摘要：Objective. We examined the effect of physical violence during pregnancy on perinatal and early-childhood mortality. Methods. We estimated the prevalence of domestic violence during pregnancy among a population-based sample of 2199 women in Uttar Pradesh, India. We used a survival regression model to examine the risks for perinatal, neonatal, postneonatal, and early-childhood (aged 1–3 years) mortality by mother’s exposure to domestic violence, after we controlled for other sociodemographic and maternal health behavior risk factors. Results. Eighteen percent of the women in our study experienced domestic violence during their last pregnancy. After we adjusted for other risk factors, births among mothers who had experienced domestic violence had risks for perinatal and neonatal mortality that were 2.59 (95% confidence interval [CI]=1.35, 4.95) and 2.37 (95% CI=1.21, 4.62) times higher, respectively, than births among mothers who had not experienced violence. We found no significant associations between domestic violence and either postneonatal or early-childhood mortality. Conclusions. Domestic violence is a significant risk factor for perinatal and neonatal mortality. It is estimated that 10% to 69% of women in the world experience some form of violence at the hands of their husband or male partner. 1 Although there is no conclusive evidence that the risk for domestic violence escalates during pregnancy, 2 – 4 it is clear that a significant subgroup of pregnant women are exposed to violence during pregnancy. The adverse consequences of violence during pregnancy on birth outcomes, such as low birthweight and prematurity, have been extensively studied. 5 – 12 However, information about the effects of violence on perinatal and early-childhood mortality is much more limited, and almost all such evidence is from studies that were conducted in developed countries. 13 – 15 The prevalence of domestic violence among pregnant women in US studies ranges from 1% to as high as 20%, with most studies reporting a range of 4% to 8%. 16 Although more limited in number, studies that were conducted in developing countries have reported prevalence rates that range from 4% to as high as 28%. 17 Infant mortality rates also are substantially higher in developing countries; today, more than 90% of neonatal deaths occur in these countries. Despite higher levels of both domestic violence and childhood mortality in developing countries, information about the association between domestic violence and child mortality in these countries is limited. 18 , 19 The pathways through which domestic violence may lead to elevated risks for perinatal and childhood mortality are not fully understood. One possible pathway is the direct effect of blunt physical trauma and the resultant fetal death or subsequent adverse pregnancy outcome. 6 , 20 A second potential pathway is elevated maternal stress levels and poor nutrition, both of which are associated with low birthweight or preterm delivery and are well-known risk factors for perinatal and infant mortality. 21 – 23 A third possible pathway is the deterrent effect of violence on women’s use of preventive or curative health services during pregnancy, delivery, and after the birth. 24 – 26 Data from Uttar Pradesh, North India—where there are high levels of both domestic violence within marriage 18 , 27 and early childhood mortality levels 28 , 29 —provided a unique opportunity for investigating this association. Our objectives were to (1) examine the bivariate association between domestic violence and mortality risks during early childhood, (2) investigate the association between domestic violence and maternal health care behaviors, and (3) explore the association between domestic violence and perinatal, neonatal, postneonatal, and early-childhood mortality risks, after we controlled for the effects of maternal health care behaviors and other sociodemographic characteristics.
