A study of more than 2,500 pregnant women in Africa has shown that those who experience violence from their partners are 50% more likely to lose their baby in at least one pregnancy. The study findings support the idea of prenatal screening for spousal violence in Africa, the region with the highest levels of fetal loss in the world. These are the conclusions of an Article published in this week's edition of The Lancet, written by Dr Amina Alio, Department of Community and Family Health, University of South Florida, Tampa, Florida, USA, and colleagues.
The authors analysed data from the Cameroon Demographic Health Survey. In the violence module of this survey, women were questioned about their experience of physical, emotional, and sexual violence inflicted by their spouses. Respondents were also asked about any stillbirths and spontaneous abortions. From detailed questions, violence was categorised into subtypes: (1) physical violence, including instances of pushing or shoving, throwing objects, slapping, arm twisting, punching, hitting with an object, kicking, dragging, attempting to strangle or burn, threatening with a weapon, and attacking with a weapon; (2) emotional violence, referring to verbal or physical public humiliation and verbal threat to the woman or her family; and (3) sexual violence, incorporating being forced to have sex or to undertake sexual acts. The authors included all women who responded to the violence module questions by referring to their "husband" or "spouse".
Of the 2562 women who responded to the violence module, those exposed to spousal violence (1307) were 50% more likely to experience at least one episode of fetal loss compared with women not exposed to abuse. Repeated fetal loss was associated with all forms of spousal violence, but emotional violence had the strongest association. If the prevalence of spousal abuse could be reduced to 50%, 25%, or eliminated completely, preventable excess recurrent fetal loss would be 17%, 25%, and 33% respectively.
The authors conclude: "Spousal violence increases the likelihood of single and repeated fetal loss. A large proportion of risk for recurrent fetal mortality is attributable to spousal violence and, therefore, is potentially preventable. Our findings support the idea of routine prenatal screening for spousal violence in the African setting, a region with the highest rate of fetal death in the world."
In an accompanying Comment, Dr Claudia Garcia-Moreno, Department of Reproductive Health and Research, WHO, Geneva, Switzerland, says: "More support is needed for education and information for health-care providers and the integration of intimate-partner violence and sexual violence into existing initiatives for maternal, infant, and child health. There is also a major need for more research on primary prevention interventions. "The focus on fetal outcomes should not detract from the impact of violence on women's health and lives. Violence against women is a violation of their human rights."
Dr Amina Alio, Department of Community and Family Health, University of South Florida, Tampa, Florida, USA T) +1 813-974-9654 E) aalio@health.usf.edu
Dr Claudia Garcia-Moreno, Department of Reproductive Health and Research, WHO, Geneva, Switzerland T) +41 22 791 4353 / +41 79 509 0650 E) garciamorenoc@who.int
For full Article and Comment: http://press.thelancet.com/spousalviolencefinal.pdf
Journal
The Lancet