Original research articlePredictors of intimate partner violence in women seeking medication abortion☆
Introduction
Intimate partner violence (IPV) is defined by the World Health Organization as any actions within a relationship resulting in physical, psychological or sexual harm. This can include physical aggression, forced sexual acts, psychological abuse or any controlling behaviors [1].
IPV is an important women's health issue that has been associated with multiple negative health outcomes. Associations include interference by the woman's partner in seeking health care [2], limited reproductive control through forced unprotected sex or induced abortions [3], and repeat pregnancies among adolescents within 12–18 months [4]. A recent review article summarizing the effect of IPV on aspects of sexual health included sexual risk-taking behavior, unplanned pregnancies and induced abortions, and sexual dysfunction [5].
IPV is common among women in the United States. Approximately 23% of women report a lifetime history of physical assault by their current or former partner [6], [7]. Rates of IPV are typically higher among ethnic minority women when compared to those of white women [8], [9], [10]. IPV is also common among women seeking medical care. McCloskey et al. [11] surveyed women ages 18–60 years (mean age 35) in the waiting rooms of a variety of health care settings in the Boston area. Seventeen percent of women in emergency departments and 13% of women in obstetrics and gynecology offices reported IPV in the last 12 months. Among women in obstetrics and gynecology offices, more pregnant women than non-pregnant women reported IPV in the last 12 months (17% vs. 10%) [11]. There have been several studies investigating IPV among women seeking surgical abortion. IPV was reported by 14–26% of the women in the year leading up to the abortion and by 21–41% of the women in their lifetime [12], [13], [14], [15], [16], [17]. Women who choose medication abortion may be different than women who choose surgical abortion [18], but data on the rates of IPV among women seeking medication abortion are scant [19]. In this study, we describe the rate of IPV among women seeking medication abortion and examine risk factors for such a history.
Section snippets
Methods
Pregnant women (n=1128) who were up to 63 days of gestation and desiring an abortion were recruited for a prospective, multicenter, randomized trial comparing misoprostol immediately following vs. 24 h following mifepristone administration [the Medical Abortion at the Same Time (MAST) trial]. The study sites were four urban, university-affiliated clinics (Pittsburgh, PA; Portland, OR; Chicago, IL; Los Angeles, CA) that serve demographically diverse populations. Detailed methods have been
Responders vs. non-responders
Of the 1128 subjects who were enrolled, 1060 (94.0%) responded to the IPV questions. Participants who did not respond to IPV questions differed from those who did; they were more likely to be Hispanic (22.1% vs. 11.2%; p=.05), they had more prior pregnancy terminations (1.1±1.2 vs. 0.7±1.0; p=.008) and they were of earlier GA at admission (47.5±7.3 vs. 50.5±7.7 days; p=.02). The proportion of subjects who responded to IPV questions also differed by study site. Of the 610 participants at Site 1,
Discussion
Twenty-three percent of the women studied reported past or current IPV. Previous studies have explored the prevalence of IPV among those seeking surgical abortion and have found rates of lifetime IPV to be higher (27–41%) than what was found in this study [12], [13], [14], [15], [16]. Kazi et al. [19] also found a lower rate of IPV (17%) among women seeking medical abortion than has been reported in surgical abortion literature. The rate in our study is similar to the estimated baseline rate
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Cited by (6)
Should violence services be integrated within abortion care? A UK situation analysis
2016, Reproductive Health MattersCitation Excerpt :There are no published articles on integrated IPV interventions within abortion services. Although context-specific and not generalisable, individual studies about IPV disclosure or intervention in relation to abortion services described in detail in the above mentioned systematic review indicate that: IPV questionnaires may be acceptable in abortion facilities;19 non-responding women may differ from responders in that they have undergone more abortions;20 only half the women during a period of universal screening were asked about IPV;21 some women report IPV-defining events although not identifying themselves as experiencing IPV;22 many women wish to talk about IPV with regard to further management or intervention,23 with some citing their doctor as the main source of information;24 and women in violent relationships appear as likely to attend for follow-up23 and more likely to know about community resources.24 Previous situation analyses of abortion generally relate to the provision of safe abortion and quality of care rather than the intersection with IPV.25,26,27
Domestic violence in a UK abortion clinic: Anonymous cross-sectional prevalence survey
2015, Journal of Family Planning and Reproductive Health CareAbortion and domestic violence: Women’s decision-making process
2014, Affilia - Journal of Women and Social WorkAssociation between intimate partner violence and preventive screening among women
2013, Journal of Women's Health
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Funding for the Medical Abortion at the Same Time (MAST) study was provided by an anonymous foundation.