More than 1 in 4 women experience domestic abuse. When a woman becomes pregnant, the frequency and severity of this abuse may be at risk of increasing (1). Domestic abuse has also been shown to increase a woman's risk of delivering before 37 weeks, potentially putting her child in danger of lifelong complications. On the other side, early delivery is associated with an increased risk of maltreatment for infants born prematurely. Despite this pervasive link between domestic abuse and prematurity, it is rarely acknowledged in prevention education. For our March Collaboratory, we invited researchers, neonatologists and social workers to help us confront this challenging topic and lead a discussion on how we can all come together in the name of prevention.
The event, hosted at UCSF's Mission Hall and moderated by Laura Jelliffe-Pawlowski, began with PTBi-CA epidemiologist Rebecca Bear, who provided a brief introduction to her work analyzing California hospital records. Bear explained that through her research she saw a correlation between a woman's history of abuse and whether or not a person had a preterm birth. The results of her research indicated that the rates of preterm birth among women who had experienced abuse were nearly double than those who had not experienced abuse. However, this rate was not found once adjusting for variables such as age. Bear explained that the study was able to shed light on how health issues such as high blood pressure may be the indicator of stress that can be traced back to the violence and the preterm birth.
Human Service Agency Social Worker, Alexis Cobbins, shared her experience working directly with families who suffer from domestic violence and preterm birth. She explained that when child protective services removed a mother’s baby at birth because of the threat of violence from her abusive partner, “the babies’ attachment and bonding were disrupted. It was almost like she was suffering twice. Once from his abuse and then from child protective services – from their lens of keeping the child safe”. Though Alexis noted through her agency's advocacy efforts they were able to reunite baby and mother, there needs to be a better understanding of how meet the mother's needs of safety rather than focusing solely on the child.
We need to think about institutional racism. Women who try to get help get put into the system in a punitive way, so this contributes to the reluctance to report.
Alexis Cobbins, Title
Human Service Agency
Hector Santamaria, a social worker at the Human Service Agency, and Artanesha Jackson, a Clinical Social Worker at UCSF Benioff Children's Hospital Oakland, also spoke about their experiences working firsthand with survivors of domestic violence how it related to their preterm births. Hector explained that what is needed is more than a specific intervention but rather, "a change in culture. I think it starts with those difficult conversations within our own families and our own communities."
Liz Rogers, a Neonatologist and California PTBi researcher, spoke about how babies with complex medical needs are at greater risk of experiencing abuse or neglect and that babies who are born early are at risk of having complex medical needs. Through her research, she was able to drill down to see which complications of preterm birth increased risk for non-accidental traumas, such as fractures, which indicates abuse or neglect. Rogers noted, “really across the board [of medical complications] there remained a significantly higher risk of non-accidental traumas.”
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Speakers
Rebecca Baer is an epidemiologist with the California Preterm Birth Initiative and UC San Diego Department of Pediatrics. For the past 10 years, Rebecca has been researching risk factors for adverse pregnancy outcomes and neonatal morbidities.
Alexis Cobbins is a Social Worker with over 10 years of experience providing culturally relevant and responsive services through a trauma-informed approach. Alexis currently works for the Human Services Agency in San Francisco, supervising staff in the Project 500 Program and was the former Program Manager for the San Francisco Black Infant Health Program.
Artanesha Jackson is a Clinical Social Worker at UCSF Benioff Children's Hospital Oakland in the Department of Community Health and Engagement with over fifteen years of direct service experience. Artanesha combats health inequity by leveraging technology to address social determinants of health as the Program Manager for the FINDconnect Program.
Dr. Elizabeth Rogers is an Associate Professor of Pediatrics at the University of California San Francisco, where she practices neonatology in the Intensive Care Nursery (ICN). Dr. Rogers is the Director of the ROOTS Program, The Grove Small Baby Unit, and the ICN Follow Up Program at UCSF.
Hector Santamaria is a social worker, mentor, and fatherhood advocate for the SF City & County Human Services Agency. In his work, he strives to honor and celebrate the critical roles we play in family and community health. Hector’s mission is to support Family Resource Systems in recognizing, honoring and celebrating the critical role fathers and father figures play in the lives of children.
1. Burch, R. L., & Gallup, G. G. (2004). Pregnancy as a stimulus for domestic violence. Journal of Family Violence, 19(4), 243-247.
