Birth Outcomes and Maternal Morbidity in Abused Pregnant Women With Public Versus Private Health Insurance

Authors

  • Margaret H. Kearney,

    Corresponding author
    1. Margaret H. Kearney, RNC, PhD, FAAN, Alpha Chi, Associate Professor, at William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
    Search for more papers by this author
  • Lois A. Haggerty,

    1. Lois A. Haggerty, RNC, PhD, Alpha Chi, Associate Professor, at William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
    Search for more papers by this author
  • Barbara H. Munro,

    1. Barbara H. Munro, RN, PhD, FAAN, Alpha Chi, Dean and Professor, at William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
    Search for more papers by this author
  • Joellen W. Hawkins

    1. Joellen W. Hawkins, RNC, PhD, FAAN, Alpha Chi, Professor, at William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
    Search for more papers by this author

  • This research was supported by a grant from the National Institute of Nursing Research (R15 NR04246) awarded to Dr. Hawkins. Coinvestigators in addition to the authors included Cynthia Aber, RN, EdD, Associate Professor, University of Massachusetts Boston; Joyce Dwyer, RN, MS, MPH, Associate Professor, William F. Connell School of Nursing, Boston College; Loretta P. Higgins, RN, EdD, Associate Professor and Associate Dean of Undergraduate Programs, William F. Connell School of Nursing, Boston College; Deborah Mahony, RN, ScD, Professor, University of Massachusetts Boston; and Carole W. Pearce, RNC, PhD, Associate Professor, Department of Nursing, University of Massachusetts Lowell.

Dr. Kearney, William F. Connell School of Nursing, Boston College, 140 Commonwealth Ave., Chestnut Hill, MA 02467-3812. E-mail: Kearnema@bc.edu

Abstract

Purpose: To compare the effects of recent intimate partner abuse on maternal and infant health in publicly versus privately insured pregnant women.

Design: Exploratory descriptive analysis in 13 Massachusetts prenatal care sites from records of 2,052 women who had been screened during pregnancy for domestic violence.

Methods: Clinicians screened pregnant women for domestic violence using the Abuse Assessment Screen. After delivery, prenatal and birth outcome data and abuse screening results were extracted from medical records by project staff. Odds ratios were used to compare maternal and infant health indicators in abused and nonabused women. Data from women with public and private health insurance then were examined separately, using logistic regression to control for low education and single marital status while examining the odds of adverse maternal and infant outcomes in abused and nonabused women.

Findings: In the sample as a whole, recently abused women were more likely to be publicly insured and unmarried, to have less than 12 years of formal education, and to have medical and obstetrical complications. Parity, ethnic background, and infant birth outcomes did not differ in relation to abuse. In separate analyses for women with public and private health insurance, after controlling for marital status and education, abuse increased the odds of low infant Apgar scores, poor nutrition, hyperemesis, hypertension, and substance abuse in publicly insured women, and abuse increased the odds of poor nutrition and bleeding during pregnancy for privately insured women.

Conclusions: The different correlates of abuse in publicly and privately insured women might be important for clinicians caring for these different populations. Screening for abuse and providing abuse-related services are indicated for pregnant women.

Ancillary