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Health Care Providers > Role of Health Professionals > Identifying Abuse

Screening


When to screen

As a health care provider, you are likely to come across victims/survivors of violence against women. Probing for abuse may either be carried out routinely or in specific situations such as when indicators of abuse are identified. Screening helps identify more women facing violence and hence, provide care rather than if one waits for the woman to disclose abuse. Services and departments of the hospital such as Casualty, Psychiatry, Gynecology and ANC are likely to see a large number of women who may be abused and provide a good opportunity for such an endeavor. Therefore at least in these services, screening must be done.


As per WHO clinical and policy guidelines for %u201CResponding to Intimate Partner Violence and Sexual Violence Against Women, one should probe when assessing conditions that may be caused or complicated due to violence. Some of these conditions could be obvious such as

  1. fractures,
  2. unexplained reproductive or gastrointestinal symptoms,
  3. attempted suicide,
  4. chronic pain,
  5. repeated abortions,

or they could be less obvious like


  1. repeated health complaints, or consultations without any diagnosis,
  2. fatigue,
  3. sleep disturbances etc.

One should also take care to ask for violence when the partner seems controlling, intrusive, overly attention and refuses to leave the room. During screening, ensure a private setting to ask questions relating to violence. .  


SCREENING QUESTIONS:

You may screen women for domestic violence by asking direct questions about abuse or indirect ones. Irrespective of the questions used, the women should be assured confidentiality and be made comfortable.

Direct Questioning: 


-Because violence is so common in women%u2019s lives, we have started asking all patients about it. Whatever you say will be kept confidential and won%u2019t leave this room.
-Have you ever been kicked, punched, slapped, shoved or otherwise hurt by someone in your home? 
-Has your partner ever forced you to have sex when you did not want to? Has he ever refused safe sex?


Indirect Questioning:

-Your injuries do not look like they are accidental. I am concerned that your symptoms may have been caused by someone hurting you. Did someone cause these injuries?  You can tell me without fear. Whatever you tell me will not be told to anyone without your permission.
-Your complaints seem to be related to stress. Do you face any tensions with your partner/ at home?


How to Screen :

If you suspect that a woman is being abused, probe with a great deal of sensitivity. Whether or not she reveals abuse is inextricably linked to how sensitive you are.


Assure her confidentiality.


Tell her that in your experience, you have often seen women who report violence and reassure her that she will not be judged or endangered by disclosure. Considering the stigma associated with abuse, it is understandable that she will not be open to sharing her private oppression with you.


Maintaining confidentiality is of utmost importance in such instances. Before you start questioning the woman, make sure that she is alone. You can ask accompanying people to leave the room while you talk to her. Apart from the fact that women find it difficult to talk in front of family members (who may be abusers), it is likely that she will face violence when she goes back home if the abuser gets wind of the fact. Worse, she will never be allowed to return to you and will lose an opportunity to get help.

Keep in mind that it is your ethical obligation to not jeopardize the woman's safety at any cost.


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