Definition

The percentage of people who reported physical abuse by their husband/partner, ex-husband/ex-partner, or someone else during the 12 months before pregnancy, or during pregnancy, divided by the number of people who delivered a live infant.

Numerator

The number of people who reported physical abuse by their partner/husband, ex-husband/ex-partner, or someone else 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 people 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 50% or it is not considered representative of that population. See the PRAMS website at [https://www.cdc.gov/prams/php/methodology/] 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 individuals of all ages may experience IPV, it occurs most often among people of reproductive age. People with histories of IPV before pregnancy are at risk for unintended pregnancies, depression, and anxiety. People 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

Healthy People 2030: IVP-D04 Reduce intimate partner violence (i.e., contact sexual violence, physical violence, and stalking) across the lifespan (developmental)

How Are We Doing?

The overall percentage of people experiencing domestic violence in the year before pregnancy or during pregnancy in Utah was 2.5% during 2019-2022. While IPV during pregnancy has serious consequences, it is often undetected during prenatal visits. 36% of people who delivered a live infant in 2022 said their prenatal care provider did not ask if someone was hurting them emotionally or physically.

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: [https://vipp.utah.gov/wp-content/uploads/DV-Healthcare-Manual.pdf].

Relevant Population Characteristics

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

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 and Human Services, 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.

Data Notes

The PRAMS survey asked the following two questions: [[br]] 1) During the 12 months before you got pregnant with your new baby, did your husband/ partner, ex-husband/partner, or someone else push, hit, slap, kick, choke, or physically hurt you in any other way? [[br]] 2) During your most recent pregnancy, did your husband/partner, ex-husband/partner or someone else push, hit, slap, kick, choke, or physically hurt you in any other way?.   [[br]] [[br]] **The estimate 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.

Data Source

Utah Department of Health and Human Services Pregnancy Risk Assessment Monitoring System (PRAMS)

Data Notes

The PRAMS survey asked the following two questions: [[br]] 1) During the 12 months before you got pregnant with your new baby, did your husband/ partner, ex-husband/partner, or someone else push, hit, slap, kick, choke, or physically hurt you in any other way? [[br]] 2) During your most recent pregnancy, did your husband/partner, ex-husband/partner or someone else push, hit, slap, kick, choke, or physically hurt you in any other way?.   [[br]] [[br]]

Data Source

Utah Department of Health and Human Services Pregnancy Risk Assessment Monitoring System (PRAMS)

Data Notes

The PRAMS survey asked the following two questions: [[br]] 1) During the 12 months before you got pregnant with your new baby, did your husband/ partner, ex-husband/partner, or someone else push, hit, slap, kick, choke, or physically hurt you in any other way? [[br]] 2) During your most recent pregnancy, did your husband/partner, ex-husband/partner or someone else push, hit, slap, kick, choke, or physically hurt you in any other way?

Data Source

Utah Department of Health and Human Services Pregnancy Risk Assessment Monitoring System (PRAMS)

Data Notes

The PRAMS survey asked the following two questions: [[br]] 1) During the 12 months before you got pregnant with your new baby, did your husband/ partner, ex-husband/partner, or someone else push, hit, slap, kick, choke, or physically hurt you in any other way? [[br]] 2) During your most recent pregnancy, did your husband/partner, ex-husband/partner or someone else push, hit, slap, kick, choke, or physically hurt you in any other way?

Data Source

Utah Department of Health and Human Services Pregnancy Risk Assessment Monitoring System (PRAMS)

Data Notes

The PRAMS survey asked the following two questions: [[br]] 1) During the 12 months before you got pregnant with your new baby, did your husband/ partner, ex-husband/partner, or someone else push, hit, slap, kick, choke, or physically hurt you in any other way? [[br]] 2) During your most recent pregnancy, did your husband/partner, ex-husband/partner or someone else push, hit, slap, kick, choke, or physically hurt you in any other way?

Data Source

Utah Department of Health and Human Services Pregnancy Risk Assessment Monitoring System (PRAMS)

References and community resources

1. Hahn, C. K., Gilmore, A. K., Aguayo, R. O., & Rheingold, A. A. (2018). Perinatal Intimate Partner Violence. Obstetrics and gynecology clinics of North America, 45(3), 535-547. [[br]][https://doi.org/10.1016/j.ogc.2018.04.008] 2. Wadsworth, P., Degesie, K., Kothari C., Moe A., (2018). Intimate Partner Violence During the Perinatal Period. The Journal for Nurse Practitioners, Volume 14, Issue 10, 753-759.[[br]] [https://doi.org/10.1016/j.nurpra.2018.08.009] 3. Snider C, Webster D, O'Sullivan CS, Campbell J. Intimate partner violence: Development of a brief risk assessment for the emergency department. Acad Emerg Med. 2009;16(11):1208-1216. [[br]] [[br]] ===American Academy of Pediatrics Resources=== Domestic Intimate Partner Violence[[br]] [https://publications.aap.org/pediatricsinreview/article-abstract/31/4/145/33149/Intimate-Partner-Violence?redirectedFrom=fulltext] Intimate Partner Violence: The Role of the Pediatrician[[br]][https://pediatrics.aappublications.org/content/125/5/1094.full? sid=2281d56f-e24e-4a8d-a2aa-0ac98d7ab081]