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Associations between intimate partner violence and reproductive and maternal health outcomes in Bihar, India: a cross-sectional study.
Reprod Health. 2018 Jun 19; 15(1):109.RH

Abstract

BACKGROUND

Bihar, India has higher rates of intimate partner violence (IPV) and maternal and infant mortality relative to India as a whole. This study assesses whether IPV is associated with poor reproductive and maternal health outcomes, as well as whether poverty exacerbates any observed associations, among women who gave birth in the preceding 23 months in Bihar, India.

METHODS

A cross-sectional analysis of data from a representative household sample of mothers of children 0-23 months old in Bihar, India (N = 13,803) was conducted. Associations between lifetime IPV (physical and/or sexual violence) and poor reproductive health outcomes ever (miscarriage, stillbirth, and abortion) as well as maternal complications for the index pregnancy (early and/or prolonged labor complications, other complications during pregnancy or delivery) were assessed using multivariable logistic regression, adjusting for demographics and fertility history of the mother. Models were then stratified by wealth index to determine whether observed associations were stronger for poorer versus wealthier women.

RESULTS

IPV was reported by 45% of women in the sample. A history of miscarriage, stillbirth, and abortion was reported by 8.7, 4.6, and 1.3% of the sample, respectively. More than one in 10 women (10.7%) reported labor complications during the last pregnancy, and 16.3% reported other complications during pregnancy or delivery. Adjusted regressions revealed significant associations between IPV and miscarriage (AOR = 1.35, 95% CI = 1.11-1.65) and stillbirth (AOR = 1.36, 95% CI = 1.02-1.82) ever, as well as with labor complications (AOR = 1.27, 95% CI = 1.04-1.54) and other pregnancy/delivery complications (AOR = 1.68, 95% CI = 1.42-1.99). Women in the poorest quartile (Quartile 1) saw no associations between IPV and miscarriage (Quartile 1 AOR = 0.98, 95% CI = 0.67-1.45) or stillbirth (Quartile 1 AOR = 1.17, 95% CI = 0.69-1.98), whereas women in the higher wealth quartile (Quartile 3) did see associations between IPV and miscarriage (Quartile 3 AOR = 1.55, 95% CI = 1.07, 2.25) and stillbirth (Quartile 3 AOR = 1.79, 95% CI = 1.04, 3.08).

DISCUSSION

IPV is highly prevalent in Bihar and is associated with increased risk for miscarriage, stillbirth, and maternal health complications. Associations between IPV and miscarriage and stillbirth do not hold true for the poorest women, possibly because other risks attached to poverty and deprivation may be greater contributors.

Authors+Show Affiliations

Bill & Melinda Gates Foundation, New Delhi, India.Center on Gender Equity and Health, Department of Medicine, University of California, San Diego School of Medicine, 9500 Gilman Drive, MC 0507, La Jolla, San Diego, CA, 92093-0507, USA.Bill & Melinda Gates Foundation, New Delhi, India.Bill & Melinda Gates Foundation, New Delhi, India.Center on Gender Equity and Health, Department of Medicine, University of California, San Diego School of Medicine, 9500 Gilman Drive, MC 0507, La Jolla, San Diego, CA, 92093-0507, USA.Center on Gender Equity and Health, Department of Medicine, University of California, San Diego School of Medicine, 9500 Gilman Drive, MC 0507, La Jolla, San Diego, CA, 92093-0507, USA.Center on Gender Equity and Health, Department of Medicine, University of California, San Diego School of Medicine, 9500 Gilman Drive, MC 0507, La Jolla, San Diego, CA, 92093-0507, USA. anitaraj@ucsd.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29921276

Citation

Dhar, Diva, et al. "Associations Between Intimate Partner Violence and Reproductive and Maternal Health Outcomes in Bihar, India: a Cross-sectional Study." Reproductive Health, vol. 15, no. 1, 2018, p. 109.
Dhar D, McDougal L, Hay K, et al. Associations between intimate partner violence and reproductive and maternal health outcomes in Bihar, India: a cross-sectional study. Reprod Health. 2018;15(1):109.
Dhar, D., McDougal, L., Hay, K., Atmavilas, Y., Silverman, J., Triplett, D., & Raj, A. (2018). Associations between intimate partner violence and reproductive and maternal health outcomes in Bihar, India: a cross-sectional study. Reproductive Health, 15(1), 109. https://doi.org/10.1186/s12978-018-0551-2
Dhar D, et al. Associations Between Intimate Partner Violence and Reproductive and Maternal Health Outcomes in Bihar, India: a Cross-sectional Study. Reprod Health. 2018 Jun 19;15(1):109. PubMed PMID: 29921276.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Associations between intimate partner violence and reproductive and maternal health outcomes in Bihar, India: a cross-sectional study. AU - Dhar,Diva, AU - McDougal,Lotus, AU - Hay,Katherine, AU - Atmavilas,Yamini, AU - Silverman,Jay, AU - Triplett,Daniel, AU - Raj,Anita, Y1 - 2018/06/19/ PY - 2017/12/28/received PY - 2018/06/06/accepted PY - 2018/6/21/entrez PY - 2018/6/21/pubmed PY - 2018/11/27/medline KW - Delivery complications KW - Induced abortion KW - Intimate partner violence KW - Miscarriage KW - Physical abuse KW - Pregnancy complications KW - Reproductive health KW - Sexual abuse KW - Stillbirth SP - 109 EP - 109 JF - Reproductive health JO - Reprod Health VL - 15 IS - 1 N2 - BACKGROUND: Bihar, India has higher rates of intimate partner violence (IPV) and maternal and infant mortality relative to India as a whole. This study assesses whether IPV is associated with poor reproductive and maternal health outcomes, as well as whether poverty exacerbates any observed associations, among women who gave birth in the preceding 23 months in Bihar, India. METHODS: A cross-sectional analysis of data from a representative household sample of mothers of children 0-23 months old in Bihar, India (N = 13,803) was conducted. Associations between lifetime IPV (physical and/or sexual violence) and poor reproductive health outcomes ever (miscarriage, stillbirth, and abortion) as well as maternal complications for the index pregnancy (early and/or prolonged labor complications, other complications during pregnancy or delivery) were assessed using multivariable logistic regression, adjusting for demographics and fertility history of the mother. Models were then stratified by wealth index to determine whether observed associations were stronger for poorer versus wealthier women. RESULTS: IPV was reported by 45% of women in the sample. A history of miscarriage, stillbirth, and abortion was reported by 8.7, 4.6, and 1.3% of the sample, respectively. More than one in 10 women (10.7%) reported labor complications during the last pregnancy, and 16.3% reported other complications during pregnancy or delivery. Adjusted regressions revealed significant associations between IPV and miscarriage (AOR = 1.35, 95% CI = 1.11-1.65) and stillbirth (AOR = 1.36, 95% CI = 1.02-1.82) ever, as well as with labor complications (AOR = 1.27, 95% CI = 1.04-1.54) and other pregnancy/delivery complications (AOR = 1.68, 95% CI = 1.42-1.99). Women in the poorest quartile (Quartile 1) saw no associations between IPV and miscarriage (Quartile 1 AOR = 0.98, 95% CI = 0.67-1.45) or stillbirth (Quartile 1 AOR = 1.17, 95% CI = 0.69-1.98), whereas women in the higher wealth quartile (Quartile 3) did see associations between IPV and miscarriage (Quartile 3 AOR = 1.55, 95% CI = 1.07, 2.25) and stillbirth (Quartile 3 AOR = 1.79, 95% CI = 1.04, 3.08). DISCUSSION: IPV is highly prevalent in Bihar and is associated with increased risk for miscarriage, stillbirth, and maternal health complications. Associations between IPV and miscarriage and stillbirth do not hold true for the poorest women, possibly because other risks attached to poverty and deprivation may be greater contributors. SN - 1742-4755 UR - https://www.unboundmedicine.com/medline/citation/29921276/Associations_between_intimate_partner_violence_and_reproductive_and_maternal_health_outcomes_in_Bihar_India:_a_cross_sectional_study_ L2 - https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-018-0551-2 DB - PRIME DP - Unbound Medicine ER -