As repercussões da violência entre parceiros íntimos na utilização de serviços de saúde nos primeiros seis meses de vida.

Abstract

The main objective of this thesis was to evaluate the relationship between Physical Intimate Partner Violence (PIPV) in the first six months after birth and use of health services among children under six months old. To study the construct use of health services the initiation of the child s monitoring and the number of visits at Primary Health Care (PHC) were used. Additionally, we estimated the prevalence of PIPV in the first six months after birth among mothers of children in this age group assisted at PHC in Rio de Janeiro. The information underlying the study originated from a cross-sectional study conducted in 27 PHC facilities in the city of Rio de Janeiro, between June and September 2007. The study population was selected using cluster sampling in two stages. The PHC primary sampling units were sampled with probability of selection proportional to the volume of pediatric appointments performed leading to a geographically representative sample of the municipality. Children secondary sampling units were selected systematically, according to the order of appointments output. The sample included 927 children in the first six months of life whose mothers reported having a partner at the time of the interview among those who sought appointment with a pediatrician or well-child care. Information was obtained through interviews with the child's mother using a structured questionnaire containing previously validated scales such as the Revised Conflict Tactics Scales (CTS2) to measure PIPV. The first paper presents the prevalence of PIPV in the first six months postpartum in study population and in certain subgroups according to sociodemographic and mothers and babies health characteristics. High frequencies of spousal violence were found, especially among mothers in unfavorable socioeconomic conditions and who had gaps in prenatal care, breastfeeding and use of health services. The other two articles show that PIPV after childbirth presents a serious risk to the regular monitoring of child at health services. The second paper revealed that PIPV is an independent risk factor for late initiation of child s monitoring at PHC in women who had not worked or had an informal employment and among those who had not undergone an adequate prenatal care. The third paper showed that the PIPV increases the risk of children with mothers reporting not currently working have a number of visits lower than expected for their age in their first six months of life. It is hoped that the dissemination of the results of this thesis can contribute to raising awareness of health professionals and policy-makers of the Health Sector about the importance of actions to combat violence and thus contribute to the promotion of health in its broadest sense.