Does Your Partner Abuse You?

Obstetricians and gynecologists should screen all of their patients for intimate partner violence at periodic intervals such as at annual visits or during prenatal care, according to a new recommendation from the American College of Obstetricians and Gynecologists(ACOG)

The College’s Committee on Health Care for Underserved Women noted that the prevalence of the problem and the long-term health consequences for women are driving the need for routine screening.

More than one in three women (36%) in the United States have experienced rape, physical violence, or stalking by an intimate partner at some point during their lives, according to figures published in 2010 by the Centers for Disease Control and Prevention. Intimate partner violence (IPV) extends beyond just physical and sexual violence. The term also includes psychological abuse and reproductive coercion, ranging from name calling and threats to isolation and sabotaging efforts at contraception.

The consequences of IPV are wide-ranging, too, and include acute injuries, chronic headaches, sleep and appetite disturbances, and recurrent vaginal infections. Among pregnant women who experience IPV, the abuse has been associated with stillbirth, placental abruption (sudden separation of the placenta during pregnancy), fetal injury, preterm delivery, and low birth weight of the baby that is born

A good person to talk to about this happening in your life is your Ob.gyn.
Ob.gyns. are in a “unique position” to aid women who experience IPV because of their special physician-patient relationship and because of the many opportunities for intervention, according to the committee opinion.

ACOG advised ob.gyns. to screen all patients, and do it periodically because some women will not disclose abuse the first time they are asked about it. Other signs that should prompt an IPV assessment include depression, substance abuse, mental health problems, or requests for repeat pregnancy tests at a time when the patient does not wish to be pregnant. During pregnancy, obstetric patients should be screened at the first prenatal visit, at least once a trimester, and at the postpartum visit, according to ACOG.

The recommendation suggests starting the conversation with a framing statement such as, “We’ve started talking to all of our patients about safe and healthy relationships because it can have such a large impact on your health.” This lets the patient know that the screening is universal and isn’t being done because IPV is suspected. It’s also important to let patients know about the confidentiality of the discussion, and tell them exactly what state laws mandate that physicians disclose.

The committee opinion also emphasizes that physicians do screening for IPV in private, integrate the questions into routine intake forms, and ensure that the office staff is regularly trained about IPV.

IPV screening is part of the list of recommended preventive services for women that most health plans will be required to cover starting on Aug. 1,2012. The preventive services coverage requirement was part of the Affordable Care Act, and the Department of Health and Human Services recently issued the list of recommended services with input from the Institute of Medicine.

Physicians should offer patients information that includes community resources (mental health services, crisis hotlines, rape relief centers, shelters, legal aid, and police contact information) and appropriate referrals, according to the committee opinion. But such information should not be forced upon unwilling patients or slipped unknowingly into their belongings, where their abusers might find them. Offering abused patients a private phone to call the National Domestic Violence Hotline can be very helpful because abusers often monitor cell phone logs or Internet use; the hotline is “a multilingual resource that can connect a patient to local domestic violence programs, help with safety planning, and provide support” (1-800-799-SAFE [7233]).

There is a “Futures Without Violence website” that doctors who wish to learn about how to help patients dealing with IPV may want to go to (Visit the website at www.futureswithoutviolence.org, click on Our Work, then click on the Health section.)

But not all health groups support routine universal screening,for example,the U.S. Preventive Services Task Force does not

It should be clear,however that all the recommendations from screening are based on the hope that identifying women in this way will get them on a path to seeking help, if indeed help is available. Current research evidence does not demonstrate that universal screening improves women’s health or well-being, or decreases their exposure to violence,” Dr. Nadine Wathen of the University of Western Ontario, London,said in an interview.
MARY ELLEN SCHNEIDER,Ob.Gyn.News

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