Interventions for women who report domestic violence during and after pregnancy in low- and middle-income countries: a systematic literature review

Abstract

Background: Domestic violence is a leading cause of social morbidity and may increase during and after pregnancy. In high-income countries screening, referral and management interventions are available as part of standard maternity care. Such practice is not routine in low-and middle-income countries (LMIC) where the burden of social morbidity is high. Methods: We systematically reviewed available evidence describing the types of interventions, and/or the effectiveness of such interventions for women who report domestic violence during and/or after pregnancy, living in LMIC. Published and grey literature describing interventions for, and/or effectiveness of such interventions for women who report domestic violence during and/or after pregnancy, living in LMIC was reviewed. Outcomes assessed were (i) reduction in the frequency and/or severity of domestic violence, and/or (ii) improved physical, psychological and/or social health. Narrative analysis was conducted. Results: After screening 4818 articles, six studies were identified for inclusion. All included studies assessed women (n = 894) during pregnancy. Five studies reported on supportive counselling; one study implemented an intervention consisting of routine screening for domestic violence and supported referrals for women who required this. Two studies evaluated the effectiveness of the interventions on domestic violence with statistically significant decreases in the occurrence of domestic violence following counselling interventions (488 women included). There was a statistically significant increase in family support following counselling in one study (72 women included). There was some evidence of improvement in quality of life, increased use of safety behaviours, improved family and social support, increased access to community resources, increased use of referral services and reduced maternal depression. Overall evidence was of low to moderate quality. Conclusions: Screening, referral and supportive counselling is likely to benefit women living in LMIC who experience domestic violence. Larger-scale, high-quality research is, however, required to provide further evidence for the effectiveness of interventions. Improved availability with evaluation of interventions that are likely to be effective is necessary to inform policy, programme decisions and resource allocation for maternal healthcare in LMIC. Trial registration: Systematic review registration number: PROSPERO CRD42018087713.

Adverse Childhood Experiences and Implications of Perceived Stress, Anxiety, and Cortisol Among Women in Pakistan

“…In LMIC, home violence in the form of interpersonal violence is particularly common, which is also re ected in our sample (51,52). Home violence was the only domain that signi cantly predicted cortisol, possibly because it is linked to consequences that are emotional in nature: isolation, fear, guilt, low self-esteem (53).…”

Violence and adversity among pregnant women and new mothers in central Vietnam

“…A search of the literature revealed most studies have been produced through North-North collaboration (e.g., US., UK, Europe, Canada), while LMICs are battling both a higher burden of violence and resource scarcity for effective interventions (Sapkota et al, 2019). To date, there has been little discussion about the detrimental effects of p-IPV from the South-South collaboration (Daley et al, 2020). Thus, this project provides an important opportunity to advance the comparative understanding of the difference of marital relationships and family functions between developed and less developed countries, and bridge the research gaps between East and West, providing a complement to global violence literature.…”

“…Thus, one of the critical issues is to develop or adapt instruments/indicators to reflect the 'latent trait' being assessed, which refers to the field of psychometric properties (i.e., reliability and validity). A recent systematic review of six interventions confirmed that screening, referral, and supportive counselling services are beneficial for abused women during pregnancy and after childbirth in LMICs (Daley et al, 2020). However, many barriers to IPV screening during antenatal check-ups have been documented, including low perception of the need to screen, feelings of distress, and difficulty disclosing (Duchesne et al, 2021).…”

“…While ample evidence highlights the important role of mental disorder (e.g. depression) screening during antenatal care (Accortt & Wong, 2017;Daley et al, 2020;Duchesne et al, 2021;O'Connor et al, 2016), how to minimise maternal distress during clinical interviews for investigating maternal mental disorder and various forms of p-IPV remains uncertain (Barney et al, 2009;Rössler, 2016). Some studies have suggested a "gold standard" method to improve rapport and open disclosure, including one on one interviews in a private place where participants can be asked about specific experiences of violent acts (Abbe & Brandon, 2013;Ruiz-Pérez et al, 2007;Wright et al, 2021).…”

Partner Violence During Pregnancy: The Role of an Oral and Maxillofacial Surgeon

“…It may first occur or increase in frequency during the course of a pregnancy. 3 Universal screening efforts of traumatic injuries in emergency departments for partner violence have been recommended to maximize identification of survivors. 1 As experts on the maxillofacial region, oral and maxillofacial surgeons (OMSs) can play a prominent role in ensuring adequate screening and identification of partner violence in pregnant patients.…”