Abstract
Objective
Intimate partner violence (IPV) is pervasive and can lead to severe health consequences. In the United States, 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 study of 606 parturients at a single academic medical center from 2011 to 2022. Structured questionnaires were administered to randomly chosen, 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.
Results
Of 606 study participants, 568 (94%) provided data on IPV. Of those, 20.4% reported IPV (case) and 80.6% reported no IPV (control). In total, 74.6% of the study population was enrolled prepandemic. 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
IPV is common, reported by one in five 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 highlights the importance of addressing the influence of racism and gender-based discrimination on adverse birth outcomes in the United States.
Keywords: COVID-19, discrimination, intimate partner violence, IPV, pandemic, perinatal, pregnancy, racism
One in four women in the United States has experienced physical and/or sexual intimate partner violence (IPV).1 IPV is behavior within an intimate relationship resulting in physical or psychological harm, including physical aggression, sexual coercion, emotional abuse, controlling behaviors, and stalking.2 Intimate partners include spouses, dating partners, sexual partners, and other romantic partners.
IPV during pregnancy is associated with adverse birth outcomes such as preterm birth, low birth weight, small-for-gestational-age infants, and neonatal death,3–5 yet IPV data on the obstetric population is less robust than on the general population. Prevalence ranges from 5 to 20%,4–6 and risk factors for IPV during pregnancy are inconclusive. However, some well-established exposures are young age, history of abuse, low socioeconomic status, low education, unmarried status, and unintended pregnancy.4–6
These exposures are examples of social determinants of health (SDoH), or “conditions in which people are born, grow, work, live, and age”7 that impact health status and inequities. The COVID-19 pandemic has highlighted how social determinants can drive poor health outcomes, particularly in marginalized groups. Increased rates and severity of IPV have been documented during the pandemic8,9 in part due to shifting social conditions.
In this study, we aim to quantify IPV in an urban perinatal cohort, gain a better understanding of the relationship between SDoH and IPV around the time of pregnancy, and assess whether the COVID-19 pandemic has influenced the rate of IPV in this population.
Materials and Methods
This is a nested case–control study within a prospective cohort of 606 postpartum patients who delivered at a single urban academic medical center between 2011 and 2022. The greater prospective cohort study utilize a comprehensive questionnaire to gather data on SDoH and perinatal outcomes. It is approved by the Institutional Review Board at the study institution.
Inpatient postpartum patients are screened for study eligibility. Parturients aged 18 years or older and able to provide informed consent are eligible, as are those under 18 with parental consent. On June 22, 2021, eligibility expanded to Spanish-speaking patients due to the addition of bilingual study personnel. Written informed consent is obtained prior to administration of the survey.
Study personnel administered a 280-question survey that gathers data related to the study participant’s demographic characteristics and SDoH including housing conditions, neighborhood safety, socioeconomic status, psychosocial support, faith and community, health beliefs and behaviors, reproductive agency, and attitudes about structural violence. With sensitive topics such as IPV, participants have the option of reading the questions and filling out the answer choices themselves.
A medical record review is performed for missing maternal demographic and newborn data. Survey responses are recorded and stored in a locally housed secure Research Electronic Data Capture (REDCap), a Health Insurance Portability and Accountability Act (HIPAA)-compliant database with measures to maintain confidentiality. Participants were not compensated for study participation.
Cases were defined as having if they answered Yes to any of the following: (1) Physical abuse by an intimate partner during this most recent pregnancy, (2) Verbal abuse by an intimate partner before or during this pregnancy, or (3) Forced sex by an intimate partner causing this pregnancy. Participants who answered No to all three questions comprised the control group. Subjects were excluded from the case–control analyses if they had missing data for all three questions.
The survey questions regarding verbal or sexual abuse were not pregnancy-specific and could include abuse either prior to or during pregnancy: “During your pregnancy or before were you ever a victim of verbal abuse?” and “Have you ever been forced to engage in sexual activity against your will…If yes, was this forced sex the cause of your pregnancy?” Therefore, to identify cases of pregnancy-specific abuse, we performed a sensitivity analysis using a second composite variable for IPV (Pregnancy IPV Composite 2) that included only those who answered yes to questions 1 and 3, excluding the question regarding verbal abuse (question 2). The survey does not include questions about verbal or sexual abuse specifically during pregnancy.
Differences in the frequency of SDoH were compared between IPV case and control groups. Commonly studied SDoH such as educational attainment were examined, in addition to pregnancy characteristics, joy, social support, and perceived gender and racial discrimination. SDoH data were obtained from participant survey responses. Certain factors such as low joy and low social support were analyzed as compositive variables, defined in the Supplementary Material (available in the online version). Participants self-reported their race, which was then further classified for analysis (Supplementary Material [available in the online version]). The food insecurity composite variable uses questions from a U.S. Department of Agriculture-validated survey10 (Supplementary Material [available in the online version]). The unintended pregnancy composite variable incorporates mistimed pregnancies (Supplementary Material [available in the online version]), a common categorization in the literature. Discrimination was defined as the participant indicating any level of perceived inferior treatment due to race, skin, color, ethnicity, or gender. Non-Hispanic white participants were excluded from the analysis of perceived racial discrimination.
To examine the influence of the COVID-19 pandemic on IPV, an analysis was performed examining the association of SDoH and IPV before and during the pandemic. Although the first state of emergency for COVID-19 was declared on March 12, 2020, we designated March 30, 2020, as the date of onset to account for the rollout of new patient care guidelines at the study institution.
Baseline maternal characteristics were compared between the case and control groups using χ2 tests and student’s t-tests for categorical and continuous variables, respectively. A p-value <0.05 and 95% CI excluding 1.0 were considered statistically significant. Odds ratios and 95% confidence intervals (CI) were calculated using logistic regression to quantify the association between maternal SDoH and IPV overall, both before and during the pandemic. We chose not to adjust for SDoH because of their complex interplay with each other and the paucity of understanding regarding how specific SDoH contribute to IPV. Statistical analysis was performed using STATA BE 17.0 software (StataCorp, College Station, TX).
Results
Of 606 total study subjects, 568 (94%) provided sufficient data on IPV to be categorized in the case (N = 116, 20%) and control (N = 452, 80%) groups. Table 1 displays comparisons of sociodemographic characteristics between IPV cases and controls. The mean maternal age of the study population was 27 years old. The youngest study participant was 13 years old and reported sexual IPV causing pregnancy. There was no significant racial or ethnic difference in the frequency of IPV and no missing data on race or ethnicity. Nearly half of the study population was non-Hispanic Black (49.2%) and less than 5% Hispanic. IPV cases were more likely to be unmarried, have low income, have food or housing insecurity, use tobacco, alcohol, or illicit drugs during pregnancy, and have an unintended pregnancy. Perceived racial and gender discrimination was prevalent in the case group at 32.5% and 31.1%, respectively.
Table 1.
Differences in maternal characteristics among pregnancies with and without reported intimate partner violence, N = 568
| Maternal social determinants of health | IPV cases (N = 116) | IPV controls (N = 452) | p-value |
|---|---|---|---|
| Sociodemographic characteristics | |||
| Age at delivery (y) | 27.1 (± 6.2) | 26.8 (± 6.0) | 0.64 |
| Age at delivery range (y) | 13–42 | 14–43 | |
| < 18 | 3 (2.6%) | 7 (1.6%) | 0.71 |
| 18–34 | 99 (85.3%) | 395 (87.4%) | |
| ≥ 35 | 14 (12.1%) | 50 (11.1%) | |
| Unmarried | 99 (85.3%) | 304 (67.9%) | <0.001a |
| Race1 | |||
| Asian/Pacific Islander | 1 (0.9%) | 16 (3.5%) | 0.23 |
| Hispanic/Latino | 6 (5.2%) | 12 (2.7%) | |
| Multiracial/Other | 4 (3.5%) | 22 (4.9%) | |
| Non-Hispanic Black | 52 (44.8%) | 222 (49.1%) | |
| Non-Hispanic White | 53 (45.7%) | 180 (39.8%) | |
| Education | |||
| No high school diploma | 34 (29.3%) | 121 (26.8%) | 0.3 |
| High school graduate/GED, some college or associate degree | 71 (61.2%) | 263 (58.2%) | |
| Bachelor’s degree or more | 11 (9.5%) | 68 (15.0%) | |
| Household income | |||
| ≤ $40,000 | 86 (85.2%) | 317 (74.4%) | 0.02a |
| > $40,000 | 15 (14.9%) | 109 (25.6%) | |
| Hours worked per week during pregnancy | 20.4 (± 18.4) | 21.3 (± 18.4) | 0.66 |
| Unemployed during pregnancy | 52 (45.2%) | 182 (40.3%) | 0.34 |
| WIC during pregnancyb | 77 (66.4%) | 274 (60.6%) | 0.26 |
| Medicaid during pregnancy | 80 (69.0%) | 267 (59.1%) | 0.05 |
| Food insecurity2 | 61 (54.0%) | 148 (34.0%) | <0.001a |
| Lacks transportation | 43 (37.4%) | 129 (28.9%) | 0.08 |
| Large household (>5 members) | 17 (14.9%) | 52 (11.5%) | 0.32 |
| Lived in shelter or homeless during pregnancy | 9 (8.0%) | 10 (2.3%) | <0.01a |
| Pregnancy and newborn characteristics | |||
| Alcohol use during pregnancy | 19 (16.7%) | 42 (9.4%) | 0.03a |
| Illicit drug use during pregnancyc | 26 (22.6%) | 60 (13.3%) | 0.01a |
| Smoked cigarettes during pregnancy | 43 (37.4%) | 108 (24.0%) | <0.01a |
| Prepregnancy BMI (kg/m2) | |||
| Underweight <18.5 | 5 (4.6%) | 20 (4.6%) | 0.45 |
| Normal 18.5–24.9 | 34 (31.5%) | 157 (36.2%) | |
| Overweight 25.0–29.9 | 24 (22.2%) | 112 (25.8%) | |
| Obese ≥30.0 | 45 (41.7%) | 145 (33.4%) | |
| Gravida (no. of pregnancies) | 3 (2, 5) | 2 (1, 4) | <0.001a |
| Para (no. of deliveries) | 2 (1.5, 3) | 2 (1, 3) | 0.07 |
| Interpregnancy interval (mo) | 37.8 (± 46.8) | 34.1 (± 34.7) | 0.43 |
| Short interpregnancy interval (<12 months) | 30 (34.5%) | 84 (28.1%) | 0.25 |
| < 5 prenatal visits | 16 (15.5%) | 64 (15.6%) | 0.99 |
| Total stillbirths | 0.05 (± 0.2) | 0.03 (± 0.2) | 0.52 |
| Living children | 2.6 (± 1.7) | 2.3 (± 1.6) | 0.08 |
| Preterm birth (<37 wk) | 25 (21.6%) | 86 (19.1%) | 0.55 |
| Low birth weight (<2,500 g) | 29 (25.2%) | 90 (20.0%) | 0.23 |
| Unintended pregnancy3 | 89 (78.1%) | 296 (65.5%) | 0.01a |
| Intends on breastfeeding | 69 (65.7%) | 269 (64.2%) | 0.77 |
| Joy and support | |||
| Low support from father of the baby4 | 43 (45.7%) | 117 (29.3%) | <0.01a |
| Low social support5 | 37 (32.5%) | 93 (20.9%) | <0.01a |
| Low joy6 | 43 (39.1%) | 92 (21.3%) | <0.001a |
| Discrimination | |||
| Racial discrimination7 | 37 (32.5%) | 77 (17.2%) | <0.001a |
| Gender discrimination7 | 33 (31.1%) | 64 (15.1%) | <0.001a |
Abbreviations: BMI, body mass index; GED, general education development; IPV, intimate partner violence.
Note: Data are reported as number (%), mean (± standard deviation), and median (interquartile range).
χ2 performed for group comparisons of categorical variables. t-tests performed for group comparisons of continuous variables.
Indicates statistical significance at p < 0.05.
WIC, Special Supplemental Nutrition Program for Women, Infants and Children.
Illicit drug use includes marijuana, solvents or inhaled chemicals, cocaine, methamphetamine, hallucinogens, and non-prescribed narcotics or tranquilizers. Variables 1 to 7 are defined in Supplementary Material (available in the online version).
The factors most strongly associated with IPV were housing insecurity (OR = 3.73; CI: 1.48, 9.42), unmarried status (OR = 2.76; CI: 1.59, 4.79), and perceived gender discrimination (OR = 2.54; CI: 1.56, 4.15). Other SDoH significantly associated with IPV, such as food insecurity, low joy, and support, and the strength of their association are displayed in Table 2 and Fig. 1.
Table 2.
Maternal social determinants of health associated with intimate partner violence around the time of pregnancy, N = 116
| Maternal social determinants of health | IPV cases (N = 116) OR (95% CI) |
|---|---|
| Demographic factors | |
| Unmarried | 2.76 (1.59, 4.79)a |
| Non-Hispanic Black | 0.83 (0.55, 1.24) |
| Non-Hispanic White | 1.26 (0.83, 1.89) |
| Social and economic factors | |
| ≤ $40,000 income | 1.97 (1.09, 3.56)a |
| Medicaid during pregnancy | 1.54 (0.996, 2.38) |
| Food insecurity2 | 2.27 (1.50, 3.46)a |
| Lived in a shelter or homeless during pregnancy | 3.73 (1.48, 9.42)a |
| Pregnancy factors | |
| Alcohol use during pregnancy | 1.92 (1.07, 3.46)a |
| Illicit drug use during pregnancy | 1.91 (1.14, 3.19)a |
| Smoked cigarettes during pregnancy | 1.90 (1.23, 2.93)a |
| Gravida ≥3 | 2.29 (1.48, 3.54)a |
| Unintended pregnancy3 | 1.88 (1.16, 3.04)a |
| Joy and support | |
| Low support from father of the baby4 | 2.03 (1.28, 3.22)a |
| Low social support5 | 1.82 (1.16, 2.86)a |
| Low joy over past year6 | 2.37 (1.52, 3.71)a |
| Discrimination | |
| Racial discrimination7 | 2.32 (1.46, 3.68)a |
| Gender discrimination7 | 2.54 (1.56, 4.15)a |
Abbreviations: CI, confidence interval; IPV, intimate partner violence; OR, odds ratio.
Note: Data are reported as number (%), and ORs with 95% CI.
Indicates statistical significance at p < 0.05. Variables 2 to 7 are defined in Supplementary Material (available in the online version only).
Fig. 1.
Social determinants associated with intimate partner violence around the time of pregnancy data are reported as odds ratios (OR) with 95% confidence intervals (CI).
IPV at any point during a participant’s lifetime was prevalent, reported by over one in five parturients (22.6%), Table 3. The most common type of reported IPV was verbal abuse, disclosed by 18.5% of the overall cohort. Less commonly reported were physical IPV during pregnancy (2.3%), and sexual IPV causing pregnancy, which was reported by three participants (0.5%). Sexual IPV—being forced to engage in sexual activity against one’s will at any point—was reported by more than one in seven study participants (15.8%). There were no reported instances of all three forms of IPV occurring in the same person during pregnancy.
Table 3.
Rates of intimate partner violence within overall cohort, N = 606
| Intimate partner violence | Rate (N = 606) |
|---|---|
| Lifetime IPV | 137 (22.6%) |
| Pregnancy IPV Composite 1 | 116 (19.1%) |
| Pregnancy IPV Composite 2 | 17 (2.8%) |
| Verbal IPV before or during pregnancy | 112 (18.5%) |
| Physical IPV during pregnancy | 14 (2.3%) |
| Sexual IPV causing pregnancy | 3 (0.5%) |
| Physical IPV during pregnancy and verbal IPV | 12, (2.0%) |
| Sexual IPV causing pregnancy and verbal IPV | 1 (0.2%) |
| Lifetime sexual IPV | 96 (15.8%) |
Abbreviation: IPV, intimate partner violence.
Notes: Lifetime IPV: Are you currently or have you ever been in a relationship where you were physically hurt, threatened, or made to feel afraid?
Pregnancy IPV Composite 1: Answer yes to any of these three questions: Did you experience any physical abuse during this pregnancy; OR During your pregnancy or before were you ever a victim of verbal abuse; OR Was forced sex the cause of pregnancy?
Pregnancy IPV Composite 2: Answer yes to any of these two questions: Did you experience any physical abuse during this pregnancy; OR Was forced sex the cause of pregnancy?
Lifetime Sexual IPV: Have you ever been forced to engage in sexual activity against your will?
Three-quarters of the study participants were enrolled prior to the start of the COVID-19 pandemic and 25% occurred after March 30, 2020. Although the absolute rates of all types of reported IPV were higher during the pandemic, the absolute rate differences were small and none of these differences were statistically significant, as shown in Table 4.
Table 4.
Rates of intimate partner violence prior to and after the onset of COVID-19 pandemic (March 30, 2020), N = 606
| Intimate partner violence | Prepandemic birth (N = 452) | Pandemic birth (N = 154) | OR (95% CI) | p-value |
|---|---|---|---|---|
| Lifetime IPV | 100 (23.4%) | 37 (24.5%) | 1.06 (0.69, 1.64) | 0.78 |
| Pregnancy IPV Composite 1 | 83 (19.8%) | 33 (22.2%) | 1.15 (0.73, 1.82) | 0.54 |
| Pregnancy IPV Composite 2 | 12 (2.8%) | 5 (3.4%) | 1.19 (0.41, 3.43) | 0.75 |
| Verbal IPV before or during pregnancy | 79 (18.8%) | 33 (21.9%) | 1.21 (0.77, 1.91) | 0.41 |
| Physical IPV during pregnancy | 9 (2.1%) | 5 (3.3%) | 1.59 (0.52, 4.81) | 0.41 |
| Sexual IPV causing pregnancy | 3 (0.7%) | 0 (0%) | – | – |
| Physical IPV during pregnancy and verbal IPV | 7 (1.7%) | 5 (3.3%) | 2.02 (0.63, 6.45) | 0.24 |
| Sexual IPV causing pregnancy and verbal IPV | 1 (0.2%) | 0 (0%) | – | – |
| Lifetime sexual IPV | 68 (16.0%) | 28 (18.5%) | 1.19 (0.73, 1.94) | 0.48 |
Abbreviation: CI, confidence interval; IPV, intimate partner violence; OR, odds ratio.
Note: Data are reported as number (%) and ORs with 95% CI.
Discussion
Principal Findings
In this urban cohort, one-fifth (20.4%) of 568 parturients reported IPV, aligning with the higher end of estimates in the literature.5 Our analysis not only confirmed known social risk factors for IPV but also identified several novel factors, such as racial and gender-based discrimination. Despite evidence of increased IPV during COVID-19 in the general population,8 there was no significant change in the rate of IPV after the onset of the pandemic in our study population.
Results in Context
Consistent with prior publications, we found that unmarried status, income near or below the poverty line, and unintended pregnancy are associated with IPV around the time of pregnancy.4–6 While young age and low education are typically cited as risk factors for IPV,4–6 our study found no association, perhaps related to the low number of participants in our study who were under the age of 18. Our study is also part of emerging literature on food and housing insecurity, gravida, and levels of joy in relation to IPV during pregnancy, all of which we found to be significantly associated with IPV. Utilization of Medicaid and WIC (Special Supplemental Nutrition Program for Women, Infants and Children) was higher in IPV cases but not to a statistically significant extent. This contrasts a cross-sectional study using 2004–2011 National Pregnancy Risk Assessment Monitoring System survey data (N = 319,689).11
A meta-analysis examining risk factors for violence during pregnancy identified race, drug abuse, and lack of social support as understudied variables.6 Here, we found that race was not predictive of IPV, but lack of social support and substance use during pregnancy were. Further, while race was not associated with IPV in our study, we found that perceived racism was. Combined with gender-based discrimination as another significant IPV risk factor, these results highlight the need to address structural violence in society as a driver of IPV.
COVID-19 sparked concern for an IPV “pandemic within a pandemic” with at-risk individuals spending more time at home with their abusers during quarantine. Wood et al’s cohort study on pregnant women in Ethiopia is one of, if not the only publication to date addressing the influence of COVID-19 on IPV in an obstetric population.9 They observed a modest increase in IPV during pregnancy during the pandemic (15.1%, N = 983) compared to prepandemic (10.5%, N = 1,405), adjusted odds ratio (aOR) 1.51, 95% CI, p < 0.05. When stratified by urban versus rural residence, the increase in IPV for urban households was more dramatic, 10.9% compared to 5.6% in rural residences, aOR = 2.09, 95% CI, p < 0.05.
Qualitative interviews with the participants in Wood et al’s study named loss of income and increased time spent at home as key stressors exacerbating IPV.9 Our study assesses similar questions among an urban perinatal cohort, but we found that COVID-19 had no influence on the rate of IPV. Although our sample size was similar to the population studied in Ethiopia (N = 884, compared to N = 606 in our study), we found very small rate differences in IPV before and during the pandemic. The disparity in findings between these studies may be related to inherent differences in population characteristics and access to social support. It is also possible that the large percentage of unmarried participants in this study was protective in that fewer individuals lived with their abusive partner during quarantine.
Clinical Implications
Our study and others published previously demonstrate the high incidence of IPV during pregnancy, highlighting the importance of interdisciplinary, trauma-informed interventions and social support to address this complex issue. Antiviolence and antiracism efforts are critical in clinical and behavioral health settings, shelters, and medical education. A model infrastructure within clinical settings would also feature tobacco cessation and substance use specialists, mental health professionals with IPV training, and a social work network for food and housing resources.
Additionally, the therapeutic value of clinicians listening to survivors' stories cannot be overstated. As demonstrated in a qualitative study of individual experiences of IPV during pregnancy, there is much to be learned about a patient’s support system—or lack thereof— risk of suicide, and more through active listening and structured screening.12 Trauma-informed trust-building and safety planning in a clinical setting could establish a lifesaving relationship for parturients suffering from IPV.
Research Implications
Accessible and confidential means of contraception remains a key prevention method. Drexler et al propose that unplanned pregnancy may be the greatest modifiable risk factor for IPV.5 With the current climate around access to abortion and women’s reproductive rights, further research could focus on methods for patient-centered family planning in individuals with a history of IPV. Other directions for research include streamlined screening methods with the rise of telehealth during COVID-19. Despite concerns that patients may not be able to speak privately during virtual visits,5 telehealth presents a way to reach those whose abusive partners accompany them to clinic visits. Finally, the field would benefit from more qualitative and quantitative investigation around the impact of racism and gender discrimination on IPV outcomes.
Strengths and Limitations
Although our study adds depth to the limited existing knowledge surrounding the association between IPV during pregnancy and SDoH, it has important limitations. If participants are uncomfortable answering certain personal questions, they may deny the presence of negatively perceived factors or not answer the question due to social desirability bias. This could bias the identified associations toward the null. Recall bias may also play a part in questions about early pregnancy. Additionally, our analysis was constrained by the questionnaire’s preexisting timeline, and we were unable to quantify sexual and verbal abuse during pregnancy alone. The wording for three of the five survey questions on IPV included abuse before pregnancy. For example, “During your pregnancy or before, were you ever a victim of verbal abuse?” Generalizability is another limitation as this population is based solely in a single metropolitan city in the United States.
Conclusion
IPV during pregnancy is a public health concern. Multiple lives are at risk in these cases; in addition to fatal and non-fatal physical injury, mothers are at high risk for major depression, posttraumatic stress disorder, substance use, sexually transmitted infections, and suicide.4,13 Regarding fetal health, numerous studies have shown that IPV during pregnancy is significantly associated with preterm birth and low birth weight,3,13 the second leading cause of infant death nationally.14 We suggest here that targeting SDoH in clinical settings, creating opportunities for patients to disclose abuse, and probing further into the relationship between identity-based discrimination and IPV all represent chances to promote the safety of pregnant patients and their children.
Supplementary Material
Key Points.
One in five parturients disclosed IPV.
Racial discrimination was correlated with IPV.
Food and housing insecurity increase IPV risk.
COVID-19 did not increase the rate of IPV.
Psychosocial support is vital during pregnancy.
Funding
This study was funded by the NIH-University of Cincinnati Medical Student Summer Research Program (grant no.: T35DK060444)
Footnotes
Conflict of Interest
None declared.
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