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Partner violence during pregnancy, psychosocial factors and child outcomes in Nicaragua
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Umeå University, Faculty of Medicine, Clinical Sciences, Obstetrics and Gynaecology.
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The objectives of the thesis was to explore partner violence during pregnancy in Nicaragua – its prevalence and characteristics, how women perceive, understand and cope with it, its association with specific child outcomes such as low birth weight (LBW), small for gestational age (SGA) and preterm birth, and possible pathways. A cross-sectional community-based study was conducted with 478 pregnant women and for a sub-sample of 147 salivary cortisol was measured. A case-referent hospital-based study was organized including 303 mothers immediately after delivery. In-depth interviews were conducted with women survivors to increase understanding of partner violence during pregnancy.

The prevalence of emotional, physical and sexual partner abuse during pregnancy was 32.4%, 13.4% and 6.7% respectively. Seventeen percent of the victims suffered all three types of violence and in two thirds the abuse was severe and repeated. Half of the abused women had experienced punches and kicks directed to the abdomen; however, only 14% had sought health care and very few had disclosed the abuse or contacted police or authorities. Adolescent mothers, unwanted pregnancy and late registration for antenatal care or no check-ups were more likely among victims. The access to social resources facilitated the women’s ability to cope with the abuse, but the pregnancy itself was a barrier to receiving support from family, friends or society. The ability to confront abuse was determined by a complex interplay of factors such as economic independence, severity of abuse, access to social resources, implications for important others (i.e. children), socioeconomic group and a personal ability to cope with social norms.

Low social resources, high levels of emotional distress and attempted suicide were associated with violence during pregnancy. Abuse during pregnancy was also found as an independent risk factor for LBW. Sixteen percent of LBW was attributed to physical abuse by a partner during pregnancy. A significant association between abuse during the index pregnancy and SGA was found.

Partner violence during the pregnancy, low social resources and emotional distress were associated with higher levels of salivary cortisol. Pregnant women with high cortisol values were significantly more likely to give birth to SGA babies. A substantial decrease of birthweight, 142 grams, was estimated to be associated with increases in cortisol due to violence exposure.

Partner violence during pregnancy is a serious social problem that impacts the rights, health and wellbeing of both the woman and her unborn child. The studies call for prioritization of intervention programmes for prevention and detection of violence, treatment and rehabilitation of the victims and the perpetrators, and change of the structural causes producing violence in society.

Place, publisher, year, edition, pages
Umeå: Folkhälsa och klinisk medicin , 2005. , 72 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 976
Keyword [en]
Public health, abuse during pregnancy, partner violence, pregnant women, low birth weight, small for gestational age, Nicaragua
Keyword [sv]
Folkhälsomedicin
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-578ISBN: 91-7305-916-1 (print)OAI: oai:DiVA.org:umu-578DiVA: diva2:143845
Public defence
2005-09-14, Sal B, Tandläkarhögskolan, Umeå universitet, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2005-08-31 Created: 2005-08-31 Last updated: 2009-11-30Bibliographically approved
List of papers
1. Violence against pregnant women: prevalence and characteristics. A population-based study in Nicaragua.
Open this publication in new window or tab >>Violence against pregnant women: prevalence and characteristics. A population-based study in Nicaragua.
2005 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 112, no 9, 1243-1248 p.Article in journal (Refereed) Published
Abstract [en]

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.

Keyword
Adult, Aged, Cross-Sectional Studies, Female, Humans, Middle Aged, Nicaragua/epidemiology, Pregnancy, Pregnancy Complications/*epidemiology/psychology, Prevalence, Questionnaires, Socioeconomic Factors, Spouse Abuse/psychology/*statistics & numerical data, Stress; Psychological
Identifiers
urn:nbn:se:umu:diva-13889 (URN)10.1111/j.1471-0528.2005.00621.x (DOI)16101603 (PubMedID)
Available from: 2008-04-09 Created: 2008-04-09 Last updated: 2011-04-08Bibliographically approved
2. Physical partner abuse during pregnancy: a risk factor for low birth weight in Nicaragua
Open this publication in new window or tab >>Physical partner abuse during pregnancy: a risk factor for low birth weight in Nicaragua
Show others...
2002 (English)In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 100, no 4, 700-705 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To assess whether being physically abused during pregnancy increases the risk of a low birth weight (LBW) infant. METHODS: We conducted a hospital-based case-control study in León, Nicaragua. Cases consisted of 101 newborns with a birth weight under 2500 g, and for each case two controls with a birth weight over 2500 g were selected randomly from infants born the same day. Anthropometry of newborns was done immediately after birth, and background information and data on experiences of violence and potential confounders were obtained through private interviews with mothers. Crude and adjusted odds ratios (ORs) and population-attributable proportion were calculated for exposure to partner abuse in relation to LBW. Multivariate logistic regression analysis was used to control for potential confounding. RESULTS: Seventy-five percent of LBW newborns (cases) were small for gestational age and 40% were preterm. Twenty-two percent of the mothers of LBW infants had experienced physical abuse during pregnancy by their intimate partners compared with 5% of controls. Low birth weight was associated with physical partner abuse even after adjustment for age, parity, smoking, and socioeconomic status (OR 3.9; 95% confidence interval 1.7, 9.3). Given a causal interpretation of the association, about 16% of the LBW in the infant population could be attributed to physical abuse by a partner in pregnancy. CONCLUSION: Physical abuse by a partner during pregnancy is an independent risk factor for LBW.

Identifiers
urn:nbn:se:umu:diva-4650 (URN)10.1016/S0029-7844(02)02093-8 (DOI)12383537 (PubMedID)
Available from: 2005-08-31 Created: 2005-08-31 Last updated: 2011-04-08Bibliographically approved
3. Nicaraguan women's experience of abuse during pregnancy. A qualitative approach
Open this publication in new window or tab >>Nicaraguan women's experience of abuse during pregnancy. A qualitative approach
Article in journal (Refereed) Submitted
Identifiers
urn:nbn:se:umu:diva-4651 (URN)
Available from: 2005-08-31 Created: 2005-08-31Bibliographically approved
4. Neuroendocrine response to violence during pregnancy: relation to pregnancy duration and fetal growth
Open this publication in new window or tab >>Neuroendocrine response to violence during pregnancy: relation to pregnancy duration and fetal growth
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Manuscript (Other academic)
Identifiers
urn:nbn:se:umu:diva-4652 (URN)
Available from: 2005-08-31 Created: 2005-08-31 Last updated: 2010-01-13Bibliographically approved

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