The magnitude of intimate partner violence during pregnancy in Eldoret, Kenya: exigency for policy action

Abstract

Intimate partner violence (IPV) is sexual, psychological and physical coercive acts used against persons by intimate partners. When IPV occurs during pregnancy (IPVp), it can result in adverse maternal and pregnancy outcomes. No policy nor practice direction exists to address the rates and risk factors of IPVp in Kenya. Determining the prevalence, types and determinants of IPVp in Western Kenya would aid in the identification of pregnant women affected by and/or at risk of IPVp, as well as informing the development of policy, practices and programmes to support preventive interventions. In this cross-sectional study of 369 women who had given birth at Moi Teaching and Referral Hospital, participants were recruited using systematic sampling and data collected via structured questionnaires adopted from the WHO Violence Against Women Instrument. Associations were made in relation to physical or sexual violence and psychological violence. Logistic regression was used to assess the association between determinants and occurrence of IPVp. The overall prevalence of IPVp was 34.1%. Prevalence of physical or sexual violence was 22.8%. Psychological violence emerged as the most common (27.4%) form of IPVp. A lower than tertiary level of education and previous experience of IPV were individually associated with physical/sexual IPVp, whereas psychological IPVp was associated with previous experience of IPV and was prevented by the intimate partner having formal employment. Preterm birth rates were found to be higher than the country’s rates. The prevalence rates of IPVp are high in Western Kenya. Strategies that address the promotion of respectful, nonviolent relationships and that interrupt the development of risk factors are required. Policies (clinical guidelines) targeting prevention of IPVp and screening and the identification of at-risk women and survivors of IPVp are needed urgently. Primary prevention through interrupting the occurrence of predisposing factors is key in addressing IPVp.

Intimate partner violence among pregnant women in Kenya: forms, perpetrators and associations

“…We revealed that almost one in ten women (9.2%) have experienced violence during pregnancy in Kenya. Although this rate is high, it is lower compared to prevalence rates of 28–67% reported in different health facility based studies in Kenya [ 3 , 20 – 22 , 24 ]. Clinic-based studies generally show a higher number of women reporting violence vis-à-vis population-based ones [ 3 ].…”

“…We ascertained that more than two thirds (67.8%) of pregnant women have experienced emotional violence - which is consistent with previous research findings in health facility based studies in Kenya (55.8%) [ 21 ]. Likewise, we found higher rates of psychological violence than in two Kenyan health facility based studies in Kisumu (29%) and Uasin Gishu County (27.4%) [ 20 , 22 ]. This high rate of emotional violence is alarming, as this form of violence is associated with postnatal depression, anxiety, and other adverse mental health problems [ 6 , 48 ] - which can limit a woman’s ability to care for herself and for her child [ 22 ].…”

“…This high rate of emotional violence is alarming, as this form of violence is associated with postnatal depression, anxiety, and other adverse mental health problems [ 6 , 48 ] - which can limit a woman’s ability to care for herself and for her child [ 22 ]. Furthermore, psychological violence is very subtle and it can be hard for survivors to prove it [ 22 ].…”

“…In Kenya, the prevalence of IPV during pregnancy ranges from 34 to 67% across different health facilities, which is the highest among the available data from Africa [ 20 – 22 ]. Some health facility-based studies in Kenya revealed that 27–56% of women reported experiencing physical violence, between 10 and 30% were exposed to psychological violence, and 12–39% were subjected to sexual violence [ 20 – 22 ].…”

“…In the broader Kenyan community, IPV is accepted and socialised as a normal and timeless tradition, thus, its practice is legitimised [ 15 , 20 , 23 ]. Moreover, most studies about IPV among pregnant women in Kenya were conducted in healthcare facilities [ 3 , 20 – 22 , 24 ], whereas research with population-based and nationally representative data is scarce. This can be particularly problematic due to the fact that pregnant women who are not able to access healthcare are often underrepresented in IPV studies [ 20 ].…”