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Intimate Partner Violence During Pregnancy. A Guide for Clinicians

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Facts About Intimate Partner Violence (IPV)

• Affects approximately 1.5 million women each year

• Affects as many as 324,000 pregnant women each year

• May be more common than conditions for which pregnant women are routinely screened

• Possibly associated with unintended pregnancy, delayed prenatal care, smoking, alcohol and drug abuse

Notes:
The facts about intimate partner violence and its effects on women’s health are alarming. Each year, approximately 1 and a half million women in the United States report a rape or physical assault by an intimate partner.¹ This number includes as many as 324,000 women who are pregnant when violence occurs.² These numbers probably underestimate the true magnitude of the problem because we know that most incidents are never reported.

Violence during pregnancy may be a more common problem than conditions for which pregnant women are routinely screened.3 Studies have found possible associations between intimate partner violence and unintended pregnancy, delayed prenatal care, and behavioral risk factors such as smoking and alcohol and drug abuse.^3,4,5

Reproductive health care services are used routinely by millions of women each year and can provide an important point of contact during which screening for intimate partner violence and appropriate intervention or referral can occur. The purpose of this presentation is to suggest ways that you as a clinician can play a vital role in this effort.

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All Women Are At Risk

Victims of IPV come from every:

• Age group
• Religion
• Ethnic/racial group
• Socioeconomic level
• Educational background
• Sexual orientation

Notes:
Why should providers screen every woman for intimate partner violence?

Although we know that not all women experience violence, we also know that violence against women frequently is unrecognized and unreported. We also know that there is no single profile of an abused woman or of a perpetrator. 

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Window of Opportunity

• 96% of pregnant women receive prenatal care

• Average of 12–13 prenatal care visits

• Opportunity to develop trust in health care providers

Notes:
For many women, pregnancy may present a unique opportunity for repeated contact with health care providers. For this reason, pregnancy can be an important window of opportunity to identify patients experiencing violence and refer them to the appropriate services. This is true for women who are experiencing violence for the first time during pregnancy and for those who are experiencing ongoing violence. 

In the United States, 96% of women who have a live birth receive prenatal care. Most receive prenatal care within the first or second trimester of pregnancy. On average, pregnant women are seen for 12 or 13 prenatal visits.6 

The frequency of these visits offers an opportunity to develop trust between the patient, her health care provider, as well as other staff. Trust is a key factor in a woman’s decision to disclose information about intimate partner violence.

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Window of Opportunity

During pregnancy, victims of IPV may be motivated by the:

• Desire to be a good parent

• Desire to prevent child abuse

• Opportunity to think about the future

Notes:
For a victim of intimate partner violence, the desire to be a good parent and to protect her child from possible abuse can be a powerful motivator for change in her life. Although the effect of pregnancy on a woman’s decision making is unknown, for some women, it is a time to think about the future.

As clinicians, you can serve an important role as advocates for change in a woman’s life by offering information, compassion, and support. The act of screening itself may be a key intervention that can help a woman begin to improve the quality of her life.7

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Intimate Partner

Current or former:

• Spouse

• Partner

• Boyfriend

• Girlfriend

Notes:
The term intimate partner violence is also known as domestic violence, spouse abuse, or woman abuse. Before we can talk about intimate partner violence and how it may relate to pregnancy, it is necessary to define what we mean by an intimate partner and what we mean by violence. 

About three quarters of acts of violence against women older than age 18 are perpetrated by a current or former husband, cohabitating partner, or date.1 In other cases, the perpetrator is another family member, such as a parent or guardian, or a more casual acquaintance. 

We define “intimate partner” as a current or former partner, including a spouse, boyfriend, or girlfriend.8 Because many women continue to be at risk for violence after a relationship ends, it is essential to ask about former partners, such as divorced or separated spouses, and former boyfriends, or girlfriends.

Intimate partners can be the opposite or the same sex as the victim.

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Violence

Coercive control exhibited through:

• Physical violence

• Sexual violence

• Threats of physical or sexual violence

• Psychologic or emotional abuse

Notes:
Intimate partner violence can be expressed through many types of violent behavior. Its hallmark is coercive control, which includes actual physical or sexual violence, threats of physical or sexual violence, and psychologic or emotional abuse. Often, psychologic and emotional abuse occur along with physical or sexual violence.

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Physical Violence

Intentional use of force, such as:

Notes:
Physical violence is defined as the intentional use of force with the potential for causing injury, harm, or death. It includes, but is not limited to, these acts: 

It also includes coercing other people to commit such acts. Again, violence can be actual or threatened.

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Sexual Violence

• Actual or threatened use of physical force to compel a person to engage in a sexual act against her/his will
• Attempted or completed sex act with a person unable to:
  • avoid participation
  • communicate unwillingness
  • understand the nature of the act
• Abusive sexual contact

Notes:

Sexual violence generally consists of three categories: 

(Read slide text) 

Examples of abusive sexual contact include unwanted touching, fondling, or other sexual contact that does not necessarily involve intercourse. Rape with an object is also included in sexual violence.

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Psychologic and Emotional Abuse

• Humiliating, name-calling, using profanity
• Embarrassing victim deliberately—especially in public
• Controlling victim's movement and activities
• Isolating victim from friends and family
• Controlling financial resources
• Withholding information or resources

Notes:

(Read slide text) 

This is not a comprehensive list. Many other behaviors may be perceived by the victim as emotionally abusive. Breaking an object or threatening to harm a child or pet may be as effective at controlling a victim as is physical injury.

Date last reviewed: 03/21/2006
Content source: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion