Spousal violence increases risk of losing pregnancy

USF Health’s Amina Alio, PhD, was lead author of the new study in Lancet, finding a strong link between spousal violence and fetal loss.

Women victimized by spousal abuse are at significantly increased risk of losing at least one pregnancy.

A study of more than 2,500 women in Africa by the University of South Florida College of Public Health’s Amina Alio, PhD, and colleagues found that women who experience domestic violence of any kind were 50 percent more likely to have a least one episode of fetal loss (stillbirth or spontaneous abortion) than women reporting no partner violence. The findings were reported in the January 24, 2009 issue of the journal Lancet.

It is estimated that half of African women suffer abuse by their partners.

“Violence against women by their male intimate partners is a violation of human rights and an important public health problem worldwide,” said Dr. Alio, lead author and an assistant professor of Community and Family Health at the USF College of Public Health. “Our findings support the need to screen women in Africa for spousal violence not only during routine prenatal visits, but also following a miscarriage or stillbirth. These events signal a 50 percent probability that the woman is the victim of some sort of physical, emotional or sexual violence by a partner.”

The authors analyzed data from the Cameroon Demographic Health Survey. In the violence module of this survey, women were questioned about their experience of physical, emotional, and sexual violence inflicted by their spouses. Respondents were also asked about any stillbirths and spontaneous abortions. From detailed questions, violence was categorized into subtypes: (1) physical violence, including instances of pushing or shoving, throwing objects, slapping, arm twisting, punching, hitting with an object, kicking, dragging, attempting to strangle or burn, threatening with a weapon, and attacking with a weapon; (2) emotional violence, referring to verbal or physical public humiliation and verbal threat to the woman or her family; and (3) sexual violence, incorporating being forced to have sex or to undertake sexual acts. The authors included all women who responded to the violence module questions by referring to their “husband” or “spouse”.

Of the 2,562 women who responded to the violence module, those exposed to spousal violence (1307) were 50 percent more likely to experience at least one episode of fetal loss compared with women not exposed to abuse. Repeated fetal loss was associated with all forms of spousal violence, but emotional violence had the strongest association. If the prevalence of spousal abuse could be reduced to 50 percent, 25 percent, or eliminated completely, preventable excess recurrent fetal loss would be 17 percent, 25 percent, and 33 percent respectively.

“Spousal violence increases the likelihood of single and repeated fetal loss. A large proportion of risk for recurrent fetal mortality is attributable to spousal violence and, therefore, is potentially preventable,” the authors concluded. “Our findings support the idea of routine prenatal screening for spousal violence in the African setting, a region with the highest rate of fetal death in the world.”

Providing commentary for the study, Dr. Claudia Garcia-Moreno of the World Health Organization’s Department of Reproductive Health and Research in Geneva, Switzerland, wrote: “More support is needed for education and information for healthcare providers and the integration of intimate-partner violence and sexual violence into existing initiatives for maternal, infant, and child health. There is also a major need for more research on primary prevention interventions.”

Hamisu Salihu, MD, associate professor of epidemiology at the USF College of Public Health, and Philip Nana, MD, of the University of Yaounde in Cameroon were study co-authors.

– A news release by Lancet was used in this report.