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Review
. 2014 Nov 12;2014(11):CD009414.
doi: 10.1002/14651858.CD009414.pub3.

Interventions for preventing or reducing domestic violence against pregnant women

Shayesteh Jahanfar  1 , Louise M Howard, Nancy Medley
Affiliations
Review

Interventions for preventing or reducing domestic violence against pregnant women

Shayesteh Jahanfar et al. Cochrane Database Syst Rev. .

Abstract

Background: Domestic violence during pregnancy is a major public health concern. This preventable risk factor threatens both the mother and baby. Routine perinatal care visits offer opportunities for healthcare professionals to screen and refer abused women for effective interventions. It is, however, not clear which interventions best serve mothers during pregnancy and postpartum to ensure their safety.

Objectives: To examine the effectiveness and safety of interventions in preventing or reducing domestic violence against pregnant women.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2014), scanned bibliographies of published studies and corresponded with investigators.

Selection criteria: We included randomised controlled trials (RCTs) including cluster-randomised trials, and quasi-randomised controlled trials (e.g. where there was alternate allocation) investigating the effect of interventions in preventing or reducing domestic violence during pregnancy.

Data collection and analysis: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.

Main results: We included 10 trials with a total of 3417 women randomised. Seven of these trials, recruiting 2629 women, contributed data to the review. However, results for all outcomes were based on single studies. There was limited evidence for the primary outcomes of reduction of episodes of violence (physical, sexual, and/or psychological) and prevention of violence during and up to one year after pregnancy (as defined by the authors of trials). In one study, women who received the intervention reported fewer episodes of partner violence during pregnancy and in the postpartum period (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.43 to 0.88, 306 women, moderate quality). Groups did not differ for Conflict Tactics Score - the mean partner abuse scores in the first three months postpartum (mean difference (MD) 4.20 higher, 95% CI -10.74 to 19.14, one study, 46 women, very low quality). The Current Abuse Score for partner abuse in the first three months was also similar between groups (MD -0.12 lower, 95% CI -0.31 lower to 0.07 higher, one study, 191 women, very low quality). Evidence for the outcomes episodes of partner abuse during pregnancy or episodes during the first three months postpartum was not significant (respectively, RR 0.50, 95% CI 0.25 to 1.02, one study with 220 women, very low quality; and RR 0.60, 95% CI 0.35 to 1.04, one study, 271 women, very low quality). Finally, the risk for low birthweight (< 2500 g) did not differ between groups (RR 0.74, 95 % CI 0.41 to 1.32, 306 infants, low quality).There were few statistically significant differences between intervention and control groups for depression during pregnancy and the postnatal period. Only one study reported findings for neonatal outcomes such as preterm delivery and birthweight, and there were no clinically significant differences between groups. None of the studies reported results for other secondary outcomes: Apgar score less than seven at one minute and five minutes, stillbirth, neonatal death, miscarriage, maternal mortality, antepartum haemorrhage, and placental abruption.

Authors' conclusions: There is insufficient evidence to assess the effectiveness of interventions for domestic violence on pregnancy outcomes. There is a need for high-quality, RCTs with adequate statistical power to determine whether intervention programs prevent or reduce domestic violence episodes during pregnancy, or have any effect on maternal and neonatal mortality and morbidity outcomes.

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Conflict of interest statement

Louise Howard is funded by a National Institute for Health Research Programme Grant for Applied Research on Improving the Healthcare Response to Domestic Violence and is a member of the WHO Guideline Development Group and the NICE/SCIE Guideline Development Group developing guidelines on the preventing and reducing domestic violence.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 1 Partner abuse: episodes during pregnancy.
1.2
1.2. Analysis
Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 2 Partner abuse: episodes during the first 3 months postpartum.
1.3
1.3. Analysis
Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 3 Partner abuse: abuse score first 3 months postpartum (Conflict Tactics Scale).
1.4
1.4. Analysis
Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 4 Partner abuse: abuse score in first 3 months postpartum (Conflict Tactics Scale).
1.5
1.5. Analysis
Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 5 Partner abuse in the first 3 months postpartum (Current abuse score).
1.6
1.6. Analysis
Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 6 Partner abuse: total episodes at final study assessment (pregnancy and up to 10 weeks postpartum).
1.7
1.7. Analysis
Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 7 Partner violence at 7‐8 months postpartum.
1.8
1.8. Analysis
Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 8 Women with depression (after the intervention) during pregnancy.
1.9
1.9. Analysis
Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 9 Mean Depression Episodes, Psychiatric Status Rating).
1.11
1.11. Analysis
Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 11 Women with depression up to 3 months postpartum.
1.12
1.12. Analysis
Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 12 Depression scores up to 3 months postpartum.
1.13
1.13. Analysis
Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 13 Women with depression up to 1 year postpartum.
1.14
1.14. Analysis
Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 14 Depression scores up to 1 year postpartum.
1.23
1.23. Analysis
Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 23 Mean infant birthweight (g).
1.24
1.24. Analysis
Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 24 Number of low‐birthweight (< 2500 g) babies.
1.25
1.25. Analysis
Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 25 Preterm labour (before 37 weeks' gestation).
1.26
1.26. Analysis
Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 26 (Non‐prespecified outcome) Mean gestational age at birth (weeks).
1.27
1.27. Analysis
Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 27 (Non‐prespecified outcome) Women adopting safety behaviours.
1.28
1.28. Analysis
Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 28 (Non‐prespecified outcome) stress score in late pregnancy.
1.29
1.29. Analysis
Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 29 (Non‐prespecified outcome) Did not discuss abuse with care providers.
1.30
1.30. Analysis
Comparison 1 Any intervention to prevent violence (all interventions) versus standard care, Outcome 30 (Non‐prespecified outcome) Women reporting any domestic violence 2‐4 years postpartum.
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References

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