Intimate Partner Violence Before Pregnancy in North Dakota

North Dakota

The Centers for Disease Control and Prevention (CDC) defines intimate partner violence (IPV) as physical violence, sexual violence, stalking or psychological aggression (including coercive tactics) by a current or past intimate partner (spouse, boyfriend/girlfriend, dating partner or continuous sexual partner). IPV can lead to lasting physical and mental health issues, and women who experience IPV before or during pregnancy are less likely to receive adequate prenatal care. Additionally, more than half of all female homicides are related to IPV, and approximately 10% of women killed by an intimate partner experienced violence sometime during the month before their deaths. 

According to the National Intimate Partner and Sexual Violence Survey, 42% of women in the United States report experiencing some form of IPV in their lifetime. The true prevalence of IPV is unknown due to underreporting. Underreporting may also be higher among certain populations, as cultural background, socioeconomic status and age affect whether and how individuals talk about IPV. 

Risk factors for IPV include conflict or economic stress within a relationship and male dominance in the family. Individuals who experience IPV before or during pregnancy are at increased risk of:

• High blood pressure and edema.
• Severe nausea, vomiting and dehydration.
• Kidney and urinary tract infections.
• Hospital visits.
• Delivering preterm or low birth weight infants.
• Giving birth to infants who require intensive unit care.

A 2017 study calculated the lifetime cost of intimate partner violence at $103,767 per female victim, representing a total economic burden of $3.6 trillion.

The prevalence of intimate partner violence is higher among:

• Divorced, separated and single women compared with married women. 
• Women whose parents have less than a high school education compared with women whose parents have higher levels of education.
• Non-Hispanic Black, American Indian/Alaska Native and multiracial women compared with all other racial and ethnic groups. 
• Younger women compared with older women.

The U.S. Preventive Services Task Force recommends that clinicians screen all women of reproductive age for IPV and connect women who screen positive to intervention services. 

In a survey of women who had recently given birth, more than half of those who reported physical partner violence said they were not screened for IPV in the 12 months before pregnancy. Barriers to screening include time constraints during a visit, personal discomfort and not knowing what to do if a patient is experiencing IPV. In response, the CDC has developed shorter IPV screening questionnaires and is working on further guidance for assisting patients who are experiencing IPV. For example, asking specific behavioral questions and avoiding loaded terms like “abuse” can improve the outcome of IPV screenings. The CDC provides further resources for those who may be experiencing IPV.

There are several strategies for preventing IPV early in the pipeline, such as: 

• Teaching social-emotional, conflict management and communication skills. 
• Preventing negative developmental pathways that could lead to future violence by increasing education around parenting skills and healthy family relationships. 
• Creating protective social environments in schools, neighborhoods and workplaces.
• Improving financial security for low-income families. 
• Increasing survivor supports such as victim-centered advocacy and health care services, housing programs and legal and law enforcement protections.

Healthy People 2030 has identified the need to reduce intimate partner violence as an important public health issue and currently has an objective in developmental status.

Bailey, Beth A. “Partner Violence during Pregnancy: Prevalence, Effects, Screening, and Management.” International Journal of Women’s Health 2 (August 9, 2010): 183–97. https://doi.org/10.2147/IJWH.S8632.

Basile, Kathleen C., Marci F. Hertz, and Sudie E. Back. “Intimate Partner Violence and Sexual Violence Victimization Assessment Instruments for Use in Healthcare Settings: Version 1.” Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2007. https://permanent.fdlp.gov/gpo36292/ipvandsvscreening.pdf.

Breiding, Matthew J., Kathleen C. Basile, Sharon G. Smith, Michele C. Black, and Reshma Mahendra. “Intimate Partner Violence Surveillance Uniform Definitions and Recommended Data Elements.” Version 2.0. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2015. https://www.cdc.gov/intimate-partner-violence/communication-resources/intimatepartnerviolence.pdf.

Chen, Zhou, Wen Ma, Ying Li, Wei Guo, Wang Senhu, Wansu Zhang, and Yunsong Chen. “Using Machine Learning to Estimate the Incidence Rate of Intimate Partner Violence.” Scientific Reports 13, no. 1 (2023): 5533. https://doi.org/10.1038/s41598-023-31846-8.

Kozhimannil, Katy B., Valerie A. Lewis, Julia D. Interrante, Phoebe L. Chastain, and Lindsay Admon. “Screening for and Experiences of Intimate Partner Violence in the United States Before, During, and After Pregnancy, 2016–2019.” American Journal of Public Health 113, no. 3 (March 2023): 297–305. https://doi.org/10.2105/AJPH.2022.307195.

Niolon, Phyllis Holditch, Megan Kearns, Jenny Dills, Kirsten Rambo, Shalon Irving, Theresa L. Armstead, and Leah Gilbert. “Preventing Intimate Partner Violence Across the Lifespan: A Technical Package of Programs, Policies, and Practices.” Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2017. https://www.cdc.gov/violenceprevention/pdf/ipv-technicalpackages.pdf.

Paterno, Mary T., and Jessica E. Draughon. “Screening for Intimate Partner Violence.” Journal of Midwifery & Women’s Health 61, no. 3 (May 1, 2016): 370–75. https://doi.org/10.1111/jmwh.12443.

Petrosky, Emiko, Janet M. Blair, Carter J. Betz, Katherine A. Fowler, Shane P. D. Jack, and Bridget H. Lyons. “Racial and Ethnic Differences in Homicides of Adult Women and the Role of Intimate Partner Violence — United States, 2003–2014.” Morbidity and Mortality Weekly Report 66, no. 28 (July 21, 2017): 741–46. https://doi.org/10.15585/mmwr.mm6628a1.

Ramaswamy, Amrutha, Usha Ranji, and Alina Salganicoff. “Intimate Partner Violence (IPV) Screening and Counseling Services in Clinical Settings.” Issue Brief. KFF, December 2, 2019. https://www.kff.org/womens-health-policy/issue-brief/intimate-partner-violence-ipv-screening-and-counseling-services-in-clinical-settings/.

Testa, Alexander, Jacqueline Lee, Daniel C. Semenza, Dylan B. Jackson, Kyle T. Ganson, and Jason M. Nagata. “Intimate Partner Violence and Barriers to Prenatal Care.” Social Science & Medicine 320 (March 2023): 115700. https://doi.org/10.1016/j.socscimed.2023.115700.

White House Gender Policy Council. “National Strategy on Gender Equity and Equality.” Washington, D.C.: White House, March 2021. https://www.whitehouse.gov/wp-content/uploads/2021/10/National-Strategy-on-Gender-Equity-and-Equality.pdf.

Yakubovich, Alexa R., Heidi Stöckl, Joseph Murray, G. J. Melendez-Torres, Janina I. Steinert, Calla E. Y. Glavin, and David K. Humphreys. “Risk and Protective Factors for Intimate Partner Violence Against Women: Systematic Review and Meta-Analyses of Prospective–Longitudinal Studies.” American Journal of Public Health 108, no. 7 (July 2018): e1–11. https://doi.org/10.2105/AJPH.2018.304428.