title: Effects of Socioeconomic Status and Social Support on Violence against Pregnant Women: A Structural Equation Modeling Analysis.
abstract: Few studies have used structural equation modeling to analyze the effects of variables on violence against women. The present study analyzed the effects of socioeconomic status and social support on violence against pregnant women who used prenatal services. This was a cross-sectional study based on data from the Brazilian Ribeirão Preto and São Luís birth cohort studies (BRISA). The sample of the municipality of São Luís (Maranhão/Brazil) consisted of 1,446 pregnant women interviewed in 2010 and 2011. In the proposed model, socioeconomic status was the most distal predictor, followed by social support that determined general violence, psychological violence or physical/sexual violence, which were analyzed as latent variables. Violence was measured by the World Health Organization Violence against Women (WHO VAW) instrument. The São Luis model was estimated using structural equation modeling and validated with 1,378 pregnant women from Ribeirão Preto (São Paulo/Brazil). The proposed model showed good fit for general, psychological and physical/sexual violence for the São Luís sample. Socioeconomic status had no effect on general or psychological violence (p>0.05), but pregnant women with lower socioeconomic status reported more episodes of physical/sexual violence (standardized coefficient, SC = -0.136; p = 0.021). This effect of socioeconomic status was indirect and mediated by low social support (SC = -0.075; p<0.001). Low social support was associated with more episodes of general, psychological and physical/sexual violence (p<0.001). General and psychological violence indistinctly affected pregnant women of different socioeconomic status. Physical/sexual violence was more common for pregnant women with lower socioeconomic status and lower social support. Better social support contributed to reduction of all types of violence. Results were nearly the same for the validation sample of Ribeirão Preto except that SES was not associated with physical/sexual violence.
authors.affiliation: Department of Medicine III, Federal University of Maranhao, Sao Luis, Maranhao, Brazil.
authors.forename: Marizélia Rodrigues Costa
authors.initials: MR
authors.lastname: Ribeiro
authors.affiliation: Department of Public Health, Federal University of Maranhao, Sao Luis, Maranhao, Brazil.
authors.forename: Antônio Augusto Moura da
authors.initials: AA
authors.lastname: Silva
authors.affiliation: Department of Public Health, Federal University of Maranhao, Sao Luis, Maranhao, Brazil.
authors.forename: Maria Teresa Seabra Soares de Britto E
authors.initials: MT
authors.lastname: Alves
authors.affiliation: Department of Public Health, Federal University of Maranhao, Sao Luis, Maranhao, Brazil.
authors.forename: Rosângela Fernandes Lucena
authors.initials: RF
authors.lastname: Batista
authors.affiliation: Department of Odontology, Federal University of Maranhao, Sao Luis, Maranhao, Brazil.
authors.forename: Cecília Cláudia Costa
authors.initials: CC
authors.lastname: Ribeiro
authors.affiliation: Department of Preventive Medicine, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil.
authors.forename: Lilia Blima
authors.initials: LB
authors.lastname: Schraiber
authors.affiliation: Department of Pediatrics, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil.
authors.forename: Heloisa
authors.initials: H
authors.lastname: Bettiol
authors.affiliation: Department of Pediatrics, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil.
authors.forename: Marco Antônio
authors.initials: MA
authors.lastname: Barbieri
mesh_terms: D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D017579:Domestic Violence / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007182:Income; D015233:Models, Statistical; D011247:Pregnancy; D012307:Risk Factors; D012742:Sex Offenses / Q000706:statistics & numerical data; D012944:Social Support; D012959:Socioeconomic Factors