Safety at the visit: intimate partner violence and reproductive coercion

How to ask

• Ask alone: never with a partner, relative or older child in the room, and never through a family member as interpreter. If she is never alone, that itself is information.
• Frame it as routine: 'Because violence at home is common and affects health, I ask everyone: does anyone at home hurt, threaten or control you?' Then listen.
• Reproductive coercion: pressure to become or not become pregnant, sabotaged contraception, forced continuation or termination. Offer methods a partner cannot detect (implant, IUD with the strings cut short, injectable) when she asks for something 'he will not know about'.
• Pregnancy is a time of increased risk: violence often starts or escalates, and the antenatal visits are repeated safe opportunities to ask.

When she discloses

• Believe her, say it is not her fault, and that help exists. Do not tell her to leave; leaving is the most dangerous time and it is her decision.
• Assess immediate danger: weapons, escalation, strangulation (a strong predictor of later homicide), threats to kill, children at risk, and whether it is safe to go home today.
• Offer, do not insist: a safety plan, the local shelter and crisis line, a social worker, documentation of injuries with her consent, and a follow-up appointment on any pretext.
• Know your reporting duties where you practise: children at risk usually must be reported; adult disclosures usually may not be reported without consent, with exceptions that differ by jurisdiction.
• Document in her words, in a record the partner cannot access through a shared portal.

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