Safeguarding children and public health: midwives' responsibilities.
OBJECTIVE
Using a healthy settings framework, this study aims to compare and contrast how midwives working in either hospital or community settings are currently responding to the co-occurrence of domestic and child abuse; their perceived role and willingness to identify abuse; record keeping; reporting of suspected or definite cases of child abuse; and training received.


METHODS
A survey questionnaire was sent to 861 hospital and community midwives throughout Northern Ireland, which resulted in 488 midwives completing the questionnaire, a 57% response rate. Comparisons were made using descriptive statistics and cross-tabulation and the questionnaire was validated using exploratory factor analysis.


RESULTS
Community midwives reported receiving more training on domestic and child abuse. Although a high percentage of both hospital and community midwives acknowledged a link between domestic and child abuse, it was the community midwives who encountered more suspected and definite (p < 0.001) cases of child abuse. More community midwives reported being aware of the mechanisms for reporting child abuse. However, an important finding is that although 12% of community midwives encountered a 'definite' case of child abuse, only 2% reported the abuse, leaving a 10% gap between reporting and identifying definite cases of child abuse. Findings suggest that lack of education and training was a problem as only a quarter of hospital midwives reported to have received training on domestic violence and 40% on child abuse. This was significantly less than that received by community midwives, where the figures were 57% and 62%, respectively.


CONCLUSIONS
Midwives need training on how to interact with abused mothers using non-coercive, supportive and empowering mechanisms. Many women may not spontaneously disclose the issues of child or domestic abuse in their lives, but often respond honestly to a sensitively asked question. This issue is important as only 13% of the sample actually asked a woman a direct question about domestic violence.
Lazenbatt
Anne
A
Institute of Child Care Research, School of Sociology Social Policy & Social Work, Queen's University Belfast, 6 College Park, Belfast BT7 1NN, Northern Island. a.lazenbatt@qub.ac.uk
D000328:Adult; D002648:Child; D002649:Child Abuse / Q000517:prevention & control* / Q000706:statistics & numerical data; D003153:Community Health Services; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D015994:Incidence; D019221:Mandatory Reporting; D008430:Maternal-Child Health Centers; D008880:Midwifery; D009660:Northern Ireland / Q000453:epidemiology; D024382:Professional Role; D013179:Spouse Abuse / Q000517:prevention & control* / Q000706:statistics & numerical data