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Relationship factors and trajectories of intimate partner violence among South African women during pregnancy and the postpartum period.

ABSTRACT: Intimate partner violence (IPV) is a significant public health problem in South Africa. However, there is limited research on whether and how IPV changes during pregnancy and the postpartum period and on the factors that might affect women's risk during this time. In this study, we describe the mean trajectories of physical and psychological IPV during pregnancy and the postpartum period and examine whether relationship power, partner social support, and relationship stress are associated with women's trajectories of IPV. Data come from a longitudinal study with 1,480 women recruited during pregnancy between May 2008 and June 2010 at a public clinic in Durban. Women completed behavioral assessments at their first antenatal visit, at fourteen weeks and at nine months postpartum. Women's experiences of IPV were measured at all three time points and relationship power, partner social support and relationship stress were each measured at the baseline assessment. We used multilevel random coefficients growth modeling to build our models. The mean trajectory for both types of IPV was flat which means that, on average, there was not significant change in levels of IPV over pregnancy and the postpartum period. However, there was significant individual variability in trajectories of IPV over the study period. Women who had higher relationship power had lower levels of physical and psychological IPV over time than women with lower relationship power. Additionally, women with higher relationship stress and lower partner support had higher levels of psychological IPV at pregnancy. Interventions that maximize women's relationship power and partner social support and minimize relationship stress during this transformative time are needed.

SUBMITTER: Groves AK

PROVIDER: S-EPMC4182034 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Relationship factors and trajectories of intimate partner violence among South African women during pregnancy and the postpartum period.

Groves Allison K AK McNaughton-Reyes H Luz HL Foshee Vangie A VA Moodley Dhayendre D Maman Suzanne S

PloS one 20140930 9

Intimate partner violence (IPV) is a significant public health problem in South Africa. However, there is limited research on whether and how IPV changes during pregnancy and the postpartum period and on the factors that might affect women's risk during this time. In this study, we describe the mean trajectories of physical and psychological IPV during pregnancy and the postpartum period and examine whether relationship power, partner social support, and relationship stress are associated with w ...[more]

PMID: 25268363

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Project description:BACKGROUNDViolence against women by intimate partners remains unacceptably common worldwide. The evidence base for the assumed psychological impacts of intimate partner violence (IPV) is derived primarily from studies conducted in high-income countries. A recently published systematic review identified 13 studies linking IPV to incident depression, none of which were conducted in sub-Saharan Africa. To address this gap in the literature, we analyzed longitudinal data collected during the course of a 3-y cluster-randomized trial with the aim of estimating the association between IPV and depression symptom severity.METHODS AND FINDINGSWe conducted a secondary analysis of population-based, longitudinal data collected from 1,238 pregnant women during a 3-y cluster-randomized trial of a home visiting intervention in Cape Town, South Africa. Surveys were conducted at baseline, 6 mo, 18 mo, and 36 mo (85% retention). The primary explanatory variable of interest was exposure to four types of physical IPV in the past year. Depression symptom severity was measured using the Xhosa version of the ten-item Edinburgh Postnatal Depression Scale. In a pooled cross-sectional multivariable regression model adjusting for potentially confounding time-fixed and time-varying covariates, lagged IPV intensity had a statistically significant association with depression symptom severity (regression coefficient b = 1.04; 95% CI, 0.61-1.47), with estimates from a quantile regression model showing greater adverse impacts at the upper end of the conditional depression distribution. Fitting a fixed effects regression model accounting for all time-invariant confounding (e.g., history of childhood sexual abuse) yielded similar findings (b = 1.54; 95% CI, 1.13-1.96). The magnitudes of the coefficients indicated that a one-standard-deviation increase in IPV intensity was associated with a 12.3% relative increase in depression symptom severity over the same time period. The most important limitations of our study include exposure assessment that lacked measurement of sexual violence, which could have caused us to underestimate the severity of exposure; the extended latency period in the lagged analysis, which could have caused us to underestimate the strength of the association; and outcome assessment that was limited to the use of a screening instrument for depression symptom severity.CONCLUSIONSIn this secondary analysis of data from a population-based, 3-y cluster-randomized controlled trial, IPV had a statistically significant association with depression symptom severity. The estimated associations were relatively large in magnitude, consistent with findings from high-income countries, and robust to potential confounding by time-invariant factors. Intensive health sector responses to reduce IPV and improve women's mental health should be explored.

Project description:Intimate partner violence (IPV) is a significant global problem, prevalent in low and middle-income countries (LMICs). IPV is particularly problematic during the perinatal and early postnatal period, where it is linked with negative maternal and child health outcomes. There has been little examination of profiles of IPV and early life adversity in LMIC contexts. We aimed to characterize longitudinal IPV and to investigate maternal maltreatment in childhood as a predictor of IPV exposure during pregnancy and postnatally in a low resource setting. This study was nested in the Drakenstein Child Health Study, a longitudinal birth cohort. Maternal IPV (emotional, physical and sexual) was measured at six timepoints from pregnancy to two years postpartum (n?=?832); sociodemographic variables and maternal maltreatment in childhood were measured antenatally at 28-32 weeks' gestation. Associations between maternal maltreatment in childhood and IPV latent class membership (to identify patterns of maternal IPV exposure) were estimated using multinomial and logistic regression. We observed high levels of maternal maltreatment during childhood (34%) and IPV during pregnancy (33%). In latent class analysis separating by IPV sub-type, two latent classes of no/low and moderate sexual IPV and three classes of low, moderate, and high emotional and physical IPV (separately) were detected. In combined latent class analysis, including all IPV sub-types together, a low, moderate and high exposure class emerged as well as a high antenatal/decreasing postnatal class. Moderate and high classes for all IPV sub-types and combined analysis showed stable intensity profiles. Maternal childhood sexual abuse, physical abuse and neglect, and emotional abuse predicted membership in high IPV classes, across all domains of IPV (aORs between 1.99 and 5.86). Maternal maltreatment in childhood was associated with increased probability of experiencing high or moderate intensity IPV during and around pregnancy; emotional neglect was associated with decreasing IPV class for combined model. Intervening early to disrupt this cycle of abuse is critical to two generations.

Project description:Objectives Intimate partner violence (IPV) is an important contributor to the burden of disease in South Africa. Evidence-based approaches to IPV in primary care are lacking. This study evaluated a project that implemented a South African protocol for screening and managing IPV. This article reports primarily on the benefits of this intervention from the perspective of women IPV survivors. Design This was a project evaluation involving two urban and three rural primary care facilities. Over 4-8 weeks primary care providers screened adult women for a history of IPV within the previous 24 months and offered referral to the study nurse. The study nurse assessed and managed the women according to the protocol. Researchers interviewed the participants 1 month later to ascertain adherence to their care plan and their views on the intervention. Results In total, 168 women were assisted and 124 (73.8%) returned for follow-up. Emotional (139, 82.7%), physical (115, 68.5%), sexual (72, 42.9%) and financial abuse (72, 42.9%) was common and 114 (67.9%) were at high/severe risk of harm. Adherence to the management plan ranged from testing for syphilis 10/25 (40.0%) to consulting a psychiatric nurse 28/58 (48.3%) to obtaining a protection order 28/28 (100.0%). Over 75% perceived all aspects of their care as helpful, except for legal advice from a non-profit organisation. Women reported significant benefits to their mental health, reduced alcohol abuse, improved relationships, increased self-efficacy and reduced abusive behaviour. Two characteristics seemed particularly important: the style of interaction with the nurse and the comprehensive nature of the assessment. Conclusion Female IPV survivors in primary care experience benefit from an empathic, comprehensive approach to assessing and assisting with the clinical, mental, social and legal aspects. Primary care managers should find ways to integrate this into primary care services and evaluate it further.

Project description:BackgroundIntimate partner violence during pregnancy is a strong predictor of maternal postpartum depression. In Ethiopia, evidence on the association of intimate partner violence during pregnancy with postpartum depression is very limited. To design appropriate intervention, it is thus important to understand how postpartum depression varies as a function of the type and severity of intimate partner violence victimization during pregnancy. The aim of this study is to explore the association of different types of intimate partner violence during pregnancy and its severity with postpartum depression in Eastern Ethiopia.MethodA community-based cross-sectional study was conducted from January to October 2018. The study included a sample of 3015 postpartum women residing in Eastern Ethiopia. The cutoff point for postpartum depression was defined as ⩾13 points according to the Edinburgh Postnatal Depression Scale. The prevalence ratio with 95% confidence intervals was calculated, and the association between the main predictor (i.e. intimate partner violence during pregnancy) and the outcome variable (postpartum depression) was determined using log binomial regression model.Results16.3% (95% confidence interval: 14.9-17.7) of women experienced postpartum depression. After controlling potential confounding factors, the prevalence of postpartum depression among women exposed to severe physical intimate partner violence during pregnancy was 1.98 times higher as compared to those not exposed to physical intimate partner violence during pregnancy (adjusted prevalence ratio = 1.98; 95% confidence interval: 1.53-2.54). Exposure to psychological intimate partner violence during pregnancy was found to increase the prevalence of postpartum depression by 1.79 as compared to non-exposure to psychological intimate partner violence during pregnancy (adjusted prevalence ratio = 1.79; 95% confidence interval: 1.48-2.18).ConclusionThe study provides evidence that psychological and severe physical intimate partner violence during pregnancy were significantly associated with maternal postpartum depression. Screening of pregnant women for intimate partner violence and providing them the necessary support can minimize the risk to postpartum depression.

Project description:BackgroundIntimate partner violence (IPV) around the time of pregnancy is a widespread global health problem with many negative consequences. Nevertheless, a lot remains unclear about which interventions are effective and might be adopted in the perinatal care context.ObjectiveThe objective is to provide a clear overview of the existing evidence on effectiveness of interventions for IPV around the time of pregnancy.MethodsFollowing databases PubMed, Web of Science, CINAHL and the Cochrane Library were systematically searched and expanded by hand search. The search was limited to English peer-reviewed randomized controlled trials published from 2000 to 2013. This review includes all types of interventions aiming to reduce IPV around the time of pregnancy as a primary outcome, and as secondary outcomes to enhance physical and/or mental health, quality of life, safety behavior, help seeking behavior, and/or social support.ResultsWe found few randomized controlled trials evaluating interventions for IPV around the time of pregnancy. Moreover, the nine studies identified did not produce strong evidence that certain interventions are effective. Nonetheless, home visitation programs and some multifaceted counseling interventions did produce promising results. Five studies reported a statistically significant decrease in physical, sexual and/or psychological partner violence (odds ratios from 0.47 to 0.92). Limited evidence was found for improved mental health, less postnatal depression, improved quality of life, fewer subsequent miscarriages, and less low birth weight/prematurity. None of the studies reported any evidence of a negative or harmful effect of the interventions.Conclusions and implicationsStrong evidence of effective interventions for IPV during the perinatal period is lacking, but some interventions show promising results. Additional large-scale, high-quality research is essential to provide further evidence about the effect of certain interventions and clarify which interventions should be adopted in the perinatal care context.

Project description:Background: Intimate partner violence (IPV) during pregnancy can lead to negative consequences for both the mother and offspring. Although IPV is recognized as a worldwide public health issue, its prevalence is considered to be underestimated because cases are likely underreported, suggesting that there might be unmeasured IPV. The aim of this study was to develop an instrument to detect IPV in pregnant women. Methods: A total of 6,590 women in Aichi prefecture, Japan, who took part in a 3 or 4 month infant health checkup program, participated in the study. Questionnaires assessing history of IPV during pregnancy (physical abuse and verbal abuse), maternal characteristics, partner's characteristics, and household characteristics were mailed to women before, or distributed at, the checkup. Women returned the questionnaires to the checkup sites or mailed them back to the health centers. A prediction model for history of IPV was then generated using potential risk factors selected based on the literature. Results: Among 6,530 women who responded to either question on IPV during pregnancy (response rate = 67.3%), the rate of participants who experienced any IPV during pregnancy was 11.1% (physical IPV = 1.2%; verbal IPV = 10.8%). Multiple logistic regression analyses showed that maternal age (<25 years old), multiparity, history of artificial abortion, negative feelings when the pregnancy was confirmed (e.g., confused), having no one to provide support during pregnancy, having relationship problems with their partner, paternal smoking during pregnancy, and difficult financial status were associated with any abuse from the partner. Based on the analysis, the Intimate Partner Violence during Pregnancy Instrument (IPVPI) was developed, comprising of eight questions to detect unmeasured IPV in pregnant women, and showed moderate predictive power (area under receiver operating characteristic curve = 0.719, 95% confidence interval: 0.698 to 0.740) ranging from 0 to 16 with a cut-off point of 2 (sensitivity = 79.5%, specificity = 47.1%). Conclusion: The IPVPI, which allows to ask indirect questions rather that asking directly about experience of IPV, might be helpful to detect unmeasured IPV in pregnant women in fields of primary healthcare and obstetrics. Further research longitudinal studies are needed to improve the sensitivity and specificity of the IPVPI.

Dataset Information

Relationship factors and trajectories of intimate partner violence among South African women during pregnancy and the postpartum period.

Publications

Relationship factors and trajectories of intimate partner violence among South African women during pregnancy and the postpartum period.

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