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

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.

Figure 1

Lifetime and recent (<12 months) physical domestic violence

Figure 2

Perinatal, neonatal and infant mortality rates (per 1000) by violence exposure. 'Asterisk' indicates rate significantly different from the ‘no violence rate’ at the 5% level

Figure 3

Unadjusted HRs for perinatal, neonatal and infant mortality. 'Asterisk' indicates rate significantly different from the ‘no violence rate’ at the 5% level