Domestic Abuse on Pregnant Womens Health Essay Example
Domestic Abuse on Pregnant Womens Health Essay Example

Domestic Abuse on Pregnant Womens Health Essay Example

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  • Pages: 16 (4180 words)
  • Published: August 12, 2017
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Domestic maltreatment is a global public health issue that affects women from various racial, ethnic, and socio-economic backgrounds. Pregnant women are particularly vulnerable to abuse, with studies indicating that at least 20% of expectant mothers face such violence. This puts both the mothers and their unborn babies at significant health risks throughout the entire pregnancy.

Exploring the Impact of Domestic Abuse on the Health of Pregnant Women

In this library research paper, our objective was to examine the effects of domestic abuse on the health and well-being of pregnant women. We conducted a thorough analysis of existing literature and also discussed the ethical dilemmas faced by healthcare professionals when providing care to victims of abuse.


The issue of violence against women, especially those who are pregnant, is now widely acknowledged as a significant global health and social concern. It


has severe repercussions for both the victims themselves and their children's overall welfare. Healthcare providers must consider how experiencing abuse in current or past intimate relationships can impact the health of their pregnant clients. Historical evidence suggests a positive correlation between individuals with a history of abuse and their utilization of psychiatric facilities (March of Dimes, 2005).

The significant number of women seeking long-term treatment from mental health institutions after experiencing abuse is not surprising, given that a task force in the Region of Peel, Canada identified violence as the primary health risk in 1997. Various studies and statistics support this claim. For instance, a nationwide survey conducted in Canada revealed that 61% of women who were physically or sexually assaulted by their male partners sustained injuries (Solicitor General of Canada, 1997). Moreover, pregnancy is commonly anticipated to bring happines

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and well-being to a woman's life; ideally, it should be a time characterized by peace and safety. Unfortunately, many women do not experience such reality.

According to a study by Hedin and Janson (2000), a significant percentage of adult females who experience abuse are also abused while pregnant, with estimates ranging from 40% to 60%. It is also reported that 95% of those who are abused during pregnancy have previously been victims of abuse. The literature suggests that pregnancy is a particularly risky time for domestic violence, especially for women with a history of victimization. Negative outcomes of abuse during pregnancy include attempts or self-induced abortions, therapeutic abortions, spontaneous abortions, as well as an increased likelihood of divorce or separation. Women who are victims of domestic violence often suffer physical injuries such as scratches, bruises, cuts, and fractures. A study conducted in Newfoundland found a link between abuse and the institutionalization of women in psychiatric settings; specifically revealing that 42% of currently assaulted women had experienced assault prior to being hospitalized (Carlisle, 2000).

According to a different survey, the rate of maltreatment involving intoxicant and prescription drugs is higher among women in abusive relationships (Noel & Yam, 1998). However, these studies do not definitively prove the causal relationship between substance abuse and mental health problems. It remains unclear whether alcohol and drug abuse contribute to mental issues that lead to institutionalization or if the abuse itself causes substance abuse and subsequent mental health complications.

Some argue that violence against women is exaggerated and should be considered a private matter instead of a public concern. However, violence against women in Canada incurs estimated health-related expenses reaching $1.6 billion annually

(Carlisle, 2000), while in the United States it results in a significant decline in productivity, increased healthcare costs, and reduced family income ranging from $10 to $67 billion each year.

However, the current amount does not adequately reflect the existing cost associated with violence against women and their children. Dealing with this issue incurs high costs, both financially and psychologically/emotionally/physically for the victims. Therefore, it is crucial that we address this urgent social problem promptly. As citizens and healthcare providers, it is our responsibility to assist these women in improving their quality of life by putting an end to abuse. Typically, a woman's first point of contact when seeking help is with a healthcare professional.

Statement of Purpose

This research paper aims to conduct a comprehensive literature review on the prevalence of domestic abuse and explore its impact on the health of pregnant women who experience intimate partner or spousal abuse.

The text will discuss the ethical dilemmas faced by healthcare practitioners, specifically nurses, when providing care for pregnant women who have experienced abuse. It will also cover methods for identifying abusive behaviors during pregnancy. Additionally, the text aims to enhance the author's knowledge and skills in this area while promoting professional creativity.

Definition of Domestic Abuse

According to the Public Health Agency of Canada (PHAC), domestic abuse encompasses various forms of mistreatment including sexual, emotional/psychological, financial, physical, and verbal abuse targeted at a person's partner or significant other. In this paper, domestic intimate partner abuse/violence refers to any of these behaviors experienced by women from their partners.

Domestic Abuse Against Women

It is widely recognized that domestic abuse has roots in culture, society, economics, and psychology.

The unequal power dynamics between men and

women in work and relationships give rise to the issue. In various cultures, domestic violence is deeply ingrained and sometimes justified by cultural and religious norms, leading men to not see violence against women as disrespectful. Women historically relied on men for financial support, resulting in submissive behavior and feelings of powerlessness. Ultimately, these factors sustain male dominance (Payne, 2006; Carcia-Moreno et al., 2006; Valladares et al., 2005).

Approximately one in three adult females worldwide have experienced physical violence, sexual coercion, or other forms of maltreatment. The issue of abused adult females is largely unreported due to feelings of embarrassment and the belief that it reflects negatively on their roles as women, wives, and mothers (CDC, 1989). These individuals often experience emotions such as despair, sadness, and insecurity and may feel dependent on their abusers for survival.

Unfortunately, it was not until 1996 that domestic abuse or intimate partner violence was officially recognized by the World Health Organization as a matter concerning public health and human rights.

Violence against adult females has a long history of mistreatment in both industrialized and non-industrialized parts of the world. In the past, husbands had the legal right to "discipline" their wives using any reasonable means according to British common law. Similarly, cultural practices and state laws in North America supported a man's authority to discipline his wife until the late 1800s. It was not until 1895 that women were able to cite domestic violence as grounds for divorce.

The Violence against Women Act, enacted in 1994, resulted in increased research on domestic abuse and provided support for law enforcement and social services to protect battered women. Men who commit intimate partner violence

against women engage in various harmful behaviors such as forced sexual intercourse, physical aggression, psychological abuse, and controlling actions.

Types of Maltreatment

When discussing domestic abuse, people often think it only involves physical harm done to a woman by her partner. However, domestic maltreatment encompasses more than just physical violence. It can also involve emotional, economic, physical, and sexual abuse. Research indicates that between 10% to 52% of women have encountered physical violence in their relationships, while 10% to 30% have experienced sexual abuse from their partners (Garcia-Moreno et al., 2006).

The idea of maltreatment encompasses different types. Statistics Canada (2001, p. 11) defines physical maltreatment as deliberately causing harm to someone's body using force. Physical abuse can manifest in various ways like hitting, slapping, pushing, or any act that causes physical pain or discomfort. In the United States, an estimated 4 to 6 intimate relationships encounter instances of physical violence each year and one-third of women will endure partner-inflicted physical assault during their adult years.

In the U.S.A., an estimated 2 to 4 million adult females experience intimate partner violence each year (Newton, 2001). Literature shows that many women have shared their experiences of abuse, indicating that it started or escalated during pregnancy or when they had young children (Ulla Diez et al., 2009; Bostock, Plumpton, & Pratt, 2009).

The maltreatment of a woman may occur when she shows care for someone else, such as an unborn or young child, resulting in feelings of jealousy. The level of assault or injuries not only determines the physical harm caused by physical abuse but also the mental harm it inflicts (Payne, 2006). Financial abuse is a form of domestic violence where

money is used by the abuser to control their partner. The victim faces financial deprivation when their partner either prohibits them from working or refuses to allow them to work. Even if they are permitted to work, the abuser demands that the victim surrender their earnings, thus creating dependence on the abuser for finances.

Adult women may experience economic abuse, where they rely on their spouse for basic needs such as food and healthcare. Abusers often manipulate the situation by putting all household bills under the victim's name to damage their credit. Another tactic used by abusers to assert power over women is emotional abuse or psychological abuse. Health Canada states that there is no universally accepted definition of emotional abuse. This form of abusive behavior typically seeks to undermine a person's self-esteem, perception, and independence.

Emotional abuse encompasses various types of verbal mistreatment, including name-calling, shouting, threats, and blaming. It also involves social isolation and bullying. Additionally, emotional abuse can lead to physical violence. The public often overlooks the harm inflicted by emotional abuse as it lacks visible scars and bruises typically associated with physical abuse.

Statistics Canada conducted case-study interviews which revealed that emotional maltreatment, even though it is not visible, can have significant effects on individuals. These interviews with abused adult females showed that the long-term cumulative impact of emotional maltreatment can be just as harmful as physical violence (Statistics Canada, 2001). It is crucial to understand that all types of abuse, including physical, sexual, and financial abuse, inevitably lead to some level of emotional consequences. A study carried out in Canada on abuse in college and university dating relationships discovered that 81 percent of

male respondents confessed to emotionally mistreating their female partners (Health Canada, 2006).

According to the World Health Organization (WHO) definition, sexual abuse against women is a persistent form of violence. This includes forced sexual contact, harassment, trafficking, unwanted advances, and torment (2003). Studies have shown that this type of violence has detrimental effects on mental health such as post-traumatic stress disorder, depression and anxiety disorders, eating disorders, substance abuse problems, and suicidal behavior (Payne, 2006; Galvani, 2007; Garcia-Moreno et al., 2006; Svavarsdottir & Orlygsdottir, 2008).

According to a survey conducted by Galvani in 2007, a significant number of adult females who receive substance abuse treatment have experienced domestic abuse. The World Health Organization (WHO) also conducted research that suggests one out of four women may encounter sexual violence from an intimate partner. The National Coalition Against Domestic Violence states that many abused women have been raped by their partners at least once during their relationship. Moreover, a notable percentage of women have faced sexual abuse throughout their lives, although the proportion has decreased over the past five years. WHO's study across multiple countries reveals that various women have suffered physical or sexual abuse from their partners. However, these statistics do not fully represent the true extent of violence against women as numerous victims choose not to report due to reasons like shame, social stigma, fear of escalating or recurring abuse, and potential material losses.

Certain states have women who are concerned about the potential harm they may face from authorities when they disclose abusive behaviors. It is important to note that even engaging in non-consensual sexual activity within a relationship is still considered a violation of basic human


The Impact of Domestic Abuse on Pregnant Women

Violence towards women by their male partners or ex-partners remains a significant and ongoing public health concern. This violence leads to physical injuries and various immediate and long-term health consequences, including mental disorders and complications during pregnancy. Domestic abuse often occurs when a woman is pregnant.

It is concerning to discover that a significant portion of pregnant women partake in harmful behaviors and practices linked to negative pregnancy outcomes. Multiple scholars have conducted extensive research to identify pregnant women who are at risk of experiencing intimate partner violence. Shockingly, data from the Center for Disease Control shows that over 300,000 (4-8 percent) of pregnant women suffer abuse during their pregnancy. Similarly, a study carried out in Canada found that 6-8 percent of women were abused while pregnant, with 95 percent enduring abuse during the first trimester (Stat Canada, 2003). Reports also indicate that physically abused women are coerced into engaging in sexual activity in approximately 40 to 45 percent of cases (PHAC).

Approximately 95% of victims of domestic or intimate spouse violence are adult females, and around two-thirds of all marriages will experience domestic violence at least once. This results in approximately 4 million adult females being assaulted by their spouses annually. Domestic violence surpasses injuries caused by car accidents, mugging, and rape combined as the primary reason for emergency room visits by women. Moreover, it is the leading cause of injuries for women and often occurs during pregnancy.

One survey revealed that 37% of pregnant adult females experience physical abuse during gestation, regardless of category, race, or education. Additionally, 60% of all battered adult females endure abuse while pregnant. Pregnant

women who were interviewed indicated that maltreatment during gestation is closely linked to the existing problem of intimate partner violence. The maltreatment experienced during pregnancy can negatively impact the health of both the mother and the baby, including complications such as low weight gain, anemia, sexually transmitted infections, and bleeding during the first and second trimesters. These complications are significantly more prevalent among abused women (Saltzman, Johnson, Colley Gilbert, & Goodwin, 2003; Martin et al.).

According to studies (Kearney, Haggerty, Munro, & Hawkins, 2001; Kearney, Haggerty, Munro, & Hawkins, 2003), violence against pregnant women not only poses a threat to their own well-being but also endangers the fetus. The abuser restricts the woman's ability to protect herself and her unborn child. Consequently, abused pregnant women frequently experience issues such as substance abuse (including alcohol and drugs), cigarette smoking, and inadequate nutrition. Multiple articles have discussed the unknown number of pregnant women who face abuse in relationships and the consequent effects ranging from physical and emotional harm to maternal and fetal mortality.

Many studies have found that gestation is a common risk factor for domestic violence. The prevalence rate of violence during gestation ranges from 0.9% to 28%. These studies have also identified various demographic and lifestyle variables that are associated with abuse during pregnancy. For example, Espinosa, Osborne, Bostock et al., Garcia-Moreno et al., and Valladares et al. have all provided data on this topic.

, 2005), it has been found that younger adult females may be at higher risk of abuse during pregnancy. The researchers discovered that these young women may not have the life experience necessary to fully understand the seriousness of getting involved with dangerous

or violent individuals, and they may perceive violence within a broader context related to their vulnerability. Additionally, unplanned pregnancies can also contribute to this risk. A population-based study confirms that women who have unplanned pregnancies are 2.5 times more likely to experience maltreatment compared to those who planned their pregnancies (Whitehead;A;Fanslow, 2005). An estimated half of all unplanned pregnancies in the United States result in termination.

According to a study conducted by Parker, McFarlane, and Soeken (2000), 20.6% of teenagers reported experiencing maltreatment during pregnancy. This is compared to 14.2% of adult women based on structured interviews of pregnant women aged 13 to 42. Additionally, Persily and Abdulla (2001) analyzed data from a pilot study in rural West Virginia. The study found that pregnant women under the age of 20 experienced domestic violence at a rate of 18.5%, while the rate was 9.4% for pregnant women aged 20 to 29, and 4.4% for pregnant women aged 30 and older. Furthermore, researchers have investigated the relationship between alcohol use, tobacco use, and other substance abuse during pregnancy and domestic violence.

Persily and Abdulla found that there was a significant relationship between tobacco usage and maltreatment. However, they did not find any significant difference between alcohol and illicit drug usage and maltreatment of pregnant women. In contrast, Galvani (2007), Parker et al. (2000), and Amaro et al. (1998) discovered that pregnant women who were victims of domestic violence reported using cigarettes, alcohol, or other drugs more frequently than non-victims. These findings also suggested that abused pregnant women were much more likely to continue substance abuse during their pregnancy. Another shocking discovery was that pregnant women in abusive relationships tended

to delay seeking prenatal care due to their controlling partners. According to McFarlane et al. (1998), abused women were almost twice as likely as non-abused women to start prenatal care in the third trimester. The study by Persily and Abdulla (2001) revealed that 38% of the abused women in their sample registered for antenatal classes after 20 weeks of pregnancy, compared to 23% of the non-abused women.

Furthermore, a large number of pregnant adult females experience domestic maltreatment while also suffering from depression and anxiety (Collins & Thomas, 2004; Ulla Diez et al., 2009). According to Persily and Abdulla (2001), 83% of victims of domestic maltreatment during pregnancy reported feeling depressed, and 89% reported feeling anxious. Amaro and colleagues (1998) discovered that victims of domestic violence were more likely to experience depression during pregnancy, feel less happy about being pregnant, and have a history of depression and attempted suicide compared to non-abused pregnant women. The question is whether the abuse causes the depression or if the pre-existing history of depression resurfaces during pregnancy. In order to combat and prevent violence against women, especially pregnant women, a variety of social support resources need to be made available to women who are abused during pregnancy.

In a Canadian survey (Wathen ; MacMillan, 2003), it was found that out of 109 pregnant women who reported abuse, 8 shared a common source of social support. These eight women who were abused had a distinct lack of family support, while the remaining 101 non-abused women identified family members as their main source of support. Another study by Amaro et al (1998) found a connection between a lack of support during pregnancy and

higher rates of violence. Similarly, Espinosa and colleagues (2002) discovered that pregnant women who experienced abuse had fewer individuals they could rely on for assistance or discuss personal issues with.

In international documents, some women believed that domestic abuse should not be discussed as it was seen as a private matter. However, Bostock et al. (2009) found that the ability to discuss safety from domestic abuse depended on factors such as empathy, understanding, shared experiences, and access to effective support systems. It is important for women to have connections with family, friends, legal, police, social, and health services in order to escape abusive relationships. Failure to recognize the unacceptable nature of violence against women perpetuates abusive situations.

The text suggests that the understanding of "not having anyone to turn to" may contribute to the mistreatment of women by men who are married to or in a relationship with them. The information emphasizes the need for further evaluation of domestic violence during pregnancy and the factors related to inadequate health, social, and legal resources for responding to women experiencing domestic abuse. Additionally, there are gaps in research in certain areas. Firstly, there is limited data on domestic violence during pregnancy using population-based samples of women and studies conducted in a variety of clinical settings. Secondly, more research is required to determine the most effective methods for identifying domestic violence and assessing its severity and duration.

Currently, there is no available survey indicating the extent and long-term impact of abuse on children born into such conditions. It is also unclear whether the abuse ceases after childbirth. Further investigation into perpetrator-focused intervention is necessary. Punishment is currently the only method for

dealing with domestic abuse perpetrators; however, it is common knowledge that this does not eliminate abuse.

In order to address this issue effectively, further research is needed to find suitable interventions for abusive individuals. These countries should be prioritized for investigation as healthcare providers have a responsibility to regularly assess for domestic violence and intervene appropriately in violent and abusive situations.

Ethical Consideration for Healthcare Providers

As part of their professional role, nurses face ethical decisions in their everyday nursing practice. When dealing with domestic violence, nurses often encounter ethical dilemmas related to quandary, harm, distributive justice, violation, and authority. One particularly perplexing challenge for healthcare professionals assisting victims of abuse is the "revolving door syndrome," where the same victims are repeatedly admitted for care. The nurse may see this as an ethical dilemma since they may want to break the cycle of abuse, but the victim may not want any help.

The physicians and nurses feel frustrated and powerless because they are unable to fix the problem or get women to change their situations. This frustration leads to comments like "you again?" or "now, will you leave him?" or "don't you get it?" when victims come to the emergency department. The reality is that despite their good intentions, it is the professional healthcare providers who don't understand. They don't understand that these women are unhappy in their situations and may not necessarily attract violent men (McMurray, 2005).

They often find themselves in a situation where they perceive that there is no way out. These women are emotionally isolated and financially dependent on their abusers. The uncertainty of being on their own outside of the marriage, especially when children are

involved, and the fear of impoverishing or jeopardizing the children compels the victims to stay in abusive relationships. Therefore, their primary motivation is to reduce the impact and frequency of the abuse rather than leaving the abuser (Bates ; Hancock, 2001; Lutenbacher, Cohen ; Mitzel, 2003).

As a result, individuals become emotionally invested in the situation and accept it as normal, even disregarding the danger of lethal force (Nicolaidis, Curry, Ulrich et al, 2003). Carver (2003), a psychologist with over 30 years of experience helping victims in these situations, describes this dilemma as a combination of Stockholm Syndrome and cognitive dissonance. In addition to addressing this dilemma, healthcare professionals working with abused clients may also experience moral distress. Moral distress arises when an individual knows the ethically correct action to take but is unable to act upon it or when one acts in a way that contradicts their personal and professional values, which undermines their integrity and authenticity (Redman & Fry, 2000). Moral distress can be a significant issue in nursing.

The consequences of moral hurt for nurses include both physical and emotional stress, which in turn leads to a sense of loss of unity and dissatisfaction with their work environment. Numerous studies have shown that moral hurt is a major factor contributing to nurses leaving their profession and work settings. It not only affects relationships with patients and others, but also has an impact on the overall quality, quantity, and cost of nursing care (Redman & Fry, 2000). Additionally, nurses may feel overwhelmed when faced with the need to assist in cases of domestic violence. However, they may find it difficult to adhere to their moral

beliefs due to personal, cultural, social, or institutional constraints imposed by the clients.

When dealing with domestic abuse, healthcare workers often face a dilemma when it comes to pregnant women in abusive relationships. On one hand, it is clear what the "right" course of action is for the health worker. However, the client's right to exercise freedom and choice makes it impossible for the nurse to take appropriate action without the victim's consent. Another ethical issue in domestic abuse is distributive justice, which involves the fair distribution of social benefits and burdens in society. In the context of healthcare ethics, this principle focuses on the distribution of goods and services. Unfortunately, there is a limited supply of these resources, making it impossible for everyone to have everything they want or need. The governing systems aim to develop and enforce policies that address broad public health issues, such as domestic violence, with an emphasis on the just and equitable allocation of limited resources.

In 2002, the Ontario authorities announced their plans to allocate over $21 million towards addressing domestic violence, in response to the recommendations from the Hedley jury inquest in February 2002 (Cross, Ontario Women Justice Network, 2002, November). It is evident that the provincial authorities in Ontario is taking action to address this ongoing issue in society. However, according to the Middlesex-London Health Unit, the estimated annual cost of violence against women in Ontario in 2000 was $4.2 billion (Malone, 2005). This highlights the inadequacy of government support and the need for increased funding to properly help all victims of domestic violence. Effective clinical decision-making and implementation is essential in nursing practice, but it also requires

a careful examination of power distribution within the clinical environment.

In cases of domestic violence, men typically hold the power in the household. To break the cycle of violence, it is necessary to change the dynamics of power through education and interventions, rather than relying on medical interventions. Additionally, nurses possess the necessary clinical knowledge and willingness to support their abused clients, however...

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