Pregnant Women Commonly Report a History of Abuse

By Will Boggs, M.D.
Medscape Medical News
June 20, 2014

NEW YORK (Reuters Health)—Almost half of pregnant women surveyed in six European countries reported a history of abuse at some time in their lives, according to findings from a prospective cohort study.

"The levels of abuse reported agree well with other studies," Dr. Mirjam Lukasse from Oslo and Akershus University College of Applied Sciences in Oslo, Norway told Reuters Health by email. "What I had little idea about was how many reported current suffering. And on the whole for sexual abuse less than one third reported no current suffering, for emotional abuse this is about one fifth, and really physical abuse is that which gave least current suffering (only half of the women expressed current suffering)."

"Of course there is overlap between the different types of abuse so one cannot divide them like this," she said. "But really many women suffer from the abuse experienced and some suffer a lot."

Although evidence suggests that pregnant women are particularly vulnerable to abuse, there had been no international population–based studies conducted among pregnant women attending routine antenatal care.

Dr. Lukasse and colleagues estimated the prevalence of physical, emotional, and sexual abuse experienced as a child or as an adult among 7174 women participating in the Bidens study, a six–country (Belgium, Iceland, Denmark, Estonia, Norway, and Sweden) cohort study of unselected pregnant women.

Overall, 3530 (49.2%) reported a history of abuse, and this figure was still 34.8% after excluding mild physical abuse, according to the May 20 Acta Obstetricia et Gynecologica Scandinavica online report.

The level of current suffering from this abuse differed by country and type of abuse. Current moderate or severe suffering from emotional abuse ranged from 68.1% of Estonian women to 88.8% of Icelandic women who reported a history of emotional abuse. For physical abuse (excluding mild), current moderate or severe suffering ranged from 46% of Estonian women to 70% of Icelandic women.

Overall, 44.9% of women with a history of physical abuse reported no current suffering, compared with 21.3% of those reporting emotional abuse and 28.6% of those reporting sexual abuse.

Women who experienced more than one type of abuse reported a higher median score for suffering, compared with women who reported only one type of abuse.

"Many countries have introduced routinely asking pregnant women about abuse and this eventually will reduce the rate of abuse," Dr. Lukasse said. "I also think routinely asking about abuse in accidents and emergency departments is advisable and in women meeting psycho–social services."

"Research shows that women do not mind being asked," Dr. Lukasse said. "And those who have experienced it may not answer positively until they have been asked several times. Continuity of carer is important as this offers the opportunity to build a trusting relationship."

"You may save lives by asking!" Dr. Lukasse concluded. "Studies show that a history of abuse is associated with a great number of symptoms and diseases which cause women to visit a doctor. So doctors will meet a higher prevalence of abuse among their patients than is generally found in society and among unselected pregnant women."

Acta Obstet Gynecol Scand, Copyright © June, 2014.