Physical abuse in pregnancy

Abstract

Objectives: To determine the prevalence of physical abuse during late pregnancy and to investigate how abused and nonabused pregnant women differ in demographic characteristics, health habits, psychologic distress and attitudes about fetal health.

Design: Survey of women attending for prenatal health care or admitted to hospital for delivery. The information was obtained on one occasion from self-report questionnaires, completed with the option of anonymity.

Settings: Community-based prenatal clinic, private obstetricians' offices in a large city, private family physicians' offices in a large city, family physicians' offices in a small town, and a university teaching hospital.

Patients: English-speaking women at 20 weeks' or more gestation attending or admitted consecutively.

Interventions: Three self-report questionnaires: the General Health Questionnaire (GHQ), the Fetal Health Locus of Control (FHLC) and the study questionnaire.

Results: Thirteen women (2.4%) refused to participate in the survey. Of the 548 women who completed the questionnaires 36 (6.6%) reported physical abuse during the current pregnancy and 60 (10.9%) before it. There were no significant differences in rates of abuse between settings. Of the women abused during the pregnancy 23 (63.9%) reported increased abuse during the pregnancy, and 28 (77.8%) remained with the abuser. Twenty-four pregnant women (66.7%) received medical treatment for abuse, but only 1 (2.8%) told her prenatal care provider of the abuse. Factor analysis revealed three factors associated with physical abuse in pregnancy: "social instability" (comprising low age, unmarried status, lower level of education, unemployment and unplanned pregnancy), "unhealthy lifestyle" (comprising poor diet, alcohol use, illicit drug use and emotional problems) and "physical health problems" (comprising health problems and prescription drug use). The GHQ scores showed that the abused women were significantly more emotionally distressed than the nonabused women (p < 0.001). The FHLC scores showed that the abused women believed they had little "internal control" over the health of their fetuses and that "chance" played the most important role in the outcome of their pregnancy (p < 0.001).

Conclusions: Abused pregnant patients are a frequently undetected high-risk group. Prenatal care should include a routine screening question about domestic violence, and identified patients should be appropriately counselled and referred.