Talking about intimate partner violence in multi-cultural antenatal care: a qualitative study of pregnant women’s advice for better communication in South-East Norway

Abstract

BackgroundIntimate partner violence (IPV) against women constitutes a major public health problem. Antenatal care is considered a window of opportunity to disclose and to communicate about IPV. However, little is known about how women from different ethnic backgrounds wish to communicate about their experiences with IPV during pregnancy in antenatal care. The aim of the present study was to explore how women from different ethnic backgrounds experienced IPV and what their recommendations were about how midwives should communicate about IPV in antenatal care.MethodsQualitative individual interviews with eight women who had experienced IPV during pregnancy were conducted and analysed using thematic analysis. The participants were purposively recruited from three crisis shelters in South-East Norway.ResultsThe participants either had immigrant backgrounds (n = 5) or were ethnic Norwegians (n = 3). All participants received antenatal care by a midwife. Although none of the participants were asked about IPV during antenatal care, they wished to talk about their experiences. Most participants felt that it would be important for the midwife to make them aware that they were victims of violence. Participants offered different suggestions on how and when midwives should talk about IPV. Facilitators to talk about IPV with the midwife were a good relationship with and the trustworthiness of the midwife, information about possible negative health outcomes for the newborn owing to IPV and knowing that the midwife could help them. The main barriers to talk about IPV with the midwife were that the participants were accompanied by their husbands during antenatal care, fear that the Child Welfare Service would take away their children after disclosure and cultural acceptance of violence. Participants with immigrant backgrounds also experienced difficulties in talking about IPV owing to their limited language skills. They thought that professionally trained interpreters with experience of IPV could overcome this barrier.ConclusionEven though none of the participants were asked about IPV in antenatal care, they offered different suggestions on how and when midwives should talk about IPV. Participants irrespective of their ethnical backgrounds perceived antenatal care as a key area to facilitate disclosure of IPV. Midwives’ communication and strategic skills to address IPV are crucial for help-seeking women. Training midwives’ skills in culture-sensitive communication might help to overcome cultural barriers to talk about violence.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1308-6) contains supplementary material, which is available to authorized users.

‘We don’t see because we don’t ask’: Qualitative exploration of service users’ and health professionals’ views regarding a psychosocial intervention targeting pregnant women experiencing domestic and family violence

“…Women further expressed a better ability to adopt safety strategies, seek social support and cope with mental consequences of DFV, similar to another study [22]. While participants acknowledged the use of an individualised approach in relation to a woman's circumstances and varying informational needs [30] and reported its beneficial effects, the wider literature showed the short-term effects of such counselling intervention [14,31]. Hence, studies with longer follow-up are recommended to conclude about the sustained effects of the counselling-based intervention.…”

Towards understanding the Nordic paradox: A review of qualitative interview studies on intimate partner violence against women (IPVAW) in Sweden

“…These include women's experiences of violence (Almqvist & Broberg, ; Bergman, ; Bruno, ; Enander, , , , ; Eriksson & Ulmestig, ; Flinck, Paavilainen, & Astedt‐Kurki, ; Häggblom & Möller, ; Hydén, , , ; Jarnkvist & Brännström, ; Römpötti, ; Scheffer Lindgren & Renck, ), of violence during pregnancy (Edin, Dahlgren, Lalos, & Högberg, ; Edin & Högberg, ; Edin & Nilsson, ; Engnes & Lundgren, ; Finnbogadóttir, Dykes, & Wann‐Hansson, ) and motherhood (Almqvist & Broberg, ; Georgsson et al, ), and of leaving violent relationships (Enander, ; Enander & Holmberg, ; Häggblom & Möller, ; Holmberg & Enander, ; Hydén, , ; Hydén, ; Jarnkvist, ; Münger, ; Scheffer Lindgren & Renck, ). Studies have investigated women's experiences with the judicial (Agevall, ; BRÅ, ; Brännvall, ; Bruno, ; Ekström, ; Green, ; Jarnkvist, ; Jarnkvist & Brännström, ), social service (Eriksson & Ulmestig, ; Jarnkvist & Brännström, ; Nikupeteri, ; Ulmestig & Panican, ) and health care systems (Garnweidner‐Holme, Lukasse, Solheim, & Henriksen, ; Gillå et al, ; Häggblom & Möller, ; Leppakoski, Paavilainen, & Astedt‐Kurki, ; Mørk, Andersen, & Taket, ; Örmon & Hörberg, ; Örmon, Torstensson Levander, Sunnqvist, & Bahtsevani, ; Pratt‐Eriksson, Bergbom, & Lyckhage, ). The impact of IPVAW on the health (Örmon, Torstensson Levander, Sunnqvist, & Bahtsevani, ; Scheffer Lindgren & Renck, ), economy (Eriksson & Ulm...…”

“…Simultaneously, studies emphasize that while immigrated women form a heterogeneous group, factors related to migration, economic insecurity, social isolation, and discrimination may increase vulnerability to IPVAW (Garnweidner‐Holme et al, ; Ulmestig & Eriksson, ). Differences between gender structures in Sweden and countries of origin may create friction (Andersson & Lundberg, ; Fernbrant et al, ).…”

“…Differences between gender structures in Sweden and countries of origin may create friction (Andersson & Lundberg, ; Fernbrant et al, ). Immigrated women may be met with racism (Pratt‐Eriksson et al, ) or have needs that the Nordic welfare institutions are not organized to meet (Garnweidner‐Holme et al, ; Helmersson, ; Olsson & Bergman, ), while the perceptions among professionals that violence is accepted in some cultures may also lead to nonintervention (Holmberg & Bender, ; Keskinen, ; Sundborg et al, ). Keskinen () emphasizes the dangers both of culturalizing explanations of violence as resulting from static foreign cultures, and of universalizing assumptions that dynamics of gendered violence are the same everywhere.…”

“…A process of othering is seen in many women's noted resistance to being defined as IPVAW victims (e.g., Agevall, 2012;Engnes & Lundgren, 2013;Garnweidner-Holme et al, 2017;Gottzén & Korkmaz, 2013;Häggblom & Möller, 2007;Hydén, 1992). Particularly, resistance is observed among women who are highly educated or self-perceived as strong (Jarnkvist, 2015;Jarnkvist & Brännström, 2016b;Scheffer Lindgren & Renck, 2008b).…”