Intimate Partner Violence During Pregnancy: Incidence and Associated Health Behaviors in a Rural Population

  • Beth A. BaileyEmail author
  • Ruth Ann Daugherty
Original Paper


Objectives: The goal of this investigation was to examine the prevalence of different types of intimate partner violence (IPV) during pregnancy, as well as the association between both physical and psychological IPV and negative health behaviors, including smoking, other substance use, inadequate prenatal care utilization, and nutrition, in a rural sample. Methods: 104 southern Appalachian women, primarily Caucasian and lower SES, completed a pregnancy interview focused on IPV (CTS2) and health behaviors. Medical records were also reviewed. Results: 81% of participants reported some type of IPV during the current pregnancy, with 28% reporting physical IPV, and 20% reporting sexual violence. More than half were current smokers. Physical IPV during pregnancy was associated with significantly increased rates of pregnancy smoking (including decreased rates of quitting and reducing), increased rates of alcohol, marijuana, and harder illicit drug use around the time of conception, and later entry into prenatal care. The experience of psychological IPV during pregnancy was associated with a significantly decreased likelihood of quitting or reducing smoking during pregnancy, an increased rate of alcohol use around the time of conception, and an increased rate of pre-pregnancy obesity. Conclusions: In this sample, pregnancy IPV and smoking occurred at rates well above national averages. Additionally, while physical IPV during pregnancy was associated with several negative pregnancy health behaviors, the experience of psychological IPV, even in the absence of physical IPV, also placed women at increased risk for negative health behaviors, all of which have been linked to poor pregnancy and newborn outcomes.


Pregnancy IPV Psychological IPV Pregnancy health behaviors Pregnancy smoking 



This study was supported by NCMHD Project EXPORT grant number 5 R24 MD001106-02 awarded to Dr. Joellen Edwards, and by an East Tennessee State University Research Deve-lopment Committee award to Dr. Beth Bailey.

The authors wish to thank all of the women who participated in this project for their time and dedication to this effort. We would also like to thank the physicians and staff at Bristol Family Practice Center for their assistance with participant recruitment and data collection.


  1. 1.
    Tjaden P, Thoennes N. Prevalence, incidence, and consequences of violence against women: Findings from the national violence against women survey. National Institute of Justice CDC Research Brief Report; 1998.Google Scholar
  2. 2.
    Campbell JC, Lewandowski LA. Mental and physical health effects of intimate partner violence on women and children. Psychiatr Clin North Am 1997;20:353–74.PubMedCrossRefGoogle Scholar
  3. 3.
    Neggers Y, Goldenberg R, Cliver S, Hauth J. Effects of domestic violence on preterm birth and low birth weight. Acta Obstetricia et Gynecologica Scandinavica 2004;83:455–60.PubMedCrossRefGoogle Scholar
  4. 4.
    Norton L, Peipert J, Zierler S, Lima B, Hume L. Battering in pregnancy: An assessment of two screening methods. Obstet Gynecol 1995;85:321–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Stenson K, Heimer G, Lundh C, Nordstrom ML, Saarinen H, Wenker A. The prevalence of violence investigated in a pregnant population in Sweden. J Psychosom Obstet Gynecol 2001;22:189–97.Google Scholar
  6. 6.
    Shumway J, O’Campo P, Gielen A, Witter FR, Khouzami AN, Blakemore KJ. Preterm labor, placental abruption, and premature rupture of membranes in relation to maternal violence or verbal abuse. J Matern-Fetal Med 1999;8:76–80.PubMedCrossRefGoogle Scholar
  7. 7.
    D’Avolio D, Hawkins JW, Haggerty LA, et al. Screening for abuse: Barriers and opportunities. Health Care for Women Int 2001;22:349–62.CrossRefGoogle Scholar
  8. 8.
    Humphreys J, Parker B, Campbell J. Intimate partner violence against women. Women’s Health and Illness Issues 2001:275–306.Google Scholar
  9. 9.
    Gazmararian JA, Lazorick S, Spitz AM, Ballard T, Saltzman L, Marks JS. Prevalence of violence against pregnant women. JAMA 1996;275:1915–20.PubMedCrossRefGoogle Scholar
  10. 10.
    Centers for Disease Control and Prevention. PRAMS 1996 surveillance report. Atlanta, GA: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention.Google Scholar
  11. 11.
    Griffin MP, Koss MP. Clinical screening and intervention in cases of partner violence. Online J Issues Nurs 2002;1/31:1–11.Google Scholar
  12. 12.
    Sagrestano LM, Rodriguez AC, Carroll D, et al. A comparison of standardized measures of psychosocial variables with single-item screening measures used in an urban obstetric clinic. JOGNN 2002;31(2):147–55.PubMedCrossRefGoogle Scholar
  13. 13.
    Jasinski JL, Kantor GK. Pregnancy, stress and wife assault: Ethnic differences in prevalence, severity, and onset in a national sample. Violence Vict 2003;16(3):219–32.Google Scholar
  14. 14.
    Curry MA. The interrelationships between abuse, substance use, and psychosocial stress during pregnancy. J Obstet Gynecol Neonatal Nurs 1998;27:692–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Norton LB, Peipert JF, Zierler S, Lima B, Hume L. Battering in pregnancy: An assessment of two screening methods. Obstet Gynecol 1995;85:321–5.PubMedCrossRefGoogle Scholar
  16. 16.
    Dunn LL, Oths KS. Prenatal predictors of intimate partner abuse. JOGNN 2004;33:54–63.PubMedCrossRefGoogle Scholar
  17. 17.
    McFarlane J, Parker B, Soeken K. Abuse during pregnancy: Associations with maternal health and infant birth weight. Nurs Res 1996;45:37–42.PubMedCrossRefGoogle Scholar
  18. 18.
    Coker AL, Sanderson M, Dong B. Partner violence during pregnancy and risk of adverse pregnancy outcomes. Paediatr Perinatal Epidemiol 2004;18:260–9.CrossRefGoogle Scholar
  19. 19.
    Bullock LFC, Mears JLC, Woodcock C, Record R. Retrospective study of the association of stress and smoking during pregnancy in rural women. Addict Behav 2001;26:405–13.PubMedCrossRefGoogle Scholar
  20. 20.
    Ventura SJ, Martin JA, Curtin SC, Mathews TJ. Advance report of final natality statistics, 1995. Mon Vital Stat Rep 1997;45S:1–84.Google Scholar
  21. 21.
    Rennison C, Welchans S. Bureau of Justice Statistics special report: IPV. United States Department of Justice, Office of Justice Programs #NCJ178247 May 2000. pp. 1–11.Google Scholar
  22. 22.
    Saltzman LE, Johnson CH, Gilbert BC, Goodwin MM. Physical abuse around the time of pregnancy: An examination of prevalence and risk factors in 16 states. Matern Child Health J 2003;7(1):31–43.PubMedCrossRefGoogle Scholar
  23. 23.
    Denham SA. Describing abuse of pregnant women and their healthcare workers in rural Appalachia. MCN 2003;28(4):264–9.Google Scholar
  24. 24.
    Bohn DK. Lifetime and current abuse, pregnancy risks, and outcomes among Native American women. J Health Care of the Poor and Underserved 2002;13(2):184–98.Google Scholar
  25. 25.
    Fernandez FM, Krueger PM. Domestic violence: Effect on pregnancy outcome. JAOA 1999;5:254–6.Google Scholar
  26. 26.
    Curry MA, Harvey SM. Stress related to domestic violence during pregnancy and infant birth weight. In: Campbell JC, editor. Empowering survivors of abuse. Thousand Oaks, CA: Sage; 1998.Google Scholar
  27. 27.
    Parker B, McFarlane J, Soeken K. Abuse during pregnancy: Effects on maternal complications and birth weight in adult and teenage women. Obstet Gynecol 1994;84:323–8.PubMedGoogle Scholar
  28. 28.
    Murphy CC, Schei B, Myhr T, DuMont J. Abuse: A risk factor for low birth weight? A systematic review and meta-analysis. Can Med Assoc J 2001;164(11):1567–72.Google Scholar
  29. 29.
    Curry MA, Perrin N, Wall E. Effects of abuse on maternal complications and birth weight in adult and adolescent women. Obstet Gynecol 1998;92:530–4.PubMedCrossRefGoogle Scholar
  30. 30.
    Anderson BA, Marshak HH, Hebbeler DL. Identifying intimate partner violence at entry to prenatal care: Clustering routine clinical information. J Midwifery Womens Health 2002;47(5):353–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Martin SL, Beaumont JL, Kupper LL. Substance use before and during pregnancy: Links to intimate partner violence. Am J Drug Alcohol Abuse 2003;29(3):599–617.PubMedCrossRefGoogle Scholar
  32. 32.
    Kearney MH, Munro BH, Kelly U, Hawkins JW. Health behaviors as mediators for the effect of partner abuse on infant birth weight. Nurs Res 2004;53(1):36–45.PubMedCrossRefGoogle Scholar
  33. 33.
    Altarac M, Strobino DM. Abuse during pregnancy and stress because of abuse during pregnancy and birthweight. JAMWA 2002;57(4):208–14.PubMedGoogle Scholar
  34. 34.
    Tuten M, Jones HE, Tran G, Svikis DS. Partner violence impacts the psychological and psychiatric status of pregnant, drug-dependent women. Addict Behav 2004;29:1029–34.PubMedCrossRefGoogle Scholar
  35. 35.
    Parker B, McFarlane J, Soeken K, Torres S, Campbell D. Physical and emotional abuse in pregnancy: A comparison of adult and teenage women. Nurs Res 1993;42:173–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Goodwin M, Gazmararian JA, Johnson CH, Gilbert BC, Saltzman LE, Group PW. Pregnancy intendedness and physical abuse around the time of pregnancy: Findings from the Pregnancy Risk Assessment Monitoring System, 1996–1997. Matern Child Health J 2000;4:85–92.PubMedCrossRefGoogle Scholar
  37. 37.
    Taggert L, Mattson S. Delay in prenatal care as a result of battering in pregnancy: Cross-cultural implications. Health Care for Women Int 1996;17:25–34.CrossRefGoogle Scholar
  38. 38.
    Kearney MH, Haggerty LA, Munro BH, Hawkins JW. Birth outcomes and maternal morbidity in abused pregnant women with public versus private health insurance. J Nurs Sch 2003;35(4):345–9.CrossRefGoogle Scholar
  39. 39.
    Johnson PJ, Hellerstedt WL, Pirie PL. Abuse history and nonoptimal prenatal weight gain. Public Health Rep 2002;117:148–56.PubMedGoogle Scholar
  40. 40.
    Straus MA. Manual for the conflict tactics scales (CTS) and test forms for the Revised Conflict Tactics Scales. Durham, NH: Family Research Laboratory, University of New Hampshire; 1995.Google Scholar
  41. 41.
    Straus MA. Cross cultural reliability and validity of the revised conflict tactic scales. Durham, NH: University of New Hampshire, Family Research Laboratory. Available in: http://pubpages,∼mas2.Google Scholar
  42. 42.
    Sokol RJ, Martier SS, Ager JW. The T-ACE questions: Practical prenatal detection of risk-drinking. Am J Obstet Gynecol 1989;160:863–70.PubMedGoogle Scholar
  43. 43.
    Delaney-Black V, Covington C, Templin T, Ager JW, Martier SS, Compton S, Sokol RJ. Prenatal coke: What’s behind the smoke? Ann NY Acad Sci 1998;846:277–88.PubMedCrossRefGoogle Scholar
  44. 44.
    Jacobson SW, Chiodo LM, Sokol RJ, Jacobson JL. Validity of maternal report of prenatal alcohol, cocaine, and smoking in relation to neurobehavioral outcome. Pediatrics 2002;109:815–25.PubMedCrossRefGoogle Scholar
  45. 45.
    Christensen AE, Tobiassen M, Jensen TK, Wielandt H, Bakketeig L, Host A. Repeated validation of parental self-reported smoking during pregnancy and infancy: A prospective cohort study of infants at high risk for allergy development. Paediatr Perinat Epidemiol 2004;18:73–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Kessner DM, Singer J, Kalk CE, Schlesinger ER. Infant death: An analysis by maternal risk and health care (vol 1). Washington, DC: Institute of Medicine National Academy of Sciences; 1973.Google Scholar
  47. 47.
    Defining overweight and obesity: Scholar
  48. 48.
    Institute of Medicine. National Academy of Sciences, Subcommittee on Nutritional Status and Weight Gain during Pregnancy. Washington (DC): National Academy Press; 1990.Google Scholar
  49. 49.
    Dye T, Tolliver N, Lee R, Kenney C. Violence, pregnancy and birth outcome in Appalachia. Paediatr Perinat Epidemiol 1995;9:35–47.PubMedCrossRefGoogle Scholar
  50. 50.
    Johnson M, Elliott BA. Domestic violence among family practice patients in midsized and rural communities. J Fam Pract 1997;44:391–400.PubMedGoogle Scholar
  51. 51.
    Jesse DE. Prenatal psychosocial needs: Differences between a TennCare group and a privately insured group in Appalachia. J Health Care Poor Underserved 2003;14(4):535–49.PubMedGoogle Scholar
  52. 52.
    Willis SM. Recovering from my own little war: Women and domestic violence in rural Appalachia. J Appalachian Stud 1998;4:255–70.Google Scholar
  53. 53.
    Carawan G, Carawan C. Voices from the mountains. New York: Knopf; 1975.Google Scholar
  54. 54.
    Tripp-Reimer T, Freidl MC. Appalachians: A neglected minority. Nurs Clin North Am 1977;12:41–54.PubMedGoogle Scholar
  55. 55.
    Petersen R, Gazmararian J, Spitz A, Rowley DL, Goodwin MM, Saltzman LE, et al. Violence and adverse pregnancy outcomes: A review of the literature and directions for future research. Am J Prev Med 1997;13:366–73.PubMedGoogle Scholar
  56. 56.
    Bohn DK, Tebben JG, Campbell JC. Influences of income, education, age, and ethnicity on physical abuse before and during pregnancy. JOGNN 2004;33(5):561–71.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Department of Family Medicine, James H. Quillen College of MedicineEast Tennessee State UniversityJohnson CityUSA

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