Violence

Thomas W. Strahan Memorial Library
Index
Standard of Care for Abortion
Abortion Decision-Making
Psychological Effects of Abortion
Social Effects and Implications
Physical Effects of Abortion
Abortion and Maternal Mortality
Adolescents and Abortion
Definition of Terms
Women's Health After Abortion
Material Yet to be Cataloged
Strahan Summary Articles

Sub-Index
Psychological Effects
Validity of Studies
Reviews
Risk Factors
PTSD
Grief and Loss
Guilt
Ambivalence or Inner Conflict
Anxiety
Intrusion / Avoidance / Nightmares
Denial
Dissociation
Narcissism
Self-Image
Self Punishment
Depression
Psychiatric Treatment
Self-Destructive Behavior
Substance Abuse
Long-Terms Effects of Abortion
Replacement Pregnancies
Sterilization
Impact of Abortion On Others
Violence
Rape, Incest, Sexual Assault
After Late Term Abortion

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See also Suicide

"Wantedness" as a Factor in Child Abuse

"Child Abuse: A Study of the Child's Perspective," Philip G. Ney Child Abuse and Neglect 10:511-518(1986).

In a study of 57 children admitted to the Child and Family Psychiatric Unit at Christchurch Hospital, New Zealand, a three-way study of abuse experience via mother, child and staff was undertaken. When wantedness by mothers was compared to abuse, there was no significant correlation between mothers not wanting their child and either the extent or severity of any kind of abuse. Some 85% of these children were wanted after they were born. Mother's ambivalence about their pregnancies appears to have been greatest during the early stages.

"The Hostility of Parents to Children: Some Notes on Infertility, Child Abuse and Abortion," Victor Calef, International Journal of Psychoanalytic Psychotherapy 1(1) :76, February 1972

A case of extensive therapy of a woman patient is described by a psychiatrist. The woman physically abused her children and also aborted an apparently "unwanted" pregnancy. The pregnancy was not, in fact, unwanted but due to pathological behavior had to be "destroyed." Unresolved conflicts in the woman's family of origin were uncovered, i.e., resentment against her father for failing to protect the woman from her cruel mother.

Child Abuse: An Interactional Event, A. Kadushin and J.A. Martin, (New York: Columbia University Press, 1981) 236

A study of non-sexual physical abuse by parents in Wisconsin found that less than 5% of the mothers had considered either abortion or adoption as a means of "unburdening" themselves of the child. Three out of four parents had a positive reaction to the child at birth.

"Antecedents of Child Abuse," W.A. Altemeier, S. O'Connor, P. Vietze, H. Sandler and K. Sherrod, Journal of Pediatrics 100(5):823 (1982)

In a Vanderbilt University study of 1,400 low-income mothers, it was found that mothers who had physically injured their children did not differ significantly from the non-abusing mothers in money available to raise a child, in considering abortion or adoption, readiness for motherhood or current feelings about the baby; abusing mothers had more aggressive tendencies, were more likely to think they had unfair treatment as a child and were more likely to have lost a child to foster care or avoidable death.

"Social aspects of the battered baby syndrome," M.S. Smith, R. Hanson and S. Noble, Br. J. Psychiatry 125:568(1974).

A British study of 134 battered children under five years of age compared to children under five years who were emergency hospital admissions with no battering found that abortion had been considered by only 12% of the mothers of battered children vs. 2% of controls, which was not considered statistically significant. Family size and family income was similar between the two groups but battered children were more likely to be illegitimate and mothers of battered children tended to be more isolated than controls.

Child Abuse and Its Relationship to Abortion

One of the arguments advanced for the legalization of abortion was that it would reduce child abuse. However, there is evidence that it may increase abuse and neglect of children as the following articles indicate.

"Smoking during pregnancy and child maltreatment," J. Chessare J. Pascoe, and E. Baugh, International Journal for Bio-Social Research 8:1-6(1986).

Women who continue to smoke during pregnancy had three times higher child abuse reporting rates in the 18 months following delivery than women who did not smoke during pregnancy. Ed. Note: women with a history of abortion are more likely to smoke during subsequent pregnancies compared to women with no history of abortion.

"Maternal Perinatal Risk Factors and Child Abuse," M. Benedict, R. White and P. Comely, Child Abuse and Neglect 9:217-224(1985).

A Johns Hopkins study of 532 Baltimore mothers in maltreating families (two-thirds black) found that mothers tended to be younger, have shorter birth intervals, less prenatal care and were significantly more likely to have had a prior stillbirth or reported abortion or a prior child death. Some 18% of abusing families had one or more prior stillbirth or abortion vs. 12% of non-abusing families. Where there were two stillbirths or abortions or a combination thereof, the rate was nearly doubled (4.3% vs. 2.4%). The authors called these findings "provocative" and concluded that reproductive history and the circumstances surrounding past pregnancies may provide important clues of what family dynamics may be related to subsequent maltreatment.

"Smoking in pregnancy:a study of psychosocial and reproductive risk factors," AW Morales et al, J Psychosom Obstet Gynaecol 18(4):247, 1997

A British study found that women who were more likely to smoke during pregnancy were more likely to have had previous miscarriages and terminations, more likely to report marital difficulties, and more likely to physically discipline their one year old infants. see also "Smoking during pregnancy and child maltreatment," J Chessare et al, Int'l Journal for Biosocial Research 8:1, 1986 (Women who continued to smoke during pregnancy had three times higher child abuse reporting rates compared to women who did not smoke during pregnancy.)

"Association of Drug Abuse and Child Abuse," PK Jaudes and E Ekwo, Child Abuse & Neglect 19(9): 1065-1075, 1995

A study at a Chicago urban medical center of children exposed to drugs in utero found that the risk of subsequent abuse or neglect was 80% higher among children whose mothers had previously planned abortion after controlling for confounding variables.

"Drug Use Among Adolescent Mothers: Profile of Risk," Amaro, Cabral, Zuckerman, Pediatrics, 84(1):144, July 1989.

In Boston inner city study of adolescent mothers in 1984-86, mothers with a prior elective abortion were twice as likely to use alcohol, marijuana, cocaine or opiates than non-drug users (33% v. 16%). Drug users were nearly three times more likely to report being threatened, abused or involved in fights during pregnancy than non-users (24% v. 9%).

"Post-Abortion Trauma. 9 Steps to Recovery," Jeanette Vought, (Grand Rapids: Zondervan, 1991).

In a study of 68 women in a post-abortion support group 10-15 years post-abortion, 32% reported lacking patience with their children, 29% reported sometimes being verbally or emotionally abusive with them, 20% acknowledged frequent anger toward their children, 15% admitted feelings of unexpected rage toward their children and 13% felt they over disciplined their children--29% also reported being over-protective of their children and 14.7% reported having difficulty bonding to their children.

"Two Hidden Predisposing Factors in Child Abuse," Emanuel Lewis, Child Abuse and Neglect 3:327-330(1979).

With all bereavement which occurs during or shortly before or after pregnancy, mourning tends to be inhibited. Quick replacement pregnancies impede the mourning of stillbirth; stillbirth can often lead to marital difficulty and if there is a family difficulty in containing violence, the child may be battered; child abuse is a pathological mourning reaction.

"Relationship Between Abortion and Child Abuse, Philip," Ney, Canadian Journal of Psychiatry 24:610-620(1979).

Death to Canadian children from social causes rapidly increased after early abortion became available on demand in 1969; British Columbia and Ontario, with the highest rates of abortion, are also the provinces with the highest rates of child abuse. Newfoundland, Prince Edward Island and New Brunswick, with low rates of abortion, have low rates of child abuse. Rates of increase of child abuse parallels increases in abortion. Rather than preventing child abuse, abortion on request may be a cause of the increase in battered and murdered children because, (1) Having an abortion may decrease an individual's instinctual restraint against the occasional rage felt toward those dependent on her care. (2) Allowing infants to die by permissive abortion might diminish the social taboo against aggressing the defenseless. (3) Abortion may devalue children, thus increases guilt and self-hatred, the parent may displace it onto a child. (5) A woman's choice for abortion increases the hostile frustration of some men, intensifying the battle of the sexes for which children are scapegoated. (6) Abortion of the first child may truncate the developing mother-infant bond, thereby diminishing future mothering capability. (7) A previous abortion may result in depression which interferes with the mother's capacity to bond to her newborn.

"Induced Abortion as a Precipitating Factor in Child Abuse or Neglect: Case Studies," Association for Interdisciplinary Research Newsletter 4(1), Spring, 1991, p.7

Severe anger and hostility shortly before undergoing an induced abortion spilled over to precipitate an act of reported physical abuse on a 9 year old child by the mother.

===A Survey of Post-Abortion Reactions, David C. Reardon, (Springfield, Illinois: The Elliot Institute, 1987).

In a 1987 survey of 100 women who were contacted through state Women Exploited by Abortion chapters/ 22% reported being sexually abused as a child and 22% reported being physically abused as a child.

"The Spectrum of Fetal Abuse in Pregnant Women," John T. Condon Journal of Nervous and Mental Disease 174(9):509-516, September 1986.

"The fetus is a (potential) recipient par excellence for projection and displacement. The symbiotic relationship between the mother and unborn child... can provide a setting in which ambivalence or hostility can be acted out as assault or maltreatment."

Child Neglect or Failure to Bond

"The correlates of antenatal attachment in pregnant women," JT Condon et al, Br J Med Psychol 70(Pt. 4): 359-372, Dec, 1997.

Women having low maternal-foetal attachment were characterized by high levels of depression and anxiety, low levels of support outside the partner relationship, and high levels of control, domination, and criticism within the partner relationship.

"Infant Abortion and Child Abuse: Cause and Effect," Philip G. Ney, in The Psychological Consequences of Abortion Ed. D. Mall and W.F. Watts, (Washington D.C.: University Publications of America, 1979)

Neglect of a subsequent child was related to the depression in a mother from a previous abortion.

"Relationship Between Induced Abortion and Child Abuse and Neglect: Four Studies," Philip G. Ney, T. Fung, A.R. Wickett, Pre- and Perinatal Psychology Journal 8(1):43-63, Fall, 1993.

A mother with a history of psychiatric problems and a prior abortion subsequently married and gave birth to a child. Although she was excited at the pregnancy "as soon as they handed me the baby, I handed him back. It was a weird sensation." Later when she returned home she began screaming and hitting her baby, tossing him violently on the bed and desperately trying to stop his crying, "I used to get pissed off when he cried. I never felt close, not as much as I thought I would." She concluded, "If I had had the first child, I would not have been frightened and wouldn't have this problem."

"Some maladaptive syndromes of pregnancy and the puerperium," Richard L. Cohen, Obstetrics and Gynecology 27(4):562-570 (1966).

A history of abortions, periods of sterility, traumatic deliveries, or loss of children...may interfere with the mother's emotional growth. Quoting J. Rose, "The Prevention of Mothering Breakdown Associated with Physical Abnormalities of the Infant" in Prevention of Mental Disorders in Children, G. Caplan ed. (New York: Basic Books, 1961.)

Canonical Variates of Post-Abortion Syndrome, Helen P Vaughan, (Portsmouth, NH: Institute for Pregnancy Loss, 1990) 51

10% of stressed women felt that their abortion had a negative effect on subsequent bonding to and parenting children.

"The disturbance of the mother-child relationship by unsuccessful attempts at abortion," G. Caplan, Mental Hygiene 38:67-80(1954).

An unsuccessful attempt at abortion was found to be a direct cause of a disturbed mother-child relationship. Sixteen cases were studied.

"Motivation of Surrogate Mothers: Initial Findings," Philip Parker, American Journal of Psychiatry 140(1):117-118, January 1983.

In a study of 125 women who applied to be commercial surrogates, 35% either had a voluntary prior abortion (26%) or had relinquished a child for adoption (9%). Women felt, often unconsciously, that surrogate motherhood would help them master unresolved feelings of previous voluntary loss. Women stated, "It would be their baby, not mine," "I'm only an incubator," "I'd be nest watching" and, "I'll attach myself in a different way- hoping it's healthy." For an example of comment on commercial surrogacy, see "Death without dignity for commercial surrogacy: The case of Baby M. G. Annas," Hastings Center Report 18(2):21-24 (1988).

"Antecedents of Child Abuse and Neglect in Premature Infants," R. Hunter, N. Kilstrom, E. Kraybill and F. Loda, Pediatrics 61(8):629-635, April 1978.

In a study of 282 infants admitted to the newbom intensive care unit of a hospital, 255 were eventually discharged home to their parents. Ten of the 255 were subsequently reported for physical abuse (2) or neglect (8) during the first year of life. Reported families were noted to be severely isolated without adequate social support, frequent marital maladjustment, financial problems, poor use of medical services, inadequate child care arrangements, inadequate child spacing, lower birth weight, congenital defects in abused child at birth, expressed disappointment over the sex of the baby and 40% claimed to have seriously considered abortion, compared to only 7% of those who were not reported. Forty-one infants of the 255 discharged to their homes were considered high risk for abuse or neglect, yet few of these infants were reported for maltreatment. Parents of reported infants were most likely to be rated by the interviewer as impulsive, apathetic- futile, childish-dependent, or retarded or illiterate.

"Breaking the Cycle in Abusive Families," R. Hunter and N. Kilstrom, American Journal of Psychiatry 136(10):1320 (1979)

Repeat families representing 9 out of 10 families who had been reported primarily for neglect and who had been part of an earlier study/were compared with 40 nonrepeating families where there had been child abuse in the family of origin but not with current offspring. Repeating parents had less working through of childhood misfortunes. Non- repeaters were more active in churches or other social groups and were more hopeful. Ed. Note - Factors such as isolation, hopelessness, lack of social support and despair seemed to indicate a spiritual need in the abusing or neglecting families.

Family Violence and Abortion

The prevalence of intimate partner violence among women and teenagers seeking abortion compared with those continuing pregnancy. Bourassa D, Berube J. J Obstet Gynaecol Can 2007;29:415–23.

Interviews with 350 women seeking abortion found that 25.7 percent reported being a victim of physical or sexual abuse in the year prior to the abortion, and 41.1 percent reported being a victim of violence at some point during their lifetime. These rates were significantly higher than for a group of women interviewed a a perinatal clinic who were carrying a pregnancy to term.

Due to the high rates of exposure to partner violence among women seeking abortions, the authors recommend pre-abortion screening for intimate partner violence with appropriate education and referrals to reduce and avoid violence.

Note: While this study's title includes the phrase "intimate partner violence" the questionnaire on which it is based does not delineate whether or not the male partner involved in the pregnancy was the perpetrator of violence or abuse. Instead, the questionnaire includes exposure to violence or abuse of nearly every form from any source. Unfortunately, the survey instrument appears to be designed to maximize reports of violence but lacks the specificity required to actually determine, as one would expect, if the violence was from the male partner involved in the pregnancy. In this study, for example, they collapsed exposure to violence from the current partner and an ex-partner, without delineating if the violence was reported relative to the man who impregnated her. Furthermore, nothing in the questionnaire aids in determining if an abusive partner is pressuring for or against an abortion.

A noteworthy finding was that lifetime exposure to violence increased with age among women in the abortion group but decreased with age for women in the birthing group. Since risk of abortion increases following a prior abortion, it is likely that older women in the abortion group had a greater incidence of multiple abortions in their history. The heightened risk of abuse in older women having abortions may be at least in part due to prior exposure to abortion(s).

Contraceptive use and associations with intimate partner violence among a population-based sample of New Zealand women. Fanslow J, Whitehead A, Silva M, Robinson E. Aust N Z J Obstet Gynaecol. 2008 Feb;48(1):83-9. See also news report

Women who had experienced domestic violence were twice as likely to have an abortion than other women (21% vs 10%). They were also more likely to have miscarriages (42% vs 28%). Need to check this source. News reports may be pointing to a different study by Fanslow.

Prevalence of family violence amongst women attending an abortion clinic in New Zealand. Whitehead A, Fanslow J. Aust N Z J Obstet Gynaecol. 2005 Aug;45(4):321-4.

ABSTACT: AIMS: To measure the prevalence of family violence reported by women seeking a termination of pregnancy (TOP). METHODS: A cross sectional survey involving consecutive women at one Health Waikato abortion clinic. Participants completed a self-administered questionnaire in private counselling rooms. RESULTS: Sixty-two of the 125 women invited to participate did so (response rate: 49.6%). The reported lifetime prevalence of physical or sexual abuse was 50.8%. The reported lifetime prevalence of physical abuse was 43.3% and that of sexual abuse was 32.2%. The reported prevalence of physical abuse within the last year was 13.3%, and of sexual abuse within the last year was 8.5%. Of women reporting a lifetime history of physical abuse, 69% reported that her partner was the perpetrator/one of the perpetrators of abuse. CONCLUSIONS: The study demonstrated a high prevalence of family violence amongst women attending an abortion clinic. Consideration should be given to screening for family violence in abortion clinics in New Zealand. Screening should be accompanied by the provision of appropriate information and support for women with family violence issues.

Termination of pregnancy: associations with partner violence and other factors in a national cohort of young Australian women. Taft AJ, Watson LF. Aust N Z J Public Health. 2007 Apr;31(2):135-42.

OBJECTIVE: To examine the associations between termination and other reproductive events, socio-demographic characteristics and experience of violence among a community-based national sample of young Australian women. METHODS: Using multiple logistic regression, we analysed data from the Younger cohort of the Australian Longitudinal Study on Women's Health comprising 14,776 young women aged 18-23 in survey 1 (1996), of whom 9,683 aged 22-27 also responded to survey 2 (2000). We stratified respondents into those aged below 20 and those who were older at survey 1. We compared the characteristics associated with terminations among teenage women in 1996 (survey 1) with those of women aged over 20 in 1996 who had not then reported a termination and who responded to survey 2 in 2000. Finally, we compared the characteristics of women reporting terminations, births, preterm births and miscarriages. RESULTS: Women reporting teenage terminations were more likely to be in a de facto relationship (OR = 1.94, 95% CI 1.17-3.21), less well educated (OR = 2.32, 95% CI 1.44-3.74), have no private health insurance, and be a victim of partner violence (OR = 3.11, 95% CI 1.76-5.49). Women reporting later terminations were also more likely to be abused by a partner (OR = 3.52, 95% CI 2.14-5.81).The relationship with violence held for the other reproductive events. CONCLUSION AND IMPLICATIONS: Partner violence is a strong predictor of termination and other reproductive outcomes among young Australian women. Education has a protective effect. Prevention and reduction of partner violence may reduce the rate of unwanted pregnancy.

"Past Trauma and Present Functioning of Patients Attending a Women's Psychiatric Clinic," E.F.M. Borins, P.J. Forsythe, Am. J. Psychiatry 142(4): 460, April, 1985

Physical or sexual abuse was significantly related to abortion, and abortion and trauma were significantly correlated in a sample of 100 women attending a psychiatric clinic.

"Women Psychiatric Outpatients Reporting Continuing Post-Abortion Distress: A Preliminary Inquiry," D. Hanley, H. Piersma, D. King, D. Larson. D. Foy, Presented at the Eight Annual Meeting of the International Society for Traumatic Stress Studies: Los Angeles, Oct. 23,1992.

In a study of women at an outpatient mental health facility approximately two-thirds of post abortion women reported having been physically and/or sexually abused as children, adolescents, or adults before and/or after their abortions.

"Child sexual abuse, HIV sexual risk, and gender relations of African-American women," GM Wingood, RJ DiClemente, Am J Prev. Med 13(5): 380-384, 1997

Women who reported a history of childhood sexual abuse were 50% more likely to have had an abortion.

"Psychosocial and behavioral factors associated with physical and sexual abuse among HIV infected women," LA Bedimo et al, Int Conf AIDS, 1998; 12:219 (abstract no. 14185)

Among women attending a HIV outpatient program in New Orleans, Louisiana, 45% reported ever experiencing sexual abuse, 82% acquired HIV through heterosexual contact. Among those sexually abused, 27% first experienced it before the age of 17. Factors associated with a history of sexual abuse included having a history of abortion (33% vs. 9%).

"The Prevalence of Domestic Violence Among Women Seeking Abortion," SL Glander et al, Obstetrics and Gynecology 91:1002, 1996

A study of urban women seeking abortions at a single abortion facility found that 39.5% reported prior abuse.

"Stressful Life Events and Alcohol Problems among Women Seen at a Detoxification Center," E.R. Morrissey and M.A. Schuckit, J. Studies on Alcohol 39(9):1559 (1978).

A 1976 Seattle, Washington study of women at a detoxification center found that problem drinkers and secondary alcoholics were found to be significantly more likely to have experienced alcoholic related problems subsequent to an abortion. Sixty-four percent of the secondary alcoholics and 32% of the problem drinkers reported physical fights while drinking.

Psycho-Social Stress Following Abortion, Anne Speckhard (Kansas City, MO: Sheed&Ward, 1987).

In a study of 30 women reporting stress following abortion 92% reported feelings of anger, rage or hostility toward others following the abortion. Feelings of anger were alternately directed at self, one's partner, medical professionals or significant others who were viewed as having taken a coercive role in the abortion decision.

"Women Who Seek Therapeutic Abortion: A Comparison with women Who Complete Their Pregnancies," C. Ford, P. Castelnuovo-Tedesco, K. Long, American Journal of Psychiatry 129(5):58/ November, 1972.

In a study of women seeking abortion for mental health reasons compared with a control group of pregnant women not seeking abortion, the abortion group was found to be more likely to have received psychiatric treatment (42.5% v. 21.1%) and much more likely to exhibit masochistic behavior patterns (35% v. 6%). Many women in the abortion group had been involved in relationships with men which they described as abusive and assaultive. Other women had engaged in self-destructive behavior such as cutting themselves with knives or scissors. Other women were involved in self-defeating behavior such as supporting irresponsible husbands or were married to alcoholics and/or philanderers.

Reproductive and Sexual Coercion. Committee on Health Care for Underserved Women. ACOG. Feb 2013

This ACOG committee recommends efforts to educate the public and to prevent "sexual coercion," including disregard by men for getting women pregnant, but studiously avoids raising any concerns about men pressuring women to abort pregnancies.

Abortion as a Risk Factor for Violence During Pregnancy

"Violence During Pregnancy and Substance Abuse," Amaro, Fried, Cabral, Zuckerman, Am. J. Public Health 80(5): 575, May, 1990.

A prospective study of 1243 pregnant women who were predominately poor, urban minority women at Boston City Hospital during 1984-87 found that 7% reported physical or sexual violence during pregnancy. A prior elective abortion increased the relative risk of violence during pregnancy. (RR 1.68) Victims of violence were more likely to have had a history of depression, suicide, current unhappy feelings about the pregnancy, lack of support during pregnancy and were more likely to be heavy users of alcohol or illicit drugs.

"Domestic violence during pregnancy. The prevalence of physical injuries, substance abuse, abortions and miscarriages," LW Hedin, PO Janson , Acta Obstet Gynecol Scand 79(8):625-630, 2000.

Among 207 women from three different antenatal clinics in Goteborg, Sweden, 30 were abused during the current pregnancy. A higher proportion of abused women had undergone one or more abortions compared to the non-abused group.

"Pregnancy outcomes and health care use: Effects of abuse," J Webster et al, Am J Obstet Gynecol 174:769, 1996

An Australian hospital evaluated past and present abuse during pregnancy and found that abused women were significantly more likely to have had a higher incidence of miscarriage, two or more induced abortions, or neonatal death compared to non-abused women.

Beyond Choice, Don Baker, (Portland, Oregon: Multonomah Press, 1985).

A father still grieving the loss of his first child by abortion (coerced by his wife's parents) was upset about a subsequent pregnancy which occurred shortly after the abortion. Once in a fit of anger during an argument over finances, he struck his pregnant wife in the stomach. Five days after the birth of the baby, he left for work and never returned. A brief note said, "I'm sorry Deb. We couldn't have the baby we wanted and now we have got one I can't stand. It's too much for me to handle, Tim." His wife, Debbie, never saw Tim again.

"Physical Abuse in Pregnancy," Hillard, Obstetrics and Gynecology 66:185 (1985).

In a study of 742 pregnant women seen at the University of Virginia Obstetric clinics in 1982-83,10.9% indicated they had experienced physical abuse at some time in the past; 4.1% reported abuse during their current pregnancy. Those in currently abusive relationships were more likely to have considered abortion (34%) compared to controls (21%).

"Protecting the Children of Battered Women," Richard M. Tolman, Journal of Interpersonal Violence 3(4):476-483, December 1988.

A recent example of induced abortion as a result of coercion and violence of the father against the mother and unborn child is reported. The husband beat the wife extensively over the course of a 13-year marriage. He beat her during pregnancies, punching her in the face and stomach, and kicking her between the legs. Following the birth of their first two children, he had forced her to have two abortions she did not want. The wife became pregnant a third time when the husband forced her to have sex with him which resulted in the birth of their third child after the wife refused to have an abortion. The husband reportedly called the third child a "raw piece of meat." The case was referred to by social workers as "not atypical."

"Sixty Battered Women," Elaine Hilberman and Kit Munson, Victimology 2:460- 470(1977-1978).

An unborn child may be used as a focal point for family violence. In a study of sixty battered women referred by the medical staff of a rural health clinic, the women involved reported changes in the pattern of family violence during pregnancy. There was increasing abuse for some with the pregnant abdomen replacing face and breasts as the target for battering with abortions and premature births as the result. Others reported less abuse with pregnancy and one woman deliberately stayed pregnant to avoid violence.

Homicide of Women During and Following Pregnancy

"Pregnancy-associated deaths in Finland 1987-1994- definition problems and benefits of record linkage," M Gissler et al, Acta Obstet Gynecol Scand 76:651-657, 1997.

A Finnish register linkage study identified all deaths that occurred up to 1 year after an ended pregnancy. The mortality rate was 27 per 100,000 births and 101 per 100,000 abortions. Compared to women of reproductive age with no pregnancy (1.0), the relative risk of death from homicide following abortion was 4.33 (1.03-18.2, 95% CI) compared to a relative risk of 0.31 ( 0.02-4.42, 95% CI) following childbirth.

"Enhanced Surveillance for Pregnancy-Associated Mortality-Maryland, 1993-1998," IL Horton and D Cheng, JAMA 285(11): 1455-1459, 2001.

247 pregnancy-associated deaths were identified from any cause during pregnancy or within 1 year of delivery during 1993-1998. 182 deaths (73.7% ) of the pregnancy- associated deaths followed a live birth and 53 deaths occurred among pregnant women who were undelivered; 84 deaths occurred within 42 days of delivery, and 103 deaths occurred 43-365 days following delivery or termination of pregnancy; 50 deaths from homicide were identified among pregnant women or women who had been recently pregnant. An editorial noted that the enhanced surveillance revealed that when an expanded definition of maternal mortality is used, threats from a woman's social environment, like homicide, may be found to be more deadly than those from a biological environment.

"Hidden from View: violent deaths among pregnant women in the District of Columbia, 1988 -1996," CJ Krulewitch et al, J Midwifery Women's Health 46(1): 4-10, 2001

651 autopsy charts were examined from 1988-1996 in the DC office of the Chief Medical Examiner. Among these, 30 (4.6%) documented evidence of pregnancy and 95.4% were not pregnant. Among the 30 deaths where pregnancy was documented, 13 (43.3%) were victims of homicide. Among non-pregnant women, homicide was the leading manner of death (32.3%); 75% of those who were pregnant died from gunshot trauma; 3 out of 4 women with evidence of pregnancy who were victims of homicide were in their first 20 weeks of pregnancy. Many of the accused perpetrators in the study had the same address as the victim which suggests the possibility of domestic violence.

"Violence during Pregnancy and Substance Use," H Amaro et al, Am J Public Health 80(5): 575, 1990

A prior elective abortion increased the risk of violence during pregnancy by 68%, compared to no abortion history among a sample of poor, urban, mostly minority women.

"Pregnancy outcomes and health care use: Effects of abuse," J Webster et al, Am J Obstet Gynecol 174:769, 1996

An Australian hospital evaluated past and present abuse during pregnancy and found that abused women were significantly more likely to have had a higher incidence of miscarriage, two or more induced abortions, or neonatal death compared to non-abused women.

"Domestic violence during pregnancy," LW Hedin and PO Janson, Acta Obstet Gynecol Scand 79:625-630, 2000

A Swedish study compared physically abused women with non-abused women during pregnancy. In the group of abused women a higher proportion had undergone one or more abortions than in the non-abused group. Smoking and alcohol use were strongly associated with physical and sexual abuse.

"Mediation of Abusive Childhood Experiences: Dissociation and Negative Life Outcomes," E Becker-Lausen , Am J Orthopsychiatry 65(4): 560, 1995

Dissociation was significantly related to reports of females of previously becoming pregnant and having an abortion in high school. Individuals who detach from reality by dissociation may disregard clues that may otherwise warn them of danger and become " sitting ducks" for later abuse.