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Patient is (PIC)turing Pregnancy - Partner Violence

Background

Note: Reproductive Coercion:

  • Pressuring partner to have sex

  • Interfering with contraceptive use (ex. removing condom during sex)

  • Forcing sex without condom

  • Intentional exposure of partner to STIs

  • Pressuring partner to conceive

  • Pressuring partner to discontinue/terminate pregnancy or plans of pregnancy

Though present in all population groups, IPV is most prevalent in women of reproductive age, women in the military and veterans. The exact prevalence rate is unknown due to underreporting.

IPV is associated with mortality, physical disabilities, chronic health conditions, PTSD, substance abuse, unintended pregnancy, fetal injury, premature births, and low birth weight.

  • Preconception Significance: IPV is the result of many unwanted pregnancies and violence may escalate during pregnancy and postpartum period.

Though overall estimates are low due to underreporting of intentional injuries, study found that 25 percent of women calling a domestic violence hotline had been forced into pregnancy.

  • Risk Identification Strategies: Screening for ongoing/historical IPV, in addition to clinical practices displaying posters and educational brochures about IPV to encourage disclosure (women are more likely to disclose in clinical encounters and routine screening experiences).

Screening:

 

Clinician Guide

  • Keep woman comfortable and explain that you routinely ask all women questions to assess safety.

  • Assure her that anything you discuss with her is confidential. However, if state law dictates a reporting policy on IPV, that must be disclosed prior to the discussion.

  • Suggested questions:

    • Indirect:

      • How are things at home?

      • How do you feel about the relationships in your life?

      • Any problems with your partner?

  • Direct:

    • Are you afraid of your partner?

    • In the past year, have you been hit, slapped, kicked, or any other have any other physical abuse done to you by someone?

    • Does your partner ever make you feel uncomfortable?

    • Has anyone ever forced you into sexual activities that you did not want?

    • **Sexual coercion and pregnancy** Does you partner also want a pregnancy in the next year?

  • If woman answers “yes” to any of these questions or types of questions, acknowledge her trauma and let her know that you are concerned for her welfare and current environment. Encourage her to plan for safety and refer to local/state/national resources for IPV.

  • Provider could consider strategies for the office: designating staff member to educating women on IPV and safety plans, providing posters and brochures with resources and supportive services, offering your office phone to women who want to act immediately.

  • Explain that pregnancy does not make the situation better, nor does it provide a safe haven from IPV.

  • If the partner does not want pregnancy within the next year, discuss how to address the discord in the relationship before stopping contraception, as pregnancy will most likely bring more discord. Work to find an effective but unlikely to be discovered by partner, method of contraception.

  • Assure her of your and your staff’s availability to her, and that she can trust you during this process in achieving safety.

 

Page Updated: 8/14/2017