Date Published: January 20, 2017
Publisher: Public Library of Science
Author(s): Marizélia Rodrigues Costa Ribeiro, Antônio Augusto Moura da Silva, Maria Teresa Seabra Soares de Britto e Alves, Rosângela Fernandes Lucena Batista, Cecília Cláudia Costa Ribeiro, Lilia Blima Schraiber, Heloisa Bettiol, Marco Antônio Barbieri, Gabriele Fischer.
Few studies have used structural equation modeling to analyze the effects of variables on violence against women. The present study analyzed the effects of socioeconomic status and social support on violence against pregnant women who used prenatal services. This was a cross-sectional study based on data from the Brazilian Ribeirão Preto and São Luís birth cohort studies (BRISA). The sample of the municipality of São Luís (Maranhão/Brazil) consisted of 1,446 pregnant women interviewed in 2010 and 2011. In the proposed model, socioeconomic status was the most distal predictor, followed by social support that determined general violence, psychological violence or physical/sexual violence, which were analyzed as latent variables. Violence was measured by the World Health Organization Violence against Women (WHO VAW) instrument. The São Luis model was estimated using structural equation modeling and validated with 1,378 pregnant women from Ribeirão Preto (São Paulo/Brazil). The proposed model showed good fit for general, psychological and physical/sexual violence for the São Luís sample. Socioeconomic status had no effect on general or psychological violence (p>0.05), but pregnant women with lower socioeconomic status reported more episodes of physical/sexual violence (standardized coefficient, SC = -0.136; p = 0.021). This effect of socioeconomic status was indirect and mediated by low social support (SC = -0.075; p<0.001). Low social support was associated with more episodes of general, psychological and physical/sexual violence (p<0.001). General and psychological violence indistinctly affected pregnant women of different socioeconomic status. Physical/sexual violence was more common for pregnant women with lower socioeconomic status and lower social support. Better social support contributed to reduction of all types of violence. Results were nearly the same for the validation sample of Ribeirão Preto except that SES was not associated with physical/sexual violence.
Violence against pregnant women seems to be a more frequent situation than the obstetrical complications commonly investigated during prenatal care, such as gestational diabetes . Its rates range from 0.9% to 57.1% depending on the definitions and types of violence investigated, the methodologies used and on sociocultural differences [1–6]. In Brazil, the WHO Multi-Country Study On Women’s Health and Domestic Violence Against Women detected an 8% prevalence of abuse of pregnant women in São Paulo and an 11.1% prevalence in the Forest Zone of Pernambuco .
This cross-sectional study used data from the Brazilian Ribeirão Preto and São Luís birth cohort studies (BRISA), which investigated the etiological factors of preterm birth in the municipalities of São Luís (Maranhão/Brazil) and Ribeirão Preto (São Paulo/Brazil) in 2010 and 2011. In both municipalities, data were collected in a similar way.
The characteristics of the sample in São Luís are presented in Table 1. Of the interviewed women, 75% had completed 9 to 11 years of education. The percentages of pregnant women in families of economic class C and receiving less than one minimum wage were 68% and 5%, respectively. About 75% of the family heads had manual occupations.
In the BRISA prenatal cohort, psychometric analysis of the latent variables used to measure general, psychological and physical-sexual violence showed the same factor structure and invariant factor loadings in the São Luís and Ribeirão Preto samples.