U of A epidemiologist works to improve domestic violence screening for pregnant women

Maeve Wallace, an associate professor in the Department of Health Promotion and Sciences received a $148,000 grant from the Eunice Kennedy Shriver National Institute of Child Health and Development (NICHD) to explore intervention and assistance strategies for women receiving maternity care who may be experiencing domestic violence. 

According to the National Institutes of Health, maternal mortality rates in the United States are higher than that of other high-income nations. Further, the work of Dr. Wallace and others over the past decade has found that homicide is a leading cause of death for pregnant women in America, creating a great need for research on interventions to prevent violence against pregnant and postpartum women. 

The project, titled “Provider and Survivor Perspectives on Screening for Intimate Partner Violence during Pregnancy and Postpartum,” will identify improved ways to screen for domestic violence in maternity care settings and support women who may be experiencing domestic violence while pregnant or in their first year postpartum. 

“Pregnancy is a time when people are at greater risk of experiencing fatal violence, and maternity care visits offer a unique and important opportunity to identify and assist people who might be experiencing violence at home,” Wallace said.

Today, women who receive maternity care are only screened for domestic violence about 20%-30% of the time, despite recommendations for universal screening. Improving screening rates and the way in which screening is conducted would significantly increase safety measures and opportunities for intervention. 

The research team will conduct a series of focus groups consisting of maternity care providers – such as OBGYNs, nurses, and midwives – and of women who experienced violence during their pregnancy. The team will ask questions to identify barriers to universal, consistent screening, and will seek to better understand the experiences of women who have experienced domestic violence and their interactions with health care providers. 

The NICHD grant will fund a small portion of the researchers’ salaries as well as incentives for participants in the study. The focus groups are based in New Orleans, Louisiana, where Wallace works with co-investigators specializing in social work from Tulane University and in domestic violence prevention at the New Orleans Health Department. 

Louisiana has consistently ranked among the states with higher rates of domestic violence, and with some of the highest rates of domestic violence-related homicide against women. The state’s public health officials and advocacy groups have been working to address this issue through a combination of legislative changes, support services, and public awareness campaigns, but significant challenges remain.

Improving support for people experiencing violence largely comes down to a need for more training. According to Wallace, many professionals in maternity care feel they lack the skills to have these types of difficult conversations with women and therefore are ineffective at screening for violence and unable to offer help. 

Research that includes firsthand accounts of survivors is scarce, which makes Wallace’s study both unique and exceptionally valuable.

Asking survivors about their lived experiences and healthcare interactions is crucial for creating new training programs for health care providers. It will also inform new policies and protocols for maternity care facilities, creating places where people feel safe and comfortable enough to disclose that they are experiencing violence and be connected to support services when they do.

“The inclusion of survivors in this study will have an incredibly positive impact on the literature at large,” Wallace said. “Developing a training and intervention program with survivors in mind will improve responses, increase screening, and, ultimately, reduce maternal mortality.”