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Violence and Reproductive Health: Maternal and Child Health Journal
special issue |
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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
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PRAMS
A surveillance project of CDC and state health departments. PRAMS collects state-specific,
population-based data on maternal attitudes and experiences prior to, during
and immediately following pregnancy.
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