Gender-based violence and kangaroo mother care in Amhara, Ethiopia Open Access

Carter, Mary (Summer 2018)

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Background: Gender-based violence affects one out of every three women and can lead to adverse birth outcomes such as low birth weight. These infants are at increased risk for neonatal morbidity and mortality. Kangaroo mother care is an effective and free intervention that promotes health and reduces morbidity and mortality. Gender-based violence has been shown to alter a woman’s health behaviors and affect health outcomes for both the mother and baby. However, no study had previously investigated the relationship between gender-based violence and kangaroo mother care.

Methods: This study included a literature review of the relationship between gender-based violence and breastfeeding practices, a secondary data analysis of the 2016 Ethiopian Demographic and Health Survey, and, as part of a larger parent study, a gender-based violence survey.

Results: An Ethiopian woman who has experienced polyvictimization has greater odds of delivering at home. The more forms of violence a woman has experienced the higher her odds of a home birth even after controlling for sociodemographic factors (at least 3 forms OR=1.92; at least 4 forms OR=2.21; at least 5 forms OR=3.31). Women who report physical intimate partner violence or polyvictimization are at higher risk of ineffective kangaroo mother care in Amhara Ethiopia (OR=5.06, OR=3.87 respectively).

Conclusion: 73% of Ethiopian woman deliver at home and only 2% have a skilled provider. Gender-based violence, specifically polyvictimization increases a woman’s likelihood of delivering at home. Home birth may be a barrier to effective kangaroo mother care because these women are usually without a skilled provider who can assess the infant, initiate kangaroo mother care and educate and support the mother. Additionally, this study suggests that even if kangaroo mother care is initiated, specific forms of gender-based violence and polyvictimization may effect a woman’s ability to exclusively breastfeed, provide prolonged skin-to-skin contact and provide effective kangaroo mother care to her low birth weight neonate in Amhara, Ethiopia.

Table of Contents

Chapter 1 Introduction 1

Gender-Based Violence 1

Preterm Birth, Low Birth Weight, Neonatal Death 3

Kangaroo Mother Care 4

Gender-Based Violence and Preterm Birth/Low Birth Weight 5

Gender-Based Violence and Kangaroo Mother Care 5

Study Design 8

Organization of the Dissertation 9

Chapter 2 Gender-based violence and breastfeeding practices: Making sense of the literature 17

Abstract 18

Introduction 19

Methods 20

Results 25

Discussion 32

Conclusion 34

Chapter 3 Gender-Based Violence and Home Birth in Ethiopia 41

Abstract 42

Introduction 43

Methods 45

Analyses 47

Results 47

Discussion 51

Chapter 4 Gender-Based Violence: A barrier to Kangaroo Mother Care 56

Abstract 57

Introduction 58

Methods 59

Analyses 63

Results 63

Discussion 68

Chapter 5 Summary and Conclusions 75

Gender-based violence and breastfeeding: Making sense of the literature 75

Gender-based violence and home birth in Ethiopia 77

Gender-based violence: A barrier to kangaroo mother care in Amhara, Ethiopia 78

Contribution to the literature 79

Implications for future research 80

Conclusion 81

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