Intimate Partner Violence and Reproductive Coercion Intervention in a Health Care Setting

Intimate Partner Violence &
Reproductive Coercion
Intervention in a Health Care
Setting
Meghan Benson, MPH, CHES
Director of Community Education
Meghan.Benson@ppwi.org
608-251-6587 ext. 1
Safe Healthy Strong 2014
Health Care Provider Track
August 8, 2014
UW-Milwaukee Zilber School of Public Health

Conflict of Interest
Statement
 I have received no support or commercial funding
for this presentation, or for any products
mentioned herein.
Copyright © 2013. Planned Parenthood of Wisconsin, Inc.

About
PLANNED PARENTHOOD
 Annual reproductive health exams
 Birth control (including EC & condoms)
Copyright © 2014 Planned Parenthood of Wisconsin, Inc.
 Cancer screening
 STI testing & treatment
 HIV testing & risk-reduction education
 Pregnancy testing & all-options education
 NEW! Online appointment scheduling – www.ppwi.org
 Abortion services (Appleton, Madison & Milwaukee)
 Referrals for other health & social services
 Education & training
 Organizing & advocacy

Objectives
 Explain the prevalence of intimate partner and sexual
violence in family planning and other reproductive health
care settings
 Describe reproductive coercion as intimate partner violence
(IPV)
 List important knowledge, skills, and resources need to
effectively screen for IPV
 Describe a brief, brochure-based IPV intervention found to be
effective in health care settings
 Demonstrating competency in normalizing healthy
relationships, screening for IPV, and making referrals for IPV

First, a few quick
conversations…
 Language is important – victim vs. survivor?
 Trigger warning
 Please practice self-care

Importance of
Partnerships
 Health care providers and sexual assault
(SA) and intimate partner violence
(IPV)/domestic violence (DV) service
providers play different and unique roles in
prevention and intervention
 Increased collaboration will only improve health
outcomes
 Cross-referrals

We’ve come a long way,
but we need to do more.
 In addition to intervention (especially once serious injury
occurs), prevention and early intervention are necessary
 In addition to criminal justice, other approaches – including
broader community and population interventions – are
needed
 In addition to interventions in ER and urgent care, other
health care settings can be utilized
 In addition to addressing the needs of women and children,
the needs of men and LGBTQ+ individuals, who are victims
and survivors

Prevalence of
Interpersonal Violence
 1 in 3 women will experience sexual or physical violence in
her lifetime
 1 in 5 women will be sexually assaulted with half reporting
being raped by a partner
 1 in 4 women will experience intimate partner violence
 In a family planning setting (e.g. Title X health center) – more
than 1 in 2 women will experience intimate partner violence
 Disparities in these rates exist among women of color,
LGBTQ+ individuals, those who have been incarcerated,
and other marginalized groups

The impact of IPV – beyond black
eyes and broken bones…
 Long-term health consequences
 Outcomes related to sexual and reproductive health
 IPV increased the risk of unintended pregnancy
 Pregnancy also increase the risk of IPV
 Tobacco use – 42% of women experience IPV could not stop
smoking, compared to 15% of women not experiencing IPV
 Breastfeeding – 35-52% less likely to breastfeed & 41-71% more
likely to cease breastfeeding by 4 weeks postpartum
 Postpartum depression – 5X more likely to experience
 Homicide is the second leading cause of injury-related deaths
among pregnant women

The importance of health
care providers!
 Women who talked to their health care provider
about IPV
 4X more likely to use an intervention
 2.6X more likely to exit the relationship
 SA & IPV/DV service providers also have a unique
opportunity to ensure victims and survivors access
health care
 17% of women experiencing IPV report a partner has
prevented them from accessing health care services
compared to only 2% of women who do not report IPV

 Interfering with birth control methods
 Coercing a partner to have unprotected sex
 Controlling pregnancy outcomes

 Health care providers are key!
 Providing a discreet method of birth control
 “Warm referrals” for SA and IPV services

Your Own Experience
 Has a health care provider ever screened you for
SA or IPV/DV?
 Reproductive coercion?
 How was the screening done?
 Form
 Discussion with provider
 Were you alone?
 Especially in the context of prenatal care

Umm…
 “Has your partner ever hit, punched,
kicked, slapped, pushed, shoved, or choked
you?”
 “Do you feel safe at home?”

Barriers for Health Care
Providers
 Scope of work
 Comfort level
 What to do after disclosure?
 Frustration
 Limited time

Addressing Barriers
 SA & IPV/DV screening as a standard of care
 Training & resources
 On-site services & “warm referrals”
 Focus on the goal of intervention – education and
support
 Brief, simple, and integrated interventions are
available

Brief, Brochure-Based Intervention

Futures Without Violence
www.futureswithoutviolence.org

First, do no harm.
 Screen patients alone
 Screen patients in the language they will understand
 Only used a trained medical interpreter
 Do not use family members or friends to translate
 Before screening, review the limits of confidentiality
 Mandated reporting for minors
 Reports required by law are allowed under HIPAA
 However, you violate HIPAA if you report something not
mandated by law

Example Discussion
Before we get started, I want you to know that
everything you say to me is confidential, meaning I
won’t talk to anyone else about what you tell me
UNLESS you tell me that someone is hurting you, you
are planning to hurt yourself, or you are planning on
hurting someone else.

Screening as a Standard
of Care
 How often should you ask about SA and IPV/DV?
 At least annually
 With each new partner
 Multiple, repeat visits for pregnancy tests, EC, STI
tests, etc… can be clinical indicators to assess more
frequently

Screening as a Standard
of Care
 When should you ask about SA and IPV/DV?
 During any sexual and reproductive health care visits
 Pregnancy test
 Birth control
 STI/HIV tests
 Initial & annual visits
 Abortions
 Where should you provide education?
 In a private setting
 Alone

Elements of Intervention
 4 Cs
 Confidentiality
 Conversation
 Normalizing the activity – “We talk about this with [or
we show this to] all our patients.”
 Card
 Review the safety card
 Offer harm reduction strategies
 Connect
 “Warm referral” to SA or IPV/DV service provider

Practice!
• In groups of 3 – one provider, one patient,
and one observer – practice introducing
the Did You Know Your Relationship Affects
Your Health? brochure

Panel 1
 Starts by addressing healthy relationships
 Positive behaviors are considered first
 Normalizes conversations about healthy
relationships
 Supports those already in healthy relationships

Panel 2
 Begins addressing specific unhealthy
relationship behaviors
 Reproductive coercion
 Sexual assault
 Controlling behaviors

Panel 3
 Further explores unhealthy and abusive
relationship behaviors
 Fear of partner
 Protective behaviors/self-management strategies
 Physical violence

Panel 4
 Harm reduction approaches
 “Invisible” contraception
 Safety planning to include EC
 NOT harm elimination
 For patients unable to leave an abusive
relationship

Panel 6 & 7
 Provides additional support and resources
 Opportunity to connect a patient with a SA
or IPV/DV advocate
1. On-site advocate
2. “Warm referrals”
3. Phone number, addresses, and websites for local SA
and IPV/DV service providers

Practice!
• In groups of 3 – one provider, one patient,
and one observer – practice using the Did
You Know Your Relationship Affects Your
Health? brochure to:
• Normalize healthy relationships
• Explore unhealthy relationship behaviors
• Assess for reproductive coercion and other forms of
physical violence
• Provide harm reduction strategies and referrals, as
appropriate

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Intimate Partner Violence and Reproductive Coercion Intervention in a Health Care Setting

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