Disability, disclosure, and missed opportunities: a qualitative study of perinatal intimate partner violence screening

Background: Intimate partner violence (IPV) during the perinatal period is a significant public health issue. Persons with disabilities (PWD) experience higher rates of IPV yet are less likely to be screened, and little is known about their experiences with screening and interventions. This study explored perinatal IPV screening experiences among PWD in the United States. Methods: As part of a mixed method study on psychosocial risks and maternal-infant outcomes among PWD, we conducted semi-structured interviews with 45 pregnant or recently pregnant PWD. Twenty-two participants reported experiencing or having experienced current or recent IPV. Interviews addressed pregnancy health, healthcare experiences, IPV screening, interventions, and care recommendations. Reflexive thematic analysis was used to identify key themes. Results: Analysis revealed three key themes. First, participants described silence, fear, and stigma as barriers to disclosure, often minimizing abuse or feeling ashamed, particularly in the absence of direct and empathetic assessment by healthcare providers. Second, participants reported missed opportunities and gaps in healthcare provider response, including superficial screening, limited follow-up, and experiences of bias or discrimination, which reinforced isolation and hindered access to support. Third, participants highlighted the transformative power of supportive care, noting that providers who listened attentively, validated their experiences, and connected them to resources promoted safety, empowerment, and engagement with care. Conclusions: Persons with disabilities face unique barriers to IPV disclosure during the perinatal period, and current screening practices are often insufficient. Embedding IPV screening within trauma-informed and disability-informed care can enhance disclosure, improve access to resources, and promote maternal and infant health. Health systems should implement tailored screening approaches, healthcare provider training, and systemic supports to ensure appropriate IPV identification and response for PWD.