Domestic violence, food insecurity and mental health of pregnant women in the COVID-19 lockdown in Cape Town, South Africa

Abstract

Introduction Common mental disorders (CMD) such as depression and anxiety are associated with low household income, food insecurity and intimate partner violence in perinatal women. The national COVID-19 lockdown in South Africa resulted in increased levels of poverty and food insecurity. We aimed to explore the relationship between CMDs, food insecurity and experiences of violence among pregnant women during the COVID-19 lockdown.Methods Perinatal women, attending 14 healthcare facilities in Cape Town, were enrolled in the study during baseline data collection before the COVID-19 lockdown. During the lockdown period, fieldworkers telephonically contacted the perinatal women who were enrolled in the study and had provided contact details. The following data was collected from those who consented to the study: socio-demographic information, mental health assessment, food insecurity status and experiences of abuse. Poisson regression was used to model the associations of a number of risk factors with the occurrence of CMDs.Results Of the 2149 women enrolled in the ASSET study, 885 consented to the telephonic interviews. We found that 12.5% of women had probable CMDs and 43% were severely food insecure. Psychological distress increased significantly during the lockdown period, compared to before the COVID-19 outbreak. The strength of the association between key risk factors measured during the lockdown and psychological distress increased during the COVID-19 lockdown. Using multivariate Poisson regression modelling, we showed that the risk of CMDs was almost three times more likely in women who were severely food insecure or who experienced psychological or sexual abuse. Conclusions This study provides evidence of the effect of the COVID-19 lockdown on the mental health status of perinatal women living in low resource settings in Cape Town, and highlights how a crisis such as the COVID-19 lockdown amplifies the psycho-social risk factors associated with CMDs in perinatal women.

The impact of COVID-19 lockdowns on physical domestic violence: Evidence from a list randomization experiment

“…Due to the nature of attrition in the sample, and the relatively higher probability of those with a previous history of violence being omitted from the final sample (see Appendix A ), this is likely to reflect a lower bound of the increase in violence. This estimate would represent a greater increase in violence than that reported in phone surveys conducted in South Africa, Bangladesh and Kenya during the pandemic (see Abrahams et al, 2020 ; Egger et al, 2021 ; Hamadani et al, 2020 ), However, due to differences in methodology (LE, as opposed to direct questions), our focus on physical violence only (as opposed to a broader definition) and differences in the population of interest (males and female, as opposed to women only), results may not be directly comparable. Second, while the pre-pandemic levels of violence are shown to be higher for females in our sample, our results indicate no significant difference in the probability of increased violence occurring during the pandemic between females and males.…”

“…Only three surveys in low- and middle-income countries, to our knowledge, have used direct questions in a quantitative phone survey to measure domestic violence during the COVID-19 lockdowns. Hamadani et al (2020) find that 6.5% of mothers enrolled in a child iron supplement program report an increase in physical violence in Bangladesh, while Abrahams, Boisits, Schneider, Prince, and Lund (2020) find that levels of domestic violence (physical, psychological and sexual) increased among pregnant women in Cape Town (by approximately 3%). In rural Kenya, Egger et al (2021) also estimate a 4% increase in domestic violence (defined similarly) experienced by women during the pandemic, although this result was not statistically significant.…”

Food insecurity and its socioeconomic and health determinants in pregnant women and mothers of children under 2 years of age, during the COVID-19 pandemic: A systematic review and meta-analysis

“…The publications date from 2020 to 2022, with six cross-sectional articles ( 14 – 19 ) and four longitudinal articles ( 20 – 23 ). The studies were developed in different continents: America ( 14 , 16 – 19 , 23 ); Africa ( 14 ); Asia ( 15 , 21 , 22 ).…”

Exploring Factors Associated with Pregnant Womxn’s Experiences of Material Hardship during COVID-19

“…Perhaps the most signi cant contribution that this study makes to the COVID-19 literature is the inclusion of economic abuse as part of measurement of intimate partner violence. Although researchers have highlighted the increase in intimate partner violence that has emerged as part of the COVID-19, both in the general population [49,51] and among pregnant women speci cally [52,53]. To the author's knowledge none of these studies included economic abuse.…”

“…Naghizadeh and colleagues found one-third of their sample of 250 pregnant women seeking services at an obstetrics clinic in Iran reported experiencing intimate partner violence and those who had experienced abuse reported lower mental health quality of life [52]. Similarly, a study of 885 pregnant women in South Africa found approximately 12% of women t the criteria to be classi ed as having probable common mental health disorders; a higher percentage of these women reported anxiety about being infected with COVID, were severely food insecure during the lockdown and had experienced either psychological, physical, or sexual abuse by an intimate partner [53].…”