These discussions plant the seeds for women to grow into readiness to leave abusive relationships, Dr. Espey said. Of course, keep in mind any legal requirements in your state to report abuse.
Sherry Boschert/IMNG Medical Media
Ms. Virginia A. Duplessis with a copy of the Futures Without Violence guide for clinicians.
Adolescents often feel more comfortable being asked initially about abuse and coercion if it’s asked electronically, Virginia A. Duplessis said at ACOG’s annual meeting. In live conversations, "We’re moving from ‘Have you ever been punched, slapped, or kicked?’ to more nuanced conversation," said Ms. Duplessis, a program manager for Futures Without Violence, a nonprofit organization formerly known as the Family Violence Prevention Fund, headquartered in San Francisco.
Teens may not understand that violence and coercion are not acceptable ways to show love, she said.
Dr. Stein also pointed to a segment of the Tyra Banks television talk show that’s posted online, in which adolescents in the audience had trouble identifying types of abuse other than physical abuse.
Other times, the patient may have the knowledge, but feel unable to act on it. Ms. Duplessis described her frustration in a previous job as a community educator when teens who had condoms or birth control pills and knew how to use them kept reporting that they weren’t used. It’s not that they were dumb or apathetic, she finally learned; reproductive coercion often was the problem. The girls feared the consequences of negotiating condom use more than they feared pregnancy, or their partners threw away their pills.
That frustration with patients who do not follow a plan of care is one reason that clinicians don’t screen for intimate partner violence, she said. They also may not be comfortable starting conversations on this topic, or don’t ask because they don’t know what to do if a patient discloses intimate partner violence or coercion.
Futures Without Violence offers free materials to clinicians to simplify screening, such as folding wallet-size "safety cards" to give patients that list screening questions and resources.
Ms. Duplessis manages Project Connect, a national public health initiative to prevent violence against women through efforts focused on adolescent health, reproductive health, and home visiting programs. Funded by the U.S. Office on Women’s Health, Project Connect’s 10 geographically and ethnically diverse sites explore new ways to prevent, identify, and respond to domestic and sexual violence.
In a randomized, controlled pilot trial, a community-based intervention achieved some success (Contraception 2011;83:274-80). Clinicians asked 906 women at four family planning clinics questions about intimate partner violence and sexual and reproductive coercion, and reviewed the "safety cards" they gave to patients. The intervention took less than a minute of time in some cases, or longer if a positive screen led to more discussion.
Among women who had experienced recent partner violence, those in the intervention group were 71% less likely to report pregnancy coercion and 63% more likely to end an unhealthy or unsafe relationship, compared with a control group who got usual care.