Objective: Perinatal intimate partner violence affects the health and safety of postpartum women and their infants. However, it has not been well recognized and addressed in the study setting. Hence, this study aimed to explore postpartum women’s lived experiences of perinatal intimate partner violence and its contributing factors in Wolaita Zone, Southern Ethiopia. Methods: A phenomenological study approach was used to explore postpartum women’s lived experiences of perinatal partner violence from January to March 2020. A total of twenty-two postnatal women and five health extension workers (HEWs) were interviewed. Interviews were audio-recorded, transcribed verbatim in local languages, and then translated into English. Data were analyzed thematically, using deductive and inductive coding. The consolidated criteria for reporting qualitative research (CORE-Q) checklist was followed to report the findings. Results: Results indicated that postpartum women had experienced recurrent violence before, during, and after pregnancy from their husbands, with 16 out of 22 women being subjected to perinatal intimate partner violence. A majority of the participants delineated their exposure to perinatal physical violence next to perinatal psychological violence. Many of the interviewed women noted that violence during pregnancy was exacerbated and increased during postpartum. Moreover, the interviewees revealed that some partners were not only a serious threat to their wives, but also their infants during the postpartum period. Four of the participants stated that their newborns were hit and thrown by their father and became unconscious. Participants linked husbands’ perinatal violence with suspicion about the newborn, male-child preference, partner infidelity and jealousy, contraceptives usage, alcohol consumptions, indifference to shortages on household necessities, improper parenting, and financial problems. Conclusion: This study highlights that postpartum women are experiencing continuous and severe forms of perinatal IPV in the study setting. Thus, community-level interventions that minimize perinatal partner violence against postnatal women and their infants are needed.
The study was conducted in Wolaita Zone. Wolaita Zone is located in the Southern Nations, Nationalities, and People’s Region. Wolaita Sodo is its capital town which is 330 km south of Addis Ababa, Ethiopia. The zone is administratively divided into sixteen districts (woredas) and six town administrations. It is one of the most densely populated zones with an estimated total population of 2.5 million people. It has a total of 310,454 households with an average household size of 4.84 persons and 297,981 housing units.30 There are 7 hospitals (5 governmental and 2 private), 68 health centers, and 345 health posts located within zone.31 On average, two Health Extension Workers (HEWs) are assigned to each health post. The study was conducted in the five rural health posts (Sura Koyoo, Kindo koyoo, Dolla, Bossa Kacha, and Bilbo Bedessa) and one Women, Children and Youth Affairs (WCYA) department (Sodo city) between January to March 2020. In the context of our study, the population of interest was postnatal women who reported any violence grievances, either to health posts in the rural setting or WCYA in the urban setting. These study sites were conveniently selected based on the potential to access victims exposed to partner violence. The phenomenological study approach was employed to explore perinatal IPV experiences lived by postpartum women living in the Wolaita zone. The phenomenological approach underpins the interpretive ontological and epistemological paradigm, which seeks to understand the lived experience through the eyes of the people experiencing it.32 In this study; the above approach offers an opportunity to explore the postpartum women’s lived experience of perinatal IPV. This approach allows the researcher to understand not only the individual’s lived experience but also the condition surrounding it.32,33 In this process, phenomenology values both philosophy and method. Moreover, this approach also provides many opportunities for interviewees, including catharsis, self-reflection; healing, empowerment, and sense of purpose.33 A total of twenty-two participants were recruited from urban and rural settings with the help of HEWs and the head of WCYA. The inclusion criteria included; currently married postpartum women aged 18 years and older with index children aged below twelve months and reporting violent grievances either to health posts or the WCYA Department. Participants were recruited using the convenience sampling method and consecutively interviewed at each site34,35 where informal interviews were conducted before sequential questioning.36 No postpartum women who fulfilled the inclusion criteria and were approached for an interview declined to participate in the study. Similarly, five HEWs from different rural health posts who interact with women seeking treatment for other conditions37 were also interviewed. Health extension workers who had a minimum of a college diploma in health science, and have been working in the health extension program at health posts for more than two years were included in the interview. The data saturation38 was achieved with the 22nd interviewee and further data collection stopped. Semi-structured, in-depth interview guides were used to gather data from two groups of respondents: postpartum women violence victims and HEWs. Different interview guides were used to interview the two respective groups (Supplementary File 1). The interview guides for postnatal women consisted of main and probing questions such as; socio-demographic characteristics, marriage history, index pregnancy intention, contraception, and perinatal IPV experiences for index birth. For instance, some of the main questions asked to interviewees were: Could you please tell me a little about yourself and your husband? How did you come to know him? What is your main reason to visit this institution? When did your problems with your husband start? How does he treat you in front of others in the perinatal period? Could you tell me if your partner has ever inflicted any physical harm on your body in the perinatal period? Could you tell me if your partner harassed you sexually in the perinatal period? How can you explain your husband’s feelings about contraceptive use before pregnancy versus now? The interview questions for HEWs probed reasons for postpartum women visiting the health post, reporting of IPV, and types of IPV reported. Interviews were conducted face-to-face with participants in a private and quiet environment, which was either at the health posts or WCYA department based on their personal preferences. Participants were interviewed in both Amharic and Wolaita languages. A neutral single bilingual interviewer [TL], a male principal investigator, who had a Master in Reproductive and Maternal Health and was experienced in qualitative research, conducted the interviews to avoid inter-interviewer differences. The interviewer had no contact with the service centers to ensure there was no effect on their responses. An empathetic rapport was made with each interviewee for five to seven minutes. At the beginning of the interview, permission was requested from each interviewee to record the audio. Each participant was interviewed separately. The length of the interviews was thirty-five minutes on average. Field notes were recorded to include key messages and participants’ non-verbal cues. After interviewing the first four participants, the interview guide was slightly modified to accommodate new ideas. Two pilot interviews were conducted with HEWs to validate interview guides. However; no changes were required. All study participants were compensated with one hundred Ethiopia birr (about $3) at the end of interviews. The transferability of the findings was ensured by collecting data from two target groups for triangulation.33 All audio recordings were transcribed verbatim and translated to the English language. Audit trails for the transcribed data were done with each interviewee to ensure trustworthiness and to minimize errors. All transcripts of the interviews were checked for errors by the simultaneous readings of the transcripts beside the audio-recorded voices. Final transcripts were also compared with field notes to ensure quality. Verbatim transcripts were analyzed using the OpenCode software version 4.02 for computer-assisted coding and categorization. The text was read several times to be familiar with the data. Line-by-line coding was then conducted by the principal investigator [TL]. The key attributes of each term or narrates were coded and tallied and later used to create categories. The codes were compared based on their similarities and differences and then subsequently grouped into categories. Data were analyzed thematically, using deductive and inductive coding38 where salient quotes were used to support the themes. The consolidated criteria for reporting qualitative research (COREQ) from a 32- item checklist was used to report the findings.39
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