Around 20,000 disclosures of domestic abuse are made to maternity services in England each year, according to an analysis which exposes both the scale of the violence taking place behind closed doors and the pressure placed on NHS workers expected to respond to it.
The charity For Baby’s Sake contacted 118 NHS trusts, of which 74 supplied usable data. Across those trusts, about 3.3 percent of maternity bookings involved a disclosure of current or previous domestic abuse. Applying that proportion to maternity bookings across England produced an estimate of approximately 20,000 disclosures a year, based on a three-year average of the most recent available data.
Even this is likely to be an underestimate. The figure records disclosures, not the true prevalence of abuse. Whether somebody discloses what’s happening depends on whether they’re seen alone, whether they feel safe, whether they trust the consequences and whether an overstretched worker has enough time to ask the question properly.
Gill Walton, chief executive of the Royal College of Midwives, said the findings “lay bare” a reality already familiar to midwives.
“Midwives are often the only professional a pregnant woman sees regularly and alone, which makes them uniquely placed to spot the signs of domestic abuse and respond with care,” Walton said.
“But recognising a disclosure is only the first step – staff need proper, specialist training to know how to respond and services need the time and resources to follow through with support, so that no disclosure is ever a missed opportunity to protect a parent and their baby.”
That time and those resources can’t be separated from the wider condition of the NHS. Midwives working long hours on understaffed wards are being asked to identify abuse, assess immediate danger, protect confidentiality and arrange specialist support while still carrying the rest of an increasingly heavy workload. A safeguarding policy on paper can’t manufacture the time needed to build trust with somebody whose safety may depend on speaking privately and without being rushed.
Veronica Oakeshott, interim head of external affairs at Women’s Aid, said:
“Midwives and other maternity staff play such a crucial role when it comes to reporting disclosures of domestic violence which are made to them. However, maternity staff also need better support so they know what the next steps are regarding what to do with these disclosures.”
She added: “They’re already facing immense pressure working on busy maternity wards, so it’s essential that they receive adequate support and training on how to handle these disclosures moving forward.”
The Material Roots of Domestic Abuse
Domestic abuse is often presented either as an inexplicable act committed by an unusually cruel individual or as a private relationship that has gone wrong. Both explanations hide its social character. Abuse isn’t an ordinary argument which becomes too heated. Government guidance describes coercive control as an intentional pattern of behaviour through which one person exerts power over another.
The perpetrator remains responsible for choosing to abuse. Alcohol, unemployment, mental distress or previous exposure to violence may be risk factors, but none makes abuse inevitable and none transfers responsibility onto the victim or the circumstances. Millions of people experience poverty, drink alcohol or survive childhood violence without abusing anybody.
There is no single cause operating in every case. The World Health Organization’s review of the evidence identifies interacting factors at the individual, relationship and wider social levels. These include childhood exposure to abuse, attitudes which excuse violence, a sense of entitlement, controlling behaviour and harmful alcohol use. At the social level, it identifies gender inequality, norms upholding male privilege, poverty and unemployment, discriminatory family and property laws and sexism within public institutions. These are associated factors rather than mechanical causes, but together they help explain why abuse follows clear social patterns.
Domestic abuse can be committed against anyone, including men and people in same-sex relationships. Calling it gendered isn’t about pretending those victims don’t exist. It’s only a recognition or the the general pattern. In England and Wales, women accounted for 72.1 percent of victims in domestic abuse-related crimes recorded by police during 2024–25 and 69.6 percent of domestic homicide victims between 2021–22 and 2023–24. Women are not the only victims, but violence and coercive control take place within a society where male authority over women has been cultivated for centuries.
Patriarchy isn’t merely a collection of backward opinions inside individual men’s heads. It is a material system reproduced through property, employment, the family, the state and the division of labour. It assigns women responsibility for care and domestic work while historically giving men greater control over income, property and public life. Ideas about male entitlement survive because they are repeatedly produced by these unequal relations.
Marxists trace this oppression through the history of class society. Engels argued that the patriarchal family developed alongside private property and inheritance. Household labour, once part of the common work of a wider community, became a private service performed within the individual family. Formal legal equality could therefore remove explicit privileges enjoyed by husbands without abolishing the economic relations which had supported their authority.
Capitalism inherited these patriarchal relations and reshaped them around wage labour. A worker doesn’t arrive at work ready-made. Somebody has to cook, clean, care for children and sick relatives, and perform the daily labour required to reproduce the working class from one generation to the next. Capital depends on this work while leaving much of it unpaid inside private households.
Women have entered paid employment in enormous numbers, but the domestic burden was never socialised on the same scale. ONS time-use research found that employed women still spent significantly more time than employed men on both unpaid household labour and unpaid care. Women are expected to sell their labour to an employer and then return home to perform another shift without wages.
This doesn’t mean unpaid housework automatically produces domestic abuse, or that every heterosexual household recreates the same relations. It means that the unequal division of labour can give an abusive partner material weapons. An abuser may prevent somebody from working, take their wages, control benefits, create debts, monitor spending or threaten to leave them without housing or childcare. Economic abuse turns the victim’s need for the means of survival into an instrument of coercion.
That connection appears in the most severe cases. Among the 45 intimate-partner cases for which relevant information was available in a Home Office analysis of domestic homicide reviews, coercive control had been identified in 67 percent and financial abuse in 33 percent. These figures don’t describe every abusive relationship, but they show that domestic violence often involves a sustained system of rule rather than a sudden loss of temper.
Class also shapes a survivor’s ability to escape. Domestic abuse isn’t confined to the working class, and poverty doesn’t turn working-class men into abusers. A wealthy woman can still be terrorised inside her home. But money can buy a hotel room, childcare, transport and legal representation. A survivor dependent on one wage, trapped in an unaffordable private tenancy or waiting for benefits has fewer routes out. The same applies where an abuser can exploit disability, insecure immigration status or racist and transphobic treatment by public institutions. Patriarchal oppression is experienced through these wider class and social relations rather than separately from them.
This is also why legal equality by itself is insufficient. Lenin observed after the Bolshevik Revolution that abolishing discriminatory laws had not automatically ended women’s domestic slavery. Cooking, childcare and other domestic labour had to be transformed from isolated private burdens into social responsibilities. His argument was a warning against the crude idea that women’s oppression, and the habits produced by it, disappear as soon as the ownership of industry changes.
Pregnancy can intensify these existing relations of dependence and control. The NHS states that abuse against women often begins during pregnancy and that existing abuse can become worse. Pregnancy doesn’t cause somebody to become abusive. It can, however, reduce a partner’s earnings, increase their need for care and housing, and give an abuser new ways to threaten both the parent and the expected child.
The estimated 20,000 disclosures made to maternity services are therefore not simply 20,000 unrelated private misfortunes. They are points at which violence cultivated inside the supposedly private household becomes visible to a public service. The maternity ward encounters the consequences of a social order which proclaims equality in law while continuing to organise care, income, housing and family life through deeply unequal relations.
Judith Rees, chief operating officer and designated safeguarding lead at For Baby’s Sake Trust, said:
“Having worked as a midwife, health visitor and nurse across 33 years within the NHS, I know how important the relationship between a maternity professional and a parent can be. Creating the right opportunity to ask about domestic abuse, and knowing how to respond when someone says ‘yes’, can be life-changing.”
She added: “Midwives need to understand the impact domestic abuse can have on a parent and their baby, be able to recognise risk and respond safely, and know where to go for specialist support. Pregnancy and the early postnatal period give us a critical window to intervene, and when we get that response right, we have an opportunity to improve outcomes for parents and babies.”
But referral can only open doors that actually exist. Training a midwife to identify abuse doesn’t by itself provide a survivor with a secure council home, an adequate independent income, affordable childcare, legal representation or a place in a refuge. Without that material support, the state risks turning disclosure into an administrative process which records danger without providing a safe route out of it.
Kate Brintworth, chief midwifery officer for NHS England, said:
“All staff working in NHS maternity and neonatal services are committed to ensuring that any disclosure of domestic abuse will be met with compassion, sensitivity and clear options for support. Midwives receive mandatory safeguarding training, alongside specialist training on how to ask sensitive questions about abuse, and can refer women to specialist domestic abuse services for support with issues such as housing and legal advice where needed.”
Abuse Support Services are Overstretched and Underfunded
The NHS statement describes the formal route available after a disclosure, but a referral isn’t the same thing as receiving support. There are no published national figures tracing these estimated 20,000 maternity disclosures through to their eventual outcomes. But there’s direct evidence that some of the services to which survivors may be referred can’t meet all the demand placed upon them.
Women’s Aid estimated that 65.2 percent of referrals into refuges in England were rejected during 2024–25, the highest proportion recorded since 2019–20. Not every rejection resulted from underfunding or a shortage of places, but in 42.7 percent of rejected referrals the refuge recorded that it lacked the space or capacity to meet the survivor’s needs. Women’s Aid counted 4,619 bedspaces across 286 refuges, leaving provision 19.9 percent below the Council of Europe’s recommended level.
The shortage is much worse for women whom the system considers harder or more expensive to accommodate. Only 11.5 percent of refuge vacancies advertised during the year could consider a woman with no recourse to public funds, while just 1.1 percent were suitable for wheelchair users. A nominal right to seek safety means little when the available space excludes a survivor because of her immigration status, disability or support needs.
Women’s Aid’s No Woman Turned Away project works specifically with women facing barriers to obtaining safe accommodation, so its users aren’t a representative sample of all survivors. But their experiences show what those barriers can mean. Among the women supported by the project during 2023–24, 24 percent experienced further abuse from the perpetrator while waiting to enter a refuge.
The lack of capacity also affects the support available to children. In a Domestic Abuse Commissioner report, 51 percent of responding services said they had to place children on reserve or additional waiting lists because referrals exceeded their capacity or funding. Another 27 percent said they had turned referrals away for the same reason. The most commonly reported wait was between one and three months, while some services reported waits of six months or longer.
An Office for National Statistics study following the experiences of 40 survivors found that obtaining accommodation took anywhere from less than a day to more than a year. Women described “going around in circles” while trying to find the right person to help them. The study also found that survivors often valued the practical and emotional support provided by refuge workers once they obtained a place. The problem wasn’t indifference from specialist workers, but restricted access, staff shortages and a lack of suitable accommodation.
This is evidence that maternity staff may be identifying abuse and directing survivors towards a system in which places and specialist support are rationed. The state can require a midwife to ask the right questions and complete the right referral, but it hasn’t provided enough refuge space, housing or specialist services to guarantee that help will be there at the other end.
Capitalist society calls violence in the home a private matter until its consequences reach a hospital ward. It then gives an overworked midwife a safeguarding procedure and expects her to hold together everything the wider system has allowed to fall apart.
