"It'S Not A Yes Or No Question": Disparities Between Women'S Accounts Of Disclosing Intimate Partner Violence And Patient Documentation In Antenatal Settings: A Qualitative Synthesis

Objective: Routine inquiry has been introduced in many health settings to identify women who are experiencing intimate partner violence (IPV). A range of validated tools exist; however, little attention has been given to how health professionals interpret women's responses and whether they align with women's own perceptions about whether they disclosed abuse. Method: This qualitative synthesis was undertaken in eight Australian antenatal clinics over 14 months. We invited women in waiting areas to participate in an anonymous interview about antenatal assessment, to identify those with past year IPV and their recollections of disclose abuse to midwives. Accounts were compared with file review data from antenatal records. Focus groups conducted at each site with midwives explored these findings. Results: Eleven Aboriginal and 32 non-Aboriginal antenatal patients who had experienced abuse were interviewed and files reviewed. IPV disclosures were often not recorded in clinical notes, despite protocols for asking and documenting. Of the 43 women, 30 (70%) reported they had disclosed their abuse in response to screening and 13 (30%) reported they did not disclose. Of the 30 who disclosed, only 16 (53%) antenatal records documented a disclosure. Qualitative analysis of patient interviews and focus group discussions with midwives identified two key themes: (a) women's responses to screening questions were rarely "yes" or "no" and (b) midwives were often unclear whether women's responses constituted IPV. Conclusions: Screening tools are needed, which recognize that IPV is not a binary construct and support health professionals to interpret women's responses.