Intimate Partner Violence Before Pregnancy in New Hampshire

New Hampshire

The Centers for Disease Control and Prevention (CDC) defines intimate partner violence (IPV) as physical violence, sexual violence, stalking or psychological aggression (including coercive tactics) by a current or past intimate partner (spouse, boyfriend/girlfriend, dating partner or continuous sexual partner). IPV can lead to lasting physical and mental health issues, and women who experience IPV before or during pregnancy are less likely to receive adequate prenatal care. Additionally, more than half of all female homicides are related to IPV, and approximately 10% of women killed by an intimate partner experienced violence sometime during the month before their deaths. 

According to the National Intimate Partner and Sexual Violence Survey, 42% of women in the United States report experiencing some form of IPV in their lifetime. The true prevalence of IPV is unknown due to underreporting. Underreporting may also be higher among certain populations, as cultural background, socioeconomic status and age affect whether and how individuals talk about IPV. 

Risk factors for IPV include conflict or economic stress within a relationship and male dominance in the family. Individuals who experience IPV before or during pregnancy are at increased risk of:

• High blood pressure and edema.
• Severe nausea, vomiting and dehydration.
• Kidney and urinary tract infections.
• Hospital visits.
• Delivering preterm or low birth weight infants.
• Giving birth to infants who require intensive unit care.

A 2017 study calculated the lifetime cost of intimate partner violence at $103,767 per female victim, representing a total economic burden of $3.6 trillion.

The prevalence of intimate partner violence is higher among:

• Divorced, separated and single women compared with married women. 
• Women whose parents have less than a high school education compared with women whose parents have higher levels of education.
• Non-Hispanic Black, American Indian/Alaska Native and multiracial women compared with all other racial and ethnic groups. 
• Younger women compared with older women.

The U.S. Preventive Services Task Force recommends that clinicians screen all women of reproductive age for IPV and connect women who screen positive to intervention services. 

In a survey of women who had recently given birth, more than half of those who reported physical partner violence said they were not screened for IPV in the 12 months before pregnancy. Barriers to screening include time constraints during a visit, personal discomfort and not knowing what to do if a patient is experiencing IPV. In response, the CDC has developed shorter IPV screening questionnaires and is working on further guidance for assisting patients who are experiencing IPV. For example, asking specific behavioral questions and avoiding loaded terms like “abuse” can improve the outcome of IPV screenings. The CDC provides further resources for those who may be experiencing IPV.

There are several strategies for preventing IPV early in the pipeline, such as: 

• Teaching social-emotional, conflict management and communication skills. 
• Preventing negative developmental pathways that could lead to future violence by increasing education around parenting skills and healthy family relationships. 
• Creating protective social environments in schools, neighborhoods and workplaces.
• Improving financial security for low-income families. 
• Increasing survivor supports such as victim-centered advocacy and health care services, housing programs and legal and law enforcement protections.

Healthy People 2030 has identified the need to reduce intimate partner violence as an important public health issue and currently has an objective in developmental status.

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