Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, England.
London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, England.
BMC Pregnancy Childbirth. 2023 Nov 16;23(1):796. doi: 10.1186/s12884-023-06085-4.
One in five women in the UK are survivors of rape and sexual assault, and four in five women will give birth. This implies that a substantial number of women experience rape and sexual assault before pregnancy. We highlight and explore the voices and lived experiences of survivors during pregnancy and birth, to better understand the relationship between sexual violence, biomedicine, and pregnancy and to inform maternity care practice.
This qualitative research took an intersectional feminist approach. We conducted in-depth individual interviews in England with fourteen women who self-identified as survivors of rape or sexual assault, and who had experienced pregnancy and birth after the assault. We conducted open line-by-line coding of the interview transcripts, and identified key themes and sub-themes inductively.
Three themes help summarise the narratives: control, safety and trauma. Maintaining a sense of control was important to survivors but they often reported objectification by healthcare staff and lack of consent or choice about healthcare decisions. Participants' preferences for giving birth were often motivated by their desire to feel in control and avoid triggering traumatic memories of the sexual assault. Survivors felt safer when they trusted staff. Many participants said it was important for staff to know they were survivors but none were asked about this. Pregnancy and birth experiences were triggering when they mirrored the assault, for instance if the woman was prevented from moving. Many of our participants reported having unmet mental health care needs before, during or after pregnancy.
Survivors of sexual violence have specific maternity care needs. For our participants, these needs were often not met, leading to negative or traumatic experiences of pregnancy and birth. Systemic biases and poor birth experience jeopardise both psychological and physical safety. Funding for maternity and mental health services must be improved, so that they meet minimum staffing and care standards. Maternity services should urgently introduce trauma-informed models of care.
英国每五名女性中就有一名是强奸和性侵犯的幸存者，其中五分之四的女性会生育。这意味着相当数量的女性在怀孕前经历过强奸和性侵犯。我们强调并探讨了幸存者在怀孕和分娩期间的声音和生活经历，以更好地了解性暴力、生物医学与怀孕之间的关系，并为产妇护理实践提供信息。
这项定性研究采用了交叉女权主义方法。我们在英格兰对 14 名自我认同为强奸或性侵犯幸存者的女性进行了深入的个人访谈，这些女性在遭受性侵犯后经历了怀孕和分娩。我们对访谈记录进行了开放式逐行编码，并通过归纳法确定了主要主题和子主题。
三个主题有助于总结这些叙述：控制、安全和创伤。幸存者保持控制感很重要，但他们经常报告医护人员的物化以及在医疗保健决策方面缺乏同意或选择。参与者选择分娩的主要动机是他们希望感到控制并避免触发对性侵犯的创伤记忆。当幸存者信任医护人员时，他们会感到更安全。许多参与者表示，医护人员了解他们是幸存者很重要，但没有人询问过这一点。当怀孕和分娩经历与性侵犯相似时，例如当女性被阻止移动时，这些经历可能会引发创伤。我们的许多参与者报告说，在怀孕前、怀孕中和产后都有未得到满足的心理健康护理需求。
性暴力幸存者有特定的产妇护理需求。对我们的参与者来说，这些需求往往得不到满足，导致怀孕和分娩的负面或创伤性经历。系统偏见和糟糕的分娩体验危及心理和身体安全。必须改善产妇和心理健康服务的资金，以确保它们满足最低人员配备和护理标准。产妇服务机构应紧急引入以创伤为中心的护理模式。
