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Intimate partner violence among economically disadvantaged young adult women: associations with adolescent risk-taking and pregnancy experiences.

Article Excerpt
Relationship violence occurs at every socioeconomic level and across all age-groups, but women in their early 20s living in economically disadvantaged urban communities are especially vulnerable. Nonfatal intimate partner violence peaks during late adolescence and young adulthood, (1,2) and women living in poverty are more likely to be victimized by intimate partners than are more affluent women. (3,4) Intimate partner violence has frequently been examined in terms of its impact on reproductive health. This is understandable, given the potential seriousness of violence, especially when women are pregnant and their own health and the health of their fetus may be in jeopardy In this article, we flip the equation to consider the relationship between women's risk behaviors and pregnancy during adolescence and their exposure to intimate partner violence during their early 20s.

A constellation of factors, including family histories of abuse and high levels of community violence, and such aspects of structural violence as discrimination and racism, are known to contribute to increased risks of intimate partner violence in settings where relationships and families are challenged by poverty. (5) Low-income, predominantly minority, young women may also be at risk because of their reproductive histories, which differ in a number of ways from those of their more affluent peers. (6) Socioeconomically disadvantaged women are more likely than others to initiate sex before entering high school, get pregnant unintentionally as teenagers, become mothers before age 21 and be single parents. If they become pregnant, they face hurdles to high school graduation as well as postsecondary education, which limit their employment prospects and potentially constrain their ability to leave abusive relationships. (7) Some evidence suggests that young women in these circumstances may be more likely to bear a child than to get an abortion, even if they are not in a stable relationship or married. (8) Further, despite the growing acceptance of single parenthood and declines in the overall U.S. abortion rate from 1994 to 2000, the rate of abortions rose sharply for women with incomes of less than twice the federal poverty line. (9) A disproportionate number of abortions in the United States are obtained by never-married women, residents of metropolitan areas, and blacks and Hispanics--in sum, a large proportion of women of reproductive age residing in our nation's inner cities. (10)

Research has also drawn links between behaviors in adolescence and intimate partner violence during the teenage and young adult years. (11-13) This is especially a concern for urban young women, who report relatively high levels of peer-directed violence, especially during middle school, a time when such behaviors as fighting often peak among both boys and girls. (14) Once initiated, these aggressive patterns of interacting and resolving interpersonal conflicts may be difficult to break. (15) Indeed, it appears that those who engage in aggressive behavior during the middle school years are particularly vulnerable to dating violence during adolescence, as well as adult partnership violence, and that those who experience intimate partner violence once are at risk of repeat occurrences. (16-18) Whether such violence occurs, however, may be influenced by other life events and relationship stressors, including women's experiences with pregnancy.

Because far more women than men are killed or seriously harmed by a partner every year, (19-21) most research on the connections between reproductive health and intimate partner violence understandably focuses on women as victims. However, in contrast to other forms of interpersonal violence, intimate partner violence is as often perpetrated by women as by men, perhaps in part because women underestimate the potential harm of partners' retaliation: Statistics clearly indicate that men strike with more deadly force. (22) Here, we focus on women as both victims and perpetrators, to obtain a better understanding of overall intimate partner violence involvement and its links to prior risk behaviors and pregnancy experiences.

Intimate partner violence has been correlated with negative maternal and infant health outcomes that may be a consequence of HIV and other STDs, as well as with stress and exacerbation of chronic health problems. (23) In a 2007 review, Coker identified 51 research reports, mostly cross-sectional, that address the link between intimate partner violence and sexual and reproductive health. Intimate partner violence was associated with sexual risk-taking, inconsistent condom use, partner nonmonogamy, having an unplanned pregnancy or induced abortion, having an STD and sexual dysfunction. (24) In a review of research on the consequences of unintended pregnancies which account for an estimated half of U.S. pregnancies (25)--Pallitto et al. also draw a connection to intimate partner violence, while noting that research on associations between the two is limited. (26) In a study that compared women visiting family planning and prenatal clinics, those seeking an abortion were more likely than those continuing their pregnancies to have been victims of intimate partner violence in the past year. (27) In a multistate survey of women who had recently given birth, those whose pregnancies had been unwanted or mistimed reported rates of physical violence that were about five times the rate among women who had intended their pregnancies; in analyses controlling for income and education levels, women who had had mistimed or unwanted pregnancies accounted for 70% of those who reported physical violence. (28)

Women who experience physical violence and emotional abuse during pregnancy may have an elevated risk for miscarriage, although evidence is mixed. (29,30) Data from women giving birth in 26 states and participating in the 2000-2003...

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