Birth outcomes for women exposed to intimate partner violence during pregnancy: a prospective cohort study in Livingstone District, Zambia

Millions of women worldwide are impacted by the public health issue of intimate partner violence (IPV). The link between physical violence and unfavorable birth outcomes is still not well established. The objective was to examine the association between IPV exposure and birth outcomes with the use of Danger Assessment (DA) tool for physical violence for further analysis. This was a prospective cohort study involving 421 pregnant women undergoing prenatal care in Livingstone, Zambia. The pregnant women were recruited between weeks 6 and 24 of pregnancy, reassessed at week 34 to determine whether they had been exposed to violence different forms of IPV in pregnancy. Thereafter, they were evaluated immediately after delivery to estimate gestational age (GA) at delivery, newborn weight, APGAR score. Logistic regression analysis was used to examine the association between IPV exposure and birth outcomes after adjusting for relevant variables. In addition, those who experienced physical assault were further examined by the DA, a tool that is used to determine level of exposure risk that is on a scale of 1–20. Pregnancy-related IPV affected one-third of the women 129(29.5%) with Psychological violence at 100 (23.8%), Sexual violence at 32 (7.6%), financial violence at 7% (29) while Physical Violence as least with only 15 women(3.6%). Compared to other types of violence, only Physical IPV exposure increased the risk of of low birthweight (LBW) LBW 5.52 times higher than those who are not exposed; (AOR = 5.03; CI 95%: 1.41, 17.9) with a p-value of 0.013. Further more, from those that had a score of between 8 and 13 (increased danger) one had an abortion compared to those exposed to variable Danger who had only LBW outcome. However, preterm delivery and APGAR score were not associated with physical violence with a (AOR = 0.96; CI at 95%=(0.26,3.58) with a p-value of 0.954 and (AOR = 2.10; CI at 95%= 0.23, 19.0 with a p-value of 0.508 respectively. Physical violence exposes pregnant women to having LBW babies and the consequences are worse for those exposed to a higher risk of danger. The higher the risk of Danger, the more likely they are to lose pregnancies. The use of the DA to assess the risk of danger should be considered alongside other IPV interventions in Antenatal care which include adjustment to client flow to include administration of the DA and provision of skilled health personnel with strong collaborative systems in order to reduce the potential risk of LBW and abortions. However, given the small number of women disclosing violence due to barriers to disclosure in this setting, further research in needed with more women disclosing IPV and that the DA be tested for psychometric properties in the study setting.