Abstract
Objectives Although several studies have examined risk factors associated with abuse during pregnancy or postpartum periods, many used clinic-based or small regional samples, and few were national or population-based, limiting their generalizability and clinical utility. The purpose of this study was to describe the correlates of abuse around the time of pregnancy among a nationally representative sample of women in Canada. Methods Using data from 6421 postpartum women (weighted n = 76,500) who completed the Canadian Maternity Experiences Survey from 10/2006 to 01/2007, we explored the association between demographic, psychosocial, behavioral, medical/obstetric factors and ‘any’ and ‘severe’ abuse. ‘Any abuse’ was defined as an affirmative answer to one or more of 10 items asked about physical or sexual abuse or threats of abuse. ‘Severe abuse’ was defined as experiencing a combination of threats and physical or sexual abuse. Odds ratios and their 95 % confidence intervals were generated from multivariable logistic regression models. Results 10.5 % of women (weighted n = 8400) reported ‘any’ abuse and 4.3 % (weighted n = 3400) reported ‘severe’ abuse in the previous 2 years. Correlates of severe abuse included: age <20 years; household income below the low income cut-off; single; stressful life events; history of depression or antidepressant use; smoking during pregnancy; and alcohol use prior to pregnancy. Correlates of ‘any’ abuse were the same as ‘severe’ abuse with the addition of age 20–34 years, developing a new health problem during pregnancy, and inadequate support during pregnancy. Increased odds of ‘any’ and ‘severe’ abuse were found for women who self-identified as Aboriginal and reduced odds of ‘any’ abuse were found among immigrant women and those who took folic acid pre-pregnancy. Conclusions We identified risk factors that may enhance early detection of abuse in the perinatal period, and inform the development of interventions and preventive strategies to address this important public health problem.
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References
Spivak, H. R., Jenkins, L., VanAudenhove, K., et al. (2014). CDC grand rounds: A public health approach to prevention of intimate partner violence. Morbidity and Mortality Weekly Report, 63(2), 38–41.
McFarlane, J., Maddoux, J., Cesario, S., et al. (2014). Effect of abuse during pregnancy on maternal and child safety and functioning for 24 months after delivery. Obstetrics and Gynecology, 123(4), 839–847. doi:10.1097/AOG.0000000000000183.
Howard, L. M., Oram, S., Galley, H., et al. (2013). Domestic violence and perinatal mental disorders: A systematic review and meta-analysis. PLoS Medicine, 10(5), e1001452. doi:10.1371/journal.pmed.1001452.
Urquia, M. L., O’Campo, P. J., Heaman, M. I., et al. (2011). Experiences of violence before and during pregnancy and adverse pregnancy outcomes: An analysis of the Canadian Maternity Experiences Survey. BMCPregnancyChildbirth, 11, 42. doi:10.1186/1471-2393-11-42.
Janssen, P. A., Heaman, M. I., Urquia, M. L., et al. (2012). Risk factors for postpartum depression among abused and nonabused women. American Journal of Obstetrics and Gynecology, 207(6), 489 e1–489 e8. doi:10.1016/j.ajog.2012.09.022.
Beydoun, H. A., Beydoun, M. A., Kaufman, J. S., et al. (2012). Intimate partner violence against adult women and its association with major depressive disorder, depressive symptoms and postpartum depression: A systematic review and meta-analysis. Social Science and Medicine, 75(6), 959–975. doi:10.1016/j.socscimed.2012.04.025.
Bailey, B. A. (2010). Partner violence during pregnancy: Prevalence, effects, screening, and management. International Journal of Women’s Health, 2, 183–197.
Beydoun, H. A., Tamim, H., Lincoln, A. M., et al. (2011). Association of physical violence by an intimate partner around the time of pregnancy with inadequate gestational weight gain. Social Science and Medicine, 72(6), 867–873. doi:10.1016/j.socscimed.2011.01.006.
Moraes, C. L., Amorim, A. R., & Reichenheim, M. E. (2006). Gestational weight gain differentials in the presence of intimate partner violence. International Journal of Gynecology & Obstetrics, 95(3), 254–260. doi:10.1016/j.ijgo.2006.08.015.
Shah, P. S., & Shah, J. (2010). Maternal exposure to domestic violence and pregnancy and birth outcomes: A systematic review and meta-analyses. Journal of Women’s Health, 19(11), 2017–2031. doi:10.1089/jwh.2010.2051.
Sharps, P. W., Laughon, K., & Giangrande, S. K. (2007). Intimate partner violence and the childbearing year: Maternal and infant health consequences. Trauma Violence Abuse, 8(2), 105–116.
Gazmararian, J. A., Lazorick, S., Spitz, A. M., et al. (1996). Prevalence of violence against pregnant women. JAMA, 275(24), 1915–1920.
Public Health Agency of Canada. (2008). Aboriginal women and family violence. Ottawa: National Clearinghouse on Family Violence.
World Health Organization. (2005). Summary report: WHO multicountry study on women’s health and domestic violence against women. Switzerland: World Health Organization.
Janssen, P. A., Holt, V. L., Sugg, N. K., et al. (2003). Intimate partner violence and adverse pregnancy outcomes: A population-based study. American Journal of Obstetrics and Gynecology, 188(5), 1341–1347.
Stewart, D. E., & Cecutti, A. (1993). Physical abuse in pregnancy. CMAJ, 149(9), 1257–1263.
James, L., Brody, D., & Hamilton, Z. (2013). Risk factors for domestic violence during pregnancy: A meta-analytic review. Violence and Victims, 28(3), 359–380.
Salmon, D., Baird, K. M., & White, P. (2013). Women’s views and experiences of antenatal enquiry for domestic abuse during pregnancy. Health Expectations. doi:10.1111/hex.12060.
Renker, P. R., & Tonkin, P. (2006). Women’s views of prenatal violence screening: Acceptability and confidentiality issues. Obstetrics and Gynecology, 107, 348–354. doi:10.1097/01.AOG.0000195356.90589.c5.
Anderson, B. A., Marshak, H. H., & Hebbeler, D. L. (2002). Identifying intimate partner violence at entry to prenatal care: Clustering routine clinical information. Journal of Midwifery & Women’s Health, 47(5), 353–359.
Yelland, J., & Brown, S. J. (2014). Asking women about mental health and social adversity in pregnancy: Results of an Australian population-based survey. Birth, 41(1), 79–87. doi:10.1111/birt.12083.
O’Reilly, R., Beale, B., & Gillies, D. (2010). Screening and intervention for domestic violence during pregnancy care: A systematic review. Trauma, Violence, & Abuse, 11(4), 190–201. doi:10.1177/1524838010378298.
Rabin, R. F., Jennings, J. M., Campbell, J. C., et al. (2009). Intimate partner violence screening tools: A systematic review. American Journal of Preventive Medicine, 36(5), 439–445. doi:10.1016/j.amepre.2009.01.024.
Goodwin, M. M., Gazmararian, J. A., Johnson, C. H., et al. (2000). Pregnancy intendedness and physical abuse around the time of pregnancy: Findings from the pregnancy risk assessment monitoring system, 1996–1997. PRAMS Working Group. Pregnancy Risk Assessment Monitoring System. Maternal and Child Health Journal, 4(2), 85–92.
Saltzman, L. E., Johnson, C. H., Gilbert, B. C., et al. (2003). Physical abuse around the time of pregnancy: An examination of prevalence and risk factors in 16 states. Maternal and Child Health Journal, 7(1), 31–43.
Muhajarine, N., & D’Arcy, C. (1999). Physical abuse during pregnancy: Prevalence and risk factors. Canadian Medical Association Journal, 160(7), 1007–1011.
Heaman, M. I. (2005). Relationships between physical abuse during pregnancy and risk factors for preterm birth among women in Manitoba. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 34(6), 721–731. doi:10.1177/0884217505281906.
Daoud, N., Urquia, M. L., O’Campo, P., et al. (2012). Prevalence of abuse and violence before, during, and after pregnancy in a national sample of Canadian women. American Journal of Public Health, 102(10), 1893–1901. doi:10.2105/AJPH.2012.300843.
Dzakpasu, S., Kaczorowski, J., Chalmers, B., et al. (2008). The Canadian Maternity Experiences Survey: Design and methods. Journal of Obstetrics and Gynaecology Canada, 30(3), 207–216.
Public Health Agency of Canada. (2006). What mothers say: The Canadian Maternity Experiences Survey. Ottawa: Public Health Agency of Canada.
Public Health Agency of Canada. (2009). What mothers say: The Canadian Maternity Experiences Survey. Ottawa: Public Health Agency of Canada.
Statistics Canada. (2007). Microdata user guide: Maternity experiences survey. Ottawa: Statistics Canada.
Statistics Canada. (1993). Canadian violence against women survey. Ottawa: Statistics Canada. http://www.statcan.gc.ca/cgi-bin/imdb/p2SV.pl?Function=getSurvey&SDDS=3896&lang=en&db=imdb&adm=8&dis=2-a1. Accessed June 17 2014.
Statistics Canada. (2006). Low-income cut-offs for 2005 and low income measure for 2006. Ottawa: Ministry of Industry.
Newton, R. W., & Hunt, L. P. (1984). Psychosocial stress in pregnancy and its relation to low birth weight. BMJ, 288(6425), 1191–1194.
Kingston, D., Heaman, M., Fell, D., et al. (2012). Factors associated with perceived stress and stressful life events in pregnant women: Findings from the Canadian Maternity Experiences Survey. Maternal and Child Health Journal, 16(1), 158–168. doi:10.1007/s10995-010-0732-2.
Brown, S. J., McDonald, E. A., & Krastev, A. H. (2008). Fear of an intimate partner and women’s health in early pregnancy: Findings from the Maternal Health Study. Birth, 35(4), 293–302.
Bowen, E., Heron, J., Waylen, A., et al. (2005). Domestic violence risk during and after pregnancy: Findings from a British longitudinal study. BJOG, 112(8), 1083–1089. doi:10.1111/j.1471-0528.2005.00653.x.
Cokkinides, V. E., & Coker, A. L. (1998). Experiencing physical violence during pregnancy: Prevalence and correlates. Family & Community Health, 20(4), 19–37.
Bullock, L., Bloom, T., Davis, J., et al. (2006). Abuse disclosure in privately and medicaid-funded pregnant women. Journal of Midwifery & Women’s Health, 51(5), 361–369.
Daoud, N., Smylie, J., Urquia, M., et al. (2013). The contribution of socio-economic position to the excesses of violence and intimate partner violence among aboriginal versus non-Aboriginal women in canada. Canadian Journal of Public Health, 104(4), e278–e283.
Wilson, D., de la Ronde, S., Brascoupe, S., et al. (2013). Health professionals working with First Nations, Inuit, and Metis consensus guideline. JOGC, 35(6), 550–558.
Boyer, Y. (2011). First Nations, Metis and Inuit health and the law: A framework for the future (Dissertation). Ottawa: University of Ottawa.
Almeida, C. P., Cunha, F. F., Pires, E. P., et al. (2012). Common mental disorders in pregnancy in the context of interpartner violence. Journal of Psychiatric and Mental Health Nursing. doi:10.1111/j.1365-2850.2012.01937.x.
Austin, M. P., & Marce Society Position Statement Advisory Committee. (2014). Marce International Society position statement on psychosocial assessment and depression screening in perinatal women. Best Practice & Research Clinical Obstetrics & Gynaecology, 28(1), 179–187. doi:10.1016/j.bpobgyn.2013.08.016.
US Preventive Services Task Force. (2013). Intimate partner violence and abuse of elderly and vulnerable adults: Screening. Rockville, MD: US Preventive Services Task Force.
World Health Organization-WHO. (2011). Intimate partner violence during pregnancy. Switzerland: World Health Organization.
Committee on Obstetric Pratice. (2015). The American College of Obstetricians and Gynecologists Committee Opinion No. 630. Screening for perinatal depression. Obstetrics and Gynecology, 125(5), 1268–1271. doi:10.1097/01.AOG.0000465192.34779.dc.
National Institute for Health and Care Excellence-NICE. (2014). Antenatal and postnatal mental health: Clinical management and service guidance, Contract No. 192. UK: NICE.
Austin, M. P., Highet, N., & the Guidelines Expert Advisory Committee. (2011). Clinical practice guidelines for depression and related disorders—anxiety, bipolar disorder and puerperal psychosis—in the perinatal period. A guideline for primary care health professionals. Melbourne: Beyondblue.
Charles, P., & Perreira, K. M. (2007). Intimate partner violence during pregnancy and 1-year post-partum. Journal of Family Violence, 22(7), 609–619.
Stewart, D. E., Gagnon, A. J., Merry, L. A., et al. (2012). Risk factors and health profiles of recent migrant women who experienced violence associated with pregnancy. Journal of Women’s Health, 21(10), 1100–1106. doi:10.1089/jwh.2011.3415.
Miszkurka, M., Zunzunegui, M. V., & Goulet, L. (2012). Immigrant status, antenatal depressive symptoms, and frequency and source of violence: What’s the relationship? Archives of Women’s Mental Health, 15(5), 387–396. doi:10.1007/s00737-012-0298-7.
Hyman, I., Forte, T., Du Mont, J., et al. (2009). Help-seeking behavior for intimate partner violence among racial minority women in Canada. Womens Health Issues, 19(2), 101–108. doi:10.1016/j.whi.2008.10.002.
Daoud, N., O’Campo, P., Urquia, M. L., et al. (2012). Neighbourhood context and abuse among immigrant and non-immigrant women in Canada: Findings from the Maternity Experiences Survey. International Journal of Public Health, 57(4), 679–689. doi:10.1007/s00038-012-0367-8.
Fanslow, J., Silva, M., Whitehead, A., et al. (2008). Pregnancy outcomes and intimate partner violence in New Zealand. Australian and New Zealand Journal of Obstetrics and Gynaecology, 48(4), 391–397. doi:10.1111/j.1479-828X.2008.00866.x.
Kita, S., Yaeko, K., & Porter, S. E. (2013). Prevalence and risk factors of intimate partner violence among pregnant women in Japan. Health Care for Women International. doi:10.1080/07399332.2013.857320.
McGuire, M., Cleary, B., Sahm, L., et al. (2010). Prevalence and predictors of periconceptional folic acid uptake—prospective cohort study in an Irish urban obstetric population. Human Reproduction, 25(2), 535–543. doi:10.1093/humrep/dep398.
American College of Obstetricians andGynecologists. (2012). Committee opinion no. 518: Intimate partner violence. Obstetrics and Gynecology, 119, 412–417.
Society of Obstetricians and Gynaecologist of Canada. (2011). Substance use in pregnancy. Journal of Obstetrics and Gynaecology Canada, 33(4), 367–384.
Coker, A. L., Garcia, L. S., Williams, C. M., et al. (2012). Universal psychosocial screening and adverse pregnancy outcomes in an academic obstetric clinic. Obstetrics and Gynecology, 119(6), 1180–1189. doi:10.1097/AOG.0b013e318253d76c.
Roelens, K., Verstraelen, H., Van, E. K., et al. (2008). Disclosure and health-seeking behaviour following intimate partner violence before and during pregnancy in Flanders, Belgium: A survey surveillance study. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 137(1), 37–42. doi:10.1016/j.ejogrb.2007.04.013.
McFarlane, J., & Parker, B. (1994). Abuse during pregnancy: A protocol for prevention and intervention. New York: March of Dimes Birth Defects Foundation.
Straus, M. A. (1979). Measuring intra family conflict and violence: The Conflict Tactics (CT) Scales. Journal of Marriage and the Family, 41(1), 13.
Austin, M. P., Colton, J., Priest, S., et al. (2011). The Antenatal Risk Questionnaire (ANRQ): Acceptability and use for psychosocial risk assessment in the maternity setting. Women Birth. doi:10.1016/j.wombi.2011.06.002.
Taft, A., O’Doherty, L., Hegarty, K., et al. (2013). Screening women for intimate partner violence in healthcare settings. Cochrane Database of Systematic Reviews, 4, CD007007. doi:10.1002/14651858.CD007007.pub2.
O’Campo, P., Kirst, M., Tsamis, C., et al. (2011). Implementing successful intimate partner violence screening programs in health care settings: Evidence generated from a realist-informed systematic review. Social Science and Medicine, 72(6), 855–866. doi:10.1016/j.socscimed.2010.12.019.
Taillieu, T. L., & Brownridge, D. A. (2010). Violence against pregnant women: Prevalence, patterns, risk factors, theories, and directions for future research. Aggression and Violent Behavior, 15(1), 14–35. doi:10.1016/j.avb.2009.07.013.
Acknowledgments
This research was supported by funds to the Canadian Research Data Centre Network (CRDCN) from the Social Science and Humanities research Council (SSHRC), the Canadian Institute for Health Research (CIHR), and the Canadian Foundation for Innovation (CFI) and Statistics Canada. Although the research and analysis are based on data from Statistics Canada, the opinions expressed do not represent the views of Statistics Canada or the Canadian Research Data Centre Network (CRDCN). The authors would like to acknowledge the members of the Maternity Experiences Study Group of the Public Health Agency of Canada’s Canadian Perinatal Surveillance System who were instrumental in the development of the MES and Statistics Canada for its collaboration with the Public Health Agency of Canada in the implementation of the MES. We would like to thank Erin Corston, former Director, Health and Environment, Native Women’s Association of Canada, for reviewing the manuscript for relevance to Aboriginal women’s health. Dr. Heaman received career support from a Canadian Institutes of Health Research (CIHR) Chair in Gender and Health award (2008–2013). Dr. Kingston receives career support from the Alberta Centre for Child, Family and Community Research (2013–2015) and a CIHR New Investigator Award (2015–2019). Dr. Urquia is supported by a CIHR New Investigator Award (2013–2018). Dr. O’Campo is supported by the Alma and Baxter Ricard Chair in Inner City Health. Dr. Janssen is supported by a career salary award from the Child and Family Research Institute. Dr. Smylie receives career support through a CIHR New Investigator Award in Knowledge Translation. No funding was received for this research.
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Kingston, D., Heaman, M., Urquia, M. et al. Correlates of Abuse Around the Time of Pregnancy: Results from a National Survey of Canadian Women. Matern Child Health J 20, 778–789 (2016). https://doi.org/10.1007/s10995-015-1908-6
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DOI: https://doi.org/10.1007/s10995-015-1908-6