Violence affects babies in the womb

A ground-breaking study, the first of its kind in South Africa, has found that intimate partner violence during pregnancy places babies in utero at high risk of low birthweight.

"Violence against women is a global public health problem," said researcher Dr Nastassja Koen, from UCT's Department of Psychiatry. "Exposure to intimate partner violence during pregnancy has been associated with a number of adverse maternal and foetal outcomes. However, there is a paucity of data from low-middle-income countries."

Koen and her team found that a large proportion of their study sample had experienced intimate partner violence during the previous year, "with exposure to emotional intimate partner violence most frequently reported, followed by physical and then sexual abuse". A notable difference in infant birthweight was found where violence had occurred.

The researchers say there are a number of reasons for this. First, "abdominal trauma and consequent placental damage and premature contractions or rupture of membranes may explain a direct causal association," says Koen. Also, infection or genital trauma resulting from "forced sexual activity" might increase the risk of adverse infant outcomes. Another reason was that pregnant women exposed to psychosocial trauma experienced an increase in circulation of a substance called cortisol, which inhibited foetal growth.

"Further research is needed to assess the relevant underlying mechanisms, to inform public health policies and to develop appropriate trauma interventions for low- and middle-income country settings."

Pre- and post-natal depression

According to Ingrid le Roux, who runs the Philani Child Health and Nutrition Project, risk is increased where resources are low. Philani's "mentor mothers" go door-to-door in informal settlements to provide support to pregnant women and newborn infants. "More than 30 percent of the mothers we visit suffer from pre- and post-natal depression, and in many cases this is due to partner violence. It is often difficult to address, but the stress of that situation for the mother puts stress on the baby in utero."

Le Roux said babies with low birthweight were born into communities where resources were so scarce that the child "cannot catch up and remains malnourished". Babies with low birthweight are much more vulnerable to infection, while mortality among such babies was far higher than among babies of normal weight.

"There is also a connection with obesity later in life," she said. "The theory behind this is that low birthweight babies often result from the pregnant mother not getting enough nutrition - so the metabolism of the baby is set at a low level right from the beginning. Later on, if the child has access to food - which in these settings is mainly high in carbohydrate and low in nutrition - the low metabolism leads to obesity, which is also associated with high blood pressure and many other dangerous conditions."

According to the World Health Organisation, low birthweight also results in substantial costs to the health sector. Although the prevalence of such births is slowly dropping globally, it is as high as 30 percent in many developing countries.

This article, by Tanya Farber (tanya.farber@inl.co.za), first appeared in the Cape Times on 17 June 2014