Measuring Gender-Based Household Maltreatment in Urban Slums of Mumbai, India.

Emerging research has documented non-violent forms of abuse against wives in India. Gender-based household maltreatment (GBHM) has been linked to poor maternal and child health outcomes, but the measurement of GBHM requires statistical validation. The objective of this study is to evaluate a new measure of GBHM of women by husbands and in-laws during the perinatal period for validity and internal reliability (before, during, and post pregnancy). This study utilized cross-sectional quantitative data collected from women (n = 1,049) seeking immunizations for their infants <6 months of age at large urban health centers in three major slum communities in Mumbai, India. After domain mapping and item consolidation, exploratory factor analysis identified a single factor among final scale items for each perinatal time period, with Velicer's Minimum Average Partial (meeting criterion at <0.065) confirming a single factor. Overall, the measure shows good internal reliability and both face and construct validity. On these merits, the measure should be assessed for utility in determining whether the more commonly reported non-violent forms of abuse act as a risk factor for poor maternal and child health outcomes.

Assessing the relationship between intimate partner violence, externally-decided pregnancy and unintended pregnancies among women in slum communities in Mumbai, India.

BACKGROUND: India contends with a high rate of intimate partner violence (IPV), which is associated with unintended pregnancy and reflects low levels of women's decision-making control in relation to their reproductive health. Few studies from South Asia have examined the relationship between pregnancy decision-making, IPV and unintended pregnancy. AIM: This study examined associations between unintended (mistimed and unwanted) pregnancy, women's reports of pregnancy decided externally by husband or in-laws, and IPV, among a sample of married, postpartum women. METHODS: Data from the 'Mechanisms for Relations of Domestic Violence to Poor Maternal and Infant Health in India' study were analysed. Descriptive comparisons between levels of unintended pregnancy were run on all major variables. Unadjusted and adjusted multinomial logistic regression analyses assessed women's reports of having externally-decided pregnancies and IPV victimisation in the year prior to pregnancy as factors in mistimed and unwanted pregnancies. RESULTS: Mistimed and unwanted pregnancies were reported by 12.2% and 7.2% of women, respectively. Externally-decided pregnancies were reported by 8.8% of women. Some 29.4% of women reported experiencing physical and/or sexual IPV in the year prior to pregnancy. Women reporting externally-decided pregnancies were significantly more likely to have had mistimed pregnancies than intended pregnancies, as were women reporting IPV. Neither external pregnancy control nor IPV were associated with unwanted pregnancy. CONCLUSIONS: Women's exclusion from pregnancy decision-making and violence from husbands relate to their ability to time their pregnancies as they wish. The lack of significant association between external decision-making and IPV with unwanted pregnancy may be due to low reporting of unwanted pregnancy. The overall findings highlight the importance of integrating women's involvement in reproductive health decision-making and IPV reduction messaging in programming for the women's health sector.

Impact of the RHANI Wives intervention on marital conflict and sexual coercion.

OBJECTIVE: To assess the effects of the RHANI (Reducing HIV among Non-Infected) Wives intervention on marital conflict and intimate partner violence (IPV) in urban India. METHODS: A 2-armed cluster-randomized controlled trial (7 intervention, 6 control clusters) of the RHANI Wives intervention was conducted with 220 women contending with a history of IPV and/or husband's drunken behavior. Participants were surveyed at baseline and 4.5-month follow-up. Outcome measures included marital conflict (arguments with husband in past 3 months), marital IPV (physical or sexual violence from husband in past 3 months), and marital sexual coercion (husband forcing sex at last sex). Intention-to-treat logistic generalized linear mixed models were used to determine intervention impact. RESULTS: One-third (35.0%) of participants reported physical or sexual abuse from their husband in the past 3 months, and 58.6% reported that their husband was drunk in the past 30 days. Intention-to-treat analyses indicated time×treatment reductions in marital conflict (risk ratio [RR] 0.4; 90% confidence interval [CI], 0.1-0.9; P=0.06) and marital sexual coercion (RR 0.2; 90% CI, 0.05-0.9; P=0.08), but not IPV. CONCLUSION: The findings suggest the potential utility of this intervention in reducing marital conflict and sexual coercion among women in urban India. ClinicalTrials.gov: NCT01592994.