domestic violence screening in adolescent pregnancy anisha abraham maj md mph l.
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Domestic Violence Screening in Adolescent Pregnancy Anisha Abraham, Maj, MD, MPH. 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

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objectives
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
domestic violence and women
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)
domestic violence and women4
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)
domestic violence and pregnancy
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)
violence and teen pregnancy
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).
violence and teen pregnancy7
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)
violence and teen pregnancy8
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.
domestic violence and children
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
domestic violence and children10
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.
definition domestic violence abuse
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
types of abuse
Types of Abuse
  • Physical-pushing, shoving
  • Psychological-ignoring, controlling, criticizing
  • Sexual-touching,calling with sexual names
risks factors for violence during adolescence
Risks Factors for Violence during Adolescence
  • Media
  • Drugs/Alcohol
  • Access to Firearms
  • Lack of Self-Esteem
  • Peer Group/School Influences
  • Lack of Family Support
risk factors for domestic violence in adolescence
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
signs symptoms of abuse among pregnant teens
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
signs symptoms among children in abusive homes
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
complications of abuse during pregnancy
Complications of Abuse during Pregnancy
  • Poor maternal weight gain
  • Infection
  • Anemia
  • Increased second and third- trimester bleeding
  • Miscarriage/Abortion
barriers to screening
Barriers to Screening
  • Lack of provider recognition
  • Provider discomfort
  • Fear of offending patient
  • Time constraints
  • Feeling of powerlessness in the area of treatment
importance of screening
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)
setting the stage
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!
screening for domestic violence risks
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?
domestic violence counseling
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
summary
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