Rural/urban differences in rates and predictors of intimate partner violence and abuse screening among pregnant and postpartum United States residents

Katy Backes Kozhimannil, Emily C. Sheffield, Alyssa H. Fritz, Carrie Henning-Smith, Julia D. Interrante, Valerie A. Lewis

Research output: Contribution to journalArticlepeer-review


Objective: To describe rates and predictors of perinatal intimate partner violence (IPV) and rates and predictors of not being screened for abuse among rural and urban IPV victims who gave birth. Data Sources and Study Setting: This analysis utilized 2016–2020 Pregnancy Risk Assessment Monitoring System (PRAMS) data from 45 states and three jurisdictions. Study Design: This is a retrospective, cross-sectional study using multistate survey data. Data Collection/Extraction Methods: This analysis included 201,413 survey respondents who gave birth in 2016–2020 (n = 42,193 rural and 159,220 urban respondents). We used survey-weighted multivariable logistic regression models, stratified by rural/urban residence, to estimate adjusted predicted probabilities and 95% confidence intervals (CIs) for two outcomes: (1) self-reported experiences of IPV (physical violence by a current or former intimate partner) and (2) not receiving abuse screening at health care visits before, during, or after pregnancy. Principal Findings: Rural residents had a higher prevalence of perinatal IPV (4.6%) than urban residents (3.2%). Rural respondents who were Medicaid beneficiaries, 18–35 years old, non-Hispanic white, Hispanic (English-speaking), or American Indian/Alaska Native had significantly higher predicted probabilities of experiencing perinatal IPV compared with their urban counterparts. Among respondents who experienced perinatal IPV, predicted probabilities of not receiving abuse screening were 21.3% for rural and 16.5% for urban residents. Predicted probabilities of not being screened for abuse were elevated for rural IPV victims who were Medicaid beneficiaries, 18–24 years old, or unmarried, compared to urban IPV victims with those same characteristics. Conclusions: IPV is more common among rural birthing people, and rural IPV victims are at higher risk of not being screened for abuse compared with their urban peers. IPV prevention and support interventions are needed in rural communities and should focus on universal abuse screening during health care visits and targeted support for those at greatest risk of perinatal IPV.

Original languageEnglish (US)
Article numbere14212
JournalHealth services research
Issue number2
StatePublished - Apr 2024

Bibliographical note

Publisher Copyright:
© 2023 The Authors. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust.


  • domestic violence
  • intimate partner violence
  • maternal health
  • pregnancy
  • rural health


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