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Published in: BMC Women's Health 1/2016

Open Access 01-12-2016 | Research article

Experience of intimate partner violence among young pregnant women in urban slums of Kathmandu Valley, Nepal: a qualitative study

Authors: Keshab Deuba, Anustha Mainali, Helle M. Alvesson, Deepak K. Karki

Published in: BMC Women's Health | Issue 1/2016

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Abstract

Background

Intimate partner violence (IPV) is an urgent public health priority. It is a neglected issue in women’s health, especially in urban slums in Nepal and globally. This study was designed to better understand the IPV experienced by young pregnant women in urban slums of the Kathmandu Valley, as well as to identify their coping strategies, care and support seeking behaviours. Womens’ views on ways to prevent IPV were also addressed.

Methods

20 young pregnant women from 13 urban slums in the Kathmandu valley were recruited purposively for this qualitative study, based on pre-defined criteria. In-depth interviews were conducted and transcribed, with qualitative content analysis used to analyse the transcripts.

Results

14 respondents were survivors of violence in urban slums. Their intimate partner(s) committed most of the violent acts. These young pregnant women were more likely to experience different forms of violence (psychological, physical and sexual) if they refused to have sex, gave birth to a girl, or if their husband had alcohol use disorder. The identification of foetal gender also increased the experience of physical violence at the prenatal stage. Interference from in-laws prevented further escalation of physical abuse. The most common coping strategy adopted to avoid violence among these women was to tolerate and accept the husbands’ abuse because of economic dependence. Violence survivors sought informal support from their close family members. Women suggested multiple short and long term actions to reduce intimate partner violence such as female education, economic independence of young women, banning identification of foetal gender during pregnancy and establishing separate institutions within their community to handle violence against young pregnant women.

Conclusions

Diversity in the design and implementation of culturally and socially acceptable interventions might be effective in addressing violence against young pregnant women in humanitarian settings such as urban slums. These include, but are not limited to, treatment of alcohol use disorder, raising men’s awareness about pregnancy, addressing young women’s economic vulnerability, emphasising the role of health care professionals in preventing adverse consequences resulting from gender selection technologies and working with family members of violence survivors.
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Literature
1.
go back to reference Samarasekera U, Horton R. Prevention of violence against women and girls: a new chapter. Lancet. 2014;385:1480–1482. Samarasekera U, Horton R. Prevention of violence against women and girls: a new chapter. Lancet. 2014;385:1480–1482.
2.
go back to reference Sprague S, Bhandari M, Della Rocca GJ, Goslings JC, Poolman RW, Madden K, Simunovic N, Dosanjh S, Schemitsch EH, Investigators P. Prevalence of abuse and intimate partner violence surgical evaluation (PRAISE) in orthopaedic fracture clinics: a multinational prevalence study. Lancet. 2013;382(9895):866–76.CrossRefPubMed Sprague S, Bhandari M, Della Rocca GJ, Goslings JC, Poolman RW, Madden K, Simunovic N, Dosanjh S, Schemitsch EH, Investigators P. Prevalence of abuse and intimate partner violence surgical evaluation (PRAISE) in orthopaedic fracture clinics: a multinational prevalence study. Lancet. 2013;382(9895):866–76.CrossRefPubMed
3.
go back to reference Carter J. Patriarchy and violence against women and girls. Lancet. 2014;385:e40–e41. Carter J. Patriarchy and violence against women and girls. Lancet. 2014;385:e40–e41.
4.
go back to reference Devries KM, Mak JY, García-Moreno C, Petzold M, Child JC, Falder G, Lim S, Bacchus LJ, Engell RE, Rosenfeld L, et al. Global health. The global prevalence of intimate partner violence against women. Science. 2013;340(6140):1527–8.CrossRefPubMed Devries KM, Mak JY, García-Moreno C, Petzold M, Child JC, Falder G, Lim S, Bacchus LJ, Engell RE, Rosenfeld L, et al. Global health. The global prevalence of intimate partner violence against women. Science. 2013;340(6140):1527–8.CrossRefPubMed
5.
go back to reference Stöckl H, Devries K, Rotstein A, Abrahams N, Campbell J, Watts C, Moreno CG. The global prevalence of intimate partner homicide: a systematic review. Lancet. 2013;382(9895):859–65.CrossRefPubMed Stöckl H, Devries K, Rotstein A, Abrahams N, Campbell J, Watts C, Moreno CG. The global prevalence of intimate partner homicide: a systematic review. Lancet. 2013;382(9895):859–65.CrossRefPubMed
6.
go back to reference MoHP. Nepal Demographic and Health Survey. Kathmandu: Ministry of Health and Population, New ERA, and ICF International; 2011:1-291. MoHP. Nepal Demographic and Health Survey. Kathmandu: Ministry of Health and Population, New ERA, and ICF International; 2011:1-291.
7.
8.
go back to reference Aekplakorn W, Kongsakon R. Intimate partner violence among women in slum communities in Bangkok, Thailand. Singapore Med J. 2007;48(8):763–8.PubMed Aekplakorn W, Kongsakon R. Intimate partner violence among women in slum communities in Bangkok, Thailand. Singapore Med J. 2007;48(8):763–8.PubMed
10.
go back to reference Decker MR, Peitzmeier S, Olumide A, Acharya R, Ojengbede O, Covarrubias L, Gao E, Cheng Y, Delany-Moretlwe S, Brahmbhatt H. Prevalence and health impact of intimate partner violence and non-partner sexual violence among female adolescents aged 15–19 years in vulnerable urban environments: a multi-country study. J Adolesc Health. 2014;55(6 Suppl):S58–67.CrossRefPubMed Decker MR, Peitzmeier S, Olumide A, Acharya R, Ojengbede O, Covarrubias L, Gao E, Cheng Y, Delany-Moretlwe S, Brahmbhatt H. Prevalence and health impact of intimate partner violence and non-partner sexual violence among female adolescents aged 15–19 years in vulnerable urban environments: a multi-country study. J Adolesc Health. 2014;55(6 Suppl):S58–67.CrossRefPubMed
11.
12.
go back to reference Devries KM, Kishor S, Johnson H, Stöckl H, Bacchus LJ, Garcia-Moreno C, et al. Intimate partner violence during pregnancy: analysis of prevalence data from 19 countries. Reprod Health Matters. 2010;18(36):158–70.CrossRefPubMed Devries KM, Kishor S, Johnson H, Stöckl H, Bacchus LJ, Garcia-Moreno C, et al. Intimate partner violence during pregnancy: analysis of prevalence data from 19 countries. Reprod Health Matters. 2010;18(36):158–70.CrossRefPubMed
13.
go back to reference Chaudhary P. Prevalence of gender-based violence among pregnant women at paropakar maternity and women Hospital. Kathmandu: FPAN; 2007. Chaudhary P. Prevalence of gender-based violence among pregnant women at paropakar maternity and women Hospital. Kathmandu: FPAN; 2007.
14.
15.
go back to reference Ludermir AB, Lewis G, Valongueiro SA, de Araújo TV, Araya R. Violence against women by their intimate partner during pregnancy and postnatal depression: a prospective cohort study. Lancet. 2010;376(9744):903–10.CrossRefPubMed Ludermir AB, Lewis G, Valongueiro SA, de Araújo TV, Araya R. Violence against women by their intimate partner during pregnancy and postnatal depression: a prospective cohort study. Lancet. 2010;376(9744):903–10.CrossRefPubMed
16.
go back to reference Salazar M, Högberg U, Valladares E, Ohman A. The supportive process for ending intimate partner violence after pregnancy: the experience of Nicaraguan women. Violence Against Women. 2012;18(11):1257–78.CrossRefPubMed Salazar M, Högberg U, Valladares E, Ohman A. The supportive process for ending intimate partner violence after pregnancy: the experience of Nicaraguan women. Violence Against Women. 2012;18(11):1257–78.CrossRefPubMed
17.
go back to reference Burch R, Gordon G. Pregnancy as a stimulus for domestic violence. J Fam Violence. 2004;19(4):243–7.CrossRef Burch R, Gordon G. Pregnancy as a stimulus for domestic violence. J Fam Violence. 2004;19(4):243–7.CrossRef
18.
go back to reference Nasrullah M, Zakar R, Zakar MZ, Abbas S, Safdar R. Circumstances leading to intimate partner violence against women married as children: a qualitative study in Urban Slums of Lahore, Pakistan. BMC Int Health Hum Rights. 2015;15:23.CrossRefPubMedPubMedCentral Nasrullah M, Zakar R, Zakar MZ, Abbas S, Safdar R. Circumstances leading to intimate partner violence against women married as children: a qualitative study in Urban Slums of Lahore, Pakistan. BMC Int Health Hum Rights. 2015;15:23.CrossRefPubMedPubMedCentral
19.
go back to reference Ickovics JR, Reed E, Magriples U, Westdahl C, Schindler Rising S, Kershaw TS. Effects of group prenatal care on psychosocial risk in pregnancy: results from a randomised controlled trial. Psychol Health. 2011;26(2):235–50.CrossRefPubMedPubMedCentral Ickovics JR, Reed E, Magriples U, Westdahl C, Schindler Rising S, Kershaw TS. Effects of group prenatal care on psychosocial risk in pregnancy: results from a randomised controlled trial. Psychol Health. 2011;26(2):235–50.CrossRefPubMedPubMedCentral
20.
go back to reference Stöckl H, March L, Pallitto C, Garcia-Moreno C, Team WM-cS. Intimate partner violence among adolescents and young women: prevalence and associated factors in nine countries: a cross-sectional study. BMC Public Health. 2014;14:751.CrossRefPubMedPubMedCentral Stöckl H, March L, Pallitto C, Garcia-Moreno C, Team WM-cS. Intimate partner violence among adolescents and young women: prevalence and associated factors in nine countries: a cross-sectional study. BMC Public Health. 2014;14:751.CrossRefPubMedPubMedCentral
21.
go back to reference Puri M. Unintended pregnancy among young couples in Nepal: Determinants and consequences of unintended pregnancy. Germany: VDM Verlag Dr. Muller Aktienge sellschaft and Co. KG; 2009. Puri M. Unintended pregnancy among young couples in Nepal: Determinants and consequences of unintended pregnancy. Germany: VDM Verlag Dr. Muller Aktienge sellschaft and Co. KG; 2009.
22.
go back to reference Visaria A. Religion and gender bias: an exploration of Hindu-Muslim differences in son preference in India. USA: Gradiate Group in Demography, University of Pennsylvania; 2013. Visaria A. Religion and gender bias: an exploration of Hindu-Muslim differences in son preference in India. USA: Gradiate Group in Demography, University of Pennsylvania; 2013.
23.
go back to reference Das Gupta M. Family systems, political systems, and Asia’s ‘Missing Girls’: The construction of son preference and its unraveling. Washington D.C: The World Bank; 2009.CrossRef Das Gupta M. Family systems, political systems, and Asia’s ‘Missing Girls’: The construction of son preference and its unraveling. Washington D.C: The World Bank; 2009.CrossRef
24.
go back to reference Das Gupta M, Zhenghua J, Bohua L, Zhenming X, Chung W, Hwa-Ok B. Why is Son preference so persistent in East and South Asia? a crosscountry study of China, India and the Republic of Korea. J Dev Stud. 2003;40(2):153–87.CrossRef Das Gupta M, Zhenghua J, Bohua L, Zhenming X, Chung W, Hwa-Ok B. Why is Son preference so persistent in East and South Asia? a crosscountry study of China, India and the Republic of Korea. J Dev Stud. 2003;40(2):153–87.CrossRef
25.
go back to reference Krishnan A, Amarchand R, Byass P, Pandav C, Ng N. “No one says ‘No’ to money” - a mixed methods approach for evaluating conditional cash transfer schemes to improve girl children’s status in Haryana. India Int J Equity Health. 2014;13:11.CrossRefPubMed Krishnan A, Amarchand R, Byass P, Pandav C, Ng N. “No one says ‘No’ to money” - a mixed methods approach for evaluating conditional cash transfer schemes to improve girl children’s status in Haryana. India Int J Equity Health. 2014;13:11.CrossRefPubMed
26.
go back to reference Temmerman M. Research priorities to address violence against women and girls. Lancet. 2014;385:e38–e40. Temmerman M. Research priorities to address violence against women and girls. Lancet. 2014;385:e38–e40.
27.
go back to reference Ellsberg M, Arango DJ, Morton M, Gennari F, Kiplesund S, Contreras M, Watts C. Prevention of violence against women and girls: what does the evidence say? Lancet. 2014;385:1555–1566. Ellsberg M, Arango DJ, Morton M, Gennari F, Kiplesund S, Contreras M, Watts C. Prevention of violence against women and girls: what does the evidence say? Lancet. 2014;385:1555–1566.
28.
go back to reference Edin KE, Dahlgren L, Lalos A, Högberg U. “Keeping up a front”: narratives about intimate partner violence, pregnancy, and antenatal care. Violence Against Women. 2010;16(2):189–206.CrossRefPubMed Edin KE, Dahlgren L, Lalos A, Högberg U. “Keeping up a front”: narratives about intimate partner violence, pregnancy, and antenatal care. Violence Against Women. 2010;16(2):189–206.CrossRefPubMed
29.
go back to reference Lumanti. Status of squatter communities along the Bagmati river and its tributaries in Kathmandu valley. Kathmandu: Lumanti; 2008. p. 1–69. Lumanti. Status of squatter communities along the Bagmati river and its tributaries in Kathmandu valley. Kathmandu: Lumanti; 2008. p. 1–69.
30.
go back to reference Green J, Thorogood N. Qualitative methods for health research. Thirdth ed. Los Angeles: Sage; 2014. Green J, Thorogood N. Qualitative methods for health research. Thirdth ed. Los Angeles: Sage; 2014.
31.
go back to reference Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–12.CrossRefPubMed Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–12.CrossRefPubMed
32.
go back to reference WHO. Putting women first: ethical and safety recommendation for research on domestic violence against women. Geneva: World Health Organization; 2001. WHO. Putting women first: ethical and safety recommendation for research on domestic violence against women. Geneva: World Health Organization; 2001.
33.
go back to reference Nepal Health Research Council. National ethical guidelines for health research in Nepal and standard operating procedures. Kathmandu: Nepal Health Research Council; 2011. Nepal Health Research Council. National ethical guidelines for health research in Nepal and standard operating procedures. Kathmandu: Nepal Health Research Council; 2011.
34.
go back to reference Jeyaseelan L, Sadowski LS, Kumar S, Hassan F, Ramiro L, Vizcarra B. World studies of abuse in the family environment--risk factors for physical intimate partner violence. Inj Control Saf Promot. 2004;11(2):117–24.CrossRefPubMed Jeyaseelan L, Sadowski LS, Kumar S, Hassan F, Ramiro L, Vizcarra B. World studies of abuse in the family environment--risk factors for physical intimate partner violence. Inj Control Saf Promot. 2004;11(2):117–24.CrossRefPubMed
35.
go back to reference Thompson MP, Kingree JB. The roles of victim and perpetrator alcohol use in intimate partner violence outcomes. J Interpers Violence. 2006;21(2):163–77.CrossRefPubMed Thompson MP, Kingree JB. The roles of victim and perpetrator alcohol use in intimate partner violence outcomes. J Interpers Violence. 2006;21(2):163–77.CrossRefPubMed
37.
go back to reference Jhingan HP, Shyangwa P, Sharma A, Prasad KM, Khandelwal SK. Prevalence of alcohol dependence in a town in Nepal as assessed by the CAGE questionnaire. Addiction. 2003;98(3):339–43.CrossRefPubMed Jhingan HP, Shyangwa P, Sharma A, Prasad KM, Khandelwal SK. Prevalence of alcohol dependence in a town in Nepal as assessed by the CAGE questionnaire. Addiction. 2003;98(3):339–43.CrossRefPubMed
38.
go back to reference Leonard KE. Alcohol and intimate partner violence: when can we say that heavy drinking is a contributing cause of violence? Addiction. 2005;100(4):422–5.CrossRefPubMed Leonard KE. Alcohol and intimate partner violence: when can we say that heavy drinking is a contributing cause of violence? Addiction. 2005;100(4):422–5.CrossRefPubMed
39.
go back to reference Lamichhane P, Harken T, Puri M, Darney PD, Blum M, Harper CC, et al. Sex-selective abortion in Nepal: a qualitative study of health workers’ perspectives. Womens Health Issues. 2011;21(3 Suppl):S37–41.CrossRefPubMed Lamichhane P, Harken T, Puri M, Darney PD, Blum M, Harper CC, et al. Sex-selective abortion in Nepal: a qualitative study of health workers’ perspectives. Womens Health Issues. 2011;21(3 Suppl):S37–41.CrossRefPubMed
40.
go back to reference Valladares E, Peña R, Persson LA, Högberg U. Violence against pregnant women: prevalence and characteristics. A population-based study in Nicaragua. BJOG. 2005;112(9):1243–8.CrossRefPubMed Valladares E, Peña R, Persson LA, Högberg U. Violence against pregnant women: prevalence and characteristics. A population-based study in Nicaragua. BJOG. 2005;112(9):1243–8.CrossRefPubMed
41.
go back to reference Shamu S, Abrahams N, Temmerman M, Shefer T, Zarowsky C. “That pregnancy can bring noise into the family”: exploring intimate partner sexual violence during pregnancy in the context of HIV in Zimbabwe. PLoS One. 2012;7(8):e43148.CrossRefPubMedPubMedCentral Shamu S, Abrahams N, Temmerman M, Shefer T, Zarowsky C. “That pregnancy can bring noise into the family”: exploring intimate partner sexual violence during pregnancy in the context of HIV in Zimbabwe. PLoS One. 2012;7(8):e43148.CrossRefPubMedPubMedCentral
42.
go back to reference Bornstein RF. The complex relationship between dependency and domestic violence: converging psychological factors and social forces. Am Psychol. 2006;61(6):595–606.CrossRefPubMed Bornstein RF. The complex relationship between dependency and domestic violence: converging psychological factors and social forces. Am Psychol. 2006;61(6):595–606.CrossRefPubMed
43.
go back to reference Basu B, Famoye F. Domestic violence against women, and their economic dependence: a count data analysis. Rev Pol Econ. 2004;16(4):457–72.CrossRef Basu B, Famoye F. Domestic violence against women, and their economic dependence: a count data analysis. Rev Pol Econ. 2004;16(4):457–72.CrossRef
45.
go back to reference Coates J, Rogers B, Brewer N, Schoonmaker L. Domestic violence against women is associated with lower household food security in rural Bangladesh. FASEB J. 2010; 24(124.1). Coates J, Rogers B, Brewer N, Schoonmaker L. Domestic violence against women is associated with lower household food security in rural Bangladesh. FASEB J. 2010; 24(124.1).
46.
go back to reference Craparo G, Gori A, Petruccelli I, Cannella V, Simonelli C. Intimate partner violence: relationships between alexithymia, depression, attachment styles, and coping strategies of battered women. J Sex Med. 2014;11(6):1484–94.CrossRefPubMed Craparo G, Gori A, Petruccelli I, Cannella V, Simonelli C. Intimate partner violence: relationships between alexithymia, depression, attachment styles, and coping strategies of battered women. J Sex Med. 2014;11(6):1484–94.CrossRefPubMed
47.
go back to reference Lindhorst T, Nurius P, Macy RJ. Contextualized assessment with battered women: strategic safety planning to cope with multiple harms. J Soc Work Educ. 2005;41(2):331–52.CrossRefPubMedPubMedCentral Lindhorst T, Nurius P, Macy RJ. Contextualized assessment with battered women: strategic safety planning to cope with multiple harms. J Soc Work Educ. 2005;41(2):331–52.CrossRefPubMedPubMedCentral
48.
go back to reference Ragavan M, Iyengar K, Wurtz R. Perceptions of options available for victims of physical intimate partner violence in northern India. Violence Against Women. 2015;21(5):652–75.CrossRefPubMed Ragavan M, Iyengar K, Wurtz R. Perceptions of options available for victims of physical intimate partner violence in northern India. Violence Against Women. 2015;21(5):652–75.CrossRefPubMed
49.
go back to reference Rose LE, Campbell J, Kub J. The role of social support and family relationships in women’s responses to battering. Health Care Women Int. 2000;21(1):27–39.CrossRefPubMed Rose LE, Campbell J, Kub J. The role of social support and family relationships in women’s responses to battering. Health Care Women Int. 2000;21(1):27–39.CrossRefPubMed
50.
go back to reference Evans MA, Feder GS. Help-seeking amongst women survivors of domestic violence: a qualitative study of pathways towards formal and informal support. Health Expect. 2015;19(1):62-73. Evans MA, Feder GS. Help-seeking amongst women survivors of domestic violence: a qualitative study of pathways towards formal and informal support. Health Expect. 2015;19(1):62-73.
51.
go back to reference Subedi M. Caste system: theories and practices in Nepal. J Sociol Antropol. 2010;IV:134–59. Subedi M. Caste system: theories and practices in Nepal. J Sociol Antropol. 2010;IV:134–59.
Metadata
Title
Experience of intimate partner violence among young pregnant women in urban slums of Kathmandu Valley, Nepal: a qualitative study
Authors
Keshab Deuba
Anustha Mainali
Helle M. Alvesson
Deepak K. Karki
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Women's Health / Issue 1/2016
Electronic ISSN: 1472-6874
DOI
https://doi.org/10.1186/s12905-016-0293-7

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