What is domestic abuse?
Domestic abuse is defined by the Home Office as
‘Any incident of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults who are or have been intimate partners or family members, regardless of gender or sexuality.’
Domestic abuse occurs across the whole of society although some vulnerable women are particularly at risk, including women who are poor, have mental health problems or who are in temporary accommodation.
Examples of domestic abuse
Shaking, smacking, punching, kicking, presence of finger or bite marks, starving, tying up, stabbing, suffocation, throwing things, using objects as weapons, female genital mutilation, ‘honour violence’. Physical effects are often in areas of the body that are covered and hidden (i.e. breasts and abdomen).
Forced sex, forced prostitution, ignoring religious prohibitions about sex, refusal to practise safe sex, sexual insults, sexually transmitted diseases, preventing breastfeeding.
Intimidation, insulting, isolating a woman from friends and family, criticising, denying the abuse, treating her as an inferior, threatening to harm children or take them away, forced marriage.
Not letting a woman work, undermining efforts to find work or study, refusing to give money, asking for an explanation of how every penny is spent, making her beg for money, gambling, not paying bills.
Swearing, undermining confidence, making racist remarks, making a woman feel unattractive, calling her stupid or useless, eroding her independence.
Domestic violence and pregnancy
Domestic violence during pregnancy endangers both the pregnant woman and her unborn child. It increases the risk of:
- premature birth
- low birth weight
- fetal injury
However, a woman who is experiencing domestic abuse may have particular difficulties using antenatal care services:
- the perpetrator of the abuse may try to prevent her from attending appointments
- the woman may be afraid that disclosure of the abuse will worsen her situation
- the woman may feel ashamed or guilty about being abused and worried about the reaction of the healthcare professional.
- 1 in 4 women experience domestic violence over their lifetimes.
- 6-10% of women suffer domestic violence in a given year.
- 1 woman in 9 is severely beaten by her male partner in a given year.
- On average, a woman is assaulted 35 times before her first call to the police.
- In 90% of domestic violence incidents, children were in the same or the next room.
- In over 50% of known domestic violence cases, children were also directly abused.
- Over a third of domestic violence starts or gets worse when a woman is pregnant.
- 15% of women report violence during their pregnancy.
- 40%–60% of women experiencing domestic violence are abused while pregnant.
- More than 14% of maternal deaths occur in women who have told their health professional they are in an abusive relationship.
Why don’t abused women leave their abuser right away?
Women who are being abused may:
- not be safe if they leave an abuser – leaving is often the most dangerous time of all
- be afraid of the abuser
- be financially dependent on the abuser
- be dependent on their abuser for their immigration status
- believe they cannot manage alone
- suffer chronic post-traumatic stress and be unable to make critical decisions
- love the abuser and believe he will change
- not want to be responsible for breaking up the family
Why is it so hard to disclose domestic abuse?
Women who are being abused may:
- feel ashamed and guilty, believing the abuse is their fault
- think no one will believe them
- have been threatened by the abuser with worse abuse if they talk
- worry that their children will be taken away by social services
- never be allowed by the abuser to be alone with a health professional
- not realise that what they are experiencing is abuse.
What should health professionals do?
NICE and the Department of Health recommend that women experiencing domestic abuse need:
- To be asked sensitively, as part of routine care, whether they are experiencing abuse.
- To be asked more than once – most women will not disclose abuse the first time they are asked.
- To be asked about abuse only when they are alone (or with a professional interpreter), which means that they need to be seen alone at least once during the pregnancy, even if normally accompanied by partner or family member.
- To be believed when they disclose abuse.
- Assurance that information disclosed will be confidential (subject to any child protection issues raised), and will not be recorded in the hand held notes she takes home.
- Information including:
- a credit card-sized information card that includes local and national helpline numbers (this format means the card can be hidden from an abuser)
- safety information, and encouragement to make a safety plan (but not to write it down, again to avoid the risk of an abuser finding it).
- Plans for follow-up care, such as additional appointments, referral to a domestic abuse support worker, information sharing (with consent) with the GP, being allocated to a named midwife.
- More flexible appointments if they need time to disclose.
- To have their fear about involvement of social services addressed.
- 10. To be allowed to make their own decisions about what to do next without being pressured into a particular course of action (e.g. to leave the abuser).
- 11. To have their decisions respected non-judgmentally, even if it is a decision that the healthcare professional finds frustrating (e.g. to return to the abuser).
- 12. To know they are not alone in the experience of being abused.
Useful organisations and resources
Freephone 24 hour National Domestic Violence Helpline
0808 2000 247
Free online training on identifying and responding to domestic abuse: http://www.seeabuse.com/
This page draws on referenced NICE guidance, A Department of Health taskforce report and a Department of Health handbook.
Pregnancy and complex social factors (CG110)
A model for service provision for pregnant women with complex social factors
NICE guidance 2011 http://guidance.nice.org.uk/CG110
Responding to violence against women and girls –the role of the NHS. The report of the Taskforce on the Health Aspects of Violence Against Women and Children (2010)
Responding to domestic abuse: a handbook for health professionals Department of Health (2005)