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Honor Killings in the Middle East and North Africa: A Systematic Review of
the Literature
Andrzej Kulczycki and Sarah Windle
Violence Against Women 2011 17: 1442
DOI: 10.1177/1077801211434127
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ulczycki and WindleViolence Against Women
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Article
Honor Killings in the Middle
East and North Africa:
A Systematic Review
of the Literature
Violence Against Women
17(11) 1442–1464
© The Author(s) 2011
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DOI: 10.1177/1077801211434127
http://vaw.sagepub.com
Andrzej Kulczycki1 and Sarah Windle1
Abstract
A systematic review of the research literature on honor killings in the Middle East and
North Africa (MENA) indicates a paucity of studies relative to the presumed magnitude of
the problem. Forty articles were reviewed and critically appraised, of which only 9 contained
primary data and 11 presented original secondary analyses. Despite a recent increase
in published studies, persistent methodological limitations restrict the generalizability of
findings. Most studies focus on legal aspects, determinants, and characteristics of victims and
perpetrators.Victims are mostly young females murdered by their male kin. Unambiguous
evidence of a decline in tolerance of honor killings remains elusive.
Keywords
honor crimes, honor killings, Middle East, North Africa, systematic review
A decade ago, the United Nations Population Fund (UNPF) estimated that “perhaps as
many as 5,000 women and girls” were killed each year worldwide in the name of “honor”
by members of their own families (United Nations Population Fund, 2000). A more recent
estimate does not exist for this woefully underreported phenomenon. Victims are often
buried in unmarked graves, records of their existence may be eradicated, and perpetrators
frequently go unpunished or receive token sentences. Many such murders are disguised as
suicides or accidents, and no one from outside of a particular family or community will
know what really happened. Rooted in social standing, cultural mores, and institutions, the
concept of family honor provides a socially sanctioned justification for murder because a
woman is regarded as a vessel of the family reputation.
1
University of Alabama at Birmingham, AL, USA
Corresponding Author:
Andrzej Kulczycki, Department of Health Care Organization and Policy, Maternal and Child Health
Concentration, University of Alabama at Birmingham, 320 Ryals School of Public Health,
1665 University Blvd., Birmingham, AL 35294-0022, USA
Email: andrzej@uab.edu
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Kulczycki and Windle
1443
Honor killings are perpetrated for a range of offenses related to the perceived misuse of
female sexuality, most notably marital infidelity and premarital sex. Unacceptable behaviors
may also include contacting persons of different faiths, initiating a separation or divorce,
being a victim of rape, and even such alleged misdemeanors as flirting, or otherwise impugning the family honor. Such murders mainly occur in the Middle East and North Africa
(MENA), and parts of South Asia (United Nations [UN], 2000). The problem has recently
surfaced in North America and Europe, with a spate of headline-grabbing cases concerning
the murder or mutilation of immigrant or second-generation Muslim women by their close
relatives in the name of family honor. This has pushed these countries to slowly recognize
honor killings as a distinct crime and to question the limits of multicultural tolerance (Chesler,
2009; Korteweg & Yurdakul, 2009; Meetoo & Mirza, 2007). Such murders may be the most
extreme end of a much larger problem that includes unlawful confinement, coerced marriages, forced abortions, rape, and other physical and emotional abuse.
The MENA region is a geographically large area that comprises countries at different
levels of socioeconomic development, but which also exhibits many commonalities in language, religion, and in their sociocultural contexts more generally. Most of these societies
retain rigid gender stratification systems, with laws and customs that reinforce the subordinate position of women. Although the status of women has in many cases improved, violence against women remains a major problem (Boy & Kulczycki, 2008; Freedom House,
2005; United Nations Development Programme [UNDP], 2005).
Honor killings have historically occurred in many deeply patriarchal cultures, including the
Balkans1 and other parts of Mediterranean Europe (Gilmore, 1987; Peristiany, 1966). The
ongoing existence of the problem in the MENA region remains shrouded in taboo, but has
recently attracted more attention. International media and human rights groups have helped
raise social consciousness of the issue, as has the work of a number of local human and women’s rights activists, and various publicized accounts of honor killings.2 In addition, there has
been an increase in the number of published studies on the topic, as highlighted here.
This systematic review presents a critical synthesis of the research literature on honor killings within the MENA region. It draws several general and methodological observations
concerning this research literature, summarizes and interprets findings, and highlights gaps in
knowledge and opportunities for the advancement of knowledge and interventions. In terms
of substantive foci, the review is organized around the key issues of the incidence of honor
killings, the characteristics of victims and perpetrators, public opinion, sociostructural causes,
and possible strategies toward reducing and eliminating honor killings in the region.
Method
Search Strategy and Selection Criteria
The literature search was conducted in mid-/late 2008 using multiple sources, so as to
consider all available and eligible evidence. First, published literature was sought from six
electronic bibliographic databases (PubMed, Google Scholar, CWI [Contemporary
Women’s Issues], ASSIA [Applied Social Sciences Index and Abstracts], PAIS International,
and Popline), as well as the online archive of the journal, Violence Against Women. Second,
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1444
Violence Against Women 17(11)
the bibliography of each article was inspected as a potential source of additional publications
of interest, which were then examined further. Third, we reviewed pertinent publications and
website materials from relevant international development agencies (UN, UNFPA, and the
World Health Organization [WHO]), nongovernmental organizations (NGOs) and advocacy
groups involved in women’s rights, reproductive rights and human rights (including Human
Rights Watch, Amnesty International, the Center for Reproductive Rights, the International
Women’s Health Coalition, and the International Center for Research on Women).
No restrictions were imposed on publication date or language. All articles were independently assessed by both authors according to a priori criteria. Selected articles had to
cover honor killings in the MENA region as their main subject, or present original data
about such killings. We used a broad definition of the region, searching for “Middle East,”
“North Africa,” and all 22 members of the League of Arab States as well as Israel, Iran, and
Turkey. Included articles also had to be peer-reviewed or to have at least documented their
sources of evidence in a verifiable manner if the study’s peer-review status was unclear. We
followed up grey literature where applicable; these materials (such as conference proceedings and local NGO reports) tended to be elicited through Google Scholar. Search terms
used were paired combinations of the following terms: honor, honour, or customary with
killing, crime, or murder (e.g., “honor killing,” “honour killing,” “customary murder”) as
well as femicide and honor/honour. Data extraction and quality assessment were carried
out on studies selected for full-text appraisal. Given the heterogeneous nature of the studies identified, we could not use a single quality assessment tool, but a checklist was developed using the following criteria: (a) relevance to the systematic review, (b) validity and
appropriateness of the methodology, (c) quality of evidence, (d) quality of reporting, and
(e) limitations of the study.
Findings
Search Outcomes and Quality Appraisal
Six hundred seventy-eight search results were initially examined, including those from database searches (165), organization websites (141), and the journal Violence Against Women
(24). Google Scholar results were viewed until 50 articles in a row had no relevance, ending
at 348 results. Most documents initially identified were excluded due to a lack of relevance.
Common reasons included coverage of another region or type of violence against women,
consideration of honor killings in only an incidental manner, or discussion of the notion of
honor rather than honor killings. A total of 40 full-text articles met our selection criteria for
inclusion; all were published in English, and none were written in languages (Arabic,
Hebrew, or other) native to the region. This outcome may reflect both the operational aspects
of our search tools and the controversial and incendiary nature of the social problem discussed, rendering it both difficult to study and to publish on within the region.
Approximately half the articles had at least one author based in North America or Europe,
with the rest written by authors from within the MENA region. Nine of the studies were set
in Jordan, seven in Turkey, five in Gaza/West Bank, three in Israel and the occupied
Palestinian territories, one in Israel alone, two in Egypt, two among Kurdish populations in
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Kulczycki and Windle
1445
Iraq and Turkey, and one in Lebanon. Ten more articles referred to the Middle East in general. Four authors each had 2 articles meeting the inclusion criteria (Abdo, Kulwicki, Sev’er,
and Welchman), and 2 additional authors had 3 articles included (Mojab and ShalboubKevorkian), tying 6 authors to 14 articles. No systematic review of the literature has been
published, although many articles presented narrative accounts of previous studies.3
Almost all (37 of 40) articles included in the review were published since 2000, although
we did not exclude earlier references.
Most studies were descriptive rather than analytic. Eleven articles included an analysis
of secondary data and only nine articles presented primary data on honor killings, be they
statistics on incidence or characteristics, or qualitative data (Table 1). Most articles discussed notions and definitions of honor killings, the pervasive nature of the phenomenon,
and some potential causes. Nearly half the articles focused primarily on either legal aspects
of the crimes (6), the characteristics of victims and perpetrators (6), or both (6).
We make three more methodological observations about this literature. First, in addition
to the scarcity of primary data on honor killings and the difficulty of data collection, the
rigor of such data is frequently problematic. Many studies have questionable validity and
reliability. Data were obtained mainly from interviewed police, lawyers, government representatives, NGO workers, laypersons, and potential victims (Table 1). Other analyses reporting primary data were based on verbal autopsies, survey data, and case studies. However,
data validity may have been compromised by the willingness of threatened women, victims’
families, the police, and other knowledgeable informants to share their true opinions with
researchers. Data derived from case studies and small or nonrepresentative samples are also
problematic because the method of sampling or case finding is not always reported, and the
results may not be generalizable.
Second, analyses of secondary data also have severe limitations, not always sufficiently
acknowledged by the authors. A commonly adopted study design involves analyzing court
and police records, mortality reports, NGO reports, and newspaper accounts for the incidence of honor killings in relation to other homicides, characteristics of victims and perpetrators, circumstances of the murder, and for how the cases were processed in court. Such
studies typically lament the general inadequacy of police and court record keeping. However,
honor killings also go unreported, or are misreported, and therefore may never appear in
court or other records that constitute secondary data. Similarly, newspaper and other media
accounts only describe reported cases, and likewise may not be representative.
Third, the literature is characterized by a large amount of duplicated material, be it of data
or commentary. This is particularly problematic with regard to the reporting of honor killing
estimates based on poorly verified data. Such duplication of material may stem from a lack
of data and of a systematic literature review. Some articles with no original data do present
original ideas, but others contribute little to advancing the knowledge base and discussion.
Terms and Concepts
For the purposes of this review, because of its clarity and general acceptance, the term
honor killing is used to refer to any homicide where the perpetrators’ motivation is given as
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Violence Against Women 17(11)
Table 1. Articles Containing Primary Data on Honor Killings in MENA Countries
Reference
Al-Adili,
Shaheen,
Bergstro,
and
Johansson
(2008)
Araji and
Carlson
(2001)
Begikhani
(2005)
Glazer and
Ras (1994)
Kardam
(2007)
Nanes (2003)
Population
characteristics
Method and year
of data collection
Verbal autopsy;
West Bank,
2000-2001
Palestine; single
women of
reproductive
age
Jordan; students
at two
universities
Survey of
perceptions of
the seriousness
of family
violence; 1998
Interviews; 2004
Iraqi Kurdistan;
judges,
politicians,
lawyers,
police officers,
women
activists,
survivors, and
witnesses
Case study of
Israel; Israeli
gossip; no year
Arab Muslim
women, Masdar given
El-Nabea
village
Interviews; 2005
Turkey; NGOs,
professionals
and laypersons
in four cities
(Istanbul,
Şanlıurfa, Adana,
and Batman)
Jordan; executive Case study,
interviews
committee
and personal
members of
communications;
the Campaign
2000-2001
to Eliminate
So-called
Crimes of
Honor
Sample size
154
625
52
NA
195
(18 group
interviews,
with total
sample
~250)
NA
Key findings
Seven honor-related deaths
(4 homicides and 3 suicides)
suspected (5% of all single
female deaths), with other
suspicious homicides, suicides,
and unintentional injuries
13% of males and 11% of females
reported personal exposure
(not defined) to an honorrelated female homicide
Few honor killings prosecuted,
with considerable judicial
discretion for leniency and
judgments of local councils
preferred. Religious leaders and
judiciary view reform attempts
as motivated by Western values
and as an opening for immoral
behavior
Women’s gossip may instigate
honor killings, renders lower
status women more vulnerable
to its effects, and maintains
women’s subordinate position
Perceptions of honor vary by
age, background, residence,
education, and social
relationships. Most interviewees
had witnessed an honor killing
or could relate a story; not all
dishonorable conduct results in
murder, with key determinants
being marital status and nature
of the behavior; few had ideas
on how to reduce honor
killings, and many expressed
hopelessness
Experience of campaign members
suggests the difficulties and
possibilities for autonomous civil
society in Jordan
(continued)
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1447
Kulczycki and Windle
Table 1. (continued)
Reference
Population
characteristics
Method and year
of data collection
Sample size
Key findings
Interviews; 2003
Peratis (2004) Jordan; females
in protective
custody at
a facility in
Amman
Interviews; no
West Bank and
Shalhoubyear given
Gaza, Palestine;
Kevorkian
victims,
(2005)
therapists,
doctors, and
legal personnel
4
Structured
Sheeley (2007) Jordan; adults
interviews;
from urban
2005-2006
areas (Amman,
Zarqa, and
Irbid) and
some smaller
localities
200
Women may be detained against
their will for protection from
honor killing; release only
possible if family guarantees
safety
Criminal justice personnel
collaborate with local leaders
to reach a resolution; legal
personnel use forced virginity
testing regularly to preserve
family unity; courts view victims
as not free of guilt
28% personally knew an honor
killing victim; 4% reported an
honor killing in their extended
family; 1% reported an honor
killing in their immediate
family; 95% disagreed/strongly
disagreed with the statement
that “honor killings are morally
just”
—
Note: NA indicates not applicable
honor, that is, for reasons of suspected or known culturally defined sexual impropriety. The
term honor crime is used to refer to the infringement of a broader variety of personal liberties for stated reasons of honor, such as forced marriage, expulsion from place of residence
and community, rejection by the family, disfiguration and other emotional, social, or
physically coercive acts (Begikhani, 2005; Faqir, 2001; Kardam, 2007; Peratis, 2004; Sen,
2005; Sirman, 2004; Welchman & Hossain, 2005). However, many authors use the terms
honor killing, honor crime, honor murder, and honor-based crime interchangeably, to refer
to an intrafamilial murder or attempted murder of a female by a male relative for reasons
of honor. Nevertheless, pervasive discomfort with these terms is evident from the number
of authors who use quotation marks when using them (Abdo, 2004; Begikhani, 2005;
Centre for Egyptian Women’s Legal Assistance [CEWLA], 2005; Connors, 2005; Hassan &
Welchman, 2005; Hoyek, Sidawi, & Mrad, 2005; Khan, 2006; Peratis, 2004; Sheeley, 2007;
Touma-Sliman, 2005; Welchman & Hossain, 2005).
Most authors characterize honor killings as communal in nature, resulting from a family
council decision and plan to restore honor (An-Na’im, 2005; Arin, 2001; Cinthio &
Ericsson, 2006; Sev’er, 2005; Sev’er & Yurdakul, 2001; Warrick, 2005). In Turkey, this
quality is emphasized further in the case of torë (custom) killings, which many urban residents view as pertaining to disputes such as family blood feuds, distinct from honor
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1448
Violence Against Women 17(11)
killings, which they perceive more as individual actions committed when family members
are confronted with behavior they neither expect nor approve of. However, most other
Turks do not differentiate between the two, considering the basic motives to be the same
because both types of murder are committed with the justification of honor (Kardam, 2007;
Sirman, 2004). Several authors also refer separately to crimes of passion that occur in the
context of a private relationship between a man and a woman and as a result of passionate
anger. This would exclude honor crimes committed by a male blood relation in the context
of a familial and/or communal decision (Abu-Odeh, 1996; Khan, 2006). Likewise, some
courts distinguish between crimes committed “in the heat of passion” and crimes “in
defense of the family honor;” the latter is socially understood and justified as the loss of
both conjugal and family honor caused by the woman (Khan, 2006; Warrick, 2005).
However, many studies reviewed here treat crimes of passion and crimes of honor as equally
motivated by the systemic subjugation of women by men (CEWLA, 2005; Khafagy, 2005;
Hadidi, Kulwicki, & Jahshan, 2001; Hoyek et al., 2005; Shalhoub-Kevorkian, 2002;
Welchman & Hossain, 2005). Frequently, lack of information about the circumstances surrounding the murder and the inability to draw firm conclusions about the motive of the
perpetrator make it impossible to be certain about the degree of similarity or dissimilarity
between crimes of honor and crimes of passion.
Most articles ascribe the existence and perpetuation of honor killings to the control of
female sexuality, of women in general, and of resources within the family. Honor for men
rests on socioeconomic status within the community, and on the closely policed honor of
their female blood relations. Honor for women is based on unquestionable sexual propriety,
namely sexual activity only within marriage. Family honor is further rooted in economic
and legal systems that emphasize material wealth remaining in the family, underscoring the
importance for men of ensuring the paternity of their wives’ children. Consequently, families consider women their property, and women may themselves become involved in policing the behavior of related females, as the consequences of dishonor affect the entire family.
A family may attempt to keep the community unaware of an act that violated the honor code;
however, discussion and gossip about any honor misconduct bring shame to the family,
which may kill to regain social status.
Incidence
Both the quantity and quality of data on the incidence of honor killings are very limited,
owing to the lack of accurate case identification. This is mostly due to underreporting and
misreporting of such deaths to authorities, including their disguise as disappearances, accidents, or suicides that may often have resulted from the victim being forced into such a
position (Al-Adili, Shaheen, Bergstro, & Johansson, 2008; Begikhani, 2005; Faqir, 2001;
Hassan & Welchman, 2005; Hoyek et al., 2005; Kardam, 2007; Khan, 2006; Kressel et al.,
1981; Mojab, 2004; Peratis, 2004; Sev’er, 2005; Warrick, 2005). Honor killings are rarely
used as an explicit classification category, and homicide cases may not contain sufficient
information to determine motive (Begikhani, 2005; Hoyek et al., 2005; Shalhoub-Kevorkian,
2001). Consequently, there are major difficulties in using police, court, and medical records
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Kulczycki and Windle
1449
to estimate honor killings. Persons with knowledge of killing may not want to discuss an
issue deemed private and sensitive and may fear reprisals (Peratis, 2004).
Many articles cited estimates of honor killings that were difficult to trace and often
appeared uncorroborated. Only five articles presented estimates based on primary data or
original secondary analysis, with four pertaining to the occupied Palestinian territories and
Israel. Reported deaths among women of childbearing age in the West Bank, 2000-2001,
were examined by Al-Adili et al. (2008) through interviews with the families (n = 154) of
unmarried women (Table 1). The authors concluded that at least seven deaths of single
women (four suspected homicides and three alleged suicides) and two confirmed homicides
of married women were honor related, accounting for 5% of reported single female deaths
and 80% of women victimized
during pregnancy have also experienced violence prior to
pregnancy.6 Other research has shown a significant increase
in sexual coercion and psychological abuse during pregnancy
among women who experience prior physical violence.7
Physical and sexual violence during pregnancy increases
women’s risk of psychological and physical health outcomes,
including pregnancy complications and adverse birth outcomes. This unique type of violence threatens both maternal
and child health because it is often chronic and ongoing
during and after the pregnancy. IPV affects the mortality and
morbidity of both infant and mother and is associated with
other health and economic risk factors.8 For example, IPV
during pregnancy is associated with perinatal health consequences, including low weight gain, anemia, kidney infections, and first and second trimester bleeding.9,10
Reproductive health problems, such as sexually transmitted
diseases (STD) including HIV infection, are also more common among pregnant women who experience coercively
controlling, severe physical violence,11 perhaps related to the
fact that nearly 40%–50% of women in these relationships are
forced to have sex.12 Adverse pregnancy outcomes associated
with IPV include low birth weight, preterm birth,5 increased
risk of cesarean delivery,9 uterine rupture, hemorrhage,13 and
antenatal hospitalization.14 IPV during pregnancy is also
linked to intermediary risks for women, including unintended
1
Syracuse University, Syracuse, New York.
State University of New York Upstate Medical University, Syracuse, New York.
3
Centers for Disease Control and Prevention, Atlanta, Georgia.
4
Royal College of Physicians, National Clinical Guideline Centre, London, England.
2
1501
1502
pregnancy, depression and other psychological problems,14,15
and increased risk of femicide13,16 and neonatal death.13,17
Placental abruption, the premature separation of the placenta from the uterus during pregnancy, is a significant contributor to both maternal and fetal mortality and accounts
for approximately 12% of all perinatal deaths.18 Placental
abruption has been discussed as a potential consequence of
IPV19; however, empirical evidence linking the two is sparse.
Common risk factors for placental abruption include advanced maternal age, hypertension, trauma, and maternal
substance use. Some of these risk factors are also either directly or indirectly associated with IPV. For example, violence
and assault (e.g., blunt force to the abdomen) by a partner is
the second leading cause of pregnancy trauma and represents
22% of all pregnancy trauma cases.20 IPV victims also report
higher tobacco, alcohol, and illicit drug use,10,14 which may
stem from increased levels of stress and fear associated with
victimization.9 El Kady et al.13 reported a significant link between IPV and placental abruption among nearly 5 million
women identified through maternal discharge records in
California between 1990 and 1999. To date, however, no study
has empirically linked IPV to placental abruption after statistically controlling for other known biological risk factors for
placental abruption. The current study examines factors associated with reporting IPV during prenatal care and the extent to which IPV and other risk factors (i.e., tobacco, alcohol,
and drug use; preeclampsia; and gestational diabetes) are
associated with pregnancy trauma and placental abruption.
Materials and Methods
Study design and sample
The database for these analyses was developed for the
evaluation of the Syracuse Healthy Start (SHS) program. SHS
is an infant mortality reduction initiative funded by the
Health Resources and Services Administration (HRSA), and
the SHS evaluation was funded by the Centers for Disease
Control and Prevention (CDC). IRB approval was obtained
from State University of New York (SUNY) Upstate Medical
University.
Current analyses used all births at a large urban hospital of
residents in a 9-ZIP code high-risk area in the City of Syracuse,
New York, from January 1, 2000, to March 31, 2002. Prenatal
and hospital obstetrical charts were reviewed, and a data
abstraction form was generated for each mother and infant.
Prenatal charts were reviewed in outpatient settings, including publicly funded clinics, high-risk referral clinics, and
private offices. If a private provider did not grant access to
that office’s prenatal charts, the review was performed on the
prenatal summary transmitted to the hospital for delivery
(30% of prenatal charts). The documentation of prenatal
screening was comparable across different settings because all
clinical sites use the same prenatal record form. This form was
developed by one of the co-authors on this article (R.H.A.) and
sent to the birth hospitals before the birth for inclusion in the
hospital delivery chart. Items abstracted from the prenatal
chart included screening tests performed, symptoms, conditions, treatments, pregnancy complications, and risk factors
for prematurity. Inpatient charts were reviewed at the delivery hospital, and items abstracted included symptoms, conditions, and treatments during the delivery hospitalization,
and perinatal, postnatal, and postpartum outcomes.
LEONE ET AL.
Chart reviewers, blind to the purpose of the review, were
recruited from among the major delivery hospital’s obstetrical
nursing and paraprofessional clinical staff and attended two
3-hour training sessions. The first 10 charts a reviewer abstracted were rereviewed by one of the co-authors (K.D.M.),
and 5% of all charts were rereviewed by the same co-author
(K.D.M.). Prenatal chart reviewers were blind to birth outcomes, and inpatient chart reviewers were blind to prenatal
conditions. All charts were abstracted onto a scannable form
(Cardiff Teleform, Plymouth, MI) to facilitate data entry. Data
from the chart reviews were merged with existing electronic
databases: the Electronic Birth Certificate, the Regional Perinatal Data System, SHS enrollment, and the neonatal intensive care (NICU module). In addition to the quantitative data
described, the data abstraction form included three open
comment sections that allowed chart reviewers (i.e., nurses) to
write in anecdotal information. These anecdotes are rich with
information but were not recorded on each chart in a uniform
manner. Many of these anecdotes record details about IPV.
The total sample included 2873 women for whom IPV data
were available. Data about placental abruption were available
for all of the 2873 women, and data about pregnancy trauma
were available for 2860 of these women.
Independent variables
Sociodemographic characteristics. The current study included seven patient sociodemographic characteristics. These
variables were collected in patient medical charts as part of
the standard medical procedure. Maternal race, highest education level, and marital status were coded as categorical
variables; maternal employment was measured as a dichotomous (Yes/No) variable; maternal socioeconomic status
(SES) was measured as a dichotomous (Yes/No) variable
based on whether or not the patient received Medicaid (indicating lower income); and maternal age was measured as a
continuous variable in years for descriptive purposes and as a
dichotomous variable based on a median split (
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