Intimate partner violence during pregnancy and adverse birth outcomes: A case-control study

Reproductive Health, Volume 16, No. 1, Year 2019

Interpretation

Background: Intimate partner violence is a common phenomenon in Ethiopia families. About 81% of women believed that a husband is justified in beating his wife. About 30-60% of families were affected by their intimates. Women suffer physical, emotional, sexual and economic violence by their intimate partners. It often remains either for the sake of family secrecy, cultural norms or, due to fear, shame and community’s reluctance on domestic affair and social stigma.The objective of this study is to examine the association between intimate partner violence during pregnancy and adverse birth outcomes. Methods: A hospital based unmatched case control study was conducted in four zonal hospitals of Tigray region. A total of 954 study participants (318 cases and 636 controls) were taken. Systematic sampling was used to select the cases and controls. Ethical clearance was obtained throughout the study period. Result: Out of 954 interviewed mothers, 389 (40.8%) had experienced intimate partner violence during their index pregnancy period. More than two third (68.6%) of cases had been exposed to intimate partner violence. Multivariable logistic regression analysis showed that, women exposed to intimate partner violence during pregnancy were three times more likely to experience low birth weight (AOR = 3.1; CI 95% [1.470,6.618]) and preterm birth (AOR = 2.5; CI 95% [2.198-2.957]). It was observed that women who had been exposed to physical violence during pregnancy were five times more likely to experience low birth weight (AOR = 4.767; CI 95% [2.515, 9.034]) and preterm birth (AOR = 5.3; CI 95%: 3.95-7.094). Conclusion and recommendation: It was found that the risk of preterm birth and low birth weight was increased when the pregnant women were exposed to more than one type of intimate partner violence and physical violence during pregnancy. Therefore, Efforts to address maternal and newborn health need to include issues of violence against women. A hospital-based unmatched case control study design was conducted in Tigray Regional state of Northern Ethiopia, from March to January 2017 in four randomly selected Zonal Public Hospitals. Tigray forms the northernmost reaches of the nine ethnic regions of Ethiopia and is located between 36 ° and 40 °’ East longitude. Its North-South extent spans 12 and a half degrees to 15 ° north. It is bordered by Eritrea in the North, Sudan to the West, Amhara national state to the Southwest and Afar of Ethiopia to the East. The region covers 54,572 km2 ranging from low-arid to highland (above 2200 masl) areas. Tigray is subdivided into six administrative zones such as Central zone (Aksum), Eastern zone (Adigrat), North Western zone (shire), Southern zone (Michew), Western Zone (Humera), Mekelle (special zone). Tigray has an estimated population of 5,247,005 according to the 2009 EFY population estimation. Among those 2,660,002 are Females and 2,587,003 are Males [14]. The source and study populations for this study were all women who gave birth in selected Zonal Hospitals of Tigray, Ethiopia. All sampled women who gave birth in selected were also studied population for this study. Cases were all women who had adverse birth outcomes (neonates born prematurely and with low birth weight) and Controls were all women who had a normal birth outcome (neonates born at term and with normal birth weight) in the selected zonal hospitals of Tigray, Ethiopia, during the study period. Data were collected by face to face interview method using a pre-tested structured questionnaire (Additional file 1). It consisted of sociodemographic, obstetric, and experiences-of-violence related questions. Four female nurses and supervisors were recruited as interviewers and as supervisors respectively. Data collectors and supervisors were trained for two days on techniques of interviewing, the purpose of the study, importance of privacy, sensitivity of the issue, discipline and approach to the interviewees and confidentiality of the respondents. Adverse birth outcomes were measured by low birth weight, preterm birth. Low birth weight was defined as a live birth weighing < 2500 g. Preterm was defined as a neonate born before 37 completed weeks. The cut off points used for the birth outcomes were based on standards [17]. Intimate partner violence during pregnancy was assessed by asking women if she had experienced any act of physical, sexual or psychological abuse during index pregnancy by intimate partner. Controlling behaviors were defined as isolating a person from family and friends; monitoring their movements; and restricting access to financial resources, employment, education or medical care. Index pregnancy period, in this study refers to all trimesters of last pregnancy. The data were checked for completeness and inconsistencies, then entered using Epi-Info version 7 and cleaned and analyzed in SPSS version 21. Cross-tabulation was done to see the distribution of cases and controls. Descriptive statistics were used to characterize the sample and numerical data and was presented as mean + SD, median ± interquartile range, proportion or percentages. The binary logistic regression model was employed to examine the relationship or statistical association between the outcome variable and selected independent variables. All variables with a P value < 0.05 were included in the multivariable analysis. A multi-variable analysis was carried out to evaluate the association between intimate partner violence and adverse birth outcome after adjusting for confounding variables. Results were presented as adjusted odds ratios (AOR) with 95% CI, which express the magnitude of the effect of each category on the outcome relative to the reference category. The significance level was set at P-value (< 0.05). Results were presented using tables and texts. Ethical clearance was obtained from the institutional review board (IRB) of Aksum University, College of Health Science. Official permission was obtained from the Tigray regional health bureau. In addition, the ethical considerations were done by considering the personal and revealing nature of the study, which needed the required voluntary and informed consent to be obtained from the participants. Prior to administering the questionnaires, the objectives of the study were clearly explained to the participants and verbal consent was obtained. Confidentiality and anonymity were ensured throughout the execution of the study.

AI Digest

Study Justification:

– Intimate partner violence is a common issue in Ethiopian families, with a high percentage of women believing that a husband is justified in beating his wife.
– The study aims to examine the association between intimate partner violence during pregnancy and adverse birth outcomes.
– This research is important because it sheds light on the impact of violence on pregnant women and their babies, highlighting the need for interventions to address this issue.

Study Highlights:

– The study was conducted in Tigray region, Northern Ethiopia, in four randomly selected Zonal Public Hospitals.
– A total of 954 study participants (318 cases and 636 controls) were included in the study.
– Results showed that 40.8% of interviewed mothers had experienced intimate partner violence during their pregnancy.
– Women exposed to intimate partner violence during pregnancy were three times more likely to experience low birth weight and preterm birth.
– Physical violence during pregnancy increased the risk of low birth weight and preterm birth even further.

Recommendations for Lay Reader and Policy Maker:

– Efforts to address maternal and newborn health should include interventions to prevent and address violence against women.
– Policies and programs should be implemented to raise awareness about intimate partner violence and its impact on pregnancy outcomes.
– Health facilities should provide support and resources for pregnant women who are experiencing violence, including counseling and referral services.
– Community education and awareness campaigns should be conducted to challenge cultural norms and reduce the acceptance of violence against women.

Key Role Players:

– Healthcare providers: They play a crucial role in identifying and supporting pregnant women who are experiencing intimate partner violence.
– Community leaders and organizations: They can help raise awareness, challenge cultural norms, and provide support to survivors of violence.
– Government agencies: They are responsible for implementing policies and programs to address violence against women and improve maternal and newborn health.

Cost Items for Planning Recommendations:

– Training and capacity building for healthcare providers on identifying and responding to intimate partner violence.
– Development and dissemination of educational materials and awareness campaigns.
– Establishment of support services, such as counseling centers and helplines.
– Monitoring and evaluation of interventions to assess their effectiveness and make necessary adjustments.

Strength of Evidence

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is strong because it is based on a hospital-based unmatched case-control study design with a large sample size. The study also obtained ethical clearance and used multivariable logistic regression analysis to examine the association between intimate partner violence during pregnancy and adverse birth outcomes. However, to improve the evidence, the abstract could provide more details on the sampling method, data collection process, and statistical analysis techniques used.

Abstract

A hospital-based unmatched case control study design was conducted in Tigray Regional state of Northern Ethiopia, from March to January 2017 in four randomly selected Zonal Public Hospitals. Tigray forms the northernmost reaches of the nine ethnic regions of Ethiopia and is located between 36 ° and 40 °’ East longitude. Its North-South extent spans 12 and a half degrees to 15 ° north. It is bordered by Eritrea in the North, Sudan to the West, Amhara national state to the Southwest and Afar of Ethiopia to the East. The region covers 54,572 km2 ranging from low-arid to highland (above 2200 masl) areas. Tigray is subdivided into six administrative zones such as Central zone (Aksum), Eastern zone (Adigrat), North Western zone (shire), Southern zone (Michew), Western Zone (Humera), Mekelle (special zone). Tigray has an estimated population of 5,247,005 according to the 2009 EFY population estimation. Among those 2,660,002 are Females and 2,587,003 are Males [14]. The source and study populations for this study were all women who gave birth in selected Zonal Hospitals of Tigray, Ethiopia. All sampled women who gave birth in selected were also studied population for this study. Cases were all women who had adverse birth outcomes (neonates born prematurely and with low birth weight) and Controls were all women who had a normal birth outcome (neonates born at term and with normal birth weight) in the selected zonal hospitals of Tigray, Ethiopia, during the study period. Data were collected by face to face interview method using a pre-tested structured questionnaire (Additional file 1). It consisted of sociodemographic, obstetric, and experiences-of-violence related questions. Four female nurses and supervisors were recruited as interviewers and as supervisors respectively. Data collectors and supervisors were trained for two days on techniques of interviewing, the purpose of the study, importance of privacy, sensitivity of the issue, discipline and approach to the interviewees and confidentiality of the respondents. Adverse birth outcomes were measured by low birth weight, preterm birth. Low birth weight was defined as a live birth weighing < 2500 g. Preterm was defined as a neonate born before 37 completed weeks. The cut off points used for the birth outcomes were based on standards [17]. Intimate partner violence during pregnancy was assessed by asking women if she had experienced any act of physical, sexual or psychological abuse during index pregnancy by intimate partner. Controlling behaviors were defined as isolating a person from family and friends; monitoring their movements; and restricting access to financial resources, employment, education or medical care. Index pregnancy period, in this study refers to all trimesters of last pregnancy. The data were checked for completeness and inconsistencies, then entered using Epi-Info version 7 and cleaned and analyzed in SPSS version 21. Cross-tabulation was done to see the distribution of cases and controls. Descriptive statistics were used to characterize the sample and numerical data and was presented as mean + SD, median ± interquartile range, proportion or percentages. The binary logistic regression model was employed to examine the relationship or statistical association between the outcome variable and selected independent variables. All variables with a P value < 0.05 were included in the multivariable analysis. A multi-variable analysis was carried out to evaluate the association between intimate partner violence and adverse birth outcome after adjusting for confounding variables. Results were presented as adjusted odds ratios (AOR) with 95% CI, which express the magnitude of the effect of each category on the outcome relative to the reference category. The significance level was set at P-value (< 0.05). Results were presented using tables and texts. Ethical clearance was obtained from the institutional review board (IRB) of Aksum University, College of Health Science. Official permission was obtained from the Tigray regional health bureau. In addition, the ethical considerations were done by considering the personal and revealing nature of the study, which needed the required voluntary and informed consent to be obtained from the participants. Prior to administering the questionnaires, the objectives of the study were clearly explained to the participants and verbal consent was obtained. Confidentiality and anonymity were ensured throughout the execution of the study.

Materials

https://efashare.b-cdn.net/materials/a129beb00149996eea6e3afd538fb656285e565ff01a31d0486a9912cd414a66/12978_2019_670_MOESM1_ESM.docx

Innovations

Based on the study, the following innovations can be developed to improve access to maternal health by addressing the issue of intimate partner violence during pregnancy:

1. Mobile health (mHealth) applications: Develop mobile applications that provide information and resources on intimate partner violence during pregnancy, including signs, risks, and available support services. These apps can also include features for reporting violence and accessing emergency assistance.

2. Telemedicine services: Implement telemedicine services that allow pregnant women to consult healthcare providers remotely, enabling them to seek help and support for intimate partner violence without having to physically visit a healthcare facility.

3. Online support groups: Create online support groups and forums where pregnant women can connect with others who have experienced intimate partner violence during pregnancy. These platforms can provide a safe space for sharing experiences, seeking advice, and accessing emotional support.

4. Text message reminders: Utilize text message reminders to provide pregnant women with information and resources related to intimate partner violence during pregnancy. These reminders can include tips for safety planning, contact information for support services, and educational messages.

5. Community-based interventions: Implement community-based interventions that involve local organizations, community leaders, and healthcare providers working together to raise awareness about intimate partner violence during pregnancy and provide support to affected women. This can include organizing community events, workshops, and awareness campaigns.

By implementing these innovations, it is possible to improve access to maternal health for pregnant women experiencing intimate partner violence, ensuring they receive the support and care they need.

AI Innovations Description

The recommendation that can be developed into an innovation to improve access to maternal health based on the study is to address the issue of intimate partner violence during pregnancy. This can be achieved through the following strategies:

1. Awareness and education: Implement comprehensive awareness and education programs targeting both women and men to increase knowledge about the negative impact of intimate partner violence during pregnancy on maternal and newborn health. This can be done through community-based workshops, health campaigns, and media platforms.

2. Strengthen healthcare provider training: Provide training to healthcare providers on identifying and addressing intimate partner violence during pregnancy. This includes developing protocols and guidelines for healthcare providers to effectively screen, assess, and provide support to pregnant women experiencing violence.

3. Integrated services: Integrate services for maternal health and intimate partner violence within healthcare settings. This involves establishing referral pathways and collaborations between healthcare providers, social workers, and support organizations to ensure comprehensive care for pregnant women affected by violence.

4. Community engagement: Engage community leaders, religious leaders, and influential individuals to advocate against intimate partner violence during pregnancy. This can help change societal norms and attitudes towards violence and promote supportive environments for pregnant women.

5. Legal and policy reforms: Advocate for the implementation and enforcement of laws and policies that protect pregnant women from intimate partner violence. This includes strengthening legal frameworks, providing access to justice, and ensuring the rights of pregnant women are upheld.

By implementing these recommendations, it is possible to improve access to maternal health by addressing the issue of intimate partner violence during pregnancy and creating a safer and supportive environment for pregnant women.

AI Innovations Methodology

To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be used:

1. Design a randomized controlled trial: Randomly select a sample of pregnant women from the target population and divide them into two groups – an intervention group and a control group. The intervention group will receive the recommended strategies to address intimate partner violence during pregnancy, while the control group will receive standard care.

2. Implement the intervention: In the intervention group, implement the strategies outlined in the recommendations, including awareness and education programs, healthcare provider training, integrated services, community engagement, and legal and policy reforms. Ensure that the intervention is delivered consistently and according to the recommended guidelines.

3. Collect baseline data: Before implementing the intervention, collect baseline data on access to maternal health, including indicators such as antenatal care attendance, skilled birth attendance, and maternal and neonatal health outcomes. This will serve as a comparison for post-intervention data.

4. Monitor and evaluate the intervention: Throughout the intervention period, monitor the implementation of the strategies and evaluate their effectiveness in improving access to maternal health. This can be done through regular data collection, including surveys, interviews, and medical records review.

5. Analyze the data: After the intervention period, analyze the data collected to assess the impact of the recommendations on access to maternal health. Compare the indicators between the intervention group and the control group to determine the effectiveness of the strategies in improving access to maternal health.

6. Draw conclusions and make recommendations: Based on the analysis of the data, draw conclusions about the impact of the recommendations on access to maternal health. Identify any significant improvements or areas that need further attention. Make recommendations for scaling up the strategies or modifying them based on the findings.

By following this methodology, it will be possible to simulate the impact of the main recommendations outlined in the abstract on improving access to maternal health. This will provide valuable insights into the effectiveness of these strategies and guide future efforts to address intimate partner violence during pregnancy and improve maternal health outcomes.

Author

Dima Health

Statistics:

Citations: 59

Identifiers:

DOI: 10.1186/s12978-019-0670-4

Research Areas:

Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Violence and Injury

Study Countries:

Eritrea, Ethiopia, Multi-Countries, Sudan

Study Design:

Case-Control Study, Cross Sectional Study

Study Approach:

Quantitative

Participants Gender:

Female