The presence of other forms of gender-based violence

Whilst covering all aspects of gender-based violence (GBV) is beyond the scope of this course, the implications of different forms of GBV for pregnancy journeys must not be ignored.

Pregnant people may have been subjected to rape or sexual assault by acquaintances, strangers or other family members. The sexual violence may have occurred in the context of war and torture; this is especially pertinent to migrant women who seek maternity care. Thus, forging close connections with local rape crisis will be essential to ensure adequate care of these victims. They may have had exposure to child sexual abuse (CSA) which has important implications for survivors’ experiences of pregnancy, birth and parenting.

An excellent resource, Pregnancy, Birth and Parenthood after Childhood Sexual Abuse,, developed by King’s College London and Wellcome Trust (n.d.), in association with survivors of CSA and The Survivors Trust, can be recommended to survivors of CSA and supporters. It can also be used by professionals keen to understand more about supporting patients or services users affected by childhood abuse.

A person may have needs around female genital mutilation (FGM) and all maternity services should have clear policy and procedures for maximising the quality of care offered to survivors of FGM.

Examining the migration context of pregnant people’s lives is important. Those affected by human trafficking, sexual exploitation, modern-day slavery and sex work are high-risk groups in this setting (Nightingale et al., 2020). These experiences are strongly connected with reproductive coercion and control and perpetrators control access to maternal and child health care. Because of the unique issues that affect these victims, it is essential that maternity services have identified suitable community partners and forged those connections to facilitate smooth referral when needed.

Forced, early or arranged marriage, which may or may not incorporate experiences of international movement, are associated with substantial barriers to providing support. There is frequently language difference and need to involve interpreters, which can affect the flexibility of interventions. There may be a lack of knowledge of one’s rights to safety and protection. Wide-ranging fears include a backlash from the partner and extended family; bringing shame on the family or community; having to return to the country of origin where safety would be further compromised; not understanding the role of law enforcement, health and other institutions (in the host country).

Across the exposures indicated above, individuals accessing maternal and health services have complex psychological, health and social needs. These needs can only be met through a holistic, trauma-informed, multidisciplinary response.

Strong links with community services that can respond to the complexity of GBV needs, as well as those of members of migrant or minority communities, will not only be essential for the service users but will provide reassurance to the midwives and other professionals caring for their pregnancies that the wider needs are receiving attention.

In summary, providers need to be alert to signs of all forms of GBV and to the silencing of pregnant people. A healthcare worker may feel overwhelmed by some of these issues or believe they lack the capability to manage the problem; adopting the LIVES approach and showing the person compassion are powerful tools in this situation. This may be their one chance for change.

References

_{King’s College London & Wellcome Trust. (n.d.). Pregnancy, Birth and Parenthood after Childhood Sexual Abuse. Web link}

_{Nightingale, S., Brady, G., Phimister, D., & O’Doherty, L. (2020). Experiences of pregnancy and maternity care for women exposed to human trafficking and sexual exploitation: a systematic review and qualitative evidence synthesis. Evidence Based Midwifery, 18(4), 6-16.}