Intimate Partner Violence among Pregnant Women Related to Disclosure of Sickle Cell Disease: Evidence from the Sickle Cell Belt of Central India

Nafisa Halim^1*Archana Patel²Janet Turan³Anuradha Shrikhande⁴Patricia Kavanagh⁵Mari-Lynn Drainoni⁵David Henderson⁵Shweta Murali⁶Nandini Agarwal⁷Patricia Hibberd^1,5

• ¹Boston University, Boston, United States
• ²Lata Medical Research Foundation, Nagpur, Maharashtra, India
• ³University of Alabama at Birmingham, Birmingham, Alabama, United States
• ⁴Sickle Cell Association of Nagpur, India, India
• ⁵Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts, United States
• ⁶Institue of Medical Research, Durham, United States
• ⁷Boston Medical Center, Boston, Massachusetts, United States

Background. Intimate partner violence (IPV) negatively impacts pregnant women and their unborn children. Globally, an estimated 19%, 9%, and 6% of women experience psychological, physical, and sexual IPV, respectively, during pregnancy. These rates are higher for pregnant women living with a stigmatizing disease. We examined the effect of antenatal screening for sickle cell disease (SCD) using the sickle cell solubility test on the risk of IPV among pregnant women in the city of Nagpur in Maharashtra state of India. We hypothesized that a positive solubility test increases the risk of IPV via partner disclosure. Methods. We conducted a cohort study comparing IPV in 182 pregnant women, before (baseline) and after (endline) having a solubility test. Of the 182, 91 pregnant women with a positive solubility test and 91 with a negative solubility test. We used the 49-item Indian Family Violence and Control Scale (=0.88) to measure IPV, and estimated associations using binomial logistic regressions with robust standard errors. Results. Women with a positive solubility test were at least twice as likely to experience physical, sexual, or psychological IPV as pregnant women with a negative solubility test, even after adjusting for baseline differences between these two groups on common IPV risk factors including the lower level of education and scheduled-caste membership. Conclusion.Pregnant women who have a positive solubility test are at risk of IPV after they follow routine instructions to disclose their test result to their male partner, so that both partners can undergo further testing to determine the risk of SCD, sickle cell trait, or no risk of the baby having SCD. Implications.Across resource-poor settings, in areas with high prevalence of SCD, antenatal clinics are increasingly screening pregnant women for prevention of mother-to-child transmission of SCD, there is a need to integrate strategies for women to disclose sickle cell screening test results and prevention of IPV caused by male partners.