A new study analyses the violent behaviours exhibited towards pregnant women. While 21% of women suffer emotional violence during pregnancy, 3.6% encounter physical or sexual violence. Furthermore, 36.1% of those who reported physical violence claimed that it happened "very often" or "daily."

Whilst for many women pregnancy is a happy time, for almost one in four it turns out not to be so enjoyable. An investigation into the prevalence of domestic violence against pregnant women has found that 22.7% endure some kind of violence -- emotional, physical or sexual -- within their relationship.

The data, gathered from a sample of 779 women who gave birth in 15 state hospitals in Andalusia, can be extrapolated to the rest of Spain and other countries with similar sociocultural environments. The participating midwives were trained to collect the data, which took place in full anonymity and confidentiality.

"Until now there had been no studies of this kind in Spain, and consequently the magnitude of this problem in our midst was unknown," Stella Martín de las Heras, researcher at the University of Granada and main author of the study, explains. "The consequences, however, are very serious, both for the health of the mother and that of the fetus."

In this study, intimate partner violence was discovered using two internationally standardised instruments, the Abuse Assessment Screen (AAS) and the Index of Spouse Abuse (ISA). "We think that the way questions are asked could impact the discovery of violence in various cultural contexts, and this is borne out in the results we obtained," Martín de las Heras adds.

The results, published in the journal Acta Obstetricia et Gynecologica Scandinavica, show that the prevalence of partner violence against pregnant women is high in Spain when compared with nearby countries, in which the figure hovers around 3.4% to 8.3%.

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"With these figures, detection of violence should be routinely included in pregnancy management, and protocols for action should be established where necessary," she suggests. "The involvement and motivation of health professionals is crucial."

Significant differences between methods

When the data were analysed with the two detection instruments separately, considerable differences between them were discovered. The AAS found that 7..7% of pregnant women underwent some form of violence, while using the ISA this figure rose to 21.3%.

"I cannot explain the reasons behind this discrepancy, because each study has used a different methodology and drawing conclusions from this is not possible," the lecturer in the department of Legal Medicine, Toxicology and Biological Anthropology affirms. "What is beyond doubt is that the figures make us reflect on the potential health implications for the woman and the fetus."

The mean percentage found in this study (22.7% of women who suffer some kind of violence in their relationship) was obtained by joining together the results from the AAS and ISA, without duplicating the cases discovered.

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The divergence between the two methods lies in the manner in which questions are asked. The AAS is based on very general questions, in which women have to self-define as abused. On the other hand, with the ISA method, women respond to imagined everyday life experiences.

For example, when responding to the statement "my partner demands that I obey his whims," the majority of the women surveyed did not believe that such behaviour amounted to violence, justifying it as their "partner's character."

In this way, the ISA detects situations and their frequencies, which, when taken together, determine whether a woman is being violently mistreated. "However, if one were to directly ask the women if they thought that they were being mistreated, they might respond with no," stresses Martín de las Heras.

Statements such as "my partner gets angry and is impossible to deal with when I tell him he is drinking too much" were responded to affirmatively by over 10% of women. Furthermore, almost 18% of women responded affirmatively, to differing degrees, to the question, "My partner gets angry if I don't agree with him."

Types of violence

The authors analysed the various types of violence women can fall prey to. 21% of women were subjected to emotional violence and 3.6% to physical or sexual violence during pregnancy. "Although emotional violence is more common, we must not dismiss physical violence as it is especially serious during pregnancy," the researcher continues.

In fact, 36.1% of women who reported physical violence said that it happened "very often" or "daily" and 20.3% categorised it as severity level 3 -- severe bruises, burns or broken bones. Moreover, three women reported suffering physical violence to the abdomen.

The study also looked at the sociodemographic factors that could be linked to violence during pregnancy, such as age, education, occupation, nationality, type of relationship and cohabitation, and support in their environment..

Martín de las Heras points out that some stereotypes did not appear among the results: "For example age and place of origin. Younger women are no more likely to be subject to violence during pregnancy. Neither are women with foreign (not Spanish) nationality, who in our study came from Latin America and North Africa."

However, pregnant women who maintained non-committed relationships or did not have support from the communities around them -- a family member or friend to turn to in times of need -- were more likely to suffer intimate partner violence when pregnant. By contrast, women who worked were better protected against such violence.