“Screening” for Domestic Violence

Abstract

Domestic violence has been recognized as a public health concern worldwide with serious social and health consequences, including adverse pregnancy outcome. Although health-care professionals are becoming better informed about domestic violence, and women accept being questioned in this regard, studies have shown that fewer than 10% of physicians ask women routinely about domestic violence, even during pregnancy. Further, based on traditional criteria for screening, reviews have not supported screening programs for domestic violence. This purist approach to screening is inconsistent with what we know about domestic violence and provides a rationale for health-care professionals who are personally uncomfortable with routinely asking women about domestic violence to avoid such an approach. Biomedical models are inadequate to measure the “success” of screening for complex psychosocial health issues. Recent studies suggest that merely asking about violence and providing validation and support reduces violent incidents. The term “screening” in this context may be a misnomer better replaced by “routine enquiry.” Published systematic reviews and guidelines about domestic or relationship violence acknowledge the seriousness of the problem from a health perspective and the justification to include routine enquiry about domestic violence as part of health care, even when concluding that the evidence is lacking to justify screening programs as traditionally defined. Continued education and support for health professionals is essential in ensuring that women are not unknowingly left at greater risk due to a non-systematic approach.