Exposure to trauma in pregnant women and its association with previous perinatal complications, IPV and antenatal service satisfaction in rural Ethiopia: a cross-sectional facility-based study

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BACKGROUND: We aimed to describe the prevalence of exposure to traumatic events and post-traumatic stress disorder (PTSD) in pregnant women attending antenatal care (ANC) in rural Ethiopia. We hypothesised that antenatal PTSD symptoms would be associated with previous obstetric complications and intimate partner violence (IPV) and impact negatively on women´s satisfaction with ANC. METHODS: The design was a facility-based cross-sectional study in primary health centres providing ANC in southern Ethiopia. Trauma events were assessed using the Life Events Checklist (LEC) and PTSD checklist for DSM-5 (PCL-5). Previous obstetric complications were extracted from clinical records. IPV was measured using the 'Non-Graphic Language' screening test and ANC satisfaction was measured using a locally validated adapted version of the Mental Health Service Satisfaction Scale. Generalized linear mixed-effects regression models were used to calculate prevalence ratios between PTSD, IPV and ANC satisfaction. RESULTS: Out of 2079 interviewed women, 52.3% (n = 1,087) reported one or more traumatic life events on the LEC. Physical assault was the most common traumatic event experienced (n = 485; 23.3%) and witnessed (n = 1,176; 56.6%) but only 289 (13.9%) screened positive for IPV. One hundred and six women (5.1%) met DSM-5 criteria for PTSD. Women meeting diagnostic criteria for PTSD had five times increased prevalence of IPV in their current pregnancy [prevalence ratio (PR) 4.34, 95%CI 3.01-6.30; p < 0.001]. Only twenty-six women had a record of previous obstetric complications (0.01%). Overall, women with PTSD reported less satisfaction with antenatal care. CONCLUSIONS: Despite high exposure to traumatic life events, particularly physical violence, among pregnant women attending ANC in Southern Ethiopia, the prevalence of PTSD is relatively low. Previous obstetric complications and IPV were under-reported, relative to known prevalence estimates. Our study highlights the challenges of detection of psychosocial needs in the ANC setting and the need for targeted interventions to support women's disclosure of difficulties in maternity care settings.

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