Perinatal Intimate Partner Violence and Disability: Implications for Women’s Health Care

Abstract

Background:

Intimate partner violence (IPV) during the perinatal period is a significant public health concern with adverse consequences for maternal, fetal, and infant health. Women with disabilities experience disproportionately high rates of perinatal IPV, often compounded by disability-related abuse that exploits dependence on caregiving, mobility, communication, or access to medical care. Despite frequent contact with health care providers during the perinatal period, IPV among women with disabilities remains underrecognized and inadequately addressed.

Objective:

To summarize current knowledge on perinatal IPV among women with disabilities and highlight considerations for identification and response within perinatal health care settings.

Content:

This narrative review synthesizes existing literature on the prevalence and risk factors for perinatal IPV among women with disabilities, including disability-related abuse. We describe associated physical and mental health consequences and examine multilevel barriers to identification and disclosure, including structural, provider-level, and interpersonal factors that contribute to inequities in care. Practical approaches for disability-informed IPV screening, safety planning, and referral are discussed within trauma-informed care frameworks relevant to perinatal and women’s health settings.

Conclusions:

Improving recognition and response to perinatal IPV among women with disabilities is critical for advancing equity in maternal health care and improving maternal and infant outcomes.

Intimate partner violence (IPV) is a major public health concern with serious implications for maternal and infant health, particularly during the perinatal period, when physiological changes, shifting family dynamics, and frequent health care contact may increase both risk and opportunity for identification. Globally, 5.5%–18.7% of women experience IPV during the perinatal period, with women with disabilities facing a two- to fourfold higher risk than those without disabilities.^1–3 Perinatal IPV, defined as violence occurring in the year prior to pregnancy, during pregnancy, or within the first year postpartum, encompasses physical, sexual, psychological, and stalking behaviors by a current or former partner. For women with disabilities, IPV may also include disability-related abuse that exploits disability-specific needs, compounding health risks and making recognition and detection in the clinical setting more challenging.

Purpose

Health care providers, particularly those practicing in obstetric, primary care, and women’s health settings, are uniquely positioned to identify and address perinatal IPV. This review provides a disability-informed clinical update on perinatal IPV, with an emphasis on screening, intervention, and safety planning tailored to the needs of women with disabilities.

Methods

This narrative review synthesizes current literature addressing IPV during the perinatal period among women with disabilities and implications for clinical practice. Relevant articles were identified through targeted searches of PubMed and Scopus using combinations of the following keywords: IPV, pregnancy, perinatal, disability, disability-related abuse, screening, and safety planning. Additional articles were identified through reference lists of key publications and existing reviews on IPV screening and perinatal health. Priority was given to population-based studies, systematic reviews, clinical guidelines, and qualitative research examining the experiences of women with disabilities or the implementation of IPV screening and intervention in perinatal care settings. Publications primarily from 2000 to the present were included, with emphasis on studies relevant to clinical practice in high-income health care settings. This approach was intended to provide a clinically focused overview of current evidence and practice considerations rather than a formal systematic review.

Prevalence and risk factors for IPV in women with disabilities

An estimated 12%−20% of U.S. women of reproductive age have a disability.^4–7 Per the Centers for Disease Control and Prevention, a disability includes any condition of the body or mind that makes it more difficult for individuals with a condition to participate in certain activities (activity limitation) and fully interact with the world around them (participation restrictions). ⁵ As such, there are many types of disabilities, including those that affect an individual’s vision, hearing, movement, thinking, learning, communication, mental health, and social relationships. ⁸

Women with disabilities may encounter unique vulnerabilities for IPV related to social isolation, financial dependence, and reliance on partners for caregiving or assistance with daily activities. In addition to physical, sexual, and psychological abuse, perpetrators may use tactics that leverage disability-related needs, such as withholding assistive devices, interfering with medical care, or restricting mobility.^9,10 Structural inequities within health care systems, including inaccessible clinical environments, limited availability of disability-inclusive services, and fragmented perinatal care, along with stigma and ableism, may discourage disclosure or cause health care providers to miss signs of abuse.^11,12 These vulnerabilities are further magnified by intersecting social identities such as race and ethnicity, poverty, and rural residence, which are independently associated with both higher IPV risk and reduced access to supportive resources, thereby widening inequities in safety and health during the perinatal period.^13,14

Despite growing research documenting these risks, perinatal IPV among women with disabilities remains underrecognized in clinical settings. ¹⁵ Table 1 provides an overview of varied types of disability-related abuse, with examples specific to the perinatal period and sample screening questions to facilitate disclosure.

Table 1.

Types of Disability-Related Abuse Relevant to the Perinatal Period

Type of disability-related abuse	Description	Perinatal-relevant examples	Sample screening questions
Interference with medical care	Actions that limit access to health care, medications, or clinical decision-making	Preventing prenatal or postpartum visits; withholding prescribed medications; refusing transportation to care	“Has anyone ever tried to stop you from getting medical care you need during or after pregnancy?” “Has anyone interfered with your medications or treatments?”
Control of assistive devices or mobility	Restricting access to equipment necessary for independence or safety	Hiding or damaging wheelchairs, walkers, prosthetics, braces; confining patient to inaccessible spaces	“Has anyone ever hidden, damaged, or kept you from using equipment you need to move safely?”
Caregiving manipulation or neglect	Using caregiving responsibilities as a means of control or punishment	Refusing help with activities of daily living during pregnancy or postpartum recovery; threatening withdrawal of care	“Do you depend on anyone for daily help? If so, has that help ever been withheld or used to control you?”
Reproductive and pregnancy-related coercion	Exerting control over reproductive or pregnancy-related decisions	Pressuring continuation or termination of pregnancy; interfering with contraception or postpartum family planning	“Has anyone pressured you about whether to continue or end this pregnancy?” “Has anyone interfered with your birth control or family planning decisions?”
Communication control	Limiting the ability to communicate freely or privately	Preventing use of interpreters, augmentative communication devices, or private conversations with providers	“Is there anyone who controls how or when you communicate with others, including health care providers?”
Financial exploitation tied to disability	Misuse or restriction of financial resources tied to disability	Controlling disability benefits; restricting funds needed for medical supplies or infant care	“Does anyone control your money or benefits in a way that makes it hard to care for yourself or your baby?”
Threats involving custody or institutionalization	Using disability status to threaten loss of children or autonomy	Threatening to report the patient as an “unfit parent” or place them in institutional care	“Has anyone ever threatened to take your child or report you as unfit because of your disability?”

Population-based studies consistently demonstrate higher rates of IPV among women with disabilities compared with women without disabilities, in part due to higher rates of poverty, less employment opportunities, less access to health care (including being uninsured or underinsured) and less social supports.^5,16–18 Using population-based data, research has demonstrated that during the perinatal period, women with disabilities are approximately 2.5 times more likely to experience IPV and nearly four times more likely to experience reproductive coercion than women without disabilities.^2,3,9 Despite more frequent contact with health care providers during pregnancy, research has shown that women with disabilities are significantly less likely to be screened for IPV as compared to women without disabilities. ¹⁵

Health consequences

Perinatal IPV is associated with numerous adverse physical and mental health consequences, including acute injuries such as fractures, lacerations, dislocations, head injuries, or sequelae from strangulation. ¹⁹ Perinatal IPV can cause chronic health conditions, including chronic pain (e.g., back pain, neck pain), gastrointestinal disorders (e.g., irritable bowel syndrome, stomach ulcers), gynecological and reproductive health disorders (e.g., pelvic pain, urinary tract infections, sexually transmitted infections), and respiratory conditions (e.g., asthma).^19–21 Chronic pain, a common feature of many disabilities, is more prevalent in women who have experienced IPV. ²²

Mental health consequences, including depression, anxiety, posttraumatic stress disorder, and suicidal ideation, are common and may be intensified by prior trauma or disability-related stressors. Women experiencing abuse during pregnancy are 2.5 times more likely to report depressive symptoms than non-abused women and are more than nine times as likely to report antenatal suicidal ideation as compared to non-abused women.^21,23

IPV during pregnancy is associated with adverse birth outcomes, including higher rates of spontaneous abortion or stillbirth, preterm birth, low birth weight, and infants who are small for gestational age.^24–27 These outcomes may result from direct physical trauma, heightened physiological stress, reduced prenatal care utilization, or maladaptive coping behaviors, such as increased rates of smoking.^27,28 For women with disabilities, barriers to consistent prenatal and postpartum care may further increase risk, with research showing lower levels of engagement in prenatal care in women with disabilities. ¹⁵

Screening in perinatal care settings

Screening for IPV during perinatal care visits can identify survivors while also linking women with supports and interventions to increase their safety and improve health outcomes. As such, multiple organizations in the United States recommend routine screening for IPV in all women presenting to primary, preventative, and prenatal care.^29–31 The United States Preventive Services Task Force found that there were minimal risks to IPV screening when done privately, as well as evidence for effective interventions to support women experiencing IPV. ²⁹

Prior studies indicate that prenatal care providers have not consistently implemented universal IPV screening, citing time constraints and uncertainty about managing disclosures as persistent barriers, although screening rates appear to have increased over time to approximately half of pregnant patients.^32–34 These barriers may be even more pronounced for women with disabilities, whose clinical encounters are often shaped by accessibility challenges, communication needs, the presence of caregivers, and providers’ tendency to attribute symptoms or risks to disability rather than to violence.^15,35 Indeed, using population-based data from the Pregnancy Risk Assessment Monitoring System, researchers found that during pregnancy, respondents with a disability were significantly less likely to be screened for IPV as compared to those without a disability. ¹⁵ A recent qualitative study explored the experiences of IPV screening during the perinatal period among abused women with disabilities, finding women with disabilities experienced superficial screening, limited follow-up in the face of disclosure, as well as experiences of bias or discrimination when disclosing IPV. ³⁶ In addition, geographic variation in IPV training requirements and health care resources may disproportionately affect women with disabilities, who often rely on fragmented systems of care and may have fewer accessible screening and referral options. ³⁴

When caring for women with disabilities, health care providers should ensure that screening is accessible and conducted without the presence of partners or caregivers who may also be perpetrators. Professional interpreters and accessible communication tools should be used as needed. Providers should avoid attributing injuries, emotional distress, or missed appointments solely to disability and instead maintain a high index of suspicion for IPV. Normalizing statements, such as “Because violence and control are common concerns during pregnancy, I ask all my patients about their safety at home,” may facilitate disclosure.

Screening tools

Validated screening tools such as the Abuse Assessment Screen (AAS), ³⁷ the Hurt, Insulted, Threatened or Screamed, ³⁸ and the Woman Abuse Screening Tool are commonly used in clinical practice. ³⁹ While these tools have strong psychometric properties, they may not fully capture disability-related abuse. The Abuse Assessment Screen-Disability was developed based on the AAS and includes two additional questions assessing disability-related abuse (e.g., refusing help with essential daily activities such as bathing and withholding assistive devices such as a wheelchair). ⁴⁰ Curry and colleagues evaluated an eight-item screening measure specifically designed for women with physical and/or cognitive disabilities. The tool assesses a range of experiences, including emotional mistreatment, financial control, threats to personal safety, neglect of basic needs, and interference with access to adaptive or assistive equipment. ⁴¹ Collectively, such disability-specific screening measures represent an important step toward more accurately detecting and addressing violence experienced by women with disabilities; yet, their use in clinical practice remains very low. Providers should supplement standardized tools with open-ended questions that explore interference with medical care, mobility, or access to assistive devices. Sample screening questions to elicit types of disability-related abuse are provided in Table 1.

Barriers to identification and disclosure

Identification and disclosure of IPV among perinatal women with disabilities are affected by barriers operating at patient, provider, and system levels. At the patient level, women may fear losing essential caregiving support or custody of their children, particularly when their partners also function as caregivers. Prior negative or stigmatizing health care experiences may further erode trust and willingness to disclose. ⁴² Communication barriers, including limited access to interpreters or assistive technologies, can also hinder disclosure. ¹⁵ Provider-level barriers include insufficient training in disability-informed IPV care, discomfort initiating conversations about violence during pregnancy, and misattribution of injuries or psychological distress to disability rather than potential abuse. ³⁶ At the system level, time constraints during clinical encounters, fragmented prenatal and postpartum care, and limited availability of accessible, disability-competent referral resources further limit opportunities for identification and intervention. Table 2 summarizes multilevel barriers to IPV identification among women with disabilities and outlines strategies to support more effective identification.

Table 2.

Multilevel Barriers to IPV Identification in Women with Disabilities

Level	How the barrier manifests in clinical practice	Implications for clinicians
Patient	Reliance on a partner for caregiving, transportation, or communication may limit privacy and increase fear of disclosure	Proactively ensure private screening encounters and explicitly address safety concerns related to caregiving dependence
	Previous stigmatizing or dismissive health care encounters reduce trust	Use trauma- and disability-informed communication to normalize screening and validate concerns
	Communication needs are unmet during clinical encounters	Utilize professional interpreters and accessible formats rather than relying on partners or family members
Provider	Limited familiarity with disability-related abuse leads to narrow definitions of IPV	Expand screening to include interference with medical care, mobility, or assistive devices
	Symptoms or injuries attributed solely to disability or chronic illness	Maintain a high index of suspicion for IPV and avoid diagnostic overshadowing
	Hesitancy to address IPV during pregnancy	Integrate IPV screening as a routine component of perinatal care rather than a discretionary task
System	Short visits and competing clinical priorities	Embed brief, standardized screening into prenatal and postpartum workflows
	Discontinuity between prenatal and postpartum care settings	Screen repeatedly across the perinatal continuum and document clearly to support continuity
	Limited availability of accessible IPV resources	Partner with social work and community organizations to identify disability-competent referral options

Safety planning

Safety planning during the perinatal period is a critical component of care for women with disabilities experiencing IPV and should be individualized to account for disability-related needs that may affect mobility, communication, caregiving, and access to resources. Compared with nondisabled women, women with disabilities may face additional challenges implementing traditional safety plans, including reliance on partners for assistance with activities of daily living, transportation to prenatal care, medication management, or use of assistive devices. As such, effective safety planning requires collaborative, patient-centered approaches that explicitly address access to mobility aids, medications, medical equipment, accessible housing or shelters, and reliable support persons, while prioritizing autonomy and minimizing risk of retaliation.^13,43–45

In clinical settings, safety planning often begins with the health care provider who identifies IPV, but it should typically be developed in collaboration with professionals who have expertise in IPV advocacy and disability services. ⁴⁶ Obstetric and prenatal providers play an important role in initiating the conversation, assessing immediate safety concerns, and facilitating referral to trained IPV advocates, social workers, or community-based domestic violence programs that can assist in developing a more comprehensive safety plan. When available, collaboration with disability service organizations can help ensure that safety strategies account for accessibility needs and disability-related supports. ⁴⁷

Several practical considerations may be particularly important when safety planning with women with disabilities during the perinatal period. Providers and advocates should discuss strategies for maintaining access to essential medications, prenatal care appointments, and assistive devices in the event that a woman needs to leave the home quickly. Identifying trusted individuals who can provide temporary caregiving assistance, transportation, or communication support may also be critical. ⁴⁸ In situations where a partner controls access to mobility devices, medications, or medical equipment, safety plans may include identifying safe locations where backups can be stored or arranging access through trusted friends, family members, or service providers. ⁴⁹

Accessible emergency resources should also be discussed. Not all domestic violence shelters are equipped to accommodate individuals with mobility impairments, service animals, or specialized medical equipment. As such, referrals should prioritize programs with demonstrated accessibility or those that collaborate with disability service organizations.^13,50 Because pregnancy and the postpartum period often involve frequent health care encounters, health care providers may have multiple opportunities to revisit safety planning over time. Reassessing safety, updating contact information for support services, and reinforcing that assistance remains available can help build trust and support ongoing engagement with care. ⁴⁸

Trauma- and Disability-Informed Care Framework

A trauma- and disability-informed care framework is essential for effectively addressing perinatal IPV among women with disabilities, given the high prevalence of prior trauma, structural inequities, and disability-related vulnerabilities in this population. Trauma-informed care emphasizes recognition of the widespread impact of trauma, awareness of its signs and symptoms, and the integration of this knowledge into clinical practice to avoid retraumatization, as articulated by the Substance Abuse and Mental Health Services Administration’s “Four R’s”: realizing, recognizing, responding, and resisting retraumatization. ⁵¹ For women with disabilities, trauma-informed approaches must be paired with disability-informed care, which acknowledges the impact of ableism, prioritizes accessibility, and respects autonomy and self-determination.^12,42 In perinatal settings, this includes ensuring physical and communication accessibility, avoiding diagnostic overshadowing, supporting informed decision-making, and recognizing how dependence on partners for caregiving or mobility may shape safety, disclosure, and care preferences. Interdisciplinary collaboration among obstetric, primary care, mental health, social work, and disability services is critical to operationalizing trauma- and disability-informed care and promoting equitable, patient-centered responses to IPV across the perinatal continuum. ³⁶

Conclusion

Perinatal IPV among women with disabilities represents a critical yet persistent gap in women’s health care, with significant implications for maternal autonomy, safety, and maternal–infant outcomes. Despite frequent contact with health care providers throughout the perinatal period, disability-related abuse and IPV remain underrecognized due to structural barriers, ableism, and limitations of conventional screening approaches. Integrating trauma- and disability-informed frameworks into perinatal care, coupled with accessible screening, individualized safety planning, and coordinated referral pathways, is essential to advancing equity and improving outcomes for this marginalized population.

Authors’ Contributions

J.L.A.: Conceptualization, writing—original draft preparation. K.H.A.: Writing—reviewing and editing. M.H.: Writing—reviewing and editing. J.G.: Writing—reviewing and editing.