How health visitors from one healthcare organisation in the north of England endeavour to meet the perceived needs to Pakistani mothers living with violence and abuse and the challenges they encounter in keeping such women safe

Domestic abuse is a public health issue with long term health and social consequences for its victims. The prevalence of domestic abuse among women seeking healthcare is higher than in the general UK population and often begins or worsens in pregnancy. Health visitors, because of their role with pregnant women and mothers are in a key position to offer both supportive interventions and to play a preventative role in domestic abuse.
The aim of this research is to improve understanding of issues health visitors face when working with Pakistani mothers living with domestic abuse. The study is set in the north of Britain in an area that has experienced chain migration and settlement from the Mirpur and Faisalabad regions of Pakistan since the 1970s. Taking a qualitative approach and informed by a critical realist perspective, first-hand accounts from health visitors working in the area are used.
The findings of the study confirm that domestic abuse perpetrated against some Pakistani mothers is a complex aspect of health visiting practice compounded by deep rooted cultural and social practices within many Pakistani families. The key challenge health visitors face appears to be non-disclosure of abuse by many Pakistani women and the main approach taken by health visitors in this situation is predominantly one of harm minimisation. Inconsistencies in practice were however noted.
Three overarching themes were found from the analysis of the data which depict the challenges health visitors face and the endeavours they take to keep women safe. The theme of Presence depicts a range of actions linked to ‘seeing’ or ‘being with’ women and includes carrying out repeated enquiry into abuse. Role Strain describes how the health visitors express difficulty in fulfilling the various demands and expectations of the role. The term Covert Actions encompasses a range of seemingly hidden or concealed activities undertaken by health visitors in an endeavour to maintain Presence.
The study provides useful insight into the forms of evidence many health visitors deem can legitimately inform their clinical interventions when working with this population group and succeeds in extending current understanding of the types of knowledge health visitors draw from to inform their decisions in this specific area of practice. It also provides awareness of the wider challenges health visitors can encounter when working more generally among collectivist and honour-based communities and raises questions about some of the philosophical assumptions usually associated with Western models of healthcare.
Implications for practice are that mainstream domestic abuse interventions should be used with sensitivity to the different cultural contexts in which many Pakistani mothers live, and attempts should be made to develop appropriate interventions that derive from those contexts. This includes holistic assessment tools that are flexible enough to allow clinical judgements to be informed by the more subjective elements of evidence gathering and which take into consideration the impact of the multiple oppressions some women encounter.
Recommendations for service providers are that they should take a broader view of domestic violence that recognises ‘difference’ and therefore enables health visiting interventions to be flexible and responsive to differing need. This includes considering more community-based interventions among certain population groups