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29 November 1998

Policing pregnant women

The Department of Health's proposals to monitor pregnant women for signs of domestic abuse could do more harm than good, writes Brid Hehir

On Monday 23 November the Department of Health (DoH) launched 'Why mothers die: the confidential enquiry into maternal deaths'. The report draws attention to the number of pregnant women who suffer domestic violence at the hands of their male partners, and encourages medical staff to look out for signs of abuse during antenatal check-ups.

The report makes the frankly ridiculous claim that one in three women suffers domestic violence during pregnancy. Such inflated figures are a result of the broadening definition of abuse. In November 1997 the Royal College of Midwifes gave the following as 'indicators' of an abusive relationship: high incidence of miscarriage, unplanned and unwanted pregnancies, smoking, alcohol and drug abuse, missed appointments and dominant partners ('Domestic abuse in pregnancy'). It may surprise the DoH and midwife leaders that what they perceive as abuse could in fact be an acceptable way of life for those involved in the relationship under scrutiny.

The Royal College of Midwifes encouraged its members to look out for these 'indicators' of abuse, thereby undermining the trust placed in them by pregnant women. Health visitors who provide care to families with small children are also expected to look out for signs of domestic violence. Now this kind of snooping is being recommended by the Department of Health to all medical staff who come into contact with pregnant or recently delivered women. Health professionals are encouraged to suspect every pregnant woman of being a potential victim of domestic violence, and to suspect every male partner as a potential abuser. Real life, of course, is not like that; couples would no doubt be highly offended if they thought that their every antenatal or postnatal encounter with health professionals was being used to surreptitiously or openly detect domestic violence.

One possible outcome of the DoH's recommended intrusiveness is that pregnant women or mothers may deliberately absent themselves from the healthcare they or their children need if they suspect their relationship is being viewed as suspect by the very people they should be able to trust. Women are not the victims that health ministers and the Royal Colleges of Obstetrics and Midwifery perceive them to be. Women sometimes end up in less than desirable relationships and make mistakes, but in general they do the best they can and make decisions in their own and their children's best interests. The number of women who have left violent relationships and made new lives for themselves and their children, without any help from healthcare professionals, has always impressed me.

The medical profession should take pride in having recognised and dealt so effectively with the life-threatening conditions that can affect women's and fetal health in pregnancy. If they want to get involved in social issues they could perhaps publicise the desperate need of so many mothers for adequate housing, transport and nursery provision. Policing women is not the role of doctors, midwifes or nurses; we should reject the DoH's proposals.

Brid Hehir is a practising health visitor and former midwife

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