Social Determinants of Health Associated with Intimate Partner Violence in an Urban Obstetric Population.

Abstract

Objective:  Intimate partner violence (IPV) is pervasive and can lead to severe health consequences. In the United States, 25% of women have experienced sexual violence, physical violence, and/or stalking by an intimate partner. However, less is known about the frequency and risk factors for IPV in the obstetric population.

Study design:  Nested case-control study from a prospective cohort study of 606 parturients at a single academic medical center from 2011 to 2022. Structured questionnaires were administered to randomly chosen, consented patients during their postpartum hospital stay to gather information on social determinants of health (SDoH) and birth outcomes. The case group included participants who reported forced sex causing pregnancy, verbal abuse before or during pregnancy, or physical abuse during pregnancy. The control group reported none of these. Odds ratios were used to quantify the relationship between IPV and maternal sociodemographic characteristics, pregnancy factors, and levels of perceived support and discrimination.

Results:  Of 606 study participants, 568 (94%) provided data on IPV. Of those, 20.4% reported IPV (case) and 80.6% reported no IPV (control). In total, 74.6% of the study population was enrolled prepandemic. Unmarried status, low income, food insecurity, housing insecurity, substance use during pregnancy, higher gravidity, unintended pregnancy, low social support, and racial and gender discrimination were all significantly associated with IPV; maternal race and pregnancy during the COVID-19 pandemic were not.

Conclusion:  IPV is common, reported by one in five parturients in our population. Although maternal race was not associated with IPV in this perinatal cohort, experiencing racism was. Initiatives aimed to address SDoH such as substance use, family planning, and access to food and housing remain key opportunities to support pregnant patients experiencing IPV. The connection between perceived discrimination and IPV found here highlights the importance of addressing the influence of racism and gender-based discrimination on adverse birth outcomes in the United States.

Key points: · One in five parturients disclosed IPV.. · Racial discrimination was correlated with IPV.. · Food and housing insecurity increase IPV risk.. · COVID-19 did not increase the rate of IPV.. · Psychosocial support is vital during pregnancy..