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Women often remark that they want to be asked and that they would not have disclosed otherwise for many reasons including: fear of not being believed, fear that their children will be taken away, fear of worsening violence once outsiders are involved, embarrassment about what is happening to them and lack of awareness that help can be obtained from health care professionals. Some women have further barriers to disclosure such as language and culture.

Routine enquiry increases detection and is acceptable to women (Reference1). Antenatal care provides an opportunity for repeated enquiry, which may further increase detection. However routine enquiry must only be introduced with a robust policy for referral and training and support for those involved in screening in conjunction with local groups working in this area. Inappropriate responses or advice from health care professionals can worsen the situation. In addition, those asking the question may have been victims of domestic violence themselves and find the prospect of discussing it with another individual difficult.

What can we do?

In the absence of a comprehensive screening programme with support, there is still much that can be done as an individual. As health care professionals we are trained to identify problems and to solve them. This is not usually possible in domestic violence but it is our responsibility to help women identify and acknowledge abuse, provide appropriate referral and on going support.

Be aware of the presentation

Provide privacy – ideally all women should be seen alone at least once during their pregnancy

Provide interpreters if appropriate- do not rely on family members

Do listen, be supportive and non- judgemental- women need to be believed Be aware of appropriate referral – women’s aid provide advice for professionals as well as women themselves Recognise your limitations – ask for advice

Explain the limitations of confidentiality- under the child protection act, social services must be alerted if there is any concern regarding the safety of children in the home. This must be explained to the woman.

Do not give directive advice or try and solve the problem Do not encourage her to leave – a woman is most at risk of serious abuse or even death when she leaves or prepares to leave (Reference2)

If she is thinking of leaving, help with appropriate referral and a check list of things she may need, birth certificates, keys, national insurance number, visa, passport, telephone numbers, toiletries, clothes

Do not confront the partner

Safety is paramount- this includes your safety and that of the woman’s children

Do not document in the hand-held notes

If consent for documentation is given it should be in hospital or GP records that are not accessible to the perpetrator – for example notes should not be given to women to carry to scan appointments within the hospital

Careful detailed documentation may be used as evidence in later legal action

Offer referral for legal advice- family lawyers may provide advice free of charge or have links via local agencies. Part IV of the family law act 1996 includes occupation orders, which concern the right to occupy the family home and non-molestation orders, which provide protection against violence and abuse. Health care professionals should not give legal advice but refer.

Do not be despondent if she chooses not to leave – there are many complex reasons for this, she needs ongoing support whatever she decides to do

Asking the question

When the above criteria have been met it is appropriate to explain why you are asking the question. For example:

“ I am sorry if someone has already asked you about this and I don’t wish to cause you any offence, but we know that throughout the country 1 in 4 women experiences violence at home at some time during their life. I noticed that you have a number of bruises/cuts/burns (as appropriate).” ( Reference3)

It is then appropriate to ask direct questions, for example:

Do you ever feel frightened by your partner, or other people at home?

Have you ever been slapped, kicked or punched by your partner?

Your partner seems very concerned and anxious about you. Sometimes people react like that when they feel guilty, was he responsible for your injuries?

These are suggestions adapted from the Department of Health manual, see below. They are not a comprehensive list and each situation will demand slightly different questions. A more detailed assessment tool, the Abuse Assessment Screen has been used successfully in the antenatal setting to improve detection rates (Reference4, Reference5). Questions must be asked with the appropriate referral advice available- see above.

Further advice for Professionals:

Department of Health Domestic Violence: Resource Manual for Health Care Professionals.

Free copies available at or

DH Publications
PO Box 777


1. Mezey G, Bacchus L, Haworth A, Bewley S. 2000. An exploration of the prevalence, nature and effect of domestic violence in pregnancy. ESRC study.

2. Manmer J, Itzin C. (2000). Home Truths About Domestic Violence: feminist influences on policy and practice. London: Routledge.

3. Camden Multi-Agency Domestic Violence Forum. Domestic Violence: a training pack for health profseeionals.

4. McFarlane J, Parker B. (1994) Abuse during pregnancy: A protocol for prevention and intervention. New York: March or Dimes Birth Defects Foundation.

5. Norton L B, Jefferey F P, Zierler S Lima B, Hume L. Battering in pregnancy: an assessment of two screening methods. Obstet Gynecol 1995; 85(3): 321-325, Abstract

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