Risk Factor Violence

Violence and Victims, Volume 28, Number 3, 2013
Risk Factors for Domestic Violence

During Pregnancy:
A Meta-Analytic Review
Lois James, PhD
David Brody, PhD
Zachary Hamilton, PhD
Washington State University
This article presents the results of a meta-analysis of the existing research literature, in an
effort to increase our understanding of the prevalence of domestic violence (DV) among
pregnant women, and of risk factors associated with DV during pregnancy. Across 92 inde-
pendent studies, the average reported prevalence of emotional abuse was 28.4%, physical
abuse was 13.8%, and sexual abuse was 8.0%. Composite odds ratio effect sizes were
calculated for the demographic, behavioral, and social risk factors identified by 55 inde-
pendent studies. Both victimization and perpetration risk factors were analyzed. Abuse
before pregnancy and lower education level were found to be strong predictors of abuse
during pregnancy. Pregnancy being unintended by either the victim or the perpetrator,
lower socioeconomic status, and being unmarried were found to be moderate predictors
of abuse during pregnancy.
Keywords: meta-analysis; pregnant; intimate partner violence (IPV); spousal abuse
D
omestic violence (DV) is a widespread social problem that affects between 17%
and 25% of women throughout their lifetime (Washington State Department
of Health, 2004). Although prevalence estimates for DV during pregnancy are
unclear, homicide by a spouse or romantic partner is the number one cause of death for
pregnant women (Cheng & Horon, 2010). Prior meta-analytic reviews have revealed
several common risk factors for DV, including illicit drug use, violence having been
witnessed as a child, traditional attitudes toward gender roles, less marital satisfaction,
lower educational achievement, and lower socioeconomic status (Schumacher, Slep, &
Heyman, 2001; Stith et al., 2000; Sugarman & Frankel, 1996; Sugarman & Hotaling,
1997). A growing number of studies have paid specific attention to the relationship
between DV and pregnancy; however, the impact of risk factors on DV remains
unclear. To develop and implement effective screening and intervention processes,
researchers and practitioners need a clear understanding of these pregnancy-specific
DV risk factors.
© 2013 Springer Publishing Company 359

http://dx.doi.org/10.1891/0886-6708.VV-D-12-00034
360 James et al.
LITERATURE REVIEW
Domestic Violence (DV) can be broadly defined as a pattern of abusive behaviors between
partners in an intimate relationship (American Medical Association, 2009). DV is also
known as domestic abuse, spousal abuse, battering, family violence, and intimate partner
violence (IPV). Acts of violence include physical aggression/threats of physical aggres-
sion, sexual abuse, emotional abuse (intimidation, stalking, neglect), and economic depri-
vation (Markowitz, 2000). In the United States, approximately 4.8 million women suffer
intimate partner–related physical assaults and rapes, and 2.9 million men are victims of
physical assault from their partners each year (Centers for Disease Control and Prevention,
2011). However, it is estimated that as few as 1% of DV cases are reported to the police
(Roberts & Springer, 2007), suggesting that underreporting of DV is widespread. Despite
the large body of research dedicated to understanding the dynamics of DV, there is much
that remains uncertain.
One of the most concerning elements of DV is its existence among populations of preg-
nant women. Several issues arise when assessing the relationship between pregnancy and
DV, including the difficulty of estimating the prevalence of abuse among pregnant women.
More than 100 studies have examined the prevalence of DV during pregnancy, and studies
report widely different results based on sampling.
Reports on the prevalence of DV during pregnancy differ from country to country. For
example, in Brazil, the prevalence of DV during pregnancy is estimated to be 63% (Audi,
Segall-Corrêa, Santiago, Andrade, & Pèrez-Escamila, 2008), whereas in Canada, it is
estimated to be 1% (Janssen et al., 2003). Other studies have reported prevalence rates of
4% in China (Leung, Leung, Lam, & Ho, 1999), 5% in England (Bowen, Heron, Waylen,
& Wolke, 2005), 9% in New Zealand (Gao, Paterson, Carter, & Iusitini, 2008), 25% in
Mexico (Castro, Peek-Asa, & Ruiz, 2003), and 28% in India (Khosha, Dua, Devi, &
Sunder Sud, 2005). These statistics may reflect both differences in the prevalence of DV
during pregnancy and differences in reporting. Awareness and documentation of DV differ
from country to country (Bowen et al., 2005; Cardoza, 2005).
Prevalence of DV also varies by setting. Gazmararian and colleagues (1996) reported
a prevalence range of 0.9%–20.1% with the lowest prevalence for women sampled from
a private clinic (average income approximately $50,000 a year) and the highest preva-
lence for women sampled from a public clinic (average income less than $20,000 a year).
National estimates indicate a lower prevalence of DV during pregnancy than hospital set-
ting studies. The results of the Pregnancy Risk Assessment Monitoring System (PRAMS)
show a DV prevalence rate of 2.9%–5.7% among several thousand pregnant women across
11 participating states (Centers for Disease Control and Prevention, 1999). Finally, in a
sample of women attending an obstetrical clinic, Shumway and colleagues (1999) found
that 36% of subjects suffered from verbal abuse, 16% suffered from moderate physical
violence, and 14% suffered from severe physical violence. It is hard to estimate the preva-
lence of DV during pregnancy with studies reporting such different results. Analytical
synthesis of results is necessary to investigate the true prevalence of DV among preg-
nant women.
It is clear that the prevalence of DV for pregnant women varies; however, frequently
missing from these descriptive studies of prevalence is an understanding of what influences
this variance. Although several studies have attempted to identify specific risk factors
predicting DV during pregnancy, the findings are mixed. For example, regarding race/
ethnicity of abused pregnant women, some studies have found no significant differences
Risk Factors for Domestic Violence During Pregnancy 361
(Renker, 1999; Wiemann, Agurcia, Berenson, Volk, & Rickert, 2000), whereas others
have found White women to be at greater risk (Glander, Moore, Michielutte, & Parsons,
1998; McFarlane, Parker, Soeken, & Bullock, 1992), and still others have found Hispanic
women to be at greater risk (Jasinski & Kaufman Kantor, 2001). When examining the
effects of age, studies have found both older age (.35 years; Hedin, 2000) and younger
age (,19 years; Martin, Mackie, Kupper, Buescher, & Moracco, 2001) to increase the risk
of DV for pregnant women. With discrepancy in research findings, it is difficult to judge
the strength of these risk factors from a review of the literature.
Several risk factors to predict DV are more consistently observed in the research,
although still idiosyncratically. For example, low socioeconomic status and lower educa-
tion level (not graduating high school and/or not continuing on into third-level education)
have emerged as predictors for DV during pregnancy across several studies (Cokkinides
& Coker, 1998; Goodwin, Gazmararian, Johnson, Gilbert, & Saltzman, 2000). Women for
whom pregnancy was unintended are also consistently reported to be at greater risk for DV
(Campbell, Oliver, & Bullock, 1993; Cokkinides, Coker, Sanderson, Addy, & Bethea, 1999;
Jasinski, 2001). Stressful life events such as the death of a family member co-occurring
with pregnancy or lifetime exposure to violence (witnessing violence as a child, multiple
abusive relationships, etc.) have been significantly related to increased risk for DV during
that time (Jasinski & Kaufman Kantor, 2001). In addition, men who experience more life
stress possess a greater likelihood to abuse their partners during pregnancy (Chan, 1994;
Conger, Burgess, & Barrett, 1979). Finally, studies have reported low levels of social sup-
port (Curry, 1998), being single (Cokkinides & Coker, 1998), being a first-time parent
(Goodwin et al., 2000), and alcohol abuse (Martin, English, Clark, Cilenti, & Kupper,
1996) as risk factors for DV during pregnancy. Although these studies suggest that low
socioeconomic status, lower education level, unintended pregnancy, stressful life events,
lack of social support, being single, first-time parenting, and alcohol abuse are risk factors
for DV during pregnancy, they report considerable differences in the predictive power of
these risk factors, and they do not compare effect sizes to indicate which risk factors are
most salient. This information is critical to inform preventive measures.
The goal of this study is to analytically synthesize the results of these earlier studies.
This will be accomplished through two objectives: (a) to estimate the overall prevalence
of DV among pregnant women and (b) to identify the risk factors that predict DV among
pregnant women. Given the mixed results of previous studies, we expected to find a certain
amount of heterogeneity in synthesized results. To estimate the prevalence of DV among
pregnant women, we calculated overall prevalence reported by all studies conducted on
DV among pregnant women as well as for two important subgroups. Prior research sug-
gests that prevalence of DV differs based on perception of what constitutes DV (Awusi,
Okeleke, & Ayanwu, 2009). Consequently, we separated studies conducted on DV during
pregnancy in more developed countries from studies conducted in less developed countries
(based on the International Monetary Fund’s World Economic Outlook Report, 2010).
Prior research also suggests that the prevalence of DV is higher among samples of preg-
nant women interviewed in hospital settings than among samples from national surveys
(Gazmararian et al., 1996). For this reason, we estimated prevalence of DV for pregnant
women based on setting: hospital setting or national survey. Finally, we established risk
factors based on all studies, risk factors specific to more developed countries versus less
developed countries, and risk factors reported in hospital settings versus national surveys.
Based on previous research, we hypothesized that prevalence of DV among pregnant
women would be higher in less developed countries than in more developed countries, and
362 James et al.
higher among hospital setting samples than among nationally surveyed samples. We also
hypothesized that risk factors would differ for pregnant women in less developed countries
than in more developed countries (based on the differing perceptions and awareness of DV
internationally). This study was expected to provide a more accurate and objective assess-
ment of the prevalence of DV among pregnant women and what makes some pregnant
women more likely to experience DV than others. This information is vital when develop-
ing targeted screening programs and effective intervention procedures.
METHOD
This study used meta-analytic procedures to assess the prevalence of DV during preg-
nancy and the impact of each risk factor associated with DV during pregnancy, in an
effort to provide a greater understanding of the association between pregnancy and DV.
The methodological steps consisted of a broad literature search, specification of inclusion
criteria, coding information gathered, and analyzing the coded data.
Literature Search
The studies included in this meta-analysis were identified using several methods. As an
initial step, we conducted searches across several disciplines using several online data-
bases including Academic Search Complete, Proquest, Google Scholar, Criminal Justice
Abstracts, Social Sciences Abstracts, MedLine, and PubMed Central. We entered combi-
nations of search terms (domestic violence/abuse, intimate partner violence/abuse, family
violence, spouse/spousal violence/abuse, and marital violence/abuse). These search terms
were cross-referenced with the terms pregnant and pregnancy to limit the search results
to studies relevant to the current research. In addition to searches of electronic databases,
the reference lists and reviews of prior research from identified studies were explored
for additional studies for inclusion in the current meta-analysis. Following these search
procedures, 115 studies were identified and investigated using our inclusion criteria.
Inclusion Criteria
Several inclusion criteria were used to select studies for this meta-analysis from the
pool of 115 potential studies. First, the study must sample pregnant women. Studies did
not have to exclusively investigate DV against pregnant women; however, studies that
included samples of pregnant and nonpregnant women had to distinguish between these
samples to warrant inclusion in this study. Second, the study must specifically investigate
the relationship between DV and pregnancy. Studies that examined DV before or after
pregnancy, but not during pregnancy itself, were excluded. Third, the study must include
a measure of physical abuse. Studies that solely reported emotional abuse were excluded.
This was to try and enhance consistency between the definition of abuse across studies
(definitions of physical abuse are considerably more consistent than emotional or other
nonphysical forms of abuse). Fourth, each study must test an independent sample. Studies
that reported the results of a previously conducted study were included only if they tested a
new DV risk factor. Two additional criteria were used for the meta-analysis on risk factors:
the study must identify specific risk factors for DV, and the study must include enough
quantitative data to calculate effect sizes. Fifth, only studies reported in English were con-
sidered (English translations were included). Finally, it was not necessary that each study
be published. Several dissertation studies were included. Furthermore, studies from any
country that met the inclusion criteria were included. These inclusion criteria were based
on prior meta-analytic reviews of DV among women in general (Schumacher et al., 2001;
Stith et al., 2000; Sugarman & Frankel, 1996; Sugarman & Hotaling, 1997). Of the pool of
potential studies (N 5 115), 92 met the inclusion criteria for estimating prevalence of DV
among pregnant women and 55 met the inclusionary criteria for estimating risk factors.
These studies were then coded to enable analysis.
Coding
There were 92 studies coded to estimate the prevalence of DV during pregnancy. Of those,
55 studies contributed to the analysis on risk factors. Studies were coded for descriptor
variables (author/authors, year of publication, title, publishing journal, country, and setting
in which the study was conducted), measurement variables (study design, data gathering
method, and measurement tool), sample size and response rate, abuse prevalence statistics
(physical, emotional, and sexual), perpetrator, effect size variables (for each risk factor
identified), recommendations, limitations, suitability for meta-analysis, and any other
points of interest. For objectivity and accuracy, one researcher coded all studies and a
separate researcher reviewed the coded studies to establish interrater reliability. Strong
interrater reliability was established before analysis was carried out.
Data Analysis
A study dataset was created to record the sample and effect size (odds ratio) of each
study’s findings. Odds ratios were preferred over other measures of effect size such as r
or Cohen’s d because risk factors were typically calculated using dummy variables (the
presence or absence of a risk factor), making odds ratios easy to interpret.
Predictor measures were selected based on commonality in study reporting practices.
Given our moderate sample size, we elected to set a low threshold for inclusion. Hence,
if five or more studies reported a risk factor, it was included as a DV predictor measure.
Of the 55 studies that met the inclusion criteria for the meta-analysis of risk factors,
nine risk factors were identified and examined: abuse before pregnancy, lower educa-
tional level, low socioeconomic status, single (being unmarried), victim alcohol abuse,
perpetrator alcohol abuse, pregnancy unintended/unwanted by victim, pregnancy unin-
tended/unwanted by perpetrator, and lifetime adversity/exposure to violence. The mean
odds ratio and corresponding standard deviation for each risk factor across studies were
calculated.
When the data had been adjusted for outliers, odds ratios were weighted by sample
size to calculate a composite odds ratio effect size for each risk factor (Hunter & Schmidt,
1990; Marin-Martinez & Sanchez-Meca, 2010). In other words, each odds ratio was mul-
tiplied by its respective sample size, and the sum of this computation was divided by the
sum of all of the sample sizes. This calculation resulted in a single, composite, mean odds
ratio effect size for each risk factor. Thus, the composite odds ratio is the collective effect
size for each risk factor’s prediction of DV during pregnancy.
Our review of the literature suggested that there might be an issue between DV preva-
lence and the location where the information was collected. To account for these discrep-
ancies, comparisons were conducted to examine differences in survey (home vs. hospital)
and country types (developed vs. developing), and are provided in subsequent sections.
The results of each of these analyses are presented in the following texts.
364 James et al.
RESULTS
The studies included in this meta-analysis were analyzed for prevalence of DV during
pregnancy (overall abuse, physical abuse, emotional abuse, and sexual abuse), risk factors
for DV during pregnancy, and additional analyses looking at differences between countries
and settings.
Prevalence Variables
Of the 92 studies used to determine prevalence of DV among pregnant women, sample
subjects were found for 23 countries. The mean reported prevalence rate was 19.8%.
The prevalence of emotional abuse (including threats of violence, isolation, degradation,
and neglect) was 28.4%, physical abuse (including hitting, biting, slapping, pushing,
and restraint) was 13.8%, and sexual abuse (including rape, coercion, and stalking) was
8%. The range in sample size was 65–64,994, with an average sample size of 2,863
(SD 5 8,104), indicating large variation in sample sizes.
The average prevalence of overall DV, emotional DV, physical DV, and sexual DV for
each country, as well as the number of studies from that country, are shown in Table 1.
Brazil and Uganda had the highest overall prevalence at 63.4% and 57.0%. China and
Australia possessed the lowest overall prevalence at 4.8% and 5.8%.
For reasons discussed in the beginning of this article, an additional descriptor
variable, developed versus developing country, was added. Countries were classed
as “developed” or “developing” based on the International Monetary Fund’s World
Economic Outlook Report, April 2010. By these standards, Australia, Canada, England,
Israel, New Zealand, Sweden, Switzerland, and the United States are considered
developed countries and Bangladesh, Brazil, China, India, Jordan, Mexico, Nicaragua,
Nigeria, Pakistan, Peru, Saudi Arabia, South Lebanon, Thailand, Turkey, and Uganda are
considered developing countries. The overall prevalence of DV for developed countries
was 13.3%, compared to 27.7% for developing countries. This difference was found to
be significant (t 5 2.74, p 5 .014), and to have a large effect size (r 5 .55; Lipsey &
Wilson, 2001). This is consistent with our hypothesis that prevalence of DV during preg-
nancy would be higher in less developed countries. It is interesting to note, however, that
although China is classed as a developing country, it has the lowest reported prevalence
of DV during pregnancy.
Another descriptor variable, hospital setting versus at-home survey, was created for
reasons discussed in the beginning of this article. The overall prevalence of DV reported
in hospital-based surveys is 21.3%, compared to 11.0% reported in at-home surveys. This
difference was found to be significant (t 5 3.23, p 5 .003) and to have a large effect size
(r 5 .51). This result is consistent with our hypothesis that prevalence of DV during preg-
nancy would be higher in pregnant women sampled from hospital settings than nationally
surveyed samples.
Risk of Domestic Violence During Pregnancy

Fifty-five studies were examined for risk factors of DV during pregnancy. Originally
identified by the parent studies, nine factors were identified and coded. Seven were
victim risk factors: abuse before pregnancy, lower educational level, low socioeconomic
status, single, alcohol abuse, pregnancy unintended/unwanted, and lifetime adversity/
exposure to violence. The remaining two were perpetrator risk factors: alcohol abuse
TABLE 1. Prevalence Statistics by Country

Prevalence Prevalence Prevalence Prevalence
Country Overall Emotional Physical Sexual Count
Australia 5.80% Not reported 5.80% Not reported 1

Bangladesh 12.00% Not reported 12.00% Not reported 1
Brazil 63.40% 40.40% 12.35% 4.55% 2
Canada 8.88% 1.50% 3.45% Not reported 4
China 4.80% 4.70% 1.55% 4.67% 3
England 8.37% 9.55% 9.55% Not reported 3
India 23.93% 7.50% 23.53% 7.50% 6
Israel 20.30% 21.60% 20.30% 4.10% 1
Jordan 15.00% Not reported 15.00% Not reported 1
Lebanon 11.00% Not reported 11.00% Not reported 1
Mexico 16.05% 18.20% 12.10% 10.00% 2
New Zealand 16.10% 77.10% 23.20% Not reported 2
Nicaragua 32.40% 32.40% 13.40% 6.70% 1
Nigeria 35.54% 54.90% 21.11% 11.61% 8
Pakistan 35.00% 44.33% 16.53% 14.00% 3
Peru 30.75% 11.90% 15.60% 3.10% 2
Saudi Arabia 21.00% Not reported 21.00% Not reported 1
Sweden 24.00% 14.50% 11.00% 3.30% 1
Switzerland 7.00% 5.00% 3.00% 2.00% 1
Thailand 14.90% 14.90% 9.90% 4.80% 1
Turkey 12.66% 15.50% 4.55% 4.60% 3
Uganda 57.00% Not reported 57.00% Not reported 1
United States 16.86% 20.53% 13.08% 10.20% 43
and pregnancy unintended/unwanted. If a study reported multiple options for a single

risk factor, the odds ratio for the most extreme category was used in the calculation
of composite effect sizes. For example, if a study reported the relative risk of DV for
pregnant women with three separate dummy variables (“less than 10 years of education”
[yes or no], “10 to 12 years of education” [yes or no], and “more than 12 years of educa-
tion” [yes or no]), the first category was chosen to represent “lower educational level.”
All other variables were consequently collapsed into “greater than 10 years of educa-
tion” or, in other words, not “less than 10 years of education.” A similar procedure was
applied to “low socioeconomic status,” whereby the lowest category provided by each
study as a risk factor was used in the calculation of the composite low socioeconomic
status effect size.
366 James et al.
TABLE 2. Summary of Risk Factors With Composite Effect Sizes and Number of
Reporting Studies
Composite Number of
Risk Factor Effect Size (95% CI) Studies
Abuse before pregnancy 4.00 (28.14–16.14) 12

Lower educational level 1.92 (0.72–3.12) 23
Single 1.73 (0.86–2.58) 15
Perpetrator alcohol abuse 1.73 (20.30–3.78) 11
Low socioeconomic status 1.66 (0.58–2.74) 16
Pregnancy unintended/unwanted by 1.66 (20.75–4.07) 15
victim
Victim alcohol abuse 1.25 (0.17–2.33) 19
Pregnancy unintended/unwanted by 1.21 (0.22–2.20) 14
perpetrator
Lifetime adversity/exposure to violence 1.13 (23.47–5.73) 8
Each of these nine risk factors was reported by five or more studies with relevant odds
ratio data. Factors identified as risk factors by fewer than five studies included race, drug
abuse, and lack of social support, and these were consequently omitted from the analysis.
Combined, the studies reported 133 distinct odds ratios on the nine risk factors. These dis-
tinct odds ratios were used to calculate a composite odds ratio effect size for each risk fac-
tor. Table 2 lists each risk factor’s composite odds ratio effect size, the standard deviation
of the composite effect size, and the number of studies that reported the given risk factor.
Composite odds ratio effect sizes ranged from 4.00 to 1.13 (see Appendix for specifics
for each risk factor). The risk factor “abuse before pregnancy” was found to have the larg-
est effect size (4.00). This means that women who were previously abused were four times
more likely to be abused during pregnancy than women with no history of abuse. However,
the CI included zero (CI 5 28.14–16.14), which indicates that we cannot have confidence
in the broad generalizability of this result.1
Several other risk factors were found to predict DV during pregnancy. Pregnant women
with a lower level of education were almost twice as likely to be abused as women pos-
sessing higher levels (ES 5 1.92, CI 5 0.072–0.312). An effect size of 1.73 was found
for being single; in other words, women who were unmarried possessed 73% greater odds
of being abused during pregnancy than married women (CI 5 0.86–2.58). Women of low
socioeconomic status were at 66% increased risk (ES 5 1.66, CI 5 0.58–2.74). Pregnant
women whose partners abused alcohol possessed 73% greater odds of being abused than
pregnant women whose partners did not abuse alcohol (ES 5 1.73); however, the stability
of this effect is questionable (CI 5 20.03–3.78). Women who did not intend or want their
pregnancy possessed 66% greater odds of being abused than women who had planned their
pregnancy (ES 5 1.66), although the CI range also included zero (20.75–4.07).
Victim alcohol abuse was a fairly weak predictor for DV during pregnancy. Women who
abused substances possessed 25% greater odds of being abused during their pregnancy
than women who did not (ES 5 1.25, CI 5 0.17–2.33). Other risk factors with weak effect
sizes were “pregnancy unintended/unwanted by perpetrator” (ES 5 1.21, CI 5 0.22–2.20)
and “lifetime adversity/exposure to violence throughout life” (ES 5 1.13; although the CI
range included zero for this effect estimate [23.47–5.73]). Men indicating that the preg-
nancy was unintended/unwanted possessed 21% greater odds to abuse their partners than
men whose partners’ pregnancies were planned. Women who had experienced adversity or
who had been exposed to violence possessed only 13% greater odds to be abused during
pregnancy than women who had not.
Additional Analyses
Given the discrepancy in DV prevalence rates for developed countries (16.0%) versus
developing countries (25.3%), and for at-home surveys (11.0%) versus hospital setting
designs (21.3%), composite risk factor effect sizes were calculated for each classification.
Table 3 shows the risk factors for DV in samples of pregnant women from developed and
developing countries.
These results indicate that risk factors predicting DV among pregnant women living
in developed countries differ from those in developing countries. Based on the reports
from the research literature, abuse before pregnancy is the only strong predictor of DV
during pregnancy in developing countries. Providing further support, this study found that
pregnant women in less developed countries who have been previously abused possess
nearly fourteen times greater odds of being abused during pregnancy than women with
no history of abuse, although the CI range included zero (25.59–33.33). In contrast, for
pregnant women in more developed countries, having a lower educational level, having
TABLE 3. Risk Factors for Domestic Violence During Pregnancy in Developed
and Developing Countries
Composite Effect Size: Composite Effect Size:
Developed Countries Developing Countries
Risk Factor (95% CI) (95% CI)
Abuse before pregnancy 1.31 (222.63–24.63) 13.87 (25.59–33.33)

Lower educational level 2.56 (1.02–4.10) 1.12 (20.52–2.76)
Single 2.27 (1.32–3.22) NA
Perpetrator alcohol abuse 2.04 (21.98–6.06) 0.95 (0.35–1.55)
Low socioeconomic status 2.11 (0.21–4.02) 0.35 (20.15–0.85)
Pregnancy unintended/unwanted 2.10 (1.49–2.71) 0.41 (21.46–2.28)
by victim
Victim alcohol abuse 1.48 (0.48–2.48) 0.28 (24.35–4.91)
by perpetrator
Lifetime adversity/exposure to 1.42 (24.11–7.07) NA
violence
NA 5 not applicable.
368 James et al.
TABLE 4. Risk Factors for Domestic Violence During Pregnancy Using At-Home
Surveys and Hospital Setting Designs
Composite Effect Composite Effect
Size: At-Home Size: Hospital Setting
Risk Factor Surveys (95% CI) Designs (95% CI)
Abuse before pregnancy NA 5.97 (26.17–18.11)

Lower educational level 3.06 (1.79– 4.33) 0.82 (20.76–2.40)
Single 2.49 (1.68–3.30) 0.64 (20.77–2.05)
Perpetrator alcohol abuse 2.36 (20.74 –5.46) 0.61 (22.06–3.28)
Low socioeconomic status 2.77 (1.31– 4.23) 0.45 (20.89–1.79)
by victim
Victim alcohol abuse 1.59 (0.50 –2.68) 0.99 (22.13–6.11)
Pregnancy unintended/unwanted 2.41 (1.22 –3.60) 0.40 (20.90–1.70)
by perpetrator
Lifetime adversity/exposure to 0.91 (211.10–12.92) 0.35 (24.86–5.56)
violence
an unintended or unwanted pregnancy, being single, having a partner who abuses alcohol,
and being of low socioeconomic status all increased the risk for DV (by at least twice the
odds). All of these risk factors have stable effects except for “perpetrator alcohol abuse,”
whose CI range includes zero (CI 5 21.98 2 6.06).
Table 4 shows the risk for DV for pregnant women sampled using at-home surveys and
hospital setting designs. For studies using at-home surveys, lower educational level, unin-
tended or unwanted pregnancy (as perceived by either the victim or the perpetrator), single
marital status, perpetrator alcohol abuse, and low socioeconomic status all at least double
the risk of DV during pregnancy (however the CI range for perpetrator alcohol abuse con-
tains zero [CI 5 20.74 – 5.46]). For studies conducted in a hospital setting, abuse before
pregnancy is the strongest predictor, followed by victim alcohol abuse. It should be noted
that all of the risk factors reported for women sampled from hospital settings possessed
CI ranges that contained zero, indicating large variability in reported predictive power of
these risk factors.
DISCUSSION
This study represents the first meta-analysis to examine the prevalence and the risk factors
for DV against pregnant women. The results show that, based on the body of literature
investigating DV during pregnancy, the prevalence of emotional abuse, physical abuse,
and sexual abuse during pregnancy is 28.4%, 13.8%, and 8.0%, respectively. As hypoth-
esized, the prevalence of DV during pregnancy appears to be higher in less developed
countries than in more developed countries. This finding likely reflects value and custom
differences between these two country types; however, additional research is necessary to
further investigate this result. Also, consistent with our hypothesis, the prevalence of DV
in pregnant women sampled from hospital clinics appears to be higher than nationally
gathered surveys. This may reflect pregnant women having more confidence to disclose
sensitive information to a nurse or a doctor; however, it may also be due to sample selec-
tion methods. Again, future research should explore this inference further.
Our results demonstrate that abuse before pregnancy is the strongest risk factor for
predicting DV during pregnancy (although the large CI range indicates that studies report
differences in the predictive power of this risk factor). Nevertheless, when study findings
were synthesized, pregnant women whose partners previously abused them were found
to have four times greater odds of being abused during pregnancy than women with no
history of abuse. Other risk factors for DV during pregnancy were lower education, single
marital status, alcohol abuse (particularly by the perpetrator), low socioeconomic status,
and unintended or unwanted pregnancy.
Consistent with our hypothesis, differences are observed regarding the risk factors that
are more salient for pregnant women in less developed countries compared to pregnant
women in more developed countries. For pregnant women in developing countries, the
only strongly reported predictor of DV during pregnancy is abuse before pregnancy.
For women in more developed countries, lower educational level, having an unintended
or unwanted pregnancy, being single, having a partner who abuses alcohol, and being of
low socioeconomic status all at least double the odds of DV. Future research is necessary
to explore whether there are other risk factors for DV in samples of pregnant women in
less developed countries. In addition, the limitations of this study need to be explored.
LIMITATIONS
As with any meta-analysis, several limitations should be addressed. First, it is likely that
despite an extensive literature search, studies may have been missed. As a result, it is pos-
sible that additional studies could contribute and possibly modify the current findings.
Second, there is also the danger that studies with significant results are more likely to be
published, increasing the composite effect sizes for risk factors. When fewer studies con-
tribute to a particular risk factor, any study with a large effect size will have a big influence
on the composite effect size for that risk factor. However, only one risk factor (lifetime
adversity/exposure to violence throughout life) was calculated with less than 10 indepen-
dent studies’ effect sizes, indicating an adequate sample size for most risk factors, and
reducing the likelihood that an undue contribution from 1 (or a few) overlooked study may
have contributed to an inaccurate calculation of risk factor composite effect sizes. Third, in
combining effect size calculations from multiple countries it is possible that some qualita-
tive meaning was lost. For example, “low socioeconomic status” and “lower education
level” may mean different things in developed countries and developing countries. Our
breakdown of effects by country type suggests that the results may reflect differences in
the meaning of risk factors, as well as differences in their magnitude.
The frequent limitations cited in the original studies should also be considered. The
most frequent limitation reported in original studies was sampling bias. Many studies
sampled from low-income women. A number, however, sampled from primarily middle
class women. It is possible that these opposing sampling biases serve to reduce the overall
limitation of sampling bias. A second limitation that was apparent but not often mentioned
370 James et al.
in the original studies was a lack of clarification for certain risk factors. For example,
“lifetime adversity/exposure to violence” is fairly ambiguous.
Several risk factors of interest such as race, drug abuse, and lack of social support were
unable to be calculated because of insufficient reporting. Further research is needed to
assess the contribution of race and ethnicity, drug abuse, and lack of social support as risk
factors on DV during pregnancy.
Finally, as expected from the mixed reports in the research literature, a large amount
of heterogeneity within risk factors was observed. Many of the confidence interval ranges
span zero, bringing the stability of our findings into question. However, large CI ranges
are typically observed in meta-analyses, particularly across diverse samples that may be
exposed to very different conditions (such as heterogeneity in SES, education, and atti-
tudes toward women). This is particularly salient in the current meta-analysis given the
diverse definitions of DV across countries. Large CI ranges are to be expected—this does
not mean that risk factors with a CI range including zero should be discarded, just that
they should be interpreted as having varying predictive power across studies. As a first
step toward synthesis, we have produced some revealing results. It is critical that future
research on DV investigate samples of pregnant women, if we are to provide reliable infor-
mation to practitioners and policy makers.
PRACTITIONER AND POLICY IMPLICATIONS
Readers may question the need to partake in a meta-analysis of such a distinct population
demographic. It is true that pregnant women represent only a small portion of DV cases
and even a smaller portion of the overall prevalence of violence. That being said, the
physical restrictions also make this subpopulation one of the most vulnerable. Pregnancy
restricts a woman’s ability to defend against DV, and the threat of injury to her fetus likely
increases feelings of helplessness and trauma associated with domestic abuse.
Most women, at some point in their lives, become pregnant. To decrease their relative
risk and the risk to their future children, it is necessary to implement interventions that
not only screen for the identified risk factors but also lessen the opportunity for abusive
situations. The two primary study findings are (a) that the incidence of DV prior to preg-
nancy is predictive of abuse during pregnancy (although it varies in predictive power),
and (b) that the prevalence of DV in pregnant women sampled in health care settings is
considerably higher than national averages based on survey data, suggesting that health
care settings provide a more efficient net when screening for DV. The conjunction of
these findings should prove useful to practitioners. Specifically, health care professionals
have demonstrated the use of motivational interviewing (MI) to improve their patients’
lives by discouraging negative health patterns. Even if victims of abuse are aware of the
potential negative health risk they are exposed to in an abusive relationship, they may not
envision how this cycle of violence may ultimately affect them if and when a pregnancy
occurs. Nurses and other public health practitioners should integrate and emphasize this
information into current MI practices to further encourage women to dissolve abusive
relationships.
Several additional predictors may also serve as proxy indicators for DV. In particular,
single women with less education from lower socioeconomic classes should be targeted
for screening and intervention, given their increased risk of DV during pregnancy. This is
particularly troubling because single pregnant women from lower socioeconomic classes
are less likely to make as many scheduled trips to the hospital during their pregnancy
(American Psychological Association, 2011). Practitioners need to be aware of these
women’s increased risk for DV during pregnancy and, when feasible, consider home visits
to screen for abuse. At the very least, for those women exhibiting these proxy indicators,
efforts should be made during hospital and even routine gynecological appointments to
establish whether these women are being abused. In a similar vein, practitioners need to
be aware that pregnant women who visit the emergency room during their pregnancy may
be suffering from abuse. We hope that our findings promote future studies to investigate
DV in samples of pregnant women, to increase understanding of risk factors, and to help
practitioners and policy makers battle this troubling social problem.
NOTE
1. A CI range this large suggests that some studies reported that history of abuse was a huge
predictor of DV during pregnancy, and some studies reported that history of abuse did not predict
future domestic violence outcomes.
REFERENCES
Amaro, H., Fried, L., Cabral, H., & Zuckerman, B. (1990). Violence during pregnancy and substance
use. American Journal of Public Health, 80, 575–579.
American Psychological Association. (2011). Fact sheet: Women & socioeconomic status. Retrieved
from http://www.apa.org/pi/ses/resources/publications/factsheet-women.aspx
Audi, C. A., Segall-Corrêa, A. M., Santiago, S. M., Andrade, Mda G., & Pèrez-Escamila, R. (2008).
Violence against pregnant women: Prevalence and associated factors. Revista de Saúde Pública,
42(5), 877–885.
Awusi, V. O., Okeleke, V. O., & Ayanwu, B. E. (2009). Prevalence of domestic violence during
pregnancy in Oleh, a suburban Isoko Community, Delta State, Nigeria. Benin Journal of
Postgraduate Medicine, 11(Suppl.), 15–20.
Bacchus, L., Mezey, G., & Bewley, S. (2004). Domestic violence: Prevalence in pregnant women
and associations with physical and psychological health. European Journal of Obstetrics,
Gynecology, and Reproductive Biology, 113, 6–11.
Bailey, B., & Daugherty, R. (2007). Intimate partner violence during pregnancy: Incidence
and associated health behaviors in a rural population. Maternal Child Health Journal, 11,
495–503.
Berenson, A., Stiglich, N., Wilkinson, G., & Anderson, G. (1991). Drug abuse and other risk fac-
tors for physical abuse in pregnancy among white non-Hispanic, black, and Hispanic women.
American Journal of Obstetrics & Gynecology, 164, 1491–1499.
Bowen, E., Heron, J., Waylen, A., & Wolke, D. (2005). Domestic violence risk during and after
pregnancy: Findings from a British longitudinal study. BJOG: an International Journal of
Obstetrics and Gynaecology, 112, 1083–1089.
Campbell, J. C., Oliver, C. E., & Bullock, L. F. (1993). Why battering during pregnancy? AWHONNS
Clinical Issues in Perinatal and Women’s Health Nursing, 4, 343–349.
Cardoza, E. V. (2005). Partner violence during pregnancy: Psychosocial factors and child outcomes
in Nicaragua (Doctoral dissertation, Umeå University).
Castro, R., Peek-Asa, C., García, L., Ruiz, A., & Kraus, J. (2003). Risks for abuse against pregnant
Hispanic women. American Journal of Preventive Medicine, 25, 325–332.
Castro, R., Peek-Asa, C., & Ruiz, A. (2003). Violence against women in Mexico: A study of abuse
before and during pregnancy. American Journal of Public Health, 93, 1110–1116.
372 James et al.
Centers for Disease Control and Prevention. (1999). PRAMS 1996 Surveillance Report. Atlanta, GA:
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health
Promotion, Centers for Disease Control and Prevention.
Centers for Disease Control and Prevention. (2011). Understanding intimate partner violence.
Retrieved from http://www.cdc.gov/ViolencePrevention/pdf/IPV_factsheet-a.pdf
Certain, H., Mueller, M., Jagodzinski, T., & Fleming, M. (2008). Domestic abuse during the previous
year in a sample of postpartum women. Journal of Obstetric, Gynecologic, and Neonatal
Nursing, 37, 35–41.
Chan, Y. C. (1994). Parenting stress and social support of mothers who physically abuse their chil-
dren in Hong Kong. Child Abuse & Neglect, 18, 261–269.
Charles, P., & Perreira, K. (2007). Intimate partner violence during pregnancy and 1-year post-
partum. Journal of Family Violence, 22, 609–619.
Cheng, D., & Horon, I. L. (2010). Intimate-partner homicide among pregnant and postpartum
women. Obstetrics & Gynecology, 115, 1181–1886.
Clark, C., Hill, A., Jabbar, K., & Silverman, J. (2009). Violence during pregnancy in Jordan: Its
prevalence and associated risk and protective factors. Violence Against Women, 15, 720–735.
Cokkinides, V. E., & Coker, A. L. (1998). Experiencing physical violence during pregnancy:
Prevalence and correlates. Family and Community Health, 20, 19–38.
Cokkinides, V. E., Coker, A., Sanderson, M., Addy, C., & Bethea, L. (1999). Physical violence during
pregnancy: Maternal complications and birth outcomes. Obstetrics & Gynecology, 93, 661–666.
Conger, R. D., Burgess, R. L., & Barrett, C. (1979). Child abuses related to life change and percep-
tions of illness: Some preliminary findings. Family Coordinator, 28, 73–78.
Covington, D., Justason, B., & Wright, L. (2001). Severity, manifestations, and consequences of
violence among pregnant adolescents. Journal of Adolescent Health, 28, 55–61.
Cripe, S., Sanchez, S., Perales, M., Lam, N., Garcia, P., & Williams, M. (2008). Association of inti-
mate partner physical and sexual violence with unintended pregnancy among pregnant women
in Peru. International Journal of Gynecology and Obstetrics, 100, 104–108.
Curry, M. A. (1998). The interrelationships between abuse, substance use, and psychosocial stress
during pregnancy. Journal of Obstetrics, Gynecology, and Neonatal Nursing, 27, 692–699.
Datner, E., Wiebe, D., Brensinger, C., & Nelson, D. (2007). Identifying pregnant women experienc-
ing domestic volence in an urban emergency department. Journal of Interpersonal Violence,
22, 124–135.
de Moseson, B. A. G. (2004). Intimate partner violence during pregnancy: Risk factors from the
Oregon Pregnancy Risk Assessment Monitoring System. Unpublished master’s thesis, Oregon
Health and Science University School of Medicine, Portland, Oregon.
Díaz-Olavarrieta, C., Pazb, F., Abuabara, K., Martínez Ayala, H., Kolstad, K., & Palermo, T. (2007).
Abuse during pregnancy in Mexico City. International Journal of Gynecology and Obstetrics,
97, 57–64.
Dunn, L., & Oths, K. (2004). Prenatal predictors of intimate partner abuse. Journal of Obstetric,
Gynecologic, & Neonatal Nursing, 33, 54–63.
Fanslow, J., Silva, M., Robinson, E., & Whitehead, A. (2008). Violence during pregnancy:
Associations with pregnancy intendedness, pregnancy-related care, and alcohol and tobacco use
among a representative sample of New Zealand women. Australian and New Zealand Journal
of Obstetrics and Gynaecology, 48, 398–404.
Farid, M., Saleem, S., Karim, M., & Hatcher, J. (2008). Spousal abuse during pregnancy in Karachi,
Pakistan. International Journal of Gynecology and Obstetrics, 101, 141–145.
Fawole, A., Hunyinbo, K., & Fawole, O. (2008). Prevalence of violence against pregnant women in
Abeokuta, Nigeria. Australian and New Zealand Journal of Obstetrics and Gynaecology, 48,
405–414.
Fikree, F., Jafarey, S., Korejo, K., Afshan, A., & Durocher, J. (2006). Intimate partner violence
before and during pregnancy: Experiences of postpartum women in Karachi, Pakistan. Journal
of Pakistan Medical Association, 56, 252–257.
Gao, W., Paterson, J., Carter, S., & Iusitini, L. (2008). Intimate partner violence and unplanned
pregnancy in the Pacific Islands Families Study. International Journal of Gynecology and
Obstetrics, 100, 109–115.
Gazmararian, J. A., Lazorick, S., Spitz, A. M., Ballard, T. J., Saltzman, L. E., & Marks, J. S. (1996).
Prevalence of violence against pregnant women. Journal of the American Medical Association,
275, 1915–1920.
Glander, S. S., Moore, M. L., Michielutte, R., & Parsons, L. H. (1998). The prevalence of domestic
violence among women seeking abortion. Obstetrics & Gynecology, 91, 1002–1006.
Goodwin, M., Gazmararian, J. A., Johnson, C. H., Gilbert, B. C., & Saltzman, L. E. (2000).
Pregnancy intendedness and physical abuse around the time of pregnancy: Findings from
the Pregnancy Risk Assessment Monitoring System, 1996-1997. Maternal and Child Health
Journal, 4(2), 85–92.
Guo, S. F., Wu, J. L., Qu, C. Y., & Yan, R. Y. (2004). Physical and sexual abuse of women before,
during, and after pregnancy. International Journal of Gynecology and Obstetrics, 84, 2812286.
Hammoury, H., Khawaja, M., Mahfoud, Z., Afifi, R., & Madi, R. (2009). Domestic violence against
women during pregnancy: The case of Palestinian refugees attending an antenatal clinic in
Lebanon. Journal of Women’s Health, 18, 337–345.
Hedin, L. W. (2000). Postpartum, also a risk period for domestic violence. European Journal of
Obstetrics & Gynecology and Reproductive Biology, 89, 41–45.
Hunter, J., & Schmidt, F. (1990). Dichotomization of continuous variables: The implications for
meta-analysis. Journal of Applied Psychology, 75, 334–349.
International Monetary Fund. (2010). World Economic Outlook (WEO): Recovery, risk and rebal-
ancing. Retrieved from http://www.imf.org/external/pubs/ft/weo/2010/02/
Janssen, P., Holt, V., Sugg, K., Emanuel, I., Critchlow, C., & Henderson, A. (2003). Intimate partner
violence and adverse pregnancy outcomes: A population-based study. American Journal of
Obstetrics & Gynecology, 188, 1341–1347.
Jasinski, J. L. (2001). Pregnancy and violence against women: An analysis of longitudinal data.
Journal of Interpersonal Violence, 16, 713–734.
Jasinski, J. L., & Kaufman Kantor, G. (2001). Pregnancy, stress and wife assaults: Ethnic differences
in prevalence, severity and onset in a national sample. Violence and Victims, 16, 1–14.
Karaoglu, L., Celbis, O., Ercan, C., Ilgar, M., Pehlivan, E., Gunes, G., . . . Egri, M. (2005). Physical,
emotional and sexual violence during pregnancy in Malatya, Turkey. European Journal of
Public Health, 16, 149–156.
Kaye, D. (2006). Domestic violence during pregnancy in Uganda (Doctoral thesis, Karolinska
Institutet).
Khosha, A., Dua, D., Devi, L., & Sunder Sud, D. (2005). Domestic violence in pregnancy in north
Indian women. Indian Journal of Medical Sciences, 59, 195–199.
Leung, W. C., Leung, T. W., Lam, Y. Y. J., & Ho, P. C. (1999). The prevalence of domestic vio-
lence against pregnant women in a Chinese community: Social issues in reproductive health.
International Journal of Gynaecology and Obstetrics, 66, 23–30.
Lipsey, M., & Wilson, D. (2001). Practical meta-analysis. Thousand Oaks, CA: Sage.
Lutgendorf, M., Busch, J., Doherty, D., Conza, L., Moone, S., & Magann, E. (2009). Prevalence
of domestic violence in a pregnant military population. Obstetrics & Gynecology, 113,
866–872.
Marin-Martinez, F., & Sanchez-Meca, J. (2010). Weighting by inverse variance or by sample
size in random-effects meta-analysis. Educational and Psychological Measurement, 70,
56–73.
Markowitz, S. (2000). The price of alcohol, wife abuse, and husband abuse. Southern Economic
Journal, 67, 279–303.
Martin, S. L., English, K. T., Clark, K. A., Cilenti, D., & Kupper, L. L. (1996). Violence and sub-
stance abuse among North Carolina pregnant women. American Journal of Public Health, 86,
991–998.
374 James et al.
Martin, S. L., Mackie, L., Kupper, L., Buescher, P., & Moracco, K. E. (2001). Physical abuse of
women before, during, and after pregnancy. Journal of the American Medical Association, 285,
1581–1584.
McFarlane, J., Parker, B., Soeken, K., & Bullock, L. (1992). Assessing for abuse during pregnancy.
Journal of the American Medical Association, 267, 3176–3178.
Muhajarine, N., & D’Arcy, C. (1996). Physical abuse during pregnancy: Prevalence and risk factors.
Canadian Medical Association Journal, 160, 107–111.
Muthal-Rathore, A., Tripathi, R., & Arora, R. (2002). Domestic violence against pregnant women inter-
viewed at a hospital in New Delhi. International Journal of Gynecology & Obstetrics, 76, 83–85.
Naved, R., & Persson, L. (2008). Factors associated with physical spousal abuse of women during
pregnancy in Bangladesh. International Family Planning Perspectives, 34, 71–78.
Olagbuji, B., Ezeanochie, E., Ande, A., & Ekaete, E. (2010). Trends and determinants of pregnancy-
related domestic violence in a referral center in southern Nigeria. International Journal of
Gynecology and Obstetrics, 108, 101–103.
Peedicayil, A., Sadowski, L., Jeyaseelan, L., Shankar, V., Jain, D., Suresh, S., & Bangdiwala, S.
(2004). Spousal physical violence against women during pregnancy. BJOG: an International
Journal of Obstetrics and Gynaecology, 111, 682–687.
Perales, S., May, S., Nelly, C., Sixto, L., Sanchez, E., & Williams, M. (2009). Prevalence, types, and
pattern of intimate partner violence among pregnant women in Lima, Peru. Violence Against
Women, 15, 224–250.
Purwar, M., Jeyaseelan, L., Varhadpande, U., Motghare, V., & Pimplakute, S. (1999). Survey of physi-
cal abuse during pregnancy, GMCH, Napur, India. Journal of Obstetrics and Gynaecology, 25,
165–171.
Renker, P. R. (1999). Physical abuse, social support, selfcare, and pregnancy outcomes of older ado-
lescents. Journal of Obstetrics, Gynecology, and Neonatal Nursing, 28, 377–388.
Roberts, A. R., & Springer, D. W. (Eds.). (2007). Social work in juvenile and criminal justice settings
(3rd ed.). Springfield, IL: Charles C Thomas.
Rodriguez, M., Heilemann, M., Fielder, E., Ang, A., Nevarez, N., & Mangione, C. (2008). Intimate
partner violence, depression, and PTSD among pregnant Latina women. Annals of Family
Medicine, 6, 44–52.
Saltzman, L., Johnson, C., Gilbert, B., & Goodwin, M. (2003). Physical abuse around the time of
pregnancy: An examination of prevalence and risk factors in 16 States. Maternal and Child
Health Journal, 7, 31–43.
Schumacher, J. A., Slep, A. M. S., & Heyman, R. E. (2001). Risk factors for male-to-female partner
physical abuse. Aggression and Violent Behavior, 6, 281–352.
Shumway, J., O’Campo, P., Gielen, A., Witter, F. R., Khouzami, A. N., & Blakemore, K. J. (1999).
Preterm labor, placental abruption, and premature rupture of membranes in relation to maternal
violence or verbal abuse. The Journal of Maternal-Fetal Medicine, 8(3), 76–80.
Stewart, D., & Cecutti, A. (1993). Physical abuse in pregnancy. Canadian Medical Association
Journal, 149, 1257–1263.
Stith, S. M., Rosen, K. H., Middleton, K. A., Busch, A. L., Lundeberg, K., & Carlton, R. P. (2000).
The intergenerational transmission of spouse abuse: A meta-analysis. Journal of Marriage and
the Family, 62, 640–654.
Sugarman, D. B., & Frankel, S. L. (1996). Patriarchal ideology and wife assault: A meta-analytic
review. Journal of Family Violence, 11, 13–40.
Sugarman, D. B., & Hotaling, G. T. (1997). Intimate violence and social desirability: A meta-
analytic review. Journal of Interpersonal Violence, 12, 275–290.
Washington State Department of Health. (2004). Violence against women: Information for health
care providers. Retrieved from http://www.doh.wa.gov/hsqa/emstrauma/vaw/default.htm
Wiemann, C. M., Agurcia, C. A., Berenson, A. B., Volk, R. J., & Rickert, V. I. (2000). Pregnant
adolescents: Experiences and behaviors associated with physical assault by an intimate partner.
Maternal and Child Health Journal, 4(2), 93–101.
Zehner, A. (2009). Intimate partner violence and pregnancy: Data from the Chicago Women’s
Health Risk Study. Department of Epidemiology and Community Health Master of Public
Health Program MPH Research Project: EPID 691Virginia Commonwealth University.
Acknowledgments. We would like to thank Karen MacKendrich for her thorough review of our
methods and analysis, and Wendy Molyneux for her help with editing and wordsmithing. We would
also like to thank the two anonymous reviewers for their feedback and suggestions.
Correspondence regarding this article should be directed to David Brody, PhD, Department of
Criminal Justice and Criminology, Washington State University, PO Box 4872, Pullman, WA 99164-
4872. E-mail: brody@wsu.edu
376 James et al.
APPENDIX. Studies Reporting Effect Sizes on Risk Factors

Risk factor 1: abuse before pregnancy (composite effect size 5 4.00)
Prevalence Sample Effect
Author Country Overall Size Size (OR)
Bacchus et al. (2004) England 3.00% 200 3.20

Castro, Peek-Asa & Mexico 24.50% 914 9.47
Ruiz (2003)
Castro, Peek-Asa, Garcia, Mexico & 29.20% 219 8.74
Ruiz & Kraus (2003) United States
Cripe et al. (2008) Peru 40.00% 2,167 1.63
Díaz-Olavarrieta et al. (2007) Mexico 7.60% 1,314 6.44
Farid et al. (2008) Pakistan 44.00% 500 3.03
Guo et al. (2004) China 3.60% 12,044 52.70
Lutgendorf et al. (2009) United States 14.50% 1,162 5.99
Martin et al. (1996) United States 2.00% 2,096 10.36
Naved & Persson (2008) Bangladesh 12.00% 2,553 2.43
Stewart & Cecutti (1993) Canada 6.60% 548 17.15
Risk factor 2: lower educational level (composite effect size 5 1.92)
Amaro, Fried, Cabral, & United States 7.00% 1,243 1.12

Zuckerman (1990)
Audi et al. (2008) Brazil Not reported 1,379 1.77
Ruiz (2003)
Charles & Perreira (2007) United States 8.50% 4,365 2.60
Cokkinides & Coker (1998) United States 5.10% 6,718 1.30
Datner et al. (2007) United States 15.00% 1,199 1.46
Farid et al. (2008) Pakistan 44.00% 500 2.02
Fawole et al. (2008) Nigeria 14.20% 534 12.54
Fikree et al. (2006) Pakistan 23.00% 300 2.40
Gazmararian et al. (1996) United States 12.10% 12,612 3.00
Goodwin et al. (2000) United States 8.80% 39,348 1.30
Hammoury et al. (2009) Lebanon 11.00% 351 6.86
Karaoglu et al. (2005) Turkey 31.70% 842 2.40
(Continued)

Khosha et al. (2005) India 28.00% 991 0.94

Muhajarine & D’Arcy (1996) Canada 5.70% 605 4.80
Muthal-Rathore et al. (2002) India 21.00% 800 2.90
Peedicayil et al. (2004) India 16.00% 9,938 1.10
Perales et al. (2009) Peru 21.50% 2,392 1.29
Purwar et al. (1999) India 22.00% 600 3.14
Saltzman et al. (2003) United States 5.30% 64,994 4.70
Zehner (2009) United States NA 705 1.75
Risk factor 3: single (composite effect size 5 1.73)
Amaro et al. (1990) United States 7% 1,243 2.52

Berenson et al. (1991) United States 29.00% 501 1.10
Certain et al. (2008) United States 7.40% 1,519 7.05
Gao et al. (2008) New Zealand 23.20% 1,088 1.75
Jasinski (2001) United States Not reported 3,500 4.66
Lutgendorf et al. (2009) United States 14.50% 1,162 2.80
Risk factor 4: perpetrator alcohol abuse (composite effect size 5 1.73)

Clark et al. (2009) Jordan 15.00% 390 4.02
de Moseson (2004) United States 2.45% 1,795 7.86
(Continued)
378 James et al.

Fawole et al. (2008) Nigeria 14.20% 534 3.04

Risk factor 5: low socioeconomic status (composite effect size 5 1.66)

Ruiz (2003)
Dunn & Oths (2004) United States 10.90% 439 2.00
Fanslow et al. (2008) New Zealand 9.00% 2,391 1.28
Risk factor 6: pregnancy unintended / unwanted by victim (composite effect size 5 1.66)
Amaro et al. (1990) United States 7.00% 1,243 1.99

Cripe et al. (2008) Peru 40.00% 2,167 1.72
(Continued)

Kaye (2006) Uganda 57.00% 379 5.70
Risk factor 7: victim alcohol abuse (composite effect size 5 1.25)

Bailey & Daugherty (2007) United States 81.00% 104 7.00
Berenson et al. (1991) United States 29.00% 501 3.80
Cokkinides et al. (1999) United States 5.00% 6,143 3.70
Covington et al. (2001) United States 16.00% 545 3.90
Datner et al. (2007) USA 15.00% 1,199 1.53
Gao et al. (2008) New Zealand 0.232 1,088 1.68
Janssen et al. (2003) Canada 1.00% 4,750 3.69
Olagbuji et al. (2010) Nigeria 28.00% 502 11.60
Wiemann et al. (2000) United States 29.00% 724 3.31
Risk factor 8: pregnancy unintended/unwanted by perpetrator (composite effect size 5 1.21)

(Continued)
380 James et al.


Hammoury et al. (2009) Lebanon 11.00% 351 3.80
Kaye (2006) Uganda 57.00% 379 5.90
Risk factor 9: lifetime adversity/exposure to violence (composite effect size 5 1.13)
Bowen et al. (2005) England 5.10% 7,591 14.69

Ruiz (2003)
Clark et al. (2009) Jordan 15.00% 390 3.90
Rodriguez et al. (2008) United States 44.00% 210 3.91
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Violence and Victims, Volume 28, Number 3, 2013

Risk Factors for Domestic Violence

Keywords: meta-analysis; pregnant; intimate partner violence (IPV); spousal abuse

© 2013 Springer Publishing Company 359

Risk of Domestic Violence During Pregnancy

TABLE 1. Prevalence Statistics by Country

Australia 5.80% Not reported 5.80% Not reported 1

and pregnancy unintended/unwanted. If a study reported multiple options for a single

Abuse before pregnancy 4.00 (28.14–16.14) 12

Abuse before pregnancy 1.31 (222.63–24.63) 13.87 (25.59–33.33)

Abuse before pregnancy NA 5.97 (26.17–18.11)

PRACTITIONER AND POLICY IMPLICATIONS

APPENDIX. Studies Reporting Effect Sizes on Risk Factors

Bacchus et al. (2004) England 3.00% 200 3.20

Amaro, Fried, Cabral, & United States 7.00% 1,243 1.12

APPENDIX. Studies Reporting Effect Sizes on Risk Factors

Khosha et al. (2005) India 28.00% 991 0.94

Amaro et al. (1990) United States 7% 1,243 2.52

Audi et al. (2008) Brazil Not reported 1,379 2.76

APPENDIX. Studies Reporting Effect Sizes on Risk Factors

Fawole et al. (2008) Nigeria 14.20% 534 3.04

Castro, Peek-Asa & Mexico 24.50% 914 2.31

Amaro et al. (1990) United States 7.00% 1,243 1.99

APPENDIX. Studies Reporting Effect Sizes on Risk Factors

Amaro et al. (1990) United States 7.00% 1,243 5.15

Amaro et al. (1990) United States 7.00% 1,243 2.40

APPENDIX. Studies Reporting Effect Sizes on Risk Factors

Gao et al. (2008) New Zealand 23.20% 1,088 1.52

Bowen et al. (2005) England 5.10% 7,591 14.69

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