Preventing or reducing partner violence against women during pregnancy

Violence against women by partners during pregnancy is a major public health concern. It can cause physical and psychological harm to women and may lead to pregnancy complications and poor outcomes for babies. It is not clear what sort of intervention best serves women and infants during pregnancy and after giving birth to ensure their safety. Interventions that might work include counselling and psychological therapy to give women more confidence and to encourage them to make plans to avoid abuse. Referral to social workers, shelters and other community-based resources may also help. For partners, referral can be made to 'batterer' treatment programs.  

Routine prenatal care offers opportunities for healthcare staff to identify women at risk of being abused. In this review we included 10 randomised trials involving a total of 3417 women, seven of which studied pregnant women who were at high risk of partner violence. The interventions examined in the studies included a single brief individualised consultation, case management and referral to a social care worker, and multiple therapy sessions during pregnancy and after birth. Due to the lack of data, and the different way outcomes were reported, we were unable to identify interventions that worked better than others. Studies focused on different outcomes and we were not able to pool information to draw conclusions about the overall effectiveness of the interventions. Most of the studies did not report on whether or not there had been any reduction in episodes of violence. There was evidence from a single study that the total number of women reporting partner violence during pregnancy and after birth was reduced for women receiving a psychological therapy intervention. Several of the studies examined whether women who received interventions were less likely to have depression after the birth of the baby, but the evidence was not consistent. Other outcomes for the baby such as reduced birthweight and preterm birth were reported in only one study, and the intervention did not lessen the risk of preterm birth (< 2500 g). None of the studies reported results for important outcomes such as stillbirth, neonatal death, miscarriage, maternal deaths, antepartum haemorrhage, and placental abruption. More information is needed from well-conducted trials before any particular interventional approach can be recommended.

Authors' conclusions: 

There is insufficient evidence to assess the effectiveness of interventions for domestic violence on pregnancy outcomes. There is a need for high-quality, RCTs with adequate statistical power to determine whether intervention programs prevent or reduce domestic violence episodes during pregnancy, or have any effect on maternal and neonatal mortality and morbidity outcomes.

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Background: 

Domestic violence during pregnancy is a major public health concern. This preventable risk factor threatens both the mother and baby. Routine perinatal care visits offer opportunities for healthcare professionals to screen and refer abused women for effective interventions. It is, however, not clear which interventions best serve mothers during pregnancy and postpartum to ensure their safety.

Objectives: 

To examine the effectiveness and safety of interventions in preventing or reducing domestic violence against pregnant women.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2014), scanned bibliographies of published studies and corresponded with investigators.

Selection criteria: 

We included randomised controlled trials (RCTs) including cluster-randomised trials, and quasi-randomised controlled trials (e.g. where there was alternate allocation) investigating the effect of interventions in preventing or reducing domestic violence during pregnancy.

Data collection and analysis: 

Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.

Main results: 

We included 10 trials with a total of 3417 women randomised. Seven of these trials, recruiting 2629 women, contributed data to the review. However, results for all outcomes were based on single studies. There was limited evidence for the primary outcomes of reduction of episodes of violence (physical, sexual, and/or psychological) and prevention of violence during and up to one year after pregnancy (as defined by the authors of trials). In one study, women who received the intervention reported fewer episodes of partner violence during pregnancy and in the postpartum period (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.43 to 0.88, 306 women, moderate quality). Groups did not differ for Conflict Tactics Score - the mean partner abuse scores in the first three months postpartum (mean difference (MD) 4.20 higher, 95% CI -10.74 to 19.14, one study, 46 women, very low quality). The Current Abuse Score for partner abuse in the first three months was also similar between groups (MD -0.12 lower, 95% CI -0.31 lower to 0.07 higher, one study, 191 women, very low quality). Evidence for the outcomes episodes of partner abuse during pregnancy or episodes during the first three months postpartum was not significant (respectively, RR 0.50, 95% CI 0.25 to 1.02, one study with 220 women, very low quality; and RR 0.60, 95% CI 0.35 to 1.04, one study, 271 women, very low quality). Finally, the risk for low birthweight (< 2500 g) did not differ between groups (RR 0.74, 95 % CI 0.41 to 1.32, 306 infants, low quality).

There were few statistically significant differences between intervention and control groups for depression during pregnancy and the postnatal period. Only one study reported findings for neonatal outcomes such as preterm delivery and birthweight, and there were no clinically significant differences between groups. None of the studies reported results for other secondary outcomes: Apgar score less than seven at one minute and five minutes, stillbirth, neonatal death, miscarriage, maternal mortality, antepartum haemorrhage, and placental abruption.

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