Introduction
Physical spousal abuse towards pregnant women cuts across societies and classes in developed and developing countries of the world. It is a gross violation of human rights and has many far-reaching consequences for a woman and her fetus including serious social and health problems (Neuberger, 1992; Gazmararian, 1996; Valladares, 2002; American Medical Association, 1992).
Although the literature on this issue has grown in recent years, studies in developing countries and those using population-based data are scarce. In addition, previous studies vary greatly with respect to the definition of physical spousal abuse, sample size and composition, and reference periods (Vallandares, 2002; and Gazmararian, 1995).
It is clear from the research that physical spousal abuse toward women during pregnancy is an issue that cuts across countries; however, prevalence varies from country to country, and even within countries. According to the majority of clinic-based studies in the United States of America, prevalence of spousal abuse during pregnancy ranges from 4% to 8% (Gazmararian, 1996; Gazmararian, 1995; Muhajarine & D’Arcy, 1999 and Stewart & Cecutti, 1993). An analysis of 1996-1998 Pregnancy Risk Assessment Monitoring System (PRAMS) data from sixteen U.S. states estimated that the overall prevalence of physical spousal abuse during pregnancy was 5% (Saltzman, 2003); the highest prevalence was in Oklahoma (7%) and the lowest in Maine (4%). Separate studies in North and South Carolina found the prevalence in those states to be 6% and 11%, respectively (Martin, 2001; and Cokkindes, 1999).
According to a review of six studies from India, China, Pakistan and Ethiopia, the prevalence of physical spousal abuse during pregnancy ranged from 4% to 28% (Nasir and Hyder, 2003). Four of these studies were hospital-based and found prevalence of 4-22% (Leung, Leung and Lam, 1999; Purmar, 1999; Fikree & Bhatti, 1999; and Faruqi, 1996); the other two were population-based, covering both urban and rural areas, and reported prevalence of 10-28% (Nasir & Hyder, 2003; Deyessa, 1998; and International Clinical Epidemiologists Network, 2000). A multi country, population-based study conducted by the World Health Organisation (WHO) from which the data for the current study are drawn, shows that the rate of physical spousal abuse of women during pregnancy in ten developing countries ranged from 3% to 28% (Garcia-Moreno, 2005).
Eighteen percent of economically disadvantaged currently married women living with their husbands in six villages in Bangladesh experienced physical spousal abuse during at least one pregnancy; for 3%, the abuse got worse during pregnancy (Bates, 2004).
Although, some abused women first experience physical abuse during pregnancy, most do not. A Brisbane study of antenatal patients found that 18% of ever abused women were first abused during a pregnancy (Taft, 2001). According to studies in Turkey (Karaoglu, 2006) and Canada, (Stewart & Cecutt, 1993), however, about 86% of ever-abused women were abused for the first time when they were not pregnant. In addition, an analysis of nationally representative longitudinal U.S. data suggests that pregnant women are not at greater risk of victimization than non pregnant women (Jasinki, 2001). Furthermore, the WHO multi country study found that in most of the developing countries studied, the onset of physical abuse did not overlap with pregnancy (Garcia-Moreno, 2005).
The research results vary on whether abuse toward women increases, decreases, or remains the same during pregnancy. There is evidence that pregnancy can be a time of respite for some previously abused women (Jasinki, 2001; Bermon, 1991; Campbell, 1998; Campbell, 1995; Castro, Peek-Asa & Ruiz, 2003; Martin, 1996; and Hedin, 2000), perhaps because of stigma associated with physically injuring a pregnant women, (Karaoglu, 2006; Jasinki, 2001; Borenson, 1991 and Campbell, 1998). If this is the case, partners abuse, only to replace it with emotional abuse, such as insults, threats and humiliation (Karaoglu, 2006 and Martin, 2004). The WHO multi-country study reports that the majority of women who suffered from abuse before and during pregnancy in all sites reported that during the last pregnancy in which they were abused, the abuse was the same or somewhat less severe or frequent than before the pregnancy (Stewart & Cecutte, 1993; Borenson, 1991; Campbell, 1992 and Taggart, 1996). In constrast, other studies have found an escalation of abuse during pregnancy (Garcia-Moreno, 2005). For example, 64% of Canadian women who were abused during pregnancy reported that their abuse increased during pregnancy (Stewart & Cecutti, 1993).
In recent research, women who were abused during pregnancy had a history of abuse (Glander, 1998; Horrigan, Schroeder, & Schaffer, 2000; and Jasinki, 2004). Five studies found that a past history of abuse (i.e. abuse before pregnancy) is one of the strongest predictors of abuse during pregnancy (Stewart & Cecutti, 1993; Castro, Peek-Asa & Ruiz, 2003; Martin, 2004; McFarlance, 1992 and Su-fang, 2004). In addition, multiple social, economic, cultural biological, and environmental factors contribute to abuse toward women during pregnancy.
Low socio-economic status has consistently been identified as a risk factor for violence during pregnancy (Gazmararian, 1995; Purmar, 1999; Karuoglu, 2006; Su-fang, 2004; and Goodwin, 2000). Economically, disadvantaged women, both in the United States and in developing countries, have the highest rates of reported abuse during pregnancy (Campbell, 2004); although women from higher income groups experience abuse, they may be less likely than others to disclose their abuse (International Clinical Epidemiologists Network, 2000). Urban residence is a predictor of violence during pregnancy (Karaoglu, 2006; and Su-fang, 2004). In both developing and developed countries, women’s low level of education is associated with physical abuse during pregnancy, (Muhajarin, 1999; Purmar, 1999; Farugi, 1996; Karaoglu, 2006 and Bohn, 2004), male partners’ low level of education is also a contributing factor (Leung, Leung & Lam, 1999; Faruqi, 1996 and International Clinical Epidemiologists Network, 2000). Finally, young pregnant women are more likely than those who are older to be abused (Muhajarine, 1999; Stewart & Cecutti, 1993; Hedin, 1999 and O’Camp, 1994).
Poor spousal communication is one of the factors associated with marital violence (Berns, Jacobson & Gottman, 1999 and Gordis, Margolin & Vickerman, 2005). Studies exploring the relationship between couple communication or interaction and physical violence during pregnancy are not numerous; however, according to at least two studies, poor couple communication is related to violence during pregnancy in India and China (Purmar, 1999; Sun-fang, 2004).
In Nigeria, most research work on physical spousal abuse has been based on prevalence and patterns; scarcely do we have studies linking physical spousal abuse to women during pregnancy. It is against this background that this study becomes relevant in filling such missing gaps in our knowledge in the issue of physical spousal abuse of women during pregnancy in Lagos metropolis area of Lagos State, Nigeria.
Purpose of Study
The purpose of this study is to investigate the relationship of the factors positively associated with physical spousal abuse of women during pregnancy in Lagos metropolis, Nigeria.
To achieve the purpose of this study, the following research questions were answered:
1. To what extent would factors positively associated with physical spousal abuse influence women during pregnancy?
2. What is the relative contribution of each of these factors (dowry demand, involvement spousal communication, past history of abuse religion, husband’s level of education and age at marriage) to the prediction of physical spousal abuse of women during pregnancy?
3. There is no significant relationship between the determinants factors and physical spousal abuse of women during pregnancy.
Methodology
Research Design
This study employed an ex-post-facto design. This design does not involve the manipulation of any variable. The event has already occurred and the researcher only investigated what was already there.
Participants
The participants for this study consists of all married women in Lagos metropolis whose ages ranged between 21 years – 49 years, and are currently pregnant. A total of two hundred and fifty were randomly drawn from pregnant women attending antenatal clinics in Lagos University Teaching Hospital, Lagos Maternity Hospital and Ikoyi Specialist Hospital, all in Lagos Metropolis. The choice of Lagos area for the study was chosen because it is an area where support services for abused women are currently available or could be established, the populations are broadly representative of socio-economic strata and not perceived as having high levels of domestic violence.
All the participants involved in the study can read, write and respond to questions.
Instrumentation
Two major instruments were used in the study:
1. Self-Reporting Questionnaire factors positively associated with physical spousal abuse of women during pregnancy. Women answered questions about the age at marriage, dowry demand at marriage, past history, of abuse, couples religion, husband’s level of education, and spousal level of communication. It has 30 items rated on a 4 point Likert-type scale. The respondents indicated their degree of agreement with each item by ticking Strongly Agreed (4); Agreed (3); Disagreed (2) and Strongly Disagreed (1). It has 0.67 and 0.73 as the internal consistency and revalidation reliability respectively.
2. Physical Spousal Abuse Inventory: Women answered questions on experience of physical assault perpetrated by one’s partner during any pregnancy was the dependent variable in the analyses. The questions on violence during pregnancy were modified versions of questions used by Campbell (1998) and those developed by the Centre for Disease Control and Prevention (CDC) for the PRAMS model in the United States (1999). Psychometric analysis was performed on the violence questions to ascertain the appropriateness of the behavioural items included. The items had good internal consistency, indicating that the instrument provided a reliable and valid measure of violence during pregnancy.
Procedure for Data Collection
The participants for the study were administered the two questionnaires with the assistance of two research assistants and the hospital attendants in the three hospitals involved in the study. The collected questionnaires were scored and the data obtained from them were analysed to answer the research questions. On the whole, 250 copies of the questionnaires were distributed and returned fully filled, giving a return rate of 100%.
Data Analysis
The data collected were analysed using multiple regression analysis and chi-square (x2) statistics to establish the relationship of the factors tested and physical spousal abuse of women during pregnancy.
Results:
1. Using a combination of the independent variables to predict physical spousal abuse of women during pregnancy.
Table I: Summary of Regression Analysis of Sample Data
Multiple R = 0. 462
Multiple R-Square = 0.213
Adjusted R-Square = 0.197
Standard Error of Estimate = 3.06
Analysis of Variance
Sources of Variation
df
SS
Ms
F-ratio
Regression
4
617.444
123.48886
13.229*
Residual
245
2277.5997
9.3344
Total
249
-
-
* Significant at 0.05 level of confidence
Table I shows that the combination of the six independent variables (dowry demand involvement, spousal communication, past history of abuse, religion, husband’s level of education and age at marriage) in predicting physical spousal abuse of women during pregnancy gave a co-efficient of multiple regression (R) of 0.462 and a multiple R-Square (R2) of 0.213. The result shows that 21.3% of the variance in the prediction of physical spousal abuse of women during pregnancy is accounted for by the independent variables. The table also indicates that, the analysis of variance of the multiple regression data gave an F-ratio of 13.229 significant at 0.05 level of confidence.
2. Relative Contribution of Independent Variables to the Prediction of Physical Spousal Abuse of Women during pregnancy
Variables
B
SEB
Beta
T-ratio
Sign. – T
Remark
1
Dowry Demand Involvement
0.103
0.045
0.146
2.284
0.0162
Sig.
2
Spousal Communication
-0.811
0.378
-0.135
-2.146
0.0146
Sig.
3
Past History of Abuse
-.0979
0.404
0.143
-2.425
0.0161
Sig.
4
Religion
-0.113
0.399
0.017
-0.283
0.7771
NS
5
Husband’s level of Education
0.194
0.401
0.028
0.484
0.6287
NS
6
Age at Marriage
-1.014
0.411
0.142
-2.461
0.0145
Sig.
7
Constant
40.904
7.634
-
5.358
-
0.000
Table 2 shows for each independent variable, the standardised regression weight (B), the Standard Error Estimate (SEB), the Beta, the T-ratio, and the level at which the T-ratio, and the level at which the T-ratio is significant. As indicated in the table the T-ratio is associated with four variables (dowry demand involvement, spousal communication, past history of abuse, and age at marriage) were significant at 0.05 level of confidence while religion and husband’s level of education were not significantly associated with the dependent variable.
3. There is no significant relationship between the determinant factors and physical spousal abuse of women during pregnancy.
Table 3: Cross-tabulation and chi-square (X2) analysis of determinant factors and physical spousal abuse of women during pregnancy
Determinant Factors
Response of determinant factors
Total
X2 Cal.
X2 Crit.
df
Sig. Level
Remark
SD
D
A
SA
1
Dowry Demand Involvement
15
(7.5)
5
(2.5)
25
(12.5)
12
(6.0)
57
36.7
3.33
9
0.05
Sig.
2
Spousal Communication
14
(7.0)
3
(1.5)
40
(20.0)
32
(16.0)
89
3
Past History of Abuse
4
(2.0)
2
(1.0)
7
(3.5)
22
(11.0)
35
4
Religion
4
(2.0)
2
(1.0)
3
(1.5)
6
(3.0)
15
5
Husband’s level of Education
4
(2.0)
5
(2.5)
4
(2.0)
6
(3.0)
19
6
Age at Marriage
12
(6.0)
5
(2.5)
8
(4.0)
10
(5.0)
35
7
Total
53
22
87
88
250
X2 = 36.7, DF = 9, P <0.05 = Significant
Table 3 above shows the cross-tabulation of the determinant factors and physical spousal abuse of women during pregnancy. From the table above, the X2 calculated value (36.7) at 0.05 level of significance is greater than X2 critical value of 3.33. Therefore, the null hypothesis was rejected and the alternative hypothesis, that state that there is a significant relationship between the detrimental factors and physical spousal abuse was accepted. By implication, this means that the determinant factors has it consequences, and has an association with spousal physical abuse of women during pregnancy.
Discussion of Findings
The results obtained showed that a combination of dowry demand, spousal communication, past history of abuse, religion, husband’s level of education and age at marriage when taken together seemed to be effective in predicting physical spousal abuse of women during pregnancy. The observed F-ratio of 13.229, significant at 0.05 level is an evidence that the effectiveness of a combination of the independent variables in the prediction of physical spousal abuse could not have occurred by chance. Furthermore, the coefficient of multiple correlation of 0.462 and a multiple R + square of 0.213 showed the magnitude of the relationship between physical spousal abuse and the combination of the independent variables. The results indicated that a relationship of the independent variables accounted for only 21.3% of the total variance in spousal physical abuse among pregnant women.
The results in Table 2 revealed the contribution made by each independent variable to the prediction of spousal physical abuse of women during pregnancy. The t-ratio values associated with each independent variables showed that dowry demand, past history of abuse, age at marriage, spousal communication contributed significantly to the prediction whereas religion and husband’s level of education did not.
Based on the above, dowry demand involvement, age at marriage, past history of abuse and spousal communication are the most important predictors of physical spousal abuse of women during pregnancy. This results agree with the findings reported by Bern, Jacobson and Gottman (1999); Gordise, Margolin and Vickerman (2005); that poor couple communication is related to violence during pregnancy in India and China Su-fang (2004); and Purmar (1999). Martins (2001); Wiemann (2000) and Dunn (2000) focuses their report on abuse by past or current intimate partners. In contrasts, other studies have found an escalation of violence during pregnancy – Stewart & Cecutti (1993); Berenson (1991); Campbell (1992) and Taggart & Mattson (1996).
In the view of Stewart and Cecutti (1993); Castor, Peek and Ruiz (2003), Martin (2004); McFarlance (1992) and Su-fang (2004) found that a past history of abuse (i.e. abuse before pregnancy) is one of the strongest predictors of abuse during pregnancy.
Another finding from this study was that religion and the husband’s level of education was not a major predictor of spousal physical abuse was however, at variance of the work of Leung, Leung and Lam (1999); Faruqi (1990); and International Clinical Epidemiologists Network (2000) that, male partners’ low level of education is also a contributing factor. In addition, multiple social, economic, cultural, biological and environmental factors also contribute to violence toward women during pregnancy.
Although religion was not found to significantly predict physical spousal abuse of women during pregnancy in the sample involved in this study, attention of social workers and counselling psychologists should be directed to religious teaching among couples as it could check violence among family members and the individuals in the society.
Conclusion
In view of the fact that family history of spousal violence increases a daughter’s risk of such abuse and other factors as dowry demand, poor couple communication, and age at marriage have been found to be positively correlated to abuse, these factors should be widely communicated.
Further research is needed to determine whether increased couple communication reduces the likelihood of violence or whether absence of violence can lead to increased couple communication.
References
Bates LM. Socioeconomic factors and processes associated with domestic violence in rural Bangladesh, International Family Planning Perspectives, 2004, 30(4): 190-199.
Berenson AB. Drug abuse and other risk factors for physical abuse in pregnancy among white non-Hispanic, black, and Hispanic women, American Journal of Obstetrics and Gynecology, 1991, 164(6 Pt. 1):1491-1499.
Berns, SB. Jacobson NS and Gottman, JM. Demand-withdraw interaction in couples with a violent husband, Journal of Consulting and Clinical Psychology, 1999, 67(5): 666-674.
Bohn DK, Tebben JG and Campbell JC, Influences of income, education, age, and ethnicity on / physical abuse before and during pregnancy, Journal of Obstetrics, Gynecology and Neonatal Nursing, 2004, 33(5):561-571.
Campbell JC 0IM&, The dynamics of battering during pregnancy, in: Campbell JC, ed., Empowering Survivors of Abuse: Health Care for Battered Women and Their Children, Thousand Oaks, CA, USA: Sage, 1998, pp. 81-89.
Campbell JC eWt, Correlates of battering during pregnancy, Research in Nursing and Health, 1992, 15(3):21 9-226.
Campbell JC, Garcia-Moreno C and Sharps P, Abuse during pregnancy in industrialized and developing countries, Violence Against Women, 2004, 10(7):770-789.
Campbell JCt^Wfl, The influence of abuse on pregnancy intention, Women’s Health Issues, 1995, 5 (4):214-223.
Castro R, Peek-Asa C and Ruiz A, Violence against women in Mexico: a study of abuse before and during pregnancy, American Journal of Public Health, 2003, 93(7): 1 1 10-1 116.
Centres for Disease Control and Prevention (CDC), PRAMS Model Surveillance Protocol, Atlanta, GA, USA: CDC, 1999.
Cokkinides VE. Physical violence during pregnancy: maternal complications and birth outcomes, Obstetrics & Gynecology, 1999, 93(5):661-666.
Council on Scientific Affairs, American Medical Association, Violence against women: relevance for medical practitioners, Journal of the American Medical Association, 1992, 267(23):3184-3189.
Deyessa N. Magnitude, type and outcomes of violence against women in Bulajira, South Ethiopia, Ethiopian Medical Journal, 1998, 36(2):83-92.
Dunn LL and Oths KS, Prenatal predictors of intimate partner abuse, Journal of Obstetric, Gynecologic, & Neonatal Nursing, 2004, 33(1):54-63.
Faruqi N, The women’s group report on women speaking about domestic violence, poster presented at the Third Annual National Symposium, Aga Khan University, Karachi, Pakistan, Sept. 21-22, 1996.
Fikree FF and Bhatti LI, Domestic violence and health of Pakistani women, International Journal of Gynaecology and Obstetrics, 1999, 65(2):195-201.
Garcia-Moreno C. WHO Multicountry Study on Women’s Health and Domestic Violence Against Women: Initial Results on Prevalence, Health Outcomes and Women’s Responses, Geneva: World Health Organization (WHO), 2005.
Gazmararian JA. Prevalence of violence against pregnant women, Journal of the American Medical Association, 1996, 275(24): 1915-1920.
Gazmararian JA. The relationship between pregnancy intendedness and physical violence in mothers of newborns, Obstetrics & Gynecology, 1995, 85(6):1031-1038.
Glander SS. The prevalence of domestic violence among women seeking abortion, Obstetrics & Gynecology, 1998, 91(6):1002- 1006.
Goodwin M. Pregnancy intendedness and physical abuse around the time of pregnancy: findings from the Pregnancy Risk Assessment Monitoring System, 1996-1997, Maternal and Child Health Journal, 2000, 4(2):85-92.
Gordis EB, Margolin G and Vickerman K. Communication and frightening behaviour among couples with past and recent histories of physical marital aggression. American Journal of Community Psychology, 2005, 36(1-2): 177-191.
Hedin LW. Postpartum, also a risk period for domestic violence, European Journal of Obstetrics & Gynecology and Reproductive Biology, 2000, 89(1):41-45.
Hedin LW. Prevalence of physical and sexual abuse before and during pregnancy among Swedish couples, Canadian Medical Association Journal, 1999, 160(7):1007-1011.
Horrigan TJ, Schroeder AV and Schaffer RM, The triad of substance abuse, violence, and depression are interrelated in pregnancy, Journal of Substance Abuse Treatment, 2000, 18(1):55-58.
International Clinical Epidemiologists Network (INCLEN) and International Center for Research on Women (ICRW), Indiasafe: Studies of Abuse in the Family Environment in India-A Summary Report, New Delhi, India and Washington, DC: INCLEN and ICRW, 2000.
Jasinski JL, Pregnancy and violence against women: an analysis of longitudinal data, Journal of Interpersonal Violence, 2001, 16(7):713- 734.
Jasinski JL. Pregnancy and domestic violence: a review of the literature, Trauma, Violence & Abuse, 2004, 5(1 ):47-64.
Karaoglu Ltfitatt, Physical, emotional and sexual violence during pregnancy in Malatya, Turkey, European Journal of Public Health, 2006, 16(2): 149-156.
Leung WC, Leung TW and Lam YY, The prevalence of domestic violence against pregnant women in a Chinese community, International Journal of Gynaecology and Obstetrics, 1999, 66(1):23-30.
Martin SL. Changes in intimate partner violence during pregnancy, Journal of Family Violence, 2004, 19(4):201-210.
Martin SL. Physical abuse of women before, during and after pregnancy, Journal of the American Medical Association, 2001, 285(12): 1581-1584.
Martin SL. Violence and substance abuse among North Carolina pregnant women, American / Journal of Public Health, 1996, 86(7):991-998.
McFarlane J. Assessing for abuse during pregnancy: severity and frequency of injuries and associated entry into prenatal care, Journal of the American Medical Association, 1992, 267(23):3176-3178.
Muhajarine N and D’Arcy C, Physical abuse during pregnancy: prevalence and risk factors, Canadian Medical Association Journal, 1 999, 1 60(7):1 007-1 011 .
Nasir K and Hyder A, Violence against pregnant women in developing countries, European Journal of Public Health, 2003, 13(2):105- 107.
Newberger EH. Abuse of pregnant women and adverse birth outcome. Current knowledge and implications for practice, Journal of the American Medical Association, 1992, 267(17):2370-2372.
O’Campo P. Verbal abuse and physical violence among a cohort of low-income pregnant women, Women’s Health Issues, 1994, 4(1):29-37.
Purwar MB. Survey of physical abuse during pregnancy, Government Medical College and Hospital, Nagpur, India, Journal of Obstetrics and Gynecological Research, 1999, 65(3): 195-201.
Saltzman LE. Physical abuse around the time of pregnancy: an examination of prevalence and risk factors in 16 states, Maternal and Child Health Journal, 2003, 7(1):31-42.
Stewart DE and Cecutti A, Physical abuse in pregnancy, Canadian Medical Association Journal, 1993, 149(9):1257-1263.
Su-fang G. Domestic abuse on women in China before, during, and after pregnancy, Chinese Medical Journal, 2004, 117(3):331- 336.
Taft A, Intimate partner abuse in pregnancy, Obstetrics & Gynecology, 2001, 3(4):250-253.
Taggart L and Mattson S, Delay in prenatal care as a result of battering in pregnancy: cross-cultural implications, Health Care for Women International, 1996, 17(1):25-34.
Valladares E. Physical partner abuse during pregnancy: a risk factor for low birth weight in Nicaragua, Obstetrics & Gynecology, 2002, 100(4):700-705.
Wiemann CM. Pregnant adolescents: experiences and behaviors associated with physical assault by an intimate partner, Maternal and Child Health Journal, 2000, 4(2):93-101.
