4,000 women die each year in the US as a result of battery

40-60% of female homicide victims are killed by their intimate partners

Domestic Violence is the number one reason women in the reproductive age group are hurt in the US

25% of female suicide attempts*23% of women seeking prenatal care25-35% of women seen in ERs60% of mothers of abused children14% of women in internal medicine clinics

Our mothers, our sisters, our daughters and our friends

Are all ages and from all socioeconomic, ethnic, religious and educational groups

*Stark, Evan, and Filtcraft, 1996

Battered Women are…

Only about 1 in 20 patients that are victims of DV are recognized as such by their doctors

Our patients provide their own barriersWe worry about offending our patientsWe don’t have timeWe have our own hang upsWe don’t know what to do if she says “yes”We really don’t believe that we make a differenceWe do not know the frequency or impact of DV on

our patient’s lives

We Don’t Ask!

Universal Screening

JUSTIFIED!An educational toolRemoves prejudice and misconceptionsShould be on Health care screen and again face to faceShould be privateKeep it simpleDon’t forget to screen men, lesbians, the elderly

Universal ScreeningOpportunities

Every patient seen in the ER First Prenatal Visit & Postpartum

• Risk of violence and serious injury increases during pregnancy and postpartum

Admission to the HospitalDuring routine annual examinationUpon noticing any injury or unusual interaction between the

couple

Findings and Clues

Substance abuse Depression and anxiety Sexually transmitted

diseases Miscarriage and stillbirth Decreased fetal

movement Pain during ultrasound

• Inappropriate use of the ER

• Unusual interactions during counseling

• Preterm contractions• Preterm delivery

12% of births in the US Related to DV??

• Vaginal bleeding Placental abruption

Pregnancy provides opportunities…

Easier to establish good communication with patientFrequent visitsIncreased counselingNursing involvement in L&D and post partum

Patient more motivated to seek help

One in six neonates will go home to a violent home

CA State Law AB 1652

…every health practitioner employed in any health care facility who has knowledge of or observes a patient whom he/she suspects is suffering from a wound or injury which is the result of abusive conduct to make a report to local law enforcement by

1. Phone immediately2. Written report within 2 working days

Reporting is not enough…

Safety assessmentHow serious is the threat or injury?

Lethality prediction is iffy…Is there someone else in the house?What about child abuse?What about depression, suicide risk?Is there a gun in the house?Where can she go?Should she be admitted to the hospital?

You are not alone

Call your local shelterConsider women’s support groups

Human Options-IrvineInterval House-Santa AnaLaura’s House- San ClementeWomen’s Transitional Living Center- Fullerton

714-992-1931Carolina Harris