Violence During Pregnancy and the Postpartum Period

Violence against women is a significant and disturbing problem which affects women around the world, including those who are pregnant or postpartum. Although numerous studies from around the globe agree that violence is a common problem among pregnant women, estimates of the prevalence of this violence vary considerably. Most prevalence studies examining violence during pregnancy have focused on physical violence. A 2010 review of 18 studies (including studies from Canada, China, England, Hong Kong, Mexico, Pakistan, Peru, Thailand and the U.S.) found that 1% to 30% of pregnant women experienced physical violence during pregnancy, with most estimates being between 3% and 11% (Taillieu & Brownridge, 2010). Although these estimates of the prevalence of physical violence during pregnancy vary, it is clear that a significant number of women experience physical violence during pregnancy.

Less is known about the prevalence of other types of violence during pregnancy, such as emotional or sexual violence. Although estimates concerning emotional and sexual violence during pregnancy vary, there does appear to be a common pattern: the prevalence of emotional violence is generally greater than the prevalence of physical violence, whereas the prevalence of sexual violence is generally less than the prevalence of physical violence (Perales et al., 2008). Fewer studies have estimated the prevalence of violence during the postpartum period, with most of these studies finding a lower prevalence of violence during the nine months of pregnancy than during the first 12 months postpartum.

Risk Factors for Violence

• One of the most consistent and strongest predictors of violence during pregnancy is having experienced violence before pregnancy (Bohn, Tebben, & Campbell, 2004; Dunn & Oths, 2004; Guo, et al., 2004; Helton, McFarlane, & Anderson, 1987; Martin et al., 2001; Saltzman, Johnson, Gilbert, & Goodwin, 2003).
• As in the case of violence during pregnancy, a history of violent victimization, both before and during pregnancy, is a strong risk factor for violence during the postpartum period; however, for some women, violence first begins during the postpartum period (Martin et al., 2001; Charles & Perreira, 2007).
• Younger pregnant women (with different studies using different definitions of ÒyoungerÓ) have been found to be at increased risk of violence compared to older pregnant women (Cokkinides, Coker, Sanderson, Addy, & Bethea, 1999; Devries, Kishor, Johnson, Stockl, Bacchus, Garcia-Moreno & Watts, 2010; Janssen, Holt, Sugg, Emanuel, Crichlow, & Henderson, 2003; Saltzman et al., 2003).
• Studies have found that women are more likely to experience violence during pregnancy if they are unmarried (Cokkinides et al., 1999; Janssen et al., 2003; Saltzman et al., 2003; Steward & Cecutti, 1993), with lower levels of education (Bohn et al., 2004; Cokkinides et al., 1999; Nasir & Hyder, 2003; Saltzman et al., 2003), or lower incomes (Janssen et al., 2003; Nasir & Hyder, 2003).
• Reproduction-related variables also have been found to be risk factors for violence during pregnancy. For example, women with unintended pregnancies are more likely than women with intended pregnancies to experience violence during pregnancy (Gazmararian et al., 1995; Goodwin, et al., 2000).

Outcomes Related to Violence Against Women who are Pregnant or Postpartum

• Research has found that homicide was the second leading cause of injury-related death during pregnancy and the first year postpartum in the U.S. from 1991 through 1999, only surpassed by motor vehicle crashes (Chang, Berg, Saltzman, & Herndon, 2005).
• Violence in pregnancy and postpartum has been linked to elevated levels of various types of emotional health problems, including depression, anxiety, post-traumatic stress disorder, and other forms of psychological distress (Amaro et al., 1990; Campbell et al., 1992; Harris-Britt, Martin, Li, Casanueva, & Kupper, 2004; Steward & Cecutti, 1993; Romito, Pomicino, Lucchetta, Scrimin, & Turan, 2009).
• Maternal exposure to domestic violence was significantly associated with an increased risk of low infant birth weight, as well as an increased risk of preterm birth, and miscarriage in some cases (Shah & Shah, 2010; Berrios & Grady, 1991).
• Studies have also found that the occurrence of domestic violence during the first six months postpartum was associated with significantly higher levels of child neglect, psychological child abuse, and physical child abuse during the childrenÕs first five years of life (McGuigan & Pratt, 2001).

Interventions

• Researchers have found some limited evidence that healthcare based interventions can be somewhat effective in helping pregnant violence survivors. Examples of healthcare based interventions include educational interventions in prenatal care (Humphreys, Tsoh, Kohn, & Gerbert, 2011); psychological interventions (Kiely, El-Mohandes, El-Khorazaty, & Gantz, 2010; Zlotnick, Capezza, & Parker, 2011); and empowerment interventions (Cripe et al., 2010; Tiwari et al., 2005).
• Research regarding effectiveness of postpartum interventions for violence survivors found that home visitations programs were shown to somewhat reduce victimization of women, however, this reduction did not meet the traditional level of statistical significance (Bair-Merritt et al., 2010).

Finally, rigorous research designs (such as randomized controlled trials) are needed to document the effectiveness of preventive and therapeutic interventions for violence during pregnancy and the postpartum period. Such large-scale multi-year investigations are costly. But investing to enhance our knowledge of this topic may well lead to identification of effective interventions that could be widely implemented to decrease the burden of suffering for women and their families, and to avoid the costly consequences of violence against pregnant and postpartum women.