_________________________________________________________________ Domestic and Sexual Violence
DOMESTIC VIOLENCE BEHAVIORS
Physical Abuse
Psychologic/Verbal Abuse Sexual Abuse
Financial/Economic Abuse Withholding of money, refuse to allow victim to open bank account, all property is in the perpetrator’s name, victim is not allowed to work
Kicking, punching, biting, slapping, strangling, choking, abandoning in unsafe places, burning with cigarettes, throwing acid, throwing objects, refusing to help when sick, stabbing, shooting
Intimidation, humiliation, put-downs, ridiculing, control
Rape, forms of sexual assault (such as forced masturbation, fellatio, or oral coitus), sexual humiliation, unwanted touching, perpetrator refuses to use contraceptives, coerced abortion
of victim’s movement/ relationship/behaviors,
stalking, threats, threatening to hurt victim’s family and children, social isolation, ignoring needs or complaints
Source: Compiled by Author
Table 1
Research indicates that this form of violence is relatively common. A 2018 systematic review found that 5% to 16% of women had experienced reproductive coercion [7]. In another study of young women (16 to 29 years of age) present- ing to family planning clinics in California found that 53% of respondents reported physical or sexual partner violence, 19% reported experiencing pregnancy coercion, and 15% reported birth control sabotage [8]. Of those who reported being victims of partner violence, 35% reported reproductive control. Research indicates that reproductive coercion is often one of multiple forms of interpersonal violence experienced by a victim [9]. Furthermore, studies suggest that reproductive control and unintended pregnancy may disproportionately affect women of color [10]. According to the American College of Obstetricians and Gyne- cologists (ACOG), interventions that focused on awareness of reproductive and sexual coercion and provided harm-reduction strategies reduced pregnancy coercion by 71% among women who experienced IPV [11]. The ACOG recommends the fol- lowing screening questions: • Has your partner ever forced you to do something sexually that you did not want to do or refused your request to use condoms? • Has your partner ever tried to get you pregnant when you did not want to be pregnant? • Are you worried your partner will hurt you if you do not do what he wants with the pregnancy? • Does your partner support your decision about when or if you want to become pregnant? Interventions targeted to protect victims of contraceptive coercion include helping conceal contraceptives, placement of an intrauterine device or other implanted birth control, and appropriate referrals [11].
SIGNS OF ABUSE/VICTIMIZATION
DOMESTIC VIOLENCE It is imperative that healthcare professionals work together to establish specific guidelines that will facilitate identification of batterers and their victims. In a 2016 study of 288 healthcare facilities in Florida, 78% understood the importance of IPV screening and had some type of IPV screening policy institute in their setting [12]. However, many of the respondents did not know which screening tool was used or the types of screening questions asked. These guidelines should review appropriate interview techniques and should also include the utilization of screening tools, such as intake questionnaires. The following is a review of certain signs and symptoms that may indicate the presence of abuse. Although victims of domestic violence do not display typical signs and symptoms when they present to healthcare providers, there are certain cues that may be attributable to abuse. The obvious cues are the physical ones. Injuries range from bruises, cuts, black eyes, concussions, broken bones, and miscarriages to permanent injuries such as damage to joints, partial loss of hearing or vision, and scars from burns, bites, or knife wounds. In addition to physical signs and symptoms, domestic violence victims also exhibit psychological cues that resemble an agitated depression. If the perpetrator is present with the victim during an assessment, they may attempt to control the situation; this may manifest as an unwillingness to leave the victim alone or answering questions for the victim. Unfortunately, healthcare professionals may respond to these women by diagnosing the patient to be neurotic or irrational [13]. Healthcare professionals should cast aside these misper- ceptions of abused victims and work within their respective practice settings to develop screening mechanisms to detect women who exhibit these symptoms. In addition, it is impor- tant to recognize that vulnerable populations, including lesbian, gay, bisexual, transgender, and other gender/sexual minority (LGBT+) individuals, those with human immunode- ficiency virus (HIV), individuals with disabilities, and veterans are also at risk and should be screened for IPV [14].
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MDCT2026
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