Pregnancy Resulting From Rape
1998; Elsevier BV; Volume: 27; Issue: 1 Linguagem: Inglês
10.1111/j.1552-6909.1998.tb02587.x
ISSN1552-6909
Autores Tópico(s)Sex work and related issues
ResumoPregnancy resulting from rape is more prevalent than generally recognized, and violations of women's sexual and reproductive self-determination take many forms. Four themes—relationship rape, power dynamics, maternal ambivalence, and social reactions and support—can be identified in one woman's experiences and the literature. Recommended interventions, based on a woman-centered empowerment framework, include safety assessment, formulating a safety plan, and facilitating social support. Emergency postcoital contraception is a preventive option. Pregnancy resulting from rape is more prevalent than generally recognized, and violations of women's sexual and reproductive self-determination take many forms. Four themes—relationship rape, power dynamics, maternal ambivalence, and social reactions and support—can be identified in one woman's experiences and the literature. Recommended interventions, based on a woman-centered empowerment framework, include safety assessment, formulating a safety plan, and facilitating social support. Emergency postcoital contraception is a preventive option. Care of pregnant women has long been the focus of women's health nursing, and violence against women has emerged recently as a major concern of the profession. Still, the intersection of these phenomena—the care of women who are pregnant as a result of violence—remains largely unexplored and unaddressed. The incidence of pregnancy resulting from rape is likely greater than generally recognized, and both rape and pregnancy present adaptive challenges to a woman's sense of self, health, and well-being. Krueger, 1988Krueger M. Pregnancy as a result of rape.Journal of Sex Education and Therapy. 1988; 14: 23-27Google Scholar described pregnancy resulting from rape as a "double crisis" (p. 23). This article explores pregnancy resulting from rape and addresses issues of incidence, definition, theory, and professional application. The experiences of one patient serve as a valuable guide for this exploration. The criminal statistics of the U.S. Department of Justice (USDOJ) estimate that nearly 500,000 rapes and sexual assaults against women occur each year, yet fewer than 90,000 of these crimes are reported to the police (Bureau of Justice Statistics, 1994Bureau of Justice Statistics Sourcebook of criminal justice statistics. U.S. Department of Justice, Washington, DC1994Google Scholar). In a special report, USDOJ researchers noted difficulties in estimating the incidence of violence against women, particularly sexual assault (Bachman and Saltzman, 1995Bachman R. Saltzman L.E. Special report: Violence against women—Estimates from the redesigned survey. U.S. Department of Justice, Washington, DC1995Google Scholar). Assaults that do not involve strangers, weapons, or physical violence may not be understood or reported as rape and are underestimated in criminal statistics. The likelihood that a rape will result in pregnancy is also difficult to determine. Estimates based on a single random coitus model derived from ovulation, fertility, and probability data suggest a 4%-10% likelihood that a given rape will result in pregnancy (Krueger, 1988Krueger M. Pregnancy as a result of rape.Journal of Sex Education and Therapy. 1988; 14: 23-27Google Scholar, Shulman et al., 1992Shulman L.P. Muram D. Speck P.M. Counseling sexual assault victims who become pregnant after the assault.Journal of Interpersonal Violence. 1992; 7: 205-210Crossref Scopus (2) Google Scholar). However, evidence suggests that the actual incidence of pregnancy resulting from rape is much higher than this model predicts: Wartime data, bolstered by tragically large samples, have shown that up to 70% of rape conceptions occurred during supposedly infertile periods of the menstrual cycle (Jochle, 1973Jochle W. Coitus-induced ovulation.Contraception. 1973; 7: 527-564Abstract Full Text PDF Scopus (66) Google Scholar). A theory of coitus-induced ovulation suggests that fear, anger, and stress may act to trigger ovulation in humans, and that rape may actually be more likely than consensual intercourse to result in pregnancy (Jochle, 1973Jochle W. Coitus-induced ovulation.Contraception. 1973; 7: 527-564Abstract Full Text PDF Scopus (66) Google Scholar, Krueger, 1988Krueger M. Pregnancy as a result of rape.Journal of Sex Education and Therapy. 1988; 14: 23-27Google Scholar). Even if the single random coitus model accurately reflects the likelihood of pregnancy resulting from stranger rape, the model is not applicable to domestic rape. An estimated 1.8 million (U.S. Department of Health and Human Services, 1991U.S. Department of Health and Human Services Healthy people 2000: National health promotion and disease prevention objectives. Author, Washington, DC1991Google Scholar) to 3.9 million (Commonwealth Fund, 1993Commonwealth Fund First comprehensive national health survey of American women. Author, Washington, DC1993Google Scholar) women are abused each year, and most of these women are forced to have sex against their will (Campbell and Humpherys, 1993Campbell J.C. Humpherys J. Nursing care of survivors of family violence.2nd. ed. Mosby, St. Louis1993Google Scholar). In an abusive relationship, a woman's sexual and reproductive self-determination is systematically and repeatedly violated, making coerced pregnancy a probable eventuality.In an abusive relationship, a woman's sexual self-determination is repeatedly violated. Pregnancy prophylaxis is a routine and highly effective treatment for women who report being raped (Krueger, 1988Krueger M. Pregnancy as a result of rape.Journal of Sex Education and Therapy. 1988; 14: 23-27Google Scholar, Shulman et al., 1992Shulman L.P. Muram D. Speck P.M. Counseling sexual assault victims who become pregnant after the assault.Journal of Interpersonal Violence. 1992; 7: 205-210Crossref Scopus (2) Google Scholar), but data previously cited show that only a fraction of criminal rapes are reported. The apparently larger population of rape victims, women subject to the power and control of an abuser, are unlikely to have access to this treatment. Brownmiller, 1975Brownmiller S. Against our will: Men, women, and rape. Simon & Schuster, New York1975Google Scholar classic Against Our Will radically redefined rape. Historically construed as a crime against the property of a husband or father and a violation of abstract values such as sanctity, chastity, or virginity, rape also was widely misunderstood as a crime of sexual passion. Brownmiller argued convincingly that rape is rather a crime of power against a woman's right to self-determination. Pence and Paymar, 1992Pence E. Paymar M. Power and control: Tactics of men who batter. Duluth Domestic Violence Intervention Project, Duluth, MN1992Google Scholar power and control model of domestic violence provides an understanding of rape in intimate relationships. "Men in abuser groups freely state that they believe they have a right to sex. They interpret the withholding of sex as an act of power which must be challenged" (p. 106). The Power and Control Wheel (see Figure 1) delineates the elements of a coercive system that empowers the abuser and controls the victim. Andrist, 1988Andrist L.C. A feminist framework for graduate education in women's health.Journal of Nursing Education. 1988; 27: 66-70PubMed Google Scholar advocated a woman-centered empowerment framework as the guiding philosophy of women's health nursing. "Restoration of the whole person" (p. 66) is a fundamental commitment of the profession. Essential to this commitment is the purpose to "empower women towards self-determination" (p. 69). When a woman's pregnancy is conceived by rape—a profound assault against her whole person and an utter violation of her self-determination—a profession guided by an empowerment framework is committed to respond. MR was a 20-year-old woman, gravida 2, para 1, when she sought prenatal care at 18 weeks gestation in the obstetric clinic of a major southeastern academic health care center. She was unmarried and living with her parents and her 2-year-old daughter. In a history-taking interview, she disclosed that her pregnancy was the result of rape. MR agreed to relate her experiences for publication in this article on the condition that identifying details be altered to protect her confidentiality. Data were collected in two brief face-to-face interviews, an extensive telephone interview, and a review of her medical record. MR's experiences support four themes identified in the literature on violence against women: relationship rape, power dynamics, maternal ambivalence, and social reactions and support. Data from the U.S. Department of Justice indicate that only about one in five rapes is committed by a stranger (Bachman and Saltzman, 1995Bachman R. Saltzman L.E. Special report: Violence against women—Estimates from the redesigned survey. U.S. Department of Justice, Washington, DC1995Google Scholar). Although forcible rape is prevalent in abusive relationships, violations of a woman's reproductive self-determination may be perpetrated more subtly. Knowing that her resistance will ultimately result in violent rape, a battered woman may submit to unwanted sex to avoid physical harm. Furthermore, denial of access to contraception was a common theme in a qualitative study of battered women (Campbell et al., 1995Campbell J.C. Pugh L.C. Campbell D. Visscher M. The influence of abuse on pregnancy intention.Women's Health Issues. 1995; 5: 214-222Abstract Full Text PDF PubMed Scopus (86) Google Scholar). In a woman-centered framework, any unwanted act of sex is rape, and any pregnancy that results from coercion is a violation of a woman's will, whether she is physically overwhelmed or whether she submits to an abusive authority. JR, the man who raped MR, was intimately known to her. In a consensual relationship, they unintentionally conceived her first child. They planned to marry, and JR agreed to "help with the baby" in the meantime. MR decided to abstain from further sexual relations until they were married: "I sure didn't want another accident like that to happen." MR's second pregnancy was conceived in a violent rape. MR's parents were away from home when JR came to babysit. "He showed up mad because he had to cancel out on his plans," and an argument ensued. "He accused me of not being a good mother, and I was too demanding, and I was raising his daughter without any discipline. He didn't understand about 2-year-olds." During their argument, JR became increasingly violent.His whole face changed, his voice got deeper, and I was afraid. I got pushed into the bedroom, and I was down on the bed. It was like he had demons in his body. I'm not sure what happened: I don't know if I willed myself to black out, or if he knocked me out. But I knew that [having sex] was what his intent was. Brownmiller, 1975Brownmiller S. Against our will: Men, women, and rape. Simon & Schuster, New York1975Google Scholar identified rape as an element of a patriarchal system of power over women and reproduction: "Men began to rape women when they discovered that sexual intercourse led to pregnancy" (p. 328). Pence and Paymar, 1992Pence E. Paymar M. Power and control: Tactics of men who batter. Duluth Domestic Violence Intervention Project, Duluth, MN1992Google Scholar model recognizes that women's childbearing, childrearing, and economic roles are central elements in the abusive system of power and control. Respondents in the Campbell et al., 1995Campbell J.C. Pugh L.C. Campbell D. Visscher M. The influence of abuse on pregnancy intention.Women's Health Issues. 1995; 5: 214-222Abstract Full Text PDF PubMed Scopus (86) Google Scholar study also recognized coerced childbearing as a weapon in the arsenal of power and control. One respondent said, "They own you when you have a child by him—part of the purpose in having a baby is to control you" (p. 219). Another woman stated more simply, "Once you have that first kid, that makes you need them" (p. 219). MR's first pregnancy seriously compromised her self-determination and helped to establish JR's power over her. "It blew my career chances and my reputation. I had to have a husband sometime," she said. MR felt pressured by her own and JR's parents to sacrifice her established career goals in favor of her maternal role, whereas JR was largely excused from the responsibilities of marriage and fatherhood "until he could get his diploma and find a job." MR's perceived need for JR as a husband, father, and provider prevented her from reporting or disclosing the rape: "My parents wouldn't have let me marry him if they knew, and the courts wouldn't let me keep my [second] baby if they knew I had a husband like that." Denial, minimization, and blame compose another spoke of the Power and Control Wheel (Pence and Paymar, 1992Pence E. Paymar M. Power and control: Tactics of men who batter. Duluth Domestic Violence Intervention Project, Duluth, MN1992Google Scholar). Women and their abusers may deny or minimize the abuse or attribute it to influences the abuser cannot control. MR stated that JR denied any recollection of raping her, and she attributed his violent behavior to an unspecified, undiagnosed psychiatric disorder. She stated that he was not a violent person: "I've seen him break things, beat up a car, tear up a tree, but he's not like that with people." The power and control model recognizes that displays of violent behavior, even when not directed at a person, serve to demonstrate the abuser's capacity for violence and to intimidate his victim. A patriarchal power system contributed to JR's social, economic, and emotional control over MR. JR's rape of MR and her subsequent pregnancy were manifestations of, rather than aberrations within, this system. Raphael-Leff, 1990Raphael-Leff J. Psychotherapy and pregnancy.Journal of Reproductive and Infant Psychology. 1990; 8: 119-135Crossref Scopus (14) Google Scholar drew on her experience as a psychoanalyst working with pregnant women to identify the challenges of adapting to pregnancy in general and to pregnancy resulting from rape in particular. Loss and grief are identified as normative experiences of pregnancy exacerbated by rape, especially when the rapist is intimately known and the rape is a violation of intimate roles. For women who have been raped, invasive medical procedures may trigger traumatic memories and emotions. Maternal attachment to a fetus and then to an infant conceived by rape is described as the "difficult task of differentiating the baby from the experience" (p. 128). Raphael-Leff, 1990Raphael-Leff J. Psychotherapy and pregnancy.Journal of Reproductive and Infant Psychology. 1990; 8: 119-135Crossref Scopus (14) Google Scholar cited ambivalent maternal reactions to quickening and observed that unsuccessful adaptation to pregnancy may lead to inappropriate parenting. Depression, unstable relationships, and self-destructive behavior also are cited as potential long-term complications. Although MR was reluctant to define her experience as an "out-and-out rape" because she was previously intimate with JR, she stated that her experience was "even worse than a real rape. What you lose being raped isn't as bad as losing the person you thought you had." MR described her early pregnancy experience as a state of "violent denial." She refused to acknowledge fetal movements, describing the sensations as "cramps" and "gas pains." At 22 weeks gestation, she purchased a dress in her usual size to wear in her wedding, which was scheduled for the 38th week of gestation. "I guess I knew it wouldn't fit, but I just couldn't face what was going to happen." In the prenatal period, MR reported dreams of a baby "with a face like he [JR] was making when it happened." She felt great anger toward JR for "forcing me into it." She feared that she was "carrying a monster in my body." A woman pregnant as a result of rape faces the same three resolution options as any other pregnant woman: abortion, adoption, or parenthood. MR was deeply ambivalent about her pregnancy resolution options. She considered abortion, but decided that she could not "kill anything that's alive." Her prenatal plan was to carry her pregnancy in secret, then relinquish the infant for adoption, but she refused to formalize this decision legally. A few hours after giving birth, she abruptly left the hospital against medical advice. These events were reported to the state department of human services, which handled the case as an instance of child abandonment."Once we saw he wasn't a monster, I couldn't give him up." Processes of pregnancy adaptation and maternal role attainment have not been studied among rape victims. Respondent statements in Campbell et al., 1995Campbell J.C. Pugh L.C. Campbell D. Visscher M. The influence of abuse on pregnancy intention.Women's Health Issues. 1995; 5: 214-222Abstract Full Text PDF PubMed Scopus (86) Google Scholar study suggest that some abused women were able to form maternal attachments. Although describing pregnancies inflicted against their will, their statements suggest that they recognized their children as individuals with needs, including the need to be insulated from the violence by which they were conceived. MR stated that at the moment she first saw her newborn, she formed her maternal attachment. "Once we saw he wasn't a monster, I couldn't give him up." MR and JR sought and eventually attained legal custody of their second child. Social support has been identified as a factor in women's recovery from rape and their adaptation to pregnancy. Acceptance by significant others of the woman and her pregnancy has been identified as a major component of maternal adaptation (May and Mahlmeister, 1994May K.A. Mahlmeister L.R. Maternal and neonatal nursing: Family-centered care. Lippincott, Philadelphia1994Google Scholar). Unsupportive responses of significant others have been correlated negatively to women's recovery from rape (Davis et al., 1991Davis R.C. Brickman E. Baker T. Supportive and unsupportive responses of others to rape victims: Effects on concurrent victim adjustment.American Journal of Community Psychology. 1991; 19: 443-451PubMed Google Scholar). Emm and McKenry, 1988Emm D. McKenry P.C. Coping with victimization: The impact of rape on female survivors, male significant others, and parents.Contemporary Family Therapy. 1988; 10: 272-279Crossref Scopus (21) Google Scholar concluded that social support is "imperative" in the treatment of rape victims (p. 278). MR described her options for marriage and parenthood as an "either-or" dilemma. Her parents were willing to support her as an unmarried mother of one child, but "they made it real clear it better not happen again, or I'd be on the street." She felt that her parents would not support her unless she married JR, and that they would not allow her to marry him if they knew he had raped her. "If I wanted my baby, I had to get married, but I couldn't let them find out what happened." Pence and Paymar, 1992Pence E. Paymar M. Power and control: Tactics of men who batter. Duluth Domestic Violence Intervention Project, Duluth, MN1992Google Scholar power and control model identifies social isolation as an element of abusive relationships. Without an affirming frame of reference, women are more likely to internalize an abuser's estimation of their personal worth. When she had her first child, MR stated, "I lost my reputation and all my friends," and about her second pregnancy, she said, "there was nobody I could possibly tell." At the time of our final interview, MR still had not disclosed to anyone other than health care providers that she had been raped. She identified "listening to me scream" and "giving me straight information" as supportive provider responses. She said the most important thing for a woman pregnant against her will to know is that "there are people out there who will support you and take care of you." A common theme in nursing care of women subject to violence is that "assessment is intervention" (McFarlane, 1993McFarlane J. Abuse during pregnancy: The horror and the hope.AWHONN's Clinical Issues in Perinatal and Women's Health Nursing. 1993; 4: 351-361Google Scholar). Although victims may minimize or deny their experiences with violence, assessment serves a purpose even when the documented findings are inaccurate. Assessment lets the woman know that her experience is significant, that it is an acceptable topic to address with her nurse, and that help is available even if she does not initially disclose her victimization or seek help. Respondents in the Campbell et al., 1995Campbell J.C. Pugh L.C. Campbell D. Visscher M. The influence of abuse on pregnancy intention.Women's Health Issues. 1995; 5: 214-222Abstract Full Text PDF PubMed Scopus (86) Google Scholar study unanimously agreed that they wanted to be asked about violence and expressed dismay that many of their health care providers did not do so. Screening for abuse, rape, and violence is a routine assessment for many women's health care providers. Numerous authors emphasize that every woman should be privately screened (Campbell et al., 1995Campbell J.C. Pugh L.C. Campbell D. Visscher M. The influence of abuse on pregnancy intention.Women's Health Issues. 1995; 5: 214-222Abstract Full Text PDF PubMed Scopus (86) Google Scholar, Christian, 1995Christian A. Home care of the battered pregnant woman: One battered woman's pregnancy.Journal of Obstetric, Gynecologic, and Neonatal Nursing. 1995; 24: 836-842Crossref PubMed Scopus (1) Google Scholar, King et al., 1993King M.C. Torres S. Campbell D. Ryan J. Sheridan D. Ulrich Y. McKenna L.S. Violence and abuse of women.AWHONN's Clinical Issues in Perinatal and Women's Health Nursing. 1993; 4: 163-172PubMed Google Scholar, McFarlane, 1993McFarlane J. Abuse during pregnancy: The horror and the hope.AWHONN's Clinical Issues in Perinatal and Women's Health Nursing. 1993; 4: 351-361Google Scholar). Because definitions of abuse, rape, and violence differ and because minimization and denial are significant factors in screening accuracy, research has been conducted to develop screening questions that elicit a reliable response (McFarlane, 1993McFarlane J. Abuse during pregnancy: The horror and the hope.AWHONN's Clinical Issues in Perinatal and Women's Health Nursing. 1993; 4: 351-361Google Scholar). Three questions, adapted from Mc-Farlane's work, can effectively screen for violence, rape, and other forms of abuse (see Table 1).Table 1Assessment to Screen for AbuseNote. From Abuse During Pregnancy: The Horror and the Hope, by J. McFarlane, 1993McFarlane J. Abuse during pregnancy: The horror and the hope.AWHONN's Clinical Issues in Perinatal and Women's Health Nursing. 1993; 4: 351-361Google Scholar, AWHONN's Clinical Issues in Perinatal and Women's Health Nursing, 4(3), pp. 351-361. Adapted with permission.Screening QuestionsHave you been hit, slapped, kicked, or physically hurt in the last year?Have you ever been afraid of your husband/partner?Were you ever made to do something sexual that you didn't want to do? Open table in a new tab After screening results in a positive finding, the next priority is the woman's safety. Factors correlated with domestic homicide (see Table 2) should be noted and discussed with the woman. Domestic abuse increases in intensity and lethality during pregnancy and is correlated with pregnancy complications (Campbell and Humpherys, 1993Campbell J.C. Humpherys J. Nursing care of survivors of family violence.2nd. ed. Mosby, St. Louis1993Google Scholar, Christian, 1995Christian A. Home care of the battered pregnant woman: One battered woman's pregnancy.Journal of Obstetric, Gynecologic, and Neonatal Nursing. 1995; 24: 836-842Crossref PubMed Scopus (1) Google Scholar, McFarlane, 1993McFarlane J. Abuse during pregnancy: The horror and the hope.AWHONN's Clinical Issues in Perinatal and Women's Health Nursing. 1993; 4: 351-361Google Scholar). Because fear is a significant sequela of all rape, the woman's subjective self-assessment of safety may be equally important in cases of stranger rape. A safety plan (see Table 3) is an important assessment and an empowering intervention.Table 2Domestic Homicide Risk Factors to Discuss With Abused WomenRisk FactorsPresence of weapons in the homeAbuser's threats to kill the woman, himself, or othersEscalating pattern of violence in the past yearAbuser's use of alcohol or drugsAbuser's violence outside the home Open table in a new tab Table 3A Personal Safety Plan for Women Who Are AbusedElements of PlanList of important phone numbersMedications and instructions for emergency contraceptionChange of clothesTransportationList of four safe places to go, including friends' home, relatives' home, and sheltersDocuments, including identification and birth certificatesMoneyChildren's favorite toys and/or blanketsCourt order of protection Open table in a new tab When assessment reveals that a nonpregnant woman is subject to domestic abuse, the nurse must recognize that forced sex and denial of access to contraception are likely. Formulating a contraception plan that can be implemented without the abuser's consent and cooperation is probably the most effective primary prevention against pregnancy resulting from domestic rape. A thorough review of contraceptive options can help the woman select a plan she can implement, given the patterns of abuse and control in her relationship.A contraception plan that can be implemented without the abuser's cooperation is the most effective primary prevention. Finally, assessment provides the woman with an opportunity to relate traumatic experiences and express feelings of loss and other troubling emotions. Anger, fear, shame, grief, and feelings of worthlessness, undesirability, or self-judgment should be affirmed as normal responses. Even if the woman does not express them, anticipatory acknowledgment of these emotions may help her recognize that these feelings do not mean she is actually at fault—a point that the nurse should explicitly affirm. Referral to sexual abuse counseling should be offered to all raped or sexually abused women, and referral for psychiatric care is mandated for signs of depression or self-destructive behavior. Still, the nurse should recognize that he or she has been chosen by the woman for disclosure. The empathetic and therapeutic use of self, listening, and acceptance are the most important interventions. Emergency contraception gives women the power to prevent pregnancy after unwanted sex, but many women are unaware of the relative availability, safety, and efficacy of this treatment. Educating all female patients about hormonal pregnancy prophylaxis should be routine in woman-centered nursing care. Some providers prescribe pregnancy prophylaxis on an anticipatory basis, so that the treatment is available to a woman when and where she needs it (Planned Parenthood Federation of America, 1996Planned Parenthood Federation of AmericaFamily planning protocols. Author, New York1996Google Scholar). Counseling women who are pregnant as a result of rape, coercion, or control focuses on pregnancy resolution options and identification of support resources. Practice-tested counseling protocols for unintended pregnancy include formulating specific plans for the woman to tell someone about her situation, as well as assessing the woman's attitudes and those of significant others toward each of the three pregnancy resolution options (Planned Parenthood, 1995Parenthood Planned Counseling manual. Author, Nashville, TN1995Google Scholar). In cases of domestic rape, assessment includes the woman's access to each option. For women who choose to carry a pregnancy resulting from rape, assessment includes signs of maternal adaptation and attachment. Behaviors such as wearing appropriate maternity clothes and making plans for the infant are noted as signs of adaptation to pregnancy (May and Mahlmeister, 1994May K.A. Mahlmeister L.R. Maternal and neonatal nursing: Family-centered care. Lippincott, Philadelphia1994Google Scholar). Appreciation or denial of quickening also is noted. Attributing personality characteristics to fetal activity may be demonstrating adaptive attachment, whereas explaining sensations as cramps or gas indicates ambivalent attachment. In the postpartum period, attachment behaviors such as claiming, touching, making eye contact, and meeting the infant's needs are assessment findings indicative of attachment. Nursing research must begin to address the issue of pregnancy as a result of rape, coercion, and control. Conducting generalizable quantitative research, especially studies of intervention efficacy, would present enormous practical, methodological, and ethical difficulties. Qualitative research on the experiences of women pregnant as a result of rape and on the processes of maternal adaptation and attachment in rape pregnancy would be a more practical contribution to the nursing literature. The practice recommendations presented in this article were gathered from tangentially related literature and research that did not focus primarily on pregnancy resulting from rape. Until the problem is studied more directly and extensively, effective interventions may remain unknown, and important issues may remain unaddressed. Beyond practice and research, this topic has implications for the nurse's role as advocate. Nurses can inform women about their legal rights, including their rights in adoption, abortion, and criminal law. A nurse can involve a woman in a plan of care, support her selfdetermination, and enhance her sense of control. Limiting invasive examinations and procedures is always indicated, and a nurse can provide explanation and emotional support when they are truly necessary. As political agents, women's health nurses must (a) support laws and policies that reflect the fact that domestic rape is no less rape than stranger rape, (b) protect a woman from being violated by the criminal justice system, (c) ensure free choice among pregnancy resolution options, and (d) support and empower women's self-determination. Nurses have been identified as the primary resource "strategically placed to intervene" (Boychuk Duchscher, 1994Boychuk Duchscher J.E. Acting on violence against women.Canadian Nurse. 1994; 90: 21-25PubMed Google Scholar, p. 25) for women subjected to violence. Women's health nurses must be the primary resource when violence against women results in pregnancy. The problem demands the full scope of our professional roles as clinicians, researchers, advocates, and educators.JOGNN Review Panel: 1998Erin Anderson, ARNP, MSNRebecca Attenborough, RN, MNLinda Bell, RN, MScBonnie Berk, RN, BSCaroline Brown, RNC, MS, DEdElizabeth G. Damato, RNC, MSNBarbara Dion, RNC, ICCE, MA, MSNEmily Drake, RNC, MSNSusan Drummond, RN, MSNHeidi Funk, RNC, MSAnita J. Gagnon, RN, MPH, PhDColleen Gerlach, RN, BSN, MBACheryl A. Glass, RNC, MSNJeanne T. Grace, RNC, PhDAnnette Gupton, RN, PhDJudith Harris, ARNP, EdDMary Henrikson, RNC, MN, ARNP, WHCNPDebra Jackson, RNC, BSN, MPHMary Brewer Jones, RN, MSN, PhDSuzan Kardong-Edgren, RNC, MS, FACCEAnne Katz, RN, MNJo M. Kendrick, RNC, MSN, OGNPJanet W. Kenney, RN, PhDVirginia Kinnick, RN, CNM, EdDCheryl P. Kish, RN, MSN, EdDLinda J. Kobokovich, RNC, MScNMira Lessick, RN, PhDMartina Letko, RNC, MS, MBAKelly Lindgren, RN, MSSharon Lock, RNC, FNP, PhDJudith Maloni, RN, PhDLouise Martell, RN, PhDSharon McCoy, RNC, MSPaula P. Meier, RN, DNSc, FAANAnne A. Moore, RNC, MSNDianne Morrison-Beedy, RNC, WHNP, PhDDenise Palmer, RN, MSCynthia Persily, RN, PhDJudith Poole, RNC, MNDiana J. Reiser, RN, MAEd, MNLinda Samson, RNC, PhD, CNAASharleen H. Simpson, ARNP, MSN, MA, PhDNora F. Steele, RNC, DNSMartha Tabas, RN, C, MSCecilia Tiller, RN, DSNJudith Carveth Trexler, RN, PhD, CNMM. Terese Verklan, RNC, PhDLuanne Wielichowski, RNC, MSNJeanne M. Wilton, RN, MS, IBCLCLucia D. Wocial, RNC, MSN, PhD Erin Anderson, ARNP, MSNRebecca Attenborough, RN, MNLinda Bell, RN, MScBonnie Berk, RN, BSCaroline Brown, RNC, MS, DEdElizabeth G. Damato, RNC, MSNBarbara Dion, RNC, ICCE, MA, MSNEmily Drake, RNC, MSNSusan Drummond, RN, MSNHeidi Funk, RNC, MSAnita J. Gagnon, RN, MPH, PhDColleen Gerlach, RN, BSN, MBACheryl A. Glass, RNC, MSNJeanne T. Grace, RNC, PhDAnnette Gupton, RN, PhDJudith Harris, ARNP, EdDMary Henrikson, RNC, MN, ARNP, WHCNPDebra Jackson, RNC, BSN, MPHMary Brewer Jones, RN, MSN, PhDSuzan Kardong-Edgren, RNC, MS, FACCEAnne Katz, RN, MNJo M. Kendrick, RNC, MSN, OGNPJanet W. Kenney, RN, PhDVirginia Kinnick, RN, CNM, EdDCheryl P. Kish, RN, MSN, EdDLinda J. Kobokovich, RNC, MScNMira Lessick, RN, PhDMartina Letko, RNC, MS, MBAKelly Lindgren, RN, MSSharon Lock, RNC, FNP, PhDJudith Maloni, RN, PhDLouise Martell, RN, PhDSharon McCoy, RNC, MSPaula P. Meier, RN, DNSc, FAANAnne A. Moore, RNC, MSNDianne Morrison-Beedy, RNC, WHNP, PhDDenise Palmer, RN, MSCynthia Persily, RN, PhDJudith Poole, RNC, MNDiana J. Reiser, RN, MAEd, MNLinda Samson, RNC, PhD, CNAASharleen H. Simpson, ARNP, MSN, MA, PhDNora F. Steele, RNC, DNSMartha Tabas, RN, C, MSCecilia Tiller, RN, DSNJudith Carveth Trexler, RN, PhD, CNMM. Terese Verklan, RNC, PhDLuanne Wielichowski, RNC, MSNJeanne M. Wilton, RN, MS, IBCLCLucia D. Wocial, RNC, MSN, PhD
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