Musa Abdulbasit, Chojenta Catherine, Geleto Ayele, Loxton Deborah
College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.
BMC Womens Health. 2019 Feb 26;19(1):36. doi: 10.1186/s12905-019-0735-0.
Intimate partner violence exposes women to a wide range of health problems that can either directly or indirectly lead to maternal death. Although in a number of studies intimate partner violence has been associated with inadequate utilization of antenatal care and skilled delivery care, in other studies no association has been found. Therefore, we aimed to comprehensively review the evidence, and quantify the strength and direction of the association between intimate partner violence and utilizing adequate antenatal and skilled delivery care services.
We systematically searched studies from MEDLINE, Embase, Psych INFO, CINAHL, and Maternity and Infant Care. Two independent reviewers screened the articles for eligibility. Quality and risk of bias in the articles were evaluated by using the Newcastle-Ottawa scale for observational studies. Pooled odds ratios and 95% confidence intervals were computed to estimate the association of intimate partner violence and antenatal care, and skilled delivery care. Random-effects models were used to allow for the significant heterogeneity that might possibly be found between studies. The degree of heterogeneity was expressed by using the I statistic.
The meta-analyses have shown that women who experienced intimate partner violence had 25% decreased odds (AOR = 0.75, 95%CI = 0.61, 0.92) of using adequate antenatal care than those who did not experience IPV. Similarly, women who experienced IPV had 20% decreased odds (AOR = 0.8, 95%CI = 0.69, 0.92) of using skilled delivery care compared to those who did not experience IPV.
The meta-analyses indicated that experiencing intimate partner violence is associated with a lower likelihood of receiving adequate antenatal care and skilled delivery care. Both community-based and facility-based interventions that target the reduction of partner violence, and strictly implementing proven health facility-based counselling interventions, could aid in improving utilization of maternal health care services.
亲密伴侣暴力使女性面临一系列广泛的健康问题，这些问题可能直接或间接导致孕产妇死亡。尽管在一些研究中，亲密伴侣暴力与产前护理和熟练接生护理利用不足有关，但在其他研究中未发现关联。因此，我们旨在全面回顾证据，并量化亲密伴侣暴力与充分利用产前和熟练接生护理服务之间关联的强度和方向。
我们系统检索了来自MEDLINE、Embase、Psych INFO、CINAHL以及母婴护理数据库的研究。两名独立评审员筛选文章以确定其是否符合要求。使用纽卡斯尔-渥太华量表对观察性研究评估文章的质量和偏倚风险。计算合并比值比和95%置信区间，以估计亲密伴侣暴力与产前护理及熟练接生护理之间的关联。采用随机效应模型来考虑研究之间可能存在的显著异质性。异质性程度用I统计量表示。
荟萃分析表明，经历过亲密伴侣暴力的女性接受充分产前护理的几率比未经历亲密伴侣暴力的女性低25%（调整后的比值比[AOR]=0.75，95%置信区间[CI]=0.61，0.92）。同样，与未经历亲密伴侣暴力的女性相比，经历亲密伴侣暴力的女性接受熟练接生护理的几率低20%（AOR=0.8，95%CI=0.69，0.92）。
荟萃分析表明，经历亲密伴侣暴力与接受充分产前护理和熟练接生护理的可能性较低有关。以减少伴侣暴力为目标的社区干预和机构干预，以及严格实施经过验证的基于医疗机构的咨询干预措施，有助于提高孕产妇保健服务的利用率。
