Postpartum, also a risk period for domestic violence

Abstract

Objective: In the first European study of its kind the prevalence of physical and sexual violence postpartum was estimated in a random sample of 207 Swedish born women attending antenatal clinics. Study design: The Severity of Violence Against Women scale (SVAW) was used to measure the frequency of threats and severity of physical and sexual abuse by means of a postal questionnaire covering a period of 8 weeks postpartum. In the sample of women the same research tool had been employed during the preceding pregnancy in the form of a personal interview. Results: The non-response rate was 75/207 (36%) with a small difference in the rates of drop-out between women who had been abused or not abused during their pregnancy. Of the 132 women answering the questionnaire, 32 reported threats, physical or sexual abuse postpartum. Of those 32 women, 22 (69%) stated that they had not been subject to abuse previously. Women who were abused postpartum were older and were married to a higher extent than those who had been abused prior to and during pregnancy. Conclusions: Abuse does not appear to be restricted to a specific socio-demographic group of women or to a specific period in a woman’s reproductive life. Therefore, questions to women regarding both threats and physical violence should be part of all clinical practices.

Introduction

Domestic violence is recognised as a global health problem [1].

High rates of violence towards a woman by her intimate partner is not rare and it occurs in all socio-demographic groups [2]. The prevalence of violence at any time in a woman’s life ranges from 9.7 to 29.7% and the prevalence figures of violence during pregnancy varies between 0.9 and 20.1% [3]. Several studies confirm physical abuse during pregnancy and how it effects the maternal health [4]. Thus, pregnancy is not a protective period for the abused woman.

Research evidence indicates that abuse during pregnancy causes serious health problems for both the woman and the unborn child and that abused women often enter prenatal care late [5], [6]. Pregnant women in abusive relations have been shown to endure a substantial risk of being subjected to alcohol consumption, smoking, abdominal pain, gastrointestinal disorders, hospitalisations, injuries, gynecological and psychiatric problems [7], [8], [9], [10].

Most studies have focused on the period before and during pregnancy and only a few have reported domestic violence in the postpartum period. For instance, in one study the prevalence of moderate to severe violence was estimated to be 25% [11]. In another follow up study of 30 women who had reported abuse during pregnancy, 90% of the women reported a total of 57 abusive incidents 3 months after delivery [12]. These studies also suggest that the postpartum period involves an increased risk of moderate to severe violence.

In a paper by Ballard et al. [3] four distinct patterns are mentioned (1) no violence before pregnancy, but violence during pregnancy (violence starts), (2) violence both before and during pregnancy (violence continues), (3) violence before pregnancy but not during pregnancy (violence ceases) and (4) no violence either before or during pregnancy. An important next step must therefore be to investigate the pattern of physical abuse before, during and after pregnancy and establish how and if there is a correlation.

We have previously reported the frequency of threats, severity and pattern of physical and sexual abuse in pregnant women [13]. The aim of the present study was to investigate the prevalence of threats, severity of physical and sexual abuse in the same group of women during the postpartum period.