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Domestic Abuse

Domestic Abuse - “Any incident of threatening behaviour, violence or abuse between adults
who are or have been intimate partners or family members, regardless of gender or
sexuality.”
Types of abuse include:




Physical
Psychological
Sexual
Financial
Emotional

Stats



Lifetime risk of 30% in women and 16% in men
75% result in physical injury or adverse mental health consequences to the victim
4% of women experience stalking every year
66,000 women living with consequences of FGM

When to suspect
Often have unnecessary investigations and medication for nonspecific or mental health
symptoms. Consider asking if health markers for domestic abuse. These include:









Depression
Unexplained symptoms / nonspecific symptoms
Tiredness
Chronic pain
Genital injuries
STI
Self – harm
Frequent surgery or A&E attendance
Delayed presentation
Inconsistent story to injuries, injuries at different stage of healing

Risk factors







Female
Young age
Pregnancy – 30% starts in pregnancy
Substance abuse
Mental ill health
Chronic illness or disability
Cultural factors:
o Living in community which practices FGM or honor crimes
o Isolation
o Immigration status
o Language barrier
Leaving violent partner
Stalking

What to do
Explore concerns, ensure they are safe and reinforce confidential nature of discussion. See
them on their own. They may not want to share.
Indirect questioning

and some may need help or intervention. normal fertility may take up to a year to re-establish. and not using contraception.  “Is everything alright at home” “Are you getting on with your partner” Direct questioning HARK questions developed as a framework to identify people who suffered domestic abuse. Timing of pregnancy • • In couples having regular sexual intercourse every 2 or 3 days. Following use of the contraceptive injection. The optimum biological age for pregnancy is between 20-35 years of age . and 92% within two years. 84% will become pregnant within a year. [5] The rest may take longer to conceive.     Humiliation: "In the last year. have you been humiliated or emotionally abused in other ways by your partner?" "Does your partner make you feel bad about yourself?" "Do you feel you can do nothing right?" Afraid: "In the last year have you been afraid of your partner or ex-partner?" "What does your partner do that scares you?" Rape: "In the last year have you been raped by your partner or forced to have any kind of sexual activity?" "Do you ever feel you have to have sex when you don't want to?" "Are you ever forced to do anything you are not comfortable with?" Kick: "In the last year have you been physically hurt by your partner?" "Does your partner threaten to hurt you?" Preconception history Barriers to conception Conception counselling How to Increasing chances Women on progesterone-only injection for contraception may have delayed fertility of up to a year.