Preventing domestic violence during pregnancy in India requires systemic change and investment in training to identify vulnerable groups of women and save lives, writes Minajbanu Memon, master’s student at Lund University.
In Sweden, one of the main recommendations for healthcare is to routinely ask patients about exposure to violence, especially to women in antenatal, women in psychiatric care, and children and youth in psychiatric care. This made me wonder about the healthcare care system in India. During my first pregnancy in India, no one asked questions related to violence. But when I visited my midwife in Sweden she always asked about violence during checkups.
According to WHO, violence among women is becoming serious public health concern. I therefore think antenatal care provides an excellent opportunity for screening for women experiencing violence during pregnancy. Globally, 1 in 3 women experience physical and/or sexual violence in their lifetime. The most common perpetrator is their partner. Violence during pregnancy obviously has serious effects on health and well-being of pregnant women and their unborn children.
In India, domestic violence is a huge problem. Estimates of prevalence vary widely from 18% to 70% as it is difficult to measure. Other studies have reported prevalence of psychological and sexual domestic violence among pregnant women to be 29% and 6% respectively. Pregnant women in India should be identified as high-risk groups for developing preventive interventions because of severe health consequences.
Intimate partner violence in pregnancy increases the likelihood of miscarriage, stillbirth, pre-term delivery and low birth weight babies. Studies done by WHO showed that women who experienced intimate partner violence were 16% more likely to suffer a miscarriage and 41% more likely to have a pre-term birth. Globally, where prevalence of intimate partner violence is high, there is a strong need to train health-care providers to recognize and respond to violence during pregnancy and refer women for appropriate support and care, if required.
In India, most of the time women hide being exposed to violence due to socio-cultural norms, lack of awareness and fear. Some research reported education level of women, husband’s education, history of violence in the family, and provision of spurious justification for violence have emerged as some of the leading factors associated with the violence inflicted during pregnancy. An Indian NGO conducted a cross sectional study on domestic violence in Mumbai slum areas. The findings showed that husbands justifiedhitting or beating their wife if she disrespects his parents and him, doesn’t cook food properly, goes out without telling him and refuses to have sex with him. Other reasons for violence were If he suspects her of being unfaithful, drunk, and generally “doesn’t meet his expectations”. These results reveal India as a verypatriarchal society where gender roles, norms and values put women under pressure to accept being victims of violence. I was surprised to see that more than 50% of women in the survey agreed that in certain circumstances, husbands have right to beat his wife, even when she is pregnant.
During one of the qualitative studies on healthcare providers’ perception in identifying violence training, reports showed barriers to providing care for survivors of violence, including a lack of human resource, acceptability, and feasibility to address violence during consultation, the time during regular clinical practice and a lack of strong referral network.
So how can we improve the terrible situation related to domestic violence in India? One way could be to adopt the Swedish model of screening for violence. When pregnant women visit for antenatal checkups, she should be asked questions about violence and receive information on the health hazards of domestic violence during pregnancy. She should also be offered help without any judgment. There is also a need to sensitize men about the consequences of violence during pregnancy. Increased involvement of men in maternal health, particularly in antenatal care, can also help to reduce the occurrence of violence against women during pregnancy.
Healthcare providers in India should take a much more active role in preventing domestic violence during pregnancy. This requires systemic change and investment in training to identify ‘hidden victims’ to safeguard vulnerable group of women and eventually save lives.
Written by Minajbanu Memon, master’s student at Lund University.