Intimate partner violence among postpartum women reporting prior fertility treatment

Abstract

To determine the prevalence of intimate partner violence (IPV) among women reporting use of fertility services compared to those who conceived spontaneously in a national sample of postpartum women. A cross-sectional population-based study using data from the Pregnancy Risk Assessment Monitoring System (PRAMS), which included women with recent live births between 2009-2016. Women self-reported use and type of fertility treatment as well as IPV before or during their most recent pregnancy. Weighted percentages for reported IPV were calculated and compared between women with and without a prior history of fertility treatment preceding their recent pregnancy. We adjusted for maternal age, maternal race/ethnicity, maternal education, marital status, pre-pregnancy BMI, number of stressors (e.g. homelessness) experienced in the preceding 12 months prior to delivery, tobacco use in the three months prior to pregnancy, pre-pregnancy health insurance, annual household income, number of prior live births, outcome of prior pregnancy (including preterm or low birth weight), birth plurality, outcome of most recent pregnancy (including NICU admission or neonatal death), breastfeeding status of most recent neonate. Using multivariate logistic regression, the adjusted odds of IPV as a function of fertility treatment status were calculated. Of the 37,114 women, 4,664 (12.6%) reported fertility treatment and 766 (2.1%) reported IPV. Of the women who reported use of fertility treatment, 59 (1.3%) reported IPV prior to or during their most recent pregnancy. Women who reported use of fertility treatment were less likely to endorse IPV as compared to women who did not report use of fertility treatment prior to their most recent pregnancy (p<0.0001). After adjustment, the odds of IPV were similar among women who received fertility treatment and those who did not (adjusted odds ratio 1.10, 95% confidence interval 0.64-1.89). There was no difference in type of fertility treatment and IPV (including fertility-enhancing drugs, artificial or intrauterine insemination, assisted reproductive technology, or other medical treatment). Predictors of IPV within this population included age less than 20, greater number of reported stressors, tobacco use prior to pregnancy, and household annual income less than $52,000. Non-Hispanic White race/ethnicity and being married were protective against IPV. Despite the known adverse psychosocial implications of infertility, its treatment did not confer greater risk of IPV within this postpartum population. The difficulties associated with infertility, however, may have been mitigated by successful treatment but could be potentiated if unsuccessful. The preconception period, inclusive of encounters with infertility specialists, represents a unique opportunity to screen and counsel women, especially those who may be at higher risk for IPV.