Pregnant women in developing countries are at risk of experiencing multiple forms of violence, including physical, sexual, and psychological abuse, often perpetrated by intimate partners. These forms of violence can have adverse consequences for both maternal and fetal health. The current study revealed that more than half of the studied women (58.8%) had experienced violence. The results align with Fekadu et al.16, who observed a prevalence rate of 58.7%, and Padmasri et al.17, who discovered a prevalence of 52.8%. On the other hand, Nejatizade et al.18 reported a lower prevalence of 30.3%. Different sampling techniques, cultural norms, sociodemographic characteristics, and determinants of women’s health and social empowerment are some of the variables that may have an impact on these variations in prevalence rates. In addition, participants’ willingness to disclose experiences of domestic violence during pregnancy may be influenced by feelings of shame, fear of societal judgment, and concerns about how their families, partners, and community perceive them.
In our study, psychological violence was found to be the most prevalent form of domestic violence among pregnant women, affecting 44.2% followed by physical, and the least common form of violence was sexual. These findings are consistent with previous research, as shown by Elkhateeb et al.8 and Modiba et al.19. However, Ayeni and Tekbaş20 found that sexual violence is more frequent among violent acts.
Violence against pregnant women is influenced by various factors. In contrast, Rayhan et al.21 reported that long-term married women are less likely to face violence. This discrepancy may be explained by contextual differences. In our study context, prolonged marriages might result in a cumulative exposure to stressors or entrenched patterns of conflict that escalate over time.
Addressing the effect of demographic factors, our study found that uneducated, non-working women in insufficient income families experience higher rates of violence, a finding in agreement with Ayeni and Tekbaş20 and Finnbogadóttira et al.22. Similarly, a meta-analysis carried out by Nabaggala et al.23 assessing educational disparities in IPV prevalence among ever-partnered women in sub-Saharan Africa found significantly higher violence rates among those with lower education levels. Furthermore, Agarwal et al.24 in a comprehensive review of that issue mentioned that women who have a low level of education or low income may be at a higher risk of experiencing IPV during pregnancy. These findings can be attributed to the fact that education empowers women with knowledge of their rights and psychological resilience, while unemployed pregnant women face increased violence risk due to financial dependence, isolation, limited support, and stress, making it harder to seek protection.
In Egypt, traditional gender roles, family-centered norms, and stigma often prevent women from disclosing abuse, particularly during pregnancy. According to the 2005 Egyptian Demographic and Health Survey (EDHS), 47% of ever-married women reported having experienced physical violence since the age of 15. Supporting this, the Egyptian Centre for Women’s Rights reported in 2008 that violence against women was on the rise25,26.
Violence during pregnancy could have severe consequences, The current research reported that violence is associated with a significant increase in multiple maternal complications which aligns with the systematic review and meta-analysis done by Raziani et al.27 which highlighted an association between overall IPV scores and an increased risk of adverse pregnancy outcomes, including premature rupture of membranes (PROM), unwanted pregnancy, pre-eclampsia, miscarriage, cesarean section, and vaginal bleeding. Additionally, a scoping review by Finnbogadóttirb et al.28 on the consequences of violence on pregnancy and childbirth found that women with such a history face a higher risk of common pregnancy-related complaints, hospitalization, fear of childbirth, cesarean section, and both physical and mental health complications.
Moreover, Violence during pregnancy has been linked to adverse fetal outcomes. Our results found that women who experienced violence had higher rates of preterm birth, fetal distress, and LBW. These findings are consistent with those of Melaku et al.29, who reported that women exposed to domestic violence had a fourfold higher risk of preterm birth and a 2.5-fold higher risk of perinatal death compared to unexposed women. Supporting our results, a systematic review and meta-analysis of 50 studies across 17 countries by Donovan et al.30 found that women subjected to IPV exhibited elevated levels of stress-related hormones, contributing to preterm birth and LBW. Similar conclusions were drawn by Pastor-Moreno et al.31 in their review of 39 studies. However, in contrast, Al Shidhani et al.32 found no significant association between domestic violence and adverse birth outcomes. Fetal complications may be explained by a hypothesis proposed by Noormohamadi et al.33, suggesting that vasoconstriction—triggered by the activation of the pituitary, adrenal, and sympathetic nervous systems in response to violence—can reduce uterine-placental blood flow. This reduction may lead to fetal hypoxia, increasing the risk of intrauterine growth restriction (IUGR) and LBW.
Limitations
This study has some limitations. Underreporting of violence is possible due to its sensitive nature, and recall bias may have affected the accuracy of participants’ responses. The hospital-based sampling may introduce selection bias, excluding women who use private facilities. Additionally, loss to follow-up, particularly among women delivering in other hospitals or who can’t be reached by phone, may have affected postpartum data completeness.