Stressful events among pregnant Salvadoran women: a cross-cultural comparison

Abuse During Pregnancy in Industrialized and Developing Countries

Abuse during pregnancy has increasingly been identified as an important problem with significant consequences for maternal and infant health, particularly in North America. The authors review available evidence of the prevalence and consequences of abuse during pregnancy, including maternal mortality, outside of North America. The range of prevalence found in developing countries is much wider (3.8% to 31.7%) than that of industrialized countries (3.4% to 11%), which is much closer to findings from North America. There is a need for more studies using consistent definitions and methodologies to examine the patterns and forms of abuse related to pregnancy worldwide.

Correlates of high perceived stress among pregnant Hispanic women in Western Massachusetts

Prenatal psychosocial stress has been associated with adverse pregnancy outcomes, even after controlling for known risk factors. This paper aims to evaluate correlates of high perceived stress among Hispanic women, a group with elevated rates of stress during pregnancy. We conducted this analysis among 1,426 pregnant Hispanic women using data from Proyecto Buena Salud, a prospective cohort study conducted in Western Massachusetts. Cohen's Perceived Stress Scale (PSS-14) validated in English and Spanish was administered in early (mean = 12.4 weeks gestation), mid (mean = 21.3 weeks gestation) and late (mean = 30.8 weeks gestation) pregnancy at which time bilingual interviewers collected data on socio-demographic, acculturation, behavioral, and psychosocial factors. High perceived stress was defined as a PSS score >30. Young maternal age (odds ratio (OR) = 0.6; 95 % confidence interval (CI) 0.4-0.9 for <19 vs. 19-23 years), pre-pregnancy consumption of alcohol (OR = 2.2; 95 % CI 1.4-3.5 for >12 drinks/month vs. none) and smoking (OR = 2.2; 95 % CI 1.3-3.7 for >10 cigarettes/day vs. none) were associated with high perceived stress during early pregnancy. Furthermore, higher annual household income (OR = 0.4; 95 % CI 0.1-0.9 for >$30,000 vs. <$15,000), greater number of adults in the household (OR = 1.8; 95 % CI 1.1-3.0 for ≥3 vs. 1) and language preference (OR = 0.6; 95 % CI 0.4-0.9 for Spanish vs. English) were associated with high stress during mid-pregnancy. Likewise, annual household income was inversely associated with high stress during late pregnancy. Our results have important implications for incorporation of routine screening for psychosocial stress during prenatal visits and implementation of psychosocial counseling services for women at high risk.

Influences of Income, Education, Age, and Ethnicity on Physical Abuse Before and During Pregnancy

OBJECTIVE

To examine the influence of socioeconomic status, education, ethnicity, and age on the prevalence of intimate partner abuse before and during pregnancy.

DESIGN

Retrospective correlational analysis.

SETTING

Data were collected at six postpartum maternity settings.

PARTICIPANTS

1,004 women from six ethnic groups.

MAIN OUTCOME MEASURE

Prevalence of intimate partner violence.

RESULTS

15.9% of study participants reported physical abuse by their current partner and 5.2% reported abuse during pregnancy. Decreased income, not having a high school education, and ethnicity were significantly related to current abuse and abuse during pregnancy in bivariate analyses. Having less than a high school education emerged as the most significant predictor of both abuse variables in multivariate analyses. African American and Puerto Rican women had the highest incidence of abuse in their current relationship. No significant differences were found in rates of abuse during pregnancy among women from different ethnic groups.

CONCLUSIONS

The results of this analysis support the notion that abuse is most prevalent among the most disadvantaged women. However, it is not income per se, but rather the highly related variables of education and ethnicity that have the largest effect. Abuse occurs frequently among all women, warranting universal screening during health care encounters. Further research is needed to evaluate relationships between education, ethnicity, income, and abuse.

Risks for abuse against pregnant Hispanic women: Morelos, Mexico and Los Angeles County, California

BACKGROUND

Although violence against women is gaining international attention as a prevention priority, little is known about how risks differ across countries.

METHODS

A comparative study of violence against pregnant Mexican women in Morelos, Mexico, and Latina women in Los Angeles County, California, United States. In 1998 and 1999, women in prenatal clinics were interviewed about psychological abuse and sexual and physical violence by their partner, during and the 1 year prior to the index pregnancy. The overall response rate for Morelos was 99%, with a sample size of 914; Los Angeles County had a response rate of 96.9%, with a sample size of 219.

RESULTS

Women in Morelos reported a higher prevalence of violence compared to women in the California (14.8% v 11.9%, respectively). A partner aged <20 years was associated with increased violence in both countries, but the association of violence with other socioeconomic factors differed by country. For example, employed women had higher odds of violence in California but lower odds in Morelos. Women who experienced violence during both the year prior to pregnancy and as a child were more than 25 times more likely to be abused during pregnancy than women not reporting this type of abuse.

CONCLUSION

The identification of factors associated with violence against women, especially as they differ by culture and ethnicity, will help clinicians to better identify victims and to design and implement culturally appropriate prevention programs.

Correlates of experiencing life events just before or during pregnancy

This study evaluates the prevalence of selected life events around the time of pregnancy, examining changes in the prevalence of these events, and identifying maternal characteristics associated with these events. We used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) to examine 18 stressful life events among women who recently gave birth and to identify maternal characteristics associated with these events. PRAMS is a mail sample survey with telephone follow-up for non-respondents. Sixty-four percent of women experienced at least one event. The prevalence of specific events ranged from 0.4 to 30%. Women who experienced events differed from those who did not. Most notably, women of low socioeconomic status (SES) were much more likely to experience stressful life events. These events were also associated with other demographic and behavioral characteristics after controlling for SES. These results have implications for interpreting studies of stressful life events. The strong associations with SES highlight the importance of controlling for SES in studies of life events and health, and of considering differences in SES when interpreting these studies.

[Research on violence against women in Latin America: from blind empiricism to theory without data]

Research on violence against women in Latin America presents an interesting paradox: while the number of studies is quite small, there also appears to be a sense that research on this topic has been exhausted, despite the lack of any definitive responses to the nature and causes of the problem. This results from the boom in studies with a strong empirical focus, lacking any basis in more general sociological theory. On the other hand, research using social theory tends to ignore the existing mediations between structural arrangements and any individual specific behavior, as well as the interactive nature of domestic violence. Meanwhile, empirical research presents inconsistent results and tends to run into methodological problems such as operational confusion, contradictory findings, and results and recommendations that are too obvious. New research designs must be developed to enrich the field and which are solidly based on the body of conceptual knowledge in social sciences, abandoning designs without theory and those which are merely statistical. Only then will it be possible to imagine the new research questions that the problem of violence requires.

Culturally appropriate care for pregnant Latina women who are victims of domestic violence

Latina women who are pregnant and experiencing domestic violence face many barriers to accessing care and finding culturally appropriate services. These barriers are entwined in a complex web of social, cultural, economic, political, and legal issues. Leininger's cultural care model is presented as a framework to discuss culturally appropriate assessment of Latina women in various health care settings. Recommendations are made for the role of nurses in primary prevention interventions at the individual and community levels.

Prenatal risk factors among foreign-born Central American women: a comparative study

The purpose of this study was to compare the incidence of empirically established prenatal risk factors for low birthweight (LBW) outcomes among two groups of low-income mothers: foreign-born Central American women and nonimmigrant, non-Hispanic women. Two hundred ninety-six women who were part of a larger study of maternal role sufficiency were included in the present study: 127 Central American women and 169 nonimmigrant, non-Hispanic women who identified themselves as Black (n = 59) or White (n = 110). Data were collected by public health nurses (PHNs) during home visits and by research nurses in prenatal health department clinics. Comparisons were made between the two groups in areas of demographic characteristics, prenatal health behaviors, and prenatal stressful life-events. Foreign-born Central American mothers were found to be less educated, more likely to be living with their partners, less likely to engage in prenatal health risk behaviors, and less likely to identify stressors in their lives. The initiation of prenatal PHN services by the target group was similar to the comparison group. Their rate of LBW deliveries did not reflect the protective effect often attributed to foreign-born Hispanic mothers. Findings are discussed in light of the paradox of LBW and Hispanic heritage. Recommendations for practice, clinical research, and public policy are also addressed.