Domestic Violence - TOG article

Question 1

What % of women receiving AN/PN care and those receiving gynae services report a hx of DV?

Answer 1

AN/PN: 13-24%

Gynae: 21%

Question 2

What is the estimated cost of care for DV violence-related physical and mental heath conscerns?

Answer 2

£2billion /yr

Question 3

What are the risk factors for DV?

Answer 3

Female gender
Young Age
Unmarried status
Low income
Coverage by medical assistance or being uninsured
Hx of childhood maltreatment
Pregnancy (esp unintended)
Delayed antenatal care
Repeat TOP

Question 4

How is DV typically characterised?

Answer 4

Ongoing, repetitive acts of relatively minor physical assual with patterns of control, intimidation and isolation

May control access to money, transport, modes of communication, healthcare (20%)

Question 5

Which somatic symptoms are victims of DV more likely to report?

Answer 5

Headache, Dizziness
Chest pain and palpitations
Back pain
Nausea and indigestion, stomach pain, diarrhoea/constipation
Menstrual/pelvic pain, dyspareunia
Insomnia, depression, anxiety, PTSD, suicidal ideation

Question 6

What is reproductive coercion?

Answer 6

Attempts by men to control their female partners’ pregnancies and outcomes
1/5
1/7 - interference with contraception 35% victims report birth control sabotage

Question 7

How many women with newborns report physical abuse by partner during pregnancy?

Answer 7

4%

32% physical or sexual abuse in the previous year

Question 8

What are the risk factors for DV during pregnancy?

Answer 8

Previous DV
Young age
Single
Inadequate housing, finances or education
Substance misuse
Mental health problems
Trouble with the police

Question 9

What are the maternal and fetal risks of DV?

Answer 9

Vaginal Bleeding
Kidney infections
Preterm labour
Death - 3x increase homicide
?LBW

Question 10

What screening questions are recommended?

Answer 10

Is anyone close to you threatening or hurting you?
Is anyone hitting, kicking, choking or hurting you physically?
Is anyone forcing you to do something sexually that you do not want to do?

Family planning:
Has your partner ever tampered with birth control or tried to get you pregnant when you didn’t want to be?

Avoid vague: are you being physically abused?

Question 11

What should be done when a woman reveals she is experiencing DV?

Answer 11

1. Acknowledge experience, tell her not alone, noone deserves to be abused
2. Brief safety assessment to establish severity:
   - Does abuser have a weapon?
   - Has he made threats to kill you?
   - Do you feel safe to go home now?
   - Enquire first, most recent, most severe episodes
   - Suicide ideation/unintended pregnancies or TOPs/contraceptive tampering
3. Services available info (Women’s Aid) - innocuously
4. Safety planning
   - ID place to go should she be in imminent danger
   - Copy personal documents/bank details/change of clothes/extra car keys and hide outside the home

• Documentation (not in handheld notes)
• Injuries documented/photos

Question 12

How many women are affected by DV?

Answer 12

1 in 4