Original ArticlesPregnancy and delivery for women with a history of child sexual abuse☆
Introduction
THE EXTENT OF child sexual abuse (CSA) has received considerable public and professional attention in recent years. Estimated prevalence rates for women are reported in the range between 6% and 62% depending on the definitions and methods used Finkelhor 1994, Gibbons 1996, Russell 1986. In Norwegian studies the prevalence of child sexual abuse among women ranges from 8% to 19% Bendixen et al 1994, Schei 1990, Sætre et al 1986.
The long term effects of child sexual abuse comprize a wide range of psychological and social effects, as well as effects on somatic health such as headache, multiple somatic symptoms, pelvic pain, dysmenorrhoea, dyspareunia, vaginal discharge, and gastrointestinal illness Beitchman et al 1992, Drajier 1989, Drossman et al 1995. It has also been shown that women with a history of CSA have high health care utilization, and are objects of more intervention such as surgical procedures than nonabused women Drossman et al 1995, Kirkengen et al 1993. Genital tract infections have been related to preterm birth (McGregor et al., 1995), and abuse has been proposed as a risk factor for pelvic inflammatory disease (Schei, 1991). It is therefore likely that CSA could be reflected in the course of pregnancy, and in complications during pregnancy and delivery, while also affecting the outcome of pregnancy, for example birth weight.
The relationship of pregnancy and childbirth to the long-term effects of CSA has only been studied to a limited degree and mostly in case series. The results have been inconclusive.
The primary aim of this study was to examine whether women who delivered low birth weight infants were more likely to have experienced CSA than women who delivered nonlow birth weight infants. Secondary aims were to explore medical complications, urogenital infections, use of health care services, medical treatment during pregnancy, intervention during delivery, and discomfort during pregnancy among women with or without a history of CSA. This was part of a study of abuse and low birth weight.
Section snippets
Participants
Women were recruited during an 18-month period stretching from 1992 to 1994 at the Department of Obstetrics, the University Hospital of Trondheim. Women who delivered a baby with birth weight below 2500g regardless of the gestational age constituted the case group. Following each identified case the next woman delivering a baby with birth weight 2500g or more was selected as a control subject. One hundred and fourteen cases and controls were sampled. In all, 11 women were lost to followup,
Results
A total of 34 women (19%) disclosed information of unpleasant sexual experiences before 18 years of age, including exhibitionism, verbal sexual advances, and forced nongenital touching. Twenty-five (14%) of the women, 12 cases and 13 controls, reported experiences of CSA involving at least genital touch (Table 1). Two women did not want to give details of the abuse experience. They are categorized as a special group and are included in the abused group in the subsequent analysis. Birth of LBW
Discussion
This study demonstrated that a high proportion (14%) of Norwegian parous women reported experiences of CSA. Women who delivered a LBW infant were not more likely to have a history of CSA, but the analyses suggest that abused women more often were smokers during pregnancy, had menarche and sexual debut at a lower age, and reported more discomfort during pregnancy. Abused women had used more health care services during pregnancy compared to nonabused women when controlled for LBW.
The detection
Acknowledgements
The authors would like to thank the women who took part in this study, and the Department of Obstetrics at the University Hospital of Trondheim for their support.
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This study was supported by a research fellowship from the Norwegian Research Council.