Sociodemographic characteristics of pregnant women exposed to domestic violence during pregnancy in an Iranian setting

Comparison of maternal-fetal attachment, anxiety, depression, and prevalence of intimate partner violence in Iranian women with intended and unintended pregnancy: a cross-sectional study

BACKGROUND

Unintended pregnancies and intimate partner violence can adversely affect women, infants, and their psychological well-being. The study aimed to compare depression, anxiety, maternal-fetal attachment, and the prevalence of intimate partner violence between women with and without unintended pregnancies in Tabriz, Iran. The study sought to address the lack of research on this topic in the Iranian context.

METHODS

This cross-sectional study was conducted on 486 pregnant women attending health centers in Tabriz City between 2022 and 2023. A cluster sampling method was utilized, and data were gathered through the administration of socio-demographic, Maternal Fetal Attachment, Edinburgh Postnatal Depression, World Health Organization Domestic Violence, and Pregnancy Anxiety instruments. A general linear model (GLM), controlling for potential confounding variables, was used to compare anxiety, depression, and maternal-fetal attachment between the two groups. Multivariable logistic regression analysis, also controlling for potential confounding variables, was employed to compare the prevalence of domestic violence between the two groups.

RESULTS

The results of the adjusted GLM indicated that women with unintended pregnancies had significantly lower maternal-fetal attachment (Adjusted mean difference (AMD):-9.82, 95% CI:-12.4 to -7.15 ; p < 0.001)), higher levels of depression (AMD: 2.89; CI: 1.92 to 3.86 ; p < 0.001), and higher levels of anxiety (MD: 5.65; 95% CI: 3.84 to 7.45; p < 0.001) compared to women with intended pregnancies. During pregnancy, 40% of women with unintended pregnancies and 19.2% of women with intended pregnancies reported experiencing at least one form of physical, sexual, or emotional violence. The results of the adjusted multivariable logistic regression revealed that women with unintended pregnancies had a significantly higher odds of experiencing emotional violence (adjusted odds ratio [aOR]: 2.94; 95% CI: 1.64 to 5.26; p < 0.001), sexual violence, (aOR: 2.25; 95% CI: 1.32 to 3.85; p = 0.004), and physical violence (aOR: 2.38; 95% CI: 1.50 to 3.77; p < 0.001) compared to women with intended pregnancies.

CONCLUSIONS

The study found that women with unintended pregnancies had lower levels of maternal-fetal attachment, higher levels of anxiety and depression, and a high prevalence of intimate partner violence, including physical, sexual, and emotional violence, compared to women with intended pregnancies. These results emphasize the importance of implementing policies aimed at reducing unintended pregnancies.

Aftermath of COVID-19: Exploring the Perception of Violence Against Women in the Middle East and North Africa

This article explores the perception of violence against women (VAW) in the Middle East and North Africa in the aftermath of the COVID-19 pandemic using Arab Barometer VI parts 1 and 3 (N = 12,548). Results showed that men and social conservatism were less likely to perceive that the VAW in the community had increased. For religious people, the odds of perceiving violence in the community were higher. Individuals whose jobs were interrupted because of the COVID-19 outbreak were more likely to perceive VAW in the community has increased compared to individuals whose jobs were not interrupted. The strongest predictor of the perception of increased VAW in the community because of COVID-19 was the current economic situation of the country. Those who perceived the economic situation of the country as bad were 1.6 times more likely to believe that VAW has increased. Government handling of the crisis and overall government performance increased the odds of perceiving that VAW has increased. Investigating correlates of VAW as the consequence of the COVID-19 pandemic is crucial because it helps governments, emergency services, and community leaders develop strategies of prevention for future disasters and improve community and institutional reactions.

The prevalence of intimate partner violence among Iranian pregnant women: a systematic review and meta-analysis

BACKGROUND

Intimate partner violence against pregnant women is an important public health concern and human rights issue. According to the various findings of previous studies, this study was conducted to assess the pooled prevalence of intimate partner violence against Iranian women.

METHODS

In this systematic review and meta-analysis, a literature search was conducted in databases such as PubMed, Scopus, Web of Science, MagIran, and Scientific Information Database without a time limit. Heterogeneity was assessed by Cochrane Q test statistics and the I2 test, and the results were incorporated into a random effects model to estimate the prevalence of intimate partner violence. Data analysis was performed using R software version 4.3.2.

RESULTS

The overall prevalence of intimate partner violence was reported to be 51.5% (95% confidence interval (CI) 45.0-58.1), and the prevalence rate of physical, sexual, and psychological intimate partner violence was 18.0% (95% CI 15.1-20.9), 22.1% (95% CI 17.7-26.60) and 43.2% (95% CI 36.6-49.8), respectively. The lowest level of physical, sexual, and emotional intimate partner violence rate was observed in district 1 of Iran (includes Tehran, the capital of Iran and the surrounding provinces). The rate of physical and sexual intimate partner violence prevalence decreased with the increased mean age of the husband (P=0.005) and the mean age of the wife (P=0.035), respectively.

CONCLUSIONS

Studies included in this review report that more than half of Iranian women experience violence during pregnancy. In order to prevent adverse maternal and neonatal consequences, it is necessary to identify these women and introduce them to support centres.

Relationship Between the Psychological Distress and Spiritual Well-Being in Pregnant Women Exposed to Domestic Violence: A Cross-Sectional Study in Iran

Maternal psychological distress is often associated with domestic violence. Spiritual well-being can affect the psychological capacity to deal with distress. This study aimed to investigate the relationship between psychological distress and spiritual well-being in pregnant women exposed to domestic violence. This cross-sectional study was conducted on 305 pregnant women subjected to domestic violence in southern Iran. The participants were selected using the census method. Data were collected using the Spiritual Well-being Scale (SWB), the Kessler Psychological Distress Scale (K10), and the Hurt, Insult, Threaten, Scream (HITS) screening tool (short form) and were analyzed with descriptive and inferential statistics (t-test, ANOVA, the Spearman correlation coefficient, and multiple linear regression) in SPSS software version 24. The mean scores ± standard deviation of the participants' psychological distress, spiritual well-being, and domestic violence were 24.68 ± 6.43, 79.89 ± 18.98, and 11.24 ± 1.5, respectively. The results showed that psychological distress had a significant negative correlation with spiritual well-being (ρ = - 0.84, P < 0.001) and domestic violence (ρ = - 0.73, P < 0.001). The results of the multiple linear regression analysis also showed that spiritual well-being and domestic violence could predict the psychological distress of pregnant women who were exposed to domestic violence, which explained 73% of the psychological distress in the participants. According to the study results, spiritually oriented education can be provided for women to reduce their psychological distress. Also, it is recommended that necessary interventions be used to reduce domestic violence and empower women to prevent it.

Intimate partner violence during pregnancy among married women in Putalibajar municipality, Nepal

Introduction

Intimate partner violence during pregnancy (IPVDP) is increasingly being recognized as a significant problem in the developing world due to its adverse health consequences on both pregnant women and children. The objective of the study is to measure the magnitude of intimate partner violence during pregnancy and the factors associated with IPVDP.

Methods

A community-based cross-sectional study was conducted among 263 married women in their extended postpartum period between October 2019 and March 2020 in Putalibajar municipality, Nepal. A face-to-face interview was conducted and data were collected using an interview schedule. A Chi-square test and logistic regression analysis were performed to examine the association between IPVDP and the independent variables.

Results

Among the 263 women interviewed, 30% experienced IPV during pregnancy, the most common type of violence was controlling behavior (20.2%) followed by emotional (18.6%), sexual (10.6%), economic (6.1%), and physical violence (5.3%). It was observed that IPV was more likely to occur among women whose husbands consumed alcohol (AOR = 3.171; CI 95%: 1.588-9.167), women whose husbands consumed tobacco (AOR =3.815; CI 95%: 2.157-7.265), women who sometimes received family support during pregnancy (AOR =2.948; CI 95%: 1.115-7.793) and women who did not decide on marriage timing (AOR =2.777; CI 95%: 1.331-5.792).

Conclusion

Three out of ten pregnant women experienced IPVDP. To prevent violence, and ensure women's empowerment, formulating strict laws and discouraging the element of a violent milieu is important.

Domestic Violence Against Women in North African and Middle Eastern Countries: A Scoping Review

This scoping review aimed to identify the scope of the current literature on the prevalence, consequences, and risk factors of domestic violence (DV) against women by their husbands or male partners in North African and Middle Eastern countries. The methodology for this scoping review was based on the framework outlined by Arksey and O'Malley. Studies published on DV against women over the age of 15 by partner or husband and published in peer-reviewed scientific journals between January 1970 and April 2018 were included in the review. The databases MEDLINE, PsychINFO, CINAHL, HealthSTAR, EMBASE, Scopus, African Journals Online, Turkish Journal Database, and gray literature sources were searched. On completion of the review process, 151 full-text articles were identified for charting. This review demonstrated that women's age, women's education level, duration of marriage, history of childhood abuse/witnessing family violence, living in the rural region, and family income level were negatively associated with DV, indicating that younger women, women with lower education, a longer marriage duration, and a lower income level had a higher risk of exposure to DV in this region. Anxiety, depression/insomnia, and physical injury were the most common health problems reported by victims in the region. The highest proportion of women with no response to violence was reported in Jordan, Saudi Arabia, and Turkey. The findings of this scoping review represent the first attempt to summarize the literature from North African and Middle Eastern countries and demonstrate the similarity in DV-related behaviors among women despite the cultural and regional diversity of the studies.

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

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

The correlation between sexual dysfunction and intimate partner violence in young women during pregnancy

Background

Sexual function is one of the main aspects of life. Pregnancy affects sexual function. The aim of this study was to determine the sexual dysfunction in young pregnant women and its correlation with intimate partner violence (IPV).

Methods

This cross-sectional study was conducted using two-stage cluster sampling method. The data were collected using a socio-demographic questionnaire, Female Sexual Function Index (FSFI), and Conflict Tactics Scale (CTS2). Multivariate logistic regression was used to determine the relationships between sexual dysfunction with IPV and socio-demographic factors.

Results

The results of this study on 346 pregnant women aged 18–29 years showed that mean (SD = standard deviation) of the total sexual function score was 25.4 (5.9), within a possible score range of 2 to 36. About 66% of the young pregnant women had a sexual dysfunction. The lowest and the highest prevalence of sexual dysfunction were in sub domains of sexual satisfaction and sexual desire, respectively. The prevalence of overall IPV against young women was 63%. The most common type of IPV experienced by women was psychological aggression (56.6%). There were statistically significant relationships between sexual dysfunction and IPV (OR (Odds Ratio) = 0.4, 95% Confidence Interval = 0.2 to 0.6, p <  0.001), sufficiency of income for expenses (0.2, 0.1 to 0.6, p = 0.005), husband educational level (0.5, 0.3 to 0.9, p = 0.028) and marriage duration (1.9, 1.0 to 3.7, p = 0.044).

Conclusions

Sexual dysfunction has a high prevalence in young pregnant women and IPV had correlation with sexual dysfunction. The routine screening for sexual dysfunction and IPV is recommended during pregnancy for detection and consulting.

Intimate partner abuse among couples during pregnancy and its predictors as reported by pregnant women visiting governmental health care centres in Tabriz, Iran

Little is known about intimate partner abuse (IPA) among couples during pregnancy in Iran. This study aimed to compare the rates of IPA by pregnant women towards their husbands (perpetration), and women's experience of IPA from their husbands (victimization) and determine the predictors of the two behaviours. The cross-sectional study was conducted on 525 pregnant women at 24-30 weeks of gestation visiting governmental health care centres/posts in Tabriz, Iran, in 2014. The study sample was selected using random cluster sampling. The Revised Conflict Tactics Scale (CTS2) was used to assess IPA perpetration and victimization. The McNemar test was employed to compare the prevalences of IPA perpetration and victimization, and adjusted logistic regression was utilized to determine the socio-demographic predictors of overall IPA perpetration and victimization. The overall rates of women's reported abuse of their husbands (perpetration) and women's experience of abuse from their husbands (victimization) were 70% and 67%, respectively, but the difference was not statistically significant (p=0.086). The prevalence of psychological aggression perpetrated by women towards their husbands was significantly higher than that experienced by the women from their husbands (65% vs 58%, p<0.001). The prevalences of sexual coercion (15% vs 30%) and injury (8% vs 16%) perpetrated by women on their husbands were significantly lower those they experienced by the women from their husbands (p<0.001). There was no statistically significant difference between the prevalence of perpetration of physical violence towards husbands by women (19%) and that experienced by women from their husbands (22%) (p=0.072). Women's and husbands' satisfaction with their own occupations were predictors of both perpetration and victimization of IPA. The observed high rates of IPA perpetration by, women and victimization of, women during pregnancy, and the significantly higher rate of violence towards women compared with that perpetrated by women, especially for sexual coercion and injury, require health policymakers and care providers to make serious efforts to identify such violence, and take appropriate measures to reduce it, during pregnancy in women in Iran.

Relationship between Demographic Factors and Violence during Pregnancy in Iran: A Meta-Analysis Study

Objective: Domestic violence is the most common form of violence against women and a major health problem worldwide. The aim of this study was to examine the relationship between demographic factors and domestic violence during pregnancy through meta-analysis. Method : This meta-analysis study was conducted in Iran. All the articles published during 2001 up to Jun 2018 were extracted independently by 2 trained investigators from domestic and foreign databases including, Science Medlib, SID, Web of Science, PubMed, Science Direct, Irandoc, Medline, Scopus, Magiran, and Google Scholar with keywords and their compounds. The results of studies pooled using the random effects model Cochran and I2 tests were used to check heterogeneity. Data were analyzed using Stata Ver. 11.2. Results: A total of 28 articles with the sample size of 15 020 people were included in the study. The findings of the meta-analysis showed that low level of maternal education (OR:1.68) (CI 95%:1.15, 2.46), low education level of the spouse (OR:1.73) (CI 95%:1.31, 2.29), unemployment of the husband (OR:1.61) (CI 95%: 1.05, 2.48), and smoking of the husband (OR:2.51) (CI 95%: 1.64, 3.84) were important factors in the increase in domestic violence during pregnancy. Having 3 children or fewer (OR: 0.30) (CI 95%: 0.16, 0.56) and enough and regular visits to physicians to receive adequate prenatal care (OR: 0.31) (CI 95%: 0.16, 0.57) were deterrent for violence during pregnancy. Conclusion: Based on our findings, level of education, unemployment, prenatal care, smoking, and number of children are associated with violence during pregnancy. Thus, paying attention to these factors and controlling them can reduce violence during pregnancy and its adverse consequences.

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

Background:

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

Methods:

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

Results:

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

Conclusions:

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

Related factors of violence against women with infertility: A systematic review study based on an ecological approach

Background and aim

Infertility as a global problem, affects the different aspects of women’s health. Also, violence against infertile women affects their psychological wellbeing and treatment consequence. This study aimed at reviewing related factors to violence against infertile women, based on an ecological approach.

Methods

In this systematic review, the researchers conducted their search in electronic databases such as Google Scholar, and then in more specialized ones such as Medline via PubMed, Science Direct, Up-to-date, Springer, SID, Magiran, Iranmedex and Irandoc with the key words violence, infertility, women, risk factors, social environment, and individuality, from 1988 to 2016. The selection of papers was undertaken from 20–27 January 2017. The articles were selected based on the following criteria: 1), the articles focused on the research question 2), infertility and violence were included in the title of the articles, and 3) articles were published in online journals. Exclusion criteria were articles which focused on violence against the general population, pregnant women and female sex workers and articles that were not available in full text form or written in other languages (Not Persian or English). The quality of selected studies was appraised using a 16-item checklist adapted from Tao. This checklist consisted of 16 items which used a 0 or 1 scoring system (not eligible or eligible). If an article received a score of 75% (12–16 points), it was of high quality. A score of 50% to 74% (8–12 points) indicated moderate quality, and less than 50% (8 points) indicated low quality. The process of titles, abstracts and full-texts’ appraisal led to the selection of 16 articles, which were used to write this article

Results

Two of the articles based on 16-items of the check list had high quality score, 8 of them had moderate and the remaining articles had low quality score. Our findings were classified under three categories corresponding with the ecological approach: (1) Microsystem level “individual sociodemographic and infertility characteristics”, (2) Mesosystem level “interpersonal’ and husband sociodemographic characteristics” and (3) Macro system level considered ethnicity and cultural factors.

Conclusion

Violence against infertile women and the stress caused by it, would affect the consequences of infertility treatment. It is noted that various cultural-contextual factors cause violence in different societies. There is a need for the development of screening tools and applying counselors to identify infertile women at the risk of violence, and provide clinical services, counseling and social support.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Quality of life in women who were exposed to domestic violence during pregnancy

BACKGROUND

Quality of life in pregnant women is an important issue both for women's and fetus' health. This study aimed to examine quality of life in a group of women who were exposed to domestic violence during pregnancy.

METHODS

This was a cross sectional study of quality of life among a consecutive sample of pregnant women attending to a teaching hospital in Lorestan, Iran. Women were screened for experiencing violence using the Abuse Assessment Screen (AAS) questionnaire and were categorized as psychological abused, physical abused and non-abused groups. Quality of life was assessed using the Short-Form 36 Health Survey (SF-36). One-way analysis of variance and t-test were used to examine differences in quality of life in the study sub-samples. In addition logistic regression analyses were performed to investigate the association between general health and mental health and independent variables including age, education, parity and type of violence.

RESULTS

In all 266 pregnant women were approached, of which 230 (86.5%) agreed to participate in the study. Of these, 149 women (64.8%) reported that they had experienced either physical or psychological violence during pregnancy. A significant difference between abused and non-abused groups was identified, with the abused group recording lower mean scores on all sub-scales with the exception of the bodily pain (p = 0.27). In addition comparing quality of life between physical and psychological abused groups, women who reported physical violence recorded lower mean scores for physical functioning, role physical, bodily pain and general health, while women reporting psychological abuse had lower mean scores on social functioning, role emotional, vitality and mental health. Comparison between the physically and psychologically abused groups indicated significant differences only for role physical (p = 0.04), bodily pain (p = 0.003) and general health (p = 0.04). After adjusting for age, parity, and education, physical abuse was associated with poor physical health (OR = 2.13, 95% CI = 1.05-4.36, p = 0.03), while emotional abuse was significantly associated with poor mental health (OR = 1.89, 95% CI = 1.09-3.84, p = 0.04).

CONCLUSION

Domestic violence against women during pregnancy in Iran was evident and this had significant adverse association with their quality of life. Indeed health care professionals involved in the care of women need to be aware of the extent of the problem and consider how it may be impacting on the women in their care.

Gender-based Violence Among Pregnant Women of Syangja District, Nepal

Objectives

This study aims to determine prevalence of gender-based violence among pregnant women attending an antenatal care (ANC) clinic.

Methods

Between September 2014 and December 2014, a cross-sectional study was conducted among 202 pregnant women attending the antenatal ward of the Primary Healthcare Centre (PHC) of Syangja district, Nepal. The data were collected using semistructure questionnaires with face-to-face interviews. SPSS software (IBM Corp, Armonk, NY, USA) was used for analysis the data.

Results

The prevalence rate of gender-based violence was found to be 91.1% (184). Most of the respondents (87%) faced economic violence followed by psychological (53.8%), sexual (41.8%), and physical (4.3%) violence. Women experienced: (1) psychological violence with most complaining of angry looks followed by jealousy or anger while talking with other men, insults using abusive language and neglect; (2) economic violence with most complaining of financial hardship, denial of basic needs and an insistence on knowing where respondents were and restricting them to parents' home or friends/relatives' houses (jealousy); (3) physical violence by slapping, pushing, shaking, or throwing something at her, twisting arm or pulling hair, and punching and kicking; and (4) sexual violence by physically forcing her to have sexual intercourse without consent, and hurting or causing injury to private parts. Most (100%) of the perpetrators were found to be husbands and mothers-in-law (10.7%) who violated them rarely.

Conclusion

The prevalence of gender-based violence (GBV) among pregnant women attending the ANC clinic was greater in the Syangja district of Nepal. Women's empowerment, economic autonomy, sensitization, informal or formal training regarding GBV for men and women, and the need for large-scale population-based surveys are the major recommendations of this study.