Intimate partner violence (IPV) is a serious public health issue. Experienced mostly by girls and women, and with higher rates for single mothers, IPV often goes unrecognized, particularly during pregnancy.
Approximately one in 13 children in Canada are affected by IPV. For these children, exposure to IPV among caregivers while growing up is a serious form of maltreatment with long-term consequences for mental health and academic functioning.
In addition to the essential efforts to respond to the needs of children and families experiencing IPV, (for example, emergency shelters and interventions following exposure) it is critical to identify research-based approaches to prevention.
Findings from the Canadian randomized controlled trial of Nurse-Family Partnership (NFP), a nurse home-visiting program for expectant mothers and their children, are promising.
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New research led by the Children’s Health Policy Centre at Simon Fraser University (SFU) found that NFP showed promise in reducing exposure to intimate partner violence, while also improving mental health for young first-time mothers and their children.
Previous findings showed NFP benefits regarding prenatal substance exposure, and child problem behaviour and vocabulary by age two.
Early prevention to reduce exposure to IPV
These findings come at a crucial time. IPV is occurring at epidemic proportions. Yet supports for children and mothers remain inadequate and early childhood prevention investments remain sparse.
Canadian policymakers have an opportunity to invest in effective primary prevention programs, before children are born, to ensure that all children reach their potential.
NFP is such a program and was designed to improve the lives of both mothers and children. The Children’s Health Policy Centre co-led the BC Healthy Connections Project or BCHCP, the Canadian randomized controlled trial of NFP.
Public health nurses across four British Columbia regional health authorities (Fraser, Interior, Island and Vancouver Health) provided intensive nurse-home visits with girls and young women experiencing disadvantage, beginning in pregnancy and continuing until children reached age two years — up to 64 visits.
Nurses aimed to develop a therapeutic relationship with mothers, to encourage them in gaining the knowledge, skills and behaviours to support healthy pregnancies and children’s development. Health authorities also invested in NFP-IPV nurse education throughout the BCHCP trial to support nurses in identifying and addressing maternal IPV exposure and protecting children.
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The BCHCP involved 739 pregnant girls and young women, ages 14 to 24 years, and their 737 children. The study team at SFU collected research interview data at six timepoints from all families on various maternal-child outcome indicators. The trial’s main child outcomes included injuries, cognition, language and a mental health-problem behaviour indicator. IPV was exploratory, and not one of the NFP trial’s main goals.
Upon study entry in early pregnancy, before being randomly allocated to NFP or the comparison group (existing services), more than one-third (38 per cent) of mothers-to-be reported IPV exposure within the past-year. These IPV rates were higher than those reported (29 per cent) in the general female population (ages 15-24 years). By the end of the trial, when children were age two years, significantly fewer NFP mothers reported IPV exposure (since last interview) and psychological distress (in the previous month).
These findings warrant follow up of long-term outcomes given the positive, albeit exploratory, nature of these findings by the time children were age two years.
The BCHCP trial completed data collection and NFP delivery for participants in 2019. NFP has continued to be offered to eligible families as an enhanced public health program in three B.C. health authorities. In addition, two similar enhanced family visiting programs are being delivered by Fraser Health and Vancouver Coastal Health to better serve a broader range of families.
Early IPV prevention could save $9 billion
A 2014 study found the economic burden imposed by childhood IPV exposure over a 10-year span was approximately $7 billion (which translates to $9 billion in 2024).
These costs could have been averted by early childhood prevention programming. Yet in 2024, only 6.1 per cent of Canada’s health spending was allotted to public health, including prevention. Prevention programs with rigorous evidence of effectiveness warrant implementation to make a difference for children and mothers.
Championing primary prevention of childhood adversities is crucial. Additional international NFP trials conducted in the Netherlands, the United States and Norway have prioritized IPV prevention and analyses. Yet, these trials also have mixed results, emphasizing the need for rigorous methods and an examination of effects across diverse populations and settings.
The BCHCP involved active, sustained collaborations among research, policy and practice, focused on the early years, starting prenatally. Similar policy-engaged research focusing on promoting healthy youth relationships for youth in Grades 7 to 9 has also shown promise for preventing IPV.
IPV exposure is a violation of human rights. It is common, but not inevitable. The research evidence offers clear direction to policymakers — those who need to act — on investing in a promising prevention program designed to make a difference for children, and for their mothers, starting very early in life.
