Access and utilisation of maternity care for disabled women who experience domestic abuse: a systematic review
Women with disabilities are at greater risk for physical abuse than women without disabilities. However, no previous population-based studies have examined physical abuse against women with disabilities around the time of pregnancy, a critical period for mother and child. The objective of this study was to describe the prevalence of physical abuse before and during pregnancy among a representative sample of Massachusetts women with and without disabilities. Data from the 2007–2008 Massachusetts Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed in 2010. Disability prevalence was 4.9% (95% CI = 3.9–6.2) among Massachusetts women giving birth during 2007–2008. The prevalence of physical abuse during the 12-months before pregnancy among women with disabilities was 13.6% (95% CI = 7.2–24.0) compared to 2.8% for women without disabilities (95% CI = 2.1–3.7). Similarly, 8.1% (95% CI = 4.0–15.7) of women with disabilities compared to 2.3% (95% CI = 1.7–3.1) of women without disabilities experienced physical abuse during pregnancy. Multivariate analyses indicated that women with disabilities were more likely to report physical abuse before pregnancy (OR = 4.3, 95% CI = 1.9–9.7), during pregnancy (OR = 2.8, 95% CI = 1.1–7.1), or during either time period (OR = 3.2, 95% CI = 1.4–7.1) than women without disabilities while controlling for maternal age, education, race/Hispanic ethnicity, marital status and household poverty status. No difference was observed by disability status in the likelihood of prenatal-care providers talking to women about physical abuse. These analyses reveal disproportionate prevalence of physical abuse before and during pregnancy among women with disabilities. Screening for physical abuse and timely referral of women in need of assistance are critical to optimize health outcomes for both mother and child.