Provider perspectives on a safety card intervention for partner violence and reproductive coercion

Introduction: The prevalence of intimate partner violence (IPV) among family planning clients is significantly higher than population-based estimates. This care-seeking pattern is likely related to the association of IPV with increased risk for pregnancy and sexually transmitted infection. Thus, clinicians providing reproductive health services are particularly well-positioned to intervene with a large number of women affected by IPV. Methods: Qualitative interviews were conducted with 24 providers about their experiences implementing a brief safety card intervention to adolescent and young adult family planning clients. Results: Providers described feeling more confident discussing IPV and reproductive coercion with their clients after implementing the intervention. Specifically, the safety card helped to normalize the discussion about IPV. Introducing the safety card as something to share with friends and family facilitated a more open discussion about healthy relationships. The card also shifted provider behaviors from using a checklist to screen for IPV to a more fluid conversation integrated into the clinic visit. Intervention training helped providers make the link between reproductive coercion and IPV for the first time; most providers reported feeling more knowledgeable about and comfortable offering harm reduction strategies to their clients including longer acting reversible contraceptives. Implementation challenges included lack of time, the need for increased connections to local domestic violence programs, and in some sites, limited support from clinic administration when positive disclosures occurred. Conclusions: Family planning providers found a brief safety card was an acceptable way to guide their conversations with clients about partner violence and reproductive coercion.