Associations between attitudes accepting of wife abuse and emotional abuse, forced heavy work, and food deprivation during pregnancy in Nepal: a cross-sectional study

BACKGROUND: Social norms and gendered power relationships contribute to the acceptability of 'wife abuse' - a common form of domestic violence globally. OBJECTIVES: To estimate the prevalence and overlap of emotional abuse, forced heavy work, and food deprivation during pregnancy and examine their association with women's attitudes accepting of wife abuse in Nepal. METHODS: Baseline data were used from a randomized controlled trial involving pregnant women aged 18 and older attending routine antenatal care at two public hospitals in Nepal between January 2023 and March 2025. Participants completed a color-coded audio computer assisted self-interview. Attitudes toward wife abuse were assessed using 16 items drawn from three existing instruments. Exploratory factor analysis identified three distinct attitudinal factors. The dependent variable was a composite indicator of emotional abuse, forced heavy work, or food deprivation (coded as present if any were reported). Associations between the three attitudinal factors and composite outcome were analyzed using multiple logistic regression, adjusting for relevant sociodemographic variables. RESULTS: Emotional abuse, forced heavy work, or food deprivation was reported by 6.7% of participants. Acceptance of wife abuse for domestic shortcomings (Factor 1) was significantly associated with higher odds of experiencing abuse (aOR [1.75 (1.23-2.50)]. CONCLUSIONS: Pregnant women who endorsed attitudes accepting wife abuse - particularly for perceived domestic shortcomings - had higher odds of experiencing emotional abuse, forced heavy work, or food deprivation. These findings highlight importance of addressing harmful gender norms within households and ensuring antenatal care settings include safe opportunities to identify and support women at risk.