Effects of intimate partner violence on pregnancy outcome

Abstract

Introduction: Intimate partner violence (IPV) is a significant, yet preventable public health problem that affects millions of women regardless of age, economic status, race, religion, ethnicity, sexual orientation, or educational background. The IPV has been associated with poor pregnancy outcomes, such as anemia, still birth, abruption, fetal injury, preterm delivery, and low birth weight. With this background, we did a screening study to assess prevalence, demographic features, and maternal and neonatal outcomes. Materials and methods: This is a prospective observational study done at the Modern Government Maternity Hospital, Osmania Medical College, Hyderabad, India. About 300 pregnant women admitted for various obstetric reasons during January 2013 and December 2013 and delivered were considered for the study. History and various aspects of domestic violence were obtained with a detailed written pro forma. Descriptive analysis was carried out to summarize relevant variables. Primary outcomes included incidence, risk factors, maternal morbidity, and fetal and neonatal outcome. Results: About 114 women (38%) revealed domestic violence, which is very high compared with 0.8% when there was no screening for domestic violence. A total of 186 women showed no history of violence. Demographic features and obstetric outcomes were compared. About 90% women in both groups were economically dependent. About 50% women did not have a right over their reproductive choices. About 33 women faced violence at the time of pregnancy (28.9%). Very strong association between antenatal care booking and partner abuse was observed. About 50% had less than three visits and 64.4% of abusive partners are alcoholic. Gender bias, male child preference, unemployment, and dowry were the other common causes for abuse. Abruption was seen in 6.14% in the abuse group vs 1.79% in the control group. Preterm labor was 6.14 vs 2.15%. Four women with severe acute maternal morbidity due to IPV and one case of severe sexual violence have been highlighted. Conclusion: Domestic violence and IPV are widely prevalent, and what is visible is only the tip of the iceberg. It contributes to a spectrum of maternal and fetal complications. The obstetrician– gynecologist has the unique opportunity to screen for domestic violence, and screening for domestic violence has to be made part of antenatal care. Linking up medical, legal, police, welfare homes, and counseling can go a long way. Millennium development goal (MDG) 3, i.e., gender parity, should be the route to achieve MDG 4 and 5.