Gender‐based violence in obstetric and gynecologic care: Secondary victimization, ethics, and trauma‐informed practice‐scoping review

Abstract

Domestic, sexual, and gender‐based violence (DSGBV) affects between 27% and 35% of women worldwide. The rate of this type of violence is higher in many low‐ and middle‐income nations, and it exceeds 37% for women living in those countries. Many DSGBV survivors begin their healthcare experience at an obstetrics or gynecology (OB‐GYN) office. Survivors might experience several barriers to receiving appropriate OB‐GYN treatment because of failures to screen, secondary victimization, provider behavior, ethical dilemmas, and structural barriers; these barriers can affect the survivor's ability to disclose to a care provider, receive continuous care, and achieve long‐term health outcomes. A search of the scientific literature was performed using PubMed and Scopus databases, gathering peer‐reviewed articles that focused on DSGBV epidemiology, reproductive health outcomes of victims, secondary victimization in healthcare environments, trauma‐informed care, ethical principles, and factors related to institutions that provide OB‐GYN services to women. This review followed a scoping review methodology. The authors used a dual‐reviewer systematic search, screening, and data‐extraction process, which has been described in the methods section. Collected data were thematically synthesized to understand the power imbalance between OB‐GYN practitioners and their patients, the professional behaviors of OB‐GYN providers, the privacy dilemmas that exist between OB‐GYN providers and their patients, how the training models for OB‐GYN practitioners in high‐income settings are applied to low‐income and middle‐income settings, and the adaptation strategies that can be implemented to provide trauma‐informed care in low‐income and middle‐income settings. Domestic, sexual, and gender‐based violence (DSGBV) exposure is related to an increase of 1.5 to 2.0 times in unintended pregnancy, 1.7 times in unsafe abortion, and approximately 2.0 times in high‐prevalence areas HIV risk. This type of intimate partner violence during pregnancy is found in 3–9 percent of women, and it is linked to both late antenatal booking and poor attendance of antenatal visits. Less than one out of every four survivors reports violence in healthcare settings globally. Negative institutional responses occur in 30%–60% and are associated with more severe post‐traumatic symptomatology and, in multi‐country data, with most survivors never consulting formal health care or social services at all. The trauma‐informed training programs show a 25%–40% reduced patient‐reported distress and up to 47% disclosure comfort. OB‐GYN encounters are ethically powerful clinical situations that form the dignity, safety, and trust of survivors. To reduce the burden of secondary harm, it is necessary to integrate trauma‐informed and rights‐based frameworks into reproductive healthcare systems to promote health equity worldwide.