Intimate Partner Violence Consensus Statement
157 - Published April 2005
Objective: To provide health care providers with a summary of
current knowledge on intimate partner violence (IPV) and to
propose recommendations for best practices. To provide tools and
resources to support interventions
Outcomes: Optimizing provider skills in assessing for intimate partner
violence (IPV) and responding to disclosure, promoting institutional
and community coordination in a public health approach, and
improving safety and health for all women.
Evidence: Published and unpublished meta-analyses on screening
for violence were reviewed, as well as literature published
subsequent to December 2002. To update the 1996 guidelines on
domestic violence, key reports and documents produced by
governments, professional associations, and coalitions were
identified. External stakeholders critiqued a draft document and
Values: The quality of the evidence is rated with the criteria described
in the Report of the Canadian Task Force on the Periodic Health
Examination. Recommendations for practice are ranked according
to the method described in this report.
Recommendations: Comments are to be received from reviewers,
and then summary statements and recommendations are to be
Summary Statements and Recommendations
IV B. INCIDENCE AND PREVALENCE
1. Canadian surveys of IPV, the most common form of violence
experienced by women, have found an annual prevalence between
6% and 8%; this is considered a conservative estimate, owing to
2. Prevalence rates among pregnant and adolescent women appear
to be greater (III).
3. All women, regardless of socioeconomic status, race, sexual
orientation, age, ethnicity, health status, and presence or absence
of current partner, are at risk for IPV (III).
IV C. IMPACT
i. Physical and mental health
1. Violence is a significant cause of morbidity and mortality for women
2. Women experiencing violence have an increased risk for substance
abuse, mental disorders, chronic physical disorders, and sexual
health complaints (II-2).
ii. Maternal and fetal health
1. Women abused during pregnancy are more likely to be depressed,
suicidal, and experience pregnancy complications and poor
outcomes, including maternal and fetal death (III).
iii. Children exposed to IPV
1. Children whose mothers experience IPV are at greater risk of
developmental difficulties and may themselves be abused (III).
2. Some provinces require reporting to child protection agencies when
children live in households where IPV occurs (III).
1. Health professionals should enquire about the well-being and
safety of children whose mothers’ are experiencing IPV. When
concerned or when obliged by law, they must report their findings
to child protection agencies (B).
iv. Groups with special issues or needs
1. Women who are immigrants or refugees, lesbians, women of
colour, Aboriginal, and women who have disabilities may
experience forms of IPV, may experience IPV differently, and may
have more barriers to disclosure than mainstream women (III).
1. Health care professionals should be sensitive to the manifestations
of IPV in populations with differing needs (B).
IV D. INTERVENTION
1. At least 3 systematic reviews of “screening” for IPV have found
insufficient evidence to recommend for or against routine
screening. Asking women about violence is not a screening
intervention: victims are not asymptomatic; disclosure is not a test
result, it is a voluntary act, and the presence or absence of
violence is not under the victim’s control; and most interventions
required to protect and support survivors are societal, not medical
2. For pregnant women, clinical interventions that included
counselling to increase safety behaviours resulted in the adoption
of these practices (I) and reductions in abusive incidents (II).
i. Asking about IPV
1. Training of health providers may reduce barriers to asking about
2. Most women do not disclose IPV spontaneously because of
multiple perceived barriers; however, they often choose to disclose
when asked (III).
3. Several validated questionnaires exist for enquiring about IPV;
however, the nature of the clinician–patient relationship and how
questions are asked seem more important than the screening tool
1. Providers should include queries about violence in the behavioural
health assessment of new patients, at annual preventive visits, as
a part of prenatal care and in response to symptoms or conditions
associated with abuse (B).
ii. Responding to disclosure and nondisclosure
1. Women considered the provision of referrals to useful services
(advocacy, job training, and financial support) to be the most
important role for health care professionals (III).
1. Application of the Stages of Change Model to the counselling of
women experiencing IPV requires further evaluation and research
iii. Documentation and legal issues
1. Proper charting is important when caring for IPV victims. Records
made for clinical reasons may be used for legal purposes (III).
2. Unless subpoenaed, records may only be released with the
patient’s written consent, specifying the information to be released
1. Health care professionals should make clear, legible, and objective
clinical notes, using the woman’s own words about abuse and
adding diagrams and photographs when appropriate (B).
2. When in doubt, physicians should consult the medical records
department or their college for advice on the release of records (B).
V. ROLES AND RESPONSIBILITIES
A. Professional Support and Coordination
1. A comprehensive strategy of service development and prevention
of IPV requires the coordinated response of health and community
2. Administrative support and training sessions improve the ability of
residents and professionals to identify and assist abused women
1. Professional organizations, accreditation bodies, and institutions
should set standards and support quality control measures for
programs addressing IPV (B).
2. Providers need a supportive environment, ongoing training,
appropriate human resources (i.e. multidisciplinary teams), strong
links to the community, and effective referral networks (B).
3. Institutions and clinicians’ offices should have protocols for IPV,
handouts for clients, and up-to-date lists of community resources
B. Strategies for Supporting Women Experiencing IPV
i. Creating the environment
1. Secure and confidential environments, well-trained staff, printed
and visual patient resources, and provider tools such as checklists,
documentation aids, and facilitated referrals are necessary for the
facilitation of IPV disclosure (B).
ii. Approaches to asking
1. Providers should be caring, nonjudgmental and respectful in their
approach to asking about IPV (B).
2. Questions about IPV should be behaviour-specific (B).
iii. Responding to nondisclosure
1. The decision to disclose or not to disclose should be respected (B).
II. Assessment of risk—Recommendations
1. Essential elements of health sector response include
documentation, risk assessment, addressing the safety of children
present in the home, facilitation of a safety plan, and effective
referral and follow-up (B).
2. Providers should assess women disclosing violence for depression
and suicide risk (B).
3. Women disclosing the presence of children at risk should be
assisted by the reporting health professional in contacting their
local child welfare agency (B).
1. The SOGC has identified violence as an important determinant of
women’s health and is committed to supporting its members in
their care of abused women (III).
J Obstet Gynaecol Can 2005;27(4):365–388