“Part of the abuse is not letting me get him medical care”: A qualitative examination of children's unmet health needs in the context of post-separation abuse

Background: Children exposed to intimate partner violence (IPV) experience disparities in health outcomes and healthcare access. Mechanisms explaining how IPV affects children's health needs, particularly after parental separation, are poorly understood. Objective: The aim of this qualitative study is to examine maternal survivors' experiences of IPV following separation from an abusive co-parent (“post-separation abuse”) and their children's health needs. Participants and setting: The research team conducted individual semi-structured interviews with N = 33 maternal post-separation abuse survivors from 18 states in the United States. Methods: Qualitative interviews were coded and analyzed using ATLAS.ti through an iterative thematic inquiry approach, with each interview coded by at least 2 study team members. Results: Most participants (85 %) reported difficulty accessing healthcare for their children. The analysis team identified five broad domains of post-separation abuse tactics contributing to children's unmet health needs: (1) obstruction and manipulation of children's healthcare, (2) stalking and intimidation, (3) legal abuse, (4) disregarding children's well-being, and (5) economic abuse. Conclusions: This study provides foundational insights into specific behaviors by abusive co-parents and court-imposed barriers that impact children's health needs. Improved understanding of post-separation abuse is essential to design interventions and policies to ensure children's access to needed healthcare and to reduce health disparities.