Intended for healthcare professionals

Rapid response to:

Primary Care

Reported frequency of domestic violence: cross sectional survey of women attending general practice

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7332.271 (Published 02 February 2002) Cite this as: BMJ 2002;324:271

Rapid Response:

Missing Variable Would Improve Study

Dear Editor,

Bradley's identification of fear of partner and controlling behavior
as screening variables to identify risk for domestic violence against
women is clearly helpful. The study would have been improved, however, if
the researchers had also examined another variable associated with
domestic violence and controlling behavior: a history of abortion.

Women who report a history of abortion are over twice as likely to
report violent acts committed by their partner in the last year compared
those who do not report a history of abortion (OR=2.27; 95% CI = 1.53 to
3.36).(1) They are also fourteen times more likely to be victims of
homicide compared to those who carry to term.(2)

Pregnancy may expose women to abuse if a male partner is unwilling to
accept or tolerate the birth of a child. Verbal or physical abuse may be
used to compel them to submit to an unwanted abortion.(3) According to one
study of battered women, the target of battery during their pregnancies
shifted from their face and breasts to their pregnant abdomen,(4) which
suggests hostility toward the woman's fertility. This problem may be
widespread since numerous studies show that pregnant women are at higher
risk of being abused.(5, 6)

Coerced abortions can clearly be a form of and result of abuse.
Following a coerced abortion, a woman's reactions of grief and depression
may trigger repeated acts of violence on the part of the male who may
interpret her withdrawal as rejection and repudiation. Furthermore, even
voluntary abortions may contribute to domestic violence if there are post-
abortion psychological reactions—on either the part of the woman or man.
If either or both partners experience grief, resentment, anger, substance
abuse, self-punishing or self-destructive behaviors, this may aggravate
the frequency and intensity of subsequent domestic conflicts.(3)

This hypothesis is supported by clinical experience with abused women
as well as the results of a survey of 260 post-abortive women of whom 53
percent agreed with the statement that after their abortion "I started
losing my temper more easily," and 48 percent agreed that "I became more
violent when angered." In this same sample, 56 percent reported
experiencing suicidal feelings, with 28 percent actually attempting
suicide one or more times. Approximately 37 percent described themselves
as "self-destructive" with another 13 percent "unsure," that is unwilling
to rule out that they had become self-destructive.(3)

Further analyses of this data revealed that increased post-abortion
levels of self-hatred, hatred of the male, and hatred of men in general,
were all significantly correlated to each other. In addition, suicidal
tendencies and self-destructive behavior were statistically associated
with shorter tempers and increased levels of anger and violence (p<
.00001). In turn, short tempers and self-destructive behavior were also
significantly associated with feeling less in touch with one's emotions,
feeling unable to grieve, faking displays of happiness, and feeling less
control over one's life.

In summary, women who are angry and self-destructive following an
abortion may be less inclined to avoid violent confrontations. In
addition, the association between abortion and abuse may indicate that a
substantial number of women may be submitting to unwanted abortions in the
face of abuse and coercive pressure.

Research on domestic violence would be improved by closer attention
to these associations. In the meantime, screening for domestic violence
would be improved by examining pregnancy histories. An additional benefit
from such screening is that abortion is also associated with higher rates
of suicide, substance abuse, and depression and is therefore a useful
marker for identifying women who may benefit from intervention counseling.

NOTES

1. Russo NF, Denious JE. Violence in the lives of women having
abortions: implications for practice and public policy. Professional
Psychology: Research and Practice 2001; 32:142-150.
2. Gissler M, Kauppila R, Merilainen J, Toukomaa H, Hemminki E. Pregnancy-
associated deaths in Finland 1987-1994 -- definition problems and benefits
of record linkage. Acta Obset Gynecol Scand 1997;76:651-657.
3. Burke T, Reardon DC. Forbidden Grief: The Unspoken Pain of Abortion.
Springfield, IL: Acorn Books, 2002.
4. Hilberman E, Munson K. Sixty battered women. Victimology 1977-78; 2:460
-470.
5. Gazmararian JA, Adams MM, Saltzman LE, Johnson CH, Bruce FC, Marks JS,
Zahniser SC The relationship between pregnancy intendedness and physical
violence in mothers of newborns. The PRAMS Working Group. Obstet Gynecol
1995 Jun;85(6):1031-8.
6. Amaro H, Fried LE, Cabral H, Zuckerman. Violence during pregnancy and
substance use. Am J Public Health 1990 May;80(5):575-9.

Competing interests: No competing interests

22 February 2002
David C. Reardon
Director of Research
Elliot Institute, Springfield, IL