Domestic violence and abuse against women is a global public health issue (World Health Organisation (WHO), 2010). It has a long history, exists in many cultures, and is accepted as part of everyday living. It is embedded in society and pervades all socioeconomic, gender and cultural groups, has devastating impact on the lives of survivors and until the late 20th century has gone mostly unchallenged (WHO, 2005). Within the UK domestic violence is usually regarded as violence between adults who are or have been in an intimate relationship or family relationship with each other (Hague and Malos, 2005). In most situations, domestic violence occurs within the context of a relationship of a cohabiting couple and includes physical, sexual and emotional abuse as well as controlling behaviours.
Domestic violence is predominantly perpetrated by men against women, although it can also be perpetrated by women against men. However, according to Kantor and Jasinski (1998) the violence is usually very different from the violence men perpetrate towards women, in that it is usually less harmful, frequently carried out in self-defence and less likely to be motivated by an attempt to control, dominate or terrorise. Domestic violence also occurs in same sex relationships, although currently there is a lack of knowledge about its extent and consequences or indeed an understanding about the differences between violence in a same sex relationship and violence within heterosexual relationships (Harne and Radford, 2008), with most of the existing research limited to lesbian relationships (Hester et al, 2010). According to Hester et al, (2010) this limiting evidence-base can be attributed to a potential for a homophobic backlash from society, and the hidden nature of the lesbian, gay, bisexual and transgender population means that it is very difficult to recruit a random or even a representative sample.
Around 520 000 people die in the world every year as a result of domestic violence (WHO, 2010) and living with it results in a poorer health status, reduced quality of life and increased utilisation of health services (Williamson, 2000; Hegarty, 2006; Baty et al, 2008). The precise relationship between pregnancy and domestic violence remains unclear (Reilly et al, 2010). However, what is known is that the consequences of domestic violence during pregnancy include a higher incidence of neonatal death, premature labour, low birth weight infants and miscarriage (Campbell et al, 1992, 1998; McFarlane et al, 1996a, 1996b; Shumway et al, 1999; Campbell, 2001; Covington et al, 2001; Valladares et al, 2002; Janssen et al, 2003; El Kady et al, 2005; Martin et al, 2006; Shah and Shah, 2010).
Study aim
Although researchers have addressed the pervasiveness and epidemiological aspects of partner violence and abuse, very few have focused on the experiences of abuse during pregnancy (Stanley and Wise, 1983; Kelly, 1988; Lugones and Spelman, 1990), and for that reason the women's voices shaped this research. The overall purpose of this research was to explore women's experiences of domestic violence within the context of their pregnancy as told by the women themselves. It was also relevant to understand the perceived effect domestic violence had on their health and wellbeing. In order to achieve these aims, feminist phenomenology was employed to access and interpret women's accounts of domestic violence.
This article will not report on the conduct of the research or the findings, but will convey the utility of a feminist phenomenological approach to researching experiences of domestic violence during pregnancy.
The context of domestic violence
Domestic violence is a broad concept which includes many forms of physical violence, sexual violence, and a range of behaviours and acts that may be used in isolation or together to control the woman. Physical violence can include the use of physical force such as slapping, hitting, kicking, punching, hair pulling, biting, using knives and weapons, burning and scalding. Psychological and emotional abuse comprises verbal threats, intimidation and coercion, isolation, deprivation of basic needs such as food, money and clothing, and the restriction of information, education, employment and social activities. Sexual violence incorporates behaviours such as rape, forced sexual contact or being forced to watch or take part in pornographic sexual activities (Department of Health (DH), 2005; Harne and Radford, 2008; Women's Aid Federation of England, 2011).
Nine detailed surveys of intimate domestic abuse/violence in England and Wales have been conducted since 1995, each using a computer assisted self-completion questionnaire to maximise confidentiality. It is estimated that one in four adult women experience domestic violence at some point in their adult lives and two women are murdered every week by a partner or ex-partner (Office for National Statistics, 2012). In 2010/11 7.3% (1.2 million) of women in England and Wales reported experiencing domestic abuse. It is known that it can lead to negative consequences in many spheres of life, including educational achievement, economic opportunities, increased uptake of risky health behaviours and reduced capacity to parent (WHO, 2010).
Domestic violence continues to be one of the most common crimes in the UK. In 2004, self-reporting figures (British Crime Survey (BCS), 2004) confirmed that there was little evidence of any changing trends in the prevalence of partner violence concluding that women are generally at a higher risk than men to have experienced all types of abuse (partner abuse, family abuse, sexual assault and stalking). More recently, statistics show that for women who have been a victim of serious sexual assault since the age of sixteen, the perpetrator was a partner or ex-partner (Smith et al, 2011). The BCS survey also indicated that on average 10 000 women were sexually assaulted and 2 000 women were raped every week (BCS, 2004) demonstrating that despite any advances in awareness raising and policy development, the continued violence and abuse experienced by women in the UK remains an urgent and a pervasive concern. Women who are physically assaulted by their partner are also at high risk of sexual assault and rape as part of the pattern of abuse (John et al, 2004). Sexual assault is associated with a range of gynaecological complications, including vaginal infections, vaginal bleeding, chronic pelvic pain and recurrent urinary infections (Golding, 1996; Plichta, 1996; Stein and Barrett-Connor, 2000; Coker at al, 2000). A woman may have very little control over her own or her partner's use of contraception and may often be fearful of insisting on the use of contraception or condom use (Campbell, 2002; WHO, 2002, 2005). Living with and surviving continued physical, sexual and psychological violence may induce the woman to draw on high risk behaviours to help her manage the violence; including smoking and the harmful use of alcohol and drugs (WHO, 2010).
In the UK, one in seven children and young people under the age of 18 will have lived with domestic violence (Radford et al, 2011). Research has consistently shown that a high percentage of children who live in homes where domestic abuse occurs, are also being physically or/and sexually abused (Hague and Malos, 2005). It is known that nearly three-quarters of children on the ‘at risk’ register live in households where domestic violence is occurring (DH, 2002), signifying the unmistakable association between child abuse and domestic violence.
In this study, none of the women suggested that their partners were purposely physically violent towards their children. However, some of the men regularly threatened to harm the children if the women did not obey their rules or give in to their demands. Stark (2007: 251) identifies this behaviour by the men as ‘child abuse as tangential spouse abuse’, where the partner threatens to hurt the children as an extension of the mother, adding to his ability to control or hurt her. Stark suggests this tactic is usually used when the woman has stopped reacting to direct threats or violence, or when she has left the perpetrator and he has less access to her (Stark, 2007). Brandon et al (2013) concluded that domestic violence was present in the family of two-thirds of the serious case reviews where a child died.
Theoretical explanations of domestic violence
As the intention of the research was to explore women's experiences of domestic violence during their pregnancy, it was essential that the approach would allow their voices to be heard. It was important to empower participants to convey their feelings and experiences in their own words. McLaughlin (2003) states that it is no longer acceptable for women's experiences to be considered as universal; instead they should be viewed as multiple and different. Many theories have evolved in an attempt to explain the reasons for violence against women. Just as no single act of domestic violence is an accurate reflection of all violence that occurs within a relationship, no one theory fully explains what causes partner violence. Without empirical verification, theories remain speculations that are unsubstantiated (Barnett et al, 2005). Historically, the prevailing attitude to domestic violence was the belief that it was a private affair between a husband and wife and that unless the violence was causing serious injury to women and children, no one interfered. Explanations that a perpetrator may offer for his violence include resentment and jealousy against a woman, her relationship with friends and family, spending too much time away from the home, being a bad housekeeper, denying men the right to sexual intercourse or being too independent (Hague and Malos, 2005). Violence against women can also be attributed to a multifaceted collection of factors including gender inequality and social norms that exist around masculinity and economic inequality (WHO, 2010).
In a social system where women's subordination to men is defined as natural, violence continues to be seen and accepted as a conventional means of controlling women. In some countries men still have the power to kill, imprison, enslave and punish their wives and children without fear of punishment or recourse (Levesque, 2001). Several theoretical explanations have been proposed to account for domestic violence such as: men's possessiveness and jealousy; disagreements and expectations concerning domestic work and resources; men's sense of the right to punish their women for perceived wrong doing; the importance to men of maintaining or exercising their power and authority in their own homes. Such traditionalist explanations have held credence with the legal system and still do in many countries around the world where women are expected to obey their husbands in marriage.
Acknowledging ethnic and gender differences is important as the UK is multi-ethnic and previously government bodies have been slow to acknowledge that some forms of violence and abuse may be culturally specific. Some women's groups such as Southall Black Sisters and Brent Asian Women's Group in London began their own movement to bring attention to the specific experiences of domestic violence in Asian communities (Harne and Radford, 2008). In the last decade four main issues for women in black ethnic minority groups have been deliberated in the media and public policy; forced marriage, female genital mutilation, honour-based crime, and women's Islamic dress. All four issues have helped fuel popular media representations of minority cultural and religious groups as being particularly oppressive to women (Dustin and Phillips, 2008). Dustin and Phillips (2008) suggest the management of these issues has been problematic, with initiatives to protect women becoming entangled with the anti-immigration agenda, suggesting that inaction could be seen as racist but then so could action. This does little to support women who are exposed to on-going coercion and abuse. A small number of women's groups particularly amongst Asian and African-Caribbean populations were actively campaigning and encouraging dialogue with the government and leaders of the minority communities for many years before it figured in the media representations (Gupta, 2003).
Domestic violence in pregnancy
There is increasing evidence that during pregnancy a woman is at particular risk of violence and abuse and this is of special concern as the violence not only poses a threat to the woman but also to her unborn baby. Research findings suggest that pregnancy itself can act as a trigger for domestic violence or exacerbate ongoing existing violence (Webster et al, 1996; Bewley et al, 1997; Valladares et al, 2002). It is estimated that for almost 30% of women who suffer from domestic violence in their lifetime, the first incidence of violence will occur during pregnancy (Helton et al, 1987). Women who experience violence during pregnancy are also at increased risk of adverse mental health outcomes. In 1997, Campbell and Lewandowski intimated that the psychological health consequences of experiencing domestic violence prompts women to seek health care services as frequently as for physical health problems.
Interpretive phenomenology
Interpretive phenomenology facilitates researchers to identify both common and unique experiences as well as the fundamental nature of people's experiences and interpretations of key features in their life (Sarantakos, 2005; Bryman, 2008). Phenomenological methods to explore domestic violence have been used by several researchers to explore a variety of experiences of domestic violence and abuse (Denzin, 1984; Eisikovitis and Buchbinder, 1999; Garko, 1999; Reitz, 1999; Shamai, 2000; Wesley et al, 2000; Taylor et al, 2001). Phenomenology was initially considered as it facilitates an understanding of the lived experiences of women who had been victims of domestic violence, allowing for the exploration of the essence of the experience. The motivation for this research stemmed from a desire to understand the violent situation for some women, and an intention to improve healthcare services during pregnancy and beyond. It was also important that the philosophical framework was congruent with the researcher's own perspectives, historicity (background as a midwife), and horizon (frame of reference as an experienced researcher of domestic violence). Heidegger (1962) describes the ability and potential ‘to be’ as ‘Dasein’ and this necessitates a view that the person and the world are co-constituted, this being an indissoluble unity. From this premise, a woman makes sense of the world from within her own existence and not while detached from it.
Feminist theory
It is recognised that Feminism has developed into a research methodology and is underpinned by theories and multiple constructions about women's perspectives of oppression and consciousness (Holloway and Wheeler, 2010). What unites different feminist strands is the overarching principles that gender is a key determinant of social status, and that the male gender is often considered as privileged and powerful compared to the female gender. Furthermore, it has been suggested that until recently research has been owned by the powerful (men) at the expense of women, and men and women differ in their perceptions of life due to their social status (Reinharz, 1983; Sarantakos, 2005; Parahoo, 2006; Holloway and Wheeler, 2010). Feminist researchers intend to contribute to the improvement of the lives of women through the uncompromising tenet of feminist methods which are concerned with the importance of women's lives and their position in the social structure of society. There is conjecture that feminist research arose out of failure of conventional research (usually conducted by men on women) to serve women's interests (Parahoo, 2006) and promotes an allegiance to changing the position of women in society. The main principles guiding the research were in accordance with feminist research in that the principal investigator was a woman; the purpose of the work was to study women with the focus of the research being women's experiences; and that the research had the potential to help the participants as well as the researcher.
The research was characterised by a non-hierarchical relationship with an articulation for feelings and a concern for values. Feminist research therefore places an emphasis on two main purposes: increasing awareness and sensitisation, it also advocates a change in the social, political and health policies that impact on women's lives (Parker and McFarlane, 1991). The study was conducted through a postmodern feminist lens as its fundamental principles fitted with the perspective and world of the researcher. Drawing on postmodern feminism, and with a focus on representation and text, the purpose of the research was always that the research be directed by the voices of women who participated in the study.
‘For almost 30% of women who suffer from domestic violence in their lifetime, the first incidence of violence will occur during pregnancy’
Talking to women about their experiences of violence and abuse clearly raises ethical issues, and feminist researchers have acknowledged that talking about the effects of experiences of violence can be distressing but cathartic (Kelly et al, 1995). In-depth interviews are favoured and widely used by feminists as the method allows for a more sensitive approach to research (Maynard, 1994). This was evident in this study as several of the participants reported feeling empowered by the opportunity not only to talk about their experiences but also to have those experiences valued and believed.
Feminist phenomenology
Fisher (2000) claimed that there are various possibilities for a relationship of feminism and phenomenology. Prior to this, phenomenology and feminism were rarely associated and Studlar (1990) offers an explanation that, historically, phenomenology was an exemplar of male philosophical observation, whereas feminism has focused on transforming a domineering system rather than being content to interpret it (Reinharz, 1992). Feminist phenomenology has developed out of the reconsideration and expansion of the work of some classical phenomenologists namely Edmund Husserl (1970), Martin Heidegger (1962) and Maurice Merleau-Ponty (1962). Additionally, Simone de Beauvoir (1989), Judith Butler (1989), Iris Marion Young (1990a; 1990b) and Sandra Lee Bartky (1990) have all combined phenomenology with feminist theory (Schües et al, 2011) where their particular interest was to relate interpretive phenomenology to the issue of gender. While each method has its own identity, both phenomenology and feminism can be integrated in order to strengthen the overall philosophical foundation in an attempt to gain a deeper understanding of the experience of living with domestic violence and abuse (Fisher, 2000). Fisher (2000) proposes that Simone de Beauvoir can rightfully be considered as the influential creator of feminist phenomenology. de Beauvoir's original work (1949; 1953) draws on the phenomenology of Husserl and Heidegger with a direct focus on embodied lived experience and the role of language in revealing the world's meaning. de Beauvoir's work added to the richness of interpretive phenomenological description, with first person accounts of the gendered character of experience that had been previously neglected. de Beauvoir's publication ‘The Second Sex’ (1949), although controversial, is also considered to be a seminal landmark in the history of feminism (Borde and Malovany-Chevallier, 2009) and has been credited with starting the second wave of feminist activism (Scholz, 2000).
The relevance of intersectionality
Feminist discourse on intersectionality has developed over the past two decades and while there are some differences in interpretation and application, intersectionality theory considers the ways in which hierarchies of power exist alongside several defined categories such as race, class and gender (Crenshaw, 1991; Sokoloff and Dupont, 2005). The feminist view on domestic violence is to acknowledge that women experience a higher and more frequently fatal rate of violence and abuse than men due to a socially structured gender inequality (Sokoloff and Dupont, 2005). Furthermore, Feltey (2001: 365) claims that although violence against women happens within individual people's lives and is experienced at a personal level, there is no doubt that it is ‘culturally produced out of intersecting relations of gender, race, social class, and sexuality’. The overall contribution of feminism has been significant in challenging earlier sociological and psychological models of domestic violence that depicted domestic violence as simply a ‘family problem’ (Kurz, 1989). Crenshaw (1994) first introduced the theoretical concept of intersectionality to help explain the reality of abused women experiencing other diverse oppressions. These included, but were not restricted to, gender, racism and violence. Bograd (2005: 26), suggests Crenshaw's hypothesis of intersectionality does not situate domestic violence as a ‘monolithic phenomenon’. Instead she states that intersectionalities can colour the meaning and nature of the violence, how it is experienced by self and likewise how it is responded to by others (Bograd, 2005). Sokoloff and Pratt (2005), and Lockhart and Danis (2010), have adopted this theoretical proposition to explain the diverse experiences of abused women. From this perspective, the overall effects of violence and abuse are augmented by additional victimisations which may occur outside of the abusive relationship. These additional factors suggest that no one facet is privileged as an explanatory construct of domestic violence and abuse. Indeed, Crenshaw (1994) believes that gender inequality, although a major facet, is nevertheless modified by its intersection with other systems of power and oppression. Therefore, while all women are susceptible to violence and abuse by a partner, particularly women's self-image and how they are judged by others may differ depending on variables including race, wealth, and citizenship (Bograd, 2005). Lockhart and Mitchell (2010) propose the failure to understand the lived experiences of survivors of violence from within a more holistic contextual framework may result in significant consequences for those women who are already marginalised. This was certainly true for the women who participated in the research.
Integration of feminist phenomenology and intersectionality
The philosophy and discourse of de Beauvoir, Bartky and Young appeared to offer a conceptual framework to the research that resonated with many of the women's individual and lived experiences of domestic violence in terms of gender inequality and oppression. However, the women's narratives suggested there were aspects of their experiences which lay outside the discourse of de Beauvoir and others. While gender as an explanatory model was important in this research, the concept of intersectionality also had the potential to provide a theoretical explanation for some of the spheres of victimisation or vulnerabilities which seemed to co-exist alongside the violence and abuse. It might seem obvious that a woman's lived experience must make visible all the multifaceted realities which co-exist and interact, thus determining her overall experiences. Yet violence against women cannot be read through the lens of gender alone (Lipsitz Bem, 1993). It was also important to consider the intersecting factors that actually shaped the living realities of the women affected. Such realities determined their needs and help seeking patterns (Lockhart and Danis, 2010). One could suggest that perhaps pregnancy in itself should be regarded as an additional living reality to be considered as an internalised ideology alongside others. Utilising an intersectionality conceptual framework had the potential to provide a deeper explanation, allowing the unpacking of some of the demographic factors alongside the power relations and gender inequality. Some of the factors were considered to be ‘concrete’, for example, unchangeable attributes including ethnicity, which in turn influenced the more transient socioeconomic attributes; where they lived and their social status. These in turn, impacted on the woman's psychological and cultural attributes. Lockhart and Danis (2010) maintain that women must be considered as having multilayered, sociopolitical identities which stem from race, social class, employment, education, ethnicity, physical characteristics and geographical location.
Being reflexive
Researching domestic violence is a harrowing experience and requires a range of skills, compassion and resilience. Throughout the research process reflection facilitated interpretation and helped the researcher develop a sense of awareness and emotional balance in response to hearing about experiences. Intersubjective reflection, also known as reflexivity, has developed significantly in the past decade and has been utilised in phenomenological and feminist research (Finlay, 2002; Etherington, 2004). In the last decade the use of ‘self’ has become more and more legitimate in research (Finlay, 2003a); to be reflexive is to be aware of the personal, social and cultural contexts in which we live and work and to understand how these can impact on the way we interpret our world (Etherington, 2004). Finlay (2002) considers reflexive activities to be integral to the interpretive process, suggesting that reflexivity is a continuous process of reflection by the researcher where they consider their own values and prejudices. Likewise, feminist theory and feminist methods generally include an acknowledgement to reflexivity as a method to transcend the differences of power, ethnicity and class in the research field (Stanley and Wise, 1990). Whilst supporting Stanley and Wise's (1990) and Finlay's (2003b) suppositions, it has to be acknowledged that reflexivity is not a simple activity, it is not always possible to stand back and examine the effects of one's preconceptions, especially if one is not aware of what they are. Reflexivity is challenging; it requires a huge effort on the part of the researcher to identify and interrogate personal and professional practice (Finlay and Gough, 2003). A reflexive approach accepts that the researcher is a central figure who influences the collection, selection and interpretation of data (Finlay, 2002). Phenomenologists such as Merleau-Ponty (1962) and Gadamer (1976) concur with Heidegger (1962), in that they both suggest the bracketing interview, like other bracketing procedures, is not intended to completely eliminate a researcher's preconceptions. Its purpose is to alert the researcher to their existence, allowing the researcher to take steps to limit the effect that such biases may have on the descriptions offered by participants. They simply intimate that the most important lesson that the bracketing process can teach us, is that complete reduction is actually impossible to achieve.
‘The combination of feminist theory, interpretive phenomenology and intersectionality provided a sensitive, political, gender specific framework through which experiences of domestic violence were interpreted’
Conclusions
Embarking on research in this particular subject was complicated and demanding. It required considerable contemplation and deliberation because we recognised that any qualitative methods used had the potential to cause distress to participants. Feminist phenomenology provided a structure and set of principles which reminded us of the researcher's responsibilities in this type of exploration. The combination of feminist theory, interpretive phenomenology and intersectionality provided a sensitive, political, gender specific framework through which experiences of domestic violence during pregnancy were interpreted.
The philosophical and theoretical approaches enabled us to protect the vulnerable women in this participant group and ensure they were not threatened by the research or made more vulnerable by participating in it. Utilising feminist phenomenology enabled the researcher, as a principal figure in the process of conducting domestic violence research, to contribute to the quality of the research through a diligent effort to act and react to the variety of experiences accounted by participants.