Bibliographic Info
Recommendation
Context specific recommendation
Only in specific contexts
Certainty of evidence
Low
Clinical enquiry about the possibility of intimate partner violence (IPV) should be strongly considered at antenatal care visits when assessing conditions that may be caused or complicated by IPV in order to improve clinical diagnosis and subsequent care, where there is the capacity to provide a supportive response (including referral where appropriate) and where the WHO minimum requirements are met
Notes and Remarks
- 1.This recommendation is consistent with the 2013 publication Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines. The evidence on clinical enquiry was indirect (strong recommendation) and the evidence on universal screening was judged as being of low to moderate quality (conditional recommendation).
- 2.“Universal screening” or “routine enquiry” (i.e. asking all women at all health-care encounters) about IPV is not recommended. However, the WHO guidelines identify ANC as a setting where routine enquiry could be implemented if providers are well trained on a first-line response and minimum requirements are met.
- 3.Examples of conditions during pregnancy that may be caused or complicated by IPV include:
- – traumatic injury, particularly if repeated and with vague or implausible explanations;
- – intrusive partner or husband present at consultations;
- – adverse reproductive outcomes, including multiple unintended pregnancies and/or terminations, delay in seeking ANC, adverse birth outcomes, repeated STIs;
- – unexplained or repeated genitourinary symptoms;
- – symptoms of depression and anxiety;
- – alcohol and other substance use;
- – self-harm, suicidality, symptoms of depression and anxiety.
- 4.The GDG agreed that, despite a paucity of evidence, it was important to make a recommendation due to the high prevalence and importance of IPV. ANC provides an opportunity to enquire about IPV among women for whom barriers to accessing health care may exist, and also allows for the possibility for follow-up during ANC with appropriate supportive interventions, such as counselling and empowerment interventions. However, the evidence on benefits and potential harms of clinical enquiry and subsequent interventions is lacking or uncertain.
- 5.A minimum condition for health-care providers to ask women about violence is that it must be safe to do so (i.e. the partner is not present) and that identification of IPV is followed by an appropriate response. In addition, providers must be trained to ask questions in the correct way and to respond appropriately to women who disclose violence.
- 6.Research on IPV is needed to answer the following questions:
- – Which are the most effective strategies for identifying, preventing and managing IPV in pregnancy?
- – Does asking routinely about violence impact on ANC attendance?
- – Can interventions targeted at partners of pregnant women prevent IPV?
- 7.Detailed guidance on responding to IPV and sexual violence against women can be found in the 2013 WHO clinical and policy guidelines, available at: http://www.who.int/reproductivehealth/ publications/violence/9789241548595/en/
- 8.Minimum requirements are: a protocol/standard operating procedure; training on how to ask about IPV, and on how to provide the minimum response or beyond; private setting; confidentiality ensured; system for referral in place; and time to allow for appropriate disclosure
Also Featured In
This recommendation also appears in the following guidelines:
Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines
Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines
Consolidated guidelines on HIV testing services, 2019
WHO Guidelines for the health sector response to child maltreatment
Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach
WHO recommendations on maternal health: guidelines approved by the WHO Guidelines Review Committee, second edition. Geneva: World Health Organization; 2025
Consolidated guidelines on differentiated HIV testing services.