Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, 200032, China.
Prime Institute of Public Health, Peshawar Medical College, Peshawar, 25000, Pakistan.
BMC Pregnancy Childbirth. 2024 May 24;24(1):386. doi: 10.1186/s12884-024-06584-y.
Existing research has shown that intimate partner violence (IPV) may hinder maternal access to healthcare services, thereby affecting maternal and child health. However, current studies have ignored whether emotional intimate partner violence (EV) could negatively affect maternal healthcare use. This study aims to evaluate the impact of invisible IPV on maternal healthcare utilization in Pakistan.
We analyzed nationally representative data from the Pakistan Demographic and Health Survey database from 2012-2013 and 2017-2018. Exposure to physical intimate partner violence (PV) and EV was the primary predictor. Based on women's last birth records, outcomes included three binary variables indicating whether women had inadequate antenatal care (ANC) visits, non-institutional delivery, and lack of postnatal health check-ups. A logistic regression model was established on weighted samples.
Exposure to EV during pregnancy was significantly associated with having inadequate ANC visits (aOR = 2.16, 95% CI: 1.06 to 4.38, p = 0.033) and non-institutional delivery (aOR = 2.24, 95% CI: 1.41 to 3.57, p = 0.001). Lifetime exposure to EV was associated with increased risks of inadequate ANC visits (aOR = 1.48, 95% CI: 1.00 to 2.19, p = 0.049). Lifetime exposure to low-scale physical intimate partner violence (LSPV) (adjusted OR (aOR) = 1.73, 95% CI: 1.29 to 2.31, p < 0.001) was associated with increased risks of having no postnatal health check-ups.
Pregnant women who experienced EV and LSPV are at greater risk of missing maternal healthcare, even if the violence occurred before pregnancy. Therefore, in countries with high levels of IPV, early screening for invisible violence needs to be integrated into policy development, and healthcare providers need to be trained to identify EV and LSPV.
现有研究表明，亲密伴侣暴力（IPV）可能会阻碍产妇获得医疗保健服务，从而影响母婴健康。然而，目前的研究忽略了情感亲密伴侣暴力（EV）是否会对产妇医疗保健的使用产生负面影响。本研究旨在评估在巴基斯坦无形 IPV 对产妇医疗保健利用的影响。
我们分析了 2012-2013 年和 2017-2018 年巴基斯坦人口与健康调查数据库的全国代表性数据。身体亲密伴侣暴力（PV）和 EV 的暴露是主要的预测因素。根据妇女最近一次分娩记录，结果包括三个二元变量，分别表示妇女是否接受了足够的产前护理（ANC）就诊、非机构分娩和缺乏产后健康检查。在加权样本上建立了逻辑回归模型。
怀孕期间暴露于 EV 与 ANC 就诊不足（aOR=2.16，95%CI：1.06 至 4.38，p=0.033）和非机构分娩（aOR=2.24，95%CI：1.41 至 3.57，p=0.001）显著相关。终生暴露于 EV 与 ANC 就诊不足的风险增加相关（aOR=1.48，95%CI：1.00 至 2.19，p=0.049）。终生暴露于低强度身体亲密伴侣暴力（LSPV）（调整后的比值比（aOR）=1.73，95%CI：1.29 至 2.31，p<0.001）与产后健康检查缺失的风险增加相关。
经历过 EV 和 LSPV 的孕妇即使暴力发生在怀孕之前，也更有可能错过产妇保健。因此，在亲密伴侣暴力发生率较高的国家，需要将早期筛查无形暴力纳入政策制定，并培训医疗保健提供者识别 EV 和 LSPV。
