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Domestic violence against women in pregnancy

 
September 2005
  • Domestic violence has been identified as a prime cause of miscarriage or still-birth(1), and of maternal deaths during childbirth(2) .
  • Legally, if a miscarriage is caused by abuse, the assailant can be charged under S.58 of the Offences against the Person Act, "using an instrument with intent to cause a miscarriage"(3) .
  • If a baby is born prematurely as a result of an assault, and then dies, the assailant may be charged with manslaughter(4) .
  • Within the six weeks following birth, 11 new mothers were known to have been murdered by their male partners during 2000-02, and 14% of all the women who died during or immediately after pregnancy (43 women) had reported domestic violence to a health professional during the pregnancy(5) .
  • Between 4 and 9 women in every 100 are abused during their pregnancies and/or after the birth(6).
  • 30% of domestic violence starts in pregnancy(7).
  • 12% of the 378 women whose death was reported to the Confidential Enquiry on Maternal Deaths had voluntarily reported domestic violence to a healthcare professional during their pregnancy(8). None had routinely been asked about domestic violence so this is almost certainly an under-estimate.
  • One study in the USA found a significant relationship between pregnancy, domestic violence, and suicide: pregnant women who attempt suicide are very likely to have been abused(9).
  • Women receiving care on antenatal and postnatal wards were questioned in a study examining the prevalence of domestic violence and its associations with obstetric complications and psychological health. 23% of women had a lifetime experience of domestic violence, and 3% had experienced violence in the current pregnancy - probably an under-estimate(10). The effects can be cumulative and long-lasting; so abuse prior to the current pregnancy could also result in adverse effects for mother and child.
  • Royal College of Midwives Position paper advocates recognition of abuse, documenting it, and giving woman information to make her own choices(11).
  • Routine enquiry about domestic violence during antenatal booking is infrequent despite such enquiry being included in clinical practice recommendations and is made less frequently than any other aspect of social history taking(12).
  • Midwives usually do not raise the subject of domestic violence, and women often feel "silenced" and unable to talk about it with their midwife(13).
  • Routine enquiry about domestic violence in maternity settings is accepted by women, provided it is conducted in a safe confidential environment(14). A pilot project in Leeds found that 92% of women questioned were in favour of routine enquiry(15).
  • Midwives approve in theory of routine questioning about domestic violence, and also broadly agree (81%) that it is their responsibility; but in practice, only about 60% are happy to do it(16). Practical and personal difficulties - including lack of time, staff shortages, and difficulty in obtaining sufficient privacy - were frequently cited(17).
  • Training is essential in order to sustain routine questioning and ensure midwives are aware of how to respond to disclosure. Those midwives who - after training - do question women about domestic violence find benefits for themselves also(18).
  • Healthcare professionals have a duty to record anything that might impact on the health of their patients including domestic violence.
  • NSF (National Standard Framework) for Children, Young people and Maternity Services(19) includes points on identification of and response to domestic violence in pregnancy: women should be offered "a supportive environment and the opportunity to disclose" and maternity service staff should be "aware of the importance of domestic violence and competent in recognising the symptoms and presentations" and "able to make a sensitive enquiry" and "provide basic information" and referral to local services.
Jackie Barron
Amended May 2005
 
Notes:

1. Mezey, Gillian (1997) "Domestic Violence in Pregnancy" in Bewley, S., Friend, J., and Mezey, G.: (1997) (ed.) Violence against women (Royal College of Obstetricians and Gynaecologists)
2. Lewis, Gwynneth, Drife, James, et al. (2001) Why mothers die: Report from the confidential enquiries into maternal deaths in the UK 1997-9; commissioned by Department of Health from RCOG and NICE (London: RCOG Press); also Why Mothers Die 2000-2002 - Report on confidential enquiries into maternal deaths in the United Kingdom (CEMACH.
3. See Bristol Evening Post 18th December 2004, report on Nycoma Edwards whose assault on his girlfriend led to miscarrying at 4 and half months.
4. See report from July 2000 of a Carlyle case where assault resulted in birth of baby (born at 8 and a half months by caesarean section).
5. Lewis, Gwynneth, and Drife, James (2005) Why Mothers Die 2000-2002 - Report on confidential enquiries into maternal deaths in the United Kingdom (CEMACH).
6. Figures from a recent Australian study: Taft, Angela (2002) Violence against women in pregnancy and after childbirth: Current knowledge and issues in healthcare responses Australian Domestic and Family Violence Clearinghouse Issues Paper 6.
7. Why mothers die, op.cit.
8. Lewis, Gwynneth, Drife, James, et al. (2001) Why mothers die: Report from the confidential enquiries into maternal deaths in the UK 1997-9; commissioned by Department of Health from RCOG and NICE (London: RCOG Press)
9. Stark, E. and Flitcraft, A. (1996) Women at risk (London: Sage)
10. Bacchus, Loraine (2004) "Domestic violence and health" in Midwives Vol.7, no.4, April 2004
11. Royal College of Midwives (1999) Domestic abuse in pregnancy: Position Paper 19a (London: RCM)
12. Foy, Robbie et al. (2000) "Antenatal detection of domestic violence" in The Lancet Vol.355, p.1915.
13. Aston, Gill, 2004: "The silence of domestic violence in pregnancy during women's encounters with healthcare professionals" in Midwives Vol.7, no.4, April 2004.
14. Price, Sally (2004) "Routine questioning about domestic violence in maternity settings" in Midwives Vol.7, no.4 April 2004
15. Leeds Inter-Agency Project (2005) Health and social care project report: promoting good practice in health service responses to women and children experiencing domestic violence (Leeds: LIAP)
16. From Sally Price et al. research at UWE, see above
17. Leeds Inter-Agency Project (2005) op.cit.
18. Vicky Lavis, informal comment, from experience in Wakefield.
19. Department of Health (2004) National Service Framework for Children, Young People and Maternity Services: Part 111 Maternity Standard (London: Gateway ref. 3779)