Focus Groups in Sweden Examine Whether Midwives Inquire about Violence Against Women
Tuesday, August 23, 2005 3:15 PM

In 2004, a study was conducted in Sweden "to describe and use the experience gained by antenatal-care midwives who routinely questioned pregnant women about personally experienced violence."  The study was comprised of five focus-groups with a total of 21 midwives of a city in south-central Sweden. Recognizing that violence against women is a "serious public health issue" and acknowledging the beneficial effect of screening pregnant women for abuse, this study set out to gather information about the method and frequency of screening by midwives.

The National Board of Health and Welfare provides midwives with standardized questions about psychosocial and physical risk factors. However, these guidelines do not include questioning about violence. Nonetheless, service providers are not limited to the guidelines issued and are able to adapt and interpret them as appropriate. As a result of a study conducted in 1997 and 1998 on physical and sexual abuse, one county "introduced questions about emotional, physical and sexual abuse as part of the regular psychosocial assessment." The midwives were given at least one day of training on domestic violence before conducting the revised assessments, which were be done twice during pregnancy and once after birth. In addition to questioning, each woman was to be given a resource card that provided information about available services.

In the focus groups, midwives indicated various perceived roles for themselves. They expressed a desire to raise awareness about the problem and provide information about services. They also wanted to "send the message to women that abuse is not shameful, that they are not alone, that midwives care about abused women," that they can talk about it and help is available. Despite the desire to help, the midwives identified a number of obstacles to completing the screening. There was an expressed need to establish rapport with the woman before asking the sensitive questions about abuse. Although instructed to ask the questions during three visits, the same confidential and trusting relationship kept midwives from asking the questions more than once, out of fear for conveying mistrust. Another significant obstacle was the presence of the spouse during the visits. While the midwives welcome and encourage the spouse to attend, his presence prevented them from asking the women questions about abuse. Other obstacles included lack of time and placing these questions as a low priority, oversight, and language difficulties. Some even indicated that preconceived notions about who may be a victim kept them from asking the questions.

The participants also discussed best practices and possible ways to improve the screening. They emphasised the importance of continued training and education about violence against women and about the services that are available to victims and to midwives that need advice about dealing with the victims. Suggestions were made to overcome the sensitive nature of the questions, such as reading them verbatim to make it more formal and tying the questions to related issues so that the questioning is more natural. To avoid the problem with the presence of the spouse, some recommended scheduling at least one visit with the woman alone, even insisting upon it if necessary. To help the midwives feel more comfortable about asking the questions, "many agreed that abuse assessment should be discussed at staff meetings at the clinics." The midwives were encouraged to use professional interpreters over the telephone if they did not share a common language. The study's conclusion stressed the need to make it a priority to screen all women. It also pointed out the "responsibility of the local health-care management establish official policies and instructions relating to questioning and referral" and provide proper support for the practice.

Cited in: Kristina Stenson et al., "Midwives' Experiences of Routine Antenatal Questioning Relating to Men's Violence against Women," Midwifery, 5 January 2005.