One in six Australian women experience physical or sexual violence by someone they know at some point in their adult life. More than half (54%) of women living with abusive partners experience violence during pregnancy.
Domestic violence at any stage of life results in poorer health, reduced quality of life and higher use of health services. During pregnancy, violence also contributes to miscarriage, premature labour, low birth weight and a higher incidence of infant death.
Given that more than 300,000 women seek antenatal care each year, midwives are ideally placed to identify women experiencing violence and to provide immediate support and referrals to other agencies for emotional, financial and practical support.
But some midwives are reluctant to enquire about domestic violence, or lack the confidence and knowledge to do so effectively.
Violence in pregnancy
A history of violence before pregnancy is one of the strongest predictors of pregnancy violence. For these women, the frequency and intensity of violence often increases during pregnancy.
Pregnancy can also be a trigger for violence. A quarter of Australian women who have experienced partner violence were abused for the first time during pregnancy.
The period following birth is also a time of increased risk of domestic violence for women, as parental stress increases while caring for a newborn infant.
Worldwide, high levels of fear, control and sexual violence in intimate relationships result in women being unable to negotiate the use of contraception and prevent pregnancies.
A recent study in the United Kingdom found women in violent relationships were more likely than other women to terminate a pregnancy. They were three times as likely to conceal a termination from their partner.
A World Health Organisation study involving over 26,000 women across ten low- and middle-income countries concluded that if domestic violence could be reduced by 50%, rates of unintended pregnancy could be reduced by up to 18% and abortion rates by 40%.
What can midwives do?
Maternity services that offer care by the same midwife allow women to form a trusting relationship with their midwife throughout pregnancy, labour and after her child is born.
This relationship allows midwives to routinely enquire about the nature of a woman’s relationship, her sense of safety, available support and health education needs.
But our research team recently surveyed 152 Australian midwives and found a significant proportion were not equipped to talk to their clients about domestic violence.
Two-thirds of the midwives we surveyed didn’t know about the risks and signs of domestic violence. One-third didn’t know that younger women are at greater risk of DV. And around 25% incorrectly believed that perpetrators were violent because of alcohol or drug use.
Perhaps unsurprisingly, midwives who had some education or training about domestic violence achieved higher knowledge scores than midwives who had received no formal training.
We also interviewed 24 midwives working in a variety of maternity models of care in Australia. All the midwives believed that routine enquiry for domestic violence should occur. But most (21) felt unprepared and unsupported in this role.
Our interviewees reported a lack of ongoing education and training programs. They were unsure about how to respond to women’s disclosure of domestic violence.
Time for policy reform
Research from countries such as Canada and the United Kingdom also found a lack of knowledge to be an important barrier to the frequency of screening for physical, emotional and sexual abuse during pregnancy.
But a five-year study of midwives in Bristol, United Kingdom, shows this can be reversed. My colleagues and I found that training and supporting midwives to use sensitive questioning leads to an increase in knowledge and willingness to screen for domestic violence.
All the midwives surveyed reported that enquiring about domestic violence was now a fundamental part of their role. They women they care for are now more likely to disclose they’re in violent relationships.
Last week the Queensland Domestic Violence Task Force recommended improving services for pregnant women and their families, and ensuring that all midwives receive appropriate training.
It recommended asking all women attending ante-natal clinics about their exposure to domestic and family violence and providing appropriate referrals if domestic violence is disclosed.
To facilitate change in this area, we need to to develop better training, screening tools and practice protocols to assist midwives – not just in Queensland, but Australia-wide. This must include an awareness of the needs of ethnic and other minority groups and the development of appropriate inter-agency pathways.
Anyone at risk of family and domestic violence and/or sexual assault can seek help 24 hours a day, seven days a week, either online or by calling 1800 RESPECT (1800 737 732). Information is also available in 28 languages other than English.