Intimate partner violence, forced first sex and adverse pregnancy outcomes in a sample of Zimbabwean women accessing maternal and child health care

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Background:
Intimate partner violence (IPV) remains a serious problem with a wide range of health consequences including poor maternal and newborn health outcomes. We assessed the relationship between IPV, forced first sex (FFS) and maternal and newborn health outcomes.
Methods:
A cross sectional study was conducted with 2042 women aged 15–49 years attending postnatal care at six clinics in Harare, Zimbabwe, 2011. Women were interviewed on IPV while maternal and newborn health data were abstracted from clinic records. We conducted logistic regression models to assess the relationship between forced first sex (FFS), IPV (lifetime, in the last 12 months and during pregnancy) and maternal and newborn health outcomes.
Results:
Of the recent pregnancies 27.6% were not planned, 50.9% booked (registered for antenatal care) late and 5.6% never booked. A history of miscarriage was reported by 11.5%, and newborn death by 9.4% of the 2042 women while 8.6% of recent livebirths were low birth weight (LBW) babies. High prevalence of emotional (63,9%, 40.3%, 43.8%), physical (37.3%, 21.3%, 15.8%) and sexual (51.7%, 35.6%, 38.8%) IPV ever, 12 months before and during
pregnancy were reported respectively. 15.7% reported forced first sex (FFS). Each form of lifetime IPV (emotional, physical, sexual, physical/sexual) was associated with a history of miscarrying (aOR ranges: 1.26 –1.38), newborn death (aOR ranges: 1.13 –2.05), and any negative maternal and newborn health outcome in their lifetime (aOR ranges: 1.32–1.55). FFS was associated with a history of a negative outcome (newborn death, miscarriage, stillbirth)(aOR1.45 95%CI: 1.06 – 1.98). IPV in the last 12 months before pregnancy was associated with unplanned pregnancy (aOR ranges 1.31–2.02) and booking late for antenatal care. Sexual IPV (aOR 2.09 CI1.31–3.34) and sexual/physical IPV (aOR2.13, 95%CI: 1.32 – 3.42) were associated with never booking for antenatal care. Only emotional IPV during pregnancy was associated with low birth weight (aOR1.78 95%CI1.26 – 2.52) in the recent pregnancy and any recent pregnancy negative outcomes including LBW, premature baby, emergency caesarean section (aOR1.38,95%CI:1.03 – 1.83).
Conclusions:
Forced first sex (FFS) and intimate partner violence (IPV) are associated with adverse maternal and newborn health outcomes. Strengthening primar y and secondary violence prevention is required to improve pregnancy-related outcomes.
Keywords:
Intimate partner violence, Forced first sex, Maternal and newborn health outcomes, Zimbabwe

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Authors & affiliation: 
Simukai Shamu, Stephen Munjanja, Christina Zarowsky, Patience Shamu, Marleen Temmerman and Naeemah Abrahams 1 Foundation for Professional Development, 173 Mary Road, The Willows, Pretoria 0184, South Africa. 2 School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. 3 Department of Obstetrics and Gynaecology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe. 4 University of Montreal Hospital Research Centre, Montreal, QC, Canada. 5 School of Public Health, University of the Western Cape, Bellville 7535, South Africa. 6 Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa. 7 International Centre for Reproductive Health, Ghent University, 9000 Ghent, Belgium. 8 Gender and Health Research Unit, Medical Research Council, Cape Town, South Africa.
Ranking: 
Published In: 
Shamu et al. BMC Public Health (2018) 18:595
Publication date: 
Thursday, May 3, 2018