ArticleUniversal screening for domestic violence in abortion
Introduction
Domestic violence is widely recognized as a major public health issue associated with injury, mental health problems, substance abuse, and chronic disability. Attendance at health care facilities such as abortion clinics brings women in contact with professionals who can screen for domestic violence and offer information and referral. The questions themselves are an intervention, because they communicate that domestic abuse is an important social/health issue, and that the clinic can be a place where women can turn to if and when they decide to address the abuse.
Section snippets
Literature review
In addition to physical injury and chronic health problems such as headache,1 irritable bowel syndrome,2 and chronic pelvic pain,3 abused women are at risk for depression, suicidal behavior, and substance abuse.4
Health care providers have an ethical duty to diagnose and treat domestic violence.5 Leadership has been provided by many professional organizations, including the American Nurses Association, the American College of Obstetricians and Gynecologists, and the American Medical Association,
Method
The study took place in an urban free-standing abortion clinic which provides medical abortions induced with methotrexate and misoprostol. The clinic sees about 1,200 abortion patients/year. There are three other abortion clinics in the city which offer surgical abortions. A study compared women presenting for medical abortions with those presenting for surgical abortions at one of the other clinics and found that the medical abortion patients included fewer teenagers but otherwise were similar
Results
There were 499 women seen during the time period of the study. There were only 254 (50.9%) who were asked the screening questions. There was a difference in ethnicity in the women screened compared with the women not screened: 58% of whites, 40% of East Asians, and 37% of South Asians were screened (P = .003) (Table 2). About half of the reasons given for not screening were patient-centered reasons, such as that the woman’s English was inadequate, the partner was in the room, or the woman was
Discussion
This is the first report of universal screening for domestic violence in an abortion clinic. The fact that only half of women were asked the questions shows how difficult it is to implement a policy of universal screening. The counselors were all enthusiastic and very positive about this project and were well trained to handle abuse issues. In a less supportive atmosphere universal screening might result in even a lower percentage of women asked. Because it has not been clinic policy to
Conclusion
Screening for domestic violence in women presenting for abortion is challenging, but feasible. The prevalence rate of domestic violence in this population seeking abortion was similar to that of the general population. Overall, the women were receptive to this screening, and we found that this was a good time to offer them information about resources.
Acknowledgements
The authors acknowledge the enthusiasm and support of counselors Skye Stuart, Siri Heiberg, and Chris MacMillan. They thank Ludek Podhradsky and Sandy Basra, who helped with data entry.
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