Violence against Women Increases the Risk of Infant and Child Mortality: A Case-Referent Study in Nicaragua. (Research)

Article excerpt

Voir page 15 le resume en francais. En la pagina 15 figura un resumen en espanol.

Introduction

Violence against women has serious consequences for their physical (1,2) as well as mental health (3-5). Physical violence against women is a major public health problem in many settings, with a lifetime prevalence varying from 20% to 50% (6-10). During pregnancy 1-20 % of women are exposed to violence (11), and there are indications that the severity of violence may increase during pregnancy (12). Unemployment, strained economic resources, a history of family violence, and alcohol abuse have been reported to increase the occurrence of physical violence against women (13,14).

A few studies, mostly in high-income countries, have suggested that physical violence against pregnant women increases the risk of preterm labour (15) or delivery (16), fetal distress or death (16-18), and low-birth-weight offspring (19-23).

So far, little is known about the possible effect of violence against women on the survival of their offspring. However, low birth weight is an important risk factor for increased infant mortality (24,25), and an abused and chronically stressed mother may experience difficulties in coping with the multiple needs of her small child (26).

A recent population-based study in Leon, Nicaragua, indicated that 40% of women of reproductive age (n = 488) had been exposed to physical violence by a partner (27). Among ever-married women (n = 360), the lifetime prevalence of physical violence by a current or former intimate partner was 52%, and 27% of women reported having been exposed to violence in the 12 months prior to being interviewed. Furthermore, 70% of cases of violence were classified as severe. Violence was associated with poverty, high parity, and a history of marital violence in the partner's family (27). A total of 31% of women exposed to violence were beaten during one or more pregnancies, and 33% reported that beatings were commonly accompanied by forced sex (28). Physical violence from partners also increased the risk of the woman suffering from emotional distress (29), and the children of mothers who had experienced violence were more than twice as likely to suffer from learning, emotional, or behavioural problems compared with children whose mothers had never been so exposed (28).

Using the same population-based sampling frame that was employed in this population-based study in Nicaragua (27), we report here the results of a case-referent study on mortality among under-5-year-olds. The aim was to assess the effect of physical and sexual violence against mothers on the mortality risks of children in this age group.

Methods

A case-referent study was nested into a demographic database consisting of 9500 households, covering 50 out of the 208 geographical clusters in urban and rural areas of the municipality of Leon, Nicaragua. The database was established in 1993 by Leon University and Umea University by means of a population survey performed on a random sample of households, representing nearly 25% of the population of Leon. All women aged 15-49 years in the sample were interviewed and detailed information regarding their migration history, birth history, deaths of children, education, employment, and housing conditions was obtained (30). In mid-1996, all households were revisited and information on all the women of reproductive age was updated, including answers to specific questions identifying all births and any deaths of children aged <5 years.

Cases were defined as children born alive to women in the database described above and who died before the age of 5 years, between January 1993 and June 1996. For each case, two referents (alive), matched for sex and age at death, were randomly selected from the database. Initially, 156 children, identified as potential cases, were matched with 312 referents. The mothers of all cases and selected referents were visited and invited to participate in the study. …