Mechanisms for Relations of Domestic Violence to Poor Maternal and Infant Health

描述（由申请人提供）：印度育龄妇女被丈夫和其他家庭成员虐待的比率惊人，在怀孕期间被虐待的妇女更容易出现怀孕并发症、流产、生下低体重婴儿和不能存活的婴儿。然而，人们对这些关联的机制知之甚少。拟议的研究将提供定性和定量数据，以澄清丈夫和其他家庭成员对妻子的暴力行为（即“家庭暴力”）与在印度孟买一个主要贫民窟的大型公共城市卫生中心（UHC）寻求婴儿免疫接种的人的妊娠并发症和产后母婴健康之间的关系。一个顺序的研究设计将被利用，涉及定性研究的两个阶段，通知定量研究的最后阶段。第一阶段将涉及与寻求为6个月或更小的婴儿接种疫苗的家庭暴力受害者进行深入访谈（n=40）；第二阶段将包括焦点小组，与年幼婴儿同住的父亲（2组，总n=12-24人）和与最近分娩的儿媳同住的婆婆（2组，总n=12-24人）。由此产生的模型将与以前的研究结果相结合，为参加全民健康覆盖的婴儿母亲（n=750）进行儿童免疫调查，以定量评估1)家庭暴力（怀孕前、怀孕期间和怀孕后）与妊娠并发症（即早产、先兆子痫、妊娠糖尿病、出血、尿路感染）、产后产妇健康（即抑郁、贫血、生殖器感染）之间的关系；母乳喂养困难)和婴儿健康（即体重过轻、营养不良、腹泻、呼吸窘迫、发烧）；2)根据先前的研究和定性研究假设的家庭暴力与其他形式的虐待之间的关联，以代表家庭暴力对孕产妇和婴儿健康影响的近距离机制（如营养剥夺、虐待儿童、干扰孕产妇对婴儿的照顾、家务劳动需求过多）；3)家庭暴力与母婴健康结果之间的关联是否通过这些机制发生（即被这些机制修正）。这些数据将被综合起来，为家庭和诊所干预项目提供建议，并将以报告的形式广泛传播给印度的从业人员、研究人员和政策制定者。

DESCRIPTION (provided by applicant): Indian women of child-bearing age are abused by both husbands and other family members at alarming rates, and women abused around the time of pregnancy are more likely to suffer complications of pregnancy, miscarry, and give birth to low weight infants and infants that do not survive. However, little is understood regarding the mechanisms responsible for these associations. The proposed study will provide qualitative and quantitative data to clarify the relations of violence against wives by both husbands and other family members (i.e., 'domestic violence') to pregnancy complications and postpartum maternal and infant health among those seeking infant immunization at a large public urban health center (UHC) located in a major slum of Mumbai, India. A sequential research design will be utilized involving two phases of qualitative study informing a final phase of quantitative study. Phase 1 will involve in-depth interviews with victims of domestic violence seeking immunization for infants 6 months of age or younger (n=40); Phase 2 will involve focus groups with fathers residing with their young infants (2 groups, total n=12-24 individuals) and mothers-in-law residing with daughters-in-law who have recently given birth (2 groups, total n=12-24 individuals). The resulting model will be integrated with findings from previous research to create a survey for mothers of young infants (n=750) attending the UHC for child immunization to quantitatively assess 1) associations of domestic violence (prior to, during and post pregnancy) to pregnancy complications (i.e., preterm delivery, preeclampsia, gestational diabetes, hemorrhage, UTI), postpartum maternal health (i.e., depression, anemia, genital infection, breastfeeding difficulties) and infant health (i.e., low weight, poor nutrition, diarrhea, respiratory distress, fever), 2) associations of domestic violence to other forms of maltreatment hypothesized based on prior research and qualitative study to represent proximal mechanisms for the effect of domestic violence on maternal and infant health (e.g., nutritional deprivation, child abuse, interference with maternal care of infant, excessive household labor demands), and 3) whether associations of domestic violence and maternal and infant health outcomes occur via (i.e., are modified by) these mechanisms. These data will be synthesized to create recommendations for family and clinic-based intervention programs, and will be broadly disseminated in the form of reports for Indian practitioners, researchers and policymakers.