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IPV: An Under-Recognized Public Health Epidemic

Ob-Gyns Asked to Screen All Women at Office Visits

January 23, 2012

Washington, DC -- Ob-gyns are uniquely positioned to help women who are victims of intimate partner violence (IPV), a significant public health problem in the US, according to recommendations issued today by The American College of Obstetricians and Gynecologists (The College). The College says that ob-gyns should routinely screen all women for IPV at periodic intervals including during prenatal visits, offer them support, and have referral and resource information handy for those being abused.

IPV is a pattern of assault and coercion that includes physical injury, psychological abuse, sexual assault, progressive isolation, stalking, deprivation, intimidation, and reproductive coercion. The goal of these destructive behaviors is to establish control over a partner. IPV is an equal-opportunity problem, occurring among both heterosexuals and same-sex couples and at every level of society, regardless of age, gender, income level, religion, race, ethnicity, or educational background.

“Women of all ages experience intimate partner violence, but it is most prevalent among reproductive-age women,” said Maureen G. Phipps, MD, chair of The College’s Committee on Health Care for Underserved Women. “We have a prime opportunity to identify and help women who are being abused by incorporating this screening into our routine office visits with each and every patient.” The signs and symptoms of a woman being abused can present as physical injuries but can also manifest as chronic headaches, chronic pelvic pain, irritable bowel syndrome, and recurrent vaginal infections. IPV is often linked to unintended pregnancy, depression, anxiety, substance abuse, and suicide.

Approximately one in every four women in the US has been physically and/or sexually assaulted by a current or former partner. However, because IPV encompasses more than just physical and sexual violence, its true prevalence is unknown because victims fear disclosure. “Nearly 324,000 pregnant women are abused by their partners each year in the US,” said Dr. Phipps. According to The College, IPV is associated with poor pregnancy outcomes, including stillbirth, poor weight gain, infection, fetal injury, preterm delivery, and low birth weight. “Sadly, one of the leading causes of maternal mortality in this nation is homicide.”

One way some partners use to maintain power and control in a relationship is through reproductive coercion, with or without physical or sexual violence. Partners may sabotage a woman’s use of contraception, refuse to wear condoms, or intentionally expose her to a sexually transmitted infection, including HIV. Perpetrators can also control the outcomes of pregnancies, whether through forcing a partner to continue an undesired pregnancy or to have an abortion, or forbidding sterilization or access to reproductive health services.

“We need to start normalizing the conversation about abuse with all of our patients, much like we’ve done with HIV testing,” said Dr. Phipps. “Many women will not admit to being abused, but bringing up the subject in a caring and straightforward manner over time may encourage them to eventually seek help.”

The College and Futures Without Violence jointly developed a patient education card about IPV and reproductive coercion for teens and adults that is available in both English and Spanish.

 

Committee Opinion #518 “Intimate Partner Violence” is published in the February 2012 issue of Obstetrics & Gynecology.

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 55,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org

 

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