LEC 8: Intimate Partner Violence Flashcards
1
Q
Intimate Partner Violence
A
- Annual prevalence 6 – 8 %, conservative estimate
- Prevalence rates among pregnant and adolescent women appear to be greater
- All women, regardless of socioeconomic status, race, sexual orientation, age, ethnicity, health status, and presence or absence of current partner, are at risk for IPV.
2
Q
IMPACT: Maternal and Fetus/ Newborn
A
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Maternal
- Delayed/less prenatal care
- Stress/Depression
- Less weight gain
- Increased substance use/abuse
- Increased physical and sexual health complaints
-
Adverse Birth Outcomes
- Preterm birth
- Low birthweight
- SGA
3
Q
Abuse in Pregnancy
A
- Abuse during pregnancy may affect up to 26% of pregnant women.
- Study of pregnant or newly PP women who were substance dependent (alcohol, tobacco, cocaine, heroin or a combination), 70 % reported having been in one or more abusive relationships.
- 45% reported being battered during their current or most recent pregnancy.
- US study (2007) showed 81% of prenatal patients at a family practice clinic reported some type of IPV during pregnancy; 28% reported physical IPV, and 20% reported sexual violence.
4
Q
Canadian Figures on IPV
A
-
Prevalence:
- 51% women >16 years of age reported at least 1 incident of physical / sexual assault
- 25% of women had been abused by their intimate partners
- Likely underreported
-
Pregnancy:
- Abuse may begin / escalate in pregnancy or diminish.
- 63,300 women self-reported being victimized by a partner while they were pregnant which represents 11% of all female spousal victims.
- Of Canadian women who reported being abused by their partner in pregnancy, 40% stated violence BEGAN during the pregnancy
5
Q
Aboriginal and First Nations Women
A
- Aboriginal / FN women report higher for all types of violence than those who did not identify themselves as belonging to this group
- MB/SK: FN 57.2% vs Non - FN18.5%
- In some Northern communities, believed 75% - 90 % of women battered.
- Aboriginal / FN women experienced more severe violence and 8x more likely to be killed by their partner
6
Q
Assessing Abuse
A
- Injuries consistent with assault are not adequately explained / minimal response to serious injury
- Reports vague, non-specific, chronic health concerns
- Changes her story with different interviews / interviewers
- Painful vaginal examinations
- Anxious behavior - crying, sighing, minimizing statements, searching / engaging eye contact or no eye contact
- Comments about emotional abuse “My partner says I’m stupid (ugly, dumb)
- Comments about a “friend” who is abused
- Women behaves afraid or partner; defers to him, checks out responses with him
- Partner hovers, conspicuously unwilling to leave unattended, speaks for the women, minimizes time with care provider / others, may be overbearing, dominant
- Partner may be focused on themselves rather than her injuries, her labour or health concerns
- Woman may have difficulty following recommended treatments
7
Q
Potential Barriers to Care
A
- May ignore or devalue needs, delay or do not seek care
- Receive disjointed or inconsistent care by using ER / walk in clinics than consistent care provider
- Worry about police or child protection involvement - avoid revealing abuse to health care professionals
- Fears revealing abuse may cause escalation of violence
8
Q
AVOID
A
- Making referrals without her consent
- Inappropriate to make referrals without the patients knowledge- NEED consent
- Calling police without her consent
- Speaking to her abusive partner about abuse
- Prescribing inappropriate medications that may compromise ability to keep herself safe
- Recommending treatment plans that are impossible to adhere within the constraints of her relationship
9
Q
Health Care Providers- Building Trust
A
- Assure confidentiality and privacy, where abuser, family, staff cannot overhear
- Receive explicit and informed consent of all consultation / referrals
- Validate her experiences
- Believe her!
- Respect her right to not disclose
- Respect her right to leave (and return) to the abusive relationship
- Do not pressure her to make changes she’s unable/ unwilling to do
- Non-judgmental, open and trusting relationship critical
10
Q
Assessing and Screening for IPV
A
- Studies have found insufficient evidence that recommend for or against “routine” screening.
- Several validated questionnaires exist for enquiring about IPV; however, the nature of the clinician–patient relationship and how questions are asked seem more important than the screening tool.
- Providers should include queries about violence in the assessment of new patients at annual preventive visits as part of prenatal care.
- Most women do not disclose IPV spontaneously because of multiple, perceived barriers, however, they often choose to disclose when asked
11
Q
Health Care Providers- Empowering Women
A
- Provide information, ensure able to make decisions without judgment
- Take steps to ensure she is in control of information and the process
- Acknowledge woman’s expertise in knowing what is best for her safety and safety of children
- Recognize diversity among women - avoid stereotyping; understand the complexity of abuse, ways that abusive partners can exert control, how gender, race, class, sexual orientation age and physical / mental ability shape women’s experiences
12
Q
Health Care Providers - Clear & Safe Discussion
A
- Ensure you have time alone with the woman in case she needs to speak in confidence
- If partner will not leave alone, do not confront, but consider ways to provide assistance, find a private moment
- Demonstrate you are comfortable and knowledgeable about discussing abuse - provide information about resources, posters and cards about services openly available in the office e.g. waiting rooms, bathrooms
13
Q
Principles for Dealing with Disclosure
A
- Be supportive when abuse disclosed
- Link health concerns with abuse and other health impacts
- Assess for minimize potential barriers to care
- Provide women with information about Community and Legal services
- Encourage and help develop a safety plan with the women
