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Domestic Violence Screening of Obstetric Triage Patients in a Military Population

Lutgendorf, M. A.; Thagard, A.; Rockswold, P. D.; Busch, J. M.; Magann, E. F.

Obstetrical & Gynecological Survey: February 2013 - Volume 68 - Issue 2 - p 77–79
doi: 10.1097/OGX.0b013e318281d593

Domestic violence, or intimate partner violence (IPV) is a well-known problem, with its many complications and associated costs. Up to 23% of pregnant women have been reported to be affected by IPV. During prenatal visits, caregivers have an opportunity to screen for IPV and make appropriate interventions. No studies have yet investigated the prevalence of IPV in a military population presenting for emergency obstetric care. This study was designed to determine the prevalence of IPV in this population and to identify factors correlated with IPV and the acceptability of IPV screening.

The investigation was approved by appropriate military personnel. The anonymous survey study included pregnant women presenting to a military medical center for unscheduled emergency care. They were screened for IPV using the Abuse Assessment Screen (AAS), which is a validated 5-item questionnaire that assesses physical, emotional, and sexual violence. It also includes 26 additional questions to assess risk factors and demographics. The survey was administered in a private setting, separated from the patient’s spouse, significant other, family members, or friends. Women received an envelope containing the survey and a resource card with contact information for organizations for battered women. Informed consent was implied when patients voluntarily completed the survey. Completed surveys were placed in a sealed envelope and then into a locked collection box. Those who did not wish to participate were instructed to place the blank survey in the envelope and collection box. Surveys were reviewed as a group at the end of the collection period to ensure anonymity. Answers to the AAS were used to estimate the incidence of IPV in this cohort. Women were considered abused if they answered yes to these questions: (1) Have you ever been emotionally or physically abused by your partner or someone important to you? (2) Within the past year, have you been hit, slapped, kicked, or otherwise physically hurt by someone? (3) Since you have been pregnant, have you been hit, slapped, kicked, or otherwise physically hurt by someone? (4) Within the past year, has anyone forced you to have sexual activities? (5) Are you afraid of your partner or anyone listed above? Data were analyzed using STATA statistical software. Each woman was categorized based on responses as abused, abused within the last year, and abused during the current pregnancy. The survey also included 25 questions to assess risk factors for domestic violence, demographics, and attitudes toward IPV screening.

Of 499 surveys distributed, 461 were included in the final analysis. Of these 461 surveys, 104 women (22.6%; 95% confidence interval [CI], 6.7%–26.4%) screened positive for current or a history of abuse. Most women were in their 20s, white, high school graduates with some college, and dependent spouses of military personnel. The lifetime prevalence of IPV was 22.6% (95% CI, 18.7%–26.4%), with 104 women recording at least 1 positive answer on the AAS. Ninety-nine positive responses to the AAS were from women who reported being abused physically or emotionally by a person close to them. Physical abuse in the past year was reported by 19 women (4.1%; 95% CI, 2.3%–5.9%), and 13 women (2.8%; 95% CI, 1.3%–4.3%) reported IPV since becoming pregnant; in both circumstances, most indicated that her husband or boyfriend was the abuser. Seven women (1.5%; 95% CI, 0.4%–2.7%) reported forced sexual activities, and 11 women (2.4%; 95% CI, 1.0%–3.8%) reported being afraid of their partner or someone listed on the form. Separated or divorced women, compared with married women and single women, were at increased adjusted risk of physical or emotional abuse by a partner or other important person. Three factors were significant for abuse: marital status, reporting a suspicion that friends or peers in their community were being abused, and duration of pregnancy. The mean gestational age at presentation for care was 35 weeks; however, women who reported IPV presented for care an average of 2.5 weeks earlier in their pregnancy compared with women without domestic violence. Factors protective against IPV were having supportive family or friends within 100 miles and a spouse/significant other with them at the visit. Of 425 women, 390 (91.8%) would not be offended by IPV screening. Of 412 women, 366 (88.8%) thought that patients should be routinely screened for IPV. The responses were similar regardless of women’s IPV history.

With the increased stressors and demands placed on military service members and their families, this is an important area for future research. Studies with multiple screenings throughout pregnancy may identify a higher prevalence of IPV in a pregnant military population. These results confirm the importance of continued routine screening in pregnant women, especially those presenting for emergency care during their pregnancy.

Department of Obstetrics and Gynecology, Naval Medical Center Portsmouth (M.A.L., A.T., J.M.B.); and Navy and Marine Corps Public Health Center (P.D.R.), Portsmouth, VA; Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR (E.F.M.).

© 2013 Lippincott Williams & Wilkins, Inc.