Maternal morbidity associated with violence and maltreatment from husbands and in-laws: findings from Indian slum communities

Abstract

BackgroundIntimate partner violence (IPV) victimization is linked to a broad range of negative maternal health outcomes. However, it is unclear whether IPV is directly related to poor maternal outcomes or whether IPV is a marker for other forms of chronic, mundane maltreatment of women that stem from the culture of gender inequity that also gives rise to IPV. To determine the prevalence of non-violent forms of gender-based household maltreatment by husbands and in-laws (GBHM), and violence from in-laws (ILV) and husbands (IPV) against women during the peripregnancy period (during and in the year prior to pregnancy); to assess relative associations of GBHM, ILV and IPV with maternal health.MethodsCross-sectional data were collected from women <6 months postpartum (n = 1,039, ages 15-35 years) seeking child immunization in Mumbai, India. Associations of IPV, ILV and GBHM during the peripregnancy period with maternal health (prenatal care in first trimester, no weight gain, pain during intercourse, high blood pressure, vaginal bleeding, premature rupture of membranes, premature birth) were evaluated.ResultsOne in three women (34.0 %) reported IPV, 4.8 % reported ILV, and 48.5 % reported GBHM during the peripregnancy period. After adjusting for other forms of abuse, IPV related to pain during intercourse (AOR = 1.79); ILV related to not receiving first trimester antenatal care (AOR = 0.49), and GBHM remained associated with premature rupture of membranes (AOR = 2.28), pain during intercourse (AOR = 1.60), and vaginal bleeding (AOR = 1.80).ConclusionAfter adjusting for ILV and IPV, peripregnancy GBHM remained significantly associated with multiple forms of maternal morbidity, suggesting that GBHM is a prevalent and reliable indicator of maternal health risk.

Intimate partner violence and perinatal health: a systematic review

“…Seven studies with high methodological quality included outcomes of premature rupture of membranes . Two found an association with undifferentiated IPV, five with physical IPV, and two others with psychological IPV . The risk was between 1.9 and 5.1 times higher in women exposed to physical IPV, 3.2 times higher in women exposed to undifferentiated IPV and between 1.5 and 1.6 times higher in women exposed to psychological IPV.…”

“…Forty-one studies (82%, n = 41) were of high methodological quality (indicating low risk of bias) ( Table 2). [18][19][20][21][22][23][24][25][26]28,29,[31][32][33][34][35][36][37][38][39][40][41]43,[46][47][48][49][51][52][53][56][57][58][59][60][61][62][63][65][66][67] Most of the studies with high or moderate risk of bias obtained low scores in sample selection 30,45,50,54,55,64 or comparability. 27,45,50,…”

Intimate partner violence and severe maternal morbidity among pregnant and postpartum women in São Paulo, Brazil

“…The unfavorable characteristics and living conditions of the pregnant women subjected to IPV can be seen from the perspective of gender analysis [36][37][38][39] . When deprived of the autonomy to fully exercise their social functions, such as access to education, paid jobs, health services and other public policies of social support, women in general submit themselves to a hierarchy of male power that is socially and culturally constituted in many societies, and in particular, in countries with low indicators of human and social development 1 .…”

“…IPV and severe maternal morbidity are configured as issues of gender and human rights and should be seen as such in the field of public policies concerning health care 25,38,40 . Both the events imply that there is a need to implement institutional changes to make IPV more visible, as well as to adopt new practices to improve obstetrical care based on continuously monitoring pregnant and postpartum women who develop potentially life-threatening conditions 1,25,35,38,40 . Therefore, we propose routine screening for IPV among pregnant women so that victims of violence are included in network care programmers, e.g.…”

“…The systematic monitoring of severe maternal morbidity through indicators of potentially life-threatening maternal conditions is also suggested as an important strategy to understand their determining factors and to intervene in them in a timely manner. The development of improved care technologies can significantly reduce maternal morbidity 38,[40][41][42] . Finally, this study's results support a deeper analysis of the phenomena of IPV and severe maternal morbidity as a priority to qualify the integral health care provided to women.…”