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INTIMATE PARTNER VIOLENCE DURING PREGNANCY: Oregon PRAMS 2001

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... committed by a spouse, ex-spouse, current or former boyfriend or girlfriend. Both men and women are victims of IPV. Majority of perpetrators are men ... – PowerPoint PPT presentation

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Title: INTIMATE PARTNER VIOLENCE DURING PREGNANCY: Oregon PRAMS 2001


1
INTIMATE PARTNER VIOLENCE DURING PREGNANCY
Oregon PRAMS 2001
  • Bertha Alicia Moseson, MD, MPH
  • 10th Annual MCH EPI Conference, Atlanta
  • December 8, 2004

2
INTIMATE PARTNER VIOLENCE (IPV)
  • IPV (domestic violence, battering, spousal abuse)
    is violence committed by a spouse, ex-spouse,
    current or former boyfriend or girlfriend
  • Both men and women are victims of IPV
  • Majority of perpetrators are men
  • Most suffer multiple acts over time
  • Cuts across socioeconomic, religious, and ethnic
    lines

3
PREVALENCE OF IPV IN USA
  • 2.1 of women 18 and older are victims of
    violence (2 million women)
  • 75 are victims of intimate partner violence
  • More women than men experience IPV, and women are
    more likely to be injured
  • 324,000 experience IPV during pregnancy
  • Prevalence is 4-8 in most studies and as high as
    20 in some studies

4
CONSEQUENCES OF INTIMATE PARTNER VIOLENCE IN
PREGNANCY (IPVP)
  • Puts pregnant woman and fetus at risk for
    physical and mental health problems
  • Associated with increased smoking and poor weight
    gain, both factors for delivery of low birth
    weight babies
  • Risk to fetus and mother as high as other
    conditions that are routinely screened for in
    pregnancy

5
OBJECTIVES OF THIS STUDY
  • To develop a model, using Oregon PRAMS data, that
    might predict when a pregnant woman is being
    battered by her partner
  • To use the model to identify women in prenatal
    care who are being physically abused by their
    partners earlier in the cycle of violence

6
METHODS Data collection and population
  • Oregon Pregnancy Risk Assessment Monitoring
    System (PRAMS), 2001
  • 2490 surveys mailed/1795 responded (72.1)
  • 1548 answered question about IPVP
  • Excluded
  • All women
  • 26 women did not answer question about IPVP

7
METHODSStatistical Analysis
  • Data management SAS for windows v 8e
  • Crosstab and logistic regression SUDAAN 8.02
  • Outcome variable
  • Intimate Partner Violence in Pregnancy (IPVP)
  • Crosstab for association CMH Chi-square with
    p-value
  • Logistic regression of selected variables with
    significant OR based on 95 CI

8
METHODSThe Question
  • During your most recent pregnancy, did your
    husband or partner push, hit, slap, kick, choke,
    or physically hurt you in any other way?
  • No
  • Yes

9
MEHTODSModel Building
  • Four categories of variables selected for model
    building (some variables found in more than one
    model)
  • 1. Male partner characteristics
  • 2. Pregnancy characteristics
  • 3. Relationship characteristics
  • 4. Maternal socio-demographic factors

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RESULTS Highly correlated variables not used in
model building
  • Highest odds ratios in our study, suggest these
    are proxy variables for IPVP
  • During the 12 months before you got pregnant, did
    your husband/partner push, hit, slap, kick,
    choke, or physically hurt you in any other way?
    (OR 321.39)
  • During the 12 months before your baby was born
    did you and your husband/partner argue more than
    usual? (OR 272.22)
  • During the 12 months before your baby was born,
    were you involved in a physical fight? (OR 81.78)

16
RESULTSEffect of Pregnancy on IPV
  • Prevalence of IPV before pregnancy 4.17
  • 68 women in sample
  • Prevalence of IPV during pregnancy 2.45
  • 36 women in sample
  • 5 of these women indicated battering started
    during pregnancy

17
DISCUSSION Husband/Partner said he did not want
her to be pregnant
  • Likely to cause increased stress in an already
    stressful relationship
  • May be related to feelings of loss of control by
    a controlling male partner
  • Jealousy if woman gets more attention
  • Anger if he feels he is not the father

18
DISCUSSION Loss of a previous pregnancy
  • Association has been shown as an outcome in
    several studies
  • Possible mechanisms
  • Trauma to the uterus and placenta
  • Smoking and drug use
  • Depression and inadequate diet
  • Sexually transmitted diseases and HIV
  • Preterm labor

19
DISCUSSION Someone close to you has a problem
with drinking or drugs
  • Found to be significant in other PRAMS studies
  • A coping mechanism for stress and PTSD
  • What came first? Battering or substance abuse
  • Independent of question about womans alcohol use
    during pregnancy

20
DISCUSSION Lots of bills you couldnt pay
  • Consistently more significant than income
  • Income
  • Being on OHP Crude OR 2.25 (0.65,7.72)
  • Lots of bills you couldnt pay
  • Crude OR 13.56 (3.34, 63.26)
  • Adjusted OR 7.87 (1.84, 33.65)

21
DISCUSSION Surveillance for IPVP
  • In Oregon, in 2001, only 49 of women in prenatal
    care recalled having been asked about IPVP
  • Many asked only at intake history and physical
  • Women need to develop trust in provider
  • Providers dont want to know, because so few
    resources available to pregnant women

22
LIMITATIONS
  • Women
  • Only women with live born baby surveyed
  • Questionnaire mailed to womans home
  • Questions open to interpretation
  • Asking for recall of events up to 24 months ago
  • Reluctance to reveal sensitive, embarrasing and
    potentially threatening information

23
CONCLUSIONS
  • The model has identified factors which are
    associated with IPVP in Oregon Women
  • These factors can guide prenatal care providers
    in identifying women at higher risk for IPVP
  • Obstetrical care providers must be encouraged to
    identify and counsel women in abusive
    relationships or refer them for counseling
  • For the health of the mother and fetus
  • For better delineation of this Public Health
    problem

24
CONCLUSIONS
  • If a woman denies abuse, but admits to partner
    doesnt want her to be pregnant, previous
    pregnancy loss, close to someone with drug or
    Etoh problem, or lots of bills she cant pay,
    she should be asked, in private, about abuse at
    each prenatal visit

25
FUTURE WORK
  • Health People 2010 goal for IPV 3.3/1000
  • Increased awareness and training for OB providers
    to detect and document abuse
  • Increased public health awareness
  • More services for pregnant women
  • More research on factors causing IPVP, more
    emphasis on working with abuser

26
ACKNOWLEDGEMENTS
  • Oregon Department of Human Services, Office of
    Family Health
  • Oregon Health Science University, Department of
    Public Health Preventive Medicine
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