G Model
EURO 8923 1–4 European Journal of Obstetrics & Gynecology and Reproductive Biology xxx (2015) xxx–xxx
Contents lists available at ScienceDirect
European Journal of Obstetrics & Gynecology and Reproductive Biology journal homepage: www.elsevier.com/locate/ejogrb 1
Prevalence and predictors of intimate partner violence among women attending infertility clinic in south-western Nigeria
2 3 4
Q1 Peter
5
O. Aduloju *, Nelson B. Olagbuji, Ajayi B. Olofinbiyi, Jacob O. Awoleke
Department of Obstetrics and Gynaecology, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
A R T I C L E I N F O
A B S T R A C T
Article history: Received 11 October 2014 Received in revised form 12 February 2015 Accepted 19 February 2015
Objective: The study evaluated the prevalence and predictors of intimate partner violence among infertile women attending infertility clinic of Ekiti State University Teaching Hospital, Ado-Ekiti. Study design: A cross sectional study of infertile women presenting at the clinic between 1st November 2012 and 31st October 2013 was done. A semi-structured questionnaire on violence was administered to 170 consecutive women who consented to participate. The data were analysed using SPSS 17 and significances test were performed on variables associated with violence with Student’s t test and Chi square test. Logistic regression was done to determine predictive factors associated with intimate partner violence. Results: The prevalence of intimate partner violence associated with infertility among the women was 31.2%. There were no significant differences in the age of the women, duration of marriage and duration of infertility between the women who had experienced violence and those who had not experienced it; p > 0.05. Unemployment, polygamous marriage, husbands’ social habits, primary infertility and prolonged duration of infertility were associated with violence in these women; p < 0.05. Education of the women and their husbands, their religion and ethnicity were not significantly associated with violence; p > 0.05. However with logistic regression, the unemployment status of the women and prolonged duration of infertility were the predictors of violence against women with infertility in this study, p value < 0.05. More than 50% of the women reported psychological violence as the commonest form of violence experienced by them ever, since the diagnosis of infertility was made and in the past one year. All forms of violence experienced were aggravated by infertility in these women. Conclusion: Women with infertility are prone to intimate partner violence and this would further aggravate the challenges of infertility being faced by these women. ß 2015 Published by Elsevier Ireland Ltd.
Keywords: Prevalence Predictors Intimate partner violence Infertile women South-western Nigeria
6 7 8 9 10 11 12 13 14 15 16 17
Introduction Q2
Infertility is a common gynaecological problem that is associated with social stigma, social neglect, economic deprivation, emotional stress, unhappiness and marital instability [1]. It is a global problem with regional variation in the prevalence rate and the World Health Organisation (WHO) estimates that 8–12% of couples would experience difficulty in conception after 1 year of regular unprotected sexual intercourse [2,3]. Both male and female factors have been implicated in the aetiology of infertility with each factor being responsible in about 30–40% of cases while the remaining 30% are due to the interaction of both female and male
* Corresponding author. Tel.: +234 8033900908. E-mail addresses: [email protected], [email protected] (P.O. Aduloju).
factors [4]. However, the woman is often blamed for the couple’s infertility in most cases and suffers deprivation economically, socially and emotionally as consequences [3,5,6]. In fact, infertility is a major cause of marital discord and divorce [2]. Violence against women is a global major health and human right concerns as this affects millions of women all over the world across ethnicity, culture, socioeconomic and educational classes. The Declaration on the elimination of violence against women, adopted by the United Nation in 1992, defines violence against women as ‘‘any act of gender based violence that results or likely to result in physical, sexual or psychological harm or suffering to women including threats of such harm, coercion or arbitrary deprivation of liberty whether occurring in public or private life [7]. The World Health Organization (WHO) estimates that at least one in five women have experienced violence in their lives [8]. There are several studies on risk factors for domestic violence in pregnancy while studies on domestic violence and infertility are
http://dx.doi.org/10.1016/j.ejogrb.2015.02.027 0301-2115/ß 2015 Published by Elsevier Ireland Ltd.
Please cite this article in press as: Aduloju PO, et al. Prevalence and predictors of intimate partner violence among women attending infertility clinic in south-western Nigeria. Eur J Obstet Gynecol (2015), http://dx.doi.org/10.1016/j.ejogrb.2015.02.027
18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34
G Model
EURO 8923 1–4 2
P.O. Aduloju et al. / European Journal of Obstetrics & Gynecology and Reproductive Biology xxx (2015) xxx–xxx
35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51
limited in Nigeria. It has been found that women with infertility are twice more likely to be at risk of suffering from violence than women who have children [2,6]. The life time prevalence of domestic violence against women with infertility varies widely all over the world: it is 1.8% in Hong Kong [9], 33.6% in Turkey [2] and 61.8% in Iran [6] while one of the few available studies from Nigeria reported 41.8% [10]. Women who experience violence are more likely to have depression, anxiety, psychosomatic symptoms, eating problems and sexual dysfunctions. The effects of violence may also be fatal as a result of intentional homicide, severe injury or suicide [2]. Despite the magnitude and enormous nature of violence against women, there is paucity of studies on violence against women with infertility in Sub-Saharan Africa especially Nigeria. This study was carried out to determine the prevalence of violence and its predictive factors among women attending infertility clinic of Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria.
remarks, refusal of food) harmed by your partner since not been able to have a baby successfully? (3) Have you been physically (hit, slapped, kicked you), sexually (had sexual intercourse using threat or force) or psychologically (insulted, threatened, humiliating remarks, refusal of food) harmed by your partner in the past 1 year? Women who reported history of violence in the past and/or present formed the abused group while women who reported no history of violence in both past and present constituted the nonabused group. The study was approved by the Ethics and Research Committee of Ekiti State University Teaching Hospital, Ado-Ekiti. The questionnaires were made anonymous and the women were at liberty to withdraw or refrain from the study without any consequence.
99 100 101 102 103 104 105 106 107 108 109 110 111 112 113
Data analysis
114
52
Materials and methods
53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98
This cross-sectional study was carried out at the Gynaecological Clinic of Obstetrics and Gynaecology department of Ekiti State University Teaching Hospital, Ado-Ekiti from 1st November 2012 to 31st October, 2013. Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria is a tertiary health institution that serves as a referral centre for the Specialist and General hospitals as well as health care centres in the state. There are also referrals from the neighbouring states (Ondo, Osun and Kogi states). The Department of Obstetrics and Gynaecology has a total of 80 beds in the antenatal, postnatal and gynaecological wards. There are eight consultants, ten specialist registrars and ten intern doctors which are divided into two firms. The two firms run separate gynaecological clinic days on Mondays and Thursdays. The annual delivery rate is about 1800 and the average number of patients with infertility seen in the gynaecological clinic per month is 20. Case definition: Infertility was defined as inability of the couple to achieve pregnancy after at least 12 months of regular unprotected sexual intercourse [2,3]. Women that presented in the clinic with infertility based on this definition were recruited into the study while those with difficulty in achieving pregnancy of less than 12 months duration were excluded from the study. The objectives of the study were duly explained to the women that met the inclusion criteria and informed consent was obtained from them. A total of 170 women attending the infertility clinic who consented to participate in the study were consecutively recruited between 1st November 2012 and 31st October 2013. All the women that agreed to participate in the study filled and returned their questionnaires. A semi structured questionnaire which was adapted from a validated WHO screening tool on violence [2] was administered to the women who participated in the study by trained house officers. The questionnaire has two sections: the first section elicited informations about the sociodemographic characteristics of the women – age, parity, ethnicity, education and occupation of women and their spouse, duration of infertility, type and duration of marriage. Questions like any history of re-marriage and reasons for such, was the marriage legally constituted and who was responsible for the upkeep of the house were also asked in this section. The second section of the questionnaire inquired about history of violence in the participants. The screening questions were: (1) Have you ever been physically (hit, slapped, kicked you), sexually (had sexual intercourse using threat or force) or psychologically (insulted, threatened, humiliating remarks, refusal of food) harmed by your partner? (2) Have you been physically (hit, slapped, kicked you), sexually (had sexual intercourse using threat or force) or psychologically (insulted, threatened, humiliating
Statistical analysis was performed using Statistical Software for Social Sciences (SPSS) version 17 (Chicago, IL, USA). Variables were presented in frequency and average in means (standard deviation). Tests of significance of differences were done at p values
EURO 8923 1–4 European Journal of Obstetrics & Gynecology and Reproductive Biology xxx (2015) xxx–xxx
Contents lists available at ScienceDirect
European Journal of Obstetrics & Gynecology and Reproductive Biology journal homepage: www.elsevier.com/locate/ejogrb 1
Prevalence and predictors of intimate partner violence among women attending infertility clinic in south-western Nigeria
2 3 4
Q1 Peter
5
O. Aduloju *, Nelson B. Olagbuji, Ajayi B. Olofinbiyi, Jacob O. Awoleke
Department of Obstetrics and Gynaecology, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
A R T I C L E I N F O
A B S T R A C T
Article history: Received 11 October 2014 Received in revised form 12 February 2015 Accepted 19 February 2015
Objective: The study evaluated the prevalence and predictors of intimate partner violence among infertile women attending infertility clinic of Ekiti State University Teaching Hospital, Ado-Ekiti. Study design: A cross sectional study of infertile women presenting at the clinic between 1st November 2012 and 31st October 2013 was done. A semi-structured questionnaire on violence was administered to 170 consecutive women who consented to participate. The data were analysed using SPSS 17 and significances test were performed on variables associated with violence with Student’s t test and Chi square test. Logistic regression was done to determine predictive factors associated with intimate partner violence. Results: The prevalence of intimate partner violence associated with infertility among the women was 31.2%. There were no significant differences in the age of the women, duration of marriage and duration of infertility between the women who had experienced violence and those who had not experienced it; p > 0.05. Unemployment, polygamous marriage, husbands’ social habits, primary infertility and prolonged duration of infertility were associated with violence in these women; p < 0.05. Education of the women and their husbands, their religion and ethnicity were not significantly associated with violence; p > 0.05. However with logistic regression, the unemployment status of the women and prolonged duration of infertility were the predictors of violence against women with infertility in this study, p value < 0.05. More than 50% of the women reported psychological violence as the commonest form of violence experienced by them ever, since the diagnosis of infertility was made and in the past one year. All forms of violence experienced were aggravated by infertility in these women. Conclusion: Women with infertility are prone to intimate partner violence and this would further aggravate the challenges of infertility being faced by these women. ß 2015 Published by Elsevier Ireland Ltd.
Keywords: Prevalence Predictors Intimate partner violence Infertile women South-western Nigeria
6 7 8 9 10 11 12 13 14 15 16 17
Introduction Q2
Infertility is a common gynaecological problem that is associated with social stigma, social neglect, economic deprivation, emotional stress, unhappiness and marital instability [1]. It is a global problem with regional variation in the prevalence rate and the World Health Organisation (WHO) estimates that 8–12% of couples would experience difficulty in conception after 1 year of regular unprotected sexual intercourse [2,3]. Both male and female factors have been implicated in the aetiology of infertility with each factor being responsible in about 30–40% of cases while the remaining 30% are due to the interaction of both female and male
* Corresponding author. Tel.: +234 8033900908. E-mail addresses: [email protected], [email protected] (P.O. Aduloju).
factors [4]. However, the woman is often blamed for the couple’s infertility in most cases and suffers deprivation economically, socially and emotionally as consequences [3,5,6]. In fact, infertility is a major cause of marital discord and divorce [2]. Violence against women is a global major health and human right concerns as this affects millions of women all over the world across ethnicity, culture, socioeconomic and educational classes. The Declaration on the elimination of violence against women, adopted by the United Nation in 1992, defines violence against women as ‘‘any act of gender based violence that results or likely to result in physical, sexual or psychological harm or suffering to women including threats of such harm, coercion or arbitrary deprivation of liberty whether occurring in public or private life [7]. The World Health Organization (WHO) estimates that at least one in five women have experienced violence in their lives [8]. There are several studies on risk factors for domestic violence in pregnancy while studies on domestic violence and infertility are
http://dx.doi.org/10.1016/j.ejogrb.2015.02.027 0301-2115/ß 2015 Published by Elsevier Ireland Ltd.
Please cite this article in press as: Aduloju PO, et al. Prevalence and predictors of intimate partner violence among women attending infertility clinic in south-western Nigeria. Eur J Obstet Gynecol (2015), http://dx.doi.org/10.1016/j.ejogrb.2015.02.027
18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34
G Model
EURO 8923 1–4 2
P.O. Aduloju et al. / European Journal of Obstetrics & Gynecology and Reproductive Biology xxx (2015) xxx–xxx
35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51
limited in Nigeria. It has been found that women with infertility are twice more likely to be at risk of suffering from violence than women who have children [2,6]. The life time prevalence of domestic violence against women with infertility varies widely all over the world: it is 1.8% in Hong Kong [9], 33.6% in Turkey [2] and 61.8% in Iran [6] while one of the few available studies from Nigeria reported 41.8% [10]. Women who experience violence are more likely to have depression, anxiety, psychosomatic symptoms, eating problems and sexual dysfunctions. The effects of violence may also be fatal as a result of intentional homicide, severe injury or suicide [2]. Despite the magnitude and enormous nature of violence against women, there is paucity of studies on violence against women with infertility in Sub-Saharan Africa especially Nigeria. This study was carried out to determine the prevalence of violence and its predictive factors among women attending infertility clinic of Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria.
remarks, refusal of food) harmed by your partner since not been able to have a baby successfully? (3) Have you been physically (hit, slapped, kicked you), sexually (had sexual intercourse using threat or force) or psychologically (insulted, threatened, humiliating remarks, refusal of food) harmed by your partner in the past 1 year? Women who reported history of violence in the past and/or present formed the abused group while women who reported no history of violence in both past and present constituted the nonabused group. The study was approved by the Ethics and Research Committee of Ekiti State University Teaching Hospital, Ado-Ekiti. The questionnaires were made anonymous and the women were at liberty to withdraw or refrain from the study without any consequence.
99 100 101 102 103 104 105 106 107 108 109 110 111 112 113
Data analysis
114
52
Materials and methods
53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98
This cross-sectional study was carried out at the Gynaecological Clinic of Obstetrics and Gynaecology department of Ekiti State University Teaching Hospital, Ado-Ekiti from 1st November 2012 to 31st October, 2013. Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria is a tertiary health institution that serves as a referral centre for the Specialist and General hospitals as well as health care centres in the state. There are also referrals from the neighbouring states (Ondo, Osun and Kogi states). The Department of Obstetrics and Gynaecology has a total of 80 beds in the antenatal, postnatal and gynaecological wards. There are eight consultants, ten specialist registrars and ten intern doctors which are divided into two firms. The two firms run separate gynaecological clinic days on Mondays and Thursdays. The annual delivery rate is about 1800 and the average number of patients with infertility seen in the gynaecological clinic per month is 20. Case definition: Infertility was defined as inability of the couple to achieve pregnancy after at least 12 months of regular unprotected sexual intercourse [2,3]. Women that presented in the clinic with infertility based on this definition were recruited into the study while those with difficulty in achieving pregnancy of less than 12 months duration were excluded from the study. The objectives of the study were duly explained to the women that met the inclusion criteria and informed consent was obtained from them. A total of 170 women attending the infertility clinic who consented to participate in the study were consecutively recruited between 1st November 2012 and 31st October 2013. All the women that agreed to participate in the study filled and returned their questionnaires. A semi structured questionnaire which was adapted from a validated WHO screening tool on violence [2] was administered to the women who participated in the study by trained house officers. The questionnaire has two sections: the first section elicited informations about the sociodemographic characteristics of the women – age, parity, ethnicity, education and occupation of women and their spouse, duration of infertility, type and duration of marriage. Questions like any history of re-marriage and reasons for such, was the marriage legally constituted and who was responsible for the upkeep of the house were also asked in this section. The second section of the questionnaire inquired about history of violence in the participants. The screening questions were: (1) Have you ever been physically (hit, slapped, kicked you), sexually (had sexual intercourse using threat or force) or psychologically (insulted, threatened, humiliating remarks, refusal of food) harmed by your partner? (2) Have you been physically (hit, slapped, kicked you), sexually (had sexual intercourse using threat or force) or psychologically (insulted, threatened, humiliating
Statistical analysis was performed using Statistical Software for Social Sciences (SPSS) version 17 (Chicago, IL, USA). Variables were presented in frequency and average in means (standard deviation). Tests of significance of differences were done at p values
