What is Intimate Partner Violenc e (IPV)?
Intimate partner violence (IPV) is the actual or threatened physical, sexual, or psychological harm by a current or former partner or spouse. The pattern of assaultive or coercive behaviors is characterized by the control or domination of one person over another.
Examples of IPV include:
· Physical violence
o hit, slap, scratch, choke (strangle), bite, push, kick
o use of restraints or one’s strength against another person
· Sexual violence
o unwanted kissing or fondling
o rape or forced sexual acts
· Psychological abuse
o stalking, harassment, degradation, intimidation, name-calling, isolation
o threats of physical or sexual violence (using words, gestures, weapons)
o limiting or controlling access to money, family, friends, food,
transportation, medicine, healthcare
· Reproductive coercion
o refusal to use contraception or condoms resulting in unintended
pregnancy or exposure to sexually transmitted infections
o control over pregnancy options
How common is IPV?
IPV is common. More than one-third of women and one-fourth of men in the U.S. have experienced rape, physical violence, and/or stalking by an intimate partner at some point in their lifetime. Nearly three in ten women and one in ten men in the U.S. reported at least one measured impact (such as symptoms of post traumatic stress disorder, being injured or needing health care or legal services) related to the violent behavior [National Intimate Partner and Sexual Assault Survey: 2010 Summary Report].
Violence occurs in all socioeconomic groups and to individuals among every culture, race, ethnicity, gender, and religion.
In Maryland, the leading cause of death among pregnant and postpartum women is homicide [Cheng and Horon. Obstet Gynecol 2010]. The majority of these homicides are perpetrated by a current or former intimate partner. According to self-reported postpartum survey data, 7% of mothers were physically abused by an intimate partner during pregnancy or in the year before pregnancy [Maryland PRAMS Focus on Intimate Partner Violence, 2011].
Can IPV affect my health?
Current or past IPV can result in acute injuries, mental health problems such as depression, post traumatic stress disorder (PTSD), chronic medical disorders such as migraine headaches, chronic pain, and reproductive health problems such as infertility, adverse pregnancy outcomes.
With such a large impact on health, shouldn’t women be routinely screened in the health care setting?
Yes! It is recommended by every major professional medical organization including the American Medical Association (AMA), American Academy of Family Physicians (AAFP), American College of Physicians (ACP), American College of Obstetricians and Gynecologist (ACOG), American Academy of Pediatrics (AAP) and the American Psychiatric Association (APA).
Health care providers are often the first and only professionals seen by women who are in a violent or abusive relationship. Domestic violence assessment is not an option; it is a standard of care. Women do not mind being asked about IPV.
Any tips for doing an IPV assessment?
1) Always assess for IPV in private, without anyone who accompanied the patient.
2) Avoid the use of stigmatizing terms such as “abuse”, “rape”, or “battered”.
3) Develop a strategy that is nonjudgmental and employs culturally relevant language.
As a health care provider, how can I assess for IPV?
For more information about IPV assessment, see
“Intimate Partner Violence: A Guide for Health Care Providers”
There are many screening tools for IPV however even the most common tools have not been evaluated with any rigor in terms or number of studies or subjects. Because many women may never divulge IPV to a provider, it is important to provide education and resources about IPV to all women.
Prior to the assessment* it is useful to frame the questions and discuss confidentiality:
"Because violence is so common in many women's lives and because there is help available for women being abused, I now ask every patient about domestic violence.”
“I want you to know that everything here is confidential. I won’t tell anyone else about what is said unless you give me permission.”
[Note exceptions for Maryland, in cases of abuse of vulnerable adults, children < 18 years of age by a guardian, or treating certain injuries.]
Sample IPV Assessment questions:
1. "Has your current or former partner ever threatened you or made
you feel afraid?" (examples include stalking, threatens to hurt you or your
children if you did or didn’t do something, controls whom you talk
to/where you go, goes into rages)
2. “Has you partner ever hit, choked or physically hurt you?”
(“hurt” includes being hit, slapped, kicked, strangled, bitten, shoved)
3. ”Has your partner ever forced you to do something sexually that you
did not want to do, or refused your request to use condoms?”
For contraception/family planning discussions, also ask:
4. ”Does your partner support your decision about when or if you want
to become pregnant?”
5. “Has your partner ever messed with your birth control or tried to get
you pregnant when you didn’t want to be?”
Educate everyone, whether abuse is disclosed or not.
Even if abuse is not acknowledged, providing all patients with educational materials normalizes the conversation, making it acceptable for women to receive information without disclosure. Convey to all women that:
o information is available (keep brochures/posters in bathroom, exam
room, waiting room); hand out a small IPV resource card that can fit
in patient’s shoe or other concealable area
o you/staff are available for help and support
o abuse is wrong and it is not the victim’s fault
o everyone has the right feel safe
*adapted from American College of Obstetricians & Gynecologists Committee Opinion No. 518, “Intimate Partner Violence”, February 2012
DOMESTIC VIOLENCE/INTIMATE PARTNER VIOLENCE PROGRAMS IN MARYLAND