Advertisement
JOGC

Screening in the Prenatal Period for Intimate Partner Violence and History of Abuse: A Survey of Edmonton Obstetrician/Gynaecologists

Published:October 26, 2018DOI:https://doi.org/10.1016/j.jogc.2018.05.003

      Abstract

      Objective

      This study sought to understand how obstetrician gynaecologists (OB/GYNs) in Edmonton, Alberta screen prenatal patients for intimate partner violence (IPV). It also aimed to explore attitudes, beliefs, and perceptions regarding IPV and identify barriers to screening for IPV. Institutional protocols, resources, and support available to clinicians and patients were also reviewed.

      Methods

      All Royal College of Physicians and Surgeons of Canada–certified OB/GYNs practicing general obstetrics in Edmonton were identified and were mailed letters and electronic questionnaires with two follow-up letters or emails at 2-week intervals. Personal and clinical practice demographic information was collected. Physicians' perceptions, screening practices, and barriers to screening were identified. Responses were collected, stored, and analyzed using a secure online database, Research Electronic Data Capture Database; all responses were completely anonymous.

      Results

      Of 58 physicians surveyed, 49 completed questionnaires (84% response rate). A total of 33% of respondents either never or rarely screened women for IPV during prenatal visits, 69% either never or rarely screened for childhood abuse, 94% did not have a screening protocol, and 77% did not have written materials to provide to patients. Multiple barriers were identified. A total of 94% of OB/GYNs believed that they were inadequately screening for IPV.

      Conclusion

      Screening of pregnant women for IPV and a history of abuse is suboptimal. There are multiple barriers (cultural, societal, economic, and institutional) that prevent women from being screened for IPV and receiving appropriate support services.

      Résumé

      Objectif

      Cette étude avait pour but de décrire l’approche des obstétriciens-gynécologues d’Edmonton (Alberta) en ce qui a trait au dépistage de la violence conjugale (VC) chez les patientes enceintes. Elle visait aussi à explorer les attitudes, les croyances et les perceptions à l’égard de la VC et à repérer les obstacles à son dépistage. Nous avons également examiné les protocoles institutionnels, les ressources et le soutien offert aux cliniciens et aux patientes.

      Méthodologie

      Nous avons envoyé à tous les obstétriciens-gynécologues certifiés par le Collège royal des médecins et chirurgiens du Canada qui exercent l’obstétrique générale à Edmonton des lettres et des questionnaires électroniques, puis deux lettres ou courriels de suivi à deux semaines d’intervalle. Des renseignements personnels et des renseignements sur les caractéristiques démographiques de leurs patientes ont également été recueillis. Nous avons ensuite relevé les perceptions, les pratiques de dépistage et les obstacles au dépistage des médecins, nous avons recueilli, stocké et analysé les réponses à l’aide d’une base de données sécurisée en ligne, la Research Electronic Data Capture Database. Toutes les réponses étaient entièrement anonymes.

      Résultats

      Des 58 médecins sondés, 49 ont rempli les questionnaires (taux de réponse : 84 %). Au total, 33 % des répondants procédaient rarement ou jamais au dépistage de la VC durant une visite prénatale, 69 % procédaient rarement ou jamais au dépistage des mauvais traitements au cours de l’enfance, 94 % n’avaient pas de protocole de dépistage et 77 % n’avaient pas de documents papier à fournir aux patientes. Un grand nombre d’obstacles ont été relevés. Au total, 94 % des obstétriciens-gynécologues considéraient que leur approche de dépistage de la VC était insuffisante.

      Conclusion

      Le dépistage de la VC et des antécédents de mauvais traitements chez les femmes enceintes est sous-optimal. Un grand nombre d’obstacles (culturels, sociétaux, économiques et institutionnels) rendent le dépistage difficile et empêchent ces femmes d’obtenir des services de soutien approprié.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Obstetrics and Gynaecology Canada
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Widom C.S.
        • Czaja S.
        • Dutton M.A.
        Child abuse and neglect and intimate partner violence victimization and perpetration: a prospective investigation.
        Child Abuse Negl. 2014; 38: 650-663
        • Gazmararian J.A.
        • Lazorick S.
        • Spitz A.M.
        • et al.
        Prevalence of violence against pregnant women.
        JAMA. 1996; 275: 1915-1920
        • García-Moreno C.
        • Pallitto C.
        • Devries K.
        • et al.
        Global and Regional Estimates of Violence Against Women: Prevalence And Health Effects of Intimate Partner Violence and Non-partner Sexual Violence.
        (Geneva: World Health Organization; Available at:)
        • Ferris L.
        • Nurani A.
        • Silver L.
        The National Clearinghouse on Family Violence.
        (A Handbook Dealing With Woman Abuse and the Canadian Criminal Justice System—Guidelines for Physicians. Ottawa: Health Canada; Available at:) (Accessed on July 18, 2018)
        • Cherniak D.
        • Grant L.
        • Mason R.
        • et al.
        Intimate partner violence consensus statement.
        J Obstet Gynaecol Can. 2005; 27: 365-418
        • Black M.C.
        • Basile K.C.
        • Breiding M.J.
        • et al.
        The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 summary report.
        (Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control)2011
        • Afifi T.O.
        • MacMillan H.L.
        • Boyle M.
        • et al.
        Child abuse and mental disorders in Canada.
        CMAJ. 2014; 186: E324-E332
        • Sinha M.
        Measuring Violence Against Women: Statistical Trends.
        (Ottawa: Statistics Canada; Available at:)
        • Sinha M.
        Family Violence in Canada: A Statistical Profile, 2010.
        (Ottawa: Statistics Canada, Juristat: Canadian Center for Justice Statistics; Available at:)
        • Zhang T.
        • Hoddenbagh J.
        • McDonald S.
        • et al.
        An Estimation of the Economic Impact of Spousal Violence in Canada, 2009.
        (Ottawa: Department of Justice, Canada; Available at:) (Accessed on July 18, 2018)
        • Bailey B.A.
        Partner violence during pregnancy: prevalence, effects, screening, and management.
        Int J Womens Health. 2010; 2: 183-197
        • Muhajarine N.
        • D'Arcy C.
        Physical abuse during pregnancy: prevalence and risk factors.
        CMAJ. 1999; 160: 1007-1011
        • Stewart D.E.
        • Cecutti A.
        Physical abuse in pregnancy.
        CMAJ. 1993; 149: 1257-1263
        • Christiaens I.
        • Hegadoren K.
        • Olson D.M.
        Adverse childhood experiences are associated with spontaneous preterm birth: a case-control study.
        BMC Med. 2015; 13: 124
        • Donovan B.M.
        • Spracklen C.N.
        • Schweizer M.L.
        • et al.
        Intimate partner violence during pregnancy and the risk for adverse infant outcomes: a systematic review and meta-analysis.
        BJOG. 2016; 123: 1289-1299
        • Deshpande N.A.
        • Lewis-O'Connor A.
        Screening for intimate partner violence during pregnancy.
        Rev Obstet Gynecol. 2013; 6: 141-148
        • Chisholm C.A.
        • Bullock L.
        • Ferguson 2nd., J.E.J.
        Intimate partner violence and pregnancy: screening and intervention.
        Am J Obstet Gynecol. 2017; 217: 145-149
        • O'Doherty L.
        • Hegarty K.
        • Ramsay J.
        • et al.
        Screening women for intimate partner violence in healthcare settings.
        Cochrane Database Syst Rev. 2015; (CD007007)
        • Rivas C.
        • Ramsay J.
        • Sadowski L.
        • et al.
        Advocacy interventions to reduce or eliminate violence and promote the physical and psychosocial well-being of women who experience intimate partner abuse.
        Cochrane Database Syst Rev. 2015; (CD005043)
        • Alvarez C.
        • Fedock G.
        • Grace K.T.
        • et al.
        Provider screening and counseling for intimate partner violence: a systematic review of practices and influencing factors.
        Trauma Violence Abuse. 2017; 18: 479-495
        • Horan D.L.
        • Chapin J.
        • Klein L.
        • et al.
        Domestic violence screening practices of obstetrician-gynecologists.
        Obstet Gynecol. 1998; 92: 785-789
        • ACOG committee opinion no
        518: intimate partner violence.
        Obstet Gynecol. 2012; 119: 412-417
        • National Institute for Healthcare and Excellence (NICE)
        Antenatal Care For Uncomplicated Pregnancies: Clinical Guideline.
        (London: NICE; Available at:)
        https://www.nice.org.uk/guidance/cg62
        Date: 2008
        Date accessed: June 15, 2018
        • Basile K.
        • Hertz M.
        • Back S.
        Intimate Partner Violence and Sexual Violence Victimization Assessment Instruments for Use in Healthcare Settings.
        (Version 1.0. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control)2007
        • Rabin R.F.
        • Jennings J.M.
        • Campbell J.C.
        • et al.
        Intimate partner violence screening tools: a systematic review.
        Am J Prev Med. 2009; 36 (e4): 439-445
        • Nelson H.D.
        • Bougatsos C.
        • Blazina I.
        Screening women for intimate partner violence: a systematic review to update the U.S. Preventive Services Task Force recommendation.
        Ann Intern Med. 2012; 156 (W-279, W-80, W-81, W-82): 796-808
        • Coker A.L.
        • Garcia L.S.
        • Williams C.M.
        • et al.
        Universal psychosocial screening and adverse pregnancy outcomes in an academic obstetric clinic.
        Obstet Gynecol. 2012; 119: 1180-1189
        • Renker P.R.
        • Tonkin P.
        Women's views of prenatal violence screening: acceptability and confidentiality issues.
        Obstet Gynecol. 2006; 107: 348-354
        • Chang J.C.
        • Decker M.R.
        • Moracco K.E.
        • et al.
        Asking about intimate partner violence: advice from female survivors to health care providers.
        Patient Educ Couns. 2005; 59: 141-147
        • Todahl J.
        • Walters E.
        Universal screening for intimate partner violence: a systematic review.
        J Marital Fam Ther. 2011; 37: 355-369
        • Roelens K.
        • Verstraelen H.
        • Van Egmond K.
        • et al.
        A knowledge, attitudes, and practice survey among obstetrician-gynaecologists on intimate partner violence in Flanders, Belgium.
        BMC Public Health. 2006; 6: 238