Intimate Partner Violence Screening
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Direct answer
Nearly one in three ever-partnered women worldwide experiences physical and/or sexual intimate partner violence in her lifetime — WHO's headline statistic — and Indian data from NFHS-5 sit in the same territory, with just under 30 per cent of ever-married women reporting spousal physical or sexual violence. Pregnancy raises rather than lowers risk: violence commonly begins or escalates during pregnancy, and in several settings homicide is a leading cause of maternal death. Antenatal care is the single best screening opportunity, so WHO recommends routine enquiry — asking all women in private, with the partner absent — paired with a first-line response summarised as LIVES: Listen, Inquire, Validate, Enhance safety, Support. Positive disclosures earn validation without judgement, documentation of injuries, a danger assessment (strangulation, weapons, escalation), a safety plan, and connection to support services and legal remedies such as the Protection of Women from Domestic Violence Act 2005. Confidentiality is the spine of the whole encounter.
What you must remember
- Numbers to quote: WHO — about 30 per cent of ever-partnered women experience physical and/or sexual IPV; NFHS-5 India — just under 30 per cent of ever-married women report spousal physical or sexual violence.
- Why screen in antenatal clinics: violence escalates in pregnancy (abdominal and breast injuries target the gravid uterus), associates with miscarriage, abruption, preterm birth and low birth weight, and delays antenatal attendance.
- How to ask: private setting, partner or family absent, professional interpreter (never a family member), direct behaviour-specific questions ("Has your partner ever hit, kicked or physically hurt you?"); tools include the Abuse Assessment Screen and HITS.
- Presentation clues: injuries in different healing stages, injuries inconsistent with the story, delay in seeking care, partner answering for the patient, chronic pelvic pain, depression, substance use, repeated "accidents".
- First-line response — LIVES: Listen without judgement; Inquire about needs and concerns; Validate that the violence is not her fault; Enhance safety with a personalised plan; Support with information and referral.
- Documentation: verbatim quotes, body maps and photographs with consent, date and time — records anchor future proceedings under the Domestic Violence Act 2005.
- Safety triage: strangulation history, threats with weapons, threats to kill, separation violence and stalking mark high lethality — urgent safety planning and possible same-day shelter referral.
- Boundaries of the clinician's role: offer, never impose, solutions; respect autonomy (leaving is a process, not an event); never counsel the couple together; for a competent adult's undisclosed IPV, her consent governs disclosure.
A consultation that gets it right
A 24-year-old primigravida at 28 weeks has missed two visits and presents with a bruised forearm she attributes to a fall. She is seen alone — the husband is politely occupied at registration — and asked the screening questions in her language. She discloses slapping and, last week, being grabbed by the throat. The response follows LIVES: the doctor listens fully, validates ("this is not your fault; you and your baby deserve safety"), asks about her priorities, performs a danger assessment (strangulation places her in the high-risk band), documents with consent including a body map, and builds a safety plan — a packed bag, memorised helpline numbers, a code word, and where to go tonight if needed. She is offered referral to the medical social worker and the protection officer under the Domestic Violence Act 2005 for protection and residence orders, and a mental health screen. She is not told to leave immediately; she is asked again at every subsequent visit. The lesson: safety, support and documentation — in that order of emphasis.
Where students slip
Candidates prescribe solutions ("advise her to leave") without understanding that separation is the most dangerous period, or counsel the couple jointly, which escalates danger. Some suggest confronting the partner or calling police without consent — breaches that expose the woman. Others miss the clinical thread: unexplained injuries, chronic pain syndromes and non-attendance are IPV until gently excluded. Finally, the Protection of Women from Domestic Violence Act 2005 provides civil protection orders independent of criminal proceedings, and the clinician's records feed both.
Frequently asked questions
Why is the antenatal clinic the recommended setting for IPV screening?
Pregnancy both escalates violence and brings women into repeated, legitimate contact with health services, making private routine enquiry feasible and effective when the partner is absent.
What is the LIVES first-line response?
Listen, Inquire about needs, Validate that the abuse is not her fault, Enhance safety with a personalised plan, and Support with referral — WHO's structured clinical response to disclosure.
Which features mark high danger in a disclosed case of IPV?
Strangulation, threats to kill or with weapons, escalating frequency, stalking and violence around separation — indicators warranting urgent safety planning and shelter options.
What do Indian data say about intimate partner violence prevalence?
NFHS-5 found just under 30 per cent of ever-married women reported spousal physical or sexual violence, consistent with WHO's global figure of about one in three ever-partnered women.
Under which Indian law can a survivor seek protection?
The Protection of Women from Domestic Violence Act 2005, which provides civil protection, residence and maintenance orders via protection officers, alongside applicable criminal provisions.