Prevalence of abuse reported by pregnant women - impact on postpartum depression and breastfeeding: A prospective population-based analysis in the Norwegian Mother and Child Cohort Study

Abstract

Background: Abuse of women is a violation of human rights, and has adverse impact on physical, mental and reproductive health. Yet, there is limited population based knowledge about the effect on postpartum health and breastfeeding. There is also need for increased understanding about the impact of abuse from different perpetrators. Large scale, population based, prospective studies are requested to assess the public health impact of abuse. Aims: To investigate the prevalence of adult sexual, physical and emotional abuse, and its relation to socio demographics and other characteristics. To examine the association between abuse and postpartum depression and early breastfeeding cessation and whether a potential association differed between known and unknown perpetrators in a population based sample. Methods: Our studies included pregnant women participating in the Norwegian Mother and Child Cohort study. The information was based on self reported questionnaires and was linked to the Medical Birth Registry of Norway. Paper I had a cross-sectional design and included 65,393 women. Papers II and III were prospective, and included 53,065 and 53,934, respectively. Results: Overall, 32% reported any lifetime abuse, whereas 20% had experienced adult abuse and 19% childhood abuse. Recent abuse was reported by 5% of the women. Emotional abuse was the most common type of abuse both for adults and children, and 30% of the abused reported two or more types of abuse. For all types of abuse, known perpetrator was more commonly reported. Logistic regression analyses found that all types of adult abuse, as singular or combined exposures, were significantly associated with postpartum depression. The highest risk was seen among those exposed to recent adult abuse, compared with no adult abuse. Past and recent abuse was associated with cessation of breastfeeding before four months, and highest risk of cessation was seen in women exposed to three types of abuse. This is one of the first studies to document the association between emotional abuse, as singular or combined exposure, and early breastfeeding cessation. The increased risk of early breastfeeding cessation was independent of prior depression, postpartum depression and other confounders. Conclusion: Norwegian women reported high prevalence rates of abuse. Different types of abuse, as singular and combined exposures, whether recent or past, were associated with postpartum depression and early cessation of breastfeeding; which underscore the huge burden of abuse on women’s health. The strong association between emotional abuse and breastfeeding cessation highlights that emotional abuse alone, or in combination with other types of abuse, should be assessed for. Abuse is not inevitable, accordingly, higher attention and effort from health care providers, in order to initiate interventions to end abuse is crucial.