Domestic Violence Impact on Maternal and Child Health Outcomes

Introduction

Domestic violence (DV) is a pervasive issue that has far-reaching consequences, particularly for pregnant women and their children. In India, where maternal and child health outcomes lag behind global standards, understanding the impact of DV is crucial. This comprehensive article aims to explore the effects of DV on the health and well-being of mothers and their children in rural India, while also examining the barriers that prevent survivors from accessing essential healthcare services.

The Impact of Domestic Violence on Maternal Health

Domestic violence during pregnancy can have severe consequences for the physical and mental health of mothers. Qualitative interviews with DV survivors in rural India revealed a wide range of adverse health outcomes, including:

• Poor physical health: Survivors described suffering from various injuries, such as swollen and bruised faces, burns from hot objects, open wounds, and vaginal tears due to marital rape.
• Miscarriages and unwanted pregnancies: The physical abuse experienced during pregnancy often led to miscarriages and forced childbearing, as abusive partners sometimes preferred to have a male child.
• Mental health issues: Psychological abuse, including threats and controlling behaviors, contributed to depression, suicidal ideation, and self-harm among the pregnant women.

One survivor from the state of Uttar Pradesh shared her harrowing experience: “My husband would often beat me, leading to severe bleeding and miscarriage. He wanted a son, and when I gave birth to a girl, he became even more abusive.”

The impact of DV on maternal mental health is particularly concerning, as studies have found strong associations between DV during pregnancy and antenatal depression, as well as postpartum depression. A prospective cohort study in Vietnam revealed that physical and sexual IPV during pregnancy were significantly linked to higher odds of postpartum depression, even after adjusting for confounding factors.

The Toll on Child Health and Development

Domestic violence during pregnancy can also have far-reaching consequences for the health and well-being of children. The qualitative interviews conducted in rural India highlighted several ways in which DV affects child outcomes:

• Lack of care and neglect: Survivors reported that their abusive partners often prevented them from seeking healthcare for their children or caring for them properly, leading to neglect and suboptimal child development.
• Abuse and maltreatment: Some children were directly subjected to physical or emotional abuse by their fathers, further exacerbating the trauma.

The quantitative evidence from LMICs corroborates these findings. A prospective cohort study in Vietnam found that physical IPV during pregnancy was significantly associated with a higher risk of preterm birth and low birth weight, while recurrent physical, emotional, or sexual violence during pregnancy increased the likelihood of inadequate breastfeeding in the first year of life.

Furthermore, a study from China revealed that children of mothers exposed to domestic violence during pregnancy exhibited poorer behavioral development, including weaker rhythmicity, more negative mood, withdrawn behavior, and poorer motor skills at 10 months of age. This suggests that the adverse impact of DV during pregnancy can have lasting effects on a child’s development.

The Role of Social Support

Social support is a crucial factor in mitigating the negative consequences of DV during pregnancy. Studies from LMICs have found that a lack of support from partners, family, or the broader community can significantly increase the odds of experiencing DV during this vulnerable time.

Conversely, higher levels of social support have been shown to reduce the mental health impact of DV. In Malaysia, for example, moderate to high levels of social support were associated with lower odds of antenatal depression among women experiencing DV. Similarly, in Mexico, family support was found to buffer the association between DV and antenatal anxiety and depression.

However, the qualitative research in rural India reveals a more nuanced picture. In some communities, where patriarchal attitudes prevail, women’s social networks may actually encourage them to remain in abusive relationships, often for the sake of their children. As one survivor explained, “My family asked me to stay in the marriage for the sake of the children, even though my husband was very violent.”

The Impact of the COVID-19 Pandemic

The COVID-19 pandemic has had a significant impact on the lives of pregnant women and their access to support systems. Studies conducted in the first year of the pandemic in LMICs, such as Iran and Ethiopia, have reported a concerning rise in the prevalence of DV during pregnancy, with one study in Iran finding that around 35% of pregnant women experienced domestic violence.

The pandemic has also exacerbated the mental health consequences of DV during pregnancy. A study from South Africa found that psychological and sexual IPV during the pandemic were associated with higher odds of common mental disorders, such as depression and anxiety, among pregnant women.

Interestingly, one study from Jordan bucked the trend, reporting a lower prevalence of DV during pregnancy during the pandemic compared to the pre-pandemic period. However, this finding may be influenced by factors such as the method of data collection (an online survey) or the specific context of the study location.

The disruption to social support systems and access to healthcare services caused by the pandemic has undoubtedly made it more challenging for pregnant women experiencing DV to seek help and receive the support they need. As the pandemic continues to evolve, it is crucial that further research is conducted to understand the long-term implications of COVID-19 on DV and maternal-child health outcomes in rural India.

Barriers to Healthcare Access and Utilization

The qualitative research in rural India has highlighted several barriers that prevent pregnant women experiencing DV from accessing and utilizing essential healthcare services:

1. Restricted access to care: Abusive partners or in-laws often actively prevented women from seeking medical attention, either by forbidding them from leaving the home or by accompanying them to appointments.

2. Financial constraints: The economic dependence of many women on their abusive partners, coupled with the high costs of healthcare, made it difficult for them to access the care they needed.

3. Stigma and lack of support: The social stigma surrounding DV and the lack of a supportive network often discouraged women from seeking help, even when they recognized the need for it.

As one survivor from Uttar Pradesh shared, “My husband would not let me go to the doctor for my checkups. He would accompany me and not allow me to speak to the doctor about the abuse.”

Recommendations and Conclusion

To address the pressing issue of DV and its impact on maternal and child health in rural India, a multifaceted approach is required. Key recommendations include:

1. Increased education and awareness: Campaigns to educate the public, particularly in rural areas, about the far-reaching consequences of DV as a social determinant of maternal and child health.

2. Universal screening and intervention programs: Implementing routine DV screening during pregnancy and postpartum, accompanied by tailored support services to address the unique needs of survivors.

3. Strengthening the healthcare system: Ensuring that healthcare providers in rural areas are equipped with the knowledge and resources to identify, support, and refer DV survivors to appropriate services.

4. Addressing social and cultural norms: Challenging the deep-rooted patriarchal attitudes and gender-based biases that enable and perpetuate DV, particularly in the context of pregnancy and childbirth.

By taking these steps, we can work towards creating a safer and more supportive environment for pregnant women and their children in rural India, ultimately improving maternal and child health outcomes. As the Stanley Park High School community, we have a responsibility to be at the forefront of this crucial issue, advocating for change and providing resources to empower and support our students and their families.