6.-March-2011-Saving-Mothers-Lives-reviewing-maternal-deaths-to-make-motherhood-safer-2006-2008

Annex 12.1. Domestic abuseTable 12.3. Characteristics of the antenatal care received by women who were murdered or known to be suffering domestic abuse; UK: 2006–08Type ofdeathDied inearlypregnancyBooked after 22 weeksor missed morethan three visitsLate or non-attenders for antenatal careNo antenatal careSubtotalTotal numberof deathsof womenn n n n % n %Direct 0 1 0 1 50 2 6Indirect 2 2 1 5 33 15 44All 2 3 1 6 35 17 50Coincidental 1 4 0 5 63 8 24Late deaths 0 2 1 3 33 9 26Total 3 9 2 14 41 34 100the other women who died from a range of other causeshad proactively self-reported domestic abuse to a healthcareprofessional either before or during their pregnancy. Overall,38% of these mothers were poor attenders or late bookersfor antenatal care as shown in Table 12.3. This is animprovement of the 56% reported in the last Report.Mothers who themselves were subject to sexualabuse in childhoodIn a recent report from the Violence against Women andChildren Task Force, 21% of girls under 16 experience sexualabuse during childhood. 1 It is estimated that across theUK there are upwards of five million adult women whoexperienced some form of sexual abuse during childhood. 1While assessing all of the deaths available to this Report, 17mothers were identified who had declared that they hadbeen sexually abused by a relative, usually their father, inchildhood. Most of these women had chaotic or vulnerablelifestyles and two, maybe three, were prostitutes. Seven ofthese died of Direct and Indirect causes, and the others generallydied from later suicides or overdoses of drugs ofaddiction.The mothers who were murderedThe 11 deaths of murdered women known to this Enquirymust be regarded as a minimum, because in this trienniumthe case ascertainment was mainly focused on identifyingDirect and Indirect deaths. However, the general lessons tobe learnt from the cases that were available for assessmentunderline the need for vigilance, especially when there maybe a high index of suspicion.All but three of the women were killed while still pregnant.One, a prostitute, died at the hands of a serial killer,and another was killed by a neighbour following a domesticdispute. A third, a recently arrived young school-age bridewho spoke no English, was stabbed by her husband’s girlfriend.Seven other women were killed by their partners,one of whom then took his own life in prison. In anothercase, the circumstances surrounding the death of a motherwho was alleged to have died in a house fire were highlysuspicious and suggestive of murder by the known, violenthusband. Of these women, five died early in pregnancy andhad not yet been ‘booked’ by the midwife so did not havean opportunity to disclose domestic abuse. One of thesewomen was in a known violent relationship. Two of thesewomen had already been referred for maternity care bytheir GPs, neither of whom mentioned their known poorsocial circumstances and past histories of abuse in thereferral letter. None of the women who were booked forcare disclosed abuse, and one was not asked. Five of theseven women killed by their partners were from minorityethnic groups, of which two had recently arrived in the UKand their husbands or family members acted as their translators.For example:A newly arrived young bride who spoke no English andwhose own relatives lived on another continent had no familysupport at all. She booked late, but her midwives wereaware that her husband was extremely violent because shewas already known to social services. She repeatedlyattended the Emergency Department with abdominal painsand vague symptoms, but these were not taken seriously. Afew weeks after she delivered by caesarean section, she wasfound at home with extremely severe burns and died shortlyafterwards. Her husband’s relatives, who seem to have colludedwith him throughout, stated that this was the resultof an accident in the kitchen, a fact that those reporting hercase to this Enquiry seem to have accepted at face value.In the opinion of the assessors, this woman was eithermurdered by her husband or committed suicide becauseª 2011 Centre for Maternal and Child Enquiries (CMACE), BJOG 118 (Suppl. 1), 1–203 147