Judith McFarlane

Risk factors for femicide in abusive relationships: results from a multisite case control study.

OBJECTIVES This 11-city study sought to identify risk factors for femicide in abusive relationships. METHODS Proxies of 220 intimate partner femicide victims identified from police or medical examiner records were interviewed, along with 343 abused control women. RESULTS Preincident risk factors associated in multivariate analyses with increased risk of intimate partner femicide included perpetrators access to a gun and previous threat with a weapon, perpetrators stepchild in the home, and estrangement, especially from a controlling partner. Never living together and prior domestic violence arrest were associated with lowered risks. Significant incident factors included the victim having left for another partner and the perpetrators use of a gun. Other significant bivariate-level risks included stalking, forced sex, and abuse during pregnancy. CONCLUSIONS There are identifiable risk factors for intimate partner femicides.

Battered and pregnant: a prevalence study.

We interviewed 290 pregnant women randomly selected from public and private prenatal clinics, 80 per cent of whom were at least five months pregnant (ages 18-43, 42 per cent Latino, 22 per cent Black). Twenty-four women reported physical battering during this pregnancy (44 reported physical battering before the current pregnancy). Eight of the 24 pregnant women had sought medical treatment for injuries sustained; none reported having been assessed by prenatal care providers for abuse.

Abuse during pregnancy: associations with maternal health and infant birth weight.

A stratified, prospective cohort analysis was completed on 1,203 African American, Hispanic, and white women. All women were assessed for abuse at the first prenatal visit and twice more during pregnancy. They were also assessed for risk factors of low birth weight using Institute of Medicine correlates. Prevalence of physical or sexual abuse during pregnancy was 16% (1 of 6). Abused women were twice as likely to begin prenatal care during the third trimester, with abuse preceding late entry. Abuse was recurrent, with 60% of the women reporting repeated episodes. More severe abuse was significantly correlated with lower infant birth weights for all three ethnic groups. Abuse during pregnancy was a significant risk for low birth weight as well as maternal low weight gain, infections, anemia, smoking, and use of alcohol and drugs. When compared to women who were not abused, women abused during pregnancy delivered infants averaging 133 g less. Abused white women delivered infants with the greatest reduction in birth weight.

Testing an intervention to prevent further abuse to pregnant women

Although violence against women is recognized as a major public health problem, few interventions have been developed to reduce abuse. In this study, 132 pregnant women received three counseling sessions that were designed to reduce further abuse. A comparison group of 67 abused women were offered wallet-sized cards listing community resources for abuse. Women in both groups were followed at 6 months and 12 months post-delivery. Using repeated measures MANCOVA with entry scores as a covariate, we found significantly less violence reported by women in the intervention group than by women in the comparison group.

The birth-weight / battering connection.

This paper presents a random study of postpartum women aged 18 years or older to examine the correlation of low birth weight (LBW) with female physical abuse. A total of 589 women in both private and public hospital were interviewed on the demographic information to explore womans history of battering to uncover verbal abuse and threats of physical abuse and to find out whether the woman smokes or had used alcohol during pregnancy. Findings revealed that significantly more LBW infants were born to battered women (12.5%) than to nonbattered women (6.6%). At the private hospital 17.5% of battered women had LBW infants while at the public hospital the LBW rate was slightly higher among battered women. However the difference was not statistically different. Alcohol consumption was reportedly less in public patients than among the private patients. Battered women did smoke more than the nonbattered women in both hospital settings but found no significant association of smoking itself with LBW deliveries. From the study it was found out that there is a correlation between battering and LBW.

Stalking and Intimate Partner Femicide

An 18-item stalking inventory and personal interviews with knowledgeable proxy informants and victims of attempted femicide were used to describe the frequency and type of intimate partner stalking that occurred within 12 months of attempted and actual partner femicide. One hundred forty-one femicide and 65 attempted femicide incidents were evaluated. The prevalence of stalking was 76% for femicide victims and 85% for attempted femicide victims. Incidence of intimate partner assault was 67% for femicide victims and 71% for attempted femicide victims. A statistically significant association existed between intimate partner physical assault and stalking for femicide victims as well as attempted femicide victims. Stalking is revealed to be a correlate of lethal and near lethal violence against women and, coupled with physical assault, is significantly associated with murder and attempted murder. Stalking must be considered a risk factor for both femicide and attempted femicide, and abused women should be so advised.

Secondary Prevention of Intimate Partner Violence: A Randomized Controlled Trial

Background: Despite the recognition of intimate partner violence (IPV) against women as a global health issue associated with significant morbidity and mortality, evidence-based treatment strategies for primary care settings are lacking. Objective: To assess the comparative safety behaviors, use of community resources, and extent of violence following two levels of intervention. Methods: A randomized, two-arm, clinical trial was completed in urban public primary care clinics with 360 abused women who assessed positive for physical or sexual abuse within the preceding 12 months. Two interventions were tested: a wallet-sized referral card and a 20-minute nurse case management protocol. Outcome measures were differences in the number of threats of abuse, assaults, danger risks for homicide, events of work harassment, safety behaviors adopted, and use of community resources between intervention groups over a 24-month period. Results: Two years following treatment, both treatment groups of women reported significantly (p <.001) fewer threats of abuse (M = 14.5; 95% CI 12.6, 16.4), assaults (M = 15.5, 95% CI 13.5, 17.4), danger risks for homicide (M = 2.6; 95% CI 2.1, 3.0), and events of work harassment (M = 2.7; 95% CI 2.3, 3.1), but there were no significant differences between groups. Compared to baseline, both groups of women adopted significantly (p <.001) more safety behaviors by 24 months (M = 2.0; 95% CI 1.6, 2.3); however, community resource use declined significantly (p <.001) for both groups (M = −0.2; 95% CI −0.4,−0.2). There were no significant differences between groups. Discussion: Disclosure of abuse, such as what happens with abuse assessment, was associated with the same reduction in violence and increase in safety behaviors as a nurse case management intervention. Simple assessment for abuse and offering of referrals has the potential to interrupt and prevent recurrence of IPV and associated trauma.

Physical and emotional abuse in pregnancy: a comparison of adult and teenage women.

A sample of 691 African American, Hispanic, and white pregnant teenage and adult women were interviewed in the prenatal setting. On their first prenatal visit, 182 (26%) women reported physical or sexual abuse within the past year. There were significant differences between the teens and adults, with a higher percentage of teens (31.6%) reporting abuse during the prior year than adults (23.6%). The rate of abuse during pregnancy was 21.7% for teens and 15.9% for adult of women. Adult women scored significantly higher than teens on two measures of mental abuse. Mental abuse was significantly correlated with physical abuse for all subjects.

Abuse during pregnancy and femicide: urgent implications for women's health

OBJECTIVE To describe the odds of femicide (homicide of females) for women abused during pregnancy. METHODS A ten‐city case‐control design was used with attempted and completed femicides as cases (n = 437) and randomly identified abused women living in the same metropolitan area as controls (n = 384). The attempted and completed femicide cases were identified from police and medical examiner records. Interviews of attempted femicide victims and a proxy for the femicide victim were compared with data from abused controls, identified via random digit dialing in the same ten cities. RESULTS Abuse during pregnancy was reported by 7.8% of the abused controls, 25.8% of the attempted femicides, and 22.7% of the completed femicides. Five percent of the femicide victims were murdered while pregnant. After adjusting for significant demographic factors, such as age, ethnicity, education, and relationship status, the risk of becoming an attempted/completed femicide victim was three‐fold higher (adjusted odds ratio 3.08, 95% adjusted confidence interval 1.86, 5.10) for women abused during pregnancy. Black women had more than a three‐fold increase in risk (adjusted odds ratio 3.6, 95% adjusted confidence interval 2.4, 5.5) as compared with white women. Compared with women not abused during pregnancy, controls and attempted/completed femicide victims abused during pregnancy reported significantly higher levels of violence. CONCLUSION Femicide is an important, but often unreported, cause of maternal mortality. This is the first report of a definite link between abuse during pregnancy and attempted/completed femicide. This research documents the immediate need for universal abuse assessment of all pregnant women.

Identifying and helping battered pregnant women.

Because battering during pregnancy is a frequent occurrence, nurses must routinely assess women for injury during prenatal visits