Domestic violence in pregnancy

Editor-That domestic violence intensifies in pregnancy, especially during the last trimester, is undeniable. As the article by Ozge Tuncalp and Susan Richman points out, domestic violence is so prevalent in pregnant women that it could be described as the most common complication.¹ Although we routinely screen pregnant women for pre-eclampsia and gestational diabetes mellitus, it is unfortunate that there is no recommended screening system in place for identifying and dealing with domestic violence.

"Routine inquiry" of women patients about whether they have experienced domestic violence has long been suggested, but recent studies have cast a shadow on this idea.³ Although the method was found to have helped identify more cases of domestic violence, none of the subsequent interventions were proved to have resulted in improved outcomes for these women. This lack of evidence for improved outcomes after identification has led to widespread scepticism about routine screening in healthcare settings. More attention has to be paid to this area of developing standard intervention protocols that could be implemented in various clinical settings.

Another problem that the article doesn't describe in detail is about the effect of domestic violence on the victims' health. The incidence of somatic complaints, sexual and gynaecological problems, such as pelvic pain, anxiety, and depression are higher in these women. These could be more disabling than the acute injuries sustained because of the violence.

1. Tuncalp O, Richman S. When love hurts. studentBMJ 2006;14:434-5. (November.)
2. Cole TB. Is domestic violence screening helpful? JAMA 2000;284:551-3.
3. Ramsay J, Richardson J, Carter YH, Davidson LL, Feder G. Should health professionals screen women for domestic violence? Systematic review. BMJ 2002;325:314.