Intimate Partner Violence Before Pregnancy

Intimate Partner Violence Before Pregnancy in United States

United States

Intimate partner violence (IPV) describes any behavior, action or pattern of psychological, physical and/or sexual harm within an intimate relationship. IPV can lead to lasting physical and mental health issues. Additionally, over half of all female homicides are related to IPV, and approximately 10% of women killed by an intimate partner experienced violence in the month preceding their death. 

One study found that IPV is slightly more prevalent before pregnancy than during pregnancy. Though IPV exists in many forms, the majority of IPV research has focused on physical abuse. According to the National Intimate Partner and Sexual Violence Survey, around 1 in 4 women in the United States report experiencing some form of IPV in their lifetime. The true prevalence of IPV, however, is unknown due to underreporting.

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

• High blood pressure and edema.
• Vaginal bleeding.
• Severe nausea, vomiting or dehydration.
• Kidney and urinary tract infections.
• Hospital visits.
• Preterm delivery and delivering low birthweight infants.
• 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 IPV before pregnancy is higher among:

• Divorced, separated and single women compared with married women. 
• Women with lower incomes compared with those with higher incomes.
• Non-Hispanic Black women compared with non-Hispanic white women. Black and American Indian/Alaska Native women are disproportionately affected by IPV and are more likely to be killed by an intimate partner than white women. 
• 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. 

Studies have found that the majority of health care providers are not routinely screening women for IPV. Barriers to screening include time constraints during a visit, personal discomfort and not knowing what to do if a patient is experiencing IPV. As a result, the Centers for Disease Control and Prevention (CDC) has developed shorter screening questionnaires to identify IPV and is working to help health care providers assist patients who are experiencing IPV. Asking specific behavioral questions and avoiding loaded terms like “abuse” can improve the outcome of IPV screening. The CDC provides resources for those who may be experiencing IPV.

There are several strategies for preventing IPV, including: 

• Teaching social-emotional, conflict management and communication skills. 
• Preventing negative developmental pathways, such as poor parenting skills and lack of family support, that could lead to future violence. 
• 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.

Bailey, Beth A. “Partner Violence during Pregnancy: Prevalence, Effects, Screening, and Management.” International Journal of Women’s Health 2 (August 9, 2010): 183–97. https://doi.org/10.2147/IJWH.S8632.

Basile, Kathleen C., Marci F. Hertz, and Sudie E. Back. “Intimate Partner Violence and Sexual Violence Victimization Assessment Instruments for Use in Healthcare Settings: Version 1.” Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2007. https://permanent.fdlp.gov/gpo36292/ipvandsvscreening.pdf.

Krug, Etienne G., Linda L. Dahlberg, James A. Mercy, Anthony B. Zwi, and Rafael Lozano, eds. World Report on Violence and Health. Geneva: World Health Organization, 2002. https://doi.org/10.1016/S0140-6736(02)11133-0.

Moyer, Virginia A. “Screening for Intimate Partner Violence and Abuse of Elderly and Vulnerable Adults: U.S. Preventive Services Task Force Recommendation Statement.” Annals of Internal Medicine 158, no. 6 (March 19, 2013): 478. https://doi.org/10.7326/0003-4819-158-6-201303190-00588.

Niolon, Phyllis Holditch, Megan Kearns, Jenny Dills, Kirsten Rambo, Shalon Irving, Theresa L. Armstead, and Leah Gilbert. “Preventing Intimate Partner Violence Across the Lifespan: A Technical Package of Programs, Policies, and Practices.” Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2017. https://www.cdc.gov/violenceprevention/pdf/ipv-technicalpackages.pdf.

Paterno, Mary T., and Jessica E. Draughon. “Screening for Intimate Partner Violence.” Journal of Midwifery & Women’s Health 61, no. 3 (May 1, 2016): 370–75. https://doi.org/10.1111/jmwh.12443.

Peterson, Cora, Megan C. Kearns, Wendy LiKamWa McIntosh, Lianne Fuino Estefan, Christina Nicolaidis, Kathryn E. McCollister, Amy Gordon, and Curtis Florence. “Lifetime Economic Burden of Intimate Partner Violence Among U.S. Adults.” American Journal of Preventive Medicine 55, no. 4 (August 22, 2018): 433–44. https://doi.org/10.1016/j.amepre.2018.04.049.

Petrosky, Emiko, Janet M. Blair, Carter J. Betz, Katherine A. Fowler, Shane P. D. Jack, and Bridget H. Lyons. “Racial and Ethnic Differences in Homicides of Adult Women and the Role of Intimate Partner Violence — United States, 2003–2014.” Morbidity and Mortality Weekly Report 66, no. 28 (July 21, 2017): 741–46. https://doi.org/10.15585/mmwr.mm6628a1.

Saltzman, Linda E., Christopher H. Johnson, Brenda Colley Gilbert, and Mary M. Goodwin. “Physical Abuse Around the Time of Pregnancy: An Examination of Prevalence and Risk Factors in 16 States.” Maternal and Child Health Journal 7, no. 1 (March 1, 2003): 31–43. https://doi.org/10.1023/A:1022589501039.

Silverman, Jay G., Michele R. Decker, Elizabeth Reed, and Anita Raj. “Intimate Partner Violence Victimization Prior to and during Pregnancy among Women Residing in 26 U.S. States: Associations with Maternal and Neonatal Health.” American Journal of Obstetrics and Gynecology 195, no. 1 (July 2006): 140–48. https://doi.org/10.1016/j.ajog.2005.12.052.

Smith, Sharon G., Xinjian Zhang, Kathleen C. Basile, Melissa T. Merrick, Jing Wang, Marcie-jo Kresnow, and Jieru Chen. “The National Intimate Partner and Sexual Violence Survey (NISVS): 2015 Data Brief – Updated Release.” Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, November 2018. https://www.cdc.gov/violenceprevention/pdf/2015data-brief508.pdf

Vest, Joshua R., Tegan K. Catlin, John J. Chen, and Ross C. Brownson. “Multistate Analysis of Factors Associated with Intimate Partner Violence.” American Journal of Preventive Medicine 22, no. 3 (April 2002): 156–64. https://doi.org/10.1016/S0749-3797(01)00431-7.