By PPH Foundation

Sexual Assault Awareness Month, April

Experiences of sexual violence can have lasting effects on a woman’s health, including during pregnancy and childbirth. While often discussed in terms of physical and psychological trauma, emerging evidence shows that sexual violence can also increase the risk of complications such as postpartum haemorrhage, through pathways that affect both the body and access to care.

Women who have experienced sexual violence are more likely to face unintended pregnancies, delayed antenatal care, and untreated infections, all of which increase vulnerability during childbirth. In addition, trauma, both physical and psychological, can contribute to complications such as prolonged labour, poor uterine contraction, and increased risk of obstetric interventions, factors closely associated with postpartum haemorrhage. The effects of stress and trauma on the body, including hormonal imbalance and heightened inflammatory responses, can further compromise a woman’s ability to recover after delivery.

Recent research continues to highlight these links. A 2023 study in BMC Pregnancy and Childbirth found that women with a history of intimate partner violence had a significantly higher risk of adverse maternal outcomes, including haemorrhage and obstetric complications. Similarly, findings published in The Lancet Global Health, 2022, emphasize that social and structural determinants, including violence against women, play a critical role in maternal morbidity and mortality, often intersecting with direct causes such as postpartum haemorrhage. The World Health Organization also identifies violence against women as a major public health issue that directly and indirectly contributes to poor maternal outcomes.

According to Prof Ann-Beatrice Kihara, a Co-Lead of the End PPH Initiative, “Maternal health cannot be separated from the social realities that women face. When a woman has experienced violence, the impact extends into pregnancy and childbirth, increasing her risk of complications such as postpartum haemorrhage. Addressing these risks requires a system that recognizes and responds to both the clinical and social dimensions of care.”

Addressing this challenge requires a comprehensive and integrated approach. Early identification is critical, with routine screening for gender-based violence recommended as part of antenatal care. Creating safe, confidential spaces where women can disclose experiences of violence allows healthcare providers to offer timely support and appropriate referrals.

Strengthening clinical care is equally important. Women with a history of sexual violence may require closer monitoring during pregnancy and childbirth, including preparedness for complications such as haemorrhage. Ensuring access to skilled birth attendance, emergency obstetric care, and blood services significantly reduces the risk of severe outcomes.

Psychosocial support also plays a vital role. Evidence shows that counselling, trauma-informed care, and community support systems improve both maternal health outcomes and overall wellbeing. Integrating mental health services into maternal care helps address the long-term effects of trauma, reducing stress and improving recovery after childbirth.

Beyond the health system, prevention remains key. Addressing sexual violence through policy, community engagement, and education not only protects women’s rights but also contributes to better health outcomes across the life course.

As the world marks Sexual Assault Awareness Month, the message is clear. Ending preventable maternal deaths requires addressing the full spectrum of risks that women face. By recognizing and responding to the link between sexual violence and postpartum haemorrhage, we take a critical step toward safer, more equitable maternal care.

Sources
World Health Organization. Violence against women prevalence estimates, 2018. Geneva, WHO, 2021.
Devries KM et al. Intimate partner violence during pregnancy and maternal outcomes. BMC Pregnancy and Childbirth. 2023,23:145.
Kassebaum NJ et al. Global causes of maternal death. The Lancet Global Health. 2022,10(9):e1234–e1244.
World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva, WHO, 2020.

Image by freepik</a>