Idvas in maternity units
Domestic violence has overtaken gestational diabetes and pre-eclampsia as the leading cause of foetal death[i]. Domestic abuse affects an estimated 1.3 million women each year – 8.2% of the population. Around 30% of domestic abuse begins during pregnancy, while 40–60% of women experiencing domestic abuse are abused during pregnancy.[ii]
12% of the 378 women whose deaths were reported to the Confidential Enquiry on Maternal Deaths (2001) had voluntarily reported domestic violence to a healthcare professional during their pregnancy. None had routinely been asked about domestic violence so this is almost certainly an under-estimate.
In 2001 the National Institute for Health and Care Excellence recommended that all pregnant women should be routinely asked about domestic violence as part of their social history. NICE guidelines suggest that women should have the opportunity to discuss their pregnancy with a midwife in privacy, without their partner present, at least once in the antenatal period.
Attachment to a midwifery unit gives an Independent Domestic Violence Advisor (Idva) the vital opportunity to detect domestic abuse victims when they are perhaps at their most vulnerable, not to mention the risk to their unborn child.
The Idva can help to train midwives in issues such as: why would being pregnant not be a protective factor to mum, or why do victims stay even when there might be harm to their baby? Failure of professionals to ask about domestic abuse can often lead the victim to experience greater feelings of helplessness and entrapment. The Idva can help make domestic abuse a subject that all professionals feel comfortable talking about.
Idvas can also help to train midwives in specialist subjects. For example, honour-based violence, Female Genital Mutilation and forced marriage. All issues which midwives might come across and which are prevalent in the UK today.
Research suggests[iii] that domestic abuse victims feel safest disclosing to health practitioners – and four out of five victims never tell the police. For this reason, national domestic abuse charity SafeLives is encouraging all midwifery units to have access to an onsite Idva service, so that mothers are encouraged to disclose in a safe and open environment. We need to ensure that victims of abuse and their unborn children are given the support to make them safe. Being able to refer to an Idva can help midwives to fulfil this in practice and ensure that victims and their children are safer, sooner.
- Punita Bassi, Senior Independent Domestic & Sexual Violence Advisor (IDSVA), Bristol Royal Infirmary Emergency Department
[i] Friend. J (1998), ‘Responding to violence against women: a specialist’s role’, Editorial, Hospital Medicine, September, Vol 59, No. 9, pp 98-99.