Intimate partner violence among pregnant women and women attending out-patient services in Thailand : a longitudinal study

Abstract

Introduction"Intimate partner violence refers to any behaviour within an intimate relationship that causes physical, psychological or sexual harm to those in that relationship. It includes acts of physical aggression, psychological abuse, forced sexual intercourse or any other controlling behaviour." (Krug, Dahlberg, Mercy, Zwi & Lozano, 2002).Surveys in the health care setting in Thailand found among pregnant women, 13.1% report ever been abused (Thananowan & Heidrich, 2008), 34% had been exposed to violence (Chatchawawit, 2008), 26.6% had experienced threats and physical violence (Saito, Creedy, Cooke & Chaboyer, 2013), and among postpartum women, 9.5% had been subjected to threats and physical violence in Thailand (Saito, Creedy, Cooke & Chaboyer, 2012). Few studies, mostly during pregnancy and the postpartum period studied intimate partner violence (IPV) longitudinally (Escriba-Aguir, Royo-Marques, Artazcoz, Romito & Ruiz-Perez, 2013). For example, Groves, McNaughton-Reyes, Foshee, Moodley and Maman (2014, p.9) found the "mean trajectory for physical and psychological partner violence was flat which suggests that, on average, there was not a significant change in the levels of IPV over pregnancy and the first 9 months postpartum." In Sricamsuk's (2006) cohort study in Koen Khaen in Northern Thailand the prevalence of psychological, physical and sexual violence reduced from 53.7% psychological, 26.6% physical and 19.2% sexual violence during pregnancy to 35.4% psychological, 9.5% physical and 11.3% sexual violence at 6 weeks postpartum.Several studies found that the majority of IPV victims, including those with mental health problems, do not seek assistance from health care or other community agencies (Ali, Mogren & Krantz, 2013; Nikbakht Nasrabadi, Hossein & Abbasi, 2014). For example, 80%-90% of women who experienced in Thailand had never accessed community agencies such as health care services or the police (Archavanitkul, Kanchanachitra, Im-Em & Lerdsrisantad, 2003).The aim of this study was to assess the change of IPV severity over time, among pregnant women and women attending out-patient services who screened positive IPV.DesignA longitudinal prospective study of 207 abused pregnant women and women attending out-patient services who assessed positive for physical, emotional or sexual abuse within the preceding 12 months in eight hospitals in Nakhon Pathom and one hospital in Samut Sakhon Province, Thailand. The women were informed that they would be contacted for interviews beginning 2, 4 and 6 months post delivery or post baseline assessment.ProceduresAfter informed consent a female research assistant screened (see below 3 questions) pregnant women when attending an antenatal care clinic visit and women attending out-patient services (18-49 years) for partner violence. For the woman who is positive for abuse, by responding "yes" to questions 1 or 2 or 3 on the Abuse Assessment Screen:1. During the last 12 months, have you been pushed, shoved, slapped, hit, kicked or otherwise physically hurt by someone? Yes___No___; IF Yes, by whom_____2. During the last 12 months, have you been emotionally or morally abused by someone? Yes_No_; IF Yes, by whom_____3. During the last 12 months, have you been forced into sexual activities by someone?Yes_No_; IF Yes, by whom_Every woman (18 years or older) who has screened positive on the Abuse Screen for intimate partner (i.e., spouse/common-law, ex-spouse/ex-common-law, boyfriend/girlfriend, or ex-boyfried/ex-girlfriend) physical or emotional or sexual abuse occurring within the preceding 12 months was verbally administered a structured questionnaire. The researcher adhered strictly to the research principles with regard to research on violence against women (World Health Organization, 1999) such as the safety of respondents and the researcher, and protecting confidentiality to ensure the women's safety and data quality. …