Maryland domestic violence prevention expert discusses the impact of interpersonal violence on pregnancy

By

Hannah Saunders

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Homicide is the leading cause of death for pregnant women in the U.S., and intimate partner violence (IPV) is often left unaddressed during the birthing journey. The 2024 Maryland Maternal Mortality Summit highlighted the impact violence can have on birthing people and their children on May 9.

Dr. Nadine Finigan-Carr, executive director for the University of Maryland’s Center for Domestic Violence Prevention, discussed the intersection between IPV and maternal mortality. IPV can be committed by current or former partners, and includes physical and sexual violence, stalking, and psychological aggression. 

“Issues of violence really impact maternal mortality in ways some of us don’t even think about,” Finigan-Carr said. 

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IPV starkly increased during the beginning of the COVID-19 pandemic, specifically when many individuals were locked down for health reasons. IPV numbers have yet to come back down to pre-pandemic levels, Finigan-Carr said, and pregnant women continue to experience sexual, emotional, and physical aggression. 

IPV is linked to both short-term and long-term health outcomes like femicide, suicide, maternal mortality, and AIDS-related mortality. Other health concerns that result from IPV include sexually transmitted diseases, unintended pregnancy, pregnancy complications, abortion complications, depression and anxiety, eating and sleeping disorders, alcohol and substance use, self-harm and poor self-esteem.

“IPV increases the risk of maternal mortality,” Finigan-Carr said. “Abuse during pregnancy poses direct risks, like physical trauma and chronic illnesses. It increases your odds of having complications during pregnancy.” 

Pregnancy-related complications that result from IPV include vaginal bleeding, urinary tract infections, early labor, and the premature rupture of membranes. The baby could also experience a low birth weight, and birthing parents may struggle with building an attachment to their child since previous trust in a loved one has been eroded. Finigan-Carr said children who are born to women who experience IPV during pregnancy show signs of behavioral health issues up to 42 months, which is during the child’s major developmental period when they are learning about speech and social communication skills.

“IPV during pregnancy is as common as gestational diabetes and preeclampsia,” Finigan-Carr said. 

IPV is the primary driver of the maternal mortality crisis in the U.S. About 324,000 women are at risk of IPV during pregnancy each year. About 55 percent of all birthing women experience IPV. 

“The risk of murder remains high for up to 24 months postpartum for some women who have experienced IPV,” Finigan-Carr said. “In Maryland, women are the victims in most IPV cases, with 92 percent of assaults being IPV-related.”

Homicide is the leading cause of death for postpartum women, with over half of reported cases perpetrated by intimate partners. To address this maternal mortality issue, Finigan-Carr encouraged screening all individuals for IPV. She said some facilities only screen women of color, since they experience greater rates of violence than white women, for example. 

“When you’re screening, you have to ask about arguing,” Finigan-Carr said. 

While arguments with family members and partners are not rare, an increase in arguments represents a higher association with increased aggression, even if physical violence is not involved. Finigan-Carr said healthcare providers’ role in the process is to respond to survivors of violence, while providing competent, compassionate, and confidential assessments for them, along with care, treatment, and referrals. 

Birthing people experiencing IPV will require the assistance of medical providers, community-based advocates, culturally-specific victims’ services providers, law enforcement, the legal system, and the child welfare system, Finigan-Carr said. 

Finigan-Carr suggested that healthcare facilities implement face-to-face screenings for IPV by using the Abuse Assessment Screen tool during a patient’s initial prenatal visit, once per trimester, and for postpartum visits. If a patient discloses that they are experiencing IPV, staff should conduct a thorough assessment and refer the patient to the appropriate agency. 

Readers interested in learning more about reproductive rights issues in Maryland can register to attend our 2024 Maryland State of Reform Health Policy Conference, which will be held on June 7 at the Baltimore Marriott Waterfront. A “Privacy Implications for Reproductive Rights” panel will be held at 10:45 a.m.

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