Intimate Partner Violence and Infertility

by Jana Lognon and Robin Brooks-Sherriff

Spring 2008

Intimate partner violence (IPV) is defined as the abuse of power within relationships of family that endangers the survival, security or well-being of another person. IPV includes behaviours such as physical abuse, psychological abuse, harassment, verbal abuse, sexual abuse, financial abuse, and spiritual abuse (Government of Alberta, 2007). While we largely refer to women in this article, the incidence of IPV for men is nearly as high as with women.

 

IPV is an astoundingly common issue for Canadian families. Statistics Canada found that 29% of women experience violence from their marital partner in their lifetime, with women aged 25-34 having the highest rates of spousal violence. Eight percent of women and seven percent of men have experienced violence from their marital partner in the last 5 years (Johnson & Au Coin, 2003).

 

Fertility clinics work with couples at a crossroads in their family development, as well as during a very stressful and vulnerable time in their lives. Assessment and support of clients dealing with domestic violence can improve their safety, health and quality of life while the children they hope to have will benefit from the support their parents receive.

 

In North America there is an unwillingness to recognize the prevalence and impact of IPV. IPV is perhaps the most under recognized public health issue for Canadian families. For example, 32% of homeless people on Halifax streets state family violence as the reason they had no home (Halifax Regional Municipality, 2005). The Calgary Police service reports that the Domestic Violence Unit receives 1000 referrals in a month (Calgary Police Service, 2006). It is estimated that 30 % of all women in Canadian emergency rooms are there with injuries related to IPV. The measurable health-related costs of family violence in Canada amount to more than 1.5 billion dollars (Basen, 2004).

 

Nursing research has shown that during the year of pregnancy, birth and post partum, IPV impacts key health predictors for both the infant and mother. Key indicators of well being such as maternal weight gain during pregnancy, substance abuse, smoking, low birth weight babies and infant weight gain after birth are adversely affected by intimate partner violence. (Campbell, J. C., Woods, A. B., Chouaf, K. L., & Parker, B., 2000). During pregnancy, 6.6% of Canadian women report IPV (Stewart & Cecutti, 1993). Cross sectional studies have also found associations between IPV and an increase in mental health issues such as depression, anxiety, and posttraumatic stress disorder (Jaffe, Wolfe, Wilson, & Zak, 1986).

How does this apply to or impact families undergoing fertility treatment? There is no research specific to IPV with families undergoing fertility treatment. However, if we presume that the statistics for IPV in the general population correlate to the client population at fertility clinics, then we know that this issue affects a significant portion of fertility patients. It is also probably safe to say that the stress of fertility testing and treatments and the added financial strain from the cost of fertility treatments may even add to a crisis for a potentially vulnerable family.

 

IVF nurses and physicians regularly come into contact with couples who are struggling in their marital or other family relationships for a variety of reasons. Some of these relationships are dysfunctional, some are controlling, while others are verbally or physically abusive. As these people look to becoming parents, they deserve appropriate assessment and support. The children these couples hope to have needhealth care professionals to support their parents to be the bestparents they can be.

 

Here are the details of a nursing assessment we carried out on IPV in Canadian IVF clinics (Brooks-Sherriff, Lognon & Trumper, 2007). We outline current practices and barriers; the results of this study were initially presented at the Canadian Fertility and Andrology Society Conference in Halifax, 2007.

Method. Initially, 22 IVF clinics were contacted with nine nursing leaders completing a qualitative cross-sectional telephone survey. Both free-standing and hospital-based clinics from six provinces were included. The interviews were then analyzed for current nursing practice, barriers and potential education opportunities.

Results. Patients were not being routinely assessed for IPV issues by nursing staff in the surveyed clinics. In two clinics patients identified themselves as IPV victims. In four other instances nurses picked up observable IPV issues while three clinics had not identified any IPV. If identified, patients were referred to counselling or to their family doctor. Two clinics delayed IVF treatment until counselling was undertaken.

 

Eight nurses felt they had limited comfort asking patients about IPV. Five nurses felt they did not have the skills to assess for IPV while four felt they had some ability to discern IPV issues but lacked concrete assessment skills. Appropriate cross-cultural evaluation of IPV was also identified as a barrier to assessment.

Seven nurses felt that there was a professional obligation to assess and offer support for IPV. All nursing leaders identified education regarding assessment tools, support and resources as important in order to facilitate increased IPV evaluation while contradictory views were expressed regarding the usefulness of an IPV policy.

 

Discussion. While IPV is a pervasive issue in Canadian families, fertility nurses are not routinely assessing their patient populations. Nursing leaders feel there is a professional obligation to assess and support patients with IPV issues, but there is a lack of skills and information to do so. Therefore, critical assessment of a very vulnerable patient population could be improved with suitable education on safe, effective assessment and intervention.

 

Most health professionals and lay people alike are uncomfortable with discussing IPV. In the above study of fertility clinics across Canada, it was found that clients are not routinely being assessed for IPV. Health care professionals frequently cite lack of time, privacy and concrete skills to help these families as reasons why they do not get more involved. Culturally we still want to believe that this is a private issue. Clearly it is not. The potential for life threatening injuries and long-term health and social impacts are too great.

 

 

 

 

Offering support. If the answer is “No”, then it is a perfect time to reassure and educate. A response could be, “I want you to know that violence is wrong and if you ever have an issue with violence, new or old, I would be open to discussing it with you.” A survivor of violence, be it physical or emotional, may not disclose the first time they are asked or even the second or third time. But each time they are asked, it is an opportunity for them to move to a healthier place.

If the answer is “Yes”, then offer support and validation. The following are examples of supportive messages:

 

• “I imagine it is hard to tell me these things. I believe you.”

• “It takes a lot of courage to speak up and I respect you for it.”

• “You are not to blame, and you do not deserve to be treated this way.”

• “You are not alone. There is help available”

 

Information and Resources. When a survivor discloses abuse, most often the situation is not an immediate crisis. The responsibility for action is still the survivor’s. It is not your responsibility to solve the issue of IPV for this person. As a health care professional or supportive friend, your role is to provide information and support so that the survivor can make the right decision for herself. She may not be ready to make that decision right now, but hopefully she will start thinking about it and possibly make a plan. You can help by providing access to resources and supporting her decisions. They are her decisions to make, not yours.

 

The national Clearinghouse on Family Violence

Local YWCA and women’s shelters

Your local police - usually has a victim’s assistance department

Local emergency room

 

National Domestic Violence Hotline 1-800-363-9010

(All provinces, bilingual service in English & French)

IPV is heartbreakingly common in Canada. There is no reason to believe that couples struggling with infertility are any less at risk. In fact the relationship stressors they endure may actually predispose them to escalation.

 

IPV deprives people of one of the most basic human requirements: the need to feel and be safe and secure. The impact of IPV encompasses every aspect of health and well-being through the life cycle and often continues in the next generation. Assessing for IPV and offering support and choices has been shown to break this cycle and move people to healthier places in their families and relationships.

 

Fertility patients deserve this assessment and support at this critical point in their family development. The support provided now may well prevent further escalation, violence in pregnancy and offer a healthier beginning to a new child. The challenge for Canadian fertility centres is to offer all the support a family needs to make a strong and healthy beginning.

Jana Lognon (BScN) has worked for 20 years in a variety of settings (rural hospitals, emergency departments, maternal-child, community health) and family violence is an issue that she has witnessed in all of these areas. Most recently, her work in the fertility setting has inspired her to make a difference in stopping the cycle of violence in Canadian families.

 

Robin Brooks-Sherriff has a Bachelor of Science in Nursing with a specialty in perinatal nursing. She has 6 years experience in fertility nursing and another 5 in maternal-child nursing. Improving intimate partner violence assessment and support for women is both a professional and personal journey to offer hope to all families.

 

Basen, G. (2004). Warning: An abusive relationship is hazardous to your health. [On-line]. Available: http://www.cwhn.ca/resources/violence/warning.html

Brooks-Sherriff, R., Lognon, J., & Trumper, R. (2007, Sept). Nursing assessment of intimate partner violence in Canadian IVF clinics: Current practices and barriers. Research presented at the Canadian Fertility and Andrology Society, Halifax, NS.

Calgary Police Service. (2006). Citizen’s police academy: Victim support at the heart of domestic conflict unit. Available: http://www.calgarypolice.ca/community/cpa_8.html

Campbell, J.C., Howard, P.K., Humphreys, J., Jerierski, M. B., Kincaide, M., Lewis-O’Connor, A., & Sharps, P. W. A call to action: The nursing role in routine assessment for intimate partner violence. [On-line]. Available: www.endabuse.org/programs/health/files/nursing.pdf

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Campbell, J. C., Woods, A. B., Chouaf, K. L., & Parker, B. (2000). Reproductive health consequences of intimate partner violence. Clinical Nursing Research, 9(3), 217-237.

Government of Alberta. (2007). Know your rights: Alberta’s protection against family violence act information sheet. [On-line]. Available: http://www.child.alberta.ca/home/documents/familyviolence/doc_opfvb_sheet_Rights_colour.pdf

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Stewart, D. E., & Cecutti, A. (1993). Physical abuse in pregnancy. Canadian Medical Association Journal, 149, 1257-1263.