Implementation of a Family Planning Clinic–Based Partner Violence and Reproductive Coercion Intervention: Provider and Patient Perspectives

Abstract

Context Despite multiple calls for clinic-based services to identify and support women victimized by partner violence, screening remains uncommon in family planning clinics. Furthermore, traditional screening, based on disclosure of violence, may miss women who fear reporting their experiences. Strategies that are sensitive to the signs, symptoms and impact of trauma require exploration. Methods In 2011, as part of a cluster randomized controlled trial, staff at 11 Pennsylvania family planning clinics were trained to offer a trauma-informed intervention addressing intimate partner violence and reproductive coercion to all women seeking care, regardless of exposure to violence. The intervention sought to educate women about available resources and harm reduction strategies. In 2013, at the conclusion of the trial, 18 providers, five administrators and 49 patients completed semistructured interviews exploring acceptability of the intervention and barriers to implementation. Consensus and open coding strategies were used to analyze the data. Results Providers reported that the intervention increased their confidence in discussing intimate partner violence and reproductive coercion. They noted that asking patients to share the educational information with other women facilitated the conversation. Barriers to implementation included lack of time and not having routine reminders to offer the intervention. Patients described how receiving the intervention gave them important information, made them feel supported and less isolated, and empowered them to help others. Conclusions A universal intervention may be acceptable to providers and patients. However, successful implementation in family planning settings may require attention to system-level factors that providers view as barriers.

Women’s Reproductive Coercion and Pregnancy Avoidance: Associations With Homicide Risk, Sexual Violence, and Religious Abuse

“…Research has found that reproductive coercion may be indicated by a woman’s repeated requests for pregnancy testing, emergency contraception, and sexually transmitted infection (STI) testing (Kazmerski et al, 2015; Miller & Silverman, 2010), and routine screening for reproductive coercion is recommended within health care settings (American College of Obstetricians and Gynecologists, 2013; Grace & Anderson, 2016; Miller et al, 2011, 2017). Regardless of whether a woman discloses this particular form of abuse, health care providers can educate clients about reproductive coercion as well as female-controlled contraception (Dutton et al, 2015; Miller et al, 2011).…”

“A Huge, Hidden Problem”: Australian Health Practitioners’ Views and Understandings of Reproductive Coercion

“…This is the first such study worldwide; there is a lack of qualitative research on reproductive coercion in general, with a particular dearth around how reproductive coercion is understood and conceptualized. No studies have explored the views of health practitioners, other than in the context of evaluating specific interventions (Miller et al, 2017). Given the key role that health practitioners can play in identifying and responding to reproductive coercion (Grace, 2016), the lack of attention paid to their perceptions has been a significant oversight to date.…”

Trauma Informed Child Welfare Systems—A Rapid Evidence Review

“…Although evaluation was limited and it was not always clear how, or if, this led to changes in the services provided, there was some evidence that this was perceived positively by professionals, resulting in substantial increases in the numbers of children screened at intake by child welfare and mental health professionals [31,32]. While this mainly positive evaluation mirrors the findings from trauma-informed screening/assessment initiatives in health services [43,44,45], implementation challenges were also noted with regard to IT systems, local culture, limited buy-in and the availability of evidence-based treatment. The importance of winning “hearts and minds” is evident in the wider TIC literature with some routine inquiry initiatives failing due to uncertainties about the benefits of screening, lack of clarity about how to use the information and respond to disclosures and concerns regarding a lack of availability of services for onward referral [46].…”