Indian women of child-bearing age are abused by both husbands and other family members at alarming rates, and women abused around the time of pregnancy are more likely to suffer complications of pregnancy, miscarry, and give birth to low weight infants and infants that do not survive. However, little is understood regarding the mechanisms responsible for these associations. The proposed study will provide qualitative and quantitative data to clarify the relations of violence against wives by both husbands and other family members (i.e., 'domestic violence') to pregnancy complications and postpartum maternal and infant health among those seeking infant immunization at a large public urban health center (UHC) located in a major slum of Mumbai, India. A sequential research design will be utilized involving two phases of qualitative study informing a final phase of quantitative study. Phase 1 will involve in-depth interviews with victims of domestic violence seeking immunization for infants 6 months of age or younger (n=40); Phase 2 will involve focus groups with fathers residing with their young infants (2 groups, total n=12-24 individuals) and mothers-in-law residing with daughters-in-law who have recently given birth (2 groups, total n=12-24 individuals). The resulting model will be integrated with findings from previous research to create a survey for mothers of young infants (n=750) attending the UHC for child immunization to quantitatively assess 1) associations of domestic violence (prior to, during and post pregnancy) to pregnancy complications (i.e., preterm delivery, preeclampsia, gestational diabetes, hemorrhage, UTI), postpartum maternal health (i.e., depression, anemia, genital infection, breastfeeding difficulties) and infant health (i.e., low weight, poor nutrition, diarrhea, respiratory distress, fever), 2) associations of domestic violence to other forms of maltreatment hypothesized based on prior research and qualitative study to represent proximal mechanisms for the effect of domestic violence on maternal and infant health (e.g., nutritional deprivation, child abuse, interference with maternal care of infant, excessive household labor demands), and 3) whether associations of domestic violence and maternal and infant health outcomes occur via (i.e., are modified by) these mechanisms. These data will be synthesized to create recommendations for family and clinic-based intervention programs, and will be broadly disseminated in the form of reports for Indian practitioners, researchers and policymakers. ? ? ?
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