Exploring the relationship between intimate partner violence during pregnancy and stillbirths : a community based nested matched case control study in district Thatta

Date of Award

2014

Document Type

Thesis

Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)

Department

Community Health Sciences

Abstract

Intimate partner violence is a public health challenge. The relationship between violence during pregnancy and stillbirths is poorly understood. We aimed to determine the association between still births and intimate partner violence during index pregnancy in district Thatta, Pakistan. METHODS: We conducted a community based, matched case control study from February to May 2014, nested within Global Network for Women's and Children's Health Research, in district Thatta. 256 cases (women with stillbirths) and 539 controls (women with live births), individually matched on parity, were selected from this registry. Trained data collectors ascertained violence using WHO questionnaire. The effect of intimate partner violence and other factors on stillbirths was determined using multiple conditional logistic regression and results reported as crude and adjusted matched odds ratios with 95% confidence intervals. RESULTS: Maternal age significantly modified the effect of intimate partner physical violence on stillbirths even after matching on parity and controlling for covariates. The impact was most pronounced among women 25-34 years old with stillbirths, whose odds of experiencing intimate partner physical violence during index pregnancy was increased 4.4 times as compared to those with live births [MAOR: 4.4 (1.9-10.5)]. Similar impact was not found among women younger than 25 years [MAOR: 0.46 (0.1-2.3)] and older Intimate partner violence is a public health challenge. The relationship between violence during pregnancy and stillbirths is poorly understood. We aimed to determine the association between still births and intimate partner violence during index pregnancy in district Thatta, Pakistan. METHODS: We conducted a community based, matched case control study from February to May 2014, nested within Global Network for Women's and Children's Health Research, in district Thatta. 256 cases (women with stillbirths) and 539 controls (women with live births), individually matched on parity, were selected from this registry. Trained data collectors ascertained violence using WHO questionnaire. The effect of intimate partner violence and other factors on stillbirths was determined using multiple conditional logistic regression and results reported as crude and adjusted matched odds ratios with 95% confidence intervals. RESULTS: Maternal age significantly modified the effect of intimate partner physical violence on stillbirths even after matching on parity and controlling for covariates. The impact was most pronounced among women 25-34 years old with stillbirths, whose odds of experiencing intimate partner physical violence during index pregnancy was increased 4.4 times as compared to those with live births [MAOR: 4.4 (1.9-10.5)]. Similar impact was not found among women younger than 25 years [MAOR: 0.46 (0.1-2.3)] and older than 34 years [MAOR: 0.7 (0.1-2.9)]. In our data, psychological [MAOR: 0.6 (0.4-1.01)] or sexual violence [MAOR: 0.7 (0.30-1.6)] during index pregnancy was not associated with stillbirths. Woman's education, working status in index pregnancy, prior stillbirths, presence of major antepartum hemorrhage, evidence of hypertensive disease, severe preeclampsia/ eclampsia, fetal malpresentation, obstructed/ prolonged labor, birth attendant and mode of delivery were identified as predictors of stillbirths. CONCLUSION: Our findings underscore the importance of intimate partner physical violence screening by clinicians during antenatal visits; since these visits tend to be the only point of contact of women with health care.

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