Domestic Violence: a Clinical Guide for Women’S Healthcare Providers

DOI: 10.1111/j.1744-4667.2012.00120.x 2012;14:197–202 Review The Obstetrician & Gynaecologist http://onlinetog.org

Domestic violence: a clinical guide for women’s healthcare providers

a,b, Amy S Gottlieb MD * aAssociate Professor (Clinical), Departments of Medicine and Obstetrics & Gynecology, The Warren Alpert Medical School of Brown University, Rhode Island, USA bDirector of Primary Care Curricula, Residency Program in Obstetrics & Gynecology, Women & Infants Hospital, 101 Dudley Street, Providence, RI 02905, USA *Correspondence: Amy S Gottlieb. Email: [email protected]

Key content To know how to enquire routinely for domestic violence and offer Domestic violence is common among obstetric and gynaecology assistance to victims. patients and is a leading cause of maternal mortality. Ethical issues Reproductive coercion involves male attempts to control female The highest standard of confidentiality is required to keep abused fertility; long-acting contraception should be considered in these women safe; at times, this standard may conflict with complete cases. information sharing. Past domestic violence and late booking for antenatal care are Healthcare providers often feel frustrated and powerless when associated with abuse during pregnancy. working with abused women. It is the woman’s decision when to Healthcare providers should ask women about domestic violence leave her violent relationship and the clinician’s role to provide directly and in private, assess victims’ safety, offer referrals to empathy and information about resources. community-based organisations and document abuse in the hospital or office record (not necessarily in the hand-held record). Keywords: abuse / pregnancy / reproductive coercion / safety assessment / screening Learning objectives To understand the prevalence of domestic violence, risk factors and the impact on women’s health.

Please cite this paper as: Gottlieb AS. Domestic violence: a clinical guide for women’s health care providers. The Obstetrician & Gynaecologist 2012;14:197–202.

Introduction number of types of abuse (e.g. physical, sexual, psychological) and the severity of the violence.9 When domestic violence Domestic violence is threatening behaviour, violence or continues, these health-related complaints increase over abuse (psychological, physical, sexual, ﬁnancial, emotional) time.12 between adults who are or have been intimate partners.1 The Compared with women without a history of partner – majority of victims are women; population studies2 4 violence, victims of domestic violence are more likely to estimate that at least one in four women worldwide will be access outpatient primary care and specialty care, visit abused by a partner during her lifetime. Clinical research5,6 in accident and emergency departments, seek mental health the UK demonstrates that 13–24% of women receiving and substance misuse services and obtain prescriptions from antenatal or postnatal care and 21% of women receiving pharmacies.13 In the UK, the cost of care for domestic gynaecological services report a history of domestic violence. violence-related physical and mental health concerns has In addition to acute trauma, exposure to domestic violence been estimated14 at almost £2 billion pounds annually. It is has wide-ranging effects on the health of women. Partner likely that this ﬁgure under-represents the true cost of abuse has been associated with increased numbers of domestic violence by not capturing all medical services gynaecological, central nervous system, gastrointestinal, accessed by abused women. musculoskeletal and cardiac complaints and with a higher risk of depression, anxiety, post-traumatic stress disorder, – The clinical setting suicidality and substance misuse.7 11 There is a dose– response relationship between the amount of symptoms Myths and stereotypes exist about abused women. Clinicians reported and the number of violent episodes experienced, the must be aware of their own biases and challenge any

ª 2012 Royal College of Obstetricians and Gynaecologists 197 Domestic violence and women’s health care assumptions not based on fact. Although domestic violence that women exposed to partner violence are more likely to – involves controlling, coercive and even criminal behaviours report: headache,7 9 dizziness, chest pain, palpitations,8,9 back – – perpetrated usually against women, it may be useful for pain,7 9 nausea and indigestion,8 stomach pain,7 9 diarrhoea – healthcare providers to view domestic violence within the and constipation,9 menstrual/pelvic pain, dyspareunia,7 9 construct of a chronic illness. As such, it has well-studied risk insomnia,9 depression,7,8,10 anxiety,7 post-traumatic stress factors, a natural history and commonly associated disorder10 and suicidal ideation.10,11 Not all individuals symptoms. presenting with these concerns are being abused, but a consistent constellation of these complaints should be a red Risk factors flag for healthcare providers to investigate the possibility of Domestic violence occurs across all racial/ethnic groups and domestic violence. socioeconomic classes.3 The following risk factors have been associated with an increased likelihood of victimisation by an 2,3 2,8,15–17 Domestic violence and reproductive intimate partner: female gender, young age, coercion unmarried status,3,8,16 low income,3,15,17 coverage by medical assistance or being uninsured16 and a history of childhood Reproductive coercion can be defined as attempts by men to maltreatment.17 Pregnancy, particularly unintended preg- control their female partners’ pregnancies and pregnancy – nancy, may also be a risk factor for abuse.16,18 21 outcomes. In Miller’s landmark study27 of 1300 sexually active young women, one in five reported partner pregnancy- History promoting behaviours, such as intimidation, threats to leave In their study17 involving approximately 3500 women, the relationship if the woman did not become pregnant or Thompson and colleagues found that many experience more actual violence, and one in seven experienced interference than one type of domestic violence and that the longer the with contraception by intimate partners. Additionally, the abuse continues, the more likely it is that multiple forms will overwhelming majority of these women reported a history of occur. Most abused women repeatedly seek outside help but domestic violence. lack the personal or economic resources to gain As the largest assessment to date of reproductive coercion – independence.22 Attempting to leave an abusive relationship in the USA, Miller’s research corroborates earlier studies,28 31 can be a particularly dangerous time for a victim.23 describing the lengths to which male partners will go to assert Domestic violence is typically characterised by ongoing, power over reproduction, such as poking holes in condoms, repetitive acts of relatively minor physical assault pulling out NuvaRings and flushing oral contraceptive pills accompanied by patterns of control, intimidation and down the toilet. The findings also support the association isolation. An abuser may try to control access to money, between domestic violence and unintended pregnancy transportation, modes of communication or even health care. demonstrated previously16,21,27 and potentially explain the When assessing access to medical services across numerous relationship between these two phenomena. In Miller’s study, specialties and practice settings, McCloskey and colleagues24 approximately 35% of domestic violence victims reported found that nearly 20% of women experiencing domestic birth control sabotage or forced pregnancy by their partners, violence within the previous year reported that their abuser with reproductive coercion in the setting of a partner abuse had interfered with their health care. This finding is history doubling the risk of unintended pregnancy. consistent with studies15,25,26 of pregnant women, which Reinforcing the concept that reproductive coercion is have revealed an association between domestic violence and about fertility control and not a particular reproductive delayed antenatal care. outcome, women in abusive relationships may be put under Intimidation can range from a raised eyebrow to open pressure to terminate their pregnancies despite partners’ threats and stalking and creates an unstable environment in refusals to use or allow contraception.28,30 Not only has which an abused woman may feel she could be assaulted for current domestic violence been shown to be more prevalent the most benign action. Isolation can take many forms and among women seeking termination of pregnancy compared serve various purposes for the abuser; separation from with women continuing their pregnancies,15,21,32,33 but male friends, family and co-workers prevents detection of the perpetrators of domestic violence report more involvement violence, fosters dependence of the woman on her abuser and with decision making about termination than their non- robs her of any potential means of escape. abusive counterparts.34 Repeat termination has been associated with domestic violence, with increased risk for Associated symptoms each additional termination.31,35 As mentioned above, domestic violence is associated with As research continues to demonstrate the prevalence of numerous health-related complaints, which tend to increase as reproductive coercion, it is incumbent upon clinicians to – the abuse continues over time. Various studies7 11 have shown assess for it. Reproductive health providers are well

198 ª 2012 Royal College of Obstetricians and Gynaecologists Gottlieb positioned to interrupt the cycle of birth control sabotage, while the British Medical Association endorses the guidance male power over pregnancy resolution and unwanted births from the Royal College of Obstetrics and Gynaecologists to or terminations. By recognising that a woman who exhibits ask routinely about domestic violence during the course of all contraceptive non-compliance, multiple unplanned obstetric and gynaecological consultations.1,51 pregnancies or repeat terminations may, in fact, be unable Because repeated enquiry may increase identification to negotiate birth control adherence within her abusive of abuse, USA-based guidelines52,53 typically encourage relationship, a provider could redirect reproductive periodic screening beyond that performed at new-patient counselling efforts toward recommending hidden, long- visits. For pregnant women in particular, the American ® acting forms of contraception such as Depo-Provera Congress of Obstetricians and Gynecologists (ACOG) (medroxyprogesterone acetate) (Pfizer UK, Walton-on-the- recommends enquiry about domestic violence at the booking Hill, Surrey, UK) injection or the intrauterine device. appointment, at least once per trimester and at the postpartum visit.46 In addition to enquiry at routine obstetric and Domestic violence in pregnancy gynaecology appointments, ACOG recommends screening for domestic violence at family planning and preconception Population-based research15,36 reveals that 4% of women appointments. with newborns report physical abuse by an intimate partner Asking about domestic violence should be carried out in a – during pregnancy. Clinical studies37 39 demonstrate even safe, private setting. No adult known to the woman should be higher rates: when asked about physical and sexual abuse in present and children should be excused from the room before the previous year, up to 32% of pregnant women reported initiating enquiry. Clinicians should be aware that language domestic violence, making abuse in pregnancy more interpreters may come from the woman’s community and common than pre-eclampsia or gestational diabetes. could, therefore, pose a potential threat to open – Abuse may begin, cease or continue during pregnancy.18 20 communication. A general statement should be followed by Previous domestic violence is strongly associated with direct, behaviourally specific enquiry. For example: violence during pregnancy.18,39 Other risk factors include ‘Because violence against women is so common in our young age, single status and the following adverse factors: society, I ask all my women patients about partner abuse. Is inadequate housing, finances or education; substance misuse; anyone close to you threatening or hurting you? Is anyone – mental health problems; or trouble with the police.16,19,25,38 40 hitting, kicking, choking or hurting you physically? Is anyone As noted above, unintended pregnancy and delayed entry forcing you to do something sexually that you do not want to into antenatal care are also associated with domestic violence. do?’54 After adjusting for confounding factors, studies have Family planning providers should also enquire about demonstrated an association between partner abuse during reproductive coercion by asking, for example, ‘Has your pregnancy and vaginal bleeding,19 kidney infections41 and partner ever tampered with your birth control or tried to get preterm labor.25,41 Abuse during pregnancy is also a marker for you pregnant when you didn’t want to be?’55 It is critical to risk of death from domestic violence, conferring a three-fold avoid vague questions like, ‘Are you being physically abused?’ increase in homicide risk and making domestic homicide one and to specify the abuser, e.g. a boyfriend or ex-boyfriend. of the leading causes of maternal mortality.42,43 Regarding the Asking directly about specific forms of abuse is acceptable to association between domestic violence and the poor obstetric women56 and has been shown to be more effective in – outcome of low birthweight, research20,41,44,45 on this domestic violence screening.57 59 relationship yields conflicting results, perhaps reflecting Practitioners who suspect undisclosed abuse should leave differences in the domestic violence screening tools the door open for future discussions by directly informing the employed and the populations studied. woman in a gentle and non-judgmental manner, such as: ‘I’m concerned there may be something going on at home and Enquiring about domestic violence would like to check in with you in a few months’. At subsequent visits the practitioner should address domestic violence as part In the USA, most major medical organisations recommend of the woman’s ongoing problem list and should be aware that – routinely asking adult women about domestic violence.46 49 she may continue to withhold information about her abusive Additionally, the Joint Commission on Accreditation of situation out of shame, denial, fear of repercussions or Healthcare Organizations,50 the entity which sets standards concerns about confidentiality.60 and accredits healthcare facilities in the USA, requires hospitals to have protocols in place to identify and assist Aiding women who are being abused victims of domestic violence in order to receive accreditation. In the UK, the Department of Health recommends routine When a woman reveals that she is experiencing domestic enquiry about partner abuse during maternity care only, violence, the healthcare provider should acknowledge her

ª 2012 Royal College of Obstetricians and Gynaecologists 199 Domestic violence and women’s health care experience and tell her that she is not alone and that no one Safety planning deserves to be abused. Qualitative research demonstrates that After domestic violence has been disclosed, the woman’s such brief statements of empathy and validation can be experience acknowledged, her safety assessed and referrals therapeutic in themselves.60 made, the provider should schedule a follow-up appointment to discuss safety planning. Safety planning involves Safety assessment consideration of scenarios in which the woman must flee The clinician should then perform a brief safety assessment to her situation immediately or decides to leave permanently. establish the severity of the situation. The use of weapons and Specifically, the clinician should encourage her to identify homicidal threats increase a woman’s risk of being places she could go to if she were in imminent danger (e.g. murdered.23 Therefore, some important questions to ask are: friends, family, refuge accommodation) and to make copies of important personal and family documents such as her Does your abuser have a weapon? driving licence, passports, pay slips, birth certificates and Has he made threats to kill you? immunisation records. If the woman has a bank account or Do you feel safe to go home now? credit cards, she should make a note of their numbers. These To comprehend fully the nature of the abusive relationship documents and numbers can be packed in a plastic bag and assess whether the violence is escalating, a provider who together with a change of clothes for her and her family and, has identified a case of domestic violence should enquire if possible, an extra set of car keys. This bag should be hidden about the first, most recent and most severe episodes, the outside the home, for example at a friend’s house or at work, specific types of abuse experienced and whether the woman to be used should she need to leave quickly. has ever sought medical treatment. Lastly, it is important to Cultural sensitivity is important during every clinical ask whether she has ever attempted suicide and whether she encounter. There should be no cultural norm that ethically or has had any unintended pregnancies, terminations or partner legally permits violence against women, but there are women interference with her contraception. Such an assessment can who live in communities where options for escaping such be done in a matter of minutes. violence are severely limited. The clinician should take this into consideration when discussing safety planning. Referrals As in the case of any newly diagnosed medical condition, a Documentation healthcare practitioner who has identified domestic violence The medical record is a legal document that could some day aid should provide the woman with information about available the victim of abuse in a court of law. It is, therefore, of utmost resources such as helpline telephone numbers and addresses importance that clinicians report in the hospital or office of websites with information about shelters, local support record any suspicions of domestic violence and any discussions groups and legal aid services. In the UK, Women’s Aid is a with the woman. (This documentation should not be included national organisation which offers a 24-hour national in the hand-held maternity notes if it could put the woman at helpline and an easy-to-use website with links to many risk.) In the event of injury, clinicians should clearly record a resources for victims of partner abuse (see ‘Websites and description of the abuse in the woman’s own words and all further information’). Providers can also obtain physical findings, using a body map and photographs if informational materials such as posters and pamphlets possible. In all cases, there should be special attention to stating from Women’s Aid. These materials can be displayed in the identity and relationship of the abuser (e.g. husband, ex- waiting and examination rooms to serve as cues to women husband) as recounted by the woman. Lastly, if a clinician that the clinical environment is a safe place in which to suspects abuse but the woman does not disclose it, this should discuss domestic violence. be included in the medical record. When offering resource information, clinicians should make certain that women are able to use them; many materials are available in languages other than English and Conclusion for women with low literacy. Take-home materials regarding Domestic violence affects one in four women and has domestic violence could pose a threat if discovered by an tremendous impact on the health and wellbeing of female abuser and this possibility should be discussed. If there is patients. Women’s healthcare providers are in a unique concern about discovery, then information taken home must position to lessen this impact, at the very least by alleviating look innocuous. Simply writing down an unidentified the isolation that is often integral to such victimisation. In telephone number on a small piece of paper may be all accordance with expert guidelines, clinicians should enquire that is necessary. Additionally, a provider may contact routinely about partner abuse and offer support and services on behalf of an abuse victim if given permission to information about available resources for women do so.

200 ª 2012 Royal College of Obstetricians and Gynaecologists Gottlieb experiencing violence. As in many other chronic illnesses, the 14 Walby S. The Cost of Domestic Violence: Up-date 2009. London: time frame for change is very likely to be prolonged; Corporate Alliance Against Domestic Violence; 2009 [www.caadv.org. uk/new_cost_of_dv_2009.php]. therefore, the goal should be to provide non-judgmental 15 Silverman JG, Decker MR, Reed E, Raj A. Intimate partner violence assistance so that these women can make informed, healthy victimization prior to and during pregnancy among women residing in choices. 26 U.S. states: associations with maternal and neonatal health. Am J Obstet Gynecol 2006;95:140–8. 16 Goodwin MM, Gazmarian JA, Johnson CH, Gilbert BC, Saltzman LE. Websites and further information For the PRAMS Working Group. Pregnancy intendedness and physical Women’s Aid: telephone 0808 2000 247; website: www. abuse around the time of pregnancy: findings from the pregnancy risk womensaid.org.uk assessment monitoring system, 1996–1997. Matern Child Health J 2000;4:85–92 [http://dx.doi.org/10.1023/A:1009566103493]. 17 Thompson RS, Bonomi AE, Anderson M, Reid RJ, Dimer JA, Carrell D, References et al. Intimate partner violence: prevalence, types, and chronicity in adult women. Am J Prev Med 2006;30:447–57 [http://dx.doi.org/ 1 British Medical Association. Domestic Abuse. London: BMA; 2007 10.1016/j.amepre.2006.01.016]. [www.bma.org.uk/images/Domestic%20Abuse_tcm41-183509.pdf]. 18 Martin SC, Mackie L, Kupper LL, Buescher PA, Moracco KE. Physical 2 Finney A. Domestic Violence, Sexual Assault and Stalking: Findings abuse of women before, during, and after pregnancy. JAMA – from the 2004/05 British Crime Survey [http://rds.homeoffice.gov.uk/ 2001;285:1581 4 [http://dx.doi.org/10.1001/jama.285.12.1581]. rds/pdfs06/rdsolr1206.pdf]. 19 Janssen PA, Holt VL, Sugg NK, Emanuel I, Critchlow CM, Henderson 3 Centers for Disease Control and Prevention. Adverse health conditions AD. Intimate partner violence and adverse pregnancy outcomes: a – and health risk behaviours associated with intimate partner violence, population based study. Am J Obstet Gynecol 2003;188:1341 7 United States 2005. MMWR 2005;57:113–7. [http://dx.doi.org/10.1067/mob.2003.274]. 4 Garcia-Moreno C, Jansen H, Ellsberg M, Heise L, Watts CH. For the 20 Valladares E, Ellsberg M, Pena R, Hogberg U, Persson LA. Physical WHO Multi-country Study on Women’s Health and Domestic Violence partner abuse during pregnancy: a risk factor for low birth weight in – Against Women Study Team. Prevalence of intimate partner violence: Nicaragua. Obstet Gynecol 2002;100:700 5 [http://dx.doi.org/ findings from the WHO Multi-country Study on Women’s Health and 10.1016/S0029-7844(02)02093-8]. Domestic Violence. Lancet 2006;368:1260–9 [http://dx.doi.org/ 21 Bourassa D, Berube J. The prevalence of intimate partner violence 10.1016/S0140-6736(06)69523-8]. among women and teenagers seeking abortion compared with those – 5 Feder G, Ramsay J, Dunne D, Rose M, Arsene C, Norman R, et al. How far continuing pregnancy. J Obstet Gynaecol Can 2007;29:415 23. does screening women for domestic (partner) violence in different 22 Sabina C, Tindale RS. Abuse characteristics and coping resources as health-care settings meet criteria for a screening programme? System- predictors of problem-focused coping strategies among battered – atic reviews of nine UK National Screening Committee criteria. Health women. Violence Against Women 2008;14:437 56 [http://dx.doi.org/ Technol Assess 2009;13:iv, 17–27. 10.1177/1077801208314831]. 6 John R, Johnson JK, Kukreja S, Found M, Lindow SW. Domestic 23 Campbell JC, Webster D, Koziol-McLain J, Block C, Campbell D, Curry violence: prevalence and association with gynaecological symptoms. MA, et al. Risk factors for femicide in abusive relationships: results BJOG 2004:111:1128–32 [http://dx.doi.org/10.1111/j.1471- from a multisite case control study. Am J Public Health – 0528.2004.00290.x]. 2003;93:1089 97 [http://dx.doi.org/10.2105/AJPH.93.7.1089]. 7 Bonomi AE, Anderson ML, Reid RJ, Rivara FP, Carrell D, Thompson RS. 24 McCloskey LA, Williams CM, Lichter E, Gerber M, Ganz ML, Sege R. Medical and psychosocial diagnoses in women with a history of Abused women disclose partner interference with health care: an – intimate partner violence. Arch Intern Med 2009;169:1692–7 unrecognized form of battering. J Gen Intern Med 2007;22:1067 72 [http://dx.doi.org/10.1001/archinternmed.2009.292]. [http://dx.doi.org/10.1007/s11606-007-0199-z]. 8 Kovac SH, Klapow JC, Kroenke K, Spitzer Rl, Williams JBW. Differing 25 Rodrigues T, Rocha L, Barros H. Physical abuse during pregnancy and – symptoms of abused versus nonabused women in obstetric- preterm delivery. Am J Obstet Gynecol 2008;198:171.e1 e6. gynecology settings. Am J Obstet Gynecol 2003;188:707–13 26 McFarlane J, Parker B, Soeken K, Bullock MS. Assessing for abuse [http://dx.doi.org/10.1067/mob.2003.193]. during pregnancy: severity and frequency of injuries and associated – 9 Eberhard-Gran M, Schei B, Eskild A. Somatic symptoms and diseases entry into prenatal care. JAMA 1992;267:3176 8 [http://dx.doi.org/ are more common in women exposed to violence. J Gen Intern Med 10.1001/jama.1992.03480230068030]. 2007;22:1668–73 [http://dx.doi.org/10.1007/s11606-007-0389-8]. 27 Miller E, Decker MR, McCauley HL, Tancredi DJ, Levenson RR, 10 Golding JM. Intimate partner violence as a risk factor for mental Waldman J, et al. Pregnancy coercion, intimate partner violence and – disorders: a meta-analysis. J Fam Viol 1999;14:99–142 [http://dx.doi. unintended pregnancy. Contraception 2010;81:316 22 [http://dx.doi. org/10.1023/A:1022079418229]. org/10.1016/j.contraception.2009.12.004]. 11 Ellsberg M, Jansen H, Heise L, Watts CH, Garcia-Moreno C. For the 28 Moore AM, Frohwirth L, Miller E. Male reproductive control of women WHO Multi-country Study on Women’s Health and Domestic Violence who have experienced intimate partner violence in the United States. – Against Women Study Team. Intimate partner violence and women’s Soc Sci Med 2010;70:1737 44 [http://dx.doi.org/10.1016/j. physical and mental health in the WHO Multi-country Study on socscimed.2010.02.009]. Women’s Health and Domestic Violence: an observational study. 29 Miller E, Decker MR, Reed E, Raj A, Hathaway JE, Silverman JG. Male Lancet 2008;371:1165–72 [http://dx.doi.org/10.1016/S0140-6736 partner pregnancy-promoting behaviors and adolescent partner violence: fi (08)60522-X]. ndings from a qualitative study with adolescent females. Ambul Pediatr – 12 Gerber MR, Wittenberg E, Ganz ML, Williams CM, McCloskely LA. 2007;7:360 6 [http://dx.doi.org/10.1016/j.ambp.2007.05.007]. Intimate partner violence exposure and change in women’s physical 30 Hathaway JE, Sillis G, Zimmer B, Silverman JG. Impact of partner abuse ’ symptoms over time. J Gen Intern Med 2007;23:64–9 [http://dx.doi. on women s reproductive lives. J Am Med Womens Assoc – org/10.1007/s11606-007-0463-2]. 2005;60:42 5. 13 Rivara FP, Anderson ML, Fishman P. Healthcare utilization and costs for 31 Gee RE, Mitra N, Wan F, Chavkin DE, Long JA. Power over parity: women with a history of intimate partner violence. Am J Prev Med intimate partner violence and issues of fertility control. Am J Obstet – 2007;32:89–96 [http://dx.doi.org/10.1016/j.amepre.2006.10.001]. Gynecol 2009;201:148.e1 e7.

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32 Saftlas AF, Wallis AB, Shochet T, Harland KK, Dickey P, Peek-Asa C. 48 American College of Physicians. Physicians’ Information and Education Prevalence of intimate partner violence among an abortion clinic Resource (PIER) on Intimate Partner Violence. Update 22 October population. Am J Public Health 2010;100:1412–5 [http://dx.doi.org/ 2010 [http://pier.acponline.org/physicians/diseases/d221/d221.html]. 10.2105/AJPH.2009.178947]. [Available to ACP members only.] 33 Woo J, Fine P, Goetzl L. Abortion disclosure and the association with 49 American College of Emergency Physicians. Domestic Family Violence domestic violence. Obstet Gynecol 2005;105:1329–34 [http://dx.doi. [www.acep.org/practres.aspx?id=29184]. org/10.1097/01.AOG.0000159576.88624.d2]. 50 Futures Without Violence. Comply with the Joint Commission 34 Silverman JG, Decker MR, McCauley HL, Gupta J, Miller E, Raj A, et al. Standard PC.01.02.09 on Victims of Abuse [http://endabuse.org/ Male perpetration of intimate partner violence and involvement in section/programs/health_care/_jcaho]. abortions and abortion-related conflict. Am J Public Health 51 Taskforce on the Health Aspects of Violence Against Women and 2010;100:1415–7 [http://dx.doi.org/10.2105/AJPH.2009.173393]. Children. Report from the Domestic Violence Sub–Group: Responding 35 Fisher WA, Singh SS, Shuper PA, Carey M, Otchet F, MacLean-Brine D, to Violence Against Women and Children – the Role of the NHS. et al. Characteristics of women undergoing repeat induced abortion. London: Department of Health; 2010 [www.dh.gov.uk/en/ CMAJ 2005;172:637–41 [http://dx.doi.org/10.1503/cmaj.1040341]. Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/ 36 Chu SY, Goodwin MM, Angelo DV. Physical violence against U.S. DH_113728]. women around the time of pregnancy, 2004–2007. Am J Prev Med 52 Kothari CL, Rhodes KV. Missed opportunities: emergency department 2010;38:317–22 [http://dx.doi.org/10.1016/j.amepre.2009.11.013]. visits by police-identified victims of intimate partner violence. Ann 37 Kiely M, El-Mohandes AA, El-Khorazaty MN, Blake SM, Gantz MG. An Emerg Med 2006;47:190–9 [http://dx.doi.org/10.1016/j. integrated intervention to reduce intimate partner violence in pregnancy: annemergmed.2005.10.016]. a randomized controlled trial. Obstet Gynecol 2010;115:273–83 53 Bullock L, Bloom T, Davis J, Kilburn E, Curry MA. Abuse disclosure in [http://dx.doi.org/10.1097/AOG.0b013e3181cbd482]. privately and Medicaid-funded pregnant women. J Midwifery 38 Parker B, McFarlane J, Soeken K. Abuse during pregnancy: effects on Womens Health 2006;51:361–9 [http://dx.doi.org/10.1016/j. maternal complications and birth weight in adult and teenage jmwh.2006.02.012]. women. Obstet Gynecol 1994;84:323–8. 54 Women and Infants Hospital’s Domestic Violence Task Force. 39 Castro R, Peek-Asa C, Ruiz A. Violence against women in Mexico: a Screening for Domestic Violence. (Official questions endorsed by the study of abuse before and during pregnancy. Am J Public Health Hospital’s Domestic Violence Task Force, forming part of the 2003;93:1110–6 [http://dx.doi.org/10.2105/AJPH.93.7.1110]. administrative policy. Accessible to Women and Infants Hospital staff 40 Bowen E, Heron J, Waylen A, Wolke D. For the ALSPAC study team. only.) Domestic violence risk during and after pregnancy: findings from a 55 Chamberlain L, Levenson R; Futures Without Violence and American British longitudinal study. BJOG 2005;112:1083–9 [http://dx.doi.org/ Congress of Obstetricians and Gynecologists. Addressing Intimate 10.1111/j.1471-0528.2005.00653.x]. Partner Violence, Reproductive and Sexual Coercion: A Guide for 41 Cokkinides VE, Coker AL, Sanderson M, Addy C, Bethea L. Physical Obstetric, Gynecologic and Reproductive Health Care Settings. San violence during pregnancy: maternal complications and birth Francisco, CA: Futures Without Violence; 2012. p. 24 [www. outcomes. Obstet Gynecol 1999;93:661–6 [http://dx.doi.org/ knowmoresaymore.org/wp-content/uploads/2008/07/Addressing- 10.1016/S0029-7844(98)00486-4]. Intimate-Partner-Violence-and-Reproductive-Coersion1.pdf]. 42 McFarlane J, Campbell JC, Sharps P, Watson K. Abuse during 56 Friedman LS, Samet JH, Roberts MS, Hudlin M, Hans P. Inquiry about pregnancy and femicide: urgent implications for women’s health. victimization experiences: a survey of patient preferences and Obstet Gynecol 2001;100:27–36 [http://dx.doi.org/10.1016/S0029- physician practices. Arch Intern Med 1992;152:1186–90 7844(02)02054-9]. [http://dx.doi.org/10.1001/archinte.1992.00400180056008]. 43 Cheng D, Horon IL. Intimate-partner homicide among pregnant and 57 Rodriguez MA, Sheldon WR, Bauer HM, Perez-Stable EJ. The factors postpartum women. Obstet Gynecol 2010;115:1181–6 [http://dx.doi. associated with disclosure of intimate partner abuse to clinicians. J org/10.1097/AOG.0b013e3181de0194]. Fam Pract 2001;50:338–44. 44 Murphy CC, Schei B, Myhr TL, Du Mont J. Abuse: a risk factor for low 58 Reichenheim ME, Moraes CL. Comparison between the abuse birth weight? A systematic review and meta-analysis. Can Med Assoc J assessment screen and the revised conflict tactics scales for measuring 2001;164:1567–72. physical violence during pregnancy. J Epidemiol Community Health 45 Yang M-S, Ho S-Y, Chou F-H, Chang S-J, Ko Y-C. Physical abuse during 2004;58:523–7 [http://dx.doi.org/10.1136/jech.2003.011742]. pregnancy and risk of low-birthweight infants among aborigines in 59 Norton LB, Peipert JF, Zierler S, Lima B, Hume L. Battering in Taiwan. Public Health 2006;120:557–62 [http://dx.doi.org/10.1016/j. pregnancy: an assessment of two screening methods. Obstet Gynecol puhe.2006.01.006]. 1995;85:321–5 [http://dx.doi.org/10.1016/0029-7844(94)00429-H]. 46 American Congress of Obstetricians and Gynecologists. Screening 60 Feder GS, Hutson M, Ramsay J, Taket AR. Women exposed to intimate Tools — Domestic Violence [www.acog.org/About_ACOG/ACOG_ partner violence: expectations and experiences when they encounter Departments/Violence_Against_Women/Screening_Tools__Domestic_ health care professionals: a meta-analysis of qualitative studies. Arch Violence]. Intern Med 2006;166:22–37 [http://dx.doi.org/10.1001/archinte. 47 American Medical Association. National Advisory Council on Violence 166.1.22]. and Abuse. Policy Compendium, April 2008 [www.ama-assn.org// ama1/pub/upload/mm/386/vio_policy_comp.pdf].

202 ª 2012 Royal College of Obstetricians and Gynaecologists