VIOLENCE AND BIRTH OUTCOMES
Exposure to violence is the lead factor in inducing fear as well as psychological stress. Medical studies show that rise in psychological stress among pregnant mothers in their premier trimester can cause preterm delivery or low birth weight. Determinants of fear of crime include; direct victimization or crime witnessing and receiving crime news from friends, coworkers and neighbours. Brazil is among countries with the highest levels of violence in the world and homicide rate is 21 cases out of 100000 citizens by the year 2011. This rate is five times the America rate and at least 20 times the rate in the United Kingdom. Among the top 50 cities all over the world, sixteen are in Brazil which is rankedbymurder rate. The leading cause of death among men of age 15-44 in Brazil is homicide while daily violence is the major issue among the citizens(Ellsberg and Heise, 2005).
The main source of data is the microdata from vital statistics from the Brazilian ministry of health 2000-2010. The data obtained is on pregnancy, the newborns and mother. Other sources are published data from avariety of sources. In theempirical analysis, the information available is scrutinized precisely on themunicipality of occurrence of homicide and theresidentialmunicipality of the mother. The focus is on small, rural municipalities as a unit measure of violence. The analysis is complemented with thestudy of Fortaleza city –one of themost violent cities in theworld. Other papers raise thepossibility that otherbehavioural responses influence birth outcomes while others focus on extreme occurrences such as landmine explosions and bombs. Effects of violence are relatively less severe if the nature of the violence is endemic.A larger fraction of women in urban areas is exposed to homicides than in rural areas. Premature infants and low birthweight pose a big risk of neonatal or infant death and in most cases require outpatient care and hospitalization as compared to normal babies. Those survive into adulthood are faced with increased morbidity, neurological and cognitive impairment. Low birthweight can either be caused by decreased gestation period or intrauterine growth retardation. Other factors include household income, maternal nutrition, disease environment and smoking (Koppensteiner and Manacorda, 2013).
Most epidemiological researches have established maternal stress as an independent and significant factor for low birthweight. Biologically, maternal glucocorticoids are produced in response to stress leading to excess secretion of corticotrophin releasing hormone which accelerates the maturation of fetus organs leading to premature birth. The complication in interpreting the underlying channels is affected by factors such as high costs of health services, household resources,poor standards of living, variations in the supply of labour and household income consumption.Brazilexperience Low birthweight of about 9 percent ranging it above average for OECD nations. Around 1 percent of babies are born under 1.5kg while 0.5 percent are born under 1kg, 6.6 percent are born before 37weeks of gestation(Krug, 2002). Low birthweightis strongly relatedto preterm delivery. In Fortaleza the cases of lowbirthweightare about 83 cases out of 1000 children and a rate of prematurity of 64 cases out of 1000 children, these results abit better than other similar municipalities but worse than smaller municipalities. About 500,000 homicides are observed in Brazil which is equivalent to a rate of 26 cases for 100000 individuals yearly. In small municipalities there are seven homicides out of 100,000 people a year which is six times inbigger municipalities. Around one-third of all homicides occur publicly, and the number is much higher in larger cities due to high incidences of gang violence and street confrontations. The major challenge in calculating the causal effect of violence on birth outcomes is that econometrician is unable to observe the characteristics of various residential places. Such unobservable characteristics could be related newborn health results and homicides rates. The strategy applied is difference-in differences identification that focuses on differential changes in homicides rates in specific areas.
Yiat=b0+b1 HOMat+Xit’b2 + Zat’b3 + da +dt +uiat
Where; Yiat -individual outcome variable, in area a at time t,
HOMat – local homicide rate
da -mother’s residential area
dt – conception month.
Xit – mother, pregnancy and newborn characteristics
Zat – time varying area features
u – error term.
The main concern to the identification is that varyingindividual and local characteristics might influence birth outcomes as well as homicides rates. For example, poor economic conditions bring about violence and poor birth outcomes because of factors such as malnutrition. Therefore, included in the formula is a large set of observable controls forpregnancy, newborns, mother, and residential locality. Also included in the model are the leads and lags of homicide occurrence to subsume standardized violence levels during pregnancy and to test precisely effects of homicides on birth outcomes.
Results depicta clear and precise estimates ofnegative impact of homicide on average birth weight during first three months of pregnancy indicated by -0.45 implying that one standard deviation increase in therate of homicide results in 2 grams reduction in birthweight. Pre and post pregnancy homicides do not evidently affect birthweight. It is hard to foresee how increased violence affects prenatal visits. However, prenatal visits may rise on account of complications that could arise during gestation period due to violence exposure. Contrary, violence can prevent pregnant mothers from accessing health facilities due to safety concerns or because of stress. Prenatal visits, particularly on first three months of pregnancy, are effective methods of detecting and preventing undesirable birth outcomes. About SES indicators, it shows that the effects are higher among less educated mothers in comparison to those with high education levels. Mothers with stillbirths’ history have strong predictor of adverse impacts of violence on birth outcomes(Ellsberg and Heise, 2005).
In conclusion, using the vital statistics data of Brazil in period 2000-2010, there is thesignificant adverse effect of violence exposure on gestation length and birthweight during first three months of thegestation period. Violence leads to increased maternal stress which is associated with thedirect impact on the development of unborn baby causing anincrease in prematurity growth. These results hold for small local municipalities and Fortaleza surroundings which is one of themost violent cities. Owing to rare nature of terrorist attacks and explosions, they are not facilitators of low birthweights, but daily violence is(Ellis, Beaver and Wright, 2009).
Koppensteiner, M. and Manacorda, M. (2013). The Effect of Violence on Birth Outcomes: Evidence from Homicides in Rural Brazil. SSRN Electronic Journal, 119, pp.16-33.
Krug, E. (2002). World report on violence and health. 7th ed. Geneva: World Health Organization, p.35.
Romito, P. (2008). Deafeningsilence: hidden violence against women and children. 6th ed. p.112.
Ellis, L., Beaver, K. and Wright, J. (2009). Handbook of crime correlates. 8th ed. Kidlington: Elsevier, pp.49-52.
Ellsberg, M. and Heise, L. (2005). Researching violence against women. 5th ed. Geneva: World Health Organization and Program for Appropriate Technology in Health (PATH), p.89.