African women in abusive relationships suffer more miscarriages and stillbirths.

More than half of a sample of over 2 000 women in Cameroon had suffered violence from their spouse.

Physical violence was the most common form (39% of women), followed by emotional violence (31%) and then sexual violence (15%). The same women also answered questions about spontaneous abortions and stillbirths. Fetal loss was significantly associated with any kind of spousal violence--women who reported violence were 50% more likely to report early or late fetal loss (odds ratio 1.5, 95% CI 1.3-1.8). The authors also found cross-sectional associations between violence and recurrent fetal loss, although this was less common. Emotional abuse was most closely linked to recurrent fetal loss (1.7, 1.2-2.3).

If the associations are causal, effective interventions to reduce domestic violence in Cameroon could prevent up to one-third of isolated or recurrent fetal loss, say the authors, who think a causal association is likely but hard to prove.

Effective interventions are notable by their absence, comments one observer. This and other studies show that domestic violence is culturally embedded in the lives of many women, and that it adversely affects their physical, mental, and reproductive health.

It is time to stop asking them about it and start developing strategies to protect them.

Alio AP, 2009; 373: 318-324.