Violence during pregnancy a way of life for many SA women

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Many South African women‚ already in difficult situations‚ are experiencing violence during pregnancy at the hands of their intimate partners‚ The Times reports a study has found. Of the 376 women who took part in the research‚ 15% had experienced intimate partner violence (IPV) during pregnancy‚ with forms of abuse ranging from sexual and physical to emotional and verbal.

This is against a backdrop of South Africa having intimate partner violence (among all women‚ not just those who are pregnant) which is “double that of the US”‚ and which is as high as 71% in some communities.

The report says the study was carried out by a team from the University of Cape Town. The sample was drawn from women attending antenatal services at a primary-level maternity facility in Cape Town.

The researchers found that the high level of violence during pregnancy resulted from a combination of poverty-related factors including food insecurity‚ mental ill-health‚ unemployment‚ unwanted pregnancies‚ and past experiences of abuse.

“In its most severe form‚ violence against pregnant women has been reported as a contributing cause of maternal deaths‚” said researchers Sally Field‚ Michael Onah‚ Thandi van Heyningen and Simone Honikman.

It has also been associated with “inadequate uptake of antenatal care‚ with abused women being more likely to delay seeking pregnancy care and to attend fewer antenatal visits.”

For mothers and their unborn babies‚ results can include “low birth weight‚ foetal death by placental abruption‚ antepartum haemorrhage‚ foetal fracture‚ rupture of the uterus and premature labour”. Also‚ the report says they add that a “strong association” had been shown between thoughts of suicide and violence experienced by pregnant women.

They said that in South Africa‚ “high levels of violence occur within a context of multiple contributing social dynamics. These include prominent patriarchal norms where masculinity is associated with defence of honour‚ harshness‚ and risk taking.” They added: “Poverty and gender inequalities contribute to the structural determinants of violence.

“Women in stable but unmarried relationships were more likely to have reported experiencing IPV than those who were married.”

Where to from here? The researchers said in the report that the study contributed towards a greater understanding of the risk profile for IPV among pregnant women in low-income settings.

Background: Rates of violence against women are reported to be highest in Africa compared to other continents. We aimed to determine associations between mental illness, demographic, psychosocial and economic factors with experience of intimate partner violence (IPV) among pregnant women in a low resource setting in Cape Town and to explore the contextual elements pertaining to domestic violence.
Methods: We recruited adult women attending antenatal services at a primary-level maternity facility. Demographic, socioeconomic and psychosocial data were collected by questionnaire. The Expanded Mini- International Neuropsychiatric Interview (MINI) Version 5.0.0 was used to assess mental health status and the Revised Conflict Tactic Scale (CTS2) used to assess IPV in the six months prior to the study. Non-parametric tests, Wilcoxon sum of rank test, Fisher Exact and two sample T test and multicollinearity tests were performed. Descriptive, bivariate and logistic regression analyses were conducted to identify associations between the outcome of interest and key predictors. A probability value of p ≤ 0.05 was selected. From counselling case notes, a thematic content analysis was conducted to describe contextual factors pertaining to forms of domestic violence (DV).
Results: The prevalence of IPV was 15% of a sample of 376 women. Women who were food insecure, unemployed, in stable but unmarried relationships, had experienced any form of past abuse and were not pleased about the current pregnancy were more likely to experience IPV. MINI-defined mental health problems and a history of mental illness were significantly associated with IPV. Qualitative analysis of 95 counselling case notes revealed that DV within the household was not limited to intimate partners and, DV in this context was often perceived as ‘normal’ behaviour by the participants.
Conclusions: This study contributes towards a greater understanding of the risk profile for IPV amongst pregnant women in low-income settings. Adversity, including food insecurity and mental ill-health are closely associated with IPV during the antenatal period. Advocates against violence against pregnant women are advised to consider that violence in the home may be perpetrated by non-intimate partners and may by enabled by a pervasive belief in the acceptability of the violence.

Sally Field, Michael Onah, Thandi van Heyningen, Simone Honikman

The Times report
BMC Women’s Health Journal

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