Requests for emergency contraception could be an important sign of abuse
Press release issued: 4 December 2018
Women who experience domestic violence and abuse (DVA) are more than twice as likely to seek emergency contraception as other women, according to a study by National Institute for Health Research (NIHR)-funded researchers at the University of Bristol and Queen Mary University of London, suggesting that requests for emergency contraception could be an important sign of abuse.
In the study, published in the British Journal of General Practice today [Tuesday 4 December], the researchers analysed medical records of over 200,000 women of reproductive age registered with a GP and found that those who had a record of DVA were 2.06 times more likely to have a consultation for emergency contraception compared to other women, rising to 2.8 times for women aged 25-39.
The researchers also found some evidence that abused women are more likely to seek emergency contraception repeatedly.
DVA is a major public health problem, with devastating consequences for the women who experience it and great financial cost to the NHS. It is known to have a significant impact on women's reproductive health, including an increased risk of unintended pregnancy and abortion, as abusive and controlling partners coerce women to have unprotected sex or rape them.
Although emergency hormonal contraceptive, also known as the morning-after pill, is available from pharmacies, women can also get it from their GP. Up to a third of all emergency contraceptives are prescribed by GPs.
The researchers are calling for this new evidence to be included in existing DVA training programmes for GPs and sexual health practitioners, and for the training to be extended to community pharmacists, to help them identify and refer women who have experienced DVA on to specialist support services. Such programmes are recommended by the National Institute for Health and Care Excellence (NICE) and the World Health Organization (WHO) as part of a multi-sector response to DVA.
Joni Jackson, Research Associate from the NIHR Collaboration for Leadership in Applied Health Research West (NIHR CLAHRC West) and co-lead author of the study, said: "We found a strong positive association between exposure to domestic violence and abuse and requests for emergency contraception. Our findings are in line with evidence from studies in other countries suggesting that women experiencing DVA use more emergency contraception than other women. GPs, pharmacists and sexual health practitioners are at the frontline responding to these requests, with community pharmacists dispensing 50 per cent of all emergency contraceptive pills. This presents an important opportunity to identify women experiencing DVA, signpost them to appropriate support services, and potentially save lives."
Dr Natalia Lewis, from the Centre for Academic Primary Care at the University of Bristol and co-lead author, added: “The negative impact of domestic violence and abuse on health results in higher use of healthcare services by abused women compared to the general population. This means that healthcare services are an important point of contact for DVA victims and survivors. We have already seen improvements in GPs' ability to identify and refer women experiencing DVA through the success of the IRIS (Identification and Referral to Improve Safety) programme. IRIS has recently been adapted for sexual and reproductive health services. Our findings support the case for adapting the IRIS intervention to the community pharmacy setting, although more research is needed to explore if and how this could be done."
The research was supported by NIHR CLAHRC West and CLAHRC North Thames.
'Exposure to domestic violence and abuse and consultations for emergency contraception: nested case-control study in a UK primary care dataset' by Joni Jackson, Natalia V Lewis, Gene S Feder, Penny Whiting, Timothy Jones, John Macleod, Maria Theresa Redaniel in British Journal of General Practice
'Use of emergency contraception among women with experience of domestic violence and abuse: a systematic review' by Natalia V Lewis, Theresa HM Moore, Gene S Feder, John Macleod, Penny Whiting in BMC Family Practice
16 days of action against domestic violence – 25 November to 10 December 2018
For help and support on domestic violence, these services provide free helplines:
- National Domestic Violence 24 hr Helpline for women experiencing abuse: 0808 2000 247
- Men's Advice Line for men experiencing abuse: Monday-Friday 9am-5pm: 0808 801 0327
- National LGBT Domestic Abuse Helpline: 0800 999 5428
- RESPECT Phoneline: Confidential helpline offering advice, information and support to help men stop being violent and abusive to partners. Monday-Friday 9am-5pm: 0808 802 4040
IRIS is a general practice-based domestic violence and abuse (DVA) training support and referral programme that has been evaluated in a randomised controlled trial. Core areas of the programme are training and education, clinical enquiry, care pathways and an enhanced referral pathway to specialist domestic violence services. It is aimed at women who are experiencing DVA from a current partner, ex-partner or adult family member. IRIS also provides information and signposting for male victims and for perpetrators.
About the Centre for Academic Primary Care
The Centre for Academic Primary Care (CAPC) at the University of Bristol is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research. It sits within Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching. Follow us on Twitter: @capcbristol
About NIHR CLAHRC West
The NIHR Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) works with its partner organisations, including local NHS and public health providers, to conduct applied health research and implement research evidence, to improve health and healthcare across the West. It undertakes applied health research projects, in collaboration with its partners across the region and nationally. The research it does must have a real-world application and fall into one of our broad thematic areas of ‘improving the management of chronic health conditions’ and 'public health interventions and population health'.
About NIHR CLAHRC North Thames
NIHR CLAHRC North Thames works across North and East London, Hertfordshire, Bedfordshire and Essex, bringing together academics, health and other partners to conduct world-leading innovative research with a direct impact on the health of patients with long-term conditions and on the health of the public. CLAHRC North Thames also supports its widespread implementation for direct benefit to patients, the population and the NHS. We have secured £35 million in matched funding from our partners in the NHS, local government, industry and the voluntary sector.
About the National Institute for Health Research
The National Institute for Health Research (NIHR): improving the health and wealth of the nation through research.
Established by the Department of Health and Social Care, the NIHR:
- funds high quality research to improve health
- trains and supports health researchers
- provides world-class research facilities
- works with the life sciences industry and charities to benefit all
- involves patients and the public at every step
For further information, visit the NIHR website www.nihr.ac.uk
This work uses data provided by patients and collected by the NHS as part of their care and support and would not have been possible without access to this data. The NIHR recognises and values the role of patient data, securely accessed and stored, both in underpinning and leading to improvements in research and care. Read more
Domestic violence facts
The UK government defines DVA as "any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality. The abuse can encompass, but is not limited to: psychological, physical, sexual, financial, emotional."
The WHO and NICE guidelines recommend a case-finding approach to identifying patients with experience of DVA: healthcare providers asking those women who present with clinical associations of DVA about safety in their relationship and at home, and signposting or referring those who disclosed to specialist DVA services. Therefore, professional awareness of clinical associations of DVA is a crucial first step towards a healthcare response to DVA.
Globally, direct experience of being subjected to domestic violence is greater among women then among men. In the UK, 27 per cent of women and 13 per cent of men have experienced some form of domestic abuse in their lifetime.