Violence against Women and girls
Violence against women and girls is a hate crime and a violation of their human rights. Sadly, it continues to be a significant issue. Midwives, MSWs and MCAs are in an unparalleled position to identify the signs of abusive behaviour, including coercive control, which the women in their care may be experiencing.
Violence against women and girls is any act of gender-based violence that results in, or is likely to result in, physical, sexual, or mental harm or suffering to women. It includes threats, coercion, or deprivation of liberty, whether occurring in public or in private life.”
Midwives have a duty to support each and every individual who seeks help as a result of violence, treating them with compassion, respect and dignity and referring them on to appropriate support and treatment in the areas of both health and psychological care.
Domestic abuse
Domestic abuse is any incident or pattern of incidents of controlling, coercive, threatening degrading behaviour, violence, or abuse between those aged 16 or over who are or have been intimate partners or family members. One in four women will be a victim of domestic abuse in their lifetime. Domestic abuse can begin or escalate during pregnancy and victims of domestic abuse do not often disclose. You may be the only person that the victim could trust, so use the opportunity to ask general questions because in some circumstances, it may not be possible to ask routine safety questions, consider other ways to explore safety. You can begin by talking about the pregnancy and asking-
- How are you coping?
- Are there any money worries?
- How is your partner coping?
- Is there family or social support you can call upon?
Coercive control
Coercive control is controlling behaviour described as a range of acts designed to make a person subordinate and/or dependent, by isolating them from sources of support. This can involve exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour (Home Office, 2013). This can include:
- Deprivation of liberty, autonomy, and the freedom to act in own interest
- Controlling interactions with family and friends
- Depriving victims of access to support or healthcare or speaking to agencies
- Monitoring and tracking emails, phone calls and conversations
- Controlling the use of social media and technology
- ‘Love bombing’ – over-expression of love
- Financial abuse
- Threats to victims or loved ones; threats to destroy personal possessions
- Sexual coercion and abuse
- Use of violence to ensure compliance.
Coercive controlling behaviour may not result in physical violence or leave visible marks on the victim; the bruises and marks are psychological and mental scars, especially if the behaviour is repeated over time. Coercive control is the springboard for all subsequent abuse and violence against women and girls.
Frequently asked questions
Who is affected/who is at risk of coercive control?
Mainly women, children and vulnerable individuals including pregnant women. Important to note that, although coercive controlling behaviour is predominantly perpetrated against girls and women, boys and men can also fall victim to this behaviour. For example, a pregnant woman could be a coercive or controlling partner. Midwives need to be aware of how this manifest, particularly where there are other children in the family who may display traits of this abuse. Coercive controlling behaviour may not result in physical violence or leave visible marks on the victim; the bruises and marks are psychological and mental scars, especially if the behaviour is repeated over time. Coercive control is the springboard for all subsequent abuse and violence against women and girls.
Is coercive controlling behaviour a crime?
Yes, it is criminalised under the offence of coercive and controlling behaviour – Section 68 of the Domestic Abuse Act (Domestic Abuse Act, 2021), even if they are in an intimate personal relationship, they live together, are members of the same family, or previously have been in an intimate personal relationship.
What should I be looking for/how does a victim of coercive controlling behaviour present?
- Is the woman always accompanied to appointments?
- Does the partner/family member always speak on their behalf, and arrange their appointments even when there are no language barriers?
- Is she often fearful to speak or express an opinion for fear of threats to herself or loved ones (direct or indirect threats)?
- Does she display disempowerment and an inability to make her own decisions?
- Is she dependent on the abuser for financial support, housing, childcare or in some cases immigration status?
- Does she appear to severely lack confidence, low self-esteem or self-worth?
- Does she say/feel she is to blame or make excuses for the abuser?
- Does she appear/tell you she is stressed or has bouts of depression?
- Is there evidence or indication of alcohol or substance misuse?
Contextualising abuse within customs and cultural norms.
Female child victims of coercive control behaviours can experience all the associated threats of coercive control. However, victims of Child marriage and Female genital mutilation are usually coerced and controlled through bribery, and false narratives about the benefits of the abuse. They sometimes experience over-expressive parental/familial love and are sometimes sworn to secrecy in order to protect the family name and honour.
What is gaslighting?
Gaslighting is emotional abuse and a subtle form of psychological abuse and manipulation that can destroy a victim’s confidence, leaving them feeling extremely vulnerable. It can make the victims doubt themselves, their memories, and their judgement, and it has a devastating impact on their mental health and wellbeing. Gaslighting can also be described as a manipulative power game and insidious deceptive behaviour.
How should I respond if someone (a pregnant woman or a colleague) describes/ displays coercive control?
Your response should be the same as for all cases of suspected or actual domestic abuse or violence against women and girls.
Ask direct questions such as:
- Do you have family/friends nearby and are you able to contact them easily?
- Does your partner/family member prevent you from contacting friends/family?
- Do you feel that you are deprived of basic needs, such as food?
- Are you able to leave your house to go to work or college?
- Does your partner or family control your everyday life, such as where you can go, whom you can see and when you can sleep?
- Are you allowed to use your mobile phone as and when you wish?
- Are you allowed to go out to do simple things like shopping?
- Do you choose what you wear or how you dress?
- Does your partner or family monitor the time you spend away from home?
- Does your partner or family spy on you?
- Are you prevented from seeing your midwife or GP on your own?
- Are you forced to have sex with someone who is not your partner?
- Does your partner or family member repeatedly put you down, or tell you that you are worthless?
- Do you feel humiliated, degraded or less of a person?
- Does your partner/family member control your finances?
- Does your partner or family member threaten or intimidate you?
- Do you feel isolated from your family and friends?
- Do you have bruises, burns or bite marks anywhere on your body?
- Does your partner or family monitor your use of the internet or social media?
- Does your partner or family read your texts, emails or letters?
- Are you repeatedly belittled, put down or told you are worthless?
- Are you pressured into having sex or into having sexual contact with someone that Is not your partner?
- Does your partner or family ‘Gaslight’[i] you – telling you that the abuse is your fault, or that you’re overreacting?
Dos
- Listen without judgement
- Reassure her that you believe her, and validate her narrative
- Explain to her that coercive control is abuse, even if she has not experienced physical violence
- Refer her to credible sources of support with her consent/if she wants to be referred
- Document clearly in her notes.
Don’ts
- Don’t blame the woman or minimise her experience
- Don’t encourage her to leave unless she discloses that there is a safety plan in place
- Don’t use your own experience to advise her
- Don’t record your discussion with the woman in her handheld notes.
Being aware
Be vigilant of smart speakers that have ‘listening in’ functions when in clients’ homes.
If you become triggered by any aspect of the discussion, seek help for yourself and consider referring the woman to someone else.
Female genital mutilation
Female genital mutilation (FGM) is a form of gender-based violence that is outlawed in many countries. FGM represents a violation of the human rights of the girls and women who are subjected to this practice, for which there are no medical benefits. FGM can have devastating and long-term physical and psychological consequences for its victims. Worldwide, 230 million girls and women alive today have been subjected to female genital mutilation. Millions of women will including those living in the UK will continue to be affected and need heath and psychological care. Midwives, as the first point of access for many women, have a key role to play in identifying survivors and refering them to FGM Specialist Clinics for health and psychological care and support. Remember FGM is a hidden crime.
In England and Wales, healthcare professionals, teachers and social care workers are required to notify the police within one month, when, in the course of their work, they discover that an act of FGM appears to have been carried out on a girl who is under 18. The term ‘discover’ includes where the victim discloses to the professional that she has been subject to FGM, or where the professional observes the physical signs of FGM. Download the publication, Q and A for Regulated Professionals: Mandatory Reporting of Female genital mutilation.
FGM Specialist Network
This discrete e-platform was created with funding from the Department of Health and NHS England, and aims to provide a virtual forum of support where relevant resources can be accessed, including links to appropriate data on FGM. The e-network also acts as a confidential platform for discussion of issues or specific problems, and for sharing information and best practice in a safe space.
Virginity testing and hymenoplasty
Virginity testing and hymenoplasty are banned in England and Wales under the Health and Care Act 2022 . It is also an offence in all four UK countries for a person to carry out Virginity Testing or Hymenoplasty.
The World Health Organization and the Royal College of Obstetricians and Gynaecologists (RCOG) and Royal College of Midwives’ position is that virginity tests have no scientific merit or clinical indication, as there is no known examination that can establish whether a woman has had vaginal intercourse or is a virgin.
Virginity testing, also referred to as hymen, ‘2-finger’ or vaginal examination, is an inspection of the female genitalia, intended to determine whether a woman or girl has had vaginal sexual intercourse.
Hymenoplasty is a procedure undertaken to reconstruct a hymen. It involves stitching hymenal remnants together at the vaginal opening, or surgically reconstructing a hymen using vaginal tissue. The aim is to ensure that a woman bleeds the next time she has intercourse to give the impression that she has not had not had vaginal intercourse. There is no guarantee that this procedure will fully reform the hymen or cause bleeding when penetration is attempted.
