Could requesting emergency contraception be a sign of domestic violence and abuse?
Domestic violence and abuse (DVA) is a major public health problem, with devastating consequences for those 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.
Limited evidence suggests that women who have experienced domestic violence and abuse end up using emergency contraceptives more than other women, because their partners may have raped them or coerced them to have unprotected sex. Pharmacists provide half of all emergency contraceptives, while GPs provide 30 per cent and sexual health practitioners provide 20 per cent.
Identification and Referral to Improve Safety (IRIS) is an evidence-based training and support programme for general practice staff to identify and refer women who are experiencing domestic violence and abuse to specialist services. IRIS teaches GP staff how to spot the signs of domestic violence and abuse, how to ask about safety in patients’ relationships, and what to do if patients disclose they’ve experienced domestic violence and abuse. IRIS has recently been adapted for sexual health clinics. But requesting emergency contraception hasn’t been included in the training as a sign of domestic violence and abuse.
This project aimed to explore whether requesting emergency contraception can indicate that women have experienced domestic violence and abuse. It also looks at whether community pharmacists would be willing and able to ask about domestic violence and abuse and respond appropriately, if a woman does disclose. The findings will be used to update IRIS for GPs and sexual health clinics, with a possibility to extend it to community pharmacies.
Extending the IRIS approach to community pharmacies could lead to:
- An increase in the number of women accessing specialist support
- Improved safety, health and care for women who have experienced domestic violence and abuse
- A new link between community pharmacies and specialist domestic violence and abuse services
- Reduction in GPs’ workload in this area
This project was a collaboration with the Centre for Academic Primary Care at University of Bristol and ARC North Thames.
What we did
This project had three parts:
- We did a ‘systematic review’ to understand the existing evidence, looking at published research on whether women who have experienced domestic violence and abuse are more likely to use emergency contraception than other women
- We analysed patient records from GP practices to establish whether women who had a consultation for emergency contraception are more likely to have experienced domestic violence and abuse, compared to other women
- We interviewed pharmacists to understand whether they feel prepared to identify and respond to women who have experienced domestic violence and abuse
What we found and what this means
In the systematic review, we found six studies looking at the use of emergency contraceptives among women who have experienced domestic violence and abuse. Overall we found some evidence that women exposed to domestic violence and abuse were more likely to use emergency contraception than other women.
In the study of GP patient records, women exposed to domestic violence and abuse in the past year were twice as likely to have had at least one consultation for emergency contraception than other women.
Interviews with pharmacists found that they want to be involved in identifying and responding to domestic violence and abuse but do not have enough knowledge, skills and resources for this extra work.
We concluded that consultations for emergency contraception would be an appropriate context for professionals to ask about domestic violence and abuse and refer women on to specialist services.
What next?
The new evidence from the systematic review and GP records will inform an update to the IRIS training for GPs and sexual health practitioners, to include a request for emergency contraception as a potential sign of domestic violence and abuse.
We are working with pharmacists to adapt the standard IRIS training for them and apply for funding to test the adaptations. This will mean women experiencing domestic violence and abuse will be able to access specialist support via their community pharmacy as well as via GPs and sexual health clinics.
Papers
Exposure to domestic violence and abuse and consultations for emergency contraception: nested case-control study in a UK primary care dataset
Read the paper
Use of emergency contraception among women with experience of domestic violence and abuse: a systematic review
Read the paper
Barriers and facilitators to pharmacists’ engagement in response to domestic violence: a qualitative interview study informed by the capability-opportunity-motivation-behaviour model
Read the paperRelated research projects
We have also investigated whether using the IRIS approach works in sexual health settings.
Lead collaborators
- Dr Natalia Lewis, University of Bristol
- NIHR, CLAHRC North Thames
ARC West Staff
Professor Jeremy Horwood
Professor of Social Sciences and Health
Joni Jackson
Senior Research Associate, Quantitative ResearchPartners on this project
University of Bath
The University of Bath is one of the UK's leading universities with an international reputation for quality research and teaching. Its mission is to deliver world class research and teaching, educating its graduates to become future leaders and innovators, and benefiting the wider population through our research, enterprise and influence.
University of Bristol
The University of Bristol is internationally renowned and one of the very best in the UK, due to its outstanding teaching and research, its superb facilities and highly talented students and staff. Its students thrive in a rich academic environment which is informed by world-leading research. It hosts the Elizabeth Blackwell Institute for Health Research.