印度比哈尔邦亲密伴侣暴力与生殖和孕产妇健康结局的关联：一项横断面研究。

Associations between intimate partner violence and reproductive and maternal health outcomes in Bihar, India: a cross-sectional study.

机构信息

Bill & Melinda Gates Foundation, New Delhi, India.

Center on Gender Equity and Health, Department of Medicine, University of California, San Diego School of Medicine, 9500 Gilman Drive, MC 0507, La Jolla, San Diego, CA, 92093-0507, USA.

出版信息

Reprod Health. 2018 Jun 19;15(1):109. doi: 10.1186/s12978-018-0551-2.

DOI:10.1186/s12978-018-0551-2

PMID:29921276

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6009820/

Abstract

BACKGROUND

Bihar, India has higher rates of intimate partner violence (IPV) and maternal and infant mortality relative to India as a whole. This study assesses whether IPV is associated with poor reproductive and maternal health outcomes, as well as whether poverty exacerbates any observed associations, among women who gave birth in the preceding 23 months in Bihar, India.

METHODS

A cross-sectional analysis of data from a representative household sample of mothers of children 0-23 months old in Bihar, India (N = 13,803) was conducted. Associations between lifetime IPV (physical and/or sexual violence) and poor reproductive health outcomes ever (miscarriage, stillbirth, and abortion) as well as maternal complications for the index pregnancy (early and/or prolonged labor complications, other complications during pregnancy or delivery) were assessed using multivariable logistic regression, adjusting for demographics and fertility history of the mother. Models were then stratified by wealth index to determine whether observed associations were stronger for poorer versus wealthier women.

RESULTS

IPV was reported by 45% of women in the sample. A history of miscarriage, stillbirth, and abortion was reported by 8.7, 4.6, and 1.3% of the sample, respectively. More than one in 10 women (10.7%) reported labor complications during the last pregnancy, and 16.3% reported other complications during pregnancy or delivery. Adjusted regressions revealed significant associations between IPV and miscarriage (AOR = 1.35, 95% CI = 1.11-1.65) and stillbirth (AOR = 1.36, 95% CI = 1.02-1.82) ever, as well as with labor complications (AOR = 1.27, 95% CI = 1.04-1.54) and other pregnancy/delivery complications (AOR = 1.68, 95% CI = 1.42-1.99). Women in the poorest quartile (Quartile 1) saw no associations between IPV and miscarriage (Quartile 1 AOR = 0.98, 95% CI = 0.67-1.45) or stillbirth (Quartile 1 AOR = 1.17, 95% CI = 0.69-1.98), whereas women in the higher wealth quartile (Quartile 3) did see associations between IPV and miscarriage (Quartile 3 AOR = 1.55, 95% CI = 1.07, 2.25) and stillbirth (Quartile 3 AOR = 1.79, 95% CI = 1.04, 3.08).

DISCUSSION

IPV is highly prevalent in Bihar and is associated with increased risk for miscarriage, stillbirth, and maternal health complications. Associations between IPV and miscarriage and stillbirth do not hold true for the poorest women, possibly because other risks attached to poverty and deprivation may be greater contributors.

摘要

背景

印度比哈尔邦相对于整个印度来说，其亲密伴侣暴力（IPV）和母婴死亡率更高。本研究评估了在印度比哈尔邦过去 23 个月内分娩的妇女中，IPV 是否与不良生殖和产妇健康结局相关，以及贫困是否加剧了任何观察到的关联。

方法

对印度比哈尔邦一个具有代表性的 0-23 个月大儿童的母亲家庭样本（N=13803）进行了横断面分析。使用多变量逻辑回归评估了一生中 IPV（身体和/或性暴力）与不良生殖健康结局（流产、死产和堕胎）以及指数妊娠的产妇并发症（早产和/或延长的产程并发症、妊娠或分娩期间的其他并发症）之间的关联，调整了母亲的人口统计学和生育史。然后，根据财富指数对模型进行分层，以确定观察到的关联在较贫穷和较富裕的女性中是否更强。

结果

样本中 45%的女性报告了 IPV。流产、死产和堕胎的发生率分别为 8.7%、4.6%和 1.3%。超过十分之一的女性（10.7%）在最近一次妊娠中出现产程并发症，16.3%的女性在妊娠或分娩期间出现其他并发症。调整后的回归显示，IPV 与流产（AOR=1.35，95%CI=1.11-1.65）和死产（AOR=1.36，95%CI=1.02-1.82）之间存在显著关联，与产程并发症（AOR=1.27，95%CI=1.04-1.54）和其他妊娠/分娩并发症（AOR=1.68，95%CI=1.42-1.99）之间也存在显著关联。最贫穷的四分位组（四分位 1）的妇女中，IPV 与流产（四分位 1 AOR=0.98，95%CI=0.67-1.45）或死产（四分位 1 AOR=1.17，95%CI=0.69-1.98）之间没有关联，而在较高财富四分位组（四分位 3）的妇女中，IPV 与流产（四分位 3 AOR=1.55，95%CI=1.07-2.25）和死产（四分位 3 AOR=1.79，95%CI=1.04-3.08）之间存在关联。