1. Domestic Violence, Health & Maternity Project Wednesday 06 th March 2013

2. Domestic Violence, Health and Maternity Project Aim To raise awareness of domestic abuse in pregnancy with maternity staff working within two Imperial College Healthcare Trust (ICHT) hospitals To facilitate the early identification and intervention of domestic abuse in pregnancy, through routinely question pregnant women attending hospital maternity services Consult with maternity staff, Black, Asian, Minority Ethnic and Refugee (BAMER) community groups and women accessing the hospitals Funding 5 year funding (Jan 2011- Dec 2015) from BIG LOTTERY for the project and coordination 2 year funding (Jan 2011- Dec 2013) from Imperial College Healthcare Charity for a dedicated Maternity Independent Domestic Violence Advocate (IDVA) Sites Queen Charlotte’s and Chelsea Hospital (QCCH) St Marys Hospital (SMH) Key partners Midwifery (Lead Safeguarding Midwives, Caseload/One to One Midwives, Community Midwives, Student Midwives, Maternity Support workers) Independent Domestic Violence Advocacy Services (ADVANCE) BAMER community groups Women accessing maternity services at QCCH and SMH Maternity Services Liaison Committee (MSLC), BME Health Forum, Children and Health Group

3. Prevalence 30% of domestic violence starts in pregnancy (Lewis and Drife, 2001,2005; McWilliams and McKiernan, 1993) Between 4 and 9 women in every 100 are abused during their pregnancies and/or after the birth (Taft, 2002) Domestic violence has been identified as a prime cause of miscarriage or still-birth (Mezey, 1997), and of maternal deaths during childbirth (Lewis and Drife, 2001, 2005) 75% of cases of domestic violence result in physical injury or mental health consequences to women (Home Office, 2001) 54% of UK rapes are committed by a woman’s current or former partner (Walby and Allen, 2004) The cost of physical healthcare treatment resulting from domestic violence, (including hospital, GP, ambulance, prescriptions) is £1,2 billion (Walby, 2004) The overall costs of domestic violence are estimated to be £278 million p.a. in greater London alone. In 2001 in England and Wales, domestic violence was estimated to cost a total of £23 billion (Walby, 2004; Stanko, 1998, 2000) At least 750,000 children a year witness domestic violence (Department of Health, 2002)

4. Impacts on Pregnant Women bruises, cuts, burns, scratches, broken bones, injuries that are untended and of several different ages, especially to the head, neck, breasts, abdomen and genitals rape and sexual assault, gynaecological injuries unplanned or unwanted pregnancy. mental illness – depression, panic attacks, anxiety, suicide, isolation enforced poverty coping mechanisms such as smoking, alcohol and drug abuse, misuse of prescribed drugs Information from the Bristol Pregnancy and Domestic Violence Programme

5. Impacts on the Foetus repeated miscarriage termination of pregnancy antepartum haemorrhage premature rupture of membranes intra-uterine growth retardation premature labour abruption placenta stillbirth low birth weight infants fractures to the foetus ruptured uterus, liver or spleen (Bullock & McFarlane 1989; Shumway et al 1999; Webster et al 1996) Information from the Bristol Pregnancy and Domestic Violence Programme

6. Purpose of Routine Enquiry in Maternity Settings Routine enquiry about domestic violence in maternity settings is accepted by women, provided it is conducted in a safe confidential environment. A pilot project in Leeds found that 92% of women questioned were in favour of routine enquiry. (Price 2004; Leeds Inter-agency Project, 2005). Domestic abuse is openly named as a health issue Offers an opportunity for women to disclose Provides an opportunity for early identification and intervention Informs women they can access specialist support

7. Why should this be implement? Intervention could… 1.Save a life 2.Improve health and well-being 3.Save NHS money 4.Give pregnant women the chance to disclose 5.Ensure that women have access to help 6.Reduce harm to children 7.Safeguard children from abuse

8. Contacts The Health and Maternity Project is offering free domestic abuse training for staff and volunteers of BAMER organisations in West London. To learn more about the dynamics of domestic abuse, recognising the signs and symptoms and how you can help survivors, contact Rina Mehta Domestic Violence, Health and Maternity Project Coordinator r.mehta@standingtogether.org.uk 020 8748 5717