UC Merced

Violence against pregnant and postpartum women is a major public health problem, placing many women at severe risk for their health and well-being. Mortality rates due to homicide (the most severe form of violence) among pregnant and postpartum individuals are well-documented and have been shown to increase over the past 10 years. However, similar estimates of pregnancy-associated violence-related morbidity are lacking: most existing studies are cross-sectional or focus only on intimate partner violence. This dissertation contributes to the literature on pregnancy-associated violence by improving our understanding of pregnancy-associated violence morbidity using comprehensive, longitudinal data (i.e., emergency department data, patient discharge data). The first study estimates the incidence of and disparities by race/ethnicity, insurance status, rurality, and age in pregnancy-associated violence injury morbidity using population-representative, linked datasets. The second study examines social and behavioral risk factors during pregnancy for mitigating postpartum violence. The third study examines associations between increases in county-level healthcare supply and reduced risk for pregnancy-associated violence and other behavioral health outcomes, namely self-harm and drug overdose. The findings demonstrate slight but increasing trends in pregnancy-associated violence over a decade. Additionally, our results identify critical individual-level and area-level sociodemographic and behavioral risk factors, and generally, that socially vulnerable groups are at higher risk for pregnancy-associated violence. Overall, the dissertation highlights violence against pregnant and postpartum women as a multi-faceted issue that requires multi-level health equity-focused solutions and behavioral health response. Future studies should consider other facets of healthcare system response that may mitigate behavioral health risk, as well as further investigate the structural and social determinants that underlie violence among pregnant and postpartum women.