Gender-Based Violence Against Pregnant Women and Its Relationship with Maternal Depression in Patients Attended at a Public Hospital in Chincha,Peru: A Cross-Sectional Study

Abstract

At least one-third of women worldwide has suffered intimate partner violence (IPV) during their lifetime. During pregnancy, IPV has serious consequences on the physical and mental health of women and children. Therefore, this study aims to describe domestic violence and maternal depression in Peruvian patients treated in a public hospital. A cross-sectional survey was conducted on pregnant women between 18 and 40 years of age who attended their prenatal checkups at the San José de Chincha National Hospital located in the Ica region in southern Peru. A total of 316 pregnant women were interviewed, of which 48.4% were between 18 and 25 years of age and 28.2% belonged to a rural area. The frequency of psychological violence and physical aggression was 19.6% (n = 62) and 7% (n = 22), respectively. Furthermore, 22.1% (n = 70) of the participants were at risk of feminicide. Maternal depression was present in 29.1% (n = 92) of the participants and 16.8% (n = 53) had suicidal thoughts. Multivariate analysis showed several risk factors: unwanted pregnancy (adjusted prevalence of the ratio [aPR]: 1.44, confidence interval [CI] 95%: 1.01–2.07), psychological violence (aPR: 1.79, CI 95%: 1.23–2.60), mild risk of feminicide (aPR: 1.97, CI 95%: 1.31–2.961), and a moderate risk of feminicide (aPR: 1.81, CI 95%: 1.11–2.95). In conclusion, the risk of femicide, the frequency of IPV against women, and the rate of maternal depression are all high among pregnant women treated at San Jose de Chincha Hospital, since one in three pregnant women has maternal depression and one in five has been a victim of psychological violence or at risk of feminicide.

Introduction

Violence against women is a major public health problem and constitutes a violation of human rights. At least one-third of the female population worldwide has suffered at least one form of gender-based violence at some point in their lifetime (WHO, 2018). The most common form of violence suffered by women is intimate partner violence (IPV), which can occur in different settings and across socioeconomic classes, cultures, and religions (Archer 2006; WHO, 2005). Domestic violence against women can appear for the first time or increase in frequency or intensity during pregnancy (Johnson et al., 2003), and it has serious consequences not only on the mother's health, but also on the newborn's development (Tinajero et al., 2016). Unfortunately, IPV is still considered a “taboo” topic for women living in low- and middle-income countries and may be unreported or underestimated (Karmaliani et al., 2008; McCauley et al., 2017).

In Peru, IPV is more common against pregnant women than against those who are not pregnant. A study conducted by the World Health Organization (WHO) found that among the countries studied, Peru had the highest rate of physical violence against pregnant women, with values of 15% in urban areas and 28% in rural areas (WHO, 2005). In another study carried out in 2010, the prevalence of severe psychological violence against pregnant Peruvian women were 42.2%. The rate of severe physical and sexual violence against the participants was 23.0% and 8.5%, respectively (Cripe et al., 2010). However, according to the last Demographic and Family Health Survey (ENDES) applied in 2018 (INEI, 2019b), the frequency of physical violence against pregnant women appears to have decreased to 9%. In this report, no data on psychological or sexual violence were recorded.

Several studies have shown that experiencing IPV during pregnancy is associated with a higher risk of preeclampsia, miscarriage, preterm delivery, perinatal mortality, and low birth weight (Parker et al., 1994; Sanchez et al., 2008; Valladares et al., 2002). Mental health problems have also been associated with IPV against pregnant women. A study carried out by the WHO and the London School of Hygiene and Tropical Medicine showed that women who suffer abuse from their partners are 2.6 times more likely to suffer from depression or anxiety (WHO, 2013). In Ethiopia, Belay et al. (2019) found that exposure to IPV during pregnancy increases the risk of suffering maternal depression (adjusted odds ratio = 17.60; 95% CI = 6.18–50.10).

In Mexico, pregnant women who had been victims of IPV were at increased risk of having depressive symptoms (odds ratio: 6.23, 95% CI = 1.49–25.92; Lara et al., 2014). Although there are many studies in Peru about maternal depression (Castro and Rivera, 2015; Friedman et al., 2016; Lam et al., 2008; Orta et al., 2019); the authors did not find a study evaluating the association between IPV and maternal depression in rural populations.

This study aims to describe domestic violence and maternal depression in patients treated at the San Jose de Chincha National Hospital, a public hospital located in the Ica region, Peru. The hospital mainly serves people from a rural context with limited economic resources, the data from this study will facilitate the development of appropriate and timely interventions that could reduce future complications.

Materials and Methods

Study design and population

An exploratory cross-sectional study was conducted with pregnant women between 18 and 40 years of age who attended their prenatal care visits at the San José de Chincha National Hospital (Ica, Peru). Information was collected from September 1, 2019 to March 6, 2020. The recruitment period ended when the first case of COVID-19 was detected in Peru. All participants voluntarily agreed to cooperate in this study. People with a psychiatric diagnosis or who were undergoing treatment were not considered, nor were people with drug abuse.

Data collection

We applied a structured questionnaire designed to collect sociodemographic data and also assess exposure to domestic violence (psychological, physical, and sexual), the presence of maternal depression, access to social support, and the risk of femicide. The questionnaire was answered by the participants in the prenatal care program with the help of both a member of the team and the head of the Obstetric Department. Over the 3 weeks leading up to the study, the interviewers were trained in the correct application of the instruments used. Data collection was supervised by the hospital authorities and the senior researcher.

Variables and instruments

The main variables were “exposure to domestic violence” and “maternal depression” (outcome). To assess exposure to domestic violence, the authors applied the Gender-Based Violence Tool designed by the Latin American Federation of Obstetrics and Gynecology Societies (FLASOG). This instrument was previously applied to the Peruvian population in several studies (Escobar et al., 2017; Távara-Orozco et al., 2007; Távara-Orozco et al., 2003). The questionnaire detects whether the violence perpetrated by a participant's current partner and/or the father of their child occurred during pregnancy and up to 6 months before their participation in the study.

The file consists of five items, with domestic violence separated into three types of violence: (i) Psychological (emotional) violence includes verbal abuse, humiliation, threats, public embarrassment, and being rejected or isolated; (ii) Physical violence includes pushing, grabbing, hair pulling, slapping, kicking, biting, hitting, being hit with objects, strangulation or suffocation, burning or scalding, and the use of a weapon for threats or physical harm; (iii) Sexual violence includes forced sexual intercourse (through physical force or threats), attempted forced sexual intercourse, unwanted and distressing sexual touching, and forced sexual activity with a third party.

To assess maternal depression during pregnancy, they applied the Edinburgh Postnatal Depression Scale, which has previously been validated and adapted for Peruvian women who are pregnant (Lam et al., 2017). This instrument consists of 10 items, each of which has a score of 0 to 3 points. If the pregnant woman's score exceeds 13 points, the result is interpreted as indicating the presence of depressive symptoms.

Social support was evaluated with the Medical Outcomes Study (MOS) questionnaire. This instrument was previously validated for the Peruvian population (Baca et al., 2017; Revilla-Ahumada et al., 2005). The MOS asks for the number of people who emotionally support the participant, and the global index of social support was calculated on a scale from 0 to 100, with a higher score indicating greater social support (Revilla-Ahumada et al., 2005).

Furthermore, the risk of feminicide was evaluated using the instrument for the assessment of the risk of intimacy partner violence made official by the Peruvian Supreme Decree No. 009-2016-MIMP (Diario El Peruano, 2016). This questionnaire consists of 19 items and was applied only to participants who mentioned having been victims of IPV. The risk categorization is calculated according to the score obtained in the instrument (Mild risk: 0–12 points, Moderate risk: 13–21 points and Severe risk: 22–24 points).

Statistical analysis

Double data entry was performed by two independent researchers using Microsoft Excel. The database was analyzed by another researcher using STATA v14. They estimated the frequency, percentages, and mean of all pertinent variables. The social support index score and the support network had a non-normal distribution; therefore, they were presented in median and interquartile ranges. The Mann–Whitney U and Kruskal–Wallis H tests were used to analyze the data obtained in the social support questionnaire. Bivariate analysis was used to measure the association between maternal depression and other relevant variables, using the prevalence of the ratio (PR) with its corresponding confidence interval (95% CI) in a two-tailed analysis. Multivariate analyses were calculated using Poisson regression models with robust variance built using the stepwise method.

Ethical considerations

Our research was approved by the Institutional Research Ethics Committee of the Universidad Privada San Juan Bautista (Registration Code: No. 188-2020-CIEI-UPSJB). All participants in this study signed an informed consent, in which the confidentiality of their personal data as well as the risks and benefits associated with participation in the study were explained. Furthermore, the execution of this study followed the safety and ethics recommendations established by the WHO for research involving female victims of domestic violence (WHO, 2001). Those women who suffered IPV were referred to the hospital psychologist to receive mental and legal support, in accordance with the Peruvian Supreme Decree No. 009-2016-MIMP (Diario El Peruano, 2016).

Results

Population characteristics

Initially, 331 participants were recruited; however, 15 of them did not meet the inclusion criteria and were excluded. A total of 316 pregnant women participated in this study. Almost half of the sample (48.4%) were between 18 and 25 years of age and the maximum age was 42 years. Most of the participants were of Peruvian nationality (83.9%), were married (63.9%), had completed high school education (75.9%), had had no previous abortions (71.2%), belonged to a urban area (71.8%), and were unemployed (84.8%). The median number of people who made up a victim's social support group was 5 [3–7] and the median index score of the global social support was 86.84 [71.05–95.72].

A total of 19.6% (n = 62) of pregnant women declared that they were victims of psychological violence and 7% (n = 22) that they were victims of physical aggression. No participant reported being a victim of sexual abuse. Furthermore, 10.4% (n = 33), 7.6% (n = 24), and 4.1% (n = 13) of the participants were at mild risk, moderate risk, and severe risk of feminicide, respectively. In addition, 29.1% (n = 92) of the participants suffered from maternal depression and 16.8% (n = 53) had suicidal thoughts. Population characteristics are detailed in Table 1.

Table 1.

Characteristics of Pregnant Women Treated at the San José de Chincha Hospital, 2019–2020

Characteristics	n	%
Sociodemographics
Age, years
18–25	153	48.4
26–30	100	31.6
Over 30	63	20.0
Nationality
Peruvian	265	83.9
Venezuelan	51	16.1
Marital status
Single	56	17.7
Cohabiting	58	18.4
Married	202	63.9
Education
High school	240	75.9
Technical	43	13.6
Higher	33	10.4
Relationship period
Less than a year	20	6.3
Over a year	296	93.7
Miscarriages
Yes	60	19
No	225	71.2
Does not know^a	31	9.8
Residence
Rural	89	28.2
Urban	227	71.8
Occupation
Unemployed	268	84.8
Employed	48	15.2
Unwanted pregnancy
Yes	136	43.0
No	180	57.0
Alcohol consumption of partner (<3 months)
Yes	93	29.4
No	197	62.3
Does not know^a	26	8.2
Pregnancy trimester
1st Trimester	1	0.3
2nd Trimester	94	29.7
3rd Trimester	99	31.3
Does not know^a	122	38.6
Social support
Global index (median, IQR)	86.84	[71.05–95.72]
People that support the victim (median, IQR)	5	[3–7]
Exposure to domestic violence
Psychological violence	62	19.6
Physical violence	22	7.0
Sexual violence	0	0.0
Childhood sexual violence	35	11.1
Feel safe at home	275	87.0
Risk of feminicide
Mild risk	33	10.4
Moderate risk	24	7.6
Severe risk	13	4.1
Maternal depression
Present (score >13)	92	29.1
EPDS total score (mean ± SD)	10.1	±5.1
Presence of suicidal thoughts	53	16.8

Participants preferred not to answer.

EPDS, Edinburgh Postnatal Depression Scale; IQR, interquartile range; SD, standard deviation.

Social support

We explored the correlation between the number of people who support these women and the global index of social support versus the presence of psychological violence, physical violence, maternal depression, and the risk of feminicide. All evaluations demonstrated a significant difference and are detailed in Table 2.

Table 2.

Analysis of the Social Support Network and the Global Index of Social Support Among Pregnant Women Treated at the San José de Chincha National Hospital, 2019–2020

Characteristics	Social support
	Number of people that support the victim		Global index
	Median [IQR]	p	Median [IQR]	p
Exposure to domestic violence^a
Psychological violence
No	5 [3–7]	0.026	86.8 [75.0–98.7]	0.004
Yes	4 [2.8–5]		59.9 [38.1–96.4]
Physical violence
No	5 [3–7]	<0.001	88.1 [77.7–99.3]	<0.001
Yes	4 [2–5]		59.2 [48.3–90.8]
Maternal depression^a
No	5 [3–8]	<0.001	89.5 [80.3–97.4]	<0.001
Yes	4 [2–5.8]		62.5 [49.0–86.5]
Risk of feminicide^b
Without risk	5 [3–7.3]	<0.001	88.2 [77.6–96.0]	<0.001
Mild risk	4 [3–6]		63.2 [44.8–86.2]
Moderate risk	3 [2–4]		55.3 [48.0–97.4]
Severe risk	4 [3–5]		51.3 [47.4–73.7]

Test of Mann–Whitney U.

Test de Kruskal–Wallis H.

Maternal depression risk factors

Bivariate analysis showed that unwanted pregnancy (p = 0.003, PR: 1.82, CI 95%: 1.23–2.69), psychological violence (p < 0.001, PR: 3.76, CI 95%: 2.78–5.07), physical violence (p < 0.001, PR: 3.25, CI 95%: 2.46–4.30), sexual violence during childhood (p = 0.012, PR: 1.69, CI 95%: 1.12–2.55), a negative perception of safety at home (p < 0.001, PR: 2.45, CI 95%: 1.76–3.40), and risk of feminicide (p < 0.001, PR: 2.10–4.56) were associated with maternal depression. Furthermore, the number of people who support IPV victims (p < 0.001, PR: 0.87, CI 95%: 0.81–0.93) and the global social support index score (p < 0.001, RP: 0.97, CI 95%: 0.97–0.98) were protective factors for depression in pregnant women (Table 3).

Table 3.

Bivariate Analysis of Factors Associated with Maternal Depression in Pregnant Women Treated at the San Jose de Chincha Hospital

EDPE
Characteristics	Present		Absent		PR (CI: 95%)	p
Characteristics	n	(%)	n	(%)	PR (CI: 95%)	p
Age, years
18–25	46	30.07	107	69.93	Ref.
26–30	26	26	74	74	0.86 (0.57–1.30)	0.488
Over 30	20	31.75	43	68.25	1.06 (0.68–1.63)	0.807
Nationality
Peruvian	74	27.92	191	72.08	Ref.
Venezuelan	18	35.29	33	64.71	1.26 (0.83–1.92)	0.274
Marital status
Single	16	28.57	40	71.43	Ref.
Cohabiting	17	29.31	41	70.69	1.07 (0.60–1.94)	0.811
Married	60	29.7	142	70.3	1.09 (0.67–1.76)	0.728
Education level
High school education	69	28.75	171	71.25	1.05 (0.71–1.56)
Technical/higher education	23	30.26	53	69.74	Ref.	0.799
Relationship period
Less than a year	6	30	14	70	1.03 (0.52–2.07)	0.928
Over a year	86	29.05	210	70.95	Ref.
Miscarriages
Yes	18	30	42	70	1.04 (0.67–1.60)	0.866
No/does not know	74	28.91	182	71.09	Ref.
Residence
Rural	23	25.84	66	74.16	0.85 (0.57–1.27)	0.431
Urban	69	30.4	158	69.6	Ref.
Occupation
Unemployed	78	29.1	190	70.9	1.00 (0.62–1.62)	0.993
Employed	14	29.17	34	70.83	Ref.
Unwanted pregnancy
Yes	65	36.11	115	63.89	1.82 (1.23–2.69)	0.003
No	27	19.85	109	80.15	Ref.
Alcohol consumption of partner (< 3 months)
Yes	24	25.81	69	74.19	0.86 (0.57–1.29)	0.472
No	59	29.95	138	70.05	Ref.
Pregnancy trimester
1st Trimester	0	0	1	100	NC^a	NC^a
2nd Trimester	30	31.91	64	68.09	1.05 (0.69–1.60)	0.809
3rd Trimester	30	30.3	69	69.7	Ref.	Ref.
Exposure to domestic violence
Psychological violence
Yes	44	70.97	18	29.03	3.76 (2.78–5.07)	<0.001
No	48	18.9	206	81.1	Ref.	Ref.
Physical violence
Yes	18	81.82	4	18.18	3.25 (2.46–4.30)	<0.001
No	74	25.17	220	74.83	Ref.	Ref.
Childhood sexual violence
Yes	16	45.71	19	54.29	1.69 (1.12–2.55)	0.012
No	76	27.05	205	72.95	Ref.	Ref.
Feel safe at home
Yes	68	24.73	207	75.27	Ref.	Ref.
No	23	60.53	15	39.47	2.45 (1.76–3.40)	<0.001
Social support (number of people)^b	4 [2–5.8]		5 [3–8]		0.87 (0.81–0.93)	<0.001
Social support Global index^b	62.5 [49.0–86.5]		89.5 [80.3–97.4]		0.97 (0.97–0.98)	<0.001
Risk of feminicide
Without risk	45	18.29	201	81.71	Ref.	Ref.
Mild risk	22	66.67	11	33.33	3.64 (2.55–5.21)	<0.001
Moderate risk	20	83.33	4	16.67	4.56 (3.31–6.27)	<0.001
Severe risk	5	38.46	8	61.54	2.10 (1.01–4.40)	0.048

NC: Not considered due to the small number of individuals with the characteristic which limited the analysis.

Median and IQR.

CI, confidence interval; PR, prevalence ratio; Ref.: Reference in the analysis within the variable.

Multivariate analysis showed that unwanted pregnancy (p = 0.049, aPR: 1.44; CI 95%: 1.01–2.07), psychological violence (p = 0.002, aPR: 1.79; CI 95%: 1.23–2.60), a low score on the global index of social support (p = 0.001, aPR: 0.99, CI 95%: 0.98–0.99), mild risk of feminicide (p = 0.001, aPR: 1.97, CI 95%: 1.31–2.96), and a moderate risk of feminicide (p = 0.017, aPR: 1.81, CI 95%: 1.11–2.95) were associated with the presence of maternal depression (Table 4).

Table 4.

Multivariate Analysis of Factors Associated with Maternal Depression in Pregnant Women Treated at The San Jose de Chincha Hospital

Characteristics	Adjusted PR (CI: 95%)	p
Unwanted pregnancy
Yes	1.44 (1.01–2.07)	0.049
No	Ref.
Psychological violence
Yes	1.79 (1.23–2.60)	0.002
No	Ref.	Ref.
Social support global index^a	0.99 (0.98–0.99)	0.001
Risk of feminicide
Without risk	Ref.	Ref.
Mild risk	1.97 (1.31–2.96)	0.001
Moderate risk	1.81 (1.11–2.95)	0.017
Severe risk	1.03 (0.57–1.88)	0.913

Median and IQR.

Discussion

This study found a high frequency of violence against pregnant women, with a predominance of psychological violence. Similarly, a significant percentage of pregnant women were at risk of feminicide. The frequency of violence against pregnant women can vary between countries and social strata (Daley et al., 2020). In Iran, a cross-sectional study demonstrated that IPV against pregnant women affected up to 64.8% of its population (Tavoli et al., 2016). In the study, the frequency of psychological violence was lower than the frequencies reported in previous years in Peru (19.6% vs. 22.4–54.0%; Escobar et al., 2017; Flores Sullca and Schirmer, 2006; Saravia et al., 2012; Távara-Orozco et al., 2003).

This difference in the prevalence of psychological violence is in accordance with the decreasing rates of domestic violence against women in not only the local but also the international context (Daley et al., 2020; Nuñez-Ochoa et al., 2020). The frequency of physical violence in this study (7%) was similar to the values reported in 2018 for the Ica region (7.7%; INEI, 2019b). Therefore, it is important to evaluate current intervention protocols for victims of physical violence and to focus on the implementation of new strategies that improve the effectiveness of intervention programs in the region.

Ica is a region with one of the highest rates of domestic violence in Peru (INEI, 2019a; Ministerio de la Mujer y Poblaciones Vulnerables, 2020). A study by the Instituto Nacional de Estadística e Informática in 2019 showed that the rates of psychological and physical violence against women were 49% and 28.2%, respectively (INEI, 2019a). In the study, the results show that the rates of psychological and physical violence against pregnant women are less frequent in this region.

In this study, no cases of sexual violence were reported. In the latest studies carried out in Peru, the frequency of sexual violence against pregnant women ranged from 3.3% to 8.6% (Barzola Macha et al., 2020; Morales et al., 2019). Although these studies were carried out in other cities in Peru, it is highly likely that the results are underrepresented by biases in data collection, such as incorrect identification of violent behaviors between couples or the lack of desire to report such behaviors.

In Latin America, the highest rate of feminicide has been recorded in Honduras (6.2 cases per 10,000 women). In Peru, 128 cases of feminicide were detected with a rate of 0.8 cases per 10,000 women (Organizacion de las Naciones Unidas, 2019). The risk of feminicide in Peru has been calculated to be 1.98% (Hernández, 2021) and in the Ica region it is 1.07% (Curro Urbano et al., 2017). In the study, 22.1% of the population was reported to be at risk of feminicide, with 4.1% at serious risk. These figures are alarming considering that it is a pregnant population. Few studies have characterized feminicide in Peru (Curro Urbano et al., 2017; Inquilla Mamani et al., 2020), and to the authors' knowledge, this is the first study to characterize the risk of feminicide against pregnant Peruvian women. These results must be taken into account with caution, as this population is extremely vulnerable.

The global prevalence of maternal depression ranges from 15% to 65%, and the frequency of suicidal ideation can range from 5% to 11% (Halim et al., 2018). Furthermore, the prevalence of maternal depression has been reported to be decreasing in developing countries, including Peru (Dadi et al., 2020). In the study, the authors found that 29.1% and 16.8% of participants presented with symptoms of maternal depression and suicidal ideation, respectively. The frequency of maternal depression detected in this study was lower than that in other Latin American countries (35–50%; Wolf et al., 2002) as well as that in previous studies carried out in Peru (Bao-Alonso et al., 2010; Lam et al., 2008; Luna Matos et al., 2009).

Similarly, the prevalence of suicidal ideation was lower compared to that in previous studies (22.4%) conducted on Peruvian pregnant women (Levey et al., 2019). This difference between results may be due to sociocultural factors such as social support, which presented higher values in this study than in others (Lam et al., 2008).

The lack of social support is a factor that has been associated with maternal depression and IPV against pregnant women (Lam et al., 2008; Ludermir et al., 2010; Wan Mahmud et al., 2004). In the study, as expected, a lower global social support index score, and a smaller number of supporters were associated to presence psychological violence, physical violence, risk of feminicide, and depressive symptoms in pregnant women. In this context, it is important to highlight that social support from family or friends plays a protective role to environmental stressors such as IPV and risk of feminicide and could decrease individual's susceptibility to depression (Cohen and Wills, 1985; Woldetensay et al., 2018).

The literature reports that unwanted pregnancy and psychological violence are associated to maternal depression (Bao-Alonso et al., 2010; Belay et al., 2019; Dadi et al., 2020; Dibaba et al., 2013). Nevertheless, they found that physical violence was associated with maternal depression just in the bivariate analysis. It was considered that this could be explained by the number of participants exposed to this type of IPV in the study. In a larger population, an association might be found.

Depression was frequent in the, as 66.67% and 83.33% of the participants who were at risk of mild and moderate feminicide, respectively, presented depressive symptoms. Feminicide is an extreme form of IPV; therefore, the association between these two characteristics was expected (Guerra Rosas and Cabrera Castillo, 2019). In the literature, the association between the risk of feminicide and the presence of depression in Peruvian women has already been described (Hernández, 2021). However, these results are the first to show the association between these two variables in pregnant Peruvian women. Furthermore, it is important to note that the instrument used to assess the risk of feminicide has not been validated in any previous study. However, the Peruvian government uses it to assess and prevent the risk of feminicide (Diario El Peruano, 2016).

In Peru, this is the first study to include the Venezuelan population in the analysis of maternal depression and IPV against pregnant women. Peru is among the countries that have received the largest numbers of Venezuelan immigrants, and this has caused various social changes (Perea et al., 2019); however, this characteristic was not associated with the presence of maternal depression in the sample studied and the number of Venezuelan participants is not large enough to perform a stratified analysis. Other variables such as living in rural areas or alcohol consumption by partners were not associated with maternal depression, contrary to what has been reported in the literature (Belay et al., 2019; Dibaba et al., 2013; Halim et al., 2018).

This study has some limitations. First, the instrument applied to assess the risk of feminicide is not used outside of Peru. Therefore, its results cannot be compared with those of other instruments that measure the same construct. Despite this, the authors believe that the results found will not vary significantly between different realities. Second, the study sample was obtained from the outpatient population treated at one hospital and does not necessarily represent the general population of the Ica region. Similarly, it should be considered that the originally proposed number of participants could not be recruited because enrollment was interrupted by the appearance of COVID-19 in Peru.

Conclusion

In this study, the frequency of maternal depression, the prevalence of IPV, and the risk of femicide are demonstrated to be high; since one in three pregnant women has maternal depression and one in five has been a victim of IPV or is at risk of feminicide. There is a need for a change in the mentality of society regarding the biological, psychological, and legal consequences of IPV and the vulnerability of both the woman and the fetus during pregnancy. Furthermore, it is important to evaluate current IPV interventions and take steps to reduce these values in Peru.

Footnotes

Acknowledgment

The authors thank the staff of the San Jose de Chincha Hospital for facilitating the introduction of the researchers and this collaboration.

Author Disclosure Statement

There are no competing financial interests present.

Funding Information

This publication was supported by the Universidad Privada San Juan Bautista SAC.

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