Intimate partner violence (IPV) is a public health problem that affects millions of women worldwide and can occur during both pregnancy and the perinatal period. We aimed to evaluate if the experience of psychological and physical intimate partner violence (IPV) adversely affects pregnancy outcomes. We established a cohort of 779 consecutive mothers receiving antenatal care including ultrasound and giving birth in 15 public hospitals, drawn using cluster sampling of all obstetric services in Andalusia, Spain (February-June 2010). Trained midwives gathered IPV data using the Index of Spouse Abuse validated in the Spanish language (score ranges: 0–100, higher scores reflect more severe IPV; cut-offs: physical IPV = 10, psychological IPV = 25). Socio-demographic data, including lack of kin support, maternal outcomes, and hospitalization were collected. Multivariate logistic regression estimated adjusted odds ratios (AOR), with 95% confidence intervals (CI), of the relationship between psychological and physical IPV and maternal outcomes, controlling for socio-demographic characteristics. Response rate was 92.2%. Psychological IPV, reported by 21.0% (n = 151), was associated significantly with urinary tract infection (127 (23%) vs 56 (37%); AOR = 1.9; 95%CI = 1.2–3.0), vaginal infection (30 (5%) vs 20 (13%); AOR = 2.4; 95%CI = 1.2–4.7) and spontaneous preterm labour (32 (6%) vs 19 (13%); AOR = 2.2; 95%CI = 1.1–4.5). Physical IPV, reported by 3.6% (n = 26), was associated with antenatal hospitalizations (134 (19%) vs 11 (42%); AOR = 2.6; 95%CI = 1.0–7.1). Lack of kin support was associated with spontaneous preterm labour (AOR = 4.7; 95%CI = 1.7–12.8). Mothers with IPV have higher odds of complications. Obstetricians, gynaecologists and midwives should act as active screeners, particularly of the undervalued psychological IPV, to reduce or remedy its effects.
A high proportion of women in Spain experience intimate partner violence during or just before pregnancy. Pregnant women in an uncommitted relationship or without kin support were at greater risk of intimate partner violence. Screening instruments for intimate partner violence during pregnancy should be evaluated in different cultural contexts.
Objective
To evaluate if the experience of psychological intimate partner violence (IPV) adversely affects breastfeeding rates.
Design
A cohort study.
Setting
Maternities in 15 public hospitals, drawn using cluster sampling of obstetric services in Andalusia, Spain.
Population
A total of 779 consecutive mothers receiving antenatal care including ultrasound and giving birth during February–June 2010.
Methods
Trained midwives gathered IPV data using the Index of Spouse Abuse validated in the Spanish language (score ranges: 0–100, higher scores reflect more severe IPV; cut‐off: psychological IPV = 25). Sociodemographic data including lack of kin support, and obstetric and neonatal outcomes were collected. Multivariate logistic regression estimated adjusted odds ratios (aOR), with 95% confidence intervals (CI), of the relationship between psychological IPV and breastfeeding, controlling for sociodemographic characteristics and obstetric complications.
Main outcome measure
Breastfeeding avoidance defined as lack of breastfeeding or pumping of breast milk to feed the new baby in the immediate post‐partum period.
Results
Response rate was 92.2%. A total of 70% (n = 545) of women initiated breastfeeding. Psychological IPV, reported by 21.0% (n = 151), increased the odds of breastfeeding avoidance (aOR = 2.0; 95% CI = 1.2–3.3) adjusting for the presence of obstetric complications (aOR = 1.6; 95% CI = 1.0–2.4).
Conclusions
Mothers with psychological IPV avoid breastfeeding. Clinicians should be aware of the risks to infant arising from this deficiency due to IPV in pregnancy.
Tweetable abstract
Psychological intimate partner violence, reported by one in five mothers in this study, on average doubles the avoidance of breastfeeding.
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