Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
Center for Advancing Population Sciences (CAPS), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
BMC Pregnancy Childbirth. 2023 Nov 3;23(1):767. doi: 10.1186/s12884-023-06084-5.
Poor physical access to health facilities could increase the likelihood of undetected intimate partner violence (IPV) during pregnancy. We aimed to determine sub-regional differences and associations between spatial accessibility to health facilities and IPV among pregnant women in Uganda.
Weighted cross-sectional analyses were conducted using merged 2016 Uganda Demographic and Health Survey and 2014 Uganda Bureau of Statistics health facility datasets. Our study population were 986 women who self-reported being currently pregnant and responded to IPV items. Outcome was spatial accessibility computed as the near point linear distance [< 5 km (optimal) vs. ≥ 5 km (low)] between women's enumeration area and health facility according to government reference cutoffs. Primary independent variable (any IPV) was defined as exposure to at least one of physical, emotional, and sexual IPV forms. Logistic regression models were sequentially adjusted for covariates in blocks based on Andersen's behavioral model of healthcare utilization. Covariates included predisposing (maternal age, parity, residence, partner controlling behavior), enabling (wealth index, occupation, education, economic empowerment, ANC visit frequency), and need (wanted current pregnancy, difficulty getting treatment money, afraid of partner, and accepted partner abuse) factors.
Respondents' mean age was 26.1 years with ± 9.4 standard deviations (SD), mean number of ANC visits was 3.8 (± 1.5 SD) and 492/986 (49.9%) pregnant women experienced IPV. Median spatial accessibility to the nearest health facility was 4.1 km with interquartile range (IQR) from 0.2 to 329.1 km. Southwestern, and Teso subregions had the highest average percentage of pregnant women experiencing IPV (63.8-66.6%) while Karamoja subregion had the highest median spatial accessibility (7.0 to 9.3 km). In the adjusted analysis, pregnant women exposed to IPV had significantly higher odds of low spatial accessibility to nearest health facilities when compared to pregnant women without IPV exposure after controlling for enabling factors in Model 2 (aOR 1.6; 95%CI 1.2, 2.3) and need factors in Model 3 (aOR 1.5; 95%CI 1.1, 3.8).
Spatial accessibility to health facilities were significantly lower among pregnant women with IPV exposure when compared to those no IPV exposure. Improving proximity to the nearest health facilities with ANC presents an opportunity to intervene among pregnant women experiencing IPV. Focused response and prevention interventions for violence against pregnant women should target enabling and need factors.
医疗设施可达性较差可能会增加妊娠期间亲密伴侣暴力（IPV）漏检的可能性。本研究旨在确定乌干达孕妇的卫生设施空间可达性与 IPV 之间的次区域差异和关联。
本研究采用 2016 年乌干达人口与健康调查和 2014 年乌干达统计局卫生机构数据集进行加权横断面分析。研究人群为 986 名自我报告目前怀孕并回答 IPV 问题的妇女。结局为空间可达性，根据政府参考截止值，计算妇女所在的计数区与卫生机构之间的近点直线距离[<5 公里（最佳）与≥5 公里（低）]。主要自变量（任何形式的 IPV）定义为至少经历过一种身体、情绪和性形式的 IPV。基于安德森医疗保健利用行为模型，按块顺序调整了包含倾向因素（孕产妇年龄、产次、居住地点、伴侣控制行为）、促成因素（财富指数、职业、教育、经济赋权、ANC 就诊频率）和需要因素（当前妊娠意愿、获得治疗资金困难、害怕伴侣、接受伴侣虐待）的协变量的逻辑回归模型。
受访者的平均年龄为 26.1 岁，标准差为±9.4；平均 ANC 就诊次数为 3.8（±1.5 标准差），492/986（49.9%）名孕妇经历过 IPV。最近卫生设施的中位数空间可达性为 4.1 公里，四分位距（IQR）为 0.2 至 329.1 公里。西南部和特索次区域报告的孕妇经历 IPV 的比例最高（63.8-66.6%），而卡拉莫贾次区域的空间可达性中位数最高（7.0 至 9.3 公里）。在调整后的分析中，与未暴露于 IPV 的孕妇相比，暴露于 IPV 的孕妇最近卫生设施的空间可达性较低的可能性显著更高，在控制了模型 2 中的促成因素（调整比值比[aOR]1.6；95%置信区间[CI]1.2，2.3）和模型 3 中的需要因素后[aOR 1.5；95%CI 1.1，3.8]。
与未暴露于 IPV 的孕妇相比，暴露于 IPV 的孕妇获得卫生设施的空间可达性明显较低。改善 ANC 期间最近卫生设施的可达性为干预 IPV 孕妇提供了机会。针对孕妇暴力行为的有针对性的应对和预防干预措施应针对促成因素和需要因素。
