Intimate partner violence (IPV) against women is common, although prevalence and correlates amongst pregnant women in developing countries are poorly researched.
To identify the magnitude of IPV, and its relationship with psychiatric morbidity and partner alcohol use.
This study was conducted among women receiving routine ante-natal care at a secondary level healthcare facility in southern Nigeria.
A cross-sectional descriptive study was conducted by recruiting pregnant women (
Past 12-month prevalence of IPV was 24.8%, with emotional abuse being the commonest type (89.8%). Forty-six participants (11.6%) screened positive for probable psychiatric morbidity. Predictors of IPV included partner alcohol use in the past 12 months (adjusted odds ratio [aOR]: 2.67; 95% confidence interval [CI]: 1.16–6.16;
Intimate partner violence was common amongst pregnant women in Nigeria. Identified modifiable risk factors can be targets for screening and intervention for women in these settings.
In the past decade, increasing research has focused on violence perpetuated on women by their intimate partners. Most research indicates that women are more likely to be victimised by almost every type of intimate partner violence (IPV).
Domestic violence has been reported to occur even during pregnancy
The aim of this study was to examine the magnitude and characteristics of IPV as well as to assess the extent to which violence by intimate partners is associated with psychiatric morbidity and partners’ alcohol use.
This cross-sectional descriptive study was conducted between August 2015 and February 2016 at the Ante-Natal Clinics of the Central Hospital, Benin-City, Edo State, Nigeria, which is the largest secondary health care facility in the city. It provides services to the communities comprising the three local government areas that make up Benin-City, with an approximate population of 1 million.
The sample size was calculated by using the formula for proportions
A semi-structured socio-demographic questionnaire was designed by the authors to elicit information on the following variables: age, marital status, educational level, parity and employment status. Participants’ reports of partner lifetime and 12-month alcohol use were also obtained.
The Composite Abuse Scale (CAS) is a 30-item validated research instrument that is based on the concept of IPV that includes not only violent acts but also coercion arising out of conflict. It is recommended as an IPV research assessment tool by the National Centre for Injury Prevention and Control
The Self-reporting Questionnaire-20 (SRQ-20) was developed as part of a collaborative study coordinated by the World Health Organization (WHO)
The scale consists of 20 dichotomous items covering depression, anxiety and somatisation symptoms. Scores range from 0 to 20 and implicitly increase with the degree of psychological distress. The SRQ was validated in a primary care setting in rural south-western Nigeria
The data collected were analysed by using the Statistical Package for the Social Sciences version 20.
Ethical clearance was obtained from the Ethics Committee of the Federal Neuro-Psychiatric Hospital, Uselu, Benin City (Ref: T/A.740/44), and the Edo State Ministry of Health prior to commencement of the study. Those with Self-reporting Questionnaire-20 (SRQ-20) scores indicative of mental ill health received counselling and a referral to a mental health practitioner. Victims of IPV were counselled about seeking help.
A total of 412 pregnant women were approached for consent to participate in this study. Three hundred and ninety-five (395) gave consent and were recruited giving a response rate of 95.87%.
Participants were aged between 16 and 44 years with a mean age (standard deviation [s.d.]) of 30.05 (5.3) years. About a quarter (
Socio-demographic characteristics of participants (
Variable | Total |
|
---|---|---|
% | ||
16–26 | 100 | 25.3 |
27–37 | 260 | 65.8 |
38–49 | 35 | 8.9 |
Benin | 199 | 50.4 |
Esan | 61 | 15.4 |
Delta Igbo | 17 | 4.3 |
Igbo | 23 | 5.8 |
Etsako | 24 | 6.1 |
Others | 71 | 18.0 |
Christian | 382 | 96.7 |
Muslim | 13 | 3.3 |
Nil formal education | 7 | 1.8 |
Primary | 45 | 11.4 |
Secondary | 198 | 50.1 |
Tertiary | 141 | 36.7 |
Employed | 311 | 78.7 |
Unemployed | 84 | 21.3 |
Managers | 4 | 1.3 |
Professionals | 43 | 13.8 |
Technicians and associate professionals | 5 | 1.6 |
Clerical support workers | 14 | 4.5 |
Service and sales workers | 178 | 57.2 |
Craft and related trade workers | 65 | 20.9 |
Elementary occupation | 2 | 0.6 |
Nulliparous | 142 | 36.0 |
Primiparous | 102 | 25.8 |
Multiparous | 145 | 36.7 |
Grand-multiparous | 6 | 1.5 |
, ISCO-08, International standard classification of occupation, 2008.
Ninety-eight (24.8%) participants reported experiencing IPV in the past year. Emotional abuse was most commonly reported, occurring singly and in combination with other forms in 89.8% of those who suffered IPV. The severe combined abuse domain of the CAS (which assesses for sexual abuse) was the least reported (5/98, 5.1%), occurring only in combination with other domains. The majority of participants who suffered IPV reported experiences of a combination of physical and emotional violence suffered at the hands of their partners (
Pattern of intimate partner violence experienced by victims.
Prevalence of intimate partner violence amongst participants (
Variable | Total |
|
---|---|---|
% | ||
Present | 98 | 24.8 |
Absent | 297 | 75.2 |
Physical abuse | 66/98 | 67.3 |
Emotional abuse | 88/98 | 89.8 |
Harassment | 47/98 | 48.0 |
Severe combined abuse | 5/98 | 5.1 |
IPV, intimate partner violence; CAS, Composite Abuse Scale.
Women who were single (
Association between socio-demographic characteristics of participants and presence of intimate partner violence.
Variable | IPV |
Statistic |
||
---|---|---|---|---|
Present ( |
Absent (%) | |||
≤ 30 years | 53 | 163 | 0.019 | 0.890 |
> 30 years | 45 | 134 | - | |
> 12 years of formal education | 30 | 115 | 2.085 | 0.149 |
≤ 12 years of formal education | 68 | 182 | - | |
Employed | 80 | 232 | 0.550 | 0.459 |
Unemployed | 18 | 65 | - | |
High | 11 | 55 | 3.374 | 0.066 |
Low | 68 | 177 | - | |
Single | 44 | 79 | 11.506 | 0.001 |
Currently married | 54 | 218 | - | |
Primi-, multi- and grand multiparous | 74 | 179 | 7.433 | 0.006 |
Nulliparous | 24 | 118 | - |
IPV, intimate partner violence;
Forty-six (11.6%) participants screened positive for psychiatric morbidity. Those who experienced IPV in the preceding 12 months were nearly four times more likely to have a psychiatric morbidity compared with those who did not experience IPV (crude odds ratio [OR]: 3.65, 95% CI: 1.84–7.21,
The association between psychiatric morbidity and various domains of intimate partner violence.
Domains of IPV | SRQ-20: |
Statistics |
||||
---|---|---|---|---|---|---|
Positive ( |
Negative (%) | Crude OR | 95% CI | |||
Present | 16 | 50 | 3.19 | 1.62–6.27 | 12.220 | 0.001 |
Absent | 30 | 299 | - | - | - | |
Present | 21 | 67 | 3.54 | 1.87–6.69 | 16.427 | 0.001 |
Absent | 25 | 282 | - | - | - | |
Present | 10 | 37 | 2.34 | 1.08–5.11 | 4.809 | 0.03 |
Absent | 36 | 212 | - | - | - | |
Present | 2 | 3 | - | - | 1.658 |
0.198 |
Absent | 44 | 346 | - | - | - |
IPV, intimate partner violence; SRQ-20, Self-Reporting Questionnaire-20;
, Yates corrected.
, Significant values.
One hundred and seventy-eight (45.1%) women reported that their partner had used alcohol in the preceding 12 months, and 225 (57%) reported a lifetime history of alcohol use amongst their partners. Pregnant women who reported that their partners used alcohol in the preceding 12 months were three times more likely to report IPV (Crude OR: 3.41, 95% CI: 2.05–5.71,
The association between partners’ alcohol use and intimate partner violence.
Partners’ alcohol use | IPV |
Statistic |
||||||
---|---|---|---|---|---|---|---|---|
Present |
Absent |
Crude OR | 95% CI | |||||
% | % | |||||||
Yes | 66 | 37.08 | 112 | 62.92 | 3.41 | 2.05-5.71 | 26.14 | 0.001 |
No | 32 | 14.75 | 185 | 85.25 | - | - | - | |
Yes | 79 | 35.11 | 146 | 64.89 | 4.3 | 2.43-7.88 | 29.74 | 0.001 |
No | 19 | 11.18 | 151 | 88.82 | - | - | - |
IPV, intimate partner violence;
, Significant values.
Following a binary logistic regression, the predictors of IPV included partner alcohol use in the past 12 months (adjusted OR: 2.67; 95% CI: 1.16–6.16;
Predictors of intimate partner violence.
Variables | SE | Wald | df | OR | 95% CI | ||
---|---|---|---|---|---|---|---|
Nulliparous | −0.927 | 0.287 | 10.418 | 1 | 0.4 | 0.23–0.70 | |
Not married | 0.751 | 0.268 | 7.866 | 1 | 2.12 | 1.25–3.58 | |
Psychiatric morbidity present | 0.929 | 0.351 | 7.002 | 1 | 2.53 | 1.27–5.04 | |
Partner alcohol use (12 month) | 0.982 | 0.427 | 5.291 | 1 | 2.67 | 1.16–6.16 | |
Partner alcohol use (lifetime) | 0.418 | 0.380 | 1.208 | 1 | 1.52 | 0.72–3.20 |
, Significant values.
Based on the results of this study it could be noted that a quarter of the women reported IPV within the past year. This rate is consistent with previous research.
Emotional abuse was the most commonly reported pattern of abuse occurring in 89.8% of participants reported IPV and is consistent with other studies from Nigeria,
Questions may also arise regarding the validity of the ‘emotional abuse’ construct on the CAS in this cultural setting because what constitutes emotional abuse on the CAS may be an acceptable way of communication. The measurement of emotional violence across cultures is complex, and there is a relative scarcity of research on emotional abuse in comparison with studies on physical or sexual violence.
Over two-thirds (67.3%) of participants reporting violence reported physical abuse by their partners, and contrasting results (4.9%) were reported by Onoh et al.
Severe combined abuse (which assesses for sexual violence on the CAS) was reported in 5 of 98 (5.1%) persons who reported IPV. A higher prevalence of sexual abuse has been reported from Africa.
In this study, a little over a 10th (11.6%) of participants screened positive for a psychiatric morbidity. This study showed significant associations between experiences of violence and probable psychiatric morbidity in participants. Age, education, religion, ethnic group or employment status or occupation did not show this association. A similar association of case-ness for a mental illness and the experience of partner violence has been reported.
Furthermore, except for severe combined abuse, emotional and physical abuses were significantly associated with probable psychiatric morbidity. On the contrary, it is possible that the presence of a psychiatric illness in an individual, for example depression, may influence interpretations of verbal and non-verbal cues of a partner. A negative view of self, environment and the future caused by an illness may lead to frequent misinterpretation of intents and contents of communication, hence, a possible over-reporting of emotional abuse.
Physical symptoms such as tiredness, diarrhoea, chest pain, poor sleep, poor appetite and poor digestion have been found to be associated with IPV.
Lastly, we also confirm that partner alcohol use increased the odds of reporting IPV. Although it would have been ideal to quantify the severity of use, we agree that it would be difficult to delineate factors that predispose to partner alcohol use, and the alcohol use itself, as it relates to IPV. We suggest that future studies are urgently required to examine the severity, contributing factors and perpetuating factors for partner alcohol use to refine strategies that would ameliorate this modifiable risk factor’s contribution to IPV. Our findings should be interpreted with the following limitations. Firstly, the use of a secondary healthcare facility and the urban-based nature of the study may restrict the generalisation of our findings to the wider settings. Secondly, some of the questions in the CAS may not be culturally adapted to describe IPV from the Nigerian perspective. Although selected for its comprehensiveness and strong psychometric properties, it has not been extensively validated beyond face validity and reliability in Nigeria. Thirdly, questions about partners’ use of alcohol were based on the respondents’ knowledge rather than self-report, making these variables less reliable.
Intimate partner violence is common amongst pregnant women presenting at the ante-natal clinic of Central Hospital, Benin-City. Most reported experiences of combinations of various forms of violence. Emotional abuse was most commonly reported amongst participants in abusive relationships. About one-tenth of participants screened tested positive for a psychiatric morbidity. There is a need to institute interventions in ante-natal settings that educate pregnant women about the nature, risks and complications of IPV as well as the provision of resources to aid coping and mitigation of IPV.
The authors have declared that no competing interests exist.
All authors contributed equally to this work.
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Data sharing is not applicable to this article as no new data were created or analysed in this study.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.