Zero tolerance for domestic violence

Abstract

Domestic violence affects about one in four women in the UK and rates around the world are similar, if not higher in some countries. Domestic violence often starts or escalates in pregnancy and is associated with a range of adverse outcomes for both the mother and baby. In spite of this, health-care workers' knowledge of this tragic situation is poor and attitudes towards its detection and management are inconsistent. Against this bleak backdrop, last week's publication in the UK of a report specifically aimed at improving care received by victims of domestic violence and the Government's announcement that screening for violence would become a routine part of antenatal services are important steps to tackle this major public-health issue. In the UK, routine antenatal screening for domestic violence was advocated by the Department of Health in 2000 and also supported by the findings of the latest report from the confidential enquiries into maternal deaths. Last week's Home Office publication complements the existing National Service Framework for Children, Young People, and Maternity Services and comes at a time when Parliament is considering the Domestic Violence, Crime, and Victims Bill, the largest review of domestic violence legislation in the UK for 30 years. Globally a mass of evidence has accumulated which supports routine antenatal screening for domestic violence; the American College of Obstetricians and Gynecologists recommends that screening should occur at the first prenatal visit, at least once per trimester and at the postpartum check-up. Although the stage for routine screening for domestic violence has been set for some time, the recent announcement that it will become standard antenatal practice throughout the UK is based on the results of a pilot project by the University of the West of England. Results showed that after appropriate training, midwives had increased confidence in raising the issue and this increased the opportunities for women to disclose abuse. The challenge then is not simply the introduction of screening, but also the provision of training for those undertaking this task and crucially the development of effective interventions for those women identified as being at risk. Although more research is required into the most effective screening and intervention tools, clearly a great deal of time and resources have already been invested globally into studying this problem. Additional resources have been promised by the government in the UK at least, and the matter is being debated by Parliament. It is now high time that health-care workers took the lead in helping the victims of domestic violence. Although difficult and sometimes painful, questions must be asked and help provided if this crime is to be prevented and its victims cared for with the priority and compassion they deserve.