Direct and indirect association of domestic violence against women and severe maternal morbidity: a case control study

Introduction: Along with the reduction in maternal mortality, severe maternal morbidity (SMM) is getting more popular for the evaluation of maternal health programs. To prevent severe maternal morbidity we should know the risk factors which are similar to maternal mortality. the goal of this study is the investigation of direct association of domestic violence and indirect association of this exposure through pregnancy, delivery and neonatal risk factors with severe maternal morbidity as outcome. Method: The target population of this case-control study is all women who gave birth in the hospitals of Torbat Heidarieh university of medical science in 2017(1397). 123 mothers with severe maternal morbidity (SMM) according to WHO criteria were selected as cases and 127 mothers who did not have WHO criteria were selected as a control group. Data were analyzed by STATA14 and mediation packages with the counterfactual approach. Result: The odds ratio of pure direct effect for physical violence through pregnancy and neonatal risk factor are 2.26 and 2.29, respectively. The odds ratio of social violence through pregnancy, delivery and neonatal risk factors are 2.54, 267, and 2.57 and for economicalal violence through neonatal risk factors is 1.99. also the interaction between physical and social violence and pregnancy risk factors increase the risk of severe maternal morbidity by 394.6% and 360%, respectively. conclusion Domestic violence against women has direct association with SMM which has a significant effect on outcome as exposure. Physical and social violence have significant interaction with SMM. It is recommended to consider domestic violence screening as one of the effective interventions to prevent SMM and to improve the health of mothers by applying control strategies.