Are emergency hormonal contraceptives indicative of domestic violence and abuse: nested case-control study using Clinical Practice Research Datalink?

Conference:

SAPC ASM 2018 - London

Talk Code:

4C.1

Presenter:

Joni Jackson

Co-authors:

Joni Jackson1,3, Natalia Lewis2,3,4, Gene Feder2,3, Penny Whiting1,3, John Macleod2,3, Timothy Jones1,3, Theresa Redaniel1,3

Author institutions:

1The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, UK, 2Centre for Academic Primary Care, 3Population Health Sciences, Bristol Medical School, University of Bristol, UK, 4NIHR CLAHRC North Thames, Centre for Primary Care and Public Health, Queen Mary University of

Problem

Domestic violence and abuse (DVA) is a public health and clinical problem which adversely affects women’s reproductive health. Our systematic review (paper in preparation) suggests that exposure to DVA is associated with an increase in the use of emergency hormonal contraceptives (EHC). Up to a third of all EHC are prescribed by GPs.

We analysed patient records from Clinical Practice Research Datalink (CPRD) to establish whether women with a prescription for EHC are more likely to have a DVA record compared to women without the prescription.

Approach

We performed a nested case-control study. From a population of female patients aged 15 to 49, registered at a participating GP practice between 2011 and 2016, we identified all cases with at least one prescription for EHC. From the same population, we randomly selected up-to four controls for each case, matched on age and general practice

We estimated odds ratios (ORs) and 95% confidence intervals (CIs) for the association between exposure to DVA and prescriptions for EHC, using univariable and multivariable conditional logistic regression models.

Findings

We identified 43 570 eligible cases and 174 280 matched controls. In the year prior to cohort entry, 0.35% cases and 0.10% of controls had at least one record of DVA. Women who experienced DVA were two times more likely to have had a prescription for EHC compared to women with no record of DVA (OR 2.10, 95% CI 1.66 to 2.67). Amongst women aged 25 to 39, the odds of being prescribed EHC was 2.8 times greater for those who had experienced DVA (OR 2.86, 95% CI 2.11 to 3.86).

Consequences

Our findings suggest that a request for emergency contraception may be an indicator of exposure to DVA amongst women. As we have identified an association between DVA and prescriptions for EHC, we will update existing domestic violence training for GPs and sexual health professionals, and extend it to other providers of EHC such as pharmacies.

Submitted by:

Joni Jackson

Funding acknowledgement:

This research was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) and NIHR CLAHRC North Thames. The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.