What happens when you don't address relationship violence in patients with disability?

Compared to non-disabled women, women with disabilities are more likely to deliver babies pre-term (31% more likely) and have infants born at a low birth weight (30% more likely) who require care in a NICU (45% more likely).

findings of Jeanne Alhusen and team's study on the intersection of disability, pregnancy, and violence

Questions about relationship violence are increasingly a routine part of primary care visits, and an important part of getting survivors of intimate partner violence (IPV) the help they need.

Understanding what’s at stake when these kinds of questions aren’t asked, though, is just as important: especially when it comes to caring for women with disabilities, who comprise between 12-20% of women of childbearing age, more than a million Americans strong, who are just as likely as their non-disabled peers to both want and have children.

Those unasked questions are part of what compelled Jeanne Alhusen, associate dean for research and the UVA Medical Center Professor of Nursing and her team to dig into new federal data, continuing their NIH-funded work and the $2.1 million R01 grant they earned. The team zeroed in on disability-related disparities specific to IPV screening to update the little that’s known about women with disabilities, who have a notoriously difficult time receiving the reproductive and family planning care they need.

49.7%

of women with disability are depressed during the perinatal period (versus 8.2% of non-disabled women)

In previous work, Alhusen found that one-third of women with disabilities reported that their pregnancies were the result of sexual violence, and that, as a group, they were 2.5 more likely to experience violence during pregnancy than their non-disabled peers. Alhusen’s new study—soon-to-be-published—pored over more than 44,500 health records of women who gave birth between 2018 and 2021, more than 40% of whom had either a moderate or severe disability.

Even Alhusen—the first scientist to demonstrate, on a population-based level, the link between exposure to violence during pregnancy and infants’ risk of being born small-for-gestational-age—called the findings “sobering.”

13.9%

of women with disability experience pregnancy-related health conditions (versus 9.9% of non-disabled women)

Compared to non-disabled women, women with disabilities are more likely to deliver babies pre-term (31% more likely) and have infants born at a low birth weight (30% more likely) who require care in a NICU (45% more likely).

“Our findings demonstrate with numbers the health inequities taking place when violence is a factor in pregnant women’s lives,” Alhusen said, noting the cascade of poor physical and mental health outcomes that women and infants who are exposed to violence experience. “We clinicians, through our care, can change these odds.”

“Our findings demonstrate with numbers the health inequities taking place when violence is a factor in pregnant women’s lives. We clinicians, through our care, can change these odds.”

Jeanne Alhusen, nurse scientist, associate dean for research, and the UVA Medical Center Professor of Nursing

The scientists say that clinicians must not only ask about relationship violence but expand and specify their line of questioning when disability is present.

Has your partner prevented you from using a wheelchair, cane, respirator, or other device?

Has your partner refused to help you with an important personal need, such as taking your medicine, getting to the bathroom, getting out of bed, bathing, getting dressed, getting food or drink, or threatened not to help you with these personal needs?

1/3

of women with disabilities experience unintended pregnancy (versus 21% of non-disabled women)

They must also take care to offer all the usual pregnancy-related advice, too, when caring for women with disabilities: everything from urging folic acid supplements to improving their health before conception.

“Disabled women are just as likely to want to and to become parents as the rest of us,” Alhusen said. “Why wouldn’t we honor and support that very human desire with the specialized care they and their babies truly deserve?”