Effects of Unplanned Pregnancy on the Initiation of Intimate Partner Violence in Southeast Iran

doi:10.21203/rs.3.rs-2319768/v1

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Effects of Unplanned Pregnancy on the Initiation of Intimate Partner Violence in Southeast Iran

https://doi.org/10.21203/rs.3.rs-2319768/v1

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Background:Violence during pregnancy may lead to pregnancy complications or adverse birth outcomes or other serious reproductive events. Unplanned pregnancy can lead to a wide range of physical and psychological consequences for mother and child and affects different aspects of social, economic and cultural health. The aim of study is to find if unplanned pregnancy can cause intimate partner violence.

Methods: This cross-sectional descriptive research was carried out with available sampling on 300 eligible women (150 with unplanned pregnancy and 150 with planned pregnancy) who referred to health care centers in, Kerman, Iran in 2021. Iranian version of domestic violence questionnaire and spss22 were used for data collection and analysis.

Results: The mean age, and age difference with spouse were 29.77±7.06 years, and 4.31±3.03 years respectively. The majority of women (28%) had a diploma, were housewives (69.65%). Comparing domestic violence in unplanned pregnancy group showed that the overall amount of violence during pregnancy (60.64±30.51) was higher than before pregnancy (51.83±25.02) and this difference was significant (p<0.05). the overall mean score of domestic violence in the group with unplanned pregnancy (60.64±30.51) is higher than the group with planned pregnancy (51.35±26.99) (p<0.05). we see that the difference in the mean score of the psychological dimension in unplanned pregnancy (14.23±6.03) and the group of planned pregnancy (10.57±5.32) is statistically significant (p<0.05). Also, the mean score of patriarchal beliefs in the group with unplanned pregnancy (36.93±20.58) during pregnancy is higher than the group with planned pregnancy (31.48±18.43) (p<0.05)

Conclusion: Results showed that all of the domestic violence which started with the beginning of unplanned pregnancy, were in low level except psychological and patriarchic beliefs parts. Onset of violence because of unplanned pregnancy can harm mother and child health significantly and needs urgent interventions.

Unplanned pregnancy

Mother health

Intimate Partner Violence

Domestic violence is one of the most common forms of violence against women and a major health problem in the world. The start of domestic violence may be during pregnancy or before it. There are multiple factors for the occurrence of violence against women. This study investigated if unplanned pregnancy can be the reason of beginning violence. 300 eligible women (150 with unplanned pregnancy and 150 with planned pregnancy) participated in the study Results showed that the mean score of domestic violence in the group with unplanned pregnancy was higher than the group with planned pregnancy. So, it seems that family planning counselling can help the partners to prevent unplanned pregnancy and indirectly reduces domestic violence.

Women in general and mothers in particular play central roles in pedagogical and familial management affairs who affectively and emotionally interlink the family members (1). Involvement of the gender prototypes into the relations has resulted in patriarch standards which indirectly cause Domestic Violence (DV) against women when takes place in family. World Health Organization announced that DV is a globally addressed issue in public health in light of both its prevalence and related physical and psychological morbidity and mortality (2). This type of violence which occasionally is referred to as domestic abuse involves physical, sexual, psychological and financial elements in addition to controlling or coercive actions and behaviors. In other word, DV or intimate partner violence (IPV) can be disproportionately influential on women. Statistical data about the women exposed to this phenomenon reports that about one in three women is physical or sexual violence victim throughout their lifespan (3, 4).

In recent decades violence against woman (VAW) has emerged as one of the most pressing and intractable social problems across regional and cultural boundaries. This is because; women, who experience physical, sexual, or psychological violence, suffer a range of health problems, often in silence. It is well known fact that the prevalence of physical or sexual violence against wife inflicted by husband varied widely across countries (5). Every year in the United States, 2–4 million women are exposed to IPV (6). Around seventeen percent of women experience DV for the first-time during pregnancy (7). Violence during pregnancy may lead to pregnancy complications or adverse birth outcomes through direct or indirect mechanisms (8). VAW is associated with many other serious reproductive events one of which is non-use of contraception, unplanned and unplanned pregnancies (5). In Nigeria, it was found that DV is mostly prevalent pre-pregnancy (43.5%) reduced to 28.3% during the pregnancy with the psychological violence as the most common form experienced. An unintended pregnancy is unplanned or mistimed pregnancy. A mistimed pregnancy occurs in women who conceived sooner or later than the desire time. An unplanned pregnancy happens in women who do not want any more children at the time of the conception (9). Unplanned pregnancy can lead to a wide range of physical and psychological consequences for mother and child and affects different aspects of social, economic and cultural health of the community (10, 11). Based on studies, pregnant women experience undesirable outcomes of the DV through sexual or physical trauma or because of stress-related mechanisms which lead to abortion, preterm childbirth, preterm placenta separation, chorioamnionitis, increase in mortality and mothers’ problems, abnormal bleeding of genital system and pelvic inflammatory diseases along with the pregnant mother’s hospitalization. (12). In Vietnam setting, Bui et al. (13) with Using non-parametric methods, found that women with higher levels of exposure to DV have children with lower welfare and this is concluded that DV negatively affects children’s’ welfare (14). Audi et al. (15) explained that DV during pregnancy remains an unsolved and neglected social problem despite the recognized adverse physical and mental health consequences. There was also relationship found between physical or sexual violence and obstetric problems, premature rupture of membranes and urinary tract infections and lack of sexual desire among women. Since unplanned pregnancy, whether persisted or led to abortion, brings prenatal risks for mother and child, and if DV was taken as a risk factor for unplanned pregnancy and abortion, then reduction of DV may contribute to minimization of unplanned pregnancy and unsafe abortions. Furthermore, due to the shared aspects of unplanned pregnancy among women and DV (e.g., socioeconomic issues, physical and psychological challenges, childbirth and postpartum outcomes, etc.), this is significant to study this particular population. So, this study aimed to investigate the effects of unplanned pregnancy on beginning of intimate partner violence

The main goal of present cross-sectional research was to study the effects of unplanned pregnancy on the beginning of intimate partner violence who referred to the Health Centers in Kerman, Iran, April to October 2021.

Inclusion Criteria: ‌ subjects with Iranian nationality, age group of 15–49 years old, married, gestational age more than 20 weeks, lack of neuropsychological disorders or diseases, lack of drug abuse, not creating stress for the woman and her husband (illness, change of work conditions, change of financial conditions) compared to before pregnancy

Exclusion Criteria: If after receiving the questionnaire participants was not reluctant to respond or continue, she would be excluded from the study process.

After selecting the samples based on inclusion criteria, and obtaining written informed consent form, the questionnaires were distributed to the sample in private, friendly and confidential manner. The questionnaire-based data collection instrumentation included the following sections: 1) demographic information of participants including wife/husband’s age, age different with spouse, marriage length (years), number of children, wife/husband’s education level, occupation and monthly family income, 2) DV assessment. Actually, we had two groups of women with planned pregnancy and unplanned pregnancy. Each participant filled out the violence questionnaire twice, and once commented on their pre-pregnancy situation, which was actually retrospective. And once about the current condition during pregnancy.

Domestic Violence

The women’s DV questionnaire was designed by Mohseni Tabrizi et al. (2012) for Iranian population which was validated with Cronbach’s Alpha of 0.83. In this questionnaire, information is collected through a form of demographic information including 10 items (1–10). In addition, there are items provided for measurement of DV, physical, sexual, economic, psychological violence and patriarchic beliefs included in this questionnaire. These include 60 items. (16). Scoring the questionnaire is in two sections and based on Likert’s 5-point spectrum as follows:

Some items are responded based on a spectrum from “never” to “always” (e.g. never, seldom, sometimes, often and always) and some items are responded based on other spectrum from completely disagree to completely agree (e.g. completely disagree, disagree, no idea, agree, completely agree) such that subjects can select one of the options as their response to the item. The scoring is from 0 to 4 (never or completely disagree = 0, seldom or disagree = 1, sometimes or no idea = 2, agree or often = 3, and completely agree or always = 4) The minimum score is 0 and the maximum score is 240.Score between 0 and 60: domestic violence against women is low. Score between 60 and 120: domestic violence against women is moderate. Above 120: Domestic violence against women is high.

Unplanned Pregnancy

We consider pregnancy based on positive pregnancy test that was taken at health center. We examined the unplanned pregnancy based on London Measure Unplanned Pregnancy (LMUP)(17).

Sample And Population

Based on unplanned pregnancy prevalence (50%), the sample size was estimated to be 300 women(150 with planned pregnancy and 150 with unplanned pregnancy) (18).

Procedure

Taking 19 clinics in Kerman into consideration, the number of planned and unplanned pregnancies in each clinic was recognized and relating to their occurrence rate, the sample size classified for each clinic was allocated. Therefore, in each clinic women with planned and unplanned pregnancy were listed by their names and they were undergone selection process in random sampling to select the final relevant number of subjects. Moreover, the selected potential participants were contacted. Among the selected participants, if anyone was reluctant to participate, did not meet the inclusion criteria or left the process of study during the surveys, other potential referents of that clinic were selected and new subjects were provided and this process was iterated so that the final sample was reached.

Statistical analysis

SPSS version 22 and descriptive statistics tests were used to analyze the data. Measurement values were expressed as mean, standard deviation and frequency. A comparison was made between the average score of violence before pregnancy and during pregnancy. Also, the average score of violence was compared between the group with unplanned pregnancy and planned pregnancy.

Demographic data analysis showed that the mean age, and age difference with spouse were 29.77 ± 7.06 years, and 4.31 ± 3.03 years respectively. 56.33% had been married for more than 6 years 14.68% had more than 2 children More than one third of the sample 37.3% had more than one child. The majority of women (28%) had a diploma, were housewives (69.65%) and had no personal income (68.31%).40.98% of husbands had education below diploma. 4.33% of men were unemployed and 35.01% of men had average income. (Table 1).

Table 1

:Participants’ Demographic Characteristics
		Unplanned Pregnancy	Planned Pregnancy
Variable		Mean ± SD
Age		29.89 ± 7.04	29.66 ± 7.08
Age Different with Spouse		4.47 ± 3.01	4.15 ± 3.05
Variable		Frequency N (%)
Number of Children	No child	36(24)	34(22.66)
	1 child	58(38.7)	(37.33)56
	2 children	35(23.3)	37(24.66)
	3 children	15(10)	16(10.66)
	> 4 children	6(4)	7(4.66)
Level of education	Illiterate	2(13)	3(2)
	Primary	15(10)	15(10)
	Secondary	22(14.7)	24(16)
	High school	10(6.7)	12(8)
	Diploma	44(29.3)	40(26.66)
	Associate	14(9.3)	12(8)
	Undergraduate	37(24.7)	36(24)
	Graduate	6(4)	8(5.33)
Occupation	Employee	30(20)	29(19.33)
	Worker	1(0.7)	2(1.33)
	Self-employed	11(7.3)	10(6.66)
	Unemployed	4(2.7)	4(2.66)
	Housewife	104(69.3)	105(70)
Income Level	No income	104(69.3)	101(67.33)
	<$80	8(5.3)	9(6)
	$80–160	12(8)	11(7.33)
	$160–240	25(16.7)	27(18)
	>$240	1(7)	2(1.33)
Spouse’s Occupation	Employee	40(26.7)	41(27.33)
	Worker	28(18.7)	28(18.66)
	Self-employed	76(50.7)	74(49.33)
	Unemployed	6(4)	7(4.66)
Year of Marriage	< 1 year	10(6.7)	9(6)
	1–3 years	35(23.3)	36(24)
	4–5 years	21(14)	20(13.33)
	> 6 years	84(56)	85(56.66)
Spouse’s Income	No income	1(7)	2(1.33)
	<$80	21(14)	19(12.66)
	$80–160	52(34.7)	53(35.33)
	$160–240	40(26.7)	42(28)
	>$240	36(24)	34(22.66)
Spouse’s Education Level	Illiterate	4(2.7)	3(2)
	Primary	14(9.3)	12(18)
	Secondary	24(16)	25(16.66)
	High school	12(8)	14(9.3)
	Diploma	46(30.7)	43(28.66)
	Associate	11(7.3)	10(6.66)
	Undergraduate	27(18)	29(19.33)
	Graduate	12(18)	14(9.3)

Comparing domestic violence in unplanned pregnancy group showed that the overall amount of violence during pregnancy (60.64 ± 30.51) was higher than before pregnancy (51.83 ± 25.02) and this difference was significant (p < 0.05). The comparison of different dimensions of violence also shows that the mean score of psychological dimension during pregnancy (14.23 ± 6.03) is higher than before pregnancy (11.08 ± 3.22) and it is statistically significant (p < 0.05). The mean score of patriarchal beliefs reached from 31.46 ± 18.74 before pregnancy to 36.93 ± 20.58 during pregnancy, which was a significant difference (p < 0.05). Other dimensions of domestic violence were not significantly different in two times(Table2). Table 3 shows that the overall mean score of domestic violence in the group with unplanned pregnancy (60.64 ± 30.51) is higher than the group with planned pregnancy (51.35 ± 26.99) (p < 0.05). By comparing the dimensions of domestic violence, we see that the difference in the mean score of the psychological dimension in unplanned pregnancy (14.23 ± 6.03) and the group of planned pregnancy (10.57 ± 5.32) is statistically significant (p < 0.05). Also, the mean score of patriarchal beliefs in the group with unplanned pregnancy (36.93 ± 20.58) during pregnancy is higher than the group with planned pregnancy (31.48 ± 18.43) (p < 0.05)

Table 2

Comparison of Intimate Partner violence in Unplanned pregnancy (before and during pregnancy)
Time Variable	Before Pregnancy	During Pregnancy	P-Value
Time Variable	Mean ± SD		P-Value
Sexual violence	2.15 ± 0.85	2.24 ± 0.98	0.46
Physical Violence	3.98 ± 1.12	4.01 ± 1.32	0.38
Psychological Violence	11.08 ± 3.22	14.23 ± 6.03	< 0.05
Economic Violence	3.16 ± 1.09	3.23 ± 1.6	0.43
Patriarchic beliefs	31.46 ± 18.74	36.93 ± 20.58	< 0.05
Total Score	51.83 ± 25.02	60.64 ± 30.51	< 0.05

Table 3

Comparison of Intimate Partner violence during pregnancy between two groups (with planned and Unplanned pregnancy)
Time Variable	Unplanned Pregnancy	Planned Pregnancy	P-Value
Time Variable	Mean ± SD		P-Value
Sexual violence	2.24 ± 0.98	2.11 ± 0.86	0.48
Physical Violence	4.01 ± 1.32	4.07 ± 1.28	0.38
Psychological Violence	14.23 ± 6.03	10.57 ± 5.32	< 0.05
Economic Violence	3.23 ± 1.6	3.12 ± 1.1	0.41
Patriarchic beliefs	36.93 ± 20.58	31.48 ± 18.43	< 0.05
Total Score	60.64 ± 30.51	51.35 ± 26.99	< 0.05

The results of this study implied that mean DV score among the women with unplanned pregnancy is borderline of moderate violence. Based on Bahmani (2018), unplanned pregnant women experienced DV more than the others (19). Other studies also indicated that violence during pregnancy is more when the pregnancy is unplanned (12). Sarayloo also concluded that unplanned pregnancy is a factor of high level of DV (20). It may be concluded that due to religious and cultural beliefs, spouses of the participants in current study accepted the unplanned pregnancy and treat it as what God may want; thus, their contact and inconsistent behavior were, compared to other studies; minimized.

Investigating the dimensions of domestic violence, it was obtained that majority of the subjects experience low level of the DV, but some researchers’ results disagreed with ours and implied that pregnant women with unplanned pregnancy were highly influenced by the psychological DV followed by physical and sexual types (21). The psychological DV includes threating, oral blaming and insulting and it can be stated that the participants’ spouses in this study might not physically damage pregnant women because of their culture and beliefs but they did not think that psychological violence is as damaging as the physical one.

A indicated that unplanned pregnant women have anxiety, social function disorder, and generally have lower psychological health than the women with planned pregnancy (22). Since the psychological violence is directly related to the increase in three first months bleeding, weight loss during the child birth and postpartum depression (23); therefore, the unplannedly pregnant women’s psychological health would reduce under the influence of psychological violence which may result in adverse outcomes. In a study in Uganda, it was implied that women with unplanned pregnancy experienced likelihood of the physical violence by their spouse or partner by 4.1 more compared to women with planned pregnancy (24). A meta-analysis showed that prevalence of the violence among pregnant women were 17%, 41% and 21% for physical, psychological and sexual violence, respectively which implied the low level of physical violence compared to other types (25). But Ler (2020) found that most prevalent type of violence among Indian women is physical and the main factors are poverty and acceptable violence by women (26). Transmission from traditional to modern society means change of the behavioral and discourse models governing the society. This may justify the low level of the physical violence in current study. The level of sexual DV of the subjects in this study was low. Consistent with this result, in a study it was implied that 47.5% of women under their spouse’s DV reported 34.2% of physical DV and 2.7% of sexual DV (27). In contrast to the present study, a systematic study implied that sexual DV in Iranian women is medium and more than the physical one(28). Shahabadi found that men’s violence during the pregnancy does not related to the planned or unplanned pregnancy and the most prevalent type posed during this period of time was sexual DV (29) which is inconsistent with current results. The spouses of present participants may fear of the damage to embryo and abortion due to their beliefs and they posed less physical violence.

Sexual violence consequences are multifaceted and varied, including vaginal problems, recurrent urinary tract infections, widespread and chronic pain, sleeping problems, chronic back problems, and fibromyalgia, eating disorders, social anxiety, severe depression, and chronic fatigue. In conclusion, sexual violence has these extremely negative and long-term consequences because of the interconnectedness of body, mind, and soul (30).

The economic violence experienced by pregnant women was in low level. In contrast to this, Aghakhani found that 88% of the women are under economic violence (31). TalebPour also reported that highest level of the violence is for financial dimension (32). The geographical and age differences along with customs and traditions of a society and ethnics can be the reason for different results and the population in (32) was women without pregnancy. Gurung (2016) found that majority of pregnant women are under the financial violence and compared to physical and psychological types, financial violence was experienced to higher extent (33). Since the economic or financial violence not only include the housekeeping costs but avoidance from the women’s employment and financial independence also along with the women’s income asking are included in this phenomenon. On the other hand, some cultures do not accept women’s employment and this should be addressed before marriage so that it will not be experienced as violence in case of occurrence.

The results indicated that violence level was moderate in dimension of patriarchic beliefs. One of the sources of the marital conflict is patriarchic attitudes. Patriarchy refers to a system which dominated the women socially, politically and economically. The patriarchic orientations and attitudes are directly influential on violence against women. A study in India reported that among different DV high prevalence reasons, the patriarchic roles and long-term cultural norms posed on women as subordinates are deepest violence (34). Zare concluded that patriarchy is directly related to psychological, physical and financial DV (35). The sociological study implied that there is a significant relationship between violence against women and violence in spouse’s father-in-law, men’s self-image of dominance, subaltern role for women and the spouse’s family intervention (36). However, the Iranian society moves toward modernity and physical violence is experienced less, but it is witnessed that patriarchic beliefs are still prevalent in society and this attitude can be changed by training and cultural interventions in long-term.

The first limitation was that, data regarding unplanned pregnancy were only available for those women with gestational age more than 20 weeks. Thus, we were unable to assess the impact of IPV on unplanned pregnancy among those who had been pregnant but had experienced miscarriage or induced abortion. The next limitation was the self-reporting of people about domestic violence, who may not have fully told the truth for some reason.

It can be seen that the onset of domestic violence exposes a woman to various areas of violence while proving an unplanned pregnancy. Since pregnancy leads to special mental and physical conditions, while unplanned pregnancy worsens the condition and causes additional stress, the presence of spousal violence in these conditions can lead to a multiplication of complications during pregnancy and infancy. Therefore, intervention planning to support these women can be effective in reducing maternal and neonatal mortality and morbidity and promoting their health.

Domestic Violence

VAW

Violence Against Woman

IPV

Intimate Partner Violence

Acknowledgements

The authors appreciate all vulnerable pregnant women who kindly participated in this study. We also appreciate health care centers staff for their cooperation.

Authors’ contributions

FKH, KA and NB contributed to conceiving and designing the research.The data were collected, analyzed, and interpreted by FKH, NB and KA. KA contributed equally to writing and revising the manuscript and approved the final manuscript.

Funding

This study did not receive any specific funding from any community funding organization, commercial or non-profit sectors

Availability of data and materials

Data are available from the authors upon reasonable request and with permission of Ethics Committee.

Ethics approval and consent to participate

This manuscript was derived from a project with code No 99000026 and was approved by the Ethics Committee of Kerman University of Medical Sciences, Iran (the code of ethics No. IR.KMU.REC.1399.125). Written informed consent was obtained to enter the study and participants were easy to withdraw the study whenever they were willing. At the request of the ethics committee, the study was conducted in accordance with the Declaration of Helsinki and Ethics Publication on Committee (COPE). Special codes were used for each of the participants to ensure the information confidentiality.

Consent for publication

Not applicable.

Competing interests

The authors of this study state that there is no conflict of interest.

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No competing interests reported.

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Effects of Unplanned Pregnancy on the Initiation of Intimate Partner Violence in Southeast Iran

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Abstract

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Introduction

Methods

Domestic Violence

Unplanned Pregnancy

Sample And Population

Procedure

Statistical analysis

Results

Discussion

Limitations

Conclusions

Abbreviations

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References

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