Obstetric violence and its association with postnatal depression: A longitudinal community-based study in rural...

Mistreatment, abuse, or neglect during childbirth is known as obstetric violence (OV), which is increasingly recognized as a human rights issue with significant public health impacts. Research shows that traumatic childbirth can profoundly affect maternal psychological health and undermine positive parenting. This study provides primary evidence on the link between OV and postnatal depression (PND) among rural women in Jharkhand, a region marked by social and infrastructural disadvantage.

(1) Estimate the prevalence and examine the predictors of OV during facility-based childbirth in rural Jharkhand, India, and (2) assess the association between OV and PND.

A longitudinal community-based study was conducted in two phases (antenatal and postnatal follow-up).

Pregnant women in their second or third trimester (n = 246) were enrolled from the rural Chatra district employing a multistage sampling approach. Follow-up assessments were completed with the postpartum (n = 189) women. OV was measured using a typology aligned with World Health Organization and Bowser and Hill's framework. PND was assessed using a Hindi-translated and reliability-tested Four-Dimensional Symptom Questionnaire. Logistic regression models were used to predict OV and to examine the association between OV and PND, while adjusting for sociodemographic factors.

Over half of the women (56.1%) experienced at least one form of OV. Physical abuse (47.6%) and non-dignified care (33.9%) were most common. Bribery demands, delivery in government facilities, and deliveries attended by nurses or midwives were the strongest predictors of OV. The prevalence of PND was significantly higher among women exposed to OV (55.7%) than among those who were not exposed (28.9%). The adjusted analysis showed that OV increased the odds of PND by more than threefold (odds ratio = 3.11, p < 0.01). Neglected care, non-dignified care, physical abuse, and privacy violations were significant predictors of PND.

OV is widespread in rural Jharkhand and strongly associated with PND. Integrating respectful maternity care standards, improving accountability in public facilities, and incorporating routine mental health screening into maternal healthcare are essential to reduce the burden of OV and PND.