This annual report - Taranaki District Health Board

Family ViolenceDefinitions and New Zealand DistributionFamily violence is defined as:“a broad range of controlling behaviours commonly of a physical, sexual and/orpsychological nature, which typically involve fear, intimidation and emotional deprivation. Itoccurs within close interpersonal relationships.” [194]Family violence encompasses violence between any members of a family group orwhānau and includes both intimate partner violence (IPV) and child maltreatment. IPV hasbeen linked to a variety of adverse pregnancy outcomes [172]. The presence of IPV withina family increases the risk of child maltreatment [195]. Pregnancy and the contactpregnant women have with health services, represent an opportunity to identify andaddress IPV and intervene to prevent child maltreatment. Whether pregnancy increasesthe risk of IPV has been widely debated. A comprehensive review in 2004 concluded thatwhile some hospital and clinic based studies had found that women were at higher risk ofIPV during pregnancy, national and international population-based studies have identifiedsignificant increases in risk associated with pregnancy [172]. A population-based study inNew Zealand identified a prevalence of IPV during pregnancy of six per cent (95% CI 4.8to 8.0) in urban regions and nine per cent (95% CI 7.5 to 44.1) in rural regions [196]. Mostwomen who report violence during pregnancy also report a history of violence precedingthe pregnancy [197]. This section focuses primarily on IPV in pregnancy. The prevention ofassault, neglect and maltreatment in children and the prevention of family violence ingeneral is considered in more detail on page 309 and page 339. The evidence base forinterventions to address family violence during pregnancy is reviewed later in this section.Associations Between Family Violence and Pregnancy OutcomesIntimate partner violence (IPV) during pregnancy has been associated with later entry intoantenatal care, adverse pregnancy outcomes, maternal behaviours such as smoking andalcohol use, and maternal physical and psychological morbidity [172,196,198]. The caresought by women during pregnancy provides an opportunity for early identification andappropriate referral of victims of IPV [199,200]. The Ministry of Health recommends that allfemales aged 16 years and older should be screened routinely for physical and sexualpartner abuse, and screening should occur at every prenatal and post-partum visit [199].Pregnancy is identified as a potential sign of child abuse in children and screening forabuse is therefore recommended for all those under 16 years.Maternal exposure to domestic violence is associated with increased risk of earlypregnancy loss, low birthweight and preterm birth [201,202]. In their systematic review of30 studies with low to moderate risk of bias (5 cross-sectional, 15 prospective cohort, 6retrospective cohort and 4 case-control studies with nearly 500,000 participants), Shah etal. found significantly increased risks of low birthweight (adjusted OR 1.53, 95% CI 1.28 to1.82) and preterm birth (adjusted OR 1.46, 95% CI 1.27 to 1.67) among women exposedto domestic violence [201]. In a cross-sectional sample of 2,391 New Zealand women,those that reported ever having experienced intimate partner violence (IPV) weresignificantly more likely to report having had a miscarriage (OR 1.41 95% CI 1.10 to 1.81)or a termination of pregnancy (OR 2.49, 95% CI 1.81 to 3.42) [203]. Unplanned pregnancywas found to be more common among those that identified themselves as being victims ofIPV (68.7% among victims of IPV compared to 55.1% non-victims, OR 1.78, 95% CI 1.32to 2.40) in a cohort of Pacific women in Auckland [204].There is significant overlap between the occurrence of child abuse and partner abuse infamilies and these issues cannot be addressed in isolation [199]. Addressing intimatepartner violence benefits children by stopping the negative effects of the adult violence onchildren, and reducing the risk of physical maltreatment of children directly [195].Pregnancy, and the contact women have with health services antenatally, represents anopportunity for the primary and secondary prevention of child maltreatment. Primaryprevention may be universal, such as child birth education, or targeted at women andfamilies at high risk. Secondary prevention involves identifying women who have hadIn-Depth Topic: Adversity in Pregnancy - 284