Adding to the strain for Indian women: Abuse by in-laws during pregnancy

The study by a multi-institutional team led by Anita Raj, professor of community health sciences at BUSPH -- published online this month in the Maternal and Child Health Journal -- found that more than one in four women study participants in the low-income Mumbai community reported violence or other forms of maltreatment from in-laws during pregnancy or after giving birth.

Such abuse, which ranged from denial of food to impeded access to medical care, was significantly more likely among women who also experienced violence from their husbands, the study found.

"Findings from this study clearly document the high prevalence of in-law abuse both in pregnancy and postpartum and more importantly, the striking relationship between perinatal in-law abuse and [intimate partner violence]" by husbands, the authors wrote. "These findings have critical implications for perinatal [intimate partner violence] prevention and intervention efforts with South Asian women and in cultural contexts where extended families form an important social unit."

The study involved in-depth interviews with women in Mumbai to gauge the prevalence of physical and non-physical abuse by in-laws and husbands during pregnancy and after giving birth. Among the forms of abuse by in-laws that women described was verbal humiliation, impeding access to health care, and denial of food during pregnancy. While rates of physical abuse were relatively low, 20 percent of women reported that in-laws had insulted them or their families in front of others during their pregnancies. Some women also reported that in-laws pressured them to become pregnant, made decisions regarding the timing of conception or abortion, and dictated who would care for the child.

In one interview included in the study, a 17-year-old Muslim woman says her in-laws "want a boy child, and as you know, I delivered [a] girl child. My sister-in-law has some uterus problems, so she is unable to conceive a child. Now my in-laws want me to deliver another child [a boy] and give the girl to my sister-in-law."

The study authors said the link between husband abuse and mistreatment by in-laws had important implications for prevention and intervention efforts for South Asian women, in a culture where social units are built around extended families.

"Evidence from this and other studies demonstrates the need to screen and address abuse from in-laws among pregnant and postpartum populations, and indicate that screening for in-law abuse also will likely improve the detection of [abuse by husbands]," the study says.

The authors also pushed for broader changes in social policy "to promote gender equitable attitudes and norms" and to improve the status of women.

Raj has done extensive research on child marriage and domestic violence in India. Her co-authors on the study include: Shagun Sabarwal and Jay G. Silverman, of Harvard School of Public Health; Michele R. Decker, of Johns Hopkins Bloomberg School of Public Health; Saritha Nair, Meghna Jethva and Balaiah Donta, of the Indian Council of Medical Research in Mumbai, India; Suneeta Krishnan, of the Women's Global Health Imperative, RTI International, and the Division of Epidemiology, University of California-Berkeley; and Niranjan Saggurti, of the Population Council, New Delhi, India.