Preconceptual care should improve the personal and social conditions for women becoming pregnant and preparing for motherhood. This is largely a public health and societal obligation. Although detrimental to health, violence and abuse do not fit the medical model of screening, diagnosis and remedy. Your review on preconceptual care was inconsistent(1) about recommending ‘screening’(2,3), when good evidence exists for the effectiveness of advocacy based interventions in antenatal settings(4).
Sexual violence can lead to pregnancy, domestic violence can start and escalate in pregnancy, and there is an especially high rate in terminations and repeat terminations(5). Thus, it is illogical to only ask about abuse after an ongoing pregnancy has started, as if child protection mattered exclusively, rather than adult protection. Doctors can offer safe, confidential space for women to talk about violence, as well as referral to specialist agencies. They can convey to women that it is ‘okay’ to talk about abuse during routine consultations, e.g. by having posters for domestic violence services in the waiting areas of GPs, emergency miscarriage units, family planning and termination clinics with a simple sticker saying “you can talk to your health care practitioner about domestic abuse or violence”. It is ordinary good practice to ask women about the quality of their relationships and offer support even before a pregnancy.
Perpetrators of abuse and violence against pregnant women should be held to account by their consciences, families, friends, communities and the criminal justice system. Better understanding of patient’s lives and needs, kindness and a focus on women’s safety will not hurt the next generation of mothers.
(2) Taket A, Nurse J, Smith K, Watson J, Shakespeare J, Lavis V. et al. Routinely asking women about domestic violence in health settings. British Medical Journal 2003; 327: 673–76
(3) Taket A, Wathen CN, MacMillan H. Should health professionals screen all women for domestic violence? PLoS Medicine / Public Library of Science 2004; 1: 7-10.
(4) Feder G, Ramsay J, Dunne D, Rose M, Arsene C, Norman R, Kuntze S, Spencer A, Bacchus L, Hague G, Warburton A, Taket A. How far does screening women for domestic (partner) violence in different health care settings meet the UK National Screening Committee criteria for a screening programme? Systematic reviews of nine UK National Screening Committee criteria. Health Technology Assessment, 2009; 13:16
(5) Jasinski J. Pregnancy and domestic violence. A review of the literature. Trauma, Violence & Abuse, 2004; 5: 47-64.
Competing interests:
SB and LB have both researched domestic violence in pregnancy and evaluated services for such women
18 June 2012
Susan Bewley
Professor of Complex Obstetrics
Loraine Bacchus, Lecturer, Gender Violence & Health Centre, London School of Hygiene & Tropical Medicine
Kings College London
Women's Academic Health Centre, St Thomas' Hospital, Westminster Bridge Rd, London SE1 7EH
Rapid Response:
Re: Prepregnancy care
Preconceptual care should improve the personal and social conditions for women becoming pregnant and preparing for motherhood. This is largely a public health and societal obligation. Although detrimental to health, violence and abuse do not fit the medical model of screening, diagnosis and remedy. Your review on preconceptual care was inconsistent(1) about recommending ‘screening’(2,3), when good evidence exists for the effectiveness of advocacy based interventions in antenatal settings(4).
Sexual violence can lead to pregnancy, domestic violence can start and escalate in pregnancy, and there is an especially high rate in terminations and repeat terminations(5). Thus, it is illogical to only ask about abuse after an ongoing pregnancy has started, as if child protection mattered exclusively, rather than adult protection. Doctors can offer safe, confidential space for women to talk about violence, as well as referral to specialist agencies. They can convey to women that it is ‘okay’ to talk about abuse during routine consultations, e.g. by having posters for domestic violence services in the waiting areas of GPs, emergency miscarriage units, family planning and termination clinics with a simple sticker saying “you can talk to your health care practitioner about domestic abuse or violence”. It is ordinary good practice to ask women about the quality of their relationships and offer support even before a pregnancy.
Perpetrators of abuse and violence against pregnant women should be held to account by their consciences, families, friends, communities and the criminal justice system. Better understanding of patient’s lives and needs, kindness and a focus on women’s safety will not hurt the next generation of mothers.
References
(1) Seshadri S, Oakeshott P, Nelson-Piercy C, Chappell L. Prepregnancy care. Clinical Review. BMJ, 2012; 344: e3467.
(2) Taket A, Nurse J, Smith K, Watson J, Shakespeare J, Lavis V. et al. Routinely asking women about domestic violence in health settings. British Medical Journal 2003; 327: 673–76
(3) Taket A, Wathen CN, MacMillan H. Should health professionals screen all women for domestic violence? PLoS Medicine / Public Library of Science 2004; 1: 7-10.
(4) Feder G, Ramsay J, Dunne D, Rose M, Arsene C, Norman R, Kuntze S, Spencer A, Bacchus L, Hague G, Warburton A, Taket A. How far does screening women for domestic (partner) violence in different health care settings meet the UK National Screening Committee criteria for a screening programme? Systematic reviews of nine UK National Screening Committee criteria. Health Technology Assessment, 2009; 13:16
(5) Jasinski J. Pregnancy and domestic violence. A review of the literature. Trauma, Violence & Abuse, 2004; 5: 47-64.
Competing interests: SB and LB have both researched domestic violence in pregnancy and evaluated services for such women