Violência entre parceiros íntimos durante a gestação: um fator de risco para o desmame precoce

Abstract

This Thesis is an offshoot of the main project entitled "Magnitude of Intimate Partner Violence (IPV) during Pregnancy and Postpartum and its Repercussions on Breastfeeding Duration and Woman's Mental Health" The main interest in this field is based on the faet that despite the recognition of IPV as a public health problem worldwide, there are still gaps in knowledge particularly regarding its magnitude during pregnancy and postpartum and its potential consequence on maternal and child health. This thesis focuses on two potential repercussions of IPV. The first article aimed at investigating the role of Severe Physical Violence during Pregnancy (SPVP) between partners on Exclusively Breastfeeding Duration (EBD). The second article tries to explore possible paths between the occurrence ofVPI and weaning premature to assess whether a low self-esteem maternal post-partum decreases the time duration of the AME. This is a cross-sectional study and infonnation was collected throughout interviews of mothers of children under 5 years old, who sough for health care assistance at 5 health centers in different regions of Rio de Janeiro. Mothers who reported having at least one intimate relationship during pregnancy that lasted for more than one moth were eligible for inclusion in the study. Mothers who gave birth to twins and children and mother who had any condition where breastfeeding was contraindicated were excluded. ln total, 811 were randomly selected. Ali infonnation was collected throughout face-to-face interview in a private place and with the partner absent. A structured questionnaire including infonnation on socio-demographic, and reproductive characteristics, conditions at birth, infant feeding and health status, mental health, and lifestyle of the mothers and their partners were used. The questionnaire also included infonnation on occurrence of different types of violence during and/or postpartum. ln order to assess SPVP a national version of the Revised Conflict Tactics Scales were used. The self-esteem levei was measured by Rosenberg scale and premature breastfeeding cessation was identified by using a current status data approach, which is based on the infonnation reported from food recall the last 7 days. The Cumulative Hazard Function was estimated by complementary log-log transfonnation models, which allowed the ensuing estimate of early breastfeeding cessation rates in different age groups and rates ratio of wean between women exposure and non-exposure to violence. As shown in lhe first article, the result suggests that SPVP is an independent risk factor of exclusive breastfeeding cessation because in that multivariate analysis women exposed to violence had an incidence-density 35% h1gnc, than those who were not exposed (RT:1,35; CI 95%: 1,01; 1,69). According to the results presented in the second article, "having a positive view of your-scll" is a protective factor against exclusive breastfeeding cessation. The probability of exclusive breastfeeding cessation is 65% lower among women reporting high self-esteem leve] (RT: 0,61; CI 95%: 0,48; 0,77) compared to the others, even after taking into account potential confounding factors. The finding indicates the necessity of incentives for adequately preparing health care personnel in dealing with lactating women in order to get a broader view of breastfeeding beyond the biologic aspccts of laetation including the maternal psychological dimension. Particularly, it is emphasized the establishment of multi-professíonal teams during pre and postnatal care and awareness of the occurrencc of IPV during pregnancy and postpartum and its repercussion on maternal self-estom.