Understanding Why Domestic Violence Can Become More Severe During Pregnancy

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This article contains references to family and domestic violence.

Rachael Natoli was in an abusive relationship for several years before she had her boys.

It continued while she was pregnant.

Natoli met her now-ex-partner while holidaying in Australia in 2007.

“Within weeks of moving in together, the physical and emotional abuse started and went on throughout the time of our relationship,” the 43-year-old tells SBS News, adding her ex was also sexually and financially abusive and used a “huge amount” of coercive control.

They got married several years later, and Natoli fell pregnant with twins in 2012. At the time, she says her ex had left on more than one occasion, and they were going through a financial separation.

“He came back when I was about five-and-a-half months pregnant … I let him back into the family home.”

A pregnant woman in a blue dress at a stadium.

Rachael Natoli fell pregnant in 2012. Source: Supplied / Rachael Natoli

Natoli says the abuse returned while they were on holidays.

“The way he convinced me to go was that no matter what happened between us, we were going to be co-parenting, and we needed to have a civil relationship, and it would allow us to rebuild some of that,” she says.

“It was really important to me that I gave the babies an opportunity to have a relationship with their father, so I agreed. But unfortunately, quite quickly, that abuse returned.

You feel even more controlled and more willing to go along with things when you’re pregnant because you’re wanting to do what’s right for your children.

Natoli says the physical violence increased when others were present. On one occasion, when she was eight-and-a-half months pregnant, the pair were finalising preparations for the boys’ bedroom when she says he assaulted her.

“We had painters upstairs in the house painting the nursery, and he became irate over something and physically grabbed me and threw me across the room,” she recalls.

“It wasn’t the first time I’d been physically assaulted, but for him to do it when I was at such a heavy stage of my pregnancy, but also when we had other people in the house … it was more of a risk — and he seemed to take more of those risks.

“I couldn’t see a way out and felt even more trapped because I was about to give birth.”

‘I was terrified most of the time’

As her due date neared, Natoli was fearful about what would follow.

She recalls feeling “terrified most of the time”.

“I was really scared about what was going to happen with the boys. I didn’t feel like I could tell anybody what was going on, to get support.”

A mother pictured with her newborn twins.

Rachael Natoli gave birth to her twin boys in December 2012. Source: Supplied / Rachael Natoli

The boys were born in late 2012. Natoli says there was no reprieve — the abuse continued straight after she gave birth.

A hospital social worker became involved, but Natoli felt unable to disclose the abuse to her.

I wouldn’t tell her the truth because I felt like if I did, my children would be taken off me.

“You’re just living in fight or flight all the time. It’s literally just surviving every single day.”

Two and a half years later, she was able to leave the relationship.

Professor Kelsey Hegarty, chair of the Centre for Family Violence Prevention at the Royal Women’s Hospital and the University of Melbourne, says experiencing family and domestic violence (FDV) during pregnancy is “common”.

For some, violence will escalate because their perpetrator is “jealous about the pregnancy and sees it as a threat”, Hegarty explains.

Others may experience it for the first time.

“Then, there’s a set of perpetrators who want the person to be pregnant, may have even forced the person to be pregnant, as part of reproductive coercion,” she says.

Family and domestic violence and pregnancy

While Hegarty points out that large longitudinal studies about experiences of FDV during pregnancy have not yet been conducted, research suggests women are at greater risk of experiencing violence from an intimate partner during pregnancy and following birth.

According to a 2015 report from the Australian Institute of Family Studies (AIFS), if FDV is already present at the onset of pregnancy, it is likely to increase in severity.

However, a lack of long-term research in this area means its pervasiveness remains unknown.

For Sarah, abuse began when she was pregnant with her first child. She’s not alone image

A 2015 report by the Australian Institute of Health and Welfare (AIHW) described FDV during pregnancy as a “serious public health problem” but noted its prevalence was difficult to determine.

In 2011, the World Health Organization estimated a prevalence rate in Australia of around 2 per cent, while a 2023 global review reported estimates ranging between 2 and 13.5 per cent across 19 countries.

According to the Australian Bureau of Statistics’ 2021-22 Personal Safety Survey, just over one in four women and one in seven men have experienced violence or abuse by a partner since the age of 15.

The same survey found an estimated 791,100 women who had experienced violence by a previous partner while living together were pregnant at some point during the relationship. Of those women, 42 per cent experienced violence during their pregnancy, including 17 per cent who experienced it for the first time.

Elise Phillips, deputy chief executive of Domestic Violence NSW, says pregnancy is embedded in the sector’s risk-assessment practices.

“It’s something that the FDV sector routinely screens for when we’re assessing risk to determine the level of threat a person is experiencing,” she says.

Power, control and gender roles

Phillips says all FDV is related to power and control, and gender inequity is the underlying driver for violence against women.

This can intersect with pregnancy.

“For some perpetrators, there might be that sense they are losing control over their partner,” she says, adding that they might feel their partner is less focused on their needs or not engaging in traditional caring roles.

“All those things can potentially work together to contribute to increases in violence if there are already problematic power and control dynamics within a relationship, or problematic attitudes around the roles that men and women have,” she says.

Young women aged 18 to 24 are more likely to experience violence during pregnancy, and Indigenous women also face greater risk, according to the AIFS.

Poor birth outcomes, such as low birth weight and premature birth, are associated with violence during pregnancy, along with postnatal depression.

There is a “strong correlation” in research between unintended pregnancy and FDV, the report concluded, with several studies also showing a “significant” link between FDV and terminations.

‘He knew it was too late for me to go’

Maria came to Australia on a temporary visa almost a decade ago, where she met her former partner.

SBS News has changed her name to protect her privacy.

“When you arrive, you want to establish yourself from the ground [up]. You don’t have family, friends; you start meeting people but you don’t have a support system around you,” she says.

It’s very easy for a perpetrator to be this rock you go to … unfortunately, some people will use it as leverage because they have this power over you.

Maria says her ex isolated her from her new friends. When she fell pregnant, he became “more controlling”.

“You think it’s protective in the beginning because he wants the best for me. That’s why he doesn’t want me to see these people, to spend money, to call my family often,” she says.

The first time Maria feared for her life was when she was pregnant.

“We were in the car and I would say something, and he would … make very unsafe turns. I would be really scared that we were going to die.”

Then, she says he “started kicking things around” and pushing her.

“It really escalated quite quickly. But at this point, I think he realised, and I realised, that I had nowhere to go. I’m pregnant in a country where I don’t have friends or family,” she says.

“He’s the father of my child and I want to have a family… In my culture, it’s very important that your child has a father. He knew it was a big deal.

“That gave him more power to show his true self because he knew it was too late for me to go.”

The reality for migrant women fleeing domestic violence in Australia image

For migrant women like Maria, accessing support can be complicated by a range of barriers.

Yasmin Ildes is a senior lawyer with inTouch Women’s Legal Centre, which provides legal support to migrant and refugee women experiencing family violence.

Ildes says the majority of women she supports are either pregnant or have children under the age of five.

“It’s very common during this time because they are more vulnerable,” she says.

“The stakes have never been higher to have security, to have a roof over their head, to not have stress with family who wouldn’t accept them turning away from their husband even if there is FDV. They might also be dependent on their partner for their visa.”

Traditional gender roles are common among multicultural communities, Ildes says.

A female patient sitting on a hospital bed with her back towards the camera.

InTouch has health justice partnerships in Melbourne that involve working with social workers in hospitals to support women who are pregnant or have given birth. Source: Getty / Stígur Már Karlsson /Heimsmyndir

Health services and screening during pregnancy

Many pregnant people have regular contact with healthcare professionals, which represents an opportunity to identify and respond to violence, AIHW says.

Perinatal, maternal and child health services can play a “critical role” in early intervention, including screening during pregnancy. Evidence suggests this can lead to higher rates of disclosure.

However, little is known about the support services currently provided.

“[Screening] definitely leads to more disclosures. We don’t have really good evidence that it leads to better outcomes for women, just because the studies haven’t been done yet,” Hegarty says.

Screening for FDV during pregnancy occurs in most states and territories in Australia, yet different tools and approaches are used.

In NSW, all public maternity and child and family services are mandated to conduct FDV routine screening as part of clinical assessments.

Routine screening for family violence is provided in Victorian public hospitals.

It’s also part of routine antenatal care across Queensland’s public health facilities along with those in South Australia, Northern Territory and Western Australia.

National perinatal data on screening is not yet available for reporting, according to the AIHW.

However, the federal government’s Australian Pregnancy Care Guidelines recommend healthcare providers ask about family violence as a routine part of antenatal care. The guidelines specify screening should occur when alone with the pregnant person and recommend the use of specific questions or tools used in each state or territory.

These recommendations are being revised and are expected to be released mid-year, a Department of Health spokesperson has confirmed.

Hegarty says there is a need for more consistent screening, with longer appointments in antenatal care.

You can’t just ask and get them [women] to disclose. You actually have to show that you can make a difference to them.

Innovative approaches to screening

Some jurisdictions have taken up a digital screening tool set up by the Centre of Perinatal Excellence (COPE).

COPE forms part of the National Perinatal Mental Health Check — the centre’s initiative to support public hospitals in providing perinatal mental health screening — which is funded by the government. Family violence screening was added in 2019.

Dr Nicole Highet, founder and executive director of COPE, says the tool aims to address challenges with traditional screening that can prevent disclosure.

“Depending on the relationship with the health professional … that may or may not lead the woman to feeling comfortable and confident to disclose,” she says.

“And we know stigma is particularly high in the perinatal period.”

Highet says both types of screening can be completed on a personal device or the clinician’s computer. Mental health screening is commonly completed before an appointment, while family violence screening must be completed during the consult to ensure the patient’s safety.

As of 30 June last year, family violence screening was being undertaken in 19 public maternity hospitals and 21 maternal and child health centres across Queensland and Victoria. More than 20,000 screens had been completed.

The tool facilitates screening and reporting in 29 languages.

The Health Department spokesperson says the wider initiative is being independently evaluated, with a final report expected mid-year.

The National Plan to End Violence against Women and Children also outlines “increasing the capacity of generalist services to identify, respond and treat violence against women” as a key step to reducing gender-based violence, the spokesperson says.

‘I wouldn’t want to disclose because I still didn’t know’

Maria says she didn’t find help from support services, such as a GP, mental health nurse or psychologist.

She doesn’t recall going through screening, saying: “I would not even want to disclose because I still didn’t know.”

I knew that I was miserable, that I was depressed. But I didn’t know that it was domestic violence because I’m from a different culture.

Maria says it took a fourth health professional to help her realise the “cycle of abuse” that she was experiencing.

She was able to leave when her child was two years old.

Health settings are often a “safe space” for the migrant and refugee community, Ildes says.

While a lot of health practitioners “do an incredible job”, she says they may need upskilling to understand how to spot and discuss signs of FDV, “particularly when they [the patient] might not be aware of it”.

Among the recommendations from last year’s Rapid Review of Prevention Approaches to prevent gender-based violence were calls for the Commonwealth and state governments to “activate the health system and workforce” as a key prevention lever.

The review identified intervention sites, including general practice and antenatal clinics and called on health ministers to prioritise upskilling and resourcing the sector.

A spokesperson for the Health Department says the health sector “has an important role to play in responding to family violence”.

“Health ministers have asked the Australian Health Practitioner Regulation Agency and national boards for improvements in the education, training and continuing professional development of health practitioners.”

The spokesperson also says the department “recognises the need for prevention and early intervention activities to reduce gender-based violence, including during pregnancy”, noting that this is among the aims of the national plan, which acknowledges that a woman is more likely to experience violence whilst pregnant.

‘There’s not enough services out there’

Patty Kinnersly, chief executive of national violence prevention organisation Our Watch, says primary prevention of violence against women, including during pregnancy, requires systemic change.

It’s about “stopping violence before it starts”.

“It requires a whole-of-society approach that tackles the underlying factors that lead to violence, including men’s control of decision-making and limits to women’s independence, which can be heightened during pregnancy,” she says.

These initiatives are being implemented to some extent in Australia, but more investment is needed to tackle the scale of the problem.

Looking back, Natoli says: “The most that could be done when I was pregnant and during those early stages of the boys’ lives was done.”

But the mother of two, who now runs her own FDV support organisation, says a lot more can be done to meet victim-survivors “wherever they are in their journey”.

“I think the hospitals do a great job, but I think there’s not enough services out there.”

If you or someone you know is impacted by family and domestic violence, call 1800RESPECT on 1800 737 732, text 0458 737 732, or visit 1800RESPECT.org.au. In an emergency, call 000.

, operated by No to Violence, can be contacted on 1300 766 491.