Profiling intimate partner violence in booked pregnant women at Alex Ekwueme Federal University Teaching Hospital Abakaliki and associated puerperal depressive sequelae: a prospective cohort study

Background: Intimate partner violence (IPV) in pregnancy is a physical, sexual, psychological or economic harm by a current or former partner or spouse on a pregnant woman. It is a global public health problem that is common but underreported. Women are at increased risk of psychiatric illness in pregnancy and after delivery with the risk of major depressive disorder being highest during the postpartum period. Intimate partner violence in pregnancy may worsen this problem.

Objectives: The objectives of the study were to determine the prevalence of intimate partner violence (IPV) in pregnancy, incidence of postpartum depression and the relationship between intimate partner violence, delivery outcomes and postpartum depression among booked pregnant women at Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi state, Nigeria (AEFUTHA).

Study design: This study was a prospective cohort study.

Setting: The antenatal clinic, antenatal ward, labour ward, postpartum clinic and under five clinic of Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi state, Nigeria were used for the study.

Method: One hundred and thirty-seven booked pregnant women that received antenatal care at AEFUTHA who met the inclusion criteria and consented to the study, were recruited from 37 weeks to 41 weeks gestation and screened for intimate partner violence and depression. Those with depression were referred for treatment while those that met the inclusion criteria were followed up to delivery and the delivery outcomes documented. They were also followed up to six weeks postpartum when they were screened for postpartum depression. Data were collated, tabulated and then statistically analysed using Statistical Package for Social Science (SPSS) software (version 25, Chicago II, USA). Numerical variables including participant's age, parity and gestational age were presented as mean, median, frequencies and standard deviation (Mean ± S.D), while categorical variables including occupation, level of education, social class and family type were presented as numbers and percentages. Chi-square test (X²) and relative risk was used for comparison between groups for categorical variables while Fisher's exact test was used when Chi-square test (X²) was not suitable. Binary regression analysis was used to determine the relationship between intimate partner violence and postpartum depression. A P value of ˂0.05 is considered statistically significant.

Results: The prevalence of intimate partner violence was 52.6%, as 72 out of the 137 women recruited endured intimate partner violence. The major risk factors for intimate partner violence in the study were low level of education, low social class, polygamy and unemployment. The general incidence of postpartum depression was 29.93% while the incidence among women with intimate partner violence was 56.94%. Women with emotional violence and verbal abuse had a five-fold increase in the incidence of postpartum depression. Sexual violence and physical violence were not statistically significant risk factors for postpartum depression.

Conclusion: Intimate partner violence is common as seen from the study. It is a significant risk factor for postpartum depression. Women that are emotionally and verbal abused are more likely to have postpartum depression. Screening pregnant women for intimate violence may identify those at risk and allow for proper interventions.