Intimate Partner Violence Before Pregnancy in Tennessee

Tennessee

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 partner (spouse, boyfriend/girlfriend, dating partner or continuous sexual partner). Research has shown that women are more likely to be victims of IPV than men, and experience a greater range and severity of consequences from IPV compared with men. IPV can lead to lasting physical and mental health issues, including post-traumatic stress disorder, unhealthy lifestyle behaviors and multiple chronic conditions. 

Women who experience IPV during the preconception or prenatal period are less likely to receive adequate prenatal care. IPV during pregnancy has added negative outcomes such as: depression and substance use during pregnancy, and poor infant birth outcomes. Homicide is the leading cause of death among pregnant and postpartum women, with more than twice the prevalence of any other cause of maternal mortality. More than half of all female homicides are related to IPV.

According to the National Intimate Partner and Sexual Violence Survey, 41% 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 during the preconception or prenatal period are at increased risk of:

• High blood pressure and edema.
• Severe nausea, vomiting and dehydration.
• Kidney and urinary tract infections.
• Needing additional 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 among women 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 women of all other racial and ethnic groups. 
• Younger women compared with older women. 
• Women with household incomes of $15,000-24,999.

The U.S. Preventive Services Task Force recommends that clinicians screen all women of reproductive age (18-44) for IPV, including those who are pregnant or postpartum, and connect those who screen positive to intervention services. 

In a survey of women who had recently given birth, more than half of those who reported experiencing physical partner violence said they were not screened for IPV in the 12 months before pregnancy. Some barriers to screening identified by providers 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 for providers and is working on developing additional guidance to assist patients experiencing IPV. For example, asking patients specific behavioral questions and avoiding loaded terms like “abuse” can improve the outcome of IPV screenings. 

There are several strategies for preventing IPV, such as: 

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

For those who may be experiencing IPV, the CDC has a list of resources, support organizations and helplines for those who may be experiencing IPV.

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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