Examining the impact of state laws on intimate partner violence

Intimate partner violence (IPV) is common with over 7% of U.S. women reporting physical or sexual violence, and/or staking in the past year. Moreover, nearly 10% of pregnant people report experiencing either physical or sexual violence during their pregnancy and the prevalence increases to 20% when psychological violence is

included. IPV has widespread consequences, including physical injury, increased rates of chronic conditions, poorer mental health, and death. Pregnancy is a particularly risky time for individuals in violent relationships: Homicide is a leading cause of death for pregnant women in the U.S. and over half of pregnancy-associated

suicides involve intimate partner conflict. When a gun is available, the risk of a fatal (versus non-fatal) IPV event increases 4-fold. Over half of women experiencing IPV are victimized multiple times over multiple years, therefore meeting the definition of a chronic condition. Reproductive coercion (RC), a hallmark of

IPV, involves controlling contraception use, contraception sabotage, pressure to become pregnant, and pregnancy decision-making. Prior work has shown people experiencing IPV often seek reproductive health services and obtaining reproductive health care can reduce the risk of future violence. Today, over half of

women in the U.S. live in states with laws restricting access to reproductive health care, and many live in states without IPV-related firearm restrictions. This timely proposal will examine relationships between state law (reproductive health law; firearm law) and rates of IPV, IPV-related morbidity and mortality among

reproductive age people between 2015-2026. We propose to leverage the natural experiment created through enactment of state laws restricting access to reproductive health services beginning in 2023. We will use data from Medicaid, the Pregnancy Risk Assessment Monitoring System (PRAMS), the National Crime Victimization

Survey (NCVS), and the National Violent Death Reporting System (NVDRS), along with strong quasi- experimental methods, such as comparative interrupted time series (ITS) or differences-in-differences (DD), to characterize the relationships between state law and rates of IPV (Aim 1), IPV-related physical and mental

health outcomes (Aim 2), health service use (Aim 2) and IPV-related mortality (Aim 3). Our comparisons will include 1) across state comparisons by state law; and 2) within state comparisons before and after law enactment. We will conduct subgroup analyses to examine for law effect heterogeneity by race/ethnicity,

income, and community disadvantage. We hypothesize that state laws that restrict access to reproductive health services will be associated with increases in IPV and IPV-related health outcomes and the impact will be greater in some groups of people. This work will yield the best available evidence on the impact of state law on

IPV and health outcomes. Our proposal aligns well with RFA-OD-23-014 by examining the impact of state laws on IPV (an understudied chronic condition) and mental and maternal health outcomes.