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

描述(由申请人提供)：印度育龄妇女受到丈夫和其他家庭成员的虐待，其程度令人震惊，怀孕期间受到虐待的妇女更有可能遭受怀孕并发症、流产和生下低体重婴儿和无法存活的婴儿。然而，人们对这些关联的机制知之甚少。这项拟议的研究将提供定性和定量数据，以澄清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中，丈夫和其他家庭成员对妻子的暴力(即家庭暴力)与怀孕并发症和产后母婴健康的关系。将采用顺序研究设计，包括定性研究的两个阶段，以提供定量研究的最后阶段。第一阶段将与寻求为6个月或以下婴儿接种疫苗的家庭暴力受害者进行深入访谈(n=40)；第二阶段将涉及与父亲与其年幼婴儿同住的重点小组(2组，共12-24人)和与新近分娩的儿媳一起居住的婆媳(2组，共12-24人)。所产生的模型将与以前的研究结果相结合，对参加UHC儿童免疫接种的750名幼儿的母亲进行调查，以定量评估1)家庭暴力(怀孕前、怀孕期间和怀孕后)与怀孕并发症(即早产、先兆子痫、妊娠期糖尿病、出血、尿路感染)、产后母亲健康(即抑郁、贫血、生殖器感染、哺乳困难)和婴儿健康(即低体重、营养不良、腹泻、呼吸窘迫、发烧)的关系，2)根据先前的研究和定性研究假设家庭暴力与其他形式的虐待之间的联系，以代表家庭暴力对母婴健康产生影响的最近的机制(例如，营养匮乏、虐待儿童、干扰对婴儿的产妇照料、过度的家庭劳动需求)，以及3)家庭暴力与母婴健康结果之间的联系是否通过这些机制发生(即被这些机制改变)。这些数据将被综合起来，以创建基于家庭和诊所的干预计划的建议，并将以报告的形式广泛传播，供印度从业者、研究人员和政策制定者使用。

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.