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DOMESTIC VIOLENCE AND PREGNANCY
Does Pakistani Women are at risk?

By Shazmeen Razak

“Domestic violence causes far more pain than the visible marks of bruises and scars. This is devastating to be abused by someone that you love and think loves you in return” (Dianne Feinstein). Domestic violence occurs in all countries, irrespective of class, race or level of education the people concerned to (Mahmood & Ali, 2006). According to Jamila (Daily Times, July 12 2007) “Statistics shows that over half a million women died annually during pregnancy and childbirth and 99% of such cases occurred in the developing countries. The situation is more horrible in Pakistan”. The cause of maternal mortality could be many for example poor health services, anemia, unawareness about the family planning methods or contraceptives, untrained midwives to carry out deliveries and other pregnancy related complications like post partum hemorrhage, and these causes eventually leads to the neonatal and fetal mortality. But the most important reason of fetal mortality related to our, Pakistani, culture is the domestic violence during pregnancy. Therefore, domestic violence during pregnancy not only affects women physically, sexually and psychologically but it also puts the life of the fetus in danger.
Domestic violence during pregnancy poorly affects women’s, physical, sexual and psychological health. Fariyal et al (2006) conducted the study on 300 patients in postnatal ward in Karachi hospital. By this study she quantified, “44% of women reported lifetime marital physical abuse and 23% during the pregnancy” (p. 252). They mentioned the physical abuse occur by throwing the objects, pushed, grabbed or shoved, hair pull, slapped or hit, kicked or bitten, choked, tried to drown, used knife, gun or other weapons by their husbands. Similarly, Ali and Khan (2007) added some effects of physical abuse such as abdominal injuries, fractures, wounds, skeletal deformities and gastrointestinal problems. The sexual abused include the forced abortion; vaginal lacerations, HIV infections, bleeding during first and second trimester and unintended pregnancy (Espinosa & Kathryn, 2002). The psychological aspects on women especially in teenagers are that they suffer from the feelings of hopelessness, powerlessness and mistrust. Additionally, women might suffer from anxiety, depression; reach late for antenatal visits in hospital, depressed mood and addiction towards alcohol and cigarette smoking. Furthermore, Sheikh (2000) stated, “the psychological effects include post traumatic stress disorders, generalized anxiety disorders, serious depressive conditions and also suicidal thoughts” (p.313).

The story does not stop here only. The more heartbreaking situation occurs when fetal life has to pay the cost. Domestic violence not only affects women but also affects the fetus and there could be the chances of preterm labour, miscarriages and low birth weight baby. Neuberg (1998) theorized the association between low birth weight and domestic violence as: Direct causal pathways include complications resulting from abdominal trauma, such as abruption placenta, fetal fractures and uterine rupture. Indirect causal pathways can be related to physical and psychological stress of mother, imposed isolation leading to poor access to prenatal care and poor maternal nutrition. The investigations hypothesized catecholamine release caused by psychological distress that precipitates preterm labour or placental hypo perfusion (as cited in Espinosa & Kathryn, 2002). These are the effects on fetus but if the baby born full term and if domestic violence continues, it affects the child’s whole life. The physical and emotional effect of pregnancy abuse indirectly and directly affects on children educational, health, social and criminal justice systems.

In conclusion, domestic violence is prevalent in all areas of the world, but it is prevalent in Pakistan at a disturbing rate. Women are the sufferers and subjected to physical, sexual and psychological abuse by their partners. Hence, abused pregnant women require complex care to help them escape the short and long term effects on violence of both, themselves and child too. By looking at the prevalence and the effects of domestic violence on women and child in Pakistan, health care providers, family members of pregnant women and especially male population should realize this burden as these types of abuses, especially in pregnancy, places the mother and the fetal life in jeopardy.