Associations between exposure to intimate partner violence (IPV) and infant developmental delay: moderating role of women’s empowerment at six weeks postpartum

Abstract Background Intimate Partner Violence (IPV) is a significant threat to women’s wellbeing and child development, particularly in lower- and middle-income countries (LMICs). Despite its prevalence, research in LMICs on the effects of IPV on child development remains limited. This study investigates the association between IPV and different domains of child development as well as the moderating role of women’s empowerment. Methods Participants included 397 women with at least mild anxiety from a randomised trial of a perinatal anxiety intervention at Holy Family Hospital in Rawalpindi, Pakistan. Child development was assessed at six weeks postpartum using the Ages and Stages Questionnaires (ASQ-3), including communication, gross and fine motor skills, problem-solving, and personal-social domains. At six weeks postpartum, women reported on IPV experiences occurring from the beginning of pregnancy to six weeks postpartum, using items from the Pakistan Demographic and Health Survey, assessing physical (7 items) and emotional (3 items) violence from the beginning of pregnancy to six weeks postpartum. Women’s empowerment was measured using a culturally adapted four-item subscale assessing “freedom from family domination,” which reflects women’s control over household influences and decision-making. Data were analysed using multivariable linear regression. Interaction terms were used to examine whether empowerment at six weeks postpartum moderated the association between IPV and child developmental delay at six weeks postpartum. Results Our findings show significant, negative associations between IPV scores and all child development scores (adjusted Bs=-0.64 to -1.00, all p-values < 0.05), suggesting poor development. Significant interactions were observed for communication, gross motor, and problem-solving domains (all p-values < 0.05), with marginal significance for the personal-social domain (p = 0.05). Among empowered women, the associations were not significant, while non-empowered women showed stronger negative impacts (adjusting Bs=-1.31 — -2.13, all p-values < 0.05). Conclusion Women’s empowerment may mitigate the adverse effects of IPV on child developmental delay. Empowerment initiatives could improve outcomes for children of mothers experiencing IPV.