3245 women were recruited and surveyed across seven hospitals in Hong Kong over a one-year period between July 2005 and April 2006. All women were above 18 years old and were between 32 to 36 weeks of pregnancy. Specially-trained nurses conducted an initial face-to-face interview and a further phone interview occurred a week after the women gave birth. Privacy and confidentiality were ensured. The research team developed bespoke questionnaires based on the Abuse Assessment Screen (AAS) and the Edinburgh Postnatal Depression Scale (EPDS) because of the cultural differences in the interpretation of the concept of emotional and physical abuse by Chinese women.
Women participating in the survey were provided with further counselling if required and had additional support in dealing with abusive partners. Participation was voluntary and informed consent provided.
10% of the women surveyed reported receiving abuse from their intimate partners. Of those abused, 73% reported psychological abuse only and 27% reported physical and sexual abuse. Of those who were physically/sexually abused, 57.5% reported receiving psychological abuse.
The most cited forms of psychological abuse were: ‘Shaming in front of friends/family’, ‘Put-downs regarding appearance or behaviour’ and ‘Ridiculing’. Researchers note that the preservation of face and maintaining harmonious relationships are valued traits in Chinese society and the common abusive patterns perpetrated by partners were to shame and ridicule women. This controlling and coercive behaviour results in the loss of self-esteem in women and increases their sense of worthlessness. Repeated over a period of time, such behaviour results in further feelings of negativity post-delivery, increasing the risk of postnatal depression and self-harm in women.
Researchers also uncovered the leading social circumstances which predispose couples to these abusive relationships, namely: being in debt, needing financial assistance, conflict with the in-laws and having an unplanned pregnancy. In particular, researchers note that the climate of fear and control surrounding abusive relationships limits the woman’s ability to control her fertility, which may lead to unintended pregnancies.
Previous research has demonstrated that psychological abuse often preceeds physical abuse and these women are in danger of coming to physical harm. Such patterns of abuse also carry on in the couples’ lives and the children are involved at the later stages. Researchers recommend that good screening and intervention programmes are needed to help identify, protect and support women in abuse relationships.
Dr Agnes Tiwari from the University of Hong Kong Li Ka Shing Faculty of Medicine, who led the study, said “Pregnancy offers a window of opportunity for health professionals to help women who are abused, including those psychologically abused.
“There is a need to use a culturally sensitive tool to assess intimate partner violence in Chinese women as demonstrated in our study. Had we not clearly identified and explained psychological abuse in our screening tool, a large portion of the abuses would not have been detected.
“In our study, the women were prepared to discuss their relationship problems with our experienced research nurses who underwent extensive training in this kind of screening. This underscores the importance of using well-trained and skilled practitioners when screening Chinese pregnant women for intimate partner violence.”
Professor Philip Steer, BJOG editor-in-chief said, “Unlike victims of physical violence, women who are subject to psychological or emotional abuse often bear no bodily markings of their mistreatment. This makes referrals to victim support groups and the Police difficult.
“What is worrying for doctors is the evidence that such women have a higher chance of suffering from postnatal depression after delivery, with some desperate enough to contemplate self-harm. Clearly, doctors and nurses need to identify the problem in their antenatal clinics so that preventive measures for mother and baby can be put into action as soon as possible.”
BJOG: An International Journal of Obstetrics and Gynaecology is owned by the Royal College of Obstetricians and Gynaecologists (RCOG) but is editorially independent and published monthly by Blackwell Publishing. The journal features original, peer-reviewed, high-quality medical research in all areas of obstetrics and gynaecology worldwide. Please quote ‘BJOG' or ‘BJOG: An International Journal of Obstetrics and Gynaecology' when referring to the journal.
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Tiwari A, Chan K, Fong D, Leung W, Brownridge D, Lam H, Wong B, Lam C, Chau F, Chan A, Cheung K, Ho P. The impact of psychological abuse by an intimate partner on the mental health of pregnant women. BJOG 2008;115:377-384.