Domestic violence and perinatal outcomes \u2013 a prospective cohort study from Nepal

On Behalf Of The Advance Study Group ,Kunta Devi Pun,Berit Schei,Shrinkhala Shrestha,Mirjam Lukasse,Jennifer Jean Infanti,Elisabeth Darj,Poonam Rishal

doi:10.1186/s12889-019-6967-y

Abstract

BackgroundDomestic violence is one of the most common forms of violence against women. Domestic violence during pregnancy is associated with adverse perinatal and maternal outcomes. We aimed to assess whether domestic violence was associated with mode of delivery, low birthweight and preterm birth in two sites in Nepal.MethodsIn this prospective cohort study we consecutively recruited 2004 pregnant women during antenatal care at two hospitals between June 2015 and September 2016. The Abuse Assessment Screen (modified) was used to assess fear and violence. Having ever experienced either fear or violence was defined as any domestic violence. Obstetric outcomes were obtained from hospital records for 1381 (69%) women, selecting singleton pregnancies only. Mode of delivery was assessed as birth by cesarean section or not. A birthweight of less than 2500 g was defined as low birthweight and preterm birth as birth before completion of 37 weeks gestation. Descriptive and multiple logistic regression analyses were performed to assess associations.ResultsTwenty percent of the women reported any domestic violence. Among all 1381 women, 37.6% gave birth by cesarean section. Of those women who delivered by cesarean section, 84.7% had an emergency cesarean section. Less than 10% of the babies were born prematurely and 13.5% were born with low birthweight. We found no significant association between exposure to any domestic violence during pregnancy and risk of a low birthweight baby or birth by cesarean section. However, having experienced both violence and fear was significantly associated with giving birth to a preterm infant [aOR 2.33 (95% CI;1.10–4.73)].ConclusionsDomestic violence is common in Nepal. This is a potential risk factor for severe morbidity and mortality in newborns. We found that the risk of having a preterm baby was higher for pregnant women who experienced both fear and violence. This should be recognized by the health sector. In this study, no significant differences were found in the rate of cesarean section nor low birthweight for women who had experienced any domestic violence compared to those who did not.

Highlights

Domestic violence is one of the most common forms of violence against women
As in Brazil [30] and Pakistan [25], we found no association between Domestic violence (DV) and low birthweight (LBW)
Any women who experienced DV after this time period would have been classified as non-exposed in our study; the lack of associations we found could be due to diluting of effects

Summary

Introduction

Domestic violence is one of the most common forms of violence against women. Domestic violence during pregnancy is associated with adverse perinatal and maternal outcomes. Domestic violence (DV) is one of the most common forms of violence against women [1]. It is defined in Nepal by the Ministry of Law, Justice and Parliamentary Affairs as any form of physical, mental, sexual, or economic harm, including acts of reprimand or emotional harm, In Nepal, women typically relocate to their husband’s homes after marriage and may become vulnerable to various forms of DV in the new household setting [3]. Women are asked ‘are you afraid of someone in the family?’ The other questions assess if they have ever been emotionally, physically or sexually abused. A positive answer to any of the AAS questions defines a woman as having experienced any form of DV [5]

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