摘要：Objectives. We describe the prevalence of abuse before, during, and after pregnancy among a national population-based sample of Canadian new mothers. Methods. We estimated prevalence, frequency, and timing of physical and sexual abuse, identified category of perpetrator, and examined the distribution of abuse by social and demographic characteristics in a weighted sample of 76 500 (unweighted sample = 6421) Canadian mothers interviewed postpartum for the Maternity Experiences Survey (2006–2007). Results. Prevalence of any abuse in the 2 years before the interviews was 10.9% (6% before pregnancy only, 1.4% during pregnancy only, 1% postpartum only, and 2.5% in any combination of these times). The prevalence of any abuse was higher among low-income mothers (21.2%), lone mothers (35.3%), and Aboriginal mothers (30.6%). In 52% of the cases, abuse was perpetrated by an intimate partner. Receiving information on what to do was reported by 61% of the abused mothers. Conclusions. Large population-based studies on abuse around pregnancy can facilitate the identification of patterns of abuse and women at high risk for abuse. Before and after pregnancy may be particularly important times to monitor risk of abuse. The World Health Organization (WHO) defines violence against women as any act of gender-based violence that results in, or is likely to result in physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life. 1 This definition is based on the United Nations Declaration on the Elimination of Violence Against Women, 2 which affirms that “violence against women constitutes a violation of the rights and fundamental freedoms of women and impairs or nullifies their enjoyment of those rights and freedoms.” 2 (p1) Despite the fact that many countries signed this declaration, violence against women still persists in many developed and developing nations. 1 It is a global public health concern as it puts many women at severe risk for their health and lives. 3,4 Among women of reproductive age, violence has been associated with a range of adverse health and pregnancy problems and outcomes such as unwanted pregnancy, 5,6 maternal pregnancy complications, 7,8 lower birth weight and preterm birth, 9–11 perinatal morbidity, 12 maternal physical health problems, 13 abortions, 14 higher utilization of health care services, 15 postpartum depression, 16 substance abuse, 17 and suicide. 18 Socially vulnerable women with low income and low education, unmarried or not cohabitating, 19 and at younger age, 20 are at higher risk for abuse. Despite 4 decades of research, however, including hundreds of studies on violence against women in North America, sound estimates of the prevalence of abuse and violence toward women during the childbearing period are difficult to obtain. A recent systematic review of research on violence against pregnant women reported that prevalence varied widely across studies, from a low of 0.9% to a high of 21%. 21 In Canada, population-based studies showed that physical violence during pregnancy was 6.6% in Ontario, 22 5.7% in Saskatoon, 23 and 1.2% in Vancouver. 24 Such wide-ranging estimates are not useful to policymakers and program planners designing services to address this critical public health problem. Prevalence variability across studies is due in part to a variety of factors related to study design. Antenatal clinic-based samples, which are the norm for this type of research, 17,25–31 may not be representative of the general population, leading to variations in estimates if, for example, women are predominantly from urban clinic samples or low-income patient populations. 19,24,32,33 Response rates vary widely across studies, from a low of 17% 27 to a high of 97% 30 ; samples with lower response rates may overrepresent low-risk women. Modes of inquiry used to assess abuse also vary widely, making comparison across studies a challenge. Although use of face-to-face interviews is common in studies from developing countries, and phone interviews and mailed surveys are often used in developed counties, 34 community-based surveys 33 and self-administered assessments have also been employed. 30 Studies have shown that women have different levels of comfort in disclosing abuse depending on the mode of inquiry, with phone and self-administered methods facilitating disclosure. 35–37 Assessment tools also vary in their coverage of behaviors that constitute partner violence. 37–40 Thus, myriad study design features have influenced the population prevalence rates reported in studies and their generalizability. In summary, few studies on abuse during pregnancy employ large population-based samples of women that enable a presentation of prevalence by subgroups and include rich information about the type, timing, frequency, and severity of abuse and the perpetrators involved. We build on the existing literature on abuse and perpetration patterns using a Canadian national sample of new mothers who were asked about abuse prior to and during pregnancy, as well as in the first several months postpartum. Our objectives were to estimate the prevalence, frequency, timing, and types of physical abuse before, during, and after pregnancy; to identify the category of perpetrator; and to examine the onset and cessation of abuse around pregnancy among a national representative sample of mothers who participated in the Maternity Experiences Survey (MES).
