Opportunities for intervention: discussing physical abuse during prenatal care visits.
BACKGROUND
The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend that screening for physical abuse during prenatal care visits becomes routine. Although prenatal care visits offer a unique intervention opportunity, screening is not yet standard practice.


METHODS
We used data from the 1996 and 1997 Pregnancy Risk Assessment Monitoring System (PRAMS) to assess the prevalence of and the factors associated with health care providers' discussion of physical abuse with pregnant women in 14 states. PRAMS is a state-specific, population-based surveillance system that collects information from women on maternal behaviors before and during pregnancy, and at 2 to 6 months postpartum.


RESULTS
Between 22% and 39% of the women surveyed reported that health care providers talked with them about physical abuse during prenatal care visits. Health care providers were more likely to discuss physical abuse with women who were black, Hispanic, young (aged <20 and 20 to 29), had a high school education or less, or paid for prenatal care with Medicaid.


CONCLUSIONS
Our results indicate that most pregnant women do not report that their prenatal care providers discussed physical abuse with them. Logistic regression analyses identified consistent associations across the 14 states between discussion of abuse and demographic and pregnancy-related factors. A better understanding of the factors associated with whether a health care provider discusses physical abuse with a pregnant woman could increase intervention opportunities.
Durant
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National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
Colley Gilbert
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B
Saltzman
L E
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Johnson
C H
CH
D000328:Adult; D005260:Female; D006801:Humans; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D011159:Population Surveillance; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*; D011322:Primary Prevention / Q000379:methods; D012494:Sampling Studies; D013179:Spouse Abuse / Q000175:diagnosis* / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology