PREVALENCE AND ASSOCIATED FACTORS OF DOMESTIC VIOLENCE AMONG PREGNANT WOMEN ATTENDING ANC CLINIC OF HEALTH INSTITUTIONS IN EASTERN TERAI, NEPAL Presenter: Diwash Timilsina 3/14/2015 1
Jul 15, 2015
PREVALENCE AND ASSOCIATED FACTORS OF
DOMESTIC VIOLENCE AMONG PREGNANT
WOMEN ATTENDING ANC CLINIC OF HEALTH
INSTITUTIONS IN EASTERN TERAI, NEPAL
Presenter: Diwash Timilsina
3/14/2015 1
INTRODUCTION
Domestic violence is defined by United Nation as violence
occurring within the private sphere, generally between individuals
who are related through intimacy, blood or law
Domestic violence includes physical acts of violence within the
family, sexual coercion, psychological abuse/ threats and
economic control over resources
Domestic violence against women (DVAW) during pregnancy is
serious public health problem worldwide [1]
Result of overall inferior status of women and girls and of
unequal power relation between genders
Cause adverse health consequences for both the mother and
fetus3/14/2015 2
PROBLEM STATEMENT
Globally, one on every three women is beaten, raped
and otherwise abused during lifetime [2]
South East Asian Region has one of the highest
prevelance of Gender based Violence in the world [3]
The terai belt of Nepal accounts for 9 percent of all GBV
during pregnancy [4]
Violence during pregnancy leads to miscarriage and
Low birth weight babies along with depression and
substance abuse among pregnant women [5]
3/14/2015 3
RATIONALE
Studies on South Asia suggest that a significant proportion of
women are physically abused during pregnancy. [6]
Nepal demographic and health survey of 2011 shows that
the Terai Region has one of the highest proportions of
gender based Violence during pregnancy in comparison to
other region. [7]
A study conducted at Karachi, Pakistan in the postnatal
wards of public tertiary hospital shows 23 percent faced
violence during the pregnancy, over half (55%) of the women
believed that antenatal care clinics were a good time to
enquire about domestic violence during pregnancy. [8]
3/14/2015 4
Research question
What is the prevalence and associated factors of
gender based domestic violence among pregnant
women in eastern terai?
3/14/2015 5
OBJECTIVES
General objective
To identify the prevalence and associated factors of gender
based domestic violence among pregnant women attending
ANC clinic at health institutions
Specific objectives
To identify period prevalence rate of GBDV
To determine the proportion of different forms of GBDV
experienced by pregnant women
To identify the association between demographic
characteristics and GBDV experienced by pregnant women
To identify the association between type of violence and
perpetrators of GBDV during pregnancy
3/14/2015 6
METHODOLOGY OF STUDY
Study design
Analytical cross-sectional study
Both qualitative and quantitative data were included
Study area
Sunsari and Siraha among five districts of eastern terai
region
Study population
Pregnant women attending antenatal clinic at health
institutions
Sampling method
Purposive sampling
3/14/2015 7
Methodology cont…
Sample size
P= 0.33 (percentage of pregnant women experiencing GBV at
Paropakar Maternity and Women’s Hospital by Chaudhary P, et
al, 2010)
q= 0.67
d= 7%, z= 1.96
n= (Z) 2.p.q/ (d) 2
n= (1.96)2* 0.33*0.67/ (0.07)2
n= 174
Design effect (DE): 1.2% 208
Non response rate (NRR): 20%
Required population sample (N) = 1.2*174+20%of 174
= 242
3/14/2015 8
Methodology cont…
Sampling Frame
Data collected from District hospital, Primary Health
Care Centre and health posts selected purposively
from each district
Data collection tools
quantitative study - a structured questionnaire for face
to face interview
qualitative study - case study guideline was prepared
for in-depth interviews
Inclusion criteria
Pregnant (4 weeks to 40 weeks of gestation) attending
antenatal clinic
3/14/2015 9
Methodology cont…
Exclusion Criteria
Pregnant who didn’t attended ANC at health institutions and
uncooperative respondents
Data management and analysis
Raw data entered in epi-data and analyzed in SPSS version
16.0
Quantitative analysis
Descriptive statistic and Inferential statistic
Qualitative analysis
case study
Ethical consideration
Approval from department of Public Health, Pokhara
University
Approval from DHOs
Written /verbal consent from each participants 3/14/2015 10
RESULTS
Period prevalence rate
Among sample size of 242 pregnant women, only 215 pregnants with mean age of twenty-four had participated
A total of 144 (67%) respondents out of 215 experienced violence during their pregnancy
Period Prevalence rate was 18.3% (Data from October 21 to November 25, 2013 was calculated and Total pregnant women at the data collection period = 786)
3/14/2015 11
Proportion of different forms of GBDV
experienced by pregnant women
Forms of Violence Frequency (n=144) Percentage
(among violated
cases)
Physical 68 47.22
Psychological 127 88.19
Sexual 88 61.11
Economical 73 50.69
Note: Total percentage exceeds 100 due to multiple answers of the respondents 3/14/2015 12
Demographic
characteristicsExperience of GBDV
(%)
Total P- value
Yes No
Age 15-19 16 (51.61) 15 (48.39) 31 (100)
0.005
20-24 61 (61.61) 38 (38.39) 99 (100)
25-29 35 (71.14) 14 (28.57) 49 (100)
30+ 32 (88.89) 4 (11.11) 36 (100)
Caste/Ethnicity Dalit 35(58.33) 25 (41.67) 60 (100)
0.028
Dis. janajati 22 (75.86) 7 (24.14) 29 (100)
Dis. non-terai
caste
38 (58.46) 27 (41.54) 65 (100)
Muslim/
Choroute
36 (83.72) 7 (16.28) 43 (100)
Adv.
Janajatis +
upper caste
13 (72.22) 5 (27.73) 18 (100)
Religion Hindu 109 (63.00) 64 (36.00) 173 (100) 0.012
Muslim 35 (83.33) 7 (16.67) 42 (100)
Association between demographic characteristics
and GBDV experienced by pregnant women
3/14/2015 13
Demographic
characteristicsExperience of GBDV
(%)
Total P- value
Yes NoDuration of
marriage
(complete
years)
1-5 79 (58.10) 57 (41.90) 136 (100)
0.003
6-10 40 (78.43) 11 (21.57) 51 (100)
11-15 13 (86.66) 2 (13.34) 15 (100)
15+ 7 (58.33) 5 (41.67) 12 (100)
Frequency of
pregnancy
One time 46 (54.76) 38 (45.23) 84 (100)
<0.001
Two times 40 (61.53) 25 (38.47) 65 (100)
Three times 31 (83.78) 6 (16.22) 37 (100)
Four and more
times
24 (82.75) 5 (17.26) 29 (100)
Education
status
Illiterate 47 (78.33) 13 (21.67) 60 (100)
0.028Literate 97 (62.58) 58 (38.42) 155 (100)
Association between demographic characteristics
and GBDV experienced by pregnant women
3/14/2015 14
Narrations of violated respondents
• “My mother-in-law acts very rude (curur) to me. She often beat, pull my hair
(kapal luchaichai) and slap me whether I commit mistake or not. I, am hated
daughter-in-law compared to other because I came with less dowry
(dahej)……my husband could not say anything against his parents.”
- 22 years women from Inurwa, Sunsari
• “I have two daughters, aged two years and three and half years. My father and
mother in laws argue with me and my husband that they want grandson (pota)
from us. If I have daughter this time, he (gharwala) will bring another wife
(sautin). I, am mentally disturbed……..”
- 26 years women from Dhodna VDC, Siraha
• “I’ am only seventeen years old and I have to marry against my will when my
father decided…..I found myself pregnant after six month of marriage. The day
my family members knew of my pregnancy, they are expecting a son (ladka)
from me. I’ am worried if I give birth to a girl (ladki)…….I have seen that the
status of mother who give birth to a girl is not good (achha) in our society
(samaj).” - 17 years women from Bastipur VDC, Siraha
3/14/2015 15
Narrations cont…
“He wanted to have intercourse time to time though I’ am pregnant. A week ago, he got visa to Saudi. As usual he came home drunk and wanted to have sex. I slept turning my face to other side. He tried to scroll me and forcefully turned me over to him. I denied several times before also. But, that night he was insisting saying “i, am leaving home soon, I will return after long so you should….”I got out of bed and tried to make him understand that I, am 7 months pregnant and our unborn child will be at risk. He slapped me badly on my cheek. I also punched him and pushed him away. Then he pulled my hair and threw me on the floor………. (weeping)”
- 32 years women from Harinagra VDC, Sunsari
3/14/2015 16
Associative characteristics of violence
categories with husband
Types of violence Husband (%) Total (%) P value
Yes No
Physical
Yes
No
58 (85.29)
63 (43.45)
10 (14.71)
84 (57.93)
68 (100)
145 (100)
<0.001
Psychological
Yes
No
105 (82.68)
15 (17.00)
22 (17.32)
73 (83.00)
127 (100)
88 (100)
<0.001
Sexual
Yes
No
82 (93.18)
34 (26.77)
6 (6.82)
93 (73.23)
88 (100)
127 (100)
<0.001
Economic
Yes
No
58 (79.45)
62 (43.66)
15 (20.55)
80 (56.34)
73 (100)
142 (100)
<0.001
3/14/2015 17
Associative characteristics of violence
categories with father-in-law
Types of violence
Father-in-law (%) Total (%) P value
Yes No
Physical
Yes
No
26 (38.24)
30 (20.41)
42 (58.26)
117 (79.59)
68 (100)
147 (100)
0.006
Psychological
Yes
No
53 (41.73)
6 (6.82)
74 (58.27)
82 (93.18)
127 (100)
88 (100)
<0.001
Sexual
Yes
No
37 (42.00)
19 (14.96)
51 (58.00)
108 (85.04)
88 (100)
127 (100)
<0.001
Economic
Yes
No
23 (31.51)
33 (23.24)
50 (68.49)
109 (76.76)
73 (100)
142 (100)
0.191
3/14/2015 18
Associative characteristics of violence
categories with mother-in-law
Types of violence Mother-in-law (%) Total (%) P value
Yes No
Physical
Yes
No
40 (58.82)
36 (24.49)
28 (41.18)
111 (75.51)
68 (100)
147 (100) <0.001
Psychological
Yes
No
72 (56.70)
6 (6.82)
55 (43.30)
82 (93.18)
127 (100)
88 (100)
<0.001
Sexual
Yes
No
46 (52.27)
30 (23.62)
42 (47.73)
97 (76.38)
88 (100)
127 (100)
<0.001
Economic
Yes
No
37 (50.68)
39 (27.46)
36 (49.32)
103 (72.54)
73 (100)
142 (100)
0.001
3/14/2015 19
Associative characteristics of violence
categories with brother-in-law
Types of violence Brother-in-laws (%) Total (%) P value
Yes No
Physical
Yes
No
8 (11.76)
5 (3.40)
60 (88.24)
142 (96.60)
68 (100)
147 (100) 0.017
Psychological
Yes
No
11 (8.66)
7 (7.95)
116 (91.34)
81 (92.05)
127 (100)
88 (100)
0.053
Sexual
Yes
No
6 (6.81)
7 (5.51)
82 (93.19)
120 (94.49)
88 (100)
127 (100)
0.693
Economic
Yes
No
8 (10.96)
5 (3.52)
65 (89.04)
137 (96.48)
73 (100)
142 (100)
0.036
3/14/2015 20
Associative characteristics of violence categories with
community people
Types of violence Community people (%) Total (%) P value
Yes No
Physical
Yes
No
6 (8.57)
6 (4.13)
62 (91.42)
139 (95.87)
68 (100)
145 (100)
0.185
Psychological
Yes
No
12 (9.45) 115 (90.55)
88 (100)
127 (100)
88 (100)
NA
Sexual
Yes
No
8 (9.10)
4 (3.15)
80 (90.90)
123 (96.85)
88 (100)
127 (59.1)
0.062
Economic
Yes
No
6 (8.22)
6 (4.23)
67 (91.78)
136 (95.77)
73 (100)
142 (100)
0.227
3/14/2015 21
DISCUSSION
Period prevalence rate calculated to be 18.23%, similar to
finding of study conducted at Persa district in 2010 which
was 19%. [6] Could be due to Similar location
The rate of physical violence reaches 47.22 % is less to
the rate of study done in formal settlement of Uganda
(68%), many of these women who have been worse
affected, they were poor, not educated and
disadvantaged. This study prevalence is nearly double
compared to the prevalence of 23% reported in a
study at Karachi Pakistan which concluded pregnancy
does not initiate risk of violence. [7,8]
3/14/2015 22
Discussion cont…
Among sexually violated women, most of them suffered
from forced sexual intercourse during pregnancy, similar
to the study conducted at Kathmandu (2005). [9] Alcoholic
husband and sexual depression of husband was
linked
Statically significant association was found between
GBDV and age of respondent, duration of marriage
and frequency of pregnancy as similar to the study
conducted in Karachi, Pakistan (2006). Increase in the
age and duration of marriage may enhance probability
of violence due to longer contact period… increase
in frequency of pregnancy may be cause of violation
due to previous history of giving birth to daughter3/14/2015 23
Discussion cont…
Perpetrators as husband and mother-in-law were found
to be associated with all types of violence to pregnant.
Most of the time the pregnant were staying in
contact with either husband or mother-in-law, may
be due to this, they are often being violated
Community people were also involved in the violence
somewhere the study area but they were not associated
with experience of violence by pregnant. Pregnant
women are at risk in their own home
3/14/2015 24
CONCLUSION
More than two-third of the respondents experienced violence during pregnancy at their home
Among violated respondents, majority of the respondents experienced emotional/psychological violence followed by sexual, economic and physical violence
Increase in the marriage duration of women enhanced experience of violence during pregnancy (statically associated)
• Muslim/chouroute had the highest experience of violence followed by dis. Janajati (caste/ethnicity statically associated)
3/14/2015 25
Conclusion cont…
Women experienced more violation in multiple
pregnancies (frequency of pregnancy statically
associated)
Perpetrators like husband and mother-in-law were mostly
involved in all type of violence studied, was statically
associated with experience of GBDV by pregnants.
Though somewhere community people were also involved
in violence to pregnant women but they did not show
statically significant association in violence experience by
women3/14/2015 26
Recommendation
Further exploratory study/research is needed to
understand the scale and determinants of GBDV among
pregnant women in eastern terai
Violence reporting shell should be established in the
study area and the cases should be promoted to report
Mass message of gender equality and women
empowerment should be widespread in the study area
Similar study findings should be used by health planners
and policy makers in understanding the importance of
screening for domestic violence before and during
pregnancy if we are to reduce or prevent the burden of
violence faced by pregnant women in the study area
3/14/2015 27
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THANK – YOUFor your attention!!!
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