Intimate Partner Violence and Gestational Weight Gain in a Population-Based Sample of Perinatal Women

The magnitude of intimate partner violence during pregnancy and associated factors in rural Ethiopia

BACKGROUND

Intimate partner violence (IPV) during pregnancy is a global public health issue associated with adverse maternal and newborn health outcomes. The aim of this study was to assess the magnitude of IPV during pregnancy and associated factors in rural Ethiopia.

METHODS

A cross-sectional survey was conducted among 432 pregnant women in the rural Hadiya Zone, Central Ethiopia, in July 2023, using structured interview questionnaires. Multivariable logistic regression was performed and the results were reported using adjusted ORs (AORs) with 95% CIs.

RESULTS

The overall prevalence of IPV during recent pregnancy was 38.37% (95% CI 33.82 to 43.18%). Among the specific forms of IPV, psychological, physical and sexual violence were 28.84% (95% CI 24.62 to 33.43%), 22.09% (95% CI 18.29 to 26.31%) and 20.70% (95% CI 17.02 to 24.84%), respectively. Key factors significantly associated with IPV during pregnancy included early marriage (before the age of 20 y), being uneducated, lower autonomy among women, husbands' cigarette smoking and alcohol consumption, poor knowledge of IPV among husbands and husbands' involvement in antenatal care (ANC). IPV during pregnancy was notably high in the study setting.

CONCLUSIONS

Empowering women with low literacy, addressing male substance abuse, raising IPV awareness, promoting women's autonomy and encouraging male involvement in ANC visits are critical for reducing IPV.

Examining perinatal health inequities: The role of disability and risk of adverse outcomes through the U.S. Pregnancy Risk Assessment Monitoring System

OBJECTIVE

To examine pre-pregnancy characteristics, pregnancy complications, and birth outcomes among respondents with self-reported disability compared to those without disability.

METHODS

A cross-sectional weighted sample of 2,006,700 respondents with singleton live births who participated in the United States Pregnancy Risk Assessment Monitoring System (PRAMS) between 2018 and 2021 provided data on disability, including difficulty in vision, hearing, ambulation, cognition, communication, and self-care. We estimated covariate-adjusted odds of differences in pre-pregnancy chronic health conditions, pregnancy intention, intimate partner violence (IPV), depression, adequacy of prenatal care, pregnancy-related health conditions, and birth outcomes by disability status.

RESULTS

Of the 2,006,700 respondents included, 59.5% reported no disability, 33.9% had moderate disability, and 6.6% had severe disability. Across most outcomes, there was a graded pattern with those with severe disability having the worst outcomes compared to the other two groups. Respondents with severe disability were more likely to report diabetes and hypertension before becoming pregnant than respondents without disabilities. Those respondents with severe disability or moderate disability had an increased odds of reporting IPV and depression than those with no disability. During pregnancy, respondents with severe disability had an increased odds of gestational diabetes (aOR 1.46, 95% CI 1.18, 1.80) and hypertensive disorders of pregnancy (aOR 1.70, 95% CI 1.43, 2.02) as compared to respondents with no disability. Respondents with moderate disability also had an increased odds of both gestational diabetes (aOR 1.19, 95% CI 1.06, 1.34) and hypertensive disorders of pregnancy (aOR 1.29, 95% CI 1.17, 1.42) as compared to those with no disability. The odds of reporting an unintended pregnancy were highest in respondents with a severe disability (aOR 1.66, 95% CI 1.43, 1.94) and were also increased in respondents with moderate disability (aOR 1.48, 95% CI 1.36, 1.62) as compared to those reporting no disability. Across most birth outcomes, respondents with severe disabilities had worse outcomes with an increased odds of low birth weight infants (aOR 1.28, 95% CI 1.08, 1.52), preterm birth (aOR 1.32, 95% CI 1.11, 1.57), and neonatal intensive care unit admission (aOR 1.45, 95% CI 1.02, 2.06) as compared to respondents with no disability. There were not differences in being classified as small for gestational age or infants' length of hospital stay by disability status.

CONCLUSIONS

Across the perinatal period, respondents with moderate or severe disability experienced worse outcomes than those without disability. There is a critical need to improve pre-conception health in an effort to reduce inequities in pregnancy outcomes. Additionally, health care providers and systems must provide equitable access to care to persons with disabilities to reduce inequities in outcomes.

Community Perspectives on Intimate Partner Violence During Pregnancy: A Qualitative Study from Rural Ethiopia

Intimate partner violence (IPV) during pregnancy is closely associated with adverse maternal and fetal outcomes. To develop prevention strategies and interventions, the exploration of cultural norms, societal attitudes, and perceptions related to IPV is vital. This study explored community perspectives on IPV during pregnancy in rural Ethiopia. We used an exploratory qualitative study design to collect data. Data were collected through in-depth interviews (IDIs) and focus group discussions (FGDs) guided by a semi-structured topic guide. The data were analyzed using a thematic analysis approach, revealing the following four themes: (1) threats to the health of the mother and the fetus; (2) the contributing factors of IPV during pregnancy; (3) coping strategies for IPV during pregnancy; and (4) the need for intervention. Supportive attitudes toward IPV, early marriage, lack of awareness among offenders about its consequences, alcohol use, poor couple communication, and provocation by wives were found to be the causes of IPV during pregnancy. Participants in this study perceived IPV as a normal and unavoidable aspect of marital relationships. Comprehensive interventions that address challenging the cultural norms that condone IPV, increase community awareness of its detrimental effects, improve couples' communication skills, and address alcohol abuse among men could play a crucial role in preventing or reducing IPV during pregnancy.

Physical intimate partner violence and prenatal oral health experiences in the United States

BACKGROUND

Intimate partner violence (IPV) is a significant public health issue, and when experienced during pregnancy, IPV substantially harms maternal health. Still, limited research has examined how IPV may influence prenatal oral health and dental care utilization. This study investigates the relationship between IPV during pregnancy and women's oral health experiences.

DATA

Data are from 31 states from 2016-2019 in the United States that participated in the Pregnancy Risk Assessment Monitoring System (N = 85,289)-a population-based surveillance system of live births conducted annually by the Centers for Disease Control and Prevention and state health departments. Multivariable logistic regression analyses were used to examine the association between physical IPV during pregnancy (measured by being pushed, hit, slapped, kicked, choked, or physically hurt any other way by a current or ex-husband/partner) and various oral health experiences.

FINDINGS

Women who experienced prenatal physical IPV reported worse oral health experiences during pregnancy, including being more likely to report not knowing it was important to care for their teeth, not talking about dental health with a provider, needing to see a dentist for a problem, going to see a dentist for a problem, as well as having more unmet dental care needs.

CONCLUSIONS

Together, these findings indicate that women who experience physical IPV during pregnancy have lower knowledge of prenatal oral health care, more oral health problems, and greater unmet dental care needs. Given the risk of IPV and oral health problems for maternal and infant health, the study findings point to greater attention toward the oral health needs of IPV-exposed pregnant women.

Intimate partner violence during the perinatal period by disability status: Findings from a United States population-based analysis

AIMS

The aim of the current study was to compare the prevalence of intimate partner violence (IPV) during the perinatal period among respondents with self-reported disability compared with those without a disability.

DESIGN

We conducted a secondary analysis of nationally representative data from the Pregnancy Risk Assessment Monitoring System data from 24 participating United States between 2018 and 2020.

METHODS

A cross-sectional sample of 43,837 respondents provided data on disability, including difficulty in vision, hearing, ambulation, cognition, communication and self-care. The exposure was perinatal IPV, defined as experiencing abuse by a current or ex-partner in the year before or during pregnancy. Regression models were used to calculated odds of IPV by disability status while accounting for relevant sociodemographic characteristics.

RESULTS

Respondents who self-reported disabilities experienced IPV at a higher rate than those without disabilities, both before and during pregnancy. In fully adjusted models, respondents with disabilities had about 2.6 times the odds of experiencing IPV before pregnancy, and about 2.5 times the odds of experiencing IPV during pregnancy, compared with those without disabilities.

CONCLUSION

Respondents with disabilities experienced IPV at higher rates than the general population, and thus are at increased risk for adverse maternal, neonatal and infant health outcomes.

IMPACT

Perinatal IPV is a significant issue globally, and our findings suggest perinatal IPV is particularly salient for persons with disability. Findings highlight the need to screen women with disabilities for IPV during the perinatal period as well as the importance of providing them appropriate, accessible information, resources and referrals.

Intimate partner physical violence and inadequate weight gain in pregnancy

Abstract Objectives: to evaluate the association between intimate partner physical violence (IPPV) and inadequate gestational weight gain (GWG). Methods: cross-sectional study composed of 554 women who attended four Basic Health Units in the city of Rio de Janeiro between 2005 and 2009. The GWG was calculated through the difference between the final weight of pregnancy and pre-gestational weight. For the measurement of IPPV, the Portuguese version of the Conflict Tactics Scales (CTS-1) was used. Data analysis was based on multinomial logistic regression models, estimating odds ratios and respective 95% confidence intervals for associations between the variables of interest. Results: the prevalence of minor and severe IPPV was 31.6% and 16.3%, respectively. Almost two-thirds of the women had insufficient or excessive GWG. After adjusting the model, it was observed that the presence of IPPV increased by 1.66 (CI95%=1.05-2.64) times the chances of insufficient GWG, compared to couples who did not experience this type of violence. Concerning the excessive GWG, the associations with IPPV were not statistically significant. Conclusion: women who experience IPPV in their relationships are more likely to have insufficient GWG during pregnancy. From this perspective, prenatal care becomes an essential service for screening domestic violence and its possible repercussions.

He hurts her womb: Physical-sexual violence and pregnancy complications among women in Afghanistan

Background: Though some studies show the association between intimate partner violence and pregnancy complications in developed countries, the association remains understudied in less developed and low-income settings. This study examines the association of physical and sexual violence with pregnancy complications among women in Afghanistan.

Methods: This study used the data from the 2015 Afghanistan Demographic and Health Survey (AfDHS). The analysis included 7229 women aged between 15 and 49 and used logistic regression to show the association of physical and sexual violence with pregnancy compilations. The analysis controlled for some potential variables and followed complex survey design factors such as strata, clusters, and survey weights.

Results: Fully adjusted regression model shows that the women who experienced physical violence were 21% (adjusted odds ratio [OR]=1.21; confidence interval [CI]=0.98, 1.50; P <0.1) more likely to endure pregnancy complications compared to those who did not face the violence. Likewise, the women experiencing sexual violence were 89% (adjusted OR=1.89; CI=1.37, 2.62; P <0.01) higher to face pregnancy complications than those who did not face any of sexual violence. More specifically, physically and sexually violated women were highly prey to the complications that increased with the increment of the violence.

Conclusion: This study adds that policymakers may formulate policies for ensuring 3C (caring couple counselling) by readdressing couple relationships, raising gender rights and awareness, providing reproductive health literacy, and increasing mental health awareness during pregnancy.

The Intergenerational Effects of Intimate Partner Violence in Pregnancy: Mediating Pathways and Implications for Prevention

Prenatal intimate partner violence (P-IPV) can have significant adverse impacts on both mother and fetus. Existing P-IPV interventions focus on the safety of the mother and on reducing revictimization; yet expanding these to address the adverse impact on the fetus has considerable potential for preventing long-term negative developmental outcomes. In this review, we draw together evidence on major pathways linking exposure to P-IPV and child outcomes, arguing that these pathways represent potential targets to improve P-IPV intervention efforts. Using a narrative review of 112 articles, we discuss candidate pathways linking P-IPV to child outcomes, as well as their implications for intervention. Articles were identified via key word searches of social science and medical databases and by inspection of reference lists of the most relevant articles, including recent reviews and meta-analyses. Articles were included if they addressed issues relevant to understanding the effects of P-IPV on child outcomes via six core pathways: maternal stress and mental illness, maternal-fetal attachment, maternal substance use, maternal nutritional intake, maternal antenatal health-care utilization, and infection. We also included articles relevant for linking these pathways to P-IPV interventions. We conclude that developing comprehensive P-IPV interventions that target immediate risk to the mother as well as long-term child outcomes via the candidate mediating pathways identified have significant potential to help reduce the global burden of P-IPV.

Exposure to Interpersonal Violence During Pregnancy and Its Association With Women's Prenatal Care Utilization: A Meta-Analytic Review

Inadequate prenatal care utilization has been proposed as a mechanism between exposure to violence during pregnancy and adverse maternal and fetal obstetric outcomes. Adequate prenatal care is important for identifying and treating obstetric complications as they arise and connecting pregnant women to supports and interventions as needed. There is some evidence that pregnant women experiencing relational violence may delay or never enter prenatal care, though this association has not been systematically or quantitatively synthesized. The present meta-analysis investigates the relationship between interpersonal violence during pregnancy and inadequate prenatal care utilization across two dimensions: (1) no prenatal care during gestation (k = 9) and (2) delayed entry into prenatal care (k = 25). Studies were identified via comprehensive search of 9 social science and health-related databases and relevant reference lists. Studies were included if (1) participants were human, (2) violence occurred in the context of an interpersonal relationship, (3) abuse occurred during pregnancy (including abuse within 12 months before the time of assessment during pregnancy), (4) the study was empirical, peer-reviewed, and included quantitative data, (5) prenatal care utilization data were available, (6) they were in English, and (7) they were not part of an intervention study. Results from random-effects models found that women abused during pregnancy were more likely to never enter care (odds ratio [OR] = 2.62, 95% confidence interval [CI] = [1.55, 4.42]) or to delay care (OR = 1.81, 95% CI [1.48, 2.23]). Sociodemographic, abuse-related, and methodological factors emerged as moderators. Practice, policy, and research implications are discussed.

Violence against pregnant women in the experience of the rape centre of Turin: Clinical and forensic evaluation

Pregnant women can be victims of violence: as a matter of fact, far from being a protective factor, pregnancy can trigger or worsen episodes of abuse. Studies conducted by the WHO highlight that its incidence fluctuates between 1% and 28%. Therefore violence during pregnancy is endemic all over the world and involves all social strata. We analysed 113 medical records concerning pregnant women (average age 27.9 ± 6.0 years, 80 foreigners), who turned to the Centro Soccorso Violenza Sessuale, one of the two Italian Rape Centre, in Turin between January 1st, 2005 and December 31st, 2017. Fifty-three women were visited in the first trimester, 41 in the second, and 16 in the third, while 3 during the puerperium. The current partner was accused to be the abuser by the 84.4% of the Italian women and by the 69.2% of the foreigners. Sixty-eight women suffered multiple forms of violence, while 98 suffered only physical violence, and 3 reported only sexual abuse. According to 20 women, violent episodes increased during pregnancy. The clinical history of these women was characterized by some recurrent physical symptoms, such as pelvic pain, abdominal pain, facial pain and headache and 54 women presented injuries (abrasions and ecchymosis). Our results confirm that violence in pregnancy is a social and public health problem. Therefore it is important that the health personnel should be prepared not only to care for women seeking help, but above all its better preparation could also identify victims of violence, which do not report abuse.

The Intersection of Maternal Morbidity and Mortality and Intimate Partner Violence in the United States

Background:

In the United States, rates of maternal morbidity and mortality (MMM) are high compared with other high-income countries and are characterized by significant racial/ethnic disparities. Typically, research on MMM focuses on obstetrical problems. Less research examines the role of intimate partner violence (IPV). Maternal health, IPV, and their intersection are linked with the impacts of social determinants of health.

Objective:

We sought to understand the intersection of MMM and IPV in the United States, particularly data issues that hinder research in this area and the resulting knowledge gaps.

Methods:

We identified major articles of interest regarding maternal morbidity and mortality and IPV in the United States and drafted a mini review based on relevant information.

Results:

Despite the prevalence of IPV during pregnancy, the intersection of maternal health and IPV has not been widely reviewed or discussed.

Conclusion:

There are a number of limitations in surveillance activities and data collection that underestimate the impact of IPV on MMM. Importantly, women who die by homicide or suicide— which in many cases is linked with IPV—are not counted as pregnancy-related deaths in the United States under the current definition. Establishing separate panels of local experts in maternal health or maternal mortality review committees (MMRCs) that are dedicated to examining violent deaths and use of the Maternal Mortality Review Information Application system would likely improve data accuracy of pregnancy-associated deaths. Based on the literature reviewed and limitations of current data, there are significant knowledge gaps on the effects of IPV and maternal health.

A Novel Model for a Free Clinic for Prenatal and Infant Care in Detroit

PURPOSE

Detroit experiences the highest preterm birth rate and some of the worst birth outcomes in the country. Women and children have extremely high levels of poverty and face numerous barriers to care including lack of trust and racial disparities in care and concrete barriers such as limited transportation and childcare, work hour conflicts, and lack of insurance.

DESCRIPTION

We report on a unique model of patient care focused on providing patient-centered care and building trusting relationships. This model is encompassed in a new free, volunteer-run, faith-based clinic which offers prenatal, postpartum, and infant care.

ASSESSMENT

In the first 2 years of operation, demand for services rose rapidly and there were stellar clinical outcomes, despite the fact that Luke patients are among the medically and socially highest risk populations in the nation.

CONCLUSION

While marginalized populations have worse birth outcomes and far more infant deaths, making care accessible and responsive to patient needs while focusing on building patient relationships is an important strategy to improve outcomes.

Intimate partner violence and perinatal health: a systematic review

BACKGROUND

Physical, psychological and sexual intimate partner violence (IPV) has been described in the literature as different types of IPV experienced by women during pregnancy all over the world.

OBJECTIVES

To review and summarise systematically the empirical evidence on the links between IPV during pregnancy and the perinatal health of mothers and fetuses/neonates.

SEARCH STRATEGY

MEDLINE (Ovid), CINAHL, Embase, Nursing@ovid (Ovid) and LILACS were searched (2008-2018).

SELECTION CRITERIA

Observational studies that examined perinatal health outcomes (i.e. pre-term birth, low birthweight, miscarriage, perinatal death and premature rupture of membranes) in pregnant women exposed to IPV.

DATA COLLECTION AND ANALYSIS

Information on study characteristics, type of IPV measured, study design, methodological quality and outcome variable extracted.

RESULTS

Fifty studies were included. Twenty-nine analysed undifferentiated IPV (n = 25 489), 34 included physical IPV (n = 7333), 22 analysed psychological IPV (n = 7833) and 18 examined sexual IPV (n = 2388). Fifteen studies were from Asia, 12 from North America and Oceania, and 12 from Central and South America. The studies examined the association between IPV and 39 different perinatal health outcomes. The most frequent outcomes reported were pre-term birth (50%), low birthweight (46%), miscarriage (30%), perinatal death (20%) and premature rupture of membranes (20%). A significant association with perinatal health outcomes was reported by 12 of the studies analysing undifferentiated IPV, 18 physical IPV, six psychological IPV and two sexual IPV.

CONCLUSIONS

The relation between IPV and perinatal health outcomes can be seen in different epidemiological designs and countries. In all, 39 different outcomes were identified and 29 were associated with IPV.

TWEETABLE ABSTRACT

A variety of poor perinatal health outcomes are associated with psychological, physical and sexual IPV.

Addressing Intimate Partner Violence to Improve Women's Preconception Health

Exposure to violence can harm women's overall health and well-being. Data suggest that one in three women in the United States experience some form of violence by an intimate partner in their lifetime. In this commentary, we describe the implications of intimate partner violence (IPV) on women's health, specifically for women of reproductive age. We use a life-course perspective to describe the compounded impact of IPV on preconception health. Preconception health generally refers to the overall health and well-being of women (and men) before pregnancy. This report also discusses primary prevention of IPV and healthcare recommendations, and highlights surveillance systems that capture IPV indicators among women of reproductive age. Ongoing collection of state-level surveillance data may inform the implementation of intervention programs tailored to reproductive age women at risk for IPV.