Survey of Physical Abuse during Pregnancy GMCH, Nagpur, India

INTRODUCTION: Domestic violence is a major health concern for women globally. Violence may commence or escalate during pregnancy and may be more frequent than obstetric complications e.g. preeclampsia or gestational diabetes for which they are routinely screened. No literature is available on abuse during pregnancy from India. OBJECTIVE: To assess the frequency and severity of physical abuse during pregnancy and its association with entry to antenatal care and to identify lifetime risk factors. STUDY DESIGN: Cross sectional study. STUDY SETTING: Secondary and tertiary care public hospital. PARTICIPANTS: Six hundred randomly selected pregnant women in third trimester of pregnancy (28-40 weeks of gestation) attending routine antenatal clinic were assessed for physical abuse using Abuse Assessment Screen (AAS) developed by McFarlane. MAIN OUTCOME MEASURES: Abuse status, gestational age at first antenatal visit and lifetime risk factors. ANALYSIS: Descriptive, Univariate and MLR. RESULTS: Of the 600 pregnant women interviewed, 152 (25.33%) women reported abuse during non pregnant state, 132 (22%) women reported physical abuse during index pregnancy and 10 (8.33%) women reported increase in abuse during pregnancy. In majority the abuse site was head and neck and 20% reported being hit in the abdomen. Abuse was recurrent in 92% of women. Six (4.54%) women were hospitalized, 5 (3.78%) needed medical assistance and 19.7% women were afraid of partner (husband). Abused women were twice as likely to begin antenatal care after 32 weeks of gestation as compared to non abused women (OR = 2.5; 95% CI 1.1-5.6, p = 0.02). Abused women were more likely to be Buddhist (p = 0.005), of greater parity with unwanted pregnancy, dwelling in slums (p = 0.005), from extended family (p = 0.005), with low level of education to husband (p = 0.009) and with stress to husband (p = 0.03). CONCLUSIONS: There is significant physical abuse during pregnancy in central India. Routine screen by AAS and a cohort study looking at adverse outcome of pregnancy is recommended.