Domestic violence is a big problem in this country, with as many as one in three women reporting abuse in the course of their lives. In some cases, the risk increases during pregnancy, but a new study from the University of Virginia shows it’s possible to protect women by screening for danger during pre-natal visits.
It’s an ugly problem – not discussed much in this country, but the fact is that many women are abused by their husbands or boyfriends during pregnancy. Dr. Jef Ferguson heads the department of obstetrics and gynecology at the University of Virginia.
“Five to ten percent of all pregnant women in the United States do suffer some form of intimate partner violence during the pregnancy.”
And whether the abuse is physical or emotional, he says, it takes a toll on the both mother and unborn baby.
“It’s more commonly born prematurely. It’s smaller when its born, can have developmental problems, still births.”
That’s why researchers at the University of Virginia, Johns Hopkins University and the University of Missouri developed a system for identifying and protecting women through interviews during pre-natal exams. It begins with a series of questions according to Linda Bullock, associate dean for research at UVA’s School of Nursing.
“Is there a gun in the home? Has he strangled her, choked her? Has he ever threatened to kill her? Has he threatened suicide? And then, of course, if he’s involved in drugs or alcohol. Also, if there’s a child in the house who is not his.”
If the interviewer identifies a woman at risk, the next step is to explore ways to protect herself and her children. Ideally, she should leave her abuser, but Bullock says that’s not always possible or wise.
“There’s only so many shelters in the United States, and most of those shelters stay full all the time. We also know leaving is the time where women are at most risk of being killed, but how – if she stays in the house – can she stay safe and keep her other children safe?”
For example, if a woman fears she’s about to be attacked, it’s important to get away from places where things that could become weapons are stored.
“Get out of the kitchen. Don’t go to the garage where there are other tools. Don’t go to the bedroom where sexual abuse might occur. The best thing is to move outside of the house. If you’re a battered woman, sometimes that thought process doesn’t come easy, because your self esteem has been so lowered, so you cannot think through these logical steps of how to keep yourself and your children safe.”
The program also suggests women pack a bag with things they might need and leave it with a friend or relative. Battered women should also compile important papers, cash and a credit card in a binder.
“With the goal of saying, ‘If there’s a fire, then we’ll have everything in this one place that we can grab this binder. We’ll have money for a hotel. We’ll have all of our important records, the kids’ immunizations, birth certificates.’”
This is advice that could come from a woman’s physician, but often Dr. Jef Ferguson says they’re reluctant to ask questions about violence in the home.
“The patient will be unhappy with me if I ask them that. The husband will come and kill me if I ask her that. I’ll have to get involved. I’ll have to go to court. There are a zillion and one reasons.”
He adds that doctors can delegate risk assessment and safety planning to a nurse or member of the office staff, or patients could be screened using a kiosk or iPad. Linda Bullock cites a recent study of more than 250 women showing that this approach – known as the Dove intervention -- makes a significant difference.
“Many of the women were able to take steps to decrease the violence in their own relationship after they received the Dove intervention.”
Next week, Bullock and other advocates of the program will be on Capitol Hill, lobbying lawmakers and policymakers to promote the program nationwide.