Domestic Violence
Screening
Routine screening of all women who contact the health care system is advocated by many institutions and professional organizations including the American College of Obstetricians and Gynecologists. Other organizations advocate more focused screening. The support for routine screening is more the result of consensus than grounded in strong research. If a more focused approach is chosen, the index of suspicion must be at the highest level and the practitioner should remain constantly vigilant for the more subtle signs of abuse. Available literature suggests that the majority of women support routine screening in a primary care setting.8 In addition to this studies have shown that women who have been victims of abuse would have disclosed had they been asked in a supportive manner.9,10
Abuse during pregnancy has been demonstrated to be a significant problem with a higher incidence than other complications that are routinely screened for.12,13 Its presence has been linked to significant pregnancy complications including miscarriage, placental abruption, premature labor and delivery, low birth weight and fetal loss.14,15,16 Studies indicate that the prevalence of women experiencing violence in pregnancy is between 0.9% and 20.1%.12 It is as yet unclear from research as to whether pregnant women are at greater risk for the initiation of violence, or if in a violent situation whether the severity or frequency of violence escalates or decreases in pregnancy.17 What is clear is that the regularity of visits may make it easier for both the physician and woman to broach the topic, and given the fact that there is a pregnancy at stake make it more important that the problem be recognized. Given these factors, pregnancy may be a time when routine screening would be important.
Remember that there are barriers to disclosure on both the client/patient's and the health professional's part.
Screening Tools
Ways of asking about abuse are obviously dependant upon communication styles. There are tools available for practitioners to use as a foundation. Whether direct or indirect questioning is employed will depend upon the physician's clinical judgment and how the interview progresses. A tool that has shown good reliability in the primary care setting is the WAST (Woman Abuse Screening Tool). It begins with indirect questions that will uncover the problem in the majority of cases and then moves onto more direct questions.
Last Modified: September 5, 2006
