Sexual violence, pregnancy and childbirth. Studies investigating the association of experienced sexual violence and outcomes in pregnancy and childbirth

Background: Sexual violence against women is a recognised public health problem, and it is a phenomenon that persists in all countries regardless of value system and culture. There is growing evidence that women who have experienced sexual violence are at greater risk for negative health outcomes, even several years after the abuse. Pregnancy does not protect women from violence. For some women, pregnancy may be the first time that they are aware of previous exposure to violence, or trauma that they have experienced may resurface. Objectives: The first aim of our study was to explore whether a history of sexual violence was associated with pregnancy-related physical symptoms. Second, we investigated the relationship between lifetime sexual violence and antenatal hospitalisations. Third, we assessed the association between sexual violence and mode of delivery, and finally, we examined the relationship between a history of sexual violence and neonatal outcomes. Subjects and methods: In this thesis, we used data from the Norwegian Mother and Child Cohort study (MoBa) linked to data from the Norwegian Medical Birth Registry. Studies I and II had a cross-sectional design and included 78 660 pregnant women. Studies III and IV were cohort studies that included 74 058 and 76 870 pregnant women, respectively. The participating women were recruited during their routine ultrasound examination, and they completed extensive questionnaires at 17 and 30 weeks gestation. History of sexual violence was reported at three levels of severity: 1) pressured into sexual acts (mild), 2) forced with violence (moderate), and 3) raped (severe). The comparison group was women not reporting sexual violence. Results: In our studies, 12.0% of the women reported mild sexual violence, 2.8% reported moderate sexual violence and 3.6% reported severe sexual violence (rape). Compared with women who did not report a history of sexual violence, women who reported a history of sexual violence suffered from more pregnancy-related physical symptoms and were more often hospitalised during pregnancy. Severe sexual violence was associated with a higher risk of elective caesarean section (CS), and moderate sexual violence was associated with an increased risk of emergency CS. There was no significant association between sexual violence and neonatal outcomes