Abstract
Objective:
Identifying factors associated with peri and post-partum intimate partner violence (IPV) may facilitate prioritizing women for psychosocial support.
Methods:
Pregnant women in Kenya were asked about IPV by their current partner at baseline (screening), during pregnancy and at 6 weeks and 6 months post-partum. IPV was defined as being physically hurt or forced to participate in sexual activities or being threatened or frightened by a partner.
Results:
Among 502 women (11.8% HIV-positive) enrolled during pregnancy and successfully followed for 6 months post-partum, 430 (85.7%) reported never experiencing IPV, 32 (6.4%) reported IPV at least once in their lifetime but not in the past 6 months, and 31 (6.2%) reported IPV in the past 6 months but not in the past month. During pregnancy and post-partum, 61 (12.2%) reported incident IPV. Women who at baseline reported IPV in the past 6 months were at 2.7-fold higher odds of experiencing IPV peri- and post-partum (OR=2.77; 95%CI: 1.17, 6.53; p=0.020) compared to women who had never experienced IPV. This association remained significant in multivariable analysis.
Conclusion:
Screening for recent IPV during antenatal care visits may be an effective means to identify women at highest risk of IPV and offer targeted prevention interventions.
Keywords: Africa, HIV/AIDS, Intimate Partner Violence, Kenya, Pregnancy, Post-Partum Incidence
INTRODUCTION
Intimate Partner Violence (IPV) is the most common form of violence women experience, with 1 in 3 women worldwide having experienced physical or sexual intimate partner violence (IPV) or non-partner sexual violence in their lifetime. [1 2] Across African countries, the prevalence of IPV during pregnancy ranges from 2.3% to 57%. [3] In Kenya studies show IPV prevalence during pregnancy ranging from 37% to 66.9%. [4] [5] Violence between intimate partners that causes physical, sexual or psychological harm is defined as IPV and includes physical aggression, sexual coercion, psychological abuse and controlling behaviors. [6]
In addition to its harm to women, IPV during pregnancy is associated with adverse pregnancy outcomes including low birth weight, preterm birth, newborns small for gestational age, and neonatal death. [7 8] HIV-positive women who are victims of ongoing IPV have reduced access and adherence to services for prevention of mother-to-child HIV transmission (PMTCT), HIV care, antiretroviral therapy (ART), and mental health services. [9-12] Characterization of factors associated with current or past IPV may enable antenatal care providers to identify women who are currently experiencing IPV and are at an elevated risk of future IPV so that they can provide appropriate services, help reduce risk of vertical HIV transmission, and ensure those living with HIV continue to have access to care services.
Few studies have followed pregnant women prospectively to identify risk factors for IPV in sub-Saharan Africa. To assess incidence and factors associated with incident IPV during pregnancy and the post-partum period, we conducted a prospective cohort study among 502 women enrolled in a clinical trial of couple counseling and testing in western Kenya who were successfully followed until 6 months post-partum. The overall objective was to determine if prior history of IPV can be used to screen women seeking antenatal services for post-partum IPV risk and prioritize them for psychosocial support.
MATERIALS AND METHODS
Study Design and Population
This longitudinal analysis was nested within the Home-based Partner Education and Testing (HOPE) Study (NIH R01HD075108), which was a randomized trial evaluating a home-based couple counseling intervention designed to improve maternal and child health and reduce heterosexual and vertical HIV transmission, as previously described [13]. Pregnant women attending their first antenatal visit at Kisumu County Hospital from September 2013 to June 2014 were recruited for the study. Kisumu County Hospital is a high-volume facility with approximately 200 new antenatal visits per month and a HIV prevalence of 9.5-12% among pregnant women at the time of the study. Women provided written informed consent to participate. This study was approved by the Kenyatta National Hospital (KNH)/University of Nairobi Ethics and Research Committee and the University of Washington Human Subjects Division.
Eligibility Criteria
Pregnant women were eligible for the HOPE study if they were ≥8 weeks gestation and in a current stable partnership (married or cohabitating) [13]. Women who experienced IPV in the past month were excluded due to the potential for harm associated with partner notification. Screening for a history of experiencing physical, sexual, and verbal violence was performed at baseline, 6 weeks and 6 months post-partum. We analyzed baseline prevalence, incidence, and correlates of IPV among women who completed 6 months post-partum follow-up.
Measures
Dependent Variable
Baseline IPV and incident IPV were defined by responses to a questionnaire administered by a formally trained nurse or community health worker, which asked about physical, sexual and verbal violence committed by the current primary intimate partner. At baseline, pregnant women were asked if they had been physically hurt by their current male partner, forced to participate in sexual activities that made them feel uncomfortable, or threatened or frightened at any point in their life, in the past 6 months, or in the past one month. The same set of questions was repeated at the 6-week and 6-month post-partum follow-up visits, assessing physical, sexual and verbal IPV experienced since the start of the study (6 weeks post-partum follow-up) and since last study visit (6-month post-partum follow-up).
For these analyses the timing of IPV was categorized as 1) No IPV reported ever (Never IPV); 2) IPV reported but not in the past 6 months (Past IPV); 3) IPV reported in the past 6 months but not in the past one month (6-month IPV). Women who had experienced IPV in the past month were excluded due to safety. Each category was mutually exclusive; for example, women who reported IPV in the past 6 months were not included in the Past IPV category. Incident IPV was defined as having reported an episode of physical or sexual or verbal abuse between enrollment and the follow-up visits at 6 weeks and 6 months post-partum. Assessment of past and incident IPV was limited to IPV data collected about the current partner, rather than any past partner.
Independent Variables
Sociodemographic characteristics that were assessed at baseline included: woman’s age, partner’s age, age difference, gestational age at enrollment, gravidity including current pregnancy, number of living children, number of lifetime sexual partners, marital status, educational attainment, separate income, household monthly income, self-reported HIV status, confirmed HIV status, partner’s HIV status as reported by the woman, and couple testing.
Data Analysis
The overall prevalence of IPV among enrolled participants was calculated as the proportion of women who reported IPV among all women who were screened and enrolled into the parent study and were successfully followed until 6 months post-partum. The prevalence of IPV in the peri-conception period of the current pregnancy (prior to enrollment in the study) was calculated as the proportion of women reporting IPV in the 6 months preceding the baseline survey. Since women who reported IPV in the last one month at screening were ineligible due to safety and thus excluded from the study, these women were not included in the calculations of prevalence overall or during the current pregnancy.
To investigate incident IPV, we used logistic regression to compare the odds of incident IPV from baseline (at which time women were pregnant) until 6 months post-partum between those who reported no history of IPV at enrollment and those who reported past IPV or IPV in the last 6 months. We evaluated sociodemographic characteristics associated with incident IPV, considering the potential confounders education level, number of lifetime sexual partners, and marital status. Analyses were conducted using Stata 14.1 (StataCorp; College Station, Texas).
RESULTS
Baseline Characteristics
A total of 502 antenatal women were included in this analysis, among whom 430 (85.7%) had never experienced intimate partner violence (IPV) with the current partner, 32 (6.4%) experienced past IPV, but not in the past 6 months, 31 (6.2%) had experienced IPV in the past 6 months, but not in the past one month and 9 had missing data. 403 (80.3%) tested HIV-negative, 59 (11.8%) HIV-positive, and 40 (7.9%) unknown status (Table 1). The median age of women was 24 years (interquartile range [IQR], 21 to 28) and the median age of their male partners was 30 years (IQR, 26 to 35) (Table 1). Median gravidity was 2 (IQR, 1 to 3) and women reported having a median of one living child (IQR, 0 to 2). Overall, half of women (n=249) women reported having a separate income from their partner. Overall, 43.2% had a primary education or lower and 56.8% had greater than secondary education…
TABLE 1.
Baseline Sociodemographic Characteristics of Pregnant Women who were Screened for the Home-Based Partner Education and Testing (HOPE) Study, by Intimate Partner Violence Experienced (n=502)
| Baseline Characteristics | Overall (n=502) n (%) or Median (IQR) |
Never IPV (n=430) n (%) or Median (IQR) |
Past IPV, but not past 6 months (n=32) n (%) or Median (IQR) |
IPV in the past 6 months, but not in past month (n=31) n (%) or Median (IQR) |
|---|---|---|---|---|
| Female age, (years) * | 24 (21-28) | 24 (21-28) | 25 (22-30) | 24 (20-28) |
| Male partner’s age (years) * | 30 (26-35) | 30 (26-35) | 29 (26-35) | 33 (27-36) |
| Difference in female-male ages ** | 5 (3-8) | 5 (3-8) | 5 (2-7) | 7 (4-10) |
| Gestational age (weeks) * | 21 (17-25) | 21 (17-25) | 21 (17-27) | 22 (18-27) |
| Gravidity including current pregnancy * | 2 (1-3) | 2 (1-3) | 3 (2-3) | 3 (2-3) |
| Number of living children * | 1 (1-2) | 1 (0-2) | 1 (1-2) | 1 (1-2) |
| Number of lifetime sexual partners * | 2 (2-3) | 2 (2-3) | 2 (2-3) | 2 (1-3) |
| Marital status * | ||||
| Unmarried | 2 (0.4%) | 2 (0.5%) | 0 (0.00%) | 0 (0.0%) |
| Married, monogamous | 441 (87.9%) | 386 (89.8%) | 29 (90.6%) | 26 (83.9%) |
| Married, polygamous | 49 (9.8%) | 41 (9.5%) | 3 (9.4%) | 5 (16.1%) |
| Education level * | ||||
| Primary school or less | 217 (43.2%) | 184 (42.8%) | 17 (53.1%) | 16 (51.6%) |
| Some secondary school | 83 (16.5%) | 70 (16.3%) | 7 (21.9%) | 6 (19.4%) |
| Secondary school completed | 110 (21.9%) | 99 (23 %) | 5 (15.6%) | 6 (19.4%) |
| Above secondary school | 83 (16.5%) | 77 (17.9%) | 3 (9.4%) | 3 (9.7%) |
| Has separate income * | 249 (49.6%) | 218 (50.7%) | 18 (56.3%) | 13 (41.9%) |
| Household monthly income * | ||||
| Less than 1000 Ksh (USD 10) | 58 (11.5%) | 57 (13.3%) | 1 (3.1%) | 0 (0.00%) |
| 1000-4999 Ksh (USD 10-49.99) | 45 (9%) | 40 (9.3%) | 4 (12.5%) | 1 (3.2%) |
| 5000-9999 Ksh (USD 50-99.99) | 158 (31.5%) | 138 (32.1%) | 8 (25.0%) | 12 (38.7%) |
| 10000 Ksh and above(≥ USD 100) | 216 (43.0 %) | 181 (42.1%) | 18 (56.3%) | 17 (54.8%) |
| Female self-reported HIV status * | ||||
| HIV Negative | 403 (80.3%) | 353 (82.1%) | 27 (84.4%) | 23 (74.2%) |
| HIV Positive | 59 (11.8%) | 51 (11.9%) | 3 (9.4%) | 5 (16.1%) |
| Male partner’s female-reported HIV status * | ||||
| HIV Negative | 248 (49.4%) | 210 (48.8%) | 22 (68.8%) | 16 (51.6%) |
| HIV Positive | 40 (8%) | 35 (8.1%) | 2 (6.3%) | 3 (9.7%) |
| Couple testing ** | ||||
| No | 302 (60.2%) | 265 (61.6%) | 17 (53.1%) | 20 (64.5%) |
| Yes | 191 (38.1%) | 165 (38.4%) | 15 (46.9%) | 11 (35.5%) |
Data are presented as n (%) or median (range) unless otherwise specified
9 missing female age; 9 missing partner’s age; 11 missing gestational age (2 preferred not to respond for gestational age); 10 missing gravidity; 28 missing number of living children; 15 missing sexual partners lifetime (3 preferred not to respond for number of lifetime sexual partners; 3 were not sure about number of lifetime sexual partners); 10 missing marital status; 9 missing for education level; 10 missing separate income (1 preferred not to respond for separate income); 25 missing household monthly income (16 preferred not to respond for household monthly income and 9 missing); 40 missing female self-report HIV status (39 missing female self-report HIV status; 1 was not sure for female self-report HIV status); 214 missing partners HIV status (211 missing partners HIV status; 3 were not sure of partners HIV status)
9 missing couple testing; 9 missing difference in partner ages (male minus female age)
Incidence of IPV in the Postpartum Period among Women Followed for 6 Months
Overall, 62 (12.4%) women reported IPV between the time of enrollment and 6 months post-partum, among whom 39 (7.8%) reported physical IPV, 13 (2.6%) reported sexual IPV, and 33 (6.6%) reported verbal IPV. We found that incident IPV was lower with increasing maternal age (OR=0.93 [00.88, 0.99]; p=0.028) and having above secondary school education versus primary school or less (OR=0.37 [0.14, 0.99]; p=0.047) (Table 2). The odds of reporting incident IPV was not statistically significantly different among women living with HIV compared to HIV-negative women.
TABLE 2.
Associations between Sociodemographic Characteristics of Pregnant Women and Incidence of Intimate Partner Violence (N=502)
| Incident IPV | ||||||
|---|---|---|---|---|---|---|
| Characteristics | n [N] | % | OR (95% CI) | P-value | aOR (95% CI)**** | P-value |
| Female age (years) | – | – | 0.93 (0.88, 0.99) | 0.028 | 0.94 (0.89, 1.01) | 0.076 |
| Male partner’s age (years) * | – | – | 0.97 (0.93, 1.02) | 0.219 | 0.97 (0.93, 1.02) | 0.227 |
| Difference in partner ages ** | – | – | 1.01 (0.96, 1.07) | 0.595 | 1.00 (0.95, 1.07) | 0.815 |
| Gestational age (weeks) * | – | – | 1.04 (0.99, 1.08) | 0.125 | 1.02 (0.98, 1.07) | 0.317 |
| Gravidity including current pregnancy * | – | – | 0.83 (0.66, 1.05) | 0.116 | 0.77 (0.61, 0.99) | 0.041 # |
| Number of living children * | – | – | 0.85 (0.67, 1.07) | 0.169 | 0.80 (0.62, 1.02) | 0.076 |
| Number of lifetime sexual partners * | – | – | 1.01 (0.81, 1.25) | 0.927 | 1.01 (0.80, 1.27) | 0.915 |
| Marital status * | -- | |||||
| Unmarried | 0 [2] | 0% | NA | NA | NA | NA |
| Married, monogamous | 55 [441] | 12% | 1 (ref) | 1 (ref) | ||
| Married, polygamous | 6 [49] | 12% | 0.98 (0.40, 2.41) | 0.964 | 0.89 (0.35, 2.26) | 0.895 |
| Education level * | ||||||
| Primary school or less | 32 [217] | 15% | 1 (ref) | 1 (ref) | ||
| Some secondary school | 11 [83] | 13% | 0.88 (0.42, 1.84) | 0.741 | 0.85 (0.41, 1.79) | 0.676 |
| Secondary school completed | 13 [110] | 12% | 0.77 (0.39, 1.54) | 0.469 | 0.80 (0.40, 1.79) | 0.526 |
| Above secondary school | 5 [83] | 6 % | 0.37 (0.14, 0.99) | 0.047 | 0.40 (0.14, 1.02) | 0.054 |
| Has separate income * | ||||||
| No | 31 [243] | 13% | 1 (ref) | |||
| Yes | 30 [249] | 12% | 0.94 (0.55, 1.60) | 0.811 | 1.03 (059, 1.79) | 0.921 |
| Household monthly income * | ||||||
| Less than 1,000 Ksh (USD 10) | 9 [58] | 16% | 1 (ref) | |||
| 1,000-4,999 Ksh (USD 10-49,99) | 6 [45] | 13% | 0.84 (0.27, 2.56) | 0.755 | 0.78 (0.25, 2.41) | 0.662 |
| 5,000-9,999 Ksh (USD 50-99.99) | 25 [158] | 16% | 1.02 (0.45, 2.35) | 0.956 | 0.90 (0.39, 2.09) | 0.803 |
| 10,000 Ksh and above (≥USD 100) | 21 [216] | 10% | 0.59 (0.25, 1.36) | 0.214 | 0.56 (0.23, 1.36) | 0.200 |
| Female self-reported HIV Status * | ||||||
| HIV Negative | 48 [403] | 12% | 1 (ref) | 1 (ref) | ||
| HIV Positive | 7 [59] | 12% | 1.00 (0.43, 2.32) | 0.992 | 0.91 (0.38, 2.18) | 0.835 |
| Confirmed female HIV status | ||||||
| HIV Negative | 47 [408] | 12% | 1 (ref) | 1 (ref) | ||
| HIV Positive | 15 [94] | 16% | 1.46 (0.78, 2.74) | 0.241 | 1.33(0.68, 2.58) | 0.400 |
| Male partners female-reported HIV status *** | ||||||
| HIV Negative | 26 [248] | 10% | 1 (ref) | 1 (ref) | ||
| HIV Positive | 5 [40] | 13% | 1.22 (0.44, 3.39) | 0.703 | 1.17 (0.39, 3.43) | 0.782 |
| Couple testing | ||||||
| No | 37 [302] | 12% | 1 (ref) | 1 (ref) | ||
| Yes | 24 [191] | 13% | 1.03 (0.59, 1.78) | 0.918 | 1.11 (0.63, 1.96) | 0.714 |
Data are presented as odds ratios (OR) or adjusted odds ratios (aOR), 95% confidence intervals (95 % CI) and p-values unless otherwise specified
9 missing female age; 9 missing male partner age; 9 missing difference in partners age; 11 missing gestational age; 10 missing gravidity; 28 missing number of living Children; 15 missing number of sexual partners; 10 missing marital status; 9 missing educational attainment; 10 missing separate income; 25 missing household income; 40 missing female self-report HIV; 214 missing male partners self-reported HIV status; 196 missing HIV tested with partner; and 9 missing couple test
Difference in partner’s age was calculated by subtracting the males age from the female’s age
Female participant reported male partner’s HIV status
Adjusted for education, number of lifetime sexual partners, marital status, and baseline IPV
For gravidity once we control for age, it is no longer statistically significant OR = 0.82 [0.61, 1.11]; p-value = 0.194
Of the 430 women who reported no lifetime IPV at baseline, fewer (n= 48, [11.2%]) reported IPV during this period of follow-up compared to 5 (16.0%) of the 32 women who reported IPV remotely (> 6 months before enrollment) (OR=1.47 [0.54, 4.01]; p=0.447) and 8 (25.8%) of 31 women who reported IPV during the 6-month period prior to enrollment (OR=2.77 [1.17, 6.53]: p=0.020) (Table 3). After adjustment for lifetime sexual partners, marital status, and education level, women who reported IPV during the last 6 months at baseline remained at a higher odds of incident IPV during follow-up (adjusted OR [aOR]= 2.55; 95% CI: 1.07-6.07; p=0.034).
TABLE 3.
Association Between Baseline IPV and Incident IPV - Crude and Adjusted Estimates (n=502)
| Intimate Partner Violence | n [N] | % | OR (95% CI) | P-value | aOR (95% CI) ** | P-value |
|---|---|---|---|---|---|---|
| Physical and/or Sexual and/or Verbal Intimate | ||||||
| Partner Violence * | ||||||
| Never IPV | 48 [430] | 11.2% | 1 (ref) | 1 (ref) | ||
| Past IPV, but not past 6 months | 5 [32] | 16.0% | 1.47 (0.54, 4.01) | 0.447 | 1.34 (0.49, 3.66) | 0.572 |
| IPV – past 6 months, never past month | 8 [31] | 25.8% | 2.77 (1.17, 6.53) | 0.020 | 2.55 (1.07, 6.07) | 0.034 |
Data are presented as odds ratios (OR), 95% confidence intervals (95 % CI), and p-values unless otherwise specified
Missing 9 for physical and/or sexual and /or verbal IPV
Adjusted for education, marital status and, number of lifetime sexual partners
DISCUSSION
In this study we found 12.2% of women reported incident IPV by their current partner during pregnancy and the post-partum period. We found that compared to those who have never experienced IPV, women who reported experiencing IPV by their current partner in the past 6 months prior to enrollment had almost 3-fold higher odds of incident IPV during the remainder of their pregnancy through 6 months post-partum. Other studies in the region and worldwide found that between 2% and 25% of women report postpartum IPV.[14-17] Our finding of an association between past IPV and incident IPV during pregnancy and 6 months post-partum is consistent with findings from other studies in Rwanda and Nigeria.[18-20] This suggests past IPV is a major predictor of pregnancy related IPV. Therefore our study and prior studies emphasize the importance of asking about prior IPV and abuse during the antenatal period in order to provide appropriate psychosocial support, IPV prevention interventions, and referrals.
Prior to adjusting for confounders, incident IPV was less common among women of older age and women with more than secondary school education; however, in our study sample women regardless of age were at risk of incident IPV. The likelihood of women reporting IPV decreased with increased age. This finding is consistent with a study conducted in South African women that showed that age was associated with IPV during pregnancy and during the postpartum period, with every year increase in age women’s risk of experiencing IPV would reduce.[17] However, a systematic review of studies done in sub-Saharan Africa had mixed results with 3 publications finding associations and 2 publications finding no associations [3]. Another study conducted in Kisumu, Kenya, the same location as our study, found that age was not associated with IPV [4]. According to Grooves et al. (2015) the inconsistency in data is attributed to differences in sampling [17]. In addition, similar to the systematic review [3], there was little evidence in the association of many demographic and health characteristics with IPV. The authors hypothesize “that relationship and structural factors may be more important to understanding IPV” during pregnancy and post-partum period [17].
Our study found that higher education was associated with lower likelihood of IPV, a relationship that has not been consistently reported in Kenyan studies [4]. Similarly, Lawako (2007) et al. conducted a study in the general population of women in Kenya and found that higher education among women was associated with lower risk of IPV, yet being employed and having a higher education/occupational status than her partner was associated with higher risk of IPV [21]. This finding in the Lawako et.al study is attributed to societal norms around the husband as the breadwinner in the household. Women who are educated and employed may challenge these norms hence are at a higher risk of IPV.[21] In addition, Lawako et al. found factors such as age differences between partners, illiteracy, and a lack of autonomy and access to information increased IPV vulnerability among women.[21] Our study would have benefited from collection of data directly from the partner at baseline and at study completion to better assess male partner factors as risks for IPV, but one of the requirements of the HOPE study was that the male partner was not in attendance at the time of screening.
Similar to the Makayato study,[4] we found no association between female HIV status (self-reported and/or confirmed) and baseline IPV nor incident IPV. However, other studies have found this association [22], and postulated that male partner behavior (specifically infidelity and having multiple partners) may explain this association. A systematic review of cross-sectional data from 12 demographic health surveys from ten African countries found a significant association between HIV infection in women and exposure to physical violence, emotional violence, and male controlling behavior.[23] The study also found a weaker association between sexual violence and HIV, with significance only in women in their first union who do not report any premarital or extramarital sex in the previous 12 months.[23] A study in South Africa found that for women who did not have a history of physical IPV in their current relationship, there was an association between a positive HIV diagnosis and post-partum physical IPV.[24] The lack of association in our sample could be due to differences in how IPV was categorized since we combined those who reported physical IPV, sexual IPV and verbal IPV, and this could have resulted in misclassification. We were not powered to look at each category individually since we had only 94 (18.7%) women who were living with HIV.
In this prospective cohort study among pregnant and post-partum Kenyan women, we also found that approximately 12.5% of women reported baseline IPV by their current partner prior to or during the current pregnancy. This is on the lower end of the estimates in different African countries, where IPV prevalence among pregnant women is among the highest globally.[3] [4] [5] A systematic review of studies on IPV in pregnant women in Africa found proportions from 2.3% to 57%. [3] Studies in Kenya found IPV prevalence during pregnancy ranging from 37% to 66.9%. [4] [5] We attribute our lower estimates to exclusion of women not in stable partnerships and ineligible for that reason, as well as IPV reported by current partner only rather than any past partner. Enrollment of women who had experienced IPV in past month would have resulted in a 19% IPV prevalence, which is still on the lower end of estimates in the region. Women not in stable partnerships may be at increased risk of IPV and would be a population to target in future studies.
This study has several strengths and some limitations. Study strengths include that we followed women longitudinally during pregnancy and postpartum. This enabled us to calculate and report incident IPV thus identifying new cases during pregnancy and postpartum, as opposed to history of IPV, which is subject to reporting bias and may have occurred outside the reporting time period. Limitations include the fact that the HOPE study was not specifically designed to assess IPV in this study population. Since all women with IPV in the last month were excluded from participation in the HOPE trial due to safety, our findings may be an underestimation of the true effect size of the relationship between past IPV and incident IPV. In addition, the study did not collect specific information about the male partner, which made it difficult to calculate male risk factors for IPV. Common to survey studies, underreporting of IPV may have occurred and in the cross-sectional portion of the study, our ability to infer causality is limited. Nevertheless, the study adds to current limited literature assessing characteristics of incident IPV in pregnant women in this region of the world.
In conclusion, our findings confirm significantly higher rates of IPV among women who had recently experienced abuse. This highlights the need to identify women at highest risk of IPV and provide effective interventions against IPV during the antenatal and post-partum period. Screening women for recent abuse may be one way of identifying these women and ensuring they receive appropriate services and referrals.
Synopsis:
Screening for recent IPV during antenatal care may be an effective means to identify women at risk of IPV and offer targeted IPV prevention interventions.
ACKNOWLEDGMENTS
The authors would like to thank the clinical, outreach, and administrative staff for their work on this study, as well as the participants who made this study possible. The research was supported by the U.S. National Institutes of Health (NIH) Grant R01 HD075108. D.K. received support from Achievement Rewards for College Scientists (ARCS) Fellowship, the University of Washington Top Scholar Award and Global Opportunities Health Fellowship (GO Health). C.F. received support from NIH Grant K24 AI087399. A.O. received additional support from NIH-FIC ORWH Award Number K43 TW010363.
Footnotes
CONFLICTS OF INTEREST
The authors have no funding or conflicts of interest to disclose.
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