Intimate partner violence among pregnant women seeking antenatal care in urban and rural public healthcare facilities in the Tshwane District

Abstract

BACKGROUND: Intimate partner violence (IPV) is recognised as a global public health and human rights concern with profound health implications. IPV has been identified as the most common type of violence that is perpetrated by men against their intimate partners. The primary objective of the study was to estimate the occurrence of IPV amongst pregnant women seeking antenatal care in one urban and one rural Community Health Centre (CHC), and to explore risk factors associated with IPV in pregnant women seeking antenatal care at these facilities. The urban Soshanguve and rural Kgabo Community Health Centres are located within the City of Tshwane Metropolitan Municipality in the Gauteng province of South Africa. METHODS: A cross-sectional facility-based study was conducted. A total sample of 361 pregnant women seeking antenatal care at the two CHC’s was selected for study by means of systematic random sampling. The number of study subjects from each of the two CHC’s was proportional to the average monthly antenatal attendances in that clinic. A questionnaire which included items on demographics and experiences of IPV was administered. Both univariate and multivariate odds of IPV exposure were estimated using logistic regression analysis. Ethical approval was obtained from the University of Pretoria’s ethics committee. RESULTS: The prevalence of reported IPV was 59% (95% CI: 0.49, 0.69) and 43% (95% CI: 0.37, 0.49) for the participants attending the rural Kgabo and urban Soshanguve CHC respectively. The most common type of violence reported across both sites was emotional violence; 53% for the rural CHC and 37% for urban the CHC. In the multiple logistic regression, being older than 24 years was found to be protective of emotional violence in urban Soshanguve CHC [OR=0.48 (95% CI: 0.25; 0.95) p=0.03]. Furthermore, the absence of a history of exposure to sexual violence was found to be protective of the various types of intimate partner violence in the urban CHC:  Emotional violence [OR=0.29; (95% CI: 0.10, 0.78) p=0.02].  Economic violence [OR=0.18; (95% CI: 0.04, 0.81) p=0.03]  Physical violence [OR=0.14; (95% CI: 0.04, 0.42) p=0.001]  Sexual violence [OR=0.096; (95% CI: 02, 0.46) p= 0.003] Abstaining from the use of alcohol was found to be protective of emotional violence in rural Kgabo than the urban Soshanguve CHC [OR=0.26; (95% CI: 0.08, 0.80) p=0.02]. Being in an intimate relationship with a male partner who does not use alcohol was also found to be protective of physical violence among respondents from urban Soshanguve [OR=0.31; (95% CI: 0.05; 0.81) p=0.01]. CONCLUSION: This was a facility based study as a result its findings cannot be generalised to the populations where these facilities are located. However, the study suggests extremely high levels of IPV among pregnant women residing in rural Winterveldt and Soshanguve urban township. The findings of this study are consistent with the reported high prevalence of intimate partner violence in South Africa. In addition, the findings of this study are in agreement with prior national and international research studies that have demonstrated that childhood exposure to sexual violence; and alcohol use by one or both partners are significantly associated with IPV later in a person’s life. It is important therefore, that the South African government and civil society organizations develop and implement a national violence prevention strategy, which will outline a coordinated response with a focus on effective primary prevention efforts that will be directed to the reduction of the occurrences of the associated risk factors. Secondary prevention could still play an important role in reducing the impact of early childhood violence. Thus early identification of the high risk factors can be used in support of interventions to reduce the burden of IPV.