Break the vicious cycle of domestic violence during pregnancy

Pregnancy presents a unique opportunity for domestic violence identification and support, given frequent interactions with healthcare providers from early pregnancy to postpartum

In India, 29 per cent of women in the reproductive age group of 15-49 years, face domestic violence. Approximately 3 per cent are pregnant women who face physical abuse (NFHS-V). 

The problem of domestic violence among pregnant women is rising in metropolitan cities. In 2022, 19 metropolitan cities registered 48,755 crime cases against women, almost a 12.3 per cent increase from 2021 (NCRB, 2022). Domestic violence is not limited to India; it is a grave concern globally.

According to recent studies, in London, one in seven pregnant women are victims of domestic violence; approximately 4 per cent of pregnant women in Canada reported abuse by an intimate partner, while in Brazil, 11 per cent of women reported domestic violence. Estimates published by the WHO indicate that globally, one in three women have been subjected to domestic violence.

Domestic violence (DV) encompasses various forms of abuse, including physical, psychological, and sexual violence. The detrimental impact of DV on both maternal and foetal health leads to adverse outcomes such as premature birth, recurrent miscarriages, and poor quality of life. Additionally, DV during pregnancy is associated with mental health consequences such as anxiety, depression, and post-traumatic stress disorder (PTSD), further exacerbating maternal morbidity rates.

Background

Untreated mental illness during the perinatal period poses a dual risk of adverse physical and emotional outcomes for both women and their developing foetuses or infants. Given these implications, our team attempted to test the impact of integrative therapies, including yoga-based techniques.

 

First of its kind in India, between 2019 and 2023, a randomised controlled trial (RCT) was carried out at Lok Nayak hospital in New Delhi. The study aimed to assess the impact of a Behavioural Intervention Package (BIP) during pregnancy on the quality of life, DV, maternal health, mental health, and coping strategies of pregnant women experiencing DV and attending antenatal clinic at Maulana Azad Medical College, New Delhi.

In total, 921 pregnant women underwent screening, with 243 randomly assigned to either the intervention or control group representing low educational and socioeconomic backgrounds, with an average age of 24 years. Around 65 per cent identified as Muslim, while 55 per cent were Hindus from other backward castes. Most of these women resided in joint family setups (79 per cent), homemakers (95 per cent), and had nearly monthly household incomes of less than Rs 10,000.

The BIP is a cognisant effort to empower pregnant women who have experienced DV by providing integrated psychosocial support to attain better physical and mental health. The BIP is based on five interdependent, critical components focused on (i). understanding the depth of the problem and assessing the need with empathy and rapport; (ii). analysing women's strengths and available resources (emotional, medical, and physical resources) for utilisation and navigating a better outcome; (iii). self-regulation mechanisms of the body's internal system through yoga-based methods (chanting, meditation, and exercise); (iv). individual counselling for effective communication and better interpersonal relations; and (v). developing better awareness and creating opportunities for alternative livelihoods.

The BIP was administered by trained clinical psychologists, public health experts, gynaecologists, anthropologists, and yoga experts. Each one-to-one session was conducted without the male partner or other family members being present. Over 28 weeks, 11 sessions with the women are to be undertaken, i.e., six weeks postnatal (after childbirth) to administer the intervention package.

Findings

The study found that the BIP intervention had a positive impact on quality of life and decreased DV, stress, and depression at personal, relational, and societal levels. High adherence to the intervention was noted, with 95 per cent compliance among participants. Additionally, the control group showed significant improvements in DV and quality of life scores from baseline to post-intervention. Unlike routine services, the positive outcome was also because of respectful care and attention given to individuals.

 

DV screening and identification are not part of the standard operating procedure. Pregnancy presents a unique opportunity for DV identification and support, given frequent interactions with healthcare providers from early pregnancy to postpartum. Thus, with the high prevalence and rising adverse consequences of violence during pregnancy, the intervention of BIP is imperative.

The introduction of BIP in routine checkups of antenatal care can be accompanied by critical therapeutic interventions, including yoga-based methods, counselling, psychotherapy, and awareness about well-being, and the health rights of women. It will not only improve the health of women and children, it also has the potential to make a dignified pregnancy for women across sections of society. Ultimately, it will improve women’s capability to enhance their freedom and choice. 

(Meerambika Mahapatro is Professor & Head of the Department, DSS, National Institute of Health & Family Welfare (NIHFW), and Sudeshna Roy is Project Technical Officer, NIHFW, New Delhi.)

Disclaimer: The views expressed above are the author's own. They do not necessarily reflect the views of DH.