Minnesota Title V MCH Needs Assessment Fact Sheets

Pregnant Women, Mothers and Infants

Domestic and Sexual Violence Screening

Summer 2004

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Size of the Problem

Over 68,000 births annually are recorded in Minnesota with an estimated 1,096,832 women of childbearing age (15 to 44 years old) residing in the state [1]. Based on Minnesota data, between 3% and 14% of pregnant women report physical, sexual or emotional abuse in the 12 months before pregnancy or during pregnancy [2,3]. At a minimum, this would represent between 2,040 and 9,520 pregnant women and their infants affected by pre-conceptual and prenatal domestic violence in Minnesota annually.

Seriousness

People affected by domestic violence
The Minnesota 2004 goal is to reduce by 15% the domestic and intimate partner violence in Minnesota. The 1996 estimated rate is 2,946 per 100,000 [4].

To support the national goal, a number of professional organizations recommend that all pregnant women receive domestic violence screening [5,6,7,8]. Yet the Minnesota Pregnancy Risk Assessment and Monitoring System (PRAMS) survey, conducted on a sample of Minnesota families with a newborn found:

  • Only 60.2% of women said their doctor, nurse or other health care worker asked if “someone was hurting you emotionally or physically” during prenatal visits; and
  • 51.5% of women said that during their prenatal care visits, a doctor, nurse or other health care worker talked with them about “physical abuse to women by their husbands or partners” [3].

Nationally, 8% of pregnant women report recent abuse, with women under the age of 20 years significantly reporting more abuse, independent of pregnancy status [9]. Minnesota data from the 2002 Minnesota Crime Survey notes that domestic abuse victims account for 26% of all violent crime victims. Of those surveyed, 2% reported that their spouse/significant other/ partner/other family member engaged in specific violent actions towards them in the past year [10]. Sexual violence increases the risk of pregnancy and a significant proportion of adolescents become pregnant as a result of nonconsensual sex [11,12].

Domestic Violence by Husband/Partner During or Before Pregnancy, Minnesota PRAMS 2002
  Percentage
Physically hurt you during 12 months before pregnancy
3.4%
Pushed, hit, slap, kick, physically hurt you while pregnant
2.7%
Threatened you/made you feel unsafe during pregnancy
2.9%
Tried to control your daily activities during pregnancy
4.2%
Source: MDH. PRAMS Survey Results-2002. 2004.

Disparities
Cross-cultural studies in domestic violence show no significant differences among races. African American women report a slightly higher incidence of abuse, but it may be that they are more willing to disclose the information. Some studies show that twice as many white female victims as African American female victims request restraining orders, and white victims are four times as likely to use a women’s shelter [13].

Economic
The cost-effectiveness of domestic violence screening was not available. Minnesota Hospital and Healthcare Partnership has documented the average cost of domestic violence at $739 per person receiving hospital treatment [14].

Interventions

Nationally, the American College of Obstetricians and Gynecologists, the American Medical Association and other national health care organizations have made domestic violence screening recommendations. The Minnesota-based Institute for Clinical Systems Improvement has standards for domestic violence screening, including during prenatal exams [6]. The U.S. Preventive Services Task Force has also strongly recommended screening for family and intimate partner violence [15]. Best Practices from MDH to prevent intimate partner violence include the following [16].

  • Increase the number of health care providers who routinely ask screening questions.
  • Increase services available to victims, perpetrators and family members.
  • Promote models of intimacy, coping skills, and community connectedness to prevent intimate partner violence.
  • Identify and promote community norms to discourage domestic violence.
  • Help individuals, families and communities assess and build on their strengths to understand and deal with risks for domestic and intimate partner violence.
  • Collect and analyze data to develop policies and interventions.

Clinical guidelines from the US National Health Resource Center on Domestic Violence highlight a ten-step process for health care organizations committed to identifying, intervening and reducing domestic violence [17].

The Family Violence Prevention Fund also has information, a toolkit and Consensus Guidelines on Identifying and Responding to Domestic Violence Victimization in Health Care Settings. www.endabuse.org/programs/healthcare [Attn: Non-MDH Link]

Effectiveness of Interventions
No data is available to document the effectiveness of prenatal domestic violence screening.

Status

Minnesota Resources
Public health programs and strategies that promote domestic violence screening include:

  • Hospital and clinic staff provided with education on the importance of domestic violence screening or women clients.
  • Dr. David McCollum, an Emergency Department physician, developed and tested a screening tool that was well received and has increased screening rates in emergency services at Ridgeview Hospital in Waconia.
  • Public health nurses and other public health providers requested training on domestic violence screening. Partners for Violence Prevention trainers provided eight regional trainings (called Domestic Violence: Assessment and Intervention in Health Care). These trainings were attended by over 200 people in 2003.

Community Awareness
No research has documented community awareness in Minnesota of domestic violence screening during and after pregnancy. However, evaluation of the training provided to public health nurses and other health providers in Minnesota show that the trainings were effective in increasing knowledge and awareness of issues related to domestic violence screening and intervention.

The recent MDH planning document, Domestic and Sexual Violence in MN: Strategies for Prevention and Intervention, can be accessed at /injury/pub/dsvstrategies.pdf.

References

1. Minnesota Center for Health Statistics. 2003
2. DHS. Minnesota Pregnancy Assessment Form Report #2: Managed Care Organizations and Fee-for-Service Data for 1998-2001. September 2003.
3. Minnesota PRAMS data for 2002. 2004
4. MDH. Healthy Minnesotans: Public Health Improvement Goals 2004. September 1998.
5. American Medical Association. Position paper H-516.965
6. Institute for Clinical Systems Improvement. Domestic Violence Clinical Guidelines. November 2002. www.ICSI.org [Attn: Non-MDH Link]
7. American College of Obstetricians and Gynecologists. Physician’s role in domestic violence identification, intervention and prevention. Technical bulletin 209. 1995.
8. American Academy of Orthopedic Surgeons. Family Violence Position Statement. Document #1156. February 2002.
9. McGrath ME, Hogan JW, Piepert JF. A prevalence survey of abuse and screening for abuse in urgent care patients. Obstste Gynecol 91:511-14. 1998.
10. Criminal Justice Statistics Center. Safe at Home: 2002 Minnesota Crime Survey. December 2003.
11. Parsons L, Goodwin MM, Peterson R. Violence Against Women and Reproductive Health: Toward Defining a Role for reproductive Health Care Services. Maternal and Child Health Journal. 2000. 4(2):135-140.
12. Leiderman S, Almo C. Interpersonal Violence and Adolescent Pregnancy: Prevalence and Implications for Practice and Policy. National Organization on Adolescent pregnancy, Parenting and Prevention.
13. Mayer BW, Coulter M. Psychosocial Aspects of Partner Abuse. Am Journal of Nursing. 102(6):24AA-24HH. June 2002.
14. MDH. Violence Data Brief. Intimate Partner Violence 1998-2001. Nov. 2002.
15. US Preventive Services Task Force. Screening for family and intimate partner violence. Annals of Internal Medicine. 140(5):382-396. March 2004.
16. MDH. Best Practices to prevent intimate partner violence. March 2003 accessed 6-14-04 www.health.state.mn.us/injury/best/best.cfm?gcbest=ipv
17. US Department of Health and Human Services. HRSA. Assessment of Selected Domestic Violence Programs in Primary Care Settings. Washington DC. February 2002.