ABSTRACT
Objective: Intimate partner violence (IPV) is pervasive and can lead to severe health consequences. In the US, 25% of women have experienced sexual violence, physical violence, and/or stalking by an intimate partner. However, less is known about the frequency and risk factors for IPV in the obstetric population. Study Design: Nested case-control study from a prospective cohort survey study of 606 parturients at a single academic medical center from 2011-2022. Structured surveys were administered to consented patients during their postpartum hospital stay to gather information on social determinants of health (SDoH) and birth outcomes. The case group included participants who reported forced sex causing pregnancy, verbal abuse before or during pregnancy, or physical abuse during pregnancy. The control group reported none of these. Odds ratios were used to quantify the relationship between IPV and maternal sociodemographic characteristics, pregnancy factors, and levels of perceived support and discrimination. Result(s): Of 606 study participants, 568 (94%) had data on IPV. Of those, 20.4% reported IPV (case) and 80.6% reported no IPV (control). 74.6% of the study population was enrolled pre-pandemic. Unmarried status, low income, food insecurity, housing insecurity, substance use during pregnancy, higher gravidity, unintended pregnancy, low social support, and racial and gender discrimination were all significantly associated with IPV;maternal race and pregnancy during the COVID-19 pandemic were not. Conclusion(s): IPV is common, reported by 1 in 5 parturients in our population. Although maternal race was not associated with IPV in this perinatal cohort, experiencing racism was. Initiatives aimed to address SDoH such as substance use, family planning, and access to food and housing remain key opportunities to support pregnant patients experiencing IPV. The connection between perceived discrimination and IPV found here highlight the importance of addressing the influence of racism and gender-based violence on adverse birth outcomes in the US. [Formula presented] [Formula presented] Copyright © 2022
ABSTRACT
Objective: To examine the difference in social determinants of health (SDH) for non-Hispanic Black pregnant women during the COVID-19 pandemic compared to pre-pandemic. Study Design: Retrospective cohort analyzing SDH in postpartum Black women in Hamilton County, OH. Women were considered to experience pregnancy during the COVID-19 pandemic if delivery occurred after March 30, 2020. The referent group were postpartum Black women who delivered from 2011-March 29, 2020. Sociodemographic, pregnancy, and infant data were collected from participants’ medical records. Structured interviews measured participants’ social determinants of health. Generalized linear regression estimated the association between birth during the pandemic and SDH. Results: 285 Non-Hispanic Black mothers were enrolled in the study. Of these, 239 (84%) delivered prior to the pandemic and 46 (16%) delivered during the pandemic. Baseline characteristics were similar between groups with few differences noted in Table 1. Black mothers who delivered during the pandemic were more likely to have access to transportation and had more frequent and earlier onset prenatal visits. They were also less likely to use food stamps during the pandemic. Women with pregnancies during the pandemic had more job opportunities and worked more hours during the week. However, Black women who delivered during the pandemic felt less safe in their neighborhood and faced more discrimination based upon their race (Table 2). No mothers in this cohort received the COVID-19 vaccine during pregnancy. Conclusion: Non-Hispanic Black women who experienced pregnancies during the pandemic had more job opportunities and more prenatal care than prior to the pandemic, yet they experienced more race-based discrimination and felt less safe in their neighborhoods. 2020 saw the lowest Black infant mortality on record in Hamilton County. Initiatives during the pandemic may have helped mothers achieve more optimal prenatal care and it is critical we examine the initiatives which mitigated SDH for this population. However, more needs to be done to improve vaccination and neighborhood safety. [Formula presented] [Formula presented]