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Open Access 
F u l l  L e n g t h  A r t i c l e  

 Frequency of Preterm Birth in Females Presenting with History 
 of Domestic Violence 

 

Numrah Afzal 1, Khadija Aziz 2, Sualeha Zulfiqar3  

1 Medical Officer, Basic Health Unit, Sakhana Bajwa 
2,3 Medical Officer, Shalamar Hospital, Lahore 

 

A B S T R A C T  

Objective: To find frequency of preterm birth in females presenting with history of domestic violence. 

Patients and Methods: This cross sectional study was done at Basic Health Unit, Sakhana Bajwa, District Gujranwala. 

Total 150 cases were included in the study having mean age of 20-40 years with single pregnancy or of any parity with 

current pregnancy of gestational age >24 weeks experiencing domestic violence. Domestic violence was defined as 

physical violence such as beating or hurting or sexual violence. All females were followed in OPD till delivery. During 

follow-up, ultrasound was performed to check fetal health. Preterm delivery was defined as delivery occurring before 

completion of 37 weeks. 

Results: The mean age of females in this study was 33.32±6.42 years (range = 23 - 50 years). The mean gestational 

age was 37.65 ± 4.3 week with minimum and maximum gestational age was 32 weeks and 41 weeks. Preterm birth was 

seen in 20(13.33%) cases, while 130(86.67%) females had full term birth. 

Conclusion: The current study shows high frequency of preterm birth in females experiencing domestic violence. Most 

of the females and their husbands were less educated, belonged to lower social class and had parity < 2. 

Key words: Intimate partner violence, trauma, psychological stress, birth outcome, preterm birth. 

Author`s Contribution 
1
 Conception, synthesis, planning of research 

and manuscript writing Interpretation and 
discussion 
2 

Data analysis, interpretation and 
manuscript writing, 

3 
Active participation in 

data collection. 

Address of Correspondence 
Numrah Afzal 
Email: numrahafzal5@gmail.com 

Article info. 
Received: March 6, 2018 
Accepted:  July 12, 2018 

Cite this article. Afzal N, Aziz K, Zulfikar S. Frequency of Preterm Birth in Females Presenting 
with history of Domestic violence JIMDC.2018; 7(3):213--216 
 

Funding Source: Nil 
Conflict of Interest: Nil 

I n t r o d u c t i o n  
 

Domestic violence in Pakistan is an endemic social 

problem. According to a study carried out in 2009 by 

Human Rights Watch, it is estimated that 70 - 90 % of 

women in Pakistan have suffered from some form of 

abuse.1 Over the last few years, domestic violence is on a 

rise in Pakistan in numbers and extent. A little percentage 

is being reported in the media. In addition to physical 

violence which is the most vulnerable and obvious form, 

the emotional and psychological abuse through which a 

woman passes is also included in domestic violence.2 It is 

noted in this report that women were more than twice as 

likely as men being beaten (25% versus 10%), five times 

were more likely to be choked (20% versus 4%) and 

almost twice likely to report ,being threatened by, and 

having a gun or knife used against them (13% versus 

7%).3 Recently it has been reported that the prevalence of 

reported cases of violence against women in Pakistan has 

increased by 7% as compared to the year 2011. Among 

total number of VAW incidents, 3,153 cases were 

reported in Punjab, 1,027 in Sindh, 283 in Khyber-

Pakhtunkhwa and 78 cases were reported in 

Baluchistan.4 Domestic violence against women during 

pregnancy affects many women and unborn infants 

worldwide. Pregnancy presents a window of opportunity 

O R I G I N A L  A R T I C L E  



 

                           214 J I M D C   2 0 1 8  214 

for health care providers to identify domestic violence and 

provide appropriate intervention.5 One study has showed 

that in females with domestic violence, the frequency of 

preterm delivery was 3.65%. 6 Another study has showed 

that preterm delivery was 6.6% with domestic violence 7 

The current study was designed to find frequency of 

preterm birth with history of domestic violence. Little is 

known about the extent of problems during pregnancy 

associated with domestic violence during pregnancy. So 

this study was conducted to confirm the effect of domestic 

violence on pregnancy outcome. 

P a t i e n t s  a n d  M e t h o d s  

This cross sectional study was conducted at Basic Health 

Unit, Sakhana Bajwa, Gujranwala. Duration of study 

was 6 months. Calculated sample size was 150 cases. It 

was computed by using the 3.65% frequency of preterm 

delivery in females with history of domestic violence, 95% 

confidence level and 5% margin of error.6 Non probability, 

consecutive sampling technique was used. Our inclusion 

criteria was married females of age 20-40years with 

singleton pregnancy, of any parity with current pregnancy 

of gestational age >24 weeks experiencing domestic 

violence. Females with language barrier, those who 

refused to be interviewed, with high risk pregnancy i.e. 

Pregnancy induced hypertension (PIH) 

(BP>140/90mmHg), pre-eclampsia (PIH with proteinuria 

+1 on dipstick) or eclampsia (PIH with or without protein 

urea), gestational diabetes (OGTT>7mmol/l) or with 

cardiac problem (abnormal ECG and medical record) 

were excluded from study. Informed consent was taken. 

Demographic profile (name, age, parity, gestational age) 

was noted. Domestic violence was defined as physical 

violence as beating or hurting or sexual violence. All 

females were followed-up in OPD till delivery. During 

follow-up, ultrasound was performed to check fetal health. 

Preterm delivery was defined as delivery occurring before 

completion of 37 weeks. All the information was recorded 

on a prescribed proforma. Collected data was entered 

and analyzed statistically by using SPSS version 20. 

Quantitative variables like age and gestational age were 

presented in the form of mean ± S.D. Qualitative 

variables like parity, preterm delivery and intrauterine 

death were calculated in the form of frequency and 

percentage. Group was compared by using chi-square 

test. p-value<0.05 was considered as statistically 

significant.  

R e s u l t s  

The mean age of pregnant females in this study was 

29.35±3.42 years with minimum and maximum ages of 23 

and 50 years respectively. Mean age of husbands in this 

study was 32.75±2.15 years with minimum and maximum 

ages of 27 and 50 years respectively. The mean age of 

wives at the time of marriage was 21.36±1.45 years with 

minimum and maximum ages of 18 and 45 years 

respectively. Mean age of husbands at the time of 

marriage was 24.67±5.64 years with minimum and 

maximum ages of 21 and 40 years respectively (Table 1). 

There were 110 (73.3%) females who had parity < 2 and 

40 (26.66%) females had a parity of ≥2.  The mean 

education of wives was 10.21±1.76 years and of 

husbands was 11.85±1.48 years. The minimum and 

maximum education among wives was reported to be 0 

years and 16 years and among husbands was 5 years 

and 18 years respectively. The preterm mean gestational 

age was 37.65 ± 4.3 week with minimum and maximum 

gestational age as 32 weeks and 41 weeks. The 

frequency of preterm birth was seen as 13.33%, while 

86.67% females had full term birth (Figure 1). 

 

Table-1: Descriptive characteristics of participants 

(n=150) 

Variables Mean SD 

Age of Females (years) 29.35 3.42 

Age of Husband (years) 32.75 2.15 

Age of female at marriage (years) 21.36 1.45 

Age of husband at marriage 

(years) 
24.67 5.64 

Weight of wife (kg) 56.79 4.75 

Weight of husband (kg) 74.33 10.56 

Height of wife (feet) 5.32 0.19 

Height of husband (feet) 5.89 3.31 

Education of wife (years) 10.21 1.76 

Education of Husband (years) 11.85 1.48 

Gestational age (months) 37.65 4.3 



 

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Figure 1: Frequency of preterm birth 

D i s c u s s i o n  

Domestic violence (DV) against women is a significant 

public health issue in both developed and developing 

countries of the world. 8-10 According to the World Health 

Organization (WHO), surveys from around the world 

indicate that approximately 10%–69% of the women 

report being physically assaulted by an intimate male 

partner at some point in their lives. 11 DV occurs globally, 

irrespective of class, creed, religion and country 12. It is an 

increasing and important community health problem that 

can be seen in any area of human life. 13In a study of 

domestic violence perpetrated by men in Pakistan, all 

reported ‘ever shouting or yelling’ at their wives, 32.8% 

and 77% reported having slapped and engaging in 

nonconsensual sex with their wives, respectively 14.  The 

prevalence of abuse during pregnancy in various 

countries has been reported to range from 5-50%.15 In 

2008, Karachi, Pakistan, a study of 500 women who 

delivered at a hospital reported that 43% reported verbal 

abuse and 13% reported physical abuse during their 

pregnancy 16. In another study from Karachi, of 300 

women who gave birth in a large public maternity hospital, 

25% reported some form of physical abuse during a 

previous pregnancy 17. Domestic violence during 

pregnancy is associated with adverse pregnancy 

outcomes such in which preterm delivery is at top 18.   

According to current study the frequency of preterm birth 

was seen as 20(13.33%) while 130(86.67%) females had 

full term birth. A study reported that  women who 

experienced moderate or severe violence had incidences 

of preterm birth of 15.4% and 17.2%, respectively 19One 

study has showed that in females with domestic violence, 

the frequency of preterm delivery was 3.65%. 6One more 

study has shown that preterm delivery was 6.6% with 

domestic violence. 7 

According to a study, violence is associated with preterm 

birth with high and significant risk of 3.14 20. Another study 

showed, that psychological abuse (OR 3.9; 95 % CI 1.19–

12.82) and mild or greater depressive symptoms (OR 3.3; 

95 % CI 0.99–11.17) were significantly associated with 

increased risk of preterm birth. Physical abuse was also 

associated with increased risk of preterm birth, but this 

was not statistically significant (OR 1.9; 95 % CI 0.59–

6.19). In each of the above adjusted models, low maternal 

education was associated with increased risk of preterm 

birth, in the analysis with depressive symptoms OR 0.18, 

CI 0.04–0.86 and in the analyses with psychological 

abuse OR 0.19, CI 0.04–0.91.21 

C o n c l u s i o n  

The current study shows high frequency of preterm birth 

in female’s who experienced domestic violence. Most of 

the females and their husbands were less educated, 

belonged to lower social class and had parity < 2. 

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