1. Group Work compiled by:  Sarah Donaldson  Jasmine Phan  Rhiannon Sands  Nicole Williams http://www.melbourne.anglican.com.au/NewsAndVie ws/TMA/PublishingImages/2011- 11/stop_violence_against_women.jpg

2.  Violence against women is defined by the United Nations as “Any act of gender based violence that results or is likely to result in physical, sexual, or psychological harm or suffering to women” (United Nations, 1993). Domestic Violence on women’s health is shattering and has the potential to significantly affect general, reproductive and the psychological health of a woman (McMurray & Tower, 2006). Domestic Violence against women is recognised as a global issue forcing countries to implement strategies to reduce the social, health and economic damage (Victorian Health Promotion Foundation (VicHealth), 2008). In evidence of this; studies demonstrate 10-69% of women report being physically assaulted by an intimate male partner at some point in their lives (WHO, 2002). Shockingly, studies also found that 36% of women reported domestic violence occurring during pregnancy and for 17% of these women it was their first experience of domestic violence (Australian Bureau of Statistics (ABS), 2006). These statistics initiated the focus of our presentation, in highlighting the need to help people understand how pregnant women may be affected and the astounding health ramifications domestic violence can have.

3.  The purpose of this presentation is to expand the knowledge about health issues of pregnant women who are exposed to domestic violence. This presentation identifies the link between domestic violence against pregnant women and evaluates the impact on their health and wellbeing during and after pregnancy and the health issues it can leave on themselves and their baby. The approach being taken in this presentation is to identify the current nursing problems by using facts and statistics and create awareness and education for pregnant women and provide support networks, groups and assistance they may require. In addition to this, the presentation should enhance nursing practice in helping healthcare providers identify women at risk and indicators to provide appropriate antenatal and postnatal care

4.  Nurses and other health professionals are often the first point of contact for women who are experiencing domestic violence (Fahcsia, 2012). It is of great importance that health care workers are able to provide informative, supportive and empathetic services to victims of domestic violence at all levels of the health system (NSW Health, 1999). Nurses are in a position to perform domestic violence screening in a safe environment without being judgmental and show genuine interest (O'Reilly, 2007). NSW Health states that any female aged 16 or over who attends an antenatal or early childhood class must be screened for domestic violence (NSW Health, 2010).  Domestic violence during pregnancy can lead to anaemia, preterm labour, infections, low birth weight babies and post-natal depression. Victims of domestic violence have greater risk of incurring physical injury and mental health issues as well as an increased risk of suicide, suicide ideation and homicide (NSW Health, 2010). Therefore, as nurses, it is important to identify women at risk and prevent further health complications to themselves and their unborn baby.

5. http://www.womensaid.ie/imglibrary/2010/06/2010060219 26581_sm.jpg

6.  If there are any children to the woman experiencing domestic violence and they live at home, nurses are obligated to contact the Department of Community Services should the nurse have concerns that the children are at risk of harm (NSW Health, 2006). No research could be found suggesting that victims of domestic violence or health staff must report abuse to NSW Police or other authority.

7.  Domestic violence is a crime which can be defined as: A person using abusive, violent or intimidating behaviour against another person to dominate, control or maintain control of that person (Baird, 2011; Gibbons, 2011). For pregnant women this could be a partner, family member or anyone they share an intimate relationship with or have previously. This can come in the form of:  Physical abuse  Sexual abuse  Psychological/emotional abuse  Social control/abuse  Financial abuse  Stalking

8.  The various forms of abuse are often used simultaneously and can cause fear, physical and emotional trauma (FAHCSIA, 2012). Children and young people living with domestic violence are often impacted greatly and may constitute as a form of child abuse (Lawlink NSW, 2007). http://26.media.tumblr.com/tumblr_ln620zE62t1qgtmnto1_400.png

9.  An ADVO is for protection. It is an order made by the court ordering a person to stop hurting or harassing you. It may include yourself and your children or other family members. This type of Apprehended Violence Order (AVO) is made when the people involved are related, in a relationship or previously been in a relationship. AVO’s can also be made so you can continue living with your partner (Lawlink NSW, 2007).

10.  Domestic Violence line 1800 656 463  Police 000  Department of Community Services Domestic Violence Line 1800 656 463  Women’s Domestic Violence Court Advocacy Services (WDVCASs) Access this service through Legal Aid or Law Access for local area information  www.legalaid.nsw.gov.au www.legalaid.nsw.gov.au  www.lawaccess.nsw.gov.aui www.lawaccess.nsw.gov.aui  Domestic and Family Violence Intervention Service (DAFVIS) http://dafvis.org.au http://dafvis.org.au  1300 888 529 Womens refuge resource centre http://www.wrrc.org.au/ http://www.wrrc.org.au/

11.  Emotional distress  Inadequate/late prenatal care  Higher incidence of UTIs and STDs  Stomach/Back pain  Bleeding during first and second trimesters  Miscarriage  Abortion  Low self-esteem  Low maternal weight gain  Foetal-maternal haemorrhage  Increased susceptibility to infections due to a weaker immune system  Uterine rupture  Exacerbation of chronic illnesses  Labour complications  Death (Homicide) in extreme cases

12.  Placenta damage  Foetal contusions/fractures  Intraventricular haemorrhage  Haemothorax  Pre-term labour  Foetal death http://forcoloredgurls.com/wp-content/uploads/2010/10/DV-Awareness-2010.jpg

13.  Mother  Depression  Anxiety  Post Traumatic Stress Disorder  Baby  Low birth weight (may be secondary to factors such as maternal smoking, inadequate nutrition or substance abuse)  Potential developmental delays  Child abuse  Stillbirth

14.  Almost 40% of Indigenous women experience domestic violence during their lives.  Indigenous women experience homicide at a rate nine times higher than non-Indigenous women.  Aboriginal and Torres Strait Islander women experience double the number of foetal deaths and low birth weight babies compared with non-Indigenous women.  Indigenous women with large extended families may be fortunate enough to receive necessary care and support. However, the remoteness of some Australian communities makes it difficult for women to seek outside assistance.  In the period 1 July 2000 to 30 June 2004, Indigenous women were hospitalised due to domestic violence at a rate 47 times higher than non-Indigenous women.

15.  In conclusion, pregnant women affected by DV are more likely to be exposed to complications and increased health risks in both pregnancy and post partum. DV against pregnant women not only affects the mother but also has devastating effects on their unborn child (VicHealth 2008). The information in this presentation reinforces the need to create more awareness, provide education and support networks, develop management plans and gain the attention of healthcare providers to enhance nursing practice at an international level.

16.  Australian Bureau of Statistics. (2006). Personal safety survey: Summary of results, Australia 2005 (No. 4906.0). Retrieved from http://www.abs.gov.au/ausstats http://www.abs.gov.au/ausstats  Baird, K. (2011). Working with women and children experiencing domestic violence [Electronic Version]. Primary Health Care, 21 (1), 16-21.  Barry, J., Harrison, J., & Ryan, P. (2009). Hospital admissions of Indigenous and non-Indigenous Australians due to interpersonal violence, July 1999 to June 2004. Australian & New Zealand Journal of Public Health, 33 (3):215-222  FAHCSIA (2012). National Plan to Reduce Violence against Women. Retrieved 14 April 2012 from http://www.fahcsia.gov.au/sa/women/progserv/violence/nationalplan/Pages/default.aspx http://www.fahcsia.gov.au/sa/women/progserv/violence/nationalplan/Pages/default.aspx  Fraser, K. (2003). Domestic violence and women’s physical health. Australian Domestic and Family Violence Clearinghouse Retrieved from http://www.adfvc.unsw.edu.au/pdf%20files/physical_health.pdf http://www.adfvc.unsw.edu.au/pdf%20files/physical_health.pdf  Gibbons, L. (2011). Dealing with the effects of domestic violence [Electronic Version]. Emergency Nurse, 19 (4), 12-17.  Lawlink NSW, (2007). Domestic Violence. Retrieved 19 April 2012 from http://www.lawlink.nsw.gov.au/lawlink/vaw/dvguidelines.nsf/pages/definitions http://www.lawlink.nsw.gov.au/lawlink/vaw/dvguidelines.nsf/pages/definitions  NSW Health (1999). Domestic Violence Policy Discussion Paper. Australia: NSW Health.  NSW Health (2010). Women's health plan 2009-2011. Retrieved 13 April 2012 from http://www.health.nsw.gov.au/policies/pd/2010/pdf/PD2010_004.pdf http://www.health.nsw.gov.au/policies/pd/2010/pdf/PD2010_004.pdf  NSW Health (2006). Domestic violence: Identifying and responding. Australia: NSW Health, pp. 1-2.  O'Reilly, R (2007). Domestic violence against women in their childbearing years: A review of the literature. Contemporary Nurse, 25 (1), pp. 13-21.  McMurray, A. (2005). Domestic Violence: Conceptual and Practice Issues. Contemporary Nurse, 18 (3), 219-232.  McMurray, A., & Tower, M. (2006). Domestic Violence, health and healthcare: Women’s accounts of their experiences. Contemporary Nurse, 21 (2), 186-187.  Mulroney, J. (2003). Australian statistics on domestic violence. Australian Domestic and Family Violence Clearinghouse Retrieved from http://www.adfvc.unsw.edu.au/pdf%20files/Statistics_final.pdf http://www.adfvc.unsw.edu.au/pdf%20files/Statistics_final.pdf  Shah, P., & Shah, J. (2010). Maternal exposure to domestic violence and pregnancy and birth outcomes: A systematic review and meta-analysis. Journal of Women’s Health, 19 (11):2017-2031  United Nations. (1993). Declaration on the Elimination of Violence against women. (Report no. A/RES/48/104). Retrieved from http://www.unhchr.ch/huridocda/huridoca.nsf/(symbol)/A.RES.48.104.En?Opendocument http://www.unhchr.ch/huridocda/huridoca.nsf/(symbol)/A.RES.48.104.En?Opendocument  Victorian Health Promotion Foundation. (2008). Violence against women in Australia: As a determinant of mental health and wellbeing (Research Summary. 4). Melbourne: VicHealth.  World Health Organisation. (2002). World Health Organisation: World Report on Violence and Health. Retrieved March 10, 2012 from http://whqlibdoc.who.int/hq/2002/9241545615.pdf http://whqlibdoc.who.int/hq/2002/9241545615.pdf