Despite the figures showing one in every three or four women seeking medical assistance have been victimized by domestic violence, screening for DV is still not routinely done. One study of physicians practicing in three different medical specialties revealed that only an average of 28 patients a year were being identified and aided for DV related problems. Another study revealed that only a quarter of female OBGyns and even fewer male OBGyns were screening for abuse. It is estimated that less than 30% of hospitals are compliant with initiatives for screening, despite standardized formats.

Barriers cited include:

• lack of time,
• staffing and privacy;
• cultural unease and uncertainties; and
• frustration and judgmentalism on the part of healthcare workers.
  

Markers of domestic violence range from the obvious to the subtle. Among the physical injuries, 48% are bruises, most often in a pattern and/or central area of the body. Twenty-four percent of physical injuries are lacerations, stab wounds and internal injuries combined. Seventeen percent are musculoskeletal. Explanations inconsistent with the injury and/or unexplained delays in seeking treatment may be used in an attempt to hide the occurrence of DV.

The strongest indicator of DV is the presence of depression. Some victims have no visible signs of battering but present with substance abuse, vague complaints and pleas for help, and suicidal episodes. Aggressive and overly attentive behavior of an accompanying partner, fearfulness in the patient about going home, and the reported lack of prenatal care are all red flags for covert DV that need to be investigated.

The American College of Obstetricians and Gynecologists (ACOG) maintain a website containing information about domestic violence. Specifically, the recommended screening is discussed at this link. Please click here and look for the answer to this question:

Ideally, during pregnancy, when and how often should screening for domestic violence occur?