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Maternal Newborn Nursing

9.1 Incidence, History, and Psychosocial Factors

Maternal Newborn Nursing9.1 Incidence, History, and Psychosocial Factors

Learning Objectives

By the end of this section, you will be able to:

  • Describe incidences and risk factors of violence against women
  • Identify populations of women particularly at risk for violence
  • Discuss psychosocial theories related to violence against women

The World Health Organization (WHO, 2021) defines violence against women as an act of violence that results in the suffering of women, whether physical, sexual, or mental, occurring in public or private life. The WHO (2021) estimates that 30 percent of women in the world have been subjected to violence in their lifetime. Certain populations of women are at a higher risk for violence than others. Research has been conducted and theories have been established in an attempt to understand patterns of violence against women.

Incidences of Violence against Women

In women over the age of 15, 45 percent to 55 percent have experienced sexual harassment, including contact harassment (grabbing, pinching, slapping, rubbing against a person in a sexual way) and noncontact harassment (comments about a person’s body parts or appearance, sexually suggestive staring, stalking, exposure of sexual organs) (United Nations Women, n.d.). Globally, 72 percent of all trafficking victims are women and girls (United Nations Women, n.d.). In the United States, one in five women has been raped in their lifetime; 46.7 percent were raped by an acquaintance (National Coalition Against Domestic Violence [NCADV], 2020). According to the Bureau of Justice Statistics (2022), of female murder victims, 76 percent were killed by someone they knew (parent, grandparent, sibling, in-law, or other family member), and the majority were killed by a gun.

According to the National Coalition Against Domestic Violence (2020), 10 million U.S. adults experience domestic violence annually. According to the WHO, 27 percent of women (aged 15 to 49 years) who have been in a relationship have experienced intimate partner violence (IPV), which can include sexual assault, stalking, and homicide (NCADV, 2020). One in 10 women in the United States has been stalked in their lifetime by an intimate partner (National Coalition Against Domestic Violence, 2020). Almost all domestic violence abusers commit financial abuse to keep the victim trapped in the relationship (National Network to End Domestic Violence, 2017). Financial abuse is defined as tactics to limit access to money or assets, such as not allowing a person to work, controlling how money is spent, refusing to pay bills, not allowing access to bank accounts (National Network to End Domestic Violence, 2017). Of the 30 percent of women subjected to violence worldwide, IPV is the most common form of abuse (WHO, 2021).

Risk Factors for Violence against Women

It is important for the nurse not to assume that abuse occurs only in certain socioeconomic, ethnic, educational, or racial groups. Violence occurs across all racial, socioeconomic, and religious groups; however, some groups are at higher risk. Some risk factors for violence against women include ideas and social practices that perpetuate gender inequality, lower levels of education, history of exposure to child maltreatment, harmful use of alcohol, financial difficulties, and communities in which higher status is given to men and lower status to women (WHO, 2021.) Some risk factors for perpetrators include low self-esteem, low education, heavy alcohol or drug use, lack of nonviolent problem-solving skills, impulsiveness, history of abuse, and witnessing violence as a child (Centers for Disease Control and Prevention [CDC], 2021b).

Populations at a Higher Risk for Violence

Some populations of women are at higher risk for violence than others. Native American, Alaska Native, and women of color are all at a higher risk for violence. Transgender men and women, LGBTQIA+ persons, and people with disabilities are also at higher risk for generalized violence. Women experiencing homelessness may have become homeless due to violence or may experience violence because of their homelessness. Pregnant women are at an increased risk for violence, especially if violence was occurring prior to pregnancy.

Native Americans and Alaska Natives

Native American women have been victimized and murdered to such an extent that the organization Missing and Murdered Indigenous Women (MMIW) was created (Jock et al., 2022). Because of indigenous laws, many Native Americans are limited in their ability to charge a non-Native person with a crime, and 90 percent of IPV against Native American women is perpetrated by non-Natives (Jock et al., 2022). Legal reform began in 2013, allowing tribes to criminally prosecute non-tribal people accused of violence against women; however, as of 2021, only 26 out of 574 tribes have implemented these reforms (Jock et al., 2022). Native American women have expressed the importance of extended families and the help they provide in recovering from IPV.

Alaska has the third highest rate of IPV and the highest rate of murder of women by men in the United States; almost half of all women in Alaska have experienced physical or sexual assault or stalking (Burrage et al., 2021). According to Burrage et al. (2021), approximately 45.9 percent of Alaska Native women experience IPV, which was considered uncommon in precolonial families. The authors note that spiritual, economic, and social differences since colonization have drastically increased IPV.

Women of Color

Women of color experience more IPV than any other racial or ethnic group in the United States, and they experience more violent abuse that can lead to homicide (Waller et al., 2023). About 45.1 percent of Black women and 40.1 percent of Black men will experience IPV in their lifetimes (NCADV, 2020). NCADV (2020) notes that in 2017, Black women had the highest rate of IPV homicides (2.55/100,000) and that more than half (57.7 percent) were killed by a firearm. Black women also experience longer lasting effects of IPV, such as chronic neck or back pain, cardiovascular disease, and disability, making them unable to work due to the prolonged exposure to more violent behavior (Waller et al., 2023).


Violence against members of the LGBTQIA+ community has been the subject of recent research, and more information continues to be discovered. Violence against women has been found to be more prevalent in LGBTQIA+ persons than in cisgender heterosexual persons (Scheer & Baams, 2021). LGBTQIA+ young adults have higher rates of physical and psychologic victimization and sexual coercion than cisgender heterosexual young adults (Scheer & Baams, 2021). Persons in same-sex relationships experiencing IPV suffer depression and anxiety more than heterosexual persons (Savage et al., 2022).

Women with Disabilities

Women with disabilities experience higher rates of violence, including physical abuse, coercion, control, and emotional abuse (Saleme et al., 2023). Unfortunately, persons with disabilities may rely on their abusive partner for assistance for daily living. This dependence causes many women to remain in the abusive environment. Therefore, women with disabilities are less likely to report the abuse (Saleme et al., 2023). While caring for a person with a disability, nurses should be aware of signs of abuse, such as bruises, burns, missing teeth, cuts, or scars.

Cultural Context

Black Women Seeking Support from the Church

According to a 2018 study, Black women are the most religious population of people in the United States. They have long considered the church a place of refuge and trust. Many Black women will seek help from the church when trying to leave a volatile relationship. Several studies suggest that Black women experience a great deal of racism and discrimination in shelters for IPV; therefore, they may turn to the church to help with emergency housing and emotional support.

(Waller et al., 2022)

Women Experiencing Homelessness

Homelessness is related to IPV in two ways: IPV can cause homelessness, and homelessness can cause more violence. Research has shown that 80 percent of homeless women and children are survivors of IPV; furthermore, these persons are at increased risk of violence while homeless (Jagasia et al., 2023). Homelessness is also related to higher morbidity and shorter life expectancy because these persons utilize fewer preventive health services, experience more injuries, and suffer from posttraumatic stress disorder (PTSD) (Jagasia et al., 2023). The combination of homelessness and IPV increases health risks due to the high-risk behaviors some use to cope with their situation, such as smoking, alcohol, and drug use (Jagasia et al., 2023). Nurses in community health can help provide much needed health care and preventive health services to the homeless. Nurses can also provide survivors of IPV with referrals to community resources for shelter and protective services from violent partners.

Transgender Women and Men

According to a study by Peitzmeier et al. (2020), transgender people, regardless of sex assigned at birth, experienced more violence than cisgender persons. The study found that transgender persons are 1.7 times more likely to be a victim of IPV, 2.2 times more likely to have experienced physical IPV, and 2.5 times more likely to have a history of sexual IPV. The study also found that abuse was associated with sexual risk-taking behavior, substance use, and poor mental health; and lack of legal protection against discrimination made transgender persons at higher risk for violence.

Clinical Judgment Measurement Model

Recognizing Cues

When the nurse is caring for a transgender person, they understand this person is at higher risk for violence. The nurse should recognize cues of violence by

  1. taking a social history;
  2. getting the patient alone to ask if they feel safe at home or with their partner;
  3. recognizing signs of abuse, such as bruises, cuts, and burns, especially in areas hidden by clothes; and
  4. determining if the patient is in immediate danger of violence from their partner or someone else.

Pregnant Women

Pregnant people experiencing IPV receive less prenatal care or enter care later than those not experiencing IPV (National Partnership for Women and Families, 2021). These persons also have an increased risk for low-birth-weight infants, preterm birth, depression, and perinatal death (National Partnership for Women and Families, 2021). The severity of violence increases during pregnancy and the postpartum period. Physical violence occurs in 2 to 35percent of all pregnant women, and sexual IPV occurs in 9 to 40 percent of pregnant women; this statistic is broad due to the fear of reporting (Selwyn, 2020). Homicide accounts for 31 percent of maternal deaths caused by injuries (National Partnership for Women and Families, 2021). Table 9.1 reveals the specific cause mortality rate for pregnancy and up to 42 days after birth. The nurse can observe pregnant patients for signs of abuse, eating disorders, sleep disorders, and delay in seeking treatment (National Partnership for Women and Families, 2021). The nurse can screen pregnant women for IPV to provide comfort and resources.

Cause Deaths per 100,000 Live Births up to 42 Days after Birth
Homicide 2.21
Hemorrhage and placental disorders 1.1
Hypertensive disorders in pregnancy, childbirth, and the puerperium 0.9
Sepsis and other infections 0.3
Table 9.1 Reasons for Maternal Death up to 42 Days Postpartum (Wallace et al., 2021)

Psychosocial Theories Related to Violence against Women

Theories have been developed to understand IPV and violence against women. The Cycle of Violence Theory discusses the three phases of abuse. The Power and Control Wheel is a graphic showing the techniques used to gain power and control through violence. Finally, the Intergenerational Transmission of Violence Theory proposes that children exposed to violence are more likely to later become involved in violence as an adult.

Walker Cycle of Violence Theory

The Cycle of Violence Theory developed by Lenore Walker explains the process of violence and includes three phases of an abusive relationship: tension-building, acute battering incident, and the honeymoon phase (Goodmark, 2011). In the tension-building phase, the woman is abused verbally and emotionally, with minor physical abuse. The tension escalates to an acute battering incident, resulting in serious assault and severe injury. The honeymoon phase then begins, characterized by the abuser begging for forgiveness, declaring love for the partner, giving gifts, and grand gestures. This cycle of violence continues until the woman leaves the relationship or dies (Goodmark, 2011).

Power and Control Wheel

Ellen Pence was the founder of the Domestic Abuse Intervention Project and developer of the Power and Control Wheel theory (Goodmark, 2011). The graphic shows the hub of the wheel being the abuser’s power and control over their partner, which is the goal of abuse (Goodmark, 2011). The spokes of the wheel contain tactics used by abusers to reinforce the power and control over their partner that leads to physical and sexual violence (Goodmark, 2011). Survivors of violence were interviewed, and eight tactics were used among almost all abusers. These tactics make up the spokes of the wheel: isolation, peer pressure, emotional blackmail, using social status, intimidation, threats, sexual coercion, and denial of abuse (Figure 9.2).

A circular chart depicting Power and Control in the center with the spokes representing ways that an abuser uses control over their victim.
Figure 9.2 Power and Control Wheel The Power and Control Wheel demonstrates abusers’ need for absolute control and the tactics they use to obtain it. (attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Intergenerational Transmission of Violence

The Intergenerational Transmission of Violence Theory proposes that experiencing or witnessing violence, especially during childhood, increases the likelihood of a person’s involvement in a violent relationship (Powers et al., 2020). This theory explains that when a child experiences or witnesses domestic violence, it becomes a normal and acceptable pattern of behavior. The child learns that violence is an acceptable behavior for conflict resolution (Powers et al., 2020). When the child becomes an adult, they are more likely to be involved in violence, as a victim or as a perpetrator (Powers et al., 2020).


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