Intimate partner violence during the perinatal period by disability status: Findings from a United States population-based analysis

Intimate partner violence: A clinical update

ABSTRACT

Intimate partner violence (IPV) is a significant public health issue associated with substantial morbidity and mortality. NPs are ideally positioned to screen for and intervene in IPV, thereby mitigating the health risks IPV carries for women, infants, and young children. Safety planning and appropriate referrals to community-based resources are critical components of addressing IPV.

Reproductive Coercion Among Women With Disabilities: An Analysis of Pregnancy Risk Assessment Monitoring Systems Data

BACKGROUND/AIMS

Reproductive coercion (RC) is a widespread yet understudied type of intimate partner violence that is associated with numerous negative outcomes. Women with disabilities may be at an increased risk of RC; however, little research has been conducted among this population. Using population-based data, we sought to examine the prevalence of RC in postpartum women with disabilities.

METHODS

This is a secondary analysis of a cross-sectional survey, the Pregnancy Risk Assessment Monitoring System, a nationally representative survey conducted by the Centers for Disease Control and Prevention in partnership with participating states. These analyses include 3,117 respondents who had information on both disability status and experiences of RC.

RESULTS

Approximately 1.9% of respondents reported experiencing RC (95% CI [1.3, 2.4]). When stratified by disability status, approximately 1.7% of respondents without a disability reported RC whereas 6.2% of respondents with at least one disability reported RC ( p < 0.001). In univariable logistic models, disability, age, education, relationship status, income, and race were all significantly associated with RC.

CONCLUSIONS

Our findings highlight the need for healthcare providers working with women with disabilities to screen for RC and potentially uncover intimate partner violence and prevent its negative health consequences. All states participating in Pregnancy Risk Assessment Monitoring System data collection are urged to incorporate measures of RC and disability status to better address this significant issue.

Prenatal Care Experiences of Childbearing People With Disabilities in Ontario, Canada

OBJECTIVE

To explore the care experiences of childbearing people with physical, sensory, and/or intellectual/developmental disabilities during pregnancy.

DESIGN

Descriptive qualitative.

SETTING

Ontario, Canada, where physician and midwifery care during pregnancy are provided at no direct cost to residents.

PARTICIPANTS

Thirty-one people with physical, sensory, and/or intellectual/developmental disabilities (who self-identified as cisgender women [n = 29] and trans or nonbinary persons [n = 2]) who gave birth in the last 5 years.

METHODS

We recruited childbearing people with disabilities through disability and parenting organizations, social media, and our team's networks. Using a semistructured guide, we conducted in-person and virtual (e.g., telephone or Zoom) interviews with childbearing people with disabilities in 2019 to 2020. We asked participants about the services they accessed during pregnancy and if services met their needs. We used a reflexive thematic analysis approach to analyze interview data.

RESULTS

Across disability groups, we identified four common themes: Unmet Accommodation Needs, Lack of Coordinated Care, Ableism, and Advocacy as a Critical Resource. We found that these experiences manifested in unique ways based on disability type.

CONCLUSION

Our findings suggest the need for accessible, coordinated, and respectful prenatal care for people with disabilities, with the requirements of such care depending on the needs of the individual person with a disability. Nurses can play a key role in identifying the needs and supporting people with disabilities during pregnancy. Education and training for nurses, midwives, obstetricians, and other prenatal care providers should focus on disability-related knowledge and respectful prenatal care.

Maternal disability and prenatal oral health experiences: Findings from Pregnancy Risk Assessment Monitoring System

BACKGROUND

Although disability has associations with poor health and reduced access to health care services, limited research exists on the connection between disability, oral health, and oral health care use. Moreover, to the authors' knowledge, no study has examined the association between disability and oral health around the time of pregnancy. This is an important gap in research, considering that both disability and oral health play a critical role in maternal and infant well-being.

METHODS

The authors obtained cross-sectional data from 15 states from 2019 and 2020 from the Pregnancy Risk Assessment Monitoring System (N = 20,189). The authors used multivariable logistic regression analyses to assess the relationship between cumulative disabilities and specific forms of disability (seeing, hearing, walking, remembering, self-care, and communicating) for 6 indicators of oral health experiences during pregnancy.

RESULTS

Women reporting multiple forms of disabilities around the time of pregnancy (especially ≥ 3 disabilities) reported lower levels of knowledge of appropriate oral health care during pregnancy, were less likely to undergo dental prophylaxis during pregnancy, were more likely to report needing care for dental health problems, and had more unmet oral health care needs than those without disabilities.

CONCLUSIONS

Maternal disability is a risk factor for poorer oral health outcomes and oral health care use during pregnancy.

PRACTICAL IMPLICATIONS

Given the potential harms of poor oral health to maternal and infant well-being, the findings of this study suggest the need for increased health promotion efforts to foster improved oral health for pregnant women living with disabilities.

Physical intimate partner violence and oral health problems during pregnancy

BACKGROUND

The aim of this study was to assess the association between physical intimate partner violence (IPV) during pregnancy and reports of prenatal oral health problems among a sample of mothers in the United States.

METHODS

Data were obtained from the Pregnancy Risk Assessment Monitoring System from 7 sites (Kentucky, Mississippi, New Hampshire, New York, Puerto Rico, Utah, West Virginia) for 2016 through 2020. The authors used multivariable logistic regression to examine the relationship between physical IPV and respondent self-reports of whether they needed to see a dentist for several oral health problems during pregnancy: (1) needing to have a tooth restored; (2) painful, red, or swollen gingivae; (3) toothache; (4) needing to have a tooth extracted; (5) having an injury to the mouth, teeth, or gingivae; or (6) another problem with teeth or gingivae.

RESULTS

Women who experienced physical IPV during pregnancy had elevated rates of oral health problems during pregnancy compared with women who did not experience IPV. The findings detailed associations between physical IPV and oral health problems that may stem from physical violence, including painful, red, or swollen gingivae; toothache; and mouth, teeth, or gingivae injury.

CONCLUSIONS

The results of this study highlight a connection between physical IPV during pregnancy and oral health problems consistent with orofacial injuries.

PRACTICAL IMPLICATIONS

The association between physical IPV and elevated rates of oral health problems and orofacial injuries highlights the critical role of oral health care providers in screening for, detecting, and intervening in IPV among pregnant women.

Depressive symptoms during the perinatal period by disability status: Findings from the United States Pregnancy Risk Assessment Monitoring System

AIMS

The aim of the current study was to compare the prevalence of depressive symptoms during the perinatal period among respondents with a disability as compared to those without a disability.

DESIGN

We conducted a secondary analysis of nationally representative data from the Pregnancy Risk Assessment Monitoring System data from 24 participating United States between 2018 and 2020.

METHODS

A cross-sectional sample of 37,989 respondents provided data on disability, including difficulty in vision, hearing, ambulation, cognition, communication and self-care. The outcome of interest was perinatal depressive symptoms, defined as experiencing depressive symptoms during the antenatal period or postpartum period. Regression models were used to calculate odds of depressive symptoms during these two time periods by disability status while controlling for relevant sociodemographic characteristics and depressive symptoms prior to pregnancy.

RESULTS

Respondents with disabilities experienced a higher prevalence of depressive symptoms in both the antenatal period and postpartum period as compared to those without disabilities. In fully adjusted models, respondents with disabilities had 2.4 times the odds of experiencing depressive symptoms during pregnancy and 2.1 times the odds of experiencing postpartum depressive symptoms as compared to respondents without disabilities.

CONCLUSION

Respondents with disabilities experience a higher prevalence of depressive symptoms throughout the perinatal period thereby increasing the risk for adverse maternal, neonatal and infant health outcomes.

IMPACT

Perinatal depression is a significant public health issue globally, and our findings suggest that persons with disability are at an increased risk for depressive symptoms both during pregnancy and in the postpartum period. Our findings represent a call to action to improve clinical and supportive services for women with disabilities during the perinatal period to improve their mental health and the consequent health of their offspring.

PATIENT OR PUBLIC CONTRIBUTION

We thank our Community Advisory Board members who have been instrumental in the conception of this study.

Disability and Interpersonal Violence in the Perinatal Period

OBJECTIVE

To compare the risk of interpersonal violence experienced by pregnant and postpartum individuals with physical disabilities, sensory disabilities, or intellectual or developmental disabilities with those without disabilities, and to examine whether a prepregnancy history of interpersonal violence puts individuals with disabilities, at excess risk of interpersonal violence in the perinatal period.

METHOD

This population-based study included all individuals aged 15-49 years with births in Ontario, Canada, from 2004 to 2019. Individuals with physical (n=147,414), sensory (n=47,459), intellectual or developmental (n=2,557), or multiple disabilities (n=9,598) were compared with 1,594,441 individuals without disabilities. The outcome was any emergency department visit, hospital admission, or death related to physical, sexual, or psychological violence between fertilization and 365 days postpartum. Relative risks (RRs) were adjusted for baseline social and health characteristics. Relative excess risk due to interaction (RERI) was estimated from the joint effects of disability and prepregnancy violence history; RERI>0 indicated positive interaction.

RESULTS

Individuals with physical (0.8%), sensory (0.7%), intellectual or developmental (5.3%), or multiple disabilities (1.8%) were more likely than those without disabilities (0.5%) to experience perinatal interpersonal violence. The adjusted RR was 1.40 (95% CI 1.31-1.50) in those with physical disabilities, 2.39 (95% CI 1.98-2.88) in those with intellectual or developmental disabilities, and 1.96 (95% CI 1.66-2.30) in those with multiple disabilities. Having both a disability and any violence history produced a positive interaction for perinatal interpersonal violence (adjusted RERI 0.87; 95% CI 0.47-1.29).

CONCLUSION

The perinatal period is a time of relative high risk for interpersonal violence among individuals with pre-existing disabilities, especially those with a history of interpersonal violence.