Abstract
BackgroundRates of violence against women are reported to be highest in Africa compared to other continents. We aimed to determine associations between mental illness, demographic, psychosocial and economic factors with experience of intimate partner violence (IPV) among pregnant women in a low resource setting in Cape Town and to explore the contextual elements pertaining to domestic violence.MethodsWe recruited adult women attending antenatal services at a primary-level maternity facility. Demographic, socioeconomic and psychosocial data were collected by questionnaire. The Expanded Mini- International Neuropsychiatric Interview (MINI) Version 5.0.0 was used to assess mental health status and the Revised Conflict Tactic Scale (CTS2) used to assess IPV in the six months prior to the study. Non-parametric tests, Wilcoxon sum of rank test, Fisher Exact and two sample T test and multicollinearity tests were performed. Descriptive, bivariate and logistic regression analyses were conducted to identify associations between the outcome of interest and key predictors. A probability value of p ≤ 0.05 was selected. From counselling case notes, a thematic content analysis was conducted to describe contextual factors pertaining to forms of domestic violence (DV).ResultsThe prevalence of IPV was 15% of a sample of 376 women. Women who were food insecure, unemployed, in stable but unmarried relationships, had experienced any form of past abuse and were not pleased about the current pregnancy were more likely to experience IPV. MINI-defined mental health problems and a history of mental illness were significantly associated with IPV. Qualitative analysis of 95 counselling case notes revealed that DV within the household was not limited to intimate partners and, DV in this context was often perceived as ‘normal’ behaviour by the participants.ConclusionsThis study contributes towards a greater understanding of the risk profile for IPV amongst pregnant women in low-income settings. Adversity, including food insecurity and mental ill-health are closely associated with IPV during the antenatal period. Advocates against violence against pregnant women are advised to consider that violence in the home may be perpetrated by non-intimate partners and may by enabled by a pervasive belief in the acceptability of the violence.
Highlights
Rates of violence against women are reported to be highest in Africa compared to other continents
Significant findings showed that women older than 29 were less likely to report an experience of intimate partner violence (IPV) than younger women
As perceptions of social support from a “special person” increased, pregnant women were less likely to report an experience of IPV relative to those who experienced a lower perception of social support
Summary
Rates of violence against women are reported to be highest in Africa compared to other continents. A World Health Organisation multi-country study on IPV found that between 15 and 71% of women reported lifetime physical or sexual violence by a partner [3]. This is an important public health concern. Domestic violence (DV) is defined as any physical, sexual, psychological or economic abuse that takes place between people who are sharing, or have recently shared a residence [4] While this usually takes place between intimate partners [5], in the context of a low-resource setting, where extended family members reside within the same household, DV is not limited to intimate partners. Data reported in epidemiologic studies are likely to underestimate the prevalence [6]
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