Abstract
BACKGROUND: Across the globe, Indigenous women in subordinate social positions (minoritized, racialized, facing discrimination) experience poorer health outcomes and greater social inequalities than non-Indigenous women. Although intimate partner violence (IPV) may significantly exacerbate these disparities, the extent of IPVs contribution to the excess of health inequality has not been systematically quantified. METHODS: We estimated IPVs relative contribution to the excess of health inequalities between Indigenous Palestinian (N = 436) and Jewish women (N = 965) citizens in Israel, aged 18-50. We calculated adjusted odds ratios (AORs) and 95% confidence intervals for 10 mental and physical health conditions, considering socioeconomic and demographic factors. Mental health outcomes included: postpartum depression (PPD; EPDS ≥ 10), depressive symptoms (CES > 0.9), anxiety (STAI ≥14), self-rated health (SRH). Physical health included: abortions, miscarriages, preterm birth, unplanned pregnancy, chronic illness. Multimorbidity included: two-plus above conditions. IPVs specific contribution to health inequalities was calculated by % change (Δ) in AORs from adjusted model (socioeconomics and demographics) to a model that also considered IPV. RESULTS: Palestinian women had significantly poorer health than Jewish women for 7 of 10 conditions: OR (95%CI): PPD = 3.57 (2.41-5.31); depression = 3.46 (2.40-4.99); anxiety = 2.06 (1.63-2.60); unplanned pregnancy = 4.83 (3.18-7.34); miscarriages = 1.89 (1.47-2.71); preterm birth = 1.97 (1.51-2.57); multimorbidity = 1.48 (1.10-1.99). OR for chronic illness was significantly lower among Palestinian women (0.11, 0.05-0.23). Abortions and SRH were non-significant. Adjusting for IPV above socioeconomic and demographic factors, AORs for ethnonational inequalities were attenuated: physical health, 0.09% to 50.4%; mental health, 23.3% to 57.8%; multimorbidity, 29.7% (non-significant). The net contribution of IPV to the excess of ethnonational health inequalities was as follows: depression = 16.76%, anxiety = 20.39%, PPD = 20.19%, SRH = 14.65%, chronic illness = no contribution, abortions = 2.60%, miscarriages = 3.17%, preterm birth = 4.09, planned pregnancy = 24.43%, and multimorbidity = 24.33%. CONCLUSIONS: Intimate partner violence (IPV) is a structural phenomenon shaped by intersecting social, economic, and systemic determinants that intensify health disparities between Palestinian and Jewish women during pregnancy and the postpartum period, and beyond what can be explained by socioeconomic or sociodemographic factors alone. Effectively addressing IPV and its underlying structural and social causes is essential for mitigating these persistent health inequalities.