Perinatal Intimate Partner Violence and Disability: Implications for Women’s Health Care

ObjectiveThe objectives of this study were to: (1) document violent and controlling behaviours within intimate partnerships during the perinatal period; and (2) determine individual, interpersonal and household-level factors influencing the...

The aim of the current study was to compare the prevalence of intimate partner violence (IPV) during the perinatal period among respondents with self-reported disability compared with those without a disability. We conducted a secondary analysis of nationally representative data from the Pregnancy Risk Assessment Monitoring System data from 24 participating United States between 2018 and 2020. A cross-sectional sample of 43,837 respondents provided data on disability, including difficulty in vision, hearing, ambulation, cognition, communication and self-care. The exposure was perinatal IPV, defined as experiencing abuse by a current or ex-partner in the year before or during pregnancy. Regression models were used to calculated odds of IPV by disability status while accounting for relevant sociodemographic characteristics. Respondents who self-reported disabilities experienced IPV at a higher rate than those without disabilities, both before and during pregnancy. In fully adjusted models, respondents with disabilities had about 2.6 times the odds of experiencing IPV before pregnancy, and about 2.5 times the odds of experiencing IPV during pregnancy, compared with those without disabilities. Respondents with disabilities experienced IPV at higher rates than the general population, and thus are at increased risk for adverse maternal, neonatal and infant health outcomes. Perinatal IPV is a significant issue globally, and our findings suggest perinatal IPV is particularly salient for persons with disability. Findings highlight the need to screen women with disabilities for IPV during the perinatal period as well as the importance of providing them appropriate, accessible information, resources and referrals.

The lifetime prevalence of intimate partner violence (IPV) among women in the United States is reported to be between 18 and 50%. One-third of female homicide victims are killed by an intimate partner and alcohol is often involved. Despite these figures, 77% of women have never been screened for IPV. Substance abuse in male partners is known to place women at risk. We examined the role of female alcohol use on rates of severe IPV. Our hypotheses were: (1) the prevalence of IPV among women seen in trauma centers is greater than that found in national surveys; (2) alcohol problems among abused women and their partners are greater than those among non-abused women; (3) females and their partners alcohol problems are each independently associated with IPV; and (4) female trauma center patients support domestic violence screening. An in-person survey was administered to 95 consecutive adult female trauma patients admitted to a Level I Trauma Center. The survey included questions about past-year and lifetime severe IPV, female and male partner alcohol use, and willingness to participate in IPV screening and referral. The multivariate associations of female and partner alcohol use with past-year severe IPV were assessed with logistic regression. Nearly one-half (46.3%) of women reported a lifetime history of severe IPV, with 26% experiencing severe IPV in the past year. Past-year IPV was identified in 59.1% of women screening positive for drinking problems, but in only 12.7% of those screening negative for drinking problems (p = 0.001). Similarly, past-year IPV prevalence was 55.2% when the partner was a problem drinker versus 8.3% when he was not (p = 0.001). Multivariate analysis showed that female problem drinking (odds ratio [OR] = 5.8) and partner problem drinking (OR=8.9) were independent predictors of past-year severe IPV. The majority of women (90.5%) felt that it was appropriate for health care professionals to screen for IPV; 90% of women with a history of IPV thought screening was important and 71% wished a previous healthcare provider had asked them about it. Female trauma patients demonstrate a higher prevalence of severe IPV than the general population. IPV rates appear to be related to both female and partner alcohol misuse. Female trauma patients endorsed IPV screening and thus should be screened for alcohol use and IPV in a way that minimizes future violence risk. Further research is needed to elucidate whether intervention for alcohol misuse has an impact on rates of IPV in this population.

To describe rates and predictors of perinatal intimate partner violence (IPV) and rates and predictors of not being screened for abuse among rural and urban IPV victims who gave birth. This analysis utilized 2016-2020 Pregnancy Risk Assessment Monitoring System (PRAMS) data from 45 states and three jurisdictions. This is a retrospective, cross-sectional study using multistate survey data. This analysis included 201,413 survey respondents who gave birth in 2016-2020 (n = 42,193 rural and 159,220 urban respondents). We used survey-weighted multivariable logistic regression models, stratified by rural/urban residence, to estimate adjusted predicted probabilities and 95% confidence intervals (CIs) for two outcomes: (1) self-reported experiences of IPV (physical violence by a current or former intimate partner) and (2) not receiving abuse screening at health care visits before, during, or after pregnancy. Rural residents had a higher prevalence of perinatal IPV (4.6%) than urban residents (3.2%). Rural respondents who were Medicaid beneficiaries, 18-35 years old, non-Hispanic white, Hispanic (English-speaking), or American Indian/Alaska Native had significantly higher predicted probabilities of experiencing perinatal IPV compared with their urban counterparts. Among respondents who experienced perinatal IPV, predicted probabilities of not receiving abuse screening were 21.3% for rural and 16.5% for urban residents. Predicted probabilities of not being screened for abuse were elevated for rural IPV victims who were Medicaid beneficiaries, 18-24 years old, or unmarried, compared to urban IPV victims with those same characteristics. IPV is more common among rural birthing people, and rural IPV victims are at higher risk of not being screened for abuse compared with their urban peers. IPV prevention and support interventions are needed in rural communities and should focus on universal abuse screening during health care visits and targeted support for those at greatest risk of perinatal IPV.

Intimate Partner Violence and Gestational Weight Gain in a Population-Based Sample of Perinatal Women

Associations between intimate partner violence, violence-related policies, and HIV diagnosis rate among women in the United States

Intimate partner violence increases the risk of detrimental health, behaviors and psychological issues in mothers, affecting infant nutrition and development. However, the potential effects of maternal exposure to intimate partner violence on breastfeeding practices are understudied, and the results of individual studies are inconsistent and conflicting. The aims of this systematic review and meta-analysis are therefore to 1) estimate the prevalence of perinatal intimate partner violence and, 2) examine the relationship between perinatal intimate partner violence and breastfeeding outcomes. This systematic review and meta-analysis will investigate the association between perinatal intimate partner violence and breastfeeding outcomes, including early initiation within 1 hour after giving birth, exclusive breastfeeding under six months, and continued breastfeeding at two years or beyond. Comprehensive searches will be conducted in PsycInfo, Scopus, Web of Science, Medline, Cochrane, JBI EBP, CINAHL, Informit, and PubMed electronic databases. Data extraction will be performed independently by two reviewers, with discrepancies resolved by a third reviewer. Statistical analysis will be conducted using STATA/SE version 17, employing random-effects models to calculate pooled effect sizes and assess heterogeneity with I2 and Chi-square tests. Subgroup analyses and meta-regression will explore potential sources of heterogeneity. Evidence suggests that intimate partner violence is linked to poor breastfeeding outcomes. This systematic review and meta-analysis will update, compile, and critically review the evidence of the role of intimate partner violence on breastfeeding outcomes. This systematic review and meta-analysis will also inform effective strategies and interventions to support breastfeeding among IPV-affected women, thereby enhancing maternal and child health. As this review and meta-analysis involves secondary analysis of existing data, ethical approval is not required. Findings will be disseminated through peer-reviewed publications and scientific conferences, aiming to inform strategies to support breastfeeding among women affected by intimate partner violence. This protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42024555048.

ABSTRACTObjective Prevalence of intimate partner violence (IPV) during pregnancy is estimated to be 4%–8%. Women with mental health difficulties are at increased risk for IPV during the perinatal period. Prevalence of IPV is high among women with eating disorders (ED); however, prevalence of IPV during the perinatal period among women with ED is unknown.Method We studied women from a population‐based cohort, the Avon Longitudinal Study of Parents and Children. Prevalence and odds of physical and emotional IPV during and after the perinatal period was investigated among women with lifetime ED, with (n = 174) or without pregnancy shape and weight concern and/or purging behaviors (n = 189), and women with no ED (n = 8723).Results Women with lifetime ED showed higher prevalence of IPV during and after the perinatal period (physical = 9.6%–14.3% and emotional = 24.1%–28.1%). Lifetime ED was associated with higher odds of physical IPV during the perinatal period (odds ratio: 2.34, 95% confidence interval: 1.11–4.93, p = .03). Lifetime ED with and without pregnancy shape and weight concerns and/or purging was associated with higher odds of IPV after the perinatal period, and higher odds of reporting emotional IPV at all time points. Associations were moderated by partner's response to pregnancy and maternal experience of childhood sexual abuse.Discussion Mothers with ED and their children may be vulnerable to negative effects due to maternal ED and IPV combined, both of which have been associated with severe and long‐lasting harmful consequences. Partner's response to pregnancy and maternal experience of childhood sexual abuse might contribute to the association between ED and IPV perinatally. © 2015 The Authors. International Journal of Eating Disorders published by Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:727–735)

Intimate Partner Violence

Intimate partner violence (IPV) during the perinatal period can negatively affect both a woman's health and the bonding with her infant. Research on IPV among pregnant women experiencing psychological distress in South Asia is limited. We examined associations between perinatal exposure to IPV and postnatal maternal-infant bonding in Pakistani women with symptoms of anxiety and assessed if breastfeeding practices moderated these associations. Postnatal data were collected from 720 Pakistani women who reported at least mild levels of anxiety symptoms in pregnancy. We performed Poisson regression with robust variance analyses to examine the associations between IPV during pregnancy or within 6 weeks after delivery (i.e., the perinatal period) and maternal-infant bonding. Interaction terms between IPV and breastfeeding practices were included in the analytic models to examine the moderating effects. About 27% of women were exposed to at least one type of perinatal IPV. Women who were exposed to IPV were more likely to have moderate to severe postpartum anxiety (n = 57, 28.9% of IPV-exposed women), compared to those without IPV (n = 65, 12.4% of unexposed women; p value < .001). Compared to women not reporting IPV, women exposed to any IPV showed a 38% increase in Postpartum Bonding Questionnaire scores, suggesting higher likelihood of impaired bonding (risk ratio [RR] = 1.38, 95% confidence interval [CI] [1.21, 1.56]). Among women who initiated breastfeeding later than 1 hr post-delivery, IPV was associated with impaired bonding (RR = 1.09, 95% CI [1.06, 1.20]), whereas no association was present for women who initiated breastfeeding within 1 hr (RR = 1.03, 95% CI [0.98, 1.08]). In addition to the efforts to reduce IPV, encouraging IPV-exposed women to adhere to the breastfeeding guidelines (e.g., early breastfeeding) may enhance maternal-infant bonding.

Intimate partner violence (IPV) includes a range of activities inflicted upon a person by a current or former intimate partner. The abuse is often recurrent and patterned, intended at establishing power and control. IPV incidence rates are highest during young adulthood, the dynamics of which are made more complex during and immediately following a pregnancy (the perinatal period). This study focuses on women's perceptions of perinatal IPV. Data come from a qualitative study stemming from a community-based longitudinal project. Participants (n = 301) were screened for lifetime incidence of IPV, and those screening positive (n = 64) were asked to participate in a follow-up interview. Forty women agreed to an interview, and 25 of those described perinatal IPV. Within this subsample, the women were asked to recall the abuse they experienced during and after pregnancy, how it impacted their health and ability to parent, as well as the impacts they believed that the abuse had on their children. Their findings indicate that perinatal IPV is pervasive and consequential. A range of abuse trajectories occurred which left the women feeling demoralized as they entered parenthood. After the birth of their children, the women often shouldered disproportionate caretaking responsibilities in addition to navigating their abusers' ongoing control tactics. While they reported various forms of IPV and recognized that their children had been exposed to it, the women did not often exhibit a clear understanding of how their own victimization impacted their children, prenatally or upon birth. More recognition came in retrospect for those with older children. Understanding the nature of perinatal IPV is critical to identifying early childhood exposure, as well as effectively working with adult survivors to mitigate it.

IntroductionThe global evidence base on intimate partner violence (IPV) prevalence and risk factors is predominantly cross-sectional, limiting clarity in changes over time. Prospective cohort data can inform trajectories, as is needed to guide prevention efforts.AimsThis study characterises (1) the prevalence of past-year IPV and trajectories among a cohort at two time points spanning 1 year and (2) individual and household factors associated with physical and/or sexual IPV, and IPV trajectories, adjusting for and stratifying on community-level norms that endorse IPV justification.MethodsExisting cohorts of women aged 15–49 were surveyed in November–December 2020 and November–December 2021 (n=30822020; n=28872021). The analytic sample restricts to married or partner-cohabiting women with complete IPV data at both time points (n=2499). County-level IPV justification norms were computed from Kenya 2022 Demographic and Health Survey data. Descriptive and multivariable regression characterise IPV prevalence, trajectories and help-seeking over 12 months, and associations of individual, dyad and community-normative factors on any IPV and trajectories.ResultsFrom 2020 to 2021, the prevalence of any past-year physical and/or sexual IPV increased slightly from 11.4% to 12.5%. Over the 12-month period, 8% of women had IPV newly begun, 4% had sustained IPV at both time points, 7% had IPV resolved by 2021 and 81% were IPV-free across time points. Norms that justify physical IPV at the county level influenced associations with trajectories and risk. Generally, individual-level factors were more associated with IPV in settings where IPV justification was less normative. Help-seeking was not associated with IPV cessation.ConclusionOverall IPV prevalence persisted over a 1-year period, with dynamic movement in and out of safety, illustrating the unmet needs for prevention and response. Social norms appear to ‘activate’ individual and household IPV risk factors, affirming the need to address the norms that perpetuate IPV.

Perinatal intimate partner violence (IPV) and perinatal cannabis and nicotine product use are common and associated with negative maternal-infant health outcomes. Substance use coercion (SUC), which involves abusive partners' controlling behaviors related to substance use, has not been studied for cannabis and nicotine products. Perinatal individuals may be particularly vulnerable to SUC, and this study aims to explore how cannabis and nicotine SUC manifests among perinatal survivors. We conducted virtual, semi-structured, 45-minute retrospective interviews with 19 IPV advocates and 15 perinatal IPV survivors. Participants were recruited through local IPV agencies and an online recruitment repository. Audio-recorded interviews were transcribed and analyzed using a deductive-inductive thematic analysis approach. Two research team members individually coded each transcript and met to resolve discrepancies. Key themes emerged relating to survivors' use, interpersonal coercive tactics, and systems-level control. Specific findings included (1) survivors using substances to cope; (2) abusive partners coercing survivors through withholding, controlling, and punishing substance use; (3) shame and stigma are key drivers of coercion; (4) partners hinder cessation efforts; and (5) child protective services and health care are systems used by abusive partners to control and manipulate perinatal survivors of IPV. The findings demonstrate that cannabis and nicotine products are used to coerce and control survivors of IPV. Future work should focus on developing survivor-centered interventions within systems to better support perinatal IPV survivors using cannabis and nicotine products. This study highlights the impact of cannabis and nicotine SUC on perinatal individuals and underscores the need to consider SUC when providing resources or treatment.

To determine the prevalence of non-violent, gender-based forms of maltreatment of women by husbands and in-laws [i.e., gender-based household maltreatment (GBHM)] during pregnancy and postpartum; to clarify the role of GBHM in compromising infant health, and whether this role extends beyond that previously observed for intimate partner violence (IPV). Cross-sectional, quantitative data were collected from women (ages 15-35) seeking immunizations for their infants <6 months of age (N = 1061) in urban health centers in Mumbai, India. Logistic regression models were constructed to assess associations between maternal abuse (perinatal IPV, in-law violence and GBHM) and recent infant morbidity (diarrhea, respiratory distress, fever, colic and vomiting). More than one in four women (28.4%) reported IPV during their recent pregnancy and/or during the postpartum period, 2.6% reported perinatal violence from in-laws, and 49.0% reported one or more forms of perinatal GBHM. In adjusted regression models that included all forms of family violence and maltreatment, perinatal GBHM remained significantly associated with infant morbidity (AORs 1.4-1.9); perinatal IPV and in-law violence ceased to predict infant morbidity in models including GBHM. Findings indicate that non-violent expressions of gender inequity (e.g., nutritional deprivation, deprivation of sleep, blocking access to health care during pregnancy) are more strongly associated with poor infant health than physical or sexual violence from husbands or in-laws in urban India. These results strongly suggest the need to expand the conception of gender inequities beyond IPV to include non-violent forms of gendered mistreatment in considering their impact on infant health.

Perinatal intimate partner violence (IPV) is highly prevalent in different regions worldwide. However, there is still insufficient systematic evidence on the risk factors for perinatal IPV across various regions and socioeconomic levels, which presents challenges in developing targeted prevention programs. The aim of this systematic review and meta-analyses was to identify the risk factors for perinatal IPV across various regions and socioeconomic levels worldwide. A comprehensive systematic literature search was conducted across multiple electronic databases, including PubMed, Cochrane Library, Embase, and Web of Science, encompassing all available studies from each database’s inception date to June 2024. Potential risk of bias in the included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. Subgroup analyses were also performed by region and level of economic development. A total of 83 studies were included in the review, involving 1,609,201 participants, of whom 90,479 (5.6%) experienced perinatal IPV. For the type of violence, 64 studies reported overall IPV, 21 reported physical violence, 12 reported psychological violence, and 10 reported sexual violence. The meta-analyses showed that major risk factors for these types of violence included woman’s education level, woman’s working status, pregnancy intention, social or family support, partner’s education level, and partner’s alcohol consumption. However, some factors varied across different regions and levels of economic development, suggesting contextual influences on risk factors for perinatal IPV. This is a comprehensive review on the risk factors for perinatal IPV across regions with varying levels of economic development. These factors vary across different regions and economic contexts. In high-income countries, IPV is more commonly associated with mental health status and addictive behaviors, while in middle- and low-income countries, it is primarily associated with low education levels, economic dependence, and partner’s risk behaviors. This finding highlights the necessity of fully considering contextual factors in future risk assessments for perinatal IPV and establishing corresponding prevention and intervention strategies.