Optional Selections

Definition

The percentage of women who reported partner-associated physical abuse during the 12 months before pregnancy, or during pregnancy, divided by the number of women who delivered a live birth.

Numerator

The number of women who reported physical abuse by their husband/partner during the 12 months before pregnancy, or during pregnancy.

Denominator

The number of women who delivered a live birth.

Data Interpretation Issues

The data only includes women who reported physical abuse during the perinatal time period. It does not include other forms of abuse. A stratified random sampling approach is used in selecting women 2-4 months postpartum to participate in PRAMS. The data are weighted by the CDC to represent the birth population for that year, adjusted for sampling probabilities, nonresponse, and noncoverage. Each strata must achieve a weighted response rate of 55% or it is not considered representative of that population. See the PRAMS website at [https://www.cdc.gov/prams/methodology.htm] for more detailed information on PRAMS and its methodology.

Why Is This Important?

Domestic violence, also known as intimate partner violence (IPV), is a major public health problem. IPV is defined as behavior designed to exert undue control over another person using physical, sexual, verbal, or emotional abuse by an intimate partner or spouse. Although women of all ages may experience IPV, it occurs most often among women of reproductive age. Women with histories of IPV before pregnancy are at risk for unintended pregnancies, depression, and anxiety. Women with histories of IPV during pregnancy are at greater risk of poor pregnancy weight gain, infection, anemia, tobacco use, stillbirth, pelvic fracture, placental abruption, fetal injury, preterm delivery, and low birth weight, as well as depression and anxiety through the first year postpartum.

Other Objectives

There is not a Healthy People 2020 objective specifically targeting domestic violence during the perinatal time period; however, proposed objective IVP-39 focuses on reducing violence by current or former intimate partners.

How Are We Doing?

The overall rate of physical abuse in the year before pregnancy or during pregnancy in Utah was 2.0% during 2014-2017. While IPV during pregnancy has serious consequences, it is often undetected during prenatal visits. Over two thirds (70.7%) of women responding to the Utah Pregnancy Risk Assessment (PRAMS) survey said their prenatal care provider did not ask about intimate partner physical abuse.

How Do We Compare With the U.S.?

There are no national data assessing the prevalence of domestic violence among childbearing women.

What Is Being Done?

The Maternal and Infant Health Program (MIHP) aims to educate healthcare providers and women of reproductive age about domestic violence by providing information and links to helpful resources.

Evidence-based Practices

The American College of Obstetricians and Gynecologists (ACOG) recommends screening all patients for domestic violence, and for women who are pregnant, screening should take place multiple times throughout the pregnancy as well as at the postpartum checkup. Screening with explicit questioning can help identify victims of IPV. Although various models of questioning are available, one simple approach recommended by ACOG, is the SAFE screening technique:[[br]] *__Stress/Safety__: Do you feel safe in your relationship?[[br]] *__Afraid/Abused__: Have you been physically hurt or threatened by your partner?[[br]] *__Friends/Family__: Are your friends and family aware of what is going on?[[br]] *__Emergency__: Do you have a safe place to go in an emergency?[[br]] [[br]] Evidence from randomized trials support a variety of interventions for women of childbearing age, including counseling, home visits, and mentoring support. Depending on the type of intervention, these services may be provided by clinicians, nurses, social workers, non-clinician mentors, or community workers. Counseling generally includes information on safety behaviors and community resources. In addition to counseling, home visits may include emotional support, education on problem solving strategies, and parenting support.

Available Services

The Domestic Violence Hotline provides referrals for shelters, counseling etc.[[br]] 1-800-897-LINK (5465) National Domestic Violence Hotline[[br]] 1-800-799-SAFE (7233) Rape Abuse & Incest National Network (RAINN) Hotline[[br]] 1-800-656-HOPE (4673)[[br]] [[br]] [[br]] The Utah Department of Health/Utah Domestic Violence Coalition provides a domestic violence screening tool for healthcare providers: "Clinical Guidelines for Assessment and Referral for Victims of Domestic Violence" which can be found at: [http://www.health.utah.gov/vipp/pdf/DomesticViolence/HmHlthTrngMnl.pdf].

Related Indicators

Relevant Population Characteristics

IPV affects millions of women regardless of age, economic status, race, religion, ethnicity, sexual orientation, or educational background.

Related Relevant Population Characteristics Indicators:

Domestic Violence Fatalities

Health Care System Factors

Although screening for IPV is recommended, studies have shown very low screening rates ranging from 1.5%-12% in primary care settings.

Risk Factors

Although anyone can experience IPV, according to a Utah Department of Health, Violence and Injury Prevention Program 2016 report, the lifetime prevalence of IPV was statistically higher among women (18.1%), those aged 35 to 49 (18.3%), among persons whose annual household income was less than $25,000 (21.7%), among persons who are currently divorced (34.2%) or separated (44.3%), among persons who are unemployed (27.3%); bisexual persons (32.6%); and adults with any disability (24.5%).

Health Status Outcomes

The percentage of women with postpartum depressive symptoms is significantly higher among women who reported IPV during pregnancy.

Graphical Data Views

Percentage of Utah Women Who Reported Physical Abuse the Year Before Pregnancy, or During Pregnancy by Maternal Age, Utah PRAMS, 2014-2017

Age Group	Percentage of Women	Lower Limit	Upper Limit	Note
Record Count: 7
17 or Under	6.3%	1.1%	11.6%	*
18-19	5.2%	1.7%	8.8%	*
20-24	2.2%	1.3%	3.0%
25-29	2.2%	1.3%	3.0%
30-34	1.1%	0.4%	1.8%	*
35-39	2.5%	0.9%	3.9%	*
40+	**			^

Data Notes

Women were asked the following two questions: [[br]] 1) During the 12 months before you got pregnant with your new baby, did your husband or partner push, hit, slap, kick, choke, or physically hurt you in any other way? [[br]] 2) During your most recent pregnancy, did your husband or partner push, hit, slap, kick, choke, or physically hurt you in any other way?. [[br]] [[br]] * Use caution when interpreting the estimate. The estimate has a relative standard error greater than 30% and does not meet UDOH standards for reliability. [[br]] [[br]] ^The estimate for the 40+ age category has been suppressed because the relative standard error is greater than 50% or the observed number of events is very small and not appropriate for publication.