Paul A Burns1, Joseph R Zunt2, Bernardo Hernandez3, Bradley H Wagenaar4, Manasi Kumar5, Danvers Omolo6, Cecilia Breinbauer7. 1. Assistant Professor, John D. Bower School of Population Health, Department of Population Health Science, University of Mississippi Medical Center. 2. Professor, Global Health, Professor, Neurology, Adjunct Professor, Epidemiology, University of Washington, Department of Global Health. 3. Associate Professor, Institute for Health Metrics and Evaluation, Department of Global Health, University of Washington. 4. Acting Instructor, Department of Global Health, University of Washington. 5. Senior Lecturer, University of Nairobi. 6. Data Analyst, Food and Agriculture Organization (FAO), United Nations. 7. Cecilia Breinbauer, Clinical Assistant Professor, Child and Adolescent Psychiatrist, Global Mental Health, Departments of Global Health, Psychiatry & Behavioral Sciences, University of Washington Deputy-Executive Director - Center for Healthy Development, Director - Child and Adolescent Development Program, Seattle, WA.
Abstract
BACKGROUND: Despite considerable achievements associated with the MDGs, under-five mortality, particularly in Sub-Saharan Africa, remains alarmingly high. Globally, intimate partner violence (IPV) affects one in three women within their lifetime. Little is known about the relationship between IPV and maternal care-seeking in the context of high rates of under-five mortality, particularly among young women and adolescent girls in low- and middle-income countries (LMICs). METHODS: Data from the Kenya Demographic Health Survey (2008-2009) were limited to a sample of women aged 15-24 years (n=1,406) with a child under-five who had experienced IPV in the last 12 months. Using multivariate logistic regression, we constructed three models: 1) base model; 2) controlling for type of residence (urban/rural); and 3) controlling for wealth status and education attainment, to estimate odds ratios (ORs) for the association between IPV and ten maternal care-seeking behaviors. RESULTS: Thirty-eight percent of the women had experienced some form of intimate partner violence in the last 12 months. Women who had experience IPV were less likely: 1) to complete a minimum of 4 antenatal visits after single IPV exposure (OR=0.61, 95% CI=0.44, 0.86 and after severe IPV (OR=0.80; 95% CI=0.44, 0.88) and 2) to deliver in health facility after severe IPV exposure (OR=0.74; 95% CI=0.54, 0.89), both adjusted for educational attainment and wealth status. Lower socio-economic status and living in a rural area were strongly associated with increased likelihood of IPV. CONCLUSIONS: Intersectional approaches that consciously focus on, and creatively address IPV may be key to the success of reducing child mortality and improving maternal health outcomes. The implementation of joint programming and development of combination interventions to effectively reduce the risk of exposure to IPV and promote maternal care-seeking behavior are needed to improve child morbidity and mortality in LMICs.
BACKGROUND: Despite considerable achievements associated with the MDGs, under-five mortality, particularly in Sub-Saharan Africa, remains alarmingly high. Globally, intimate partner violence (IPV) affects one in three women within their lifetime. Little is known about the relationship between IPV and maternal care-seeking in the context of high rates of under-five mortality, particularly among young women and adolescent girls in low- and middle-income countries (LMICs). METHODS: Data from the Kenya Demographic Health Survey (2008-2009) were limited to a sample of women aged 15-24 years (n=1,406) with a child under-five who had experienced IPV in the last 12 months. Using multivariate logistic regression, we constructed three models: 1) base model; 2) controlling for type of residence (urban/rural); and 3) controlling for wealth status and education attainment, to estimate odds ratios (ORs) for the association between IPV and ten maternal care-seeking behaviors. RESULTS: Thirty-eight percent of the women had experienced some form of intimate partner violence in the last 12 months. Women who had experience IPV were less likely: 1) to complete a minimum of 4 antenatal visits after single IPV exposure (OR=0.61, 95% CI=0.44, 0.86 and after severe IPV (OR=0.80; 95% CI=0.44, 0.88) and 2) to deliver in health facility after severe IPV exposure (OR=0.74; 95% CI=0.54, 0.89), both adjusted for educational attainment and wealth status. Lower socio-economic status and living in a rural area were strongly associated with increased likelihood of IPV. CONCLUSIONS: Intersectional approaches that consciously focus on, and creatively address IPV may be key to the success of reducing child mortality and improving maternal health outcomes. The implementation of joint programming and development of combination interventions to effectively reduce the risk of exposure to IPV and promote maternal care-seeking behavior are needed to improve child morbidity and mortality in LMICs.
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