Leight Jessica, Wilson Nicholas
(IFPRI) Poverty, Health and Nutrition Division, 1201 Eye St., Washington, D.C, 20005, USA.
Department of Economics, Reed College, 3203 SE Woodstock Blvd, Portland, OR, 97202, USA.
BMC Public Health. 2021 Feb 25;21(1):405. doi: 10.1186/s12889-021-10447-y.
High rates of maternal mortality and intimate partner violence (IPV) are both major worldwide health challenges. Evidence from single-country samples suggests that IPV may be an important risk factor for low utilization of maternal health services, but there is little large-scale evidence on this association. This paper evaluates whether IPV is a risk factor for low utilization of maternal health services in a large cross-country sample, and also compiles evidence on the relative effects of different forms of IPV.
We analyze the association between intimate partner violence and utilization of maternal health care, using a dataset compiling all Demographic and Health Surveys that report data on intimate partner violence. Using data on 166,685 women observed in 36 countries between 2005 and 2016, we estimate logistic regression models to analyze the relationship between lifetime experience of IPV and utilization of antenatal care (ANC), facility delivery care, and postnatal care. We estimate both unadjusted models and models adjusted for geographic and sociodemographic characteristics that are generally correlated with utilization of maternal health care (including age, education, number of children, wealth status, marital status, and urbanity).
Lifetime experience of any IPV is associated with decreased use of maternal health services in a broad sample of births observed in lower and middle-income countries: in particular, the utilization of four or more ANC visits, the number of ANC visits, and the utilization of facility care at birth. This association remains statistically significant even after adjusting for country of residence, subnational region of residence, and additional individual-level covariates; however, there is no statistically significant association between experience of any IPV and postnatal care. The only form of IPV significantly associated with care utilization is physical IPV.
Women experiencing physical intimate partner violence show lower levels of utilization of maternal health services in a large sample of developing and middle-income countries. Given that reduced utilization of maternal health services is correlated with maternal and neonatal health outcomes, this pattern suggests that IPV prevention may be an important component of interventions targeting enhanced maternal and neonatal health.
孕产妇死亡率居高不下和亲密伴侣暴力行为都是全球主要的健康挑战。来自单一国家样本的证据表明，亲密伴侣暴力行为可能是孕产妇保健服务利用率低的一个重要风险因素，但关于这一关联的大规模证据很少。本文评估在一个大型跨国样本中，亲密伴侣暴力行为是否是孕产妇保健服务利用率低的风险因素，同时还汇编了不同形式亲密伴侣暴力行为相对影响的证据。
我们使用一个汇总了所有报告亲密伴侣暴力行为数据的人口与健康调查数据集，分析亲密伴侣暴力行为与孕产妇保健服务利用之间的关联。利用2005年至2016年期间在36个国家观察到的166,685名妇女的数据，我们估计逻辑回归模型，以分析亲密伴侣暴力行为的终身经历与产前保健（ANC）、机构分娩护理和产后护理利用之间的关系。我们既估计了未调整模型，也估计了针对通常与孕产妇保健服务利用相关的地理和社会人口特征进行调整的模型（包括年龄、教育程度、子女数量、财富状况、婚姻状况和城市化程度）。
在低收入和中等收入国家观察到的广泛分娩样本中，任何亲密伴侣暴力行为的终身经历都与孕产妇保健服务使用减少有关：特别是，四次或更多次产前检查的利用率、产前检查次数以及出生时的机构护理利用率。即使在调整了居住国、居住的次国家区域和其他个人层面的协变量后，这种关联在统计上仍然显著；然而，任何亲密伴侣暴力行为的经历与产后护理之间没有统计学上的显著关联。与护理利用显著相关的亲密伴侣暴力行为的唯一形式是身体暴力。
在大量发展中国家和中等收入国家样本中，经历身体亲密伴侣暴力行为的妇女的孕产妇保健服务利用率较低。鉴于孕产妇保健服务利用率降低与孕产妇和新生儿健康结果相关，这种模式表明，预防亲密伴侣暴力行为可能是旨在改善孕产妇和新生儿健康的干预措施的重要组成部分。
