Perinatal mental health impacts of intimate partner violence in the African region: a systematic review and qualitative meta-synthesis.

INTRODUCTION: A range of quantitative studies has identified intimate partner violence (IPV) as a risk factor for perinatal mental health conditions, and adverse obstetric and child outcomes. Rich qualitative literature has explored women’s experiences of both perinatal mental health and IPV in the African region, in isolation. However, qualitative findings about relationships between the two are less widely reported. METHODS: We searched systematically for qualitative studies exploring women’s experiences of IPV and perinatal mental health conditions in the African region up to 16/09/2024. We searched PubMed, Embase, PsycINFO, Web of Science, Scopus, LILACS, ScieELO, Wiley online library, Cochrane, 3ie, Google Scholar, and included studies’ reference lists. We used a piloted form to extract qualitative data before qualitatively analysing the findings using reflexive thematic analysis. We assessed included studies’ risk of bias using the Critical Appraisal Skills Program qualitative reviews checklist and registered the protocol prospectively on the PROSPERO database (CRD42022278592). RESULTS: Of 4105 identified studies, 22 met inclusion criteria. The over-arching theme was cycles of suffering. Four intersecting sub-themes were socio-cultural norms, perinatal abuse, dependence and vulnerability, and foci of distress. Different forms of interpersonal violence perpetrated by partners and family members interacted with the range of women’s experiences of structural violence. Economic dependence on partners heightened perinatal vulnerability and distress, especially in women with additional vulnerabilities. Socio-cultural norms regarding gender inequity contributed to normalisation of violence and women’s sense of entrapment. A range of perinatal psychological and somatic symptoms was linked to IPV; spirituality was a key coping strategy. Where service provider perspectives were reported, lack of relevant training and resources were barriers to identification of and response to the mental health impacts of perinatal IPV. CONCLUSIONS: Relationships between perinatal mental health and IPV in the African region are complex. Interpersonal and structural factors reinforce harmful gender norms and normalise IPV, increasing women’s distress and risk of perinatal mental health conditions. While antenatal care represents an opportunity for identification and response, disrupting cycles of suffering to improve women’s mental health requires broader, culturally sensitive, multisectoral programmes addressing pervasive IPV and structural violence.