How do health practitioners in a large Australian public hospital identify and respond to reproductive abuse? A qualitative study

Abstract

Objective: Reproductive abuse is defined as a deliberate attempt to control or interfere with a woman’s reproductive choices. It is associated with a range of negative health outcomes and presents a hidden challenge for health practitioners. There is a dearth of research on reproductive abuse, particularly qualitative research. This study aims to address this gap by exploring how health practitioners in a large Australian public hospital identify and respond to reproductive abuse. Methods: We conducted semi‐structured interviews with n=17 health practitioners working across multiple disciplines within a large metropolitan public hospital in Victoria. Data were analysed thematically. Results: Three themes were developed: Figuring out that something is wrong; Creating a safe space to work out what she wants; and Everyone needs to do their part. Conclusions: Practitioners relied on intuition developed through experience to identify reproductive abuse. Once identified, most practitioners described a woman‐led response promoting safety; however, there were inconsistencies in how this was enacted across different professions. Lack of clarity around the level of response required was also a barrier. Implications for public health: Our findings highlight the pressing need for evidence‐based guidelines for health practitioners and a ‘best practice’ model specific to reproductive abuse.

Barriers to Responding to Reproductive Coercion and Abuse in Australian Primary Care

“…Despite increased recognition in research and practice, 3,20,31 the results show that there is a lot more work needs to be done to address the barriers to responding to RCA in Australian primary care. Although clinicians are willing and able to be trained to identify and respond to reproductive coercion and abuse, in the current system there would be little bene t if there is nowhere to refer women.…”

“…3 Previous studies in Australia were conducted in a tertiary hospital setting, where the challenges for clinicians centred around a lack of shared understanding between different clinicians and the need for a multidisciplinary approach. 3,20 The clinicians in the hospital did not face any barriers to access any services like the clinicians in primary care do. Guidelines for best practice are yet to be formulated in the Australian context, but comparing the current Australian literature with this study shows that guidelines can't be a 'one size ts all' like current guidelines in the US 25 as the barriers and access to services in Australia are so diverse.…”

“…19 Although GPs are trusted clinicians, very little is known about their experiences with RCA in their patients. One study (n = 17) conducted in a hospital have provided some insight into how RCA is responded to in a tertiary health setting, 20 however there are no studies exploring primary care and the challenges they face in responding to RCA. In response to these gaps, this paper aims to qualitatively explore primary care clinicians' perceptions of the barriers to responding to RCA in Australia.…”

Exploring the gray areas between “stealthing” and reproductive coercion and abuse

“…Although there has been an increase in awareness around RCA, research in this area has been plagued by inconsistencies and a lack of theoretical attention. This has resulted in wildly varied prevalence rates (Fay and Yee 2018;Rowlands and Walker 2019) and practical challenges for practitioners and service providers (Tarzia et al 2019). Elsewhere, (Tarzia et al 2018) we have argued that the term "reproductive coercion" contributes in part to this lack of definitional clarity, since it fails to capture the use of fear and control tactics by perpetrators.…”

Reproductive Coercion and Legal Recognition: Views of Domestic Violence Support Workers and Lawyers

“…Little is known, however, about how workers in these contexts identify and respond to disclosures of RC. Most research about RC to date has focused on healthcare settings IJCJ&SD 3 www.crimejusticejournal.com (Fleury-Steiner and Miller 2019;Tarzia et al 2019a;Tarzia et al 2019b). One US study explored the extent to which DV advocates proactively and/or reactively addressed RC with women accessing DV victim services (McGirr et al 2017).…”