Screening for and Experiences of Intimate Partner Violence in the United States Before, During, and After Pregnancy, 2016–2019

Katy B. Kozhimannil, PhD, MPA; Valerie A. Lewis, PhD; Julia D. Interrante, PhD, MPH; Phoebe L. Chastain, BA; Lindsay Admon, MD, MSc

Disclosures

Am J Public Health. 2023;113(3):297-305. 

In This Article

Abstract and Introduction

Abstract

Objectives: To measure rates of intimate partner violence (IPV) screening during the perinatal period among people experiencing physical violence in the United States.

Methods: We used 2016–2019 Pregnancy Risk Assessment Monitoring System data (n = 158 338) to describe the incidence of physical IPV before or during pregnancy. We then assessed the prevalence of IPV screening before, during, or after pregnancy and predictors of receiving screening among those reporting violence.

Results: Among the 3.5% (n = 6259) of respondents experiencing violence, 58.7%, 26.9%, and 48.3% were not screened before, during, or after pregnancy, respectively. Those reporting Medicaid or no insurance at birth, American Indian/Alaska Native people, and Spanish-speaking Hispanic people faced increased risk of not having a health care visit during which screening might occur. Among those attending a health care visit, privately insured people, rural residents, and non-Hispanic White respondents faced increased risk of not being screened.

Conclusions: Among birthing people reporting physical IPV, nearly half were not screened for IPV before or after pregnancy. Public health efforts to improve maternal health must address both access to care and universal screening for IPV. (Am J Public Health. 2023;113(3):297–305. https://doi.org/10.2105/10.2105/AJPH.2022.307195)

Introduction

Maternal morbidity and mortality are increasing in the United States, with some individuals and communities experiencing disproportionate risk, including Black or American Indian/Alaska Native people, low-income individuals, and rural residents.[1–4] Many recent public health efforts addressing maternal mortality have focused on clinical risk factors and the quality of hospital-based care, but maternal safety outside the clinical setting, including in homes and communities, is equally important.[5,6]

Intimate partner violence (IPV) is a leading nonobstetric cause of maternal morbidity and mortality.[7–11] IPV includes physical, emotional, and sexual violence and comprises patterns of behavior to gain or maintain power and control.[12] Although physical violence is a commonly recognized form of IPV, emotional and sexual violence are also harmful and prevalent. Examples of emotional violence are verbal insults, humiliation, isolation from friends and family, threats of harm, controlling finances, and monitoring communication or location. Examples of sexual violence are forcing or attempting to force a partner to take part in a sex act, sexual touching, and nonphysical sexual events (e.g., sexting) when the partner does not or cannot consent.[13,14] Maternal experiences of IPV are associated with higher rates of preterm birth, lower birth weights, and lower rates of breastfeeding.[11,15] Risk of the most severe outcome, homicide perpetrated by an intimate partner, is heightened around the time of pregnancy and childbirth.[7,8,16–18] Approximately 60% of homicides that occur around the time of pregnancy are related to IPV.[7]

People who give birth frequently interact with clinicians before, during, and after pregnancy, making health care a crucial setting for IPV screening and intervention. Since 2012, the American College of Obstetricians and Gynecologists has recommended regular IPV screening during pregnancy and postpartum, and in 2018, the US Preventive Services Task Force upgraded their recommendation for IPV screening for reproductive-aged individuals from I (insufficient evidence) to B (recommended), supporting universal screening nationally.[19,20] Screening and referral to treatment may attenuate maternal and infant health inequities that are exacerbated by experiences of violence.[21] Still, IPV screening is not consistently provided for all reproductive age patients in either primary care or maternity services.[19,22,23]

Understanding the extent to which birthing people experience physical violence and whether they are screened for IPV before, during, and after pregnancy will provide critical insight for public health services and policy. We measured IPV screening during the perinatal period among those experiencing physical violence in a large representative sample of US residents who gave birth, and we discuss strategies to reduce the inequities identified.

processing....