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Domestic Violence

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  • 1. Domestic Violence Screening in Adolescent Pregnancy Anisha Abraham, Maj, MD, MPH
  • 2. Objectives
    • To provide an overview of domestic violence as a public health issue
    • To review key causes and risk factors of domestic violence during teen pregnancy
    • To discuss the role of health care providers in domestic violence prevention
  • 3. Domestic Violence and Women
    • Domestic violence is the leading cause of injury to women between the ages of 15-44. (CDC, 1999)
    • Every 21 days, a woman is killed by domestic violence. (U.S. Department of Justice, 1998)
    • More than 5 million females experience some form of violence each year. Almost two of every three of these females are attacked by a relative or person known to them. (The Commonwealth Fund, 1998)
  • 4. Domestic Violence and Women
    • 34% of adults in the United States had witnessed a man beating his wife or girlfriend, and 14 % of women report that they have experienced violence from a husband or boyfriend. (U.S. Department of Justice's National Crime Victimization Survey, 1998)
    • More than 1 million women seek medical assistance each year for injuries caused by battering. (U.S. Department of Justice's National Crime Victimization Survey, 1998)
  • 5. Domestic Violence and Pregnancy
    • The prevalence of violence during pregnancy (all ages) ranges from 4-8% (Gazamarian JA. Prevalence of violence against women.. JAMA 1996)
    • Higher rates are identified when screening occurs more than once during the pregnancy (Macfarlane J. Assessing for abuse during pregnancy. JAMA . 1992.)
    • The pattern of violence may escalate during pregnancy and may be more prevalent in the postpartum period (Helton AS. Battered and pregnant: a prevalence study. Am J Pub Health . 1987)
  • 6. Violence and Teen Pregnancy
    • Women < 18 yrs were twice as likely to have experienced violence during and after pregnancy then older women (Gessner BD. Experience of violence in teenage mothers. J Adolesc Health , 1999)
    • 33.8% of births to unmarried teens younger than 16yrs resulted from statutory rape(Gessner BD, 1999)
    • One-half of teens with rape histories resulting in pregnancy were raped more than once (Boyer D. Sexual abuse as a factor in teen pregnancy. Fam Plann Perspect .1992).
  • 7. Violence and Teen Pregnancy
    • The younger the partner the greater the partner gap. Over one-half of infants born to women younger than 18 yrs were fathered by adult men .
    • 40% of 15 year -olds had partners aged 20 yrs or older. (Landry DJ. How old are US fathers? Fam Plann Perspect .1995)
    • 74% girls who have had intercourse before 14yrs, reported having sex against their will (The Alan Guttmacher Institute,1994)
  • 8. Violence and Teen Pregnancy
    • Coercive sex is frequently perpetrated by boyfriends. 53% of nonfamilial perpetrators were adolescent girls’ boyfriends, dates,friends (Gershenon HP.The prevalence of coercive sex among teenage mothers. J Interpers Viol .1989.
    • 51% of girls had their first coercive act between 13-16 yrs (Erickson PI. Unwanted sexual experiences among high school youth. J of Adol Health .1991.
  • 9. Domestic Violence and Children
    • Children are involved in 60 percent of domestic violence cases. More than three million children witness acts of domestic violence each year.
    • Up to 50 percent of all homeless women and children in this country are fleeing domestic violence.
    • More than 53 percent of male abusers beat their children
  • 10. Domestic Violence and Children
    • One in ten calls made to alert police of domestic violence is placed by a child in the home.
    • One of every three abused children becomes an adult abuser or victim.
    • Nearly 1/3 of children who witness the battering of their mothers demonstrate significant behavioral and emotional problems.
  • 11. Definition- Domestic Violence/Abuse
    • Domestic Violence -Injury to another within the context of family or intimate relationship
    • Domestic Abuse - Forceful controlling behavior that coerces the victim to do what the abuser wants
  • 12. Types of Abuse
    • Physical -pushing, shoving
    • Psychological -ignoring, controlling, criticizing
    • Sexual -touching,calling with sexual names
  • 13. Risks Factors for Violence during Adolescence
    • Media
    • Drugs/Alcohol
    • Access to Firearms
    • Lack of Self-Esteem
    • Peer Group/School Influences
    • Lack of Family Support
  • 14. Risk Factors for Domestic Violence In Adolescence
    • Commitment to relationship
    • Fear of retaliation
    • No place to go
    • Fear of living alone
    • Economic dependence
    • Belief that they are responsible
    • Hope that perpetrator will change
  • 15. Signs/Symptoms of Abuse among Pregnant Teens
    • Frequent somatic complaints (headaches, insomnia)
    • Anxiety,irritability,crying
    • Repeated visits to the ER
    • Hx of being “accident prone”
    • Injuries to breasts/abdomen
    • Hesitancy to provide info on injuries (Often accompanied by partner who will prevent victim from answering directly)
    • Anti-social behavior
    • Foreshortened sense of future
  • 16. Signs/Symptoms among Children (in abusive homes)
    • Infants - FTT, developmental delays
    • Toddlers- eating/developmental disturbances, clinging
    • School age -increased physical complaints, decreased attention, behavior disorders
  • 17. Complications of Abuse during Pregnancy
    • Poor maternal weight gain
    • Infection
    • Anemia
    • Increased second and third- trimester bleeding
    • Miscarriage/Abortion
  • 18. Barriers to Screening
    • Lack of provider recognition
    • Provider discomfort
    • Fear of offending patient
    • Time constraints
    • Feeling of powerlessness in the area of treatment
  • 19. Importance of Screening
    • 90% of female patients feel their provider can help!
    • 78% favor universal inquiry about physical/sexual assault
    • 1 out of 4 women using ER’s revealed a history of partner violence when questioned
    • 10-40% of women disclose abuse when screened by primary care providers
    • 31% of mothers disclosed partner violence when asked by their pediatrician (Mcnutt LA. Reproductive violence screening in primary care. J Am Med Womens Assoc .1999)
  • 20. Setting the Stage
    • Discuss confidentiality
    • Use clear language, avoid medical terms
    • Remain non-judgemental
    • Avoid talking down
    • Encourage discussion, use open-ended questions
    • Listen to the patient!
  • 21. Screening for Domestic Violence Risks
    • Has anyone close to you ever threatened to hurt you?
    • Has anyone ever hit, kicked, punched or hurt you physically?
    • Has anyone, including your partner, ever forced to have sex against your will?
    • Are you ever afraid of your partner?
  • 22. Domestic Violence Counseling
    • Implement universal screening
    • Acknowledge trauma
    • Assess immediate safety
    • Help establish a safety plan
    • Offer educational materials
    • Document interaction (including photos)
    • provide ongoing support
    • Offer list of community resources
    • Provide referrals
  • 23. Summary
    • Screen : Adolescent mothers for domestic violence risks (at prenatal visit, interval checkups, postpartum visit, and well-baby exams)
    • Ask : Are you ever afraid of your partner? Has anyone close to you threatened you? Hit you ? Forced sex against your will?
    • Discuss : Safety plan, legal implications,trauma
    • Provide : Documentation, as well as, information and referrals for community resources