PREVALENCE AND ASSOCIATED FACTORS OF

DOMESTIC VIOLENCE AMONG PREGNANT

WOMEN ATTENDING ANC CLINIC OF HEALTH

INSTITUTIONS IN EASTERN TERAI, NEPAL

Presenter: Diwash Timilsina

3/14/2015 1

INTRODUCTION

Domestic violence is defined by United Nation as violence

occurring within the private sphere, generally between individuals

who are related through intimacy, blood or law

Domestic violence includes physical acts of violence within the

family, sexual coercion, psychological abuse/ threats and

economic control over resources

Domestic violence against women (DVAW) during pregnancy is

serious public health problem worldwide [1]

Result of overall inferior status of women and girls and of

unequal power relation between genders

Cause adverse health consequences for both the mother and

fetus3/14/2015 2

PROBLEM STATEMENT

Globally, one on every three women is beaten, raped

and otherwise abused during lifetime [2]

South East Asian Region has one of the highest

prevelance of Gender based Violence in the world [3]

The terai belt of Nepal accounts for 9 percent of all GBV

during pregnancy [4]

Violence during pregnancy leads to miscarriage and

Low birth weight babies along with depression and

substance abuse among pregnant women [5]

3/14/2015 3

RATIONALE

Studies on South Asia suggest that a significant proportion of

women are physically abused during pregnancy. [6]

Nepal demographic and health survey of 2011 shows that

the Terai Region has one of the highest proportions of

gender based Violence during pregnancy in comparison to

other region. [7]

A study conducted at Karachi, Pakistan in the postnatal

wards of public tertiary hospital shows 23 percent faced

violence during the pregnancy, over half (55%) of the women

believed that antenatal care clinics were a good time to

enquire about domestic violence during pregnancy. [8]

3/14/2015 4

Research question

What is the prevalence and associated factors of

gender based domestic violence among pregnant

women in eastern terai?

3/14/2015 5

OBJECTIVES

General objective

To identify the prevalence and associated factors of gender

based domestic violence among pregnant women attending

ANC clinic at health institutions

Specific objectives

To identify period prevalence rate of GBDV

To determine the proportion of different forms of GBDV

experienced by pregnant women

To identify the association between demographic

characteristics and GBDV experienced by pregnant women

To identify the association between type of violence and

perpetrators of GBDV during pregnancy

3/14/2015 6

METHODOLOGY OF STUDY

Study design

Analytical cross-sectional study

Both qualitative and quantitative data were included

Study area

Sunsari and Siraha among five districts of eastern terai

region

Study population

Pregnant women attending antenatal clinic at health

institutions

Sampling method

Purposive sampling

3/14/2015 7

Methodology cont…

Sample size

P= 0.33 (percentage of pregnant women experiencing GBV at

Paropakar Maternity and Women’s Hospital by Chaudhary P, et

al, 2010)

q= 0.67

d= 7%, z= 1.96

n= (Z) 2.p.q/ (d) 2

n= (1.96)2* 0.33*0.67/ (0.07)2

n= 174

Design effect (DE): 1.2% 208

Non response rate (NRR): 20%

Required population sample (N) = 1.2*174+20%of 174

= 242

3/14/2015 8

Methodology cont…

Sampling Frame

Data collected from District hospital, Primary Health

Care Centre and health posts selected purposively

from each district

Data collection tools

quantitative study - a structured questionnaire for face

to face interview

qualitative study - case study guideline was prepared

for in-depth interviews

Inclusion criteria

Pregnant (4 weeks to 40 weeks of gestation) attending

antenatal clinic

3/14/2015 9

Methodology cont…

Exclusion Criteria

Pregnant who didn’t attended ANC at health institutions and

uncooperative respondents

Data management and analysis

Raw data entered in epi-data and analyzed in SPSS version

16.0

Quantitative analysis

Descriptive statistic and Inferential statistic

Qualitative analysis

case study

Ethical consideration

Approval from department of Public Health, Pokhara

University

Approval from DHOs

Written /verbal consent from each participants 3/14/2015 10

RESULTS

Period prevalence rate

Among sample size of 242 pregnant women, only 215 pregnants with mean age of twenty-four had participated

A total of 144 (67%) respondents out of 215 experienced violence during their pregnancy

Period Prevalence rate was 18.3% (Data from October 21 to November 25, 2013 was calculated and Total pregnant women at the data collection period = 786)

3/14/2015 11

Proportion of different forms of GBDV

experienced by pregnant women

Forms of Violence Frequency (n=144) Percentage

(among violated

cases)

Physical 68 47.22

Psychological 127 88.19

Sexual 88 61.11

Economical 73 50.69

Note: Total percentage exceeds 100 due to multiple answers of the respondents 3/14/2015 12

Demographic

characteristicsExperience of GBDV

(%)

Total P- value

Yes No

Age 15-19 16 (51.61) 15 (48.39) 31 (100)

0.005

20-24 61 (61.61) 38 (38.39) 99 (100)

25-29 35 (71.14) 14 (28.57) 49 (100)

30+ 32 (88.89) 4 (11.11) 36 (100)

Caste/Ethnicity Dalit 35(58.33) 25 (41.67) 60 (100)

0.028

Dis. janajati 22 (75.86) 7 (24.14) 29 (100)

Dis. non-terai

caste

38 (58.46) 27 (41.54) 65 (100)

Muslim/

Choroute

36 (83.72) 7 (16.28) 43 (100)

Adv.

Janajatis +

upper caste

13 (72.22) 5 (27.73) 18 (100)

Religion Hindu 109 (63.00) 64 (36.00) 173 (100) 0.012

Muslim 35 (83.33) 7 (16.67) 42 (100)

Association between demographic characteristics

and GBDV experienced by pregnant women

3/14/2015 13

Demographic

characteristicsExperience of GBDV

(%)

Total P- value

Yes NoDuration of

marriage

(complete

years)

1-5 79 (58.10) 57 (41.90) 136 (100)

0.003

6-10 40 (78.43) 11 (21.57) 51 (100)

11-15 13 (86.66) 2 (13.34) 15 (100)

15+ 7 (58.33) 5 (41.67) 12 (100)

Frequency of

pregnancy

One time 46 (54.76) 38 (45.23) 84 (100)

<0.001

Two times 40 (61.53) 25 (38.47) 65 (100)

Three times 31 (83.78) 6 (16.22) 37 (100)

Four and more

times

24 (82.75) 5 (17.26) 29 (100)

Education

status

Illiterate 47 (78.33) 13 (21.67) 60 (100)

0.028Literate 97 (62.58) 58 (38.42) 155 (100)

Association between demographic characteristics

and GBDV experienced by pregnant women

3/14/2015 14

Narrations of violated respondents

• “My mother-in-law acts very rude (curur) to me. She often beat, pull my hair

(kapal luchaichai) and slap me whether I commit mistake or not. I, am hated

daughter-in-law compared to other because I came with less dowry

(dahej)……my husband could not say anything against his parents.”

- 22 years women from Inurwa, Sunsari

• “I have two daughters, aged two years and three and half years. My father and

mother in laws argue with me and my husband that they want grandson (pota)

from us. If I have daughter this time, he (gharwala) will bring another wife

(sautin). I, am mentally disturbed……..”

- 26 years women from Dhodna VDC, Siraha

• “I’ am only seventeen years old and I have to marry against my will when my

father decided…..I found myself pregnant after six month of marriage. The day

my family members knew of my pregnancy, they are expecting a son (ladka)

from me. I’ am worried if I give birth to a girl (ladki)…….I have seen that the

status of mother who give birth to a girl is not good (achha) in our society

(samaj).” - 17 years women from Bastipur VDC, Siraha

3/14/2015 15

Narrations cont…

“He wanted to have intercourse time to time though I’ am pregnant. A week ago, he got visa to Saudi. As usual he came home drunk and wanted to have sex. I slept turning my face to other side. He tried to scroll me and forcefully turned me over to him. I denied several times before also. But, that night he was insisting saying “i, am leaving home soon, I will return after long so you should….”I got out of bed and tried to make him understand that I, am 7 months pregnant and our unborn child will be at risk. He slapped me badly on my cheek. I also punched him and pushed him away. Then he pulled my hair and threw me on the floor………. (weeping)”

- 32 years women from Harinagra VDC, Sunsari

3/14/2015 16

Associative characteristics of violence

categories with husband

Types of violence Husband (%) Total (%) P value

Yes No

Physical

Yes

No

58 (85.29)

63 (43.45)

10 (14.71)

84 (57.93)

68 (100)

145 (100)

<0.001

Psychological

Yes

No

105 (82.68)

15 (17.00)

22 (17.32)

73 (83.00)

127 (100)

88 (100)

<0.001

Sexual

Yes

No

82 (93.18)

34 (26.77)

6 (6.82)

93 (73.23)

88 (100)

127 (100)

<0.001

Economic

Yes

No

58 (79.45)

62 (43.66)

15 (20.55)

80 (56.34)

73 (100)

142 (100)

<0.001

3/14/2015 17

Associative characteristics of violence

categories with father-in-law

Types of violence

Father-in-law (%) Total (%) P value

Yes No

Physical

Yes

No

26 (38.24)

30 (20.41)

42 (58.26)

117 (79.59)

68 (100)

147 (100)

0.006

Psychological

Yes

No

53 (41.73)

6 (6.82)

74 (58.27)

82 (93.18)

127 (100)

88 (100)

<0.001

Sexual

Yes

No

37 (42.00)

19 (14.96)

51 (58.00)

108 (85.04)

88 (100)

127 (100)

<0.001

Economic

Yes

No

23 (31.51)

33 (23.24)

50 (68.49)

109 (76.76)

73 (100)

142 (100)

0.191

3/14/2015 18

Associative characteristics of violence

categories with mother-in-law

Types of violence Mother-in-law (%) Total (%) P value

Yes No

Physical

Yes

No

40 (58.82)

36 (24.49)

28 (41.18)

111 (75.51)

68 (100)

147 (100) <0.001

Psychological

Yes

No

72 (56.70)

6 (6.82)

55 (43.30)

82 (93.18)

127 (100)

88 (100)

<0.001

Sexual

Yes

No

46 (52.27)

30 (23.62)

42 (47.73)

97 (76.38)

88 (100)

127 (100)

<0.001

Economic

Yes

No

37 (50.68)

39 (27.46)

36 (49.32)

103 (72.54)

73 (100)

142 (100)

0.001

3/14/2015 19

Associative characteristics of violence

categories with brother-in-law

Types of violence Brother-in-laws (%) Total (%) P value

Yes No

Physical

Yes

No

8 (11.76)

5 (3.40)

60 (88.24)

142 (96.60)

68 (100)

147 (100) 0.017

Psychological

Yes

No

11 (8.66)

7 (7.95)

116 (91.34)

81 (92.05)

127 (100)

88 (100)

0.053

Sexual

Yes

No

6 (6.81)

7 (5.51)

82 (93.19)

120 (94.49)

88 (100)

127 (100)

0.693

Economic

Yes

No

8 (10.96)

5 (3.52)

65 (89.04)

137 (96.48)

73 (100)

142 (100)

0.036

3/14/2015 20

Associative characteristics of violence categories with

community people

Types of violence Community people (%) Total (%) P value

Yes No

Physical

Yes

No

6 (8.57)

6 (4.13)

62 (91.42)

139 (95.87)

68 (100)

145 (100)

0.185

Psychological

Yes

No

12 (9.45) 115 (90.55)

88 (100)

127 (100)

88 (100)

NA

Sexual

Yes

No

8 (9.10)

4 (3.15)

80 (90.90)

123 (96.85)

88 (100)

127 (59.1)

0.062

Economic

Yes

No

6 (8.22)

6 (4.23)

67 (91.78)

136 (95.77)

73 (100)

142 (100)

0.227

3/14/2015 21

DISCUSSION

Period prevalence rate calculated to be 18.23%, similar to

finding of study conducted at Persa district in 2010 which

was 19%. [6] Could be due to Similar location

The rate of physical violence reaches 47.22 % is less to

the rate of study done in formal settlement of Uganda

(68%), many of these women who have been worse

affected, they were poor, not educated and

disadvantaged. This study prevalence is nearly double

compared to the prevalence of 23% reported in a

study at Karachi Pakistan which concluded pregnancy

does not initiate risk of violence. [7,8]

3/14/2015 22

Discussion cont…

Among sexually violated women, most of them suffered

from forced sexual intercourse during pregnancy, similar

to the study conducted at Kathmandu (2005). [9] Alcoholic

husband and sexual depression of husband was

linked

Statically significant association was found between

GBDV and age of respondent, duration of marriage

and frequency of pregnancy as similar to the study

conducted in Karachi, Pakistan (2006). Increase in the

age and duration of marriage may enhance probability

of violence due to longer contact period… increase

in frequency of pregnancy may be cause of violation

due to previous history of giving birth to daughter3/14/2015 23

Discussion cont…

Perpetrators as husband and mother-in-law were found

to be associated with all types of violence to pregnant.

Most of the time the pregnant were staying in

contact with either husband or mother-in-law, may

be due to this, they are often being violated

Community people were also involved in the violence

somewhere the study area but they were not associated

with experience of violence by pregnant. Pregnant

women are at risk in their own home

3/14/2015 24

CONCLUSION

More than two-third of the respondents experienced violence during pregnancy at their home

Among violated respondents, majority of the respondents experienced emotional/psychological violence followed by sexual, economic and physical violence

Increase in the marriage duration of women enhanced experience of violence during pregnancy (statically associated)

• Muslim/chouroute had the highest experience of violence followed by dis. Janajati (caste/ethnicity statically associated)

3/14/2015 25

Conclusion cont…

Women experienced more violation in multiple

pregnancies (frequency of pregnancy statically

associated)

Perpetrators like husband and mother-in-law were mostly

involved in all type of violence studied, was statically

associated with experience of GBDV by pregnants.

Though somewhere community people were also involved

in violence to pregnant women but they did not show

statically significant association in violence experience by

women3/14/2015 26

Recommendation

Further exploratory study/research is needed to

understand the scale and determinants of GBDV among

pregnant women in eastern terai

Violence reporting shell should be established in the

study area and the cases should be promoted to report

Mass message of gender equality and women

empowerment should be widespread in the study area

Similar study findings should be used by health planners

and policy makers in understanding the importance of

screening for domestic violence before and during

pregnancy if we are to reduce or prevent the burden of

violence faced by pregnant women in the study area

3/14/2015 27

REFERENCES

1. World health organization. Violence against women. Geneva: WHO, 1998,

WHO/FRH/WHD

2. Mbokata M, Moodley J. Domestic Abuse. An antenatal survey at King Edward

VIII Hospital. Durban S. Afr Med J. 2003; 93:455-57.

3. Niaz U. The Psychiatric Clinic and Stress Research Centre, Karachi, Pakistan.

Violence against women in South Asian countries. Arch Womens Ment

Health.2003; 6:173–184.

4. Nepal. Nepal demographic and health survey. Kathmandu: MoHP; 2011.

5. UN Department of Public Information, DPI/2546A, November 2009.

6. UNICEF (2001). A Reference Kit on Violence Against Women and Girls in

South Asia. ISBN. 92(806): 3704-5.

7. Fikree FF, Jafarey SN, Korejo R, Afshan A, Durocher JM. Intimate partner

violence before and during pregnancy: experiences of postpartum women in

Karachi, Pakistan. JPMA. June, 2006; 56(6):252-48.

8. Uganda, Burch, R.L., & Gallup, G.G. (2004), Pregnancy as a stimulus for

domestic violence. Journal of Family Violence, 19(4): 243–7.

3/14/2015 28

9. Adhikari T and Tamang J. Sexual coercion of married women in Nepal. BMC

Women’s Health. 25 May 2011; 1472(6874): 11-19.

10. Lydia O, et al. Intimate Partner Violence Among Economically Disadvantaged

Young Adult Women: Associations With Adolescent Risk-Taking and

Pregnancy. Experiences perspectives on sexual and reproductive health.

2009; 41(2): 84–91.

11. Fikree FF, Jafarey SN, Korejo R, Afshan A, Durocher JM. Intimate partner

violence before and during pregnancy: experiences of postpartum women in

Karachi, Pakistan. JPMA. June, 2006; 56(6):252-48.

12. Hammoury N, Khawaja M. Screening for domestic violence during pregnancy

in an antenatal clinic in Lebanon. EJPH. March 25, 2007; 17(6): 605–06.

13. Crempien, RC. Domestic violence during pregnancy and Maternal Health:

Explanatory study in Primary Health Centres in Pe`nalol`en, Chile. 2011.

14. Niaz U. Violence against women in South Asian countries. Arch Women’s

Mental Health. 2003; 6:173–184.

15. Moore. M. “Reproductive Health and Intimate Partner Violence.” Family

Planning Perspectives, 1999; 31(6): 302-306.

16. Rao V. Wife beating in Rural South India: A Qualitative and Econometric

Analysis” Social Science and Medicine, 1997; 44: 1169-80.

17. Lugdentorf. Prevalence of Domestic violence in a Pregnant Military

Population, America. April 2009; 113 (4): 866-872.3/14/2015 29

THANK – YOUFor your attention!!!

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