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Abstract
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OBJECTIVES: A survey was conducted in the maternity hospitals of French Guiana in 2017-2018 centered on uses of tobacco, alcohol and pemba (clay) during pregnancy, including questions about violence and the perception of adverse situations during pregnancy. The data used here allow an analysis of lifetime violence and the experience of the last pregnancy.
METHODS: An ad hoc questionnaire was designed including some questions to identify at risk situations and T-Ace items for measuring problematic alcohol use. It was adapted to specificities of the local population groups, migrants or from borders, and asking for the maternal tongue. It was administered to women following childbirth. The questionnaire was strictly anonymous. The ethics committee had validated the questionnaire and the collection procedures (Decision 2017-25). In addition, to the issue of violence, seven questions were asked about women's experiences with pregnancy. A bivariate analysis identified significantly associated variables that were used for a multicomponent analysis to identify a typology of women based on their pregnancy experience (Modalisa8 and SPSS19). The very small number of women who smoked tobacco or cannabis during pregnancy (16 and 7 women respectively) led us to ignore these variables.
RESULTS: The survey interviewed 789 women throughout Guyana. They were on average 28.9 years old at this pregnancy and had an average of 3.24 living children comprised this newborn. The questioned women were younger than in metropolitan France, less often married, with a low level of education, often foreigners, especially Haitian or Surinamese. Overall, 174 women, or 22% of the total reported having experienced violence in their lifetime, with four women refusing to answer the question. The profiles of the concerned women were not very different according to their ages or levels of education, but differed significantly from the average on several characteristics, such as their mother tongue, marital status, nationalities, whether living on state aid not related to employment or family allowances, or having no resources, living around Cayenne or Kourou and having been on the territory for less than two years. Three groups of women were distinguished by the multicomponent analysis. The first group comprised essentially foreign women living around Cayenne, alone with children, having a low educational level, and having experienced difficulties to cope with this pregnancy. They reported no use of psychoactive substances. They experienced violence more often than in the other groups (almost one in two). One in five had migrated during the last pregnancy. The second group was composed more often of French women, born in Guyana or in metropolitan France. They more often lived with a partner, had a good educational level, personal or marital incomes. They expressed more often worry, with sleep problems but with an entourage to rely on. Before pregnancy they drank alcohol at events but one in three had a T-Ace scoring at two or more. They had a good pregnancy follow-up. The last group was composed of women living around Saint-Laurent-du-Maroni or in remote communities, with a low educational level, living alone with numerous children. They didn't feel worry and had good sleep. They didn't experience violence. They differed by their use of pemba and beer and late or inadequate pregnancy follow-up.
CONCLUSIONS: Data on violence in French Guyana show that young people and women declare more often having experienced physical violence, in or out of family life. Young women are overrepresented thus a survey in childbearing women must reveal a high frequency of these events. Our data allow us to go further, by associating this experience of violence and the experience of pregnancy with socio-demographic variables. We can thus see that the overall average obtained on a large number of indicators is smoothed by extremely contrasting situations, of women feeling safe or not, well followed or not for this pregnancy, etc. The groups distinguished by the MCA reveal the contrast between women of Haitian nationality in the Cayenne region and Surinamese or Nengee-speaking women, who are grouped around Saint-Laurent-du-Maroni or in the isolated municipalities of western Guyana. One sub-group stands out in particular for the combination of lifetime violence and very unfavorable conditions during the last pregnancy, both of precariousness, isolation and recent migration. The experience of violence and pregnancy in poor conditions require close actions to take charge of these women, especially since they are at risk for sexually transmitted diseases, including HIV.
Language: fr |