Data Highlights | References | Tables

Background

Pregnant women can enhance birth outcomes and infant health by engaging in healthy behaviors and avoiding risky ones around the time of pregnancy. About 84% of pregnant women initiate prenatal care in their first trimester,¹ placing prenatal care providers in a unique position to screen for risky behaviors and to promote healthy ones early in pregnancy. 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 the U.S. Centers for Disease Control and Prevention (CDC) recommend that prenatal care providers screen for violence at the first prenatal visit, at least once per trimester, and at the postpartum checkup.^2,3

Between 4% and 9% of women—approximately 152,000 to 324,000—are physically abused while they are pregnant.⁴ Using 1996–1998 PRAMS data for 16 states, Saltzman and colleagues⁴ found that 7.2% were abused in the 12 months before pregnancy, and 5.3% were abused during pregnancy. For 75% of women, the perpetrators were husbands or partners.

In surveys of both prenatal care providers and pregnant women, researchers have found that screening and counseling pregnant women for physical abuse is low. Although most prenatal care providers screen injured women, only 17%–39% screen all pregnant women at their first prenatal care visit.^5–7 PRAMS data for multiple states in the late 1990s indicate that 22%–39% of the women surveyed reported that providers discussed physical abuse during prenatal care visits.^8,9 Black and Hispanic women, young women, women with a high school education or less, and Medicaid-covered women were more likely to receive physical abuse counseling from prenatal care providers than women in other groups.⁸

During prenatal care, assessment and counseling about intimate partner violence may contribute to achieving the Healthy People 2010 objective (Objective 15–34) of reducing physical abuse by current or former intimate partners from 4.4 cases per 1,000 persons 12 years or older (1998) to 3.3 cases per 1,000 persons 12 years or older.¹⁰ PRAMS collects data from women on whether any health care provider or worker talked to them during a prenatal care visit about physical abuse by a spouse or partner. States and professional organizations can use these data to monitor and improve the quality of intimate partner violence assessment and counseling practices in the primary care setting.

Data Highlights

• In 2002, the proportion of women who reported that their prenatal care counseling included a discussion about physical abuse by their husband or partner ranged from 24.4% (North Dakota) to 55.2% (Alaska).
  
  
• During 2000–2002, the proportion of women who reported that prenatal care counseling included a discussion about physical abuse by their husband or partner increased in 9 states (Alabama, Alaska, Florida, Illinois, Nebraska, New Mexico, Ohio, Washington, and West Virginia).

References

1. Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Munson ML. Births: final data for 2002. National Vital Statistics Reports 2003;52(10):1–113.
   
   
2. American College of Obstetricians and Gynecologists (ACOG). Domestic Violence. (ACOG educational bulletin number 257.) Washington, DC: ACOG; 1999.
   
   
3. 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.
   
   
4. 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.
   
   
5. Horan DL, Chapin J, Klein L, Schmidt LA, Schulkin J. Domestic violence screening practices of obstetrician-gynecologists. Obstetrics and Gynecology 1998;92(5):785–789.
   
   
6. Rodriguez MA, Bauer HM, McLoughlin E, Grumbach K. Screening and intervention for intimate partner abuse: practices and attitudes of primary care physicians. JAMA (Journal of the American Medical Association) 1999;282(5):468–474.
   
   
7. Chamberlain L, Perham-Hester KA. Physicians' screening practices for female partner abuse during prenatal visits. Maternal and Child Health Journal 2000;4(2):141–148.
   
   
8. Durant T, Colley Gilbert B, Saltzman LE, Johnson CH. Opportunities for intervention: discussing physical abuse during prenatal care visits. American Journal of Preventive Medicine 2000;19(4):238–244.
   
   
9. Petersen R, Connelly A, Martin SL, Kupper LL. Preventive counseling during prenatal care: Pregnancy Risk Assessment Monitoring System (PRAMS). American Journal of Preventive Medicine 2001;20(4):245–250.
   
   
10. 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 Prenatal Care Discussion of Physical Abuse by Husband or Partner, 2002

State	Respondents	Percent†	Standard Error	95% CI‡
Alabama	1,508	37.8	1.5	35.0–40.7
Alaska	1,581	55.2	1.4	52.3–58.0
Arkansas	1,894	26.8	1.4	24.1–29.6
Colorado	2,227	37.6	1.4	35.0–40.3
Florida	1,974	46.3	1.7	43.0–49.6
Hawaii	1,766	40.0	1.4	37.2–42.7
Illinois	1,879	44.7	1.2	42.3–47.1
Louisiana	1,641	38.3	1.4	35.7–41.0
Maine	1,118	39.7	1.7	36.5–43.0
Maryland	1,434	36.4	1.9	32.7–40.3
Michigan	1,519	42.4	1.5	39.6–45.3
Minnesotaa	1,099	53.2	1.9	49.4–56.9
Montana	1,027	30.3	1.5	27.5–33.2
Nebraska	1,817	40.9	1.4	38.3–43.7
New Jerseyb	906	28.1	1.7	25.0–31.5
New Mexico	1,509	51.3	1.4	48.6–53.9
New Yorkc	1,176	33.7	1.8	30.3–37.2
North Carolina	1,498	48.2	1.6	45.0–51.3
North Dakota	887	24.4	1.4	21.7–27.2
Ohio	1,348	36.1	1.7	32.9–39.4
Oklahoma	1,810	31.5	1.7	28.2–34.9
Rhode Island	1,372	40.8	1.5	37.9–43.8
South Carolina	1,341	35.2	2.1	31.2–39.4
Utah	1,537	27.6	1.5	24.8–30.6
Vermont	1,087	36.3	1.4	33.5–39.2
Washington	1,483	46.3	1.8	42.7–49.9
West Virginia	1,647	41.8	1.7	38.5–45.2
All PRAMS states§	40,085	40.2	0.4	39.4–41.0
† 2002 state range is 24.4–55.2%. ‡ 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 Prenatal Care Discussion of Physical Abuse by Husband or Partner, 2002

 

Prevalence of Prenatal Care Discussion of Physical Abuse by Husband or Partner, 2000–2002

State	2000 (%)	2001 (%)	2002 (%)	P value for trend#
Alabama	33.1	34.0	37.8	0.022*
Alaska	46.7	48.4	55.2	0.000**
Arkansas	26.5	23.4	26.8	0.904
Colorado	34.9	36.1	37.6	0.148
Florida	41.2	40.6	46.3	0.031*
Hawaii	36.9	38.1	40.0	0.088
Illinois	38.9	42.4	44.7	0.001**
Louisiana	39.8	39.2	38.3	0.454
Maine	37.3	37.2	39.7	0.305
Maryland	—	39.3d	36.4	# #
Michigan	—	38.3e	42.4	# #
Minnesota	—	—	53.2a	# #
Montana	—	—	30.3	# #
Nebraska	31.1	35.1	40.9	0.000**
New Jersey	—	—	28.1b	# #
New Mexico	42.5	44.6	51.3	0.000**
New Yorkc	31.5	38.1	33.7	0.363
North Carolina	44.9	42.1	48.2	0.154
North Dakota	—	—	24.4	# #
Ohio	31.3	36.0	36.1	0.036*
Oklahoma	28.6	31.8	31.5	0.235
Rhode Island	—	—	40.8	# #
South Carolina	33.2	39.0	35.2	0.478
Utah	24.2	24.0	27.6	0.090
Vermont	—f	31.8f	36.3	# #
Washington	40.1	48.8	46.3	0.013*
West Virginia	37.2	38.3	41.8	0.049*
# 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.