Domestic Violence During Pregnancy

Carol Brady, MA & Donna Buchanan, MSW, LCSW

Carol Brady is the Executive Director of the Northeast Florida Healthy Start Coalition.
Donna Buchanan is the Senior Human Services Program Specialist
at the Duval County Health Department for Healthy Start.

 
Women of all ages are at-risk for violence, but the incidence of abuse peaks during the reproductive years.1 The proportion of women who experience abuse during pregnancy ranges from <1% to 20% based on national studies.2 In Northeast Florida, nine percent of pregnant women who were screened and qualified for Healthy Start services in 1998-2000 (n=11,033) reported they had been hit or hurt in the last year. Six percent of the women said that they felt unsafe in their current living arrangement.3

Domestic violence impacts many aspects of women's reproductive health, including pregnancy, reproductive decision making, contraceptive use, risk of HIV/STD infection, and adherence to treatment. Violence may be a more common problem for pregnant women than preeclampsia, gestational diabetes, or placenta previa which are routinely addressed during prenatal care.44 Domestic violence often begins or worsens during pregnancy and may contribute to low birthweight, premature labor and miscarriage.

Because pregnancy may be the only time some women come into regular contact with health care providers, prenatal care visits offer a critical opportunity to identify and address physical violence. Florida's Healthy Start program provides an important resource for prenatal care providers who identify or suspect domestic violence. State statute (Chapter 383.14 FS) requires prenatal care providers to offer patients the Florida's Healthy Start Prenatal Risk Screening Instrument. This self-administered tool includes a series of questions intended to identify specific risk factors associated with poor birth outcomes. Factors are scored and any pregnant woman who scores four or more, or is referred by the provider for factors other than score, is eligible for services. Women may also request to participate in the program regardless of score. Completed Healthy Start screens are sent by the provider to the health department in their county for program enrollment.

The Healthy Start prenatal screen includes several questions designed to identify domestic violence ("Do you feel unsafe where you live?" and "In the last year, has anyone hit you or tried to hurt you?"). Positive answers should trigger further questioning by the health care provider to identify immediate safety issues and prompt referral to Healthy Start or a local women's shelter (see Community Resources). Once referred to Healthy Start, psycho-social counselors, social workers or other appropriate staff will contact the woman, complete a further assessment and link her with appropriate community resources. Healthy Start staff work with health care providers to ensure their patients' needs are met.

It is important to recognize that the Healthy Start screening instrument only provides an opportunity for self-disclosure. Denial is characteristic of many victims. Frequently, information about domestic violence may not be revealed until the woman has established a trusting relationship or rapport with the prenatal care provider or office staff. Women in abusive relationships often need help in recognizing their abuse. A more effective strategy for screening for violence during pregnancy is to routinely ask questions as part of the initial prenatal health assessment as well as throughout the woman's pregnancy (see RADAR and Asking About Domestic Violence During Pregnancy).

A slide show on intimate partner violence during pregnancy for physicians and their office staff has been developed by the American College of Obstetricians and Gynecologists and the U.S. Centers for Disease Control. It is available for download at www.cdc.gov/nccdphp/drh/wh_violence.htm.

Community Resources

References

  1. U.S. Centers for Disease Control. Highlights of national conference on violence and reproductive health: science, prevention and action, June 14-16, 1999, Atlanta.
  2. Gazmararian JA, Lazorick S, Spitz AM, et al. Prevalence of violence against pregnant women. JAMA 1996; 275: 1915-1920.
  3. Northeast Florida Healthy Start Coalition. 2002-04 Healthy Start Service Delivery Plan, 2002.

Jacksonville Medicine / May, 2002

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www.dcmsonline.org May, 2002/ Jacksonville Medicine