Physical violence toward pregnant women is more likely to occur when pregnancy was unintended

Women whose pregnancy is unwanted or mistimed are four times as likely as women with an intended pregnancy to be physically hurt by their husband or partner, according to data from a study of more than 12,000 mothers in four states.(1) Regardless of whether the pregnancy is unwanted, mistimed or wanted, violence is more common among women who are socially less advantaged (in terms of education, age, marital status and living conditions, for example) than among more advantaged women. Nevertheless, the association between physical violence and unwantedness appears to be greater among more socially advantaged women.

Data on violence and pregnancy intendedness were obtained from the Pregnancy Risk Assessment Monitoring System (PRAMS), a state specific, population-based survey of new mothers 6 months after their child's birth. The analysis was based on responses from 12,612 new mothers in Alaska, Maine, Oklahoma and West Virginia who participated in PRAMS in 1990-1991. The PRAMS questionnaire asked women if they had been "physically hurt" by their husband or partner during the 12 months prior to delivery. It also asked women to recall the time just before they became pregnant and to describe how they felt about becoming pregnant. Pregnancies were classified as unwanted if the woman did not want the pregnancy at all, mistimed if she wanted to be pregnant at some point in the future and intended if she wanted the pregnancy sooner or at that time.

Additional variables--such as the women's level of education, race, age, marital status, household crowding, participation in the Special Supplemental Food Program for Women, Infants and Children (WIC) during pregnancy and trimester in which prenatal care was initiated--were examined as covariates. (Information on household crowding, WIC status and prenatal care were obtained from the PRAMS questionnaire; birth certificates provided data on the other variables.) Women who had fewer than 12 years of education, who were nonwhite, who were younger than 20, who were unmarried, who lived in crowded conditions, who had participated in WIC or who had received no or delayed prenatal care were considered to be less advantaged.

The proportion of respondents who reported being physically hurt by their husband or partner during the 12 months preceding their child's birth ranged from 4% in Maine to 7% in Oklahoma. In most cases, less socially advantaged women reported higher rates of violence. In Alaska, for example, 11% of women with fewer than 12 years of schooling reported experiencing violence during pregnancy, compared with 2% of those with more than 12 years of education; in Oklahoma, these proportions were 13% and 4%, respectively. Similarly, 11% of unmarried women in West Virginia experienced violence while pregnant, compared with 3% of married women.

Forty-three percent of respondents in the four states reported that their pregnancy had been unintended--12% unwanted and 31% mistimed. Violence was most common among women with an unwanted pregnancy: Twelve percent reported having been hurt by their husband or partner during pregnancy, compared with 8% of women with a mistimed pregnancy and 3% with an wanted pregnancy (Table 1). (Table 1 omitted) Together, women with an unwanted or mistimed pregnancy accounted for almost 70% women who reported that they had been victims of violence by their husband or partner during pregnancy.

For all covariates except household crowding, violence was most common among women with an unwanted pregnancy. In addition, Table 1 shows that regardless of whether a pregnancy was intended, mistimed or unwanted, violence was in most cases least common among more socially advantaged women and most common among the less advantaged. However, when the researchers calculated the ratio of the prevalence of violence between women with unwanted and intended pregnancies, this ratio was greater among the more socially advantaged women than among the least advantaged.

When the researchers used multiple logistic regression analysis to compare the odds of violence between women with unwanted and intended pregnancies, they found that overall, women with an unwanted pregnancy were four times as likely as women with an intended pregnancy to have experienced physical violence from a husband or partner while pregnant (odds ratio of 4.1).

For each covariate, however, the odds of violence (comparing women with a unwanted pregnancy and those with a wanted pregnancy) were greater among more socially advantaged women. For example, among women who had more than 12 years of education, those with an unwanted pregnancy were eight times as likely as those with an intended pregnancy to have experienced violence, while among women who had fewer than 12 years of schooling, those with an unwanted pregnancy were three times as likely as those with an intended pregnancy to have experienced violence.

The researchers cite three possible interpretations of the interaction between pregnancy intendedness, social status and violence. First, they observe, it may be that socially advantaged women who have an intended pregnancy do not experience a high rate of violence, but that comparable women with an unwanted pregnancy do. Alternatively, they suggest, women with an intended pregnancy may underreport violence, and such underreporting may be especially common among more socially advantaged women. Finally, the investigators contend, violence among less advantaged women may already be so common that an unintended pregnancy cannot appreciably increase its prevalence.

The researchers point out that they lacked information on the severity, timing and frequency of the violence reported in PRAMS. For example, the questionnaire asked only about any incidence of violence in the 12 months before delivery; thus, the investigators could not determine whether the violence occurred before or during pregnancy or at both times. Additionally, they observe that individual respondents' interpretations of being physically hurt or of the intendedness of their pregnancies may have differed. Women who experienced violence, for example, may have been more likely to retrospectively assess their pregnancies as unintended.

The investigators call for additional research to understand the relationship between pregnancy intendedness and physical violence and to devise strategies for its prevention. They point out that pregnancy may be the only time when some women come into regular contact with health care providers, and therefore prenatal care visits may provide a good opportunity to screen for violence.

Reference

J. A. Gazmararian et al, "The Relationship Between Pregnancy Intendedness and Physical Violence in Mothers of Newborns," Obstetrics & Gynecology, 85:1031-1038, 1995.

Copyright The Alan Guttmacher Institute Sep 1995
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