Does routine antenatal enquiry lead to an increased rate of disclosure of domestic abuse? Findings from the Bristol Pregnancy and Domestic Violence Programme

Abstract

Background. Domestic violence (DV) during pregnancy is especially serious, but can be a challenging and difficult subject for midwives to raise with women. The Bristol Pregnancy and Domestic Violence Programme was introduced in an NHS Trust in the south-west of England to equip community midwives with the knowledge and confidence to enquire effectively about DV in the antenatal period.

Aim. To evaluate the effect of routine antenatal enquiry about domestic abuse on disclosure outcomes. Method. Semi-structured self-completion questionnaires, face-to-face interviews and focus groups were used to collect data from a group of community midwives. An audit was also conducted to assess changes in levels of DV reporting after the introduction of routine enquiry.

Results. Eight instances of DV were identified in the 17-month period prior to the programme, and 25 cases of current DV were identified in the nine months following its introduction - an almost six-fold increase. The midwives viewed routine enquiry as important and believed that they have a key role to play. They also identified a lack of pre- and post-registration training and of previous experience in dealing with issues relating to DV.

Conclusions. This study supports previous evidence that routine enquiry may increase the number of disclosures of DV during pregnancy. It also implies that any programme of enquiry must include support, appropriate referral and follow-up mechanisms for women, and that midwives require pre- and post-registration education, training and support if they are to be confident and effective in routine antenatal enquiry.