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Domestic Disease

With NIH funding, School of Nursing researcher works to dissect the Domestic Disease

December 2002

by Natalie Gutierrez

Pregnancy, for an expectant mother, normally is a time of joy and eager anticipation. Yet, for thousands of women across the nation, pregnancy is a nightmarish experience filled with violence and abuse perpetrated by a spouse or intimate partner. Statistics indicate intimate partner violence has become a problem more common for pregnant women than gestational diabetes or placenta previa.

One woman said she was several months pregnant when her husband tried to kill her. That’s when she finally left him. "I had to leave for the safety of my children and myself," she said.

Although this woman escaped years of previous abuse and possible death, others are not as fortunate. Approximately 4.4 million adult American women are abused each year. In the United States, domestic violence is the leading cause of serious injury to women and accounts for more than half of all female homicides.

A newly funded study at the School of Nursing is working to counter that trend. Gail Williams, Ph.D., R.N., associate professor in the department of family nursing care and co-director of the Center for Violence Prevention, is leading the study titled "Partner Violence/Intended and Unintended Pregnancy." The National Institute of Nursing Research (NINR) of the National Institutes of Health (NIH) awarded Dr. Williams a $146,000 grant for her research. The study focuses on detecting characteristics and patterns of intimate partner violence against women whose pregnancies are unintended. To date, only four data-based publications address the problem.

"Nearly half of all pregnancies in the United States are unplanned or unintended," Dr. Williams said. "We have established a correlation between violence and unintended pregnancy. Many perpetrators of abuse use sex as a way to control their partners."

One woman said her husband raped her to make her pregnant. She said he believed that by keeping her pregnant he could control her.

Although intimate partner violence is a problem more common than hypertension and colon cancer (for which screening is common practice), screening for abuse is not common among health care providers today.

Dr. Williams is studying the effectiveness of various screening tools in the detection of intimate partner violence. She has teamed with Planned Parenthood of San Antonio and South Central Texas to screen pregnant women between the ages of 18 and 45 for intimate partner violence. The screening process consists of two separate, confidential interviews, which take place in a private office setting at a Planned Parenthood clinic. The first set of interview questions is administered from the Abuse Assessment Screen (AAS), which identifies physical forms of abuse the woman is experiencing. The second set is from the Severity of Violence Against Women Scales (SVAWS), which identifies emotional and sexual forms of abuse as well as threats of violence.

"Because not all violence results in broken bones or cuts and bruises, many women do not realize they are in an abusive relationship until they actually see what constitutes violence as illustrated by the SVAWS. Many abusers bully their victims by threatening them. They’ll hit or kick a wall, throw objects at their victim, drive dangerously with their victim in the car or threaten her with a weapon," Dr. Williams said. "We have had nearly a two-fold increase in the detection of intimate partner violence among those we interviewed using the SVAWS in addition to the AAS."

One woman interviewed said, "I just thought he (her abusive partner) had problems or issues … and that’s the way the relationship should be. But when she (screener) came in with this list I thought, Wow, other people go through this too."

During the second interview, Dr. Williams uses the Conflict Tactics Scale (CTS2) in addition to the other screening tools. The CTS2, an instrument used in numerous studies across the nation since 1972, provides Dr. Williams with a fuller understanding of howeffectively the three tools describe the violence in pregnant women’s lives.

Dr. Williams said funding from the NINR/NIH will allow her to dig deeper into solving the link between intimate partner violence and unintended pregnancy.

"It is unclear whether a history of violence precedes the unintended pregnancy or whether the unintended pregnancy is a risk factor for the violence," Dr. Williams said. She believes a clearer understanding of the experience of intimate partner violence from the woman’s perspective is needed to develop appropriate treatment strategies.

Her newly funded study will work toward that goal by building on her current study. Dr. Williams will conduct in-depth, 60-minute, private, audiotaped interviews with pregnant women using the AAS, SVAWS and the CTS2 to learn about the history of each woman’s abuse and how each woman perceives the violence as it relates to her pregnancies.

Due to the sensitive nature of the study and the ever-present risk of violence against the women participating, Dr. Williams will perform a Danger Assessment screen to assess the women’s current risk of danger. Their scores will be used to engage the women in a discussion about safety planning and referral. In addition, all women receive a monetary stipend for participating in the study.

Dr. Williams said she hopes her study will provide the data needed to convince more health care practitioners to screen pregnant women for abuse and will convince more battered women to seek assistance.

"Screening patients for abuse and making referrals are the most effective tools health care providers can use to help prevent intimate partner violence," Dr. Williams said. "When we can prevent this type of violence, we will help ensure safer and healthier futures for mothers and babies."

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