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Hill AL, Keil MA, Chang JC, Krans EE, Kim E, Nostrand EV, Miller E, Pallatino C. Help-Seeking Among Pregnant and Postpartum Women With Lifetime Experiences of Opioid Use Disorder and Intimate Partner Violence. Violence Against Women 2024; 30:812-831. [PMID: 36437759 DOI: 10.1177/10778012221140134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
We performed content analysis using a qualitative descriptive approach of 15 semistructured interviews with pregnant and postpartum women who have experienced opioid use disorder (OUD) and intimate partner violence (IPV) regarding their experiences seeking help with both issues. Participants described that their partners impacted their ability to seek OUD care; seeking help for OUD and IPV was siloed; they felt more comfortable disclosing OUD than IPV; they perceived pregnancy as a barrier and facilitator to OUD care; and they wished for integrated services. Pregnant and postpartum women experiencing OUD and IPV acknowledged these phenomena intersect and identified a need for more comprehensive services.
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Affiliation(s)
| | | | - Judy C Chang
- University of Pittsburgh, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Elizabeth E Krans
- University of Pittsburgh, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Esther Kim
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | | | - Elizabeth Miller
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Masho SW, Rozario S, Walker D, Cha S. Racial Differences and the Role of Marital Status in the Association Between Intimate Partner Violence and Unintended Pregnancy. JOURNAL OF INTERPERSONAL VIOLENCE 2018; 33:3162-3185. [PMID: 26940349 DOI: 10.1177/0886260516635317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
More than half of all pregnancies in the U.S. are unintended which may lead to poor health outcomes. Racial and ethnic differences underlying the association between IPV and unintended pregnancy are inconsistent. This study examines the association between IPV and unintended pregnancy across racial/ethnic and marital strata among U.S. women. Data from the national 2009/11 Pregnancy Risk Assessment Monitoring System consisting of women who recently delivered a live birth baby were analyzed (n=108,220). A dichotomous variable was created to indicate whether women experienced IPV in the 12 months leading to their most recent pregnancy (yes; no). The outcome, pregnancy intention, was dichotomized as intended or unintended. Subpopulation analysis was conducted stratified by race/ethnicity and marital status. Adjusted odds ratios and 95% confidence intervals were generated using multiple logistic regression models. The odds of unintended pregnancy were increased for married non-Hispanic White women who reported IPV compared to their non-abused counterparts even after controlling for sociodemographic factors, health care access, and reproductive history. Among unmarried non-Hispanic other women, abused women were significantly less likely to report unintended pregnancy than the non-abused. No significant differences were observed for Hispanic or non-Hispanic Black women. There are significant racial and ethnic differences in the association between IPV and unintended pregnancy. Additionally, the association differed by marital status. Public health professionals and health care providers should be aware of these differences.
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Affiliation(s)
- Saba W Masho
- 1 Virginia Commonwealth University, Richmond, USA
| | | | - D'Won Walker
- 1 Virginia Commonwealth University, Richmond, USA
| | - Susan Cha
- 1 Virginia Commonwealth University, Richmond, USA
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Van Parys AS, Deschepper E, Roelens K, Temmerman M, Verstraelen H. The impact of a referral card-based intervention on intimate partner violence, psychosocial health, help-seeking and safety behaviour during pregnancy and postpartum: a randomized controlled trial. BMC Pregnancy Childbirth 2017; 17:346. [PMID: 28985722 PMCID: PMC6389099 DOI: 10.1186/s12884-017-1519-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/19/2017] [Indexed: 11/23/2022] Open
Abstract
Background We aimed to investigate the impact of a referral-based intervention in a prospective cohort of women disclosing intimate partner violence (IPV) on the prevalence of violence, and associated outcomes psychosocial health, help-seeking and safety behaviour during and after pregnancy. Methods Women seeking antenatal care in eleven Belgian hospitals were consecutively invited from June 2010 to October 2012, to participate in a single-blind randomized controlled trial (RCT) and handed a questionnaire. Participants willing to be interviewed and reporting IPV victimisation were randomised. In the Intervention Group (IG) participants received a referral card with contact details of services providing assistance and tips to increase safety behaviour. Participants in the Control Group (CG) received a “thank you” card. Follow-up data were obtained through telephone interview at an average of 10 months after receipt of the card. Results At follow-up (n = 189), 66.7% (n = 126) of the participants reported IPV victimisation. Over the study-period, the prevalence of IPV victimisation decreased by 31.4% (P < 0.001), psychosocial health increased significantly (5.4/140, P < 0.001), 23.8% (n = 46/193) of the women sought formal help, 70.5% (n = 136/193) sought informal help, and 31.3% (n = 60/192) took at least one safety measure. We observed no statistically significant differences between the IG and CG, however. Adjusted for psychosocial health at baseline, the perceived helpfulness of the referral card seemed to be larger in the IG. Both the questionnaire and the interview were perceived to be significantly more helpful than the referral card itself (P < 0.001). Conclusions Asking questions can be helpful even for types of IPV of low severity, although simply distributing a referral card may not qualify as the ideal intervention. Future interventions should be multifaceted, delineate different types of violence, controlling for measurement reactivity and designing a tailored intervention programme adjusted to the specific needs of couples experiencing IPV. Trial registration The trial was registered with the U.S. National Institutes of Health ClinicalTrials.gov registry on July 6, 2010 under identifier NCT01158690). Electronic supplementary material The online version of this article (10.1186/s12884-017-1519-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- An-Sofie Van Parys
- Department of Obstetrics and Gynaecology, International Centre for Reproductive Health, Ghent University, Faculty of Medicine and Health Sciences, De Pintelaan 185, UZP 114, 9000, Ghent, Belgium.
| | - Ellen Deschepper
- Department of Public Health, Biostatistics Unit, Ghent University, Faculty of Medicine and Health Sciences, De Pintelaan 185, 3K3, 9000, Ghent, Belgium
| | - Kristien Roelens
- Department of Obstetrics and Gynaecology, International Centre for Reproductive Health, Ghent University, Faculty of Medicine and Health Sciences, De Pintelaan 185, P4, 9000, Ghent, Belgium
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, International Centre for Reproductive Health, Ghent University, Faculty of Medicine and Health Sciences, De Pintelaan 185, P4, 9000, Ghent, Belgium
| | - Hans Verstraelen
- Department of Obstetrics and Gynaecology, International Centre for Reproductive Health, Ghent University, Faculty of Medicine and Health Sciences, De Pintelaan 185, P4, 9000, Ghent, Belgium
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Franks WLM, Crozier KE, Penhale BLM. Women's mental health during pregnancy: A participatory qualitative study. Women Birth 2017; 30:e179-e187. [PMID: 28057430 DOI: 10.1016/j.wombi.2016.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 11/08/2016] [Accepted: 11/10/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND/OBJECTIVES British public health and academic policy and guidance promotes service user involvement in health care and research, however collaborative research remains underrepresented in literature relating to pregnant women's mental health. The aim of this participatory research was to explore mothers' and professionals' perspectives on the factors that influence pregnant women's mental health. METHOD This qualitative research was undertaken in England with the involvement of three community members who had firsthand experience of mental health problems during pregnancy. All members of the team were involved in study design, recruitment, data generation and different stages of thematic analysis. Data were transcribed for individual and group discussions with 17 women who self-identified as experiencing mental health problems during pregnancy and 15 professionals who work with this group. Means of establishing trustworthiness included triangulation, researcher reflexivity, peer debriefing and comprehensive data analysis. FINDINGS Significant areas of commonality were identified between mothers' and professionals' perspectives on factors that undermine women's mental health during pregnancy and what is needed to support women's mental health. Analysis of data is provided with particular reference to contexts of relational, systemic and ecological conditions in women's lives. CONCLUSIONS Women's mental health is predominantly undermined or supported by relational, experiential and material factors. The local context of socio-economic deprivation is a significant influence on women's mental health and service requirements.
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Affiliation(s)
- Wendy L M Franks
- University of East Anglia, School of Health Sciences, Norwich, UK.
| | - Kenda E Crozier
- University of East Anglia, School of Health Sciences, Norwich, UK.
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Edin K, Nilsson B. Between desire and rape - narratives about being intimate partners and becoming pregnant in a violent relationship. Glob Health Action 2013; 6:20984. [PMID: 24314321 PMCID: PMC3855602 DOI: 10.3402/gha.v6i0.20984] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 09/16/2013] [Accepted: 11/07/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Women subjected to intimate partner violence (IPV) experience different forms of abuse. Sexual violence is often under-reported because physically abused women, in particular, might see forced sex as an obligatory part of the sexual interplay. Accordingly, abused women have less sexual autonomy and experience unplanned pregnancies more often than other women. OBJECTIVE To describe and analyse nine Swedish women's retrospective stories about IPV with a focus on power and coping strategies as intimate partners, particularly regarding experiences of sex, contraception, and becoming pregnant. Design : Nine qualitative interviews were carried out with women who had been subjected to very severe violence in their intimate relationships and during at least one pregnancy. The stories were analysed using 'Narrative method' with the emphasis on the women's lived experiences. RESULTS Despite the violence and many contradictory and ambivalent feelings, two of the women described having sex as desirable, reciprocal and as a respite from the rest of the relationship. The other seven women gave a negative and totally different picture, and they viewed sex either as obligatory or as a necessity to prevent or soothe aggression or referred to it as rape and as something that was physically forced upon them. The women's descriptions of their pregnancies ranged from being carefully planned and mostly wanted to completely unwelcome and including flawed contraceptive efforts with subsequent abortions. CONCLUSIONS Women subjected to IPV have diverse and complex experiences that have effects on all parts of the relationship. Intimacy might for some turn into force and rape, but for others sex does not necessarily exclude pleasure and desire and can be a haven of rest from an otherwise violent relationship. Accordingly, women may tell stories that differ from the ones expected as 'the typical abuse story', and this complexity needs to be recognized and dealt with when women seek healthcare, especially concerning contraceptives, abortions, and pregnancies.
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Affiliation(s)
- Kerstin Edin
- Epidemiology and Global Health, Umeå University, Umeå, Sweden; Department of Nursing, Umeå University, Umeå, Sweden; Umeå Centre of Gender Studies, Umeå University, Umeå, Sweden;
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Stöckl H, Gardner F. Women's perceptions of how pregnancy influences the context of intimate partner violence in Germany. CULTURE, HEALTH & SEXUALITY 2013; 15:1206-20. [PMID: 23905872 PMCID: PMC3818138 DOI: 10.1080/13691058.2013.813969] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Intimate partner violence during pregnancy is receiving increased attention because of its high prevalence and health effects. Still, little is known about women's perceptions on how their pregnancy influences the context in which intimate partner violence occurs. We conducted 19 in-depth interviews with women who had experienced intimate partner violence around the time of pregnancy. Women clearly perceived pregnancy as a turning point, because it created new expectations and a feeling of being overwhelmed. This led to violence by reducing women's acceptance of their partner's unemployment, alcohol abuse and lack of relationship commitment, or by increasing women's vulnerability because they felt too young to raise a child alone. Pregnancy also led to violence by bringing back childhood memories or by taking attention away from their partners. Understanding how pregnancy influences the context in which intimate partner violence occurs is important to provide abused, pregnant women with the services they need.
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Affiliation(s)
- Heidi Stöckl
- Social & Mathematical Epidemiology Group, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom , Phone: 00442079272506, Fax: 00442074365389
| | - Frances Gardner
- Department of Social Policy & Social Work, University of Oxford, Barnett House 32 Wellington Square, Oxford, OX1 2ER, United Kingdom , Phone: 00441865270334, Fax: 00441865270324
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Engnes K, Lidén E, Lundgren I. Women's experiences of important others in a pregnancy dominated by intimate partner violence. Scand J Caring Sci 2012; 27:643-50. [PMID: 22998026 DOI: 10.1111/j.1471-6712.2012.01073.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Being exposed to intimate partner violence (IPV) during pregnancy is a difficult and complex situation. Despite this, there are few studies describing women's own needs for help and support. AIM The aim of this study is to gain a deeper understanding of women's experiences of important others in relation to changing their life situation in a pregnancy dominated by IPV. METHODS The study has a qualitative phenomenological design. The data were collected through in-depth interviews with seven Norwegian women, who were exposed to IPV during pregnancy. FINDINGS Being pregnant and exposed to violence in relation to important others means confronting present life, life history and future life. The essence implies striving for control in an uncontrolled situation, where other people might be experienced as both a rescuer and a risk. This is further described in four constitutions: the child needs protection; my mother is always present for me; an exhausted run for help; and a reduced, but important social network. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE For women exposed to violence, pregnancy can offer an opportunity for change. Midwives play a unique role in relation to care and continuity in this phase of life, as they can support pregnant women, help to identify their needs, possibilities for action and advise them about appropriate services. Midwives can encourage and support women to find people whom they can trust and who can offer assistance. It is vital that midwives ask about the women's relationship to the baby and their social networks, especially the relationship with their mothers. Ethical considerations: During the whole study process, guidelines for research on violence against women were followed, to respect the integrity, security and confidentiality of the participants. The study is ethically approved.
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Affiliation(s)
- Kristin Engnes
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, Vestfold, Norway.
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Zhang Y, Zou S, Cao Y, Zhang Y. Relationship between domestic violence and postnatal depression among pregnant Chinese women. Int J Gynaecol Obstet 2011; 116:26-30. [PMID: 22024214 DOI: 10.1016/j.ijgo.2011.08.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 08/24/2011] [Accepted: 10/03/2011] [Indexed: 10/16/2022]
Abstract
OBJECTIVE To investigate the prevalence of domestic violence during pregnancy and postnatal depression, and to explore the relationship between domestic violence and postnatal depression among Chinese women. METHODS In a cross-sectional survey, 846 pregnant women were screened with the Abuse Assessment Screen; 215 women completed the postnatal follow-up. All participants underwent psychosocial assessment, with the Edinburgh Postpartum Depression Scale being used for the evaluation of postnatal depression. RESULTS The overall prevalence of domestic violence during pregnancy was 11.3%, and the most common form of domestic violence was psychologic abuse. The follow-up interviews showed a higher prevalence of postnatal depression among women who had been abused during pregnancy (25.1%) than among those who had not (6.0%). Psychologic abuse during pregnancy, an unexpected pregnancy, an attitude of acceptance toward violence, and concern over the newborn's health were related with postnatal depression. CONCLUSION Domestic violence during pregnancy and related factors contributed to postnatal depression in a population of Chinese women. The findings emphasize the importance of intervention among vulnerable populations in low-income countries.
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Affiliation(s)
- Yong Zhang
- Tianjin Mental Health Centre, Tianjin, China
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Bhandari S, Bullock LFC, Anderson KM, Danis FS, Sharps PW. Pregnancy and intimate partner violence: how do rural, low-income women cope? Health Care Women Int 2011; 32:833-54. [PMID: 21834721 PMCID: PMC4432839 DOI: 10.1080/07399332.2011.585532] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We conducted 32 in-depth interviews with 20 rural, low-income, women residing in the United States who were pregnant (n = 12) or 3 months postpartum (n = 8) and had experienced intimate partner violence (IPV). Using purposive sampling and the grounded theory method, we generated a conceptual model of coping. The urge to protect the unborn baby was the primary influence for participants' decisions about separating from or permanently leaving an abusive relationship. Implications include universal screening for IPV in child-bearing women, inquiry into maternal identity development during pregnancy, and improved resource access for rural, low-income women.
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Affiliation(s)
- Shreya Bhandari
- Department of Social Work, Wright State University, Dayton, Ohio 45435-0001, USA.
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Ludermir AB, Lewis G, Valongueiro SA, de Araújo TVB, Araya R. Violence against women by their intimate partner during pregnancy and postnatal depression: a prospective cohort study. Lancet 2010; 376:903-10. [PMID: 20822809 DOI: 10.1016/s0140-6736(10)60887-2] [Citation(s) in RCA: 200] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Partner violence against women is common during pregnancy and might have an adverse effect on the mental health of women after delivery. We aimed to investigate the association of postnatal depression with psychological, physical, and sexual violence against women by their intimate partners during pregnancy. METHODS In a prospective cohort study undertaken in Recife, northeastern Brazil, between July, 2005, and December, 2006, we enrolled pregnant women (aged 18-49 years) in their third trimester of pregnancy who were attending primary health-care clinics. The women were interviewed during pregnancy and after delivery. The form of partner violence in pregnancy was assessed with a validated questionnaire, and the Edinburgh postnatal depression scale was used to measure postnatal depression. Associations were estimated with odds ratios (ORs), adjusted for confounding factors contributing to the association between postnatal depression and intimate partner violence. FINDINGS 1133 pregnant women were eligible for inclusion in the study, of whom 1045 had complete data for all variables and were included in the analysis. 270 women (25.8%, 95% CI 23.2-28.6) had postnatal depression. The most common form of partner violence was psychological (294 [28.1%, 25.4-31.0]). Frequency of psychological violence during pregnancy was positively associated with occurrence of postnatal depression, and although this association was attenuated after adjustment, women reporting the highest frequency of psychological violence were more likely to have postnatal depression even after adjustment (adjusted OR 2.29, 95% CI 1.15-4.57). Women who reported physical or sexual violence in pregnancy were more likely to develop postnatal depression (OR 3.28, 2.29-4.70), but this association was substantially reduced after adjustment for psychological violence and confounding factors. INTERPRETATION Psychological violence during pregnancy by an intimate partner is strongly associated with postnatal depression, independently of physical or sexual violence. This finding has important policy implications since most social policies focus on prevention and treatment of physical violence. FUNDING Departamento de Ciência e Tecnologia da Secretaria de Ciência, Tecnologia, e Insumos Estratégicos, and Conselho Nacional de Desenvolvimento Científico e Tecnológico (Brazil).
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Affiliation(s)
- Ana Bernarda Ludermir
- Programa de Pós-Graduação Integrado em Saúde Coletiva, Universidade Federal de Pernambuco, Hospital das Clínicas, Cidade Universitária, Recife, PE, Brazil.
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Rose L, Alhusen J, Bhandari S, Soeken K, Marcantonio K, Bullock L, Sharps P. Impact of intimate partner violence on pregnant women's mental health: mental distress and mental strength. Issues Ment Health Nurs 2010; 31:103-11. [PMID: 20070224 PMCID: PMC3027203 DOI: 10.3109/01612840903254834] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The mental health consequences of living with intimate partner violence (IPV) are substantial. Despite the growing awareness of the incidence of depression and PTSD in women experiencing IPV, few studies have examined prospectively the experience of IPV during pregnancy and the impact of the abuse on women's mental health. As a component of a larger clinical trial of an intervention for pregnant abused women, 27 women participated in a qualitative study of their responses to the abuse in the context of pregnancy and parenting. Results indicate that women's changing perceptions of self was related to mental distress, mental health, or both mental distress and mental health.
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Affiliation(s)
- Linda Rose
- Johns Hopkins University, School of Nursing, 525 North Wolfe Street, Baltimore, MD 21205, USA.
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Kothari CL, Cerulli C, Marcus S, Rhodes KV. Perinatal status and help-seeking for intimate partner violence. J Womens Health (Larchmt) 2010; 18:1639-46. [PMID: 19788343 DOI: 10.1089/jwh.2008.1310] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although there has been much research examining the relationship between pregnancy and abuse, this study is one of the few to investigate whether perinatal status (defined as pregnancy or early postpartum) impacts the help seeking of abused women. METHODS We retrospectively reviewed 3 years of prosecutor administrative records, police incident reports, and hospital medical records for a countywide population of adult females (n = 964) assaulted by an intimate partner in 2000. Perinatal and nonperinatal victims were compared using chi-square and a series of logistic regression models, controlling for all demographic and incident-related factors. RESULTS Compared with women across the county, abused women were twice as likely to become pregnant (p < 0.001). Perinatal status did not change the rate of help seeking from police (OR 1.1, p = 0.67) or emergency departments (ED) (OR 1.1, p = 0.94), but it did change the pattern of help seeking with higher ED use in the 6 months prior to the assault (p < 0.01) and a trend toward seeking help with fewer injuries (p = 0.10). CONCLUSIONS Abused women are more likely to become pregnant. Perinatal status impacts how victims seek help from criminal justice agencies and EDs.
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Affiliation(s)
- Catherine L Kothari
- Michigan State University/Kalamazoo Center for Medical Studies, Kalamazoo, Michigan 49008, USA.
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Edin KE, Dahlgren L, Lalos A, Högberg U. “Keeping Up a Front”: Narratives About Intimate Partner Violence, Pregnancy, and Antenatal Care. Violence Against Women 2010; 16:189-206. [DOI: 10.1177/1077801209355703] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Nine women who had been subjected to severe intimate partner violence during pregnancy narrated their ambiguous and contradictory feelings and the various balancing strategies they used to overcome their complex and difficult situations. Because allowing anyone to come close posed a threat, the women mostly denied the situation and kept up a front to hide the violence from others. Three women disclosed ongoing violence to the midwives, but only one said such disclosure was helpful. This article highlights the complexity of being pregnant when living with an abusive partner and challenges antenatal care policies from the perspective of pregnant women.
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Ellis KK, Chang C, Bhandari S, Ball K, Geden E, Everett KD, Bullock L. Rural mothers experiencing the stress of intimate partner violence or not: their newborn health concerns. J Midwifery Womens Health 2009; 53:556-62. [PMID: 18984512 DOI: 10.1016/j.jmwh.2008.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 05/29/2008] [Accepted: 05/29/2008] [Indexed: 11/15/2022]
Abstract
Pregnancy and the postpartum period is a time of great physical, psychological, and emotional upheaval. Women who experience intimate partner violence experience more depression and anxiety and a higher risk of adverse pregnancy outcomes (such as those related to the abuse). While the literature supports the presence of increased health care utilization for abused women, there is little information on the way that these mothers seek medical care for their infants. This secondary analysis is part of a larger study on smoking cessation in low-income, rural pregnant women called Baby Behavioral Education Enhancement of Pregnancy (Baby BEEP). Women (N = 616) were classified as abused or not abused based on their answers to the Abuse Assessment Screen. At 6 weeks postdelivery, each woman was asked, "Has your baby had any problems that you talked to the doctor or nurse about?" The abused women (n = 211) sought health care advice significantly more often than the nonabused women (n = 405; Pearson chi(2) = 4.89; P = .027). Stress scores were elevated for all women in the study, but women categorized as abused experienced significantly more stress (P < .001).
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Affiliation(s)
- Kathleen K Ellis
- Sinclair School of Nursing, University of Missouri-Columbia, Columbia, MO 65211, USA
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Bhandari S, Levitch AH, Ellis KK, Ball K, Everett K, Geden E, Bullock L. Comparative analyses of stressors experienced by rural low-income pregnant women experiencing intimate partner violence and those who are not. J Obstet Gynecol Neonatal Nurs 2008; 37:492-501. [PMID: 18754988 PMCID: PMC2564601 DOI: 10.1111/j.1552-6909.2008.00266.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To describe the daily lives of rural pregnant women who smoked during pregnancy, with a focus on their sources of stress and the compounding effects of intimate partner violence. DESIGN A qualitative study using content analysis of research nurses' telephone logs from a large smoking cessation randomized controlled trial (N=695) in which 33% of the sample (n=227) experienced intimate partner violence in the past year. PARTICIPANTS Fifty pregnant women, 25 who had experienced intimate partner violence in the past year and 25 who had never experienced intimate partner violence, were randomly selected from those who received a nurse-delivered telephone intervention for smoking cessation (n=345). The mean age of the sample was 22 years, and the majority were White and living in a married-like relationship. RESULTS Women experiencing intimate partner violence discussed certain stressors significantly more often than nonabused women. These stressors included finances, lack of social support, legal issues, transportation issues, and abuse by the intimate partner and others. CONCLUSION Health care providers need to recognize that intimate partner violence creates a stress, which can compound the stressors of pregnancy and poverty in rural areas. Offering these women a chance to talk about their lives can help them not only to locate necessary resources, but also to break down the barriers of isolation.
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Affiliation(s)
- Shreya Bhandari
- Department of Social Work, University of Missouri-Columbia, Columbia, MO 65211, USA
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Hjerkinn B, Lindbaek M, Rosvold EO. Substance abuse in pregnant women. Experiences from a special child welfare clinic in Norway. BMC Public Health 2007; 7:322. [PMID: 17996120 PMCID: PMC2242799 DOI: 10.1186/1471-2458-7-322] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Accepted: 11/11/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Substance abuse during pregnancy may harm the foetus and can cause neonatal abstinence syndrome. Exposure to alcohol and other substances can influence the child for the rest of its life. A special child welfare clinic was set up in 1994 in Kristiansand, Norway, targeting pregnant women with substance abuse problems in the county of Vest-Agder. Pregnancy is not an indication for opioid replacement therapy in Norway, and one of the clinic's aims was to support the drug dependent women through their pregnancy without any replacements. The object of this paper is to describe concurrent health and social problems, as well as the predictors for stopping drug abuse, in the clinic's user group. METHODS Retrospective cohort study. Data was gathered from the medical records of all 102 women seen in the clinic in the period between 1992 and 2002. The study includes 59 out of 60 women that were followed until their children were two years old or placed in alternative care, and a comparison group of twice the size. Both groups were presented with a questionnaire concerning both the pregnancy and health and socio-economic issues. RESULTS Four (4.5 percent) of the women that completed their pregnancies did not manage to reduce their substance abuse. All the others reduced their substance abuse considerably. The odds ratio for stopping substance abuse within the first trimester was significantly associated with stopping smoking (O.R. 9.7) or being victims of rape (O.R. 5.3). CONCLUSION A low cost and low threshold initiative organised as a child welfare clinic may support women with substance abuse problems in their efforts to stop or reduce their substance abuse during pregnancy.
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Affiliation(s)
- Bjørg Hjerkinn
- Addiction Unit/Research Unit, Sørlandet Hospital, Kristiansand, Norway.
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Abstract
This article outlines clinical approaches to pregnant and recently delivered women who have experienced intimate partner violence. Several process theories are discussed, which help providers more deeply understand the meaning women attach to abuse and the complex nature of being both pregnant and abused. Distinctions are made between patient-centered and practitioner-centered approaches. The construct of stages of change is discussed as a basis for stage-based interventions designed to assist women at various points in their struggle to survive abuse.
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Renker PR, Tonkin P. Postpartum women's evaluations of an audio/video computer-assisted perinatal violence screen. Comput Inform Nurs 2007; 25:139-47. [PMID: 17496478 DOI: 10.1097/01.ncn.0000270040.14541.37] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
For universal screening to become a reality, research must first validate the effectiveness and acceptability of violence screening. This study describes postpartum women's perceptions of an anonymous computer-assisted self-interview for perinatal violence screening. A sample of 519 postpartum women completed interviews that included audio and video enhancements. Post-response evaluations were positive with most women, indicating that they preferred computer interviews to face-to-face or written abuse screening. In addition, participants indicated that the computer format and associated anonymity positively influenced their willingness to answer the violence questions truthfully. Computer interviews offer an alternative approach to violence screening that may help women who are hesitant to disclose abuse directly to their healthcare providers.
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Kendall-Tackett KA. Violence against women and the perinatal period: the impact of lifetime violence and abuse on pregnancy, postpartum, and breastfeeding. TRAUMA, VIOLENCE & ABUSE 2007; 8:344-53. [PMID: 17596350 DOI: 10.1177/1524838007304406] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Violence against women affects millions of women, including women who are pregnant or have recently given birth. During pregnancy, a woman's history of past abuse increases her risk of depression and posttraumatic stress disorder. And these increase the risk of pregnancy and neonatal complications. Women who have experienced past or current abuse are also at high risk for postpartum depression, which can affect their relationships with other adults and their babies. Violence against women can also affect women's ability to breastfeed, although abuse survivors often express an intention to breastfeed and are more likely to initiate breastfeeding than their nonabused counterparts. Current abuse, depression, posttraumatic stress disorder, social isolation, lack of social support, and cessation of breastfeeding all have negative health effects for mothers and babies.
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