Executive Summary
Women who are victims of intimate partnership violence (IPV) are significantly less likely to use contraception after their most recent delivery, results from a federally funded study indicate. Data analyses indicate that approximately 6.2% of women reported intimate partner violence, and 15.5% reported no postpartum contraceptive use.
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IPV is estimated to affect 25% of U.S. adult women and directly impacts their ability to use contraception, which results in many unintended pregnancies and sexually transmitted infections.
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The American College of Obstetricians and Gynecologists suggests that healthcare providers should screen women and adolescent girls for IPV and reproductive and sexual coercion at periodic intervals.
Women who are victims of intimate partnership violence (IPV) are significantly less likely to use contraception after their most recent delivery, results from a federally funded study indicate.1
According to the Family Violence Prevention Fund (now Futures Without Violence), intimate partner violence (IPV) “is a pattern of assaultive behavior and coercive behavior that may include physical injury, psychological abuse, sexual assault, progressive isolation, stalking, deprivation, intimidation, and reproductive coercion. [Such] types of behavior are perpetrated by someone who is, was, or wishes to be involved in an intimate or dating relationship with an adult or adolescent, and is aimed at establishing control of one partner over the other.”2 Intimate partner violence is estimated to affect 25% of adult women in the United States alone, and it directly impacts their ability to use contraception, which results in many unintended pregnancies and sexually transmitted infections.3
In the current study, funded by the Department of Health and Human Services’ Agency for Healthcare Research and Quality, investigators used the Pregnancy Risk Assessment Monitoring System, a population-based surveillance system, to analyze data on more than 193,000 U.S. women with live births between 2004 and 2008. Intimate partnership violence was determined by questions that asked about physical abuse by a current or former partner in the 12 months before or during pregnancy, with the outcome defined as postpartum contraceptive use (yes versus no). Multiple logistic regression analyses were conducted to assess the influence of experiencing IPV at different periods (preconception IPV, prenatal IPV, both preconception and prenatal IPV, preconception and/or prenatal IPV). Data were stratified to assess differential effects by race/ethnicity and receipt of birth control counseling.
Data analyses indicate that approximately 6.2% of women reported IPV, and 15.5% reported no postpartum contraceptive use.1 Regardless of the timing of abuse, IPV-exposed women were significantly less likely to report contraceptive use after delivery, the report states. This finding was particularly prevalent for Hispanic women who reported no prenatal birth control counseling and women of all other racial/ethnic groups who received prenatal birth control counseling.
IPV is a serious public health problem and increases the likelihood of poor perinatal health, inadequate access to healthcare and services, and risky behaviors, says Susan Cha, MPH, a doctoral candidate in the Family Medicine and Population Health Department, Division of Epidemiology, at Virginia Commonwealth University’s School of Medicine in Richmond. “Our study shows that experiencing IPV adversely affects women’s use of contraceptive methods following a recent delivery,” states Cha, who served as lead author of the current paper. “These findings support the need for better integration of violence prevention and contraceptive services; thus, health providers are encouraged to screen for IPV at regular visits, and educate their patients of available community resources and effective contraceptive options.”
What can you do?
Due to the prevalence of IPV in the United States, clinicians, specifically gynecologists, always should screen for IPV during patient visits, whether the visit is for contraception prescriptions/advice or for other gynecological issues, including routine Pap smear exams, says Julie Bergmann, MPH, a doctoral candidate in the Division of Global Public Health within the Department of Medicine at the University of California, San Diego. However, contraceptive counseling is a great entry point for a discussion between patients and their providers about IPV, and clinicians should use this opportunity to screen and counsel patients accordingly, notes Bergmann, lead author of a recent literature review of how intimate partner violence affects U.S. condom and oral contraceptive use.3
Contraceptive counseling sessions offer a “prime opportunity” to intervene and link affected women to appropriate ancillary support services for sustained IPV-related help while averting adverse sexual and reproductive health consequences, notes senior author Jamila Stockman, PhD, MPH, assistant professor in the Division of Global Public Health within the Department of Medicine at the University of California, San Diego.
Because of the connection between reproductive health and violence, the American College of Obstetricians and Gynecologists suggests that “health care providers should screen women and adolescent girls for intimate partner violence and reproductive and sexual coercion at periodic intervals.4 The Affordable Care Act offers coverage for screening and counseling for interpersonal and domestic violence without requiring a copayment, coinsurance, or deductible. The Department of Health and Human Services has adopted guidelines for women’s preventive health services to help ensure that women can receive these services as part of a comprehensive set of recommended preventive health services. (To see what other services are covered in the set, visit www.hrsa.gov/womensguidelines.)
To reinforce the need for IPV screening, the U.S. Preventive Services Task Force released a recommendation in 2013 stating that “clinicians screen women of childbearing age for intimate partner violence (IPV) such as domestic violence and provide or refer women who screen positive to intervention services.”5 (For more resources on IPV screening, see the Contraceptive Technology Update article, “Add screening for violence by intimate partners,” April 2014.)
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Cha S, Chapman DA, Wan W, et al. Intimate partner violence and postpartum contraceptive use: The role of race/ethnicity and prenatal birth control counseling. Contraception 2015; doi:10.1016/j.contraception.2015.04.009.
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Family Violence Prevention Fund. Reproductive Health and Partner Violence Guidelines: An Integrated Response to Intimate Partner Violence and Reproductive Coercion. San Francisco: Family Violence Prevention Fund; 2010.
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Bergmann JN, Stockman JK. How does intimate partner violence affect condom and oral contraceptive use in the United States? A systematic review of the literature. Contraception 2015; 91(6):438-455.
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American College of Obstetricians and Gynecologists (ACOG). ACOG Committee opinion no. 554: reproductive and sexual coercion. Obstet Gynecol 2013; 121(2 Pt 1):411.
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Moyer VA; U.S. Preventive Services Task Force. Screening for intimate partner violence and abuse of elderly and vulnerable adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2013; 158(6):478-486.
