Hit where it hurts – Healthcare access and intimate partner violence

We exploit a change in the public healthcare entitlement of undocumented migrants in Spain to investigate the causal link between withdrawal of healthcare and changes in help-seeking behaviour of women experiencing intimate partner violence (IPV). We contribute to the new literature modelling domestic violence by taking a novel look at the role of human capital in decisions to seek help when in violent relationships. We use a difference-in-differences (DiD) methodology to compare the number of foreign applicants for protection orders before and after the reform using Spanish applicants as the counterfactual. The impact of the reform was immediate; foreign applicants decreased by 16% after the health policy reform was introduced and this drop amounts to 19% in areas with stronger enforcement of the reform. We perform several robustness checks including addressing potential bias from migration changes after the reform. Our findings are important for current policy discussions on granting/limiting access to public programs for the undocumented population. We provide evidence that restricted access to the healthcare system can have unintended negative consequences for the most vulnerable groups of the population with potentially important spill-over effects to the next generation

It where it hurts: Healthcare access and intimate partner violence

This paper investigates the causal link between healthcare access and intimate partner violence (IPV) victims’ help-seeking behavior. Access to healthcare serves as a critical avenue for screening or detecting IPV. Doctors are legally mandated to report suspected criminal injuries to the authorities and can guide victims towards IPV support services. We exploit the 2012 reform in Spain that removed access to the public healthcare system for undocumented immigrants. We use court reports and protection order requests from the Judicial Branch of the Spanish government to perform a difference-in-differences approach, comparing the helpseeking behavior of foreign and Spanish women before and after the reform. We find that restricting healthcare access led to an immediate 12% decrease in IPV reporting and protection order applications among foreign women, particularly in regions with strict enforcement. Importantly, we show suggestive evidence that the reform did not change the underlying incidence of IPV but the results are driven by a reduction in injury reports from medical centers. Our findings are important given the increase in migration flows globally as well as for corrent debates on granting/limiting access to healthcare for marginalized groups

Randomised pilot and feasibility trial of a group intervention for men who perpetrate intimate partner violence against women

Background: There is a need for robust evidence on the effectiveness and cost-effectiveness of domestic abuse perpetrator programmes in reducing abusive behaviour and improving wellbeing for victim/survivors. While any randomised controlled trial can present difficulties in terms of recruitment and retention, conducting such a trial with domestic abuse perpetrators is particularly challenging. This paper reports the pilot and feasibility trial of a voluntary domestic abuse perpetrator group programme in the United Kingdom. Methods: This was a pragmatic individually randomised pilot and feasibility trial with an integrated qualitative study in one site (covering three local-authority areas) in England. Male perpetrators were randomised to either the intervention or usual care. The intervention was a 23-week group programme for male perpetrators in heterosexual relationships, with an average of three one-to-one sessions, and one-to-one support for female current- or ex-partners delivered by third sector organisations. There was no active control treatment for men, and partners of control men were signposted towards domestic abuse support services. Data were collected at three-monthly intervals for nine months from male and female participants. The main objectives assessed were recruitment, randomisation, retention, data completeness, fidelity to the intervention model, and acceptability of the trial design. Results: This study recruited 36 men (22 randomly allocated to attend the intervention group programme, 14 to usual care), and 15 current- or ex-partners (39% of eligible partners). Retention and completeness of data were high: 67% of male (24/36), and 80% (12/15) of female participants completed the self-reported questionnaire at nine months. A framework for assessing fidelity to the intervention was developed. In interviews, men who completed all or most of the intervention gave positive feedback and reported changes in their own behaviour. Partners were also largely supportive of the trial and were positive about the intervention. Participants who were not allocated to the intervention group reported feeling disappointed but understood the rationale for the trial. Conclusions: It was feasible to recruit, randomise and retain male perpetrators and female victim/survivors of abuse and collect self-reported outcome data. Participants were engaged in the intervention and reported positive benefits. The trial design was seen as acceptable. Trial registration: ISRCTN71797549, submitted 03/08/2017, retrospectively registered 27/05/2022

Impact of gender, ethnicity and social deprivation on access to surgical or transcatheter aortic valve replacement in aortic stenosis: a retrospective database study in England

Objective To assess gender, ethnicity, and deprivation-based differences in provision of aortic valve replacement (AVR) in England for adults with aortic stenosis (AS).Methods We retrospectively identified adults with AS from the English Hospital Episode Statistics (HES) between April 2016 and March 2019 and those who subsequently had an AVR. We separately used HES-linked Clinical Practice Research Datalink (CPRD) to identify people with AVR and evaluate the timeliness of their procedure (CPRD-AVR cohort). ORs for AVR in people with an AS diagnosis were estimated using multivariable logistic regression adjusted for age, region and comorbidity. AVR was considered timely if performed electively and without evidence of cardiac decompensation before AVR.Results 183 591 adults with AS were identified in HES; of these, 31 436 underwent AVR. The CPRD-AVR cohort comprised 10 069 adults. Women had lower odds of receiving AVR compared with men (OR 0.65; 95% CI 0.63 to 0.66); as did people of black (OR 0.70; 95% CI 0.60 to 0.82) or South Asian (OR 0.75; 95% CI 0.69 to 0.82) compared with people of white ethnicities. People in the most deprived areas were less likely to receive AVR than the least deprived areas (OR 0.8; 95% CI 0.75 to 0.86). Timely AVR occurred in 65% of those of white ethnicities compared with 55% of both those of black and South Asian ethnicities. 77% of the least deprived had a timely procedure compared with 58% of the most deprived; there was no gender difference.Conclusions In this large, national dataset, female gender, black or South Asian ethnicities and high deprivation were associated with significantly reduced odds of receiving AVR in England. A lower proportion of people of minority ethnicities or high deprivation had a timely procedure. Public health initiatives may be required to increase clinician and public awareness of unconscious biases towards minority and vulnerable populations to ensure timely AVR for everyone