What is the American College of Obstetricians and Gynecologists (ACOG) screening recommendation for intimate partner violence?

ACOG Screening Recommendation for Intimate Partner Violence

The American College of Obstetricians and Gynecologists (ACOG) recommends that physicians routinely ask all women direct, specific questions about abuse (Answer A). 1

ACOG's Clear Position on Universal Screening

ACOG explicitly recommends screening all women for intimate partner violence at routine obstetric-gynecology visits, family planning visits, and preconception visits. 1, 2

For pregnant women specifically, ACOG recommends screening:

• At the first prenatal visit 1, 3
• At least once per trimester 1, 3
• At the postpartum checkup 1, 3

Distinction from Other Organizations' Positions

This recommendation differs from the U.S. Preventive Services Task Force (USPSTF), which initially issued an "I statement" (insufficient evidence) in 2004 for screening women for intimate partner violence. 1 The USPSTF later updated this in 2013 to recommend screening women of childbearing age (14-46 years), but maintained an "I statement" for elderly and vulnerable adults. 1, 2

The Canadian Task Force on Preventive Health Care concluded there was insufficient evidence to recommend for or against routine screening for violence against women. 1

Rationale for ACOG's Approach

ACOG's recommendation is based on the unique position of obstetrician-gynecologists to assess and provide support for women experiencing intimate partner violence due to the nature of the patient-physician relationship and multiple opportunities for intervention during pregnancy, family planning, and annual examinations. 3

Intimate partner violence is most prevalent among women of reproductive age and contributes to gynecologic disorders, pregnancy complications, unintended pregnancy, and sexually transmitted infections. 3

Implementation in Practice

Despite ACOG's longstanding recommendation (for more than a decade as of 1998), actual screening practices vary:

• Only 39% of obstetrician-gynecologists routinely screen pregnant patients at the first prenatal visit 4
• Only 27% routinely screen nonpregnant patients at the initial visit 4
• Most screening occurs when abuse is suspected (68% during pregnancy, 72% when not pregnant) rather than universally 4

The correct answer is A: routinely ask all women direct, specific questions about abuse.