The number one cause of death during pregnancy is partner violence. Domestic violence (also called intimate partner violence, IPV) is defined by the American Medical Association as a pattern of abusive behavior in an intimate relationship.
Overall rates of domestic violence are 20-25% over a woman’s lifetime, but it is generally thought that abuse is usually underreported. In pregnant women, this number varies widely depending on the location of the research. One large investigation compiled rates across 92 countries for an average of just under 20% (over the nine month period), with the highest rates of emotional abuse, followed by physical and then sexual violence. This is higher than many other serious complications of pregnancy, such as pre-eclampsia or gestational diabetes. In fact, for almost a third of women who experience domestic violence during their lifetime, the first incident occurs in pregnancy.
Pregnancy is a particularly vulnerable time for domestic violence because of the changes in physical, social, emotional, and financial needs. And this risk continues for as long as one year after delivery.
How do I recognize IPV?
Domestic violence can sometimes be hard to recognize, especially if you are the victim. It can be more overt acts such as physical violence, verbal threats, or sexual aggression. Yet it can also be less easily recognized, such as emotional or psychological abuse. This might be neglect, controlling behavior, financial deprivation, forced reproductive choices, threats against children or pets, social isolation, or stalking.
What are the risks of IPV during pregnancy?
There are risks for both mom and baby when a woman is the victim of violence during pregnancy. The worst pregnancy outcomes include: higher rates of preterm birth, lower birth weight babies, and smaller for gestational age infants. There can also be pregnancy complications due to direct trauma.
The mental health risks for mom include higher rates of depression, anxiety, suicidal thoughts, and posttraumatic stress disorder, as well as higher rates of substance use. All of these conditions, in turn, affect pregnancy and the postpartum period (See related articles on Depression in Pregnancy, Anxiety in Pregnancy, and Postpartum Depression). Domestic violence also is linked to worse prenatal care and nutrition. The medical risks for mom include higher rates of sexually transmitted diseases and urinary tract infections and other medical complications.
The risks remain high postpartum, when the child is also at risk for violence and for complications related to being exposed to violence, and there is less likelihood of breastfeeding.
What are the risk factors for IPV during pregnancy?
There are risk factors that place a woman at higher risk of domestic violence during pregnancy:
- An unplanned pregnancy
- Lower socioeconomic status and education level
- History of abuse
- Alcohol abuse
What can be done about IPV?
The most important first step is to recognize that it is happening. We recognize many other complications and medical illnesses related to pregnancy and work hard to treat those, yet IPV often is under the radar. It is essential for clinicians to screen for IPV. I hope that if you are reading this as a victim of IPV, you will consider reaching out to your provider or a domestic violence support service in your area. In the San Francisco/Bay Area, La Casa de las Madres offers a 24 hour support crisis line and shelter options. Many other communities have similar programs.
Another important step that will help those who are being victimized is education and awareness. If you are a survivor of IPV or have knowledge about resources, please consider sharing the programs or services that you might recommend in the comments section below.
Finally, it is important for those suffering from domestic violence to recognize that they are neither responsible for the abuse nor are alone. Counseling services and support can help survivors move forward.
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James, L., Brody, D., & Hamilton, Z. Risk factors for domestic violence during pregnancy: A meta-analytic review. 2013. Violence and Victims 28(3): 359.
Shah, Prakesh S. and Shan, Jyotsna. Exposure to domestic violence and pregnancy outcomes: A systematic review and meta-analyses. 2010. Journal of Women’s Health 19(11): 2017.
Fonseca-Machado, M.O. et. al. Mental health of women who suffer intimate partner violence during pregnancy. Invest Educ Enferm. 2014; 32(2): 291-305.