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  • Ethical approval of the study was obtained from the Kilimanjaro Christian Medical University College Research and Ethical Review Committee (CRERC), certification number 592, January 17, 2014 extended yearly. Permission was sought from the Executive Director of Moshi Municipality to carry out research in the district. We followed the WHO ethical and safety recommendations when doing research on violence against women. All participants were informed about the study and approved participation through signed consent. Support services were available for women who needed further help and were provided after their approval to be referred. Support services included those related to legal, health, child support and police issues. In-depth interviews were used to explore the social support received from the natal family among victims of partner violence during pregnancy. Participants in this study were purposively selected among those who participated in a larger cohort study that assessed the impact of intimate partner violence on women’s reproductive health. The cohort study included 1,116 pregnant women and formed part of PAVE project, a multi-country study that aimed at generating insights into the prevalence, forms, and consequences of intimate partner violence. Since the focus of the larger research project was on women’s exposure to partner violence during pregnancy, the present study also focused on pregnant women. In Tanzania, the study was conducted in Moshi municipality, which is one of the seven districts in Kilimanjaro region, in the northern part of the country. It has an estimated population of 206,728 people, with annual population growth of 2.8%, which is mainly attributed to rural–urban migration. Among members of the Chaga and Pare tribes, where this study is focused, kinship is patrilineal and patrilocal and children are considered to be “owned” by the male partner [28]. Polygamy is not commonly practiced except by the few Muslims in the area. At marriage, a dowry is paid by the family of the male partner to the woman’s natal family to seek approval of the union. After the marriage ceremonies, the woman usually moves to live with her partner together with or near his family. The partner’s family members are then responsible for keeping an eye on the daily affairs of the new couple, including settling marital disputes [29]. Study participants and data collection: Eighteen participants were purposively selected among the 1,116 pregnant women enrolled in the cohort study. The study was conducted from March 2014 to May 2015. Details of this cohort study is described elsewhere [8] but briefly, pregnant women were enrolled from two antenatal care clinics before the 24th week of gestation, followed at the 34th week of pregnancy and within 48 hours of delivery. Women who participated in the cohort were aged 18 years or above, with a singleton pregnancy, who delivered within Moshi Municipality and who were willing to be followed for the entire period of the study. Enrolled to the present qualitative study were women who reported having experienced physical IPV during pregnancy. Participants with other forms of partner violence (sexual and/or emotional) were included in the study provided that they had also experienced physical violence from their partner during pregnancy. Building on the results from the cohort study, the present qualitative study aimed to further explore the life situations of women who had experienced physical violence during pregnancy. Experiencing physical violence during pregnancy was associated with unwanted birth outcomes of preterm birth and low birth weight [13]. Victims of physical violence during pregnancy were also more likely to disclose their experience to natal relatives than those with other forms of partner violence [22]. This sample was therefore selected to understand their experiences with partner violence, their decision-making process for disclosure to natal relatives and support received. The sample of women included women who were 18 to 39 years old, with varying education level (primary education/secondary education), occupation status (employed, business or housewife), marital status (married or never married) and number of children a woman had (from no child to seven children). Data were collected through in-depth interviews conducted by two researchers, one male and one female. The male researcher is a medical doctor, with ten years’ experience in providing reproductive health services to clients and is the first author of this article. Prior to conducting the field research, the research team had carefully considered whether a male researcher would be able to establish the necessary rapport with women living with partner violence. During data collection, comparisons between the interviews conducted by the male and female researcher soon indicated that respondents offered their stories in as much detail and depth to the male as to the female interviewer. It was therefore concluded that with respect to the validity of the interviews, the interviewer’s training, personality and capacity to listen in an empathetic way seemed more important than his/her gender. Similar conclusions regarding use of male interviewers have been documented in other gender based violence studies [25,30]. Further, prior to conducting the qualitative interviews, both researchers had received targeted training in the conduct of research on sensitive topics. A semi-structured interview guide with open-ended questions was used during the interview. The interview guide included questions on the forms of partner violence experienced by the participant, what compelled them to seek help, and details of the social support they received from natal relatives and others. After every interview, the collected information was reviewed and discussed by research team so that any new issue raised could guide the next interview. Most of the interviews were done in a separate room at the clinic to ensure privacy and confidentiality. For women who preferred to be interviewed at home, it was made sure that no one other than the participant and children under two years of age were present during the interview. All interviews were audio recorded with participant approval. The interviews were conducted in Swahili language, the language spoken by all participants. Baseline interviews lasted for a period of one to two hours and aimed to explore the experience of violence during pregnancy, help-seeking and support received from natal relatives. After interviewing the fifteenth participant, we felt that saturation was reached, a situation where additional information would not result into a new insight. To confirm that, three additional participants were interviewed, and review of the interviews resulted in generating no new information. Follow-up interviews were conducted with fourteen selected participants about two to three months after their first interview and lasted for about half an hour. These participants had reported experiencing repeated episodes of violence and therefore the follow up interview assessed their progress on the status of the violence they had reported, child care and support. In the cohort study, the assessment of the experience of IPV was done using the WHO questionnaire that had been used previously in Tanzania [31,32]. To assess physical violence, the women were asked if, during the index pregnancy, their partner had slapped, pushed, hit, kicked, choked or threatened to use or actually used any object that could hurt them. Emotional violence was defined as being insulted, humiliated, intimidated or threatened by the partner while sexual violence included being physically forced to have sexual intercourse, having sexual intercourse without consent or being forced to do a humiliating or degrading sexual act. In this study social support was defined as any form of assistance that female victims of partner violence felt they received from other people; this could be from a trusted friend or supportive social networks such as their natal relatives or their partner’s family. Social support included emotional support, practical support, information and/or mediation. Socioeconomic characteristics were also assessed in the present study. Socioeconomic characteristics included age of participant, education level (not attended school/primary education/secondary education and above), occupation status (employed, business or housewife) and marital status (married or never married) and number of children. Field notes were written and expanded within twenty-four hours after the interview. All audio-recorded interviews in Swahili were transcribed verbatim by an experienced transcriber followed by English translation. The two authors (GNS and DM) are residents of Tanzania, speak Swahili and English fluently and frequently cross-checked the verbatim transcription and translation. After reading the transcripts, the two authors (GNS and DM) did preliminary open coding of text to identify common themes that emerged from the transcriptions. Examples of codes that emerged were help-seeking, emotional support, practical support, and information for support, reconciliation, support networks and child support. Authors agreed on the three themes for analysis; disclosure for support, social support and social support from natal relatives. This was followed by further coding of all transcripts manually (GNS). During the whole process of analysis, there was a constant checking of the text, codes and themes while comparing to the research questions for relevance. Outcomes of interest that were analyzed included help-seeking, circumstances that surrounded the women’s decision to seek help and the support received from their natal relatives and other people. In terms of theory, a Grounded theory approach was used: through close and systematic attention to the core themes brought up by the women during interviews, the authors developed the interpretations and insights that are presented in this article.
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