Domestic violence (DV), defined in this paper as 'acts of violence that occur between people who have, or have had, an intimate relationship,' is a leading preventable contributor to death, disability and illness for women of reproductive age (15 to 44 years).
Pregnancy is as an important time for screening for DV. It presents an opportunity to identify DV, as many women will have contact with health-care services and professionals on a regular basis during the antenatal period.
Estimates indicate that around 5% of women (aged 18 and over) experience violence during pregnancy from their previous or current partner. The risk of DV has been found to be higher in pregnant women and in the period following birth, posing serious health risks to both pregnant women and their babies. There is known under-reporting of DV due to its complex and sensitive nature (including patients' reluctance to report) and under- identification by health workers.
Data on DV in pregnancy in Australia are currently poor and inconsistent across jurisdictions, with variations in what is collected and in methods of collection. An opportunity exists to collect higher quality data through the National Perinatal Data Collection (NPDC), which includes data about every woman who gives birth in Australia. These data are important for population level surveillance and for clinical care and outcomes; they can also contribute to researching the association of DV with other maternal and perinatal outcomes. Seeking to improve national data on DV in pregnancy is also timely, in light of the Prime Minister's Advisory Panel on Violence against Women, established in 2015.
The AIHW's National Maternity Data Development Project (NMDDP) aims to enhance the collection of nationally consistent data in the NPDC. As part of the NMDDP, this paper was developed as a guide to the issues that need to be considered in deciding whether and how to collect DV data in the NPDC. The data development process included a literature review, investigation of current approaches in Australia, a discussion paper, a national workshop, and consultation with a working party.
It was found that screening for DV-a process to identify victims of violence or abuse in order to offer interventions that can lead to beneficial outcomes-in the antenatal period already occurs in most Australian jurisdictions. This may be structured or unstructured, and the results of screening are not necessarily recorded in data systems.
Potential approaches to obtaining national data in the NPDC include:
- develop and implement a minimum set of standard questions, based on the questions currently in use across jurisdictions
- seek to implement a nationally consistent screening approach by encouraging all midwives to use a recommended validated DV screening tool
- maintain a flexible screening approach consistent with the National Antenatal Care Guidelines that enables screening in different ways for different populations.
It is recommended that before national data standards are developed for the NPDC, pilot testing and further consultation be conducted to determine the best way to achieve high-quality data, while gaining acceptability among clinicians and mothers.