Pregnancy and Domestic Violence
Sometimes it feels as though to truly comprehend the prevalence of domestic and sexual violence in our nation you have to spend some time as an advocate, or be a survivor. Once you are in the trenches so to speak, not only do you have people you know disclose to you about themselves and their loved ones, but every news story, magazine article, biography of a celebrity/politician/athlete containing a hint of abuse catches your eye or is sent to you by someone with the tag line: “I saw this and thought of you.” It surrounds us, yet we seem to be unaware of it until it touches our lives or the lives of someone we love.
October is National Domestic Violence Awareness Month. Why is it so important to recognize this issue among the many other causes that use October to spread their messages? It is important because one in four women will experience intimate partner violence in her lifetime. 30-60% of perpetrators of IPV (Intimate Partner Violence) also abuse the children in the home. (NCADV.org) The United Nations Development Fund for Women estimates that approximately one in three women globally “will be beaten, raped, or otherwise abused in her lifetime. In most cases, the abuser is a member of her own family.” (1)
With this post, I would like to draw special attention to the various roles pregnancy can play in a violent relationship. Abuse is about asserting power and control over another person. What makes IPV particularly heinous is that it is asserting dominance through the use of violence in what is supposed to be a loving relationship. While there are many different tactics used to control, using a woman’s fertility to control her is particularly devastating. (Note: It is important to recognize here that there are victims of IPV that are also male, and perpetrators that are female. As this particular post is about pregnancy and domestic violence, I will from here on out be speaking about female victims/survivors.)
Sexual violence is often found within IPV. Aside from assault and rape, pregnancy can also be used to control women. Pregnancy increases the lethality of domestic violence. Studies have shown that pregnant women are more likely to be victims of homicide than women who are not pregnant (2). Evidence also suggests that a “significant proportion of all female homicide victims are killed by their intimate partners” (3). Some women that experience this within IPV may be forced to become pregnant, some may have it held over their heads as something they must “earn”. Some may experience extreme violence during the pregnancy to purposely cause a miscarriage, and some may be forced to abort. Abuse during pregnancy also has consequences for children of mothers who experience prenatal IPV: “(They) are at an increased risk of exhibiting aggressive, anxious, depressed or hyperactive behavior” (4).
In February of this year, The American College of Obstetricians and Gynecologists issued the following in regards to the relationship between pregnancy and IPV: (See link for full text.)
Intimate partner violence encompasses subjection of a partner to physical abuse, psychologic abuse, sexual violence, and reproductive coercion. Physical abuse can include throwing objects, pushing, kicking, biting, slapping, strangling, hitting, beating, threatening with any form of weapon, or using a weapon. Psychologic abuse erodes a woman’s sense of self-worth and can include harassment; verbal abuse such as name calling, degradation, and blaming; threats; stalking; and isolation. Often, the abuser progressively isolates the woman from family and friends and may deprive her of food, money, transportation, and access to health care. Sexual violence includes a continuum of sexual activity that covers unwanted kissing, touching, or fondling; sexual coercion; and rape. Reproductive coercion involves behavior used to maintain power and control in a relationship related to reproductive health and can occur in the absence of physical or sexual violence. A partner may sabotage efforts at contraception, refuse to practice safe sex, intentionally expose a partner to a sexually transmitted infection (STI) or human immunodeficiency virus (HIV), control the outcome of a pregnancy (by forcing the woman to continue the pregnancy or to have an abortion or to injure her in a way to cause a miscarriage), forbid sterilization, or control access to other reproductive health services.
Approximately 324,000 pregnant women are abused each year in the United States. Although more research is needed, IPV has been associated with poor pregnancy weight gain, infection, anemia, tobacco use, stillbirth, pelvic fracture, placental abruption, fetal injury, preterm delivery, and low birth weight. In addition, the severity of violence may sometimes escalate during pregnancy or the postpartum period. Homicide has been reported as a leading cause of maternal mortality, with the majority perpetrated by a current or former intimate partner. High rates of birth control sabotage and pregnancy pressure and coercion in abusive relationships are correlated with unintended pregnancies.
While we here at The Guiding Star Project reject any notion that a woman’s body and her fertility is something to be corrected with the use of birth control, it is important to recognize that women in violent relationships have been made to believe the only support they will ever know is what the abuser has to offer them, and this sometimes leads to decisions and coping strategies that are not always easily understood by those outside the relationship. GSP seeks to eliminate reasons women would feel abortion and contraception are the only options, and to provide alternatives and support for women.
So knowing what we know about pregnancy and domestic violence, where do we go from here?
According to the Family Violence Prevention Fund (currently Futures Without Violence), 44% of women that experience IPV reach out and tell someone about the abuse. 37% of these women disclose to their health care provider. Multiple studies in different states have concluded that as many as 80% of women that experience IPV would disclose to a healthcare provider if asked in private. This means that domestic violence screenings during routine and emergency healthcare visits is crucial.
Spreading the word about the prevalence of sexual and domestic violence is important as well. There are many national organizations that have awareness kits and information readily available. (NCADV.org can connect you with all state coalitions, and NNEDV.org has information as well.) The National Domestic Violence Hotline (1-800-799-SAFE) will connect you with local hotlines that are better equipped to provide services both to victims and friends and family seeking help.
Chances are good that many of you reading this have a loved one that has experienced sexual or domestic violence. (Remember that “one in three…” statistic from the beginning of the post?) The most common question I am asked to this day on the subject of IPV is “How can I help my friend/family member?” here are some suggestions of things you can say straight from the experts at the National Center on Domestic and Sexual Violence (NCADV):
-I am afraid for you.
-I am afraid for your children.
-I am here for you.
– You don’t deserve to be abused.
All of the above statements express concern and support while giving her space to make the decision on her own. She is an expert on how to be her, and she will know when the time has come to move on. Leaving must be her decision in the end, and she will need all the support she can get.
1 United Nations Development Fund for Women. 2003. Not A Minute More: Ending Violence Against Women. Retrieved on December 4, 2008 from http://www.unifem.org/resources/item_detail.php?ProductID=7.
2 “Enhanced Surveillance for Pregnancy-Associated Mortality, Maryland 1993 – 1998,” 285(11) Journal of the American Medical Association (March 2001).
3 Frye, V. 2001. “Examining Homicide’s Contribution to Pregnancy-Associated Deaths.” The Journal of the American Medical Association. 285(11).
4 Whitaker, RC, Orzol, SM, Kahn, RS. 2006. Maternal Mental Health, Substance Use, and Domestic Violence in the Year After Delivery and
Subsequent Behavior Problems in Children at Age 3 Years. Archive of General Psychiatry. 63: 551-560.