Category Archives: Domestic violence

The Relationships Between Domestic Violence and Perinatal Depression and Anxiety – A Global Perspective

According to the World Health Organisation (WHO), depression is the leading cause of disability worldwide and is a major contributor to the overall global burden of disease. Since women are twice as likely to experience depression in their lifetime than men, it is worthwhile to explore the many risk factors that make them more susceptible.

Although depression and anxiety can have devastating effects for any individual – women have an increased chance of being affected by these common mental disorders during the perinatal period, which can have long term consequences for both mother and child.

Domestic violence (DV) and intimate partner violence (IPV) are strongly linked to depression and anxiety in the perinatal period.

Zooming in on Domestic Violence as a risk factor

Domestic violence (DV) is defined as any physical, sexual, psychological or economic abuse that takes place between people who are sharing or have recently shared a home. Intimate partner violence (IPV) relates to violence committed by a current, ex- or would-be intimate relationship that causes physical, psychological or sexual harm to either partner.

The WHO has acknowledged that all forms of interpersonal violence leads to negative health outcomes and released a global plan of action to address interpersonal violence, particularly against women, girls and children. (More in this WHO report 2016)

In Africa, there is more violence against women than on any other continent. Compared to America, twice as many women In South Africa are killed by their partners.

Violence against women during pregnancy can have negative effects for both the mother and the child. Studies have shown that negative physical effects for mother and child can include fetal death by placental rupture, premature labour, low birth weight and haemorrhage after birth.

The negative psychological effects can include lowered self-esteem, depression, anxiety, substance or alcohol misuse. These effects, in turn, render women more vulnerable to experiencing domestic violence. Furthermore, abused women are more likely to delay getting pregnancy care and to attend fewer antenatal visits.

Research on IPV from four countries

Main findings from four countries show that there is a relationship between domestic and intimate partner violence.

A recent study from Australia found that out of the 4% of pregnant women who reported a history of IPV during a routine psychosocial assessment, more than 50% were immigrants. The highest number of women reporting abuse were born in Sudan and New Zealand, while women from China and India were least likely to report IPV. It is important to note that under-reporting is very likely in many communities and this may be due to a variety of reasons such as women’s experiences of shame, stigma and lack of appropriate responses or support from others.

Those women reporting IPV were more likely to report additional psychosocial concerns including depression, thoughts of self-harm and childhood abuse.

Another study conducted in Japan showed the association between verbal and physical abuse during pregnancy and linked it to postpartum depression. The study not only offers some insights into the significant influence of both verbal and physical abuse during pregnancy on postpartum depression, but also calls for regular screening for antenatal IPV by public health nurses who could identify those women who need further support, such as referral to centres for confidential advice and support.

Similar findings were reported from Malaysia, where the exposure to IPV was significantly associated with postnatal depression. The researchers of this study are also calling for training to healthcare professional to detect and manage both problems.

A recent South African study, conducted by the Perinatal Mental Health Project, showed 15% of nearly 400 pregnant women experienced IPV. We found a substantial proportion of women were additionally experiencing violence in the home at the hands of family members other than their partners, such as brothers, in-laws and grandparents. We found that abused pregnant women are more likely to be under 30 years of age, experience a range of mental health disorders, food insecurity and are more likely to be unemployed. They are more likely to have experienced abuse in the past and be unhappy with being pregnant.

‘The atmosphere was tense in the house’ a South African mother’s story.

Next steps

  1. Research

Further research is needed to establish the best way to identify women at risk of domestic violence or intimate partner violence. A recent systematic review showed that there is promising evidence to indicate that mental health interventions for mothers may reduce their experiences of IPV. However, further research is required to determine the mechanisms and intensity of these interventions.

  1. Training and supervision

Trauma-informed care, empathy training, referral-making skills and safety planning should be embedded as an integral part of the training and supervision systems for all frontline workers who engage with mothers, across different sectors.

Clinical and policy guidelines provided by the World Health Organisation are available here.

  1. Systems strengthening

Political will, with the attendant resource allocation, is required to develop the structures able to protect and support survivors. These structures in health (physical and mental), justice, and the non-governmental sectors should operate in a co-ordinated and mutually enhancing way.

The World Health Organisation has produced an excellent manual for health managers for systems strengthening to respond to women subjected to IPV and sexual violence. This includes building awareness, advocating, analysing and planning as well as addressing leadership and governance factors.

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Pregnant women suffer at hands of violent partners in South Africa

Republished article by Tanya Farber in Sunday Times (South Africa)

Many South Africa women‚ already in difficult situations‚ are experiencing violence during pregnancy at the hands of their intimate partners‚ a new study has found.

Of the 376 women who took part in the research‚ 15% had experienced intimate partner violence (IPV) during pregnancy‚ with forms of abuse ranging from sexual and physical to emotional and verbal.

This is against a backdrop of South Africa having intimate partner violence (among all women‚ not just those who are pregnant) which is “double that of the United States of America”‚ and which is as high as 71% in some communities.

The high level of violence during pregnancy in South Africa resulted from a combination of poverty-related factors.

Just published in the international BMC Women’s Health Journal‚ the study was carried out by a team from the University of Cape Town.

The sample was drawn from women attending antenatal services at a primary-level maternity facility in Cape Town.

The researchers found that the high level of violence during pregnancy resulted from a combination of poverty-related factors including food insecurity‚ mental ill-health‚ unemployment‚ unwanted pregnancies‚ and past experiences of abuse.

“In its most severe form‚ violence against pregnant women has been reported as a contributing cause of maternal deaths,” said researchers Sally Field‚ Michael Onah‚ Thandi van Heyningen and Simone Honikman.

It has also been associated with “inadequate uptake of antenatal care‚ with abused women being more likely to delay seeking pregnancy care and to attend fewer antenatal visits.”

For mothers and their unborn babies, results can include “low birth weight‚ foetal death by placental abruption‚ antepartum haemorrhage‚ foetal fracture‚ rupture of the uterus and premature labour”.

Also‚ they add that a “strong association” had been shown between thoughts of suicide and violence experienced by pregnant women.

They said that in South Africa‚ “high levels of violence occur within a context of multiple contributing social dynamics. These include prominent patriarchal norms where masculinity is associated with the defence of honour‚ harshness‚ and risk-taking.”

They added: “Poverty and gender inequalities contribute to the structural determinants of violence.

“Women in stable but unmarried relationships were more likely to have reported experiencing IPV than those who were married.”

Where to from here? The researchers said the study contributed towards a greater understanding of the risk profile for IPV among pregnant women in low-income settings.

 

This research and other PMHP findings are available open-source online!

Domestic Violence against Women during and after pregnancy

Women are particularly vulnerable to domestic abuse during and after their pregnancy. 

Protect yourself and your baby – help is available!

It is important to know what kinds of behaviour is considered domestic abuse – it is not only physical or sexual harm. Did you know that domestic abuse can happen between any persons sharing a household – not only at the hands of your partner?

Domestic violence in period is associated w/adverse obstetric outcomes. If you are pregnant & experiencing our guide provides information on where to go and who to contact if you need support

 

 

We need sustainable solutions to deal with mental health treatment gap

On World Mental Health Day many have thought about mental health status in their countries and the treatment gaps all over the world.

Our blog focuses on articles and statistics around mental health care and in particular around maternal mental health care globally and in low- and middle-income countries.

“Mental health matters because it affects everyone”

“Around 30% of women in low-income countries and 10-15% in high-income countries have a significant mental health problem during pregnancy and after childbirth. And yet most of these women never get diagnosed or receive any treatment” Maternal Mental Health-Global Challenge

“South Africa needs sustainable solutions to deal with its mental health treatment gap, delegates heard at a roundtable discussion ahead of World Mental Health Day (WMHD) – “Economy, Equality and Access to Mental Health Services” Close the mental health treatment gap

“The mental health of pregnant women can be affected by a range of factors, including partner violence and unemployment. But one of the key drivers that adversely affect a pregnant woman’s mental health is food insecurity. Being food insecure is when someone doesn’t have food or has the wrong kinds of food.” How hunger affects the mental health of pregnant mothers


Image: Robin Hammond

“Lack of food security is driving depression, anxiety and suicidal behaviour in poor communities” How hunger erodes mental health

“From OCD to suicide and depression, these numbers will alarm you.” (South Africa focus) 10 Mental Health stats South Africa

“South African children may be affected by a myriad of traumas. According to the South African Journal of Psychiatry, children and adolescents can suffer from post-traumatic stress disorder (PTSD) after being exposed to a range of traumatic events.” Here’s how the Sesame Street’s Muppets help kids

“Crisis issue needs to be priority among developing nations” Mental health treatment a human right

“World Mental Health Day: the need for conversations on the subject in India is as strong as ever, because despite a start, not enough of them are taking place.” A poignant series of films relates the stories of people who fought and won

Sick link between hunger and mental health – linking food insecurity and mental health.

“Future actions should focus on better identification of people in vulnerable situations who may require specific support including people experiencing mental distress, early intervention and culturally appropriate mental health training for all frontline staff.” Mental health is not the problem, it’s the solution

“Children whose mothers are depressed during pregnancy have a small increased risk of depression in adulthood, according to a UK study.” Depression risk ‘starts in the womb’

“What more needs to be done to make mental health care a reality for people worldwide.” Making mental health a cultural priority

“Mental health needs a new narrative. citiesRISE is a global platform committed to transforming the state of mental health policy and practice in cities and beyond to meet the mental health needs of populations across the world.” citiesRISE new website

 

Making a case for the integration of mental health screening into HIV care

Source: Journal of Interpersonal Violence

Screening for Traumatic Experiences and Mental Health Distress Among Women in HIV Care in Cape Town, South Africa

“Traumatic events can negatively affect clinical outcomes among HIV positive women, particularly when those events result in ongoing psychological distress. Consequently, there have been calls to integrate screening and treatment of traumatic experiences and associated mental health disorders into HIV care. In South Africa, screening for traumatic experiences and mental health is not a routine part of HIV care. […]

Participants [of this study] almost unanimously agreed that it would be appropriate and acceptable to screen all women in the clinic setting for trauma and mental health symptoms. […]

The high prevalence of traumatic experiences and psychological distress in this study highlights an urgent need to integrate screening into routine HIV care. The study provides evidence of the acceptability of screening for trauma and mental health symptoms among HIV positive women, at the critical points of care engagement when they are initiating ART or have defaulted on ART. In addition, there is need to link women screened to interventions and services, as part of trauma informed HIV care.”

Full text available on Sage Journals

 

Violence against Women during and after pregnancy

Women are particularly vulnerable to domestic abuse during and after their pregnancy. 

Protect yourself and your baby – help is available!

It is important to know what kinds of behaviour is considered domestic abuse – it is not only physical or sexual harm. Did you know that domestic abuse can happen between any persons sharing a household – not only at the hands of your partner?

 

Do you have a safety plan in place for you and your baby should anything go wrong?

Find out more about all this important information in our Violence against Women leaflet

Looking for more information for new mothers? Check out our resource pages.

Breaking the link between gender-based and intimate partner violence and HIV

Intimate partner violence (IPV) during or before pregnancy is associated with many adverse health outcomes.

Pregnancy-related complications or poor infant health outcomes can arise from direct trauma as well as physiological effects of stress, both of which impact maternal health and fetal growth and development.

Antenatal care can be a key entry point within the health system for many women, particularly in low-resource settings. Interventions to identify violence during pregnancy and offer women support and counselling may reduce the occurrence of violence and mitigate its consequences.

This research will provide much-needed evidence on whether a short counselling intervention delivered by nurses is efficacious and feasible in low-resource settings that have a high prevalence of IPV and HIV.

Source: BMC Health Services ResearchBMC series

Follow the project: BioMed Central

Perinatal depression and anxiety: Let’s talk about moms and dads in Africa

In low- and middle-income countries (LMICs), competing health priorities, civil conflict, and a lack of political will mean that expenditure on mental health is a fraction of that needed to meet the mental health care needs of the population.

For mothers, this treatment gap is most notable in regions where health agendas focus on maternal mortality indicators.

Source: Essentials of Global Mental Health

Who is at risk of perinatal mental health disorder?

Common mental disorders during pregnancy and in the first year after birth are associated with certain risk factors. These include poverty, migration, extreme stress, exposure to violence (domestic, sexual and gender-based), previous history of mental disorders, alcohol and other drug use as well as low social support.

– Migration
– Violence and abuse
– Alcohol and drug use

In South Africa, there is a very high prevalence of adolescent pregnancies with 39% of 15- to 19-year old girls being pregnant at least once. When adolescent mothers suffer from depression, the likelihood of a subsequent teenage pregnancy nearly doubles.

SAsouthAfrica

– Teenage pregnancy
– HIV/AIDS

How to address maternal mental illness among economically disadvantaged parents? 

Integration of services!

Mothers in many settings are using maternal and child health services as well as social services. Thus, detection and access will increase if maternal health screening and services are integrated into these public care platforms.

How to implement a maternal mental health intervention in low-resource settings?

We are sharing our lessons learned in this learning brief. 

We have also developed a Service Development Guidelines which demonstrates how to develop a mental health intervention at your facility, even with limited resources.

Find more free & open access resources for professionals on our website

And what about dads?

Postnatal depression can affect dads too. Find out about common concerns for new dads and discover helpful tips on how they can become more involved. We compiled a leaflet with information that could help you be better prepared for what is happening. The leaflets are available in

EnglishisiXhosa • Afrikaans • French

Domestic violence during pregnancy

Domestic violence is any physical, sexual, psychological or economic abuse that takes place between people who are sharing, or have recently shared a home.

In Africa, there is more violence against women than on any other continent. Three women are killed by their partners in South Africa every day, thats twice as many women than in the United States of America. Violence during pregnancy has negative effects for both the mother and the child. Abused women are more likely to delay getting pregnancy care and to attend fewer antenatal visits.

Our recent research study looked at pregnant women who experience domestic violence in Hanover Park, Cape Town. We looked at the profile of women who reported domestic violence and what factors in their lives were associated with this abuse.

domestic_violence_during_pregnancy

We found that women who were experiencing domestic violence were more likely than those without domestic violence to:

– have a current mental health problem like depression, anxiety, suicidal thoughts or behaviours, alcohol or drug abuse

– have had past mental health problems
– have experienced past abuse
– not feel supported by their partner
– not likely feel pleased about being pregnant
– more likely experience food insecurity and not have a job

Out of this study with developed a learning brief which targets any service providers who interact with vulnerable women and children, especially those service providers who work with pregnant women. Such services providers can arise from nongovernmental organisations (NGOs) or civil society organisations and may be healthcare providers or social service providers.
Find this and more on our resources for professionals pages.

Suicide risks among pregnant women and new mothers

To mark World Suicide Prevention Day we’d like to focus on suicidal thoughts during the perinatal period

Mothers’ emotional needs can go undetected during the perinatal period where there is much attention on the baby and women often face multiple difficulties. Studies have shown that women at risk for suicide may be easier identified, by increasing screening of expectant and new mothers for major depression and conflicts with intimate partners. Thus care providers and family may be able to detect symptoms and signs of suicidal thoughts and possibly prevent further distress or the development of suicidal behaviour.

Symptoms and warning signs include 

– Talk of suicide or dying “If I died, would you miss me?” or “It would be better if I were not here or dead.”
– Depressive symptoms, including feelings of guilt, hopelessness or no sense of the future.
– Feeling isolated or wanting to be alone “No one understands me”.
– Obsessive thinking – thinking ‘too much’, especially about harming oneself or dying
– Giving things away (clothes, expensive gifts), “When I am gone, I want you to have this.”

Our recently produced Issue Brief deals with some of the risk factors and unearths some of the myths surrounding suicide during and after pregnancy.

Suicide during pregnancy - myths

Read this and other Issue Briefs on our website

#WSPD16 will be commemorated on 10 September
Join the conversation on Twitter with the hashtag #WSPD16

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