Intergenerational effects of violence on women’s perinatal wellbeing and infant health outcomes: evidence from a birth cohort study in Central Vietnam

Background Girls exposed to violence have a high risk of being victimized as adults and are more likely than non-abused women to have children who are treated violently. This intergenerational transmission may be especially serious when women suffer violence during pregnancy and early motherhood, as it impairs maternal wellbeing and infant health and development. This study examined the intergenerational effects of being exposed to childhood maltreatment (CM) and prenatal intimate partner violence (p-IPV) on perinatal mental distress and birth outcomes in central Vietnam. Methods A birth cohort study in Hue City, Vietnam was conducted with 150 women in the third trimester of pregnancy (Wave 1) and 3 months after childbirth (Wave 2). Using multivariable logistic regression models, augmented inverse-probability-weighted estimators and structural equation modelling (SEM), we analyzed a theoretical model by evaluating adjusted risk differences and pathways between CM, p-IPV and subsequent perinatal adversity and indicators of infant health problems. Results One in two pregnant women experienced at least one form of CM (55.03%) and one in ten pregnant women experienced both CM and p-IPV (10.67%). Mothers who experienced p-IPV or witnessed IPV as a child were approximately twice as likely to experience poor mental health during pregnancy [ARR 1.94, 95% CI (1.20–3.15)]. Infants had a two-fold higher risk of adverse birth outcomes (low birth weight, preterm birth, admission to neonatal intensive care) [ARR 2.45 95% CI (1.42, 4.25)] if their mothers experienced any form of p-IPV, with greater risk if their mothers were exposed to both CM and p-IPV [ARR 3.45 95% CI (1.40, 8.53)]. Notably, significant pathways to p-IPV were found via adverse childhood experience (ACE) events (β = 0.13), neighborhood disorder (β = 0.14) and partner support (β = − 1.3). Conclusion These results emphasize the detrimental and prolonged nature of the effect of violence during childhood and pregnancy. Exposure to childhood maltreatment and violence during pregnancy increases the risk of maternal mental health difficulties and adverse birth outcomes. Antenatal care systems need to be responsive to women’s previous experiences of violence and maternal mental health. The significant protective role of partner support and social support should also be considered when designing tailored interventions to address violence during pregnancy.

1179Intergenerational Effects of Violence on Women’s Perinatal Wellbeing and Infant Health Outcomes in Vietnam

Background This study examined the intergenerational effects of being exposed to childhood maltreatment (CM) and prenatal intimate partner violence (p-IPV) on perinatal mental distress and birth outcomes in central Vietnam. Methods A birth cohort study in Hue City, Vietnam was conducted with 150 women in the third trimester of pregnancy (Wave 1) and three months after childbirth (Wave 2). Using multivariable logistic regression models, augmented inverse-probability-weighted estimators and structural equation modelling (SEM), we analyzed a theoretical model by evaluating adjusted risk differences and pathways between CM, p-IPV and subsequent perinatal adversity and indicators of infant health problems. Results One in two pregnant women experienced at least one form of CM (55.03%) and one in ten pregnant women experienced both CM and p-IPV (10.67%). Mothers who experienced p-IPV or witnessed IPV as a child were approximately twice as likely to experience poor mental health during pregnancy [ARR 1.94, 95% CI (1.20-3.15)]. Infants had a two-fold higher risk of adverse birth outcomes (low birth weight, preterm birth, admission to neonatal intensive care) [ARR 2.45 95% CI (1.42, 4.25)] if their mothers experienced any form of p-IPV, with greater risk if their mothers were exposed to both CM and p-IPV [ARR 3.45 95% CI (1.40, 8.53)]. Notably, significant pathways to p-IPV were found via adverse childhood experience (ACE) events (β = 0.13), neighborhood disorder (β = 0.14) and partner support (β = -1.3). Conclusions These results emphasize the detrimental and prolonged nature of the effect of violence during childhood and pregnancy. Exposure to childhood maltreatment and violence during pregnancy increases the risk of maternal mental health difficulties and adverse birth outcomes. Antenatal care systems need to be responsive to women’s previous experiences of violence and maternal mental health. The significant protective role of partner support and social support should also be considered when designing tailored interventions to address violence during pregnancy. Key messages Mothers with violent and adverse family backgrounds have twice the risk of poor mental health during pregnancy, and their infants have twice the risk of adverse birth outcomes. Social support during pregnancy may have a buffering effect by reducing the long-term impact of childhood traumatic events.

PENGALAMAN PEREMPUAN KORBAN KEKERASAN DALAM RUMAH TANGGA PADA MASA KEHAMILAN

ABSTRAKKekerasan dalam rumah tangga adalah perbuatan yang dilakukan terhadap seseorang dalam bentuk fisik, verbal, seksual, dan psikologis yang menyebabkan penderitaan dan penelantaran rumah tangga. Tujuan: Mengetahui lebih dalam tentang pengalaman perempuan korban Kekerasan Dalam Rumah Tangga (KDRT) pada masa kehamilan di wilayah kerja Puskesmas Kampung Kawat, Kalimantan Barat. Metode: Desain penelitian ini menggunakan pendekatan fenomenologi. Penentuan partisipan menggunakan purposive sampling dan snow ball. Sebanyak 8 partisipan terlibat dalam penelitian ini. Pengumpulan data dilakukan dengan cara in-depth interview dengan menggunakan catatan lapangan dan perekam suara. Data dianalisis dengan metode Colaizzi. Hasil: Penelitian ini menghasilkan 6 tema yaitu bentuk kekerasan yang diterima oleh responden selama menjadi korban KDRT pada masa kehamilan, Masalah yang timbul pada kehamilan akibat KDRT, Mekanisme koping yang dilakukan korban KDRT, Perasaan yang dirasakan responden sebagai korban KDRT, Penyebab terjadinya KDRT pada masa kehamilan, Hal-hal yang diinginkan responden terhadap pelayanan kesehatan. Diskusi: pengalaman perempuan korban kekerasan dalam rumah tangga pada masa kehamilan memberikan dampak buruk terhadap ibu maupun janin. Hal-hal tersebut terlihat pada ungkapan-ungkapan yang diberikan partisipan bahwa perbuatan yang mereka terima masih membekas hingga saat ini, meskipun sudah tidak membekas pada fisik, namun masih membekas pada batin. Kesimpulan: Hasil penelitian ini dapat dikembangkan pada penelitian lebih lanjut dan menjadi tambahan informasi dalam dunia pendidikan, serta menambah wawasan dan motivasi perawat maternitas dalam memberikan asuhan keperawatan, misalnya pendampingan pada pasangan yang menikah di usia muda dengan memberikan edukasi terkait kesiapan pasangan dalam memasuki kehidupan berumah tangga.Kata Kunci: Kehamilan, kekerasan dalam rumah tangga, perempuan Experience of Women Suffering from Domestic Violence During PregnancyABSTRACTDomestic violence is a physical, verbal, sexual, and psychological act committed against a person which causes suffering and neglect of the household. Objective: To reveal further the experience of women suffering from Domestic Violence during pregnancy in the working area of the Kampung Kawat Public Health Center, West Kalimantan. Methods: This research employed a phenomenological approach. Participants were taken using purposive sampling and snow ball. 8 participants were involved in this research. Data was collected by means of in-depth interviews using field notes and voice recorders. Data were analyzed by using the Colaizzi method. Results: This research resulted in 6 themes, namely forms of violence received by respondents while being victims of domestic violence during pregnancy, problems arising in pregnancy due to domestic violence, coping mechanisms performed by victims of domestic violence, feelings experienced by respondents as victims of domestic violence, causes of domestic violence during pregnancy, things that respondents wanted from health services. Discussion: The experience of women suffering from domestic violence during pregnancy has a negative impact on the mother and fetus. These can be seen in their expressions that the actions they receive are still imprinted today. Although no longer physically imprinted, but they are still imprinted on the mind. Conclusion: The research results can be developed in further research and serve as additional information in education, as well as add insight and motivation for maternity nurses in providing nursing care, for example mentoring couples who marry at a young age by providing education about the readiness of couples to enter a married life.Keywords: Pregnancy, domestic violence, women

Conflict violence reduction and pregnancy outcomes: A regression discontinuity design in Colombia

Background The relationship between exposure to conflict violence during pregnancy and the risks of miscarriage, stillbirth, and perinatal mortality has not been studied empirically using rigorous methods and appropriate data. We investigated the association between reduced exposure to conflict violence during pregnancy and the risks of adverse pregnancy outcomes in Colombia. Methods and findings We adopted a regression discontinuity (RD) design using the July 20, 2015 cease-fire declared during the Colombian peace process as an exogenous discontinuous change in exposure to conflict events during pregnancy, comparing women with conception dates before and after the cease-fire date. We constructed the cohorts of all pregnant women in Colombia for each day between January 1, 2013 and December 31, 2017 using birth and death certificates. A total of 3,254,696 women were followed until the end of pregnancy. We measured conflict exposure as the total number of conflict events that occurred in the municipality where a pregnant woman lived during her pregnancy. We first assessed whether the cease-fire did induce a discontinuous fall in conflict exposure for women with conception dates after the cease-fire to then estimate the association of this reduced exposure with the risks of miscarriage, stillbirth, and perinatal mortality. We found that the July 20, 2015 cease-fire was associated with a reduction of the average number of conflict events (from 2.64 to 2.40) to which women were exposed during pregnancy in their municipalities of residence (mean differences −0.24; 95% confidence interval [CI] −0.35 to −0.13; p < 0.001). This association was greater in municipalities where Fuerzas Armadas Revolucionarias de Colombia (FARC) had a greater presence historically. The reduction in average exposure to conflict violence was, in turn, associated with a decrease of 9.53 stillbirths per 1,000 pregnancies (95% CI −16.13 to −2.93; p = 0.005) for municipalities with total number of FARC-related violent events above the 90th percentile of the distribution of FARC-related conflict events and a decrease of 7.57 stillbirths per 1,000 pregnancies (95% CI −13.14 to −2.00; p = 0.01) for municipalities with total number of FARC-related violent events above the 75th percentile of FARC-related events. For perinatal mortality, we found associated reductions of 10.69 (95% CI −18.32 to −3.05; p = 0.01) and 6.86 (95% CI −13.24 to −0.48; p = 0.04) deaths per 1,000 pregnancies for the 2 types of municipalities, respectively. We found no association with miscarriages. Formal tests support the validity of the key RD assumptions in our data, while a battery of sensitivity analyses and falsification tests confirm the robustness of our empirical results. The main limitations of the study are the retrospective nature of the information sources and the potential for conflict exposure misclassification. Conclusions Our study offers evidence that reduced exposure to conflict violence during pregnancy is associated with important (previously unmeasured) benefits in terms of reducing the risk of stillbirth and perinatal deaths. The findings are consistent with such beneficial associations manifesting themselves mainly through reduced violence exposure during the early stages of pregnancy. Beyond the relevance of this evidence for other countries beset by chronic armed conflicts, our results suggest that the fledgling Colombian peace process may be already contributing to better population health.

Prevalence and Associated Factors of Depression among Pregnant Mothers Who Had Intimate Partner Violence during Pregnancy Attending Antenatal Care at Gondar University Hospital Northwest Ethiopia in 2020

Background. Antenatal depression is the major obstetric problem that led to significant maternal and perinatal morbidity and mortality worldwide, especially in the third world. However, in Ethiopia this prevalence and association were not studied, as result, this study investigated the prevalence and associated factors of antenatal depression among pregnant mothers who had intimate partner violence during pregnancy. Methodology. An institution-based cross-sectional study was done among 409 pregnant mothers who had intimate partner violence during pregnancy from May to July 2019 at Gondar University Hospital. All pregnant mothers who came for ANC follow-up during the study period approached for screening of intimate partner violence during pregnancy using standard and validated screening method and instrument of the WHO multicountry study on women’s health and domestic violence to evaluate intimate partner violence, and we use EPDS for the evaluation of antenatal depression validated in Ethiopia with a cut point of 13. Result. Prevalence of depression among pregnant mothers who had any form of intimate partner violence during pregnancy was 35%: physical abuse ( AOR = 1.8 ; 95% CI: 1.19, 3.30), more than one type of abuse ( AOR = 10.18 ; 95% CI: 7.10, 16.18), poor social support ( AOR = 5.81 ; 95% CI: 1.12, 13.12), and pregnant mothers whose partner drunk for the past twelve months ( AOR = 7.16 ; 95% CI: 183, 8.00) were significantly associated with antenatal depression. Conclusion. High prevalence of antenatal depression among pregnant mothers who had intimate partner violence during pregnancy was highly associated with physical abuse, more than one type of abuse, lack of social support, and partner of pregnant mothers who is a drunk. Hence, this is important to create a screening program and prevention strategy of intimate partner violence during pregnancy at the time of antenatal follow-up to prevent and early identify its morbidity and mortality.

Caring for Mothers: A Narrative Review on Interpersonal Violence and Peripartum Mental Health

Interpersonal violence in the perinatal period is frequent and should be considered a prominent health issue due to the risk of escalation of violence and the significant impact on mothers’ parenting after childbirth. Domestic violence during pregnancy can be associated with fatal and non-fatal adverse health outcomes due to the direct trauma to a pregnant woman’s body and to the effect of stress on fetal growth and development. Emotional violence is a risk factor for prenatal and/or postpartum depression. Recent studies focusing on abusive situations during peripartum and possible preventive strategies were identified in PubMed/Medline, Scopus, Embase, and ScienceDirect. All of the available literature was retrospectively reviewed with a special attention to peer-reviewed publications from the last ten years. Results of the present narrative review suggest that perinatal health care professionals (general practitioners, gynecologists, obstetricians, psychologists, psychiatrists) should promptly detect interpersonal violence during and after pregnancy and provide health care for pregnant women. It seems pivotal to guarantee psychological care for abused women before, during, and after pregnancy in order to prevent the risk of depressive symptoms, other mental or physical sequelae, and mother-to-infant bonding failure. There is an urgent need for multifaceted interventions: programs should focus on several risk factors and should design tailored care pathways fitted to the specific needs of women and finalized to support them across the lifespan.

Intergenerational Effects of Violence on Women’s Perinatal Wellbeing and Infant Health Outcomes: Evidence from a Birth Cohort Study in Central Vietnam

Background: This study examined the intergenerational effects of being exposed to childhood maltreatment (CM) and prenatal intimate partner violence (p-IPV) on perinatal mental distress and birth outcomes in central Vietnam. Methods: A birth cohort study in Hue City, Vietnam was conducted with 150 women in the third trimester of pregnancy (Wave 1) and three months after childbirth (Wave 2). Using multivariable logistic regression models, augmented inverse-probability-weighted estimators and structural equation modelling (SEM), we analyzed a theoretical model by evaluating adjusted risk differences and pathways between CM, p-IPV and subsequent perinatal adversity and indicators of infant health problems. Results: One in two pregnant women experienced at least one form of CM (55.03%) and one in ten pregnant women experienced both CM and p-IPV (10.67%). Mothers who experienced p-IPV or witnessed IPV as a child were approximately twice as likely to experience poor mental health during pregnancy [ARR 1.94, 95% CI (1.20-3.15)]. Infants had a two-fold higher risk of adverse birth outcomes (low birth weight, preterm birth, admission to neonatal intensive care) [ARR 2.45 95% CI (1.42, 4.25)] if their mothers experienced any form of p-IPV, with greater risk if their mothers were exposed to both CM and p-IPV [ARR 3.45 95% CI (1.40, 8.53)]. Notably, significant pathways to p-IPV were found via adverse childhood experience (ACE) events (β = 0.13), neighborhood disorder (β = 0.14) and partner support (β = -1.3). Conclusion: These results emphasize the detrimental and prolonged nature of the effect of violence during childhood and pregnancy. Exposure to childhood maltreatment and violence during pregnancy increases the risk of maternal mental health difficulties and adverse birth outcomes. Antenatal care systems need to be responsive to women’s previous experiences of violence and maternal mental health. The significant protective role of partner support and social support should also be considered when designing tailored interventions to address violence during pregnancy.