World Health Organization Multi-Country Study Research Articles

Intimate Partner Violence and its associated factors among pregnant women receiving antenatal care. A Bayesian analysis approach.

Intimate Partner Violence (IPV) is a major public health problem worldwide. In developing nations, including Ethiopia, the problem is under-reported and under-estimated. Therefore, this study attempts to assess intimate partner violence and its associated factors among pregnant women receiving antenatal care at public hospitals in Amhara region, Ethiopia. A health facility-based cross-sectional study design was employed. A sample of 418 pregnant women was selected using random sampling technique from 1st May to 1st June 2021. IPV was measured using the World Health Organization (WHO) Multi-country study of violence against women assessment tool. Data were entered into Epi-data 3.1 and exported into Stata 17 for further analysis. A Bayesian multivariable logistic regression analysis was carried out from the posterior distribution, and an adjusted odds ratio (AOR) with a 95% credible interval (CrI) was used to declare statistically significant variables. The prevalence of any IPV among pregnant women was 31.3% [95% CrI 26.6%, 36.1%]. After adjusting a range of covariates, IPV during pregnancy was more likely among women whose husbands used substances [AOR = 4.33: 95% CrI 1.68, 8.95] and household decisions made by husbands only [AOR = 6.45: 95% CI 3.01, 12.64]. Conversely, pregnant women who attended primary [AOR = 0.47: 95% CrI 0.24, 0.81] and secondary [AOR = 0.64: 95% CrI 0.41, 0.92] educational levels, women who had four or more ANC visits antenatal care visits [AOR = 0.43: 95% CrI 0.25, 0.68], and women with no prior history of adverse birth outcomes [AOR = 0.48: 95% CI 0.27, 0.80] were less likely to experience IPV during pregnancy. The study revealed a relatively high prevalence of any IPV among pregnant women, with factors such as substance use by husbands and limited decision-making autonomy associated with increased IPV likelihood. Conversely, women with higher education levels, four and above antenatal care attendance, and no history of adverse birth outcomes showed a reduced likelihood of experiencing IPV during pregnancy. Therefore, targeted interventions to address substance use, empower women in decision-making, and promote education and healthcare access to mitigate IPV risk during pregnancy are recommended.

Health System Responsiveness for Persons with HIV and Disability in South Western Uganda.

Inequitable access to Human Immunodeficiency Virus/Acquired Immune Syndrome (HIV/AIDS) Treatment and Care Services (HATCS) for People With Disabilities (PWD) is a hurdle to ending the pandemic by 2030. The aim of this study was to evaluate the Health System's Responsiveness (HSR) and associated factors for PWD attending HATCS at health facilities in South Western Uganda. Between February and April 2022, we enrolled a total of 106 people with disabilities for a quantitative study and 14 key informants from selected primary care HIV clinics. The World Health Organization Multi-country study's disability assessment schedules 2.0 and Health system responsiveness (HSR) questionnaire were adopted to measure the level of disabilities and responsiveness, respectively. The level of HSR was evaluated using descriptive analysis. The association between socio-demographics, level of disabilities and HSR was evaluated through binary and multivariable logistic regression. The qualitative data were collected from 14 key informants using interview guide and analyzed according to thematic areas (deductive approaches). Overall, Health system responsiveness (HSR) was at 47.62% being acceptable to people living with HIV and Disabilities in south western Uganda. Across different domains, the best performance was reported in social consideration (68.57%) and autonomy (67.62%). The least performance was registered in dignity (2.83%), confidentiality (2.91%), prompt Attention (17.35%) and Choices (30.48%). Whereas performance in communications (53.92%) and quality of basic amenities (42.27%) were average. There were no socio-demographics or disability variables that were predictive of HATCS responsiveness. PWDs experienced lack of social support, poor communication, stigma and discrimination during the HATCs services. On the other hand, the health-care providers felt frustrated by their inability to communicate effectively with PWDs and meet their need for social support. HSR was comparatively low, with dignity, confidentiality, prompt attention, and choice ranking worst. To address the universal and legitimate requirements of PWDs in accessing care, urgent initiatives are required to create awareness among all stakeholders.

High severity of abortion complications in fragile and conflict-affected settings: a cross-sectional study in two referral hospitals in sub-Saharan Africa (AMoCo study)

BackgroundAbortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. Our study aims to describe the magnitude and severity of abortion-related complications in two referral hospitals supported by Médecins Sans Frontières and located in such settings in northern Nigeria and Central African Republic (CAR).MethodsWe used a methodology similar to the World Health Organization (WHO) near-miss approach adapted in the WHO multi-country study on abortion (WHO-MCS-A). We conducted a cross-sectional study in the two hospitals providing comprehensive emergency obstetric care. We used prospective medical records’ reviews of women presenting with abortion-related complications between November 2019 and July 2021. We used descriptive analysis and categorized complications into four mutually exclusive categories of increasing severity.ResultsWe analyzed data from 520 and 548 women respectively in Nigerian and CAR hospitals. Abortion complications represented 4.2% (Nigerian hospital) and 19.9% (CAR hospital) of all pregnancy-related admissions. The severity of abortion complications was high: 103 (19.8%) and 34 (6.2%) women were classified as having severe maternal outcomes (near-miss cases and deaths), 245 (47.1%) and 244 (44.5%) potentially life-threatening, 39 (7.5%) and 93 (17.0%) moderate, and 133 (25.6%) and 177 (32.3%) mild complications, respectively in Nigerian and CAR hospitals. Severe bleeding/hemorrhage was the main type of complication in both settings (71.9% in the Nigerian hospital, 57.8% in the CAR hospital), followed by infection (18.7% in the Nigerian hospital, 27.0% in the CAR hospital). Among the 146 women (Nigerian hospital) and 231 women (CAR hospital) who did not report severe bleeding or hemorrhage before or during admission, anemia was more frequent in the Nigerian hospital (66.7%) compared to the CAR hospital (37.6%).ConclusionOur data suggests high severity of abortion-related complications in these two referral facilities of fragile and conflict-affected settings. Factors that could contribute to this high severity in these contexts include greater delays in accessing post-abortion care, decreased access to contraceptive and safe abortion care that result in increased unsafe abortions; as well as increased food insecurity leading to iron-deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high quality postabortion care to prevent and manage complications of abortion in fragile and conflict-affected settings.

Accelerated scale-up of Kangaroo Mother Care: Evidence and experience from an implementation-research initiative in south India.

Though Kangaroo Mother Care (KMC) has demonstrated benefits for low birth weight newborns, coverage continues to be low in India. As part of a World Health Organization (WHO) multi-country study, we explored intervention models to accelerate KMC coverage in a high priority district of Karnataka, India. We used implementation-research methods, formative assessments and quality improvement approaches to design and scale-up interventions. Evaluation was done using prospective cohort study design; data were collected from facility records, and client interviews during KMC initiation, at discharge and at home after discharge. KMC was initiated at health facilities for 87.6% of LBW babies under 2000g. At discharge, 85.0% received KMC; 67.9% continued to receive KMC at home on the 7th day post-discharge. The interventions included training, mentoring and constant advocacy at many levels: public health facilities, private sector and the community. Innovations like a KMC case sheet, counselling, peer support group triggered KMC in the facilities; a KMC-link card, a microplanning and communication tool for CHWs helped to sustain practice at homes. The study provides a novel approach to designing and scaling up interventions and suggests lessons that are applicable to KMC as well as to broader reproductive, maternal, neonatal and child health programmes.

Categories and health impacts of intimate partner violence in the World Health Organization multi-country study on women's health and domestic violence.

Intimate partner violence (IPV) damages health and is costly to families and society. Individuals experience different forms and combinations of IPV; better understanding of the respective health effects of these can help develop differentiated responses. This study explores the associations of different categories of IPV on women's mental and physical health. Using data from the World Health Organization (WHO) Multi-Country Study on Women's Health and Domestic Violence, multilevel mixed effects logistic regression modelling was used to analyse associations between categories of abuse (physical IPV alone, psychological IPV alone, sexual IPV alone, combined physical and psychological IPV, and combined sexual with psychological and/or physical IPV) with measures of physical and mental health, including self-reported symptoms, suicidal thoughts and attempts, and nights in hospital. Countries varied in prevalence of different categories of IPV. All categories of IPV were associated with poorer health outcomes; the two combined abuse categories were the most damaging. The most common category was combined abuse involving sexual IPV, which was associated with the poorest health [attempted suicide: odds ratio (OR): 10.78, 95% confidence interval (CI) 8.37-13.89, thoughts of suicide: 8.47, 7.03-10.02, memory loss: 2.93, 2.41-3.56]. Combined psychological and physical IPV was associated with the next poorest outcomes (attempted suicide: 5.67, 4.23-7.60, thoughts of suicide: 4.41, 3.63-5.37, memory loss: 2.33, 1.88-2.87-). Understanding the prevalence and health impact of different forms and categories of IPV is crucial to risk assessment, tailoring responses to individuals and planning services. Previous analyses that focused on singular forms of IPV likely underestimated the more harmful impacts of combined forms of abuse.

The association between intimate partner violence and low birth weight and preterm delivery in eastern Ethiopia: Findings from a facility-based study

ObjectiveTo determine the associations between intimate partner violence during pregnancy and low birth weight and preterm birth among women who gave birth in public hospitals in Harari region, eastern Ethiopia. DesignA cross-sectional study was conducted among women who gave birth in public hospitals in Harari region. ParticipantsWomen aged 16–45 years who gave birth in hospitals from November 2018 to April 2019. SettingTwo public hospitals in Harari regional state, eastern Ethiopia MeasurementIntimate partner violence was measured using a questionnaire adapted from the World Health Organization Multi-Country Study on Women's Health and Domestic Violence against Women. Binary and multiple logistic regression was performed to establish the association between intimate partner violence and low birth weight and preterm birth. Both crude and adjusted odds ratios with 95% confidence intervals were calculated. The level of significance was set at a p-value of <0.05. ResultsIn this study, 39% of women reported experiencing partner violence during their most recent pregnancy. The prevalence of preterm birth and low birth weight were found to be 18.9% and 12.01%, respectively. After adjusting for potential confounders, women who experienced any intimate partner violence during pregnancy were 1.62 times (AOR = 1.62, 95%CI= 1.22, 2.78) more likely to give birth prematurely and 1.37 times (AOR= 1.37, 95%CI=1.73, 2.57) more likely to have a low birth weight infant relative to women who did not experience intimate partner violence during pregnancy. Conclusion and implications for practiceThe results underscore the need for including intimate partner violence prevention as an important strategy to reduce child mortality and morbidity. Screening pregnant women for intimate partner violence and providing support for women who have experienced violence might be helpful in tackling prematurity and low birth weight.

Responsiveness of health care services towards the elderly in Tanzania: does health insurance make a difference? A cross-sectional study

BackgroundResponsiveness has become an important health system performance indicator in evaluating the ability of health care systems to meet patients’ expectations. However, its measurement in sub-Saharan Africa remains scarce. This study aimed to assess the responsiveness of the health care services among the insured and non-insured elderly in Tanzania and to explore the association of health insurance (HI) with responsiveness in this population.MethodsA community-based cross-sectional study was conducted in 2017 where a pre-tested household survey, administered to the elderly (60 + years) living in Igunga and Nzega districts, was applied. Participants with and without health insurance who attended outpatient and inpatient health care services in the past three and 12 months were selected. Responsiveness was measured based on the short version of the World Health Organization (WHO) multi-country responsiveness survey study, which included the dimensions of quality of basic amenities, choice, confidentiality, autonomy, communication and prompt attention. Quantile regression was used to assess the specific association of the responsiveness index with health insurance adjusted for sociodemographic factors.ResultsA total of 1453 and 744 elderly, of whom 50.1 and 63% had health insurance, used outpatient and inpatient health services, respectively. All domains were rated relatively highly but the uninsured elderly reported better responsiveness in all domains of outpatient and inpatient care. Waiting time was the dimension that performed worst. Possession of health insurance was negatively associated with responsiveness in outpatient (− 1; 95% CI: − 1.45, − 0.45) and inpatient (− 2; 95% CI: − 2.69, − 1.30) care.ConclusionThe uninsured elderly reported better responsiveness than the insured elderly in both outpatient and inpatient care. Special attention should be paid to those dimensions, like waiting time, which ranked poorly. Further research is necessary to reveal the reasons for the lower responsiveness noted among insured elderly. A continuous monitoring of health care system responsiveness is recommended.

High rate of partner violence during pregnancy in eastern Ethiopia: Findings from a facility-based study.

Intimate partner violence during pregnancy can contribute to maternal mortality and morbidity by limiting women's ability to receive maternal health services including antenatal care and skilled delivery care. In Ethiopia, evidence regarding intimate partner violence during pregnancy is limited, and no previous studies have been conducted in the Harari region. Therefore, this study aimed to investigate the prevalence and associated factors of intimate partner violence during pregnancy among women who had given birth in public hospitals in Harari regional state, eastern Ethiopia. A hospital-based cross-sectional study was conducted from November 2018 to April 2019 among women who had given birth in public hospitals in Harari regional state, East Ethiopia. A systematic random sampling method was employed to select 648 participants. Data were collected using an interviewer-administered standardized questionnaire based on the World Health Organization Multi-Country Study on Women's Health and Domestic Violence against Women survey. Crude and adjusted odds ratios with respective confidence intervals were computed. Variables with a p-value of ≤0.05 were considered to have a significant association with intimate partner violence during pregnancy. The prevalence of intimate partner violence during the most recent pregnancy was found to be 39.81%. Furthermore, the prevalence of physical, emotional and sexual violence were found to be 25.93%, 25.62% and 3.7%, respectively. Longer duration of marriage (adjusted odds ratio = 1.68, 95% confidence interval = 1.01-2.79), most recent pregnancy being unplanned (adjusted odds ratio = 1.55, 95% confidence interval = 1.03-2.34), experiencing controlling behaviour by a partner, (adjusted odds ratio = 2.23, 95% confidence interval = 1.46-3.40) and having an attitude that justifies intimate partner violence (adjusted odds ratio = 1.60, 95% confidence interval = 1.09-2.36) were associated with experiencing intimate partner violence. The prevalence of intimate partner violence during pregnancy was found to be high. Pregnancy monitoring programs, which can detect and intervene with regard to partner's controlling behaviors and women's perception regarding justification of intimate partner violence, especially in those women with an unplanned pregnancy, could help to reduce intimate partner violence during pregnancy. Further, changing social norms that condone violence through advocacy and awareness creation might help in preventing partner violence.

Prevalence of Different Types of Intimate Partner Violence among Ever-Married Women: A Sri Lankan Study

This study examined the prevalence of intimate partner violence (IPV) among a sample of 600 ever-married women from a representative health administrative area located in the Kandy district of Sri Lanka. IPV was assessed using the world health organization (WHO) instrument developed for use in the WHO multi-country study on women’s health and domestic violence against women. Among all participants 59.5% (n=357) have experienced any type of abuse (any form of physical, psychological, sexual abuse and controlling behaviour) at least once during their lifetime. Out of the total 41.3% (n=248) have experienced abuse (any form of physical, psychological and sexual abuse) during the last 12 months. Considering the lifetime IPV experiences, 39.5% (n=237) reported physical abuse, 39% (n=234) reported psychological abuse, 12.3% (n=74) reported sexual abuse and31.3% (n=188) reported generally controlling behaviour by the partner. During the last year 14.8% (n=89) have been physically, 26.3% (n=158) have been psychologically and 7.17% (n=43) have been sexually abused. The present study reveals high lifetime and past year prevalence of IPV compared to other recent studies conducted in Sri Lanka. Furthermore, different types of IPV acts were present with chronic and severe experiences. Hence, interventions should focus on different types of IPV and various abusive behaviours. Further studies are needed to assess the association of different types of IPV and the contributory factors.

The prevalence and predictors of domestic violence among pregnant women in Southeast Oromia, Ethiopia

IntroductionDomestic violence is a common global health problem and relatively hidden and ignored form of violence against pregnant women. The magnitude of domestic violence among pregnant women is higher in low and middle-income countries including Ethiopia as compared with developed countries. Domestic violence is a violation of human right and associated with numerous adverse outcomes for mothers and the offspring. However, research on domestic violence and predictors against pregnant women is limited in Ethiopia. Therefore, the aim of this study was to assess the magnitude and predictors of domestic violence among pregnant women in southeast Oromia, Ethiopia.MethodsCross-sectional study design was utilized among 299 pregnant women selected by systematic sampling technique. A structured World Health Organization (WHO) multi-country study questionnaire on women health and domestic violence was used to measure domestic violence. Binary and multivariable logistic regression models were fitted. Odds ratios (OR) with the corresponding 95% confidence interval (95%CI)) was computed to assess the strength of association.ResultThe prevalence of domestic violence was 64.6% (CI: 58.5, 69.9%). Physical violence was reported as the commonest type of violence (44.1%) followed by psychological (39.1%) and sexual (23.7%) violence. In the multivariable analysis, being illiterate (OR = 6.3; 95%CI: 2.23, 11.65), Husband’s alcohol consumption (OR = 5.726; 95% CI 1.873, 11.51), husband history of arrest (OR = 2.59; 95% CI: 1.15, 5.88) and occupation of husband (farmer) (OR = 3.26; 95% CI: 1.29, 8.25) were significantly associated with domestic violence against pregnant women.ConclusionThis study revealed that a remarkable proportion of pregnant women had experienced domestic violence in their lifetime (64.6%). Being illiterate, husband’s alcohol consumption, occupation (farmer and self-employed), and history of arrest were significantly associated with domestic violence among pregnant women. The findings suggest screening for domestic violence among pregnant women visiting antenatal care clinic and early intervention based on the findings. Integrating health education program on domestic violence with the existing maternal health program is warranted.

Measuring psychological abuse by intimate partners: Constructing a cross-cultural indicator for the Sustainable Development Goals.

Psychological abuse within intimate relationships is linked to negative health outcomes among women and is frequently identified as more wounding than physical or sexual violence. There is little agreement, however, on how to conceptualize or measure the phenomenon, despite measurement being necessary to estimate the prevalence of psychological abuse, establish its interaction with physical and sexual violence, assess its health impacts, and monitor progress towards global Sustainable Development Goals. To address this gap, we used latent class analysis (LCA), psychometric testing, and logistic regression to evaluate the construct and content validity of alternative methods for deriving a measure of psychological partner abuse, using pooled data from the first 10 countries and 15 sites of the World Health Organization Multi-Country Study on Domestic Violence and Women's Health (WHO MCS). Our analysis finds that psychological abuse is highly prevalent, ranging from 12% to 58% across countries. A three-class solution was supported for coding psychological abuse: none, moderate-intensity abuse, and high-intensity abuse. This three-level categorization, which can be coded without LCA, demonstrates a clear graded relationship with controlling behaviors and all measured health outcomes except physical pain. Factor analysis confirms that psychological abuse and male controlling behaviors are separate constructs as measured in the WHO MCS and the Demographic and Health Surveys and should not be combined. We conclude that this is a simple way to code psychological abuse for cross-country comparison. Its use could support urgently needed research into psychological abuse across settings and identify an appropriate threshold for defining psychological violence for surveys globally.

Domestic violence against women workers in selected tea estates of South India

Background: Violence against women is an important public health problem, due to its consequences on women health. There is a considerable variation in the prevalence of domestic violence across the states and different settings in India. Objectives: The objectives of the study were to estimate the prevalence of different forms of domestic violence and determine the associated factors among women working in tea estates. Materials and Methods: A cross-sectional study was conducted in two tea estates in Tamil Nadu. All (266) ever-married women workers aged 15–49 years were included in the study. Data were collected using a pre-designed interview schedule including sociodemography and physical, psychological, and sexual domains of domestic violence. It was developed using the National Family Health Survey 3 interview schedule and the World Health Organization multi-country study on women’s health and life experiences questionnaire version 10. Results: The prevalence of domestic violence was 65%, while specifically psychological, physical, and sexual violence were 63.5%, 44.1%, and 4.1%, respectively. Domestic violence was significantly associated with socioeconomic status, spousal literacy status, age at marriage, and alcohol use (P < 0.05). Any form of violence and psychological violence were twice as common with illiterate (unadjusted odds ratio [OR]: 2.6; 95% confidence interval [CI]: 1.4–4.9) (unadjusted OR: 2.4; 95% CI: 1.1–4.9) and a spouse who consumed alcohol (unadjusted OR: 2.7; 95% CI: 1.6–4.6) (unadjusted OR: 2.5; 95% CI: 1.5–4.2), respectively. Conclusion: The prevalence of all forms of domestic violence was high among women in the selected two tea estates in South India. Significant association was found with spousal characteristics. This calls for stringent enforcement of laws and educating men toward changing the social attitude toward violence against women.

Social support factors associated with psychological resilience among women survivors of intimate partner violence in Gauteng, South Africa

ABSTRACTBackground: Women’s experiences of intimate partner violence (IPV) increase their risk for mental ill health. However, some women exposed to IPV and adversity are psychologically resilient and function well despite these exposures.Objectives: We conducted a study to investigate the factors that are associated with psychological resilience among abused women, using data collected in a household survey conducted in Gauteng province of South Africa.Methods: Data is from a cross-sectional study. A multi-stage random sampling approach was used to select a sample of 501 women. The World Health Organization (WHO) Multi-Country Study on Women’s Health and Domestic Violence Questionnaire was used to measure lifetime experience of physical and sexual IPV. Only 189 women who had experienced lifetime IPV were included in this secondary analysis. Resilience was measured as scoring below the threshold for the Centre for Epidemiological Studies Depression Scale and the Harvard Trauma Questionnaire. Other explanatory factors measured included child sexual abuse, non-partner rape, other traumatic life events, social support indicators, binge drinking and socio-demographic variables. Multivariable regression analysis was used to test factors associated with resilience.Results: Forty two percent of women scored below the threshold for post-traumatic stress disorder (PTSD) or depressive symptoms at the time of the survey and so were categorized as resilient. Social support indicators were associated with increased resilience. Women who perceived that their communities were supportive and they would easily find money in an emergency were more likely to be resilient. Women who binge drank, experienced severe IPV in the past 12 months, received negative reactions to disclosure and utilized medical or psychosocial services were less likely to be resilient.Conclusion: Social support indicators including social connectedness, stronger network ties and perceived supportive communities are key factors in fostering resilience among abused women. Interventions should aim to promote stronger and supportive social networks and increase women’s utilization of formal support services.

Women’s perspectives of mistreatment during childbirth at health facilities in Ghana: findings from a qualitative study

Mistreatment of women during childbirth at health facilities violates their human rights and autonomy and may be associated with preventable maternal and newborn mortality and morbidity. In this paper, we explore women’s perspectives on mistreatment during facility-based childbirth as part of a bigger World Health Organization (WHO) multi-country study for developing consensus definitions, and validating indicators and tools for measuring the burden of the phenomenon. Focus group discussions (FGDs) and in-depth interviews (IDIs) were used to explore experiences of mistreatment from women who have ever given birth in a health facility in Koforidua and Nsawam, Ghana. Interviews were audio-recorded, transcribed and thematic analysis conducted. A total of 39 IDIs and 10 FGDs involving 110 women in total were conducted. The major types of mistreatment identified were: verbal abuse (shouting, insults, and derogatory remarks), physical abuse (pinching, slapping) and abandonment and lack of support. Mistreatment was commonly experienced during the second stage of labour, especially amongst adolescents. Inability to push well during the second stage, disobedience to instructions from birth attendants, and not bringing prescribed items for childbirth (mama kit) often preceded mistreatment. Most women indicated that slapping and pinching were acceptable means to “correct” disobedient behaviours and encourage pushing. Women may avoid giving birth in health facilities in the future because of their own experiences of mistreatment, or hearing about another woman’s experience of mistreatment. Consensus definitions, validated indicators and tools for measuring mistreatment are needed to measure prevalence and identify drivers and potential entry points to minimise the phenomenon and improve respectful care during childbirth.

Domestic violence among antenatal attendees in a Kathmandu hospital and its associated factors: a cross-sectional study.

BackgroundDomestic violence during pregnancy is a public health problem which violates human rights and causes an adverse effect on both maternal and fetal health. The objectives of the study were to assess the prevalence of domestic violence among the pregnant women attending the antenatal clinic, to explore the associated factors, and to identify the perpetrators of domestic violence.MethodsA descriptive cross-sectional study was conducted among 404 pregnant women in their third trimester of pregnancy. Convenient sampling was used to select the study population. Data collection tools consisted of questionnaires on socio-demographic characteristics of the woman and her spouse, social support, and the woman’s attitude towards domestic violence, along with her experiences of psychological, physical, and sexual violence. Domestic violence was assessed using a questionnaire adapted from a World Health Organization multi-country study on women’s health and life experiences. Relationships between domestic violence and the various factors were determined by bivariate analysis using a chi-square test. Binary logistic regression with 95% confidence interval and adjusted odds ratio were then applied to assess the factors independently associated with domestic violence.ResultsMore than one-quarter (27.2%) of the pregnant women had experienced some form of violence. The most common form of violence was sexual violence (17.3%), followed by psychological violence (16.6%) and physical violence (3.2%). Husbands within the age group 25–34 years (AOR = 0.38), women married for 2–5 years (AOR = 0.42) and who had one or two children (AOR = 0.32) were negatively associated with domestic violence. Whereas the presence of husband’s controlling behavior (AOR = 1.88) and experience of violence before the current pregnancy (AOR = 24.55) increased the odds of experiencing violence during pregnancy. The husband was the major perpetrator in all type of violence.ConclusionsDomestic violence is common among pregnant women attending an antenatal clinic. It indicates a need for routine screening during antenatal visits to identify women experiencing violence and thus provide support services, thereby preventing them from adverse health consequences.

The relationship between the Maria da Penha Law and intimate partner violence in two Brazilian states.

BackgroundGlobally, inequality between men and women manifests in a variety of ways. In particular, gender inequality increases the risk of perpetration of violence against women (VAW), especially intimate partner violence (IPV), by males. The World Health Organization (WHO) estimates that 35 % of women have experienced physical, psychological and/or sexual IPV at least once in their lives, making IPV unacceptably common. In 2006, the Maria da Penha Law on Domestic and Family Violence, became the first federal law to regulate VAW and punish perpetrators in Brazil. This study examines the relationship between Brazilian VAW legislation and male perpetration of VAW by comparing reported prevalence of IPV before and after the enactment of the Maria da Penha Law.MethodsTo assess changes in magnitude of IPV before and after the law, we used data from the 2013 Brazilian National Health Survey; we replicated the analyses conducted for the WHO Multi-Country Study on Women’s Health and Domestic Violence Against Women-whose data were collected before the passage of the Maria da Penha Law. We compare findings from the two studies.ResultsOur analyses show an increase in the reported prevalence of physical violence, and a decrease in the reported prevalence of sexual and psychological violence. The increase may result from an actual increase in physical violence, increased awareness and reporting of physical violence, or a combination of both factors. Additionally, our analysis revealed that in the urban setting of São Paulo, physical violence was more likely to be severe and occur in the home; meanwhile, in the rural state of Pernambuco, physical violence was more likely to be moderate in nature and occur in public.ConclusionThe Maria da Penha Law increased attention and resources for VAW response and prevention; however, its true impact remains unmeasured. Our data suggest a need for regular, systematic collection of comparable population-based data to accurately estimate the true prevalence of IPV in Brazil. Furthermore, such data may inform policy and program planning to address specific needs across diverse settings including rural and urban communities. If routinely collected over time, such data can be used to develop policies and programs that address all forms of IPV, as well as evidence-based programs that address the social and cultural norms that support other forms of VAW and gender inequality.

Domestic violence and its associated factors among married women of a village development committee of rural Nepal.

BackgroundViolence against women is a global public health problem occurring in multitude of contexts and domestic violence is considered to be the most pervasive one. Poor enforcement of policies, limitation of researches and expertise in this field largely accounts for persistence of this problem and nature of domestic violence and its associated factors are poorly understood.ObjectivesThis research aimed to estimate the magnitude of different forms of domestic violence and identify its associated factors.MethodsCommunity based cross sectional study was conducted among 355 married women of reproductive age group of Kusheshwor, Sindhuli, Nepal. The questionnaire adapted from the World Health Organization Multi-Country Study was used for the face to face interviews. Occurrence of current domestic violence was used as outcome variable in logistic regression. Descriptive and multivariate analysis were performed in order to assess the magnitude of domestic violence and to identify its associated factors respectively.ResultsSelf-reported lifetime prevalence of physical violence was 29.6 % and past year prevalence was 15.2 %, while corresponding figures for sexual violence were 6.8 and 2.3 %, and for psychological violence were 31.0 and 18.3 %. Lifetime domestic violence was 38.6 % while in past 12 months, prevalence was 23.1 %. Furthermore, 12.4 % of women were experiencing all forms of violence concurrently. Women with controlling husband and having poor mental health were found to be at higher risk of domestic violence.ConclusionsDomestic violence is still rampant in our society with several forms of violence occurring together. In a country like Nepal, differentials power in relationship and poor mental health was found to be positively associated with violent episodes. This study highlights the infringement of women rights which can be the cause for serious public health consequences.

Intimate partner violence and anxiety disorders in pregnancy: the importance of vocational training of the nursing staff in facing them.

Objective: to identify the relationship between posttraumatic stress disorder, trait and state anxiety, and intimate partner violence during pregnancy. Method: observational, cross-sectional study developed with 358 pregnant women. The Posttraumatic Stress Disorder Checklist - Civilian Version was used, as well as the State-Trait Anxiety Inventory and an adapted version of the instrument used in the World Health Organization Multi-country Study on Women's Health and Domestic Violence. Results: after adjusting to the multiple logistic regression model, intimate partner violence, occurred during pregnancy, was associated with the indication of posttraumatic stress disorder. The adjusted multiple linear regression models showed that the victims of violence, in the current pregnancy, had higher symptom scores of trait and state anxiety than non-victims. Conclusion: recognizing the intimate partner violence as a clinically relevant and identifiable risk factor for the occurrence of anxiety disorders during pregnancy can be a first step in the prevention thereof.

Community economic status and intimate partner violence against women in bangladesh: compositional or contextual effects?

In this research, we used a multi-level contextual-effects analysis to disentangle the household- and community-level associations between income and intimate partner violence (IPV) against women in Bangladesh. Our analyses of data from 2,668 women interviewed as part of the World Health Organization (WHO) multi-country study on women's health and domestic violence against women showed that household income was negatively associated with women's risk of experiencing IPV. Controlling for residence in a low-income household, living in a low-income community was not associated with women's risk of experiencing IPV. These results support a household-level, not community-level, relationship between income and IPV in Bangladesh.

Comparative analysis of prevalence of intimate partner violence against women in military and civilian communities in Abuja, Nigeria.

IntroductionIntimate partner violence (IPV) occurs across the world, in various cultures, and affects people across societies irrespective of economic status or gender. Most data on IPV before World Health Organization multicountry study (WHOMCS) usually came from sources other than the military. Result of this study will contribute to the existing body of knowledge and may serve as a baseline for future studies in military populations. This study compares the prevalence of the different types of IPV against women in military and civilian communities in Abuja, Nigeria.MethodsUsing a multistage sampling technique, 260 women who had intimate male partners were selected from military and civilian communities of Abuja. Collected data on personal characteristics and different types of IPV experienced were analyzed to demonstrate comparison of the association between the different forms of IPV and the respondents’ sociodemographic and partner characteristics in the two study populations using percentages and χ-square statistics, and P-value was assumed to be significant at ≤0.05.ResultsThe prevalence of the four major types of IPV was higher among the military respondents than among civilians: controlling behavior, 37.1% versus 29.1%; emotional/psychological abuse, 42.4% versus 13.4%; physical abuse, 19.7% versus 5.9%, and sexual abuse, 9.2% versus 8.8%. Significantly more respondents from the military population (59 [45.4%]) compared to civilians (21 [19.4%]) were prevented by their partners from seeing their friends (P=0.000). The situation is reversed with regard to permission to seek health care for self, with civilians reporting a significantly higher prevalence (35 [32.4%]) than did military respondents (20 [15.4%]) (P=0.002). The military respondents were clearly at a higher risk of experiencing all the variants of emotional violence than the civilians (P=0.00). The commonest form of physical violence against women was “being slapped or having something thrown at them, that could hurt”, which was markedly higher in the military (43 [33.1%]) than in the civilian population (10 [9.3%]), (P<0.05).ConclusionIPV is a significant public health problem in Abuja, and the military population is clearly at a higher risk of experiencing all forms of IPV compared to the civilian population. The military should encourage and finance research on effect of military operations and posttraumatic stress disorders on family relationships with a view of developing evidence-based treatment models for military personnel.