Sexual violence and pregnancy-related physical symptoms

ABSTRACT: BACKGROUND: Few studies have investigated the impact of sexual violence on health during pregnancy. We examined the association between sexual violence and the reporting of physical symptoms during pregnancy. METHODS: A population-based national cohort study conducted by The Norwegian Mother and Child Cohort study (MoBa) collected data from pregnant women through postal questionnaires at 17 and 32 weeks gestation. Three levels of sexual violence were measured: 1) mild (pressured into sexual relations), 2) moderate (forced with violence into sexual relation) and 3) severe (rape). Differences between women reporting and not reporting sexual violence were assessed using Pearson's X2 test and multiple logistic regression analyses. RESULTS: Of 78 660 women, 12.0 % (9 444) reported mild, 2.8 % (2 219) moderate and 3.6 % (2 805) severe sexual violence. Sexual violence was significantly associated with increased reporting of pregnancy-related physical symptoms, both measured in number of symptoms and duration/degree of suffering. Compared to women not reporting sexual violence, the probability of suffering from [GREATER-THAN OR EQUAL TO]8 pregnancy-related symptoms estimated by Adjusted Odds Ratio (AOR) was 1.49 (1.41--1.58) for mild sexual violence, 1.66(1.50--1.84) for moderate and 1.78 (1.62--1.95) for severe. Severe sexual violence both previously and recently had the strongest association with suffering from [GREATER-THAN OR EQUAL TO]8 pregnancy-related symptoms, AOR 6.70 (2.34--19.14). CONCLUSION: A history of sexual violence is associated with increased reporting of pregnancy-related physical symptoms. Clinicians should consider the possible role of a history of sexual violence when treating women who suffer extensively from pregnancy-related symptoms.     

An unaddressed issue: domestic violence and unplanned pregnancies among pregnant women in Turkey.

OBJECTIVE: The aim of this study was to estimate the prevalence and type of domestic violence during pregnancy in Turkey and to compare socioeconomic background factors. METHODS: A survey was carried out among a representative sample of 475 pregnant women. Data were collected on the incidence and the nature of domestic violence perpetrated by the woman's spouse or other family members during her current pregnancy and before. Sociodemographic characteristics such as age, duration of marriage, number of children, monthly income, education, occupation of the husband, domestic violence towards children, contribution to family decisions, smoking habits, sexual relations and whether the pregnancy was planned or not, were also recorded. RESULTS: Of the 475 women screened for domestic violence during pregnancy, 158 (33.3%) reported physical or sexual abuse since they had become pregnant. The source of the domestic violence was mainly the husband in 105 (66.5%) women. Types of abuse were psychological in 71 (44.9%) and physical in 87 (55.1%) women. The rate of women's satisfaction with their sexual life among abused women was 43.67% compared to 61.2% among non-abused women. Abused pregnant women were less educated, had lower income, had more children, had a longer duration of marriage, were applying violence towards their children, were not contributing to family decisions, were less satisfied with their sexual life and were more likely to have unplanned pregnancies when compared to non-abused women. CONCLUSION: Antenatal care protocols should be modified to address domestic violence and contributing factors during pregnancy so that identified women can be counseled appropriately and attempts can be made to intervene to prevent further episodes of domestic violence in primary care settings.     

Physical violence during pregnancy.

Globally, women suffer due to violence. Violence during pregnancy is being increasingly recognised as a clinical as well as public health problem. The objectives of the present study were: to find out the extent and causes of violence during pregnancy; the relation of violence with, age, education, occupation; and to study the immediate effects of violence during pregnancy. A total of 2,000 pregnant women (health seekers or their friends or relatives) irrespective of age and socioeconomic status, were interviewed using a pre-designed, semistructured, pre-tested questionnaire in local language, with some open-ended questions. Out of the 2,000 pregnant women interviewed, 952 (47.6%) had been physically hit or slapped or kicked, at some time during pregnancy, many repeatedly. Though more teenagers (65.63%) and illiterate women (70.32%) were assaulted, those with a postgraduate education (41.08%) had also suffered. A total of 71.7% had been hit by their husbands - 32.4% were hit on the back and 161 (16.9%) on abdomen. Of the women who were assaulted during pregnancy, 30.25% had also suffered violence when non-pregnant. The present study reveals that violence is a common problem during pregnancy. While attempts need to be made to prevent this, it is essential that the healthcare providers who manage these women are aware of the possibility.     

Abuse during pregnancy in Mexico City.

OBJECTIVE: Measure the prevalence of physical and sexual abuse during pregnancy, determine the nature and severity of abuse, and assess correlates with abuse. METHOD: A total of 1314 women seeking prenatal care between July 2000 and January 2003 were approached at three public hospitals in Mexico City. An original composite case record form was created to measure physical and sexual abuse before and during pregnancy. RESULT: Forty-one percent of respondents had a history of physical or sexual abuse, with current abuse reported by 11.1%, and abuse during pregnancy by 7.6%. Among abused women, 71% reported an increase in the severity of abuse since becoming pregnant. Logistic regression revealed physically fighting with a partner and a history of abuse best predict violence during pregnancy. CONCLUSION: The severity of abuse among abused women appears to increase during pregnancy. Prenatal care visits in Mexico are an important opportunity for violence screening and intervention.     

Domestic violence during pregnancy in Turkey and responsibility of prenatal healthcare providers

The purpose of this study was to estimate prevalence and risk groups of domestic violence during pregnancy in Manisa, Turkey, and to determine antenatal complications or health problems and health service use. This study was a population-based, cross-sectional, and household survey. The study universe included two primary health units situated in two different socioeconomic areas (rural and urban) in the city of Manisa, Turkey, from January to June 2004; the homes of 246 women were visited and the study sample included 217 women. A questionnaire was used that comprised sociodemographic and reproductive characteristics, and the Domestic Violence Against Women Determination Scale, developed by Yanikkerem in 2002 to measure the frequencies of type and severity of violence. The Statistical Package for the Social Sciences (SPSS, version 10.0 for Windows) was used to analyze the data. Student t test and Mann-Whitney U test were used to evaluate data. Results indicated that 9.7% of women were beaten by their partner during the pregnancy (17.3% in the rural area and 2.7% in the urban area) and 14.3% of women were beaten before pregnancy. A total of 10.6% of women said they had been slapped, 9.1% reported an object was thrown at them by their partner, and 6.5% admitted to having been kicked during pregnancy. A total of 36.4% of women reported experiencing forced sexual activity. Abused pregnant women were less educated, had lower income, were unmarried, were multiparous, had more children, had a longer duration of marriage, lived rural areas, were more likely to have unplanned pregnancies, had miscarriage, had an interpregnancy interval of 2 years or less, smoked more cigarettes, did not visit a health institution for control during pregnancy and did not know the sex or knew the fetus was female when compared with nonabused women. Abused women who live with various problems during pregnancy and are victims of violence tend to feel isolated, insecure, and depressed. Our results indicate that most pregnant women do not report that their prenatal care providers discussed violence with them. Healthcare provides have an important role in this issue. Antenatal care protocols should be modified to address domestic violence and contributing factors during pregnancy so that identified women can be counseled appropriately and attempts can be made to intervene to prevent further episodes of domestic violence in primary care settings.     

Prevalence of violence against pregnant women and associated maternal and neonatal complications in Leon, Mexico

Objectives

to determine the prevalence of violence against women and associated maternal and neonatal complications in a developing country setting.

Design

cross-sectional study using a face-to-face questionnaire.

Setting

postpartum area at a tertiary care referral hospital in Leon, Mexico.

Participants

1623 postpartum women.

Data collection

women were recruited at 24–72 h post partum. The diagnosis and severity of violence were assessed using a modified questionnaire based on the Index of Spouse Abuse and Severity of Violence against Women Scale.

Findings

of 1623 women, 711 (43.8%) were diagnosed with violence during pregnancy; 563 (79.1%) experienced mild violence and 148 (20.9%) experienced severe violence. Of the women who experienced violence, 72.9% experienced psychological violence, 15.8% experienced physical violence and 11.3% experienced sexual violence. Maternal complications were higher in women who experienced violence (30.2% vs 23.6%, p=0.004). Women who experienced sexual violence had more maternal complications (43.2%), and women who experienced psychological violence had more neonatal complications (54.2%).

Key conclusions

violence during pregnancy is quite common in the study setting. Maternal complications are higher in women who experience violence during pregnancy. The type of violence has different effects on maternal and neonatal health.

Implications for practice

it is recommended that pregnant women who are experiencing violence should be identified during antenatal care to avoid maternal or neonatal complications.     

Postpartum, also a risk period for domestic violence

OBJECTIVE: In the first European study of its kind the prevalence of physical and sexual violence postpartum was estimated in a random sample of 207 Swedish born women attending antenatal clinics. STUDY DESIGN: The Severity of Violence Against Women scale (SVAW) was used to measure the frequency of threats and severity of physical and sexual abuse by means of a postal questionnaire covering a period of 8 weeks postpartum. In the sample of women the same research tool had been employed during the preceding pregnancy in the form of a personal interview. RESULTS: The non-response rate was 75/207 (36%) with a small difference in the rates of drop-out between women who had been abused or not abused during their pregnancy. Of the 132 women answering the questionnaire, 32 reported threats, physical or sexual abuse postpartum. Of those 32 women, 22 (69%) stated that they had not been subject to abuse previously. Women who were abused postpartum were older and were married to a higher extent than those who had been abused prior to and during pregnancy. CONCLUSIONS: Abuse does not appear to be restricted to a specific socio-demographic group of women or to a specific period in a woman's reproductive life. Therefore, questions to women regarding both threats and physical violence should be part of all clinical practices.     

Prevalence of physical and sexual abuse before and during pregnancy among Swedish couples

BACKGROUND: To estimate the prevalence of threats and actual acts of physical and sexual abuse during pregnancy. METHODS: Two hundred and seven pregnant Swedish women married to or cohabiting with Swedish men were randomly selected from three antenatal clinics in the city of G?teborg, Sweden. A standardized questionnaire was used for personal interviews about the women's experience of physical and sexual abuse by a husband or a boyfriend at some point in the past, during the last year and during current pregnancy. RESULTS: Twenty-seven point five percent of the women reported that they had been exposed to physical violence at some point in the past by their husband/boyfriend. Twenty-four and a half percent of the women had experienced some form of threat, physical or sexual violence during the last year. At some time (once or more) during their current pregnancy, the proportions of women who had been exposed to the following categories of violence, were as follows: 14.5%-symbolic violence, 14.5%-threats of mild violence, 2.9%-threats of moderate violence, 2.9%-threats of serious violence, 11%-mild violence, 4.3%-minor violence, 2.4%-moderate violence, 4.3%-serious violence and 3.3%-sexual violence. CONCLUSIONS: This study demonstrates that a considerable number of women had experienced threats, physical and sexual abuse during pregnancy. There is an obvious need for screening of experience of domestic violence among pregnant women to enhance the safety of women and their unborn babies.     

Domestic violence during pregnancy in Rio de Janeiro, Brazil.

OBJECTIVES: To estimate the prevalence and risk groups of domestic violence during pregnancy among public health care users in Rio de Janeiro, Brazil. The study focuses on violence perpetrated by both women and partners. METHOD: 526 women giving birth at term in public maternities from March to October 2000 were randomly selected and interviewers used the Revised Conflict Tactics Scales (CTS2). RESULTS: 33.8% [95% confidence interval (CI): 28.8-37.0%] of the respondents reported some form of physical violence and 16.5% (95% CI: 13.3-19.8%) referred to severe forms. A total of 78.3% (95% CI: 74.8-81.8%), 9.9% (95% CI: 7.5-12.7%) and 15.6% (95% CI: 12.6-18.9%) reported psychological aggression, sexual coercion and injuries, respectively. Physical violence mainly occurred among adolescent women with less schooling, who did not work outside the home, with fewer prenatal appointments, and with little social support. Families with more under-five children, alcohol and drug abuse, and low socio-economic status were also involved more frequently. CONCLUSION: High prevalence rates for various forms of domestic violence in Brazil suggest that the issue should be viewed as a major public health problem.     

Perceived health, sick leave, psychosocial situation, and sexual life in women with low-back pain and pelvic pain during pregnancy

BACKGROUND: Low-back pain and pelvic pain (LBPP) is a common problem during pregnancy. The aim of the study is to investigate perceived health, sick leave, psychosocial situation, and sexual life among women experiencing LBPP during pregnancy. METHODS: All women who gave birth at one of two hospitals in northern Sweden from 1 January 2002 to 30 April 2002 were invited to complete a questionnaire on their obstetric history, pregnancy, and delivery. Univariate and multivariate logistic regressions were performed in order to calculate odds ratio (OR) and its 95% confidence interval (CI) where applicable. Pearson's chi-square test was performed where applicable. RESULTS: Most women were married or cohabiting (98%), and reported a 'very good' or 'good' partner relationship (96%) and a satisfying sexual life before pregnancy (91%). Only a few women reported perceived health as 'quite poor' or 'poor' before pregnancy (2%); however, this proportion increased during pregnancy (13%). In general, satisfying sexual life declined during pregnancy, which was also the case for the assessment of perceived health during pregnancy. Women with LBPP during pregnancy had an increased risk of reporting poor health (OR = 3.05, 95% CI = 1.70-5.46). Overall, 68% of women had been on sick leave, and 22% had received maternity allowance. Women with LBPP reported sick leave in 72% of the participants. CONCLUSIONS: LBPP demonstrates a negative impact on perceived health and sexual life during pregnancy. A great majority of pregnant women were on sick leave at some time during pregnancy. These consequences make LBPP a major public health issue.     

Physical violence by a partner during pregnancy in Tanzania: prevalence and risk factors

Violence by an intimate partner, including violence during pregnancy, is an important human rights and public health issue. This paper presents the findings from large household surveys conducted in Mbeya and Dar es Salaam, Tanzania, in 2001-2002, as part of the WHO Multi-Country Study on Women's Health and Domestic Violence against Women. Seven (n=88) and twelve per cent (n=147) of ever-partnered, ever-pregnant women in Dar es Salaam (n=1,298) and Mbeya (n=1,205), respectively, reported being physically assaulted during pregnancy by their partner. Of those experiencing partner violence during pregnancy, 38% (n=33) and 23% (n=34) reported blows to the abdomen. More than a third of women experiencing the violence in each setting reported that it started during pregnancy. In both settings, the violence was significantly associated with adverse maternal health behaviours and outcomes, including drinking during pregnancy, having had a child that died and the partner preventing or discouraging attendance for antenatal care. Factors significantly associated with higher likelihood of partner violence during pregnancy included being currently unmarried, having had children from different fathers, partner's unfaithfulness and his refusal to use contraception. While interventions on partner violence during pregnancy have been tested in antenatal services in some developed countries, effective solutions for how to intervene in low-resource settings like Tanzania are still needed.     

Multiple violence victimisation associated with sexual ill health and sexual risk behaviours in Swedish youth

Objectives: To address the associations between emotional, physical and sexual violence, specifically multiple violence victimisation, and sexual ill health and sexual risk behaviours in youth, as well as possible gender differences. Methods: A cross-sectional population-based survey among sexually experienced youth using a questionnaire with validated questions on emotional, physical, and sexual violence victimisation, sociodemographics, health risk behaviours, and sexual ill health and sexual risk behaviours. Proportions, unadjusted/adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: The participants comprised 1192 female and 1021 male students aged 15 to 22 years. The females had experienced multiple violence (victimisation with two or three types of violence) more often than the males (21% vs. 16%). The associations between multiple violence victimisation and sexual ill health and sexual risk behaviours were consistent for both genders. Experience of/involvement in pregnancy yielded adjusted ORs of 2.4 (95% CI 1.5–3.7) for females and 2.1 (95% CI 1.3–3.4) for males, and early age at first intercourse 2.2 (95% CI 1.6–3.1) for females and 1.9 (95% CI 1.2–3.0) for males. No significantly raised adjusted ORs were found for non-use of contraceptives in young men or young women, or for chlamydia infection in young men. Conclusions: Several types of sexual ill health and sexual risk behaviours are strongly associated with multiple violence victimisation in both genders. This should be taken into consideration when counselling young people and addressing their sexual and reproductive health.     

Intimate partner violence and women's reproductive health

Intimate partner violence (IPV) is common among women. An estimated 30% of all women globally report having experienced physical or sexual violence by a husband, intimate partner or ex-partner. It is important for those working in reproductive health settings to be aware that sexual assault can occur in the context of relationships. IPV can also include reproductive and sexual coercion. Reproductive coercion includes behaviours that interfere with contraception use and/or pregnancy, while sexual coercion includes behaviours related to pressuring or coercing a person to have sex without using physical force. Past or current IPV in a woman's life can have profound implications for her reproductive and general health, and healthcare providers need to have the skills to identify IPV, and provide appropriate support and referrals as required.     

Association of intimate partner physical and sexual violence with unintended pregnancy among pregnant women in Peru

Objective

To examine the associations between lifetime physical and/or sexual intimate partner violence (IPV) with pregnancy intent among pregnant women in Lima, Peru.

Methods

A total of 2167 women who delivered at the Instituto Nacional Materno Perinatal, Lima, Peru were interviewed during the postpartum recovery period. Logistic regression was used to estimate multivariable adjusted odds ratios and 95% confidence intervals.

Results

Lifetime physical or sexual violence (40.0%) and unintended pregnancies (65.3%) were common in the study population. Compared with non-abused women, abused women had a 1.63-fold increased risk for unintended pregnancy. Unintended pregnancy risk was 3.31-fold higher among women who experienced both physical and sexual abuse compared with non-abused women. The prevalence and severity of physical violence during pregnancy was greater among women with unintended pregnancies compared with women with planned pregnancies.

Conclusion

The findings indicate the need to include IPV screening and treatment in prenatal care and reproductive health settings.     

Violence against pregnant women: prevalence and characteristics. A population-based study in Nicaragua

Objective   This study aims to estimate the prevalence and characteristics of partner abuse during pregnancy as well as to investigate associated social factors in León, Nicaragua.
Design   Cross-sectional community-based study.
Setting   All pregnant women from 50 randomly selected geographical clusters out of 208 in the municipality of León, Nicaragua.
Sample   A total of 478 pregnant women were included; only one woman refused to participate.
Method   The domestic violence questionnaire from the WHO-co-ordinated Multi-Country Study on Women's Health and Life Events was used with each participant being interviewed twice during pregnancy.
Main outcome measures   Prevalence and characteristics of partner violence during pregnancy.
Results   The prevalence of emotional, physical and sexual abuse during pregnancy was 32.4%, 13.4% and 6.7%, respectively. Seventeen percent reported experience of all three forms of violence. Two-thirds of the victims reported repeated abuse. Half of the abused women had experienced punches and kicks directed towards the abdomen and 93% had been injured. Most women had not sought health care in relation to the abuse, but those who did were usually hospitalised. Factors such as women's age below 20 years, poor access to social resources and high levels of emotional distress were independently associated with violence during pregnancy.
Conclusion   Violence against pregnant women in Nicaragua is common and often repeated. Although these women have poor access to social resources and high levels of emotional distress, they are rarely assisted by the health services. Innovative strategies are needed to provide support and counselling.     

Unintended pregnancy among unmarried adolescents and young women in Anambra State, south east Nigeria

This study identified the characteristics and factors influencing unintended pregnancy among unmarried young women in a rural community in south-east Nigeria. One hundred and thirty six unmarried teens with unintended pregnancy attending a Christian hospital in Ozubulu, a rural community in south-east Nigeria, from January 1998 to December 2001 were included in the study. Information was obtained using a semi-structured questionnaire and in-depth interview. Over 75% of the girls had their first sexual intercourse by 19 years, and over 69% had multiple partners. Over 95% had sex for economic reasons and exchanged sex for money or gifts. Only 13.5% ever used condoms. Ninety seven per cent suffered violence such as beating and verbal abuse from family members because of the pregnancy. Most of the adolescents or young women experienced major stressors, most importantly school and job termination, partner's negative attitude, religious sanction, discrimination and stigmatisation as a result of the unintended pregnancy. Unmarried pregnant adolescents or young women have particular health and psychosocial problems. Stakeholders in adolescent health, namely, parents, teachers, religious groups and health care providers, should recognise these problems and advocate for the provision of appropriate care and youth-friendly services to help youths navigate through these problems.     

Fear-based reasons for not engaging in sexual activity during pregnancy: associations with sexual and relationship well-being

Objective: Pregnant women consistently report fears that sexual activity could harm their pregnancy. Little is known, however, about the degree to which women report these fears as reasons for not having sex during pregnancy and whether these fears relate to women’s well-being. The aims of this study were to assess the importance of women’s fears of sexual activity harming the pregnancy in their decision not to engage in sex during pregnancy, and the associations between these fears and sexual and relationship well-being.

Methods: Pregnant women (N?=?261) were recruited online to complete a survey that included a novel scale of fear-based reasons for not engaging in sexual activity during pregnancy and validated measures of sexual functioning, sexual satisfaction, sexual distress and relationship satisfaction.

Results: Over half of the women (58.6%) reported at least one fear as a reason for not engaging in sexual activity while pregnant, though total fear scores were low. Greater fear-based reasons for not having sex were associated with greater sexual distress but were unrelated to sexual functioning, sexual satisfaction and relationship satisfaction.

Conclusions: Women who reported higher rates of refraining from sex due to fear that it could harm their pregnancy reported greater sexual distress, but not lower sexual functioning or sexual and relationship satisfaction. Results suggest that interventions focused on minimizing fears of sexual activity during pregnancy may not be essential for promoting women’s broader sexual and relationship well-being in pregnancy, but may help to reduce women’s global feelings of worry and anxiety about their sexual relationship.     

Domestic violence and postnatal depression in a Chinese community.

OBJECTIVES: To study the relationship between domestic violence and postnatal blues/depression in a Chinese community. METHODS: This was a prospective cohort study on 838 women after delivery in a local university teaching hospital. Between October, 2000 and February, 2001, all Chinese speaking women after delivery were invited to be interviewed by a designated research nurse using the Abuse Assessment Screen (AAS) to detect the incidence of domestic violence, the nature of violence and the perpetrator of abuse. Demographic data, pregnancy outcome, Stein's Daily Scoring System (SDSS) scores on day 2 or 3 postdelivery, Edinburgh Postnatal Depression Scale (EPDS) scores on day 2 or 3 postdelivery, 1-2 days after discharge from hospital and at 6 weeks postdelivery were compared between the abused and non-abused groups using Student's t-test, chi(2)-test and Fisher's exact test as appropriate. RESULTS: A total of 139 women (16.6%) had been abused in the last year (the abused group). Of these, 87 (10.4%) had been abused during the current pregnancy. The nature of abuse was mainly verbal. Fourteen women (1.7%) had been sexually abused in the last year. The husband/boyfriend, mother-in-law and employer/colleague were the most common perpetrators of abuse. Socio-demographic factors did not differ between the two groups except that pregnancy was more likely to be unplanned in the abused group (P=0.002). The pregnancy outcome did not differ. However, the abused group had significantly higher SDSS and EPDS scores at all stages of screening (P=0.003, P=0.000, P=0.010 and P=0.001, respectively). CONCLUSION: The findings supported our hypothesis that the effect of domestic violence on Chinese pregnant women is mainly on their psychological well-being.     

Prevalence of family violence amongst women attending an abortion clinic in New Zealand

AIMS: To measure the prevalence of family violence reported by women seeking a termination of pregnancy (TOP). METHODS: A cross sectional survey involving consecutive women at one Health Waikato abortion clinic. Participants completed a self-administered questionnaire in private counselling rooms. RESULTS: Sixty-two of the 125 women invited to participate did so (response rate: 49.6%). The reported lifetime prevalence of physical or sexual abuse was 50.8%. The reported lifetime prevalence of physical abuse was 43.3% and that of sexual abuse was 32.2%. The reported prevalence of physical abuse within the last year was 13.3%, and of sexual abuse within the last year was 8.5%. Of women reporting a lifetime history of physical abuse, 69% reported that her partner was the perpetrator/one of the perpetrators of abuse. CONCLUSIONS: The study demonstrated a high prevalence of family violence amongst women attending an abortion clinic. Consideration should be given to screening for family violence in abortion clinics in New Zealand. Screening should be accompanied by the provision of appropriate information and support for women with family violence issues.