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Intimate partner violence and the role of the health care

system

Version 2

Anna Maria Dahlbäck Bachelor in Medicine. Örebro University. Degree project, 30 ECTS Supervisor: Susanne Strand. Associated Professor of Criminology at Örebro University. Abstract:250 words.

Manuscript: 3013 Date: 2019-01-07

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Abstract

Introduction

Health care is important for identifying IPV (intimate partner violence). Screening varies between clinics. By supporting the victim, chances for cooperation in the investigation increases and thus the conviction rate. Health care needs to identify and support IPV victims when reporting crimes.

Aim

The overall aim of this study was twofold; first to examine to what extent Swedish health care facilities screen for IPV, and second to investigate the relations between cooperation in the criminal investigation and conviction rate.

Method

This was a pilot study. First national, regional and local health care facilities and agencies were approached by conducting telephone interviews. Second, data from a longitudinal study on policing IPV were used to be able to compare conviction rate if the victim participated in the legal process or not.

Results

Out of five organisations, only one agency had statistics of routinely screening for IPV, provided statistics for maternal care. Where the screening rate was 90%. In the longitudinal study including 564 perpetrators, we found that if the victim cooperated in the investigation, it was twice as likely (Odds Ratio=2.66) that the perpetrator was convicted for the crime.

Conclusion

Health care is important for identifying IPV in order to support victims to report crimes to the police, although only the maternal care screens for it routinely. More hospitals and different units need to insert routines to screen for IPV. By doing so, the women will get more support in the legal process, which could increase the chance of conviction.

Keywords: Intimate partner violence, Screening, Domestic violence, Normalization,

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Introduction

The Istanbul convention defines intimate partner violence (IPV) as physical, psychological, sexual and economic violence. It was enacted in 2014 and is the first law against abuse of women and children in Europe which is a strong action against violence against women and children [1]. Other definitions of IPV also includes stalking, aggression, emotional and controlling abuse by a partner [2].

In Europe as well as other western countries statistics confirm that one in three women has experienced an episode of sexual or physical abuse by an intimate partner after they turned fifteen [3]. In Sweden 2018, 28700 women reported to the police that they had been abused, of which 13400 where cases of intimate partner violence [4]. However according to BRÅ (The Swedish national council for crime prevention) there is only one-fourth of all cases of abuse in intimate relationships that is reported to the police [5]. It is 2.8 times more likely to get the perpetrator convicted if the women participate in the investigation according to BRÅ [6].

Violence in an intimate relationship is different from other types of violence because it happens for a long time and often gets more violent the longer the couple stay together [7]. The daily violence maintain the woman’s submissive positions in the relationship [8,9]. Victim blaming is a way of entitle the perpetrators actions [10–12]. The woman and her partner tend to normalize the abuse by different coping strategies. The man is using different types of violence against the woman and both of them adjust to it and sees it as normal behaviour [7,13–18]. Different cultures of patients play a major role in the woman´s attitude to the abuse. Most women that have been a victim of sexual violence from her partner doesn’t report it to the police or tell anyone, one reason for that is that they commonly experience it as shameful, or that they don´t report it for the sake of family honour. [17,19,20]. Studies show that some women do not even understand that they are exposed to IPV since in their culture it is seen as common and justified [16].

Confidential agreement is the foundation within health care departments but there are

exceptions. When a person has been exposed to a crime that would give the perpetrator more than one year in jail the employee can report it to the police without the patient´s approval

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4 [21]. If the patient has a child, then the employee is obligated to report it according to Social Services Act; chap.14, (SoL 14) [22].

The National board of health and welfare in Sweden have regulations for how to handle violence against women [23]. The Employment agency, the Insurance agency, the Migration Authorities and the Social department obtained a mission from the Government year 2019-2021 to improve the routines regarding IPV in Sweden [24]. In 2018 commissioned the National Board of Health and Welfare in collaboration with NCK (The National centre for knowledge on Men’s violence against women) to “Provide a national competence support” in order to develop the work on intimate partner violence. Their aim is to disseminate

knowledge to health care with information and methods on how to improve the work of combating men’s violence towards women [25].

The Istanbul convention [26] states that it is important that all agencies that work with victims of domestic violence to take actions against intimate partner violence. Educating professions that will come in contact with IPV such as medical, dentists, nurses is one way of doing this. Swedish gender equality agency has an aim to educate universities in Sweden about IPV and in 2018, 89 programs at different universities decided that they will educate their students in IPV. This is of great importance especially for those students that in their future profession will meet victims of IPV [27]. Many women who are exposed to IPV seek medical care at primary care and hospitals. Many times, it is not obvious that they have been subjected to violence, since they seek medical care for other reasons. There is a correlation between IPV and somatic diseases such as recurrent depression, insomnia, stomach pain, stress problems [17].

Health care plays an important role in identifying IPV and it seems to vary between clinics on how to handle screening of IPV. One study conducted in Canada showed that 5-10% in primary health care setting, and 5-25 % at Emergency Departments received any question on partner violence despite the fact that an obvious abuse should be suspected in 80% of the cases [28]. It seemed that nurses at primary health care settings lacked guidelines, support and also knowledge on how common IPV actually is. According to the study, this was a reason that contributed to their failure to ask about IPV [28,29]. Practice recommendations

encourage staff to ask patients about IPV but it is unsure how well the routines are followed. There seems to be few people in the health care sector that screens for IPV [30–32].

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By knowing that IPV is that common, health care needs to get a greater understanding and encouragement on how to handle IPV victims. If the women are collaborating, the chance of getting the perpetrator charged was 2.8 fold higher according to BRÅ. [4]. The literature confirms that screening of IPV at hospitals and other health care setting are low [30–32]. Therefore, it is important for the hospitals to follow the routines and guidelines and screen more often for IPV. By doing so, support in the legal process can mean greater opportunities for participation in the investigation, which leads to increased conviction. That, in turn, can reduce violence.

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Aim

The overall aim of this study was twofold; first to examine to what extent Swedish health care facilities screen for IPV. The second aim was to investigate the relations between cooperation of the woman in the criminal investigation and conviction rate.

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Methods and Materials

Health Care Facilities

For the first research question interviews were used to be able to answer our question.

Sample

The purpose of the selection of organizations was to be able to see if there were any statistics of screening of IPV at national, regional, interest organizations or local hospitals. Therefore, NCK, BRÅ, The National Board of Health and Welfare, two local hospitals were selected as interview objects, which can be seen as the research participants.

Interview procedure

The hospitals that were chosen as interview object were partly because the author tried to contact four hospitals initially, but had difficulty in finding any staff on whom the interview could be conducted. At last, the author got in contact with one doctor and one nurse at two different hospitals who could answer the questions.

The question guide, containing three questions, that was used for the interviews was based on prior studies [4,5,17,23,25,27].

1. What happens if a woman express that she is exposed to IPV in different health care facilities?

2. Are there any statistics on how often health care facilities screen for IPV in Sweden? 3. If so, how often are they screened for IPV?

Procedure

The author had short telephone interviews with the different organizations and local hospitals with staff working with IPV related questions. The staff interviewed were referred to by initial contact. Both a nurse and a doctor were interviewed at the two hospitals. The three questions were asked and the answers were written down. The interview took between 5-20 minutes.

Statistical analyses

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Cooperation and Criminal Investigation

A quantitative longitudinal database from a project on intimate partner violence conducted by Strand et al “ Polisens arbete med riskbedömning och riskhantering av partnervåldsrelaterad brottslighet” was used [33] to be able to compare conviction rate of the perpetrator if the woman participated in the investigation or not.

Sample

Data consisted of all cases of reported IPV from two regions in Sweden; Västernorrland and Jämtland, from 2011 to 2014. The purpose of their project was to “Implement and evaluate the use of structured risk assessments as a working method for police reported cases of IPV at the police authorities in Jämtland and Västernorrland” [33].

Data on victims cooperation in the investigation and conviction rates where used for

comparisons. Inclusion criteria were male perpetrators assessed for risk for intimate partner violence when reported by the victim to the police. A total of 649 males were reported for IPV offence of which 564 were included in this study. Exclusion criteria were perpetrators with missing information on victim participation (n=7), missing information on the outcome of the reported crime in the criminal justice system, due to still on-going investigation and missing personal identification number (n=85). The final study sample consisted of 86% of the eligible perpetrators. In table descriptive data of the age, relationship, and index crime (i.e. the most severe crime reported for) can be seen.

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Table 1. Descriptive data of the sample (n=564)

Characteristics N (%)

Age in years, presented in median (SD)

Perpetrator Victim

39.13 (12.89) 35.51 (12.54)

Relationship between perpetrator and victim

Cohabiting Married Girlfriend Missing 319 (56.6) 133 (23.6) 109 (19.3) 3 (0.5)

Crimes the perpetrators were charged for

Assault

Gross violation of a woman´s integrity Unlawful threats Sexual crimes Attempted murder Other 263 (46.6) 187 (33.2) 69 (12.2) 9 (1.6) 2 (0.5) 34 (6)

Data collection

Data on cooperation were retrieved from the police, by their notes on the conducted risk assessments if the victim cooperated in the investigation or not. Data on conviction rates were retrieved from the Swedish national crime register.

Statistical analyses

Data were on nominal level. c2 test was used to test the relation between cooperation in the investigation and conviction rate of the perpetrator. Odds ratio statistics was used as effect size.

Ethics

The local hospitals were my study´s research participants and it was important to preserve anonymity, according to the Swedish research council on the significance and anonymity of research participants as ethical principle, in order to take part in the study [34]. The project

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10 by Strand et al. was approved by Swedish regional ethics board, therefore, a new approval was not necessary [33].

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Results

Health Care Facilities

For the first interview question, the interviews from the two Hospitals were used to

summarize the procedure when a woman expresses that she is exposed to IPV. According to the interviews, it is sometimes necessary to explain to the victim that there are different types of violence such as physical, mental and sexual violence. When a woman expresses being exposed to any kind of IPV, but is reluctant to leave the relationship, the routines recommend that healthcare professionals should try to strengthen her self-esteem. It is also important to provide information about what a healthy relationship looks like and available support for leaving the destructive relationship.

A common problem that needs to be addressed is the risk that healthcare professionals do not have enough time during the visit when the victim expresses being exposed to IPV. On this case, a return visit should be made as soon as possible for the opportunity to try to strengthen the women and hopefully after a couple of meetings with the healthcare professional she feels sufficiently strong and able to leave the relationship.

Another important aspect when the victim expresses that she is subjected to violence is to make sure that she talks to someone in her social network (a family member or a friend) about the abuse so that she can call this person if the situation becomes more severe.

If a woman expresses that the condition is acute then it is important for healthcare

professionals to understand the seriousness and act at once. On this situation, the healthcare professionals should consider hospital admission until the social services offer her a sheltered accommodation. Social services are on-call 24 hours a day, but it can still take some time to get everything organized, so hospital admission is a good alternative.

An aspect that healthcare professionals should not forget is to document the injuries in the medical record even though the victim may not be ready to leave the relationship. The documentation may be used at a later stage if the woman chooses to report to the police.

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12 The interviews revealed also the importance that the healthcare professionals, especially the counsellors are competent at supporting the women in the process of leaving the relationship. Sometimes it is necessary to offer several visits before this is possible. It is usually said that a woman leaves a man 5 times before leaving him for good. The counsellors are invaluable for strengthening the woman so she finds the courage to leave.

The second and third question was about organizations and their statistics on IPV (table 2). The results showed that only NCK had statistics. They had statistics on how often midwives screen their patients about IPV. Maternal health clinics in Sweden has a target that they should ask 95% of their patients about violence in close relationship. Many regions achieve this and those that don’t still have a screening rate close to 90% [35].

Table 2. Statistics on screening rate of IPV by different organizations.

Organizations Screening rate of IPV (%)(If available) BRÅ No N/A National board of Health No N/A NCK Yes 90 Hospital 1 No N/A Hospital 2 No N/A

Abbreviations: N/A: (Not available), BRÅ: (The Swedish national council for crime prevention) NCK: (The National centre for knowledge on Men’s violence against women)

Cooperation and Criminal Investigation

For the second research question the results showed that of the 564 women, 73.9% (n=417) cooperated in the investigation and 26.1% (n=147) did not cooperate. Furthermore, 172 (30.5%) of the perpetrators were convicted in total, regardless of the woman participated in the legal process or not. The results showed that there was a 2.66 greater chance to get the

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perpetrator convicted if the woman participated in the investigation c2 (1 .564) = 17.07, p

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Discussion

For the first research question the results showed that there were no statistics on screening rate of IPV within the studied organisations, except for NCK who provided statistics on screening rate in the maternal care. In the second research question we found that it was a 2.66 greater chance to get the perpetrator convicted if the victim participated in the investigation.

There seems to be a built-up infrastructure within NCK mainly due to the fact that all

pregnant women meet with the maternal care for a set number of times as a routine. However, it does not appear to be similar structures at other organizations or hospitals which indicate that it is more difficult to conduct screening routines. NCK has heavily invested in maternal care to increase the knowledge of IPV for other organizations as well. It would be necessary to invest equally hard at other clinics as well. In primary care there are favourable conditions to implement IPV screening routines, considering the fact that the physicians are often seeing their patients regularly, giving the opportunity to getting to know them better. In addition, primary care is “the net” in the Swedish health care system and improved screening rate in primary care facilities could increase the identification of IPV victims. Maternal care

screening rate of IPV was approximately 90% but the literature shows that screening for IPV is done far too rarely at other Health care facilities, both in Sweden [30,36] and

internationally [17,28,31,37]. Current literature provided information about the role of the nurses regarding screening of IPV [16,17,28,36–38]. The nurses are the first to come in contact with the patients but there were less articles concerning how often the doctors screened for IPV [28]. This needs to be further addressed in future studies.

The lack of knowledge is one factor contributing to the failure of health care professionals to ask questions about IPV routinely [28,29]but there are other barriers as well that seem to be differed among different departments. In emergency departments for example, it can be difficult for the health care professional to spend time alone with the women as there is often a lot of people in motion and patients commonly share rooms [30–32]. Time also seems to be an issue since it can be time consuming to establish a relationship with the patient before you can ask questions of IPV [28,29]. In consideration of the current situation in Swedish health care, lack of time is a problem that most certain will be even more prominent due to

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Our results on 2.66 times greater chance of conviction for the perpetrator when the victim participates in the legal process is similar to the national study done by BRÅ who found that it was 2.8 times greater chance [4]. It is important to know this data in a Swedish context since the health care can provide support to the victim specifically in Sweden. Knowing this will give the health care information on the importance on victims cooperating in the investigation in order to get perpetrator convicted. Healthcare has a great opportunity to increase that figure by understanding how common IPV is and to make sure to educate its staff about IPV and how to screen for IPV in the best possible way. One aim for the health care should be to support and help victims of IPV.

The are several limitations of this pilot study that need to be discussed. First, were that we do not know why healthcare professionals do not screen more frequently for IPV despite the routines and regulations that already exists. Second, there is also lack of statistics of IPV on a national level in Sweden which makes it difficult to draw any conclusions.In addition, the interviews about health care were only conducted in two hospitals, maybe the answers would have been different if we had been able to interview more hospitals. Finally, data on

longitudinal were collected only from Västernorrland and Jämtland and not the entire country that could influence the generalizability of the results.

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Conclusion

Health care is important for identifying victims of IPV in order to support the victims when reporting the crimes to the police, although only the maternal care screens for it routinely. Further efforts need to be done at higher structural level and not only at individual clinics to be able to increase health care professionals` knowledge of IPV and then hopefully also start to screen for IPV. By doing so, the women will get more support in the legal process, which seems to increase the chance of conviction rate. Further studies would need to be done in order to see too what extend healthcare professionals ask about IPV to shed light over the issue and in the long run strengthen routines about IPV screening.

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Reference

1. Council of Europe. The Council of Europe Convention on preventing and Combating VIolence against Women and Domestic Violence (Istanbul Convention). [Internet]. Strasbourg: Council of Europe; [cited 2019 Oct 16]. Available from: https://rm.coe.int/istanbul-convention-questions-and-answers/16808f0b80

2. World report on violence and health [Internet]. Geneva: World Health Organisation; 2002 [cited 2019 Oct 15]. Available from:

https://apps.who.int/iris/bitstream/handle/10665/42495/9241545615_eng.pdf;jsessionid=1AC 9D6A0120AC59AC5C71986F44220A7?sequence=1

3. Leone M, Lapucci E, De Sario M, Davoli M, Farchi S, Michelozzi P. Social network analysis to characterize women victims of violence. BMC Public Health 2019; 19:494.

4. Brottsförebyggande rådet. Anmälda brott [Internet]. Stockholm: Brottsförebyggande rådet; 2019 [cited 2019 Sep 26]. Available from:

https://www.bra.se/statistik/kriminalstatistik/anmalda-brott.html

5. Frenzel A, Brottsförebyggande rådet. Brott i nära relationer: en nationell kartläggning [Internet]. Stockholm: Brottsförebyggande rådet (BRÅ) : Fritze [distributör; 2014 [cited 2019 Oct 17]. 2014:8. Available from:

https://www.bra.se/download/18.9eaaede145606cc8651ff/1399015861526/2014_8_Brott_i_n ara_relationer.pdf

6. Marklund F, Nilsson A. Polisens utredningar av våld mot kvinnor i nära

relationer [Internet]. Stockholm: Brottsförebyggande rådet (BRÅ) : Fritze [distributör]; 2008 [cited 2019 Oct 26]. Available from:

https://www.bra.se/download/18.cba82f7130f475a2f180007826/1371914724429/2008_25_po lisens_utredningar_vald_mot_kvinnor.pdf

7. Heimer GM. Våldsutsatta kvinnor: samhällets ansvar. 4th ed. Lund: Studentlitteratur; 2019.

8. Eliasson M. Mäns våld mot kvinnor i nära relationer en kunskapsöversikt. Stockholm: Sveriges kommuner och landsting; 2006.

9. Dawtry RJ, Cozzolino PJ, Callan MJ. I Blame Therefore It Was: Rape Myth Acceptance, Victim Blaming, and Memory Reconstruction. Pers Soc Psychol Bull 2019; 45:1269–82.

10. Martín-Fernández M, Gracia E, Lila M. Assessing Victim-Blaming Attitudes in Cases of Intimate Partner Violence against Women: Development and Validation of the VB-IPVAW Scale. Psychosoc Interv 2018; 27:133–43.

11. Gravelin CR, Biernat M, Baldwin M. The impact of power and powerlessness on blaming the victim of sexual assault. Group Process Intergroup Relat 2019; 22:98–115. 12. John IA, Lawoko S, Svanström L, Mohammed AZ. Health Care Providers’ Readiness to Screen for Intimate Partner Violence in Northern Nigeria [Internet]. In: Violence and Victims; New York. 2010 [cited 2019 Dec 9]. p. 689–704. Available from:

http://search.proquest.com/docview/817785990/abstract/75DB1ED140DD4468PQ/1

13. Cervantes MV, Sherman J. Falling for the Ones That Were Abusive: Cycles of Violence in Low-Income Women’s Intimate Relationships. J Interpers Violence 2019; :0886260519829771.

14. Lundgren E, editor. Slagen dam: mäns våld mot kvinnor i jämställda Sverige: en omfångsundersökning. Stockholm: Fritzes offentliga publikationer; 2001.

15. Wood J. The normalization of violence in heterosexual romantic relationships: women´s narratives of love and violence. Sage J 2001; :23.

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18 protocols for intimate partner violence in healthcare facilities: a qualitative study. J Clin Nurs 2017; 26:2192–201.

17. Al-Natour A, Qandil A, Gillespie GL. Nurses’ roles in screening for intimate partner violence: a phenomenological study. Int Nurs Rev 2016; 63:422–8.

18. Lundgren E. Våldets normaliseringsprocess. Två parter- två strategier. Uppsala Universitet; Jämförande rapport 14/89.

19. Fleury RE, Sullivan CM, Bybee DI, Davidson WS. Why Don’t They Just Call the Cops?: Reasons for Differential Police Contact Among Women with Abusive Partners. Violence Vict 1998; 13:333–46.

20. Djikanovic B, Stamenkovic Ž, Mikanovic VB, Vukovic D, Gordeev VS, Maksimovic N. Negative attitudes related to violence against women: gender and ethnic differences among youth living in Serbia. Int J Public Health 2018; 63:923–32.

21. Offentlighets- och sekretesslag (SFS 2009:400) | [Internet]. Stockholm: Justitiedepartementet; [cited 2019 Oct 30]. Available from:

https://www.riksdagen.se/sv/dokument-lagar/dokument/svensk-forfattningssamling/offentlighets--och-sekretesslag-2009400_sfs-2009-400 22. Socialtjänstlag (SFS 2001:453) (SoL) [Internet]. Stockholm:

Socialdepartementet; [cited 2019 Oct 30]. Available from: https://lagen.nu/2001:453#K14 23. Senaste version av Socialstyrelsens föreskrifter och allmänna råd (SOSFS 2014:4) om våld i nära relationer [Internet]. [cited 2019 Sep 30]; Available from: https://www.socialstyrelsen.se/regler-och-riktlinjer/foreskrifter-och-allmanna-rad/konsoliderade-foreskrifter/20144-om-vald-i-nara-relationer/

24. Socialstyrelsen. Plan för utökad samverkan för förbättrad upptäckt av våld i nära relationer [Internet]. Stockholm: Socialstryrelsen; Available from:

https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/ovrigt/2019-5-24.pdf

25. Socialdepartementet. Uppdrag att fordela utvecklingsmedel och ge nationellt och regionalt kompetensstod for att kvalitetsutveckla arbetet mot vald i nara relationer och stod till valdsutsatta kvinnor och barn. [Internet]. Stockholm: 2016 [cited 2019 Dec 4]. Available from:

https://www.regeringen.se/globalassets/regeringen/dokument/socialdepartementet/jamstalldhe t/uppdrag-att-fordela-utvecklingsmedel-och-ge-nationellt-och-regionalt-kompetensstod-for- att-kvalitetsutveckla-arbetet-mot-vald-i-nara-relationer-och-stod-till-valdsutsatta-kvinnor-och-barn.pdf

26. Engström A. Europarådets konvention om förebyggande av våld mot kvinnor och våld i hemmet. [Internet]. Istanbul: 2011 [cited 2019 Sep 26]. Available from:

https://www.nck.uu.se/kunskapsbanken/amnesguider/mans-vald-mot-kvinnor-ett-globalt-perspektiv/istanbulkonventionen/

27. Jernberg B.

https://www.jamstalldhetsmyndigheten.se/wp-content/uploads/2019/03/delredovisning-utbildningsuppdrag-2019-03-28.pdf. :18. 28. Gutmanis I, Beynon C, Tutty L, Wathen CN, MacMillan HL. Factors

influencing identification of and response to intimate partner violence: a survey of physicians and nurses. BMC Public Health 2007; 7:12.

29. The National Centerfor knowledge on Men´s vioelnce against women. National Action Programme for the Helath Care and Medical Services. Reception and Care of Victims of Sexual Assault. [Internet]. Uppsala: The national center for knowledge on men´s violence against women. Uppsala University; 2008 [cited 2019 Dec 17]. Available from:

http://kunskapsbanken.nck.uu.se/nckkb/nck/publik/fil/visa/484/nck-handbook-national-action-programme-sexual-assault-english-2008.pdf

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Violence against Women in Healthcare Sweden: Prevalence and Determinants. ISRN Nurs [Internet] 2011 [cited 2019 Dec 9]; 2011. Available from:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3255304/

31. Rodriguez MA, Bauer HM, McLoughlin E, Grumbach K. Screening and Intervention for Intimate Partner Abuse: Practices and Attitudes of Primary Care Physicians. JAMA 1999; 282:468–74.

32. Koziol-McLain J, Giddings L, Rameka M, Fyfe E. Intimate Partner Violence Screening and Brief Intervention: Experiences of Women in Two New Zealand Health Care Settings. J Midwifery Womens Health 2008; 53:504–10.

33. Strand S, Petersson J, Fröberg S, Storey JE. Polisens arbete med riskbedömning och riskhantering av partnervåldsrelaterad brottslighet.

34. Vetenskapsrådet. Forskningsetiska principer inom

humanistisk-samhällsvetenskaplig forskning. [Internet]. Stockholm: Vetenskapsrådet; 2002 [cited 2019 Nov 6]. Available from: http://www.codex.vr.se/texts/HSFR.pdf

35. Graviditetsregistrets årsrapport 2016. Tema: Psykisk ohälsa [Internet]. 2016 [cited 2019 Nov 7]. Available from:

https://www.medscinet.com/gr/uploads/hemsida/dokumentarkiv/GR_%C3%85rsrrapport_201 6_2.1.pdf

36. Sundborg EM, Saleh-Stattin N, Wändell P, Törnkvist L. Nurses’ preparedness to care for women exposed to Intimate Partner Violence: a quantitative study in primary health care. BMC Nurs 2012; 11:1.

37. Sormanti M, Smith E. Intimate Partner Violence Screening in the Emergency Department: U.S. Medical Residents’ Perspectives. Int Q Community Health Educ 2010; 30:21–40.

38. Häggblom AME, Möller AR. On a Life-Saving Mission: Nurses’ Willingness to Encounter With Intimate Partner Abuse. Qual Health Res 2006; 16:1075–90.

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Appendix

Ethics

Swedish research council have four ethical principles for research. The information guideline, the consent guideline, the confidential guideline and the availabilityguideline [34]. In our first research question on screening of IPV, there are no ethical difficulties when the author asked about statistics at various organizations and a few hospitals. No information about a patient has been omitted and neither of the four ethical principles has been violated. The ethics of the second part of this project was approved by the Swedish research council to Strand et al and their project “Polisens arbete med riskbedömning och riskhantering av partnervåldsrelaterad brottslighet” [33]. A new ethics approval isn´t necessary.

There are some exceptions in the information and consent principles. In a study, the

participant can participate actively or passively. For example, an interview would be active participation and passive participation means that the author can enter an authority register and thus get the information about the participant. Just when it comes to passive participation as in the data collection from Strand et al. the information requirement does not always have to be met when you went into the police register and retrieved data, which the Swedish research council also describes [34].

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Journal of Women’s health and Gynaecology 20/12-2019 Jscholar Scientific Communications

185 E homestead RD Sunnyvale, CA 94087 USA

Dear editor of Women’s Health and gynaecology.

Please consider publication of this pilot study in your journal.

-The research field of IPV (intimate partner violence) is getting more and more attention from society. It is important because it makes people understand the extent of it. This project aimed at investigating the IPV screening routines in health care facilities. There were almost no statistics to be found except in maternal care which had 90% screening rate in Sweden. But there were no statistics on how often patients at other clinics were screened for it. We also investigated conviction rate changed depending on women’s participation in the legal process. The result showed that there is a 2.66 greater chance of having the man convicted if the women participates in the legal process. Therefore, it is of great importance that health care starts to follow the routines and general advice available about IPV screening. Hopefully this could lead to that more and more women dare to talk about IPV and finally dare to report and participate in the legal process.

Kind Regards

Anna Maria Dahlbäck. Medical student. Degree project, 30 ECTS Örebro University

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Anna Maria Dahlbäck

Våld i nära relationer och Hälso och sjukvårdens roll

Statistiken visar att en av tre kvinnor har någon gång under sitt liv blivit utsatt för våld av en partner eller ex-partner. I Sverige 2018 rapporterades det 28700 misshandelsfall mot kvinnor varav hälften där förövaren var en partner eller ex-partner. Det är vanligt att normalisera en våldsam relation, både för förövare och offer.Våldet blir ofta grövre ju längre tid relationen pågår.

Vår studie visade att det är 2.66 gånger så stor chans att få förövaren dömd om kvinnan medverkar i utredningen. Få blir dömda när den utsatta inte samarbetar.

Sjukvården har en stor roll här, att identifiera de som utsätts för våld i nära relationer. För vården möter dem. De kanske inte alltid söker när de blivit utsatta för uppenbart fysiskt eller sexuellt våld utan de kan söka för andra saker som till exempel återkommande buksmärta, depression, sömnsvårigheter. Vården frågar alltid patienter vid ett nybesök om hen röker eller dricker alkohol, det finns i rutinerna, men att fråga patienten om våld i nära relation verkar inte undersökas i samma utsträckning som en del av anamnesen. Det verkar inte finnas någon statistik om hur ofta kliniker frågar om våld i nära relationer, förutom i Mödravården, de screenar för detta i nästan 90% av fallen. Denna siffra borde vara lika hög vid andra kliniker också då man vet att våldet förekommer i många olika former och situationer.

Handledare: Susanne Strand

Examensarbete: 30 högskolepoäng. Örebro Universitet.

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References

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