Violence against women and the risk of fetal and early childhood growth impairment: a cohort study in rural Bangladesh.

OBJECTIVE: To assess whether different forms of family violence against women were associated with impaired size at birth and early childhood growth. METHODS: A substudy embedded into a community-based food and micronutrient supplementation trial (MINIMat) of pregnant women in rural Bangladesh included a 2-year follow-up of the 3164 live-born children of participating women. Anthropometric data were collected from birth up to 24 months of age, and converted to WHO growth standard SD scores. Size at birth and early childhood growth were assessed in relation to women's exposure to physical, sexual and emotional violence and the level of controlling behaviour in the family. RESULTS: Fifty per cent of all women reported a lifetime experience of some form of family violence. The mean birth weight was 2701 g, 30% were low birth weight (<2500 g), mean birth length was 47.8 cm (17.5%, <or=2 SD) and at 24 months of age 37% were underweight and 50% of the children were stunted. Exposure to any form of violence was negatively associated with weight and length at birth and weight-for-age and height-for-age SD scores at 24 months of age, as well as a change in weight and height SD score from birth to 24 months of age (p<0.05, adjusted for potential confounders). CONCLUSIONS: Violence against women was associated with an increased risk of fetal and early childhood growth impairment, adding to the multitude of confirmed and plausible health consequences caused by this problem

What factors are associated with recent intimate partner violence? findings from the WHO multi-country study on women's health and domestic violence

<p>Abstract</p> <p>Background</p> <p>Intimate partner violence (IPV) against women is a global public health and human rights concern. Despite a growing body of research into risk factors for IPV, methodological differences limit the extent to which comparisons can be made between studies. We used data from ten countries included in the WHO Multi-country Study on Women's Health and Domestic Violence to identify factors that are consistently associated with abuse across sites, in order to inform the design of IPV prevention programs.</p> <p>Methods</p> <p>Standardised population-based household surveys were done between 2000 and 2003. One woman aged 15-49 years was randomly selected from each sampled household. Those who had ever had a male partner were asked about their experiences of physically and sexually violent acts. We performed multivariate logistic regression to identify predictors of physical and/or sexual partner violence within the past 12 months.</p> <p>Results</p> <p>Despite wide variations in the prevalence of IPV, many factors affected IPV risk similarly across sites. Secondary education, high SES, and formal marriage offered protection, while alcohol abuse, cohabitation, young age, attitudes supportive of wife beating, having outside sexual partners, experiencing childhood abuse, growing up with domestic violence, and experiencing or perpetrating other forms of violence in adulthood, increased the risk of IPV. The strength of the association was greatest when both the woman and her partner had the risk factor.</p> <p>Conclusions</p> <p>IPV prevention programs should increase focus on transforming gender norms and attitudes, addressing childhood abuse, and reducing harmful drinking. Development initiatives to improve access to education for girls and boys may also have an important role in violence prevention.</p

Pathways between childhood trauma, intimate partner violence, and harsh parenting : findings from the UN multi-country study on men and violence in Asia and the Pacific

2016-2017 > Academic research: refereed > Publication in refereed journal201804_a bcmaVersion of RecordPublishe

Prevalence and associated factors of depressive and anxiety symptoms during pregnancy: A population based study in rural Bangladesh

<p>Abstract</p> <p>Background</p> <p>Few studies have examined the associated factors of antepartum depressive and anxiety symptoms (ADS and AAS) in low-income countries, yet the World Health Organization identifies depressive disorders as the second leading cause of global disease burden by 2020. There is a paucity of research on mental disorders and their predictors among pregnant women in Bangladesh. This study aims to estimate the prevalence of depressive and anxiety symptoms and explore the associated factors in a cross-section of rural Bangladeshi pregnant women.</p> <p>Methods</p> <p>The study used cross-sectional data originating from a rural community-based prospective cohort study of 720 randomly selected women in their third trimester of pregnancy from a district of Bangladesh. The validated Bangla version of the Edinburgh Postnatal Depression Scale was used to measure ADS, and a trait anxiety inventory to assess general anxiety symptoms. Background information was collected using a structured questionnaire at the respondents' homes.</p> <p>Results</p> <p>Prevalence of ADS was 18% and AAS 29%. Women's literacy (OR 0.59, 95% CI 0.37-0.95), poor partner relationship (OR 2.23, 95% CI 3.37-3.62), forced sex (OR 1.95, 95% CI 1.01-3.75), physical violence by spouse (OR 1.69, 95% CI 1.02-2.80), and previous depression (OR 4.62 95% CI 2.72-7.85) were found to be associated with ADS. The associated factors of AAS were illiteracy, poor household economy, lack of practical support, physical partner violence, violence during pregnancy, and interaction between poor household economy and poor partner relationship.</p> <p>Conclusion</p> <p>Depressive and anxiety symptoms are found to occur commonly during pregnancy in Bangladesh, drawing attention to a need to screen for depression and anxiety during antenatal care. Policies aimed at encouraging practical support during pregnancy, reducing gender-based violence, supporting women with poor partner relationships, and identifying previous depression may ameliorate the potentially harmful consequences of antepartum depression and anxiety for the women and their family, particularly children.</p

Adolescent and adult first time mothers' health seeking practices during pregnancy and early motherhood in Wakiso district, central Uganda

<p>Abstract</p> <p>Background</p> <p>Maternal health services have a potentially critical role in the improvement of reproductive health. In order to get a better understanding of adolescent mothers'needs we compared health seeking practices of first time adolescent and adult mothers during pregnancy and early motherhood in Wakiso district, Uganda.</p> <p>Methods</p> <p>This was a cross-sectional study conducted between May and August, 2007 in Wakiso district. A total of 762 women (442 adolescents and 320 adult) were interviewed using a structured questionnaire. We calculated odds ratios with their 95% CI for antenatal and postnatal health care seeking, stigmatisation and violence experienced from parents comparing adolescents to adult first time mothers. STATA V.8 was used for data analysis.</p> <p>Results</p> <p>Adolescent mothers were significantly more disadvantaged in terms of health care seeking for reproductive health services and faced more challenges during pregnancy and early motherhood compared to adult mothers. Adolescent mothers were more likely to have dropped out of school due to pregnancy (OR = 3.61, 95% CI: 2.40–5.44), less likely to earn a salary (OR = 0.43, 95%CI: 0.24–0.76), and more likely to attend antenatal care visits less than four times compared to adult mothers (OR = 1.52, 95%CI: 1.12–2.07). Adolescents were also more likely to experience violence from parents (OR = 2.07, 95%CI: 1.39–3.08) and to be stigmatized by the community (CI = 1.58, 95%CI: 1.09–2.59). In early motherhood, adolescent mothers were less likely to seek for second and third vaccine doses for their infants [Polio2 (OR = 0.73, 95% CI: 0.55–0.98), Polio3 (OR = 0.70: 95% CI: 0.51–0.95), DPT2 (OR = 0.71, 95% CI: 0.53–0.96), DPT3 (OR = 0.68, 95% CI: 0.50–0.92)] compared to adult mothers. These results are compelling and call for urgent adolescent focused interventions.</p> <p>Conclusion</p> <p>Adolescents showed poorer health care seeking behaviour for themselves and their children, and experienced increased community stigmatization and violence, suggesting bigger challenges to the adolescent mothers in terms of social support. Adolescent friendly interventions such as pregnancy groups targeting to empower pregnant adolescents providing information on pregnancy, delivery and early childhood care need to be introduced and implemented.</p

Determinants of intra-household food allocation between adults in South Asia - a systematic review.

BACKGROUND: Nutrition interventions, often delivered at the household level, could increase their efficiency by channelling resources towards pregnant or lactating women, instead of leaving resources to be disproportionately allocated to traditionally favoured men. However, understanding of how to design targeted nutrition programs is limited by a lack of understanding of the factors affecting the intra-household allocation of food. METHODS: We systematically reviewed literature on the factors affecting the allocation of food to adults in South Asian households (in Afghanistan, Bangladesh, Bhutan, India, Islamic Republic of Iran, Maldives, Nepal, Pakistan, Sri Lanka) and developed a framework of food allocation determinants. Two reviewers independently searched and filtered results from PubMed, Web of Knowledge and Scopus databases by using pre-defined search terms and hand-searching the references from selected papers. Determinants were extracted, categorised into a framework, and narratively described. We used adapted Downs and Black and Critical Appraisal Skills Programme checklists to assess the quality of evidence. RESULTS: Out of 6928 retrieved studies we found 60 relevant results. Recent, high quality evidence was limited and mainly from Bangladesh, India and Nepal. There were no results from Iran, Afghanistan, Maldives, or Bhutan. At the intra-household level, food allocation was determined by relative differences in household members' income, bargaining power, food behaviours, social status, tastes and preferences, and interpersonal relationships. Household-level determinants included wealth, food security, occupation, land ownership, household size, religion / ethnicity / caste, education, and nutrition knowledge. In general, the highest inequity occurred in households experiencing severe or unexpected food insecurity, and also in better-off, high caste households, whereas poorer, low caste but not severely food insecure households were more equitable. Food allocation also varied regionally and seasonally. CONCLUSION: Program benefits may be differentially distributed within households of different socioeconomic status, and targeting of nutrition programs might be improved by influencing determinants that are amenable to change, such as food security, women's employment, or nutrition knowledge. Longitudinal studies in different settings could unravel causal effects. Conclusions are not generalizable to the whole South Asian region, and research is needed in many countries

Domestic violence and decision-making power of married women in Myanmar: analysis of a nationally representative sample

BACKGROUND: Women in Myanmar are not considered decision makers in the community and the physical and psychological effect of violence makes them more vulnerable. There is a strong negative reaction, usually violent, to any economic activity generated by women among poorer and middle-class families in Myanmar because a woman's income is not considered necessary for basic survival. OBJECTIVE: Explore the relationship between domestic violence on the decision-making power of married women in Myanmar. DESIGN: Cross-sectional. SETTING: National, both urban and rural areas of Myanmar. PATIENTS AND METHODS: Data from the Myanmar Demographic and Health Survey 2015-16 were used in this analysis. In that survey, married women aged between 15 to 49 years were selected for interview using a multistage cluster sampling technique. The dependent variables were domestic violence and the decision-making power of women. Independent variables were age of the respondents, educational level, place of residence, employment status, number of children younger than 5 years of age and wealth index. MAIN OUTCOME MEASURES: Domestic violence and decision-making power of women. SAMPLE SIZE: 7870 currently married women. RESULTS: About 50% respondents were 35 to 49 years of age and the mean (SD) age was 35 (8.4) years. Women's place of residence and employment status had a significant impact on decision-making power whereas age group and decision-making power of women had a relationship with domestic violence. CONCLUSION: Giving women decision making power will be indispensable for the achievement of sustainable development goals. Government and other stakeholders should emphasize this to eliminate violence against women. LIMITATIONS: Use of secondary data analysis of cross-sectional study design and cross-sectional studies are not suitable design to assess this causality. Secondly the self-reported data on violence may be subject to recall bias. CONFLICT OF INTEREST: None