Associations between intimate partner violence and reproductive and maternal health outcomes in Bihar, India: a cross-sectional study

Sexual and reproductive health outcomes of women who experienced violence in Germany: Analysis of the German health interview and examination survey for adults (DEGS1)

OBJECTIVES

Violence against women is a widespread public health concern with severe effects to women's sexual and reproductive health, including higher risks for miscarriage or stillbirth, unintended pregnancy and induced abortion. This study examined the association between women exposure to physical violence, psychological violence and sexual and reproductive health outcomes (contraceptive use, miscarriage or stillbirth and abortion) in Germany.

METHODS

This study used a cross-sectional research design to analyze data on violence against women and sexual and reproductive health (SRH) outcomes collected through the German Health Interview and Examination Survey for Adults, Wave 1, between 2008 and 2011 (n = 3149 women, aged 18-64 years). Multivariable logistic regression models were used to assess the association between experiences of violence among women and the presence of sexual and reproductive health outcomes, considering the influence of socio-demographic and health-related factors (age, marital status, socioeconomic status, social support, number of children, alcohol consumption, health status, chronic conditions).

RESULTS

Three associations remained significant (p<0.05) in fully-adjusted models: (i) exposure to physical violence by a parent or caregiver and birth control pill utilization (aOR, adjusted Odds Ratio, 95% CI: 1.36, 1.02-1.81) (ii) exposure to physical violence since the age of 16 and miscarriage or stillbirth (aOR, 95%CI: 1.89, 1.17-3.04); and (iii) exposure to psychological violence by a parent or caregiver and abortion (aOR, 95%CI: 1.87, 1.30-2.70).

CONCLUSIONS

The results suggest that adult German women who experienced physical or psychological violence since the age of 16, including violence perpetrated by a parent or caregiver, were more likely to report miscarriage or stillbirth and abortion. Direct assessment of violence experiences against women should be conducted by healthcare professionals in clinical encounters, particularly by obstetrics and gynaecological specialists, for the prevention of women´s adverse sexual and reproductive health outcomes. Furthermore, violence should be treated as a major public health concern and addressed through a multisectoral approach, involving the healthcare and educational sectors, researchers and relevant policymakers.

"I have to listen to them or they might harm me" and other narratives of why women endure obstetric violence in Bihar, India

BACKGROUND

Evidence suggests that obstetric violence has been prevalent globally and is finally getting some attention through research. This human rights violation takes several forms and is best understood through the narratives of embodied experiences of disrespect and abuse from women and other people who give birth, which is of utmost importance to make efforts in implementing respectful maternity care for a positive birthing experience. This study focused on the drivers of obstetric violence during labor and birth in Bihar, India.

METHODS

Participatory qualitative visual arts-based method of data collection-body mapping-assisted interviews (adapted as birth mapping)-was conducted to understand women's perception of why they are denied respectful maternity care and what makes them vulnerable to obstetric violence during labor and childbirth. This study is embedded in feminist and critical theories that ensure women's narratives are at the center, which was further ensured by the feminist relational discourse analysis. Eight women participated from urban slums and rural villages in Bihar, for 2-4 interactions each, within a week. The data included transcripts, audio files, body maps, birthing stories, and body key, which were analyzed with the help of NVivo 12.

FINDINGS

Women's narratives suggested drivers that determine how they will be treated during labor and birth, or any form of sexual, reproductive, and maternal healthcare seeking presented through the four themes: (1) "I am admitted under your care, so, I will have to do what you say"-Influence of power on care during childbirth; (2) "I was blindfolded … because there were men"-Influence of gender on care during childbirth; (3) "The more money we give the more convenience we get"-Influence of structure on care during childbirth; and (4) "How could I ask him, how it will come out?"-Influence of culture on care during childbirth. How women will be treated in the society and in the obstetric environment is determined by their identity at the intersections of age, class, caste, marital status, religion, education, and many other sociodemographic factors. The issues related to each of these are intertwined and cross-cutting, which made it difficult to draw clear categorizations because the four themes influenced and overlapped with each other. Son preference, for example, is a gender-based issue that is part of certain cultures in a patriarchal structure as a result of power-based imbalance, which makes the women vulnerable to disrespect and abuse when their baby is assigned female at birth.

DISCUSSION

Sensitive unique feminist methods are important to explore and understand women's embodied experiences of trauma and are essential to understand their perspectives of what drives obstetric violence during childbirth. Sensitive methods of research are crucial for the health systems to learn from and embed women's wants, to address this structural challenge with urgency, and to ensure a positive experience of care.

Factors associated with miscarriage in Nepal: Evidence from Nepal Demographic and Health Surveys, 2001-2016

BACKGROUND

Miscarriage is a major public health concern in low and middle-income countries (LMICs) like Nepal. This study aims to examine the factors associated with miscarriage among pregnant women of reproductive age (15-49 years) in the past 15 years.

METHODS

There were a total of weighted sample of 26,376 cross-sectional pregnancy data from Nepal Demographic and Health Surveys (NDHS) 2001, 2006, 2011, and 2016 combined together, which was used in the study. Multilevel logistic regression analysis that adjusted for cluster and survey weights was used to identify factors associated with miscarriage among pregnant women of reproductive age in Nepal.

RESULTS

The results showed that maternal age, contraception, tobacco smoking, wealth index, respondents' educational status, and, caste/ethnicity were found to be strong factors of miscarriage in Nepal. The likelihood of having a miscarriage among older women (≥40 years) was more than 100% (aOR = 2.12, 95% CI [1.73, 2.59]), among non-users of contraception was 88.9% (aOR = 1.88, 95% CI [1.68, 2.11]) (p<005) and non-smoking women had a 19% lower odds of miscarriage (aOR = 0.81, 95% CI [0.69, 0.95]). Respondents from the richest wealth index had 50% (aOR = 1.50, 95% CI [1.22, 1.85]) higher likelihood of miscarriage. Mothers with only primary education had a 25% higher chance of miscarriage (aOR = 1.25, 95% CI [1.09, 1.44]) compared to those with secondary and higher secondary education. In relation to caste/ethnicity, Dalits had 13% lesser likelihood (aOR = 0.87, 95% CI [0.74, 1.02]) and Janajatis had 26% lower chances of a miscarriage than Brahmin/Chettri (aOR = 0.74, 95% CI [0.64, 0.85]).

CONCLUSION

Findings from this study show that miscarriages are associated with maternal age, use of contraception, smoking, wealth index, caste, and ethnicity. Interventions aimed to improve use of contraceptives, avoiding smoking and pregnancy planning on the basis of maternal age, are needed to prevent miscarriage. Also, women from Brahmin ethinicity and those with the highest income index require greater attention when it comes to miscarriage prevention strategies in Nepal.

Association between intimate partner violence and pregnancy intention: evidence from the Peruvian demographic and health survey

BACKGROUND

Intimate partner violence (IPV) in Peru represents a significant public health challenge. IPV can influence women's reproductive and social behaviors, undermining fertility control, and exacerbating unintended pregnancies. Our objective was to assess the association between IPV and pregnancy intention among Peruvian women of reproductive age.

METHODS

We conducted a secondary analysis of Peru's 2020 Demographic and Family Health Survey data. The independent variable in this study was IPV against women, which includes psychological IPV, sexual IPV, and physical IPV. If a respondent experienced any of these three forms of IPV, the IPV variable was labeled as "yes"; if none were present, it was labeled as "no". The dependent variable was pregnancy intention (no vs. yes). We utilized a generalized linear model (GLM) from the Poisson family with a log link function to assess the relationship between IPV occurrences (total and each IPV type) and pregnancy intention. We report crude and adjusted prevalence ratios (aPR) with 95% confidence intervals (95%CI).

RESULTS

We analyzed data from 8466 women aged 15 to 49. The prevalence of any IPV was 49.6% (psychological IPV: 45.8%; physical IPV: 22.2%; and sexual IPV: 4.3%). Exposure to physical IPV (aPR: 1.05; 95% CI: 1.03-1.07), psychological IPV (aPR: 1.04; 95% CI: 1.02-1.06), and sexual IPV (aPR: 1.09; 95% CI: 1.04-1.13), as well as a history of any IPV (aPR: 1.05; 95% CI: 1.02-1.07), were associated with a higher probability of not intending to become pregnant. This association persisted after adjusting for confounders like age, marital status, educational attainment, education level of the child's father, place of residence, wealth, ethnicity, and parity.

CONCLUSION

One in two Peruvian women reported experiencing IPV. An association was observed between IPV exposure and a higher probability of not holding an intention to become pregnant.

Burden, trend and determinants of various forms of domestic violence among reproductive age-group women in India: findings from nationally representative surveys

BACKGROUND

Violence, a notable human rights concern, has a public health impact across the globe. The study aimed to determine the prevalence and determinants of domestic violence among ever-married women aged 18-49 years in India.

METHODS

Secondary data analysis with National Family Health Survey 5, 2019-21 data (NFHS-5) was conducted. The complex sampling design of the survey was accounted-for during analysis. The primary outcome was domestic violence. Prevalence was reported with 95% confidence interval (CI). Prevalence ratio was reported to provide the factors associated with domestic violence using Poisson regression.

RESULTS

About 63 796 ever-married women aged 18-49 years covered under domestic violence module of NFHS-5 survey were included. Prevalence of domestic violence (12 months preceding the survey) was 31.9% (95% CI: 30.9-32.9%). Physical violence (28.3%) was the most common form followed by emotional (14.1%) and sexual violence (6.1%). Women with low education, being employed, husband being uneducated or with coercive behavior had significantly higher prevalence of domestic violence.

CONCLUSIONS

One-third of the reproductive age-group women were facing some form of domestic violence. Target group interventions like violence awareness campaigns, women supportive services and stringent law enforcement should be implemented to eliminate domestic violence by year 2030.

Associations between domestic violence and poor pregnancy outcomes in taiwanese women: a nested case-control study

BACKGROUND AND AIMS

Domestic violence (DV) are one of the important risk factors for women's health outcomes. The aim of this study was explored the risk of DV association with the poor pregnancy outcomes (PPOs), including premature delivery, abortion, and stillbirth.

METHODS

A nested case-control study was applied. Data from the Taiwan National Health Insurance Research Database were collected from 2000 to 2015. A total of 41,730 participants were included in this study, including 8,346 participants in the case group and 33,384 age- and index year-matched control group. Assessments of DA and PPOs were determined according to the International Classification of Diseases, 9th Revision. We conducted a conditional logistic regression analysis to estimate the effect of DV on PPOs.

RESULTS

The mean age was 35.53 in the 41,730 female participants. The overall incidence rate of PPOs of the participants, who had experienced DV, was 84.05 per 100,000 person-years. which was significantly higher than that for the controls (18.19 per 100,000 person-years). The risk of PPOs was higher in the participants who had experienced DV than in the controls (adjusted odds ratio [AOR] = 3.31; 95% confidence interval [CI] [95% CI]: 2.83-3.86), including for premature delivery (AOR = 3.57; 95% CI: 3.05-4.17), abortion (AOR = 3.31; 95% CI: 2.83-3.86) and stillbirth (AOR = 2.98; 95% CI: 2.55-3.47). The results showed that the longer a participant has been suffering DV, the risk of PPOs was higher.

CONCLUSIONS

Present results reaved the risk of PPOs associated with DV. Especially, the longer a woman has been experiencing DV, the risk of PPOs was higher, showed a dose-response effect.

Intimate Partner Violence During Pregnancy and Maternal Morbidity in South Ethiopia: A Cohort Study

Purpose

Intimate partner violence during pregnancy is a universal public health problem. However, its link with maternal morbidity is not well understood in Ethiopia. Thus, the study assessed its effect on maternal morbidity during delivery and postpartum in South Ethiopia.

Methods

A prospective cohort study was conducted among 1535 pregnant women. Pregnant women with intimate partner violence during pregnancy were enrolled as the "exposed group", and pregnant women without intimate partner violence were registered as the "unexposed group". A total of 711 exposed and 774 unexposed women were included in the analysis of this study. Data were collected using an interviewer-administered questionnaire. Data entry and analysis were done in STATA Version 14. A generalized linear model with a log link function using the binreg command was applied to examine the effect of intimate partner violence on maternal morbidity.

Results

The level of maternal morbidity during delivery and postpartum was higher among women with intimate partner violence than women without intimate partner violence (34.0% vs 26.6%). After adjusting for confounders, women with intimate partner violence during pregnancy were more likely to experience maternal morbidity than women without intimate partner violence (aRR=4.45; 95% CI: 3.15, 6.28). Psychological violence was also identified as a risk factor for maternal morbidity (aRR=2.17; 95% CI: 1.76, 2.67). Likewise, women with physical violence were more likely to experience maternal morbidity than those without physical violence (aRR=1.31; 95% CI: 1.12, 1.53).

Conclusion

The current study demonstrated a higher level of maternal morbidity among women with intimate partner violence. Psychological violence, physical violence, and intimate partner violence during pregnancy were found to increase the risk of maternal morbidity. Strengthening the prevention and prompt management of intimate partner violence during pregnancy may significantly reduce the incidence of maternal morbidity.

Association between intimate partner violence and nutritional status among Indian women: a latent class analysis approach

BACKGROUND

Intimate partner violence (IPV) is an unabating public health issue that has numerous negative repercussions for women's health. Its detrimental impact on women's nutritional outcomes has been documented in a few studies from low- and middle-income countries; however, there is a lack of granular understanding in terms of the typology of IPV experiences and their association with nutritional outcomes. This study explores the distinct classes of IPV experience among women in India and examines how these classes are associated with their nutritional outcomes.

METHODS

Using data of 60,622 ever-married women aged 15-49 years from the 2019-21 National Family Health Survey (NFHS-5), latent class analysis (LCA) was performed to identify distinct groups of women based on their IPV experiences. BMI was used to assess women's nutritional status, and it was classified as: <18.5 kg/m2 (underweight), 18.5-24.9 kg/m2 (normal) and ≥ 25.0 kg/m2 (overweight). Further, multinomial logistic regression analyses were used to estimate the odds of being underweight or overweight by latent classes of IPV experiences.

RESULTS

LCA model identified four distinct IPV experience groups of women: Low Physical and Low Sexual IPV (LPLS-IPV) class (72%); High Physical and Low Sexual IPV (HPLS-IPV) (12.5%); High Sexual and Low Physical IPV (HSLP-IPV) (12%); and High Physical and High Sexual (HPHS-IPV) class (3.5%). The likelihood of being underweight was higher among women in the HPHS-IPV class (aOR: 1.24, 95% CI: 1.08-1.44), followed by those in the HPLS-IPV class (aOR: 1.11, 95% CI: 1.04-1.20).

CONCLUSION

The latent class groups found that high physical IPV experiences were associated with women's nutritional outcomes. The experiences of women having both high physical and sexual violence affect women's nutritional outcomes to a greater extent and they are more likely to be undernourished.

Global achievement of maternal health-related sustainable development goals targets among women exposed to intimate partner violence

Health-related Sustainable Development Goal (SDG 3) aims to ensure healthy lives. This study investigates the influence of Intimate Partner Violence (IPV) on achieving maternal health related SDG3 targets among exposed women globally.

METHODOLOGY

This study used secondary data analysis of Domestic Violence Modules from the latest Demographic and Health Surveys (DHS) of 40 countries. IPV was defined by women ever exposed to emotional, physical, severe, or sexual violence from the spouse. Achieving maternal health related SDG3 targets among women was measured by: Proportion of births attended by skilled health personnel; Antenatal care (women received antenatal care eight or more times from any provider); and the need for family planning satisfied with modern methods. The influence of IPV was estimated through adjusted OR after controlling for socioeconomic factors using logistic regression.

RESULTS

Exposure to IPV was among one-third of the women (37%) mainly physical (29%) and emotional (24%). Adjusted OR with 95%CI for the influence of IPV on women's utilization of skilled birth attendants was 0.81 (0.79-0.83)); having eight or more antenatal care visits 0.61 (0.59-0.63); and the needs for family planning with modern methods satisfied was 0.85 (0.83-0.87). Achievement of maternal health services was among 57% of the women. Women exposed to IPV were less to achieve maternal health services (50% VS 61%) with adjusted OR 0.71; 95%CI: 0.70-0.73 and it was not confounded by the positive effect of socioeconomic factors.

CONCLUSION & RECOMMENDATION

Exposure to IPV had a statistically significant negative influence on all the maternal health related SDG3 services among women. Programs working in facilitating the achievement of the SDGs related maternal health targets should include prevention of women's exposure to IPV and support for those who are exposed to it.

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.

Pathways to adverse pregnancy outcomes: exploring the mediating role of intimate partner violence and depression: results from a South African rape cohort study

Adverse pregnancy outcomes (APOs) are common occurrences that contribute to negative maternal and child health outcomes. Our aim was to test the hypothesis that trauma exposure and depression are drivers of the better-recognised risk factors for miscarriage, abortion and stillbirths. Our comparative cohort study based in Durban, South Africa recruited women who reported a recent rape (n = 852) and those who had never experienced rape (n = 853), with follow-up for 36 months. We explored APOs (miscarriage, abortion or stillbirth) among those having a pregnancy during follow-up (n = 453). Potential mediators were baseline depression, post-traumatic stress symptoms, substance abuse, HbA1C, BMI, hypertension and smoking. A structural equation model (SEM) was used to determine direct and indirect paths to APO. Overall, 26.6% of the women had a pregnancy in the follow-up period and 29.4% ended in an APO, with miscarriage (19.9%) the most common outcome, followed by abortion (6.6%) and stillbirths (2.9%). The SEM showed two direct pathways from exposure to childhood trauma, rape and other trauma, to APO which were ultimately mediated by hypertension and/or BMI, but all paths to BMI were mediated by depression and IPV-mediated pathways from childhood and other trauma to hypertension. Food insecurity mediated a pathway from experiences of trauma in childhood to depression. Our study confirms the important role of trauma exposure, including rape, and depression on APOs, through their impact on hypertension and BMI. It is critical that violence against women and mental health are more systematically addressed in antenatal, pregnancy and postnatal care.

Associations between intimate partner violence and adverse birth outcomes during pregnancy: a systematic review and meta-analysis

Background

Intimate partner violence (IPV) has been associated with an elevated risk of multiple adverse birth outcomes, yet little is known about how specific IPV influences adverse birth outcomes. The aim of this study was to examine the association between IPV during pregnancy and adverse birth outcomes (i.e., preterm birth, low birth weight, and stillbirth).

Methods

Systematic searches were conducted using four databases: EMBASE, Web of Science, PubMed, and CINAHL for observational studies published from 1 January 2011 to 31 August 2021. Two reviewers independently carried out the literature search, study selection, data extraction, assessment of the study, and risk of bias assessment; disagreements were resolved by a third reviewer. A random-effect model was used to calculate the odds ratio (OR) with a 95% confidence interval (CI) for preterm birth, low birth weight, and stillbirth. I² statistic accompanied by chi-square p-value was used to assess heterogeneity, and funnel plot and Peter's test were used to assess publication bias.

Results

In total, 23 studies met the inclusion criterion. IPV was associated with preterm birth (OR = 1.84; 95% CI: 1.37-2.49; I² = 88%), low birth weight (OR = 2.73; 95% CI: 1.66-4.48; I² = 95%), and stillbirth (OR = 1.74; 95% CI: 0.86-3.54; I² = 64%). We attained comparable results among all specific IPV including physical, sexual, emotional, and mixed.

Conclusion

Intimate partner violence and specific IPV during pregnancy were significantly associated with adverse birth outcomes, especially for physical IPV. An urgent need for greater action to prevent or intervene in IPV during pregnancy is warranted.

Systematic review registration

CRD42021282936, https://www.crd.york.ac.uk/prospero/.

Assessment of miscarriage factors among Latinas who live in the U.S.: a cross-sectional study

Introduction

Latinas in the US are underrepresented in miscarriage research, yet face several risk factors for having a miscarriage, including intimate partner violence, and increasing maternal age. Increased acculturation is associated to increased risk of intimate partner violence and adverse pregnancy outcomes among Latinas yet is also understudied in the realm of miscarriage. Thus, this study aimed to analyze and compare sociodemographic characteristics, health-related factors, intimate partner violence, and acculturation among Latinas with and without a history of miscarriage.

Methods

This study utilizes a cross-sectional design to analyze baseline data from a randomized clinical trial on the effectiveness of "Salud/Health, Educación/Education, Promoción/Promotion, y/and Autocuidado/Self-care" (SEPA), a human immunodeficiency virus risk reduction intervention for Latinas. Survey interviews were conducted in a private room at the University of Miami Hospital. Survey data analyzed include demographics, a bi-dimensional acculturation scale, a health and sexual health survey, and the hurt, insult, threaten, and scream tool. This study's sample was 296 Latinas, 18 to 50 years old, with and without a history of miscarriage. Data analyses included descriptive statistics, t-tests for continuous variables, negative binomial for counts, and chi-square for dichotomous or categorical variables.

Results

Most Latinas were Cuban (53%), lived in the U.S. an average of 8.4 years, had 13.7 years of education, and a monthly family income of $1,683.56. Latinas with history of miscarriage were significantly older, had more children, more pregnancies, and poorer self-rated health than Latinas without history of miscarriage. Although not significant, a high percentage of intimate partner violence (40%) and low levels of acculturation were reported.

Discussion

This study contributes new data about different characteristics of Latinas who have and have not experienced a miscarriage. Results can help identify Latinas at risk for miscarriage or its adverse-related outcomes and help develop public health policies focusing on preventing and managing miscarriage among Latinas. Further research is warranted to determine the role of intimate partner violence, acculturation, and self-rated health perceptions among Latinas who experience miscarriage. Certified nurse midwives are encouraged to provide Latinas with culturally tailored education on the importance of early prenatal care for optimal pregnancy outcomes.

A Meta-Analysis and Systematic Review of Community-Based Intimate Partner Violence Interventions in India

Intimate partner violence (IPV) in India remains an entrenched and prevalent public health issue. Despite ample evidence of the widespread problem of IPV in India and associated mental and physical morbidities, far less is known about intervention models to reduce IPV in India. The aims of this meta-analysis and systematic review are to assess the effectiveness of community-based interventions to reduce IPV in India and to provide a narrative synthesis of these intervention approaches. A total of 9 databases were searched to identify peer-reviewed, English-language articles published between January 2000 and September 2022. The search identified 10 studies that met study inclusion criteria, including 3 randomized control trials, 4 quasi-experimental, 2 pre/post, and 1 time-series evaluation. Eight studies were included in the meta-analysis. There was notable variation in the interventions and approaches employed to reduce IPV and varying measurement of IPV outcomes. The results of the meta-analysis show that participating in community-based IPV interventions produced a significant reduction in IPV among women. When considering different types of IPV, study participants were less likely to report physical and psychological IPV victimization. In addition, participants were also less likely to report approving of IPV after participating in community-based IPV interventions. Community-based interventions and research addressing IPV are still evolving in India. Missing descriptions of theoretical frameworks, sampling, intervention design, and inadequately reported effectiveness of intervention (both quantitative and qualitative reporting) need to be addressed. Moreover, long-term evaluations of the pilot interventions are needed to provide a clear picture of the long-term effectiveness, sustainability, and replicability of the community-based IPV interventions. The findings have implications for researchers, practitioners (community health workers, clinicians, and social workers), and policymakers keen on IPV reduction in India and globally.

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

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

Factors that affect the utilisation of maternal healthcare in the Mchinji District of Malawi

BACKGROUND

It is widely accepted that maternal healthcare is vital for improving maternal and neonatal mortality rates. Furthermore, the continuum of care-the integrated delivery of antenatal, delivery and postnatal care-has been shown to be particularly important. Sub-Saharan Africa has the highest neonatal and maternal mortality rates in the world; significant improvements in the provision and utilisation of the continuum are urgently needed, therefore the barriers preventing access need to be better understood. This study aimed to identify key factors associated with the utilisation of maternal healthcare, in the Mchinji District of Malawi.

METHODS

4,244 pregnant women from the Mchinji District of Malawi were interviewed between March and December 2013. The overall utilisation of maternal healthcare was calculated by combining the use of antenatal, delivery and postnatal care into one variable-continuum of care. Univariate and multivariate logistic regressions were performed to determine the factors associated with utilisation of maternal healthcare.

RESULTS

Utilisation of maternal healthcare in the Mchinji District was inadequate; only 24% of women received the recommended package. Being further from a healthcare facility (OR = 0.2, 95%CI = 0.04-0.96), having at least one live child (OR = 0.87, 95%CI = 0.84-0.99), previous experience of miscarriage (OR = 0.64, 95%CI = 0.50-0.82) or abuse (OR = 0.81, 95%CI = 0.69-0.95) reduced utilisation, whereas being in the richest 20% (OR = 1.33 95%CI = 1.08-1.65), having a planned pregnancy (OR = 1.3, 95%CI = 1.11-1.51) or more control over decisions (OR = 1.09, 95%CI = 0.80-1.49) increased utilisation.

CONCLUSION

Seven groups of women were identified as having an increased risk of low utilisation of maternal healthcare; women living >5km from a healthcare facility, within the poorest socio-economic group, experiencing an unplanned pregnancy, with at least one live child, experience of a previous miscarriage, no control over their healthcare decisions or experience of abuse. Policy makers should pay extra attention to these high-risk groups when designing and delivering strategies to improve maternal healthcare utilisation.

Maternal exposure to intimate partner violence and uptake of maternal healthcare services in Ethiopia: Evidence from a national survey

Background

Women exposed to Intimate Partner Violence (IPV) often do not utilize maternal health care optimally both because of stigma and other social problems. The current study aims to explore an association between maternal healthcare seeking and violence exposure among Ethiopian women and to assess if educational attainment and wealth status moderate this association.

Methods

The analyses included 2836 (weighted) currently married women with one live birth. We focus on the five years preceding the 2016 Ethiopian Demographic and Health Survey (EDHS) who participate, in the domestic violence sub-study. Exposure was determined by maternal reports of physical, emotional, sexual IPV or any form of IPV. The utilization of antenatal care (ANC) and place of delivery were used as proxy outcome variables for uptake of skilled maternal healthcare utilization. Women’s education attainment and wealth status were selected as potential moderators, as they can enable women with psychological and financial resources to counteract impact of IPV. Multilevel logistic regression analyses were used to explore the association between spousal IPV and maternal health outcomes. Moderation effects by education and wealth status were tested, and the data stratified. Using statistical software Stata MP 16.1, the restricted maximum likelihood method, we obtained the model estimates.

Results

About 27.5% of the women who reported exposure to any form of IPV had a health facility delivery. While 23.4% and 22.4% visited four or more antenatal care services among mothers exposed to emotional IPV and sexual IPV, respectively. After adjusting for potential confounding factors, only the association between maternal exposure to emotional IPV and adequate use of ANC was statistically significant (OR = 0.73, (95% CI:0.56–0.95)). But we found no significant association between IPV and utilization of health facility delivery. Some moderation effects of education and wealth in the association between IPV and maternal healthcare service utilization outcome were found.

Conclusion

Exposure to emotional IPV was associated with poor uptake of maternal health care service utilization for married Ethiopian women. While developing interventions to improve women’s maternal healthcare service use, it is crucial to consider the effects of socio-economic variables that moderate the association especially with the intersection of IPV.

Women's attitude towards intimate partner violence and utilization of contraceptive methods and maternal health care services: an analysis of nationally representative cross-sectional surveys from four South Asian countries

BACKGROUND

Intimate partner violence (IPV) adversely affects women's reproductive health outcomes but to what extent women's justification of IPV affects maternal health care service utilization is unexplored.

METHODS

The secondary cross-sectional datasets from multiple indicator cluster surveys of Afghanistan, Bhutan, Nepal and Pakistan conducted between 2010 and 2015 were used. We used a generalized linear mixed model with random effects, at both cluster- and country-level, to determine the odds ratio of maternal health service utilization at the regional level and a multivariable logistic regression model adjusting for complex survey design at the country level. Interaction between women's justification of IPV and residential location, and linear trend in the utilization of maternal health care services associated with increasing levels of women's justification of IPV, were examined using the Likelihood Ratio Test (LRT).

RESULTS

A total of 26,029 women aged 15-49 years, living with their partners and had a pregnancy outcome 2 years prior to the survey were included. Women justifying IPV were less likely to utilize contraceptive methods (aOR) = 0.86, 95% CI 0.84, 0.88), at-least one Antenatal Care (ANC) visit (aOR = 0.80, 95% CI 0.72, 0.88), four or more ANC services (aOR = 0.81, 95% CI 0.76, 0.86), institutional delivery (aOR = 0.87, 95% CI 0.80, 0.94) and Post-natal Care (aOR = 0.76, 95% CI 0.62, 0.95) services. A decreasing linear trend was observed for four or more ANC visits (LRT P = 0.96) and institutional delivery (LRT P = 0.80) with increasing levels of IPV justification. Women justifying IPV were less likely to have at least one ANC visit in urban (aOR 0.67, 95% CI 0.60, 0.75) compared to rural areas (aOR 0.83, 95% CI 0.73, 0.94).

CONCLUSIONS

Women's justification of IPV was associated with decreased odds of utilizing a wide range of maternal health care services at the regional level. Although further research that may help establish a causal link is important before formulating public health interventions, our study indicates interventions targeting women's condoning attitude toward IPV, delivered sooner rather than later, could potentially help to improve women's utilization of essential maternal health care services in the South Asian region that comprises Afghanistan, Bhutan, Nepal, and Pakistan.

The Role of Socioeconomic Factors on Women's Risk of Being Exposed to Intimate Partner Violence

The most important thing learned about intimate partner violence (IPV) over the last 20 years is that violence is gendered and can be learned after faced and can only be understood in the context of gender inequality. To promote gender equality, a number of legal reforms and policies have been put in place over the last decade. The main problem is that there is relationship between all the socioeconomic and demographic factors. This begs the question, does the high educational level, social and economic status of a woman put her at lower risk of experiencing domestic violence? The study hypothesizes that those socioeconomic factors such as literacy, political rights, urbanization, laws against violence, the annual income of women, and the number of women in the labor force can affect IPV prevalence. The study uses secondary data concerning socioeconomic factors from 26 predominantly Muslim countries in Asia-Pacific and North Africa. Findings from the study show that socioeconomic factors such as literacy, political rights, a higher level of urbanization, and the laws against violence have significant impacts and may decrease the prevalence of IPV. However, other socioeconomic factors such as the annual income of women and increased women in the labor force produced unclear results. The test for collinearity on the impacts of each socioeconomic factor against one another was found to be insignificant.

Intimate partner violence against women with disability and associated mental health concerns: a cross-sectional survey in Mumbai, India

OBJECTIVES

The risk of intimate partner violence (IPV) against women with disability is believed to be high. We aimed to compare the prevalence of past-year IPV against women with and without functional difficulties in urban informal settlements, to review its social determinants and to explore its association with mental health.

DESIGN

Cross-sectional survey.

SETTING

Fifty clusters within four informal settlements.

PARTICIPANTS

5122 women aged 18-49 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

We used the Washington Group Short Set of Questions to assess functional difficulties. IPV in the past year was described by binary composites of questions about physical, sexual and emotional violence. We screened for symptoms of depression using the Patient Health Questionnaire-9 and of anxiety using the Generalised Anxiety Disorder-7. Multivariable logistic regression models examined associations between functional difficulties, IPV and mental health.

RESULTS

10% of participants who screened positive for functional disability had greater odds of experiencing physical or sexual IPV (adjusted OR (AOR) 1.68, 95% CI 1.23 to 2.29) and emotional IPV (1.52, 95% CI 1.16 to 2.00) than women who screened negative. Women who screened positive for functional disability had greater odds than women who screened negative of symptoms suggesting moderate or severe anxiety (AOR 2.50, 95% CI 1.78 to 3.49), depression (2.91, 95% CI 2.13 to 3.99) and suicidal thinking (AOR 1.94, 95% CI 1.50 to 2.50).

CONCLUSIONS

The burden of IPV fell disproportionately on women with functional difficulties, who were also more likely to screen positive for common mental disorder. Public health initiatives need to respond at local and national levels to address the overlapping and mutually reinforcing determinants of violence, while existing policy needs to be better utilised to ensure protection for the most vulnerable.

Breaking the silence about obstetric violence: Body mapping women’s narratives of respect, disrespect and abuse during childbirth in Bihar, India

Background

Evidence on obstetric violence is reported globally. In India, research shows that almost every woman goes through some level of disrespect and abuse during childbirth, more so in states such as Bihar where over 70% of women give birth in hospitals.

Objective

1) To understand how women experience and attach meaning to respect, disrespect and abuse during childbirth; and 2) document women’s expectations of respectful care.

Methods

‘Body mapping’, an arts-based participatory method, was applied. The analysis is based on in-depth interviews with eight women who participated in the body mapping exercise at their homes in urban slums and rural villages. Analysis was guided by feminist relational discourse analysis.

Findings

Women reported their experiences of birthing at home, public facilities, and private hospitals in simple terms of what they felt ‘good’ and ‘bad’. Good experiences included being spoken to nicely, respecting privacy, companion of choice, a bed to rest, timely care, lesser interventions, obtaining consent for vaginal examination and cesarean section, and better communication. Bad experiences included unconsented interventions including multiple vaginal examinations by different care providers, unanesthetized episiotomy, repairs and uterine exploration, verbal, physical, sexual abuse, extortion, detention and lack of privacy.

Discussion

The body maps capturing birth experiences, created through a participatory method, accurately portray women’s respectful and disrespectful births and are useful to understand women’s experience of a sensitive issue in a patriarchal culture. An in-depth understanding of women’s choices, experiences and expectations can inform changes practices in and policies and help to develop a culture of sharing birth experiences.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04503-7.

Association between Intimate Partner Violence and Contraceptive Use Discontinuation in India

Research on the association between experiences of intimate partner violence (IPV) and contraceptive use discontinuation in low- and middle-income countries (LMICs) is limited. This study aims to fill this important gap using microdata collected from women aged 15-49 in the 2015-2016 National Family Health Survey (NFHS). Analyses used multivariable multinomial logistic regressions stratified by long-acting reversible contraceptive methods (LARC)/non-LARC and condom/pill to examine the association between experience of IPV and contraceptive use discontinuation while still in need (DWSIN). Experience of physical violence was associated with DWSIN among LARC/IUD users (RRR: 3.73, 95 percent CI [1.55-8.95]) Among condom users, DWSIN was higher among women who experienced emotional violence compared with women who did not experience any violence (RRR: 4.16, 95 percent CI [1.59-10.90]). Although we did not find an association between IPV and overall contraceptive use discontinuation, we did find compelling evidence of an association between IPV and IUD and condom use discontinuation in India. There is a need to understand women's experience of IPV as a part of a broader strategy to provide high-quality family planning services to all women while considering individual circumstances and reproductive aspirations to support the uninterrupted use of contraception in India.

Physical and verbal abuse amid COVID-19: a nationwide cross-sectional survey in Japan

OBJECTIVES

The detrimental impacts of abuse on victims' well-being are well documented globally, including Japan. The ongoing COVID-19 pandemic may increase the incidence of abuse in the community, creating an additional burden amid the crisis. However, the incidence of abuse in Japan during COVID-19 remains to be evaluated. Accordingly, our study aimed to assess the incidence of physical and verbal abuse among the general population in Japan and to identify the associated factors of abuse during COVID-19.

DESIGN AND SETTING

We used the data obtained from a nationwide, cross-sectional internet survey conducted in Japan between August and September 2020. Sampling weights were used to calculate national estimates, and multivariable logistic regression was performed to identify the associated factors for physical and verbal abuse.

RESULTS

Out of the total 25 482 participants, 965 (3.8 %) reported experiencing physical abuse and 1941 (7.6%) verbal abuse from April 2020 to September 2020. The incidence of physical and verbal abuse was higher among female participants. Participants who lived in areas where the 'state of emergency' was enforced were more likely to suffer from physical abuse. Similarly, vulnerable participants such as those below age 18, with low income, bad family relationships, and disabled people were more likely to experience both physical and verbal abuse. Participants suffering from COVID-19-related symptoms, who had poor health status and widows/divorcees were more likely to be verbally abused. Furthermore, those who did not follow preventive behaviours such as wearing masks in public places, abusing drugs and drinking alcohol in high amounts were also more likely to experience abuse.

CONCLUSION

The impact of abuse was found disproportionately greater in more vulnerable groups of the population. Pandemic has reinforced the existing social inequalities, which need to be addressed timely to prevent precarious repercussions.

Factors associated with women's approval on intimate partner violence in Bangladesh: A cross-sectional analysis of latest demographic and health survey 2017-18

Background

In Bangladesh, intimate partner violence (IPV) is high among women faced by their husband. Regrettably, IPV is often justified by the women themselves, resulting in poor social and health outcomes among them. In this paper, we explored the factors that influence the approval of IPV among the women by their husband in Bangladesh.

Method

The present used the data from the most recent Bangladesh Demographic and Health Survey (BDHS) 2017–18. The BDHS 2017–18 followed a two-stage stratified random sampling techniques and the present analysis was carried out among a weighted sample of 20,127 women. Multivariate logistic regression was used to identify the demographic and socio-economic factors associated with the approval of IPV among the women.

Results

Overall, one in five women (20.5%) approved at least one form of violence by their husband. In adjusted analysis, women who completed secondary education were 57% less likely [AOR = 0.43, 95% CI: 0.34–0.54] to approve IPV compared to those who had no formal education. Similarly, women who belonged to Hinduism and other religious group were 42% less likely [AOR = 0.58, 95% CI: 0.45–0.74] to approve IPV compared to those who practiced Islam. Moreover, women who were exposed to television, participated in the decision on household purchase and moving outside home had 14%, 19%, and 21% less chance for approving IPV by the husband for at least one reason (p < 0.05).

Conclusion

This study highlighted that many women in Bangladesh approve violence by their husband which could be a major obstacle to the reduction of violence from society. Behavior change intervention should be implemented, particularly targeting the less-educated Muslim women to increase the awareness on IPV in Bangladesh.

Spousal violence against women and its consequences on pregnancy outcomes and reproductive health of women in India

Background

Globally, one in three women experienced domestic violence. Alike the scenario observed in India, and a very few studies talk about violence and its consequences on women's health. Hence, the purpose of this study is to access the level of various types of spousal violence in India and to understand the association between physical, sexual and emotional violence against ever-married women by their husbands. The study further examines the consequences of spousal violence on women's health in terms of adverse pregnancy outcomes and reproductive health in India.

Methods

The study uses secondary data from National Family Health Survey-4 (NFHS-4, 2015–16). The analysis was based on a sample of ever-married women aged 15–49 years. Bivariate descriptive analysis and multiple regression analyses have been carried out to understand the association between spousal violence and its consequences on women's health.

Results

The study finds that the physical, sexual and emotional violence experienced by ever-married women in India are 29.8%, 13.8% and 7.0%, respectively. Further, the physical and sexual violence experienced by women have a significant association with an unwanted pregnancy, abortion, miscarriages and ever had termination of pregnancies. The regression analysis shows that violence by sexual partners among battered women increased the likelihood of unwanted pregnancy. Similarly, abortion and ever had a termination of pregnancies are also adversely affected by partner violence. Further, the risk of sexually transmitted infection increases 77% by sexual violence and 44% by emotional violence among battered women. Also, Sexual violence substantially increases the risk of prolonged labour during pregnancy.

Conclusion

This study revealed that one in three women experiencing violence by their husband and also it is evident that various forms of spousal violence adversely affect pregnancies outcomes and reproductive health among battered women compared to not battered.

Association between intimate partner violence during pregnancy and risk of preterm birth

Background

Preterm birth is a risk factor for child survival in both the short and long term. In Zimbabwe, the prevalence of preterm birth is rising, and there are growing concerns about the adverse consequences. This study explored the association between intimate partner violence (IPV) during pregnancy and preterm birth in Zimbabwe.

Methods

Using data from the 2015 Zimbabwe Demographic and Health Survey, we applied propensity score matching to estimate the effect of IPV during pregnancy on preterm birth among women of reproductive age (15–49 years). A total of 4833 pregnant women who gave birth during the five years preceding the survey were analysed.

Results

We successfully matched 79 women who were exposed to IPV during pregnancy to 372 unexposed during pregnancy. Using the matched sample, the probability of preterm delivery was significantly higher among women who were exposed to IPV during pregnancy than those who were not exposed. The findings showed that 7 out of 79 (8.9%) of women exposed to IPV during pregnancy experienced preterm delivery, and 11 out of 372 (3.0%) of those who were not exposed to IPV during pregnancy experienced preterm delivery. In the urban areas, those exposed to IPV during pregnancy were almost five times more likely to experience preterm delivery (OR = 4.8, 95% CI 2.0–11.6), but the association was not significantly different among women in rural areas.

Conclusion

The findings showed that women exposed to IPV during pregnancy were at increased risk of preterm birth. Some of the risk factors associated with IPV were urban residence, low economic status and unemployment. Effective policies and programmes are required to address the issue of IPV in Zimbabwe.

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

The utilization of maternal healthcare services is a key measure to reduce the incidence of maternal mortality. This study aims to examine the relationship between women’s exposure to intimate partner violence (IPV) and the utilization of maternal healthcare services, using a large-scale nationally representative data among Indian women. Data for this study were drawn from the fourth round of the National Family Health Survey (NFHS-4), which is collected during 2015–2016. In order to analyze, we utilized 24,882 currently married women aged 15–49 years who had at least one living child in the past five years preceding the survey. Women’s experience of IPV, which is manifested in various forms of physical, emotional, and/or sexual violence perpetrated by the partner, was considered as the key explanatory variable. Adequate antenatal care (ANC) [four or more ANC visits], delivery assistance by the skilled health provider, and postnatal care (PNC) within two days of delivery were used as outcome variables for assessing the utilization of maternal healthcare services. Descriptive statistics, cross-tabulation, Pearson’s chi-square test, and bivariate and multivariate logistic regression models were used in this study. Approximately 26% of the sample women (currently married) experienced any form of IPV in the past year. Bivariate analyses show that the utilization of all three components of maternal healthcare services was lower among women who experienced physical, sexual, or emotional violence, as compared to those who did not face any violence perpetrated by the partner. Multivariate analysis indicates that women’s exposure to IPV was significantly associated with a lower likelihood of adequate ANC utilization (Adjusted Odds Ratio [OR]: 0.90, 95% CI 0.84–0.97), even after controlling for socio-demographic characteristics. However, IPV had no significant relationship with skilled delivery assistance and unexpectedly a positive association with PNC usage (Adjusted OR: 1.09, 95% CI 1.02–1.16) in the adjusted analysis. Our study suggests formulating strategies toward the prevention of husband-perpetrated violence against women and targeting women who experienced spousal violence to improve their utilization of maternal healthcare services.

Domestic Violence and Coping Strategies Among Married Adults During Lockdown Due to Coronavirus Disease (COVID-19) Pandemic in India: A Cross-Sectional Study

Background:

There has been a reported increase in cases of domestic violence during the coronavirus disease 2019 (COVID-19) pandemic; however, systematic research data are still unavailable. This study was conducted to find out domestic violence prevalence and coping strategies among married adults during lockdown due to COVID-19 in India.

Methods:

A cross-sectional study was conducted among married men and women in the month of April 2020. Data regarding socio-demographic profile, domestic violence, and coping strategies used during lockdown were collected thorough Google Forms. A total of 97.9% of the forms were completely filled by the respondents. A descriptive analysis was done.

Results:

Of 94 study participants, approximately 7.4% (n = 7) had faced domestic violence during lockdown. Of these 7 participants, approximately 85.7% (n = 6) reported increased frequency of domestic violence during lockdown. Approximately half of the victims chose to ignore it (57.1%; n = 4) or used yoga/meditation (42.9%; n = 3) to cope.

Conclusions:

With approximately 7.4% study participants facing domestic violence during lockdown, it is necessary to study its detailed epidemiology in pandemics so that interventions like helpline numbers, screening of patients during tele-consultation, etc., which can be delivered even during lockdown with the help of health-care and frontline workers could be devised to address this problem.

Effect of Intimate Partner Violence on Maternal and Birth Outcomes of Pregnancy among Antenatal Clinic Attendees in Delhi: A Prospective Observational Study

Context

Violence against women is a major public health problem and a violation of their human rights. Intimate partner violence (IPV) during pregnancy has been linked to various adverse maternal health outcomes and birth outcomes.

Aims

The aim of this study is to assess the magnitude of maternal complications and adverse birth outcomes in relation to IPV.

Settings and Design

Prospective observational study was conducted from April 2015 to May 2018 in the antenatal clinic of a Tertiary Care Hospital in Delhi.

Subjects and Methods

Sample of 1500 pregnant women (≤20 weeks gestation) were recruited and followed up at regular intervals, up to the birth outcome.

Statistical Analysis Used

Data were analyzed using the Statistical Package for the Social Sciences version 25. Value of P < 0.05 was considered statistically significant.

Results

Prevalence of IPV at baseline was 29.7%. Significantly higher proportion of IPV victims (47.2%) had poor weight gain during the pregnancy. Subjects reporting violence at any of the study contacts had a higher incidence of preterm delivery (12.7%), and a significantly higher incidence of low birth weight in the newborns (32.1% vs 22.3%) (P < 0.05).

Conclusions

The findings reveal that IPV during pregnancy is common and significantly associated with adverse maternal and birth outcomes. The findings stress need for research and development of a screening tool to identify violence early in pregnancy and thus prevent its consequences.

Associations between intimate partner violence and pregnancy complications: A cross-sectional study in India

BACKGROUND

The high prevalence rates of violence of the intimate partner affects the maternal health of the woman that sometimes ends in maternal mortality as well as the possibility of an adverse effect on the newborn. The purpose of this study was to assess the prevalence and determinants of intimate physical and sexual intimate partner violence (IPV) on mothers and examine the association between IPV and pregnancy complications.

MATERIALS AND METHODS

Data for the present study were retrieved from the National Family Health Survey-IV (2015-2016). In total, 79,729 women completed the domestic violence questions, but 24,882 were considered for this analysis. The study was restricted to currently married women aged 15-49 who had given birth to at least one child in the 5 years preceding the survey. The association between self-reporting pregnancy complications with the experience of IPV was examined using Chi-square test, followed by multivariate logistic regression.

RESULTS

The study findings show that IPV, specifically physical and sexual violence, are associated with pregnancy complications. The results show that 31.6% of the women had experienced some form of IPV. The factors associated with IPV included husband's alcohol habit, women who had witnessed parental violence, and women whose husbands had shown high marital controlling behavior. The high level of pregnancy complications was reported by women who had experienced sexual violence, emotional violence, and women whose husbands display three or more specific behaviors.

CONCLUSION

Confidential screening for IPV and prompt referral to support services could be crucial in improving women's reproductive health.

Barriers to women's disclosure of domestic violence in health services in Palestine: qualitative interview-based study

Background

Domestic violence (DV) damages health and requires a global public health response and engagement of clinical services. Recent surveys show that 27% of married Palestinian women experienced some form of violence from their husbands over a 12 months' period, but only 5% had sought formal help, and rarely from health services. Across the globe, barriers to disclosure of DV have been recorded, including self-blame, fear of the consequences and lack of knowledge of services. This is the first qualitative study to address barriers to disclosure within health services for Palestinian women.

Methods

In-depth interviews were carried out with 20 women who had experienced DV. They were recruited from a non-governmental organisation offering social and legal support. Interviews were recorded, transcribed and translated into English and the data were analysed thematically.

Results

Women encountered barriers at individual, health care service and societal levels. Lack of knowledge of available services, concern about the health care primary focus on physical issues, lack of privacy in health consultations, lack of trust in confidentiality, fear of being labelled ‘mentally ill’ and losing access to their children were all highlighted. Women wished for health professionals to take the initiative in enquiring about DV. Wider issues concerned women’s social and economic dependency on their husbands which led to fears about transgressing social and cultural norms by speaking out. Women feared being blamed and ostracised by family members and others, or experiencing an escalation of violence.

Conclusions

Palestinian women’s agency to be proactive in help-seeking for DV is clearly limited. Our findings can inform training of health professionals in Palestine to address these barriers, to increase awareness of the link between DV and many common presentations such as depression, to ask sensitively about DV in private, reassure women about confidentiality, and increase awareness among women of the role that health services can play in DV.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09907-8.

Association between Intimate Partner Violence and Abortion in Nepal: A Pooled Analysis of Nepal Demographic and Health Surveys (2011 and 2016)

Background

Intimate partner violence (IPV) adversely affects female reproductive health in different ways. However, the relationship between IPV and abortion has not been adequately examined in Nepal. This study is aimed at examining the association between IPV and abortion in Nepal.

Methods

Data for this study was derived from the Nepal Demographic Health Surveys (NDHS) of 2011 and 2016. A total of 8641 women aged 15-49 years were selected for the violence module in NDHS 2011 and 2016. The analysis was restricted to 2978 women who reported at least one pregnancy five years preceding each survey. Among them, 839 women who experienced different forms of violence were included in the analysis. Various forms of IPV were taken as exposure variables while abortion as an outcome of interest. The study employed logistic regression analysis to examine the association between IPV and abortion.

Results

Nearly one in three (28.2%) women experienced any forms of IPV. A total of 22.2% women experienced physical violence. Almost one in five (19.5%) women were slapped. More than half (52.8%) of the women with no education experienced IPV. The logistic regression analyses showed a significant association between IPV and abortion. Women with severe physical violence had nearly two-fold higher odds (adjusted Odds Ratio (aOR) = 1.68; 95% CI: 1.06, 2.64) of having abortion. Similarly, women who reported physical violence were more likely to have abortion (aOR = 1.54; 95% CI: 1.09, 2.19) compared to those who did not experience such violence.

Conclusion

Intimate partner violence is associated with abortion in Nepal. It is imperative that effective implementation of IPV-preventive measures through the promotion of appropriate social and policy actions can help reduce abortion in Nepal.

Public health impact of marital violence against women in India

The public health ramifications of marital violence are well documented and include injury, mental health concerns and physical health consequences for women and their offspring. Unfortunately, there remains social tolerance and even acceptance of these abuses against women, and health systems in India have done little to support victims despite their greater health risks. However, there are promising efforts and important advancements in India that could be built on for more effective prevention and support for women. Men and boys should be engaged in gender transformative interventions with male role models to alter men's attitudes of acceptability of and justification for marital violence and consequently their actual abusive behaviours. Given the strong demonstrated connection between men's risky and problem alcohol use and marital violence, alcohol interventions may also be beneficial. We must support women and girls vulnerable to marital violence, a group disproportionately affected by violence in their natal families as well, so they know that violence need not be part of their marriage relationship, and have skills on how to engage and communicate with or even leave their male partners to reduce their risk for violence. Formal services should be expanded for those in immediate danger and particularly for rural areas, where prevalence of marital violence is highest and supports are weakest. Finally, given the pervasiveness of attitudes accepting husbands' marital violence against women, and the fact that these have remained largely unchanged in India for a decade, large scale community and social change efforts are needed.

Do male engagement and couples' communication influence maternal health care-seeking? Findings from a household survey in Mozambique

Background

This study explored effects of couples’ communication and male participation in birth preparedness and complication readiness (BPCR) on delivery in a health facility (“institutional delivery”). A cross-sectional, baseline household survey was conducted in November 2016 prior to an integrated maternal and child health project in Nampula and Sofala Provinces in Mozambique.

Methods

The study used the Knowledge, Practices and Coverage survey tool, a condensed version of the Demographic and Health Survey and other tools. The sample included 1422 women. Multivariable logit regression models tested the association of institutional delivery with couples’ communication and four elements of BPCR both with and without male partners: 1) saving money, 2) arranging transport, 3) choosing a birth companion, and 4) choosing a delivery site; controlling for partners’ attendance in antenatal care and social and demographic determinants (education, wealth, urban/rural location, and province).

Results

The odds that women would deliver in a health facility were 46% greater (adjusted odds ratio (aOR) = 1.46, 95% confidence interval (CI) = 1.02–2.10, p = 0.04) amongst women who discussed family planning with their partners than those who did not. Approximately half of this effect was mediated through BPCR. When a woman arranged transport on her own, there was no significant increase in institutional delivery, but with partner involvement, there was a larger, significant association (aOR = 4.31, 2.64–7.02). Similarly, when a woman chose a delivery site on her own, there was no significant association with institutional delivery (aOR 1.52,0.81–2.83), but with her partner, there was a larger and significant association (aOR 1.98, 1.16–3.36). Neither saving money nor choosing a birth companion showed a significant association with institutional delivery—with or without partner involvement. The odds of delivering in a facility were 28% less amongst poor women whose partners did not participate in BPCR than wealthy women, but when partners helped choose a place of delivery and arrange transport, this gap was nearly eliminated.

Conclusions

Our findings add to growing global evidence that men play an important role in improving maternal and newborn health, particularly through BPCR, and that couples’ communication is a key approach for promoting high-impact health behaviors.

Protocol for a matched-pair cluster control trial of ARCHES (Addressing Reproductive Coercion in Health Settings) among women and girls seeking contraceptive services from community-based clinics in Nairobi, Kenya

BACKGROUND

Reproductive coercion (RC) and intimate partner violence (IPV) are prevalent forms of gender-based violence (GBV) associated with reduced female control over contraceptive use and subsequent unintended pregnancy. Although the World Health Organization has recommended the identification and support of GBV survivors within health services, few clinic-based models have been shown to reduce IPV or RC, particularly in low or middle-income countries (LMICs). To date, clinic-based GBV interventions have not been shown to reduce RC or unintended pregnancy in LMIC settings.

INTERVENTION

ARCHES (Addressing Reproductive Coercion in Health Settings) is a single-session, clinic-based model delivered within routine contraceptive counseling that has been demonstrated to reduce RC in the United States. ARCHES was adapted to the Kenyan context via a participatory process to reduce GBV and unintended pregnancy among women and girls seeking contraceptive services in this setting. Core elements of ARCHES include enhanced contraceptive counseling that addresses RC, opportunity for patient disclosure of RC and IPV (and subsequent warm referral to local services), and provision of a palm-sized educational booklet.

METHODS

A matched-pair cluster control trial is being conducted to assess whether the ARCHES intervention (treatment condition), as compared to standard-of-care contraceptive counseling (control condition), reduces RC and IPV, and improves contraceptive outcomes for woman and girls of reproductive age (15 to 49 years) seeking contraceptive services from community-based clinics in Nairobi, Kenya. All six clinics were assigned to intervention-control pairs based on similarities in patient volume and demographics, physical structure and neighborhood context. Survey data will be collected from patients immediately prior to their clinic visit (baseline, T1), immediately after their clinic visit (exit), and at 3- and 6-months post-visit (T2 and T3, respectively).

DISCUSSION

This study is the first to assess the efficacy of an adaptation of the ARCHES model to reduce GBV and improve reproductive health outside of the U.S., and one of only a small number of controlled trials to assess reductions in GBV associated with a clinic-based program in an LMIC context. Evidence from this trial will inform health system efforts to reduce GBV, and to enhance female contraceptive control and reproductive health in Kenya and globally.

TRIAL REGISTRATION

Registered May 23, 2018 - ClinicalTrials.gov, NCT03534401. Unique Protocol ID: 170084.

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

BACKGROUND

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

METHODS AND FINDINGS

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

CONCLUSIONS

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

An Intergenerational Approach to Break the Cycle of Malnutrition

PURPOSE OF REVIEW

This article examines how nutritional status is treated throughout the lifecycle. In doing so, the review identifies promising life stages during which intervention may improve nutritional status of future generations.

RECENT FINDINGS

A life course perspective suggests that nutritional changes are most likely to be sustained when they occur during times of developmental transition, such as pregnancy or adolescence. Adolescence is a unique period in which malnutrition in future generations may be addressed because it is the first life stage at which pregnancy becomes feasible and individuals seek independence from parents. A need exists to begin investigating not just how nutrition changes are sustained throughout the lifespan, but how nutritional intervention in one generation impacts the next. This intergenerational approach should be undertaken with cross-discipline collaboration to have the best chance at impacting underlying determinants of malnutrition like poverty and women's education.

Intimate Partner Violence in India: Abuse in India's Empowered Action Group States

Married women in India experience intimate partner violence (IPV) at alarming rates. This study explores regional differences in Indian women's physical IPV experiences by looking at the effect of living in eight Empowered Action Group (EAG) states. It is hypothesized that women in EAG states will be more likely to have experienced physical IPV than women living outside EAG states. A sample of 65,587 women was selected from the 2005-2006 India National Family Health Survey (NFHS-3). Counter to our hypothesis, logistic regression results show that living in an EAG state decreases likelihood of physical IPV in the past 12 months.

The associations between intimate partner violence and maternal health care service utilization: a systematic review and meta-analysis

Background

Intimate partner violence exposes women to a wide range of health problems that can either directly or indirectly lead to maternal death. Although in a number of studies intimate partner violence has been associated with inadequate utilization of antenatal care and skilled delivery care, in other studies no association has been found. Therefore, we aimed to comprehensively review the evidence, and quantify the strength and direction of the association between intimate partner violence and utilizing adequate antenatal and skilled delivery care services.

Method

We systematically searched studies from MEDLINE, Embase, Psych INFO, CINAHL, and Maternity and Infant Care. Two independent reviewers screened the articles for eligibility. Quality and risk of bias in the articles were evaluated by using the Newcastle-Ottawa scale for observational studies. Pooled odds ratios and 95% confidence intervals were computed to estimate the association of intimate partner violence and antenatal care, and skilled delivery care. Random-effects models were used to allow for the significant heterogeneity that might possibly be found between studies. The degree of heterogeneity was expressed by using the I² statistic.

Results

The meta-analyses have shown that women who experienced intimate partner violence had 25% decreased odds (AOR = 0.75, 95%CI = 0.61, 0.92) of using adequate antenatal care than those who did not experience IPV. Similarly, women who experienced IPV had 20% decreased odds (AOR = 0.8, 95%CI = 0.69, 0.92) of using skilled delivery care compared to those who did not experience IPV.

Conclusion

The meta-analyses indicated that experiencing intimate partner violence is associated with a lower likelihood of receiving adequate antenatal care and skilled delivery care. Both community-based and facility-based interventions that target the reduction of partner violence, and strictly implementing proven health facility-based counselling interventions, could aid in improving utilization of maternal health care services.

Electronic supplementary material

The online version of this article (10.1186/s12905-019-0735-0) contains supplementary material, which is available to authorized users.

Association of intimate partner violence during pregnancy, prenatal depression, and adverse birth outcomes in Wuhan, China

Background

Intimate partner violence (IPV) among pregnant women constitutes a global public health problem and a potential risk factor for adverse maternal and fetal outcomes. The present study aimed to examine the associations among IPV during pregnancy, prenatal depression, and adverse birth outcomes in Wuhan, China.

Methods

A cross-sectional study was performed from April 2013 to March 2014 in Wuhan, China. Sociodemographic characteristics, IPV during pregnancy, and depressive symptoms during pregnancy were assessed in the third trimester of pregnancy. Birth outcomes were collected after delivery using medical records. Chi-square tests and logistic regression analysis were used to examine the association between IPV and prenatal depression, as well as the association between IPV combined with prenatal depression and adverse birth outcomes.

Results

After adjustment for covariates, there was a statistically significant association between IPV during pregnancy and prenatal depression (adjusted odds ratio [aOR] = 2.50, 95% confidence interval [CI]: 1.60–3.90). IPV during pregnancy (aOR = 1.67, 95% CI: 1.08–2.56) and prenatal depression (aOR = 1.72, 95% CI: 1.11–2.68) were significantly associated with adverse birth outcomes. Women experiencing psychological abuse had a significantly higher odds of prenatal depression (aOR = 2.04, 95% CI: 1.19–3.49) and of adverse birth outcomes (aOR = 2.13, 95% CI: 1.08–2.58), compared with women who did not experience IPV and prenatal depression.

Conclusions

IPV during pregnancy and prenatal depression were significantly associated with adverse birth outcomes, after adjustment for socio-demographic and behavior factors. The findings suggest that early recognition of IPV and prenatal depression during antenatal care may protect pregnant women and improve birth outcomes.