When health care providers do not assess routinely for abuse, it most likely is a result of the powerful social myths surrounding domestic violence and a lack of knowledge about incidence, prevalence, and the dynamics of abuse. This article examines commonly held myths as well as personal and social consCaints that cause practitioners not to assess for abuse. Additionally, it presents guidelines for the assessment of individual women, as well as professional role development in the area of abuse of women and suggests that nurse-midwives are generally well positioned to assess their clients for the health problems of violence and abuse.
According to C. Everett Koop, the former Surgeon General of the United States, physical and emotional abuse is one of the greatest threats to the health of women and children in this country (1). Current estimates indicate that one fifth to one third of all women will experience violence and abuse in their intimate relationships (2). The recent United Nation's Women's Conference in Beijing, China, reaffirmed what was known from previous international wornen's conferences: violence against women in the domestic context is a worldwide phenomenon affecting the health of women and their children in every nation and in all social classes. The American Nurses' Association, the American Academy of Nursing, the National League for Nursing, and the American College of Nurse-Midwives have all called for nurses to participate in the primary and secondary prevention of woman abuse.
The role of the nurse-midwife in the primary and secondary prevention of woman abuse can be one of great power. A nurse-midwife may be the first person to whom an abused woman turns for help. As experts in women's health whose particular expertise is in sexual and reproductive health, nurse-midwives have a unique relationship with women, acting both as competent health care providers and womencentered advocates. They are, often, the first nonfamily contacts with whom women feel comfortable discussing their personal and social concerns or problems. Prenatal care, gynecologic examinations, and childbirth are, for some women, the only time they visit a health care provider. Thus, the nurse-midwife has access to greater numbers of women, and in a very privileged way, than many other nurses, phy-For further information contact M Christine King, RN, EdD, Associate