Original Research – QuantitativeUnintended pregnancy and intimate partner violence around pregnancy in a population-based study
Introduction
Intimate partner violence (IPV) and unintended pregnancy are public health issues that can affect the health and well-being of women and their children. The infliction of violence by intimate partners is common in many societies and affects millions of women throughout the world every year. Studies have reported high rates of abuse during pregnancy and have linked this abuse to intrauterine growth restriction, low birth weight, fetal and infant death, and other maternal complications.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12
Previous studies have described a link between IPV and unintended (i.e., mistimed or unwanted) pregnancy.13 Unintended pregnancy has been associated with adverse outcomes for women, fetuses, and infants. It has been associated with shorter lactation periods, a lower likelihood of recognizing early signs of pregnancy, a greater likelihood of delayed entry into prenatal care, a lower-quality relationship between mother and child, and child abuse and neglect.13 Most induced abortions are unintended pregnancies and have been significantly associated with abuse,14 and unsafe abortion is one of the leading causes of maternal mortality worldwide, being more frequent in countries where abortion is illegal or severely restricted.8, 15
The relationship between IPV and unintended pregnancy has not been sufficiently explored. Out of all of the studies that have addressed IPV during or around the time of pregnancy, only a few have considered the intendedness of the pregnancy as a potential influential factor.1, 16, 17 Some authors specifically focused on the association between unintended pregnancy and IPV but applied only bivariate analyses to examine the empirical relationship between them.18, 19, 20, 21, 22, 23 More recently, researchers directly examined the association between IPV and unintended pregnancy in study populations from Colombia,24 Bangladesh25, 26 and a group of low- and middle-income countries,15 using multivariate logistic regression analysis to control for potential confounders.
Hence, further knowledge is required of the risk factors for unintended pregnancy, including those related to IPV, in different ethnic and socio-cultural settings. We analyzed the association of unintended pregnancy with IPV around pregnancy and with socio-demographic characteristics in a population-based study in Spain, a developed country. Previous studies have analyzed whether women experiencing IPV were more likely to have unintended pregnancies.15, 23, 24, 25, 26 The hypothesis of the present study was that women who report an unintended pregnancy may be experiencing IPV.
It is widely argued that heightened levels of fear and control within abusive relationships can impair women's ability to prevent pregnancy or negotiate contraceptive methods, leading to unintended pregnancy.13, 15, 18 Although emotional violence is the most frequent type of IPV, previous studies have focused on the association of physical and/or sexual abuse with unintended pregnancy.14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26 To the best of our knowledge, this is the first exploration of the association of unintended pregnancy with emotional and physical IPV around pregnancy.
The purpose of this study was to explore the potential association between unintended pregnancy and emotional and physical IPV around pregnancy, controlling for socio-demographic characteristics in a population-based sample of women who have recently given birth.
Section snippets
Study subjects, population, and sample size
A population-based study was designed based on statistics published in 2009 by the health service for all public hospitals in the region, including data on the number of deliveries in each type of hospital (regional, specialist, or district). Details of the calculation of the population for this study of IPV during pregnancy have been described elsewhere.12 A cluster sampling approach was adopted, considering the hospitals as clusters and grouping by hospital type. A sample size of 750 women
Results
The study sample included 779 women. Their mean age was 29.9 ± 5.6 years (63% aged between 25 and 34 years); 64% were married at the time of the interview, 14% had a committed relationship (unmarried) and 22% a non-committed relationship; 48% had studied for 7–12 years, 38% for <7 years, and 14% had university studies; 56% were employed at the time of the interview, 22% were housewives, 20% unemployed, and 2% were students; 91% were of Spanish origin, while the other 9% were largely from
Discussion
In this population-based sample, 15.1% of the women had not intended their recent pregnancy. In a WHO multi-country study on women's health and domestic violence in 10 low and middle-income countries,15 a mean of 38% of the women reported that the pregnancy was unwanted or mistimed at the time of the pregnancy (range, 13–68%); similar percentages to the present finding were reported in Samoa (13%) or Japan (19.7%), but the percentage was above 30% in the remaining countries. In Bangladesh,
Conclusion
Our study has shown that women who report an unintended pregnancy may be experiencing emotional IPV around pregnancy. The risk of emotional IPV is higher if women reporting an unintended pregnancy are in a committed relationship, married, or in employment. Further research is warranted on the relationship between unintended pregnancy and emotional IPV in different socio-cultural settings. The knowledge obtained could help midwives to be more aware of the potential reproductive health risk
Acknowledgements
The study was partially funded by Research Group BIO-253 of the Education and Science Department of the Regional Government of Andalusia, Spain. The authors are grateful to all of the midwives who participated in this study and to all of the women who shared their experiences.
References (35)
- et al.
Physical violence during pregnancy: maternal complications and birth outcomes
Obstet Gynecol
(1999) - et al.
Intimate partner violence and adverse pregnancy outcomes: a population-based study
Am J Obstet Gynecol
(2003) Relationship between physical abuse during pregnancy and risk factors for preterm birth among women in Manitoba
J Obstet Gynecol Neonatal Nurs
(2005)- et al.
Intimate partner violence during pregnancy: analysis of prevalence data of 19 countries
Reprod Health Matters
(2010) - et al.
A comparison of the prevalence of domestic violence between patients seeking termination of pregnancy and other general gynecology patients
Int J Gynecol Obstet
(2002) - et al.
Intimate partner violence, abortion, and unintended pregnancy: results from the WHO multi-country study on women's health and domestic violence
Int J Gynecol Obstet
(2013) - et al.
Delay entry into prenatal care: effect of physical violence
Obstet Gynecol
(1997) - et al.
The influence of abuse on pregnancy intention
Women Health Issues
(1995) - et al.
The relationship between pregnancy intendedness and physical violence in mothers of newborns
Obstet Gynecol
(1995) - et al.
Rapid repeat pregnancy and experiences of interpersonal violence among low-income adolescents
Am J Prev Med
(1999)
The prevalence of domestic violence among women seeking abortion
Obstet Gynecol
Pregnant women's perspectives on intendedness of pregnancy
Women Health Issues
Pregnancy and domestic violence: a review of the literature
Trauma Violence Abuse
Violence and reproductive health: current knowledge and future research directions
Matern Child Health J
Abuse during pregnancy in industrialized and developing countries
Violence Against Women
Violence against pregnant women: prevalence and characteristics. A population-based study in Nicaragua
BJOG
Summary report: WHO multicountry study on women's health and domestic violence against women
Cited by (22)
Unintended pregnancy among U.S. military active duty servicemembers: Estimates for 2018 and trends since 2005
2023, ContraceptionCitation Excerpt :Although the most recently published rates of unintended pregnancy declined by 18% between 2008 and 2011 [3,4], U.S. rates were still higher than found in many industrialized countries [5]. Unintended pregnancy may also result in financial costs, loss of career opportunities, and negative emotional experiences [6,7]. Pregnant servicemembers cannot deploy to combat zones, which affects the readiness of these units and the Department of Defense.
Intimate partner violence and the association of pregnancy intendedness – A cross-sectional study in southeastern Norway
2021, Sexual and Reproductive HealthcareIntimate partner violence, pregnancy intention and contraceptive use in Honduras
2019, ContraceptionCitation Excerpt :Furthermore, previous research has found a relationship between unintended pregnancies and other forms of IPV, including controlling behaviors [26,28]. Controlling behaviors can interfere with women's reproductive freedom by limiting access to and use of contraception [28,30,31]. Future research is needed in Honduras to determine the interacting effect of other forms of IPV on women's SRH outcomes.
Poor antenatal care attendance is associated with intimate partner violence: Multivariate analysis of a pregnancy cohort
2019, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :Despite the free and well-integrated antenatal care services as part of the public health system, almost 10% of the women did not attend the minimum stipulated number of antenatal visits [29]. We also documented an association between unintended pregnancy and poor antenatal care, a feature that has been previously demonstrated to be associated with IPV during pregnancy [30]. Therefore, women who report an unwanted or mistimed pregnancy should be considered a risk group of poor antenatal care and IPV during pregnancy.
Imaging of Violence Against the Elderly and the Women
2019, Seminars in Ultrasound, CT and MRICitation Excerpt :The literature shows that pregnant women subjected to IPV are more likely to have multiple sites of injury than their nonpregnant counterparts, with the most common target being the abdomen.36 Other injuries include broken bones, cuts, burns, hemorrhages, and broken teeth.37 No association was found between the nationality of the women and IPV.
Mother-newborn health indicators in possible victims of gender-based violence during pregnancy
2017, Applied Nursing ResearchCitation Excerpt :The above results are in agreement with most published findings (Boy & Salihu, 2004; Chambliss, 2008; Hassan, Kashanian, Hassan, Roohi, & Yousefi, 2014; Huth-Bocks, Levendosky, & Bogat, 2002; Martin-de-Las-Heras, Velasco, Luna, & Martin, 2015; Morales, 2011; Sarkar, 2008). However, in contrast to most investigations, we found no association between the situation of possible violence of these pregnant women and the type of delivery, complications during labor or postpartum, incidence of health problems during pregnancy, labor-associated perineal tear, active participation of the mother in labor, or length of postpartum hospital stay (Boy & Salihu, 2004; Chambliss, 2008; Hassan et al., 2014; Huth-Bocks et al., 2002; Martin-de-Las-Heras et al., 2015; Morales, 2011; Sarkar, 2008) The frequencies of low birth weight and preterm birth were higher in the newborns of mothers in a situation of possible intimate partner violence, who also showed a lower Apgar score and required more frequent hospitalization and a longer hospital stay, similar to findings reported by Huth-Bocks et al., 2002 and others(Hassan et al., 2014; Martin-de-Las-Heras et al., 2015; Sarkar, 2008).