Domestic violence screening in pregnancy and postpartum in Coventry and Warwickshire; an investigation into barriers.

Problem

Domestic violence (DV) is a significant problem in the UK; on average 2 women are killed by their partner or ex-partner every week in England and Wales. Pregnancy is identified as a particularly vulnerable time for women and for 30% of women who experience domestic violence in their lifetime, the first incident occurred in pregnancy. Domestic violence poses a substantial risk of harm to mother and baby.

Pregnancy is also a time of increased engagement with healthcare professionals and screening for domestic violence in pregnancy is included in NICE guidelines for antenatal care. In practice it is often found that screening is not routinely implemented and barriers to screening have been researched globally with key themes emerging. These themes have not been explored at a local level in Coventry and Warwickshire. This project intends to explore these barriers locally and further contribute to wider discussion about how domestic violence screening can be supported and facilitated across the UK.

Approach

This project is a qualitative study involving semi-structured interviews with 18 midwives currently employed in antenatal and postpartum care. The midwives were recruited via email with a request to participate in the study and the study was also advertised at two midwifery training days at the local trust. Recruitment was voluntary and involved midwives working in primary and secondary care. The interviews consisted of 6 open questions exploring the themes established in pre-existing literature. The interviews were audio recorded and transcribed verbatim. The data collected was free text and required qualitative analysis. It was coded using both a deductive and inductive method to allow for exploration of unexpected findings coupled with predetermined themes. A framework approach was used.

Findings

This project is ongoing and data analysis is in progress. However key themes have already emerged from the data and will be subject to further analysis. The established themes are 1. Training on DV, 2. Types of questions asked in screening, 3. Factors that influence asking the questions 4. How to respond to a disclosure. There are subthemes within these. The themes concur with the global findings into barriers to screening for domestic violence but there are also some new associated themes highlighting how these barriers come into play at a local level and within the context of the local primary care structure.

Consequences

Although ongoing, the implications for future practice are emerging. There is a clear need for further specific training on domestic violence screening for all of those involved with the care of women in pregnancy. There are substantial structural barriers to screening which could be addressed with further review of practice. More support needs to be in place to facilitate domestic violence screening and this has implications for future practice and training.