Our study adds to the existing literature with the following key findings: (1) abused women are more likely to become pregnant, and (2) being pregnant or postpartum influences their pattern of help seeking from criminal justice and ED systems but not their overall rate. Compared with nonperinatal women, perinatal women seek help with fewer observable injuries, are more likely to have visited the ED in the last 6 months, and have higher charging authorization but lower final conviction rates.
This study demonstrates yet again the vulnerability of IPV victims; not only were they younger, members of a minority, and single, but also they were twice as likely to be pregnant compared with their age-matched neighbors. Although some have speculated that pregnancy may be the precipitating factor for IPV, this finding suggests the reverse is more likely: that IPV predisposes a woman to pregnancy. Additionally, perinatal victims in our study reported violence prior to the current assault just as often as nonperinatal victims. Concluding that IPV leads to more pregnancy is consistent with other evidence that abused women are more likely to have unintended pregnancies27,28
as a result of living in an abusive relationship, with less control over use of condoms or other birth control.29
This study further documents that perinatal victims interact differently from nonperinatal victims with criminal justice and EDs. Despite fewer injuries, perinatal victims sought help from police and EDs at rates similar to that of nonperinatal victims. IPV help seeking generally is correlated with increasing severity20,30
rather than reduced severity, and this could mean that perinatal women have a lower threshold for seeking help. Also, our study provides evidence that once in the criminal justice system, such women may be more motivated participants, at least initially. Perinatal study victims were more likely to have charges authorized than were nonperinatal victims. Because charging authorization, especially with no documented injury, is often dependent on a victim providing evidence for the prosecution,31
perinatal women maybe be more actively engaged at this point in adjudication than nonperinatal women. However, that fewer perinatal cases made it to trial and even fewer to conviction suggests that perinatal victim participation waned over the course of adjudication. Studies by qualitative researchers have documented that women find it much harder to leave an abusive partner during pregnancy and the postpartum period for several reasons: increased social pressure to stay together, fear of being the sole parent and financial provider, and a natural inclination to reinvest in the relationship for the sake of the infant.32,33
Not only are perinatal women as likely as nonperinatal women to seek help from EDs for the known assaults, but they are also more likely to have used EDs in the previous 6 months. This supports other research findings that abused pregnant women have higher healthcare utilization than nonabused pregnant women.34
Clearly, many opportunities for identification and referral of this vulnerable group exist within the healthcare setting, but similar to primary care settings, few of our perinatal study victims actually disclosed their abuse to ED staff. Women, in general, rarely disclose abuse to healthcare providers unless actively and sensitively screened,35,36
an occurrence that is unfortunately rare in busy EDs.37
This presents a missed opportunity because women are open to discussing abuse with providers who express compassion and who can help link them to community resources.35
Certainly, among nonpregnant abused women, this offers a chance to empower women regarding their reproductive rights and health.
Finally, findings from our study indicate that perinatal status has a differential impact on help seeking depending on the age and race of a woman, with older and Caucasian perinatal women less likely to call police than their nonperinatal counterparts and possibly more likely to seek help from EDs. Other studies have documented the impact of demographics, especially age, on the prevalence of abuse during pregnancy,38
but this study also shows the impact of age on a pregnant woman's response to that abuse.
Given the adverse perinatal outcomes associated with IPV, adapting criminal justice and healthcare responses to address the differing needs of perinatal victims is clearly warranted. Specifically, as perinatal women continue to reach out to the criminal justice system for help but have lower case-conviction rates, it is even more crucial to arm them with future protections at the outset: safety planning, education about their legal rights, and education about shelter services. Because perinatal women are less likely to disclose IPV to ED healthcare providers but have higher overall ED utilization, active IPV screening of pregnant women could yield important benefits for both the woman and her future child. Increased identification within the healthcare setting could lead to more safety planning as well as increased victim access to community resources, which can then be leveraged against further abuse.
In the state of Michigan, some felonies, including aggravated assault, felonious assault, and criminal sexual conduct, are not specifically tagged as IPV within the prosecutor's records and, thus, were not able to be identified for inclusion in the study population. In the year 2000, of the estimated 170 IPV-related felonies, our database included 110 (65%) of them. As mentioned, our operationalization of help seeking was limited to institutional help seeking, specifically police, prosecutor, and ED venues. We were missing information on the use of other community-based IPV resources, such as shelter services, mental health, civil court, and primary care settings. In addition, we did not have information about informal sources of help seeking, such as churches, friends, and family. However, the two systems we included are the primary ones that IPV victims turn to for help, according to a Bureau of Justice Statistics Special Report.39