Should violence services be integrated within abortion care? A UK situation analysis

Abstract

The prevalence of violence against women worldwide raises the question of the desirability and feasibility of integrating interpersonal violence (IPV) services within abortion care. By examining present services and context in an Inner London borough in the UK, this situation analysis explored the hypothesis that an established, integrated, health-based service (comprising raised awareness, staff training in routine IPV enquiry and referral to a community-based in-reach IPV service) would be transferable into abortion services. Four sources of qualitative data investigated views on integrating services: key stakeholder in-depth interviews including with providers of abortion and IPV services and commissioners and IPV survivors with past abortion service use (3 user, 15 provider); qualitative analysis of the open-ended part of a survey of current abortion service users with and without experience of IPV; feedback from an interactive workshop and data from field observations. While there was consensus among all informants that women experiencing IPV and seeking abortion have unidentified, unaddressed needs, how any intervention might be organised to address these needs was contested; thus questions remain about whether, when and how to raise the topic of IPV and what to offer. Two major anxieties surfaced: a practical concern in terms of interrupting a streamlined abortion service that suits the majority of staff and patients, and a conceptual concern about risk of stigmatising abortion seekers as 'victims in crisis'. Thus, our findings indicate: when integrating IPV interventions into abortion services, local context, the integrity of separate pathways, and women's safety and agency must be considered, especially when abortion rights are under attack. Novel approaches are required and should be researched.

Safeguarding for reproductive coercion and abuse

“…This was particularly the case for telemedicine for young people, despite evidence that the move to online sexual health services, which in some cases pre-dated COVID-19, had also increased safeguarding disclosures 12 14. Moreover, these concerns are based on a false assumption that the right physical setting for a consultation is the key to ensuring safeguarding disclosures, despite the evidence that disclosure will not happen until abuse victims are ready to do so, even if they are asked direct questions and are aware of the support available to them 15. Perpetrators do not have to be present to exert coercive control.…”

Quality of care in abortion in the era of technological and medical advancements and self-care

“…Moreover, given that intimate partner violence is a risk factor for unintended pregnancy and abortion [56], and that such experiences are often underreported, it is important to take the opportunity of women coming for abortion care to screen, counsel, and refer them to various services such as shelter homes; hotlines; and legal, health, and social services. Care should be placed in preventing such screening from being stigmatizing [57]. Since it may not be possible to provide the entire constellation of services at the same point of care, effective and efficient referrals to accessible services should be made.…”