Addressing Maternal and Child Health Disparities Through Perinatal Home Visiting

Abstract

Introduction: Intimate partner violence (IPV) is a serious public health and human rights issue affecting at least 324 000 pregnant women annually. It also occurs at any age, with 1 in 3 women experiencing IPV in their lifetime. Abuse during pregnancy leads to direct and indirect harm to both the mother and child. It also is associated with increased rates of depression, posttraumatic stress disorder, placental abruption, uterine rupture, and hemorrhage. Due to the possibility of such morbidity, it is vital to identify women at risk of abuse and act as early as possible.

Objective/methods: The objective of this study was to evaluate the current IPV screening practices at Froedtert & Medical College of Wisconsin's obstetrics and gynecology (OB/GYN) clinic before and after the implementation of a standardized screening protocol for IPV using the Humiliation, Afraid, Rape, Kick (HARK) tool. Data were collected via a retrospective chart review during April-September 2019-2021, with the tool going into effect in 2020.

Results: A continuously increasing number of screens occurred in 2020 and 2021 after screening standardization. While more screenings were conducted, overall positive screening rates were lower in 2021 compared to 2019 and 2020 (P = 0.0008 and P = 0.0004, respectively). In addition, there were significantly fewer positive screens for patients who were married or those with significant others compared to those who were single or legally separated, divorced, and widowed (P = 0.0001).

Conclusions: There was no significant difference in the positive screening rate between 2019 and 2020, but with more screenings performed in 2020, additional positive screens were picked up that otherwise may have been missed before using the standardized protocol. Overall, the implementation of a standardized screening protocol using the HARK tool increased screenings in the OB/GYN clinic, which can be replicated in other health care settings.