Emergency Contraception Requests May Be Sign of Domestic Abuse

Could represent "important opportunity" for intervention and support



Women who were victims of domestic violence were more than twice as likely to have a medical consultation for emergency contraception, British researchers found.

Those women who were exposed to domestic violence or abuse within the last 12 months were more likely to have a consultation for emergency contraception (adjusted OR 2.06, 95% CI 1.64-2.61) than women with no exposure to domestic violence or abuse, reported Joni Jackson, of the University of Bristol in England, and colleagues, in the British Journal of General Practice.

Jackson said in a statement that these findings are in line with evidence from studies in other countries outside of the U.K. that suggest women who experience domestic violence and abuse use emergency contraception more than other women, and that primary care providers, pharmacists, and sexual health practitioners are "at the frontline responding to these requests."

"This presents an important opportunity to identify women experiencing [domestic violence and abuse], signpost them to appropriate support services, and potentially save lives," she said.

Researchers examined the Clinical Practice Research Datalink, an anonymized electronic database of primary care records in the U.K. They looked at female patients ages 15-49. The cases included women with at least one record of an emergency contraception consultation from January 2011 to December 2016, and each case was matched in age and general practice against four randomly selected controls with no record of emergency contraception consultation.

Overall, there were about 44,000 eligible cases and about 175,000 matched controls. Mean age was 28 for both, and over half of participants' ethnicities were classified as "missing" in both groups. Cases tended to have had more pregnancies, more children, and were more likely to have had a history of depressive episodes, the authors said.

There were 152 women in the cases and 172 in the controls who had one or more records of domestic violence or abuse. Women who had experienced domestic violence or abuse within the year before their index date were more likely to have had one or more consultations for emergency contraception (OR 3.59, 95% CI 2.88-4.47).

The authors found a positive interaction between age and exposure to domestic violence and abuse, with greater odds of emergency contraception consultation among women ages 25-39 who had exposure to domestic violence and abuse vs unexposed women (adjusted OR 2.78, 95% CI 2.08-3.75).

In addition, the authors found that after adjustment for "all covariates," there was evidence of "an independent effect" of exposure to domestic violence and abuse on the number consultations for emergency contraception (adjusted OR 1.48, 95% CI 0.99-2.21).

"The negative impact of domestic violence and abuse on health results in higher use of healthcare services by abused women compared to the general population. This means that healthcare services are an important point of contact for [domestic violence and abuse] victims and survivors," said co-author Natalia Lewis, PhD, also of the University of Bristol, in a statement.

One main study limitation was the under-recording of domestic violence and abuse in medical records, which the authors said "could attenuate the association between exposure to [domestic violence and abuse] and consultations for [emergency contraception]."

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