Social ecological factors and intimate partner violence in pregnancy
March
Social ecological factors and intimate partner violence in pregnancy
Editor: Laura A. Magee
King's College London
UNITED KINGDOM
Bosena Tebeje Gashaw 0
Berit Schei
Jeanette H. Magnus
0 College of Health Sciences, Jimma University , Jimma , Ethiopia , 2 Faculty of Medicine, University of Oslo , Oslo , Norway , 3 Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, University of Science and Technology , Trondheim , Norway , 4 Department of Obstetrics and Gynaecology, St. Olav's hospital, Trondheim University Hospital , Trondheim , Norway , 5 Department of Global Community Health and Behavioral Sciences, Tulane School of Public Health and Tropical Medicine , New Orleans, Louisiana , United States of America
Intimate partner violence (IPV) during pregnancy increases adverse pregnancy outcomes. Knowledge of societal, community, family and individual related factors associated with IPV in pregnancy is limited in Ethiopia. Our study examined these factors in an Ethiopian context.
-
Data Availability Statement: All relevant data are
within the paper and its Supporting Information
files.
Funding: This publication was supported by
NORAD (Norwegian Agency for Development
Cooperation) under the NORHED-Program,
Agreement no.ªETH-13/0024". The funders had no
role in study design, data collection and analysis,
decision to publish, or preparation of the
manuscript.
Competing interests: The authors have declared
that no competing interests exist.
Materials and methods
A cross sectional study was conducted among pregnant women attending antenatal care at
governmental health institutions, using a consecutive probability sampling strategy. A total
of 720 pregnant women were interviewed by five trained nurses or midwives, using a
standardized and /pretested survey questionnaire. Bivariate and multivariate logistic regression
analyses were applied to assess factors contributing to IPV. We used Akaike's information
criteria, to identify the model that best describes the factors influencing IPV in pregnancy.
Results
Among the women interviewed, physical IPV was reported by 35.6%, and lifetime emotional
or physical abuse by 81.0%. Perceiving violence as a means to settle interpersonal conflicts,
presence of supportive attitudes of wife beating in the society, regarding violence as an
expression of masculinity, and presence of strict gender role differences in the society, were
all positively associated to IPV in pregnancy. The presence of groups legitimizing men's
violence in the community, feeling isolated, having no social support for victims, and presence
of high unemployment, were the perceived community related factors positively associated
with IPV in pregnancy.
Conclusion
IPV in pregnancy is very prevalent in Ethiopia and is associated with multiple social ecologic
factors. Reduction of IPV in pregnancy calls for cross sectorial efforts from stakeholders at
different levels.
Background
Intimate partner violence (IPV), is an important global public health and human rights issue,
with significant health and socioeconomic development consequences [1]. Violence against
women may occur at any stage of a woman's life, including during pregnancy. The overall
global estimates of IPV around the time of pregnancy vary between 3±30% [2], with higher
prevalence reported in developing countries [3]. In Africa, the prevalence of pregnancy related
IPV is reported to be between 23±40% [4]. Prior studies in Ethiopia indicate a very high life
time prevalence of IPV among reproductive age women at 50±78% [5±10], and pregnancy
related IPV between 11±29% [11±15]. The majority of these studies examined factors
contributing to IPV in pregnancy related to the individual context, such as childhood inter-parental
exposure, early marriage, dowry payment, residence, alcohol use and or education. It is
important to conceptualize violence as a multifaceted phenomenon grounded in the interplay across
societal, community, family, and individual levels. There is a lack of studies that
simultaneously examine societal, community, family, and individual related factors contributing to
IPV in pregnancy in Africa and in Ethiopia in particular.
A healthy pregnancy is required for favourable maternal and child health outcomes. Preg
nancies affected by IPV are reported to have an increased incidence of low maternal weight
gain, anaemia, infection, first/second trimester bleeding, late entry into antenatal care (ANC),
preterm labour, premature birth and low birth weight baby [16, 17]. Homicide is also one of
the leading causes of pregnancy associated death, commonly as a consequence of IPV [18].
IPV may commence or escalate in pregnancy [19]. Studies report that IPV during pregnancy
is more common than some maternal health conditions routinely screened for during
antenatal care [4, 20]. The causes for IPV are complex and dependent on the context [21]. Many of
the previous studies have identified various individ (...truncated)