Domestic violence – a fundamental issue for sexual and reproductive health services

Thursday 3rd December 2015

For Day 9 of our 16 Days of Activism blog series, Dr Justin Varney from Public Health England discusses the role of sexual and reproductive health services in supporting survivors and tackling domestic abuse.


Professionals delivering sexual and reproductive health services are in a privileged position of trust. We share our most intimate body parts with them, and details of our sexual and emotional relationships.

Sexual and reproductive health is important at every age and in every community, as both an independent aspect of health and an indication of wellbeing.

The WHO definition[1] of sexual and reproductive health, and the subsequent global framework for action[2], challenges practitioners to move beyond a purely disease treatment framework. Instead, we must take approaches which integrate knowledge and skills for healthy, safe and empowered sexual and reproductive choices.

In 2013-14 over 1.34 million individuals[3] came into contact with NHS contraception services; nine in ten attendees were women. In 2014, there were 1.98 million individuals[4] attending a genito-urinary medicine clinic for a sexually transmitted infection – just over 55% of these were women.

8.5% of women[5] have experienced domestic violence in the last year in England and Wales. Approximately 195,000 women that had experienced domestic abuse in the last year came into contact with a sexual or reproductive NHS professional, and could have reached out for help.

Domestic abuse has serious and prolonged impacts on physical and mental health. Almost by definition it has a bearing on sexual and reproductive health, because the perpetrator of the violence is in most cases either a current or former partner.

This highlights the need for commissioners of sexual and reproductive health services to explicitly consider domestic abuse referral pathways and to enable service providers the space and capacity to deliver holistic care.

Public health professionals have an important role to play too, working across commissioners to ensure that the response to domestic abuse is joined up and that there are coherent and accessible pathways of support that clinicians can signpost victims into.

Research suggests that healthcare professionals are one of the few groups that victims feel comfortable reaching out to. Most of those who do disclose get specialist support and move into lives free from violence.

The Faculty of Sexual and Reproductive Health highlights the importance of clinicians having knowledge and understanding of sexual coercion and domestic abuse. It is also a visible topic globally and in within the UK HIV field.  Knowledge of an individual’s HIV status can be used as a weapon of coercion by a partner or ex-partner. The stigma around HIV adds an additional barrier to individuals leaving an abusive relationship.

We often think about sex being used as a weapon of violence in global areas of conflict, but the statistics on domestic abuse and sexual violence confirm that sexual violence happens in the UK too. Because of the intimate nature of the examinations and discussions in sexual and reproductive health services, the health care professional often has one-to-one time in private with an individual. This can be an important opportunity for individuals to disclose – hence it is essential professionals are ready to respond.

Being ready to respond is about having a basic level of knowledge of domestic abuse and knowing where your local specialist support services are.

NICE set out a clear recommendation that organisations should provide specific training for health and social care professionals in how to respond to domestic abuse. Public Health England commissioned AVA to refresh their free e-learning modules to align with the NICE guidelines on domestic violence and NHS professionals, and provides free access to level 1 and level 2 training. There are also excellent resources from the Royal College of Obstetrics and Gynaecology and Department of Health.

Many local domestic abuse services provide teaching and are happy to provide their contact details and information to make sure that healthcare professionals have the right information to hand when someone reaches out.

Putting up posters in toilets and waiting rooms about domestic abuse which signpost to national resources (like the National Domestic Violence Helpline  – run in partnership between Women’s Aid and Refuge) are important ways to share the information.  It also provides non-verbal permission to patients that this is a safe space for them to discuss their experience.

Supporting individuals to have a sexual and reproductive life which is free from violence and coercion is at the core of sexual and reproductive health services aims and objectives. It should be in the contract as well as in the hearts and minds of the professionals who deliver them.

Being ready to respond to disclosure of domestic abuse is a fundamental part of providing good holistic sexual and reproductive healthcare. These simple steps for commissioners and practitioners can help every provider move towards better patient outcomes.

Join the response today! #Ready2Respond

If your service would like to know more about how Women’s Aid could support you with training and resources on domestic abuse, please contact our training team at: [email protected] 

If you or a friend need help

If you or a friend need help you can call the National Domestic Violence Helpline (Run in partnership between Women’s Aid and Refuge) on 0808 2000 247 or explore our online Survivor’s Handbook which contains support and information on the many aspects of domestic abuse.

The Survivor's Handbook

About the author

Dr Justin Varney is the National Lead for Adult Health and Wellbeing for Public Health England. Public Health England work to protect and improve the nation’s health and well-being, and reduce health inequalities. Learn more about their work

About 16 Days

From 25 November, the International Day for the Elimination of Violence against Women, to 10 December, Human Rights Day, Women’s Aid will release a blog a day on our website, promoted via social media, encouraging people to take action and use their influence to help raise the status of women to a level where violence against them is no longer tolerated. Read more blogs from the series


Notes

[1] WHO (2006a). Defining sexual health: Report of a technical consultation on sexual health, 28–31 January 2002. Geneva. World Health Organization.

[2] WHO (2010) Developing sexual health programmes: A framework for action.

[3] HSCIC  Sexual and Reproductive Health Services, England – 2014-15 http://www.hscic.gov.uk/article/2021/Website-Search?productid=18929&q=contraceptive&sort=Relevance&size=10&page=1&area=both#top

[4] PHE Table 4: All STI diagnoses and services by gender and sexual risk, 2010 to 2014

[5] ONS. 2015. Crime Statistics, Focus on Violent Crime and Sexual Offences, 2013/14

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