Intimate Partner Violence Among Pregnant Young Women: A Qualitative Inquiry.

584349 research-article2015

JIVXXX10.1177/0886260515584349Journal of Interpersonal ViolenceLévesque and Chamberland

Article

Intimate Partner Violence Among Pregnant Young Women: A Qualitative Inquiry

Journal of Interpersonal Violence 1–20 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0886260515584349 jiv.sagepub.com

Sylvie Lévesque1 and Claire Chamberland2

Abstract This article explores intimate partner violence (IPV) as experienced by young women during the perinatal period. Using purposive sampling, data pertaining to the experiences of 10 young mothers were gathered through on-site participative observation and individual in-depth interviews. Interviews were coded in an inductive way to reflect the experiences of the participants before pregnancy and following pregnancy confirmation. Overall, the analyses of different manifestations of IPV and their contexts reveal the difficulty these young mothers experience in identifying themselves as a victim of IPV and in categorizing their partner’s acts as intimate violence. The fear of family separation and the desire to protect their child contributed to the complexity of violence experienced in a context of motherhood. This article also reflects on the limits of data collection on this subject through comparison of the results of the interviews with the results of the Revised Conflict Tactics Scale (CTS-2). Further research is needed to provide more insight into victimization among young mothers and to inform interventions with the goal of helping young women overcome the intersecting challenges of violence and motherhood.

1Université 2Université

du Québec à Montréal, Canada de Montréal, Québec, Canada

Corresponding Author: Sylvie Lévesque, Département de sexologie, Université du Québec à Montréal, CP 8888, succ. Centre-ville, Montréal, Québec H3C 3P8, Canada. Email: [email protected]

Downloaded from jiv.sagepub.com at University of Texas Libraries on June 5, 2015

2

Journal of Interpersonal Violence

Keywords intimate partner violence, women’s health, early pregnancy, resilience, qualitative research

Intimate Partner Violence Among Pregnant Young Women: A Qualitative Inquiry Intimate partner violence (IPV), also known as dating abuse when referring to adolescents and emerging young adults, can be defined as “behaviour within an intimate relationship that causes physical, sexual or psychological harm, including acts of physical aggression, sexual coercion, psychological abuse and controlling behaviours” (Heise & Garcia-Moreno, 2002, p.89). It is considered an important social and public health concern worldwide, mainly due to its harmful effect on the health and well-being of an individual (Bonomi, Anderson, Nemeth, Rivara, & Buettner, 2013; Postmus, Huang, & Mathisen-Stylianou, 2012; Silverman, Raj, Mucci, & Hathaway, 2001; World Health Organization, 2013). Although IPV can be present at any stage of life, pregnancy is a period of particular concern due to its effects on the health and well-being of both women and their babies (Chambliss, 2008; Daoud et al., 2012; Taillieu & Brownridge, 2010). High rates of IPV victimization are reported among young mothers (Agence de santé publique du Canada, 2009; Daoud et al., 2012; Heaman, 2005; Kingston, Heaman, Fell, & Chalmers, 2012; Martin, Mackie, Kupper, Buescher, & Moracco, 2001; Moyer, 2013). Estimates of the prevalence of IPV during pregnancy and the perinatal period vary depending on the definition of violence used, the methodological aspects of the study in question, and the instruments used as measurement. Accordingly, the statistical range of the occurrence of IPV among young mothers is quite substantial: from 9% to 67% (Curry, Doyle, & Gilhooley, 1998; Gessner & Perham-Hester, 1998; Lévesque, 2010; Lindhorst & Oxford, 2008; Quinlivan & Evans, 2005; Wiemann, Agurcia, Berenson, Volk, & Rickert, 2000). This data primarily addresses the occurrence of physical violence, as that is the form of violence on which most studies focus. However, the literature in this field shows that a number of forms of violence often occur simultaneously (Dobash, Dobash, Cavanagh, & Lewis, 2000), suggesting that young women who are victims of physical violence during pregnancy may also suffer verbal, economic, psychological, or sexual violence. Regardless of the age of victims, identifying IPV can be challenging because situations of violence are not always evident or easily recognized by the victims themselves. For instance, in a study with young mothers on their


Lévesque and Chamberland

3

perceptions of dating violence, Herrman (2013) identified a distinction in the different types of abuse experienced that the adolescents could recognize. During the focus groups she conducted, the adolescent mothers clearly differentiated physical, verbal, and emotional abuse. However, sexual abuse was more difficult to apprehend (Herrman, 2013). In a study focusing on pregnancy-promoting behaviors from male adolescents toward their female adolescent partners, Miller et al. (2007) noted that sexual violence was not often revealed in questionnaires. The authors noticed a discrepancy in the responses to the quantitative questionnaire on sexual violence, and the qualitative data where the female adolescents described experiences of coercive and forced sex (Miller et al., 2007). In a different study of 30 abused women who recently gave birth, more than half described their relationship as not abusive while reporting having experienced behaviors defined as abuse by standardized instruments such as the Index of Spousal Abuse or the Abuse Assessment Scale (Ulrich et al., 2006). The authors note that a woman’s self-perception seems to have an impact on her recognition of IPV: If, in one woman’s opinion, she did not feel degraded, was not crying, and worrying, then she was not abused. For another participant, it was not seen as abuse due to its infrequency; it only happened “once in a while.” As the authors note, “Some of the women’s explanations appeared contradictory, but when examined closely, these contradictions represented the complexities of the women’s particular situations” (Ulrich et al., 2006, p. 330). In this sense, the women’s social representations of violence and its manifestations are important domains to document for a better understanding of this phenomenon and to better direct interventions. Numerous studies in the past 30 years have focused on this goal. However, there is diversity in the various markers of identity, such as race, class, gender, sexual orientation, nationality, age, and so forth, which shape experiences of violence and their significance (Crenshaw, 1991; George & Stith, 2014). Some of these markers, namely, age and parental status, have not been studied together as much as others. In an attempt to better document these specific markers, a study aimed at exploring resilience in a context of early motherhood and IPV was undertaken. It was carried out using qualitative methods of research that incorporated individual interviews, focus groups, and on-site observations. The study allowed for a better understanding of the life trajectories of the women, their transition to motherhood, their intimate relationship and the various manifestations of violence within it, and the coping processes involved in their responses to IPV during pregnancy and early maternity (Lévesque, 2015). This article is part of that larger study and highlights the results from individual interviews with 10 young mothers and numerous on-site observations.


4


It contributes to knowledge in this field by presenting qualitative findings on manifestations of IPV in the lives of young mothers and the relational contexts in which they occur, while also examining these behaviors over time. More precisely, this article aims to demonstrate the different possible forms of IPV in the lives of the young mothers, particularly in the sexual area, and to reflect on limits encountered with regard to data collection by comparing the interview data with the results of the Revised Conflict Tactics Scale (CTS-2).

Method Ten French-speaking mothers from the Montreal metropolitan area (Canada) who were victims of violence during the perinatal period were interviewed individually for this exploratory study using an ethnographic perspective (Creswell, 1998). Ethnographic interviewing assumes the informant as expert of her own life, while the researcher avoids making assumptions about the experiences of the informant, their meanings, and representations by taking on a learning role (Kulkarni, 2007). These young mothers were recruited via referral by a counselor at an organization they were attending. Purposive sampling was employed and involves the deliberate choice of a participant based on the qualities she possesses with the goal of representing a diversity of viewpoints (Bernard, 2002). This data collection was completed through on-site investigation, with the participation of the researcher in the community groups of young mothers (Beaud & Weber, 2003). The first author, a PhD candidate in public health at the time of the study, spent time in groups of young parents and mothers at two study sites (4 months in the first, 5 months in the second, 2 days per week). The sites of the study are organizations offering services to young parents or to young mothers specifically. The first author participated in the groups as a member, with the research project goals overtly known. Services provided by the organization include, but are not limited to, counseling, support group meetings, educational activities on various topics, on-site babysitting, and referrals to external organizations for specific needs. This participation in groups of young mothers allowed for the identification of different sources of adversity faced by these women and a better understanding of their realities. In the days preceding the research interview, individual telephone conversations between potential participants and the interviewer allowed for an explanation of the research project, a presentation of the various subjects to be discussed, and confirmation of the presence of IPV. Interviews were conducted in a location selected by the respondent and options included the grounds of the organization she frequented, the respondent’s home, or a restaurant/café near



5

the respondent’s home. The interviews lasted between 45 and 90 min. Each participant received monetary compensation of US 20$. Verbal and written consent was obtained before the interviews began. The accounts provided by the participants were recorded on audiotape with their permission. At the end of each interview, a nonrecorded debriefing gave participants the opportunity to express their feelings. An intervention protocol was available: A psychotherapist agreed to meet with participants free of charge. None of the study participants required immediate help or counseling following the interview. Data collection through individual interviews ceased, and saturation was considered attained once there were repetition of themes and no new material emerging from the interviews (Morse, 1995). The first author kept a daily logbook of observations, comments, and questions following on-site observations. This logbook helped to contextualize certain events and perceptions. This research project obtained ethical approval from the ethics committee of the University of Montreal Faculty of Medicine.

Data Collection Instruments Individual interview. A guide containing 16 open-ended questions was used to conduct semistructured interviews. These questions covered themes, such as the participant’s representation of her intimate relationship, her pregnancy, the violence she experienced, her coping skills and resilience path, mobilization of resources, her future goals, and the advice she would give someone else in her situation. The guide could be modified according to the participant’s story; modifications were also made during the data collection period to document aspects that emerged from previous interviews and were judged as pertinent. Information relating to violence was obtained through questions such as, When we talked over the phone, we discussed the violence that was present in your intimate relationship. I would like, with your consent, if you could tell me more about the violence you suffered during your pregnancy. (For example, did it exist before you became pregnant? Did it cease or worsen during that time?). The informants were encouraged to share as much of their background, context, and experiences as possible. Questionnaire. At the end of the individual interviews, the mothers were asked to complete a short version of the CTS-2 (Straus, Hamby, BoneyMcCoy, & Sugarman, 1996). The CTS-2 is a widely used instrument, having been translated and validated in many languages including French. It allows participants to report violent behavior and to rate the existence of violence in their intimate relationships. It includes sexual violence and can be answered with an 8-point frequency scale (never, once, twice, 3-5, 6-10, 11-20, >20, not


6


in the last year but before) to be later recoded into a dichotomous answer (no/ yes). Most of the participants responded to the scale individually while two mothers asked the researcher to help them fill it out. One mother chose not to complete the CTS-2. The freedom to end the interview or choose not to respond to questions that made them uncomfortable were important guiding principles of this research. As such, there was no pressure put on this participant to respond and she was not questioned on her refusal to answer the CTS2. Based on an analysis of her trajectory, and to the best of our knowledge, she does not appear to differ significantly from the other mothers in terms of relationship issues or experiences of adversity.

Data Analysis Data collection and analysis occurred simultaneously; once an interview was completed, it was transcribed and reviewed for accuracy and completeness (Lincoln & Guba, 1985). Starting with the reading (and rereading) of the transcripts for contextual meaning, the material was coded. Codes are labels assigned to whole documents or sections to help catalog key concepts while preserving the context in which they occur (Bradley, Curry, & Devers, 2007). The codes were created in an inductive way to reflect the experiences of the participants (Glaser & Strauss, 1967), sorted in categories, and scrutinized within different contexts. The initially developed provisional thematic coding scheme was refined as more interviews were added. The first author did all the coding while a second author and a qualitative expert reviewed a portion of the analyses for discrepancies. Negotiated consensus and discussions allowed for the resolution of coding issues (Bradley et al., 2007). Analytical processing was performed with the software package Nvivo.

Sample Characteristics The mothers who chose to participate in this study gave birth to their first child between the ages of 15 and 19. The romantic relationships in which the young women were involved during pregnancy were qualified as important for all but one participant. For many, the father of their child was their first boyfriend; they had been dating from a few weeks to about 3 years before they became pregnant. It was apparent from their testimonies that the mothers were all strongly committed to their relationship with the father of their child. There was a range of family histories from one mother to another and many reported difficult events in their family sphere, such as violence between parents, mental health problems, drug abuse, separation or divorce, moving frequently, and so forth. Globally, their academic backgrounds were



7

similar; they had average scores, were more or less invested or interested in school, and the majority did not want to pursue postsecondary education. When their pregnancy was confirmed, very few participants had well-defined educational or career aspirations. At the time of data collection, the mothers were between 18 and 33 years of age, with 8 mothers aged between 18 and 24 years, and 2 mothers aged 32 and 33 years. Six out of 10 mothers left their abusive partner, while 4 mothers chose to pursue the relationship.

Results Young Mothers’ Representations of Their Relationships Before Pregnancy For most women, their pregnancy was in the context of a stable romantic relationship that was important to them. The duration of that relationship varied between participants; only one had her child after a transient relationship. For many of the women interviewed, this relationship was the first “real” intimate relationship of their lives. He was actually my first love. I met him when I was 13 and stayed with him for a year or so, until I was 15. We broke up; it didn’t work out. I had some boyfriends, he had some girlfriends, and we got back together at age 18. And we decided to have a child. He was my first love; it was serious. I loved him, and I know that he loved me. (Shany) My daughter’s father was my first boyfriend. You know, that was my first relationship. But we stayed together for a good two and a half years. (MarieSophie, emphasis in original)

Although the importance given to the relationship by the young women is significant, their evaluation of that relationship is not necessarily positive. When asked to describe their intimate relationship before the pregnancy, the majority of the mothers stated that their relationship or their partner were not what they had hoped for. They would recount specific situations that had triggered their doubts: lies, unmet expectations, actions or attitudes they considered inappropriate, mean remarks, infidelity, and so forth. These disruptive behaviors caused harm to their relationship. And then he’d be telling me stuff like he is at work and I would be okay. But then I would go to the club and see him with another girl, you know what I mean? Aren’t you supposed to be at work? . . . So we had fights about his drinking, other girls and phone numbers. Then he started blaming me, telling me I was the one who was behaving bad. (Alizée)


8


Overall, the discourses shared by the young mothers highlighted that their romantic relationships were not all violent prior to pregnancy. In some cases, their relationship was healthy and not an adverse relational context. However, many of the discourses do paint a more somber portrait of their intimate relationships with conflicting and disrespectful behaviors at the forefront. Some of the young mothers also report experiences of victimization at this stage. Two of the 10 mothers interviewed, Isabelle and Alizée, reported having been victims of psychological violence: control, denigration, humiliation, and threats. However, despite the difficult relational contexts that many of the participants experienced, none of the mothers we met considered putting an end to the pregnancy. Many maintained hope that the baby would calm the situation and unite them into a family.

Self-Representations of the Relationship Following Pregnancy Confirmation The analyses of the time period following pregnancy show a difficulty or resistance among some of the young mothers in qualifying their relationship as violent. This time period begins at the moment pregnancy is confirmed and includes all time thereafter. Despite choosing to participate in this study, fulfilling the criterion by stating that IPV was present, and being referred by a counselor who was aware of their victimization, the women’s discourses around violence are sometimes ambiguous. On one side, they recognize the harmful effects of their relationship, especially on the well-being and development of their child, as shown by Sky and Louise: The arguing. It was just too much. We argued in front of our son. I saw a lot of that when I was younger and I didn’t want to do that in front of my son. You know, it does really stay with them. They are like sponges so the things I remember from that age . . . I didn’t want him to see his mommy and daddy always fighting. (Sky) It was me who ended the relationship. I said you have to move, it’s not working. The kids can’t see us fighting all the time. It was every day we would fight. Every single day. And over anything. So it was bad for my son. And when he started acting out, doing what we were doing, like hurt me and stuff, to see him do that . . . Like I don’t want to see him grow up thinking it’s okay for like men to hit girls. I don’t want him to grow up like that at all. I asked him to move. (Louise)

Psychological violence, more specifically threats and control, was the most common form of violence among the young women in this study. A



9

minority of the women reported experiencing violent physical behavior, such as being shoved, having objects thrown at them, or being threatened with objects. He had been monitoring me, and he wanted to hit me. . . . So he tried to hit me, but instead he struck the wall behind me. Then he picked up his steel boot, his steel-toed boot, and rammed it into a female friend of mine. He had become—He considered it all perfectly normal. I lived through that for two months. He never hit me after that, but, you know, the signs were there. I’d turned into an idiot: I didn’t know what to do, I didn’t know how to take care of my child, I didn’t know how to do housework. Dinners, well, they were never good. (Elizabeth)

Alternatively, even if the negative impact was recognized and strategies were put forward to end it (for a more detailed analysis of this aspect, consult Lévesque, 2015), it seemed more difficult for some women to describe their relationship or partner as violent, or themselves as victims, as they did not identify with the labels. Very few used the word violence without hesitation to describe their context or their partner’s actions during the qualitative interviews. However, they would recount many situations, behaviors, or actions they considered disrespectful or disruptive in an intimate relationship context. For example, Diane reported that her partner would leave the house for several days without notice, leaving her alone with the children and her own worries: Interviewer: What do you mean, exactly? Does he go away for several days at a time? Yes, sometimes it’s for several days: 3 days, 5 days. Diane: Interviewer: And do you hear from him when he’s gone? Diane: Sometimes he calls and says, “I’m fine,” but sometimes he doesn’t. (Diane) Another participant, Maude, mentioned the considerable financial responsibilities that she had to shoulder alone even though she was on welfare while her partner worked. She also explained during the interview that her partner had a gambling problem and that he sometimes took and gambled with money she had saved to put toward bills and other household expenses. Two others noted that their partners’ actions or decisions did not reflect their needs, as illustrated by Louise’s quote below. These situations gave way to conflicts, which sometimes escalated to violence. I had been starting college and I was going to school throughout the day and when I would come home, he would be leaving to work overnight. So he would


10


come home from his work at like 1 or 2 in the morning, he would bring over a whole bunch of friends. That were super loud, they would go make music in the room and start singing and playing videogames loud loud. And I would be trying to sleep and my son, who was sleeping in the same room as me, would wake up. So he woke up my son, me and I would have to woke up for school and leave at six. And that was every day. I didn’t get any rest at all. It made me furious. (Louise)

One area in which violent behavior is experienced but underreported by many women is the sexual sphere. Among the young mothers we met, sexual violence in the context of intimate relationship is more taboo than other types of violence. When asked about the difficulties or challenges they experienced in their intimate relationships and with the actions of their partners, none of the participants referred to sexual violence in the individual interviews on their own. However, when asked specifically about this aspect, several participants reported violent behavior, mostly in the period following pregnancy. Many participants reported being forced to have sex when they had no desire to. Others felt pressure to have a more active sex life or to be sexually available to their partner, as Maude explains: I wore a sanitary napkin every day for about two and a half months, and that’s what he found the hardest to put up with. Not having . . . I tried hard to find other ways to please him, but (silence) it’s hard. . . .

Moreover, in the period following pregnancy, when faced with the reality that the baby would not trigger positive changes in their intimate relationships, some mothers felt trapped. This feeling was partly due to the desire for a united family and the presence of both parents for their child. Consequently, many mothers felt torn between affection toward their partner and the desire to maintain their family united on one side, and violent acts and an adverse relational context on the other side. Because I didn’t have a father, I really wanted to give that to my daughter, you know. I wanted so much for him to be a part of it. . . . In my mind, I had always had the idea that the two girls would have their father there. Mommy and Daddy at home. For me, it was clear that that was what I wanted. I tried right up to the end. Right up to the end I kept trying. (Shany)

Data Collection Variations Supplementary comparative analyses allow us to underline the differences in the perception of some violent behaviors based on the methods of data


11

Lévesque and Chamberland Table 1. Discrepancies Between Responses From Individual Interviews and the CTS-2. Psychological Violence

Physical Violence

Sexual Violence

Participantsa

CTS-2

Interview

CTS-2

Interview

CTS-2

Interview

Elizabeth Mimi Marie-Sophie Maude Shany Diane Alizée Sky Louise

yes no no yes yes yes yes no yes

yes yes yes yes yes yes yes yes yes

yes no no no yes yes no no yes

yes no no no yes no no nob yes

no no yes yes no no no no yes

no yes yes yes yes yes yes no no

aOne of the participants did not wish to complete the CTS-2; she is excluded from this section of the analysis. bCounselor informed us of two episodes of physical violence.

collection. In this regard, some behaviors were reported with a specific type of instrument but not another. For example, six participants reported psychological violence in the CTS-2, while all nine participants reported it in the interviews. Four participants reported physical violence with the questionnaire, while only three reported it during the interviews. Finally, three participants reported sexual victimization with the CTS-2, while five reported it during the interviews. In some cases, the CTS-2 completed at the end of the individual interview did not indicate the existence of violence, but the immediately preceding individual interview and the meeting held in preparation included precise descriptions of behaviors that fall into one of the categories of the CTS-2: physical, psychological, or sexual violence. However, for two participants (Louise and Diane), the CTS-2 provided the opportunity to report victimization that was not disclosed in the individual interviews. Discrepancies between data obtained via the individual interview and the CTS-2 are shown in Table 1.

Discussion The objective of this study was to better understand the different possible manifestations of IPV in young mothers’ lives and to reflect on the difficulties in identifying oneself as a victim of IPV or in categorizing a partner’s acts


12


as intimate violence. Overall, the young mothers approached for this study immediately recognized their intimate relationships as a major hindrance to their life paths. They reported the presence of psychological violence and, in some cases, physical violence. Sexual violence was less readily discussed but significantly present among the participants. However, there appears to be a gray zone when it comes to drawing the line between what is and is not considered violence. Certain aspects pertaining to violent relationships are easily recognized, while others are harder for the study’s participants to identify. Finally, certain actions harm the romantic relationship and create conflict without being labeled violent. Our results support previous research on the intersection of violence and parenting, and their associated challenges with regard to the lives of young mothers (Herrman, 2013; Kulkarni, 2006; Newman & Campbell, 2010). Although not discussed at first in the interviews, the young mothers we met experienced different forms of sexual violence. Our results support the findings in Kennedy’s study (2005), in which the women did not want to have sexual relationships with their partner following the birth of their baby and indicated that their partners responded with accusations of cheating and physical violence. Hardly discussed between the young mothers during participative observations, the area of sexual violence seems to be one where several taboos persist. This sexual sphere, in which several violent behaviors manifest, is still poorly documented and would benefit from further investigation. This presence of sexual violence could be linked to the higher rate of pregnancy among young mothers (Miller et al., 2014). Considering they are at an age where the rates of IPV are at its highest (Johnson, Giordano, Manning, & Longmore, 2014), the young mothers in our study also show confusion when it comes to interpreting acts of violence. As previous research has demonstrated (Miller et al., 2007; Ulrich et al., 2006), the young women whose stories are shared here are not the only ones with difficulty acknowledging the violent acts within their intimate relationships. In their study of pregnant women who were victims of violence at the hands of an intimate partner, Williams and Brackley (2009) also reported many conflicting responses. Some women would respond negatively when asked if they suffered from violence, whereas over the course of the interview, the same women shared stories where they were brutalized, pushed around, or controlled by their spouse (Williams & Brackley, 2009). Different authors have proposed explanations of this difficulty in acknowledging violence. For instance, Eisikovits and Winstok (2002) stated, “When partners remain together in spite of violence, the content and organization of their memories need to be constructed in a manner that makes this decision coherent with their everyday reality and accountable to audiences in



13

immediate interactive contexts” (p. 687). In this context, the recollection of violent acts labeled as such could be linked to the freedom of choice in staying or leaving the abusive relationship (Eisikovits & Winstok, 2002). It could also be linked with mutual nature of the violence: Many adolescent couples engage in reciprocal violence, meaning that both partners often hit, push, and slap each other (Capaldi, Wu Shortt, & Crosby, 2003; Newman & Campbell, 2010). This can influence perceptions of instances of violence, rendering them less of an issue. However, this normalization of violence could have significant effects, especially on the mental health of the young women. A study conducted with a group of American young mothers suggests that early exposure to IPV and its effects on mental health outcomes may predispose young women to avoidance of other potentially stressful situations such as entering new social relationships or seeking employment, which in turn reduces social and economic opportunities (Lindhorst & Oxford, 2008). Another study of Brazilian adolescent mothers shows that violent victimization and negative mental health outcomes are common and correlated (Ferri et al., 2007). The comparison of data obtained in individual interviews with data obtained through the CTS-2 sheds light on the relevance of using more than one form of data collection to obtain a more accurate portrait of a situation. Although both methods have proven to be crucial and relevant, in this case, each approach revealed aspects that the other had missed. Given the more personal and targeted nature of questions in the individual interviews, this method allowed participants to better describe their relational situation including conflicting and disruptive behaviors such as extramarital affairs, denigration of their body, and frequent and repeated absences. Although not considered IPV, and therefore not measured by the CTS-2, these behaviors can help reveal the relational contexts in which IPV occurs. More importantly, individual interviews yielded more reports of sexual violence, most of which went unreported on the CTS-2. Miller et al. (2007) explored a similar situation in a qualitative study focused on the partner’s violent behaviors during pregnancy. While transcribing their first five interviews, they found that the teenagers they met responded negatively to their question on sexual coercion, while they described experiences of coercive and forced sex afterward (Miller et al., 2007). Another study conducted among 30 new adult mothers who had reported violent acts during pregnancy using validated tools (the Abuse Assessment Scale and the Index of Spouse Abuse) also confirmed this trend (Ulrich et al., 2006). During an interview conducted hours after the birth of their child, more than half the participants did not regard what they had experienced as violence (Ulrich et al., 2006). Regardless, the actions and behaviors of their intimate partners, as reported by the women, did match


14


contemporary definitions of domestic violence. The women did not characterize these actions as forms of violence and cited the following reasons why: It occurred frequently, it was normal, they did not object, and they were satisfied with their relationships (Ulrich et al., 2006). However, different results were obtained in another study focused on establishing the efficacy of screening tools in a clinical setting (Kolbrun Svavarsdottir, 2010). They tested two detection instruments: The first was a self-administered questionnaire, the Woman Abuse Screening Tool (WAST), and the second was a guided interview, the Woman Abuse: Screening and First Response. Evaluation Interview Frame for Nurses and Midwives. According to their data, the self-reporting procedure on its own was comparable with the interview in terms of disclosed rates of violence. Their results also indicated that the type of lived violence could be disclosed differently depending on the selected instrument. Our results also demonstrate that despite its many advantages, the individual interview does not allow for all participants to address a subject as intimate as violence. Two of the participants chose not to disclose their experiences of sexual and physical victimization during the interview despite opportunities to do so through specific questions. They preferred to report these forms of victimization on the written questionnaire. Finally, analysis of the collected data on Sky’s trajectory indicates that, at times, neither of the two instruments allowed for disclosure of a situation of violence. When questioned on her experience of physical violence in the context of her relationship with the father of her child, Sky responded negatively in both forms of data collection. However, an interview with a counselor at a community center that she frequents revealed the presence of two violent experiences. Different hypotheses could be put forward to explain this reluctance to share experiences of victimization. It is possible that the participants felt less comfortable sharing because they did not want to tarnish their image as mothers and knew that several prejudices exist surrounding mothers who are victims of violence and their ability to protect their child (Kantor & Little, 2003). It is also possible that they did not want to damage the impression the researchers had of them from previous encounters at the organizations they frequented.

Limitations These findings must be considered in light of the study’s limitations. This study focused on a small group of women who faced specific types of adversity, namely, early pregnancy and IPV. Thus, our results cannot be generalized to all young women entering maternity or those experiencing IPV. Second, all the participants in this study were referred by a counselor



15

working at a community organization. As such, young mothers who had been victims of violence, but who were not involved in community groups or receiving services from a health clinic, are absent from this study. Third, as imposed by the ethics committee, we were not permitted to recruit mothers younger than 18 years of age. This limit is important, as the trajectories of younger mothers may differ significantly. Fourth, the manner in which the interviews were conducted, that is, informal contact through the organizations followed by a preinterview phone conversation to confirm selection criteria, may have contributed to the previously noted discrepancies between information gathered through individual interviews and information gathered by questionnaire. Despite these limitations, the results of this exploratory study raise significant issues for future research and interventions.

Implications The current findings reveal a multitude of contextual challenges reported by a sample of young resilient mothers who were victims of IPV during their pregnancy. One central challenge, recognition of violence, is of major importance for intervention. As it can be difficult for some young mothers to recognize the violent nature of their romantic relationships, increasing awareness gradually by focusing on those aspects of their relationship and only later identifying it as violent seems to be a promising approach. Several obstacles—those connected to socialization, the environment, and those resulting from the violence itself—may prevent or undermine their paths of resilience and coping (Fortin, Côté, Rousseau, & Dubé, 2007). It is also important to understand that putting an end to a violent relationship does not put an end to the violence that takes place (Rinfret-Raynor, Dubé, Drouin, Maillé, & Harper, 2008). The decision to end a violent relationship while adapting to a parental role, especially at an early age, seems to be a lengthy process marked by doubt and hesitation (Kulkarni, 2006). An important element in helping a young mother through this process is the presence of a strong social support network (Heise & Garcia-Moreno, 2002). Moreover, many guidelines have stressed the importance of establishing a relationship before abuse disclosure (Centre de liaison sur l’intervention précoce et la prévention psychosociales, 2006; Registered Nurses’ Association of Ontario, 2005; Société des obstétriciens et gynécologues du Canada, 2005). Our experience in this exploratory project, paired with the results presented above, illustrates the importance of a trusting relationship in a research context. In the interest of offering better support, further research is necessary to better document the processes involved in the termination of a violent relationship for young mothers. An awareness of the complexity of domestic


16


violence and the difficulties faced by the majority of women in ending a violent relationship, whether they are mothers or not, is also essential. Finally, it is important to highlight the contributions of qualitative research in analyzing the experience of mothers who have given birth at an early age in an adverse relationship context. The relevance of this methodology to a better understanding of the meanings and implications of violence during the transition to motherhood is fundamental. Acknowledgments We generously thank the women who participated in this study. We also thank the two organizations that supported and helped recruit the participants for this study, as well as the community workers who shared their wisdom and knowledge with us.

Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.

References Agence de santé publique du Canada [Public Health Agency of Canada]. (2009). Ce que disent les mères: l’Enquête canadienne sur l’expérience de la maternité [What Mothers Say: The Canadian Maternity Experiences Survey]. Ottawa, Ontario: Gouvernement du Canada. Beaud, S., & Weber, F. (2003). Guide de l’enquête de terrain. Produire et analyser des données ethnographiques [Participant observation guide. Producing and analyzing ethnographic data]. Paris, France: Éditions La Découverte. Bernard, H. R. (2002). Research methods in anthropology: Qualitative and quantitative methods (3rd ed.). Walnut Creek, CA: AltaMira Press. Bonomi, A. E., Anderson, M. L., Nemeth, J., Rivara, F. P., & Buettner, C. (2013). History of dating violence and the association with late adolescent health. BMC Public Health, 13, 821. doi:10.1186/1471-2458-13-821 Bradley, E. H., Curry, L. A., & Devers, K. J. (2007). Qualitative data analysis for health services research: Developing taxonomy, themes, and theory. Health Services Research, 42, 1758-1772. doi:10.1111/j.1475-6773.2006.00684.x Capaldi, D. M., Wu Shortt, J., & Crosby, L. (2003). Physical and psychological aggression in at-risk young couples: Stability and change in young adulthood. Merrill-Palmer Quarterly, 49, 1-17. Centre de liaison sur l’intervention précoce et la prévention psychosociales. (2006). L’identification précoce de la violence conjugale: Guide de formation. Montréal, Québec, Canada: Hôpital Rivières-des-Prairies. Downloaded from jiv.sagepub.com at University of Texas Libraries on June 5, 2015


17

Chambliss, L. R. (2008). Intimate partner violence and its implication for pregnancy. Clinical Obstetrics and Gynecology, 51, 385-397. Crenshaw, K. (1991). Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Review, 43, 1241-1299. Creswell, J. W. (1998). Qualitative inquiry and research design. Thousand Oaks, CA: Sage. Curry, M. A., Doyle, B., & Gilhooley, J. (1998). Abuse among pregnant adolescents: Differences by developmental age. The American Journal of Maternal/Child Nursing, 23, 144-150. Daoud, N., Urquia, M. L., O’Campo., P., Heaman, M., Janssen, P. A., Smylie, J., & Thiessen, K. (2012). Prevalence of abuse and violence before, during, and after pregnancy in a national sample of Canadian women. American Journal of Public Health, 102, 1893-1901. Dobash, R. E., Dobash, R. P., Cavanagh, K., & Lewis, R. (2000). Sage series on violence against women: Changing violent men. Thousand Oaks, CA: Sage Publications, Inc. Eisikovits, Z., & Winstok, Z. (2002). Reconstructing intimate violence: The structure and content of recollections of violent events. Qualitative Health Research, 12, 685-699. Ferri, C. P., Mitsuhiro, S. S., Barros, M. C. M., Chalem, E., Guinsburg, R., Patel, V., . . . Laranjeira, R. (2007). The impact of maternal experience of violence and common mental disorders on neonatal outcomes: A survey of adolescents mothers in Sao Paulo, Brazil. BMC Public Health, 7, 209. doi:10.1186/1471-2458-7-209 Fortin, A., Côté, I., Rousseau, S., & Dubé, M. (2007). Soutenir les mères pour prévenir les effets néfastes de la violence conjugale chez les enfants. Guide pour les intervenantes des maisons d’aide et d’hébergement. Montréal, Québec, Canada: Centre de recherche interdisciplinaire sur la violence familiale et la violence faite aux femmes. George, J., & Stith, S. M. (2014). An updated feminist view of intimate partner violence. Family Process, 53, 179-193. doi:10.1111/famp.12073 Gessner, B. D., & Perham-Hester, K. (1998). Experience of violence among teenage mothers in Alaska. Journal of Adolescent Health, 22, 383-388. Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research. New York, NY: Aldine de Gruyter. Heaman, M. I. (2005). Relationships between physical abuse during pregnancy and risk factors for preterm birth among women in Manitoba. Journal of Obstetric, Gynecologic & Neonatal Nursing, 34, 721-731. Heise, L., & Garcia-Moreno, C. (2002). Violence by intimate partners. In E. G. Krug, L. L. Dahlberg, J. A. Mercy, A. Zwi & R. Lozano-Ascencio (Eds.), World report on violence and health (pp. 87-121). Geneva, Switzerland: World Health Association. Herrman, J. W. (2013). How teen mothers describe dating violence. Journal of Obstetric, Gynecologic & Neonatal Nursing, 42, 462-470. doi:10.1111/15526909.12228


18


Johnson, W. L., Giordano, P. C., Manning, W. D., & Longmore, M. A. (2014). The age-IPV curve: Changes in the perpetration of intimate partner violence during adolescence and young adulthood. Journal of Youth and Adolescence, 44, 708726. doi:10.1007/s10964-014-0158-z Kantor, G. K., & Little, L. (2003). Defining the boundaries of child neglect. When does domestic violence equate with parental failure to protect? Journal of Interpersonal Violence, 18, 338-355. doi:10.1177/0886260502250834 Kennedy, A. C. (2005). Resilience among urban adolescent mothers living with violence: Listening to their stories. Violence Against Women, 11(12), 14901514. Kingston, D., Heaman, M., Fell, D., & Chalmers, B. (2012). Comparison of adolescent, young adult, and adult women’s maternity experiences and practices. Pediatrics, 129, e1228-e1237. doi:10.1542/peds.2011-1447 Kolbrun Svavarsdottir, E. (2010). Detecting intimate partner abuse within clinicalsettings: Self-report or an interview. Scandinavian Journal of Caring Sciences, 24, 224-232. Kulkarni, S. (2006). Interpersonal violence at the crossroads between adolescence and adulthood: Learning about partner violence from young mothers. Violence Against Women, 12, 187-207. doi:10.1177/1077801205280933 Kulkarni, S. (2007). Romance narrative, feminine ideals, and developmental detours for young mothers. Affilia, 22, 9-22. Lévesque, S. (2010). Accoucher à 16 ans, sans violence: une réalité possible? État empirique de la situation et réflexion critique. Santé mentale au Québec, 25, 195-219. Lévesque, S. (2015). Maternité précoce, violence et résilience. Des jeunes mères témoignent [Early pregnancy, violence and resilience. Young mothers bear witness]. Québec City, Canada: Presses de l’Université du Québec. Lincoln, Y. S., & Guba, E. (1985). Naturalistic inquiry. Beverly Hills, CA: Sage. Lindhorst, T., & Oxford, M. (2008). The long-term effects of intimate partner violence on adolescent mothers’ depressive symptoms. Social Science & Medicine, 66, 1322-1333. Martin, S. L., Mackie, L., Kupper, L. L., Buescher, P. A., & Moracco, K. E. (2001). Physical abuse of women before, during and after pregnancy. Journal of the American Medical Association, 285, 1581-1584. Miller, E., Decker, M. R., Reed, E., Raj, A., Hathaway, J. E., & Silverman, J. G. (2007). Male partner pregnancy-promoting behaviors and adolescent partner violence: Findings from a qualitative study with adolescent females. Ambulatory Pediatrics, 7, 360-366. Miller, E., McCauley, H. L., Tancredi, D. J., Decker, M. R., Anderson, H., & Silverman, J. G. (2014). Recent reproductive coercion and unintended pregnancy among female family planning clients. Contraception, 89, 122-128. doi:10.1016/j.contraception.2013.10.011 Morse, J. A. (1995). The significance of saturation. Qualitative Health Research, 5, 147-149. doi:10.1177/104973239500500201



19

Moyer, V. A. (2013). Screening for intimate partner violence and abuse of elderly and vulnerable adults: US preventive services task force recommendation statement. Annals of Internal Medicine, 158, 478-486. Newman, B. S., & Campbell, C. (2010). Intimate partner violence among pregnant and parenting Latina adolescents. Journal of Interpersonal Violence, 26, 26352657. doi:10.1177/0886260510388281 Postmus, J. L., Huang, C.-C., & Mathisen-Stylianou, A. (2012). The impact of physical and economical abuse on maternal mental health and parenting. Children and Youth Services Review, 34, 1922-1928. doi:10.1016/j.childyouth.2012.06.005 Quinlivan, J. A., & Evans, S. F. (2005). Impact of domestic violence and drug abuse in pregnancy on maternal attachment and infant temperament in teenage mothers in the setting of best clinical practice. Archives of Women’s Mental Health, 8, 191-199. Registered Nurses’ Association of Ontario. (2005). Nursing best practice guideline: Woman abuse: Screening, identification and initial response. Toronto, Canada: Registered Nurses’ Association of Ontario. Rinfret-Raynor, M., Dubé, M., Drouin, C., Maillé, N., & Harper, E. (2008). Violence conjugale postséparation en contexte d’exercice des droits d’accès aux enfants [ Post-separation violence against women in child custody and access context]. In S. Arcand, D. Damant, S. Gravel & E. Harper (Eds.), Violences faites aux femmes (pp. 185-207). Québec City, Canada: Presses de l’Université du Québec. Silverman, J. G., Raj, A., Mucci, L. A., & Hathaway, J. E. (2001). Dating violence against adolescent girls and associated substance use, unhealthy weight control, sexual risk behavior, pregnancy and suicidality. Journal of the American Medical Association, 286, 572-579. Société des obstétriciens et gynécologues du Canada [Society of Obstetricians and Gynaecologists of Canada]. (2005). Déclaration de consensus sur la violence exercée par le partenaire intime. Directives cliniques de la SOGC [Intimate Partner Violence Consensus Statement]. Retrieved from http://sogc.org/wpcontent/uploads/2013/01/157E-CPG-April2005.pdf. Straus, M. A., Hamby, S. L., Boney-McCoy, S., & Sugarman, D. B. (1996). The Revised Conflict Tactics Scales (CTS2). Journal of Family Issues, 17, 283-316. Taillieu, T. L., & Brownridge, D. A. (2010). Violence against pregnant women: Prevalence, patterns, risk factors, theories, and directions for future research. Aggression and Violent Behavior, 15, 14-35. Ulrich, Y. C., Mckenna, L. S., King, C., Campbell, D. W., Ryan, J., Torres, S., . . . Campbell, J. C. (2006). Postpartum mothers’ disclosure of abuse, role, and conflict. Health Care for Women International, 27, 324-343. Wiemann, C. M., Agurcia, C. A., Berenson, A. B., Volk, R. J., & Rickert, V. I. (2000). Pregnant adolescents: Experiences and behaviors associated with physical assault by an intimate partner. Maternal and Child Health Journal, 4, 93-101. Williams, G. B., & Brackley, M. H. (2009). Intimate partner violence, pregnancy and the decision for abortion. Issues in Mental Health Nursing, 30, 272-278. doi:10.1080/01612840802710902


20


World Health Organization. (2013). Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence. Geneva, Switzerland: Author.

Author Biographies Sylvie Lévesque, PhD, public health, is an assistant professor in the sexology department at Université du Quebec in Montreal. She has been doing research primarily, but not exclusively, on violence between partners, maternity in a context of intimate partner violence, and transition to parenthood. Claire Chamberland, PhD psychology, is an emeritus professor in the School of Social Work at the Université de Montréal. She is still an active researcher in the field of domestic violence and child abuse.


Intimate partner violence and suicidal ideation in pregnant women.

A Qualitative Study of Intimate Partner Violence Among Women in Nigeria.

Multilevel correlates of broadly- and narrowly-defined intimate partner violence among pregnant women in Los Angeles.

Examining Intimate Partner Violence and Health Factors Among Rural Appalachian Pregnant Women.

Childhood Abuse, Intimate Partner Violence and Risk of Migraine Among Pregnant Women: An Epidemiologic Study.

Intimate partner violence after disclosure of HIV test results among pregnant women in Harare, Zimbabwe.

Intimate partner violence among HIV positive pregnant women in South Africa.

Prevalence and risk factors of intimate partner violence among pregnant women in Japan.

Employment status and intimate partner violence among Mexican women.

Relations Between Intimate Partner Violence and Forgiveness Among College Women.

Professionals' perception of intimate partner violence in young people: a qualitative study in northern Spain.

Burden of intimate partner violence in The Gambia - a cross sectional study of pregnant women.

Intimate partner violence experienced by HIV-infected pregnant women in South Africa: a cross-sectional study.

Risk factors for severe intimate partner violence and violence-related injuries among women in India.

How Has Living with Intimate Partner Violence Affected the Work Situation? A Qualitative Study among Abused Women in Norway.

Intimate partner violence and reproductive health among methamphetamine-using women in los angeles: a qualitative pilot study.

Lesbian intimate partner violence.

The importance of intimate partner violence and suicidal ideation in pregnant women.

Associations between bride price stress and intimate partner violence amongst pregnant women in Timor-Leste.

Intimate partner violence interventions.

Intimate partner violence among adolescents and young women: prevalence and associated factors in nine countries: a cross-sectional study.

Anger, Control, and Intimate Partner Violence in Young Adulthood.

Association of childhood physical and sexual abuse with intimate partner violence, poor general health and depressive symptoms among pregnant women.

Relationship Factors and Condom Use Among Women with a History of Intimate Partner Violence.