1. Prevalence of intimate partner violence and emotional abuse during pregnancy and postpartum period in an urban public sector clinic in Durban, South Africa
L. Butler1,2, T Crankshaw3, A Gibbs3, N. Mosery4, F Luthuli4, B. Zulu4, J. Smith4, and M. Tomlinson5
1 Boston Children’s Hospital, Department of Medicine, Division of General Pediatrics, 2 Harvard Medical School, Department of Pediatrics, 3 Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal,
4 Maternal, Adolescent, and Child Health Research (MatCH), University of the Witwatersrand, 5 University of Stellenbosch, Department of Psychology
Background
Results
Intimate partner violence (IPV) is one of the most common forms of violence against women worldwide (WHO, 2013; WHO, UNDOC, & UNDP, 2014) and this negatively impacts women and indirectly their children health and development (WHO, 2013).
South Africa has high rates of IPV (Jewkes, Sikweyiya, Morrell, & Dunkle, 2011). However, little is known about the prevalence of IPV amongst pregnant women and new mothers.
Participant Characteristics
Factors Associated with IPV Experience
A total of 318 eligible women were recruited for inclusion in the study of whom 275 were enrolled. Characteristics of participants are shown in Table 1.
Recent experience of IPV was associated with increased depression symptoms, level of disability, and reduced relationship power (Table 3). There was no statistically significant association between experience of IPV in the prior 12 months and maternal age, education, socioeconomic status, food insecurity, or HIV infection status.
Table 1. Participant Characteristics (N=275)
Characteristic
N (%)
Race
Black
271 (98.6)
Indian
3 (1.1)
Mixed Race
1 (0.36)
Age (years), Median, Interquartile Range (IQR)
26.0 (22-30)
Age of infant (weeks), Median, IQR
3.3 ( )
Education
None
At least some primary (Grades 1-7)
33 (12.0)
At least some secondary (Grades 8-11)
117 (42.6)
Matriculated (Grade 12)
116 (42.2)
Post-School
8 (2.9)
Socioeconomic status (asset index)
<25%
72 (26.2)
25-50%
163 (59.3)
50-75%
36 (13.1)
>75%
4 (1.5)
Currently have boyfriend or partner
244 (88.7)
Currently married or living together as if married
70 (28.7)
Pregnancy – unplanned
234 (85.1%)
HIV status (self reported)
Positive
107 (38.9)
Negative
158 (57.5)
Refused to answer
10 (3.6)
Depression (PHQ-9)
Minimal or no depression (score 0 – 4)
137 (57.1)
Mild depression (5 – 9)
77 (32.1)
Moderate depression (10 – 14)
18 (7.5)
Moderate severe depression (15 – 19)
6 (2.5)
Severe depression (20-27)
2 (0.83)
Disability (WHO-DAS), Median, IQR
1 (0.0 – 5.0)
Food Insecurity, Median, IQR
13.0 ( )
Relationship Power
3.0 ( )
Objective
Table 3. Factors Associated With Recent IPV Experience
Variable
Odds Ratio
95% Confidence Interval
P-Value
Age
0.99
0.78
Education
0.80
0.39
Socioeconomic Status
0.98
0.08
Food Insecurity
1.03
0.50
HIV positive Status
0.86
0.71
Depression (higher = greater symptoms)
1.1
0.0009
Disability (larger = higher levels disability)
Relationship Power (lower = less power)
0.76
<0.0001
We sought to assess prevalence of physical and sexual IPV amongst new mothers presenting for post-natal care at a public sector clinic in Durban, South Africa.
Methods
Study Design
Cross-sectional study design
Participants
Women >18 years old presenting with their biological infant <6weeks old for well-child care (i.e., immunization, growth monitoring) at a public sector clinic in Durban, South Africa between DATE and DATE.
Conclusions
Procedures
IPV in this population is significant, both in terms of ever and recent experiences of IPV.
As with other studies of IPV during pregnancy and in general populations (Groves, McNaughton-Reyes, Foshee, Moodley, & Maman, 2014; Jewkes, Dunkle, Nduna, & Shai, 2010), we found that women’s greater power in relationships was protective of IPV.
The study suggests IPV prevention interventions need to focus on transforming gender relationships and strengthening livelihoods – approaches not typically focused on during pregnancy (Gibbs, Willan, Misselhorn, & Mangoma, 2012). Moreover, it highlights the potential impact of IPV on women’s ability to provide adequate care for babies, with associations between recent IPV, disability and depression. Integrating IPV prevention interventions with childcare interventions may be a productive approach.
A structured interview was administered in isiZulu by a female research assistant. Data were entered on Android electronic tablets (hand-held computers) using “ODK”, a computer-assisted personal interviewing software. Procedures to promote data quality included skip patterns and range and logical checks built into the ODK Collect entry program
Measures
Sociodemographics: age, education, race/ethnicity, infant age
Socioeconomic Status: Based on ownership index of 15 household assets
HIV Status: Women were asked if and when they last tested for HIV and their HIV serostatus if tested.
Intimate Partner Violence: Prior and recent (past 12 months) experience of emotional, physical and/or sexual abuse using a modified WHO violence against women scale
Relationship Power: Sexual Relationship Power Scale (SRPS), which conceptualizes sexual relationship power as a multi-dimensional construct consisting of relationship control and decision making dominance.
Disability – The WHO DAS 2.0 was used. The WHO DAS 2.0 produces domain-specific scores for six different functioning domains – cognition (understanding and communicating), mobility (moving and getting around), self-care (hygiene, dressing, eating and staying along), getting along(interacting with other people), life activities (household and work/school) and participation (joining in community activities).
Food insecurity: was measured using the Household Food Insecurity Access Scale (HFIAS)
Depression: Patient Health Questionnaire 9 (PHQ9), validated in isiZulu, was used to identify women at risk for depression and anxiety disorder
References
Campbell, C., & Gibbs, A. (2010). Poverty, AIDS and Gender. In S. Chant (Ed.), International Handbook on Poverty and Gender. Cheltenam: Edward Elgar.
Gibbs, A., Willan, S., Misselhorn, A., & Mangoma, J. (2012). Combined structural interventions for gender equality and livelihood security: a critical review of the evidence from southern and eastern Africa and the implications for young people. Journal of the International AIDS Society, 15(Supp. 1),
Groves, A. K., McNaughton-Reyes, H. L., Foshee, V. A., Moodley, D., & Maman, S. (2014). Relationship Factors and Trajectories of Intimate Partner Violence among South African Women during Pregnancy and the Postpartum Period.
Jewkes, R., Dunkle, K., Nduna, M., & Shai, N. (2010). Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study. Lancet, 376(9734), doi:Doi /S (10)60548-X
Jewkes, R., Sikweyiya, Y., Morrell, R., & Dunkle, K. (2011). Gender inequitable masculinity and sexual entitlement in rape perpetration South Africa: findings of a cross-sectional study. Plos One, 6(12), e29590.
WHO. (2013). Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence.
WHO, UNDOC, & UNDP. (2014). Global Status Report on Violence Prevention  
Experience of IPV
The majority of women reported having experienced some form of IPV at some point in their lifetime (Table 2). Approximately 10% reported having experienced sexual and/or physical IPV in the past 12 months (i.e., during pregnancy or after delivery).
Table 2. Experience of IPV (N=275)
Lifetime Prevalence of IPV
N (%)
Emotional Abuse
155 (56.4%)
Physical Abuse
73 (26.6%)
Sexual Abuse
14 (5.1%)
Prevalence of Sexual and/or Physical IPV in Past 12 Months
29 (10.6%)
Data Analysis
Analyses were done in SAS 9.3
Given the small sample size only univariate logistic regression reporting odds ratios were calculated.
Ethical Approvals
Funding
Ethics approvals were obtained from:
MatCH, University of Witwatersrand, Human Research Ethics Committee (HREC) at the University of the Witwatersrand
University of KwaZulu-Natal Biomedical Research Ethics Committee (BREC)
Boston Children’s Hospital Research Ethics Committee
This study was funded by the Swedish International Development Agency (SIDA) and Norad.
Contact
Dr. Lisa M. Butler:
Dr. Tamaryn Crankshaw: