Intimate partner violence against women during and after pregnancy: a cross-sectional study in Mumbai slums

BMC Public Health

David Osrin²  Shanti Pantvaidya¹  Wasundhara Joshi¹  Glyn Alcock²  Neena Shah More¹  Ujwala Bapat¹  Sushmita Das¹ 

[1] Society for Nutrition, Education and Health Action (SNEHA), Urban Health Centre, 60 Feet Road, Dharavi, Mumbai 400017, Maharashtra, India;Institute for Global Health, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK

关键词: Slums;    Maternal health;    Mumbai;    India;    Domestic violence;    Intimate partner violence;   

Others  :  1161823
DOI  :  10.1186/1471-2458-13-817

 received in 2012-12-29, accepted in 2013-09-05,  发布年份 2013

【 摘 要 】

Background

At least one-third of women in India experience intimate partner violence (IPV) at some point in adulthood. Our objectives were to describe the prevalence of IPV during pregnancy and after delivery in an urban slum setting, to review its social determinants, and to explore its effects on maternal and newborn health.

Methods

We did a cross-sectional study nested within the data collection system for a concurrent trial. Through urban community surveillance, we identified births in 48 slum areas and interviewed mothers ~6 weeks later. After collecting information on demographic characteristics, socioeconomic indicators, and maternal and newborn care, we asked their opinions on the justifiability of IPV and on their experience of it in the last 12 months.

Results

Of 2139 respondents, 35% (748) said that violence was justifiable if a woman disrespected her in-laws or argued with her husband, failed to provide good food, housework and childcare, or went out without permission. 318 (15%, 95% CI 13, 16%) reported IPV in the year that included pregnancy and the postpartum period. Physical IPV was reported by 247 (12%, 95% CI 10, 13%), sexual IPV by 35 (2%, 95% CI 1, 2%), and emotional IPV by 167 (8%, 95% CI 7, 9). 219 (69%) women said that the likelihood of IPV was either unaffected by or increased during maternity. IPV was more likely to be reported by women from poorer families and when husbands used alcohol. Although 18% of women who had suffered physical IPV sought clinical care for their injuries, seeking help from organizations outside the family to address IPV itself was rare. Women who reported IPV were more likely to have reported illness during pregnancy and use of modern methods of family planning. They were more than twice as likely to say that there were situations in which violence was justifiable (odds ratio 2.6, 95% CI 1.7, 3.4).

Conclusions

One in seven women suffered IPV during or shortly after pregnancy. The elements of the violent milieu are mutually reinforcing and need to be taken into account collectively in responding to both individual cases and framing public health initiatives.

【 授权许可】

   
2013 Das et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]UN Millennium Project: Taking action: achieving gender equality and empowering women. New York: Task force on education and gender equality; 2005.
• [2]WHO: World report on violence and health. Geneva: World Health Organization; 2002.
• [3]Heise L, Garcia-Moreno C: Violence by intimate partners. Geneva: World Health Organization; 2002. [World report on violence and health]
• [4]Jewkes R, Sen P, Garcia-Moreno C: Sexual violence. In World report on violence and health. Edited by Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R. Geneva: World Health Organization; 2002:149-181.
• [5]WHO: London school of hygiene and tropical medicine: preventing intimate partner and sexual violence against women: taking action and generating evidence. Geneva: World Health Organization; 2010.
• [6]Government of India Ministry of Health and Family Welfare: National family health survey, India (NFHS-3 2005–06). Mumbai: International Institute for Population Sciences; 2007.
• [7]Mahapatro M, Gupta R, Gupta V: The risk factor of domestic violence in India. Indian J Community Med 2012, 37:153-157.
• [8]INCLEN: Domestic violence in India: a summary report of a multi-site household survey. Washington DC: International Clinical Epidemiologists’ Network, International Center for Research on Women; 2000.
• [9]Khot A, Menon S, Dilip T: Domestic violence: levels, correlates, causes, impact, and response. A community based study of married women from Mumbai slums. Mumbai: Centre for Enquiry into Health and Allied Themes; 2004.
• [10]Jeyaseelan L, Kumar S, Neelakantan N, Peedicayil A, Pillai R, Duvvury N: Physical spousal violence against women in India: some risk factors. J Biosoc Sci 2007, 39:657-670.
• [11]Kimuna SR, Djamba YK, Ciciurkaite G, Cherukuri S: Domestic violence in India: insights from the 2005–2006 national family health survey. J Interpers Violence 2013, 28:773-807.
• [12]Sinha A, Mallik S, Sanyal D, Dasgupta S, Pal D, Mukherjee A: Domestic violence among ever married women of reproductive age group in a slum area of Kolkata. Indian J Public Health 2012, 56:31-36.
• [13]Shrivastava PS, Shrivastava SR: A study of spousal domestic violence in an urban slum of Mumbai. Int J Prev Med 2013, 4:27-32.
• [14]Ruikar MM, Pratinidhi AK: Physical wife abuse in an urban slum of Pune, Maharashtra. Ind J Public Health 2008, 52:215-217.
• [15]Pandey GK, Dutt D, Banerjee B: Partner and relationship factors in domestic violence: perspectives of women from a slum in Calcutta, India. J Interpers Violence 2009, 24:1175-1191.
• [16]Rocca CH, Rathod S, Falle T, Pande RP, Krishnan S: Challenging assumptions about women’s empowerment: social and economic resources and domestic violence among young married women in urban South India. Int J Epidemiol 2009, 38:577-585.
• [17]Stewart DE, Cecutti A: Physical abuse in pregnancy. CMAJ 1993, 149:1257-1263.
• [18]Purwar MB, Jeyaseelan L, Varhadpande U, Motghare V, Pimplakute S: Survey of physical abuse during pregnancy GMCH, Nagpur, India. J Obstet Gynaecol Res 1999, 25:165-171.
• [19]Jain D, Sanon S, Sadowski L, Hunter W: Violence against women in India: evidence from rural Maharashtra. Rural Remote Health 2004, 4:304.
• [20]Gazmararian JA, Lazorick S, Spitz AM, Ballard TJ, Saltzman LE, Marks JS: Prevalence of violence against pregnant women. JAMA 1996, 275:1915-1920.
• [21]Kashif M, Murtaza K, Kirkman M: Violence against women during pregnancy in some Asian countries: a review of the literature. Ital J Public Health 2010, 7:6-11.
• [22]Campbell J, Garcia-Moreno C, Sharps P: Abuse during pregnancy in industrialized and developing countries. Violence Against Women 2004, 10:770.
• [23]Heise L, Ellsberg M, Gottmoeller M: A global overview of gender based violence. Int J Gynecol Obstet 2002, 78(Suppl 1):S5-S14.
• [24]Ludermir AB, Lewis G, Alves Valongueiro S, de Araujo TV B, Araya R: Violence against women by their intimate partner during pregnancy and postnatal depression: a prospective cohort study. Lancet 2010, 376:903-910.
• [25]Patel V, Rodrigues M, Desouza N: Gender, poverty and postnatal depression: a study of new mothers in Goa. Am J Psychiatry 2002, 159:43-47.
• [26]Mahapatro M, Gupta RN, Gupta V, Kundu AS: Domestic violence during pregnancy in India. J Interpers Violence 2011, 26:2973-2990.
• [27]Muthal-Rathore A, Tripathi R, Arora R: Domestic violence against pregnant women interviewed at a hospital in New Delhi. Int J Gynecol Obstet 2002, 76:83-85.
• [28]Sarkar NN: The impact of intimate partner violence on women’s reproductive health and pregnancy outcome. J Obstet Gynaecol 2008, 28:266-271.
• [29]Ahmed S, Koenig MA, Stephenson R: Effects of domestic violence on perinatal and early-childhood mortality: evidence from north India. Am J Public Health 2006, 96:1423-1428.
• [30]Koenig MA, Stephenson R, Acharya R, Barrick L, Ahmed S, Hindin M: Domestic violence and early childhood mortality in rural India: evidence from prospective data. Int J Epidemiol 2010, 39:825-833.
• [31]Jejeebhoy S: Associations between wife-beating and fetal and infant death: impressions from a survey in rural India. Stud Fam Plan 1998, 29:300-308.
• [32]Ackerson LK, Subramanian SV: Intimate partner violence and death among infants and children in India. Pediatrics 2009, 124:e878-e889.
• [33]Pandey S, Lin Y: Adjusted effects of domestic violence, tobacco use, and indoor Air pollution from use of solid fuel on child mortality. Matern Child Health J 2012. doi:10.1007/s10995-012-1163-z (Epub ahead of print)
• [34]Koski AD, Stephenson R, Koenig MR: Physical violence by partner during pregnancy and use of prenatal care in rural India. J Health Popul Nutr 2011, 29:245-254.
• [35]Sarkar NN: The cause and consequence of domestic violence on pregnant women in India. J Obstet Gynaecol 2013, 33:250-253.
• [36]Yoshikawa K, Agrawal NR, Poudel KC, Jimba M: A lifetime experience of violence and adverse reproductive outcomes: findings from population surveys in India. Biosci Trends 2012, 6:115-121.
• [37]Chowdhary N, Patel V: The effect of spousal violence on women’s health: findings from the Stree Arogya Shodh in Goa, India. J Postgrad Med 2008, 54:306-312.
• [38]Sudha S, Morrison S: Marital violence and women’s reproductive health care in Uttar Pradesh, India. Womens Health Issues 2011, 21:214-221.
• [39]Santhya KG: Early marriage and sexual and reproductive health vulnerabilities of young women: a synthesis of recent evidence from developing countries. Curr Opin Obstet Gynecol 2011, 23:334-339.
• [40]Ackerson LK, Subramanian SV: Domestic violence and chronic malnutrition among women and children in India. Am J Epidemiol 2008, 167:1188-1196.
• [41]Peedicayil A, Sadowski LS, Jeyaseelan L, Shankar V, Jain D, Suresh S, Bangdiwala SI, India SG: Spousal physical violence against women during pregnancy. BJOG 2004, 111:682-687.
• [42]Khosla AH, Dua D, Devi L, Sud SS: Domestic violence in pregnancy in North Indian women. Indian J Med Sci 2005, 59:195-199.
• [43]Krishnan S: Gender, caste, and economic inequalities and marital violence in rural South India. Health Care Women Int 2005, 26:87-99.
• [44]Koenig M, Stephenson R, Ahmed S, Jejeebhoy S, Campbell J: Individual and contextual determinants of domestic violence in North India. Am J Public Health 2006, 96:132-138.
• [45]Singh P, Rohtagi R, Soren S, Shukla M, Lindow SW: The prevalence of domestic violence in antenatal attendee’s in a Delhi hospital. J Obstet Gynaecol 2008, 28:272-275.
• [46]Babu BV, Kar SK: Domestic violence against women in eastern India: a population-based study on prevalence and related issues. BMC Publ Health 2009, 9:129. BioMed Central Full Text
• [47]Babu BV, Kar SK: Domestic violence in Eastern India: factors associated with victimization and perpetration. Public Health 2010, 124:136-148.
• [48]Dalal K, Lindqvist K: A national study of the prevalence and correlates of domestic violence among women in India. Asia Pac J Public Health 2012, 24:265-277.
• [49]Chibber KS, Krupp K, Padian N, Madhivanan P: Examining the determinants of sexual violence among young, married women in Southern India. J Interpers Violence 2012, 27:2465-2483.
• [50]Ackerson LK, Kawachi I, Barbeau EM, Subramanian SV: Effects of individual and proximate educational context on intimate partner violence: a population-based study of women in India. Am J Public Health 2008, 98:507-514.
• [51]Berg MJ, Kremelberg D, Dwivedi P, Verma S, Schensul JJ, Gupta K, Chandran D, Singh SK: The effects of husband’s alcohol consumption on married women in three low-income areas of Greater Mumbai. AIDS Behav 2010, 14(Suppl 1):S126-135.
• [52]Nayak MB, Patel V, Bond JC, Greenfield TK: Partner alcohol use, violence and women’s mental health: population-based survey in India. Br J Psychiatry 2010, 196:192-199.
• [53]Schensul SL, Mekki-Berrade A, Nastasi BK, Singh R, Burleson JA, Bojko M: Men’s extramarital sex, marital relationships and sexual risk in urban poor communities in India. J Urban Health 2006, 83:614-624.
• [54]Jejeebhoy SJ, Cook RJ: State accountability for wife-beating: the Indian challenge. Lancet 1997, 349:s10-12.
• [55]Raj A, Saggurti N, Lawrence D, Balaiah D, Silverman JG: Association between adolescent marriage and marital violence among young adult women in India. Int J Gynaecol Obstet 2010, 110:35-39.
• [56]Speizer IS, Pearson E: Association between early marriage and intimate partner violence in India: a focus on youth from Bihar and Rajasthan. J Interpers Violence 2011, 26:1963-1981.
• [57]Santhya KG, Ram U, Acharya R, Jejeebhoy SJ, Ram F, Singh A: Associations between early marriage and young women’s marital and reproductive health outcomes: evidence from India. Int Perspect Sex Reprod Health 2010, 36:132-139.
• [58]Rapp D, Zoch B, Khan MM, Pollmann T, Kramer A: Association between gap in spousal education and domestic violence in India and Bangladesh. BMC Publ Health 2012, 12:467. BioMed Central Full Text
• [59]Shah More N, Bapat U, Das S, Alcock G, Patil S, Porel M, Vaidya L, Fernandez A, Joshi W, Osrin D: Community mobilization in Mumbai slums to improve perinatal care and outcomes: a cluster randomized controlled trial. PLoS Med 2012, 9:e1001257.
• [60]Officer of the Registrar General & Census Commissioner, Director of Census Operations Maharashtra: Census of India 2011. Maharashtra: New Delhi: Ministry of Home Affairs, Government of India; 2011. [Provisional population totals: paper 1 of 2011]
• [61]More NS, Bapat U, Das S, Patil S, Porel M, Vaidya L, Koriya B, Barnett S, Costello A, Fernandez A, Osrin D: Cluster-randomised controlled trial of community mobilisation in Mumbai slums to improve care during pregnancy, delivery, postpartum and for the newborn. Trials 2008, 9:7. BioMed Central Full Text
• [62]WHO: Putting women first: ethical and safety recommendations for research on domestic violence against women. WHO/FCH/GWH/01.1. Geneva: Department of Gender and Women’s Health, Family and Community Health, World Health Organization; 2001.
• [63]WHO: WHO multi-country study on women’s health and domestic violence against women. Initial results on prevalence, health outcomes and women’s responses. Geneva: World Health Organization; 2005.
• [64]Filmer D, Pritchett L: Estimating wealth effects without expenditure data - or tears: an application to educational enrollments in states of India. Demography 2001, 38:115-132.
• [65]Vyas S, Kumaranayake L: Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan 2006, 21:459-468.
• [66]Victora CG, Huttly SR, Fuchs SC, Olinto MTA: The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. Int J Epidemiol 1997, 26:224-227.
• [67]Shah More N, Bapat U, Das S, Barnett S, Costello A, Fernandez A, Osrin D: Inequalities in maternity care and newborn outcomes: one-year surveillance of births in vulnerable slum communities in Mumbai. Int J Equity Health 2009, 8:21. BioMed Central Full Text
• [68]Dalal K: Does economic empowerment protect women from intimate partner violence? J Inj Violence Res 2011, 3:35-44.
• [69]Madhivanan P, Krupp K, Reingold A: Correlates of intimate partner physical violence among young reproductive Age women in mysore, India. Asia Pac J Public Health 2011. doi:10.1177/1010539511426474 Epub ahead of print
• [70]Krishnan S, Rocca CH, Hubbard AE, Subbiah K, Edmeades J, Padian NS: Do changes in spousal employment status lead to domestic violence? Insights from a prospective study in Bangalore, India. Soc Sci Med 2010, 70:136-143.
• [71]Koenig MA, Lutalo T, Zhao F, Nalugoda F, Wabwire-Mangen F, Kiwanuka N, Wagman J, Serwadda D, Wawer M, Gray R: Domestic violence in rural Uganda: evidence from a community-based study. Bull World Health Organ 2003, 81:53-60.
• [72]Taft AJ, Watson LF, Lee C: Violence against young Australian women and association with reproductive events: a cross-sectional analysis of a national population sample. Aust N Z J Public Health 2004, 28:324-329.
• [73]Silverman JG, Gupta J, Decker MR, Kapur N, Raj A: Intimate partner violence and unwanted pregnancy, miscarriage, induced abortion, and stillbirth among a national sample of Bangladeshi women. BJOG 2007, 114:1246-1252.
• [74]Coker AL, Sanderson M, Dong B: Partner violence during pregnancy and risk of adverse pregnancy outcomes. Paediatr Perinat Epidemiol 2004, 18:260-269.
• [75]Covington DL, Hage M, Hall T, Mathis M: Preterm delivery and the severity of violence during pregnancy. J Reprod Med 2001, 46:1031-1039.
• [76]Valladares E, Ellsberg M, Pena R, Hogberg U, Persson LA: Physical partner abuse during pregnancy: a risk factor for low birth weight in Nicaragua. Obstet Gynecol 2002, 100:700-705.
• [77]Farid M, Saleem S, Karim MS, Hatcher J: Spousal abuse during pregnancy in Karachi, Pakistan. Int J Gynaecol Obstet 2008, 101:141-145.
• [78]Salari Z, Nakhaee N: Identifying types of domestic violence and its associated risk factors in a pregnant population in Kerman hospitals, Iran Republic. Asia Pac J Public Health 2008, 20:49-55.
• [79]Tiwari A, Chan KL, Fong D, Leung WC, Brownridge DA, Lam H, Wong B, Lam CM, Chau F, Chan A, et al.: The impact of psychological abuse by an intimate partner on the mental health of pregnant women. BJOG 2008, 115:377-384.
• [80]Stephenson R, Koenig MA, Acharya R, Roy TK: Domestic violence, contraceptive use, and unwanted pregnancy in rural India. Stud Fam Plann 2008, 39:177-186.
• [81]Pallitto CC, Campbell JC, O’Campo P: Is intimate partner violence associated with unintended pregnancy? A review of the literature. Trauma Violence Abuse 2005, 6:217-235.