Intimate partner violence. The gynaecologist's perspective

Abstract

From a questionnaire-based surveillance study among pregnant women constituting a regional probability sample of East-Flanders, we estimated that IPV occurred overall with one in ten women (10.1%, 95% CI 7.7-13.0%) and with about one in 30 women (3.4%, 95% CI 2.1-5.4%) during pregnancy and/or in the year preceding pregnancy. We also revealed that women experiencing IPV rarely disclose abuse spontaneously to the widely available health care services and providers, but in general approve routine questioning by their GP or gynaecologist. The crux of IPV is that most victims will not present with overt signs of abuse, but rather with a wide variety of vague and non-specific symptoms, if any. Hence there seems to exist a window of opportunities to detect women suffering from IPV through screening in the health care sector. From a questionnaire based Knowledge-Practice and Attitude Survey among OB/GYN in Flanders, it appeared that OB/GYN feel uncomfortable with a routine screening policy. They underestimate the prevalence and perceive a lack of self-efficacy in dealing with the problem and properly referring patients, they lack time and perceive it as inappropriate to question patients about IPV. On the other hand they acknowledge that there is a need for training on violence. It therefore appears that most barriers should be remediable through proper OB/GYN training and education, together with enabling strategies such as screening tools and formal referral pathways. In concordance with the National Action Plan to combat IPV, health care workers, including gynaecologists, need to develop guidelines, in order to deal with this important public health problem.