Opportunities for intervention - Discussing physical abuse during prenatalcare 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 pra ctice. Data and Methods: We used data from the 1996 and 1997 Pregnancy Risk Assess ment Monitoring System (PRAMS) to assess the prevalence of and the factors associated with health care providers' discussion of physical abuse with pr egnant women in 14 states. PRAMS is a state-specific, population-based surv eillance 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 car e providers talked with them about physical abuse during prenatal care visi ts. Health care providers were more likely to discuss physical abuse with w omen who were black, Hispanic, young (aged <20 and 20 to 29), had a high sc hool education or less, or paid for prenatal care with Medicaid. Conclusions: Our results indicate that most pregnant women do not report th at their prenatal care providers discussed physical abuse with them. Logist ic regression analyses identified consistent associations across the 14 sta tes between discussion of abuse and demographic and pregnancy-related facto rs. A better understanding of the factors associated with whether a health care provider discusses physical abuse with a pregnant woman could increase intervention opportunities.