Domestic violence is a leading cause of social morbidity and may increase during and after pregnancy. In high-income countries screening, referral and management interventions are available as part of standard maternity care. Such practice is not routine in low- and middle-income countries (LMIC) where the burden of social morbidity is high. We systematically reviewed available evidence describing the types of interventions, and/or the effectiveness of such interventions for women who report domestic violence during and/or after pregnancy, living in LMIC. Published and grey literature describing interventions for, and/or effectiveness of such interventions for women who report domestic violence during and/or after pregnancy, living in LMIC was reviewed. Outcomes assessed were (i) reduction in the frequency and/or severity of domestic violence, and/or (ii) improved physical, psychological and/or social health. Narrative analysis was conducted. After screening 4818 articles, six studies were identified for inclusion. All included studies assessed women (n = 894) during pregnancy. Five studies reported on supportive counselling; one study implemented an intervention consisting of routine screening for domestic violence and supported referrals for women who required this. Two studies evaluated the effectiveness of the interventions on domestic violence with statistically significant decreases in the occurrence of domestic violence following counselling interventions (488 women included). There was a statistically significant increase in family support following counselling in one study (72 women included). There was some evidence of improvement in quality of life, increased use of safety behaviours, improved family and social support, increased access to community resources, increased use of referral services and reduced maternal depression. Overall evidence was of low to moderate quality. Screening, referral and supportive counselling is likely to benefit women living in LMIC who experience domestic violence. Larger-scale, high-quality research is, however, required to provide further evidence for the effectiveness of interventions. Improved availability with evaluation of interventions that are likely to be effective is necessary to inform policy, programme decisions and resource allocation for maternal healthcare in LMIC. Systematic review registration number: PROSPERO CRD42018087713.

中文翻译：

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对低收入和中等收入国家报告怀孕期间和怀孕后家庭暴力的妇女的干预措施：系统文献综述


家庭暴力是社会发病率的主要原因，并且在怀孕期间和怀孕后可能会增加。在高收入国家，筛查、转诊和管理干预措施是标准孕产妇护理的一部分。在社会发病率负担较高的低收入和中等收入国家（LMIC），这种做法并不常见。我们系统地审查了现有证据，描述了干预措施的类型和/或此类干预措施对生活在中低收入国家的怀孕期间和/或怀孕后报告家庭暴力的妇女的有效性。已发表的灰色文献描述了对居住在中低收入国家的报告怀孕期间和/或怀孕后家庭暴力的妇女的干预措施和/或此类干预措施的有效性。评估的结果是（i）减少家庭暴力的频率和/或严重程度，和/或（ii）改善身体、心理和/或社会健康。进行了叙述分析。筛选 4818 篇文章后，确定纳入六项研究。所有纳入的研究均评估了怀孕期间的女性 (n = 894)。五项研究报告了支持性咨询；一项研究实施了一项干预措施，包括对家庭暴力进行常规筛查，并支持对有需要的妇女进行转介。两项研究评估了家庭暴力干预措施的有效性，咨询干预后家庭暴力的发生率在统计上显着下降（包括 488 名妇女）。一项研究（包括 72 名女性）在接受咨询后家庭支持显着增加。 有一些证据表明，生活质量得到改善，安全行为的使用增多，家庭和社会支持得到改善，获得社区资源的机会增多，转诊服务的使用增多，孕产妇抑郁症减少。总体证据的质量为低到中等。筛查、转诊和支持性咨询可能会让生活在中低收入国家、遭受家庭暴力的妇女受益。然而，需要更大规模、高质量的研究来为干预措施的有效性提供进一步的证据。有必要通过评估可能有效的干预措施来提高可用性，以便为中低收入国家孕产妇保健的政策、计划决策和资源分配提供信息。系统审评注册号：PROSPERO CRD42018087713。