Introduction
Domestic violence during pregnancy is considered a serious public health issue that affects the well-being of both mother and child. It encompasses physical, sexual, and/or emotional violence, which can lead to mental, sexual, physical health problems, among others, and may result in femicide
1
. Globally, according to the World Health Organization (WHO), one in three women has experienced physical or sexual violence from their partner. Similar figures are reported in the Americas, reaching up to 29.8%
2
. A 2013 meta-analysis, which reviewed 92 independent studies in 23 countries worldwide, revealed that the prevalence of violence during pregnancy is 19.8%
3
. In Peru, 22.5% of women are affected by violence, particularly those with an average age of 35, separated, with a lower educational level than their partner, and a lower wealth index
4
. In Peru, according to the Instituto Nacional de Estadística e Informática (INEI), in 2017, nearly a third of women experienced physical violence; the most common forms were pushing or throwing objects (26%), slapping (18.2%), and punching (15.3%)
5
. The consequences include health problems for children and economic strain on families, which also impacts society and the community
6
.
A 2022 study of pregnant women in Brazil found that violence was more common among women aged 20 to 29, with black or brown physical characteristics, incomplete primary education, and single civil status
7
. Barzola Macha MK, Moquillaza Alcántara VH, Diaz Tinoco“†” CM, Barzola Macha MK, Moquillaza Alcántara VH, Diaz Tinoco“†” CM; Violencia doméstica durante el embarazo en un hospital especializado del Perú: Prevalencia y factores asociados. Rev Chil Obstet Ginecol [Internet]. diciembre de 2020 [citado 6 de mayo de 2023];85(6):641-53. Disponible en: http://www.scielo.cl/scielo.php?script=sci_abstract&pid=S0717-75262020000600641&lng=es&nrm=iso&tlng=es
8
. Added to this are the behavioral and emotional disorders that children may develop growing up in a violent family environment
9
.
Finally, a multidisciplinary approach is required, with support from the Ministry of Women and Vulnerable Populations, as well as the engagement and commitment of other institutions such as the Judiciary, Public Ministry, and Ministry of Health, so that primary care personnel receive training, as they have the opportunity to detect and address violence at a crucial time: pregnancy
10
.
MATERIALS AND METHODS
Study Design
This article is an observational, analytical, cross-sectional, and retrospective study..
Study Population
The study universe consisted of the medical records of pregnant women from the Tablada de Lurín Maternal and Child Health Center in Lima during the period from 2020 to 2021. With a 95% confidence interval and 80% statistical power, matching two controls for each case, the final sample consisted of 659 pregnant patients who were randomly selected.
Main Research Variables
- Independent variable (IV): Age, marital status, educational level, number of children, previous illness.
- Dependent variable (DV):Domestic violence (no/yes).
Data Analysis Techniques
The analysis was performed using STATA v17.0 software. For the descriptive analysis, qualitative variables were summarized in proportions, and quantitative variables were presented as means and standard deviations. To measure the association of risk factors, crude prevalence ratios (PR) and adjusted prevalence ratios (aPR) were estimated using a Poisson regression model with robust variances. A 95% confidence level was used.
RESULTS
The final sample consisted of 659 pregnant women. The mean age was 27.95 years, with most being 18 years or older (96.05%). The predominant marital status was single motherhood (69.95%). A total of 80.42% had basic education, 15.02% had technical education, and only 4.55% had higher education. Pregnant women with more than four children accounted for 12.29%, and those with a previous illness were 10.17%. Domestic violence accounted for a total of 15.63% (Table 1).
Tabla 1. Sociodemographic characteristics of a sample of pregnant women
| Characteristics |
n |
% |
| Age |
(average = 27.95, s = 6.65) |
| 18 years and older |
606 |
92.0 |
| Younger than 18 |
53 |
8.0 |
| Marital status |
|
| Single |
461 |
70.0 |
| Cohabitant |
137 |
20.8 |
| Married |
61 |
9.3 |
| Level of education |
|
| Primary |
32 |
4.9 |
| Secondary |
388 |
58.9 |
| Technical higher education |
176 |
26.7 |
| University higher education |
63 |
9.6 |
| Number of children |
(average = 2.79, s = 0.42) |
| <= 2 |
320 |
48.6 |
| 3 a 4 |
258 |
39.2 |
| > 4 |
81 |
12.3 |
| Previous illness |
|
| No |
592 |
89.8 |
| Yes |
67 |
10.2 |
| Domestic violence |
|
| No |
556 |
84.4 |
| Yes |
103 |
15.6 |
| Total |
569 |
100.0 |
It was observed that pregnant women who had experienced domestic violence had a higher average age of 29.29 years compared to the average age (27.69 years) of those who did not experience domestic violence. Pregnant women with more than four children had a 30.42% higher exposure to domestic violence compared to mothers with two or fewer children (41.98 vs. 11.56; p<0.001) (Table 2).
In the bivariate analysis, it was found that pregnant women with more than four children had a 263% higher frequency of suffering domestic violence compared to those with two or fewer children (PR = 3.63; 95% CI: 2.44-5.39). Similarly, the highest percentage of abused pregnant women were those aged 30 years or younger, with an average age of 29.29 years (PR = 1.99; 95% CI: 1.005-2.008).
In the multivariate analysis, the observed association remained in terms of direction and magnitude; it was found that pregnant women with more than four children had a 239% higher frequency of suffering domestic violence compared to those with two or fewer children (aPR = 3.39; 95% CI: 2.24-5.12). This was adjusted for confounding variables such as categorized age, marital status, education level, and previous illnesses (Table 2).
Table 2. Factors associated with domestic violence
| Risk factors |
Without domestic violence |
With domestic violence |
Bivariate analysis |
Multivariate analysis |
| n |
% |
n |
% |
RP |
IC 95% |
RPa |
IC 95% |
| Age |
| 30 years or less |
511 |
84.3 |
95 |
15.7 |
Ref |
|
Ref |
|
| Over 30 years |
45 |
84.9 |
8 |
15.1 |
1.99 |
1.005 - 2.038 |
0.94 |
0.625 - 1.415 |
| Marital status |
| Single |
338 |
84.2 |
73 |
15.8 |
0.88 |
0.494 - 1.560 |
0.78 |
0.439 - 1.398 |
| Cohabitant |
118 |
86.1 |
19 |
13.9 |
0.77 |
0.390 - 1.516 |
0.75 |
0.390 - 1.428 |
| Married |
50 |
82.0 |
11 |
18.0 |
Ref |
|
|
|
| Level of education |
| Primary |
26 |
81.3 |
6 |
18.8 |
1.45 |
0.654 - 3.193 |
1.20 |
0.574 - 2.529 |
| Secondary |
322 |
83.0 |
66 |
17.0 |
1.31 |
0.883 - 1.947 |
1.13 |
0.762 - 1.675 |
| Higher |
208 |
87.0 |
31 |
13.0 |
Ref |
|
|
|
| Number of children |
| ≤ 2 |
283 |
88.4 |
37 |
11.6 |
Ref |
|
Ref |
|
| 3 a 4 |
226 |
87.6 |
32 |
12.4 |
1.07 |
0.688 - 1.672 |
1.07 |
0.665 - 1.716 |
| > 4 |
47 |
58.0 |
34 |
42.0 |
3.63 |
2.44 - 5.398 |
3.60 |
2.217 - 5.832 |
| Previous illness |
| No |
504 |
85.1 |
88 |
14.9 |
Ref |
|
Ref |
|
| Yes |
52 |
77.6 |
15 |
22.4 |
1.51 |
0.927 - 2.448 |
1.38 |
0.848 - 2.231 |
DISCUSSION
The prevalence of domestic violence was 15.63%, which was not similar to the results of a study conducted on postpartum women treated at the Instituto Nacional Materno Perinatal (INMP) from July to December 2019, where the percentage of domestic violence was 29.44%
11
. According to a systematic review that included 21 studies conducted in Latin America, the prevalence of violence among pregnant women varied widely, ranging from 3% to 44%. This may be due to the fact that pregnant women may hide their situation because of fears or threats from their partners; likewise, there is a lack of trained professionals to detect violence in this context
12
,
13
. Additionally, it was observed that women who experience violence often have difficulty recognizing it, as they tend to normalize it as something common in the patriarchal environment in which they are immersed
14
.
According to a study conducted among women of Chinese ethnicity, it was found that 44% of them experienced domestic violence
15
. In a study conducted in Peru, using the 2020 Demographic and Family Health Survey (ENDES), the prevalence was found to be 5.7%
16
. On the other hand, another study conducted among Peruvian women revealed that 29.44% experienced violence during pregnancy
17
.
In a systematic review that evaluated 60 longitudinal studies, it was found that the most important risk factor was unplanned pregnancy, which is reflected in the number of children, a finding that is consistent with our study, where it was observed that pregnant women with more than four children experienced domestic violence. Similarly, in our study, the percentage of pregnant women over 18 years old who were victims of violence was 15.96%, with an average age of 29.29 years. This result is significant in the bivariate analysis, with a PR of 1.99 and a CI of 1.005-2.038, which is compatible with another study conducted in Peru in 2019, where the average age of abused pregnant women was 31.31 years
18
. This highlights the importance of addressing this socioeconomic factor for the timely detection and prevention of violence. In our study, no association was found between marital status and the presence of domestic violence among pregnant women. This differs from findings in other studies: In a systematic review, it was concluded that being married is a protective factor against domestic violence in pregnant women
19
,
20
.
It was concluded that 15.6% of pregnant women suffered domestic violence. Pregnant women with more than four children had a 239% higher frequency of suffering domestic violence compared to women with two or fewer children, regardless of maternal age, marital status, educational level, or the presence of pre-existing illnesses. It is recommended that future studies explore, prospectively, both quantitative and qualitative evaluations regarding the nature of each influencing factor. Additionally, a more detailed description of domestic violence and its types is needed so that preventive strategies and programs can be developed to counter domestic violence among pregnant women.
Acknowledgements
As the corresponding author, I would like to thank the support of my co-authors, as well as my undergraduate doctors for their constant guidance in the preparation of this article. I would also like to express my gratitude to the Tablada de Lurín Maternal and Child Health Center for allowing us access to the database, and finally, to my family.
Conflict of interest statement
The authors declare that they have no conflict of interest.
