Violence against women : impact on reproductive health and pregnancy outcome

Schoeman, Jeanne (2003-03)

Thesis (MSc)--Stellenbosch University, 2003.

Thesis

ENGLISH ABSTRACT: Introduction Worldwide, up to 25% of women are assaulted during pregnancy, with estimates varying between populations. Violence has been associated with adverse pregnancy outcome, including preterm birth, abruptio placentae and low birth weight. Among the Coloured population of the Western Cape the incidence of spontaneous preterm birth is 20%, compared to the global figure of 10%. Overall, the rate of preterm labour has not dropped over the past 40 years and no clearer answer as to a specific cause has been found. The objective of this study was to determine whether patients who deliver preterm experience more domestic violence than those who deliver at term. Methods Two groups of patients were assessed. Firstly, patients who spontaneously delivered between 24 and 33 weeks (24wOd - 33w6d), who were admitted for suppression of active labour after 24 weeks, or who experienced placental abruption before 34 weeks, were screened for domestic violence using the "Abuse Assessment Screen". A second group of women, attending a local Midwife Obstetric Unit with uncomplicated pregnancies, completed the same questionnaire. The questionnaires were all administered by the same person (J.S.) after written informed consent was given. Results A total of 229 patients were interviewed, 99 in the low risk (LR) and 130 in the preterm labour (PTL) group, which included 23 women with abruptio placentae. The PTL group experienced significantly more violence throughout their lives than the LR group (59.7% vs. 40.4%, p = 0.038). Experiences of violence within the last year or during the pregnancy did not reach statistical significance between the two groups, although the numbers were higher for the PTL group. The PTL group smoked significantly more cigarettes per day (p = 0.009), used more alcohol (p < 0.001) and had a higher incidence of syphilis than the LR group (p = 0.005). These differences remained the same when the abruptio's were analyzed as a separate group. Conclusions: Women who delivered preterm did experience more violence at some point in their lives and were also more likely to engage in high-risk behaviour. Violence alone does not seem to cause PTL directly, but is part of a low socioeconomic lifestyle. The fact that the alcohol use is so high among these women is a problem that needs to be addressed, but once again, it is possibly the result of deeper social problems. The need for education on values and respect, family planning use and low risk sexual behaviour is once again challenged.

AFRIKAANSE OPSOMMING: GEWELD TEEN VROUE -IMPAK OP REPRODUKTIEWE GESONDHEID EN UITKOMS VAN SWANGERSKAP Inleiding Daar word beraam dat tot 25% van alle swanger vroue aangerand word, maar die insidensie wissel tussen verskillende populasies. Ervarings van geweld kan 'n direkte of indirekte oorsaak wees van swak verloskundige uitkoms wat voortydse kraam, abruptio placentae en lae geboortegewig insluit. In die Wes- Kaap, onder die Kleurlingbevolking, is die insidensie van voortydse kraam 20%, wat swak vergelyk met die wêreldwye insidensie van 10%. Gedurende die laaste 40 jaar het die voorkoms van voortydse kraam nie verminder nie en geen deurbrake is gemaak t.o.v die oorsaak van die probleem nie. Die doel van hierdie studie was om te bepaal of vroue wat prematuur verlos moontlik meer geweld ervaar as vroue wat op normale swangerskapsduur verlos. Metodes Twee groepe vroue is bestudeer. Die eerste groep het vroue ingesluit wat spontaan verlos het tussen 24 en 33 weke (24wOd - 33w6d) of vroue wat na 24 weke swangerskapsduur toegelaat is vir onderdrukking van kraam. Vroue met plasentale loslating (abruptio placentae) voor 34 weke, sonder onderliggende hipertensiewe toestande, was ook ingesluit in die groep. Daar is m.b.v. 'n vraelys ("Abuse Assessment Screen") bepaal watter van die vroue gesinsgeweld ervaar het. Die tweede groep het vroue ingesluit met ongekompliseerde swangerskappe en wat by 'n nabygeleë kliniek voorgeboortesorg ontvang het. Hulle is ook gevra om die vraelys te voltooi en is opgevolg om die uitkoms van hulle swangerskappe te noteer. Die vraelyste is almal deur een persoon (J.S.) aan die vroue voorgelê nadat hulle ingeligte, skriftelike toestemming gegee het. Resultate 'n Totaal van 229 vroue was ingesluit, 99 in die lae risiko (LR) groep en 130 in die voortydse kraam (VK) groep, waarvan 23 abruptio placentae gehad het. In vergelyking met die LR groep, het die VK groep het betekenisvol meer geweld in hulle leeftyd ervaar (59.7% teenoor 40.4%, p = 0.038). Geweld wat tydens die afgelope jaar of tydens die swangerskap ervaar is, het nie betekenisvol verskil tussen die twee groepe nie, alhoewel die getalle hoër was vir die VK groep. Die VK groep het betekenisvol meer sigarette per dag gerook (p = 0.009), meer alkohol gebruik (p < 0.001) en het 'n hoër insidensie van sifilis gehad as die LR groep (p = 0.005). Hierdie verskille was steeds beduidend nadat dié met abruptio placentae as 'n aparte groep geanaliseer is. Gevolgtrekking Die vroue wat prematuur verlos het, het meer emosionele en fisiese geweld in hulle leeftyd ervaar en is meer geneig om 'n ongesonde leefstyl te handhaaf. Geweld blyk nie 'n direkte oorsaak van voortydse kraam te wees nie, maar gaan gepaard met 'n lae sosio-ekonomiese lewensstyl. Die hoë insidensie van alkoholgebruik onder swanger vroue is 'n probleem wat aangespreek moet word, maar dit is waarskynlik die manifestasie van dieper emosionele probleme. Opvoeding in terme van waardes en respek, gesinsbeplanning en veilige seksuele gedrag is gevolglik 'n noodsaaklikheid.

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