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Barriers to disclosure

Disclosure marks an important step in the help-seeking process but there is a long journey before it and a long one after it.
© Coventry University. CC BY-NC 4.0
When healthcare providers have insight into and empathy for the complex factors that prevent disclosure of DVA, they are more likely to create the conditions that allow a person to disclose.
Disclosure marks an important step in the help-seeking process but there is a long journey before it and a long one after. Escaping abuse is not a linear process and people go through various stages of preparedness. Disclosure can occur in an informal (that is, with family, colleagues or friends) or a formal (such as police, health, social services, school) context.
Many survivors tell of negative experiences at the point of disclosure where they were judged as responsible for the abuse or alienated for staying in or returning to the relationship. There is a rich literature on barriers to disclosure in the context of DVA (Femi-Ajao et al., 2020; Huntley et al., 2019; Bridges et al., 2018; Johnson et al., 2017; O’Doherty et al., 2016).
These include:
  • Commitment to the relationship
  • Perceived needs of children
  • Not recognising the abuse or blaming themselves for the abuse
  • Feelings of shame or embarrassment
  • Fear that they would not be believed
  • Lost identities
  • Lack of trust in healthcare providers (and/or the police)
  • Fear of disclosure
    • Concerns about future risk of harm from their partner as a result of disclosing
    • Loss of control over what might happen next
    • Worries about the practical implications of disclosure, such as having nowhere to go, as well as the financial and professional impact
  • Despondency or a belief that nothing could be done about the abuse
  • Lack of inquiry into DVA by the healthcare provider
  • Negative prior experience of help-seeking
It is essential that providers recognise the compounding of barriers for people with minority ethnic status or other ‘protected characteristics’.
The Equality Act lists nine protected characteristics: age, disability, gender, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, sexual orientation.
These characteristics are often associated with risk but also reduce access to mainstream services. Models of disclosure and stages of preparedness for change, designed based on research with white or ethnic majorities, are largely inadequate because they do not capture the extent of the difficulties that face migrant women or those seeking asylum, women in arranged marriages and those who lack local language and/or local knowledge. Ample evidence supports that the consequences of leaving the relationship for some women are graver than remaining in it. In particular, women perceive little choice but to stay where the honour of the family is valued above the welfare of the woman. People with histories of abuse, including childhood trauma, are also faced with far greater difficulties relative to those who do not have prior abuse.
Socio-cultural context is important also. If there is a lack of political will, absent legal frameworks and weak law enforcement to address domestic abuse and wider issues of violence against women and girls, then there is little precedent for health, education and other services to address it at the community level.
Hasselle et al. (2019) identified the following as barriers to pregnant women escaping abuse:
  • Mental health barriers (such as depressive symptoms)
  • Pregnancy and health-related barriers (such as physical health symptoms)
  • Partner-related barriers (such as direct interference or demoralisation from a violent partner)
  • Practical barriers (such as transportation, lack of compensation, and childcare)
  • Cultural barriers (such as normalisation of DVA and societal stigma)
  • Perceived systemic barriers (such as mistrust of helping systems and lack of available resources)
There is an ongoing need for providers in health to be aware of what discourages disclosure, in particular, the difficulties facing pregnant women and those from ethnic, gender and other minorities and how having multiple minority status can compound the barriers for people. In Week 2, we’ll begin to address the sorts of behaviours and techniques that can create conditions for safe disclosure.
To give you a flavour, we end this section with a video of professionals and survivors reflecting on Starting the Conversation.

References

Bridges, A. J., Karlsson, M. E., Jackson, J. C., Andrews, A. R., & Villalobos, B. T. (2018). Barriers to and methods of help seeking for domestic violence victimization: A comparison of Hispanic and non-Hispanic white women residing in the United States. Violence Against Women. 24(15), 1810-1829. Web link
Femi-Ajao, O., Kendal, S., & Lovell, K. (2020). A qualitative systematic review of published work on disclosure and help-seeking for domestic violence and abuse among women from ethnic minority populations in the UK. Ethnicity & Health. 25(5), 732-746. Web link
Hasselle, A. J., Howell, K. H., Bottomley, J., Sheddan, H. C., Capers, J. M., & Miller-Graff, L. E. (2019). Barriers to intervention engagement among women experiencing intimate partner violence proximal to pregnancy. Psychology of Violence. 10(3), 290–299. Web link
Huntley, A. L., Potter, L., Williamson, E., Malpass, A., Szilassy, E., & Feder, G. (2019). Help-seeking by male victims of domestic violence and abuse (DVA): A systematic review and qualitative evidence synthesis. BMJ Open. 9, Article e021960. DOI link
Johnson, J., Ferguson, T., & Shirley, J. (2017). What are the barriers to disclosure of intimate partner violence among female victims during a healthcare encounter? Family Nurse Practitioner Theses. 14. Web link
O’Doherty, L. J., Taft, A., McNair, R., & Hegarty, K. (2016). Fractured identity in the context of intimate partner violence: Barriers to and opportunities for seeking help in health settings. Violence Against Women. 22(2), 225-248. DOI link
© Coventry University. CC BY-NC 4.0
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Identifying and Responding to Domestic Violence and Abuse (DVA) in Pregnancy

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