Falling through the cracks: Missed opportunities to counsel victims of partner violence during prenatal care

Background: Five million women are physically, sexually, and emotionally abused by intimate partners in the U.S. each year. Despite the severe health consequences and costs associated with intimate partner violence (IPV), a vast majority of cases go unreported and most health providers fail to assess patients for abuse. Objectives:To assess the extent to which women who experience IPV actually receive education on partner violence from health care providers during any prenatal care (PNC) visits. Methods:This study analyzed the 2004-2008 National Pregnancy Risk Assessment Monitoring System which included 202,367 women who delivered a live birth in the U.S. IPV victimization was measured using four items that addressed physical abuse by a current or former husband/partner in the 12 months before or during pregnancy. Responses were categorized as preconception, prenatal, and preconception and/or prenatal IPV. The outcome was receipt of IPV education by a health care worker during PNC. Separate logistic regression models provided crude and adjusted odds ratios and 95% confidence intervals. Results:Women who reported prenatal IPV were less likely to receive IPV education during PNC (OR=0.81,95%CI=0.70-0.94). Among racial/ethnic minorities, women who experienced preconception IPV were less likely to receive IPV education. Further, Medicaid recipients who reported preconception and/or prenatal IPV were less likely to receive IPV education (OR=0.76,95%CI=0.70-0.83). Conclusion:Results underscore a public health problem and missed opportunity to connect battered victims to necessary services and care. Results from the study can elucidate the state of current clinical practice and better inform policies on incorporating universal IPV screening/education into routine care.