The Acceptability of Offering Emergency Contraception to Domestic Violence Shelter Clients

Public Health Significance Approximately 36% of women in the United States will experience Intimate Partner Violence (IPV) in her lifetime. Reproductive Coercion (RC), a component of IPV, involves birth control sabotage, male partner attempts to impregnate a woman against her wishes, as well as controlling the outcomes of a pregnancy, and is experienced by 9% of women in the US. Reproductive coercion increases risk for unintended pregnancies, meaning pregnancies that are mistimed, unwanted or unplanned. Women experiencing IPV are more likely to have used emergency contraception (EC) to prevent pregnancy, but studies to date have not examined the need for EC among women seeking shelter for IPV. This pilot study assessed the acceptability and feasibility of offering EC to women during IPV shelter intake. \ud Methods Shelter staff received training on reproductive coercion (RC) and EC. Surveys were administered before, immediately after, and three months after training. Surveys assessed staff perceptions and comfort level offering EC to clients. During a six-week period, clients were asked about RC and pregnancy tests and EC were offered during shelter intake. Clients completed a survey to assess their satisfaction with having these resources available. \ud Results On a scale of 1 to 4, with 4 being very helpful, on average, women rated the helpfulness of knowing that EC was available as a 3.16. Between the training and the administration of the post-training survey, shelter staff increased their distribution of safety cards explaining the impact of violence on women’s health from 0% to 86% of staff reporting ‘all of the time.’ Assessment of clients’ health concerns as part of shelter intake increased from 50% to 86% of staff assessing ‘all of the time.’ Staff reported an increase in asking clients about EC, referring clients to family planning services, and assessing for RC, from 0% to 43% selecting ‘all of the time.’ \ud Conclusion Shelter staff were able to adopt a routine practice of assessing women for RC and reported an increased comfort level regarding EC. Offering pregnancy testing and EC in shelter was met with great acceptance among both shelter staff and clients. \u