Daphne

Summary of the Finnish studies 2000-2003

INTIMATE PARTNER VIOLENCE AGAINST WOMEN AND ITS SCREENING AT THE MATERNITY AND CHILD HEALTH CLINIC

Sirkka Perttu
Project Manager, MSc (Health Care), RN
University of Helsinki, Palmenia Centre for Continuing Education
Lummetie 2b A, FI- 01300 Vantaa, Finland
Tel: +358 9 191 29069, Mobile: +358 40 508 3656
Fax: +358 9 191 29000
sirkka.perttu@helsinki.fi

Published: Reports of the Ministry of Social Affairs and Health. Helsinki.2004, Finland.

The STAKES Programme for the Prevention of Prostitution and Violence against Women (1998-2002), funded by the Ministry of Social Affairs and Health, included a research project to identify a suitable method for identifying, addressing and discussing partner violence experienced by women. The project was carried out during the period 2000-2002 and included two surveys. Midwives and public-health nurses were given training and practical guidance in detecting and discussing partner violence. It was intended that the set of screening questions developed in the project would be introduced at maternity and child health clinics throughout the country as a pilot result. The idea for the project was based on the results of a Statistics Finland questionnaire survey of a random sample (Heiskanen & Piispa 1998). The survey revealed that young women in a relationship and women with children under seven years of age were more often the subjects of partner violence than other age groups.

The first study was carried out in 2000 at prenatal and mother-child clinics located in Vantaa and Porvoo in Southern Finland and in the Palokka health care federation of municipalities (Jyväskylä mlk, Petäjävesi, Toivakka and Uurainen) in Central Finland. The study design involved structured questionnaire interviews conducted by public-health nurses and midwives among pregnant women and mothers with infants. At the time of the interview, their youngest child was one year old or younger. The interviews were always conducted with no other persons present, in order to ensure the safety of the women and children involved.

In Vantaa, material was compiled between 1 May and 31 December 2000, while in Porvoo and the Palokka health care federation the period was between 1 September and 31 December 2000. To reinforce trust and security among women, the interviewer was always the client’s personal public-health nurse or midwife, whom the client had visited at least once before at the clinic. For the benefit of the mothers’ and children’s safety, the interviews were conducted with the mother present only.

The study aimed to examine the prevalence and characteristics of violence in relationships experienced by women who were prenatal and mother-child clinic clients during pregnancy and when their children were small. Another goal was to support public-health nurses and midwives in their efforts to recognise abuse victims as well as to encourage them to bring up the subject of violence in relationships. In the study, spousal abuse was defined as threats of violence and acts of physical and sexual violence. An 8-section set of questions was asked concerning abuse. The interviews also investigated male controlling behaviour, which meant behaviours to overpower, isolate and intimidate women. Controlling tendencies were asked through a 14-part set of questions.

A total of 1,020 women were interviewed in the first survey in 2000. Each woman was interviewed once during the material collecting period. Five women declined to participate in the interview. Over half (56 per cent) of the interviewees were prenatal clinic clients and the remainder (44per cent) were mother-child clinic clients. Their mean age was 29.5 years. Of them, 57.4 per cent were married, over a third (38.1 per cent) were in common-law relationships, while 3.5 per cent were single. Most women (73.4 per cent) had children (totalling 898; 79.6 per cent were aged 0–6 years). A quarter (26.6 per cent, n=270) were expecting their first baby. Over half (68.3per cent) were on maternity or child care leave.

In this study, "victim" was defined as a woman who had experienced in her current relationship at least one of the forms of partner violence as specified in the questionnaire. Of the interviewees, 17.9 per cent had experienced physical or sexual violence or threats in their present relationship (17 per cent of prenatal clinic clients and 19 per cent of mother-child clinic clients). Physical abuse usually involved constraints on women’s mobility, manhandling, pushing, slapping and violent threats. Young women were a risk group as potential victims. A quarter (25.0 per cent) of 18–24-year-old women had at some point been victims of physical or sexual abuse or threats by their present partner. Of the women expecting their first baby, 15.6 per cent had experienced violence in their current relationship.

Over a quarter (26.8 per cent) of men had manifested at least one of the form of controlling behaviour as specified in the questionnaire. This behaviour was usually associated with physical or sexual abuse or threats. Of the men having resorted to violence, 74.9 per cent had also acted in a manner degrading or intimidating the partner or tried to isolate her. Name-calling, intimidation and jealousy were common. Also among nonviolent men, 15.7 per cent manifested some tendency to control their partner.

Male controlling behaviour increased the risk of physical and sexual violence or threats as compared to women whose partners did not have such tendencies. Intimidation increased the risk over tenfold (risk ratio 10.7; p-value 0.0001), overpowering behaviour increased the risk sevenfold (risk ratio 7.36; p-value 0.0001) while tendencies to isolate more than doubled the risk (risk ratio 2.59; p-value 0.0001).

The women who had faced in their present relationship at least one form of partner violence as specified in the questionnaire were requested to answer further questions. Of them, almost a hundred (n=99, 54 per cent) women were given more detailed interviews. Participation in that further interview was voluntary. Those having declined a more detailed interview explained that the abuse was not serious but a passing phase, which would not recur or violence was just some quarrel or conflict situation where the partner had lost his temper and acted violently.

The women given more detailed interviews had a relatively short history of spousal abuse, a fifth (21.4 per cent) had faced violence for less than a year and about half (41.8 per cent) had experienced violence for less than five years. Most women in this group (77.3 per cent) had been victimised during pregnancy as well and 17 per cent reported that abuse had started during pregnancy. This abuse (during pregnancy) usually involved physical violence. If the violent behaviour had begun during pregnancy, the women explained it by the spouse’s jealousy or drunkenness. Another explanation given was the woman’s own behaviour, such as “I didn’t pay enough attention to him” or “He was ignored”. If abuse had started before pregnancy, male violent behaviour usually continued during it as well.

Over half (66per cent) of the participants in the further interview (n=99) mentioned a symptom or disadvantage caused by the violence. Abuse had usually caused the women anxiety or irritation (36.7per cent), depression (31.6 per cent), fear (29.9 per cent) and anger (26.5 per cent). A third believed that their children had seen or heard violent clashes in the family. Most of them reported that violence had not affected their children, while a fifth considered it to have caused distress: the children were scared, timid, aggressive or had difficulty adjusting to day-care centre or school.

Of the participants in the further interview (n=99) , 17.4 per cent had sought help from a health centre or doctor, 11.2 per cent from the police and 11.2 per cent from the social welfare authorities. All in all, a third (34 per cent) had sought help from the authorities and 15 per cent of violent men had done the same. Of the women, 70.4 per cent had told a close person, most often their mother, about their situation, while a third (29.6 per cent) had not informed anybody about the violence.

All the interviewees (n=1020) were also asked how they felt about answering these questions at prenatal and mother-child clinics. In general, the participants had a positive attitude towards questions about violence in intimate relationships. They considered it important that workers at prenatal and mother-child clinics took the initiative and asked about possible abuse. In addition, public-health nurses and midwives regarded the issue as significant. Violence in the family jeopardises the child’s development and may undermine parenthood. Consequently, the detection of such violence is a key aspect of the work done by the clinics.

In the second survey in 2002, the number of women interviewed was 510. The aim of this survey was to get more information on violence during pregnancy and after the delivery when the child is under one year old. All the interviewed women were asked about violence during pregnancy and when their children were small; the youngest child being under one-year-old. The second research was conducted in the same prenatal and mother-child clinics as the first one but the interviewees were different.

Eleven per cent (n=55) of these women had been victims of physical or sexual violence or threat of violence at some point during their pregnancy. Seven per cent (n=35) of them said to have experienced violence during another pregnancy, three per cent (n=15) during the current pregnancy and one per cent (n=5) both during previous and current pregnancies. The majority (76 per cent) of assaulters were current husbands or common-law husbands. A fifth of assaulters were ex-husbands or ex common-law husbands and four per cent were current or ex-boyfriends. A third of women had experienced violence during their pregnancy which was directed towards head, a third had experienced violence towards upper body and arms and a tenth of women had experienced violence towards their belly, another tenth towards the whole body and six per cent towards lower body and legs.

Eleven per cent of women (n=43) had been a victim of violence at some stage during their infant’s first year. In 72 per cent of cases the assaulter was the present husband or common-law husband and in more than a quarter of cases assaulters were ex-husbands and ex-common-law husbands. A third of the women told that the violence was directed towards the head area, a quarter to upper body and arms and a fifth to the whole body. The violence experienced by these women during pregnancy and during their infant’s first year was usually physical violence.

In the second survey 18 % of the women (n=510) had got some physical injuries, most of injuries were black marks and bruises. Women reported as impact of violence during pregnancy: miscarriage or threat of miscarriage 2,2 %, premature delivery of the threat of that 0,2 %, problems with the delivery or fear of delivery 0,2 %. 1 % of the women had started to use sleeping pills or other medication because of the violence and 1 % of the women victims had started to drink more alcohol during pregnancy.

On the basis of the research results and project experience, and with reference to the Abuse Assessment Screen (AAS) developed in the United States, a partner violence screening questionnaire was drawn up in autumn 2002. Guidelines were also drafted for detecting partner violence and discussing the subject, and for contacting the authorities.

A number of conclusions were drawn from the project’s two surveys. Firstly, it is important to identify partner violence risk groups at the maternity and child welfare clinics and to develop various support measures especially for young expectant mothers and for mothers of infants, and to provide them with information on partner violence and its effects.

Secondly, it is essential that the women have the opportunity to discuss their own experiences of the relationship. Discussion of male control-related behaviour allows the opportunity to detect partner violence and to discuss it at an early stage.

Thirdly, questioning about partner violence should be made a regular part of the work of maternity and child welfare clinics and should be included in their monitoring programmes. All women should be asked about partner violence using a standardized questionnaire form.

The Ministry of Social Affairs and Health in Finland recommends that maternity clinics ask about partner violence at least once during the first two trimesters of the pregnancy, and child health clinics no later than at the child’s six-month examination and subsequently at the child’s annual examinations by using the partner violence screening questionnaire developed in the research project.