1. Acceptability of Offering Emergency Contraception to Women in Domestic Violence Shelter Laura Yantz Advisor: Catherine Haggerty, PhD, MPH Community Mentor: Elizabeth Miller, MD, PhD UMPC Department of Adolescent Medicine

2. Background An estimated 1 in 4 women in the United States will experience Intimate Partner Violence (IPV) in her lifetime 1 Reproductive coercion (RC) is a component of IPV and is experienced by 9% of women in the US 1 RC - pressure by male partners to become pregnant including birth control sabotage

3. Background Limited literature is available on women in shelter and their healthcare needs Women living in shelter less likely to have health insurance than those outside of shelter 3 Women experiencing sexual violence (including RC) may seek safety in domestic violence shelters This study assessed the acceptability of offering emergency contraception (EC) to clients during shelter intake.

4. Methods Collaborative effort between Futures Without Violence and Women’s Center and Shelter of Greater Pittsburgh Training of shelter staff on RC and EC Surveys – For shelter staff Pre-training Training satisfaction Post-training – For shelter clients Intake assessment tool Client exit survey

5. Available Resources Emergency Contraception and Pregnancy Testing – Offered for a six-week period – Clients screened for RC at intake – Clients educated on availability of EC Clients offered EC and pregnancy tests at intake

6. Demographics of Staff Age20-3950.0% 40-5916.67% 60+16.67% SexFemale100.0% RaceCaucasian33.33% African American33.33% Multi-Racial16.67% Years Providing ServiceLess than 566.67% Greater than 1033.33% Training BackgroundSocial Worker33.33% Mental Health Specialist16.67% DV/SA Victim Services Advocate83.33%

7. Staff Survey Results (n = 6) Pre-Training: What are reasons that you may not address health concerns when conducting an intake of a survivor of domestic or sexual violence (DV/SV)? -Not enough time -Against policy of my workplace -It does not seem like a predominant issue/concern for them Q5: In your shelter, do you… Pre-TrainingPost-Training a. Have protocols about how to ask a client about health-related concerns? 50%85.7% b. Have a way of connecting clients to clinical services?83.3%100% c. Have educational materials on health impact of DV/SV and RC? 16.67%100%

8. Staff Post-Training Survey Results Since the training… a. I feel more confident asking a client about general health related concerns. Strongly Agree14% Agree71% b. I feel more confident asking a client about reproductive coercion or birth control sabotage. Strongly Agree71% Agree14% c. I feel more confident educating a client on longer acting contraceptive methods. Strongly Agree29% Agree29% d. I feel more confident connecting a client to local family planning services. Strongly Agree57% Agree29% e. I feel more confident assessing for clients' need for emergency contraception Strongly Agree57% Agree29% f. I feel more confident talking to my clients about pregnancy options (carrying to term, adoption or abortion). Strongly Agree29% Agree57%

9. Comparison of Pre-Training vs Post-Training Surveys

10. Comparison of Pre-Training vs Post-Training Surveys

11. Comparison of Pre-Training vs Post-Training Surveys

12. Client Exit Survey Results (n = 15) Q1: Today, did your advocate give you a form to fill out asking you if needed or wanted a pregnancy test Yes93.33% No6.67% If yes, did you request a pregnancy test on the form?Yes6.67% No86.67% Q2: Today, did your advocate give you a form asking if you needed emergency contraception or the morning after pill? Yes93.33% No6.67% If yes, did you request emergency contraception on the form? No93.33%

13. Client Exit Survey Results Q3: Today, did your advocate give you a little folded card called ‘Do You Know Your Relationship Affects Your Health?' talking about abuse and how it connects to your reproductive health and pregnancy? Yes86.67% No13.33% Q4: On a scale of 0 to 4 (0 = not helpful at all, 4 = very helpful), how helpful or unhelpful was it to learn emergency contraception was available to you if you needed it? Please circle a number below: 013.33% 3 453.33% Average3.16

14. Lessons Learned From Staff – Uncomfortable screening for RC in 2 situations of 17 – Medication delivery logistics posed a challenge From Clients – No clients requested emergency contraception – One client asked for pregnancy test – Most clients found it helpful that EC was offered – As EC is time sensitive, need to be able to integrate into intake

15. Limitations Conducted at only one shelter, small sample Results are not generalizable Only an acceptability and feasibility study No longitudinal outcomes No clinical outcomes

16. Conclusion Shelter staff have adopted routine screening of RC Staff reported increased comfort levels regarding EC distribution Shelter clients found it helpful to know that EC was available if needed Offering of pregnancy testing and EC was met with great acceptance by staff and clients

17. Next Steps Include other domestic violence agencies (multi-side study needed) Assessment of clinical outcomes including connection to sexual and reproductive health services Assessment of ongoing training needs of staff

18. References 1.Miller, et al. (2010) Pregnancy coercion, intimate partner violence and unintended pregnancy. Contraception. 2010: 81 pages 316-322 2.Kamimura, A., Parekh, A., Olson, L. (2013) Health Indicators, Social Support, and Intimate Partner Violence Among Women Utilizing Services at a Community Organization. Women’s Health Issues. 2013: 23(3) pages 179-185.