Abstract
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.
Highlights
The World Health Organisation (WHO) found lifetimeprevalence rates of exposure to physical or sexual partner violence of 15%–71% in a recent multi-country study (Abramsky et al, 2011)
This study is nested in the Drakenstein Child Health Study (DCHS), a multidisciplinary birth cohort investigating the determinants of child health in a peri-urban area in South Africa (Stein et al, 2015; Zar, Barnett, Myer, Stein, & Nicol, 2015)
Emerging in the combined analysis, was a group of mothers with very high levels of intimate partner violence (IPV) antenatally – representing 10% of the sample, this is both a large proportion of women as well as women with exposure probabilities during pregnancy approximately as high as those in the high longitudinal exposure group. For both analyses considering longitudinal patterns of IPV, membership in the high versus low class was associated with all types of maternal childhood maltreatment, indicating a relationship between maternal childhood maltreatment and severity of adult exposure to IPV
Summary
The World Health Organisation (WHO) found lifetimeprevalence rates of exposure to physical or sexual partner violence of 15%–71% in a recent multi-country study (Abramsky et al, 2011). The epidemic of intimate partner violence (IPV), predominantly affecting women, is high in low and middle-income countries (LMICs), including South Africa (Dunkle, Jewkes, Brown, Gray et al, 2004; Dunkle, Jewkes, Brown, Yoshihama et al, 2004; Jewkes et al, 2008). Levels of violence in South Africa are some of the highest globally; the intimate female homicide rate in South Africa is 5.6 per 100,000, more than double the rate in the United States (Mathews et al, 2004). This amounts to one woman being killed by an intimate partner every 8 hours (Abrahams, Matthews, Jewkes, Martin, & Lombard, 2012). In the South African context, IPV increases risk of maternal – and vertical - HIV infection (Jewkes, Dunkle, Koss et al, 2006; Jewkes, Dunkle, Nduna et al, 2006; Li et al, 2014; Maman et al, 2002)
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