Physical domestic violence among pregnant women is a serious social problem and a perinatal health issue. This study aims to determine some characteristics of physical conjugal violence among pregnant women in our context of practice. It is a retrospective study in the Dakar region at the “Maison de la Femme” or “Boutique de Droit” located in the Medina and Pikine neighborhoods over a period of six years. Pregnant women accounted for 22.7 percent of all women victims of domestic violence. The epidemiological profile of the different types of violence revealed a 98% rate of psychological violence associated with physical violence, which represents 15%, or with verbal and economic violence, which corresponds to an identical rate of 34%, negligence 9%, and sexual violence 8%. The age ranges most affected by domestic violence are those between 25-34 years of age, with 60% of victims. The socio-professional categories most affected are those constituted by the elementary profession of service sales with 56% of victims, the unemployed 25% of victims; then middle management and office workers with 14% of victims. In our series 65% of the victims had a gestational age between 01- 14 SA and 30% had a pregnancy age between 15 - 28 SA. The main violent persons are husbands with 98%. We found that 60% of the victims had localized injuries, 43% of which were head injuries, 43% were limb injuries and 14% were in other areas of the body. 95% of the victims had a simple contusion injury. Only 75% of the victims had a medical certificate and 93% of the victims had a T.T.I. less than or equal to 20 days. Medical certificates were legible for 75%, and 80% of victims received treatment. Early detection of physical violence by various health professionals is imperative to minimize the impact of violence on pregnant women. Adequate care for victims and punishment of perpetrators must be the concern of our leaders.
Keywords: Physical domestic violence; Pregnant women; Forensic medicine
The WHO study on women’s health and domestic violence shows that in several countries the prevalence of physical violence committed by an intimate partner during a woman’s lifetime ranges from 13% to 61% . Nevertheless, physical abuse of pregnant women is still perceived primarily as a criminal or human rights issue. However, it is a serious societal and perinatal health issue . Violence is known to have serious repercussions on pregnancy, including increased risk of miscarriage, premature delivery, fetal suffering, low birth weight and even fetal death . The complications of domestic violence on physical and psychological health are often neglected in the health circuit in our practice context. However, they require special attention and consideration of the reality of their impact, because the imperceptibility of these complications is a major obstacle to the protection of women. Domestic violence is considered a public health problem today, so physicians must be sentinels for the early detection and management of abused women and their children.
This study aims to determine some characteristics of physical conjugal violence among pregnant women in our practice context.
Our study took place in the Dakar region at the “Maison de la Femme ou Boutique de Droit” located in the Medina and Pikine neighborhoods. It is an institution that is set up by the Association of Senegalese Jurists. It is a center for listening, counseling, and community legal assistance. Any person in need of legal aid can benefit from their services free of charge without the obligation to provide identity papers. This is a retrospective study based on client files collected from January 2009 to December 2015. We consulted 143 files of victims of domestic violence including 103 women and 10 men at the Medina house: 29 women and 01 man in Pikine. Excluded from this study were the files of male victims of domestic violence. A total of 132 cases were retained. Elements were collected for each victim, on the basis of a file containing the significant facts of women victims of physical violence in
the file, including pregnant abused women (slaps, attempts
at strangulation, punches, kicks, etc.), use of a knife, notion of
strangulation, pinching, projection of objects, projection of the
person on the wall or on the floor, bites, twisted arms, belt, electric
extension cord, blows from a stick or broomstick etc.) We used the
SPSS software for the analysis of the data.
The epidemiological profile of the different types of violence
revealed a 98% rate of psychological violence associated with
physical violence, which represents 15%, or with verbal and
economic violence, which corresponds to an identical rate of 34%,
negligence 9%, and sexual violence 8%.
The age ranges most affected by domestic violence (physical,
verbal, economic, sexual and especially psychological and moral)
are those between 25-34 years old with 60% of victims. The most
affected socio-professional categories are those constituted by the
elementary profession of service sales with 56% of victims, the
unemployed 25% of victims; then middle management and office
workers with 14% of victims.
In our series 65% of the women had a gestational age between
01- 14SA and 30% had a gestational age between 15-28SA.
The main violent people are husbands with 98%.
Physical violence and injuries
Among women victims of physical violence, 96% reported
having at least one injury and specified the location of their injury.
Location of injury to head, body, limb
In our study, of the 37.1% of victims who reported injuries,
95.2% were able to locate their injuries. We found that 60% of
the victims had localized injuries, 43% of which were in the head,
43% in the limbs and 14% in other areas of the body. 95% of the
victims had a single contusion injury.
The medical certificate
Only 75% of the victims had a medical certificate and 93%
of the victims had an IT. T less than or equal to 20 days. Medical
certificates were legible for 75%, and 80% of victims received
It should be noted that it is the woman’s version that is
considered in the records. This explains the lack of information
on some files that only take into account one version, that of
the woman who provides information on the husband. It is true
that women are for the most part the victims, but they are not
the only actors; men are also concerned. Indeed, the centers are
dedicated to women as their name indicates: Women’s Justice
House. Our study focuses on physical violence because it is the
most perceptible and can be documented with evidence. However,
some forms of violence leave few traces, or leave traces that
should be thought to be looked for.
During our study, we found a 15% rate of physical domestic
violence among pregnant women. This result was close to that of
Boufettal H et al.  reported a 12.3% incidence of physical abuse
during pregnancy in Morocco. The same finding was made in a
multi-country study conducted by WHO , where the proportion
of women who had been physically abused during at least one
pregnancy exceeded 5% in 11 of the 15 countries studied. The
lowest figure was 1% in Japan and the highest was 28% in Peru. In
France, a national survey showed that 3-8% of pregnant women
were victims of domestic violence . The frequency obtained in
our series is close to these results. Physical conjugal violence is not
isolated. Indeed, in our context psychological or emotional violence
precedes physical violence and is characterized by intimidation
through polygamy, denigration, pressure, silence imposed by
the cultural context of our society. They can also be explained
by the authority of men over women and the religious context.
Elsewhere, they are preceded by verbal violence most of the time
and/or followed by other types of violence [7,8]. Nevertheless, the
frequency found would likely be underestimated because women
in general are reluctant to disclose violence against them due to
social stigma and fear of adverse consequences on their marriages
or social ties in families. Arulogun OS et al.  found a much higher
incidence in the Abuja region of Nigeria with 36.4% of cases. In
2011 in Nigeria, a study of pregnancy trauma at the Ebonyi State
University Hospital revealed that physical aggression was the
predominant causal factor and accounted for 46% of injuries .
Nevertheless, the 25-34 age group predominates, with 60% of
victims. The predominance of the age groups found in our series
could be explained by the fact that women of childbearing age
are more numerous. Boufettal H et al.  in Morocco reported
in their series a predominance of the 20-24-year age group with
an average age of 22.3 years and Arulogun OS et al.  found a
predominance of the 25-29 age group with a frequency of 40.7%
in the Abuja region of Nigeria.
It should be noted that educational level plays a role in
violence against women. The socio-professional categories most
affected in our study are those constituted by the elementary
profession sales of service with 56% of victims, the unemployed
25% of victims. Ann BL et al. found that the low level of women’s
education (primary school) is a factor in the risk of spousal
The high rate of pregnancy in the first trimester of pregnancy
could be explained by the increased physiological changes in the
first weeks of pregnancy due to hormones causing irritability
and susceptibility in pregnant women. In contrast, Nannini
A et al.  in Massachusetts found a rate of 16.0% in the first
trimester. Pregnant women are particularly exposed to genderbased
violence. Pregnancy is a factor that triggers or aggravates
pre-existing violence, through the physical and moral fragility
of the woman it induces . Violence during pregnancy has
consequences for both mothers and babies. In 2006, Silverman
et al.  estimated that women who have experienced violence
before and or during pregnancy are at significantly higher risk
for a large number of obstetric pathologies. They found increased
risks of up to 90% for metrorrhagia, 60% for premature rupture of
membranes, incoercible vomiting. The newborns of these women
have a significantly increased risk of prematurity up to 37% and
hypotrophy up to 21% . Similarly, MMM Leye  notes that
psychological violence in pregnant women has a negative impact
on the health of the mother and the newborn.
In most cases, the perpetrator of the violence is a man. Our
work shows that the main violent persons are the husbands with
98%. The ENVEFF 2000 survey shows that many aggressors are
men (over 80%) . The man, through some of his behavior,
seeks to exert pressure or domination over his spouse. This
violence, initially psychological, can lead to physical violence in
a second phase. It is important to know that this violence is not
a disease but an often-acquired behavior that can be changed.
It is important to analyze the causes and mechanisms of violent
men. This situation can be explained by several phenomena in our
context: religious (the possibility of being polygamous), cultural
(the man as the head of the family, the woman must be patient
and endure everything in her household to guarantee the future
of her children, a submissive and obedient woman), social (the
only financial resource for the household, the immaturity of the
man, impulsiveness), a phallocratic society (the idea that the
man is superior to the woman, a society in which power is only
exercised by men) etc. We note that the violent man wants his
wife to associate and confine herself to her desires, not taking into
account her state of pregnancy.
The victims had localized injuries 43% in the head, 43% in
the limbs and 14% in other areas of the body. Simple bruising
accounted for 95% of the types of injuries our victims suffered.
The predominance of these types of injuries confirms the variety
of vulnerate agents, as well as the variable nature of the violence
with which these instruments were used, with the victim most
often using her upper limbs for protection or defense. Also, the
easy access of the cephalic segment during fights and, moreover,
the aggressor believing that the damage to the victim’s head
and neck will not have a direct effect on the mother’s product of
conception, makes the cephalic segment the most affected place
after the upper limbs. This is consistent with the findings of
Soumah MM et al. & Benyaich et al. [15,16]. Domestic violence is at
the origin of sequelae such as intense fatigue, muscle pain limiting
activity, leading to a more or less important functional impotence
that the physician will have to assess in order to determine the
total work incapacity (TWI).
In the vast majority of cases the total work incapacity set for
the victims was less than 20 days, i.e., 93%. Soumah et al. 
reported in their study that more than half of the certificates
issued indicated a total work disability of less than 21 days, i.e.,
53.73%. Thus, Senegalese legislation provides for a fine and
prosecution in the police court for total work incapacity of less
than 21 days. However, a total work incapacity of more than 21
days is the responsibility of the court of first instance. The initial
medical certificate is of paramount importance in determining
jurisdiction with the determination of total incapacity to work.
The doctor who issues it plays an essential role in the detection
of such violence, starting with the description of the injuries, to
the drafting of the medical certificate of injury findings, which
constitutes an essential element in the prosecution of the case.
Indeed, in an Italian study of 668 doctors, 57% considered
physical signs as the main reason for suspicion of abuse and
33% considered psychological and emotional problems . The
physician must be the instigator of the sensitization of women
victims of violence to their fundamental rights and freedoms.
Physicians have not received any specific training on this issue.
It is urgent for our societies to train doctors, to create medicojudicial
units, a circuit well known to victims of domestic violence
Physical domestic violence in pregnant women must be at the
forefront of our concerns. It is a complex problem, the influx and
repercussions of which can be harmful to the woman and her fetus.
It requires a more precise evaluation to determine its extent and
its dramatic complications for the victims. The lack of adequate
training of health personnel in the care of victims of domestic
violence and the lack of dedicated structures are blocking factors
in our developing countries. Early detection of domestic violence
in pregnant women and medical personnel with forensic medical
knowledge can improve the health of the mother and her baby.