The Association Between Domestic Violence and Adverse Pregnancy Outcomes in Pregnant Women Seeking Antenatal Care at Public Hospitals in Gedeo Zone: A Prospective Cohort Study

Abstract

Background

Domestic violence is any harmful behavior by an intimate partner, such as physical, sexual, or psychological abuse. In Ethiopia, domestic violence is a serious and widespread problem. It affects two-thirds (64.6%) of pregnant women and increases the risk of maternal and perinatal morbidity and mortality. Domestic violence during pregnancy is a growing public health problem that may contribute to maternal and perinatal mortality, especially in low- and middle-income countries. This study aims to assess the association between domestic violence during pregnancy and the risk of adverse pregnancy outcomes in Gedeo Zone Public Hospitals, Southern Ethiopia.

Material and Methods

We conducted a prospective cohort study on 142 pregnant women in their third trimester who attended public health institutions in Gedeo Zone for antenatal care. We compared 47 women who were exposed to domestic violence with 95 who were not and followed them until 24 hours after delivery or drop-out. We used SPSS version-24 to analyze data and logistic regression to examine the association between domestic violence and pregnancy outcomes. We reported the results using an adjusted odds ratio with 95% confidence interval and P-value.

Results

Out of 142 women, who completed the follow-up, 47 were exposed to domestic violence and 95 were not. We found a strong link between domestic violence and preterm birth. Women exposed to domestic violence had a four-fold higher risk of preterm birth (AOR= 4.392, 95% CI: 1.117, 6.588) than those who were not. They also had a 2.5-fold higher risk of perinatal death (AOR= 2.562, 95% CI: 1.041, 6.308).

Conclusion

Domestic violence during pregnancy affects many pregnant women in southern Ethiopia and harms their babies. It leads to preterm birth and perinatal death, which can be prevented. The Ethiopian government and other stakeholders need to protect pregnant women from intimate partner violence urgently.

Keywords:

• domestic violence
• pregnant women
• preterm birth
• perinatal death
• prospective cohort

Abbreviations

ANC, Antenatal Care; AOR, Adjusted Odds Ratio; CL, Confidence Level; DV, Domestic Violence; EDHS, Ethiopian Demographic and Health Survey; HC, Head Circumference; IPV, Intimate Partner Violence; IRB, Institutional Review Board; LMP, Last normal menstrual period; SDG, Sustainable Development Goals; SGA, Small for Gestational Age; SNNPR, South Nation Nationalities Peoples Region; WHO, World Health Organization.

Data Sharing Statement

The corresponding author will provide the data that supports this study upon reasonable request. The data are not publicly accessible for ethical and privacy reasons. The data consists of anonymized demographic and clinical data of the participants and questionnaires. The data will remain available for 10 years after this paper is published. Please contact Getnet Melaku Ayele at [email protected] or [email protected] to request data access.

Ethics Approval and Consent to Participate

As recommended by the Declaration of Helsinki, the likelihood of benefits from the current research was considered. Research on domestic violence during pregnancy and adverse pregnancy outcomes raises important ethical and methodological challenges in addition to those raised by any other type of research on human subjects. Therefore, this study was conducted in accordance with the WHO’s ethical and safety recommendations for research on domestic violence and pregnancy outcomes. Ethical approval was provided by the Institutional Review Board (IRB) of Dilla University, College of Medicine, and Health Sciences (protocol unique number 015/18-06) and an official support letter was written to Gedeo Zone Health Office. Then, an official letter was obtained from Gedeo Zone Health Office to each hospital. In addition, informed written consent was obtained from pregnant mothers who were selected for the study. The study participants’ right to withdraw from the study at any time during data collection was assured.

Acknowledgments

We thank the Gedeo Zone health department for their cooperation and permission to conduct this study in the area. We also thank the personnel of Gedeo Zone hospitals and the pregnant women who participated in this study for their valuable contributions. Furthermore, we are grateful to Dilla University for giving us this opportunity and providing us with financial support, data collectors and supervisors for their role in recruitment, follow-up and data collection and the anonymous reviewers for their constructive comments and suggestions that improved the quality of the manuscript.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare they have no conflicts of interest in this work.

Additional information

Funding

This study received funding from Dilla University Research and Dissemination Office. The sponsor participated in the study conception, design, data collection and interpretation, and gave permission for publication. Even though, the funding source had a role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript, the authors have full control of all primary data and agree to allow the journal to review their data if requested.