CONTENTS

About This Course

Table of Contents

1. Introduction to the Issues
2. Understanding Alcohol Abuse
3. Understanding Violence Against Women
4. Alcohol and Domestic Violence
5. Alcohol, Sexual Assault, and Rape
6. Prevention and Early Intervention
7. Screening and Assessment
8. Diagnosis and Treatment
9. Legal and Ethical Issues

Supplements
Fact Sheets
Videos
Resources

Silence Hurts
Alcohol Abuse and Violence Against Women

Violence During Pregnancy

Most studies have found that violence during pregnancy occurs roughly in 1 in 6 pregnant women.¹² Pregnant women have a 60 percent higher likelihood of being abused than non-pregnant women.¹³ "Pregnancy" covers the pre-natal months, the period immediately after delivery, as well as the 6-9 months following delivery. Pregnancy is a unique time for intervention since women tend to visit their health care providers more often.¹⁴ In 1995, an estimated 72 percent of U.S. women aged 15-44 years received at least one type of reproductive health service, including:¹⁵

• Contraceptive counseling or prescription
• Pap smears, pelvic exam, HIV test
• Sterilization, abortion
• Prenatal or postpartum care, and
• Testing or treatment for vaginal, urinary tract, or pelvic infection

Battered women are three times more likely than nonbattered women to be pregnant when injured. As a result, they experience a higher likelihood of miscarriage, separation of the placenta from the uterus, hemorrhages, fetal fractures, low infant birth weight, and rupture of the spleen, liver, and uterus.¹⁶ This is a particularly hard time to intervene because of the emotional and financial ties to the partner/spouse.

Women whose pregnancies are unintended share some risk factors with women who experience violence: younger age, lower income, and being unmarried.¹⁷ It is estimated that between 1990 and 1995, 31 percent of births to U.S. women aged 15-44 years were unintended. While research shows there is a relationship between unintended births and violence, no causal relationship has been established.¹⁸

Most data on physical violence and pregnancy intendedness comes from the Pregnancy Risk Assessment Monitoring System (PRAMS), an ongoing, State-based system that conducts surveillance on maternal characteristics before pregnancy, during, and postpartum.

One such study examined data from 14 states and included 39,348 women who had delivered a live-born infant within the previous 2-4 months. Eighty-six percent of the mothers were at least 20 years old, 80 percent had completed at least 12 years of education, and 68 percent were married. Twelve percent said that sometime during the 12 months prior to delivery, the father had expressed not wanting to have a child.¹⁹ Women who experienced abuse during the 12 months prior to delivery had an increased chance of having a child that was not intended than women who experienced no abuse (66.3% vs. 42%).

The total incidence of abuse during pregnancy was roughly 8 percent. Women with unintended pregnancies were 2.5 times more likely to have experienced abuse than women whose pregnancies were planned. The maternal characteristics that were statistically significant in relation to abuse were:²⁰

• Less than 20 years of age,
• African-American descent and unmarried,
• Dependence on Medicaid and living in crowded conditions,
• Late entry into the prenatal system,
• Lack of father's support for pregnancy, and
• Smoking in the third trimester.

For more detailed information regarding violence during pregnancy, the Centers for Disease Control and Prevention Web site, which provides an online slide show for doctors and medical professionals to help them with clients who shows signs of domestic abuse while pregnant. The American College of Obstetrics and Gynecology (ACOG) also provides valuable resources to consumers and professionals.