Screening for violence
The following provides an overview of the types of questions practitioners might use to identify if violence is present in a patient's or client's life. Our thanks to Debbie McCarthy (Flinders Medical Centre) and the Pregnancy Advisory Centre for allowing us to reproduce their material here.
SOME POTENTIAL SCREENING QUESTIONS FOR YOUR PRACTICE MAY BE ALONG THE LINES OF:
Because domestic violence is increasingly common, we ask everyone about it as part of our consultation. Are you safe in your relationship, or is there violence present? What forms of violence are present now or have been in the past?
Has a partner or significant other ever made you feel afraid? Caused you to feel worried about the safety of other people in your household? Hurt you physically or thrown objects? Constantly humiliated or put you down? Do you want help with any of this now?
Was the sex that led to the pregnancy consensual? Has there been any forced or coerced sex? Has there been any forced or coerced decision-making?
If questioning reveals violence is present, check her vulnerability level (i.e. age, living arrangements, financial control, social isolation, language barriers, disability, etc) and provide referrals where appropriate.
- Ask alone
- Be supportive
- Call on resources
- Encourage safety
POINTS TO NOTE
If a woman discloses domestic violence or it is picked up by staff, she may not want to report it. Staff need to respect this, and not force them to seek support they’re not wanting at the time.
It may be an option to provide some normalising, e.g. “One in three women experience domestic violence at some time in their lives” OR “We see at least one woman every day here who shows signs that someone is perpetrating violence against them.”) Validation of their experience may also be helpful, irrespective of whether woman would like to take any steps at that time. E.g. “What you are experiencing is not okay. Everyone has a right to be safe.” and “It is not your fault. Violence is the responsibility of the perpetrator.”
DV Web Link is a directory of domestic violence support services in Queensland, and also has information on domestic violence, safety strategies, and seeking protection.
RED FLAGS: INDICATORS OF DOMESTIC VIOLENCE IN A WOMAN PRESENTING AT YOUR CLINIC OR SERVICE
The woman may not disclose domestic violence during intake (written or verbal). However, clinic staff may observe indicators during physical/clinical intake that the woman has experienced/may be experiencing violence . The following is a list of indicators that domestic violence is being perpetrated on the woman. This is not an exhaustive list but a select list of things most likely to be observed or revealed in an abortion clinic setting.
The woman may:
- Appear nervous, ashamed or evasive;
- Describe her partner as controlling or quick to anger;
- Seem uneasy in the presence of their partner;
- Have a partner who may insist on following her throughout the clinic visit;
- Have a partner who does most of the talking when they are together;
- Have physical signs of violence such as bruising on the breast and abdomen, multiple injury sites and small cuts;
- Give an unconvincing explanation of current injuries;
- Have recently separated;
- Have a more advanced pregnancy;
- Show signs of alcohol and/ or other drug use;
- Identify having mental health issues;
- Have other gynaecological problems such as chronic pelvic pain, have suffered previous miscarriages or unplanned pregnancies; or
- Present with signs of neglect.