Asnake Angwach Abrham, Seifu Beminate Lemma, Gebrehana Alemayehu Kasu, Gebeyehu Asaye Alamneh, Gebrekidan Amanuel Yosef, Lombebo Afework Alemu, Abajobir Amanuel Alemu
Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia.
Front Glob Womens Health. 2024 Oct 28;5:1420422. doi: 10.3389/fgwh.2024.1420422. eCollection 2024.
Intimate partner violence (IPV) is a significant public health problem, with serious consequences on women's physical, mental, sexual, and reproductive health, as well as birth outcomes. Women who encounter IPV are more likely to experience adverse birth outcomes such as low birth weight, premature delivery, and stillbirth. Although numerous studies are exploring the association between IPV and adverse birth outcomes, they merely used classical models and could not control for potential confounders. The purpose of this study was to ascertain whether there was a causation between IPV and adverse birth outcomes in sub-Saharan Africa (SSA) using a quasi-experimental statistical technique [i.e., propensity score matching (PSM) analysis].
This study used the most recent (2015-22) Demographic and Health Survey (DHS) data from 20 SSA countries. A total weighted sample of 13,727 women was included in this study. IPV (i.e., sexual, physical, emotional, and at least one form of IPV) was the exposure/treatment variable and adverse birth outcomes (preterm delivery, low birth weight, stillbirth, and macrosomia) were the outcome variables of this study. PSM was employed to estimate the impact of IPV on adverse birth outcomes.
The average treatment effects (ATE) of sexual, physical, emotional, and at least one form of IPV were 0.031, 0.046, 0.084, and 0.025, respectively. Sexual, physical, emotional, and at least one form of IPV increased adverse birth outcomes by 3.1%, 4.6%, 8.4%, and 2.5%, respectively. Findings from the average treatment effect on treated (ATT) showed that women who experienced sexual, physical, emotional, and at least one form of IPV had an increased risk of adverse birth outcomes by 3.6%, 3.7%, 3.3%, and 3.0%, respectively, among treated groups.
This study demonstrates a causal relationship between IPV and adverse birth outcomes in SSA countries, indicating a need for programs and effective interventions to mitigate the impact of IPV during pregnancy to reduce related adverse pregnancy outcomes. Furthermore, we suggest further research that investigates the causal effect of IPV on adverse birth outcomes by incorporating additional proximal variables not observed in this study.
亲密伴侣暴力（IPV）是一个重大的公共卫生问题，对女性的身体、心理、性健康和生殖健康以及分娩结局都有严重影响。遭受亲密伴侣暴力的女性更有可能经历不良分娩结局，如低出生体重、早产和死产。尽管众多研究在探索亲密伴侣暴力与不良分娩结局之间的关联，但这些研究仅使用了经典模型，无法控制潜在的混杂因素。本研究的目的是使用一种准实验统计技术[即倾向得分匹配（PSM）分析]来确定在撒哈拉以南非洲（SSA）地区亲密伴侣暴力与不良分娩结局之间是否存在因果关系。
本研究使用了来自20个撒哈拉以南非洲国家的最新（2015 - 2022年）人口与健康调查（DHS）数据。本研究纳入了总计13727名女性的加权样本。亲密伴侣暴力（即性暴力、身体暴力、情感暴力以及至少一种形式的亲密伴侣暴力）是暴露/处理变量，不良分娩结局（早产、低出生体重、死产和巨大儿）是本研究的结局变量。采用倾向得分匹配法来估计亲密伴侣暴力对不良分娩结局的影响。
性暴力、身体暴力、情感暴力以及至少一种形式的亲密伴侣暴力的平均处理效应（ATE）分别为0.031、0.046、0.084和0.025。性暴力、身体暴力、情感暴力以及至少一种形式的亲密伴侣暴力分别使不良分娩结局增加了3.1%、4.6%、8.4%和2.5%。处理组中接受性暴力、身体暴力、情感暴力以及至少一种形式的亲密伴侣暴力的女性不良分娩结局风险分别增加了3.6%、3.7%、3.3%和3.0%，这一结果来自对处理组的平均处理效应（ATT）分析。
本研究证明了在撒哈拉以南非洲国家亲密伴侣暴力与不良分娩结局之间存在因果关系，这表明需要开展相关项目和有效的干预措施，以减轻孕期亲密伴侣暴力的影响，从而减少相关的不良妊娠结局。此外，我们建议进一步开展研究，通过纳入本研究中未观察到的其他近端变量来调查亲密伴侣暴力对不良分娩结局的因果效应。
