Domestic Violence Is It a Taboo - Case Study Example

Domestic Violence – Is It a Taboo? The data collected through interviews and the results obtained could be analysed in accordance with the Philip Burnard (1991) Step by step analysis of qualitative interview data. This Burnard framework will be discussed in the context of the data obtained in the study. For Stage One ‘Notes are made after each interview regarding the topic talked about in that interview’. Considering notes made for the first interview, the main points will have to be considered. The interview took about 30 minutes. The midwife interviewed for the first interview given here considered domestic violence as a societal problem with many people involved with far reaching consequences and involving a wide variety of people. The midwife interviewed suggested that it may be difficult for midwives to discuss issues of domestic violence. It could be highlighted that domestic violence is a crime and this becomes an issue as during pregnancy or any change in life domestic violence could be reported and this could open up other choices for women. The midwife concerned stressed on the importance of using the phrase ‘relationship difficulties’ rather than domestic violence as the basis of further exploration. She pointed out that there is still a lot of discomfort in matters related to domestic violence. The Stage Two of Philip Burnard analysis emphasizes that ‘Transcripts are read through and notes made throughout the reading on general themes within the transcripts’. Thus the common or general themes that become important in these interviews are highlighted and these would suggest the following points – 1. Domestic violence is considered as something that shouldn’t be discussed openly and is taboo or largely something that should be discussed in private and people don’t seem to feel comfortable discussing this issue. 2. Domestic violence can be of several types including economic or financial, emotional or physical and is usually done within a marital relationship and can increase in pregnancy 3. Domestic violence is largely seen as a relationship abuse or difficulty, and some form of bullying at home 4. Experiences of midwives on domestic violence are varied and a lot need to be discussed and new rules will have to be made on issues of domestic violence and abusive relationships. Midwives also need more training and support to tackle domestic violence issues 5. All midwives interviewed strongly felt that it was their duty to know about the domestic violence as it had impact on the pregnant woman and also the child 6. Cultural differences in abuse and domestic violence has also been highlighted 7. Domestic violence has been largely considered a subjective issue with one’s own morals, personal values and beliefs and the society or culture that shapes us 8. Fulfilling requirements of the National Service Framework, Department of Health and other such agencies has been considered as important 9. Pregnancy makes domestic violence more of a sticky issue as a baby is also involved 10. Every midwife interviewed had some experience of domestic violence and felt that it should come out in the open and dealt with rather than kept a taboo topic. The Stage Three of the Burnard Analysis process suggests that ‘Transcripts are read through again and as many heading as necessary are written down to describe all aspects of the content’. This stage emphasizes on the need to separate contents under different headings and in this case these headings would be: Midwives’ role in domestic violence Domestic violence as taboo Domestic violence in different cultures Domestic violence as subjective Domestic violence in pregnancy Different types or aspects of domestic violence Relationship difficulties and domestic violence The health framework and domestic violence Stage Four of the Burnard analysis shows ‘The list of categories is surveyed by the researcher and grouped together under higher –order headings. The aim here is to reduce the numbers of categories by ‘collapsing ‘some of the ones that are similar into broader categories’. The issues under domestic violence issues are thus broadly grouped under a few categories to avoid complications. Stage Five of the Burnard analysis is similar to Stage Four and suggests that ‘The new list of categories and sub-headings is worked through and the repetitious or very similar headings are removed to produce a final list’. This shows that a list of a few categories or topics for discussion is finally chosen and this would include all the issues that are drawn out in the interviews. The categories drawn out are following: 1. Domestic violence and culture (including taboo, subjectivity) 2. Domestic violence and pregnancy (including relationships issues, different aspects) 3. Domestic violence and healthcare (including midwives’ role, health department initiatives) For the Stage Six, two colleagues working within healthcare system, are invited to generate category systems, independently and without seeing the researcher’s list. They also indicate three or four categories – domestic violence and culture, domestic violence as taboo, domestic violence in pregnancy and relationship difficulties, and domestic violence and healthcare/midwifery. So generally the categories decided here can be considered as having high validity. In Stage Seven as given by Burnard, ‘Transcripts are re-read alongside the finally agreed list of categories and sub-headings to establish the degree to which the categories cover all aspects of the interviews’. This process is also followed when all subheadings show that every aspect of the interviews has been covered. Stage Eight suggests that Categories used in the interviews could be colour coded such as instances of Domestic violence and culture could be marked in green Domestic violence and pregnancy could be highlighted in red Domestic violence and healthcare can be coded in blue The Stage Nine of the Philip Burnard analysis indicates that, ‘Each coded section of the interviews is cut out of the transcript and all items of each code are collected together’. Thus all items in the interviews are categorised under the three headings considered without altering the contexts in which these statements were made. In the next Stage Ten, ‘The cut out sections are pasted onto sheets, headed up with the appropriate headings and sub-headings’. This shows that from the interviews taken, the main points discussed are categorized under the headings delineated here. In the Stage Eleven of the analysis, ‘All of the sections are filed together for direct reference when writing up the findings’. So findings from the interviews are written separately but the sections categorized have direct reference to the facts collected in the interviewing process. Stage Twelve is about the writing up process and during the writing process the researcher tries to stay close to the context, the meaning and the actual process of the interviews. The last Stage Thirteen is marked by the fact that the researcher might just link up the findings with the literature and Burnard suggests that ‘The researcher must decide whether or not to link the data examples and the commentary to the literature’. This is the final process in which the interview data may or may not be in accordance with the literature review. Here I will categorize what has been spoken in the interviews in accordance with the three categories chosen. Transcript Categories Interview I I think it is a very difficult subject because it covers everybody. it is a societal problem. It is not just restricted to one particular group and that means we have to have a variety of approaches to approach a wide variety of people. I do think they have a role in discussing domestic violence but I think it is very difficult for midwives. because it may affect them personally, they may find It…because the way that society treats it…. there is a taboo and it is a stigma to admit domestic violence…. because it doesn’t fit in with our English stereotype of what the home situation should be like. I think it’s a big opportunity for health Promotion I think…as pregnant women, we have a sort of captive audience really, and its as a great opportunity because they see pregnancy as a time to often make a lot of new start about all sorts of things like smoking, and healthy eating, exercise, all sorts of things a lot of relationships change during pregnancy and a lot of women experience difficulties during this time, and things like that and then lead on to do you feel safe, have you ever felt unsafe at home. It’s really the issue of training for midwifes. Because I feel I have read quite a lot about domestic violence and I feel that I have done some study days and I have had some training on how to ask the questions, and I have explored the issue quite a lot, and I still feel very, very uncomfortable. Interview II I think in our culture generally is probably something that had been seen as a personal matter and I think certainly if I had seen any issues on television about domestic violence it was perhaps that the people’s attitude is that it is decoder as domestic and that it would only be anything involving them I mean we have an important role in helping the victim to to come forward perhaps because we have a very close relationship with the family I actually was the lead on domestic violence and I was part of the South Cambs Forum group for a little while until. with another team and then it was decided that perhaps it might be better one midwife took the lead overall in the whole community. So I am not part of that anymore but that actually helped my knowledge of domestic violence meet with professionals and looking how you actually classify domestic violence I’ve hard another case where a lady did disclose domestic violence to me She miscarried I mean sometimes as hospital midwives that’s all we can do start something in process. And I did tell the lady when she was under my care that I was going to start that process ……Well we have a statutory duty of care We have a role to protect the babies and there is lots of evidence that children who grow up in those relationships are damaged. Whether there are hit or not. It doesn’t matter, there‘re seeing violence they mentally don’t thrive and those children need to be protected. Because it is such a personal question and women …..I used to feel would be perhaps quite offended by being asked. But I now realise that if you put it in a certain way to women they actually don’t mind. Obviously as a team leader we do talk about it and obviously I’ve been running public health issues and midwives in my team have often said that they find it hard to ask. And we brought it up in some team meetings. And information shared between midwives is important and how we can perhaps ask. and some midwives have said oh , I don’t ask I find it too difficult and certainly the last two meetings we brought it up again and said we could be saving women’s lives by asking. Sometimes domestic violence starts in pregnancy so if you know or you’ve got a friend that needs any help at all the number is here. And then what I try to do is later on in pregnancy when she comes to clinic, she is not with him because we have a tick box Inside I can see if I have asked before if I hadn’t asked her then I would use the opportunity to ask her. Interview III Systematically I’ve been out in the community now for about 9/10 months, which is relatively short time since I’ve been out. It really hit me in the face with some of the women I’ve seen and Its sad and its scary to think about what’s going on out there. He was beating her and she was worried about the baby and that she tried to live and he stood at the door and smacked her. I think we do play part of it, I don’t know how much. Like I said it’s long term until the baby is born. Unless the woman discloses to us in that time we build a relationship and then we are out of it after baby is born. The woman knows she does have a point of contact, and that we are going to see her at different times in her pregnancy, I mean now we with NICE guidelines obviously with second babies we don’t have to see the mums so often during the first half of pregnancy we do not see her as much during the second half Primi- ups, first time mums we see them quite a lot. I bring in research saying domestic violence increases during pregnancy. And opening the subject to them and see how they react and things so they are aware that you’re asking. Sometimes you again bring it up later on during pregnancy. If they accept in the community perhaps that would be cause they would get away from their partner. It’s best if he is at work if they are looking upset or worried bring it up again Statistically domestic violence affects about 1:3 during pregnancy then if I do 3 bookings then 1 of them is affected by domestic violence, how do you pick that out. That for sure shows that domestic violence is really, really bad. It is emotive ….it is emotive. It is not just the woman. It’s the child as well while she is in that relationship you know what’s happened you know that the child is going to be in danger and you stick with it. Midwives need training more and more support with it I think. I have had training, I mean half day training session on it to taught by the people who talk about domestic violence, do research on domestic violence Midwives on the ward have been good when they come to contact with it but they go and community midwives are expected to deal with it , its just that women need support and the midwives do as well. Interview IV As usual negatively by women, so I think it is quite open, I don’t think , what I notice here , where women are getting raped, and beaten up and all they say is that ‘it is just a domestic.’ I think in my country they say it is actually a bad thing. And they is lots of women police who would be involved in its sexual, heterosexual offence as well as domestic offence. So I think in our country, we do recognise a lot more than they do here and have done for quite a long time. And they are prosecuted, the partners are prosecuted and the women are offered safe refuge. I don’t understand the actual course why it happens more in pregnancy. So the women come in late pregnancy others come in earlier in pregnancy with bleeds , others have had some sort of assault to them. So it’s a whole difference of culture, people accept more here while in Australia we would stand up about it. Yes, I think it is a midwives’ role. A GP as well as health visitors’ role. I think anybody who is working with those women through her pregnancy or pre pregnancy and after pregnancy. I think it’s a role of everybody who is involved with the care, so anybody in healthcare role. I think I will have to ask women differently in this country because they might think I am too confrontational otherwise , while in Australia , they are used to us asking direct questions , so I would try and speak to women , ask her ;like these questions :I am going to ask now may make you feel uncomfortable but we need to ask because ….I would give the a reasons why , because we do know for a fact that women are at more risk or domestic violence starting when they are pregnant. So I think if I explained why I ask the questions, and then ask the questions, it would be easier rather than just coming up with them. In Australia people there are a lot more open and there is more publicity about there it. Sometimes that they disclose at first visit .I think community midwives have a big role to play in this country. But off course not everyone seems the concerns of community midwives here I think one to one care which is what the Royal College of Midwives and Patricia Hewitt are advocating I think that would improve outcomes for women in relation to domestic violence In our culture you’d say that is a form of control and a form of abuse isn’t. But they’ve grown up with that and if they have a daughter they would to send their daughter home because that is their culture and we have to respect their culture. Interview V I have a role and responsibility of meeting their training needs and the needs of the client group that their looking after. So would be involved very much in the planning of that the sourcing of funds to finance it etcetera. From another angle would be involved into the interagency working with health visiting with leads for children Services around the country looking at national drivers such as National Framework for Children and the new guidelines such a Working together to look to see how we can feed to a national programme for promoting welfare on these issues and another part of this also is the reporting so there are certain things that we are asked to report on as far as training as far as incidents etcetera. I think that’s hard question because I think one has to separate your own professional feed into that, then your own personal values and morals and beliefs, which shape all of us really so I think its more of a statement that domestic violence has become ….has surfaced it hasn’t it? And issues relating to domestic violence have probably being there for a long, long time, it has become socially unacceptable for domestic violence to be ignored, the welfare of our children in our society has become much more high profile. And so one day people wouldn’t have thought of or spoke of domestic violence because they wouldn’t have accepted it, it has now become ……an issue that we expect to ask people about and we expect to challenge and to intervene. We have and are still providing training for the community midwives and the antenatal staff and we are training them on how to ask the question and we are about to start an audit, a re-audit on how it is documented and how people ask the question. We are going to feed in the future about complying or working towards fulfilling the requirements of (NSF) and how as maternity service to fit in with other agencies. So looking at integrating working because I believe we need to be working in a slightly more organised manner Interview VI It is not something that is really openly discussed in our culture, because it is really frowned upon. Women even themselves don’t like to admitting to it even being subject to domestic violence you know it takes a ….a lot to get women to admit that there has been domestic violence. I suppose it is so because it is a taboo subject, it is something that people don’t like to think as actually going on you know and maybe they feel ashamed maybe they feel particularly the women that they are somehow to blame for it I say this is the helpline number if you have any concerns regarding domestic violence this is the number or she can speak to my self or other midwives would liaise with you. And because I say I am asking everybody I am not discriminating in any way. I wish I hope that’s how it comes across. This is a very difficult subject though I know that the new guidelines require us to ask about 3 times during pregnancy and that is going to be more difficult you know. I am just thinking whose role it would be otherwise a….! For us to do it without involving another agency you know……. I don’t think its doctors role and it’s just something that I think we’ve got to take on but I do think we need more training definitely. I think we need much more support and training. We don’t have specific counselling skills. Interview VII The other thing was at booking it is asked as a question very generally very broad question about domestic violence and the question, were the kind of approach to it that as midwives as part of our roles it is important that you and your baby are safe. If you feel that there are issues of domestic violence within your home or within your community we are here to offer you support and should you need any support you know you can come to us as a very general broad, kind of approach to all women at the booking appointment so that feel that they want to divulge anything at any stage in their pregnancy they have an opportunity to do so. I think it is a midwives role to support these women and the baby in pregnancy. For part of our role as midwives is to be an advocate for the woman. She is you know centered care. I think 1in 4 pregnancies is just a significant number………. it is important issue it is more prevalent in pregnancy and we are here to support and empower women to access those needs and their subject to abuse. We have a duty of care to give to the woman and to her baby that if she divulges the information we’ve got the duty of care to make sure that that information is provided and passed on to the right people that can then help her. They taught us to make sure that the woman and the babies are focus the centre of care. Interview VIII I think it is an issue that is publicly voiced by women .An issue that only recently when the Law had changed to make public more aware of it , to make it able to prosecute and as it being more freeing for the women to be able to do so So.........also as we have been in a multicultural society other cultures it may be acceptable behaviour the women don't voice it because there are a minority in our country and also it's' socially acceptable in their own cultures. People do come to the ward do have issues and violent partners , we had a lady recently who came who's had 3 episodes of violence in this pregnancy and a total of 13 occasions where she is gone to A and E (Emergency and Accident ). I think that it’s maybe not seem to be correct for midwives to extend their role in that we are looking in that respect, but if we consider that we are looking after women and children in a family environment we stand next to the women we must be every advocate in every aspect and if that means she is in a violent relationship we therefore should be her voice as well. So I think we do tend to sweep it under the carpet and some people bring their own personal, social and cultural beliefs within it its more acceptable for them Domestic violence and culture Domestic violence and healthcare Domestic violence and culture Domestic violence and healthcare Domestic violence and pregnancy Domestic violence and pregnancy Domestic violence and healthcare Domestic violence and culture Domestic violence and healthcare Domestic violence and healthcare Domestic violence and pregnancy Domestic violence and healthcare Domestic violence and healthcare Domestic violence and culture Domestic violence and healthcare Domestic violence and pregnancy Domestic violence and culture Domestic violence and pregnancy Domestic violence and healthcare Domestic violence and pregnancy Domestic violence and pregnancy Domestic violence and culture Domestic violence and pregnancy Domestic violence and culture Domestic violence and healthcare Domestic violence and healthcare Domestic violence and culture Domestic violence and culture Domestic violence and pregnancy Domestic violence and pregnancy Domestic violence and culture Domestic violence and healthcare Domestic violence and culture Domestic violence and healthcare Domestic violence and healthcare Domestic violence and culture Domestic violence and healthcare Domestic violence and culture Domestic violence and healthcare Domestic violence and healthcare Domestic violence and culture Domestic violence and culture Domestic violence and healthcare Domestic violence and healthcare Domestic violence and culture Domestic violence and healthcare Domestic violence and pregnancy Domestic violence and healthcare Domestic violence and culture Domestic violence and culture Domestic violence and pregnancy Domestic violence and healthcare Domestic violence and culture This discussion shows that using the Burnard framework of analysis, this study could categorise the findings in three groups of domestic violence and culture, domestic violence and pregnancy and domestic violence and broad issues of healthcare. All these three headings would encompass all the issues that seem to have come out during the interview process and suggests that domestic violence should be discussed within these three perspectives to provide a comprehensive picture of the findings both in this study and in other studies. All other studies discussed in the literature review also bring out similar issues of domestic violence in pregnancy and how these issues are tackled in healthcare and how the notion is a taboo among some cultures and may not be discussed at all. Considering the issues raised by the midwives the three different aspects of domestic violence have been highlighted here and can thus this study can be said to present domestic violence in a comprehensive manner. CONCLUSION There are several issues that could be raised in the concluding remarks and this would deal with the limitations of the study as well the findings from the literature review and how these findings tally or don’t tally with the findings from the research process itself. The findings of the study show that domestic violence could be studied from three aspects of culture, pregnancy and healthcare and this is the comprehensive and conclusive statement of this research process. While the repositioning of domestic violence is being presented within an obviously rational progressive framework, there are difficulties that are experienced by midwives in this venture. The difficulties experienced were to talk about the subject itself. The subject of domestic violence is not an easy one. From my general observations in terms of the interviews, midwives were not at easy to discuss the subject. They were not fluent in their speech because Midwives struggled to explore the subject. During the interviews I could observe that this was indeed not an easy subject. The development of an official and professional obligation for health professionals to intervene in what was previously constructed as a social issue and thus external to their interventions, surely presents certain challenges. What had gone on for centuries behind closed doors was being challenged. The recent change in the social construction of domestic violence appears to signify an apparent blurring of boundaries with the integration of complex ‘social problem’ into the obligations and responsibilities of health care providers and practitioners. Despite the difficult to discuss the subject, midwives were ready and willing to break a close friendship with women to protect them and their unborn baby. The repositioning of domestic violence routine enquiry has effected in extended roles of midwives this change in obligation is viewed in wider context of extending role of primary health care to include health promotion and ill - health prevention. It squeezes it into a system already coping with massive extension of its previous role and forces domestic violence to compete with other health and social issues for priority. In health care settings where routine enquiry or screening for domestic violence has been deemed a priority the process of enquiring about and documenting domestic violence has apparently necessitated a renegotiating of the traditional subject positions within the health care interaction. Here the traditional relational positions established between patient and practitioner has been disrupted. This approach yields limited results because providers themselves generally share the same biases, prejudices and fears regarding abuse as the society at large (Leye et al 1999). As programmes have gained experience, it has become clear that providers must examine their own attitudes and beliefs about gender, power abuse and sexuality before they can develop new professional knowledge and skills about dealing with victims. Mezey et al (2003) further explains that at the end of the training most midwives remained anxious and sceptical about screening women for domestic violence. If health professionals fail to screen for domestic violence, then in essence they are condoning the practice. Recommendations to healthcare agencies and frameworks to facilitate better understanding of domestic violence would be to shed prejudice and consider domestic violence as an open topic rather than a taboo that cannot be discussed. Proving more support and training to midwives is also an important lesson learnt from these interviews. More emphasis on healthcare directives aimed at controlling or preventing domestic violence could be suggested. Apart from help lines and support of midwives, the victims themselves should be encouraged to discuss domestic violence openly and the subject should no longer remain a cultural block or taboo. Moving beyond culture and healthcare issues, domestic violence largely increases during pregnancy and more research needs to be done to understand why women during this stage are more vulnerable and how the instances of violence from spouses during pregnancy could be controlled or reduced. This research brought pout several issues in the open, the cultural differences in domestic violence and also in attitudes towards talking about domestic violence, the need for midwives training and support in tackling domestic violence and the need to have clear healthcare directives to save and support women against domestic violence, especially during pregnancy. References Burnard P (1991) Nurse Education today. 3rd of July 11 461-466 Read More