Domestic violence and abuse (DVA) is a health problem with devastating consequences to women and great cost to the NHS. Identification and Referral to Improve Safety (IRIS) is a training for general practitioners (GPs) aiming at flagging patients with signs of DVA, asking them about abuse and referring those who disclosed to the local DVA service. Limited evidence from a Domestic Homicide Review and three foreign studies suggest that a request for the 'morning-after pill' may indicate DVA, because perpetrators persuade women to have unprotected sex or commit rape. Although the 'morning-after pill' can be bought at pharmacies, most socially disadvantaged women obtain the free pill through GPs. Up to a third of all the 'morning-after pills' are provided by GPs. To strengthen the limited evidence on the link between DVA and use of the 'morning-after pill', we propose to analyse patient records from ~8% of UK GP practices to establish whether women with a prescription for the "morning-after pill" are more likely to have a DVA record compared to women without the prescription. If we find a link, we will update IRIS training and extend it to other providers of the 'morning-after pills'.
Domestic violence and abuse (DVA) is a public health and clinical problem which adversely affects women's health. IRIS is a national training, support and referral programme for GPs built upon clinical enquiry among patients with signs and symptoms of DVA (case-finding). A recent Domestic Homicide Review and rapid literature review have suggested that request for emergency contraception may be a new indicator of woman's exposure to DVA. However, such limited evidence is not sufficient to amend the existing IRIS training. It is therefore important to obtain evidence from the UK population. Currently, community pharmacies, general practices and community reproductive health clinics are the main sources of emergency contraception in the UK. Up to a third of all emergency contraceptive pills are prescribed by GPs. We propose to use the Clinical Practice Research Datalink to examine the association between prescription(s) of emergency contraception and preceding exposure to DVA. If we identify that those women who are prescribed emergency contraception are more likely to be exposed to DVA than those who do not have the prescription, we will add the new evidence to the IRIS training and extend it to all core providers of emergency contraception.
Prescription of emergency contraception; Frequency of prescription of emergency contraception.
Natalia Lewis - Chief Investigator - University of Bristol
Natalia Lewis - Corresponding Applicant - University of Bristol
gene feder - Collaborator - University of Bristol
John Macleod - Collaborator - University of Bristol
Joni Jackson - Collaborator - University of Bristol
Theresa Redaniel - Collaborator - University of Bristol
HES Admitted Patient Care;Patient Level Index of Multiple Deprivation;Pregnancy Register