Need for psychological abuse to be identified in obstetric care

Women’s health experts are calling for compulsory training of obstetric health practitioners to ensure they can recognise the signs of coercive control in female patients.

The call comes as rates of domestic violence rise amid the COVID-19 pandemic.

It also follows research from the University of South Australia and the University Melbourne that identifies the vital role that health professionals play in a woman’s decision to stay or leave an abusive relationship.

The research explored women’s experiences of coercive control during pregnancy, birth and post-delivery.

It showed that obstetric health practitioners – doctors, midwives, nurses and social workers – were in a unique position to offer empathy, support and information.

UniSA researcher, Dr Fiona Buchanan, says a greater understanding of coercive control and domestic violence is essential for these health practitioners.

“Coercive control is a form of psychological entrapment, achieved through behaviour that victimises women through acts, words and gestures designed to isolate, frighten and demean them,” Dr Buchanan said.

“Disturbingly, women with children are three times more likely to experience domestic violence than women without children and, perhaps worse, is that the frequency and severity of domestic violence is twice as high for women during pregnancy.”

Dr Buchanan said women in the study reported feeling less isolated and distressed when others acknowledged it was happening.

“When concerned health practitioners empathised with their patients and provided information and support, this helped relieve some of this distress,” she said.

“This support was singularly important to women’s perceptions of themselves and precipitated their decision to leave abusive partners.”

In Australia, it’s estimated that 25 per cent of women have experienced emotional abuse from a current or previous partner. Shockingly, one woman is killed every nine days as a result of domestic abuse.

In the 2017-2019 NSW Domestic Violence Death Review Report, 99 per cent of domestic violence-related homicides were characterised by coercive control, highlighting the immense dangers surrounding this form of psychological abuse.

Co-researcher Professor Cathy Humphreys from the University of Melbourne said health professionals hold a position of trust that enables them to offer first-line support.

There are key behaviours indicative of psychological abuse and control.

“During pregnancy, instances of overbearing behaviours or alternatively a lack of interest in antenatal care may indicate that a partner is using coercive control tactics,” Professor Humphreys explained.

“Signs of abuse could be limiting a woman’s contact with doctors; refusing to come to scans and appointments; and even making a scene when a visit is running late.

“Similarly, a lack of support or self-focus by partners is also worrisome, with some women saying that their partners blamed them for having too long a labour.”

Prof Humphreys said this damaging behaviour also extended across motherhood, where partners may isolate women from family and friends, as well as criticise them about their mothering abilities.

“All these acts exemplify ways that partners shame and demean women, and all are important warning signals for health practitioners to look out for,” she said

Prof Humphreys said health practitioners’ responses either helped women to identify their partners’ behaviours as abusive, or exacerbated women’s feelings of isolation and helplessness.

“We must find ways to ensure that all obstetric health practitioners can identify coercive control, so that we can help women to act and protect themselves and their children from further abuse,” she said.

“There’s no excuse for abuse and it’s everyone’s responsibility to prevent it.”

Domestic violence contacts
1800 RESPECT. For phone counselling, call 1800 737 73. For more information, visit
Domestic Violence Resource Centre Victoria supports workers and families to help stop domestic violence.  Visit