1. Pregnant individuals in Zimbabwe exposed to intimate partner violence during pregnancy were at increased risk of preterm birth
Evidence Rating Level: 2 (Good)
Preterm birth is becoming growingly prevalent in sub-Saharan Africa, contributing substantially to their infant mortality rate. Complications, such as sepsis, infections and cerebral palsy, have been associated with preterm birth. Thus, further investigation is required to study etiological risk factors associated with preterm birth. Particularly, the issue of intimate partner violence (IPV) has been found to be the most prevalent form of gender-based violence during and/or before pregnancy. IPV may have physical, psychological, or sexual effects on the mother, leading to possible adverse health effects for the fetus. Despite maternal and child mortality rates being high in sub-Saharan Africa, the association between IPV and preterm birth in this region has never been investigated. As such, this study estimated the effects of IPV during pregnancy on preterm birth using the 2015 Zimbabwe Demographic and Health Survey. The study included pregnant women (n=4833), aged 15 to 49 years, who gave birth 5 years prior to the survey. Preterm birth, being the outcome measure under evaluation, was defined as babies born alive before week 37 of gestation. On the other hand, IPV was measured using a series of questions about whether the women were exposed to any physical, sexual or emotional forms of violence. The statistical analysis used for this study included a propensity score analysis, estimated using logistic regression modeling. The analysis allowed for the comparison between those who did and did not report experiencing IPV, and the respective risk associated with each group. Conclusively, over 21% of the cohort reported experiencing IPV during pregnancy. Of the women who did and did not experience IPV, 8.9% and 3.0% delivered preterm, respectively. Additionally, a risk factor associated with IPV included women residing in urban areas, leading to a five-fold increased risk of preterm birth. A limitation of this study was the reliance upon self reporting which may be subject to recall bias. Furthermore, as IPV is a sensitive topic, many women may not have felt comfortable or safe disclosing information regarding their domestic situation. However, the study did have many strengths including its comprehensive propensity score analyses which accounted for baseline characteristics of participants as well as risk stratification for preterm subgroups. Overall, this study highlights the importance of identifying risk factors, such as low economic status, unemployment, and living in an urban area, which can lead to higher likelihood of IPV. Furthermore, it highlights the gravity of the situation and the need to prevent IPV not only for the women’s health and safety, but that of their children. Safety resources, health policies and education are required to remove individuals from harm, especially in their own homes.
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