Physical violence by an intimate partner and the inappropriate use of prenatal care services among women in Northeastern Brazil

Women's exposure to intimate partner violence and its association with child stunting: findings from a population-based study in rural Rwanda

BACKGROUND

Child stunting is a significant challenge for most districts in Rwanda and much of sub-Saharan Africa and persists despite multisectoral efforts. There is a notable lack of population-based studies examining the correlation between violence against women and child stunting in Rwanda.

OBJECTIVE

We aimed to investigate the association between Rwandan women's exposure to intimate partner violence (IPV) and child stunting in children under 3 years of age.

METHODS

In December 2021, a population-based cross-sectional study was conducted in the Northern Province of Rwanda, including 601 women and their children <3 years of age. The World Health Organization (WHO) Women's Health and Life Experiences Questionnaire for IPV research was utilized. Child stunting was assessed using the WHO criteria for low height for age. Multivariable logistic regression was used to examine the association between IPV and child stunting before and during pregnancy.

RESULTS

Of 601 women, 47.4% (n = 285) experienced any form of IPV during pregnancy. The prevalence rates of the types of IPV associated with child stunting varied: 33% for psychological, 31.4% for sexual, and 25.7% for physical violence. Exposure to physical violence before pregnancy and sexual violence during pregnancy was associated with higher odds of child stunting; the adjusted odds ratios were 1.29 (95% CI, 1.01-2.03) and 1.25 (95% CI, 1.04-2.01), respectively.

CONCLUSION

Women's exposure to physical and psychological violence is associated with an increased risk of child stunting. Urgent targeted interventions and support systems are needed to address the complex relationship between women's exposure to IPV and adverse effects on child growth.

Health-Related Maternal Decision-Making Among Perinatal Women in the Context of Intimate Partner Violence: A Scoping Review

Globally, it is estimated that 245 million women and girls aged 15 and over have experienced intimate partner violence (IPV) in the past 12 months. Moreover, research has highlighted the disproportionately high prevalence of IPV victimization among pregnant women. IPV can have serious health implications for women and their infants, yet little is known about maternal health-related decision-making by mothers exposed to IPV. To this end, the purpose of this scoping review was to examine what is known regarding health-related maternal decision-making among perinatal women in the context of IPV. Using Arksey and O'Malley's framework, five electronic databases were searched, resulting in 630 articles. Eligible articles were primary studies written in English, included participants who experienced IPV at any time in their life, and reported results focused on maternal health-related decision-making in the context of IPV. Thirty-six articles were screened by the review team, resulting in seven included articles. Three main themes emerged regarding health-related maternal decision-making by mothers experiencing IPV, including suboptimal breastfeeding practices, under-utilization of maternal and child health services, and poor adherence to medical recommendations/regimens that impact health-related outcomes for mother and child. The well-established risk of poorer health outcomes among women experiencing IPV, alongside the findings of this scoping review, calls for further research specifically addressing health-related decision-making among perinatal women who experience IPV.

Caring for Mothers: A Narrative Review on Interpersonal Violence and Peripartum Mental Health

Interpersonal violence in the perinatal period is frequent and should be considered a prominent health issue due to the risk of escalation of violence and the significant impact on mothers' parenting after childbirth. Domestic violence during pregnancy can be associated with fatal and non-fatal adverse health outcomes due to the direct trauma to a pregnant woman's body and to the effect of stress on fetal growth and development. Emotional violence is a risk factor for prenatal and/or postpartum depression. Recent studies focusing on abusive situations during peripartum and possible preventive strategies were identified in PubMed/Medline, Scopus, Embase, and ScienceDirect. All of the available literature was retrospectively reviewed with a special attention to peer-reviewed publications from the last ten years. Results of the present narrative review suggest that perinatal health care professionals (general practitioners, gynecologists, obstetricians, psychologists, psychiatrists) should promptly detect interpersonal violence during and after pregnancy and provide health care for pregnant women. It seems pivotal to guarantee psychological care for abused women before, during, and after pregnancy in order to prevent the risk of depressive symptoms, other mental or physical sequelae, and mother-to-infant bonding failure. There is an urgent need for multifaceted interventions: programs should focus on several risk factors and should design tailored care pathways fitted to the specific needs of women and finalized to support them across the lifespan.

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

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

Prevenção de Maus-tratos Infantis: Prática em Grupo com Gestantes em Unidade de Saúde

Resumo Considerando a complexidade do cenário brasileiro de violência, especialmente aquela sofrida por mulheres e crianças, este artigo objetiva debater possibilidades de ações que poderiam ir na contramão da violência, por meio de espaços de diálogo em grupo. No trabalho, descreve-se uma intervenção realizada com mães gestantes, a respeito das etapas do desenvolvimento infantil e de possíveis medidas de prevenção de maus-tratos infantis. A intervenção foi composta por dois blocos temáticos: a) Desenvolvimento Infantil; e b) Práticas Parentais Adequadas. Foram realizados encontros semanais com duração de duas horas cada, de modo que cada tema foi contemplado em dois encontros, acrescidos de dois dias para aplicação dos instrumentos. A fim de visualizar possíveis influências dos encontros nos conhecimentos das mães, foram utilizados dois instrumentos, em medidas de pré e pós-teste e follow-up, cujos resultados foram comparados aos de mães que não passaram pela intervenção. Foram usados questionários de avaliação dos encontros e Notas de Campo. Participaram oito mães gestantes selecionadas em uma Unidade de Saúde da Família, que foram separadas em dois grupos. As conversas suscitaram assuntos sobre situações de violência e possibilidade de transformação no cuidado com a criança. Embora não se trate de instrumentos sensíveis à realidade brasileira, percebe-se que o Grupo 1 teve melhor desempenho que o Grupo 2 e que essas médias permanecem baixas no follow-up. Reitera-se a relevância de aproximar mães de práticas que promovam cuidados adequados a um desenvolvimento infantil seguro.

Prevalence and factors associated with intimate partner violence during pregnancy in Caxias, state of Maranhão, Brazil, 2019-2020

OBJECTIVE

To analyze prevalence and factors associated with intimate partner violence during pregnancy.

METHODS

This was a cross-sectional study, with data obtained through interviews conducted with pregnant women aged 10 to 49 years during the third trimester of pregnancy, living in Caxias, state of Maranhão, Brazil (2019-2020). The instrument of the World Health Organization Violence Against Women Study was used to identify violence. A hierarchical analysis was performed using multiple logistic regression.

RESULTS

233 pregnant women were interviewed. The prevalence of violence during pregnancy was 33.0%, with predominance of psychological violence (18.9%). In the final hierarchical model, women aged <20 years old (ORadj=2.09 - 95%CI 1.17;3.54) and illicit drug use by intimate partner (ORadj=8.78 - 95%CI 2.13;28.92) remained as factors associated with the outcome.

CONCLUSION

Prevalence of violence during pregnancy was high, with illegal drug use by young women and their partners being factors associated with its occurrence.

Intimate partner violence during pregnancy: prevalence and associated factors

OBJECTIVE

To identify the prevalence of violence during pregnancy and the association with the socioeconomic, behavioral and clinical characteristics of pregnant women.

METHODS

Cross-sectional study in a low-risk maternity hospital in the municipality of Cariacica, Espírito Santo. A total of 330 puerperal women were interviewed from August to October 2017. Information on socioeconomic, behavioral, reproductive and clinical characteristics, as well as life experiences, was collected through a questionnaire. To identify the types of violence, the proper World Health Organization instrument was used. Gross bivariate and multivariate analysis was performed and adjusted for Poisson regression with robust variance.

RESULTS

Prevalence was 16.1% (95%CI 2.5–20.4) for psychological violence, 7.6% (95%CI 5.1–11.0) for physical violence and 2.7% (95%CI 1.4–5.2) for sexual violence. Psychological violence remained associated with age, family income, beginning of sexual life, disease in pregnancy, desire to interrupt pregnancy and number of partners. Physical violence was associated with schooling, beginning of sexual life and disease in pregnancy. Sexual violence remained associated with marital status and desire to interrupt pregnancy (p < 0.05).

CONCLUSIONS

Psychological violence by an intimate partner was the most prevalent among pregnant women. Women that were younger, had lower income and less schooling, who started their sexual life before the age of 14 and who wished to interrupt pregnancy, experienced violence more frequently during pregnancy.

Exploring the associations between intimate partner violence victimization during pregnancy and delayed entry into prenatal care: Evidence from a population-based study in Bangladesh

OBJECTIVE

Intimate partner violence (IPV) during pregnancy can have serious health consequences for mothers and newborns. The aim of the study is to explore: 1) the influence of experiencing IPV during pregnancy on delayed entry into prenatal care; and 2) whether women's decision-making autonomy and the support for traditional gender roles act to mediate or moderate the relationship between IPV and delayed entry into prenatal care.

DESIGN

cross-sectional survey. Multivariate logistic regression models were estimated that control for various socio-demographic and pregnancy related factors to assess whether women who experienced IPV during pregnancy were more likely to delay entry into prenatal care compared with women who had not experienced IPV. The influence of traditional gender roles acceptance and decision-making autonomy were examined both as independent variables and in interaction with IPV, to assess their role as potential mediators or moderators.

SETTING

Chandpur district, Bangladesh.

PARTICIPANTS

the sample comprised of 426 Bangladeshi women, aged 15-49 years. Postpartum mothers who visited vaccinations centres to receive their children's vaccinations constitute the sampling frame.

RESULTS

almost 70% of the women surveyed reported patterns consistent with delayed entry into prenatal care. Accounting for the influence of other covariates, women who experienced physical IPV during pregnancy were 2.61 times more likely (95% CI [1.33, 5.09]) to have delayed entry into prenatal care than their counterparts who did not report physical IPV. Neither sexual nor psychological IPV victimization during pregnancy was linked with late entry into prenatal care. Both gender role attitudes and levels of autonomy mediate the effect of IPV on prenatal care.

KEY CONCLUSIONS

the results suggest that the high rates of IPV in Bangladesh have effects that can compromise women's health seeking behaviour during pregnancy, putting them and their developing fetus at risk. Specifically, Bangladeshi women who experience physical IPV during pregnancy are more likely to delay or forgo prenatal care, an effect that is further magnified by cultural ideals that emphasize women's traditional roles and limit their autonomy.

IMPLICATIONS FOR PRACTICE

this study reinforces the need to detect and assist women suffering IPV, not only to offer them help and support but also to increase entry into prenatal care. Healthcare professionals involved in obstetrics and midwifery need to be aware of the risk factors of IPV during pregnancy and be able to identify women who are at risk for delayed entry into prenatal care.