Transforming Health Care in the US Virgin Islands: Education, Research and Health Care Reform

1. CARIBBEAN EXPLORATORY NCMHD RESEARCH CENTER UNIVERSITY OF THE VIRGIN ISLANDSGrant Support: National Center on Minority Health and Health Disparities , NIH (# P20MD002286). Transforming Health Care in the US Virgin Islands: Education, Research and Health Care Reform

2. Abuse During Pregnancy Among Women of African Heritage in the USVI and Mainland USAAugust 4, 2010 Jacquelyn Campbell, Hossein Yarandi, Phyllis Sharps, Desire Bertrand, Doris Campbell

3. Presentation Objectives • Describe the prevalence of abuse during pregnancy among women of African heritage in the US Virgin Islands and the mainland 2. Discuss consequences of abuse for pregnancy and reproductive health.

4. Background: Abuse and Pregnancy • 3.4% - 11:Prevalence of abuse during pregnancy in industrialized countries world wide (Widding_Hedin, et al, 2000; Irion, 2000; Mezey, et al, 2001; Johnson, et al, 2003) vs. • 3.8% - 31.7%: Prevalence of abuse during pregnancy in developing countries (Garcia-Moreno, Campbell, Sharps, 2006)

5. Abuse and Pregnancy • 8-22%of pregnant women • vs. 7% pre-eclampsia or hypertension during pregnancy • Most significant risk factor • Abuse before pregnancy

6. Abuse During Pregnancy Patterns of Abuse During Pregnancy • Protective period • Increased risk period (1st IPV may occur during pregnancy) • No change - “Business as usual” – the nature may change • Ethnic Group Comparison • Significantly lower in Mexican American couples 14% vs. 16% in African American and Anglo(McFarlane & Parker ‘92)

7. Abuse and Pregnancy: Health Consequences Maternal Health Correlates: • Depression • Substance abuse • Low social support spontaneous abortion, smoking • Risk of homicide (Gielen et al ‘94; Campbell et al ‘92)

8. Abuse and Pregnancy: Health Consequences Infant Health Correlates: • LBW especially in low income women (Bullock & McFarlane ‘89) • LBW connections w/ smoking, low weight gain & substance abuse (Curry et al, 99) • Child abuse- increased risk, often most severe abuse – non-biological father • IPV contributes to health disparities in maternal child outcomes for African American women (Sharps & Campbell ‘01)

9. Afro-Caribbean and African American Women’s Study

10. Team Members US Virgin Islands Doris Campbell, PhD, ARNP FAAN Gloria Callwood, PhD, RN Desiree Bertrand, MSN Janis Valmond, MPH Catherine Coverston, PhD, RN Lorna Sutton, MPA Tyra DeCastro Princess Oneida-Stuard, BSN std Melanie Ruiz, BSN std Natasha Caines, BSN std Jose Negron & Romeo Richardson United States Jacquelyn Campbell, PhD, RN, FAAN Phyllis Sharps PhD, RN, FAAN Richelle Bolyard Jamila Stockman, PhD, MPH Ayanna Johnson, BA Marguerite Baty, PhD(c), MSN, MPH, RN Jessica Draughon, PhD student Mary Paterno, BSN, RN Lareina LaFlair, PhD (c) Chris Kunselman Hossein Yarandi, PhD

11. Methods • Comparative case (N = 150 in each site) control • (N = 150 in each site) study • Eligibility criteria • Women aged 18-55 years • Self-identify as Afro Caribbean or African American • Report of a male sex partner in the past two years

12. Methods • Questionnaire administered on a touch screen computer with optional headphones - an important methodological strategy • For women of low literacy • For sensitive information • Alerts interviewer if high score on DA or suicidality • Allows increased recruitment among Spanish speaking • Recording in Spanish & English by USVI residents for increased cultural appropriateness • Study period 12/1/09 to present

13. Methods Data collected: • USA Sample sites: • Hospital Prenatal Clinics • Public Health Prenatal/Family Planning clinics • US Virgin Islands • Public health clinics • Prenatal/Postpartum public clinics

14. Abuse During Pregnancy • Among first 836 women screened for abuse • 14.4% (319) reported Ever Abuse during pregnancy

15. Prevalence of Perinatal Abuse

16. Abuse During Pregnancy

17. Perinatal Abuse: Adverse Outcomes Abused women with PTSD = reported more abuse during pregnancy (marginally significant; <0.10) compared abused women with no PTSD

18. Difficult Pregnancy (n=420)

19. Perinatal Abuse: Adverse Outcomes Using adjusted multivariate analysis, women experiencing IPV in the past two years (cases) were significantly more likely to have difficult pregnancies (AOR = 4.36)

20. Forced Sex and Pregnancy (n=112)

21. Planned Pregnancy (n=114)

22. Unwanted Pregnancy (n=114)

23. Miscarriage and Abuse (n=420)

24. Pregnancy Outcomes – Abused vs. Non-abused

25. Implications Universal Screening for Abuse – Recommended by AWHONN in North America, by WHO for resource poor settings • Prenatal visits • Postpartum visits • Home Visitation (DOVE - Sharps et al ’09) • Well Woman visits • Family Planning visits

26. Implications Poor Reproductive outcomes = High Suspicion for Abuse • Miscarriage • Unplanned or unwanted pregnancy • History of forced sex or assault

27. Implications • Ask questions – Abuse Assessment Screen – www.nnvawi.org • Maintain privacy • Maintain her safety – use “10 min”/ brochure driven ”empowerment” intervention –www.nnvawi.org • Recently shown effective in clinical trial – Kiely et al ‘10 • Make appropriate referrals

28. Thank You !! To all of the women who shared their stories, to all of the students and research assistants who listened to the stories and carefully recorded the data and to all of the project staff and assistants at each site who have worked on behalf of the project AND THE CARIBBEAN EXPLORATORY RESEARCH CENTERUNIVERSITY OF THE VIRGIN ISLANDSAND BRIGHAM YOUNG UNIVERITYCASE WESTERN UNIVERSITYJOHNS HOPKINS UNIVERSITYWAYNE STATE UNIVERSITY