Maternal–Fetal Attachment and Domestic Violence Against Iranian and Afghan Pregnant Women: A Cross-Cultural Study

Abstract

Women who have experienced more physical and psychological violence are at a higher risk of stress and depression and cannot develop a relationship with their fetuses. The present study aimed to compare maternal–fetal attachment (MFA) and domestic violence (DV) against Iranian pregnant women (IPW) and Afghan pregnant women (APW). This cross-sectional study was conducted on IPW and APW referred to Kerman health care facilities in 2019. The multistage, cluster-stratified sampling method was used and 300 questionnaires were distributed, of which 12 incomplete questionnaires were excluded. A total of 146 IPW and 142 APW completed the study. Data collection tools were the demographic and clinical information questionnaire, maternal–fetal attachment scale, and domestic violence questionnaire. Results showed that the mean scores of MFA in IPW and APW were 92.87 ± 12.55 and 103.6 ± 19.65, respectively. In addition, the mean scores of DV in IPW and APW were 9.63 ± 8.13 and 10.51 ± 9.1, respectively. A significant reverse correlation was found between the MFA and DV variables in IPW (r = −0.18, p < 0.05) and APW (r = −0.14, p < 0.05). A significant difference was found between the MFA and job status, as well as between DV and husband's addiction, in IPW. In addition, a significant difference was observed between MFA and unplanned pregnancy as well as between DV, unplanned pregnancy, history of physical illness, housing status, fetal gender, and number of children in APW. Multiple regression models showed that among DV components, verbal violence had more significant correlation with MFA in IPW and sexual violence had more significant correlation with MFA in APW. This study examined the MFA and DV against IPW and APW. Results suggest that national and local policies in Iran should examine factors contributing to DV against IPW and APW and focus on how to reduce the impact of DV on MFA.

Introduction

Attachment is one of the essential needs of human beings, which would act like an invisible connection and maintain a close relationship between the mother and the child (Moghaddam Hoseini 2011). The higher the maternal attachment in pregnancy, the more the mothers interact with their infants. It, in turn, can significantly influence baby's emotional, cognitive, and social interactions (Rabiee et al. 2019). Various factors affect maternal–fetal attachment (MFA), such as social support, mental status, age of mother, gestational age, number of deliveries, marital status, family income, level of education, and high-risk pregnancy (Sadeghi Sahebzad et al. 2014). Successful attachment depends on how mothers behave with their husbands, and domestic violence (DV) against pregnant women can have a significant effect on MFA (Torshizi and Sharifzadeh 2013).

DV is an aggressive behavior within the home, typically involving the violent abuse of a spouse or partner, which includes physical, sexual, and economic abuse; verbal threats; and divorce (Hassan et al. 2014). DV against pregnant women has serious negative effects, including fetal injury, uterine rupture, premature birth, premature rupture of membranes, low birth weight, intrauterine growth restriction, enhanced perinatal mortality, and an increase in the percentage of cesarean births (Finnbogadóttir et al. 2016; Sancho-Rossignol et al. 2018). Refugee women more often experience sexual and gender-based violence (Langlois et al. 2016). Therefore, efficient interventions seem necessary to diminish DV and improve reproductive health outcomes for women living in humanitarian settings (Delkhosh et al. 2017). In Iran, Afghan women are commonly subjected to several hostile encounters such as intimate partner violence, limited access to maternity care, and financial and housing struggles (Delkhosh et al. 2019).

Literature review

Sancho-Rossignol and colleagues (2018) declared that pregnant women exposed to DV during childhood had a poorer quality of MFA regardless of whether they experienced DV during adulthood. Rabiee and colleagues (2019) showed that 65.7% of the women experienced DV, of whom 19.3% had moderate DV and 15.1% had severe DV. Ghodrati and colleagues (2017) examined the effect of DV severity on neonatal–maternal attachment and found a statistically significant correlation between maternal–neonatal attachment and social violence. A study in Iran indicated a high prevalence of DV among Afghans (79.8%), which is almost five times higher than that in Iranian women (14.1%) (Dadras et al. 2021). It is estimated that 53% of the ever-married Afghan women aged 15 to 49 years have experienced physical DV (Ibrahimi et al. 2020).

The aim of the research

Although various studies have been conducted on DV against Iranian pregnant women (IPW) and Afghan pregnant women (APW), limited studies examined the relationship between DV and MFA in IPW and APW, especially in the Kerman province, one of the most populous cities in Iran in terms of the number of Afghan citizens. In this article, we reported (a) the level of MFA and DV against Afghan and Iranian women in Kerman city, (b) a comparison of MFA and DV in IPW and APW, (c) the association between MFA and DV in research participants, and (d) a comparison of MFA and DV based on sociodemographic characteristics of IPW and APW.

Awareness about MFA and DV is important for the health of pregnant mothers and their babies. The information obtained from pregnant women about MFA and DV would not only increase the perception of the medical team about the process of MFA but it would also improve the maternal–fetal relationship and reduce DV against pregnant mothers.

Materials and Methods

Study design

This cross-sectional study was conducted on IPW and APW referred to Kerman health care facilities in 2019.

Respondent characteristics and setting

The target population of this study consisted of IPW and APW referred to health care facilities providing perinatal and maternal care services in Kerman city in southeastern Iran. Multistage cluster-stratified sampling was used in this study, and we divided the health care facilities into four classes according to their locations. The first class represented northern centers; the second class represented southern centers; the third class represented eastern centers; and the fourth class represented western centers. Then, two health care facilities were selected from each class using the simple random method. Since no similar study was found in this field, a pilot study was conducted to estimate the sample size. Fifteen IPW and 15 APW completed the questionnaires and then the sample size was estimated using the following formula:

The 95% confidence interval and the test power of 1 − β = 0.9 were considered. In the pilot study, the mean and standard deviation for DV against IPW and APW were 8.93 ± 9.89 and 16.53 ± 21.57, respectively. According to the above numbers, 127 subjects were assigned into each group, and 150 questionnaires were distributed in each group due to dropout probability. Finally, after collection of 150 questionnaires from each group and elimination of the questionnaires with more than 10% missing data, 146 questionnaires in the IPW group and 142 questionnaires in the APW group were analyzed. Therefore, the response rate of IPW was 97% and that of APW was 94.66%.

Inclusion and exclusion criteria

Inclusion criteria consisted of Iranian and Afghan nationality, reading and writing literacy, gestational age of 20 to 40 weeks, no obstetric problems in the current pregnancy, no specific physical or psychological disease, no use of psychotropic drugs, living with husband, and not divorced. Exclusion criteria included unwillingness to participate in the study and incomplete questionnaires.

Data collection tools

The tools used in this study were the maternal demographic information questionnaire, DV against women questionnaire, and maternal–fetal attachment scale (MFAS).

Maternal demographic information questionnaire

It included 23 items about age, education, occupations of mothers and their husbands, and other information.

Maternal–fetal attachment scale

Cranley (1981) first developed this self-report scale in 1981 and confirmed its reliability by Cronbach's alpha coefficient (α = 85%). Khoramrody (2000) in Iran translated the MFAS, and its validity was confirmed with content validity and reliability was confirmed with a test-retest (r = 0.85). In the present study, Cronbach's alpha coefficient was 0.78 for IPW and 0.81 for APW. The questionnaire has five subscales for interaction (items 1, 16, 17, 20, and 24), differentiation (items 4, 8, 18, and 19), role taking (items 3, 5, 6, and 9), attribution (items 7, 10, 12, 13, 14, and 21), and giving of self (items 2, 11, 15, 22, and 23). A five-point Likert scale was used for scoring (definitely yes = 5, yes = 4, uncertain = 3, no = 2, and definitely no = 1). The scoring was reverse only for the item “I feel that my body is getting ugly.” Therefore, the minimum and maximum scores are 24 and 120, respectively, with higher scores showing higher attachment (Khoramrody 2000). Scores ranging from 24 to 56 would be considered low MFA, scores ranging from 57 to 88 would be considered moderate MFA, and scores ranging from 89 to 120 would be considered high MFA.

Domestic violence questionnaire

A researcher-made questionnaire was used to assess DV. An initial draft of the questionnaire was developed using the literature review and expert opinion (Ghafari et al. 2018; Ghodrati et al. 2017; Hassan et al. 2014; Nejatizade et al. 2017). Then, eight faculty members of the Kerman School of Nursing and Midwifery assessed the questionnaire content validity. Their corrective comments were applied to the questionnaire, and the content validity index was 0.98. The questionnaire was provided to 30 subjects (15 IPW and 15 APW) for measuring reliability. Cronbach's alpha coefficient was 0.89 for IPW and 0.88 for APW. The questionnaire consisted of 27 items in 5 dimensions: items 1–6 related to verbal violence, items 7–12 related to physical violence, items 13–17 related to sexual violence, items 18–24 related to emotional–psychological violence, and items 25–27 related to financial violence. A 6-point Likert scale was used for scoring (0 = not at all and 5 = a lot). Questionnaire minimum and maximum scores were 0 and 135, respectively, with a higher score indicating higher DV. Scores ranging from 0 to 45 would be considered low DV, scores ranging from 46 to 91 would be considered moderate DV, and scores ranging from 92 to 135 would be considered high DV.

Data collection

The researcher referred to the selected health centers after obtaining permission from the ethics committee and the head of the School of Nursing and Midwifery at Kerman University of Medical Sciences. Then, she introduced herself to the clinic staff, presented a letter of introduction and explained the research, obtained their consent, and went to the primary research setting, the perinatal and maternal care unit. Before completing the questionnaire, participants were provided the necessary explanations about the objectives of the study and informed consent was received from participants, both verbally and in writing. After provision of a private and confidential environment, Iranian and Afghan women completed the self-administered DV and MFA questionnaires. Confidentiality was maintained without putting the names or other personal information of respondents in the questionnaires. Whenever the participants needed clarification on the questions, the researcher provided sufficient explanation. Two Afghan women fluent in Persian helped the researcher to communicate with Afghan women.

Statistical analysis

The demographic characteristics of participants were presented using descriptive statistics. Results of the Kolmogorov–Smirnov test showed normal distribution of data. The Pearson correlation coefficient was used to investigate the correlation between MFA and DV among pregnant women. A t-test was used to compare MFA and DV mean scores between IPW and APW separately. The t-test and ANOVA were used to investigate MFA and DV variables in both groups in terms of background–demographic variables. Multivariate regression was used to determine the impact of DV components on MFA using the SPSS 18 software. The significance level was considered to be 0.05.

Results

The mean ages of IPW and APW were 28.3 ± 5.83 and 21.84 ± 5.92, respectively; 65.7% of the IPW and 97.9% of APW were homemakers. Most of the IPW were academically educated, while most of the APW were illiterate. Most of the husbands of IPW were academically educated, while most of the husbands of APW had middle/high school degrees; other demographic characteristics are shown in Table 1.

Table 1.

Demographic Characteristics of Iranian and Afghan Pregnant Women

Variable	Iranian participants, mean ± SD	Afghan participants, mean ± SD
Age, years	28.3 ± 5.83	21.84 ± 5.92
Age at the time of marriage	23.43 ± 5.1	17.18 ± 2.45
Husband's age	31.58 ± 6.04	24.86 ± 6.68
Husband's age at the time of marriage	26.8 ± 4.78	19.82 ± 3.34
Marital duration	5.28 ± 4.39	4.9 ± 4.87

	N = 146	%	N = 142	%
Job status
Homemaker	96	65.75	139	97.89
Employee	50	34.25	3	2.11
Education level
Uneducated	4	2.73	115	80.99
Middle/high school	12	8.22	25	17.61
Diploma	47	32.20	2	1.40
Academic	83	56.85	—	—
History of addiction
Yes	1	0.68	0	0
No	145	99.32	142	100
Marriage numbers
Once	141	96.58	139	97.89
More than once	5	3.42	3	2.11
Husband's nationality
Iranian	142	97.27	2	1.40
Afghan	3	2.05	140	98.60
Others	1	0.68	—	—
Husband's job status
Unemployed	6	4.1	16	11.3
Self-employed	81	55.5	122	85.9
Employed	59	40.4	—	—
Worker	—	-	4	2.8
Husband's education
Uneducated	5	3.42	57	40.14
Middle/high school	9	6.16	74	52.12
Diploma	52	35.62	8	5.63
Academic	80	54.80	3	2.11
Monthly income (Tomans)
<1,500,000	49	33.56	88	61.98
1,500,000–2,500,000	58	39.73	45	31.69
>2,500,000	39	26.71	9	6.33
Husband's addiction
Yes	4	2.73	3	2.11
No	142	97.27	139	97.89
Husband's marriage No.
Once	138	94.53	131	92.26
More than once	8	5.47	11	7.74
Housing status
Personal	61	41.78	12	8.45
Leased	72	49.32	115	80.99
Others	13	8.90	15	10.56
Ultrasonography in the current pregnancy
Yes	132	90.42	88	61.97
No	14	9.58	54	38.03
Fetal gender
Male	39	26.72	74	52.11
Female	58	39.72	36	25.36
Unknown	49	33.56	32	22.53
Fetal abnormality
Yes	10	6.84	3	2.11
No	136	93.16	139	97.89
Abortion history
Yes	39	26.71	34	23.94
No	107	73.29	108	76.06
Infertility history
Yes	9	6.16	3	2.11
No	137	93.84	139	97.89
Planned pregnancy
Yes	105	71.92	61	42.95
No	41	28.08	81	57.06
Children
One	50	34.25	31	21.83
Two	26	17.81	18	12.67
More than two	6	4.10	36	25.35
Unanswered	64	43.84	57	40.15
History of physical illness
Yes	9	6.16	7	4.92
No	137	93.84	135	95.08
History of mental illness
Yes	0	0	3	2.11
No	146	100	139	97.89
Husband's physical illness
Yes	8	5.47	3	2.11
No	138	95.53	139	97.89
Husband's mental illness
Yes	2	1.36	3	2.11
No	144	98.64	139	97.89

SD, standard deviation.

The mean scores for MFA in IPW and APW were 92.87 ± 12.55 and 103.6 ± 19.65, respectively. Results showed that the mean scores for MFA in both groups were at a high level. As shown in Table 2, the t-test showed a statistically significant difference in mean scores for MFA between the two groups so that the total mean scores for MFA and all its subscales in APW were higher than that in IPW.

Table 2.

Mean Scores of Maternal–Fetal Attachment and Its Dimensions in Iranian and Afghan Pregnant Women

MFA dimensions	IPW, mean ± SD	APW, mean ± SD	p
Interaction with the fetus	17.51 ± 3.84	21.89 ± 5.27	<0.001
Differentiation of self	17.04 ± 2.85	17.73 ± 4.0	<0.001
Role taking	17.06 ± 2.35	18.06 ± 3.27	<0.001
Attribution of specific characteristics and intentions	21.18 ± 4.18	25.19 ± 6.37	<0.001
Giving of self	20.08 ± 2.9	20.7 ± 3.13	0.02
Total	92.87 ± 12.55	103.6 ± 19.65	<0.001

APW, Afghan pregnant women; IPW, Iranian pregnant women; MFA, maternal–fetal attachment.

The mean scores for DV in IPW and APW were 9.63 ± 8.13 and 10.51 ± 9.1, respectively. Results showed low mean scores for DV in both groups. In addition, the t-test showed no statistically significant difference in mean scores for DV in the two groups. As shown in Table 3, among the dimensions of DV, the mean scores for verbal and emotional–psychological violence in IPW were significantly higher than that in APW, while the mean score for sexual violence in APW was significantly higher than that in IPW.

Table 3.

Mean Scores of Domestic Violence and Its Dimensions in Iranian and Afghan Pregnant Women

DV dimensions	IPW, mean ± SD	APW, mean ± SD	p
Verbal	2.62 ± 3.32	1.12 ± 3.04	<0.001
Physical	0.32 ± 1.76	0.59 ± 2.27	0.11
Sexual	4.28 ± 2.3	6.98 ± 4.37	<0.001
Emotional–psychological	2.21 ± 3.24	1.34 ± 3.41	<0.001
Financial	0.21 ± 0.66	0.48 ± 1.25	0.15
Total	9.63 ± 8.13	10.51 ± 9.1	0.66

DV, domestic violence.

The Pearson correlation coefficient showed a significant reverse correlation between the MFA and DV variables in IPW (r = −0.18, p < 0.05) and APW (r = −0.14, p < 0.05).

The t-test showed a significant difference between MFA and job status in IPW (p < 0.05). As shown in Table 4, the t-test showed a significant difference between MFA and unplanned pregnancy in APW (p < 0.05). The t-test showed a statistically significant difference in the mean scores for DV and husband's addiction in IPW (p < 0.05). As shown in Table 4, the t-test showed a significant difference in the DV, unplanned pregnancy, and history of physical illness in APW (p < 0.05).

Table 4.

Comparison of Maternal–Fetal Attachment and Domestic Violence in Iranian and Afghan Pregnant Women According to Demographic Variables

Pregnant	Variable	Demographic characteristic	Mean ± SD	p
Iranian	MFA	Job status
		Homemaker	93.46 ± 12.75	<0.001
		Employee	88.75 ± 10.33	<0.001
Iranian	DV	Husband's addiction
		Yes	19.25 ± 16.80	<0.001
		No	9.35 ± 7.69	<0.001
Afghan	MFA	Unplanned pregnancy
		Yes	107.59 ± 18.85	<0.001
		No	98.22 ± 19.57	<0.001
Afghan	DV	Unplanned pregnancy
		Yes	9.11 ± 8.54	<0.001
		No	11.59 ± 9.42	<0.001
Afghan	DV	History of physical illness
		Yes	19.33 ± 12.69	<0.001
		No	10.13 ± 8.79	<0.001

As shown in Table 5, the ANOVA test showed a significant difference in the DV, housing status, fetal gender, and number of children in APW (p < 0.05).

Table 5.

Comparison of Domestic Violence in Iranian and Afghan Pregnant Women According to Demographic Variables

Pregnant	Variable	Demographic characteristic	Mean ± SD	p
Afghan	DV	Housing status
		Personal	18.70 ± 12.82	<0.001
		Leased	10.44 ± 8.50
		Others	6.13 ± 8.06
Afghan	DV	Fetal gender
		Male	7.35 ± 6.06	<0.001
		Female	10.44 ± 8.65
		Unknown	14.17 ± 11.67
Afghan	DV	Children
		One	10.25 ± 5.54	<0.001
		Two	11.81 ± 9.63
		More than two	14.93 ± 9.63

No statistically significant difference was found in other demographic variables and MFA and DV variables between IPW and APW.

Multiple regression models showed that among DV components, verbal violence had more significant correlation with MFA in IPW and sexual violence had more significant correlation with MFA in APW. Data are shown in Tables 6 and 7.

Table 6.

Multiple Regression for Evaluating the Correlation Between Domestic Violence Components and Maternal–Fetal Attachment in Iranian Pregnant Woman

Variable	Coefficient beta	Std. error	Standardized coefficient beta	p
Verbal	−2.914	0.93	−0.451	<0.001
Physical	−3.521	1.14	−0.302	<0.001
Sexual	−1.191	0.46	−0.200	0.019
Emotional–psychological	−2.877	0.49	−0.313	<0.001
Financial	−2.489	1.05	−0.120	0.033

Table 7.

Multiple Regression for Evaluating the Correlation Between Domestic Violence Components and Maternal–Fetal Attachment in Afghan Pregnant Woman

Variable	Coefficient beta	Std. error	Standardized coefficient beta	p
Verbal	−2.801	0.83	−0.341	0.005
Physical	−1.603	0.64	−0.353	0.019
Sexual	−2.011	0.30	−0.373	<0.001
Emotional–psychological	−1.419	0.63	−0.218	0.044
Financial	−1.808	0.75	−0.132	0.030

Discussion

The results of this research showed that the mean scores for MFA in both groups were at high levels, but the mean scores for MFA and all its subscales in APW were higher than that in IPW. These findings are consistent with the results of studies conducted by Ekrami and colleagues (2019) and Tork Zahrani and colleagues (2019). It seems that attachment strategies trained by the staff of primary health care centers have played an important role in increasing MFA in both groups, and a high level of MFA in APW can be considered as a difference in individual and social characteristics between Afghan and IPW.

The results showed that the mean scores for DV in both groups were at low levels. This result was inconsistent with the results of studies by Ali Kamali and colleagues (2015), Hassan and colleagues (2014), and Nejatizade and colleagues (2017). Reasons for such inconsistency can be differences in sample sizes, research methods, and questionnaires used to measure the DV rate and cultural differences in respondents' willingness to disclose their marital experiences. A possible explanation for the low level of DV in both groups is that a pregnant woman is mostly protected by her family members, especially her husband, which decreases the rate of violence.

The results showed that among the dimensions of DV, the mean scores for verbal and emotional–psychological violence in IPW were significantly higher than that in APW, while the mean score for sexual violence in APW was significantly higher than that in IPW. These findings are consistent with the results of studies conducted by Bifftu and colleagues (2017) and Cengiz and colleagues (2014). In addition, one possible explanation for the high level of DV in Afghan women could be their restrictions in decision-making and wrong cultural traditions such as early marriage, exchange marriage, and marriage with conditional bride pricing.

Results showed a significant reverse correlation between the MFA and DV variables in IPW and APW. These findings are consistent with the results of studies conducted by Begum and colleagues (2010) and Ghodrati and colleagues (2017). It can be concluded that violence against pregnant women reduces MFA. Women who are victims of DV have a negative attitude toward their pregnancy and fetus. Family and marital counseling is recommended to reduce and control violence, increase MFA, and improve the motherhood process in these women.

The results showed a significant difference between MFA and job status in IPW. These findings are consistent with the results of studies conducted by Delavari and colleagues (2018) and Jamshidimanesh and colleagues (2012). In other words, employed pregnant women had higher MFA. In Iran, women and men have to work because of their poor economic situation, so pregnant women may pay less attention to the fetus.

The results showed a significant difference between MFA and unplanned pregnancy in APW. In other words, the MFA score in Afghan women with unplanned pregnancy was higher than that of those with planned pregnancy. This result was inconsistent with results of the study by Delavari and colleagues (2018). Sometimes an unplanned pregnancy may surprise parents and make them very attached to the fetus.

The results showed a statistically significant difference in mean scores for DV and husband's addiction in IPW. In other words, the DV score in Iranian women whose husbands were addicted was higher than those whose husbands were not addicted. This result was consistent with results of studies by Haskell and colleagues (2016) and Shorey and colleagues (2014). Drug abuse and alcohol consumption can change the personality and decrease self-confidence in men; therefore, they commit violence against their family members.

Our findings showed a significant difference in DV, housing status, fetal gender, and number of children in APW, so pregnant women living in leased houses, who do not know the fetal gender, and have more than two children reported more DV. These results were consistent with results of studies by Ali Kamali and colleagues (2015) and Nejatizade and colleagues (2017). In general, the rate of DV is associated with an increase in the number of children, which can affect the level of expectation of children and increase economic problems and stress in parents (Ali Kamali et al. 2015; Hassan et al. 2014). In Iran, the majority of Afghan families do not have personal property and lease a house for 1 year, and then they have to rent another house, so this condition can cause conflicts between the parents and predispose to violence (Dadras et al. 2021; Delkhosh et al. 2019).

Our findings also showed a significant difference in DV, unplanned pregnancy, and history of physical illness in APW. These results were consistent with the results of studies by Begum and colleagues (2010) and Delkhosh and colleagues (2019). Many families tend to have fewer children, so unplanned pregnancies raise family tensions and predispose to violence (Golchin et al. 2014). Women with a planned pregnancy, a physical or psychological disease, and poor general health usually cannot tolerate living problems, which could predispose to incidence of violence in the family.

Limitations

The present study had some limitations: (a) the present study included all pregnant mothers regardless of gravida and pregnant mothers who had reading and writing literacy, which may affect the results of the study; (b) the present study was cross-sectional and could not accurately examine the causal relationships between the variables; (c) there was lack of access to pregnant women with problems and who were not fit enough to visit the clinic; and (d) there was lack of cooperation of participants not responding truthfully to questions due to embarrassment and fear of information disclosure, which was beyond the control of the researcher.

Conclusions

In general, this study showed a low level of DV and an appropriate MFA rate in the studied populations. This study examined the MFA and DV between IPW and APW. Findings suggest that national and local policies in Iran should examine factors contributing to DV against IPW and APW as well as focus on how to reduce the impact of DV on MFA. In addition, this screening could be a positive step toward maintaining the family foundation and can seriously prevent this growing social problem and improve FMA in pregnant women. At the end, public health officials must be concerned about the health of pregnant women and perform effective actions to reduce DV and improve FMA, including establishment of follow-up and counseling centers.

Footnotes

Authors' Contributions

M.D. conceived and designed the study, J.F. and H.F. conducted the survey, and P.J.A. and H.S. were involved in data analysis and manuscript writing. F.A. supervised the study and critically reviewed the manuscript. All the authors read and reviewed the final manuscript. All authors are from the Kerman University of Medical Science (Kerman, Iran), where research and education are the primary functions.

Ethics Approval and Consent to Participate

The Ethics Committee of Kerman University of Medical Sciences approved the protocol (). Participants entered or withdrew from the study with personal consent. Ethics were observed, including respect for the rights of participants and confidentiality of participant data. The study imposed no cost on the patients, and participants' unwillingness to be involved in the study did not affect the process of care for the pregnant women.

Acknowledgments

The authors would like to thank all the people who helped perform this study. Portions of this article were previously submitted in preprint form to Research Square with DOI number, 10.21203/rs.3.rs-107804/v1.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

No funding was received for this article.

References

Ali Kamali

, Rahimi Kian

, Mir Mohammad Ali

, et al. (2015). Comparison of domestic violence and its related factors in pregnant women in both urban and rural population in Zarand city, 2014. J Clin Nurs Midwifery. 4, 69–78.

Begum

, Dwivedi

, Pandey

, Mittal

. (2010). Association between domestic violence and unintended pregnancies in India: Findings from the National Family Health Survey-2 data. Natl Med J India. 23, 198.

Bifftu

, Dachew

, Tadesse Tiruneh

, Zewoldie

. (2017). Domestic violence among pregnant mothers in Northwest Ethiopia: Prevalence and associated factors. Adv Public Health. 2017, 6506231.

Cengiz

, Kanawati

, Yıldız Ş, et al. (2014). Domestic violence against pregnant women: A prospective study in a metropolitan city, Istanbul. J Turk Ger Gynecol Assoc. 15, 74.

Cranley

. (1981). Development of a tool for the measurement of maternal attachment during pregnancy. Nurs Res. 30, 281–284.

Dadras

, Nakayama

, Kihara

, et al. (2021). The prevalence and associated factors of adverse pregnancy outcomes among Afghan women in Iran; Findings from community-based survey. PLoS One. 16, e0245007.

Delavari

, Mirghafourvand

, Mohammad-Alizadeh-Charandabi

. (2018). The relationship of maternal–fetal attachment and depression with social support in pregnant women referring to health centers of Tabriz–Iran, 2016. J Matern Fetal Neonatal Med. 31, 2450–2456.

Delkhosh

, Ardalan

, Rahimiforoushani

, et al. (2017). Interventions for prevention of intimate partner violence against women in humanitarian settings: A protocol for a systematic review. PLoS Curr. 9, ecurrents.dis.f41d45fbdca13babe4ae5be0f9732e75.

Delkhosh

, Merghati Khoei

, Ardalan

, et al. (2019). Prevalence of intimate partner violence and reproductive health outcomes among Afghan refugee women in Iran. Health Care Women Int. 40, 213–237.

10.

Ekrami

, Mirghafourvand

, Charandabi

SM-A

, Kheyradin

. (2019). Maternal-fetal attachment and its sociodemographic determinants in women with unplanned pregnancy. Int J Womens Health Reprod Sci. 7, 106–111.

11.

Finnbogadóttir

, Dykes

A-K

, Wann-Hansson

. (2016). Prevalence and incidence of domestic violence during pregnancy and associated risk factors: A longitudinal cohort study in the south of Sweden. BMC Pregnancy Childbirth. 16, 228.

12.

Ghafari

, Nahidi

, Masjedi

, Nasiri

. (2018). Correlation between physical violence and mother-fetus attachment in pregnant mothers visiting the healthcare centers of Mashhad. J Urmia Nurs Midwifery Fac. 16, 37–46.

13.

Ghodrati

, Setodeh

, Akbarzadeh

. (2017). A study of the effect of domestic violence on maternal-neonatal attachment in prim gravida women referred to hospitals affiliated to Shiraz university of medical sciences. Biomed Res. 28, 3794–3797.

14.

Golchin

NAH

, Hamzehgardeshi

, Ahoodashti

. (2014). Sociodemographic characteristics of pregnant women exposed to domestic violence during pregnancy in an Iranian setting. Iran Red Crescent Med J. 16, e11989.

15.

Haskell

, Graham

, Bernards

, et al. (2016). Service user and family member perspectives on services for mental health, substance use/addiction, and violence: A qualitative study of their goals, experiences and recommendations. Int J Ment Health Syst. 10, 9.

16.

Hassan

, Kashanian

, Hassan

, et al. (2014). Domestic violence: prevalence during pregnancy and associated maternal outcomes. J Urmia Univ Med Sci. 24, 1009–1010.

17.

Ibrahimi

, Alamdar Yazdi

, Yusuf

, Salihu

. (2020). Association of domestic physical violence with feto-infant outcomes in Afghanistan. Asia Pac J Public Health. 33, 273–279.

18.

Jamshidimanesh

, Astaraki

, Moghadam

, et al. (2012). Maternal-fetal attachment and its associated factors. Hayat. 18, 33–45.

19.

Khoramrody

. (2000). The effect of mothers touch on maternal fetal attachment. Tehran Iran Univ Med Sci. 13, 33–41.

20.

Langlois

, Haines

, Tomson

, Ghaffar

. (2016). Refugees: Towards better access to health-care services. Lancet. 387, 319–321.

21.

Moghaddam Hoseini

. (2011). Impact of maternal attachment style on mother to infant attachment. Qom Univ Med Sci J. 5, 87–91.

22.

Nejatizade

, Roozbeh

, Pormehr Yabandeh

, et al. (2017). Prevalence of domestic violence on pregnant women and maternal and neonatal outcomes in Bandar Abbas, Iran. Electron Physician. 9, 5166–5171.

23.

Rabiee

, Karimi

, Abolhassani

, Keramat

. (2019). The relationship between domestic violence and maternal-fetal attachment. Int J Health Stud. 5, 27–31.

24.

Sadeghi Sahebzad

, Baghdari

, Kheirkhah

. (2014). The relationship between marital satisfaction and social support with maternal fetal attachment in pregnant women with a history of baby loss. Iran J Obstet Gynecol Infertil. 17, 16–22.

25.

Sancho-Rossignol

, Schilliger

, Cordero

, et al. (2018). The association of maternal exposure to domestic violence during childhood with prenatal attachment, maternal-fetal heart rate, and infant behavioral regulation. Front Psychiatry. 9, 358.

26.

Shorey

, Stuart

, Moore

, McNulty

. (2014). The temporal relationship between alcohol, marijuana, angry affect, and dating violence perpetration: A daily diary study with female college students. Psychol Addict Behav. 28, 516.

27.

Tork Zahrani

, Haji Rafiei

, Mohamad Khani Shahri

, Alavi Majd

. (2019). Investigation of maternal-fetal attachment behaviors and its related factors in pregnant women, Qazvin in 2015. J Inflamm Dis. 23, 26–37.

28.

Torshizi

, Sharifzadeh

. (2013). Maternal-fetal attachment and associated factors in pregnant women referred to Birjand health centers (2012). J Birjand Univ Med Sci. 20, 279–287.