16 days of activism against violence against women and girls
Laura Seebohm, CEO of Maternal Mental Health Alliance (MMHA), shares why 16 days of activism is so important to raise awareness of gendered violence in the perinatal period and the resources available to healthcare workers.
Understanding and responding to the needs of women experiencing domestic abuse in maternity and perinatal settings is complex. We are encouraged to ‘think family’ and ensure that fathers and partners are not excluded from the support. Indeed, this is now a perinatal mental health requirement within the NHS long term plan. We know that many partners feel excluded in the maternity journey and are often a vital source of support at this vulnerable time for new and expectant mothers.
We also know that domestic abuse affects one in four women in their lifetime and, on average, two women are killed every week in the UK as a result of domestic abuse. Disturbingly, we know that 30% of domestic abuse starts in pregnancy. Women with antenatal and postnatal depression are three times more likely to report experiencing domestic abuse than women who do not experience perinatal depression. This suggests that there is something profound and significant about gendered violence and abuse in the perinatal period.
So when we ask midwives, GPs and health visitors to ask routinely and sensitively about domestic abuse at each and every contact with women during the perinatal period, we are expecting professional expertise which is skilled and sophisticated, complex, nuanced and potentially intrusive. Furthermore, we know that 78% of the NHS workforce are women and it is therefore the case that many will also be current victims and/or survivors of domestic abuse and carry their own trauma. This can impact their ability or their confidence in asking the right questions of the women in their care.
On average, women will have 16 appointments with healthcare professionals during the perinatal period and this can be an ideal opportunity to ask routinely and sensitively about domestic abuse. However, only 0.5% of maternity patients are recorded as having disclosed domestic abuse. During lockdown this fell to almost zero. Recurrent MBRRACE reports highlight domestic abuse as a factor relating to maternal death by suicide and attention is drawn to a persistent lack of recording each and every year.
Earlier this year, there was a landmark case when a perpetrator of domestic abuse was convicted for ‘unlawful killing’ in relation to the suicide of the victim who endured violence and abuse over many years. Many of us who have worked in women’s services over the years anecdotally know this is one of many.
How can we equip health care professionals to have that first conversation? What happens when the person making the assessment knows they probably only see the patient once before they are referred to the right care pathway? It is vital that midwives, GPs, health visitors and perinatal mental health teams keep returning to the question and sustain that professional curiosity. Crucial to disclosure is the slow building of therapeutic trusting relationships so women feel able to talk about it. A trauma-informed approach is the framework through which this is possible.
There are many examples of exemplary practice in this field. The LARA resource was developed for mental health services to help practitioners identify and respond appropriately to those affected by domestic abuse and is a great place to start. The content is informed by evidence from a pilot led by Professor Louise Howard who has pioneered so much work in this space, and informed by NICE clinical guidelines, Domestic Homicide Reviews, Serious Incidents, and Serious Case Reviews and expert feedback from frontline clinicians and people with lived experience. There is a real opportunity to extend this learning across universal and specialist services supporting women during the perinatal period.
While tackling violence against women and girls should be a year-round mission,16 days of activism gives us amazing global collective power and a much louder voice. It is an opportunity to acknowledge the reality for many women experiencing domestic abuse and the added risks and vulnerabilities endured during the perinatal period. We must have compassion for so many healthcare professionals working in pressured and time-poor circumstances, still striving to support women. We must have compassion for women who see no way out. Above all, we must support each other in our collective action to tackle gendered violence and abuse, possibly the most harmful of all social ills.