A move beyond screening is required to ensure adequate healthcare response for women who experience intimate partner violence

Abstract

A move beyond screening is required to ensure adequate healthcare response for women who experience intimate partner violence Commentary on: O'Doherty LJ, Taft A, Hegarty K, et al. Screening women for intimate partner violence in healthcare settings: abridged Cochrane systematic review and meta-analysis. BMJ 2014;348:g2913. ContextIntimate partner violence (IPV) is an important health and human rights issue and its impact on mortality and morbidity warrants greater engagement from the health sector. 1 2 Screening for IPV has therefore been recommended, alongside screening for smoking, depressive disorders and other health-related issues, within healthcare settings. 3 It has been acknowledged that when women disclose violence perpetrated by a partner, screening should be followed by interventions such as advocacy, social support, structured clinician support and other therapeutic interventions. However, the evidence on these interventions is still limited. Screening is therefore often implemented on its own with healthcare providers informing abused women about onsite or external services.This systematic review and meta-analysis examines the effectiveness of screening for IPV within healthcare settings when not followed by an intervention. The review aims to establish the impact of screening on the identification of IPV, referral to support agencies, improvements in women's well-being and reduction in instances of further violence, while also assessing any harm that may be caused by screening. MethodsThe authors assessed heterogeneity and publication bias, and clearly stated the question they addressed, their search strategy, study selection, assessment of study quality, data extraction and synthesis. As the review was based on a recently published Cochrane review, it adhered to recognised protocols for systematic reviews and meta-analyses from The Cochrane Collaboration and PRISMA. Eleven randomised controlled trials were eligible for inclusion, reporting on 13 027 women. The review results are reported as relative risk (RR) estimates and CIs. FindingsSix of the studies, reporting on 2564 women, found that screening increased identification of IPV (RR=2.33, 95% CI 1.39 to 3.89), with higher rates detected in antenatal care settings (RR=4.26, 95% CI 1.76 to 10.31). No evidence was found on whether screening leads to referrals in the three studies that measured it (RR=2.67, 95% CI 0.99 to 7.20), while the two studies investigating the effect of screening on IPV 3-18 months after screening found no reductions. One study established that screening does not cause harm. CommentaryThis review provides necessary evidence to the ongoing debate on screening for IPV in healthcare settings. 4 Despite this debate and recommendations for universal screening, O'Doherty and colleagues could only identify 11 trials of necessary quality for inclusion, with only three trials assessing referrals. This is concerning, as it has been established that women and healthcare providers only endorse screening if disclosure is followed by an ...

Willing but Not Able: Patient and Provider Receptiveness to Addressing Intimate Partner Violence in Johannesburg Antenatal Clinics

“…However, this constraint did not seem to dissuade providers from intervening, which differs from findings from other settings in sub-Saharan Africa where providers express ambivalence around intervening in IPV due to beliefs that violence is an acceptable means of punishing women who transgress cultural norms (Lawoko et al, 2013;Shamu et al, 2013). Robust training and ongoing support of providers seems a necessary aspect of implementing any IPV intervention in the health setting (Colombini, Mayhew, & Watts, 2008;Stöckl, 2014). Indeed, having a dedicated protocol for screening improves provider ability to identify IPV (Waalen et al, 2000) and lack of training is often a barrier to IPV screening (Beynon, Gutmanis, Tutty, Wathen, & MacMillan, 2012).…”

“…Indeed, having a dedicated protocol for screening improves provider ability to identify IPV (Waalen et al, 2000) and lack of training is often a barrier to IPV screening (Beynon, Gutmanis, Tutty, Wathen, & MacMillan, 2012). Robust training and ongoing support of providers seems a necessary aspect of implementing any IPV intervention in the health setting (Colombini, Mayhew, & Watts, 2008; Stöckl, 2014). Yet, it is striking that South African providers have virtually no access to training or clinical tools for responding to violence in the antenatal setting.…”

Dating Violence Against HIV-Infected Youth in South Africa: Associations With Sexual Risk Behavior, Medication Adherence, and Mental Health

“…Taken together, we believe there is a strong argument for routine screening. Of course, screening is not effective when implemented in isolation; it needs to be followed by engagement in effective intervention 53 . In our study, past-year IPV was associated with recent adherence; lifetime IPV was not.…”

El cribado sistemático sobre violencia de género durante el embarazo. Una cuestión especialmente importante en tiempos de COVID

“…Siendo imprescindible que los servicios sanitarios y sociales continúen sus obligaciones de atención a estas mujeres (OMS, 2020). Como es indiscutible, las ventajas del cribado sistemático solo pueden obtenerse si este se complementa con protocolos que incorporen el apoyo a las víctimas en la práctica habitual Stöckl, 2014) y una formación previa adecuada (González Muñoz, Durán Flores y González Rubio, 2019).…”