Intimate partner violence during pregnancy: maternal and neonatal outcomes

Domestic violence as a risk factor of maternal filicide

PURPOSE

This paper will investigate precursors to maternal filicide, focusing on domestic violence. While psychosis is often well described, less frequently explored are the connections between prior trauma, domestic violence, depression, and filicide. We will discuss reasons why a woman may not disclose domestic violence and suggest possible areas for intervention.

METHODS

We present a case involving domestic violence, its impact on mental health, and eventual filicide. We then present an alternative scenario of the same case where filicide is considered, but is avoided.

RESULTS

The case of the mother who experienced domestic violence and was accused and sentenced for filicide is seen in greater relief by presenting the case in an alternative scenario with effective interventions. It is clear the availability and the ability to access community supports, such as obstetric and pediatric screening, psychiatric treatment, domestic violence shelters, intimate partner violence outreach services, parenting support groups, and hospital social work case management, tragedies such as filicide can be prevented.

CONCLUSION

Traumatic early childhood experiences predispose people to a stress-response system that is more prone to inactivity and impulsivity. This can cause women in domestic violence relationships to stay, limit their options for family planning, become increasingly depressed, not seek community support, and risk impulsive action of harming their child. This risk can be mitigated by building stable relationships with their medical team, treating depression, connecting with home visitation programs, and being empowered to access contraception.

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.

Childhood or adolescent abuse and primary open-angle glaucoma in a longitudinal cohort of women

OBJECTIVE

To examine associations of childhood/adolescence abuse with primary open-angle glaucoma (POAG) and POAG subtypes.

METHODS

We included US female nurse participants from the Nurses' Health Study II (1989-2019). Participants (n = 59,712) were ≥40 years old, reported follow-up eye exams, had no glaucoma, and had early-life adverse experience data. Self-reported childhood/adolescence abuse was assessed in 2001 with the Revised Conflict Tactics Scale (CTS) and the 2-item sexual maltreatment scale of the parent-child CTS. We evaluated associations by type (any, physical, sexual) and timing (childhood, adolescence). POAG cases (n = 255) were confirmed and subtyped with medical record review. Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Severe childhood/adolescent abuse was reported by 16.5%. There was no association between any childhood/adolescent abuse (HR 1.03; 95% CI: 0.79-1.35), physical abuse, abuse experienced during childhood only or adolescence only, and POAG risk. Compared to no sexual abuse history, any sexual abuse was modestly associated with POAG (HR 1.31; 95% CI: 1.01-1.69). Specifically, we observed adverse associations with sexual abuse for the POAG subtype with paracentral vs. peripheral VF loss (Pheterogeneity = 0.04). For paracentral POAG, we observed a 1.80-fold higher risk (95% CI: 1.14-2.85) with any sexual abuse history, a 2.38-fold higher risk (95% CI: 1.25-4.53) with a threat of/actual forced sexual activity, and a significant dose-response relationship with increasing severity of sexual abuse (Ptrend = 0.005; Ptrend_FDR corrected = 0.045).

CONCLUSIONS

While any childhood/adolescence abuse history was not associated with POAG, the modest adverse associations with early-life sexual abuse history warrant confirmation in future studies.

Maternal experiences of multiple forms of intimate partner violence and associations with undernutrition among children under 5: evidence from 36 low- and middle-income countries based on demographic and health surveys

BACKGROUND

Intimate partner violence (IPV) is a global issue and has various negative impacts on women and their children's physical and psychological health. Although the co-occurrence of multiple forms of IPV (ie, physical, psychological and sexual IPV) against women is prevailing, its negative effects on their children's nutrition remain neglected. This study aimed to explore such effects among children under 5.

METHODS

We used a sample of 104 740 mother-child pairs from 36 low- and middle-income countries based on the Demographic and Health Surveys between 2005 and 2022. Pooled and income level-specific survey logistic regressions were performed to assess the associations between maternal experience of any form of IPV, multiple forms of any IPV, co-occurrence of different forms of IPV and number of IPV forms within the past 12 months, with child undernutrition.

FINDINGS

Maternal exposure to multiple forms of IPV was significantly associated with an increased risk of child wasting (OR: 1·2, 95% CI: 1·0 to 1·4) and underweight (OR: 1·2, 95% CI: 1·1 to 1·4), while no significant association was found for stunting. Significant dose-response effects of the number of IPV forms were found for child wasting (p<0·05) and underweight (p<0·05). The co-occurrence of psychological and sexual IPV showed the most significant impact on child wasting (OR: 1·4, 95% CI: 1·2 to 1·8) across subtypes of co-occurrence. Most significant results were detected in lower- and middle-income countries. Children whose mothers were shorter than average, underweight, lived in rural areas and poorer families were more vulnerable to undernutrition.

INTERPRETATION

This study highlighted the negative effect of multiple forms of maternal IPV on child wasting and underweight with a focus on the number of IPV experienced. Our findings called for enhanced policy-based efforts to end gender-based violence to protect the health and rights of both women and children.

FUNDING

This research is supported by the National Natural Science Foundation of China (No. 72074130).

Screening and Interventions for Intimate Partner Violence in Pregnancy: The Perspective of Survivors

OBJECTIVES

Intimate partner violence (IPV) poses serious risks to women's health, especially during pregnancy. Despite pregnancy being a key opportunity for IPV screening, various barriers often hinder health care provider efforts to screen for IPV. This study seeks to understand from IPV survivors how health care providers can better screen for and address IPV during pregnancy.

METHODS

Women who had experienced IPV during pregnancy were recruited via Facebook ads. A website provided study details and a consent form. After consenting, participants completed a survey covering 4 main themes: personal demographics, IPV screening in pregnancy, barriers to disclosure, and interventions offered. Written comments were invited in addition to survey completion.

RESULTS

This pilot study involved 23 participants who experienced IPV during pregnancy. Overall, 17 reported childhood abuse and 19 had experienced abuse outside of pregnancy. Although all participants supported IPV screening by health care providers during prenatal care, only 8 were screened. There was a preference for written tools over verbal assessments to enhance comfort and privacy. Barriers to disclosure included fear of partner retaliation, discomfort discussing IPV, concerns about confidentiality, and potential involvement of child protection services. Interventions offered were limited, with mental health support and social services identified as critical resources.

CONCLUSIONS

Findings support the need for improved screening practices and comprehensive support systems to address the complex needs of pregnant individuals experiencing IPV, particularly given its prevalence and ties to childhood trauma. Enhancing standardized guidelines, health care provider training, and disclosure support are essential for promoting healthier outcomes for mothers and their children.

Domestic violence in pregnancy: a systematic review of clinical guidelines

BACKGROUND

Domestic violence is a public health concern and human rights violation affecting more than one-third of all pregnant women globally. Abused pregnant women need several interventions to reduce domestic violence and its negative consequences on mother and child. The purpose of this study was to determine the quality, scope, and consistency of clinical guidelines for managing domestic violence during pregnancy.

METHODS

This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Electronic databases of Scopus, PubMed, Embase, Web of Science, Up-to-date, Cochrane Library database, Google Scholar, and Guideline repositories, including NICE, SIGN, GAC, NHMRC, NGC, New Zealand Guidelines Group, TRIP, AHRQ, G-I-N, and MD Consult, using appropriate keywords were searched. Included studies were clinical guidelines containing recommendations about domestic violence in pregnancy and postpartum. Two reviewers used the AGREE II (Appraisal of Guidelines, Research, and Evaluation version 2) instrument to evaluate the quality of guidelines, and textual syntheses were used to appraise and compare the relevant recommendations. Out of 381 relevant published guidelines, 14 clinical guidelines were ultimately reviewed systematically.

RESULTS

Seven countries had a clinical guideline for domestic violence during pregnancy. None of the reviewed guidelines was rated > 75% across all domains of AGREE II while the highest-rated domains were scope, purpose, and clarity. Four related categories were recognized from the synthesis of recommendations within the appropriate guidelines. These consisted of an introduction, domestic violence in pregnancy, the role of health care professionals, and the resources. Recommendations for privacy and confidentiality, screening, identification, support, and documentation were the most commonly reported, which all of the guidelines advised them, suggesting the importance of identification of violence in pregnancy and support for abused pregnant women. 93% of the reviewed guidelines had recommendations on communication, support and building trust, child protection, and professional education and training.

CONCLUSION

The study findings suggest that there are currently gaps in clinical guidelines in various areas, including patterns of violence, the cycle of violence, identifying risk factors for violence during pregnancy, providing medical care, implementing home visitation programs, promoting self-care and empowerment, preventing violence, offering follow-up support, and conducting community education programs. Therefore, it is crucial to develop or adapt clinical guidelines for abused pregnant women, emphasizing their needs to ensure their safety and well-being.

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.

Effects of couple-based violence prevention education on male partners' knowledge, attitudes and controlling behavior related to intimate partner violence in rural Ethiopia: a cluster randomized controlled trial

Background

Supportive attitudes toward wife-beating and the experience of controlling behavior from husbands have been known to increase the risks of intimate partner violence (IPV). The aim of this study was to determine the effects of couple-based violence prevention education in addressing IPV-related knowledge, attitudes, and controlling behavior among male partners in rural Ethiopia.

Method

A cluster randomized controlled trial was conducted using a two-arm parallel group design. The 16 clusters were randomly allocated into 8 intervention groups and 8 control groups. A total of 432 couples (432 male partners and 432 pregnant wives) participated in the trial. Couple-based violence prevention education (CBVPE) was provided to the participants in the intervention group, while the control group received routine or standard care. Difference-in-difference analysis and the Generalized Estimating Equation (GEE) model were used to assess the effectiveness of the intervention.

Result

At the endline, 94.4% of male partners in the intervention group and 94.9% in the control group were available for the intention-to-treat analysis. Male partners in the intervention group were 3.7 times more likely to have good knowledge about IPV compared to male partners in the control group (AOR = 3.7; 95% CI 2.6-5.4). Male partners in the intervention group were 67.6% less likely to report supportive attitudes toward wife-beating compared to those in the control group (AOR = 0.324; 95% CI 0.229-0.459). Also, the proportion of controlling behavior exhibited by male partners in the intervention group was 56.4% less compared to the control group (AOR = 0.436; 95% CI 0.317-0.600).

Conclusion

The intervention proved effective in enhancing knowledge about IPV, reducing supportive attitudes toward wife-beating, and curbing controlling behaviors among male partners in the study setting. This approach holds promise for scaling up and adapting to similar contexts in Ethiopia.

Trial registration

The trial was registered on ClinicalTrials.gov with the identifier NCT05856214 on May 4, 2023.

Disability-Related Disparities in Screening for Intimate Partner Violence During the Perinatal Period: A Population-Based Study

BACKGROUND

Persons with disabilities are at higher risk of experiencing intimate partner violence (IPV) during the perinatal period than persons without disabilities. Although screening for IPV during the perinatal period is recommended by many organizations, little is known about screening rates for IPV by disability status.

METHODS

Our objective was to compare rates of IPV screening during the perinatal period among persons with and without disabilities in the United States. A cross-sectional sample of 43,837 respondents provided data on disability, including difficulty in vision, hearing, ambulation, cognition, communication, and self-care. We conducted a secondary analysis of nationally representative data from the 2018-2020 Pregnancy Risk Assessment Monitoring System.

RESULTS

During pregnancy, respondents with disabilities had a lower odds of IPV screening as compared with respondents without disabilities (adjusted odds ratio .83, 95% confidence interval [.70, .99]). Despite similar screening rates in the 12 months before conception and postpartum among respondents with and without disabilities who attended health care visits, those with disabilities were less likely to receive pregnancy-related care during pregnancy (p < .0001) and in the postpartum period (p < .0001) and thus missed opportunities to be screened.

CONCLUSION

Our findings demonstrate a need for health care providers to collaborate with policy makers, disability advocates, and researchers to reduce the disparities people with disabilities face in accessing health care, including screening for IPV during the perinatal period. Such efforts are essential for maximizing the health and safety of pregnant persons and new parents with disabilities and their children during the perinatal period.

IPV Routine Enquiry in Antenatal Care: Perspectives of Women and Healthcare Professionals-A Qualitative Study

Despite one in three women experiencing abuse by an intimate partner in their lifetime, intimate partner violence (IPV) is under-reported. Globally, IPV routine enquiry is used as part of healthcare response to addressing IPV. This paper presents the views of pregnant women (n = 40) and providers (n = 30) of IPV routine enquiry as part of antenatal care policy in Ireland. Respondents supported IPV routine enquiry as part of usual antenatal care, and while immediate disclosure was recognized as important, it was not a primary expectation. Routine enquiry was seen as a woman's right and a providers' duty to provide holistic, empowered, women centered and safe care and where provision of information and education on IPV is as fundamental as the disclosure of abuse.

Perinatal intimate partner violence and breastfeeding practices: A systematic review and meta-analysis protocol

BACKGROUND

Intimate partner violence increases the risk of detrimental health, behaviors and psychological issues in mothers, affecting infant nutrition and development. However, the potential effects of maternal exposure to intimate partner violence on breastfeeding practices are understudied, and the results of individual studies are inconsistent and conflicting. The aims of this systematic review and meta-analysis are therefore to 1) estimate the prevalence of perinatal intimate partner violence and, 2) examine the relationship between perinatal intimate partner violence and breastfeeding outcomes.

METHODS AND ANALYSIS

This systematic review and meta-analysis will investigate the association between perinatal intimate partner violence and breastfeeding outcomes, including early initiation within 1 hour after giving birth, exclusive breastfeeding under six months, and continued breastfeeding at two years or beyond. Comprehensive searches will be conducted in PsycInfo, Scopus, Web of Science, Medline, Cochrane, JBI EBP, CINAHL, Informit, and PubMed electronic databases. Data extraction will be performed independently by two reviewers, with discrepancies resolved by a third reviewer. Statistical analysis will be conducted using STATA/SE version 17, employing random-effects models to calculate pooled effect sizes and assess heterogeneity with I2 and Chi-square tests. Subgroup analyses and meta-regression will explore potential sources of heterogeneity.

DISCUSSION AND CONCLUSION

Evidence suggests that intimate partner violence is linked to poor breastfeeding outcomes. This systematic review and meta-analysis will update, compile, and critically review the evidence of the role of intimate partner violence on breastfeeding outcomes. This systematic review and meta-analysis will also inform effective strategies and interventions to support breastfeeding among IPV-affected women, thereby enhancing maternal and child health.

ETHICS AND DISSEMINATION

As this review and meta-analysis involves secondary analysis of existing data, ethical approval is not required. Findings will be disseminated through peer-reviewed publications and scientific conferences, aiming to inform strategies to support breastfeeding among women affected by intimate partner violence.

STUDY REGISTRATION

This protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42024555048.

A perinatal psychiatry access program to address rural and medically underserved populations using telemedicine

BACKGROUND

Although highly prevalent, most perinatal mental health and substance use disorders often go unrecognized, undiagnosed, and untreated. Perinatal Psychiatry Access Programs have emerged as a successful model to increase the capacity of front-line maternal health care providers to address perinatal mental health conditions through education, consultation, and increased resources and referrals.

METHODS

This model has been adapted in South Carolina to include direct access to mental health treatment in response to inadequate maternity care and mental health services, including a large proportion of rural, Medically Underserved Areas in Primary Care and Mental Health Healthcare Provider Shortage Areas throughout the state. Moms IMPACTT [Improving Access to Perinatal Mental Health and Substance Use Disorder Care Through Telehealth and Tele-mentoring] leverages statewide partnerships and a virtual care model to provide: 1) people who are pregnant or within 1 year postpartum with immediate access by phone or internet to a clinician trained in perinatal psychiatric care coordination to assess and refer to an appropriate level of perinatal psychiatry services; 2) communication and care coordination with the person's healthcare provider, as appropriate; and 3) healthcare provider training and real-time psychiatric consultation for the management and treatment of perinatal mental health and substance use disorders. Adaptations to this care model have demonstrated benefit including increase access to care for patients with perinatal mental health and substance use disorders and support for frontline health providers serving this population.

RESULTS

Within the first 12 months, the Mom's IMPACTT program served people from 45 of the 46 counties in South Carolina. There were 938 encounters, 96% of which resulted in telehealth or teleconsultation with a care coordinator or program psychiatrist. Treatment was provided to 881 perinatal patients (54.6% White, 26.1% Black, 6.2% Hispanic) of whom 51.8% were insured by Medicaid, 89.7% resided in counties designed as fully Medically Underserved Areas, and 38.9% lived in counties designed as fully rural. Most calls were received directly from perinatal patients, with 60.7% (548/903) of patients requesting mental health support. Additionally, the program completed 22 consultations, and trainings with 443 healthcare providers throughout the state.

CONCLUSIONS

Adaptations made to psychiatry access program evident in Moms IMPACTT appear to be successful in meeting the specific needs of birthing people in the state of South Carolina. Suggestions and considerations are included to replicate the success of Moms IMPACTT program elsewhere.

Effectiveness of couple-based violence prevention education in reducing intimate partner violence during pregnancy in rural Ethiopia: A cluster randomized controlled trial

BACKGROUND

Pregnancy is often seen as a joyful and fulfilling time for many women. However, a significant number of women in Ethiopia experience intimate partner violence (IPV) during this period. Despite this, there is limited evidence on interventions aimed at preventing violence during pregnancy. The purpose of this trial was to examine the effectiveness of Couple-Based Violence Prevention Education (CBVPE) in reducing IPV during pregnancy in rural Ethiopia.

METHOD

A cluster randomized controlled trial was conducted using a two-arm parallel group design. The 16 clusters were randomly allocated into 8 intervention groups and 8 control groups. A total of 432 pregnant women (216 in the intervention group and 216 in the control group) participated in the trial. Couple-based violence prevention education was provided to the participants in the intervention group, while the control group received routine or standard care. We used difference-in-difference analysis and the Generalized Estimating Equation (GEE) model to assess the effectiveness of the intervention.

RESULT

At the endline, 94.9% of women in the intervention group and 95.3% of women in the control group were available for intention-to-treat analysis. There was a substantial drop in the proportion of any IPV during pregnancy from 39.4% at baseline to 13.0% at endline (p<0.001). Women in the intervention group were 74.1% less likely to report any IPV during pregnancy compared to the control group (AOR = 0.259; 95% CI 0.161-0.417). Specifically, the intervention also reduced psychological, physical, and sexual violence during pregnancy.

CONCLUSION

The study found that CBVPE is effective in reducing IPV during pregnancy in the study setting. Scale-up and adaptation to similar settings are recommended.

TRIAL REGISTRATION

The trial is registered on ClinicalTrials.gov under the identifier NCT05856214 on May 4, 2023.

Influence of spousal educational disparities on intimate partner violence (IPV) against pregnant women: a study of 30 countries

Intimate Partner Violence (IPV) during pregnancy poses a serious threat to maternal health, particularly in low- and lower-middle-income countries (LMICs). Despite these known risks, the role of spousal educational differences in IPV during pregnancy remains poorly understood. This study aimed to examine this influence, analyzing data from multiple countries across five continents. This study utilized data from Demographic and Health Surveys (DHS) focusing on lower and LMIC countries. DHS employs two-stage sampling to gather comprehensive health data. Thirty countries from five regions were selected. Covariates like husband’s age, residence, wealth, education, husband’s working status, husband’s education, and spousal educational gap were considered. Cross-sectional survey design was considered. Chi-square test was done to find the association between IPV and covariates. Binary logistic regression was used to assess whether the independent variable is related to spousal educational disparity and other covariates of IPV during pregnancy. Out of 152,643 (weighted) pregnant women from all five continents, 8357 (weighted) experienced IPV during pregnancy. IPV is most prevalent in Papua New Guinea (17.01%; 95% CI 15.76–18.38%)), while least prevalent in Cambodia (0.99%; 95% CI 0.88–1.10%)). Overall, the IPV prevalence was (5.47%; 95% CI 5.30–5.65%)). Educational disparity and socioeconomic factors play a significant role in encountering IPV during pregnancy. This study revealed complex, region-specific effects on violence likelihood, emphasizing implications for policymakers and practitioners addressing IPV. Education disparity emerged as a significant factor; lower-educated couples exhibit increased abusive behavior.

Influence of spousal educational disparities on intimate partner violence (IPV) against pregnant women: a study of 30 countries

Intimate Partner Violence (IPV) during pregnancy poses a serious threat to maternal health, particularly in low- and lower-middle-income countries (LMICs). Despite these known risks, the role of spousal educational differences in IPV during pregnancy remains poorly understood. This study aimed to examine this influence, analyzing data from multiple countries across five continents. This study utilized data from Demographic and Health Surveys (DHS) focusing on lower and LMIC countries. DHS employs two-stage sampling to gather comprehensive health data. Thirty countries from five regions were selected. Covariates like husband's age, residence, wealth, education, husband's working status, husband's education, and spousal educational gap were considered. Cross-sectional survey design was considered. Chi-square test was done to find the association between IPV and covariates. Binary logistic regression was used to assess whether the independent variable is related to spousal educational disparity and other covariates of IPV during pregnancy. Out of 152,643 (weighted) pregnant women from all five continents, 8357 (weighted) experienced IPV during pregnancy. IPV is most prevalent in Papua New Guinea (17.01%; 95% CI 15.76-18.38%)), while least prevalent in Cambodia (0.99%; 95% CI 0.88-1.10%)). Overall, the IPV prevalence was (5.47%; 95% CI 5.30-5.65%)). Educational disparity and socioeconomic factors play a significant role in encountering IPV during pregnancy. This study revealed complex, region-specific effects on violence likelihood, emphasizing implications for policymakers and practitioners addressing IPV. Education disparity emerged as a significant factor; lower-educated couples exhibit increased abusive behavior.

Trauma exposure, contextual stressors, and PTSD symptoms: patterns in racially and ethnically diverse, low-income postpartum women

BACKGROUND

Racial, ethnic, and socioeconomic disparities persist in posttraumatic stress disorder (PTSD), which are partly attributed to minoritized women being trauma-exposed, while also contending with harmful contextual stressors. However, few have used analytic strategies that capture the interplay of these experiences and their relation to PTSD. The current study used a person-centered statistical approach to examine heterogeneity in trauma and contextual stress exposure, and their associations with PTSD and underlying symptom dimensions, in a diverse sample of low-income postpartum women.

METHODS

Using a community-based sample of Black, Hispanic/Latina, and White postpartum women recruited from five U.S. regions (n = 1577), a latent class analysis generated profiles of past-year exposure to traumatic events and contextual stress at one month postpartum. Regression analyses then examined associations between class membership and PTSD symptom severity at six months postpartum as a function of race/ethnicity.

RESULTS

A four-class solution best fit the data, yielding High Contextual Stress, Injury/Illness, Violence Exposure, and Low Trauma/Contextual Stress classes. Compared to the Low Trauma/Contextual Stress class, membership in any of the other classes was associated with greater symptom severity across nearly all PTSD symptom dimensions (all ps < 0.05). Additionally, constellations of exposures were differentially linked to total PTSD symptom severity, reexperiencing, and numbing PTSD symptoms across racial/ethnic groups (ps < 0.05).

CONCLUSIONS

A person-centered approach to trauma and contextual stress exposure can capture heterogeneity of experiences in diverse, low-income women. Moreover, racially/ethnically patterned links between traumatic or stressful exposures and PTSD symptom dimensions have implications for screening and intervention in the perinatal period.

Global variation in the assessment of psychological trauma in pregnancy

A history of psychologically traumatic experiences can impact health outcomes for pregnant people and their infants. The perception and prevalence of traumatic experiences during pregnancy may differ by geographical region. To better understand trends in how and what kinds of psychological trauma are assessed globally, we conducted a secondary analysis on a larger systematic review examining psychological trauma measurement in pregnancy. Through a systematic literature review conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, completed between July 2021 and September 2023 using Ovid MEDLINE, Ovid EMBASE, Scopus, Web of Science, PsycInfo and Cochrane, we identified 576 research studies assessing psychological trauma during pregnancy that were conducted across nine geopolitical regions. Most of these studies took place in North America, followed by sub-Saharan Africa, Europe, Asia, the Middle East or Northern Africa, Oceania, South America, and Central America. The fewest number of studies was conducted across multiple regions. We found that most studies measuring psychological trauma in pregnancy across the nine geopolitical regions assessed interpersonal trauma, and the fewest number of studies assessed healthcare trauma. Moreover, for each type of psychological trauma assessed, the greatest number of studies was conducted in North America. We also found that Central America, Oceania, sub-Saharan Africa, Asia, Middle East or Northern Africa, Europe, and studies conducted across multiple regions had one-third or more studies that only used in-house assessments, rather than previously validated assessments of psychological trauma. The results of this review emphasize the need for regionally specific and culturally appropriate measures of psychological trauma for pregnant people, which prioritize the types of psychological trauma that are most common in a given region. Newly developed measures can be used for screening and treatment of patients using trauma-informed obstetric care.

The Relations Among Childhood Maltreatment and Later Intimate Partner Violence Victimization With and Without a Weapon in a Sample of Pregnant Black Individuals

Black pregnant and postpartum individuals are at risk for intimate partner violence (IPV), and those with a history of childhood maltreatment and IPV are even more likely to be re-victimized during pregnancy. However, it is unknown if specific types of child maltreatment predict later IPV with and without a weapon better than others. The current study sought to (i) document the prevalence of childhood maltreatment and IPV and (ii) examine the relations among types of childhood maltreatment and later IPV with and without a weapon within a sample of Black individuals seeking prenatal care at a large public hospital in the southeastern United States. Participants (n = 186; mean age = 27.2 years, SD = 5.3) completed measures assessing childhood maltreatment and IPV with and without a weapon. Approximately 68.5% of participants (n = 124) endorsed experiencing childhood maltreatment, while 42.6% (n = 78) endorsed experiencing IPV. The bivariate relations among five childhood maltreatment types (i.e., sexual, physical, and emotional abuse, physical and emotional neglect) and IPV with and without a weapon were assessed. All childhood maltreatment subtype scores-except childhood physical neglect-were significantly higher among participants who reported a history of IPV with or without a weapon compared to participants who denied a history of IPV with or without a weapon. Logistic regression models revealed childhood sexual abuse emerged as the only significant predictor of experiencing IPV with a weapon (B = 0.10, p = .003) and IPV without a weapon (B = 0.11, p = .001). For every point increase in childhood sexual abuse subtype score, the odds of experiencing IPV with and without a weapon increased by 10% (OR = 1.10, 95%CI [1.04, 1.18]) and 12% (OR = 1.12, [1.05, 1.20]), respectively. Findings suggest that screening for childhood sexual abuse may provide a critical opportunity for maternity care providers to identify individuals at increased risk for IPV victimization with and without a weapon.

Intimate partner violence among women of reproductive age during the COVID-19 pandemic in Ethiopia: a systematic review and meta-analysis

Objectives

Intimate partner violence (IPV) is the violence committed by both current and former spouses and partners, and the rate of this violence is known to increase during different pandemics. The pooled prevalence of IPV among pregnant women before the COVID-19 pandemic was 37%, however, the pooled prevalence of IPV among women during COVID-19 is not yet known. Therefore, this study aimed to assess the pooled prevalence of IPV and its determinants among women of reproductive age during the COVID-19 pandemic in Ethiopia.

Design

Systematic review and meta-analysis.

Data sources

The review was done as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline using different search databases such as: PubMed/Medline, Cochrane Library, Virtual Health Library Regional Portal, HINARI (research4life), and Google Scholar.

Eligibility criteria

Those quantitative studies conducted in Ethiopia during the COVID-19 pandemic, that reported the prevalence of IPV among women of reproductive age, and were published in English from 13 March 2020 to 15 October 2025, were included for this study.

Data extraction and synthesis

All authors independently extracted data using the Joanna Briggs Institute manual for evidence synthesis. Any incongruity of the result in the data extraction process was resolved through discussions and consensus (ie, a Delphi process). The data were analysed using Stata Corp V.11 software. The heterogeneity between studies was assessed using I2 test statistics and the random-effects meta-analysis was done using the restricted maximum likelihood method. Publication bias was assessed using funnel plots, and Egger's and Begg's tests.

Result

In this study, a total of 802 articles were identified using different electronic databases. Finally, 12 studies that fulfilled the eligibility criteria were included for systematic review and meta-analysis. A total of 7397 study participants were sampled from April 2020 to August 2021. The overall estimated pooled prevalence of IPV was 33.5% (95% CI 22.9% to 44.1%) and the prevalence of physical, psychological and sexual violence was 16.4%, 28.2% and 17.4%, respectively. Different factors such as: age of the young women (adjusted odds ratio (AOR)=3.24; 95% CI 0.6, 5.8, p=0.015), lack of formal education (AOR=2.63; 95% CI 1.7, 3.6, p=0.000), partner's substance use (AOR=2.07; 95% CI 1.5, 2.7, p=0.000), partner not attending formal education (AOR=3.38; 95% CI 2.2, 4.6, p=0.000) and partner's alcohol use (AOR=2.82; 95% CI 1.1, 4.6, p=0.000) were found to be significantly associated with IPV among women during the COVID-19 pandemic.

Conclusions

In this study, a third of women of reproductive age experienced IPV during the COVID-19 pandemic. Women whose partners used alcohol and other substances were found to be vulnerable to IPV. Therefore, this finding gives an insight for policymakers to focus on empowering women and their partner's economic and educational status, promoting health education for partners towards the negative impact of bad behaviours like alcohol and other substance utilisation on their health, and the physical, mental and social wellbeing of women. Moreover, the burden of IPV is increased not only during such a pandemic but also during different internal displacements, conflicts and unrest. Therefore, we recommend policymakers to frequently assess IPV-related burdens during such events and act accordingly.

Social Determinants of Health Associated with Intimate Partner Violence in an Urban Obstetric Population

OBJECTIVE

 Intimate partner violence (IPV) is pervasive and can lead to severe health consequences. In the United States, 25% of women have experienced sexual violence, physical violence, and/or stalking by an intimate partner. However, less is known about the frequency and risk factors for IPV in the obstetric population.

STUDY DESIGN

 Nested case-control study from a prospective cohort study of 606 parturients at a single academic medical center from 2011 to 2022. Structured questionnaires were administered to randomly chosen, consented patients during their postpartum hospital stay to gather information on social determinants of health (SDoH) and birth outcomes. The case group included participants who reported forced sex causing pregnancy, verbal abuse before or during pregnancy, or physical abuse during pregnancy. The control group reported none of these. Odds ratios were used to quantify the relationship between IPV and maternal sociodemographic characteristics, pregnancy factors, and levels of perceived support and discrimination.

RESULTS

 Of 606 study participants, 568 (94%) provided data on IPV. Of those, 20.4% reported IPV (case) and 80.6% reported no IPV (control). In total, 74.6% of the study population was enrolled prepandemic. Unmarried status, low income, food insecurity, housing insecurity, substance use during pregnancy, higher gravidity, unintended pregnancy, low social support, and racial and gender discrimination were all significantly associated with IPV; maternal race and pregnancy during the COVID-19 pandemic were not.

CONCLUSION

 IPV is common, reported by one in five parturients in our population. Although maternal race was not associated with IPV in this perinatal cohort, experiencing racism was. Initiatives aimed to address SDoH such as substance use, family planning, and access to food and housing remain key opportunities to support pregnant patients experiencing IPV. The connection between perceived discrimination and IPV found here highlights the importance of addressing the influence of racism and gender-based discrimination on adverse birth outcomes in the United States.

KEY POINTS

· One in five parturients disclosed IPV.. · Racial discrimination was correlated with IPV.. · Food and housing insecurity increase IPV risk.. · COVID-19 did not increase the rate of IPV.. · Psychosocial support is vital during pregnancy..

Association between physical intimate partner violence and postpartum contraceptive use in the United States-evidence from PRAMS 2016-2021

OBJECTIVE

Intimate Partner Violence (IPV) continues to be a major global public health concern, impacting physical and psychological well-being of individuals, including their reproductive and sexual health. The objective of this study is to examine the association between physical intimate partner violence and the utilization of contraception during the postpartum period in the United States.

METHOD

This study used data from the CDC's Pregnancy Risk Assessment Monitoring System (PRAMS) survey study phase 8, covering 2016-2021. The sample included 165,204 women reporting physical IPV during pregnancy or 12 months before their last pregnancy and their postpartum contraceptive use. Descriptive, bivariate, and logistic regressions were used to analyze the relationship between IPV and postpartum contraceptive use, adjusting for relevant factors and addressing sampling weights.

RESULTS

The study found a 3.2% prevalence of physical IPV, with state variances ranging from 2.2% to 5.5%. Among women who experienced physical IPV, 91.0% used contraception, compared to 94.5% of those who did not experience physical IPV. Experiencing physical IPV significantly decreased the likelihood of using any postpartum contraceptive method by 42% (aOR: 0.58; 95% CI: 0.48-0.70) compared to those who did not experience physical IPV during the same period, after adjusting for covariates. Factors that increased the probability of using contraception during the postpartum period included women's higher educational attainment, being married or cohabitating, being employed anytime during pregnancy, and having an unintended last pregnancy.

CONCLUSION

This study highlights the significant association between physical IPV and reduced use of postpartum contraception in the United States. It calls for the integration of IPV considerations into public health policies and clinical initiatives to improve maternal well-being.

Intimate Partner Violence and Pregnancy and Infant Health Outcomes - Pregnancy Risk Assessment Monitoring System, Nine U.S. Jurisdictions, 2016-2022

Intimate partner violence (IPV) can include emotional, physical, or sexual violence. IPV during pregnancy is a preventable cause of injury and death with negative short- and long-term impacts for pregnant women, infants, and families. Using data from the 2016-2022 Pregnancy Risk Assessment Monitoring System in nine U.S. jurisdictions, CDC examined associations between IPV during pregnancy among women with a recent live birth and the following outcomes: prenatal care initiation, health conditions during pregnancy (gestational diabetes, pregnancy-related hypertension, and depression), substance use during pregnancy, and infant birth outcomes. Overall, 5.4% of women reported IPV during pregnancy. Emotional IPV was most prevalent (5.2%), followed by physical (1.5%) and sexual (1.0%) IPV. All types were associated with delayed or no prenatal care; depression during pregnancy; cigarette smoking, alcohol use, marijuana or illicit substance use during pregnancy; and having an infant with low birth weight. Physical, sexual, and any IPV were associated with having a preterm birth. Physical IPV was associated with pregnancy-related hypertension. Evidence-based prevention and intervention strategies that address multiple types of IPV are important for supporting healthy parents and families because they might reduce pregnancy complications, depression and substance use during pregnancy, and adverse infant outcomes.

Thematic Synthesis of the Experiences of Intimate Partner Violence Among Mothers Who Use Substances

OBJECTIVE

To integrate the findings of qualitative research to describe the experiences of intimate partner violence (IPV) among mothers who use substances.

DATA SOURCES

A systematic search of the literature was conducted using the databases of the American Psychological Association PsycINFO, CINAHL, and PubMed along with a manual search of Google Scholar.

STUDY SELECTION

The Joanne Briggs Institute critical appraisal checklist for qualitative research criteria was used to assess the studies for selection. Inclusion criteria comprised (a) qualitative research, (b) available in English, (c) published in peer-reviewed journals, (d) inclusive of descriptions of IPV experienced by mothers who use substances, (e) conducted in the United States, and (f) published between January 2013 and October 2023.

DATA EXTRACTION

The researchers highlighted and extracted data from studies that met the inclusion criteria. Data describing IPV among mothers who use substances were extracted.

DATA SYNTHESIS

A thematic synthesis was used to integrate the findings using three stages and included (a) free line-by-line coding of the findings of the primary studies, (b) the development of the free codes into associated areas to construct descriptive subthemes, and (c) the development of overarching analytic themes.

CONCLUSION

Findings from 11 qualitative studies were synthesized. Four descriptive subthemes emerged to delineate the experiences of IPV in mothers who use substances: Experience of Various Types of IPV, Lack of Structures to Identify and Address IPV, Coping With Violence by Taking Substances, and Substance Use Influences Behaviors of IPV. Nurses who work with mothers who use substances should be knowledgeable about local resources for IPV, complete ongoing educational training for IPV screening, and be familiar with recommended guidelines for the routine assessment of IPV.

I had to tell to survive"- a cross-sectional study on exposure to intimate partner violence in pregnant women and the importance of screening

BACKGROUND

There is a lack of knowledge in Swedish healthcare regarding correlations of exposure to intimate partner violence (IPV) from before to during pregnancy, and associated factors as well as pregnant women's perceptions related to screening for IPV in healthcare settings. The frequency of women exposed to IPV during pregnancy is difficult to establish as it is reported at different rates across different studies, depending on the definitions and screening strategies used.

AIMS

1. Describe prevalence of IPV experienced by pregnant women. 2. Investigate changes in IPV exposure before and during pregnancy. 3. Examine frequency of screening and women's opportunities and willingness to talk about IPV exposure.

METHODS

A cross-sectional survey in Stockholm, Sweden.

FINDINGS

6.2 % of women (n = 202) reported exposure to IPV before pregnancy and 2.1 % (n = 72) reported exposure during pregnancy, of these, sixteen women reported exposure only during pregnancy. There were significant associations between exposure to IPV and symptoms of depression, age, living situations and employment status. Sixty-four percent of the exposed women were asked about violence in healthcare settings.

DISCUSSION

An important finding was that the frequency of IPV decreased from before to during pregnancy. The reasons for this are unknown but may be multi-factorial.

CONCLUSION

Our investigation provides crucial insights into IPV during pregnancy. Results highlight that relying solely on prevalence rates is inadequate to understand the complexity of IPV exposure related to pregnancy. Screening for IPV and understanding how women perceive and disclose their exposure is complex yet vital for midwives in antenatal care.

The Consequences of A History of Violence on Women's Pregnancy and Childbirth in the Nordic Countries: A Scoping Review

Violence against women (VAW) is a global challenge also in the childbearing period. Despite high gender equality, there is a high prevalence of VAW in the Nordic countries. This scoping review aims to explore predictors for and consequences of a history of violence on women's pregnancy and childbirth in the Nordic countries, including women's experience of the impact of violence and the interventions used to detect, address consequences, and prevent further violence. The framework by Arksey and O'Malley was followed, and English, Finnish, Icelandic, Norwegian, Danish, and Swedish literature was included. The population was women aged ≥18 residing in the Nordic countries during the perinatal period. Eight databases were searched: MEDLINE, CINAHL, PubMed, PsycINFO, Web of Science, ASSIA, Social Services-, and Sociological abstracts. There was no limitation of the search time frame. The initial screening resulted in 1,104 records, and after removing duplicates, 452 remained. Finally, 61 papers met the inclusion criteria. The results covering the past 32 years indicated that childbearing women with a history of violence are at greater risk of common complaints and hospitalization during pregnancy, fear of childbirth, Cesarean section, breastfeeding difficulties, and physical and mental health problems. While extensive research was found on the associations between a history of and current violence and outcomes related to pregnancy, there was a lack of intervention studies and studies from Finland. Efforts must be made to scientifically test the methods used to reduce and treat the adverse effects of a history of violence and prevent further violence.

Facilitators and barriers for digital screening and a supportive intervention within antenatal care among danish pregnant women facing intimate partner violence: A qualitative study nested in the STOP study

OBJECTIVE

To understand barriers and facilitators for participation in digital IPV screening and a digital supportive intervention among pregnant women.

METHODS

Pregnant women attending standard antenatal care in the Region of Southern Denmark were systematically screened for IPV through a digital questionnaire. Those who screened positive were offered 3-6 video consultations with midwives and access to safety planning app. Semi-structured qualitative interviews were conducted with pregnant women who screened positive for IPV and participated in a digital supportive intervention.

RESULTS

Twenty pregnant women were interviewed, and the following facilitators for participation were highlighted: The digital systematic screening approach was acceptable and helped acknowledge IPV exposure as women experienced it as more private and allowed for reflection time compared to risk-based, face-to-face screening. Video counselling was highly acceptable, as the digital approach eased conversations on sensitive topics and the flexibility boosted participation. Trust in the healthcare system, having a trained midwife as a counsellor, and familiarity with the digital tool enhanced participation. Barriers included concerns about disclosing IPV, technological issues, and the need for a private space for counselling. Additionally, women who had experienced digital violence were uncomfortable with the digital nature of the intervention. The safety app was perceived as being inefficient as it did not meet the needs of the women.

CONCLUSION

Systematic digital screening and supportive video counselling for IPV within antenatal care is well-received among pregnant women as it offers increased privacy and flexibility and facilitating discussions on sensitive topics. To enhance participation, barriers such as confidentiality concerns, technological challenges, and the need for private counselling spaces must be addressed. Incorporating digital tools into antenatal care can supplement other support services and increase the proportion of pregnant women who receive help.

Knowledge and attitude toward intimate partner violence among couples: a baseline findings from cluster randomized controlled trial in rural Ethiopia

Background

Intimate partner violence (IPV) continues to be a major public health issue in Ethiopia. Studies have shown that knowledge and attitudes play a crucial role in predicting IPV. There is a lack of comprehensive evidence on the extent and factors associated with knowledge and attitudes toward IPV in many developing countries, particularly in rural Ethiopia. The objective of this study was to assess the level of knowledge and attitudes toward IPV and associated factors among couples in Central Ethiopia.

Methods

A baseline survey involving 432 couples (432 pregnant women and 432 husbands) was conducted in July, 2023, in Hadiya Zone, Central Ethiopia. Data were collected using face-to-face interviewer-administered questionnaires. Multivariable logistic regression analysis was performed, and adjusted odds ratios with 95% confidence intervals were reported.

Results

The findings revealed that 53.0% of women and 58.4% of men had good knowledge of IPV, while 56.0% of women and 65.6% of men held supportive attitudes toward IPV. Women's knowledge of IPV was significantly associated with age (25-34 years), educational attainment (secondary and higher/college education), antenatal care (ANC) visits, and husbands' alcohol consumption. Men's knowledge of IPV was associated with age at marriage <20, educational attainment (secondary and college/ higher education), monogamous marriage, and alcohol consumption. Predictors of women's attitudes toward IPV included marrying before the age of 20, partner smoking, and poor knowledge of IPV. Moreover, predictors of men's attitudes toward IPV included younger age (15-24), monogamous marriage, alcohol consumption, and poor knowledge of IPV.

Conclusion and recommendation

The study found that more than half of couples had good knowledge of IPV, with a notable percentage also holding supportive attitudes toward it. Enhancing women's education, changing attitudes, ANC visits, and addressing male substance use would help in increasing couples' awareness of IPV and its consequences.

The impact of intimate partner violence on adverse birth outcomes in 20 sub-Saharan African countries: propensity score matching analysis

Background

Intimate partner violence (IPV) is a significant public health problem, with serious consequences on women's physical, mental, sexual, and reproductive health, as well as birth outcomes. Women who encounter IPV are more likely to experience adverse birth outcomes such as low birth weight, premature delivery, and stillbirth. Although numerous studies are exploring the association between IPV and adverse birth outcomes, they merely used classical models and could not control for potential confounders. The purpose of this study was to ascertain whether there was a causation between IPV and adverse birth outcomes in sub-Saharan Africa (SSA) using a quasi-experimental statistical technique [i.e., propensity score matching (PSM) analysis].

Method

This study used the most recent (2015-22) Demographic and Health Survey (DHS) data from 20 SSA countries. A total weighted sample of 13,727 women was included in this study. IPV (i.e., sexual, physical, emotional, and at least one form of IPV) was the exposure/treatment variable and adverse birth outcomes (preterm delivery, low birth weight, stillbirth, and macrosomia) were the outcome variables of this study. PSM was employed to estimate the impact of IPV on adverse birth outcomes.

Results

The average treatment effects (ATE) of sexual, physical, emotional, and at least one form of IPV were 0.031, 0.046, 0.084, and 0.025, respectively. Sexual, physical, emotional, and at least one form of IPV increased adverse birth outcomes by 3.1%, 4.6%, 8.4%, and 2.5%, respectively. Findings from the average treatment effect on treated (ATT) showed that women who experienced sexual, physical, emotional, and at least one form of IPV had an increased risk of adverse birth outcomes by 3.6%, 3.7%, 3.3%, and 3.0%, respectively, among treated groups.

Conclusion

This study demonstrates a causal relationship between IPV and adverse birth outcomes in SSA countries, indicating a need for programs and effective interventions to mitigate the impact of IPV during pregnancy to reduce related adverse pregnancy outcomes. Furthermore, we suggest further research that investigates the causal effect of IPV on adverse birth outcomes by incorporating additional proximal variables not observed in this study.

Views from midwives and perinatal nurses on barriers and facilitators in responding to perinatal intimate partner violence in Japan: baseline interview before intervention

BACKGROUND

Midwives and perinatal nurses play a crucial role in responding to intimate partner violence (IPV) against pregnant women; however, these roles are often not performed adequately. This study aimed to identify provider-related, healthcare system, and social barriers and facilitators to IPV response from the perspective of midwives and perinatal nurses.

METHODS

This qualitative descriptive study used semi-structured interviews with five midwives and a nurse from perinatal care facilities in Tokyo, Japan. A framework approach was employed to analyze the interview transcripts.

RESULTS

Barriers included inadequate knowledge about IPV and reluctance to provide support by healthcare providers. Barriers in the healthcare system included the absence of structural infrastructure for IPV response. This involved the lack of screening tool adoption, the partner's presence during interviews, and time constraints. Additionally, there was insufficient systematic and collaborative coordination within and outside the team. Another barrier was the lack of in-service training to develop IPV-related knowledge and skills. Finally, there was uncertainty about how the support at healthcare facilities impacts women's lives. Further barriers in the social system included the absence of additional reimbursement for IPV response. There was also a lack of a comprehensive approach to IPV that provides for the rehabilitation of perpetrators and care for the children of victims and a culture that discourages separation from the perpetrator. Conversely, facilitators included healthcare providers recognizing the perinatal period as an opportunity to address IPV. They also acknowledged IPV as a prevalent issue, practiced conscious self-care, and systematically collaborated within the healthcare team.

CONCLUSION

This study emphasized the need for routine IPV screening in perinatal care and the importance of team-based educational interventions for healthcare providers to facilitate implementation.

Identifying Pregnant Patients With Suspected Intimate Partner Violence

INTRODUCTION

Intimate partner violence (IPV) is the leading cause of death in pregnant women. Although it can be difficult to identify patients experiencing IPV, injuries to the head, neck, or face due to an assault are known to correlate with intentional injury. The objective of this study is to assess the contemporary burden of IPV in pregnancy and describe the patient characteristics.

METHODS

The National Inpatient Sample was queried for all pregnant women between January 2016 and December 2019. Patients were divided into two groups: suspected IPV (SIPV) and no-SIPV groups. We defined SIPV as any pregnant patient with an identified head, neck, or face injuries categorized as intentional assault. Multivariable logistic regression analysis was performed to assess the association between SIPV and variables of interest.

RESULTS

A total of 28,540 pregnant patients presented with traumatic injuries with 530 (.02%) identified as SIPV. Suspected IPV patients were younger (25 vs 27 years, P = .012), more likely to be of Black race (46% vs 28%, P = .002), more likely to be in the lowest income quartile (51% vs 38%, P = .031), less likely to have private insurance (12% vs 34%, P < .001), and have higher rates of substance use disorder (35% vs 18%, P < .001). Black race and history of substance use disorder were associated with increased odds of SIPV-related injuries (odds ratio [OR]: 2.01, interquartile range [IQR]: 1.27-3.16, P = .003 and OR: 2.30, IQR 1.54-3.43, P < .001, respectively).

CONCLUSIONS

Our results suggest that there are significant racial and socioeconomic disparities in potential risk for IPV during pregnancy.

The effect of a digital intervention on symptoms of depression in pregnant women exposed to Intimate partner violence in Denmark and Spain (STOP study)

INTRODUCTION AND OBJECTIVE

Intimate Partner Violence (IPV) during pregnancy is a significant public health concern associated with adverse maternal and fetal health outcomes, including increased risk of depression. This study aimed to assess the effectiveness of a digital empowerment-based intervention in reducing symptoms of depression among IPV-exposed pregnant women.

STUDY DESIGN

This intervention study was nested within a cohort study conducted in Denmark and Spain. Pregnant women attending antenatal care were digital screened for IPV using the Abuse Assessment Screen (AAS) and the Women's Abuse Screening Tool (WAST). Those screening positive were offered a digital intervention comprising 3-6 video consultations with trained IPV counsellors and access to a safety planning app. Changes in depression scores from baseline to follow-up were evaluated using mixed model regression.

RESULTS

From February 2021-October 2022, 1,545 pregnant women (9.6 %) screened positive for IPV within our population (8.5 % in Denmark and 17.0 % in Spain) with 485 (31.4 %) meeting the criteria for the intervention. Of those eligible, 104 (21.4 %) accepted the intervention, and 55 completed it (13.1 %). Post-intervention, a significant reduction in Edinburgh Postnatal Depression Scale (EPDS) was found, with a mean difference of -3.9 (95 % CI: -5.3; -2.4), compared to the average pre-intervention score of 11.3. Stratifying the analyses across sociodemographic variables did not alter the overall result, indicating a reduction in EPDS scores irrespective of setting or sociodemographic factors. Notably, the intervention was most effective for women initially presenting with EPDS scores above the depression cut-off.

CONCLUSION

The findings suggest that a brief digital intervention is associated with a reduction in depression symptoms among pregnant women exposed to IPV, particularly among those with high depressive scores. This highlights the potential of digital interventions in delivering counseling and shows efficacy when administered by both midwives and psychologists in diverse settings. However, the absence of a control group underscores the need for caution in interpreting the results.

Assessing prenatal and early childhood social and environmental determinants of health in the HEALthy Brain and Child Development Study (HBCD)

The HEALthy Brain and Child Development (HBCD) Study, a multi-site prospective longitudinal cohort study, will examine human brain, cognitive, behavioral, social, and emotional development beginning prenatally and planned through early childhood. The charge of the HBCD Social and Environmental Determinants (SED) working group is to develop and implement a battery of assessments to broadly characterize the social and physical environment during the prenatal period and early life to characterize risk and resilience exposures that can impact child growth and development. The SED battery consists largely of measures that will be repeated across the course of the HBCD Study with appropriate modifications for the age of the child and include participant demographics, indicators of socioeconomic status, stress and economic hardship, bias and discrimination (e.g., racism), acculturation, neighborhood safety, child and maternal exposures to adversity, environmental toxicants, social support, and other protective factors. Special considerations were paid to reducing participant burden, promoting diversity, equity, and inclusion, and adopting trauma-informed practices for the collection of sensitive information such as domestic violence exposure and adverse childhood experiences. Overall, the SED battery will provide essential data to advance understanding of child development and approaches to advance health equity across infant and child development.

The relationship between spousal violence, maternal functioning, depression, and anxiety among Iranian postpartum mothers: a prospective study

BACKGROUND

Violence against women is a critical public health issue that adversely affects physical and mental health, contributing to injuries, chronic conditions, and mental health disorders. This study addresses the gap in understanding the relationship between spousal violence with maternal functioning and mental health in postpartum mothers.

METHODS

This Prospective study was conducted on 316 postpartum women who gave birth in Al-Zahra and Taleghani Educational Treatment Centers in Tabriz, Iran, from June 2023 to October 2023. Participants were selected using convenience sampling and followed up for 6-8 weeks. The data were collected using the Revised Conflict Tactics Scale (CTS2), the Edinburgh Postnatal Depression Scale (EPDS), the Postpartum Specific Anxiety Scale (PSAS), and the Barkin Index of Maternal Functioning (BIMF). A general linear model, adjusted for individual, social, and obstetric variables, was used to determine the relationship between domestic violence, maternal functioning, depression and anxiety.

RESULTS

Most women (84%) experienced one or more types of intimate partner violence (IPV), including psychological, physical, or sexual abuse. About one-third (32.9%) reported psychological abuse, 21.2% physical violence, 49.4% sexual coercion, and 6.3% reported injuries. The adjusted general linear model showed that the mean depression score was lower in individuals without any experience of violence compared to those who had experienced any violence (β: -1.75; 95% CI: -3.40 to -0.10; p = 0.038). The mean depression score was significantly higher in homemakers compared to employed individuals (β = 3.53; 95% CI = 1.22 to 5.84, p = 0.003). The mean maternal functioning score was significantly higher in those who had not experienced mild physical violence compared to those who had (β = 2.94; 95% CI = 0.34 to 5.55, p = 0.027). The mean anxiety score was lower in individuals with high income (β: -3.38; 95% CI: -5.73 to -1.04; p = 0.005) and moderate income (β: -2.21; 95% CI: -4.35 to -0.07; p = 0.043) compared to those with low income.

CONCLUSION

The findings reveal a high prevalence of violence, particularly sexual coercion, significantly affecting maternal functioning and mental health. Socioeconomic factors also play a crucial role in postpartum mental health. These results highlight the urgent need for enhanced prevention efforts and targeted interventions that consider the socio-economic context and specific forms of violence.

Interventions for intimate partner violence during the perinatal period: A scoping review: A systematic review

Background

Intimate partner violence (IPV) is a prevalent global health problem. IPV that occurs before pregnancy often continues during the perinatal period, resulting in ongoing violence and many adverse maternal, obstetrical, and neonatal outcomes.

Objectives

This scoping review is designed to broadly capture all potential interventions for perinatal IPV and describe their core components and measured outcomes.

Search Methods

We conducted a search for empirical studies describing IPV interventions in the perinatal population in June 2022. The search was conducted in MEDLINE, EMBASE, PsycInfo, CINAHL, Cochrane Central Register of Controlled Trials, Web of Science, Applied Social Sciences Index & Abstracts, ClinicalTrials.gov and MedRxiv. Hand searching of references from select articles was also performed.

Selection Criteria

Included studies described an intervention for those experiencing IPV during the perinatal period, including 12 months before pregnancy, while pregnant or in the 12 months post-partum. The search encompassed January 2000 to June 2022 and only peer-reviewed studies written in either English or French were included. Included interventions focused on the survivor exposed to IPV, rather than healthcare professionals administering the intervention. Interventions designed to reduce IPV revictimization or any adverse maternal, obstetrical, or neonatal health outcomes as well as social outcomes related to IPV victimization were included.

Data Collections and Analysis

We used standard methodological procedures expected by The Campbell Collaboration.

Main Results

In total, 10,079 titles and abstracts were screened and 226 proceeded to full text screening. A total of 67 studies included perinatal IPV interventions and were included in the final sample. These studies included a total of 27,327 participants. Included studies originated from 19 countries, and the majority were randomized controlled trials (n = 43). Most studies were of moderate or low quality. Interventions included home visitation, educational modules, counseling, and cash transfer programs and occurred primarily in community obstetrician and gynecologist clinics, hospitals, or in participants' homes. Most interventions focused on reducing revictimization of IPV (n = 38), improving survivor knowledge or acceptance of violence, knowledge of community resources, and actions to reduce violence (n = 28), and improving maternal mental health outcomes (n = 26). Few studies evaluated the effect of perinatal IPV interventions on obstetrical, neonatal or child health outcomes.

Authors' Conclusions

The majority of intervention studies for perinatal IPV focus on reducing revictimization and improving mental health outcomes, very few included obstetrical, neonatal, and other physical health outcomes. Future interventions should place a larger emphasis on targeting maternal and neonatal outcomes to have the largest possible impact on the lives and families of IPV survivors and their infants.

"Breaking through the Brokenness": An Arts-Based Qualitative Exploration of Pregnant Women's Experience of Intimate Partner Violence while Receiving Trauma- and Violence-Informed Antenatal Care

Intimate partner violence (IPV) is a pervasive, worldwide public health concern. Risk of IPV may elevate during the perinatal period, increasing maternal and fetal health risks. Trauma- and violence-informed care shows promise among interventions addressing associated mental health sequelae. As a secondary analysis, the purpose of this study was to employ a qualitative arts-based exploration to better understand pregnant women's experiences of trauma and violence-informed perinatal care in the context of IPV. Using an arts-based qualitative methodology, different art forms were used to analyze, interpret, and report data, resulting in a layered exploration to represent phenomena. From this, four themes were reflected in four poetic pieces: Black Deep Corners, Triggering my Thoughts, Breaking through the Brokenness, and Now Perfectly Imperfect. Nine pieces of visual art were created reflecting these themes, creating a layered, embodied, artistic way to empathically explore and translate phenomena.

"It is like a curse". The lived experiences of the intersection of intergenerational violence, pregnancy, and intimate partner violence among urban Wisconsin Indigenous women

BACKGROUND

Intimate Partner Violence (IPV) is a significant public health concern that disproportionately impacts Indigenous American women more than any other ethnic/racial group in the United States.

PURPOSE

This study aims to inform the work of nurses and allied health professionals by providing insight into the lived realities of Indigenous women in urban areas and how IPV manifests in the lives of Indigenous women.

METHODS

Postcolonial and Indigenous feminist frameworks informed this qualitative study. Using thematic analysis, we analyzed data from semi-structured individual interviews with 34 Indigenous women in large urban areas in the upper Midwest.

FINDINGS

This manuscript discusses one broad theme: experiences of IPV during pregnancy and the devastating impacts on women and their children in the form of intergenerational trauma. Under this broad theme, we identified two sub-themes: impacts of IPV on individual pregnancy experiences and linkages to adverse pregnancy-related outcomes related to physical IPV during the childbearing years.

CONCLUSION

This Indigenous-led study informs the development of effective Indigenous-specific interventions to minimize barriers to accessing prenatal care and help-seeking when experiencing IPV to reduce the devastating consequences for Indigenous women and their families.

Intimate Partner Violence and Antenatal Depression Among Underserved Pregnant Women

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

Intergenerational consequences of violence: violence during pregnancy as a risk factor for infection in infancy

Introduction

Psychosocial stress during pregnancy has long-lasting and important consequences in the following generations, as it can affect intrauterine development. The impact on the developing immune system is notoriously important due to the associated morbidity and mortality in the first years of life. Little attention has been given to the role of violence during pregnancy (VDP), especially its impact on infant infectious morbidity.

Methods

We analyzed data from two Brazilian birth cohorts (n = 2,847) in two distinct cities (Ribeirão Preto and São Luís), collected during pregnancy and at the beginning of the second year of life. The association between VDP and infection in infancy was analyzed with structural equation modeling, using the WHO-VAW questionnaire as exposure and a latent variable for infection as the outcome.

Results

VDP was reported by 2.48% (sexual), 11.56% (physical), and 45.90% (psychological) of the mothers. The models presented an adequate fit. In the city of São Luís, VDP was significantly associated with the latent construct for infection (standardized beta = 0.182; p = 0.022), while that was not the case for the Ribeirão Preto sample (standardized beta = 0.113; p = 0.113). Further analyses showed a gradient effect for the different dimensions of the exposure, from psychological to physical and sexual violence.

Conclusion

Our results suggest an association of VDP with infant morbidity in a poorer socioeconomic setting, and highlight the importance of considering the different dimensions of intimate partner violence. These findings may have important implications for the comprehension of global health inequalities and of the effects of gender-based violence.

Intimate Partner Violence and its associated factors among pregnant women receiving antenatal care. A Bayesian analysis approach

BACKGROUND

Intimate Partner Violence (IPV) is a major public health problem worldwide. In developing nations, including Ethiopia, the problem is under-reported and under-estimated. Therefore, this study attempts to assess intimate partner violence and its associated factors among pregnant women receiving antenatal care at public hospitals in Amhara region, Ethiopia.

METHODS

A health facility-based cross-sectional study design was employed. A sample of 418 pregnant women was selected using random sampling technique from 1st May to 1st June 2021. IPV was measured using the World Health Organization (WHO) Multi-country study of violence against women assessment tool. Data were entered into Epi-data 3.1 and exported into Stata 17 for further analysis. A Bayesian multivariable logistic regression analysis was carried out from the posterior distribution, and an adjusted odds ratio (AOR) with a 95% credible interval (CrI) was used to declare statistically significant variables.

RESULTS

The prevalence of any IPV among pregnant women was 31.3% [95% CrI 26.6%, 36.1%]. After adjusting a range of covariates, IPV during pregnancy was more likely among women whose husbands used substances [AOR = 4.33: 95% CrI 1.68, 8.95] and household decisions made by husbands only [AOR = 6.45: 95% CI 3.01, 12.64]. Conversely, pregnant women who attended primary [AOR = 0.47: 95% CrI 0.24, 0.81] and secondary [AOR = 0.64: 95% CrI 0.41, 0.92] educational levels, women who had four or more ANC visits antenatal care visits [AOR = 0.43: 95% CrI 0.25, 0.68], and women with no prior history of adverse birth outcomes [AOR = 0.48: 95% CI 0.27, 0.80] were less likely to experience IPV during pregnancy.

CONCLUSION

The study revealed a relatively high prevalence of any IPV among pregnant women, with factors such as substance use by husbands and limited decision-making autonomy associated with increased IPV likelihood. Conversely, women with higher education levels, four and above antenatal care attendance, and no history of adverse birth outcomes showed a reduced likelihood of experiencing IPV during pregnancy. Therefore, targeted interventions to address substance use, empower women in decision-making, and promote education and healthcare access to mitigate IPV risk during pregnancy are recommended.

Epidemiology of violence against young children in Jamaica

Violence against young children is known to have detrimental short and long-term effects. Yet, few studies investigate the prevalence of violence against young children, particularly very young children under the age of 2 years. This paper reports on the prevalence of violence against young children in Jamaica using data obtained from the JA KIDS birth cohort study that undertook pre-enrolment of pregnant mothers in the antenatal period and followed full or sub-samples of parents and children at 9-12 months, 18-22 months and 4-5 years. Violence in pregnancy was experienced by 6.1% of pre-enrolled mothers. As many as 43.1% of Jamaican children ages 9-12 months were shouted at, and almost 30% were slapped. Physical and emotional violence increased with age, and by 4-5 years, approximately 90% of children experienced physical and emotional violence. Non-violent methods, primarily explaining and reasoning with children, were also reported by more than 95% of parents at 4-5 years. Corporal punishment was the most common form of violence experienced, but young children also witnessed hurtful physical and emotional violence between mothers and their partners and lived in communities in which there were violent events. Strategies to reduce young children's experiences as victims and witnesses of violence are discussed.

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.

Integrated domestic violence and reproductive health interventions in India: a systematic review

BACKGROUND

Domestic violence is a leading cause of poor health outcomes during pregnancy and the postpartum period. Therefore, there is a need for integrated domestic violence interventions in reproductive health care settings. India has one of the highest maternal and child mortality rates. This review aimed to identify characteristics of existing evidence-based integrated domestic violence and reproductive healthcare interventions in India to identify gaps and components of interventions that demonstrate effectiveness for addressing domestic violence.

METHODS

A systematic review of intervention studies was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Three research team members performed independent screening of title, abstracts and full-texts.

RESULTS

The search resulted in 633 articles, of which 13 articles met inclusion criteria for full text screening and analysis. Common components of integrated violence and reproductive health interventions that were effective in addressing domestic violence included: psychoeducation/education (n = 5), skill building (n = 5), counseling (n = 5), engaging stakeholders with use of trained lay peer facilitators (n = 3), and engaging male spouses (n = 3).

CONCLUSIONS

Interventions in India for domestic violence that are integrated with reproductive health care remain few, and there are fewer with effective outcomes for domestic violence. Of those with effective outcomes, all of the interventions utilized psychoeducation/education, skill building, and counseling as part of the intervention.

Societal implications of the Dobbs v Jackson Women's Health Organization decision

On June 24, 2022, the US Supreme Court's decision in Dobbs v Jackson Women's Health Organization marked the removal of the constitutional right to abortion in the USA, introducing a complex ethical and legal landscape for patients and providers. This shift has had immediate health and equity repercussions, but it is also crucial to examine the broader impacts on states, health-care systems, and society as a whole. Restrictions on abortion access extend beyond immediate reproductive care concerns, necessitating a comprehensive understanding of the ruling's consequences across micro and macro levels. To mitigate potential harm, it is imperative to establish a research agenda that informs policy making and ensures effective long-term monitoring and reporting, addressing both immediate and future impacts.

Causal Pathways Between the Acute Experience of Violence During Pregnancy and Fetal Intrauterine Growth Restriction: A Cohort Study

Introduction: Violence during pregnancy (VDP) is a prevalent global issue with dire consequences for the mother and the developing fetus. These consequences include prematurity, low birthweight, and intrauterine growth restriction (IUGR), but its pathways remain elusive. This study investigated the causal pathways between VDP and IUGR using mediation analysis. Methods: A prospective population-based birth cohort was followed from the beginning of the third gestational trimester to the second year of life. IUGR was defined by the Kramer index, and information on VDP was collected using the WHO-Violence Against Women (WHO VAW) questionnaire. Cases were considered positive only when no other life episodes were reported. Ten different mediators were analyzed as possible pathways based on previous research. Path analysis was conducted to evaluate these relationships. Results: The path analysis model included 755 dyads and presented an adequate fit. Violence during pregnancy showed a direct effect (β = -0.195, p = 0.041) and a total effect (β = -0.276, p = 0.003) on IUGR. Violence was associated with gestational depression or anxiety, tobacco and alcohol consumption, changes in blood pressure, and the need for emergency care, but these did not constitute mediators of its effect on IUGR. The sum of the indirect effects, however, showed a significant association with IUGR (β = -0.081, p = 0.011). Conclusion: The acute experience of violence during pregnancy was associated with IUGR, primarily via a direct pathway. An indirect effect was also present but not mediated through the variables analyzed in this study. The robust strength of these associations underscores the negative health consequences of violence against women for the succeeding generation.

Barriers to routine screening for intimate partner violence during pregnancy in Nigeria

Background

The benefits of routine screening for intimate partner violence (IPV) among pregnant women include early identification, prompt management, referral of IPV victims, and creating awareness about IPV. Despite these benefits, the practice of routine screening of IPV remains limited in midwifery settings in low-income countries. The purpose of this study is to identify and describe midwives' perspectives of the barriers in conducting routine screening of IPV for pregnant women in northern Nigeria.

Methods

A case study qualitative descriptive design was used to collect data from ten midwives in the antenatal clinic of a tertiary hospital. Non-participant observation and individual face-to-face semi-structured interviews were used as data collection methods. Thematic data analysis was carried out using Yin's five stage analytical cycle.

Findings

Three themes, with related subthemes, emerged from the data: (i) The theme of "Internal" barriers to IPV screening has four subthemes; midwives' personal discomfort in asking IPV- related questions, perceived mistrust of midwives by pregnant women, midwives' own perceptions of IPV as a personal matter, and midwives' lack of skills to screen for IPV. (ii) "External" barriers to IPV screening subsumes three subthemes: antenatal card related barriers, workload related barriers, and protocol barriers. (iii) "Structural" barriers to IPV screening have two subthemes: lack of space for privacy and lack of resources for managing pregnant women who have experienced IPV.

Conclusion

Knowing the barriers to midwives' screening practices is important because it may help in the development of contextually relevant and acceptable screening guidelines for midwives in Nigeria. Education and training of midwives will eliminate the internal barriers while the external barriers will need the intervention of hospital authorities and government to eliminate their effects on screening.

Magnus J, Assefa N, Wordofa MA. The protocol for a cluster randomized controlled trial to evaluate couple-based violence prevention education and its ability to reduce intimate partner violence during pregnancy in Southwest Ethiopia

BACKGROUND

A significant proportion of women in Ethiopia suffer from violence by their intimate partner during pregnancy, which has adverse maternal and newborn outcomes. Couple-focused interventions are effective in reducing and/or controlling violence between women and their intimate partners. However, interventions addressing intimate partners of the victims are not well studied, particularly in the Ethiopian setting. This study aims to assess the effect of couple-based violence prevention education on intimate partner violence during pregnancy.

METHODS

We will use a cluster randomized controlled trial to evaluate the effectiveness of couple-based violence prevention education compared to routine care in reducing intimate partner violence during pregnancy. Sixteen kebeles will be randomly assigned to 8 interventions and 8 control groups. In the trial, 432 couples whose wife is pregnant will participate. Health extension workers (HEWs) will provide health education. Data will be collected at baseline and endline. All the collected data will be analyzed using Stata version 16.0 or SPSS version 25.0. We will use the McNemar test to assess the differences in outcomes of interest in both intervention and control groups before and after the intervention for categorical data. A paired t-test will be used to compare continuous outcome of interest in the intervention and the control groups after and before the intervention. The GEE (Generalized Estimating Equation), will be used to test the independent effect of the intervention on the outcome of the interest. Data analysis will be performed with an intention-to-treat analysis approach. During the analysis, the effect size, confidence interval, and p-value will be calculated. All tests will be two-sided, and statistical significance will be declared at p < 0.05.

DISCUSSION

We expect that the study will generate findings that can illuminate violence prevention strategies and practices in Ethiopia.

TRIAL REGISTRATION

It has been registered on ClinicalTrials.gov as NCT05856214 on May 4, 2023.

Management of Maxillofacial Trauma in Pregnant Women

INTRODUCTION

Trauma during pregnancy deserves special attention as management must be directed towards both the mother and the fetus. Management of maxillofacial fractures in pregnancy can adversely affect the well-being of the fetus by impinging on normal functions such as respiration, mastication, and nutrition. Pregnancy complicates the management of facial injury due to the maintenance of the patent airway, anesthesia considerations, and imaging restraints. The purpose of this study is to use three illustrative from our own institution to further elucidate education on the management of mandible fracture in pregnancy with a focus on multidisciplinary treatment and outcomes.

METHODS

A retrospective chart review was performed for all cases of facial fractures admitted to Ryder Trauma Center from 2012 to 2022. During this time, 4,910 patients presented with facial fractures 1319 patients were female. Three of the patients were pregnant at the time of admission. Demographics, mechanism of injury, associated injuries, and management information were collected.

RESULTS

Patient 1 was a 20-year-old female presented to Ryder Trauma Center following a motor vehicle collision. She was 17 weeks pregnant at the time of admission and was found to have a left mandibular angle fracture. Patient 2 was a 14-year-old female who presented to Ryder Trauma Center status post gunshot wound to the mandible after she and her brother were unknowingly playing with a loaded gun. She was 18 weeks pregnant at the time of admission, with a past medical history of domestic violence, suicidal ideation, and major depressive disorder. Patient 3 was a 20-year-old female 36 weeks pregnant at the time of admission. She presented with a right paraymphyseal fracture and left mandibular angle fracture as a result of falling on the stairs. Patients all underwent surgical repair of fractures.

Impact of sex, race, and social determinants of health on neonatal outcomes

Despite the global improvements in neonatal outcomes, mortality and morbidity rates among preterm infants are still unacceptably high. Therefore, it is crucial to thoroughly analyze the factors that affect these outcomes, including sex, race, and social determinants of health. By comprehending the influence of these factors, we can work towards reducing their impact and enhancing the quality of neonatal care. This review will summarize the available evidence on sex differences, racial differences, and social determinants of health related to neonates. This review will discuss sex differences in neonatal outcomes in part I and racial differences with social determinants of health in part II. Research has shown that sex differences begin to manifest in the early part of the pregnancy. Hence, we will explore this topic under two main categories: (1) Antenatal and (2) Postnatal sex differences. We will also discuss long-term outcome differences wherever the evidence is available. Multiple factors determine health outcomes during pregnancy and the newborn period. Apart from the genetic, biological, and sex-based differences that influence fetal and neonatal outcomes, racial and social factors influence the health and well-being of developing humans. Race categorizes humans based on shared physical or social qualities into groups generally considered distinct within a given society. Social determinants of health (SDOH) are the non-medical factors that influence health outcomes. These factors can include a person's living conditions, access to healthy food, education, employment status, income level, and social support. Understanding these factors is essential in developing strategies to improve overall health outcomes in communities.

The Impact of Negative Moral Character on Health and the Role of Spirituality: A Narrative Literature Review

Although negative moral character is highly prevalent, it is not included in the International Classification of Diseases (ICD). Along with the modification of WHO ICD-11, spirituality should be acknowledged for its potetnial role in the prevention of negative moral traits. This study aimed to explore the effects of negative moral character on health and determine the role of spirituality in improving negative moral traits. This narrative literature review was conducted from 2020 to 2023 in Kabul, Afghanistan. The articles were obtained from the Web of Science, PubMed, and Google Scholar databases. As demonstrated in this narrative literature review, most of the relevant experimental and observational studies have found that negative moral character can have significant negative impact on overall health and well-being. Many studies have established the positive role of spirituality in improving negative moral character. These studies concluded that facilities must be available within schools, universities, and communities for everyone to gain knowledge of spirituality and improve their negative moral character. Considering the adverse impacts of negative moral character on health, the current study proposes the addition of moral disorder to the WHO International Classification of Diseases. According to this literature review, spirituality will improve negative moral character and strengthen excellent moral traits.

Exclusive breastfeeding and its association with intimate partner violence during pregnancy: analysis from Pakistan demographic and health survey

BACKGROUND

Intimate partner violence (IPV) is a global social issue and increasingly asks for the attention of policymakers. IPV is one of the main factors that affect the health of pregnant women and their infants during pregnancy and after childbirth; it will not only cause direct harm to women themselves but also reduce women's exclusive breastfeeding (EBF) behavior and pose a threat to newborn health. Existing facts on the association between IPV and EBF in the Pakistani context are negligible and incomplete to an enduring measure of IPV practice. To this effect, the present study aims to investigate the relationship between EBF and IPV practiced during the prenatal period and post-delivery.

METHODS

The statistics study has drawn from the Pakistan Demographic and Health Survey (PDHS) 2018. A total of 1191 breastfeeding females aged 15-49 with children under 6 months were selected for the present study. T-test or chi-square test of Univariate test of hypothesis; Logistic regression model was utilized to explore the potential impact of IPV on female exclusive breastfeeding from three dimensions of physical, sexual and psychological violence, to provide data support for the Pakistani government to formulate policies to promote female EBF. All investigations have been performed in STATA software 16.0 (Stata Corp, College Station, TX, USA) at 95% confidence interval.

RESULTS

Among the 1191 participants, 43.6% (520 / 1191) of the females were EBF, while the rates of physical, sexual, and emotional IPV were 47.44%, 30.23%, and 51.72%, respectively. Logistic regression analysis showed that females who have experienced physical IPV were 32% less likely to be exclusively breastfed (aOR = 0.68; 95% CI; 0.490, 0.980; P < 0.05), the chances of EBF were reduced by 22% in women who experienced IPV (aOR = 0.78; 95 CI; 0.55, 1.00; P < 0.05), females who experienced emotional IPV were 31% less probable to exclusively breastfed (aOR = 0.69; 95% CI; 0.47, 0.92; P < 0.05).

CONCLUSIONS

This study determines the adverse effects of sexual and psychological violence on EBF practices in women. Policymakers in Pakistan should actively implement assistance programs to reduce IPV, emphasize monitoring women's experiences of IPV before and after giving birth, and encourage women to break the "culture of silence" when they experience IPV to maximize their access to assistance.