Intimate Partner Violence Before Pregnancy

Intimate Partner Violence Before Pregnancy in California

California

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.

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