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- Pun, Kunta Devi, et al.
(author)
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Community perceptions on domestic violence against pregnant women in Nepal : a qualitative study
- 2016
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In: Global Health Action. - : Taylor & Francis Group. - 1654-9716 .- 1654-9880. ; 9, s. 1-13
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Journal article (peer-reviewed)abstract
- Background: Globally, knowledge of health sector options to respond to domestic violence during pregnancy is increasing, but this topic is under-investigated in Nepal. This gap affects the provision of adequate antenatal care services and understanding of factors that influence women's willingness and ability to use available services. It is critical to know more about the social norms in a community that promote and prevent women experiencing domestic violence from seeking antenatal care. Objective: To explore community perceptions of domestic violence against pregnant women. Methods: A qualitative study was conducted in Dhulikhel municipality, involving 41 men and 76 women in 12 focus group discussions in different gender and family role separated groups. The interviews were recorded, transcribed in verbatim, and analyzed using content analysis. A socio- ecological model was used as a theoretical framework to illustrate linkages between individual, relationship, community, and societal influences on perceptions of domestic violence during pregnancy. Results: The community recognized different forms of violence during pregnancy threatening women's physical and psychological health and presenting obstacles to seeking antenatal care. Some types of culturally specific violence were considered particularly harmful, such as pressure to give birth to sons, denial of food, and forcing pregnant women to do hard physical work during pregnancy, which may leave daughters- in-law vulnerable to domestic violence in extended families. A culture where violence is normalized and endurance and family reconciliation are promoted above individual health was perceived to cause women to tolerate and accept the situation. Participants suggested actions and strategies to address continuing violence, which indicated a societal transition toward increased awareness and changing attitudes and practices. Conclusions: Domestic violence during pregnancy needs to be addressed at different levels in Nepal, where women are often dependent on others for access to health care. Social norms were perceived to be shifting toward reduced acceptance of violence against women, but restrictions on women's life options, movement, and decision-making authority were still considered impediments to pregnant women's health.
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| 2. |
- Pun, Kunta Devi, et al.
(author)
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Domestic violence and perinatal outcomes - a prospective cohort study from Nepal
- 2019
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In: BMC Public Health. - : BioMed Central. - 1471-2458. ; 19
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Journal article (peer-reviewed)abstract
- Background: Domestic violence is one of the most common forms of violence against women. Domestic violence during pregnancy is associated with adverse perinatal and maternal outcomes. We aimed to assess whether domestic violence was associated with mode of delivery, low birthweight and preterm birth in two sites in Nepal. Methods: In this prospective cohort study we consecutively recruited 2004 pregnant women during antenatal care at two hospitals between June 2015 and September 2016. The Abuse Assessment Screen (modified) was used to assess fear and violence. Having ever experienced either fear or violence was defined as any domestic violence. Obstetric outcomes were obtained from hospital records for 1381 (69%) women, selecting singleton pregnancies only. Mode of delivery was assessed as birth by cesarean section or not. A birthweight of less than 2500g was defined as low birthweight and preterm birth as birth before completion of 37weeks gestation. Descriptive and multiple logistic regression analyses were performed to assess associations. Results: Twenty percent of the women reported any domestic violence. Among all 1381 women, 37.6% gave birth by cesarean section. Of those women who delivered by cesarean section, 84.7% had an emergency cesarean section. Less than 10% of the babies were born prematurely and 13.5% were born with low birthweight. We found no significant association between exposure to any domestic violence during pregnancy and risk of a low birthweight baby or birth by cesarean section. However, having experienced both violence and fear was significantly associated with giving birth to a preterm infant [aOR 2.33 (95% CI;1.10-4.73)]. Conclusions: Domestic violence is common in Nepal. This is a potential risk factor for severe morbidity and mortality in newborns. We found that the risk of having a preterm baby was higher for pregnant women who experienced both fear and violence. This should be recognized by the health sector. In this study, no significant differences were found in the rate of cesarean section nor low birthweight for women who had experienced any domestic violence compared to those who did not.
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| 3. |
- Pun, Kunta Devi, et al.
(author)
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Exposure to domestic violence influences pregnant women's preparedness for childbirth in Nepal : A cross-sectional study
- 2018
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:7
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Journal article (peer-reviewed)abstract
- Objective: This study aimed to evaluate if domestic violence affected women's ability to prepare for childbirth. Birth preparedness and complication readiness (BP/CR) includes saving money, arranging transportation, identifying a skilled birth attendant, a health facility, and a blood donor before childbirth. During data collection, Nepal experienced two earthquakes and therefore it was possible to examine associations between domestic violence, women's BP/CR and effects of the earthquakes.Methods: Women who were between 12 and 28 weeks of gestation participated in a descriptive crosssectional study at a hospital antenatal clinic in Nepal, where they completed a structured questionnaire on sociodemographic characteristics, obstetric history, experiences of domestic violence, and BP/CR. The 5-item Abuse Assessment Screen was used to assess prevalence of domestic violence, and a questionnaire on safe motherhood obtained from Jhpiego was used to assess BP/CR status. The participants self-completed the questionnaire on a tablet computer. Those who reported at least three out of five BP/CR activities were considered prepared for childbirth.Results: A total of 1011 women participated in the study: 433 pre-earthquakes and 578 post-earthquakes. With respect to BP/CR, 78% had identified a health facility for childbirth and 65% had saved money prior to childbirth. Less than 50% had identified a birth attendant to assist with the delivery, transportation to a health facility, or arranged for a potential blood donor. Prior to the earthquakes, 38% were unprepared; by contrast, almost 62% were not prepared after the earthquakes. A significant association was found between exposure to violence and not being prepared for childbirth (AOR = 2.3, 95% CI: 1.4-3.9). The women with increased odds of not being prepared for childbirth were illiterate (AOR = 9.9, 95% CI: 5.7-17), young (AOR = 3.4, 95% CI: 1.6-7.2), from the most oppressed social classes (AOR = 3.0, 95% CI: 1.2-7.6), were married to illiterate husbands (AOR = 2.5, 95% CI: 1.2-5.2), had attended fewer than four antenatal visits (AOR = 2.0, 95% CI: 1.4-2.6), had low incomes (AOR = 1.7, 95% CI: 1.1-2.9) or lived in rural settings (AOR = 1.5, 95% confidence interval CI: 1.2-2.1).Conclusion: The paper identifies vulnerable women who require extra care from the health system, and draws attention to the need for interventions to reduce the harmful effects of domestic violence on women's preparations for childbirth.
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| 4. |
- Pun, Kunta Devi, et al.
(author)
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'Violence exists to show manhood' : Nepali men's views on domestic violence - a qualitative study
- 2020
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In: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 13:1
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Journal article (peer-reviewed)abstract
- BackgroundThere is significant evidence of the prevalence and factors associated with domestic violence in high and low-income country settings. However, men’s views on domestic violence are still understudied and have never been reported in Nepali society.ObjectiveThe aim of the study was to explore Nepali men’s perceptions regarding domestic violence in their communities.MethodThe authors undertook a qualitative study using focus group discussions.ResultsSixty-six married men, considered they were responsible for upholding family discipline and physically demonstrating their masculinity, and they suggested that violence was a mean for achieving this. Men’s frustration when unable to fulfil their family’s expectations or material needs, and cultural attitudes that precluded interference in other families’ lives, were perceived as factors contributing to domestic violence. The men held the opinion that women also perpetrated domestic violence. Some men were reluctant to accept domestic violence as a norm in Nepali families and were aware of recent changes in societal expectations regarding gender roles.ConclusionOverall, the Nepali men who participated in the study held different and sometimes opposing views on domestic violence, ranging from violence justified as a necessity for family discipline, uneasy acceptance that violence was commonplace in families, to definite opposition to the use of domestic violence. The study’s findings provide information for identifying points of intervention for violence-prevention efforts and strategies to alter the social and cultural norms that lead to acceptance of domestic violence.
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| 5. |
- Rishal, Poonam, et al.
(author)
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Improving Safety Among Pregnant Women Reporting Domestic Violence in Nepal - A Pilot Study
- 2020
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In: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 17:7, s. 1-13
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Journal article (peer-reviewed)abstract
- Introduction: Domestic violence (DV) during pregnancy is associated with poor health outcomes for both the mother and newborn, and sometimes death. In a low-income country like Nepal, women have few options to leave abusive situations. Therefore, there is a need for interventions to improve their safety. The aim of our study was to explore the use of safety measures before and after an educational intervention among women who have reported DV during pregnancy. Materials and methods: Of 1010 pregnant women screened consecutively for DV using the Abuse Assessment Screen (AAS) during routine antenatal care, 181 women reported domestic violence. All 1010 participating pregnant women were taught 15 safety measures using a locally developed flipchart. We obtained contact with 80 of the 181 eligible women postpartum, of whom 62 completed the follow-up assessment. We explored and described the use of safety measures at baseline and follow-up, using a standardized instrument called the Safety Behavior Checklist. Results: At follow-up, less than half of the women (n = 30, or 48.3%) reported any form of DV. Of the women who reported DV at follow-up, significantly more reported the experience of both violence and fear at baseline (21.9%, p = 0.01) compared with the women who did not report DV at follow-up (3.3%, p = 0.01). Women reporting DV at baseline and follow-up used more safety measures at baseline (56) and follow-up (80) compared with women reporting DV at baseline only (36 and 46). Women reporting DV at baseline and follow-up used more safety measures for the first time at follow-up, 57 new measures compared with the 28 new measures used by women reporting DV at baseline only. Conclusions: The use of a flipchart teaching session on safety measures within antenatal care may increase the number of safety measures women use to protect themselves during pregnancy and decrease the risks of adverse health effects of DV.
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| 6. |
- Rishal, Poonam, et al.
(author)
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Prevalence and associated factors of domestic violence among pregnant women attending routine antenatal care in Nepal
- 2018
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In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 46:8, s. 785-793
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Journal article (peer-reviewed)abstract
- Aims: The primary aim of this study was to assess the prevalence of domestic violence (DV) and its associated factors among pregnant women in Nepal. The secondary aims were to investigate disclosure of DV by women to health-care personnel and to assess whether health-care personnel had asked women about their experience of DV.Methods: This cross-sectional study included 2004 pregnant women between 12 and 28 weeks of gestation attending routine antenatal care at two hospitals in Nepal from August 2014 to November 2015. In this study, DV was defined as fear of a family member and/or an experience of physical, emotional or sexual violence. Associated risk factors were analysed using logistic regression analyses.Results: Twenty-one per cent of the women had experienced DV; 12.5% experienced fear only, 3.6% violence only and 4.9% experienced both violence and fear. Less than 2% per cent reported physical violence during pregnancy. This study found that just 17.7% had ever been asked by health-care personnel about DV, and of the women who had reported DV, only 9.5% had disclosed their experience to health-care personnel. Women of young age and low socio-economic status were more likely to have experienced DV. Women who reported having their own income and the autonomy to use it were at significantly lower risk of DV compared to women with no income.Conclusions: A substantial proportion of women reported having experienced DV. Victims had rarely disclosed their experience of DV to health-care personnel. This study underlines the importance of integrating systematic assessment of DV in antenatal care.
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