Effects of Intimate Partner Physical Violence on Newborns’ Birth Outcomes Among Jordanian Birthing Women

Abstract

Intimate partner physical violence against women (VAW) during pregnancy is a common experience all over the world. In Jordan, the number is double the reported international average. Data on effect of violence on birth outcomes are important for planning, implementing, and evaluating maternal health programs. The research question was, “Does intimate partner physical VAW during pregnancy increase the risk of negative birth outcomes for newborns among birthing women in Jordan?” Natural experiment design was used for this study. A consecutive sampling technique was used for selecting the victims of physical violence (n = 79) and a simple random sampling for selecting non-victims (n = 79). Intimate partner physical violence was measured by using the Arabic version of World Health Organization’s (WHO) domestic violence questionnaire, which has an accepted interrater validity. Analysis of covariance (ANCOVA) and chi-square were used to detect the differences in birth outcomes between the victims and non-victims of physical violence. The results showed that there is a significant difference in newborn’s birth weight between the victims of violence and non-victims with a small effect size. However, there were no significant differences between the two groups in preterm birth and assisted newborn ventilation. The non-significant effect of violence on the incidence of preterm birth contradicts the published literature. Intimate partner violence (IPV) is rooted in Jordanian culture and widely accepted among married Jordanian women. Midwives, doctors, educators, and policy makers should work together to eradicate violence and detect victims of it, to improve birth outcomes and decrease newborn morbidity and mortality rates.

Keywords

battered women domestic violence domestic violence and cultural contexts perceptions of domestic violence

The United Nations defines violence against women (VAW) as

any act of gender-based violence that results in, or is likely to result in, physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life. (United Nations, 1993)

This definition was adopted by the World Health Organization’s (WHO) fact sheet N°239 (WHO, 2012).

Intimate partner violence (IPV) is a “behavior within an intimate relationship that causes physical, sexual or psychological harm, including acts of physical aggression, sexual coercion, psychological abuse and controlling behaviors” (WHO/London School of Hygiene and Tropical Medicine, 2010).

Intimate partner physical VAW is a major worldwide problem. The WHO reported in its multi-country study on women’s health and domestic VAW that between 13% of the women in Japan (the lowest) and 61% of the women in Provincial Peru (the highest) had suffered physical violence by a male partner. Also, between 6% of the women in Japan and 59% of the women in Ethiopia suffered sexual violence (WHO, 2005). In Jordan, the estimated prevalence of IPV is very high as reported in a large-scale study (n = 517) by Clark, Bloom, Hill, and Silverman (2009). They reported that a large proportion of women in Jordan have experienced IPV at some point during their marriage. The percentages of Jordanian women who experienced at least one form of violence were as follows: control, 97.2%; psychological violence, 73.4%; physical violence, 31.2%; and sexual violence, 18.8% (Clark et al., 2009).

IPV against women during pregnancy is a common experience all over the world and ranged from 2.0% in Australia to 13.5% in Uganda (Devries et al., 2010). In Jordan, the number is double the reported international average, as around 41% of pregnant Bedouin women reported suffering from some form of IPV, with physical violence the most common (34.7%) and sexual violence (15.5%) the least (Okour & Badarneh, 2011). Another Jordanian study found that around 24% of pregnant women reported suffering from spousal violence (the figures for physical, emotional, verbal, and sexual violence were 10.4%, 23.4%, 23.7%, and 5.7%, respectively; Oweis, Gharaibeh, & Alhourani, 2010). Women with lower socioeconomic status (low income and low education), younger, not married, and from minority backgrounds are at higher risk of violence during pregnancy (Bailey, 2010).

Newborn’s birth outcomes such as birth weight, gestational age, Apgar scoring, mortality, and the use of ventilator are excellent indicators for the maternal physical and psychological health during pregnancy. Data on birth outcomes are essential for planning, implementing, and evaluating maternal health programs. Such information also has implications for the clinical practice now and in the future (Wadhera & Millar, 1996). Better understanding of the effect of the IPV on newborn’s birth outcomes could have clinical and public health implications (Nojomi & Akrami, 2006). For example, health care providers would develop clinical plans that recognize the risk and enhance the safety of women and their unborn children based on this understanding (Mezey & Bewley, 1997).

Women during pregnancy have a unique situation. The broader negative health effects of IPV, will threat the health of women as much as their fetuses’ (Nojomi & Akrami, 2006). Intimate partner physical VAW during pregnancy has negative consequences on birth outcomes and lead to higher social and economic costs, which represent a significant public health concern. It is linked to preterm birth and low birth weight (Abdollahi, Abhari, Delavar, & Charati, 2015), which in turn delay the physical, behavioral, and mental development of the child (Bailey, 2010), and has been linked with health and chronic disease risk across the life span (Gamborg et al., 2007; Gavin, Nurius, & Logan-Greene, 2012). Furthermore, it potentially affects life chances, as the lower the birth weight, the greater the risk of mortality (Class, Rickert, Lichtenstein, & D’Onofrio, 2014). Violence during pregnancy is positively correlated with miscarriage, premature rupture of membranes, and stillbirth (Abdollahi et al., 2015; Sarkar, 2008; WHO, 2012).

Data on IPV during pregnancy from the Middle Eastern region are very important at national and international levels. It is needed to reinforce advocacy efforts, help policy makers to understand the problem to design an appropriate interventions in order to help victims (Nojomi & Akrami, 2006).

Problem

Although IPV against women during pregnancy is more common than some health conditions (e.g., prevalence of urinary tract infections [UTI] is 9%, Malkawi, Hiasat, & Shehadeh, 2006; and prevalence of antenatal depression is 19%, Mohammad, Gamble, & Creedy, 2010, among Jordanian women), which are routinely screened during pregnancy in Jordan’s antenatal clinics and increases the likelihood of negative birth outcomes, there is a lack of research on this topic in Jordan. Some Jordanian research has been done to identify the prevalence of the problem and its associated factors, yet no studies have been carried out on the effect of intimate partner physical VAW during pregnancy on newborns’ birth outcomes.

Hypothesis

Hypothesis 1: Newborns of victims of physical violence will have worse birth outcomes than newborns of non-victims of physical violence.

Research Question

Research Question 1: Does intimate partner physical VAW during pregnancy increase the risk of negative birth outcomes for newborns among birthing women in Jordan?

Literature Review

Researchers who carried out previous studies found that physical violence during pregnancy has negative outcomes on the newborns (Bailey, 2010; Madkour, Xie, & Harville, 2013; Meiksin, Meekers, Thompson, Hagopian, & Mercer, 2015; Pavey, Gorman, Kuehn, Stokes, & Hisle-Gorman, 2014; Shah & Shah, 2010). Newborns of victims of violence were more likely to have low birth weight (Bailey, 2010; Meiksin et al., 2015; Pavey et al., 2014; Shah & Shah, 2010), preterm birth (Bailey, 2010; Pavey et al., 2014; Shah & Shah, 2010), respiratory problems, and neonatal hospitalization (Pavey et al., 2014).

Reviewing the literature in the Islamic region indicated three studies, one study in Saudi Arabia and two in Iran. The Saudi researchers found that fetal distress and pre-maturity were more likely to occur among victims (Rachana, Suraiya, Hisham, Abdulaziz, & Hai, 2002). The researchers in Iran found that physical abuse during pregnancy produced infants with lower birth weight (Abadi, Ghazinour, Nygren, Nojomi, & Richter, 2013; Abdollahi et al., 2015).

It is worth noting here that most previous studies used non-equal sample size for comparison, which may affect the homogeneity of variance assumption for parametric statistical tests (Pallant, 2005). For that reason, the researchers in this study decided to use equal sample sizes.

Reviewing the Jordanian literature in regard to violence during pregnancy revealed that there are only two published articles (Okour & Badarneh, 2011; Oweis et al., 2010), and both studies were descriptive, cross-sectional studies, carried out in the north of Jordan and focused on the prevalence of different types of violence against pregnant women. Oweis et al.’s (2010) study used 316 suitable pregnant women, while Okour and Badarneh’s (2011) study used a survey with 303 pregnant women. The two studies found that physical violence was higher than the reported international figures in developed countries, which was 10.4% for Oweis et al. and 34.7% for Okour and Badarneh. No studies were located in Jordan examining the effect of physical violence on birth outcomes or comparing the newborn’s birth outcomes between the pregnant victims of physical violence and non-victims. Therefore, the primary purpose of this study was to compare newborn’s birth outcomes between victims of physical violence and non-victims among newborns to Jordanian birthing women.

Method

Design

Natural experiment design was used for this study. This non-experimental design was used because the independent variable is ethically not manipulative. To enhance internal validity of this design, we compared victims of physical violence with non-victims.

Birthing women were screened by using the Arabic version of the WHO’s (2005) domestic violence questionnaire for their experience of intimate partner physical violence during their current pregnancy. Newborns of victims of physical violence were compared with non-victims’ newborns. Newborn’s birth outcomes were measured for both groups and compared.

Setting

A Jordanian governmental hospital was selected randomly from a list of the hospitals with the highest birth rates (more than 6,000 births annually) based on the Ministry of Health (MOH) statistics (MOH, 2011). Permission to access women was obtained from the Jordanian MOH. In Jordan, the MOH is accountable for all health dealings according to Health Law No. 47 for 2008. It is responsible for the provision of all levels of care (primary to tertiary) that are provided by the public and the private sectors and provides health insurance for all pregnant Jordanian women (Department of Statistics [Jordan] & ICF Macro, 2010).

Sample

For nursing studies, utilizing a minimum power of 0.80 enables the study to detect differences or relationships that exist in the population (Polit & Beck, 2011). For the current study, the birth weight was considered the major outcome, and power analysis was performed based on it. And it has been estimated that the proportion of low birth weight newborns will be 33% for the victims of intimate partner physical violence during pregnancy and 8% for the group of non-victims of intimate partner physical violence, and this considered a large effect (Polit & Beck, 2011; this estimation was based on the findings of Rachana et al.’s, 2002, study). Based on power analysis, the sample size needed to keep the risk of type II error down to 20% was more than 75 participants per group. Table of estimated population difference between two proportions (Polit & Beck, 2011), assuming an α of .05 and a power of .80, was used to calculate the sample size. We estimated the proportions for both groups from the above-mentioned study. Then, we find the proportion for one group in the first column and the proportion for the second group in the top row. The approximate sample size requirement for each group was found at the intersection. For this study, the researchers used a cluster randomized sample technique to select major hospitals in Jordan. Then, the researchers used a consecutive sampling technique for selecting the victims of physical violence and simple random sampling for selecting non-victims to enhance representativeness of the sample for the target population. Consecutive sampling that was used to select the victim’s group enhanced the representativeness of the sample for the total population, while simple random sampling of the non-victims improved the achievement of an equal comparable group. Demographic differences between victims and non-victims were controlled by statistics (by using ANCOVA).

Participant Recruitment

The target population for this study was newborns of women who gave birth within the previous 24 hr in any of the Jordanian hospitals, aged 17 to 45 years old and living with their husbands during their pregnancy. Women with any mental problem were excluded from the study. These criteria were selected to decrease the effect of extraneous variables on the findings (Fahmy & Abd El-Rahman, 2008).

Instruments

The study’s questionnaire included three parts:

1. Women’s information questionnaire. In the current study women’s demographics, health information, family support, obstetric history, and family planning use were measured by a validated Arabic version questionnaire, which was used by Clark et al. (2009) in their study “prevalence estimate of intimate partner violence in Jordan,” which was based on the results of focus group discussions conducted in Amman. This part includes four sub-parts. The questionnaire contains 44 items (age, education, information about marital status, residence, information about the husband, work status, household income, height, weight, health status, previous pregnancies, problems during the current pregnancy, pregnancy plans, breast feeding plans, social support, antenatal care visits, newborn sex, family planning).

2. Domestic Violence Questionnaire screening tool. This part includes nine sub-parts (intimate partner’s violence part, relatives’ violence part, childhood violence part, seeking help part, conclusion part). All these parts were validated in Clark et al.’s (2009) study based on their focus group. Intimate partner physical violence was measured by using the Arabic version of WHO’s (2005) domestic violence questionnaire, which was modified by Clark et al. (2009) based on the results of focus group discussions conducted in Amman. This tool was originally developed by WHO (WHO, 2005) and is known as an accredited tool for identifying IPV in different cultures. It originally contains three different violence types: control and humiliation (10 items), psychological violence (8 items), and physical and sexual violence (8 items). For the purpose of this study, only data on physical violence were used. According to Clark et al.’s work, the questionnaire items were considered to be valid representations of women’s experiences if they captured the events that the participants described within each of these categories. This tool has an accepted interrater validity through being reviewed by some Jordanian physicians.

For the purpose of the study, the WHO operational definition (Garcia-Moreno, Jansen, Ellsberg, Heise, & Watts, 2006) of current prevalence of IPV was adopted, which is “the proportion of ever-partnered women reporting at least one act of physical or sexual violence during the 12 months before the interview” (p. 1262).

3. Newborn’s birth outcomes questionnaire. Newborn’s birth outcomes were measured by outcomes questionnaire. The questionnaire includes five items about the newborn’s health, which includes birth weight, gestational age, use of electrical fetal monitoring, Apgar scoring, mortality, and the use of ventilator. This comprehensive questionnaire was developed by the researchers based on a thorough literature review (Abu-Saad & Fraser, 2010; Arcos, Uarac, Molina, Repossi, & Ulloa, 2001; Okenwa, Lawoko, & Jansson, 2010; Sarkar, 2008; Wax et al., 2010; WHO, 2012), and it is believed that to cover most reported birth outcomes in the literature. The questionnaire was validated by three academic members who confirmed its validity in measuring newborn’s birth outcomes. Furthermore, the reviewers suggested practical and context-sensitive changes which were very helpful in maximizing the potential content validity of the questionnaire.

Data Collection Procedure

The data were collected by four research assistants, who were well-trained by the primary investigator on how to recruit and collect data from participants. The research assistants visited the MOH’s hospitals, identified and invited participants in the postnatal department who matched the inclusion criteria and were willing to participate in our study. Following this, the consent form was signed by each participant after being given adequate time to decide. To ensure confidentiality, each client was asked not to write her name on the form, and to seal the completed questionnaire in an envelope. After that, the research assistants ensured that the questionnaires were completed by the participants within a time limit of half an hour. Furthermore, the data collectors extracted information about the birth and newborn from the records. The data were collected between January 2014 and December 2014.

Data Analysis

Data were analyzed by using SPSS (Version 17) for obtaining descriptive and inferential statistics. Descriptive statistics were used to identify the characteristics of the sample. Analysis of covariance (ANCOVA) and chi-square were used to detect the differences in birth outcomes between the newborns of victims of partner violence and those of non-victims. Significance level was set to be p < .05. Assumptions of statistical tests were evaluated for the current study data, and the results showed that the data were appropriate for statistical analysis (Pallant, 2005). The cases that had missing data were deleted pairwise without any biases, n = 158, p value was set to be .05.

Ethical Considerations

This study is intended to fully protect human rights, and details of it are comprehensively disclosed in the attached consent form. The researchers’ assistant was available at the time of the consent and throughout the study to answer women’s questions. At any time during the study, women were free to withdraw without affecting their care. The research protocols were approved by the Hashemite University’s and the Ministry of Health’s Institutional Review Boards. All the information collected during the study was strictly confidential.

The researchers assured that there were no physical, psychological, economical, or social risks for the participants if they agreed to participate. Furthermore, the researcher’s assistant assured the participants that if they suffered from any problem as a result of their participation, they would be referred to the appropriate care. By participating in this study, the participants were comfortable in being able to discuss their situation or problem with a friendly, objective person. Furthermore, the researchers of this study assured the respect for all religions, cultures, norms, and values, and there was no discrimination among participants if they belonged to other religions, cultures, norms, and values.

The primary investigator of this study has a responsibility to maintain confidentiality and anonymity and this responsibility was observed at all times during this research. To ensure anonymity, no private data that could identify participants were used in the study report or in further publications, and each questionnaire was assigned a number for data processing. All information was processed on a personal computer protected by a personal password. All the data were deleted at the end of the study.

Results

The total sample was 158 women, and the mean age was 28 years (SD = 6.1). The majority of the participants (n = 93, 58.9%) were living within a nuclear family, while 21.7% (n = 34) were within a compound family (same house), 19% (n = 30) in the same building with their parents in law, and 1% (0.6) other. Their educational level ranged from illiterate (n = 12, 7.6%) to higher education (n = 34, 21.5%). Around 67% of them were educated to elementary and secondary school level (n = 53, 33.5%, n = 52, 32.9%, respectively), while only 7 (4.4%) to primary school. More than half of their husbands were educated to secondary or higher education (n = 85, 53.8%). Almost all the participants were living in urban areas (n = 156, 98.7%), while two (1.3%) were living in the rural area. Ninety-three percent (n = 147) of the respondents were house wives, and 10.8% (n = 17) of their husbands were out of work. Their family income ranged between 0 and 1,000 JD (US$1,400; M = 318.5, SD = 165.7). The majority of the respondents were married to non-relatives (n = 99, 62.7%), while 21.5% (n = 34%) were married to first-degree relatives, 7.6% (n = 12) were married to second-degree relatives, and 8.2% (n = 13) were married to third-degree relatives. Most of the women (n = 147, 93%) had a monogamous husband. All the women had at least one child (M = 2.9, SD = 1.8), with the range between one and nine children.

All the women had given birth within the previous 24 hr with a mean gestational age of 38.3 gestational weeks (SD = 2.7). More than half of the babies were males (n = 85, 53.8%), while 46.2% (n = 73) were females. The mean birth weight of the 158 babies was 2,997 g (SD = 662.7 g). APGAR scores at the 1st, 5th, and 10th min ranged between 0 and 10 with means of 8.9 (SD = 2), 9 (SD = 2), and 9.2 (SD = 1.9), respectively. Four of the babies (2.5%) were dead at birth, two (1.3%) were suffering from cephalhematoma, and five (3.2%) had body bruising.

Effect of Violence on Newborn’s Birth Outcomes

For the purpose of the study and based on the WHO definition of IPV (Garcia-Moreno et al., 2006), the respondents were divided into two groups: women who had experienced physical violence and women who did not experience physical violence. Demographic variables (mother’s age, gestational age, educational level, income, number of children, and employment of the mother and her husband) were compared between the two groups (victims of physical violence and non-victims of physical violence) using two-tailed independent-samples t tests for continuous variables and chi-square statistics tests for categorical variables to ensure the equality of the two groups in their demographical variables. There were significant differences in mother’s age for the victims of physical violence (M = 29.1, SD = 5.8) and the non-victims of physical violence (M = 26.9, SD = 6.2), t(158) = −2.3, p = .02*). There were no significant differences in gestational age, educational level, income, number of children, and employment of the mother and her husband variables between the victims and the non-victims (ps were between 0.4 and 1). Researchers of previous studies have reported a negative relationship between advanced maternal age and birth weight (Reichman & Pagnini, 1997; Weng, Yang, & Chiu, 2014). Therefore, the mother’s age was included as a covariate in the analysis (ANCOVA) to exclude its effect from the effect of physical violence on birth weight.

A one-way between-groups ANCOVA was conducted to compare weight of the babies for victims of physical violence (M = 2,900 g, SD = 699 g, n = 79) with weight of the babies for non-victims’ (M = 3,091 g, SD = 613 g, n = 79). Participants’ ages in years was used as the covariate in this analysis. There was a significant difference between the two groups in babies’ weight, F(1,155) = 4.6, p = .03*, partial η² = 0.03.

A chi-square test was conducted to compare the incidence of preterm birth for victims of physical violence with the incidence of preterm birth for non-victims. The findings showed that the proportion of preterm birth among victims (12.7%, n = 10) is not significantly different (p = .8) from the proportion among non-victims (13.9%, n = 11).

A chi-square test was conducted to compare assisted newborn ventilation for victims of physical violence with assisted newborn ventilation for non-victims. The findings showed that the proportion of newborns of victims who needed assisted ventilation (10.1%, n = 8) is not significantly different (p = .2) from the proportion of newborns who needed assisted ventilation among non-victims (3.8%, n = 3).

Discussion

The results of the current study showed that there is a significant difference in newborn’s birth weight between the victims of violence and non-victims with a small effect size (Cohen, 1988) after controlling the effect of maternal age. Newborns of non-victims were significantly heavier than newborns of victims. This result is congruent with the WHO (2012) report, Bailey (2010), Sarkar (2008), and Arcos et al.’s (2001) studies, which reported a significant effect of violence during pregnancy on lowering birth weight.

However, there were no significant differences between the two groups in preterm birth and assisted newborn ventilation. The non-significant effect of violence on the incidence of preterm birth contradicts the published literature, which revealed a significantly higher preterm incidence among the victim group (Bailey, 2010; Rachana et al., 2002; Sarkar, 2008; WHO, 2012).

These results could be explained within the context of Jordanian culture and the wide acceptance of physical violence among Jordanian women, as reported in 2002, 2007, and 2012 Jordan Population and Family Health Survey (JPFHS). The vast majority of Jordanian women accept at least one reason as a justification for wife beating (87% in 2002 JPFHS, 90% in 2007 JPFHS, and 70% in 2012 JPFHS; Department of Statistics [Jordan] & ICF Macro, 2010; Department of Statistics [Jordan] and Macro International, 2008; Department of Statistics [Jordan] and ORC Macro, 2003), while the 2009 JPFHS did not include data on domestic violence (Department of Statistics [Jordan] & ICF Macro, 2010).

These results could be influenced by the type of sampling plan (i.e., no random assignment), having produced a non-equal group for comparison, which would necessitate caution when explaining the findings. However, the use of ANCOVA in analyzing the data might help decrease the effect of the sampling plan by controlling the effect of the age difference.

In this study, we found that older women were more likely to suffer from violence than younger women, and this might not be true. As a subsequent analysis of the data showed that older women were more likely to be employed and educated, which means that they are more likely to be empowered to report IPV than the younger women, and this was reflected in the findings as older women are more vulnerable for violence.

Limitations

Our study has some limitations. First, there is potential for mis-classification of the women into the groups, as women in Jordan tend to avoid disclosure of their private lives to avoid negative consequences and social stigma (Al-Badayneh, 2012). This may have contaminated the non-victim sample, which may in fact include victims who did not report violence they had suffered. Second, recall bias is a concern in our study of the effect of violence on adverse newborn outcomes. Some women may have experienced violent behavior from her husband during pregnancy, but could not remember it. Third, the selection of participants was not randomized, which may result in a biased sample and findings from which it is difficult to generalize. However, listing of victims was not practical in our study and the sampling used (consecutive sampling) in this study might help in reducing this bias. Last, data collected in our study were of a self-report nature, which may have some inaccuracy as a result of inaccurate comprehension, or discomfort with self-disclosure. However, researcher’s assistants were presented during the questionnaire completion and answered all queries of the participants.

Recommendations

Based on our study findings, we suggest the following recommendations. For education, midwifery educators should focus more on enhancing communication skills of their students to help the victims disclose their experiences of violence with a trusted person. Furthermore, educators should focus more on training their students about how to use the screening tools of violence correctly. For policy makers, the Ministry of Health should implement a policy to use the WHO’s Domestic Violence Questionnaire screening tool as a part of antenatal care at Maternal Child Health Care centers. Furthermore, Arabic material for IPV training of health care professionals has already been developed, evaluated, and available in the private sector for some years, and seemed to be effective in identifying women who are subjected to violence (Institute for Family Health, 2008). These programs if adopted in the public sector could improve the daily practice in identifying the victims of violence by improving the midwives’ competence in how to manage the problem, particularly improving their ability to discuss the subject with victims in a sensitive manner. Furthermore, it is recommended to have a well-organized strategic plan, including all health care levels from primary care to tertiary one, to eliminate violence in the Jordanian culture. Moreover, private and public sectors need to work together to avoid repetition of the service and improve the quality of the care for victims (Al-Badayneh, 2012). For practice, midwives should screen all pregnant women if they have experienced violence in their relationship and refer them to social help whenever necessary. Moreover, training programs for health care professionals about criminal laws in relation to violence is recommended. This will improve identifying and reporting skills of violence and punishment for the perpetrators, which in turn will help in limiting the phenomena. For research, further research is needed to identify some effective interventions to decrease violence and intervene during pregnancy. Following up a cohort group of physical violence’s victims and comparing them with non-victims is also recommended.

Conclusion

IPV is rooted in Jordanian culture and widely accepted among married Jordanian women. It was found that violence during pregnancy has some effect on newborn’s birth weight and not on gestational age. Midwives, doctors, educators, and policy makers should work together to eradicate violence and detect victims of it, to improve birth outcomes and decrease newborn morbidity and mortality rates.

Footnotes

Acknowledgements

Many thanks to the women who willingly gave their time to participate in this study.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by the Hashemite University’s Scientific Research Support Fund.

Author Biographies

Sanaa Abujilban is an assistant professor, working at Hashemite University in Jordan, with interest in physical violence against pregnant women. She holds a BSc in nursing, MSc in nursing education, higher diploma in midwifery, and a PhD in midwifery from University of Ulster. Previously, she worked as a staff nurse in pediatric floor for 5 years. She is married with three children, and lives in Zarqa, Jordan.

Lina Mrayan is an assistant professor, working at Hashemite University in Jordan, with interest in the transition to parenthood and women health issues. She Holds BSc in nursing, MSc in nursing education and a PhD in Nursing Science from Glasgow Caledonian University.

Hanan Al-Modallal received her PhD from the University of Kentucky, USA. Dr. Al-Modallal is an Associate Professor working at the Hashemite University, Jordan. She has continued her research with women who have experienced intimate partner violence with a focus on refugee populations, college women, mental health problems and workplace violence.

Esra’a Isaa is a clinical instructor working at the Hashemite University in Jordan, with interest in psychology of women. Holds BSc in nursing, and is a candidate of master degree in psychiatric, mental health nursing program.

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