Associations between intimate partner violence and reproductive and maternal health outcomes in Bihar, India: a cross-sectional study.
ABSTRACT: BACKGROUND:Bihar, India has higher rates of intimate partner violence (IPV) and maternal and infant mortality relative to India as a whole. This study assesses whether IPV is associated with poor reproductive and maternal health outcomes, as well as whether poverty exacerbates any observed associations, among women who gave birth in the preceding 23 months in Bihar, India. METHODS:A cross-sectional analysis of data from a representative household sample of mothers of children 0-23 months old in Bihar, India (N = 13,803) was conducted. Associations between lifetime IPV (physical and/or sexual violence) and poor reproductive health outcomes ever (miscarriage, stillbirth, and abortion) as well as maternal complications for the index pregnancy (early and/or prolonged labor complications, other complications during pregnancy or delivery) were assessed using multivariable logistic regression, adjusting for demographics and fertility history of the mother. Models were then stratified by wealth index to determine whether observed associations were stronger for poorer versus wealthier women. RESULTS:IPV was reported by 45% of women in the sample. A history of miscarriage, stillbirth, and abortion was reported by 8.7, 4.6, and 1.3% of the sample, respectively. More than one in 10 women (10.7%) reported labor complications during the last pregnancy, and 16.3% reported other complications during pregnancy or delivery. Adjusted regressions revealed significant associations between IPV and miscarriage (AOR = 1.35, 95% CI = 1.11-1.65) and stillbirth (AOR = 1.36, 95% CI = 1.02-1.82) ever, as well as with labor complications (AOR = 1.27, 95% CI = 1.04-1.54) and other pregnancy/delivery complications (AOR = 1.68, 95% CI = 1.42-1.99). Women in the poorest quartile (Quartile 1) saw no associations between IPV and miscarriage (Quartile 1 AOR = 0.98, 95% CI = 0.67-1.45) or stillbirth (Quartile 1 AOR = 1.17, 95% CI = 0.69-1.98), whereas women in the higher wealth quartile (Quartile 3) did see associations between IPV and miscarriage (Quartile 3 AOR = 1.55, 95% CI = 1.07, 2.25) and stillbirth (Quartile 3 AOR = 1.79, 95% CI = 1.04, 3.08). DISCUSSION:IPV is highly prevalent in Bihar and is associated with increased risk for miscarriage, stillbirth, and maternal health complications. Associations between IPV and miscarriage and stillbirth do not hold true for the poorest women, possibly because other risks attached to poverty and deprivation may be greater contributors.
Project description:OBJECTIVES:To assess the rate of stillbirth and associated risk factors across nine states in India. DESIGN:Secondary analysis of cross-sectional data from the Indian Annual Health Survey (2010-2013). SETTING:Nine states in India: Madhya Pradesh, Chhattisgarh, Rajasthan, Uttarakhand, Jharkhand, Odisha, Bihar, Assam and Uttar Pradesh. PARTICIPANTS:886?505 women, aged 15-49 years. MAIN OUTCOME MEASURES:Stillbirth rate with 95% CI. Adjusted OR to examine the associations between stillbirth and (1) socioeconomic, behavioural and biodemographic risk factors and (2) complications in pregnancy (anaemia, eclampsia, other hypertensive disorders, antepartum and intrapartum haemorrhage, obstructed labour, breech presentation, abnormal fetal position). RESULTS:The overall rate of stillbirth was 10 per 1000 total births (95%?CI 9.8 to 10.3). Indicators of socioeconomic deprivation were strongly associated with an increase in stillbirth: rural residence (adjusted OR (aOR) 1.27, 95%?CI 1.16 to 1.39), female illiteracy (aOR 1.43, 95%?CI 1.17 to 1.74), low socioeconomic status (aOR 2.42, 95%?CI 1.82 to 3.21), schedule caste background (aOR 1.11, 95%?CI 1.04 to 1.19) and woman not in paid employment (aOR 1.15, 95%?CI 1.07 to 1.24). Women from minority religious groups were at higher risk than the Hindu majority (Muslim (aOR 1.33, 95%?CI 1.25 to 1.43); Christian (aOR 1.42, 95%?CI 1.19 to 1.70)). While a few women smoked (<1%), around 9% reported chewing tobacco, which was associated with an increased odds of stillbirth (aOR 1.11, 95%?CI 1.02 to 1.21). Adverse pregnancy and birth characteristics were also associated with stillbirth: antenatal care visits <4 (aOR 1.08, 95%?CI 1.01 to 1.15), maternal age <25 years (aOR 1.29, 95%?CI 1.21 to 1.37) and ?35 years (aOR 1.16, 95%?CI 1.04 to 1.29), multigravida (aOR 3.06, 95%?CI 2.42 to 3.86), multiple pregnancy (aOR 1.77, 95%?CI 1.47 to 2.15), assisted delivery (aOR 3.45, 95%?CI 3.02 to 3.93), caesarean section (aOR 1.73, 95%?CI 1.58 to 1.89), as were pregnancy complications (aOR 1.42, 95%?CI 1.33 to 1.51). CONCLUSION:India is an emerging market economy experiencing a rapid health transition, yet these findings demonstrate the marked disparity in risk of stillbirth by women's socioeconomic status. Tobacco chewing and maternal and fetal complications were each found to be important modifiable risk factors. Targeting the 'at-risk' population identified here, improved recording of stillbirths and the introduction of local reviews would be important steps to reduce the high burden of stillbirths in India.
Project description:BACKGROUND:Objectives were to assess associations between intimate partner violence (IPV), violence during armed conflict (i.e. crisis violence), and probable post-traumatic stress disorder (PTSD). METHODS:Using a sample of 950 women in rural Côte d'Ivoire, logistic generalized estimating equations assessed associations between IPV and crisis violence exposures with past-week probable PTSD. RESULTS:Over one in 5 (23.4%) women reported past-year IPV, and over one in 4 women (26.5%) reported experiencing IPV prior to the past year (i.e. remote IPV). Crisis violence was experienced by 72.6% of women. In adjusted models including demographics, crisis violence (overall and specific forms), and IPV (remote and past-year), women who reported past-year IPV had 3.1 times the odds of reporting probable past-week PTSD (95%CI: 1.8-5.3) and those who reported remote IPV had 1.6 times the odds (95%CI: 0.9-2.7). Violent exposures during the crisis were not significantly associated with probable PTSD (any crisis violence: aOR: 1.04 (0.7-1.5); displacement: aOR: 0.9 (95%CI: 0.5-1.7); family victimization during crisis: aOR: 1.1 (95%CI: 0.8-1.7); personal victimization during crisis: aOR: 1.7 (95%CI: 0.7-3.7)). CONCLUSION:Past-year IPV was more strongly associated with past-week probable PTSD than remote IPV and violence directly related to the crisis. IPV must be considered within humanitarian mental health and psychosocial programming.
Project description:BACKGROUND: A substantial reduction in neonatal deaths is required in India to meet the Millennium Development Goal of a two-thirds reduction in child mortality by 2015. We report neonatal mortality estimates and utilisation of maternal care in the Indian state of Bihar. METHODS: A representative population-based sample of 14,293 women who had a live birth in the last 12 months based on multistage sampling from all 38 districts of Bihar was selected for interview in early 2012. We estimated neonatal mortality rate and its associations using multiple logistic regression, assessed maternal care coverage and its inequality by wealth index, and retention of mothers in the health system for the full sequence of maternal care services. RESULTS: Neonatal mortality rate for Bihar was 32.2 (95% confidence interval [CI] 27.6-36.8) per 1,000 live births. Postnatal care related variables were significantly associated with neonatal deaths - no delayed bathing of new born (odds ratio [OR] 3.45, 95% CI 2.47-4.81) and no kangaroo care immediately after birth (OR 2.20, 95% CI 1.49-3.25). History of maternal complications and delivery in a private sector health facility had nearly twice the odds of neonatal death; the latter was driven by the very high neonatal mortality associated with private facility delivery in the lower two wealth index quartiles. A pattern of mass deprivation was seen for coverage of 4 or more ANC visits, health facility delivery and postnatal care for the same woman, with only 5.2% of women receiving this overall; this coverage was low for the highest wealth index quartile as well at 12.2%. Coverage of 4 or more ANC visits was 7.4% and 27.7% in the lowest and the highest wealth quartiles, respectively. Giving birth in a health facility was reported by 49.5% of women in the lowest wealth index quartile and by 77.7% in the highest quartile. Only 21.2% women reported post-natal care within 2 weeks of delivery in the lowest wealth index quartile, and 42.2% in the highest quartile. CONCLUSIONS: Neonatal mortality continues to be relatively high in Bihar, and the utilization of maternal care very low and inequitable. Interventions need to address these deficiencies.
Project description:Background: Violence against women is a global public health problem. A better understanding of risk factors for intimate partner violence (IPV) exposure during pregnancy is important to develop interventions for supporting women being exposed to IPV. Objective: The purpose of this study was to measure the prevalence of IPV during pregnancy and analyse how social support and various risk factors are associated with IPV. Methods: A cross-sectional study conducted among 1309 pregnant women in Dong Anh district, Vietnam. Information about socio-economic conditions and previous exposure to IPV was collected when women attended antenatal care before the 24th gestational week. Information about social support information and exposure to IPV during pregnancy was collected in the 30th-34th gestational week. Multivariable regression was used to identify associations between IPV, social support and other potential risk factors. Results: The prevalence of IPV exposure during pregnancy was 35.2% (Emotional violence: 32.2%; physical violence: 3.5% and sexual violence: 9.9%). There was a statistically significant association between previous IPV exposure, lack of social support and IPV exposure during pregnancy. After adjustment for socioeconomic characteristics, pregnant women who had previously been exposed to IPV were more likely to be exposed IPV at least one time (AOR = 6.3; 95% CI: 4.9-8.2) as well as multiple times (AOR = 6.0; 95% CI: 4.5-8.0). Similarly, pregnant women having a lack of social support had a higher likelihood of being exposed to IPV at least one time (AOR = 3.1; 95% CI: 2.4-3.9) or multiple times (AOR = 2.9; 95% CI: 2.2-3.8). Conclusion: IPV is relatively high during pregnancy in Vietnam. Previous exposure to IPV and lack of social support is associated with increased risk of violence exposure among pregnant women in Vietnam.
Project description:Importance:The US Preventive Services Task Force recently determined that there is insufficient evidence to recommend routine screening for intimate partner violence (IPV) in women who are middle-aged and older. Certain Veterans Health Administration (VHA) clinics have been routinely screening women of all ages for IPV since 2014. Objectives:To examine the proportion of women older than childbearing age (ie, ?45 years) who have positive results when routinely screened for past-year IPV at VHA clinics and to evaluate the associations of a positive screening result with health conditions and health service utilization. Design, Setting, and Participants:This cohort study included 4481 women aged 45 years and older who were screened for past-year IPV in 13 VHA outpatient clinics in 11 states between April 2014 and April 2016. Data analysis was conducted from March 2019 to August 2019. Exposure:Positive screening result for past-year IPV. Main Outcomes and Measures:Mental and physical health conditions (identified using International Classification of Diseases, Ninth Edition [ICD-9] and ICD-10 codes from VHA medical record data) and VHA health services utilization (identified using inpatient and outpatient VHA encounter data) in the 20 months after screening. Results:In this study, 2937 of 4481 women (65.5%) were middle-aged (ie, aged 45 to 59 years), and 1544 (34.5%) were older (ie, aged ?60 years), with 1955 (43.6%) black participants. A total of 255 middle-aged women (8.7%; mean [SD] age, 51  years) and 79 older women (5.1%; mean [SD] age, 64  years) screened positive for past-year IPV. In adjusted logistic regression models among middle-aged women, screening positive for IPV was associated with subsequent diagnoses of anxiety (adjusted odds ratio [aOR], 2.00; 95% CI, 1.50-2.70; P?<?.001), depression (aOR, 2.30; 95% CI, 1.80-3.00; P?<?.001), posttraumatic stress disorder (aOR, 2.30; 95% CI, 1.80-3.00; P?<?.001), suicidal ideation and/or behavior (aOR, 3.80; 95% CI, 2.10-6.90; P?<?.001), and substance use disorder (aOR, 2.50; 95% CI, 1.80-3.50; P?<?.001). Similar but attenuated associations were seen for older women (eg, substance use disorder: aOR, 2.20; 95% CI, 1.10-4.40; P?=?.04). In adjusted negative binomial regression models among middle-aged women, screening positive for IPV was associated with a higher rate of subsequent psychosocial (eg, mental health) visits (adjusted rate ratio [aRR], 2.40; 95% CI, 2.00-2.90; P?<?.001), primary care visits (aRR, 1.20; 95% CI, 1.10-1.30; P?<?.001), and emergency department visits (aRR, 1.50; 95% CI 1.20-1.80; P?<?.001). Older women screening positive for IPV had a higher rate of psychosocial visits (aRR, 1.90; 95% CI, 1.30-2.70; P?<?.001) but not of other visit types. Conclusions and Relevance:To our knowledge, this study was the largest to evaluate routine screening for IPV among women aged 45 years and older, and it found that IPV remained prevalent and was associated with morbidity for these women. Screening for IPV in women older than 44 years may improve detection and provision of evidence-based services to this growing population.
Project description:OBJECTIVES:This study aimed to measure the prevalence and associated factors of Intimate Partner Violence (IPV) among women living with and without HIV in Wolaita Zone, Southern Ethiopia. METHODS:A comparative cross-sectional study design was used to interview the 816 women between 18-49 years of age (408 = HIV positive, 408 = HIV negative). Using a multistage sampling technique, participants were recruited from nine health facilities based on probability proportional to the number of clients. After data entry (EpiData version 184.108.40.206) the data were exported to STATA/SE 15 software. Binary and multivariable logistic regression analysis were undertaken and the odds ratio (OR) and 95% confidence interval (CI) are presented. RESULTS:The lifetime prevalence of IPV among all women was 59.7%, [95% CI: 56.31%-63.05%]. IPV was slightly higher among women living with HIV, 250(61.3%), than those who were HIV negative, 238(58.1%). Lifetime prevalence of emotional violence 413(50.6%), physical violence 349(42.8%), sexual violence 219(26.8%), and controlling behaviours by husbands/partners 489(59.9%) were reported. Associations were found between IPV and controlling behaviour of husband/partner [AOR = 8.13; 95% CI: 4.93-13.42],income [AOR = 3.97; 95% CI:1.81-8.72], bride price payment [AOR = 3.46; 95% CI:1.74-6.87], women's decision to refuse sex [AOR = 2.99; 95% CI: 1.39-6.41],age group of women [AOR = 2.86; 95% CI:1.67-4.90], partner's family choosing wife [AOR = 2.83; 95% CI:1.70-4.69], alcohol consumption by partner [AOR = 2.36;95% CI:1.36-4.10], number of sexual partners [AOR = 2.35; 95% CI:1.36-4.09], and if partner ever physically fought with another man [AOR = 1.83; 95% CI:1.05-3.19]. CONCLUSIONS:There is a high prevalence of IPV against women both living with and without HIV. Policy priorities should therefore involve males in programs of gender-based violence prevention in order to change their violent behaviour, and interventions are required to improve the economic status of women. Both sexes should be advised to have a single partner and marriage arrangements should be by mutual consent rather than being made by parents.
Project description:To examine the associations of Intimate partner violence (IPV) with stress-related sleep disturbance (measured using the Ford Insomnia Response to Stress Test [FIRST]) and poor sleep quality (measured using the Pittsburgh Sleep Quality Index [PSQI]) during early pregnancy.This cross-sectional study included 634 pregnant Peruvian women. In-person interviews were conducted in early pregnancy to collect information regarding IPV history, and sleep traits. Adjusted odds ratios (aOR) and 95% confidence intervals (95%CIs) were calculated using logistic regression procedures.Lifetime IPV was associated with a 1.54-fold increased odds of stress-related sleep disturbance (95% CI: 1.08-2.17) and a 1.93-fold increased odds of poor sleep quality (95% CI: 1.33-2.81). Compared with women experiencing no IPV during lifetime, the aOR (95% CI) for stress-related sleep disturbance associated with each type of IPV were: physical abuse only 1.24 (95% CI: 0.84-1.83), sexual abuse only 3.44 (95%CI: 1.07-11.05), and physical and sexual abuse 2.51 (95% CI: 1.27-4.96). The corresponding aORs (95% CI) for poor sleep quality were: 1.72 (95% CI: 1.13-2.61), 2.82 (95% CI: 0.99-8.03), and 2.50 (95% CI: 1.30-4.81), respectively. Women reporting any IPV in the year prior to pregnancy had increased odds of stress-related sleep disturbance (aOR = 2.07; 95% CI: 1.17-3.67) and poor sleep quality (aOR = 2.27; 95% CI: 1.30-3.97) during pregnancy.Lifetime and prevalent IPV exposures are associated with stress-related sleep disturbance and poor sleep quality during pregnancy. Our findings suggest that sleep disturbances may be important mechanisms that underlie the lasting adverse effects of IPV on maternal and perinatal health.
Project description:INTRODUCTION:Intimate partner violence (IPV) is regarded an important public health and human rights issue, characterized by physical, sexual or emotional abuse. Globally more than one in three women report physical or sexual violence by their intimate partners. Though the association between IPV and depression is known, we found no study investigating depression as a risk factor for IPV and very few studies using standard tools in assessing both IPV and depression among pregnant women. AIM:To measure the prevalence of IPV and depression during pregnancy and assess the association between IPV and depression and other determinants. METHODS:A community-based cross-sectional study was conducted among 589 pregnant women living in Wondo-Genet district, southern Ethiopia. IPV experience was assessed using a structured questionnaire of the World Health Organization (WHO), and maternal depression was measured by the Edinburgh Postnatal Depression Scale (EPDS). Descriptive statistics were computed and multivariable logistic regression was carried out to estimate risk and adjust for confounders. RESULTS:The overall prevalence of IPV was 21% (95% confidence interval [CI] = 18.1-24.7). After adjusting for potential confounders, increased risk of IPV remained among rural women (adjusted odds ratio[AOR] = 2.09; 95%CI = 1.06-4.09), women who had parental exposure to IPV (AOR = 14.00; 95%CI = 6.43-30.48), women whose pregnancy was not desired (AOR = 9.64; 95%CI = 3.44-27.03), women whose husbands used alcohol (AOR = 17.08; 95%CI = 3.83-76.19), women with depression (AOR = 4.71; 95%CI = 1.37-16.18) and women with low social support (AOR = 13.93; 95%CI = 6.98-27.77). The prevalence of antenatal depressive symptom (with EPDS score above 13) was 6.8% (95% CI 6.2-11.3). Increased risk of depression was found among women who had been exposed to IPV (AOR = 17.60; 95%CI = 6.18-50.10) and whose husbands use alcohol (AOR = 3.31; 95%CI = 1.33-8.24). CONCLUSION:One in five pregnant women experienced IPV and it was strongly associated with depression. Screening for IPV and depression at antenatal visits with referral to relevant care and service is recommended.
Project description:BACKGROUND:Hyperhomocysteinemia may be a risk factor for endothelial dysfunction. Folate and vitamin B12 regulate the homocysteine metabolic process. This study aimed to evaluate the associations between subsequent events of adverse pregnancy outcome and early variables of homocysteine, folate, and vitamin B12 in pregnant women. METHODS:This multicenter, retrospective, case-control study involved 563 pregnant women with adverse pregnancy outcome and 600 controls. Adverse pregnancy outcomes included one or more of the following events: preeclampsia, preterm birth, low birth weight, and stillbirth. The associations between subsequent events of adverse pregnancy outcome and early variables of homocysteine, folate, and vitamin B12; metabolic parameters; inflammatory markers; anthropometrics; and lifestyle habits at 11-12?weeks of gestation were analyzed using the logistic regression model. RESULTS:Compared to the lower quartile homocysteine concentrations, the upper quartile homocysteine concentrations were associated with preeclampsia, preterm birth and low birth weight. On the contrary, the lower quartile folate concentrations were associated with preeclampsia, preterm birth and low birth weight compared with the upper quartile folate concentrations. The incidence of adverse pregnancy outcome increased progressively from the first to fourth homocysteine quartiles but decreased progressively from the first to fourth folate quartiles. After adjusting for confounding factors, multivariate logistic regression analysis showed that besides systolic blood pressure, diastolic blood pressure, body mass index and age, homocysteine (IV vs I quartile, aOR 5.89, 95% CI 4.08-8.51, P?<?0.001), folate (IV vs I quartile, aOR 0.35, 95% CI 0.25-0.50, P?<?0.001), folate supplementation (yes vs no, aOR 0.55, 95% CI 0.35-0.86, P?=?0.010) during early pregnancy were independently associated with subsequent events of adverse pregnancy outcome, and vitamin B12 was rejected. Of these, the homocysteine revealed the highest odds ratio in all risk variables, and folate showed the lowest odds ratio in all protective variables. CONCLUSIONS:Higher homocysteine concentration and lower folate level during early pregnancy were associated with adverse pregnancy outcome. However, no association was found between vitamin B12 and adverse pregnancy outcome. Supplementation with folate in early pregnancy may reduce adverse pregnancy outcome.
Project description:Intimate partner violence (IPV) is a public health problem that affects millions of women worldwide and can occur during both pregnancy and the perinatal period. We aimed to evaluate if the experience of psychological and physical intimate partner violence (IPV) adversely affects pregnancy outcomes. We established a cohort of 779 consecutive mothers receiving antenatal care including ultrasound and giving birth in 15 public hospitals, drawn using cluster sampling of all obstetric services in Andalusia, Spain (February-June 2010). Trained midwives gathered IPV data using the Index of Spouse Abuse validated in the Spanish language (score ranges: 0-100, higher scores reflect more severe IPV; cut-offs: physical IPV = 10, psychological IPV = 25). Socio-demographic data, including lack of kin support, maternal outcomes, and hospitalization were collected. Multivariate logistic regression estimated adjusted odds ratios (AOR), with 95% confidence intervals (CI), of the relationship between psychological and physical IPV and maternal outcomes, controlling for socio-demographic characteristics. Response rate was 92.2%. Psychological IPV, reported by 21.0% (n = 151), was associated significantly with urinary tract infection (127 (23%) vs 56 (37%); AOR = 1.9; 95%CI = 1.2-3.0), vaginal infection (30 (5%) vs 20 (13%); AOR = 2.4; 95%CI = 1.2-4.7) and spontaneous preterm labour (32 (6%) vs 19 (13%); AOR = 2.2; 95%CI = 1.1-4.5). Physical IPV, reported by 3.6% (n = 26), was associated with antenatal hospitalizations (134 (19%) vs 11 (42%); AOR = 2.6; 95%CI = 1.0-7.1). Lack of kin support was associated with spontaneous preterm labour (AOR = 4.7; 95%CI = 1.7-12.8). Mothers with IPV have higher odds of complications. Obstetricians, gynaecologists and midwives should act as active screeners, particularly of the undervalued psychological IPV, to reduce or remedy its effects.