Date Published: July 20, 2017
Publisher: Public Library of Science
Author(s): Andrew Gibbs, Bradley Carpenter, Tamaryn Crankshaw, Jill Hannass-Hancock, Jennifer Smit, Mark Tomlinson, Lisa Butler, Susan Marie Graham.
Intimate partner violence (IPV) experienced by pregnant and post-partum women has negative health effects for women, as well as the foetus, and the new-born child. In this study we sought to assess the prevalence and factors associated with recent IPV amongst post-partum women in one clinic in eThekwini Municipality, South Africa, and explore the relationship between IPV, depression and functional limitations/disabilities. Past 12 month IPV-victimisation was 10.55%. Logistic regression modelled relationships between IPV, functional limitations, depressive symptoms, socio-economic measures, and sexual relationship power. In logistic regression models, overall severity of functional limitations were not associated with IPV-victimisation when treated as a continuous overall score. In this model relationship power (aOR0.22, p = 0.001) and depressive symptoms (aOR1.26, p = 0.001) were significant. When the different functional limitations were separated out in a second model, significant factors were relationship power (aOR0.20, p = 0.001), depressive symptoms (aOR1.20, p = 0.011) and mobility limitations (aOR2.96, p = 0.024). The study emphasises that not all functional limitations are associated with IPV-experience, that depression and disability while overlapping can also be considered different drivers of vulnerability, and that women’s experience of IPV is not dependent on pregnancy specific factors, but rather wider social factors that all women experience.
IPV during pregnancy and in the post-partum period is relatively common globally . The prevalence of IPV during pregnancy varies widely across settings. A review of studies in Africa found IPV prevalence during pregnancy ranging from 2% to 57%, with a meta-analysis estimating an overall prevalence of 15.23%, which included physical, sexual and emotional violence . In a clinic setting in Durban, South Africa, 5.2% of women in antenatal care experienced physical and/or sexual IPV in the past year . However, this is a relatively low rate of reporting given the wider prevalence of IPV in South Africa [4, 5], where population-based studies show lifetime physical IPV-victimisation prevalence of 33%, with a past-year prevalence of 13% .
Between January 2015 and March 2015, women presenting for post-natal care at the clinic were consecutively recruited and screened for eligibility. Of 346 women approached, all agreed to be screened, of whom 310 (89.6%) met study eligibility criteria. Of those eligible, 25 (8.1%) refused to participate in the study citing lack of time. An additional 10, who initially agreed to participate, did not complete the interviews for a variety of reasons including being referred to another clinic during the study visit and thus not completing interviews, and lack of time.
Recent IPV in postpartum women in this sample was relatively high at 10.55%. This is higher than a study by Groves, McNaughton-Reyes  in South Africa which reported that 5.2% experienced physical and/or sexual IPV during pregnancy and in the post-partum period. However, this is lower than the estimated prevalence of IPV experienced by pregnant women in Africa of 15.23%, although this estimate also included emotional violence which is more commonly reported . However, the rates of violence, while similar to population-based estimates in South Africa , is also relatively low, given that the clinic served a large informal settlement, and studies suggest women living in informal settlements are at high risk of experiencing IPV .
Few studies have explored the relationship between IPV, depression and disability. This analysis highlights the complex relationship between these issues and raises questions about how to conceptualise and analyse these relationships. First, it showed that while there was a close overlap between depression and disability in the study, they also appeared to be distinct in their relationship to IPV-victimisation. Second, it highlighted that not all forms of disability appeared to place women at risk of IPV-victimisation, but rather it was specific forms of disability, in this case mobility limitations that were associated to women’s vulnerability. As such, research needs to follow women over time to understand the interaction of depression and disability. Analysis also needs to disaggregate effects via disability types to understand when and how different functional limitations may impact on IPV-victimisation.