Physicians generally are mandated to report abuse in these instances. A current listing of state laws on elder abuse can be found at: www.
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Documentation of the clinical interaction provides important evidence for any future legal proceedings. The health care provider should review with the patient in advance what form of future communication is best because medical bills and follow-up phone calls may prompt retaliation from the abuser.
Preventing Intimate Partner Violence
Despite encountering violence, a patient may deny her circumstances based on fear of retaliation from her partner, fear of involvement with law enforcement and the justice system, embarrassment, or shame. Even if women do not reveal violence to their physicians, hearing validating messages and knowing that options and resources may be available could help prompt them to seek help on their own in the future. Based on the prevalence and health burden of IPV among women, education about IPV; screening at periodic intervals, including during obstetric visits; and ongoing clinical care can improve the lives of women who experience IPV.
Preventing the lifelong consequences associated with IPV can have a positive effect on the reproductive, perinatal, and overall health of all women. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher. Intimate partner violence. Committee Opinion No. American College of Obstetricians and Gynecologists.
Obstet Gynecol ;—7. Women's Health Care Physicians. This information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Introduction Intimate partner violence IPV is a pattern of assaultive behavior and coercive behavior that may include physical injury, psychologic abuse, sexual assault, progressive isolation, stalking, deprivation, intimidation, and reproductive coercion 1.
Patterns of Intimate Partner Violence Intimate partner violence encompasses subjection of a partner to physical abuse, psychologic abuse, sexual violence, and reproductive coercion. Consequences of Intimate Partner Violence Some women subjected to IPV present with acute injuries to the head, face, breasts, abdomen, genitalia, or reproductive system, whereas others have nonacute presentations of abuse such as reports of chronic headaches, sleep and appetite disturbances, palpitations, chronic pelvic pain, urinary frequency or urgency, irritable bowel syndrome, sexual dysfunction, abdominal symptoms, and recurrent vaginal infections.
Special Populations Adolescents Approximately one out of ten female high-school students in the United States reported experiencing physical violence from their dating partners in the previous year Immigrant Women Women from different backgrounds may have different perceptions about IPV and need culturally relevant care that is sensitive to language barriers, acculturation, accessibility issues, and racism. Women With Disabilities Women with physical and developmental disabilities usually are less able to care for themselves and are more reliant on their partners or caregivers for help.
Older Women An estimated 1—2 million U. Role of Health Care Providers The medical community can play a vital role in identifying women who are experiencing IPV and halting the cycle of abuse through screening, offering ongoing support, and reviewing available prevention and referral options. Written protocols will facilitate the routine assessment process: Screen for IPV in a private and safe setting with the woman alone and not with her partner, friends, family, or caregiver.
Use professional language interpreters and not someone associated with the patient. At the beginning of the assessment, offer a framing statement to show that screening is done universally and not because IPV is suspected.
Intimate Partner Violence - ACOG
Also, inform patients of the confidentiality of the discussion and exactly what state law mandates that a physician must disclose. Incorporate screening for IPV into the routine medical history by integrating questions into intake forms so that all patients are screened whether or not abuse is suspected. Establish and maintain relationships with community resources for women affected by IPV. Keep printed take-home resource materials such as safety procedures, hotline numbers, and referral information in privately accessible areas such as restrooms and examination rooms.
Posters and other educational materials displayed in the office also can be helpful. Ensure that staff receives training about IPV and that training is regularly offered. Sample Intimate Partner Violence Screening Questions While providing privacy, screen for intimate partner violence during new patient visits, annual examinations, initial prenatal visits, each trimester of pregnancy, and the postpartum checkup.
Conclusion Based on the prevalence and health burden of IPV among women, education about IPV; screening at periodic intervals, including during obstetric visits; and ongoing clinical care can improve the lives of women who experience IPV.
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Department of Justice www. Retrieved December 16, Extent, nature, and consequences of intimate partner violence: findings from the National Violence Against Women Survey. Washington, DC: Department of Justice; Retrieved August 17, Homicide trends in the United States. Retrieved August 12, Diagnostic and treatment guidelines on domestic violence. Sexuality, sexual dysfunction, and sexual assault.
In: Berek JS, editor. Pregnancy coercion, intimate partner violence and unintended pregnancy. Contraception ;— Intimate partner violence and partner notification of sexually transmitted infections among adolescent and young adult family planning clinic patients.
Intimate partner violence and high-risk sexual behaviors among female patients with sexually transmitted diseases. Sex Transm Dis ;—6. Trauma in pregnancy. Obstet Gynecol ;— Documentation of abuse to pregnant women: a medical chart audit in public health clinics.
J Womens Health ;— Abuse during pregnancy: effects on maternal complications and birth weight in adult and teenage women.
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Obstet Gynecol ;—8. Maternal and neonatal outcomes of assaults during pregnancy. Pregnancy and intimate partner violence: risk factors, severity, and health effects. Violence Against Women ;17 7 — Intimate-partner homicide among pregnant and postpartum women. Obstet Gynecol ; —6. Indeed, recent IPV research has shown differing risk profiles for physical and sexual IPV, with sexual IPV linked most strongly to norms of masculinity that emphasize sexual dominance over women, sexual entitlement within marriage, and toughness and dominance over other men [ 55 ].
Similar tensions also likely underlie the poorer communication within the relationship that is observed where the woman contributes more than her partner, and the increased likelihood of separation. Gender role strain theory posits that men who believe they are failing to fulfil the role of provider may consequently experience negative psychological symptoms and exhibit more aggression towards their female partners [ 61 ].
Such patterns have been observed in other qualitative research from Tanzania. For example, in interviews conducted among male informal sector workers in Dar es Salaam and Mbeya, men described how their masculinity and pride could be threatened in situations where their wives were dissatisfied with their low financial contributions to the family, and that this sometimes led to them using violence to maintain respect [ 62 ]. As well as a potential causal relationship between relative financial contribution and IPV, it is likely that the two share common risk factors.
Though we have controlled for several key contextual variables, there may be residual confounding by other unmeasured factors. The absence of an association in intervention communities at follow-up suggests that the intervention may have modified the risk association. Our results point more to a picture of cumulative risk.
This study has many strengths. Response and retention rates were high across both intervention and control communities. While underreporting of IPV is a concern in such studies, measurement bias was minimised through the use of standardised widely-used questions to measure IPV, administered by interviewers who had received extensive training on conducting surveys relating to IPV.
The study also has a number of limitations. Self-reported income is prone to measurement bias, especially in settings such as this where income often comes from casual or seasonal employment, multiple jobs, and home enterprises, and can vary substantially between seasons or years [ 63 ]. Furthermore, income in the form of goods may not be captured by our measure.
It is likely that this misclassification would be non-differential with respect to the outcomes of interest, thereby causing us to underestimate the association between income and abuse. Our measure of relative financial contribution to the household also relies on subjective self-reports. Women experiencing abuse could be predisposed to report other aspects of their partner in a negative light, for example downplaying his financial contribution to the household, thereby causing us to overestimate the association between her higher contribution and risk of IPV.
However, it is also possible that women who are abused by a partner might underreport their own financial role in the household due to an erosion of self-esteem and confidence, thereby causing us to underestimate the association. With cross-sectional data it is not possible to establish the direction of an association.
Similarly, disparity in financial contributions could lead to increased IPV risk, and abusive men might be more likely to withhold their own earnings from the household. The need for dyadic data data from both members of a couple to help explore the complex interplay of such factors within a relationship, is increasingly recognised within the field of IPV research. We recognise that the relationship between income and IPV is context dependent, and that the results of this analysis are not generalizable to other settings, nor necessarily to women in the study area not enrolled in microfinance programmes.
Further research from other settings is needed to more fully explore some of the themes that have emerged from this analysis. We also show that physical IPV, sexual IPV and economic abuse are not related to income in the same way, suggesting that economic interventions to reduce IPV may benefit from complementary components to address economic abuse and sexual IPV.
Because the study is still ongoing, datasets are not publicly available at this point. Global health. The global prevalence of intimate partner violence against women. Intimate partner violence and incident depressive symptoms and suicide attempts: a systematic review of longitudinal studies. PLoS Med. Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study.
Intimate partner violence is associated with incident HIV infection in women in Uganda. Paediatr Child Health. A global comprehensive review of economic interventions to prevent intimate partner violence and HIV risk behaviours. Glob Health Action. Vyas S, Watts C. J Int Dev.