Pregnancy: a time to break the cycle of family violence.

In an effort to raise the awareness and detection of domestic violence among pregnant women, the Child Protection Center, a child advocacy center at Montefiore Medical Center in the Bronx, New York, instituted an education and screening program for pregnant and parenting women who were using the OB/GYN clinic at the hospital. Pregnancy may offer a unique window of opportunity to engage women in promoting behaviors and attitudes that could help them reevaluate a violent relationship. A service and support network offered by medical centers with child advocacy center programs could provide a model for social workers and medical providers to address the serious needs of abused children and battered parents. THE CHILD PROTECTION CENTER Since 1984 the Child Protection Center (CPC) has evaluated over 12,000 sexually abused, physically abused, and neglected children. Using a family-centered approach, the CPC also provides support and counseling to family members. The CPC uses a multidisciplinary team of medical providers, social workers, police officers, child protective services caseworkers and the District Attorney's office staff to reduce systems trauma to children by coordinating the rapid assessment, investigation, arrest, and prosecution activities for serious child abuse cases. DOMESTIC VIOLENCE AND CHILD ABUSE CORRELATION The CPC's records indicate that there is a co-occurrence of child abuse and domestic violence in 60 percent of the cases evaluated at the center (Child Protection Center, 1999). Growing awareness of the correlation calls for new measures to identify victims and provide resources. An American Psychological Association report (1996) estimated that each year 3.3 million children are exposed to violence against their mothers or female caretakers. Case Examples Cases in which both child abuse and domestic violence are present are evaluated at the CPC on a daily basis. Domestic abuse includes physical battering, emotional abuse, and threats of murder. Child abuse includes sexual abuse, physical abuse, and death. Case examples illustrate the severity of issues encountered by these CPC patients. Example 1. During a psychosocial interview at the CPC, a woman described how her husband kicked her and hit her with a belt during her pregnancy. Her child was being evaluated for sexual abuse by the husband. Example 2. A one-year-old infant suffered head trauma resulting from blunt impact. During an argument, the boyfriend of the mother picked up the baby and threw the baby at her. The infant's head hit a table; he suffered a fractured skull. Example 3. During a dispute with a relative, a mother became so violently engaged that she did not realize that she had left her 18-month-old baby unattended in a bathtub until 15 minutes had passed. The child drowned during the argument. Example 4. Teen-age parents enrolled in the CPC's parent education support group cited frequent violent altercations with their boyfriends or husbands during their pregnancy and after the birth of their children. Punching, slapping, pinching, scratching, and kicking behaviors were common. Degrading remarks about the woman's appearance and intellect were frequently cited. Intervention in the OB/GYN Clinic In 1997 the CPC received a grant from the UJA Federation of New York to improve identification of potential domestic violence victims. Because of the CPC's focus on the prevention of child abuse and an interest in the positive dynamic that the period of pregnancy may offer for effective intervention, an education, outreach, and screening program was initiated in the OB/GYN clinic. Why OB/GYN? Domestic violence is a major health concern in the United States. The American College of obstetricians and Gynecologists (1998) defines domestic violence as a pattern of assaultive and coercive behaviors including physical, sexual, and psychological attacks, as well as economic coercion, used against current or former intimate partners. …