Electronic Physician (ISSN: 2008-5842) http://www.ephysician.

ir
August 2017, Volume: 9, Issue: 8, Pages: 5166-5171, DOI: http://dx.doi.org/10.19082/5166

Prevalence of domestic violence on pregnant women and maternal and neonatal outcomes in Bandar
Abbas, Iran

Abdol Azim Nejatizade1, Nasibeh Roozbeh2, Asiyeh Pormehr Yabandeh3, Fatemeh Dabiri3, Azita Kamjoo3,
Arefeh Shahi3
1
MD, Ph.D., Associate Professor, Human Molecular Genetic, Molecular Medicine Research Center, Hormozgan
University of Medical Sciences, Bandar Abbas, Iran
2
Ph.D., Assistant Professor, Mother and Child Welfare Research Center, Hormozgan University of Medical
Sciences, Bandar Abbas, Iran
3
M.Sc., Instructor of Obstetrics Department, Mother and Child Welfare Research Center, Hormozgan University of
Medical Sciences, Bandar Abbas, Iran

Type of article: Original

Abstract
Background: Pregnancy by itself, imposes great physical and psychological pressures on a person and
consequently, coupled with other stressors such as violence, can have adverse effects on the fetus and mother.
Objective: To assess the prevalence of domestic violence in pregnant women and maternal and infants’
outcomes.
Methods: This is a descriptive study using a questionnaire. Data were collected from 725 women who delivered
their babies at Shariati Hospital in Bandar Abbas in the summer and autumn of 2013. The questionnaire consisted
of four parts: demographic characteristics, factors affecting violence, areas of violence (physical, emotional,
sexual) and maternal and fetal outcomes. Data analysis was performed by SPSS 18 using descriptive statistics, t-
test, Chi-square, and logistic regression.
Results: The prevalence of physical, sexual and psychological violence were 6.5, 14.8 and 9.9 %, respectively.
The variables of age, duration of marriage, previous marriage experience and the husband’s addiction, had a
significant relationship with applying physical violence of the husband. There was significant correlation between
physical violence and maternal outcomes (p<0.000). There was a statistically significant association between
physical violence and low birth weight and growth delay in the uterus (p=0.033).
Conclusion: Due to the relatively high violence in pregnancy, and its impact on maternal and neonatal outcomes,
it is suggested that violence screening programs in the health system and educating health professionals and
women at risk and also the implementation of programs to protect these women, can be effective in reducing the
cycle of violence and its negative consequences.
Keywords: Domestic violence, Women, Maternal outcome, Neonatal outcome

1. Introduction
Violence is a hidden epidemic, and continual in the lives of the affected women whose health and well-being is at
risk. For this reason, the issue of women in health and social issues is important, and is known as a major public
health problem (1-3). According to the World Health Organization definition, violence refers to any act against
women that causes physical, psychological harm or suffering or sexual violence and lack of freedom and authority
(2). According to a World Bank report, rape and domestic violence is more prevalent than diseases such as breast
and cervical cancer and accident causes loss of 44-15 year-old women's health. (4). Therefore, around 40-50% of
women at some point in their lives experience domestic violence. As a result, their physical and mental health is
affected, and sometimes leads to suicide (5) Violence may occur at any time during a woman's life including their

Corresponding author:
Asiyeh Pormehr Yabandeh, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
Tel: +98.7633667904, Fax: +98.76-33670724, Email: [email protected]
Received: November 01, 2015, Accepted: June 27, 2017, Published: August 2017
iThenticate screening: June 20, 2017, English editing: July 28, 2017, Quality control: August 02, 2017
© 2017 The Authors. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-
NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is
non-commercial and no modifications or adaptations are made.
Page 5166
Electronic physician

pregnancy. Pregnancy by itself imposes a great physical and psychological pressure on the person and naturally,
coupled with other stressors such as violence, can have adverse effects on the fetus and the mother, and the effects
can cause the increase of maternal and infant mortality (6). Among the factors involved in violence during
pregnancy, factors such as low educational level, smoking and drug abuse, unwanted pregnancy, low income,
unemployment, less than 5 years of marriage, forced marriage, first pregnancy, age and physical and mental health
of the couple are to be noted (2-4). The increase of the vulnerability of women, the increase of economic pressure
and decrease in sexual intercourse in pregnancy are mentioned (1). Factors, such as the transition to the parenthood
role, result in impaired balance and harmony of couples, and causes a shift in the pattern of their previous
relationship (2). The prevalence of domestic violence imposed during pregnancy has been reported as 1-30 % in
various studies. The degree of violence in Iranian pregnant women has been reported by more than 60 % in
conducted studies (5, 7). Violence during pregnancy leads to premature labor, low birth weight, abortion,
hypertension, chorioamnionitis, an increased rate of caesarean, stillbirth, urinary tract infection, chronic pelvic
infection, anemia and increasing depression during pregnancy and after childbirth (2, 8-10). .Also, cases of repeated
violence and lack of delay for prenatal care can be noted (1). Violence includes three areas of physical,
psychological and sexual, but most studies have focused on the area of health in pregnancy. Given that study in all
three areas is insufficient, and since no study in this area has been done in Hormozgan province, research on
violence in pregnancy in Bandar Abbas was considered as steps to provide approaches for prevention and timely
measures in this area.

2. Material and Methods

This study was conducted in Shariati Hospital (a referral and educational Hospital) in Bandar Abbas in 2013.
Criteria of inclusion for the study were gestational age of above 20 weeks, Iranian nationality, the absence of known
physical and mental illness. The sample number for this study was determined as 725 (13), and simple random
sampling method was used. To collect the data, the researcher made questionnaire were designed by reading
scientific resources and validated by expert views. The violence questionnaire was validated using the method of
determining the validity of the content (Content Validity). To this purpose, the viewpoints of 10 faculty members of
Hormozgan University of Medical Sciences (gynecologists and obstetricians, midwives and nurses) were used. To
test the reliability of the tools, a pre-test study was conducted and use of Cronbach's alpha coefficient was
determined. That is, after interviewing 30 individuals on similar subjects under the study and completing the
questionnaire, Cronbach's alpha was calculated and reliability of the questionnaire was 0.85 and contains 46
questions. The questionnaire contained four parts ; The first part had 19 questions about demographic
characteristics; the second part, 4 questions about the factors affecting the violence; third part, 12 questions on
violence (physical, emotional and sexual) in pregnancy and the fourth, 11 questions on pregnancy outcome (mother
and fetus) the purpose of which was fetal, low birth weight, fetal death, Apgar score and other outcomes and the
consequences of motherhood pertaining to abortion, preterm labor, premature rupture of membranes of placental
abruption and other complications. The questions on violence are designed to have at least one positive answer to
each question (physical, emotional or sexual), which is carried out by the husband during pregnancy. The domain of
physical violence includes behavior such as hitting, beating, use of an implement to hit, etc. Sexual violence was
evaluated with questions such as requests and acts for sexual intercourse and coercion against one's desire. In the
area of emotional violence, questions were asked about the existence of such things as insults, humiliation, threats of
separation and death. After obtaining the consent of the patient and ensuring the confidentiality of information,
questionnaires were completed anonymously. We used descriptive statistics, t-test, Chi-square, and logistic
regression for data analysis by SPSS version 18 (SPSS Inc., Chicago, Illinois, USA).

3. Results
The results showed that the average age of women participating in the study was 24.6 years. The average age of
their spouses was 30.73±6.56 years. The average duration of marriage was 4.81. The majority of the women
participating in the study had experienced their first pregnancy (53.8%). Most people attending the study were urban
dwellers (58.9 %). In total, 93.2% of women were married with the consent of their own choice. Only 2.2% of
women and 7% of their partners had a history of a previous marriage. The education level of women was generally
low; 33.7% had primary education, and more than 90% of the women in the study were housewives. Most women
said that their husbands do not have any drug or alcohol addiction (86.1%). In this study, the prevalence of physical,
sexual and psychological violence was noted 6.5%, 14.8% and 9.9% respectively. By means of logistic regression
test (Table 1), it was shown that the variables of age, addiction of husband, marriage duration, marriage status of the
spouse and women’s medical record of chronic disease had a significant relationship with domestic violence.
Between planned or unplanned pregnancies and physical violence, no significant relationship was found. Also, no

Page 5167
http://www.ephysician.ir

significant relationship between women's education and physical violence was found, while there was a significant
correlation between men’s education and domestic violence (p=0.04, r=0.75). It means that the more educated a
man, the less domestic violence there is. Based on the findings of this study, it was indicated that there is a direct
relationship between physical violence and maternal outcomes. This means that if more physical violence was
committed against women during pregnancy, the maternal consequences would be greater (p<0.000). Yet, no
significant relationship between sexual and psychological violence and maternal outcomes was found. Also, there
was statistically significant relationship between physical violence and low birth weight (LBW), which is of fetal
outcomes (p=0.033). The results showed that there was a significant relationship between physical violence and
LBW (p<0.000, r=0.164), but there was no statistically significant relationship between psychological and sexual
violence with other variables related to fetal outcome.

Table 1. Logistic regression analysis results controlling the possible effects of demographic variables on domestic
violence
Independent variable Scale Beta coefficient p-value Odds ratio (OR)
Age (years) >20 -- -- 1
20-25 -0.69 0.001 0.49
<25 0.91 0.022 2.5
Addiction of wife (Yes/No) Cigarettes 2.09 0.039 8.16
Narcotics 2.53 0.06 12.56
Other addictive substances 3.19 0.001 24.28
Alcohol -- -- 1
Duration of marriage (years) 2-5 2.15 0.011 8.66
5-10 1.01 0.162 2.76
10-15 0.17 0.819 0.837
<15 -- -- 1
Husband’s remarried status Yes 2.27 0.027 9.55
No -- -- 1
Women experiencing chronic illness Yes 0.818 0.097 2.26
No -- -- 1
Husband’s Education Below high school diploma 0.04 0.75
Above high school diploma -- -- 1

4. Discussion
The results of our study showed that the most common types of violence were respectively 14.8% of sexual
violence, 9.9% psychological violence, and 5.6% physical violence. In a study of Dolatian in 2009 entitled ‘the
prevalence of abuse during pregnancy’ it concluded that physical violence was the lowest form of violence in
number, (8) which is consistent with our results. Also, in a study that was conducted in Ahvaz, physical violence
was less in number in comparison to other forms of violence which is consistent with our study (11). Wives’ sexual
harassment in our study was 14.8% which is consistent with Salehi’s study in Shahrekord (13.8%) (5). In a study in
China, none of the pregnant women had experienced physical violence during pregnancy (12), while other studies
have reported physical violence with more statistics (1, 5). The existing difference between the prevalence of
violence among women with different frequencies has been reported that this difference may be due to
methodology, sampling and cultural differences and the willingness of respondents to disclose experiences of
domestic violence during pregnancy as part of their private lives. It seems that men's fear of maternal and fetal risks
for physical violence is perhaps the reason for these differences. In our research, women whose husbands had not
consumed alcohol or drugs, experienced less violence, and that has been consistent with the results of Salehi and
Hassanzadeh (5, 11). Addicts experience the consequences of emotional, social, cultural and special spiritual
experience; considering emotionally low self-esteem, lack of control, reduced frustration tolerance, emotional
instability, anger, and anxiety and depression experience, and these factors are the causes (12). Experts consider
violence against women and its increase is due to economic pressures, mental health problems caused by alcohol
and drugs in a way that the findings of a study in 2001 on 439 women beaten by their husbands, showed that 40% of
women had married drug addicts (13). In our study, women in the age group below 20 years experienced physical
violence 2.5 times that of the age group over 25 years. In a study in Australia, a significant relationship between age
and incidence of violence in pregnant women was reported (14). Also, our study results are consistent with research
conducted by Dolatian (8). Being inexperienced at a younger age results in lack of ability to solve problems the

Page 5168
Electronic physician

outcome would be maladaptive behavior in family relationships. In our research, with the increase of men’s
education, the rate of domestic violence is lower. In the study of Saberian, experience of financial, verbal and
physical violence in women with husbands with lower education than high school diploma was higher (15). In this
study, women who have been married less than 2 years are subject to physical and sexual violence more than those
who have been married more than 15 years. In this regard, Salehi and Mehralian, in their study, reported that
domestic violence is reduced with increasing duration of marriage (5). Also, Dolatian et al., stated that duration of
marriage less than 5 years was associated with a higher incidence of violence (8). Our study showed that the lower
men’s education, the greater prevalence of domestic violence there is. Men’s education can affect the family's
socioeconomic status and the results show that women who are unhappy with their economic and financial situation,
more than twice as those who are satisfied with their financial situation, are subject to sexual violence by their
husbands. The study of Derakhshanpour and his colleagues also indicated that violence against women was
associated with a lack of financial consent (16). While in a study by Taherkhani, there was no connection between
the economic situation and domestic violence. They stated that the difference in data collection tools can be the
reason for the difference with other studies (4). Dolatian has also shown that more violence was witnessed in women
with an unemployed husband (8). In the current study, women who have been subject to physical violence, preterm
labor chance is increased, which is consistent with the results of the Bagherzade research (17). Although several
medical and environmental factors have been linked with preterm birth and low birth weight babies, according to the
results of some studies, maltreatment of mothers during pregnancy can also, through different mechanisms, cause
the occurrence of the above-mentioned disorders. Physical and sexual trauma through the release of stress hormones
can lead to premature delivery and low birth weight (18). With the pregnant mother's body and fetus experiencing
stress, the hypothalamus-pituitary-adrenal axis channel containing neuroendocrine start simultaneously producing
cortisol in the mother and fetus (6). Cortisol, with several mechanisms such as reducing maternal and fetal immune
system, can increase the amount of infection in their children, preterm birth and fetal birth weight. On the other
hand, the physical and psychological symptoms, anxiety, inadequate care and lack of social support, which
sometimes occurs following the outbreak of violence, may affect attitudes of women, tolerance and the influence her
attention to hygiene and health. As a result, the possibility of actions that endanger the health of the woman and her
fetus, such as smoking, alcohol, lack of referring to health centers to receive prenatal care increases. Thus, in a
reverse cycle, the process of pregnancy, childbirth and postpartum would go under degrading (19, 20). In our study,
there was a statistically significant association between physical violence during pregnancy and LBW, and it is
consistent with Faramarzy, Dolatian and Nojoomy research (8, 12, 18). Also, the study of Bahery showed that there
is a relationship between verbal and psychological violence during pregnancy and the incidence of LBW (21).
Pregnancy by itself, imposes many physical and psychological pressures on mothers and, of course, coupled with
other stressors such as violence, can cause adverse effects on the fetus and the mother. Mothers who are subject to
domestic violence are less likely to take care of themselves to receive prenatal care and nutritional supplementation
in pregnancy which can cause low birth weight and preterm labor. Preterm labor is the main reason of infants’
morbidity and mortality and the main cause of undesirable consequences of pregnancy (22) Due to adverse outcome
of domestic violence, screening of pregnant women against violence is necessary.

5. Limitations and strength of the study

Our study was of cross-sectional type, and data were extracted from hospital wards. The limitation to access the
research journals and articles is among other restrictions of this study. One of the strengths of our study is the
subject of study. Given that no study has been conducted in the province of Hormozgan to identify the prevalence of
domestic violence against women and maternal and neonatal outcomes, identifying the frequency of prevalence of
domestic violence in pregnancy factors and consequences associated with it, in addition to helping to find measures
to prevent this issue, can reduce its due consequences.

5. Conclusions
Due to the sensitive nature of the gestation period and its importance in the future health of the mother, screening for
violence during counseling before pregnancy and prenatal care is recommended. The growing awareness regarding
violence and its complications in pregnancy, legal protection for victims’ subject to violence and complications in
pregnancy, improving the working conditions of women in society, improving the knowledge of adolescents and
youth in regard to domestic violence and its complications and providing life-skills training in the form of training
programs for these groups, will reduce the incidence of domestic violence. It is suggested that a case-control study
be conducted to control the confounders in this field and to collect data from other research sources such as health
centers and institutes to be used.

Page 5169
http://www.ephysician.ir

Acknowledgments:
The authors express their gratitude to the colleagues at Hormozgan University of Medical Sciences for their
assistance and all of those who helped conduct this study.

Conflict of Interest:
There is no conflict of interest to be declared.

Authors' contributions:
All authors contributed to this project and article equally. All authors read and approved the final manuscript.

References:
1) Hesami K, Dolatian M, Shams J, Majd H. Domestic Violence Before and during Pregnancy among
Pregnant Women. IJN. 2010; 23 (63):51-59.
2) Behnam H, Mogaddam HV, Soltanifar A. A survey on the intensity and frequency of domestic violence
during pregnancy.HMSJ.2007; 14, (2):70-76.
3) Babu BV, Kar SK.Domestice violence against women in estern india:a population –based study on
prevalence and related issues.BMC Public Health.2009;9(129):1-15. PMID: 19426515
4) Taherkhani S, Mir Mohammad Ali M , Kazemnejad A, Arbabi M, Amel Valizadeh M. Prevalence of
domestic violence against women and its relationship with the couple's profile.Journal of Legal Medicine
.2008; 15( 2):123-129.
5) Salehi S, MehrAlian H A. Prevalence of domestic violence among pregnant women who refered to health
clinice of Shahrecord2002. J Shahrekord Univ Med Sci. 2005; 8(2):72-77.
6) Shamsi M, Bayati A. Frequency and severity of domestic violence in pregnant women. J Gorgan Uni Med
Sci. 2011; 13 (4):67-75.
7) Ali Kamali M , Rahimi Kian F , Mir Mohamad A, Mehran A , Shafiei E. Comparison of domestic
violence and its related factors in pregnant women in both urban and rural population in Zarand city, 2014.
J Clin Nurs Midwifery.2015; 4(2):69-78.
8) Dolatian M, Gharache M, Ahmadi M, Shams J, Alavi Majd H. Relationship between partner abuse during
pregnancy and pregnancy outcomes. Hmj. 2010; 13 (4):261-269.
9) Shamu S, Abrahams N ,Temmerman M , Musekiwa A. Zarowsky C.A systematic Review Of African
Studies On Intimate Partner Violence Against Pregnant women: Prevalence and Risk Factors.Plos
One.March 2011 ;6(3):1-9. DOI: http://dx.doi.org/10.1371/journal.pone.0017591.
10) Abdollahi F, Abhari FR, Delavar MA, Charati JY. Physical violence against pregnant women by an
intimate partner, and adverse pregnancy outcomes in Mazandaran Province, Iran. Journal of Family &
Community Medicine. 2015; 22(1):13-18. doi:10.4103/2230-8229.149577.
11) Hassan Zadeh S.Noohjah S Haghighizadeh MH.Prevalence of domestic violence and related factors in
pregnant women referring to health centers - Care of Ahvaz in 2009 .Journal - Research Jnta Shapyr.2010
;2(3):104-110.
12) Nojomi, Agaee, Eslami. Physical violence during pregnancy and maternal and neonatal outcome. Journal of
payesh.2001; 1(2):43-48.
13) Bodag Abady M .Pregnancy outcomes in victims who reffered to Mobini hospital of Sabzevar. HM J.2006;
12(3):41-46.
14) Meuleners LB.Lee AH,Janssen PA,Fraser ML.Maternal and foetal outcomes among pregnant women
hospitalized due to interpersonal violence :A population based study in western Australia,2002-2008,BMC
Pregnancy and Childbirth .2011;11(70).223-238. PMID: 21989086
15) Saberian M, Atash Nafas E, Behnam B. Prevalence of domestic violence in women referred to the heath
care centers in Semnan (2003). koomesh. 2005; 6 (2):115-122.
16) Derakhshanpour F, Mahboobi HR, Keshavarzi S. Prevalence of domestic violence against women. J
Gorgan Uni Med Sci. 2014; 16 (1):126-131.
17) Bagherzadeh R, Keshavarz T, Sharif F, Dehbashi S, Tabatabaei H. Relationship between Domestic
Violence during pregnancy and Complications of Pregnancy, type of delivery and birth weight on delivered
women in hospital affiliated to Shiraz university of Medical Sciences. Horizon Med Sci. 2008; 13 (4):51-
58.
18) Faramarzi M, Esmaelzadeh S, Mosavi S. Prevalence, maternal complications and birth outcome of
physical, sexual and emotional domestic violence during pregnancy. Acta Medica Iranica. 2005; 43(2):115-
22.

Page 5170
Electronic physician

19) Shayeghian Z, Rasolzadeh Tabatabaey S, Seddighi looye E. Effect of Maternal Anxiety during Third
Trimester of Pregnancy Outcomes and Infants' Mental Health . Hayat. 2009; 14 (4 and 3):57-65.
20) Van Dijk AE, Van Eijsden M, Stronks K, Gemke RJ, Vrijkotte TG. Cardio-metabolic risk In 5-year-old
children prenatally exposed to maternal psychosocial stress: the ABCD study. BMC Public Health. 2010;
10(1):251. Doi: 10.1186/1471-2458-10-251.
21) Baheri B, Ziai M, Zeighami M, Zeighami Sh. Frequency of Domestic Violence in Women with Adverse
Pregnancy Outcomes (Karaj 2007-2008). Scientific Journal of Hamadan Nursing & Midwifery Faculty.
2012; 20 (1):31-41.
22) Roozbeh N, Moradi S, Soltani S, Zolfizadeh F, Hasani MT, Yabandeh AP. Factors associated with preterm
labor in Hormozgan province in 2013. Electronic Physician. 2016; 8(9):2918-2923. Doi: 10.19082/2918.

Page 5171