Kaiser Permanente researchers also find ongoing rise in pregnant patients reporting unstable or unsafe living situations over 2-year period
Pregnant Kaiser Permanente patients were more likely to report intimate partner violence or living in unstable or unsafe situations during the first months of the COVID-19 pandemic, according to new research published in JAMA Network Open.
The uptick was part of an ongoing increase in intimate partner violence and unstable or unsafe living situations reported throughout 2019 and 2020, an indication of growing lack of personal safety for pregnant people.
“It is deeply concerning to see this steady increase in intimate partner violence against pregnant people over time,” said study co-author Carey Watson, MD, an obstetrician-gynecologist and medical director of the Family Violence Prevention Program for Kaiser Permanente Northern California (KPNC). “This is why we screen our members – we know abuse has the potential for significant health impacts for both the person experiencing it as well as any children who witness it.”
Investigators with the Kaiser Permanente Division of Research analyzed results of prenatal screening of 74,663 Kaiser Permanente Northern California patients in 2019 and 2020.
Over the 2-year period, the analysis found 0.2% of pregnant patients reporting intimate partner violence. In the first 2 months of the pandemic (March and April 2020), there was a jump of 101%. Over 2 years, there was a steady relative increase in intimate partner violence reports of 4.9% per month.
The study also found 2.6% of individuals reported an unstable or unsafe living situation. The researchers found a 38% increase during the first month of the pandemic in 2020, returning to a steady rise the following month. Over the course of 2019 and 2020, these was a relative increase in reports of unstable and unsafe living situations of 2.2% per month.
The authors said this was among the first studies to assess intimate partner violence among pregnant people during the pandemic using screening questions incorporated into standard prenatal care.
“Pregnancy is such a vulnerable time and intimate partner violence during pregnancy is associated with adverse outcomes such as preterm birth and perinatal depression,” said lead author Lyndsay Avalos, PhD, MPH, research scientist with the Division of Research. “The health care system can play a vital role in identifying when violence is occurring and providing support and connections with community partners and social service agencies for women who are experiencing it.”
Findings echo other research
The rise in reports coincided with the mandatory lockdowns and shelter-in-place policies that may have forced isolation at home with an abusive partner, Avalos said. “Economic insecurity caused by the pandemic could cause stress and make existing mental health or substance use conditions worse among perpetrators, leading to more violent behavior,” Avalos said. Previous research has also shown increases in intimate partner violence after natural disasters and public health emergencies, such as Hurricane Katrina.
Watson said the study findings echo reports of increased domestic incidents early in the pandemic from social service agencies, police departments, and trauma centers across the U.S. “What is surprising is that we’re seeing a small but meaningful increase in intimate partner violence over time in our prenatal population,” Watson said. “So, we want to make sure that we continue to have the support available at all of our sites and that our clinicians are well positioned to support our patients anytime that abuse is disclosed.”
KPNC maintains local advocates for intimate partner violence in its obstetrics-gynecology departments, Watson said; advocates work with clinicians on how to talk with people who have disclosed violence. KPNC also has close community partnerships for patient referrals to counseling, legal aid, housing and other services.
Senior author Kelly Young-Wolff, PhD, MPH, a research scientist with the Division of Research, said the findings underscore the importance of screening for intimate partner violence in the medical setting, something that was rolled out at KPNC starting around 2000.
“Screening for intimate partner violence is a recommended preventive service for women of reproductive age,” Young-Wolff said. “There is evidence that we can prevent future violence and mitigate the health consequences by connecting those experiencing intimate partner violence with support services and effective interventions,” Young-Wolff said. “This is particularly important during pregnancy and postpartum, when risk of homicide perpetrated by an intimate partner is greatest.”
The study was funded by the National Institute on Drug Abuse and the Office of the Director, National Institutes of Health.
Additional co-authors were G. Thomas Ray, MBA, Stacey Alexeeff, PhD, Sara R. Adams, MPH, and Monique B. Does, MPH, all of the Division of Research.
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About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 600-plus staff is working on more than 450 epidemiological and health services research projects. For more information, visit divisionofresearch.kaiserpermanente.org or follow us @KPDOR.