Association between intimate partner violence during pregnancy and maternal pregnancy complications among recently delivered women in Bangladesh

Intimate partner violence (IPV), an actual or threatened physical, sexual, or psychological abuse by a current or former partner or spouse, is a common global public health issue. Understanding both the prevalence of IPV during pregnancy and its potential impact on the health of pregnant women is important for the development and implementation of interventions to prevent maternal morbidity and mortality. The purpose of this study was to explore the association between maternal experiences of IPV during pregnancy and pregnancy complications. A health‐facility‐based cross‐sectional study was conducted from July 2015 to April 2016 among 400 randomly selected women who were admitted to the postnatal wards of Rajshahi Medical College Hospital for delivery. Data were collected through face‐to‐face interviews using a structured questionnaire. Multivariable logistic regressions were performed to assess relationships between variables of interest after controlling for potential confounders. Results indicated that 39.0% of women reported physical IPV and 26.3% of women reported sexual IPV during pregnancy. Additionally, 69.5% of women experienced medical complications (MCs); of this group, 44.3% experienced obstetric complications (OCs) and 79.3% experienced any pregnancy complication (AC) during their last pregnancy. The experience of physical IPV during pregnancy was significantly associated with the experience of MCs (adjusted odds ratio (AOR): 2.05, 95% confidence interval (CI): 1.15–4.01), OCs (AOR: 4.23, 95% CI: 2.01–7.12) and AC (AOR: 5.26, 95% CI: 2.98–10.52). Women who experienced sexual IPV during pregnancy were also at increased risk of suffering from any MC, any OC, and AC. Maternal experience of IPV during pregnancy is positively associated with pregnancy complications. Preventing IPV directed at pregnant women might reduce maternal morbidity and mortality in Bangladesh.

     

Overshadowing the Reminiscence Bump: Memories of a Struggle for Independence

We describe a study in which young and older groups of Bangladeshi participants recalled and dated autobiographical memories from across the lifespan. Memories were subsequently plotted in terms of the age of participants at time of encoding. As expected the reminiscence bump, preferential recall of memories from the period of 10 to 30 years of age, was observed. This was very marked in the younger group and but less so in the older group who also showed a second bump in the period 35 to 55 years of age. This second bump corresponded to the period of national conflict between Pakistan and the Bengalee people that resulted in the formation of an independent Bangladesh. It is proposed that both the reminiscence bump and later periods of unexpected rises in recall can be accounted for by the raised accessibility of sets of memories and this in turn is a product of the privileged encoding of highly self-relevant experiences.     

Well-being, Happiness and Why Relationships Matter: Evidence from Bangladesh

Although Bangladesh is known as one of the poorest and most densely populated countries in the world, qualitative research and anecdotal evidence suggests its people report levels of happiness that are higher than those found in many other countries. This includes ‘developed’ countries where people have larger per capita incomes and can access a wider range of public services and goods. The paper explores this apparent paradox by analysing primary quantitative and qualitative data, and engaging with existing literature on happiness and objective wellbeing in Bangladesh. The data and analysis presented makes an original and timely contribution to the limited knowledge we have of the construction and experience of happiness and life satisfaction in contexts of extreme and persistent economic poverty. It identifies and offers insights into the ‘personal’ as well as social or ‘relational’ values and goals that people in Bangladesh consider important to achieve happiness in life. It also reflects on how different people experience these values and goals in very different ways. This, we argue, leads to a better understanding of the influence of the social and cultural context in the construction of people’s happiness. In the conclusion, we reflect on the policy implications of our findings.

Breaking ground,hitting ground: A Sure Start rapid response service for parents and their under fours

This paper describes a project aimed at taking an under fours' counselling and parent support service into a neighbourhood characterized by particularly high levels of deprivation and ethnic diversity. Referrals to the local CAMHS showed a high level of disturbance in school aged children and adolescents in this area. However, children under 4 years were strikingly under-represented in referral statistics, suggesting the need to make our service more accessible to this group. The project took the form of a once-weekly clinic run in a community centre. Differences in ways of engaging and working with the families in order to make the service accessible and ‘user friendly’ are described. So, too, is a protocol developed in order to support the worker in thinking through the many anxiety raising situations to be responded to in dealing with severely deprived families living in extremely stressful situations. Three clinical examples illustrate that a major value of this initiative was in increasing the worker's understanding of ethnic and cultural differences and of how to work with them. The service also helped to promote good liaison between statutory and voluntary agencies. The project was established initially under the auspices of Sure Start, a government sponsored scheme for enriching developmental opportunities of under fours and their parents in deprived areas. After running for 18 months, it will be funded through mainstream resources, as an example of the kind of innovative work with hard to reach populations encouraged by the guidelines given in the new National Service Framework for Children in England.     

Authoritarianism and arranged marriage in Bangladesh and Korea

The relationships between authoritarianism and attitudes about arranged marriage were studied in Bangladesh and Korea. According to regression analyses (N = 417), authoritarianism was positively related to support for arranged marriages in closed-ended and open-ended responses. Authoritarianism was also negatively related to open-ended discussions about the importance of love in selecting a partner and in the importance of emotional connection in establishing a relationship. Replicating prior results from the US on women, authoritarianism was related to desires to marry individuals who were gender-typed, traditional, and with narrow interests. Despite some differences in patterns of relationships due to gender and country of origin, the findings support the general hypothesis that authoritarians are invested in maintaining the traditions of their culture.     

Mechanisms of behavioural maintenance: Long-term effects of theory-based interventions to promote safe water consumption

Theory-based interventions can enhance people’s safe water consumption, but the sustainability of these interventions and the mechanisms of maintenance remain unclear. We investigated these questions based on an extended theory of planned behaviour. Seven hundred and ten (445 analysed) randomly selected households participated in two cluster-randomised controlled trials in Bangladesh. Study 1 promoted switching to neighbours’ arsenic-safe wells, and Study 2 promoted switching to arsenic-safe deep wells. Both studies included two intervention phases. Structured interviews were conducted at baseline (T1), and at 1-month (T2), 2-month (T3) and 9-month (T4) follow-ups. In intervention phase 1 (between T1 and T2), commitment-based behaviour change techniques – reminders, implementation intentions and public commitment – were combined with information and compared to an information-only control group. In phase 2 (between T2 and T3), half of each phase 1 intervention group was randomly assigned to receive either commitment-based techniques once more or coping planning with reminders and information. Initial well-switching rates of up to 60% significantly declined by T4: 38.3% of T2 safe water users stopped consuming arsenic-safe water. The decline depended on the intervention. Perceived behavioural control, intentions, commitment strength and coping planning were associated with maintenance. In line with previous studies, the results indicate that commitment and reminders engender long-term behavioural change.     

Autonomy or Dependence – or Both?: Perspectives from Bangladesh

The idea of personal autonomy is central to many accounts of eudaimonic well-being. Yet it is often criticized as a Western concept celebrating individualism and independence over group obligations and interdependence or dependence. This paper rejects this view and argues that coherent accounts of autonomy must always recognize the interdependence of people in groups, and that autonomy can coexist with substantial relationships of dependence. It illustrates this drawing on evidence from Bangladesh, a poor country usually absent from cross-cultural studies and one where personal relationships of hierarchy and dependence are endemic. Argument and evidence are presented showing the coexistence of personal autonomy and dependence, and the relationship between collective action and autonomy. We also address some of the specific problems encountered in researching autonomy in a social context where it is mainly expressed in relational forms. We conclude that autonomy can be directed toward both personal and social goals, and can be enacted individually, or by participation in groups. Autonomy is a universal psychological need but its expression is always contextual. ESRC Research Group on Wellbeing in Developing Countries