majority of assailants were the victim's husband (77.9%). Vast majority of victims were multigravida women (89.7), and most of the traumas were localized in abdomen and genitalia (50%). Three of the women (4.4%) had miscarriage.

Conclusion

The increase in cases of IVP against pregnant women during the pandemic was striking, according to the current study. We think that this first study from Turkey on the IPV that pregnant women are exposed to during the pandemic can lead to extensive research focused on measures against IPV during pandemics, such as dissemination of telephone applications for IPV victims, increasing home visits by marriage therapists, and intensifying of education campaigns against violence.

Factors contributing to the high prevalence of intimate partner violence among south Sudanese refugee women in Ethiopia

BACKGROUND

Intimate partner violence is a universally occurring form of violence against women which is perpetrated by a husband or other intimate partner. It is a common public health problem during humanitarian crisis. Despite this, little is known about the problem among South Sudanese refugee women in Ethiopia.

OBJECTIVE

This study aimed to determine the prevalence of intimate partner violence and identify its contributing factors among married refugee women in Pinyudo refugee camp, Gambella, Ethiopia in 2021.

METHODS

A community-based cross-sectional study was conducted from March to June 2021. A random sample of 406 refugee women was included in the study. A structured, pretested, and interviewer-administered questionnaire was used to collect the data. Data were entered into epi-data version 3.1 and exported to SPSS version 22 for analysis. Multivariable logistic regression was run to identify factors associated with intimate partner violence. Statistical significance was affirmed using Adjusted Odds Ratio with its 95% Confidence Interval at a p-value ≤ 0.05.

RESULTS

A total of 406 married refugee women participated in the study making a response rate of 96.2%. The overall prevalence of intimate partner violence in the past 12 months was 48.3% 95% CI= (43.6-53.2). Low-income contribution [AOR = 2.4, 95% CI: 1.2-5.5], and attitudinal acceptance [AOR = 2.1, 95%CI: 1.2-3.8] were significantly associated with the problem.

CONCLUSION

The prevalence of intimate partner violence is alarmingly high as half of participating women reported facing the problem in the year preceding the study. Low-income contribution and attitudinal acceptance were associated with a higher probability of experiencing violence. The government, humanitarian organizations, and other stakeholders should enable refugee women to generate income. There should be continuous women empowerment and behavioral interventions to improve refugee women's attitudes towards intimate partner violence.

A Comprehensive Review of Intimate Partner Violence During Pregnancy and Its Adverse Effects on Maternal and Fetal Health

Intimate partner violence (IPV) is a significant public health issue that affects many women, including pregnant women. The aim of this comprehensive review is to examine the prevalence of IPV during pregnancy and its adverse effects on maternal and fetal health. IPV during pregnancy can take various forms, including physical, sexual, emotional, and financial abuse. The consequences of IPV during pregnancy can be severe, with adverse effects on maternal and fetal health including an increased risk of preterm birth, low birth weight (LBW), fetal injury, maternal depression, anxiety, post-traumatic stress disorder (PTSD), and even maternal death. Identifying women experiencing IPV during pregnancy and providing appropriate support and care can help mitigate the adverse effects on maternal and fetal health. The review also discusses various interventions and strategies that can be used to prevent IPV during pregnancy, such as screening and counseling for IPV, training healthcare providers to identify and manage IPV during pregnancy, and providing resources and support for women who experience IPV. Overall, the review highlights the need for increased awareness, research, and resources to prevent and address IPV during pregnancy and to promote the health and well-being of women and their infants.

Antenatal maternal intimate partner violence exposure is associated with sex-specific alterations in brain structure among young infants: Evidence from a South African birth cohort

Maternal psychological distress during pregnancy has been linked to adverse outcomes in children with evidence of sex-specific effects on brain development. Here, we investigated whether in utero exposure to intimate partner violence (IPV), a particularly severe maternal stressor, is associated with brain structure in young infants from a South African birth cohort. Exposure to IPV during pregnancy was measured in 143 mothers at 28-32 weeks' gestation and infants underwent structural and diffusion magnetic resonance imaging (mean age 3 weeks). Subcortical volumetric estimates were compared between IPV-exposed (n = 63; 52% female) and unexposed infants (n = 80; 48% female), with white matter microstructure also examined in a subsample (IPV-exposed, n = 28, 54% female; unexposed infants, n = 42, 40% female). In confound adjusted analyses, maternal IPV exposure was associated with sexually dimorphic effects in brain volumes: IPV exposure predicted a larger caudate nucleus among males but not females, and smaller amygdala among females but not males. Diffusivity alterations within white matter tracts of interest were evident in males, but not females exposed to IPV. Results were robust to the removal of mother-infant pairs with pregnancy complications. Further research is required to understand how these early alterations are linked to the sex-bias in neuropsychiatric outcomes later observed in IPV-exposed children.

Major Depression in Postpartum Women during the COVID-19 Pandemic: Can Social Support Buffer Psychosocial Risks and Substance Use?

Rates of mood disorders and substance use increased during the COVID-19 pandemic for postpartum women. The present study's aims were to: (1) examine the prevalence of major depressive disorder (MDD) in postpartum women during the COVID-19 pandemic, and (2) evaluate whether social support can buffer the associations between MDD, psychosocial factors (perceived stress, generalized anxiety, and intimate partner violence) and substance use (alcohol and drug use). A nationwide survey included 593 postpartum mothers (within 12 months from birth). Participants were assessed for a provisional diagnosis of MDD, and provided responses on validated instruments measuring stress, intimate partner violence, suicidal ideation, generalized anxiety, social support, and substance use. A hierarchical logistic regression model assessed the association of psychosocial factors and substance use with MDD. The final model shows that social support attenuates the association of MDD with perceived stress, alcohol use, and drug use, but does not buffer the relationship of MDD with anxiety or intimate partner violence. Social support was shown to significantly attenuate the effects of stress, alcohol use, and drug use on MDD, suggesting that the presence of a strong, supportive social network should be an area of increased focus for public health and healthcare professionals when caring for postpartum women.