Intimate Partner Violence during Pregnancy: An Issue Undermined in Pakistani Society
Pregnancy, a singularly life altering, and also trying period in a woman’s life, should be a time of great joy, but in most instances, that is not the case. A 38 year old woman belonging to a lower middle class family had six kids and she was facing continued violence by her alcoholic husband, which pushed her onto brink of depression. She ultimately lost her life and her child due to severe complications.
According to Devries et al. (2010), intimate partner violence (IPV) during pregnancy is any physical or sexual act committed against a pregnant woman that risks injury to her or to her baby. This is unfortunately a global reality; one in three women worldwide has been a victim of intimate partner violence at some point in her life as cited by Ali et al. (2011).
As a whole, Pakistani society remains reluctant to talk openly about violence against women. As such, the data regarding prevalence are limited. The estimated lifetime incidence of IPV during pregnancy in Pakistan is 16%-76% for physical violence, and 12%-16% for sexual violence, Ali et al. (2011). Compared to Pakistan, this figure is at 2% in Australia, Denmark and Cambodia, 10.7% in Philippines, 5% in Azerbaijan and 39.5% in Uganda according to Devries et al. (2010). Despite being grossly underreported, IPV is evidently quite high in Pakistan.
Needless to say, IPV perpetuates gender inequality and degradation of women in society. While it is difficult to pinpoint the ‘root causes’, certain societal factors definitely contribute to the prevalence of IPV and domestic abuse. Alcoholism among the male members of the family is tied to IPV. Illiteracy and large family size both contribute to the cycle of poverty. Low socioeconomic position does not necessarily lead to IPV. However a study by Ali et al. (2011) reported that low education status, low job status and large family add to mental and financial stress, potentially giving rise to IPV during pregnancy. Additionally, religio-political influences reinforce the picture of a male dominated society – the biggest contributor to IPV during pregnancy, as stated by Kapadia, Saleem and Karim (2009).
IPV during pregnancy is a life-wrecking situation whose consequences go deep. Direct negative consequences for the mother and unborn child are pre-term labor, miscarriage, low birth weight, ante-partum hemorrhage, depression and pregnancy-associated violent death. Less direct effects include substance abuse, delay in seeking care, low weight gain and unwillingness to feed, Devries (2010). According to Asad et al. (2014), women who are subjected to IPV during pregnancy are four times more likely to have suicidal tendencies. Social withdrawal follows violation of reproductive rights. IPV during pregnancy also has a profound psychological impact on children who grow up witnessing continued violence inflicted on their mother by their father. This childhood stress may later surface as mental issues, e.g. depression, or criminal and violent tendencies.
On societal and political level, IPV during pregnancy increases overall infant and maternal morbidity and mortality, which not only reflects on our image as a nation, but also sets us back on the fulfillment of millennium development goals. It fosters patriarchichal mindset of the community. Ali at al. (2011) stated that in some societies IPV is considered as a “cultural norm” in marriage due to which apathy develops regarding male domination, in the minds of women and men alike. Another factor is loss of job productivity for women who work to support their family; it can be due to maternal morbidity, which not only affects the individual woman’s life but also decreases human resource in the country.
Nurses have a role in working against this issue on an individual level. The chief intervention is to use observational and communication skills especially during antenatal visits to find out if a woman may be a victim of intimate partner violence, evident from signs of battering and bruises. The next step is to encourage and advice women to be economically independent by starting small jobs like sewing clothes or embroidery. For women with depression or with other mental disorders, psychological care must be given to return them to their previous optimal mental health.
On a community level, awareness sessions could be conducted about impact of intimate partner violence during pregnancy on maternal and child health and also how members of a society can help by intervening at the right moment. Along with that, gender equality and gender sensitization workshops could also be arranged, not just for the children, but also for members of all age groups to enhance better understanding. Conducting women empowerment and awareness sessions in communities and informing about the rights and policies given to women that strongly oppose violence and humiliation of any kind. Since there is no explicit legislation in Pakistan to counter domestic violence (Kapadia et al. 2009), advocating for women’s rights is of prime urgency. In addition, awareness about reproductive and sexual rights should be created.
IPV during pregnancy is a social evil with serious consequences that has its roots deep in the socioeconomic system of Pakistan and it can only be solved through rising awareness, proper education and adequate policy making.
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