Screening for partner violence during pregnancy

Objectives: An analysis of the international literature on partner violence provides insights for health care providers caring for women. Methods: The current literature on partner violence epidemiology, screening, and interventions was reviewed, focusing on pregnancy. Results: Adolescent girls and pregnant women are at highest risk for partner violence and homicide. Conclusion: Health care providers need to offer clinical screening and interventions to prevent consequences of partner violence, including homicide.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135655/1/ijgo273.pd

Hidden from Plain Sight: Residents' Domestic Violence Screening Attitudes and Reported Practices

Domestic violence (DV) is prevalent across all racial and socioeconomic classes in the United States. Little is known about whether physicians differentially screen based on a patient's race or socioeconomic status (SES) or about resident physician screening attitudes and practices. OBJECTIVE : To assess the importance of patient race and SES and resident and clinical characteristics in resident physician DV screening practices. DESIGN, PARTICIPANTS : One-hundred and sixty-seven of 309 (response rate: 54%) residents from 6 specialties at a large academic medical center responded to a randomly assigned online survey that included 1 of 4 clinical vignettes and questions on attitudes and practices regarding DV screening. MEASUREMENTS : We measured patient, resident, and clinical practice characteristics and used bivariate and multivariate methods to assess their association with the importance residents place on DV screening and if they would definitely screen for DV in the clinical vignette. RESULTS : Residents screened the African-American and the Caucasian woman (51% vs 57%, P =.40) and the woman of low SES and high SES (49% vs 58%, P =.26) at similar rates. Thirty-seven percent of residents incorrectly reported rates of DV are higher among African Americans than Caucasians, and 66% incorrectly reported rates are higher among women of lower than of higher SES. In multivariate analyses, residents who knew where to refer DV victims (adjusted odds ratio [AOR]=3.54, 95% confidence interval [CI]: 1.43 to 8.73) and whose mentors advised them to screen (AOR=3.46, 95% CI: 1.42 to 8.42) were more likely to screen for DV. CONCLUSION : Although residents have incorrect knowledge about the epidemiology of DV, they showed no racial or SES preferences in screening for DV. Improvement of mentoring and educating residents about referral resources may be promising strategies to increase resident DV screening.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75245/1/j.1525-1497.2006.00494.x.pd

Access and utilisation of maternity care for disabled women who experience domestic abuse:a systematic review

BACKGROUND: Although disabled women are significantly more likely to experience domestic abuse during pregnancy than non-disabled women, very little is known about how maternity care access and utilisation is affected by the co-existence of disability and domestic abuse. This systematic review of the literature explored how domestic abuse impacts upon disabled women’s access to maternity services. METHODS: Eleven articles were identified through a search of six electronic databases and data were analysed to identify: the factors that facilitate or compromise access to care; the consequences of inadequate care for pregnant women’s health and wellbeing; and the effectiveness of existing strategies for improvement. RESULTS: Findings indicate that a mental health diagnosis, poor relationships with health professionals and environmental barriers can compromise women’s utilisation of maternity services. Domestic abuse can both compromise, and catalyse, access to services and social support is a positive factor when accessing care. Delayed and inadequate care has adverse effects on women’s physical and psychological health, however further research is required to fully explore the nature and extent of these consequences. Only one study identified strategies currently being used to improve access to services for disabled women experiencing abuse. CONCLUSIONS: Based upon the barriers and facilitators identified within the review, we suggest that future strategies for improvement should focus on: understanding women’s reasons for accessing care; fostering positive relationships; being women-centred; promoting environmental accessibility; and improving the strength of the evidence base

Intimate Partner Violence during Pregnancy: Victim or Perpetrator? Does it make a difference?

Objectives: To differentiate between forms of intimate partner violence (IPV)(victim only, perpetrator only, or participating in reciprocal violence) and examine risk profiles and pregnancy outcomes. Design: Prospective Setting: Washington, DC, July 2001 to October 2003 Sample: 1044 high-risk African-American pregnant women who participated in a randomized controlled trial to address IPV, depression, smoking, and environmental tobacco smoke exposure. Methods: Multivariable linear and logistic regression Main outcome measures: Low and very low birth weight, preterm and very preterm birth Results: 5% of women were victims only, 12% were perpetrators only, 27% participated in reciprocal violence, and 55% reported no IPV. Women reporting reciprocal violence in the past year were more likely to drink, use illicit drugs, and experience environmental tobacco smoke exposure and were less likely to be very happy about their pregnancies. Women reporting any type of IPVwere more likely to be depressed than those reporting no IPV. Women experiencing reciprocal violence reported highest levels of depression. Women who were victims of IPV were more likely to give birth prior prematurely and deliver low and very low birth weight infants. Conclusions: We conclude that women were at highest risk for pregnancy risk factors when they participated in reciprocal violence and thus might be at higher risk for long-term consequences, but women who were victims of intimate partner violence were more likely to show proximal negative outcomes like preterm birth and low birth weight. Different types of interventions may be needed for these two forms of intimate partner violence

Priorities and strategies for improving disabled women's access to maternity services when they are affected by domestic abuse:a multi-method study using concept maps

BACKGROUND: Domestic abuse is a significant public health issue. It occurs more frequently among disabled women than those without a disability and evidence suggests that a great deal of domestic abuse begins or worsens during pregnancy. All women and their infants are entitled to equal access to high quality maternity care. However, research has shown that disabled women who experience domestic abuse face numerous barriers to accessing care. The aim of the study was to identify the priority areas for improving access to maternity services for this group of women; develop strategies for improved access and utilisation; and explore the feasibility of implementing the identified strategies. METHODS: This multi-method study was the third and final part of a larger study conducted in the UK between 2012 and 2014. The study used a modified concept mapping approach and was theoretically underpinned by Andersen’s model of healthcare use. Seven focus group interviews were conducted with a range of maternity care professionals (n = 45), incorporating quantitative and qualitative components. Participants ranked perceived barriers to women’s access and utilisation of maternity services in order of priority using a 5-point Likert scale. Quantitative data exploration used descriptive and non-parametric analyses. In the qualitative component of each focus group, participants discussed the barriers and identified potential improvement strategies (and feasibility of implementing these). Qualitative data were analysed inductively using a framework analysis approach. RESULTS: The three most highly ranked barriers to women’s access and utilisation of maternity services identified in the quantitative component were: 1) staff being unaware and not asking about domestic abuse and disability; 2) the impact of domestic abuse on women; 3) women’s fear of disclosure. The top two priority strategies were: providing information about domestic abuse to all women and promoting non-judgemental staff attitude. These were also considered very feasible. The qualitative analysis identified a range of psychosocial and environmental barriers experienced by this group of women in accessing maternity care. Congruent with the quantitative results, the main themes were lack of awareness and fear of disclosure. Key strategies were identified as demystifying disclosure and creating physical spaces to facilitate disclosure. CONCLUSIONS: The study supports findings of previous research regarding the barriers that women face in accessing and utilising maternity services, particularly regarding the issue of disclosure. But the study provides new evidence on the perceived importance and feasibility of strategies to address such barriers. This is an important step in ensuring practice-based acceptability and ease with which improvement strategies might be implemented in maternity care settings