Disability, disclosure, and missed opportunities: a qualitative study of perinatal intimate partner violence screening

Abstract

Background

Intimate partner violence (IPV) during the perinatal period is a significant public health issue. Persons with disabilities (PWD) experience higher rates of IPV yet are less likely to be screened, and little is known about their experiences with screening and interventions. This study explored perinatal IPV screening experiences among PWD in the United States.

Methods

As part of a mixed method study on psychosocial risks and maternal-infant outcomes among PWD, we conducted semi-structured interviews with 45 pregnant or recently pregnant PWD. Twenty-two participants reported experiencing or having experienced current or recent IPV. Interviews addressed pregnancy health, healthcare experiences, IPV screening, interventions, and care recommendations. Reflexive thematic analysis was used to identify key themes.

Results

Analysis revealed three key themes. First, participants described silence, fear, and stigma as barriers to disclosure, often minimizing abuse or feeling ashamed, particularly in the absence of direct and empathetic assessment by healthcare providers. Second, participants reported missed opportunities and gaps in healthcare provider response, including superficial screening, limited follow-up, and experiences of bias or discrimination, which reinforced isolation and hindered access to support. Third, participants highlighted the transformative power of supportive care, noting that providers who listened attentively, validated their experiences, and connected them to resources promoted safety, empowerment, and engagement with care.

Conclusions

Persons with disabilities face unique barriers to IPV disclosure during the perinatal period, and current screening practices are often insufficient. Embedding IPV screening within trauma-informed and disability-informed care can enhance disclosure, improve access to resources, and promote maternal and infant health. Health systems should implement tailored screening approaches, healthcare provider training, and systemic supports to ensure appropriate IPV identification and response for PWD.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-025-08611-y.

Background

Intimate partner violence (IPV) during the perinatal period is a significant public health issue, affecting between 3% and 9% of pregnant women, with the actual prevalence likely higher due to underreporting [1–3]. Intimate partner violence can manifest as physical violence (e.g., hitting, kicking, slapping), psychological violence (e.g., humiliation, intimidation, threats of harm), sexual violence (e.g., forced sexual intercourse, sexual coercion), and controlling behaviors (e.g., isolating from support system, restricting access to financial supports) [4, 5]. The perinatal period may represent a time of increased vulnerability because of changes in physical, psychological, and economic demands and needs, and these vulnerabilities may be particularly salient for persons with disabilities (PWD) [6–8].

PWD, who comprise 12%-20% of all persons of reproductive age in the United States, experience significantly higher rates of IPV during the perinatal period, with research demonstrating two to four times the rates of violence as compared to those without disabilities [1, 8–10]. The physical and mental health consequences of IPV on pregnancy, fetal, and infant outcomes are well-documented. During pregnancy, people who experience IPV are more likely to delay prenatal care initiation or have inadequate prenatal care, smoke or use other substances, report inadequate gestational weight gain, and experience depression, anxiety, and other adverse mental health consequences [5, 11, 12]. IPV is associated with an increased risk of low birth weight, preterm birth, small for gestational age, and neonatal intensive care unit admission, and limited research suggests these risks may be increased in PWD [2, 5, 13]. Given the disproportionate burden of IPV among PWD, these adverse maternal and infant health outcomes may be magnified, highlighting the urgent need for research that addresses the unique vulnerabilities of this population.

Despite IPV during the perinatal period being relatively common, it often remains undetected. As such, multiple organizations, including the US Preventive Services Task Force (USPSTF), recommend routine screening for IPV in women of reproductive age [14]. Yet, research suggests that screening practices are quite variable, with less than 50% of patients reporting being screened during pregnancy [15]. Barriers to screening reported by healthcare providers include a lack of expertise, time constraints, and inadequate support services when IPV is identified [3].

While limited, research demonstrates that PWD are less likely to be screened for IPV during the perinatal period. Using data from the Pregnancy Risk Assessment Monitoring System (PRAMS), researchers found respondents with disabilities had reduced odds of IPV screening during pregnancy as compared to respondents without disabilities (aOR 0.83, 95% CI 0.70–0.99) [16]. Importantly, respondents with disabilities were also less likely to receive pregnancy-related care during pregnancy and in the postpartum period, potentially reducing opportunities for adequate screening. In a qualitative study of 33 non-pregnant, rural women with disabilities, researchers reported that women described interactions with the healthcare system as a “missed opportunity” for identifying and addressing their experiences of violence [17]. Additionally, a survey study of 200 women with physical and cognitive disabilities found that only 21% reported ever having been screened for abuse by a healthcare provider [18]. Moreover, according to findings of an anonymous audio computer-assisted self-interview survey study, only 15% of a sample of 276 female abuse survivors with diverse disabilities reported ever having had a healthcare provider discuss abuse and personal safety with them [19], thus missing an opportunity to assess risks for further violence.

The elevated risk of IPV among PWD, together with its established negative impact on maternal and infant health, underscores the need to examine how IPV screening is implemented and experienced by PWD during the perinatal period. As such, this study sought to explore the experience of IPV screening and interventions for PWD who experienced IPV during the perinatal period.

Methods

Study design

This qualitative study was part of a larger mixed method study examining psychosocial risks (i.e., IPV, depression) on maternal and infant outcomes for PWD. For the qualitative aim focused on pregnant or recently pregnant PWD, we conducted individual, in-depth semi-structured interviews with persons with diverse disabilities, including limitations in hearing, vision, cognition, mobility, self-care, and independent living, who resided in the United States.

Study sample

Participants were eligible if they were disabled, pregnant or had given birth in the prior two years, had experienced psychosocial stress (conceptualized as experiences of IPV or mental health conditions during the most recent pregnancy), and were between the ages of 18 and 44 at the time of study participation. Exclusion criteria included the inability to answer simple questions that demonstrated a capacity to consent, did not understand or express themselves in English or American Sign Language, lived in an institution or group-home, or were in significant mental health crisis. The current study was approved by the (redacted for review) Institutional Review Board.

Our team used numerous recruitment methods to reach a diverse sample of participants with respect to geographic location and disability type. In partnership with our Community Advisory Board (CAB) comprised of nine women with diverse disabilities living throughout the United States, we disseminated study-related materials through social media groups, disability-related websites and newsletters, community-based organizations, and blogs and social media accounts of individuals who were actively engaged in the Disability community.

For the current study aim focused on experiences of IPV and depression, 45 PWD participated, and of these participants, 22 PWD disclosed current or recent experiences of IPV. Our interview guide was developed by our research team, in collaboration with our CAB, and was informed by our population-based analyses showing that PWD were at an increased risk of IPV during the perinatal period (citation redacted); yet, less likely to be screened for IPV during pregnancy (citation redacted). All participants were asked about their health and priorities for a healthy pregnancy, any concerns about how their disability may affect their pregnancy or birth outcomes, and their experiences in receiving health care during their pregnancy.

With respect to experiences of violence, participants were asked whether they had experienced any of the following forms of abuse during three time periods: the 12 months prior to pregnancy, during pregnancy, or the 12 months following childbirth. Abuse types included physical abuse or violence (e.g., being pushed, kicked, slapped, choked, or otherwise physically harmed); sexual abuse (e.g., being forced to engage in unwanted sexual activity or expected to engage in sexual activity in exchange for help); reproductive coercion (e.g., partner interference with birth control); emotional abuse (e.g., being yelled at, unnecessarily monitored, prevented from doing desired activities, or called names or hurtful things related to one’s disability); and disability-related abuse (e.g., being prevented from using a wheelchair, cane, or other assistive device, refusal of assistance with dressing, eating, or getting out of bed). For those participants who also disclosed IPV, they were asked about their partner’s response to the pregnancy and patterns of violence during the perinatal period, any supports received for IPV, including screening and interventions, and their recommendations for improving the care PWD receive during the perinatal period. The current analysis focuses on those participants who reported IPV during their most recent pregnancy.

Data collection

Our research team comprised female clinicians and researchers with extensive experience in perinatal health, intimate partner violence, and disability-focused research, many of whom have been working together for more than a decade. Several team members have long-standing professional and personal engagement with disability communities, which informed the study design, interview approach, and interpretation of findings. Reflexivity was addressed through regular team discussions that explicitly examined how researchers’ clinical roles, assumptions, and prior knowledge could shape data collection and analysis. Ongoing analytic dialogue supported critical reflection and enhanced the credibility and rigor of the findings.

Between January 2024 and June 2025, four research team members (JA, RH, KL, MM) conducted all interviews via videoconferencing, each lasting 45–60 min. To accommodate accessibility needs, one participant was interviewed by phone. Given that participants resided throughout the United States, conducting in-person interviews was not feasible.

Participants were informed that interviewers were scientists with clinical and research expertise in perinatal health, disability, and intimate partner violence, and that the study was motivated by a commitment to improving equitable, trauma-informed care for persons with disabilities. Prior to beginning each interview, participants were reminded that they could skip any questions, decline to answer, or ask to pause the recording at any time. To further protect participant privacy, each participant was also given a code word to use if they felt at risk of being overheard by the perpetrator or anyone else. If the code word was used, the interviewer would thank the participant, end the session, and allow them to reconnect at a safer time. Although this precaution was in place, no participant used the code word. With participants’ permission, all interviews were audio-recorded, transcribed, and reviewed by a member of the research team for accuracy. All participants were referred to by a study ID number, and no information was maintained that could potentially identify a participant (e.g., health care facility, healthcare provider name, partner’s name, specific town or location).

Data analysis

ATLAS.ti was used to assist with the organization, coding, and analysis of transcripts. Reflexive thematic analysis, as described by Braun and Clarke [20, 21], was used for data analysis. Our analysis followed Braun and Clarke’s six-stage approach to thematic analysis, including familiarization with the data, generating initial codes, generating initial themes, reviewing themes, defining and naming themes, and presenting findings. Yet, consistent with the tenets of thematic analysis, this process was iterative and flexible [20]. Member checking was not conducted; instead, analytic rigor was supported through team-based coding, iterative theme refinement, and reflexive discussion.

Four research team members (RH, KL, JA, JP) were involved in coding all manuscripts. Throughout the analytic period, the research team met regularly to discuss codes, collapse codes, cluster codes, develop themes and subthemes, review and refine themes, and define final themes. This process ensured a diversity of perspectives that reflected our team’s personal, clinical, and research expertise.

Results

Using this thematic approach, we identified three major themes related to experiences of IPV screening during the perinatal period, including silence and stigma as barriers to disclosure; missed opportunities and gaps in healthcare provider response; and the transformative power of supportive care. While participants frequently recalled being asked about various aspects of their pregnancy health, most reported that they were not directly asked about IPV. This absence of direct inquiry influenced disclosure, contributed to missed opportunities for intervention, and shaped participants’ overall perceptions of care.

Participant characteristics

As outlined in Table 1, participants (n = 22) ranged in age from 24 to 46 years, with a mean age of 33. Most were non-Hispanic White (45%) or African American (36%). Relationship status varied, with just under half of the sample married or partnered. Educational attainment was relatively high, with nearly half holding a college degree. Employment was common, with the majority working either part- or full-time, and just over half reporting household incomes above $50,000 annually.

Table 1.

Sociodemographic and clinical characteristics (n = 22)

Characteristic	N (%)*
Age, mean (range)	33 (24–46), n = 22
18–24	1 (5)
25–34	14 (64)
35–46	7 (32)
Race
Non-Hispanic White	10 (45)
African American	8 (36)
Other	4 (18)
Relationship Status
Single	4 (19)
Partnered/not married	7 (33)
Married	9 (43)
Divorced	1 (5)
Employment Status
Unemployed	5 (24)
Employed part-time	8 (38)
Employed full-time	8 (38)
Total Household Income
Less than $50,000	8 (38)
$50,000 or greater	11 (52)
Did not answer/did not know	2 (10)
Disability Type
Intellectual, cognitive, or other thinking disability	4 (18)
Deaf or hearing loss	5 (23)
Mobility or other physical disability	9 (41)
Blindness or vision loss	5 (23)
Speech	1 (5)
Mental health condition	18 (82)
Ongoing health condition^	8 (36)
IPV Type
Physical abuse	13 (59)
Sexual abuse	8 (36)
Partner interfered with birth control	1 (5)
Emotional abuse	20 (91)
Disability-related abuse	3 (14)
Education
Up to high school graduate	3 (14)
Technical school or some college	8 (38)
College graduate	10 (48)

*The number of respondents may differ across characteristics because some participants did not provide responses, and certain items allowed more than one response

^Ongoing health condition refers to a chronic or health condition that may fluctuate in severity and functional impact over time, such that it may not consistently limit daily activities but can do so episodically (e.g., lupus, fibromyalgia, rheumatoid arthritis)

In terms of disability status, participants reported a range of conditions, most commonly physical or mobility-related disabilities (41%), hearing or vision loss (each 23%), and cognitive or intellectual disabilities (18%); the vast majority (82%) also reported a mental health condition. Nearly all participants disclosed experiences of IPV, with emotional abuse being the most common (91%), followed by physical abuse (59%) and sexual abuse (36%); a smaller proportion reported disability-related abuse (14%).

Theme 1: silence, fear, and stigma as barriers to disclosure

Participants described multiple layers of silence and fear that shaped their decisions to not disclose experiences of IPV from healthcare providers. Disclosure was often constrained by internalized stigma, fear of judgment, and concerns that members of their healthcare team would treat them differently if they disclosed abuse. For many participants, experiences of previous negative encounters within healthcare settings added to these concerns. One participant noted that although she had experienced physical violence before her pregnancy, she “kept that to myself” because she was worried that “they [healthcare providers] might be judgmental about it, and that might change the perspective and the way they see me, and I believe it might actually change the way they care for me, too.” [ID88, Blindness/vision loss] This perception that disclosure could jeopardize the quality of care led several participants to avoid responding honestly to violence screening, even when questions were asked directly. Similarly, embarrassment and fear of exposure limited open conversation with healthcare providers. As one participant reflected, “I was too embarrassed to really tell my healthcare team…and I didn’t know how to really open up to them.” [ID85, Deaf or hearing loss/vision loss] For other participants, fears extended beyond healthcare provider judgment to more severe systemic consequences. One participant shared, “Yeah, I didn’t say anything about [the abuse] because I didn’t want that all to be brought up… I do find it to be true. [Native Americans] don’t get the best health care or the best outcomes, because they’re Native American or because they’re looked at like as if they’re drug addicts or alcoholics.” [ID41, Physical disability/Ongoing health condition].

Participants described hesitancy to disclose due to concerns that involvement with healthcare or child welfare systems could invite unwanted scrutiny or intervention. These concerns were amplified by experiences of ableism within healthcare settings, as participants reported that their symptoms and concerns were frequently minimized or misunderstood, reflecting broader systemic biases toward individuals with disabilities. One participant who experienced IPV during her pregnancy and whose child had to be resuscitated at birth discussed how she never felt she was understood, remarking “…since I first started getting sick [during pregnancy], I felt like I was just not believed…she [her doctor] just blamed it [symptoms] on my anxiety.” [ID40, Physical disability] Another participant explained that “once people actually heard about my disability, they felt like I was over exaggerating when I explained what was happening or what I was feeling… and that was really wrong.” [ID91, Intellectual disability/Deaf or hearing loss] Another participant recounted, “Nobody listened to me… I told them for months that I didn’t feel good, that there was something going on or something wrong… I’m sure they just thought I was being a baby about it.” [ID41, Physical disability/Ongoing health condition].

Another participant described being “profiled” for prior substance use, remarking, “even though I had no drugs in my system…CPS…they said that I was a drug addict…they were absolutely horrible.” [ID86, Mental health condition] Finally, one participant shared, “I cannot find one doctor that will listen to me and actually hear me out and see my disability and see that I’m not just somebody that’s faking it.” [ID44, Physical disability] Such experiences deepened mistrust and perpetuated the perception that healthcare providers did not fully engage with them.

Theme 2: missed opportunities and gaps in healthcare provider response

Participants frequently described interactions with healthcare providers that reflected missed opportunities to identify and address experiences of violence. Even when screening questions were administered, these were often perceived as superficial, impersonal, or not patient-centered. Such experiences reinforced participants’ reluctance to disclose, suggesting that provider tone and engagement were as critical as the act of screening itself. Several participants noted that screening was conducted as a routine checklist rather than an invitation for dialogue. One participant noted, “Oh, yeah…they ask about if I want to disclose if I’ve experienced any sort of abuse, whether it is physical, verbal, psychological… but just, do you want to disclose it? Yes, no. Or have you experienced it? Yes, no, Don’t want to discuss it.” [ID84, Mental health condition] The limited nature of these interactions, structured as closed questions, left little space for nuance or safety in disclosure.

Participants similarly described being asked general questions about safety or well-being yet perceived these inquiries as lacking genuine engagement. As one participant reflected, “They would ask how I was feeling and what was going on around me… I was always saying I was okay, but scale of one to 10, I was not okay, but I never really opened up that I was actually going through any form of violence.” [ID85, Deaf or hearing loss/vision loss] In some cases, healthcare providers missed direct physical indicators of possible abuse or failed to follow up when suspicion arose. One participant recalled, “Before my pregnancy, I had a really bad leg injury… and that happened from him. And one of my doctors knew that it wasn’t an accident… She even put it in my paperwork that she thinks it was abuse or whatever. But I never said that it was… she made him leave the room to talk to me about it. But she never gave me resources for help or anything, no.” [ID41, Physical disability/Ongoing health condition] Another participant similarly remarked, “well, if she cared enough about me and my situation, she would have seen some of the bruises herself, but she barely ever examined me.” [ID03, Physical disability/ongoing health condition].

Participants also linked these gaps to ableism and implicit bias within the healthcare system. One participant reflected, “Doctors that I stopped seeing because they said something discriminatory or off color. And so that just makes it harder to talk about the hard things with your doctor when you feel like it might pass judgment and affect the care that they give you.” [ID78, Mental health condition] Another participant with cerebral palsy discussed a biased interaction when consulting to a procedure, remarking “she [the nurse] was reading it to me like I had a mental disability, like super slow and super loud. And just things like that. They’re not needed…that’s not appropriate. You know what I mean? I don’t have any cognitive disabilities.” [ID64, Physical disability] One participant discussed years of biased healthcare experiences, recounting “it makes it hard to have the motivation to take care of your health when your own doctors aren’t caring. I’ve even struggled for years with neuropathy, and I have yet to find a doctor to prescribe me any medication.” [ID44, Physical disability] She went on to discuss multiple emergency department visits for urinary tract infections due to her spinal cord injury and shared, “there’s been times I’ve went there [ED] and I didn’t even ask for pain medication and they would come in and say ‘we don’t prescribe narcotics.’ And it’s literally as if they look at me and think I’m there for - it’s like, it - it’s so, so hard. Like, it’s so hard. I cannot find one doctor that will listen to me and actually hear me out and, like see my disability and see that I’m not just somebody that’s faking it.” [ID44, Physical disability] These encounters reflected underlying ableism and implicit bias that shaped participants’ interactions with healthcare providers. Being spoken to slowly, dismissed, or treated as incapable reinforced feelings of invisibility and mistrust. Such interactions, characterized by bias, disbelief, and a lack of respect for participants’ autonomy, likely eroded trust and reinforced reluctance to disclose sensitive information, representing critical missed opportunities for open, honest discussions about IPV.

The absence of empathetic engagement was compounded by fragmented communication across care teams. Participants described feeling unseen or dismissed, with limited follow-up or resource connection, even when indicators of distress were apparent. As one participant said, “I would say I actually felt like we [patient and healthcare provider] didn’t have a decent relationship… there was not any strong connection that made me kind of extremely comfortable to really want to disclose, like, the deepest part of my heart.” [ID85, Deaf or hearing loss/vision loss] When a participant was asked about collaboration between her obstetrician and another specialty during her high-risk pregnancy, she remarked, “Not at all. Even then, they [healthcare providers] collaborate during my pregnancy with each other. It was up to me to advocate…and that’s not right.” [ID09, Physical disability] Similarly, another participant recalled, “Yeah, they [healthcare providers] wouldn’t check in whatever happened in the last visit or anything. They were just concerned about what was going on that day. So I felt like it [communication] was not good.” [ID63, Physical disability] These narratives illustrate how standardized screening processes without relational context failed to capture the lived realities of violence among participants with disabilities.

Theme 3: the transformative power of supportive care

Although many participants described silence or missed opportunities regarding IPV screening, several also shared experiences in which compassionate and inclusive healthcare interactions created opportunities for safe disclosure. These encounters often contrasted sharply with previous negative or superficial screenings. Participants emphasized that relational, respectful communication, particularly when healthcare providers demonstrated attentiveness to both emotional and disability-related needs, shaped their experience of care. For some, empathy and validation from a healthcare provider served as a critical first step toward feeling safe. One participant compared care during distinct pregnancies, remarking, “My doctor was really great. He would talk me through fears and make sure that I understood that things I was really nervous…he was much kinder and more understanding.” [ID87, Mental health condition] Others emphasized that regular check-ins built the trust necessary to talk about sensitive issues. As one participant recalled, “She would check in with me every visit, just to see how my anxiety was… it made me feel like I could actually say what was really going on.” [ID03, Physical disability/Mental health condition] Respectful and equitable treatment was particularly meaningful for participants with disabilities, who frequently encountered bias elsewhere in the healthcare system. “I wanted to be treated just like every other pregnant person. I worked really hard to find a physician who would treat me as a normal pregnancy…and that was a big win for me.” [ID18, Physical disability/ongoing health condition].

Several participants identified that supportive communication involved more than clinical expertise; it reflected emotional presence and the willingness to listen without judgment. One explained, “I was stressed. I had lost weight…she could just see it in me. So she asked about it, and I opened up to her…we figured things out together.” [ID63, Physical disability] In these instances, participants experienced care as collaborative and patient-centered, fostering a sense of trust often absent in prior encounters. For others, supportive care also involved meaningful gestures of accessibility and affirmation. “She was always positive with me, so I didn’t feel bad about my disability. She treated me like anyone else.” [ID62, Mental health condition] Another participant recounted how her physician took the time to find a social worker of color to work with her, noting “she understands how I feel about these things.” [ID63, Physical disability] Together, these accounts highlight the power of supportive care, grounded in empathy and respect, enhanced participants’ sense of inclusion within perinatal care settings.

Discussion

This study provides critical insight into the experiences of perinatal IPV screening among PWD, a population at elevated risk for violence yet often overlooked in clinical practice. Our findings reveal that PWD frequently face intersecting barriers to disclosure, including fear, stigma, and internalized minimization of abuse. The theme of silence and stigma aligns with prior research indicating that survivors may not recognize non-physical abuse as IPV or may feel ashamed to disclose due to societal judgment (e.g., emotional or psychological abuse) [22, 23]. The lack of direct inquiry by healthcare providers further reinforced these barriers, effectively placing the burden of disclosure on participants themselves. This underscores the importance of proactive, sensitive screening approaches tailored to the needs of PWD.

In addition to disclosure barriers, participants described significant gaps in healthcare provider responses when IPV was identified. When conducted, screening was often superficial and checklist-driven, limiting opportunities for meaningful conversations or referral to resources. Several participants reported instances where providers recognized potential abuse but did not offer guidance, support, or referrals. These missed opportunities underscore systemic gaps in perinatal care for PWD and point to the need for healthcare provider training that integrates both effective screening and empathetic, trauma-informed responses. Without such approaches, screening may unintentionally perpetuate silence rather than foster support, a pattern consistent with prior research demonstrating healthcare provider time constraints, limited expertise, and resource challenges as barriers to meaningful IPV intervention and optimal perinatal care for disabled patients [3, 24]. Our findings also suggest that intersectional factors, including race, ethnicity, and prior experiences of discrimination, may further compound reluctance to disclose and shape experiences of care, reinforcing prior work showing the impact of bias on health outcomes. The silence surrounding IPV, on the part of both participants and healthcare providers, created a reinforcing cycle: participants did not disclose because healthcare providers did not ask, and healthcare providers did not ask because there was no disclosure. For women with disabilities, whose interactions with the health care system may already be complex or stigmatizing, this silence can be especially harmful [25, 26].

Importantly, our analysis identified instances of the transformative potential of supportive care. Participants who encountered healthcare providers who actively listened, validated emotional and psychological abuse, and provided tangible support described feeling empowered and safer. These experiences suggest that when healthcare providers take a patient-centered approach, they can mitigate some of the negative consequences of IPV and enhance engagement in perinatal care. This finding aligns with broader literature emphasizing the importance of compassionate, trauma-informed care in improving maternal and infant outcomes, particularly for marginalized populations [4, 27].

Study findings reinforce the importance of embedding IPV screening within a broader framework of disability-informed, trauma-sensitive perinatal care. First, IPV screening should move beyond checkbox documentation to become part of a broader relationship-building process [27]. Asking about IPV at multiple time points, through varied modalities (verbal, written, or digital), increases the likelihood of disclosure, particularly as readiness to share may change over the course of pregnancy and postpartum. Second, provider training must explicitly address the full spectrum of IPV, ensuring that non-physical forms of violence are recognized and validated [4, 27]. Third, clinicians should be attentive to the unique challenges faced by PWD, including higher baseline rates of IPV, greater dependence on partners for personal care, mobility or financial resources, and increased likelihood of experiencing discrimination in health care settings [8, 26, 28].

System-level support is equally important. Without accessible and reliable referral pathways, screening alone is unlikely to translate into effective care or safety for PWD [16]. Participants’ experiences point to the value of embedding behavioral health providers, social workers, and patient navigators into perinatal care teams to facilitate immediate, supportive connections when IPV is identified. Health care systems should also ensure that services are physically accessible, culturally responsive, and inclusive of disability-specific needs [16].

Finally, these findings underscore the need for a shift in perinatal care culture. For many survivors, barriers extend beyond whether screening occurs to whether providers are perceived as safe, trustworthy, and willing to listen. Promoting this culture requires not only targeted provider training but also organizational policies that embed trauma-informed and disability-inclusive approaches into routine care [29, 30].

Study limitations

Several limitations should be considered when interpreting these findings. First, respondents with significant intellectual disability were not eligible to participate in this study given the nature of the qualitative interviews. This is an important gap, as prior research demonstrates that individuals with intellectual and developmental disabilities experience disproportionately high rates of IPV, often with unique barriers to disclosure and access to support [31, 32]. Moreover, prior research demonstrates that people with intellectual disability value and benefit from research addressing abuse and safety [32, 33]. The absence of their perspectives means that the voices of a population at greatest risk are not represented in this analysis.

Second, the study sample included 22 participants who had experienced IPV during the perinatal period. While these narratives provide valuable insight into lived experiences, they cannot capture the full magnitude or diversity of IPV experiences among PWD. The sample size and qualitative design preclude generalizability, and it is possible that the perspectives of participants who chose to share their experiences differ from those who did not.

Finally, although participants represented a range of disabilities, perinatal experiences, and geographic contexts, the findings may not reflect the perspectives of all subgroups of persons with disabilities, particularly those facing additional structural inequities related to race, ethnicity, socioeconomic status, or rurality. Future research should include larger and more diverse samples, with particular attention to individuals with intellectual and developmental disabilities, to ensure that screening and intervention strategies address the full spectrum of needs.

Conclusion

Intimate partner violence during the perinatal period remains a significant yet under-recognized public health issue, particularly for PWD who experience disproportionately high rates of violence [8, 10]. Persons with disabilities experience unique and intersecting barriers to IPV disclosure during the perinatal period, and current screening practices are often inadequate to meet their needs. However, when healthcare providers engage in supportive, empathetic, and persistent care, meaningful interventions are possible. Efforts to improve perinatal IPV screening and response for PWD should focus on direct inquiry, trauma-informed approaches, and structural supports to ensure equitable access to care. These findings highlight the urgent need for health systems to prioritize tailored IPV screening and intervention strategies for PWD to mitigate risks and promote maternal and infant health.

Authors’ contributions

JA, RH, and KL conceptualized and designed the study; JA, RH, KL, and JP conducted data analysis; JA wrote the manuscript; all authors critically reviewed the manuscript; all authors approved the final submitted manuscript.

Funding

This work was supported by the National Institutes of Health [Grant number: R01HD117164].

Data availability

The datasets generated and analyzed during the current study are not publicly available in order to protect the confidentiality of participants. De-identified data may be available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study was reviewed and approved by the University of Virginia Social and Behavioral Sciences Institutional Review Board (UVA SBS IRB). All participants provided informed consent prior to participation, and procedures were carried out in accordance with relevant guidelines and regulations.

Consent for publication

Not applicable. No identifying information of individual participants is included in this manuscript.

Competing interests

The authors declare no competing interests.