Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Addis Ababa University School of Public Health, Addis Ababa, Ethiopia.
BMJ Open. 2022 Apr 12;12(4):e055790. doi: 10.1136/bmjopen-2021-055790.
This multimethods study aimed to: (1) compare the prevalence of intimate partner violence (IPV) during pregnancy pre-COVID-19 and during the COVID-19 pandemic using quantitative data and (2) contextualise pregnant women's IPV experiences during the COVID-19 pandemic through supplemental interviews.
Quantitative analyses use data from Performance Monitoring for Action-Ethiopia, a cohort of 2868 pregnant women that collects data at pregnancy, 6 weeks, 6 months and 1-year postpartum. Following 6-week postpartum survey, in-depth semistructured interviews contextualised experiences of IPV during pregnancy with a subset of participants (n=24).
All pregnant women residing within six regions of Ethiopia, covering 91% of the population, were eligible for the cohort study (n=2868 completed baseline survey). Quantitative analyses were restricted to the 2388 women with complete 6-week survey data (retention=82.7%). A purposive sampling frame was used to select qualitative participants on baseline survey data, with inclusion criteria specifying completion of quantitative 6-week interview after the onset of the COVID-19 pandemic, and indication of IPV experience.
A State of Emergency in Ethiopia was declared in response to the COVID-19 pandemic approximately halfway through 6-week postpartum interview, enabling a natural experiment (n=1405 pre-COVID-19; n=983 during-COVID-19).
IPV during pregnancy was assessed via the 10-item Revised Conflict and Tactics Scale.
1-in-10 women experienced any IPV during pregnancy prior to COVID-19 (10.5%), and prevalence of IPV during pregnancy increased to 15.1% during the COVID-19 pandemic (aOR=1.51; p=0.02). Stratified by residence, odds of IPV during the pandemic increased for urban women only (aOR=2.09; p=0.03), however, IPV prevalence was higher in rural regions at both time points. Qualitative data reveal COVID-19-related stressors, namely loss of household income and increased time spent within the household, exacerbated IPV.
These multimethods results highlight the prevalent, severe violence that pregnant Ethiopian women experience, with pandemic-related increases concentrated in urban areas. Integration of IPV response and safety planning across the continuum of care can mitigate impact.
本多方法研究旨在：（1）使用定量数据比较新冠疫情前和新冠疫情期间怀孕期间亲密伴侣暴力（IPV）的发生率；（2）通过补充访谈来了解孕妇在新冠疫情期间的 IPV 经历。
定量分析使用来自埃塞俄比亚绩效监测行动的数据，这是一个由 2868 名孕妇组成的队列，该队列在怀孕期间、6 周、6 个月和 1 年产后收集数据。在 6 周产后调查后，对一小部分参与者（n=24）进行了深入的半结构化访谈，以了解怀孕期间 IPV 的经历。
符合条件的参与者为居住在埃塞俄比亚六个地区的所有孕妇，这些地区覆盖了 91%的人口，他们有资格参加队列研究（n=2868 名完成基线调查）。定量分析仅限于 2388 名完成完整 6 周调查数据的女性（保留率=82.7%）。在基线调查数据中使用了一种目的性抽样框架来选择定性参与者，纳入标准为在新冠疫情期间开始后完成定量 6 周访谈，并表明有 IPV 经历。
埃塞俄比亚宣布进入紧急状态，以应对新冠疫情，大约在 6 周产后访谈的中途，这为研究提供了一个自然实验（n=1405 例为新冠疫情前；n=983 例为新冠疫情期间）。
怀孕期间的 IPV 通过 10 项修订冲突和策略量表进行评估。
10%的女性在新冠疫情前怀孕期间经历过任何形式的 IPV（10.5%），而在新冠疫情期间怀孕期间 IPV 的发生率增加到 15.1%（优势比=1.51；p=0.02）。按居住地分层，只有城市女性在疫情期间发生 IPV 的几率增加（优势比=2.09；p=0.03），然而，在这两个时间点，农村地区的 IPV 发生率都更高。定性数据显示，与新冠疫情相关的压力源，即家庭收入损失和家庭内时间增加，加剧了 IPV。
这些多方法研究结果突出了埃塞俄比亚孕妇普遍经历的严重暴力行为，而与疫情相关的增加主要集中在城市地区。在整个护理连续体中整合 IPV 应对和安全规划可以减轻其影响。
