by Vithya Murugan @vithyamurugan

Defined as a systematic, repetitive pattern of manipulative behavior used in order to gain and maintain power and control over a current or former partner/spouse, intimate partner violence (IPV) includes physical, sexual, psychological and/or financial abuse. Each year in the United States, 7 million women experience IPV.¹  The experience of IPV during pregnancy may be especially pernicious having substantial negative implications on maternal health (e.g., higher risk for miscarriage, substance use, smoking, depression, PTSD)^2,3 and neonatal health (e.g., risk of preterm birth, poor intrauterine growth, stillbirth, and fetal death).^4-6

Research estimates that between 3% and 9% of women experience IPV during pregnancy and that the severity of physical abuse increases significantly and incrementally during pregnancy.⁷ Emergency Departments (EDs) are a critical point of contact that pregnant women interface with that may serve as a platform for launching prevention programming. IPV often results in physical injury which may require immediate medical care.

Prevalence and correlates of IPV among pregnant women

In our new paper published in the September issue of BMJ Sexual & Reproductive Health, we used the latest data from the Nationwide Emergency Department Sample (NEDS) to explore the prevalence and correlates of IPV among pregnant women. We found that 0.06% of pregnant females who visited EDs in 2016 had a diagnostic code for IPV. We also found that pregnant women coded for IPV were more likely to drink, smoke, use other substances, and have mental health disorders complicating pregnancy. We also found that pregnant women coded for IPV were more likely to be younger, from lower income neighborhoods, have either Medicaid/Medicare or no insurance, and reside in urban areas.

Our study highlights the critical importance of identifying at-risk pregnant women presenting to the ED through targeted screening. Additionally, it is important to link these women with appropriate referrals and resources (e.g., alcohol and substance abuse treatment, case management, counseling).

Policy recommendations

While our study identified subpopulations of pregnant women at greater risk of experiencing IPV, we recommend universal and comprehensive screening for IPV in EDs. Screening for IPV is endorsed by multiple organizations, including the U.S. Preventative Services Task Force, yet screening rates remain quite low due to a variety of reasons including gaps in provider knowledge and providers’ perceptions that patients will not comply with recommendations.⁸ These barriers to screening are likely exacerbated by environmental factors inherent in EDs including waiting room pressures and insufficient time.⁹ However, identification provides women with opportunities to access critical supports (e.g., education, referrals, and safety planning) which may reduce the violence and, for pregnant women especially, improve health outcomes.⁹

The integration of social workers in EDs may be key in supporting physicians and nurses in identifying IPV and connecting patients to resources. Social workers may provide clinical staff with crucial training and education to screen for IPV. Additionally, social workers may provide referrals and assist in the transition of care back to the community for women experiencing IPV.¹⁰

Citations:

1. Smith SG, Zhang X, Basile KC, et al. The National Intimate Partner and Sexual Violence Survey: 2015 Data Brief–Updated Release. 2018.

2. Díaz-Olavarrieta C, García SG, Feldman BS, et al. Maternal Syphilis And Intimate Partner Violence in Bolivia: A Gender-Based Analysis Of Implications For Partner Notification And Universal Screening. Sexually Transmitted Diseases. 2007;34(7):S42-S46.

3. Bailey BA, Daugherty RA. Intimate Partner Violence During Pregnancy: Incidence And Associated Health Behaviors In A Rural Population. Maternal And Child Health Journal. 2007;11(5):495.

4. Cha S, Masho SW. Intimate Partner Violence And Utilization Of Prenatal Care In The United States. Journal of Interpersonal Violence. 2014;29(5):911-927.

5. Mogos MF, Araya WN, Masho SW, Salemi JL, Shieh C, Salihu HM. The Feto-Maternal Health Cost Of Intimate Partner Violence Among Delivery-Related Discharges In The United States, 2002-2009. Journal Of Interpersonal Violence. 2016;31(3):444-464.

6. Fanslow J, Silva M, Whitehead A, Robinson E. Pregnancy Outcomes And Intimate Partner Violence In New Zealand. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2008;48(4):391-397.

7. Alhusen JL, Ray E, Sharps P, Bullock L. Intimate Partner Violence During Pregnancy: Maternal and Neonatal Outcomes. Journal of Females’s Health. 2015;24(1):100-106.

8. Rangachari P. Coding For Quality Measurement: The Relationship Between Hospital Structural Characteristics and Coding Accuracy From The Perspective of Quality Measurement. Perspectives in Health Information Management/AHIMA, American Health Information Management Association. 2007;4.

9. Saberi E, Eather N, Pascoe S, McFadzean M-L, Doran F, Hutchinson M. Ready, Willing and Able? A Survey of Clinicians’ Perceptions About Domestic Violence Screening In A Regional Hospital Emergency Department. Australasian Emergency Nursing Journal. 2017;20(2):82-86.

10. Dawson AJ, Rossiter C, Doab A, Romero B, Fitzpatrick L, Fry M. The Emergency Department Response to Females Experiencing Intimate Partner Violence: Insights From Interviews With Clinicians In Australia. Academic Emergency Medicine. 2019;26(9):1052-1062.