Intimate Partner Violence (IPV) during pregnancy is a significant public health problem worldwide (Bailey, 2010). Precisely IPV during the prenatal period is still debatable, though it irrefutably involves many women (Van Parys et al., 2015). Globally, IPV accounts for 30% of all the violence against women aged 15 years and above (Devries et al., 2013). The prevalence of pregnancy-related IPV in sub-Saharan Africa is between 2%-57% (Devries et al., 2010; Shamu, Abrahams, Temmerman, Musekiwa, & Zarowsky, 2011), but 39% in East Africa (García-Moreno et al., 2013). In 2017, the Uganda Demographic and Health Survey (UDHS) reported that six in ten women suffered at least one of the three forms of IPV in their lifetime (UBOS, 2017). Recently in eastern Uganda, IPV of any form during pregnancy was reported as 27.8% (Epuitai, Udho, Auma, & Nabirye, 2019). However, men are also victims of partner violence though evidence indicates that women are more susceptible (García-Moreno et al., 2013).
IPV causes great danger to the success of Safe Motherhood Initiative (Onoh et al., 2013). The mother and the fetus suffer adverse effects of IPV (Heaman, 2005; Helweg-Larsen, 2013; Koenig et al., 2010; Sanjel, 2013). Women, in general, tend to desire not to open up personal issues (also known as bedroom issues) to the public, because of the fear of shame and they lack trust in individuals within their social networks (Magnussen et al., 2011). If IPV disclosure process is appropriately conducted, it is an effective strategy to cope with the violence and results in other positive impacts on the victims (Katiti, Sigalla, Rogathi, Manongi, & Mushi, 2016).
However IPV disclosure remains low among women in general for instance 77.9% of the Serbian women did not disclose (Djikanović et al., 2012), in Nigeria, only 46% disclosed IPV experience to either recognized or informal services (Okenwa, Lawoko, & Jansson, 2009), 2009). Among pregnant women 28.6% (Ayodapo, Sekoni, & Asuzu, 2017) and 23.3% (Katiti et al., 2016) did not disclose to anyone. In some cultural groups, taboos around discussing family problems with an outsider are still prohibitive (Mezey & Bewley, 1997). Many pregnant women in abusive relationships experience shame, fear, and stigma which leads to isolation and secrecy for the victim (Murray, Crowe, & Brinkley, 2015). The reported positive effect of IPV revelation include an end to the violence which may guarantee the wellbeing of the mother, her pregnancy, as well as impacting onto IPV strategy formulation (Montalvo-Liendo, 2009). Worldwide, IPV disclosure is projected to vary between 4% and 8% (Shah & Shah, 2010). However, in Nigeria and Tanzania, majority of women disclosed to relatives, friends, religious leaders, or a third party (Ayodapo et al., 2017; Katiti et al., 2016). Victims of partner violence hesitate to disclose abuse to formal establishments including healthcare institutions (Githui, Chege, Wagoro, & Mwaura, 2018). In an earlier study, pregnant women believed that screening provides the victims with the care and facts they require, they acknowledged the failure of disclosing IPV in the healthcare setting (Scholle et al., 2003). The factors identified to accelerate disclosure consist of the belief that family members and treasured friends would not be harmed when the IPV incident is reported, access to support such as housing and support groups, and a sense that privacy, desires, and aspirations would be valued in the incident of disclosing IPV(Curry et al., 2011). On the other hand involvement in communal, spiritual or partisan assemblages aided women to inform someone about the violence experienced (Katiti et al., 2016). However major reasons for failure to disclose among women in general include fear of the perpetrator, feeling uncomfortable with the health care provider and the feeling that IPV was not serious (Spangaro, Zwi, Poulos, & Man, 2010), perceived absence of privacy, unsuitable means of probing and stigmatizing attitude from care providers (García-Moreno, Jansen, Ellsberg, Heise, & Watts, 2005; Githui et al., 2018). The lack of trust in service providers and insufficient time in talking over IPV with ANC clients contribute to the failure of disclosure among prenatal women, (Katiti et al., 2016). Failure to disclose may predispose to maternal mental health problems (Helweg-Larsen, 2013) reduced maternal weight, increased likelihood of undergoing caesarian delivery, and maternal mortality (Koenig et al., 2010; Sanjel, 2013), and inadequate uptake of ANC (Heaman, 2005) hence an obstacle to achievement of the safe motherhood initiative (Onoh et al., 2013). On the other hand, fetal effects include premature birth and intrauterine fetal demise (Koenig et al., 2010; Sanjel, 2013). ANC visit provides an opportunity for disclosure and intervention that could reduce the adverse effects of IPV during the perinatal period (Githui et al., 2018).
The majority of women in developing countries interact with healthcare workers during ANC. In Uganda, the ANC policy recommends at least four visits during pregnancy and at least once during the postnatal period with a likelihood of continued monitoring, hence providing a perfect opportunity for reporting and discussing IPV (Devries et al., 2010). However, there is little evidence on IPV disclosure among pregnant women attending ANC in Uganda. In this setting, earlier IPV studies focused on the general population while few investigated IPV prevalence in pregnancy (Auma et al., 2020; Clarke et al., 2019; Epuitai et al., 2019). Therefore, this study determined the IPV disclosure and associated factors among pregnant women attending a large City hospital.