CONTENTS
- The World Takes Notice
- Intimate Partner Abuse
- Sexual Coercion
- Impact on Reproductive Health
- Threats to Health and Development
- Health Providers Play a Key Role
- An Agenda for Change
HIGHLIGHTS
- What lies behind violence?
- Culture: a double-edged sword
- Child sexual abuse is widespread
- Violence harms women in many different ways
- *Pullout guide: What Health Providers Can Do
- Responding to violence: Lessons learned
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The Center for Health and Gender Equity (CHANGE) is a research and advocacy organization that seeks to integrate concern for gender equity and social justice into international health policy and practice. CHANGE staff can be reached by e-mail at change@genderhealth.org or at http://www.genderhealth.org.
December, 1999
Series L, Number 11
Issues in World Health
Violence Leads to High-Risk Pregnancies
Obstetric risk factors. Violence before and during pregnancy can have serious health consequences for women and their children. Pregnant women who have experienced violence are more likely to delay seeking prenatal care (99, 113, 296, 351, 430, 447, 448) and to gain insufficient weight (27, 99). They are also more likely to have a history of STIs (6, 287), unwanted or mistimed pregnancies (68, 88, 167, 448), vaginal and cervical infections (99, 296, 351), kidney infections (88), and bleeding during pregnancy (99, 351).
Adverse pregnancy outcomes. Violence may also have a serious impact on pregnancy outcomes. Violence has been linked with increased risk of miscarriages and abortions (6, 232, 386), premature labor (88), and fetal distress (88). Several studies also have focused on the relationship between violence in pregnancy and low birth weight, a leading contributor to infant deaths in the developing world (6, 28, 51, 63, 88, 99, 121, 150, 193, 351, 355, 404, 447, 448). Although the findings are inconclusive, seven studies suggest that violence during pregnancy contributes substantially to low birth weight, at least in some settings (51, 63, 99, 150, 351, 447, 448). In one study at the regional hospital in León, Nicaragua, researchers found that, after controlling for other risk factors, violence against pregnant women was associated with a threefold increase in the incidence of low birth weight. Violence in pregnancy accounted for 16% of low birth weight among the infants studied and posed a greater risk of low birth weight than such factors as pre-eclampsia, bleeding, and smoking (448).
 MEXFAM (299) |
| As this Mexican guide to coping with domestic violence suggests, physical and sexual abuse during pregnancy is common. Worldwide, as many as one woman in every four is abused during pregnancy. |
How violence puts pregnancies at above-average risk is unclear, but several explanations have been suggested (326, 355). Blunt abdominal trauma can lead to fetal death or low birth weight by provoking preterm delivery (92, 342, 397). Violence also may affect pregnancy outcome indirectly by increasing women's likelihood of engaging in such harmful health behaviors as smoking and alcohol and drug abuse (see Alcohol and drug use, chapter 5.3), all of which have been linked to low birth weight (6, 67, 88, 121, 193, 285, 296, 351). Thus, particularly where smoking and substance abuse in pregnancy are relatively common, these behaviors may be the main ways in which violence in pregnancy reduces birth weight (99, 351).
Extreme stress and anxiety provoked by violence in pregnancy also may lead to preterm delivery or fetal growth retardation by increasing stress hormone levels or immunological changes (179, 225, 454). Stress can reduce women's ability to obtain adequate nutrition, rest, exercise, and medical care (64, 355). Stress resulting from abuse appears to be the most likely explanation for the link between violence and low birth weight found in studies in Nicaragua and Mexico, where smoking and alcohol use in pregnancy are rare but violence in pregnancy is common (447, 448).
Violence and maternal deaths. On the Indian subcontinent, violence may be responsible for a sizeable but underrecognized proportion of pregnancy-related deaths. In India verbal autopsies from a recent surveillance study of all maternal deaths in over 400 villages and 7 hospitals in three districts of Maharastra revealed that 16% of all deaths during pregnancy were due to domestic violence (164). In rural Bangladesh homicide and suicide, motivated by dowry-related problems or the stigma of rape and/or pregnancy outside of marriage, accounted for 6% of all maternal deaths between 1976 and 1986 and 31% of maternal deaths among women ages 15 to 19 (141). The risk of injury-related death was nearly three times higher for pregnant teenagers than for nonpregnant teenagers or for older pregnant women (384).
