Original studies
A Prospective Cohort Study of the Impact of Domestic Violence on Young Teenage Pregnancy Outcomes

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Abstract

Introduction: The incidence of domestic violence among pregnant Australian teenagers is higher than rates reported for the general community. However, there are limited data that address the impact of this abuse upon pregnancy outcome. We have examined the significant antenatal associations of domestic violence in young teenage pregnancy, and the impact of this abuse upon pregnancy outcome.

Design, Setting, Participants: A multicenter prospective cohort study was performed between January 1, 1997 and June 30, 1999. Patients were interviewed and completed questionnaires in the antenatal period to establish whether they were victims of domestic violence. Labor and delivery details were independently collated after discharge for mother and infant. Data were analyzed using an analysis of variance, with a P-value of 0.05 considered significant.

Results: Of 537 patients enrolled in the study, 157 (29.2%) were victims of domestic violence; 380 (70.8%) were not and acted as pregnant teenage controls. Key findings were that teenage victims of domestic violence (VDV) were more likely to smoke, drink alcohol, or use illegal drugs than controls (P < 0.0001). VDV had a higher incidence of infectious morbidity and Pap smear abnormalities (P < 0.007) and psychosocial pathology (P < 0.0001) than controls. A higher incidence of puerperal and neonatal morbidity was observed in VDV and their newborns compared to controls (P < 0.007). The estimated cost of hospital care for teenage VDV was double that of the Australian average.

Conclusion: We need to identify all teenage mothers exposed to domestic violence and provide them with expert intervention services. Early intervention programs are likely to be cost effective.

Introduction

Domestic violence destroys the sanctity of family life and the security that families are best able to provide.1 Although the peak rates of domestic violence are reported in women aged 20 to 24 yr, it has been suggested that working with adolescents could be a promising way to prevent the cycle of abuse and reduce the social, economic, and personal costs of this problem.

Some high-risk groups of adolescents can be identified. In Australia, there are approximately 13,000 teenage pregnancies each year, and the numbers have remained stable for the past decade despite access to contraception, abortion, and educational strategy.2 The incidence of domestic violence among pregnant Australian teenagers is higher than rates reported for the general community.3 The problems of young unsupported parenthood are thus compounded by the additional risks of physical and sexual abuse of both the adolescent mother and the newborn child.

Teenage pregnancy can also initiate a cycle of social disadvantage and dependency on government benefits.4 Pregnancy often arises from unstable or casual relationships, often with older men, and the adolescent is forced to become a parent before fully maturing into an adult.5 Furthermore, associated depression and adjustment disorders affecting the teenage mother as a result of abuse increase the likelihood of behavioral difficulties in the newborn6 and long-term illness in the child.7 The pregnant abused teenager may be incapable of adequately caring for herself, let alone caring for an infant.

Despite the adolescent antenatal patient being at risk of domestic violence,5 there are surprisingly little data that address the impact of this abuse upon pregnancy outcome. We therefore set out to audit this data by conducting a prospective multicenter study to determine the significant antenatal associations of domestic violence in young adolescent pregnancy, and the impact of this abuse upon pregnancy outcomes. Finally, we audited the cost of teenage pregnancy, both those complicated by domestic violence and the teenage–control pregnancies, and compared these to the average Australian cost of pregnancy and delivery care.

Section snippets

Methods

A multicenter prospective cohort study was performed between January 1, 1997 and June 30, 1999. Patients were enrolled at King Edward Memorial (KEMH) and Osborne Park (OPH) hospitals and the Joondalup Health Campus (JHC). All pregnant women aged 12 to 17 yr that intended to continue with their pregnancy and did not intend to give up their infant were eligible for the study. Informed patient consent and multi-institutional ethics committee approval were obtained.

Patients underwent semistructured

Results

Of the 598 pregnant women aged 12 to 17 yr eligible for the study, 61 (10.2%) declined to participate. Of the remaining 537 patients, 157 (29.2%) were victims of domestic violence and 380 (70.8%) were not and act as controls in subsequent comparisons. Table 1 summarizes the demographic data of the teenage antenatal patients who were victims of domestic violence (VDV) and the teenage antenatal controls (controls). Of note, there were no significant differences between the two groups in terms of

Discussion

In the present study, nearly 30% of pregnant teenagers aged 12 to 17 yr were victims of domestic violence. These figures agree with previously reported Australian data on the incidence of domestic violence.3, 8, 9 A cohort study designed to assess the ability of staff at specialized adolescent and general antenatal clinics, respectively, to diagnose psychosocial problems reported that 22% of teenage mothers had experienced domestic violence.3 A recent survey of women attending emergency

Acknowledgements

Grant support was provided by Innovative Funding for Homeless Youth Support Services, Health Department of Western Australia, Australia.

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