Domestic Violence


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Domestic Violence

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