Time to identify women exposed to intimate partner violence in antenatal settings

By Dr Rishi Caleyachetty

Up till now, research on the health impact of intimate partner violence (IPV) has primarily focused on gynaecological and sexual health outcomes (e.g., unwanted and unplanned pregnancies, miscarriages, sexually transmitted diseases and HIV infection), psychiatric disorders (e.g., depression, post-traumatic stress disorder and anxiety) (1) and substance use (2,3) . Although violence affects many women’s lives, maternal exposure to IPV may impact their children’s health by impairing their ability to breastfeed.

Evidence of the influence of maternal exposure to IPV on breastfeeding (early initiation of breastfeeding and exclusive breastfeeding in the first 6 months) in low- and middle-income (LMICs) is limited.

To address this gap, a group of practitioners and researchers worked together to analyze nationally representative survey data (Demographic Health Surveys) from 51 low- and middle-income countries conducted between January 2000 and January 2019.

The results have been recently published in the Maternal and Child Health Special Issue of PLOS Medicine. (4) They showed that mothers exposed to IPV were less likely to engage in initiating breastfeeding within the first hour of birth and breastfeeding exclusively in the first 6 months.

At the moment, the WHO does not recommend universal screening for IPV in women attending healthcare. (5) But the lack of evidence should not stop health workers in LMICs from considering targeted screening of women in the antenatal setting. It is important to identify women who have experienced or are experiencing IPV, connect them to essential services, and support them to initiate breastfeeding early and exclusively for 6 months. 

References

1. Campbell JC. Health consequences of intimate partner violence. Lancet Lond Engl. 2002 Apr 13;359(9314):1331–6.
2. Caleyachetty R, Echouffo-Tcheugui JB, Stephenson R, Muennig P. Intimate partner violence and current tobacco smoking in low- to middle-income countries: Individual participant meta-analysis of 231,892 women of reproductive age. Glob Public Health. 2014;9(5):570–8.
3. Yoshihama M, Horrocks J, Bybee D. Intimate partner violence and initiation of smoking and drinking: A population-based study of women in Yokohama, Japan. Soc Sci Med 1982. 2010 Sep;71(6):1199–207.
4. Caleyachetty R, Uthman OA, Bekele HN, Martín-Cañavate R, Marais D, Coles J, Steele B, Uauy R, Koniz-Booher P .Maternal exposure to intimate partner violence and breastfeeding practices in 51 low-income and middle-income countries: A population-based cross-sectional study.PLoS Med. 2019 Oct 1;16(10):e1002921. doi: 10.1371/journal.pmed.1002921.
5. O’Doherty L, Hegarty K, Ramsay J, Davidson LL, Feder G, Taft A. Screening women for intimate partner violence in healthcare settings. Cochrane Database Syst Rev. 2013;(4):CD007007.