Back to Violence and Reproductive Health

Source: Maternal and Child Health Journal, Vol. 4, No. 2, 2000

Violence and Reproductive Health: Current Knowledge and Future Research Directions
Julie A. Gazmararian, Ruth Petersen, Alison M. Spitz, Mary M. Goodwin, Linda E. Saltzman, and James S. Marks

Objective: This study examines whether unintended pregnancy is associated with physical abuse of women occurring around the time of pregnancy, independent of other factors. Methods: In 1996–1997, state-specific population-based data were obtained from the Pregnancy Risk Assessment Monitoring System (PRAMS) from 39,348 women in 14 states who had delivered a live-born infant within the previous 2–6 months. The study questionnaire asked about maternal behaviors and characteristics around the time of pregnancy. Results: Women who had mistimed or unwanted pregnancies reported significantly higher levels of abuse at any time during the 12 months before conception or during pregnancy (12.6% and 15.3%, respectively) compared with those with intended pregnancies (5.3%). Higher rates of abuse were reported by women who were younger, Black, unmarried, less educated, on Medicaid, living in crowded conditions, entering prenatal care late, or smoking during the third trimester. Overall, women with unintended pregnancies had 2.5 times the risk of experiencing physical abuse compared with those whose pregnancies were intended. This association was modified by maternal characteristics; the association was strongest among women who were older, more educated, White, married, not on Medicaid, not living in crowded conditions, receiving first trimester prenatal care, or nonsmoking during the third trimester. Conclusions: Women with unintended pregnancies are at increased risk of physical abuse around the time of pregnancy compared with women whose pregnancies are intended. Prenatal care can provide an important point of contact where women can be screened for violence and referred to services that can assist them.

Pregnant Adolescents: Experiences and Behaviors Associated with Physical Assault by an Intimate Partner
Constance M. Wiemann, Carolyn A. Agurcia, Abbey B. Berenson, Robert J. Volk, and Vaughn I. Rickert 

Objective: To better understand the experiences and behaviors of battered pregnant adolescents and the characteristics of their intimate partners. Methods: As part of a longitudinal multiracial/ethnic study of drug use among pregnant and parenting adolescents, 724 adolescents £18 years of age completed face-to-face interviews on the postpartum unit between April 1994 and February 1996. Adolescent mothers reported on demographic characteristics, social support and peer contact, level of substance use before and during pregnancy, nonconforming behaviors, and both lifetime and concurrent exposure to violence. Information about the father of her baby included his level of substance use, gang and police involvement, and intimate partner violence. Chi-square and Student’s t tests were used to identify victim, partner, and relationship characteristics associated with being assaulted by the father of her baby during the preceding year. Results: Eighty-six (11.9%) adolescents reported being physically assaulted by the fathers of their babies. Assaulted adolescents were significantly more likely than nonassaulted adolescents to have been exposed to other forms of violence over the same 12-month period, including verbal abuse, assault by family members, being in a fight where someone was badly hurt, reporting fear of being hurt by other teens, witnessing violence perpetrated on others, and carrying a weapon for protection. A history of nonconforming behavior and frequent or recent substance use was more common among both battered adolescents and their perpetrator partners. The age and race/ethnicity of the pregnant adolescent and the length of her relationship with the father of her baby were not associated with assault status. Conclusions: Pregnant adolescents who are assaulted by intimate partners appear to live in violence-prone environments and to have partners who engage in substance use and other nonconforming behaviors. Comprehensive assessments are critical for all adolescent females at risk of assault, and direct questions about specific behaviors or situations must be used.

Women, Violence, and HIV: A Critical Evaluation with Implications for HIV Services
Linda J. Koenig  and Jan Moore 

Objective: Violence is highly prevalent among women with HIV. Determining whether HIV is causally related to violence, and whether risk for violence is increased by certain HIV prevention practices, has been difficult. Methods: We review recent literature concerning (1) violence and HIV serostatus, including the risk for violence associated with disclosure of a positive serostatus, and (2) violence associated with requests that male sex partners use condoms. Results: Studies suggest that women with or at risk for HIV come from populations that are also at risk for violence. Violence is not statistically increased among HIV-infected women compared to demographically and behaviorally similar uninfected women. However, for a small proportion of women, violence may occur around disclosure or in response to condom negotiation. Conclusions: Integrating violence screening and referral into HIV services could help many women obtain the assistance they need while minimizing the risk for violence that may be associated with partner notification or condom requests.

Women’s Lives After an HIV-Positive Diagnosis: Disclosure and Violence 
Andrea Carlson Gielen, Karen A. McDonnell, Jessica G. Burke, and Patricia O’Campo 

Objectives: This research addresses four questions: (1) What role do health care providers play in women’s disclosure to others of their HIV-positive status? (2) What are women’s concerns and experiences with disclosure? (3) What violence do women living with HIV experience? (4) How is the violence related to their diagnosis and disclosures? Methods: Participants were 310 HIV-positive women enrolled in an HIV primary care clinic in an urban teaching hospital. Women were interviewed once using both quantitative and qualitative methods. Results: Women had known they were HIV-positive for an average of 5.8 years; 22% had an HIV-positive partner; 58% had disclosed their status to more than 10 people; and 68% had experienced physical abuse and 32% sexual abuse as an adult. Fifty-seven percent of the sample reported that a health care provider had told them to disclose to their sex partners. Women who were afraid of disclosure-related violence (29%) were significantly more likely than those who were not to report that a health care provider helped them with disclosure (21% vs. 10%). Although 4% reported physical abuse following a disclosure event, 45% reported experiencing emotional, physical, or sexual abuse at some time after their diagnosis. Risk factors for experiencing abuse after diagnosis were a prior history of abuse, drug use, less income, younger age, length of time since diagnosis, and having a partner whose HIV status was negative or unknown. Conclusions: Identifying women at risk for abuse after an HIV-positive diagnosis is important for those who provide HIV testing and care. Routine screening for interpersonal violence should be incorporated into HIV posttest counseling and continuing primary care services.

Sexual Violence and Reproductive Health 
Pamela M. McMahon, Mary M. Goodwin, and Gayle Stringer 

Sexual violence is a significant public health problem, and has been linked to adverse effects on women’s physical and mental health. Although some advances in the research have been made, more scientific exploration is needed to understand the potential association between sexual violence and women’s reproductive health, and to identify measures that could be implemented in reproductive health care settings to assist women who have experienced sexual violence. Three general areas needing further study include (1) expansion of the theoretical frameworks and analytic models used in future research, (2) the reproductive health care needs of women who have experienced sexual violence, (3) and intervention strategies that could be implemented most effectively in reproductive health care settings.

The Relationship Between Sexual Abuse and Sexual Risk Among High School Students: Findings from the 1997 Massachusetts Youth Risk Behavior Survey
Anita Raj, Jay G. Silverman, and Hortensia Amaro

Objective: To assess whether adolescents with a history of sexual abuse were more likely than those with no such history to engage in sexual risk behaviors. Methods: Data for this study were obtained through the 1997 Massachusetts Youth Risk Behavior Survey, a self-report questionnaire administered to a representative sample of 9th through 12th graders (N = 4014) to assess a variety of adolescent risk behaviors. Only sexually experienced adolescents (n = 1610; female = 779, male = 831) were included in the present study. Logistic regression models were constructed to examine the relationship of sexual abuse history to sexual risk behaviors. Adolescents were considered as having a history of sexual abuse if they reported ever having had sexual contact against their will. Results: Almost one-third of sexually experienced adolescent girls (30.2%) and one-tenth (9.3%) of adolescent boys reported a history of sexual abuse. After controlling for related demographics and risk behaviors, sexually abused female students were significantly more likely than those without such a history to have had earlier first coitus (OR = 2.2, 95%CI = 1.46–3.47), to have had three or more sex partners ever (OR = 2.5, 95%CI = 1.71–3.68), and to have been pregnant (OR = 1.9, 95%CI = 1.21–2.92). Sexually abused male students were significantly more likely than those without such a history to have ever had multiple partners (OR = 3.2, 95%CI = 1.56–6.57), to have had multiple sex partners in the past 3 months (OR = 2.9, 95%CI = 1.71–3.68), and to have engaged in sex resulting in pregnancy (OR = 3.4, 95%CI = 1.53–7.34). Conclusion: Both adolescent girls and boys with a history of sexual abuse report greater sexual risk-taking than those without such a history. However, although sexual abuse is more prevalent among girls than boys, the impact of sexual abuse on sexual risk appears to be even greater for boys. Programs addressing both sexual abuse and sexual risk must be made available to all adolescents.

Violence Against Women and Reproductive Health: Toward Defining a Role for Reproductive Health Care Services 
Linn Parsons, Mary M. Goodwin, and Ruth Petersen

Since a large proportion of U.S. women receive reproductive health care services each year, reproductive health care settings offer an important opportunity to reach women who may be at risk of or experiencing intimate partner violence (IPV). Although screening women for IPV in clinical health care settings has been endorsed by national professional associations and organizations, scientific evidence suggests that opportunities for screening in reproductive health care settings are often missed. This commentary outlines what is known about screening and intervention for IPV in clinical health care settings, and points out areas that need greater attention. The ultimate goal of these recommendations is to increase the involvement of reproductive health care services in sensitive, appropriate, and effective care for women who may be at risk of or affected by IPV.

Physicians’ Screening Practices for Female Partner Abuse During Prenatal Visits 
Linda Chamberlain  and Katherine A. Perham-Hester

Objective: Our purpose was to examine physicians’ screening practices for female partner abuse during prenatal visits and to identify barriers to screening. Methods: A self-administered questionnaire was developed to collect data on physicians’ screening practices and their beliefs about screening for female partner abuse. The survey was mailed to all primary care physicians practicing in Alaska. The response rate was 80% (305/383). These analyses were limited to physicians who indicated that they provided prenatal care (n = 157). Results: More than one-half of respondents providing prenatal care estimated that 10% or more of their female patients had experienced abuse. Less than one-half of respondents had recent training on partner abuse. Only 17% of respondents routinely screened at the first prenatal visit and 5% at follow-up visits. Respondents were more likely to screen at the first prenatal visit compared to follow-up visits. Multivariate analyses failed to support any associations between physicians’ characteristics and screening practices. Physicians’ perception that abuse was prevalent among their patients and physicians’ belief that they have a responsibility to deal with abuse were the only variables that were independently associated with screening at prenatal visits. Other barriers frequently cited in the literature were not predictive of screening. Conclusion: Most Alaskan physicians do not routinely screen for abuse during prenatal visits. Medical education should increase physicians’ index of suspicion for abuse, emphasize physicians’ responsibility to address partner abuse, and reinforce the importance of routine screening throughout the pregnancy. More research is needed to identify barriers to screening and strategies for integrating routine screening into prenatal care.

Future Directions for Violence Against Women and Reproductive Health: Science, Prevention, and Action
Jacquelyn C. Campbell, Kathryn E. Moracco, and Linda E. Saltzman 

Despite the recognition that violence may be associated with serious consequences for women’s reproductive health, the understanding of the relationship between the two remains limited, as does our understanding of the most effective role for reproductive health care providers and services. This paper briefly summarizes the history of the nexus of public health, health care, and violence against women in the United States. In addition, we present some considerations for future directions for research, health care practice, and policy that will advance the understanding of the complex relationship between violence and reproductive health.

Date last reviewed: 04/17/2006
Content source: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion