Domestic violence and early childhood mortality in rural India: evidence from prospective data

• Authors: Michael A Koenig, Johns Hopkins University; Robert Stephenson, Emory University; Rajib Acharya, The Population Council, New Delhi; Lindsay Barrick, Ohio University; Saifuddin Ahmed, Johns Hopkins University; Michelle Hindin, Johns Hopkins University
• Journal Title: International Journal of Epidemiology
• Volume: Volume 39, Number 3
• Publisher: Oxford University Press | 2010-06, Pages 825-833
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1093/ije/dyq066
• Subjects: Health Sciences, Public Health; Health Sciences, Epidemiology
• Keywords: Domestic violence; perinatal mortality; neonatal mortality; infant mortality; hazards regression analysis; rural India

Abstract

Objective: To investigate the relationship between domestic violence and perinatal, neonatal and infant mortality in rural India using prospective data. Methods: The study is based upon a prospective follow-up study of a cohort selected from the 1998–99 National Family and Health Survey-2 (NSFS-2), which was carried out in 2002–03 in four Indian states. Data for a total of 3909 birth outcomes that took place during this 4-year period were analysed using bivariate analysis and hazards regression analysis to control for truncated observations and possible other confounding factors. Findings: After controlling for other potentially confounding factors, births to mothers who experienced two or more episodes of recent domestic violence experienced higher perinatal [hazards ratio (HR) = 1.85, 95% confidence interval (CI) = 1.12, 2.79] and neonatal (HR = 1.62, 95% CI = 1.11, 2.53) mortality, relative to births to women whose mothers reported no violence. Overall, these births to women who experienced violence had 68% higher risk of infant mortality compared with the ‘no violence’ group. Births to women who experienced a single episode of violence were not at higher risk of mortality. Conclusions: Our study provides additional and more conclusive evidence on the importance of domestic violence for early childhood mortality in low-resource settings such as rural India. The results argue for a greater focus upon such violence within current child survival programmes.