Domestic violence during pregnancy increases risk of early childhood mortality

Domestic violence towards mothers during pregnancy significantly raises the risk of death for their children during the earliest stages of childhood, according to a study of families in India conducted by researchers at the Johns Hopkins Bloomberg School of Public Health.

The risk of death was more than twice as high during the perinatal (28 weeks of pregnancy to the first seven days after birth) and neonatal (first month following birth) periods for children of mothers who experienced domestic violence during pregnancy as when compared to children of mothers who did not. The study is published in the August 2006 edition of the American Journal of Public Health.

"Our findings indicate that almost 1 in 5 perinatal and neonatal deaths could be prevented with the elimination of domestic violence, which compares favorably with other child survival interventions," said Saifuddin Ahmed, MBBS, PhD, lead author of the study and an assistant professor in the Department of Population and Family Health Sciences at the Bloomberg School of Public Health.

The study was conducted using data from two separate health surveys conducted among men and women living in Uttar Pradesh, a poor state in northern India with high levels of both domestic violence within marriage and early childhood mortality. The men's survey included data related to incidents of domestic violence, whereas while the women's survey included data on infant and child mortality. From the surveys, the researchers matched data for 5,553 married couples and then analyzed the outcomes of 2,199 pregnant women.

According to the results, nearly 18 percent of the study participants were physically abused by their husbands during their most recent pregnancy. In comparison, the prevalence of domestic violence during pregnancy in the United States has been estimated at between 4 percent and 8 percent.

After controlling for sociodemographic and maternal heath factors, the researchers found that the mortality risk during both the perinatal and neonatal periods more than doubled for offspring of mothers who experience domestic violence. However, the researchers did not find any significant associations between domestic violence and mortality in later stages of early childhood. According to the researchers, domestic violence may elevate mortality risk through direct injury to the fetus during pregnancy, by negatively affecting the mother's stress and nutritional levels, or by deterring the mother from seeking appropriate health care.

"Our results underscore the need for public education and awareness programs in developing countries such as India that highlight the serious and negative consequences of domestic violence, not only for women but for their children as well. The prevention of domestic violence may be an important, but largely overlooked, intervention for improving child survival in such settings," said Michael A. Koenig, PhD, co-author of the study and an associate professor in the Bloomberg School's Department of Population and Family Health Sciences.

"Effects of Domestic Violence on Perinatal and Early-Childhood Mortality: Evidence from North India" was written by Saifuddin Ahmed, MBBS, PhD, Michael A. Koenig, PhD and Rob Stephenson, PhD. Stephenson is with the Rollins School of Public Health, Emory University.

The research was supported by a grant from the National Institute of Child Health and Development.