Surviving domestic violence during pregnancy

Pregnancy can cause stress in any relationship, and it's a common trigger of domestic violence. Domestic violence is a pattern of assault and coercive behavior, including physical, sexual and psychological attacks, as well as economic coercion that adults use against their partners.

Several factors suggest that risk for violence may be even higher for pregnant women with HIV infection.Women with HIV are at increased risk for violence relative to the general population, perhaps because demographic and behavioral factors associated with HIV (e.g., poverty, drug use, bartering sex) also increase a woman's exposure to violence.

In addition, some HIV-infected women may be at risk for violence when their positive sero-status is disclosed. Because a large proportion of HIV infections in women are diagnosed through routine prenatal screening, many disclosures may occur during pregnancy. Moreover, modifications of childbirth and post-delivery care to prevent perinatal transmission (e.g., additional medications, formula feeding) may make it more difficult for women who are pregnant or have recently given birth to keep their serostatus private.

The prenatal care setting, with its multiple scheduled provider contacts, presents an important opportunity for identifying and referring women at risk of domestic violence.

Violence during pregnancy is associated with an increased risk of miscarriage, low birth weight babies, and fetal injury or even death.

The story of Rose Anyango's stabbing by her husband is not heartwarming or uplifting. But the best stories often aren't. And at least Anyango has a story to tell and is willing to tell it.Because of a happy ending.

"I was lying there helpless and hopeless on the side of the street," says the Kibera fishseller, who was attacked with a kitchen knife one month before her due date.

"I was thinking about my kids, my family, looking at the blood pouring out of my abdomen. Finally I thought: 'I'm dying - this is actually the end'."

She's a very good friend but also a client, so from a selfish point of view I was thinking: 'We've got ourselves a hardworking woman who is likely to lose her life and that of her unborn baby. Her abdomen was all bloodied with bowels hanging out. Following six hours of emergency surgery, a combined team of obstetricians and Surgeons managed to save Anyango and her baby who had also been injured on the forehead from the penetrating injury. Amazingly six months later Anyango is back at her fish stall and her baby boy Prince is HIV negative and healthy.

Anyango had been violently attacked by her husband of 15 years after she disclosed to him her HIV status and asked him to accompany her to the clinic for testing.

Anyango's predicament is a stark reminder that, intimate partner violence is real, it can happen so spectacularly as to leave you gasping.