Economic Hardship and Intimate Partner Violence: Exploring Economic and Social Disparities in a Pregnant Population

Abstract

Background: Intimate partner violence (IPV) affects over 40% of women in the U.S. and is associated with serious health risks, including depression, PTSD, substance use, and adverse birth outcomes. The health consequences of IPV are especially heightened during pregnancy, a time of increased physical, emotional, and economic vulnerability. Although prior research has established a link between economic hardship and IPV, few studies have examined multiple indicators of economic hardship in relation to IPV during pregnancy. Moreover, given documented disparities in both economic conditions and IPV prevalence across racial/ethnic groups, evaluating race/ethnicity as an effect modifier can help clarify whether these associations differ across populations. This study addresses this gap by evaluating how WIC participation, household income, and insurance type are associated with IPV before and during pregnancy, and whether these associations vary across racial and ethnic groups. Methods: We conducted a cross-sectional analysis of 2016–2023 Pregnancy Risk Assessment Monitoring System (PRAMS) data from 38 U.S. states (N = 177,787). Economic hardship was measured using WIC eligibility and use, household income relative to the federal poverty level, and insurance type. IPV was defined as any physical violence from a current or former partner in the year before or during pregnancy. Survey-weighted logistic regression estimated adjusted odds ratios (aORs), controlling for maternal age, race/ethnicity, education, and marital status. Stratified models assessed effect modification by race/ethnicity. Results: IPV was reported by 2.2% of respondents (n = 3,973). Among those who experienced IPV, 82.9% lived at or below the FPL, 72.4% had public insurance, and 53.9% used WIC. Economic hardship was significantly associated with higher odds of IPV. Women with incomes at or below 100% of the federal poverty level had 5.18 times the odds of experiencing IPV compared to those with incomes above 185% of the FPL. WIC participants had 2.70 times the odds of IPV compared to women who were not eligible for the program, and those with public insurance had 2.36 times the odds compared to women with private insurance. Stratified models revealed strong associations between economic hardship and IPV across all racial and ethnic groups, with elevated odds observed when comparing individuals experiencing economic hardship to their respective higher-income, privately insured, or non-WIC-using counterparts within each group. Conclusion: Economic hardship is strongly linked to IPV before and during pregnancy, underscoring the need for targeted prevention efforts that support low-income women.