Gender Based Violence and childbirth - analyzing data from European cohort studies

Background to the study Violence against women is a major public health problem and a serious human rights violation, which occurs across the globe. The most common forms of violence against women are physical, emotional and sexual. Violence can happen at any age and is commonly divided into violence in childhood and adulthood. The terms violence and abuse are often used interchangeably, as in our context here, even though some would use abuse for ongoing recurrent violence while violence can be a single occurrence of abuse. The violence perpetrator may be known or unknown, family or others. Sexual violence includes different forms of violence against women and my involved touching or just viewing (pictures, filming). Rape and attempted rape are often seen as the most serious forms of sexual violence. Many women do not report rape and it is therefore unknown how many women have experienced rape. The incidence of rape reported in surveys vary greatly due to variation in methodological approaches and populations. Studies show that women who have been victims of sexual violence are likely to experience serious negative consequences for their health and quality of life for a long time. Women are particularly vulnerable during pregnancy. Few published studies have investigated the effects of sexual violence and other abuse in adulthood on health during pregnancy and birth outcomes. Aim of the study Main aim of the studies has been to examine the incidence of violence and if the experienced violence has negative consequences for women in pregnancy and childbirth. Methods We analysed data from the Norwegian Mother and Child Cohort Study (MoBa) and from the Bidens study, a European cohort study which included Belgium, Icland, Denmark, Estonia, Norway and Sweden. Both studies collected data through questionnaires. In the MoBa study the first questionnaire included specific questions on rape (varying levels of severity) as an adult and the second questionnaire had 4 questions on emotional (2), physical(1) and sexual (1) abuse as an adult or child. The Bidens study used 13 validated questions to assess emotional, physical and sexual abuse as a child or adult. Results Studies on sexual violence/rape using MoBa data In our first study, we reported that approximately 18% of women had experienced rape. We found a significant association between perceived rape and increased physical ailments of pregnancy. In our second study using the same MoBa cohort, we found that the experience of rape was associated with increased risk of hospitalization in pregnancy before week 32. In our third study, we investigated the relationship between the experience of rape and mode of delivery. We observed that women who had experienced rape had a higher risk of being delivered by elective Caesarean section or that birth was induced (provider-initiated start). In our fourth study found no association between rape and outcomes for the newborn, except for a significantly shortened duration of pregnancy. This reduction in gestational length happened because the birth was initiated by the physician and seems of minimal clinical significance. Studies on violence against women in adulthood using MoBa data In our first study we saw that violence against women in adulthood was common and that women often reported that the perpetrator was known to them. In our second study we saw that women who reported violence as adults have an increased risk of post-partum depression. Studies on violence against women in both childhood and adulthood in six European countries In our first Bidens study, we found that violence against women is common in all six European countries that participated in the Bidens study. There are some differences between countries, but the characteristics of women who report abuse are similar in all countries. Approximately 1 in 10 women who have experienced abuse report that serious suffering from the violence they have experienced. In our second Bidens study we found that we abuse only marginally affected how women gave birth. Only first-time mothers who reported sexual abuse as an adult had an increased risk of elective caesarean section. Conclusion Violence against women is common and influences women's physical and mental health during pregnancy and after birth. First-time mothers who have experienced sexual violence, particularly rape, are at increased risk of being induced (having a provider-initiated start of labour) or to be delivered by elective Caesarean section (before labour starts).

Gender Based Violence (GBV) is a common public health problem. The term GBV covers different forms of emotional, physical and sexual abuse of children and adults. The consequences of GBV on mental and physical health in general are well documented. The di fferent pathways described are direct injury, neurobiological changes, and an increase in health-detrimental behaviours. Research on the impact of GBV on health during pregnancy, birth and the immediate postnatal period is limited. The majority of studie s in this field so far have had small samples, selected groups of women or been limited in addressing health effects due to the cross sectional and case-controls designs. This application concerns studies which seek to assess the potential effects of GBV in two existing population-based samples of women with a longitudinal design. The first is an EU-funded cohort of around 7.000 pregnant women in six countries, called Bidens (Bidens is the acronym for the six participating countries: Belgium, Iceland, Den mark, Estonia, Norway and Sweden) was established during 2008-2010. This study investigates the prevalence of emotional, physical and sexual abuse, the impact of this abuse on health during pregnancy and outcome at birth. The applicant is coordinator of t he study and has in depth knowledge of the data. As part of her PhD she has published from the Norwegian data-set. In her postdoctoral period she will analyze the total dataset. The second study the Norwegian Mother and Child Cohort study (MoBa, 1999-200 9) the applicant has utilized in three of her papers for her PhD. MoBa is nationwide cohort study which includes >100.000 pregnant women and includes questions on GBV. It is linked to the Medical Birth Registry of Norway which allows longitudinal analyses . This application is for the funding of a postdoctoral research scholarship for Mirjam Lukasse. The period will be used to address specific research questions in both the Bidens and MoBa data-set.