Intimate Partner Violence Linked to Pregnancy Termination

Diedtra Henderson

January 08, 2014

Women who sought pregnancy termination were more likely to report intimate partner violence (IPV) than women who had not sought pregnancy termination, according to a recent meta-analysis of 23 studies. Women in violent relationships also were more likely to conceal their abortions from partners.

Megan Hall, from the Women's Health Academic Centre, King's College London, United Kingdom, and coauthors published their findings online January 7 in PLoS Medicine.

IPV occurs at varying rates across the globe, with lifetime exposure estimates ranging from 15% in Japan to 24% in the United Kingdom, 35% in the United States (including stalking), and 71% in Ethiopia, the authors write. The prevalence of forced sex within intimate relationships ranges from 5.9% to 42%.

The researchers reviewed 74 studies of varying quality that had appeared in peer-reviewed publications and included 23 published between 1985 and 2013 in their meta-analysis to determine whether there was an association between IPV and termination of pregnancy (TOP). The papers described studies conducted in North America, Asia, Europe, Africa, Australasia, and South America, with sample sizes ranging from 8 to 33,385 study participants.

Within the group, lifetime prevalence of IPV among women seeking to terminate pregnancies was 24.9%. Among women who terminated pregnancies, researchers found an association between reported IPV and depression, suicidal ideation, stress, and disturbing thoughts. One study, conducted via telephone interviews with more than 4000 women, found that more than 46% of 616 reported rapes were perpetrated by the husband or boyfriend. Women in violent relationships were more likely to have a history of multiple TOPs, according to 9 of the studies.

"The literature also suggests that women in abusive relationships were more likely to report inability to make autonomous contraceptive choices, partner contraceptive sabotage, and sexual violence, and they were less likely to have informed their partner about the pregnancy or involved him in decision-making about it," the authors write. "IPV was cited as a reason for wanting TOP, and rape-related pregnancy had a particularly high chance of leading to TOP."

The American College of Obstetricians and Gynecologists (ACOG) is among myriad organizations that have issued guidance for clinicians whose patients could be subjected to IPV. An ACOG committee opinion issued in February 2012 notes that healthcare providers are "often the first professionals" to offer care to abused women and recommends that pregnant women be screened for IPV during the first prenatal visit, once per trimester, and during the postpartum check-up.

"Obstetrician–gynecologists are in the unique position to provide assistance for women who experience IPV because of the nature of the patient–physician relationship and the many opportunities for intervention that occur during the course of annual examinations, family planning, pregnancy, and follow-up visits for ongoing care," the opinion states.

Lindsay E. Clark, MD, from Bridgeport Hospital in Connecticut, told Medscape Medical News she is hopeful the meta-analysis will trigger additional screening for IPV because of all the adverse health outcomes associated with such abuse. Dr. Clark, who is enrolled in a fellowship training program in minimally invasive gynecologic surgery at the hospital, presented the results of her study, which found that reproductive coercion with IPV is prevalent among obstetric-gynecologic patients, regardless of socioeconomic status, during ACOG's annual clinical meeting in May 2013.

The study "highlights the importance of doing what ACOG and a lot of organizations have been recommending this whole time: Trying to screen for domestic violence, screen for [IPV]," Dr. Clark told Medscape Medical News. "We should screen everyone. It can happen to anyone. Any woman can be in these kinds of situations."

The authors recommend that healthcare professionals pay heed to the high rates of physical, sexual, and emotional violence among women seeking to terminate pregnancies. They also call for termination services to have robust policies for ensuring women's safety and confidentiality and to provide "one stop" access to screening or information about IPV and referrals to specialist IPV services.

"Given that routine identification of women experiencing IPV and provision of a standard intervention has recently been shown to have no impact on quality of life or mental well-being, there is now a need for considering new strategies, including alternative intervention models and targeting perpetrators as well as the women affected," the authors conclude.

One author disclosed receiving research funding from the Economic and Social Research Council, Guys & St Thomas' Charitable Foundation, and Friends of Guys Charity and being a paid advisor for Marie Stopes International. Another author disclosed serving as a freelance associate editor for PLoS Medicine. The other authors and the commentator have disclosed no relevant financial relationships.

PLoS Med. Published online January 7, 2014. Full text

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