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Intimate Partner Violence and

Pregnancy
Melinda Manning, JD, MSW
Director: UNC Hospitals Beacon Program
UNC Hospitals Beacon Program

Providing trauma-informed care and services


for patients, employees and family members
victimized by family and intimate partner
violence.
What is IPV?

* Pattern of behaviors used to manipulate and/or


control a current or former partner
* Can include physical, sexual, emotional, psychological
and financial abuse
* Can affect ones access and usage of healthcare
Prevalence Among American Women

* 19.3% been raped in lifetime, 1.6% raped in past year


* 15% been stalked in lifetime, 4% in past year
* 31% have experienced physical violence in lifetime
* 4% in past year
* 47% experienced psychological abuse in lifetime, 14%
in last year

National Intimate Partner and Sexual Violence Survey, 2011


Prevalence Among Pregnant Women

* 3%-9% during pregnancy


* 1/3 experience less, 15% increased abuse
* Risk factors include:
* Young age
* Unmarried
* Minority race/ethnicity
* Poverty
* Partner is unemployed
* Violence in family of origin
National PRAMS Data

* Women who experience physical IPV are more likely:


* Smoke
* Experience postpartum depression
* Not receive postpartum care during 1st and 2nd trimester
* Deliver low-birthweight babies
North Carolina: IPV and Pregnancy

* Most reliable data is from 2011


* 4.2% of women pushed, hit, slapped, choked, or
physically hurt in 12 months pre-pregnancy
* 3.4% during pregnancy

2011 Pregnancy Risk Assessment Monitoring System


North Carolina PRAMS Data

* 1997-2000 (most recent report)


* Women were more likely report physical abuse if:
* Under age 21
* High school diploma or less
* Unmarried
* Lower income
* WIC and/or Medicaid
* Unintended pregnancy
Rates of Reproductive Coercion

Reproductive
autonomy
Reproductive coercion

Versage et. al. (2013-14). Pregnancy Coercion and Birth Control Sabotage in Western North Carolina MAHEC Online
Journal of Research, Volume 1, Issue 2
Effects on Pregnancy

* 2x more likely to miss prenatal care appt.


* 2x more likely not to start prenatal care until 3rd trimester
* Inadequate weight gain/poor nutrition
* Higher risk of fetal death, neonatal death
* Higher rates of STIs and urinary tract infections
* Higher rates of alcohol use and smoking
* Low birth weight
* Preterm birth
* Increased rate of C-section
* Increased rate of placental abruption
* Exacerbate preexisting conditions
* 55% of pregnancy associated suicides
* 45% of pregnancy-associated homicides
IPV Effects Post-Delivery

* Mother/Infant bonding failure


* Postpartum depression
* Breastfeeding difficulties
* Less likely to attend postpartum appointments
Recommendations

* Encourage NCHHS to include IPV questions in PRAMS,


especially on linkages between IPV and birth
outcomes
* Ongoing IPV screening, both prenatal and
postpartum
* Increased staff training on signs of IPV
* Use of empowerment counseling
RADAR Screening

* Routinely screen patients


* Ask direct questions
* Document findings
* Assess for safety
* Refer to local resources
2014 NC PRAMS Data

IPV Screening by Health Care Provider

No
Yes
Resources

* Futures Without Violence: low cost materials to give


to patients;
https://secure3.convio.net/fvpf/site/Ecommerce/15587
835?FOLDER=0&store_id=1241
* North Carolina Coalition Against Domestic Violence
https://nccadv.org/
* North Carolina Coalition Against Sexual Assault
http://www.nccasa.org/
References

* Jeanne L. Alhusen, Ellen Ray, Phyllis Sharps, Linda Bullock. Intimate Partner Violence During
Pregnancy: Maternal and Neonatal Outcomes J Womens Health (Larchmt) 2015 Jan 1; 24(1): 100
106. doi: 10.1089/jwh.2014.4872
* Alhusen, J. L., Geller, R., Dreisbach, C., Constantoulakis, L., & Siega-Riz, A. M. (2017). Intimate
partner violence and gestational weight gain in a population-based sample of perinatal
women. Journal of Obstetric, Gynecologic & Neonatal Nursing, 46(3), 390-402.
* Ayala Quintanilla, B. P., Taft, A., McDonald, S., Pollock, W., & Roque Henriquez, J. C. (2016). Social
determinants and maternal exposure to intimate partner violence of obstetric patients with severe
maternal morbidity in the intensive care unit: a systematic review protocol. BMJ Open, 6(11),
e013270. http://doi.org/10.1136/bmjopen-2016-013270
* Brownridge, D. A., Taillieu, T. L., Tyler, K. A., Tiwari, A., Chan, K. L., & Santos, S. C. (2011). Pregnancy
and intimate partner violence: risk factors, severity, and health effects. Violence against
women, 17(7), 858-881.
* Kiely, M., El-Mohandes, A. A., El-Khorazaty, M. N., & Gantz, M. G. (2010). An integrated intervention
to reduce intimate partner violence in pregnancy: a randomized trial. Obstetrics and
gynecology, 115(2 Pt 1), 273.
* Kita, S., Haruna, M., Matsuzaki, M., & Kamibeppu, K. (2016). Associations between intimate partner
violence (IPV) during pregnancy, mother-to-infant bonding failure, and postnatal depressive
symptoms. Archives of women's mental health, 19(4), 623-634.
Questions?

Thank you!
Melinda.Manning@unchealth.unc.edu
(984)974-0470