Intimate Partner Violence in Pregnancy

Intimate Partner Violence in Pregnancy

Intimate Partner Violence during Pregnancy

It is a socially unconscionable and truly terrible reality that many women in America are subjected to physical violence and other forms of emotional and psychological abuse during their pregnancy. it's enough of an injustice that any woman should be physically abused by an intimate partner at any time; but the nine-month period in a woman's life when she is pregnant is psychologically a very sensitive, important time for her; the notion of abuse being visited upon her by her partner shows his cowardice, cruelty, and besides being a felony, is brutally unfair.

According to a study conducted by Michigan State University (Huth-Bocks, et al., 2004), which was published by the Michigan Association for Infant Mental Health in the Infant Mental Health Journal, during pregnancy a woman develops very significant "attitudes toward and representations of her developing infant." Women, the study explains, "...gradually develop rich and specific representations of their infants" as their pregnancy moves forward. And a good many of those representations that the fetus is being affected by "are constructed from mothers' own experiences in relationships." This is a key time for a woman to bond with her unborn.

And with that in mind, an ideal pregnancy for a woman would be one in which life is routine, peaceful, and full of positive experiences that the mother wishes for her child; any physical or other cruel forms of abuse she may encounter during her pregnancy is an unacceptable infringement into her life, and into the emerging relationship with her child; and that abuse she is forced to put up with, can, in many cases, have a debilitating impact on the yet-to-be-born baby. This paper reviews scholarly research literature on many facets of the issue.

The Available Statistics on Intimate Partner Violence

According to a research study administered by the National Institute of Justice, a part of the U.S. Department of Justice (Tjaden, et al., 1998), of the 8,000 women surveyed, fifty-two percent said they have been physically assaulted by an adult male during their lifetimes. In a more recent study published by the highly regarded U.S. General Accounting Office (GAO, 2002) ("Violence Against Women: Data on Pregnant Victims and Effectiveness of Prevention Strategies Are Limited"), the GAO asserts that violence against women - whether pregnant or not - includes "hitting, pushing, kicking, sexually assaulting, using a weapon, and threatening violence." Violence can also include "verbal or psychological abuse, stalking, or enforced social isolation" - i.e., preventing the woman from interacting with friends, family.

The Center for Disease Control's (CDC) PRAMS ("Pregnancy Risk Assessment Monitoring System"), according to the GAO report, has no "current national estimate measuring the prevalence of violence during pregnancy." The CDC is attempting to be more productive in terms of collecting data regarding violence against women, however: whereas only 5 states collected data in 1987, in 2001, some 32 states and Washington, D.C. received grants that were awarded specifically for the collection of data regarding "maternal behaviors, such as the use of alcohol and tobacco, and experiences - including physical abuse - before, during, and immediately following pregnancy."

The FBI and the CDC gather information on homicides nationally, but neither agency collects data on whether female victims of homicide were pregnant; that having been said, some 17 states (plus New York City and Puerto Rico) report the pregnancy status of the woman on death certificates, albeit those data are not always "comparable" because some of the victims were only "recently pregnant." And among the states that keep "recently pregnant" data, the word "recently" ranges from 42 days into the pregnancy to one year following delivery of the baby. Further confusing matters with reference to death certificates reflecting pregnancy, "researchers have reported that physicians completing death certificates after a pregnant woman's death failed to report that the woman was pregnant" or was recently pregnant in "at least 50% of the cases."

On the subject of physicians not being as thorough as they could be on issues of violence and pregnancy, the GAO report indicates that "fewer than half of physicians routinely screen women for violence during pregnancy." The more likely setting is the prenatal doctor's office: if a doctor suspected a patient was being abused, he or she asked her about that. In the 15 states that provided PRAMS data for 1998, between 25 and 40% of pregnant women responding to a questionnaire said a health care provider did speak with them about intimate partner violence during prenatal visits.

The Literature on Violence against Pregnant Women

An Empirical Study by Michigan State University: In the Huth-Bocks article, mentioned in the Introduction, the authors report that pregnancy is a time when the woman "reorganizes a woman's relationship with her own mother" (81). and, a mother's "mental representations of self and others," the report continues, are made active and "reworked" during her pregnancy; in particular "after the first trimester" when the fetus becomes like a "real baby" to the mother. In setting up their research on what happens to a pregnant woman who is abused - and later, to her child - the authors write that there are three sets of representations that are particularly important for an expectant mother during pregnancy, according to the article: a) "representation of her own mother and her own attachment experiences"; b) "representations of her infant"; and c) "representations of herself as a mother" (82).

Mothers, the research shows, "conceptualized and organized their relationship with their babies during pregnancy in ways that were similar to the way mothers conceptualized their relationships with their own mothers." (in other words, it is healthy and natural for the mother to visualize how she wants her child to turn out, emotionally and physically, at different periods in the child's future life.) and using the Working Model of the Child Interview (WMCI), developed for clinical purposes to assess maternal representations of the infant, mothers "of securely attached babies" had significantly higher ratings on the WMCI when it came to "richness in perceptions, openness to change, narrative coherence, and care-giving sensitivity."

In fact, when the WMCI was given to 96 pregnant women, and then re-administered to those same women when their child was 1-year-old, the results reflected a "significant concordance" between what the mother "represented" (visualized, projected) of their infants during pregnancy" and how that child actually is evolving as a young person. So, there is clinical, empirical evidence of a firm connection between how mothers are able to perceive their unborn children, and how they indeed "perceive and interact with their children after they are born."

Those facts having been presented, the article goes on to report that the newborn child of a woman who has been battered or otherwise had violence visited upon her, is also a victim. "Clearly domestic violence is a traumatizing experience that often is chronic and repetitive and has a myriad of negative consequences for its victims." The research suggests that "domestic violence occurs in the context of a significant attachment relationship" (an intimate partner), which very likely influences "the victim's capacity for relatedness and her internal working model of herself" and her child.

Moreover, when pregnant, women are "forming and reorganizing representations of others, themselves as care givers, and their infants." What is tragic when a woman is beaten or slapped repeatedly during pregnancy, is that "the pregnancy itself and the growing, moving fetus may be perceived as threatening at times." This could be true because the fetus "may re-evoke aspects of the trauma associated with being battered by a partner." Even harmless acts by an infant, the article continues, "may trigger the attachment system and dysregulated feelings if the acts resonate with the parent's experience of trauma."

The study conducted by Michigan State University involved 206 pregnant women, 18 to 40 years of age, in their last trimester, who were involved in some kind of romantic relationship for at least 6 weeks during the pregnancy. Forty-four percent of the women in the study reported domestic violence (DV) during the current pregnancy, and 56% reported no DV. The battered group on the whole tended to be "significantly younger, less educated," and more often they were unmarried than the "non-battered women" were.

Meanwhile, results showed that the representations of women who experienced violence were characterized by the following: "less flexibility or openness to change; less coherence; less caregiving sensitivity; less acceptance of the child; greater perceived infant difficult; less joy; more anger; more anxiety; more depressive affect; and less feelings of self-efficacy as a caregiver."

Maternal and Child Health Journal: An examination of abused pregnant women in 16 states: Another study shows that approximately 3.9 million American women experienced "live births" in 1998, according to a recent study (Saltzman, et al., 2003); and among those women an estimated 152,000 to 324,000 - approximately 4 to 8% - were abused ("experienced violence" against them). The research article published in Maternal and Child Health Journal reports that in a majority of states from which data were available, "the prevalence of physical abuse by a husband or partner during pregnancy was higher among women having less than 12 years of education and women who were Medicaid recipients."

As to the statistics on violence against women in terms their ethnicity, the report indicated "no consistent pattern" with regard to race. Regarding abuse visited upon a woman in the year preceding her pregnancy, estimates range from 4 to 26% of the females indeed were abused in that time frame, according to the study. Clearly, there is a wide gap in these estimates, indicating the need for additional research.

Meanwhile, is there evidence that a woman's risk of being physically abused increases during her pregnancy? Saltzman's article explains that though "statements are commonly made that the incidence of abuse escalates" during the time a woman is carrying a baby, "little is actually known" regarding those generalized assumptions. Much of the information that has been brought forward with reference to that issue is "anecdotal evidence" or "small studies with self-selected participants"; these studies have not, the writer asserts, been on "comparisons of pregnant women to women who are not pregnant."

Saltzman also reports that a recent "multivariate analysis using longitudinal data from the national Survey of Families and Households" - in other words, a study that can be verified and is not anecdotal - shows that "pregnant women are not any more or less likely to suffer intimate partner violence than women who are not pregnant."

The PRAMS research that was done (PRAMS was alluded to earlier to in this paper) in order to collect more "self-reported maternal behaviors and experiences" which occur before, during, and after pregnancy, uses the information gathered in four ways: a) describes the levels and patterns of abuse; b) describes the demographic; c) describes any stressful circumstances around the time of pregnancy; d) describes a woman's relationship to her abuser.

Each month in each of the states monitored through PRAMS (currently 32 states, but this study involved only 16 states), a "stratified sample of 100-250 new mothers" was selected from birth certificates, and the mother received a 14-page questionnaire 2-6 months following her delivery. The follow-up by research to the questionnaire was substantial and thorough.

The 16-state findings: "we found the prevalence of abuse across 16 states 7.2% before pregnancy, 5.3% during pregnancy, and 8.7% around the time of pregnancy (before or during pregnancy or at both times)." In all, 64,994 women were involved in the study; half of them were between 20 and 29 years of age; two-thirds were married; for less than half (42%) it was their first birth; 76.6% were white, 19% were black and the remainder were Latino, Native American, and Asian/Pacific Islander.

By far the most frequent perpetrator of abuse on pregnant women, the study showed, was a "husband or partner" - 75% of the abusers - and only 5.4% of pregnant women were abused by "a family member, friend, or someone else into a single perpetrator group for comparison purposes."

Society for Pediatric and Perinatal Epidemiologic Research: Are abused women more or less likely to use health care services during pregnancy? North Carolina's Pregnancy Risk Assessment Monitoring System surveyed 2,648 recently postpartum women (Martin, 2002); and the prevalence of physical abuse was 6.1% during pregnancy and 6.9% in the year before pregnancy. The study showed that abused women were "less likely" than non-abused women to "receive particular types of services during pregnancy," services such as prenatal care and classes for childbirth procedures. However, abused women were "more likely" than non-abused women to seek services like home health visits, "hospitalizations during pregnancy" and also services related to nutrition.

American Family Physician: Abuse During Pregnancy Linked to Smaller, Premature Newborns: A cross-sectional study of 372 postpartum women in the Philippines revealed that 19.4% had been physically abused during pregnancy, and 9.4 had been sexually abused during pregnancy. And significantly, the newborn babies of the abused women - within both categories - had lower birth weight, shorter birth length and smaller chest circumference measurements than the babies of non-abused mothers. The women who were abused suffered from "higher incidences of stillbirths" and more of their babies were born preterm (Neff, 2000).

Who were the primary perpetrators of the violence against this group of women? Husbands (33%), live-in partners (30.5%), and parents (29%) were accused, in that order, by the women, of visiting the violence upon them. The abused women were more likely to be unemployed (95.8%), to be younger (66.6%), to be less educated (41.7%), and to have "unemployed spouses (31.9%).

Maternal and Child Health Journal: Pregnant Adolescents: Experiences and Behaviors Associated with Physical Assault by an Intimate Partner: This research project involved 724 postpartum adolescents (up to 18 years of age) and was conducted between 1994 and 1996 (Wiemann, 2000); those taking part in the study: had to be either African-American, White, Mexican-American; had to be able to read and write at a 5th grade level in either English or Spanish; had to assure the researchers they planned to "retain custody" of their babies; had no "major psychiatric disorder"; had delivered an infant weight at least 1500 grams; and had to assure researcher they were not intimately involved with anyone other than the fathers of their babies at the time of delivery.

The study sample included 287 Mexican-Americans, 220 African-Americans, and 217 Caucasians, and each subject was interviewed privately for one hour, within 48 hours of their delivery. The results showed that of the 724 adolescent mothers, 210 (29%) had "experienced some type of physical violence" during the previous year. Eighty-six (11.9%) reported that they had been "physically assaulted by the father of their babies."

Also, 124 of the adolescents (16.9%) reported having being "physically assaulted by a family member or other relative or having been in a fight where someone was badly hurt." Of those partner abuses, 15% were reported by African-American adolescents, 11% by Caucasians, and 10% by Mexican-Americans. Interestingly, adolescent mothers who had been violently assaulted "had achieved, on average, a higher mean number of years of education," and had indicated a "lower level of both family and partner social support than those who were not assaulted."