Holly Ashley is a Reno obstetrician and gynecologist who hopes to change the way health screening works, one patient at a time. At the moment, there's not much of a universal system for questioning OBGYN patients about domestic violence—not in the straight-shooting way a doctor might ask about someone's menstrual cycle, for example.
Nevada ranks No. 6 in the country for women murdered by men, according to the Violence Policy Center. It's an unsettling figure for Ashley, who says the American Congress of Obstetricians and Gynecologists has piles of materials for members and their patients—packets about vaccines, packets about influenza during pregnancy, you name it—but little to address domestic abuse. The fact that it's statistically worse during pregnancy makes her mission all the more salient.
How does regular screening work, for starters?
Well, if you look at the annual exam or the new obstetric-exam history and physical, we’re required to focus on a lot of areas. We look at your past sexual-infection history, your menstrual history, any history of past gynecologic surgeries. We do a routine health history. We ask about cancer assessment. … [Domestic violence] is a public health problem that needs to be part of it as well. We ask about seat belt use, sunscreen, helmets … .
Yeah, why not ask about abuse, too?
[Nodding] We also need to ask about emotional, physical and sexual health, in that your relationship does affect your health. There are a lot of things that go on in an abusive relationship that prevent a person from coming in for care: shame, fear, not having access to rides, the partner controlling her every move. When people ask, “Why don’t [the women] leave?” it really should be, “Why do abusers abuse?” The problem is that when a woman leaves, that’s potentially the most violent time. It’s the highest risk of homicide.
How do you ask patients the tough questions?
You have to make it part of your universal screening, and of course in a confidential manner without the partner in the room. If the partner’s in the room, you have to be really creative.
How do you get them away from the partner, then, to talk?
It doesn’t always happen right away. I had a patient who wanted to talk about STDs, and she didn’t want her partner there, but he came anyway. Sometimes it’s about leaving the information out so they’ll pick it up, and maybe the partner won’t see them do it. I try to keep cards, to put signs in the bathroom, to be anonymous in some ways.
Apparently, the city is getting a new prosecutor and taking some other steps to target domestic abuse.
There are a lot of really smart people in Reno, so some changes are happening. Luckily, Reno also has a lot of organizations. We have the Nevada Network Against Domestic Violence, the Washoe County Domestic Violence Task Force, and various shelters.
So what’s next for you?
I don’t have my script figured out. That’s what I need to do. I need to take the inspiration and motivation and drive and desire to help, and figure out the most efficient and successful way of asking these few questions to get at the root of the issue; to have the person open up; to get the answers or at least more information, then direct them to the right resources.