Domestic violence and pregnancy

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Pregnancy when coupled with domestic violence is a form of intimate partner violence (IPV) where health risks may be amplified. Abuse during pregnancy, whether physical, verbal or emotional, produces many adverse physical and psychological effects for both the mother and fetus. Domestic violence during pregnancy is categorized as abusive behavior towards a pregnant woman, where the pattern of abuse can often change in terms of severity and frequency of violence. Abuse may be a long-standing problem in a relationship that continues after a woman becomes pregnant or it may commence in pregnancy. [1] Although female-to-male partner violence occurs in these settings, the overwhelming form of domestic violence is perpetrated by men against women. [2] Pregnancy provides a unique opportunity for healthcare workers to screen women for domestic violence though a recent review found that the best way in which to do this is unclear. [3] Reducing domestic violence in pregnancy should improve outcomes for mothers and babies though more good quality studies are needed to work out effective ways of screening pregnant women. [3]

Contents

Causes and triggers

Domestic abuse can be triggered by pregnancy for a number of reasons. Pregnancy itself can be used a form of coercion and the phenomenon of preventing an intimate partner's reproductive choice is referred to as reproductive coercion. Studies on birth control sabotage performed by males against female partners have indicated a strong correlation between domestic violence and birth control sabotage. [4] Pregnancy can also lead to a hiatus of domestic violence when the abuser does not want to harm the unborn child. The risk of domestic violence for pregnant women is greatest immediately after childbirth. [5]

Domestic violence can increase a woman's chances of becoming pregnant and the number of children she has, both because the woman may be coerced into sex and because she may be prevented from using birth control. [6] A correlation has been shown between large families and domestic violence. [6] Whereas previously it was thought that having many children and the resultant stress of large families increased likelihood domestic violence, it has been shown that the violence commonly predates the births. [6]

Birth control sabotage

Birth control sabotage, or reproductive coercion, is a form of coercion where someone manipulates another person's use of birth control - weakening efforts to prevent an unwanted pregnancy. Replacing birth control pills with fakes, puncturing condoms, and threats and violence are examples of prevention of an individual's attempt to avoid pregnancy. Pregnancy-promoting behavior of abusive male partners is one method of domestic violence and is associated with unwanted pregnancy, particularly in adolescents. [7] Reproductive coercion itself is a form of domestic violence because it results from unwanted sexual activity and hinders a woman's ability to control her body. Forced pregnancy can also be a form of financial abuse when a woman becomes trapped in a relationship because the pregnancy has led to economic dependence for new mothers. [8]

Unintended pregnancies are two to three times more likely to be associated with abuse than intended pregnancies. [9] Research among adolescent populations shows females who experience IPV use condoms at low rates and are fearful of negotiating the use of condoms. [10] In a study of sexually experienced women 15–19 in Uganda, surveys found that 14% of women's first sexual intercourse had been coerced. Of those 14%, the women were far more likely to be having unprotected sex without the use of modern contraceptives and to have had unintended pregnancies within the last six months compared to women who had not been sexually coerced. [11] In Egypt, over 80% of rural women believe that beatings are sometimes justified [12] and one of the most common reasons given as a just cause for beatings is refusing a man sex. [13] [14] This affects the ability of women to protect themselves from unwanted sexual contact and the consequences of sexual intercourse, such as pregnancy and sexually transmitted infections. [15]

A study conducted by the Center for Impact Research on young mothers classified birth control sabotage into two categories: verbal and behavioral. Verbal sabotage is verbal or emotional pressure not to use birth control, or pressure to become pregnant. Behavioral sabotage is the use of force to prevent the use of birth control, or to have unprotected sexual intercourse. [4]

Mechanisms

In most cases, domestic violence can be prompted by or intensified by pregnancy, but in some cases domestic violence ends during pregnancy because the abuser makes a conscious effort to not harm the fetus. [16]

Decreased violence

Domestic violence does not always increase during pregnancy and can even lead to a hiatus in violence. This phenomenon can provide protection for both the woman and child. [16] Because this can lead to decreased violence, some women use pregnancy as a means of protection against domestic abuse. Since abuse generally restarts after the pregnancy ends, women may get pregnant intentionally to prevent violence. However, since women who have been abused before getting pregnant are more likely to experience violence during pregnancy, this is not a reliable means of protection. [17]

Increased violence

Although pregnancy can be a protective period for some women, either in terms of a hiatus of pre-existing violence, for others it is a risk period during which abuse may begin or escalate. Women with violent partners have a hard time protecting themselves from unintended pregnancy and sexual violence can directly lead to pregnancy. [18] Studies consistently indicate that domestic violence is more common in large families. [19] However, international studies show that 25% of women are abused for the first time during pregnancy. [8]

In one study conduct by Campbell et al., women were asked to speculate on why they thought they were abused during their pregnancies. The answers were categorized into four categories: [16]

Effects

There are many dangerous effects that violence during pregnancy can cause for both the mother and child. A violent pregnancy is considered high risk because verbal, emotional, and physical abuse all lead to adverse health consequences for both the mother and fetus. [20] Violence during pregnancy has been associated with miscarriage, late prenatal care, stillbirth, preterm birth, fetal injury (including bruising, broken and fractured bones, stab wounds [21] and low birth weight. [18] Violence during pregnancy also leads to additional risks for the mother such as increased mental health problems, suicide attempts, worsening of chronic illness, injury, substance abuse, anxiety, stress, chronic pain, and gynecological problems. [22] Women battered during pregnancy were more frequently and severely beaten throughout the course of their relationship compared to women who were not abused during pregnancy. [16] IPV also accounts for a large portion of maternal mortality. Homicide is the second leading cause of injury related deaths in pregnant and post-partum women in the United States [23] and a study conducted in hospital in India found that 16% of all deaths during pregnancy were a result of partner violence. [24] Studies have also found a correlation between domestic violence and increased use of abortion. [25] Pregnant abused women are less likely to report abuse or leave their abuser because of added financial and housing security concerns. [26]

Risk factors

Certain women are more likely to be abused during pregnancy than others. Women who have been abused before getting pregnant are at higher risk of violence during pregnancy. [27] Abuse is not restricted to a specific socio-economic or demographic group of women or to a specific period in a woman's reproductive life. [28]

In general, the rate of physical violence during pregnancy decreases as household income increases. Women whose total household income was less than $16,000 were much more likely to experience physical or sexual violence during pregnancy than women with a total household income over $16,000. [29]

Partner violence in a relationship increases the chances of unintended pregnancy. A Canadian study that outlined causes of physical abuse identified “social instability” (e.g. low age, unmarried, lower level of education, and unemployment) as a trigger for violence and used unplanned pregnancies as an example. This suggests that partner violence can lead to increased unintended pregnancies which, in turn, increases physical abuse. [30] Younger women are statistically more susceptible to reproductive coercion and this may be due to less experience in relationships and, for minors, less access to doctor's appointments and emergency contraception. Adolescents are especially at risk and teenage pregnancy is correlated with increased rates of domestic violence. [7] Young women with older boyfriends are more likely to experience domestic violence. [4] Women who experience physical violence from their husbands are less likely to use contraception and more likely to have an unwanted pregnancy. [2]

Epidemiology

A study done on reporting rates of domestic violence concluded that a woman's risk of physical and sexual violence during pregnancy is under-reported and underestimated. [27] Each year, over 324,000 pregnant women are victims of domestic violence in the United States. [31] A number of countries have sought to statistically estimate the number of adult women who have experienced domestic violence during pregnancy:

Incidence rates are higher for teenagers. [35] The incidence rate for low-income teen mothers is as high as 38%. [15]

See also

Related Research Articles

<span class="mw-page-title-main">Teenage pregnancy</span> Childbirth in human females under the age of 20

Teenage pregnancy, also known as adolescent pregnancy, is pregnancy in a female adolescent or young adult under the age of 20. Worldwide, pregnancy complications are the leading cause of death for women and girls 15 to 19 years old. The definition of teenage pregnancy includes those who are legally considered adults in their country. The WHO defines adolescence as the period between the ages of 10 and 19 years. Pregnancy can occur with sexual intercourse after the start of ovulation, which can happen before the first menstrual period (menarche). In healthy, well-nourished girls, the first period usually takes place between the ages of 12 and 13.

Reproductive rights are legal rights and freedoms relating to reproduction and reproductive health that vary amongst countries around the world. The World Health Organization defines reproductive rights as follows:

Reproductive rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. They also include the right of all to make decisions concerning reproduction free of discrimination, coercion and violence.

Sexual violence is any harmful or unwanted sexual act—or attempt to obtain a sexual act through violence or coercion—or an act directed against a person's sexuality without their consent, by any individual regardless of their relationship to the victim. This includes forced engagement in sexual acts, attempted or completed, and may be physical, psychological, or verbal. It occurs in times of peace and armed conflict situations, is widespread, and is considered to be one of the most traumatic, pervasive, and most common human rights violations.

<span class="mw-page-title-main">Sexual and reproductive health</span> State of the reproductive system without evidence of disease, disorders, or deficiencies

Sexual and reproductive health (SRH) is a field of research, health care, and social activism that explores the health of an individual's reproductive system and sexual well-being during all stages of their life. Sexual and reproductive health is more commonly defined as sexual and reproductive health and rights, to encompass individual agency to make choices about their sexual and reproductive lives.

Domestic violence occurs across the world, in various cultures, and affects people across society, at all levels of economic status; however, indicators of lower socioeconomic status have been shown to be risk factors for higher levels of domestic violence in several studies. In the United States, according to the Bureau of Justice Statistics in 1995, women reported a six times greater rate of intimate partner violence than men. However, studies have found that men are much less likely to report victimization in these situations.

Teen dating violence is the physical, sexual, or psychological / emotional abuse within a dating relationship among adolescents. Intimate partner violence (IPV) has been a well examined and documented phenomenon in adults; however, there has not been nearly as much study on violence in adolescent dating relationships, and it is therefore not as well understood. The research has mainly focused on Caucasian youth, and, as of 2013, there are no studies which focus specifically on IPV in adolescent same-sex relationships.

Violence against women in Peru is defined as harassment or violence propagated against those who are born women. Intimate partner violence (IPV) is the most common form of gender-based violence that occurs though it can occur concurrently with sexual and emotional violence.

Intimate partner sexual violence (IPSV) deals with sexual violence within the context of domestic violence. Intimate partner sexual violence is defined by any unwanted sexual contact or activity by an intimate partner in order to control an individual through fear, threats, or violence. Women are the primary victims of this type of violence.

<span class="mw-page-title-main">Factors associated with being a victim of sexual violence</span>

One of the most common forms of sexual violence around the world is that which is perpetrated by an intimate partner, leading to the conclusion that one of the most important risk factors for people in terms of their vulnerability to sexual assault is being married or cohabiting with a partner. Other factors influencing the risk of sexual violence include:

<span class="mw-page-title-main">Estimates of sexual violence</span>

Surveys of victims of crime have been undertaken in many cities and countries, using a common methodology to aid comparability, and have generally included questions on sexual violence. The United Nations has conducted extensive surveys to determine the level of sexual violence in different societies. According to these studies, the percentage of women reporting having been a victim of sexual assault ranges from less than 2% in places such as La Paz, Bolivia (1.4%), Gaborone, Botswana (0.8%), Beijing, China (1.6%), and Manila, Philippines (0.3%), to 5% or more in Istanbul, Turkey (6.0%), Buenos Aires, Argentina (5.8%), Rio de Janeiro, Brazil (8.0%), and Bogota, Colombia (5.0%).

<span class="mw-page-title-main">Domestic violence</span> Abuse of members of the same household

Domestic violence is violence or other abuse that occurs in a domestic setting, such as in a marriage or cohabitation. Domestic violence is often used as a synonym for intimate partner violence, which is committed by one of the people in an intimate relationship against the other person, and can take place in relationships or between former spouses or partners. In its broadest sense, domestic violence also involves violence against children, parents, or the elderly. It can assume multiple forms, including physical, verbal, emotional, economic, religious, reproductive, financial abuse, or sexual abuse. It can range from subtle, coercive forms to marital rape and other violent physical abuse, such as choking, beating, female genital mutilation, and acid throwing that may result in disfigurement or death, and includes the use of technology to harass, control, monitor, stalk or hack. Domestic murder includes stoning, bride burning, honor killing, and dowry death, which sometimes involves non-cohabitating family members. In 2015, the United Kingdom's Home Office widened the definition of domestic violence to include coercive control.

Unintended pregnancies are pregnancies that are mistimed or unwanted at the time of conception, also known as unplanned pregnancies.

Pregnancy is a potential result of rape. It has been studied in the context of war, particularly as a tool for genocide, as well as in other unrelated contexts, such as rape by a stranger, statutory rape, incest, and underage pregnancy. The current scientific consensus is that rape is at least as likely to lead to pregnancy as consensual sexual intercourse, with some studies suggesting rape may actually result in higher rates of pregnancy than consensual intercourse.

Reproductive coercion is a collection of behaviors that interfere with decision-making related to reproductive health. These behaviors are meant to maintain power and control related to reproductive health by a current, former, or hopeful intimate or romantic partner, but they can also be perpetrated by parents or in-laws. Coercive behaviors infringe on individuals' reproductive rights and reduce their reproductive autonomy.

Domestic violence in Kenya constitutes any harmful behavior against a family member or partner, including rape, assault, physical abuse, and forced prostitution. Domestic violence in Kenya reflects worldwide statistics in that women are the overwhelming majority of victims. Over 40% of married women in Kenya have reported being victims of either domestic violence or sexual abuse. Worldwide, over 30% of "ever-partnered women" aged 15 and older have experienced physical or sexual partner violence. The distinct factors and causes of this high percentage have often not been studied due to lack of data.

<span class="mw-page-title-main">Reproductive rights in Latin America</span>

Latin America is home to some of the few countries of the world with a complete ban on abortion and minimal policies on reproductive rights, but it also contains some of the most progressive reproductive rights movements in the world. With roots in indigenous groups, the issues of reproductive rights include abortion, sexual autonomy, reproductive healthcare, and access to contraceptive measures. Modern reproductive rights movements most notably include Marea Verde, which has led to much reproductive legislation reform. Cuba has acted as a trail-blazer towards more liberal reproductive laws for the rest of Latin America, while other countries like El Salvador and Honduras have tightened restrictions on reproductive rights.

Women's reproductive health in the United States refers to the set of physical, mental, and social issues related to the health of women in the United States. It includes the rights of women in the United States to adequate sexual health, available contraception methods, and treatment for sexually transmitted diseases. The prevalence of women's health issues in American culture is inspired by second-wave feminism in the United States. As a result of this movement, women of the United States began to question the largely male-dominated health care system and demanded a right to information on issues regarding their physiology and anatomy. The U.S. government has made significant strides to propose solutions, like creating the Women's Health Initiative through the Office of Research on Women's Health in 1991. However, many issues still exist related to the accessibility of reproductive healthcare as well as the stigma and controversy attached to sexual health, contraception, and sexually transmitted diseases.

Teenage pregnancy is a girl between the ages of 13 and 19 becoming pregnant. The term used in everyday speech usually refers to girls who have not yet reached legal adulthood, which in Australia is anyone under the age of 18. At the national level, the teenage birth rate has declined in the last decade. The rate was about 16 babies per 1,000 women aged 15–19 years between 2011 and 2012 but this had fallen to 11.9 births per 1,000 women aged 15–19 in 2015, the lowest figure on record. Terminations can be performed up until the 12-week mark. About half of all teenage pregnancies are terminated in Australia.

Non-consensual condom removal, or "stealthing", is the practice of a person removing a condom during sexual intercourse without consent, when their sex partner has only consented to condom-protected sex. Purposefully damaging a condom before or during intercourse may also be referred to as stealthing, regardless of who damaged the condom.

Violence against women in Uganda is an issue that negatively affects various aspects of women's lives. COVID-19 has worsened the current condition for women facing domestic violence. Perceived changing social standards and cultural norms indicate power dynamics which is a primary cause of violence carried out against women. Refugee women in Uganda are uniquely subjugated as they have the least access to gaining social or monetary capital. However, there has been recent legislation aimed at improving the quality of life for Ugandan women and refugee women in Uganda.

References

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  7. 1 2 Miller, Elizabeth, Decker, Michelle, Reed, Elizabeth, Male Partner Pregnancy-Promoting Behaviors and Adolescent Partner Violence: Findings from a Qualitative Study with Adolescent Females.
  8. 1 2 Pregnancy offers no protection from abuse
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