August 22, 2023
Written by Audrey Smith
Intimate partner violence is a significant public health concern in the United States and a leading nonobstetric cause of maternal morbidity and mortality. It can take on many forms, including physical, emotional and sexual abuse as well as patterns of behavior that seek to gain or maintain control over a partner.
Many people experience intimate partner violence for the first time or experience an intensification of violence during pregnancy. Maternal experiences of intimate partner violence are associated with higher rates of preterm birth, lower birth weights and lower rates of breastfeeding. The risk of the most severe outcome, homicide perpetrated by an intimate partner, is also heightened around the time of pregnancy and childbirth, with approximately 60% of homicides that occur around the time of pregnancy related to intimate partner violence. This gives health care providers a uniquely important opportunity to screen their pregnant patients and offer assistance during health care visits.
Since 2012, the American College of Obstetricians and Gynecologists has recommended regular screening for intimate partner violence during pregnancy and postpartum. Despite this, screenings for intimate partner violence aren’t consistently provided to all patients of childbearing age.
Associate Professor in the Department of Health Policy and Management Valerie Lewis, PhD, recently published the first in a set of research studies evaluating the role health care providers play in interventions for patients experiencing intimate partner violence. Along with collaborators at the University of Michigan and University of Minnesota, Lewis analyzed 2016-2019 data from the Pregnancy Risk Assessment Monitoring System (PRAMS), which surveys postpartum individuals between 2 to 6 months after childbirth. The PRAMS survey asked whether a partner or ex-partner physically hurt the respondent in any way either before or during pregnancy. The survey also asked whether they had health care visits during the 12 months before pregnancy, prenatal care visits, or any health care visits postpartum. If they reported a health care visit, respondents were asked whether a health care worker asked if someone was hurting them emotionally or physically.
The study found that there are two primary groups experiencing intimate partner violence who aren’t being screened for it. The first group is those who don’t receive regular health care visits during their pregnancy, so there is little opportunity for screening. Those in this group are largely disadvantaged and are disproportionately Indigenous, Hispanic, from rural areas, uninsured or on Medicaid. The second group not being consistently screened is generally more advantaged and is mostly comprised of white married women who are privately insured.
“There are a lot of stereotypes and misperceptions around who experiences intimate partner violence,” said Lewis. “I hope that our research will help improve outcomes by highlighting the need for both stronger policies that improve access to health care and improved processes within health care to make sure no one slips through the cracks when it comes to screening for intimate partner violence.”
The stakes are high when it comes to addressing intimate partner violence. Additional research from Lewis and her collaborators will continue to explore the role that the health care system can play in screening for intimate partner violence and improving outcomes for patients.
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