Associations between recent intimate partner violence and receipt and quality of perinatal health services in Uttar Pradesh.

Jay G Silverman,Yamini Atmavilas,Nabamallika Dehingia,Kultar Singh,Dharmendra Chandurkar,Sabrina C Boyce,Ruvani W Fonseka,Anita Raj,Katherine Hay,Nihaya Daoud

doi:10.1371/journal.pone.0232079

Abstract

BackgroundIndia suffers some of the highest maternal and neonatal mortality rates in the world. Intimate partner violence (IPV) can be a barrier to utilization of perinatal care, and has been associated with poor maternal and neonatal health outcomes. However, studies that assess the relationship between IPV and perinatal health care often focus solely on receipt of services, and not the quality of the services received.Methods and findingsData were collected in 2016–2017 from a representative sample of women (15-49yrs) in Uttar Pradesh, India who had given birth within the previous 12 months (N = 5020), including use of perinatal health services and past 12 months experiences of physical and sexual IPV. Multivariate logistic regression models assessed whether physical or sexual IPV were associated with perinatal health service utilization and quality.Reports of IPV were not associated with odds of receiving antenatal care or a health worker home visit during the third trimester, but physical IPV was associated with fewer diagnostic tests during antenatal visits (beta = -0.30), and fewer health topics covered during home visits (beta = -0.44). Recent physical and recent sexual IPV were both associated with decreased odds of institutional delivery (physical IPV AOR 0.65; sexual IPV AOR 0.61), and recent sexual IPV was associated with leaving a delivery facility earlier than recommended (AOR = 1.87). Neither form of IPV was associated with receipt of a postnatal home visit, but recent physical IPV was associated with fewer health topics discussed during such visits (beta = -0.26).ConclusionsIn this study, reduced quantity and quality of perinatal health care were associated with recent IPV experiences. In cases where IPV was not related to care receipt, IPV remained associated with diminished care quality. Additional study to understand the mechanisms underlying associations between IPV and care qualities is required to inform health services.

Highlights

More than 7,000 newborns and 830 women die each day due to neonatal and maternal complications [1,2], prompting the UN to make lowering global maternal and neonatal mortality key targets of the Sustainable Development Goals for 2030 [3]
Reports of intimate partner violence (IPV) were not associated with odds of receiving antenatal care or a health worker home visit during the third trimester, but physical IPV was associated with fewer diagnostic tests during antenatal visits, and fewer health topics covered during home visits
In this study, reduced quantity and quality of perinatal health care were associated with recent IPV experiences

Summary

Introduction

More than 7,000 newborns and 830 women die each day due to neonatal and maternal complications [1,2], prompting the UN to make lowering global maternal and neonatal mortality key targets of the Sustainable Development Goals for 2030 [3]. Three perinatal health interventions key to reducing maternal and neonatal mortality are high quality antenatal care ANC), delivery by trained medical providers, and high-quality postnatal care (PNC) [6]. Typical indicators of adequacy of antenatal care, including those utilized in major studies of the associations of care to morbidity and mortality, focus solely on quantity of such care received, e.g., receipt of a minimum of four ANC visits [6,7]. Quality of ANC is known to be critical to maternal and neonatal survival, independent of quantity (number of visits), and quality, rather than quantity of perinatal care has been described recently by the WHO as the greatest barrier to reaching global development goals [8,9]. Intimate partner violence (IPV) can be a barrier to utilization of perinatal care, and has been associated with poor maternal and neonatal health outcomes. Studies that assess the relationship between IPV and perinatal health care often focus solely on receipt of services, and not the quality of the services received

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Discussion

Conclusion