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MATERNAL AND CHILD HEALTH JOURNAL, 2000, Vol. 4, N° 2

Special Issue: Violence and Reproductive Health

GAZMARARIAN, Julie A.; PETERSEN, Ruth; SPITZ, Alison M.; GOODWIN, Mary M.; SALTZMAN, Linda E.; MARKS, James S.

Violence and reproductive health: Current knowledge and future research directions.

Objective: Despite the scope of violence against women and its importance for reproductive health, very few scientific data about the relationship between violence and reproductive health issues are available. Methods: The current knowledge base for several issues specific to violence and reproductive health, including association of violence with pregnancy, pregnancy intention, contraception use, pregnancy terminations, and pregnancy outcomes, are reviewed and suggestions are provided for future research. Results: Despite the limitations of current research and some inconclusive results, the existing research base clearly documents several important points: (1) violence occurs commonly during pregnancy (an estimated 4%-8% of pregnancies); (2) violence is associated with unintended pregnancies and may be related to inconsistent contraceptive use; and (3) the research is inconclusive about the relationship between violence and pregnancy outcomes. Conclusions: Improved knowledge of the risk factors for violence is critical for effective intervention design and implementation. Four areas that need improvement for development of new research studies examining violence and reproductive-related issues include (1) broadening of study populations, (2) refining data collection methodologies, (3) obtaining additional information about violence and other factors, and (4) developing and evaluating screening and intervention programs. The research and health care communities should act collaboratively to improve our understanding of why violence against women occurs, how it specifically affects reproductive health status, and what prevention strategies may be effective.

(FAMILY PLANNING, MATERNAL AND CHILD HEALTH, HEALTH CONDITIONS, HEALTH SERVICES, VIOLENCE, WOMEN'S STATUS, DEMOGRAPHIC RESEARCH, INTERDISCIPLINARY RESEARCH).

English - pp. 79-84.

J. A. Gazmararian, USQA Center for Health Care Research, 2859 Paces Ferry Road, Suite 820, Atlanta, Georgia 30339, U.S.A.; R. Petersen, Cecil Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, U.S.A.; A. M. Spitz, M. M. Goodwin and J. S. Marks, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, MD K-35, Atlanta, Georgia 30341, U.S.A.; L. E. Saltzman, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, MD K-35, Atlanta, Georgia 30341, U.S.A.

julie.gazmararian@phc.aetna.com.

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GOODWIN, Mary M.; GAZMARARIAN, Julie A.; JOHNSON, Christopher H.; COLLEY GILBERT, Brenda; SALTZMAN, Linda E.; The PRAMS Working Group.

Pregnancy intendedness and physical abuse around the time of pregnancy: Findings from the pregnancy risk assessment monitoring system, 1996-1997.

Objective: This study examines whether unintended pregnancy is associated with physical abuse of women occurring around the time of pregnancy, independent of other factors. Methods: In 1996-1997, state-specific population-based data were obtained from the Pregnancy Risk Assessment Monitoring System (PRAMS) from 39,348 women in 14 states who had delivered a live-born infant within the previous 2-6 months. The study questionnaire asked about maternal behaviors and characteristics around the time of pregnancy. Results: Women who had mistimed or unwanted pregnancies reported significantly higher levels of abuse at any time during the 12 months before conception or during pregnancy (12.6% and 15.3%, respectively) compared with those with intended pregnancies (5.3%). Higher rates of abuse were reported by women who were younger, Black, unmarried, less educated, on Medicaid, living in crowded conditions, entering prenatal care late, or smoking during the third trimester. Overall, women with unintended pregnancies had 2.5 times the risk of experiencing physical abuse compared with those whose pregnancies were intended. This association was modified by maternal characteristics; the association was strongest among women who were older, more educated, White, married, not on Medicaid, not living in crowded conditions, receiving first trimester prenatal care, or nonsmoking during the third trimester. Conclusions: Women with unintended pregnancies are at increased risk of physical abuse around the time of pregnancy compared with women whose pregnancies are intended. Prenatal care can provide an important point of contact where women can be screened for violence and referred to services that can assist them.

(UNITED STATES, WOMEN'S STATUS, VIOLENCE, UNPLANNED PREGNANCY, PRENATAL CARE).

English - pp. 85-92.

M. M. Goodwin, C. H. Johnson, B. Colley Gilbert, Division of Reproductive Health, National Center for Chronic Disease Promotion and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, MD K-35, Atlanta, Georgia 30341, U.S.A.; J. A. Gazmararian, USQA Center for Health Care Research, 2859 Paces Ferry Road, Suite 820, Atlanta, Georgia 30339, U.S.A.; Linda E. Saltzman, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, MD K-35, Atlanta, Georgia 30341, U.S.A.

mmg2@cdc.gov.

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WIEMANN, Constance M.; AGURCIA, Carolyn A.; BERENSON, Abbey B.; VOLK, Robert J.; RICKERT, Vaughn I.

Pregnant adolescents: Experiences and behaviors associated with physical assault by an intimate partner.

Objective: To better understand the experiences and behaviors of battered pregnant adolescents and the characteristics of their intimate partners. Methods: As part of a longitudinal multiracial/ethnic study of drug use among pregnant and parenting adolescents, 724 adolescents = 18 years of age completed face-to-face interviews on the postpartum unit between April 1994 and February 1996. Adolescent mothers reported on demographic characteristics, social support and peer contact, level of substance use before and during pregnancy, nonconforming behaviors, and both lifetime and concurrent exposure to violence. Information about the father of her baby included his level of substance use, gang and police involvement, and intimate partner violence. Chi-square and Student's t tests were used to identify victim, partner, and relationship characteristics associated with being assaulted by the father of her baby during the preceding year. Results: Eighty-six (11.9%) adolescents reported being physically assaulted by the fathers of their babies. Assaulted adolescents were significantly more likely than nonassaulted adolescents to have been exposed to other forms of violence over the same 12-month period, including verbal abuse, assault by family members, being in a fight where someone was badly hurt, reporting fear of being hurt by other teens, witnessing violence perpetrated on others, and carrying a weapon for protection. A history of nonconforming behavior and frequent or recent substance use was more common among both battered adolescents and their perpetrator partners. The age and race/ethnicity of the pregnant adolescent and the length of her relationship with the father of her baby were not associated with assault status. Conclusions: Pregnant adolescents who are assaulted by intimate partners appear to live in violence-prone environments and to have partners who engage in substance use and other nonconforming behaviors. Comprehensive assessments are critical for all adolescent females at risk of assault, and direct questions about specific behaviors or situations must be used.

(UNITED STATES, VIOLENCE, WOMEN'S STATUS, ADOLESCENT PREGNANCY, DRUG ADDICTION, BEHAVIOUR).

English - pp. 93-101.

C. M. Wiemann, C. A. Agurcia, Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, U.S.A.; A. B. Berenson, Department of Obstetrics and Gynecology, University of Texas Medical Branch-Galveston, Galveston, TX, U.S.A.; R. J. Volk, Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, U.S.A.; V. I. Rickert, Department of Pediatrics, Mount Sinai School of Medicine, New York, NY, U.S.A.

cwiemann@bcm.tmc.edu.

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MCMAHON, Pamela M.; GOODWIN, Mary M.; STRINGER, Gayle.

Sexual violence and reproductive health.

Sexual violence is a significant public health problem, and has been linked to adverse effects on women's physical and mental health. Although some advances in the research have been made, more scientific exploration is needed to understand the potential association between sexual violence and women's reproductive health, and to identify measures that could be implemented in reproductive health care settings to assist women who have experienced sexual violence. Three general areas needing further study include (1) expansion of the theoretical frameworks and analytic models used in future research, (2) the reproductive health care needs of women who have experienced sexual violence, (3) and intervention strategies that could be implemented most effectively in reproductive health care settings.

(UNITED STATES, SEXUALITY, VIOLENCE, PUBLIC HEALTH, WOMEN'S STATUS, HEALTH SERVICES, RESEARCH).

English - pp. 121-124.

P. M. McMahon, Division of Violence Prevention, Louisiana Office of Public Health, 325 Loyola Av., Room 315, New Orleans, Louisiana 70112, U.S.A.; M. M. Goodwin, Division of Reproductive Health, National Center for Chronic Disease Promotion and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, MD K-35, Atlanta, Georgia 30341, U.S.A.; G. Stringer, Washington Coalition of Sexual Assault Programs, Olympia, Washington, U.S.A.

pmcmahon@dhh.state.la.us.

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PARSONS, Linn; GOODWIN, Mary M.; PETERSEN, Ruth.

Violence against women and reproductive health: Toward defining a role for reproductive health care services.

Since a large proportion of U.S. women receive reproductive health care services each year, reproductive health care settings offer an important opportunity to reach women who may be at risk of or experiencing intimate partner violence (IPV). Although screening women for IPV in clinical health care settings has been endorsed by national professional associations and organizations, scientific evidence suggests that opportunities for screening in reproductive health care settings are often missed. This commentary outlines what is known about screening and intervention for IPV in clinical health care settings, and points out areas that need greater attention. The ultimate goal of these recommendations is to increase the involvement of reproductive health care services in sensitive, appropriate, and effective care for women who may be at risk of or affected by IPV.

(UNITED STATES, VIOLENCE, WOMEN, HEALTH SERVICES, HEALTH CENTRES, HEALTH POLICY).

English - pp. 135-140.

L. Parsons, Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Medical Center Bd., Winston-Salem, NC 27157, U.S.A.; M. M. Goodwin, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, MD K-35, Atlanta, Georgia 30341, U.S.A.; R. Petersen, Cecil Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, U.S.A.

lparson@bgsm.edu.

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CAMPBELL, Jacquelyn C.; MORACCO, Kathryn E.; SALTZMAN, Linda E.

Future directions for violence against women and reproductive health: Science, prevention, and action.

Despite the recognition that violence may be associated with serious consequences for women's reproductive health, the understanding of the relationship between the two remains limited, as does our understanding of the most effective role for reproductive health care providers and services. This paper briefly summarizes the history of the nexus of public health, health care, and violence against women in the United States. In addition, we present some considerations for future directions for research, health care practice, and policy that will advance the understanding of the complex relationship between violence and reproductive health.

(VIOLENCE, WOMEN, MATERNAL AND CHILD HEALTH, PUBLIC HEALTH, FAMILY PLANNING, FAMILY PLANNING CENTRES, RESEARCH).

English - pp. 149-154.

J. C. Campbell, Johns Hopkins University, School of Nursing, 535 North Wolfe Street, Room 436, Baltimore, Maryland 21205-2110, U.S.A.; K. E. Moracco, Department of Health Behavior and Health Education and UNC Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, U.S.A.; L. E. Saltzman, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, MD K-35, Atlanta, Georgia 30341, U.S.A.

jcampbel@son.jhmi.edu.

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