 |
2002 PRAMS Surveillance Report: Multistate Exhibits
Physical Abuse |
|
Data Highlights | References | Tables
Background
Physical violence against women around the time of pregnancy can adversely affect the health and well-being of women, their fetuses and infants, and other children in the household. Annually in the United States, almost 2 million women are physically assaulted, including more than 1.3 million who are physically assaulted by an intimate partner (i.e., a current or former spouse, cohabiting partner, or boyfriend).1 About 4% to 9% of women—approximately 152,000 to 324,000—are physically abused while they are pregnant.2 The Centers for Disease Control and Prevention (CDC) defines physical violence as "the intentional use of physical force with potential for causing death, injury, or harm. Physical violence includes, but is not limited to, scratching, pushing, shoving, throwing, grabbing, biting, choking, shaking, poking, hair pulling, slapping, punching, hitting, burning, and use of restraints or one's body, size, or strength against another person. Physical violence also includes the use of a weapon against a person."3
The physical effects of trauma on pregnancy are determined by such factors as gestational age of the fetus, type and severity of the trauma, and the level of disruption to normal uterine and fetal physiology.4 In pregnant women, physical injury from abuse commonly involves the breast and abdomen.5 Blunt abdominal trauma resulting from a physical assault can lead to fetal loss from one or more of the following: maternal shock, placental abruption or other placental injury, direct fetal injury, uterine rupture, or maternal death.6 Trauma can also lead to infection, labor, and antepartum hemorrhage.4,7 Penetrating abdominal trauma from gunshot or stab wounds may directly injure the fetus, umbilical cord, or placenta, resulting in fetal loss.6
Physical abuse is associated with various risky maternal behaviors, pregnancy complications, and adverse birth outcomes. Physical abuse around the time of pregnancy is associated with use of alcohol, tobacco, and drugs; high level of stressful life events (e.g., involved in a fight, increased arguing with a husband or partner, having someone close with an alcohol or drug problem, recent separation or divorce, homelessness, financial hardship); delayed entry into prenatal care; pregnancy perceived as unintended by mother or male partner; maternal infection, anemia, second- and third-trimester bleeding, and inadequate weight gain; preterm labor; and low birthweight.2,5,7–13
Using 1996–1998 PRAMS data for 16 states, Saltzman and colleagues2 found that 8.7% of mothers were physically abused by a husband, partner, other family member, friend, or other perpetrator around (before or during) the time of pregnancy: 7.2% were abused in the 12 months before pregnancy, and 5.3% were abused during pregnancy. For 75% of mothers who were physically abused, the perpetrators were husbands or partners. An estimated 6.5% of mothers reported physical abuse by their husbands or partners around the time of pregnancy: 5.4% reported abuse in the 12 months before their most recent pregnancy and 4.1% reported abuse during pregnancy. The most common pattern of physical abuse by a husband or partner (excluding ex-husbands and former partners) was abuse that started before pregnancy and continued during the pregnancy, suggesting that pregnancy status might not be a factor in the abuse. Abuse ending during pregnancy was the second most common pattern, and abuse starting during pregnancy was the least common.2
For a majority of women who are abused around the time of pregnancy, abuse often begins prior to pregnancy, suggesting that circumstances unrelated to the pregnancy may play a role in women's risk.2,9 First pregnancies, those that are unintended (mistimed or unwanted), and those that occur at a young age may contribute to or intensify existing stress in a relationship and heighten the risk of violence.10 Pregnancy in the context of other stressors—financial hardship and chronic poverty and unemployment—can also contribute to marital discord and the risk of abuse.10 Studies based on PRAMS data have found an association between stressful life events and the risk of physical abuse around the time of pregnancy.2,9
Characteristics of women at risk for abuse around the time of pregnancy include those who are younger than 20, are unmarried, have fewer than 12 years of education, report that their pregnancies are unwanted or mistimed, have spouses or partners who report that the pregnancies are unwanted or mistimed, are pregnant with their first child, use tobacco during pregnancy, have a low-birthweight infant, are Medicaid recipients, obtain prenatal care from a public source, experience stressful events, or live in crowded households.2,10,11,13–15
During pregnancy, frequent prenatal care visits can help to build trust between pregnant women and their health care providers and can provide a unique window of opportunity for providers to identify and assist women who are at risk for or are experiencing violence.16 Because some women may not disclose abuse the first time they are asked, and because abuse may begin later in pregnancy, the American College of Obstetricians and Gynecologists (ACOG) and CDC recommend that prenatal care providers screen for violence at the first prenatal visit, at least once per trimester, and at the postpartum checkup.5,16
PRAMS provides data on the prevalence of physical abuse by a husband or partner, or by another individual (e.g., family member, friend, other) during the 12 months before pregnancy and during the most recent pregnancy. Data on the number of women who experience physical abuse before or during pregnancy can increase awareness and support for efforts to assess and counsel women about intimate partner violence in the primary care setting. These data can also be used to monitor state progress toward achieving the Healthy People 2010 objective (Objective 15–34) of reducing the rate of physical assault by current or former intimate partners to 3.3 physical assaults per 1,000 people aged 12 years or older. 17
Data Highlights
- In 2002, the prevalence of physical abuse by a husband or partner during the 12 months before the most recent pregnancy ranged from 2.3% (New Jersey) to 8.3% (Oklahoma).
- During 1996–2002, the prevalence of physical abuse during the 12 months before pregnancy decreased in 1 state (Florida).
- During 2000–2002, the prevalence of physical abuse during the 12 months before pregnancy decreased in 1 state (Hawaii).
- In 2002, the prevalence of physical abuse by a husband or partner during pregnancy ranged from 1.9% (Maine) to 6.3% (Arkansas).
- During 1996–2002, the prevalence of physical abuse during pregnancy decreased in 2 states (Florida and West Virginia).
- During 2000–2002, the prevalence of physical abuse during pregnancy decreased in 1 state (Hawaii) and increased in 1 state (Nebraska).
References
- Tjaden P, Thoennes N. Full Report of the Prevalence, Incidence, and Consequences of Violence Against Women: Findings From the National Violence Against Women Survey. Washington, DC: U.S. Department of Justice (DOJ), Office of Justice Programs; 2000. Publication number NCJ 183781.
- Saltzman LE, Johnson CH, Gilbert BC, Goodwin MM. Physical abuse around the time of pregnancy: an examination of prevalence and risk factors in 16 states. Maternal and Child Health Journal 2003;7(1):31–43.
- Petersen R, Saltzman LE, Goodwin M, Spitz A. Key Scientific Issues for Research on Violence Occurring Around the Time of Pregnancy. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion and the National Center for Injury Prevention and Control; 1998.
- Pearlman MD, Tintinalli JE, Lorenz RP. Blunt trauma during pregnancy. The New England Journal of Medicine 1990;323(23):1609–1613.
- American College of Obstetricians and Gynecologists (ACOG). Domestic Violence. (ACOG educational bulletin number 257.) Washington, DC: ACOG; 1999.
- American College of Obstetricians and Gynecologists (ACOG). Obstetric Aspects of Trauma Management. (ACOG educational bulletin number 251.) Washington, DC: ACOG; 1998.
- Berenson AB, Wiemann CM, Wilkinson GS, Jones WA, Anderson GD. Perinatal morbidity associated with violence experienced by pregnant women. American Journal of Obstetrics and Gynecology 1994;170(6):1760–1766; discussion 1766–1769.
- Martin SL, Beaumont JL, Kupper LL. Substance use before and during pregnancy: links to intimate partner violence. The American Journal of Drug and Alcohol Abuse 2003;29(3):599–617.
- Martin SL, Griffin JM, Kupper LL, Petersen R, Beck-Warden M, Buescher PA. Stressful life events and physical abuse among pregnant women in North Carolina. Maternal and Child Health Journal 2001;5(3):145–152.
- Jasinski JL. Pregnancy and violence: an analysis of longitudinal data. Journal of Interpersonal Violence 2001;16(7):712–733.
- Goodwin MM, Gazmararian JA, Johnson CH, Gilbert BC, Saltzman LE. Pregnancy intendedness and physical abuse around the time of pregnancy: findings from the Pregnancy Risk Assessment Monitoring System, 1996–1997. PRAMS Working Group. Maternal and Child Health Journal 2000;4(2):85–92.
- Dietz PM, Gazmararian JA, Goodwin MM, Bruce FC, Johnson CH, Rochat RW. Delayed entry into prenatal care: effect of physical violence. Obstetrics and Gynecology 1997;90(2):221–224.
- Parker B, McFarlane J, Soeken K. Abuse during pregnancy: effects on maternal complications and birth weight in adult and teenage women. Obstetrics and Gynecology 1994;84(3):323–328.
- Gazmararian JA, Adams MM, Saltzman LE, Johnson CH, Bruce FC, Marks JS, et al. The relationship between pregnancy intendedness and physical violence in mothers of newborns. PRAMS Working Group. Obstetrics and Gynecology 1995;85(6):1031–1038.
- Martin SL, Mackie L, Kupper LL, Buescher PA, Moracco KE. Physical abuse of women before, during, and after pregnancy. JAMA (Journal of the American Medical Association) 2001;285(12):1581–1584.
- American College of Obstetricians and Gynecologists (ACOG) and Centers for Disease Control and Prevention (CDC) Workgroup on the Prevention of Violence during Pregnancy. Intimate Partner Violence During Pregnancy: A Guide for Clinicians. Washington, DC: ACOG and CDC; 2003.
- U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd Edition. Washington, DC: U.S. Government Printing Office; 2000.
Prevalence of Physical Abuse by Husband or Partner During the 12 Months Before Pregnancy, 2002
| State |
Respondents |
Percent† |
Standard Error |
95% CI‡ |
| Alabama |
1,555 |
5.8 |
0.7 |
4.5–7.4 |
| Alaska |
1,611 |
5.2 |
0.5 |
4.2–6.4 |
| Arkansas |
1,968 |
8.1 |
0.8 |
6.6–9.9 |
| Colorado |
2,264 |
2.7 |
0.4 |
2.0–3.6 |
| Florida |
2,009 |
3.9 |
0.6 |
2.9–5.4 |
| Hawaii |
1,807 |
3.8 |
0.4 |
3.1–4.8 |
| Illinois |
1,862 |
4.1 |
0.5 |
3.2–5.2 |
| Louisiana |
1,679 |
7.0 |
0.7 |
5.7–8.6 |
| Maine |
1,137 |
3.3 |
0.6 |
2.2–4.7 |
| Maryland |
1,456 |
5.6 |
1.0 |
4.0–7.8 |
| Michigan |
1,541 |
4.9 |
0.7 |
3.8–6.4 |
| Minnesotaa |
1,144 |
3.4 |
0.6 |
2.4–4.9 |
| Montana |
1,038 |
6.7 |
0.8 |
5.2–8.5 |
| Nebraska |
1,880 |
4.4 |
0.6 |
3.4–5.6 |
| New Jerseyb |
945 |
2.3 |
0.4 |
1.6–3.3 |
| New Mexico |
1,554 |
7.6 |
0.7 |
6.3–9.1 |
| New Yorkc |
1,223 |
4.8 |
0.8 |
3.4–6.7 |
| North Carolina |
1,549 |
3.7 |
0.6 |
2.7–5.0 |
| North Dakota |
902 |
3.4 |
0.5 |
2.6–4.5 |
| Ohio |
1,369 |
4.3 |
0.7 |
3.1–5.8 |
| Oklahoma |
1,796 |
8.3 |
1.0 |
6.4–10.5 |
| Rhode Island |
1,411 |
4.4 |
0.6 |
3.3–5.9 |
| South Carolina |
1,395 |
6.2 |
1.1 |
4.4–8.7 |
| Utah |
1,572 |
2.9 |
0.5 |
2.0–4.2 |
| Vermont |
1,025 |
4.1 |
0.6 |
3.1–5.5 |
| Washington |
1,517 |
3.4 |
0.6 |
2.4–4.9 |
| West Virginia |
1,673 |
5.4 |
0.8 |
4.0–7.1 |
| All PRAMS states§ |
40,882 |
4.6 |
0.2 |
4.2–4.9 |
† 2002 state range is 2.3–8.3%.
‡ Confidence interval.
§ Aggregate of the 27 PRAMS states.
a Data represent Minnesota births from May–December 2002.
b Data represent New Jersey births from July–December 2002.
c Data exclude New York City. |
Prevalence of Physical Abuse by Husband or Partner During the 12 Months Before Pregnancy, 2002
Healthy People 2010 Objective 15–34
Reduce the rate of physical assault by current or former intimate partners to 3.3 physical assaults per 1,000 persons aged 12 years and older. |
Prevalence of Physical Abuse by Husband or Partner During the 12 Months Before Pregnancy, 1996–2002
| State |
1996
(%) |
1997
(%) |
1998
(%) |
1999
(%) |
2000
(%) |
2001
(%) |
2002
(%) |
P value
for trend# |
| Alabama |
5.4 |
6.1 |
4.5 |
4.9 |
6.5 |
7.5 |
5.8 |
0.109 |
| Alaska |
6.4 |
6.5 |
6.8 |
4.3 |
8.0 |
7.4 |
5.2 |
0.821 |
| Arkansas |
— |
7.3 |
7.4 |
5.9 |
9.0 |
8.6 |
8.1 |
0.160 |
| Colorado |
— |
— |
4.0 |
3.9 |
3.2 |
3.6 |
2.7 |
0.061 |
| Florida |
5.2 |
5.2 |
5.1 |
5.8 |
4.8 |
3.9 |
3.9 |
0.048* |
| Hawaii |
— |
— |
— |
— |
6.1 |
5.0 |
3.8 |
0.001** |
| Illinois |
— |
5.4g |
4.1 |
5.2 |
5.4 |
5.1 |
4.1 |
0.595 |
| Louisiana |
— |
— |
6.7 |
5.8 |
6.4 |
8.2 |
7.0 |
0.172 |
| Maine |
4.4 |
3.6 |
3.6 |
3.1 |
4.0 |
3.4 |
3.3 |
0.348 |
| Maryland |
— |
— |
— |
— |
— |
4.9d |
5.6 |
# # |
| Michigan |
— |
— |
— |
— |
— |
3.5e |
4.9 |
# # |
| Minnesota |
— |
— |
— |
— |
— |
— |
3.4a |
# # |
| Montana |
— |
— |
— |
— |
— |
— |
6.7 |
# # |
| Nebraska |
— |
— |
— |
— |
4.2 |
5.0 |
4.4 |
0.774 |
| New Jersey |
— |
— |
— |
— |
— |
— |
2.3b |
# # |
| New Mexico |
— |
—h |
8.2h |
7.1 |
8.2 |
6.0 |
7.6 |
0.314 |
| New Yorkc |
5.5 |
4.0 |
4.3 |
4.8 |
3.1 |
3.0 |
4.8 |
0.226 |
| North Carolina |
— |
5.0i |
5.4 |
4.4 |
4.5 |
5.1 |
3.7 |
0.188 |
| North Dakota |
— |
— |
— |
— |
— |
— |
3.4 |
# # |
| Ohio |
— |
— |
— |
5.0 |
4.9 |
5.4 |
4.3 |
0.572 |
| Oklahoma |
7.6 |
6.3 |
7.0 |
5.0 |
6.7 |
5.5 |
8.3 |
0.950 |
| Rhode Island |
— |
— |
— |
— |
— |
— |
4.4 |
# # |
| South Carolina |
7.0 |
5.9 |
4.8 |
5.6 |
3.6 |
4.9 |
6.2 |
0.298 |
| Utah |
— |
— |
— |
3.1 |
3.2 |
4.0 |
2.9 |
0.971 |
| Vermont |
— |
— |
— |
— |
—f |
3.3f |
4.1 |
# # |
| Washington |
5.1 |
4.0 |
4.2 |
4.4 |
4.6 |
3.9 |
3.4 |
0.232 |
| West Virginia |
6.1 |
6.4 |
7.3 |
5.9 |
5.0 |
6.2 |
5.4 |
0.263 |
# Based on a test for linear trend using logistic regression.
* p value is less than 0.05.
** p value is less than 0.001.
# # < 3 years of data available; test for linear trend not applicable.
a Data represent Minnesota births from May–December 2002.
b Data represent New Jersey births from July–December 2002.
c Data exclude New York City.
d Data represent Maryland births from February–December 2001.
e Data represent Michigan births from July–December 2001.
f Data represent Vermont births from October 2000–December 2001.
g Data represent Illinois births from June–December 1997.
h Data represent New Mexico births from July 1997–December 1998.
i Data represent North Carolina births from July–December 1997. |
Prevalence of Physical Abuse by Husband or Partner During Pregnancy, 2002
| State |
Respondents |
Percent† |
Standard Error |
95% CI‡ |
| Alabama |
1,558 |
4.2 |
0.6 |
3.2–5.6 |
| Alaska |
1,611 |
3.1 |
0.4 |
2.4–4.0 |
| Arkansas |
1,967 |
6.3 |
0.8 |
5.0–7.9 |
| Colorado |
2,263 |
2.0 |
0.4 |
1.4–2.8 |
| Florida |
2,008 |
2.9 |
0.5 |
2.1–4.1 |
| Hawaii |
1,805 |
3.0 |
0.4 |
2.3–3.9 |
| Illinois |
1,863 |
2.9 |
0.4 |
2.2–3.9 |
| Louisiana |
1,682 |
5.4 |
0.6 |
4.3–6.8 |
| Maine |
1,137 |
1.9 |
0.5 |
1.2–3.1 |
| Maryland |
1,456 |
4.8 |
0.9 |
3.3–7.0 |
| Michigan |
1,543 |
4.2 |
0.6 |
3.2–5.6 |
| Minnesotaa |
1,143 |
2.8 |
0.6 |
1.8–4.2 |
| Montana |
1,041 |
4.3 |
0.6 |
3.2–5.7 |
| Nebraska |
1,882 |
4.4 |
0.6 |
3.4–5.6 |
| New Jerseyb |
943 |
2.7 |
0.6 |
1.8–4.1 |
| New Mexico |
1,552 |
5.6 |
0.6 |
4.5–6.9 |
| New Yorkc |
1,225 |
3.7 |
0.7 |
2.5–5.4 |
| North Carolina |
1,548 |
3.4 |
0.6 |
2.4–4.7 |
| North Dakota |
902 |
2.6 |
0.5 |
1.8–3.6 |
| Ohio |
1,368 |
4.2 |
0.7 |
3.1–5.8 |
| Oklahoma |
1,796 |
5.8 |
0.9 |
4.3–7.8 |
| Rhode Island |
1,412 |
2.8 |
0.5 |
2.0–4.0 |
| South Carolina |
1,394 |
5.7 |
1.1 |
4.0–8.2 |
| Utah |
1,570 |
2.7 |
0.5 |
1.8–4.0 |
| Vermont |
1,024 |
2.5 |
0.5 |
1.7–3.6 |
| Washington |
1,515 |
2.0 |
0.5 |
1.2–3.2 |
| West Virginia |
1,670 |
3.4 |
0.6 |
2.5–4.7 |
| All PRAMS states§ |
40,878 |
3.7 |
0.1 |
3.4–4.0 |
† 2002 state range is 1.9–6.3%.
‡ Confidence interval.
§ Aggregate of the 27 PRAMS states.
a Data represent Minnesota births from May–December 2002.
b Data represent New Jersey births from July–December 2002.
c Data exclude New York City. |
Prevalence of Physical Abuse by Husband or Partner During Pregnancy, 2002
Healthy People 2010 Objective 15–34
Reduce the rate of physical assault by current or former intimate partners to 3.3 physical assaults per 1,000 persons aged 12 years and older. |
Prevalence of Physical Abuse by Husband or Partner During Pregnancy, 1996–2002
| State |
1996
(%) |
1997
(%) |
1998
(%) |
1999
(%) |
2000
(%) |
2001
(%) |
2002
(%) |
P value
for trend# |
| Alabama |
5.3 |
4.3 |
3.8 |
3.9 |
4.9 |
5.8 |
4.2 |
0.766 |
| Alaska |
5.7 |
4.1 |
3.9 |
4.1 |
5.2 |
5.0 |
3.1 |
0.145 |
| Arkansas |
— |
4.5 |
5.5 |
5.8 |
7.3 |
6.5 |
6.3 |
0.047* |
| Colorado |
— |
— |
2.8 |
3.3 |
2.3 |
3.1 |
2.0 |
0.171 |
| Florida |
4.1 |
4.2 |
4.1 |
3.9 |
4.3 |
2.9 |
2.9 |
0.047* |
| Hawaii |
— |
— |
— |
— |
4.7 |
4.0 |
3.0 |
0.005* |
| Illinois |
— |
3.6g |
4.1 |
3.5 |
3.5 |
3.7 |
2.9 |
0.247 |
| Louisiana |
— |
— |
5.2 |
5.4 |
4.5 |
6.2 |
5.4 |
0.543 |
| Maine |
2.9 |
3.0 |
2.5 |
2.1 |
2.3 |
2.8 |
1.9 |
0.240 |
| Maryland |
— |
— |
— |
— |
— |
4.1d |
4.8 |
# # |
| Michigan |
— |
— |
— |
— |
— |
2.6e |
4.2 |
# # |
| Minnesota |
— |
— |
— |
— |
— |
— |
2.8a |
# # |
| Montana |
— |
— |
— |
— |
— |
— |
4.3 |
# # |
| Nebraska |
— |
— |
— |
— |
3.0 |
3.7 |
4.4 |
0.041* |
| New Jersey |
— |
— |
— |
— |
— |
— |
2.7b |
# # |
| New Mexico |
— |
—h |
6.6h |
6.3 |
6.6 |
5.4 |
5.6 |
0.198 |
| New Yorkc |
3.6 |
3.9 |
2.4 |
4.3 |
2.7 |
3.0 |
3.7 |
0.744 |
| North Carolina |
— |
4.6i |
4.2 |
3.2 |
3.8 |
4.1 |
3.4 |
0.417 |
| North Dakota |
— |
— |
— |
— |
— |
— |
2.6 |
# # |
| Ohio |
— |
— |
— |
4.3 |
3.6 |
4.5 |
4.2 |
0.879 |
| Oklahoma |
5.6 |
4.8 |
5.1 |
3.8 |
4.2 |
4.1 |
5.8 |
0.750 |
| Rhode Island |
— |
— |
— |
— |
— |
— |
2.8 |
# # |
| South Carolina |
4.7 |
5.6 |
3.9 |
4.9 |
3.0 |
3.1 |
5.7 |
0.516 |
| Utah |
— |
— |
— |
2.1 |
2.4 |
3.2 |
2.7 |
0.300 |
| Vermont |
— |
— |
— |
— |
—f |
2.6f |
2.5 |
# # |
| Washington |
3.7 |
2.4 |
3.5 |
3.2 |
3.2 |
2.8 |
2.0 |
0.122 |
| West Virginia |
4.4 |
5.2 |
4.7 |
4.2 |
3.2 |
3.8 |
3.4 |
0.040* |
# Based on a test for linear trend using logistic regression.
* p value is less than 0.05.
# # < 3 years of data available; test for linear trend not applicable.
a Data represent Minnesota births from May–December 2002.
b Data represent New Jersey births from July–December 2002.
c Data exclude New York City.
d Data represent Maryland births from February–December 2001.
e Data represent Michigan births from July–December 2001.
f Data represent Vermont births from October 2000–December 2001.
g Data represent Illinois births from June–December 1997.
h Data represent New Mexico births from July 1997–December 1998.
i Data represent North Carolina births from July–December 1997. |
Back | Next
Page last reviewed: 5/13/09
Page last modified: 8/23/06
Content source: Division
of Reproductive Health,
National Center for Chronic Disease
Prevention and Health Promotion |
|
|
