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In Canada, the annual prevalence of violence against women is about 8% among nonpregnant2 and 6% to 8% among pregnant women.3,4 For the purpose of our review5 and recommendations, violence against women is defined as physical and psychological abuse of women by their male partners, including sexual abuse and abuse during pregnancy. Of women who are abused, 25% suffer episodes of beating, 20% of choking and 20% of sexual assault; 40% suffer injury, and 15% receive medical care as a result of partner violence. Separate from physical violence, 19% of women suffer emotional abuse and controlling behaviour, including financial abuse or control.2 Emotional forms of abuse are highly correlated with physical violence: 5-year rates of violence are 10 times greater among those in emotionally abusive situations than among those who do not report emotional abuse.2 Women exposed to partner violence are at increased risk of injury and death as well as a range of physical, emotional and social problems.6 Abuse during pregnancy is associated with impairment in both the mother and child, including low birth weight.7
The following interventions were evaluated:
· Screening of all women, including pregnant women, in the primary care setting to detect intimate partner violence
· Interventions for women who are abused
· Treatment programs for men who abuse their partners
· Decrease in the incidence of physical, sexual or emotional abuse by men against their female partners
· Increase in women's use of safety behaviours, social support, community resources, etc., following intervention
· Reprisal violence by men against women seeking intervention
· Failure to detect abuse (either by not screening or through false-negative results of screening)
In 1996, the US Preventive Services Task Force concluded that there is insufficient evidence to recommend for or against the use of specific screening tools to detect domestic violence, although it suggested that clinicians be alert to signs of abuse and use selective screening questions if indicated.24 The American Medical Association's Council on Scientific Affairs recommends routine screening in primary care settings and a structured approach to documentation and referral to appropriate community resources.25 The Society of Obstetricians and Gynaecologists of Canada (SOGC) advocates a high degree of clinical suspicion and outlines key physical and psychological presenting symptoms.26 Although not directly encouraging routine screening, the SOGC provides a brief set of screening questions to be used as part of history-taking. The American College of Obstetricians and Gynecologists takes a similar approach.27 Both groups also provide guidance regarding counselling (including safety planning), referral and follow-up. A similar case-finding approach is also advocated by the American Academy of Pediatrics.28
β See related article page 570
The Canadian Task Force on Preventive Health Care is an independent panel funded by Health Canada.
This statement is based on the technical report: “Prevention and treatment of violence against women: systematic review and recommendations,” by H.L. MacMillan and C.N. Wathen, with the Canadian Task Force on Preventive Health Care. The full technical report is available online (www.ctfphc.org/Sections/Domestic_violence.htm) or from the task force office (ctf/at/ctfphc.org).
Correspondence to: Canadian Task Force on Preventive Health Care, 117–100 Collip Circle, London ON N6G 4X8; fax 519 858-5112; ctf/at/ctfphc.org