JAMA Network Open Review of 684000 Cases Ties Maternal Intimate Partner Violence to 10-36 Percent Rise in Under-Five Mortality

The Curtin University-led analysis pooled data from 28 observational studies spanning low- and middle-income settings. Physical, sexual, and emotional violence each correlated with elevated neonatal death; physical violence alone tracked with higher post-neonatal infant mortality. Mechanisms cited include maternal injury, depression, delayed antenatal care, and disrupted breastfeeding. The design cannot establish causation and leaves residual confounding by poverty and healthcare access unmeasured.

Prior WHO multi-country studies and a 2023 Lancet Global Health meta-analysis reported similar gradients but lacked the neonatal focus and sample size here. Those earlier works also showed stronger effects in settings with weak legal protections, suggesting policy context modifies risk. The current review under-samples high-income countries, limiting generalizability to Australia or the United States where screening programs already exist.

Integration of routine IPV screening into prenatal visits, as recommended by USPSTF and ACOG, offers one testable pathway. Modeling from the 2019 WHO INSPIRE framework indicates that scaling such screening plus referral could avert 4-7 percent of preventable neonatal deaths in high-burden districts within five years, provided referral completion exceeds 60 percent.

Next required evidence is a cluster-randomized trial in at least two WHO regions that measures both IPV reduction and under-five mortality as co-primary endpoints with five-year follow-up.