Clinician views and experiences with reproductive coercion screening in a family planning service

BACKGROUND

Reproductive coercion refers to behaviour that interferes with a person's reproductive autonomy, such as contraceptive sabotage, pregnancy coercion, controlling a pregnancy outcome or forced sterilisation. Routine screening for reproductive coercion, together with clinician education, was implemented at a family planning service in New South Wales, Australia, in December 2018. A study was undertaken to explore the views and experiences of clinicians in undertaking reproductive coercion screening at this service.

METHODS

Clinicians were invited to complete an online survey and interview to discuss their understanding of reproductive coercion and their views and experiences of undertaking reproductive coercion screening. Descriptive and thematic content analysis was conducted.

RESULTS

Clinicians deemed reproductive coercion screening to be relevant and important in family planning services. Key barriers to reproductive coercion screening and responding to disclosures included time constraints and limited appropriate referral pathways. Ongoing education and training with resources such as a decision-support tool on reproductive coercion screening and management, as well as effective multi-disciplinary collaboration, were identified as strategies to improve the screening program.

CONCLUSIONS

Findings from our study highlight that clinicians' perceived reproductive coercion screening as a relevant and important component of sexual and reproductive healthcare. Ongoing reproductive coercion education, training and support would ensure the competency and confidence of clinicians undertaking screening. Identifying appropriate referral pathways with multi-disciplinary collaboration (involving clinicians, social workers, support workers and psychologists) would support clinicians in undertaking screening and responding to disclosures of reproductive coercion in Australian health care settings which provide family planning and sexual and reproductive health services.

Training medical students: victim's perceptions of selectively screening women for intimate partner violence in health care settings

BACKGROUND

Routine IPV screening is a controversial topic and there is no evidence to suggest that it improves the health outcomes of women. Consequently, understanding the socio-cultural dimensions, becomes essential to ensure that victims receive appropriate and local support. This study was conducted to gather the perceptions of victims of IPV on the relevance of raising the topic at health care facilities and to determine specific categories of women to target for screening by medical personnel. It also explored how the information gathered could support victims and whether medical students should be trained on issues relating to IPV.

METHODS

Thirty-three key informant interviews were conducted among women attending clinics from three teaching hospitals in the Lagos, Oyo and Osun States of South West Nigeria. The hospitals offer antenatal, emergency, primary care and community outreach clinics which are well-attended by women. A six-item questionnaire assessed eligibility for participation in the study and participants were then purposively sampled. Interviews were conducted using a semi-structured guide. Ethical approval and gatekeepers' permissions were obtained, and each participant signed informed consent. Data was collected between June and November 2017. The data was entered into Excel and analysed deductively to answer each objective.

RESULTS

Most (n = 24) participants stated that medical practitioners should ask all women who present to health care facilities, about their experiences of IPV. Physically, medically and socially vulnerable women, including those in relationships with men in risky occupations, were identified as needing special attention and possible follow-up. They supported the use of the information within and outside of the health care facility, depending on the need of the woman. The majority (n = 24) indicated a need to train medical students about IPV and 19 participants suggested for the topic to be curriculated. Most victims favoured the inclusion of a multidisciplinary team in teaching medical students about IPV.

CONCLUSIONS

Victims of IPV were in support of initiatives to discuss the topic among some groups of female patients in health care settings. They thought it would enhance the quality of care (medical, psychological, legal and social) to victims. They identified an inter-professional team of stakeholders to include when training medical students about IPV.

Intimate partner sexual violence and risk for femicide, suicidality and substance use among women in antenatal care and general out-patients in Thailand

BACKGROUND

Little is known about the occurrence and health consequences of intimate partner sexual assault. The aim of this study was to assess the prevalence and correlates of sexual assault in the context of intimate partner violence (IPV) in Thailand.

METHODS

In a cross-sectional survey adult female participants were systematically screened (self-administered or interview administered) for IPV in antenatal care and general outpatient clinics in nine randomly selected hospitals in two provinces in the central region. Measures included the Abuse Assessment Screen, Severity of Violence Against Women Scale, Danger assessment and suicidal behaviour.

RESULTS

From 14,288 women screened, 1.5% were positive for IPV and 207 participated in the study. The mean age of the study participants was 26.8 years (SD = 9.3). Fifty-seven women, 27.5% of the sample, reported sexual assault, one or more times, during the relationship in the past 12 months. Most reported some form of psychological abuse (82.1%), physical violence (67.1%) and danger (72.0%). In all, 21.3% reported psychological, physical and sexual violence. Bivariate analyses found that older age, being recruited in the general out-patient department, greater number of children, high psychological abuse, high physical violence, danger and suicidal behaviour in the past 12 months were associated with sexual assault. In multivariable backward conditional logistic regression physical violence (OR = 5.32, CI = 2.52-11.24) and suicidal behaviour (OR = 3.28, CI = 1.37-7.83) were found to be associated with sexual assault.

CONCLUSIONS

The study found a moderate rate of sexual assault in intimate violent partner relationships and those sexual assaults are more likely to co-occur with physical intimate partner violence and suicidal behaviour. This knowledge may be helpful in the detection and management of sexual assault in intimate violent partner relationships of women in health care settings in Thailand.

Nurse and midwifery education and intimate partner violence: a scoping review

AIMS AND OBJECTIVES

This scoping review aims to identify the scope of current literature considering nurse/midwife educational practices in the areas of intimate partner violence to inform future nursing/midwifery educational policy and practice.

BACKGROUND

Intimate partner violence is a global issue affecting a significant portion of the community. Healthcare professionals including nurses/midwives in hospital- and community-based environments are likely to encounter affected women and need educational strategies that support best practice and promote positive outcomes for abused women and their families.

DESIGN

Scoping review of relevant literature from January 2000 to July 2015.

METHOD

Search of databases: CINHAL, MEDLINE, EMBASE, PROQUEST Central and COCHRANE Library. Reference lists from included articles were searched for relevant literature as were several grey literature sources.

RESULTS

This review demonstrates low levels of undergraduate or postregistration intimate partner violence education for nursing/midwifery staff and students. Existing intimate partner violence education strategies are varied in implementation, method and content. Outcomes of these educational programmes are not always rigorously evaluated for staff or client-based outcomes.

CONCLUSIONS

Further research is needed to evaluate existing intimate partner violence education programmes for nurses/midwives and identify the most effective strategies to promote improved clinical practice and outcomes for abused women and their families.

RELEVANCE TO CLINICAL PRACTICE

Intimate partner violence has a significant social and public health impact. The World Health Organization has identified the need to ensure that healthcare professionals are adequately trained to meet the needs of abused women. Intimate partner violence education programmes, commencing at undergraduate studies for nurses/midwives, need to be implemented with rigorously evaluated programmes to ensure they meet identified objectives, promote best practice and improve care for abused women.

Early mortality from external causes in Aboriginal mothers: a retrospective cohort study

Background

Maternal loss can have a deep-rooted impact on families. Whilst a disproportionate number of Aboriginal women die from potentially preventable causes, no research has investigated mortality in Aboriginal mothers. We aimed to examine the elevated mortality risk in Aboriginal mothers with a focus on external causes.

Methods

We linked data from four state administrative datasets to identify all women who had a child from 1983 to 2010 in Western Australia and ascertained their Aboriginality, socio-demographic details, and their dates and causes of death prior to 2011. Comparing Aboriginal mothers with other mothers, we estimated the hazard ratios (HRs) for death by any external cause and each of the sub-categories of accident, suicide, and homicide, and the corresponding age of their youngest child.

Results

Compared to non-Aboriginal mothers and after adjustment for parity, socio-economic status and remoteness, Aboriginal mothers were more likely to die from accidents [HR = 6.43 (95 % CI: 4.9, 8.4)], suicide [HR = 3.46 (95 % CI: 2.2, 5.4)], homicide [HR = 17.46 (95 % CI: 10.4, 29.2)] or any external cause [HR = 6.61 (95 % CI: 5.4, 8.1)]. For mothers experiencing death, the median age of their youngest child was 4.8 years.

Conclusion

During the study period, Aboriginal mothers were much more likely to die than other mothers and they usually left more and younger children. These increased rates were only partly explained by socio-demographic circumstances. Further research is required to examine the risk factors associated with these potentially preventable deaths and to enable the development of informed health promotion to increase the life chances of Aboriginal mothers and their children.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3101-2) contains supplementary material, which is available to authorized users.

Screening women for intimate partner violence in healthcare settings

BACKGROUND

Intimate partner violence (IPV) damages individuals, their children, communities, and the wider economic and social fabric of society. Some governments and professional organisations recommend screening all women for IPV rather than asking only women with symptoms (case-finding). Here, we examine the evidence for whether screening benefits women and has no deleterious effects.

OBJECTIVES

To assess the effectiveness of screening for IPV conducted within healthcare settings on identification, referral, re-exposure to violence, and health outcomes for women, and to determine if screening causes any harm.

SEARCH METHODS

On 17 February 2015, we searched CENTRAL, Ovid MEDLINE, Embase, CINAHL, six other databases, and two trial registers. We also searched the reference lists of included articles and the websites of relevant organisations.

SELECTION CRITERIA

Randomised or quasi-randomised controlled trials assessing the effectiveness of IPV screening where healthcare professionals either directly screened women face-to-face or were informed of the results of screening questionnaires, as compared with usual care (which could include screening that did not involve a healthcare professional).

DATA COLLECTION AND ANALYSIS

Two authors independently assessed the risk of bias in the trials and undertook data extraction. For binary outcomes, we calculated a standardised estimation of the odds ratio (OR). For continuous data, either a mean difference (MD) or standardised mean difference (SMD) was calculated. All are presented with a 95% confidence interval (CI).

MAIN RESULTS

We included 13 trials that recruited 14,959 women from diverse healthcare settings (antenatal clinics, women's health clinics, emergency departments, primary care) predominantly located in high-income countries and urban settings. The majority of studies minimised selection bias; performance bias was the greatest threat to validity. The overall quality of the body of evidence was low to moderate, mainly due to heterogeneity, risk of bias, and imprecision.We excluded five of 13 studies from the primary analysis as they either did not report identification data, or the way in which they did was not consistent with clinical identification by healthcare providers. In the remaining eight studies (n = 10,074), screening increased clinical identification of victims/survivors (OR 2.95, 95% CI 1.79 to 4.87, moderate quality evidence).Subgroup analyses suggested increases in identification in antenatal care (OR 4.53, 95% CI 1.82 to 11.27, two studies, n = 663, moderate quality evidence); maternal health services (OR 2.36, 95% CI 1.14 to 4.87, one study, n = 829, moderate quality evidence); and emergency departments (OR 2.72, 95% CI 1.03 to 7.19, three studies, n = 2608, moderate quality evidence); but not in hospital-based primary care (OR 1.53, 95% CI 0.79 to 2.94, one study, n = 293, moderate quality evidence).Only two studies (n = 1298) measured referrals to domestic violence support services following clinical identification. We detected no evidence of an effect on referrals (OR 2.24, 95% CI 0.64 to 7.86, low quality evidence).Four of 13 studies (n = 2765) investigated prevalence (excluded from main analysis as rates were not clinically recorded); detection of IPV did not differ between face-to-face screening and computer/written-based assessment (OR 1.12, 95% CI 0.53 to 2.36, moderate quality evidence).Only two studies measured women's experience of violence (three to 18 months after screening) and found no evidence that screening decreased IPV.Only one study reported on women's health with no differences observable at 18 months.Although no study reported adverse effects from screening interventions, harm outcomes were only measured immediately afterwards and only one study reported outcomes at three months.There was insufficient evidence on which to judge whether screening increases uptake of specialist services, and no studies included an economic evaluation.

AUTHORS' CONCLUSIONS

The evidence shows that screening increases the identification of women experiencing IPV in healthcare settings. Overall, however, rates were low relative to best estimates of prevalence of IPV in women seeking healthcare. Pregnant women in antenatal settings may be more likely to disclose IPV when screened, however, rigorous research is needed to confirm this. There was no evidence of an effect for other outcomes (referral, re-exposure to violence, health measures, lack of harm arising from screening). Thus, while screening increases identification, there is insufficient evidence to justify screening in healthcare settings. Furthermore, there remains a need for studies comparing universal screening to case-finding (with or without advocacy or therapeutic interventions) for women's long-term wellbeing in order to inform IPV identification policies in healthcare settings.

Advocacy interventions to reduce or eliminate violence and promote the physical and psychosocial well-being of women who experience intimate partner abuse

BACKGROUND

Intimate partner abuse is common in all societies and damages the health of survivors and their children in the short and long term. Advocacy may decrease the impact of this abuse on women's health.

OBJECTIVES

To assess the effects of advocacy interventions conducted within or outside of health care settings on women who have experienced intimate partner abuse.

SEARCH STRATEGY

We searched: CENTRAL and DARE (Cochrane Library Issue 3, 2008), MEDLINE (1966 to 31/7/08), EMBASE (1980 to 2008 week 30), and 11 other databases, to end July 2008. We also searched relevant websites, reference lists and forward citation tracking of included studies, and handsearched six key journals. We contacted principal investigators and experts in the field.

SELECTION CRITERIA

Randomised controlled trials comparing advocacy interventions for women with experience of intimate partner abuse against usual care.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed trial quality and undertook data extraction. For binary outcomes we calculated a standardised estimation of the odds ratio (OR) and for continuous data we calculated either a standardised mean difference (SMD) or a weighted mean difference (WMD), both with a 95% confidence interval.

MAIN RESULTS

We included ten trials involving 1527 participants. The studies were heterogeneous in respect of: intensity of advocacy, outcome measures and duration of follow-up (immediately post-intervention to three years), permitting meta-analysis for only a minority of outcomes. Intensive advocacy (12 hours or more duration) may help terminate physical abuse in women leaving domestic violence shelters or refuges at 12-24 months follow-up (OR 0.43, 95% CI 0.23 to 0.80), but not at up to 12 months follow-up. The evidence indicates that intensive advocacy may improve quality of life at up to 12 months follow-up, but the confidence intervals included zero (WMD 0.23, 95% CI 0.00 to 0.46). Depression did not improve following intensive advocacy at up to 12 months follow-up (WMD -0.05, 95% CI -0.19 to 0.09), nor did psychological distress (SMD -0.16, 95% CI -0.39 to 0.06). Only two meta-analyses of brief advocacy interventions (less than 12 hours duration) were possible; an increased use of safety behaviours was consistent with the receipt of brief advocacy both at up to 12 months (WMD 0.60, 95% CI 0.14 to 1.06) and at 12-24 months (WMD 0.48, 95% CI 0.04 to 0.92) follow up.

AUTHORS' CONCLUSIONS

Based on the evidence reviewed, it is possible that intensive advocacy for women recruited in domestic violence shelters or refuges reduces physical abuse one to two years after the intervention but we do not know if it has a beneficial effect on their quality of life and mental health. Similarly, there is insufficient evidence to show if less intensive interventions in healthcare settings for women who still live with the perpetrators of violence are effective.