Jan. 22, 2001 -- By the time Mary found out she was pregnant, her fiancé already was showing signs of becoming an abuser. He was unreasonably jealous and shouted at her frequently. She decided it was in her best interest to have an abortion.
After they married, she told her husband about the abortion during an argument. Even though he didn't want children, he responded by beating her head against a cement wall until she passed out. She woke up in bed two days later, her bloody head wrapped in a towel. He refused to take her to a hospital.
Yet Mary -- she asked that her real name not be used -- feels certain she would have suffered worse had she gone through with the pregnancy. "I knew that if I had a child, he would have killed or beaten the child first to get to me, and I wasn't willing to risk that," she says.
As many as 20% of pregnant women are abused, according to a 1997 study by the Centers for Disease Control and Prevention. Many of those women were in abusive relationships to start with and found their pregnancies only heightened the violence.
How Could Anyone Do This?
"Most people think, 'How can anyone hit a pregnant woman?'" says Elizabeth Carll, PhD, a Long Island, N.Y., clinical psychologist specializing in violence and author of Violence in Our Lives: Impact on Workplace, Home and Community.
"Pregnancy is such a stressful time, and the male partner may feel jealous and fear the child is replacing him," Carll says. "Abusive men are typically jealous of their partner's friends and family, and tend to want to separate their partner from them."
In fact, it's not unusual for the violence to be directed toward the pregnant woman's belly, the unborn fetus inside being a source of a victimizer's rage, says Mark Shapiro, MD, a professor of trauma surgery and a board member of the Saint Louis Hospital Response to Community Violence organization.
"The fetus is most at risk during the third trimester," Shapiro says. "I've seen fetuses that were shot or situations in which the mother was kicked in the stomach and spontaneously aborted. Pregnant women get scratched, punched, stabbed, shot, and sexually assaulted. It's rare to have to do a cesarean section to save a fetus, but it happens."
The Consequences of Violence
When a woman is the victim of violence, the consequences for both her and the fetus can be serious, if not fatal. The March of Dimes cites a study that found pregnant women who are physically abused are at an increased risk for poor weight gain, infection, bleeding, anemia, smoking, and alcohol use. The organization also points to another report that found newborns of abused women average 133 grams less in birth weight compared to newborns born to women who were not abused. And an article in the May 1997 American Journal of Preventive Medicine that reviewed several studies on the subject indicated that consequences of physical violence during pregnancy can include preterm labor and delivery, skull fractures, intracranial hemorrhage, and other injuries to the fetus.
Domestic violence has garnered enough attention in recent years that the American College of Obstetrics and Gynecology recommended a year ago that physicians screen all patients for sexual and physical abuse at every visit. It's a sensitive subject few women will bring up on their own.
"I always sought medical help after every abusive situation, and if someone would have just seen through my excuses, I could have been saved sooner," Mary says.
Why Not Just Leave?
Many people ask, "Why not just leave the relationship?" Carll says. But women in abusive relationships typically were physically or sexually abused as children, she says -- and for them, an abusive relationship is familiar ground. Mary was sexually abused by her grandfather when she was a little girl, and she comes from a family in which physical violence was passed from generation to generation.
After five years, she got herself out of her violent marriage and into a good one, and has since had two children. Her past experiences, however, still haunt her.
"I love my children dearly, but I remember being terrified to tell my husband of the pregnancy, even though we planned it and he is far from abusive," she says. "It still set off a lot of old feelings."
Elaine Marshall is a freelance writer in Reno, Nev. She also reports for Time magazine and teaches at the Reynolds School of Journalism at the University of Nevada, Reno.