Maternal morbidity associated with violence and maltreatment from husbands and in-laws: findings from Indian slum communities.
BACKGROUND
Intimate partner violence (IPV) victimization is linked to a broad range of negative maternal health outcomes. However, it is unclear whether IPV is directly related to poor maternal outcomes or whether IPV is a marker for other forms of chronic, mundane maltreatment of women that stem from the culture of gender inequity that also gives rise to IPV. To determine the prevalence of non-violent forms of gender-based household maltreatment by husbands and in-laws (GBHM), and violence from in-laws (ILV) and husbands (IPV) against women during the peripregnancy period (during and in the year prior to pregnancy); to assess relative associations of GBHM, ILV and IPV with maternal health.


METHODS
Cross-sectional data were collected from women <6 months postpartum (n = 1,039, ages 15-35 years) seeking child immunization in Mumbai, India. Associations of IPV, ILV and GBHM during the peripregnancy period with maternal health (prenatal care in first trimester, no weight gain, pain during intercourse, high blood pressure, vaginal bleeding, premature rupture of membranes, premature birth) were evaluated.


RESULTS
One in three women (34.0 %) reported IPV, 4.8 % reported ILV, and 48.5 % reported GBHM during the peripregnancy period. After adjusting for other forms of abuse, IPV related to pain during intercourse (AOR = 1.79); ILV related to not receiving first trimester antenatal care (AOR = 0.49), and GBHM remained associated with premature rupture of membranes (AOR = 2.28), pain during intercourse (AOR = 1.60), and vaginal bleeding (AOR = 1.80).


CONCLUSIONS
After adjusting for ILV and IPV, peripregnancy GBHM remained significantly associated with multiple forms of maternal morbidity, suggesting that GBHM is a prevalent and reliable indicator of maternal health risk.
Division of Global Public Health, Department of Medicine, Center on Gender Equity and Health, University of California, San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA. jgsilverman@ucsd.edu.
Jay G
JG
Silverman
National Institute for Research on Reproductive Health, Indian Council on Medical Research, Mumbai, India.
Donta
D
Balaiah
Division of Global Public Health, Department of Medicine, Center on Gender Equity and Health, University of California, San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA.
Julie
J
Ritter
Division of Global Public Health, Department of Medicine, Center on Gender Equity and Health, University of California, San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA.
Anindita
A
Dasgupta
Division of Global Public Health, Department of Medicine, Center on Gender Equity and Health, University of California, San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA.
Sabrina C
SC
Boyce
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Michele R
MR
Decker
National Institute for Research on Reproductive Health, Indian Council on Medical Research, Mumbai, India.
D D
DD
Naik
National Institute for Research on Reproductive Health, Indian Council on Medical Research, Mumbai, India.
Saritha
S
Nair
Population Council, New Delhi, India.
Niranjan
N
Saggurti
Division of Global Public Health, Department of Medicine, Center on Gender Equity and Health, University of California, San Diego School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA.
Anita
A
Raj
D000293:Adolescent; D000328:Adult; D002648:Child; D003430:Cross-Sectional Studies; D017579:Domestic Violence / Q000523:psychology / Q000706:statistics & numerical data*; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D007194:India; D009017:Morbidity; D011204:Poverty Areas; D011247:Pregnancy; D011256:Pregnancy Outcome; D012307:Risk Factors; D013179:Spouse Abuse / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D055815:Young Adult
Gender-based household maltreatment; In-law violence; Intimate partner violence; Maternal health; Maternal morbidity