Exposure to domestic violence and abuse and consultations for emergency contraception: nested case-control study in a UK primary care dataset

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Abstract

Background
Evidence of an association between exposure to domestic violence and abuse (DVA) and use of emergency contraception (EC) is lacking in the UK.

Aim
To quantify the association between exposure to DVA and consultations for EC in general practice.

Design
Nested case-control study.

Setting
UK general practice.

Method
From the Clinical Practice Research Datalink, we identified 217,850 women aged 15-49, registered with a general practitioner (GP) between 01.01.2011 and 31.12.2016. Cases with consultations for EC (n=43,570) were each matched on age and GP with four controls with no consultations for EC (n=174,280). We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for the association between exposure to DVA in the past year and consultations for EC. Covariates included age, ethnicity, socio-economic status, pregnancy, children, alcohol misuse, depression.

Results
Women exposed to DVA were 2.06 times more likely to have a consultation for EC than unexposed women (95% CI 1.64-2.61). Women aged 25-39 with exposure to DVA were 2.8 times more likely to have a consultation for EC, compared to unexposed women (95% CI 2.08-3.75). We found some evidence of an independent effect of exposure to DVA on the number of consultations for EC (OR 1.48, 95% CI 0.99 to 2.21).

Conclusions
A request for EC in general practice can indicate possible exposure to DVA. Primary care consultation for EC is a relevant context for identifying and responding to DVA as recommended by the WHO and NICE guidelines. DVA training for providers of EC should include this new evidence.
Original languageEnglish
Number of pages9
JournalBritish Journal of General Practice Open
Early online date3 Dec 2018
DOIs
Publication statusE-pub ahead of print - 3 Dec 2018

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