IRTT factor F15 · Health and wellbeing
Pregnancy and Maternity
Pregnancy and the months after birth can increase vulnerability, and the perpetrator may use this time to tighten surveillance and limit choices.
The factor
Reproductive coercion includes control of contraception, forced pregnancy, pressure to terminate and the denial of reproductive choices to the survivor.
Repeated or closely spaced pregnancies can also be used as a mechanism of control, with serious consequences for physical and emotional health.
Effect on risk
Abuse in pregnancy may include violence targeted at the pregnancy, missed antenatal appointments because of controlling behaviour, and interference with maternal health and care.
Risk and points of access from pregnancy to the first year
- Booking appointmentBy 10 weeksMidwives should offer a safe chance to talk about domestic abuse, in private.
- Antenatal careAppointments and scansMissed appointments, or a partner at every contact, can signal control.
- Health visitorFrom 28 weeksThe antenatal contact, often at home, is a further chance to ask safely.
- BirthLabour and deliveryPain and distress may be dismissed, and racism shapes how women are heard.
- Postnatal weeksMidwife home visitsAbuse can escalate after birth, alongside isolation and exhaustion.
- Health visitor reviewsNew birth to 8 weeksRoutine questions about domestic abuse give another chance to offer support.
- First year after birthUp to 12 monthsMental health causes, including suicide, lead maternal deaths in this period.
MBRRACE-UK found the maternal death rate for Black women was nearly three times that of white women in England between 2022 and 2024.
MBRRACE-UK also found that 22% of the women who died in pregnancy or the year after, between 2021 and 2023, were experiencing domestic abuse.
Survivors in our West Midlands research described being dismissed by GPs and mental health services, which can leave a survivor reluctant to attend maternity appointments.
“I’ve kind of struggled going back to the GP since… and I’m kind of still to this day, almost avoid doctors and thing.”
Survivor S01, West Midlands needs assessment
The Birthrights inquiry found Black women were labelled aggressive or angry, had their pain dismissed, and heard staff describe Black women as having tough skin.
NICE guidance requires interpreters to be independent of the woman, although Birthrights found many women with limited English had no interpreter at all.
Migrant survivors may avoid antenatal care for fear of NHS charges or Home Office contact, although maternity care must never be refused because of charges.
Questions for practice
- How has the perpetrator used pregnancy or the period after birth, and has the abuse started or changed since the pregnancy began?
- Is the survivor able to attend antenatal and postnatal appointments freely, or is the perpetrator controlling or attending every contact with services?
- Has the survivor felt dismissed or disbelieved in maternity care, and how might racism in that care affect whether they attend appointments or disclose abuse?
- Is an independent interpreter available when the survivor needs one, so that the partner or family never interpret in maternity appointments?
- Does the survivor fear that disclosing abuse will lead to the baby being removed, and has the safeguarding process been explained clearly?
- Has the survivor experienced pressure around contraception, pregnancy or termination, and do they have a safe space to talk about their choices?
- Which health professionals are already in contact with the survivor, and could any of them offer a safe point of access for support?
Using the IRTT
Pregnancy and maternity is factor F15 in the Intersectional Risk Tracker Tool, which assesses it alongside forty other intersectional risk factors.
Our two-hour session on pregnancy, maternity and domestic abuse risk on Thursday 22 April 2027 explores this factor through case study discussion.
Further reading
Related factors
Sources