Burns Paul A, Zunt Joseph R, Hernandez Bernardo, Wagenaar Bradley H, Kumar Manasi, Omolo Danvers, Breinbauer Cecilia
Assistant Professor, John D. Bower School of Population Health, Department of Population Health Science, University of Mississippi Medical Center.
Professor, Global Health, Professor, Neurology, Adjunct Professor, Epidemiology, University of Washington, Department of Global Health.
Glob Soc Welf. 2020 Mar;7(1):1-13. doi: 10.1007/s40609-017-0106-4. Epub 2018 Feb 2.
Despite considerable achievements associated with the MDGs, under-five mortality, particularly in Sub-Saharan Africa, remains alarmingly high. Globally, intimate partner violence (IPV) affects one in three women within their lifetime. Little is known about the relationship between IPV and maternal care-seeking in the context of high rates of under-five mortality, particularly among young women and adolescent girls in low- and middle-income countries (LMICs).
Data from the Kenya Demographic Health Survey (2008-2009) were limited to a sample of women aged 15-24 years (n=1,406) with a child under-five who had experienced IPV in the last 12 months. Using multivariate logistic regression, we constructed three models: 1) base model; 2) controlling for type of residence (urban/rural); and 3) controlling for wealth status and education attainment, to estimate odds ratios (ORs) for the association between IPV and ten maternal care-seeking behaviors.
Thirty-eight percent of the women had experienced some form of intimate partner violence in the last 12 months. Women who had experience IPV were less likely: 1) to complete a minimum of 4 antenatal visits after single IPV exposure (OR=0.61, 95% CI=0.44, 0.86 and after severe IPV (OR=0.80; 95% CI=0.44, 0.88) and 2) to deliver in health facility after severe IPV exposure (OR=0.74; 95% CI=0.54, 0.89), both adjusted for educational attainment and wealth status. Lower socio-economic status and living in a rural area were strongly associated with increased likelihood of IPV.
Intersectional approaches that consciously focus on, and creatively address IPV may be key to the success of reducing child mortality and improving maternal health outcomes. The implementation of joint programming and development of combination interventions to effectively reduce the risk of exposure to IPV and promote maternal care-seeking behavior are needed to improve child morbidity and mortality in LMICs.
尽管千年发展目标取得了显著成就，但五岁以下儿童死亡率，尤其是在撒哈拉以南非洲地区，仍然高得惊人。在全球范围内，亲密伴侣暴力（IPV）影响着三分之一的女性。在五岁以下儿童死亡率居高不下的背景下，尤其是在低收入和中等收入国家（LMICs）的年轻女性和少女中，关于亲密伴侣暴力与孕产妇寻求护理之间的关系知之甚少。
肯尼亚人口与健康调查（2008 - 2009年）的数据仅限于15 - 24岁的女性样本（n = 1406），这些女性育有一名五岁以下儿童，且在过去12个月内经历过亲密伴侣暴力。我们使用多变量逻辑回归构建了三个模型：1）基础模型；2）控制居住类型（城市/农村）；3）控制财富状况和教育程度，以估计亲密伴侣暴力与十种孕产妇寻求护理行为之间关联的比值比（ORs）。
38%的女性在过去12个月内经历过某种形式的亲密伴侣暴力。经历过亲密伴侣暴力的女性不太可能：1）在单次亲密伴侣暴力暴露后至少完成4次产前检查（OR = 0.61，95%CI = 0.44，0.86），在严重亲密伴侣暴力暴露后（OR = 0.80；95%CI = 0.44，0.88）；2）在严重亲密伴侣暴力暴露后在医疗机构分娩（OR = 0.74；95%CI = 0.54，0.89），两者均根据教育程度和财富状况进行了调整。较低的社会经济地位和居住在农村地区与亲密伴侣暴力发生可能性增加密切相关。
有意识地关注并创造性地解决亲密伴侣暴力的交叉方法可能是降低儿童死亡率和改善孕产妇健康结果成功的关键。需要实施联合规划并开发综合干预措施，以有效降低遭受亲密伴侣暴力的风险并促进孕产妇寻求护理行为，从而改善低收入和中等收入国家儿童的发病率和死亡率。
