摘要：Objectives. We examined the joint associations of marital status and duration of cohabitation on self-reported intimate partner violence, substance use, and postpartum depression among childbearing women. Methods. We analyzed data from the 2006–2007 Canadian Maternity Experiences Survey, a cross-sectional nationwide sample of 6421 childbearing women. Cohabiting women were married or nonmarried women living with a partner; noncohabiters were single, divorced, or separated women. We further categorized cohabiters by their duration of cohabitation (≤ 2, 3–5, or > 5 years). We used logistic regression to generate adjusted odds ratios and 95% confidence intervals. Results. About 92% of women were cohabiters. Compared with married women living with a husband more than 5 years, unmarried women cohabiting for 2 years or less were at higher odds of intimate partner violence (adjusted odds ratio [AOR] = 4.64; 95% confidence interval [CI] = 2.85, 7.56), substance use (AOR = 5.36; 95% CI = 3.06, 9.39), and postpartum depression (AOR = 1.87; 95% CI = 1.25, 2.80); these risk estimates declined with duration of cohabitation. Conclusions. Research on maternal and child health would benefit from distinguishing between married and unmarried cohabiting women, and their duration of cohabitation. Since the mid-20th century, births to unmarried women have been steadily increasing. In recent years, in several European countries, births out of wedlock outnumbered those of married couples. 1 The prevalence of such births in Canada increased from 9% in 1971 to 30% in 2006 2,3 ; in the United States, it reached 40% by 2007. 4 These trends reflect a decline in the rate of marriage and the emergence of nonmarital cohabitation as a popular living arrangement. 5 As marital status has evolved, its categorization for the purposes of administration data collection or health research has not kept pace, so that it is still unclear about how marital status relates to maternal well-being and reproductive outcomes. It is known that infants of unmarried women fare worse than those of married women in terms of low birth weight, preterm birth, and infant mortality. 6–8 When unmarried women are distinguished by whether or not they have a regular partner, a gradient of increased risk of adverse outcomes has been observed for married mothers, unmarried mothers with a partner, and unmarried mothers without a partner. 7–11 Further distinctions have been hampered by the lack of fine categorizations of these relationships. For example, it is unclear whether indicators of health and well-being among women without partners differ between never-married single mothers and those who experience divorce or separation. Among childbearing women with partners, it is not known whether indicators of health and well-being are affected by duration of cohabitation, which is deemed to reflect the commitment to, and stability of, a couple’s relationship, 12 and whether the association of duration of cohabitation and maternal well-being, if any, is different between married and cohabiting women. To advance knowledge on these issues, we used a rich data set from a national survey of Canadian childbearing women and evaluated marital status, cohabitation status, and duration of cohabitation and their interplay with selected psychosocial problems around the time of pregnancy (i.e., right before pregnancy, during pregnancy, and shortly after delivery) known to be associated with marital status, such as intimate partner violence, substance use, and postpartum depression. 13–16 On the basis of previous reports suggesting potential heterogeneity of risk of adverse outcomes within marital status groups, 7,11,12 we hypothesized that a finer categorization of childbearing women’s relationship with their partners, one that distinguished marital and cohabitation status and its duration, would reveal differences in indicators of maternal psychosocial well-being beyond those observed according to marital status alone. Violence against women is a worldwide problem, 16,17 and intimate partner violence around the time of pregnancy may hinder health care utilization and have negative physical and mental health consequences for both the mother and the infant. 16–18 Substance use (street drugs, tobacco, and alcohol) during pregnancy is associated with maternal complications, impaired fetal growth, and behavioral and cognitive problems in childhood. 19,20 Postpartum depression may impair the ability of women to take care of themselves and affect attachment and communication with their children, resulting in negative effects on infant social, emotional, and cognitive development. 21–23 As these 3 psychosocial outcomes have important interpersonal components, they are intimately connected with marital status and marital transitions. 24–26 In some cases, marital status may influence the likelihood of these outcomes via unintended pregnancy and partner support. 24,27 In many cases, a woman’s childbearing desires may differ from those of her partner, 27 and a partner’s disagreement with the current pregnancy may be an indicator of poor relationship quality and a predictor of poor maternal well-being. 24,27,28 However, it is also true that psychosocial problems may trigger changes in marital status, as in the case of separation or divorce following partner abuse, 29 or when a woman’s poor health causes her to be rejected by her partner. 25 Pregnancy is a critical period for maternal well-being, and couples’ arrangements and the assessment of associations of psychosocial problems around the time of pregnancy with more detailed categorizations of unions is likely to improve our ability to discriminate who is at risk and who is not.
