THE ROLE OF HEALTH SERVICES IN ENCOURAGING DISCLOSURE 
OF VIOLENCE AGAINST WOMEN
Vesna LESKOŠEK1*, Miha LUČOVNIK2, Lucija PAVŠE2, Tanja PREMRU SRŠEN2, Megie KRAJNC2, 
Ivan VERDENIK2, Vislava GLOBEVNIK VELIKONJA2
1University of Ljubljana, Faculty of Social Work, Topniška 31, 1000 Ljubljana, Slovenia
2University Medical Centre Ljubljana, Division of Obstetrics and Gynaecology, Department of Perinatology, 
Šlajmerjeva 3, 1000 Ljubljana Slovenia
Received: Jan 26, 2017
Accepted: Jul 6, 2017 
Original scientific article
Introduction. The aim of the survey was to assess the differences in disclosure by the type of violence to better 
plan the role of health services in identifying and disclosing violence. 
Methods. A validated, anonymous screening questionnaire (NorAQ) for the identification of female victims of 
violence was offered to all postpartum women at a single maternity unit over a three-month period in 2014. 
Response rate was 80% (1018 respondents). Chi square test was used for statistical analysis (p<0.05 significant).
Results. There are differences in disclosure by type of violence. Nearly half (41.5%) of violence by health care 
services was not reported, compared to 33.7% physical, 23.4% psychological, and 32.5% sexual that was reported. 
The percentage of violence in intimate partnership reported to health care staff is low (9.3% to 20.8%), but 
almost half of the violence experienced by heath care services (44%) is reported. Intimate partnership violence 
is more often reported to the physician than to the psychologist or social worker. Violence in health care service 
is reported also to nurses. 
Conclusions. Disclosure enables various institutions to start with the procedures aimed at protecting victims 
against violence. Health workers should continuously encourage women to speak about violence rather than 
asking about it only once. It is also important that such inquiries are made on different levels of health care 
system and by different health care professions, since there are differences to whom women are willing to 
disclose violence.
Uvod. Namen raziskave je ugotoviti razlike v razkritju nasilja glede na različne vrste nasilja, da bi lahko 
ustrezneje načrtovali vlogo zdravstvenih institucij v identificiranju in razkrivanju nasilja.
Metode. Na Ginekološki kliniki v Ljubljani smo leta 2014 opravili raziskavo z naslovom Nasilje med nosečnostjo 
– NANOS. Prevod in priredbo vprašalnika The NorVold Abuse Questionnaire – NorAQ smo na poporodnem oddelku 
tri mesece v anonimizirani obliki ponujali v izpolnjevanje vsem ženskam po porodu. Vprašalnik je razdeljen v 9 
poglavij, ima 101 vprašanje in obsega 11 strani. Odzivnost je bila 80-odstotna (1018 respondentk) Rezultati so 
bili obdelani s statističnim paketom SPSS (SPSS for Windows version 21, IBM Corp., Armonk, NY, ZDA). Razlike 
med skupinami so bile testirane, upoštevajoč 95-odstotni interval zaupanja in statistično pomembnost pri p 
< 0,05.
Rezultati. Rezultati kažejo na razlike v razkritju med različnimi vrstami nasilja. Podatki so pokazali, da 
približno tretjina žensk nikoli ne razkrije nasilja, ki ga doživljajo, in manj kot polovica tistih, ki o tem 
spregovorijo, razkrije celotno dogajanje. Manj kot polovico nasilja (41,5%) zdravstvenih delavcev respondentke 
niso prijavile, kar je višji odstotek kot pri drugih vrstah nasilja, kjer niso prijavile 33,7% fizičnega, 23,4% 
psihičnega in 32,5% spolnega nasilja. Zdravstvenemu osebju razkrije psihično, fizično ali spolno nasilje v 
intimnih razmerjih od 9,3 do 20,8% anketirank in 44% jih razkrije nasilje zdravstvenega osebja. Najpogosteje 
nasilje v intimnih razmerjih razkrijejo zdravnikom, psihologom in socialnim delavcem, nasilje zdravstvenih 
delavcev pa razkrijejo zdravnikom in medicinskim sestram. Najmanj posledic doživljajo zaradi nasilja 
zdravstvenih delavcev (posledice trpi 16,2%) in največ, če doživijo spolno nasilje (posledice trpi 55,3%). Pri 
spolnem nasilju tudi največ žensk ne razkrije nasilja, vendar zelo trpijo zaradi posledic (30,3%). Pomoč poišče 
manj žensk, kot jih trpi posledice nasilje. Pri fizičnem nasilju jih pomoč poišče le 10,9%, pri psihičnem 20,4% 
in pri spolnem 25%.
Zaključek. Razkritje je ključno dejanje, ki omogoča, da različne institucije lahko sprožijo postopke zaščite 
žrtve pred nasiljem. Zdravstveni delavci bi morali kontinuirano (in ne le enkrat) spodbujati ženske, da 
spregovorijo o nasilju. Pomembno je, da o tem sprašujejo in k razkritju spodbujajo različni zdravstveni delavci 
na različnih ravneh zdravstvenega sistema. Čeprav razkritje v zdravstvu ni pogosto, se ravno zdravstvo srečuje 
z vsemi ženskami, zato lahko pomembno vpliva na razkritje.
ABSTRACT
Keywords: 
disclosure, differences 
by type of violence, 
encouraging disclosure 
of violence in health 
care
IZVLEČEK
Ključne besede: 
razkritje, razlike 
glede na vrsto nasilja, 
spodbujanje razkritja 
v zdravstvu
*Corresponding author: Tel: + 386 40 286 715; E-mail: vesna.leskosek@fsd.uni-lj.si
10.1515/sjph-2017-0030 Zdr Varst 2017; 56(4): 220-226
VLOGA ZDRAVSTVENIH USTANOV PRI SPODBUJANJU RAZKRITJA 
NASILJA NAD ŽENSKAMI
Leskošek V, Lučovnik M, Pavše L, Premru Sršen T, Krajnc M, Verdenik I, Globevnik Velikonja V. The role of health services in encouraging disclosure of violence against 
women. Zdr Varst 2017; 56(4): 220-226.
220
© Nacionalni inštitut za javno zdravje, Slovenija. 
1 INTRODUCTION 
Violence against women during pregnancy attracted much 
professional attention in the past decades and became an 
important research topic in medicine as well. The reason 
is primarily the growing awareness of the multiple effects 
of violence on the physical and mental health of women 
and children. The World Health Organisation (WHO) 
studies on intimate partner violence (IPV)  indicate that, 
on the global level, the average incidence of violence 
during pregnancy is between 4% and 12%. These estimates 
vary significantly between countries ranging from 1% 
and 70%. Approximately one third of cases include kicks 
and punches in the abdomen (1). The consequences of 
violence during pregnancy can be long-lasting, and can 
cause a life-long trauma in children. Violence threatens 
person’s physical and mental health and may lead to 
homicide or suicide. The WHO pointed out that violence 
may lead to addictive behaviour, which causes additional 
damage to the child who may suffer the consequences of 
drug abuse and alcohol consumption (1). 
Studies of violence before and during pregnancy most 
often focus on the prevalence, incidence, consequences 
and dynamics of violence, with data gathered using both 
quantitative and qualitative methods. The findings of 
those studies show that violence during pregnancy has 
multiple effects on health of the mother and the child, 
for example, low weight at birth, premature birth, a 
low gain of weight during pregnancy, kidney infection, 
antepartum haemorrhage, caesarean section, miscarriage 
or neo-natal death (2-4). Mental health problems are 
also frequent, for example, depression, post-traumatic 
stress disorder, panic disorder, anxiety, as well as abuse of 
various substances (5, 6). Violence can also cause lack of 
attachment to the child and lower rates of breastfeeding 
(1). It can cause physical injuries to fetus, such as bruises, 
broken bones, and stab wounds, and death in extreme 
cases (7). Several meta-analyses of existing studies of 
violence during pregnancy have been conducted (8-10) as 
well as many national studies. The latter are important 
because they are conducted in specific socio-cultural 
environments and structural conditions, so they can offer 
new insights. In addition, they are an important source of 
various comparisons and trans-national analysis. 
Violence during pregnancy has not been a conspicuous 
research topic in Slovenia so far. A question referring 
to it was included in the national survey ‘Violence 
against women in Slovenia’ (11). Data showed that 
5.5% of women experienced violence during pregnancy. 
Matko (12) conducted a qualitative study on the sample 
comprising 13 women who at the time of research, lived 
in the maternity home or the shelter for women, and 
who experienced violence during pregnancy. Her results 
show that 5 (38%) children were born prematurely. This 
is a much higher proportion of preterm birth compared 
to approximately 6% of preterm deliveries in the general 
population in Slovenia (13). More than half of children 
had health or other problems, such as developmental 
disorders, hyperactivity, dyslexia, or they needed learning 
support. Her conclusion is that women experience various 
kinds of violence during pregnancy. For some of them, 
physical violence began only during pregnancy and was 
followed by a ban on breastfeeding or other forms of 
restricting contact with the new-born. The consequences 
for women were emotional distress and physical injuries 
(12).
Violence against women is an important public health 
problem also because of high expenses of treatment of 
injuries caused by it. Female victims receive hospital 
treatment and need medicines more often than women 
who have no such experience (14). In the opinion of 
the Institute of Public Health’s researchers, violence 
in Slovenia has not been sufficiently recognized as an 
important issue in public health, although there is a 
growing awareness of the problem (15). An important step 
forward was the adoption of the Rules on procedures for 
dealing with domestic violence in the implementation of 
health activities, which sets the professional and ethical 
standards of work with the victims of violence. The 
document imposes on health care workers the obligation 
to report violence, to cooperate within multi-disciplinary 
teams at centres of social work, and to assess the threat 
to the victim. The document further specifies that health 
workers should acquire relevant knowledge and skills 
through additional training programmes (16). 
In 2014, the University Medical Centre Ljubljana, 
Division of Obstetrics and Gynaecology, Department of 
Perinatology, conducted the survey ‘Violence during 
pregnancy – NANOS’ that sought to establish the incidence 
of physical, psychological and sexual violence, as well 
as violence within the health care system before and 
during pregnancy. In addition, potential influences on the 
psychological and physical health of mothers and children 
were also studied. The study is a response to the growing 
responsibility of health workers to act upon the notice 
of violence and an important step in understanding the 
country’s specific effects of violence on pregnant women. 
We used the translated and adapted NorVold Abuse 
Questionnaire – NorAQ, developed by Swahnberg and 
Wijma (17), which included questions on violence against 
women in health-care system due to negative effects that 
it might have on women and their capability of disclosing 
violence to health care workers. 
In this article, we focus on data about the disclosure of 
violence and on the role of health care workers in the 
process of disclosure. The main research question is what 
are the differences in disclosure concerning the type of 
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violence and what are the differences in disclosure of 
violence experienced in intimate partnership or within 
the health care system. Results are important for future 
development of health care practices that will encourage 
women to disclose the violence. 
2 METHOD
We conducted an observational cross-sectional study among 
all women who delivered at our perinatal centre during 
a three-month period. Quantitative and investigative 
research method was applied. We used the translated and 
adapted NorVold Abuse Questionnaire – NorAQ, developed 
by Swahnberg and Wijma (17). The questionnaire is 
divided into 9 sections and comprises 101 questions. The 
main sections include general questions about pregnancy, 
childbirth and contacts with gynaecologists, health, 
psychological abuse, abuse perpetrated by health care 
system, physical abuse, sexual abuse, current partnership, 
concluding questions, and an addition comprising 9 
questions about childbirth. The questionnaire comprised 
11 pages of easily comprehensible questions. 
The anonymous questionnaire was offered to all 
postpartum women at a single maternity unit over a 
three-month period in 2014. Of the total 1272 women, 
1018 responded, which amounts to 80% response rate. 
The questionnaire was available in print and online. Only 
7 women chose online version. 
The results were processed using the SPSS software (SPSS 
for Windows version 21, IBM Corp., Armonk, NY, USA). 
Differences between groups were tested using parametric 
and non-parametric tests, with confidence interval of 95% 
and statistical significance at p<0.05.
2.1 The Main Characteristics of the Sample
The average age of respondents was 31 years (the youngest 
one was 18 and the oldest 47); 32.8% of respondents 
had university education, 31.5% had secondary school 
education, 1.8% had only elementary school, and 1.6% had 
a doctoral degree. 52.1% of respondents are cohabitating, 
46.5% were married, and 1.2% were single or divorced. 
As to the ethnic structure, 87% declared themselves as 
Slovenes, 5% as Serbs, 4.9% as Bosnians, with most of the 
remaining respondents coming from ex-Yugoslav republics 
and Eastern European countries. The percentage of 
employed women in the group was high. Of those, 72.3% 
said they were employed, 5.4% said that they were on a 
maternity leave, and 5.9% said that they were on a longer 
sick leave. Other respondents were either students or 
unemployed. Most women (85%) support their families 
along with their partners; 11% of respondents said that 
their partner was the only breadwinner in the family, 
and 2.4% said that they earned livelihood alone. As many 
as 33% said that they had no job guaranteed after the 
end of the maternity leave. Mobbing at a workplace was 
experienced by 10.4% of respondents. Sixty percent of 
respondents lived in their own dwellings, 22.1% in a rented 
accommodation, and 17.8% with their relatives or friends. 
One person lived in a maternity home. Approximately one 
quarter (25.9%) of respondents came from the rural area.
Pregnancy was unplanned or undesired for 0.3% of 
respondents, while 25.9% of them did not plan it, but 
assessed it as desired. The sex of the child was deemed 
irrelevant by 69.2% of respondents, while 12.4% wished 
for a boy, and 18.4% for a girl. In the opinion of 67.9% 
of respondents, gender was irrelevant for their partners; 
17.5% of partners wanted a boy, and 14.6% wanted a girl.
One fourth of respondents had a miscarriage before 
current pregnancy, and 15% terminated pregnancy. One 
fourth already had a gynaecological surgery. Approximately 
one tenth of respondents assessed their health during 
pregnancy as poor; 24% visited a physician more than ten 
times during pregnancy, 38.2% up to three times, and 
15.5% were hospitalised. Psychiatric help was sought by 
3.4% of respondents during pregnancy. Approximately 15% 
experienced anxiety, and 11% were depressed.
Data point to some trends that are mirroring the societal 
change. More women live in co-habitation, the extent of 
employed is high, a vast majority is sharing the financial 
support of the family, although 11% is economically 
depended on their partners. Their future employment 
status is insecure, which reflects the precariousness of 
current employment patterns. For the tenth of them the 
workplace is a source of violence as they are experiencing 
mobbing. The ethnic structure of the sample reflects the 
ethnic structure of the Slovene society. For most couples, 
the gender of a child does not matter, but there are some 
differences between those that preferred a daughter 
or a son. Women whished more to have a daughter and 
men whished more to have a son. The health of women 
is an issue to be further explored. 15% of women who 
experienced anxiety and 11% who were depressed are 
relatively high percentages. A quarter of women also 
visited physician more than 10 times during pregnancy. 
Partly their psychological and physical condition can be 
explained with the age, but more in-depth research is 
needed. 
2.2 Data on Violence Experienced in Different Life 
Periods
We sought to establish the presence of four types of 
violence, i.e. psychological, physical and sexual violence, 
as well as violence perpetrated by health care system. 
Table 1 shows the incidence of individual types of violence, 
enabling us to establish the scope of the phenomenon. 
Some women experienced violence as children and 
as adults, and some experienced several types of 
Table 1.
Table 2.
Table 3.
Incidence of individual types of violence in various periods of life.
Disclosure to anyone.
Reporting violence to health care staff.
Before the age of 18
In adulthood
During pregnancy
Whenever
No
Yes, partly
Yes, everything
Physician 
Nurse  
Psychologist
Social worker
6.1
2.0
0.0
7.6
32.5
26.0
41.6
42.9
/
42.9
14.7
2.7
10.1
5.8
16.1
41.5
10.2
48.3
65.5
27.6
3.4
3.4
14.8
14.1
3.2
26.1
23.4
29.4
47.2
28.6
4.8
57.1
9.5
22.4
9.5
1.0
29.2
33.7
21.8
44.4
46.2
/
38.5
15.4
31.2
19.1
9.2
46.9
Period of life
% of disclosure 
% of disclosure 
Sexual violence
Sexual violence
Sexual violence 
(N=7)
Violence by health 
care system 
Violence by health care 
system 
Violence by health care 
system (N=29)
Psychological 
violence
Psychological violence
Psychological violence 
(N=21)
Physical violence 
Physical violence 
Physical violence 
(N=13)
Any type 
of violence
10.1515/sjph-2017-0030 Zdr Varst 2017; 56(4): 220-226
223
violence simultaneously. Violence during pregnancy was 
experienced by 9.2% of respondents, most frequently 
by health care system. While most of the IPV is gender-
specific, meaning that most of the perpetrators are men, 
violence in health care is performed by both genders. 
Comparing to the national prevalence study on violence 
against women (11), our survey shows a slightly higher 
extent of physical violence (23% in national survey), 
significantly less psychological violence (49.9% in national 
survey), and a slightly higher extent of sexual violence 
(6.5%), which is the consequence of different methodology 
and age limits. The national study was asking for violence 
experienced after 15 years of age. The comparison is 
also difficult to make because some women experience 
more than one kind of violence at the same time, which 
is pointed out in the European survey on violence against 
women (18). 
3 RESULTS
In Table 2, we compare data on disclosure of any kind 
of violence. Approximately one third of respondents 
reported violence they experienced, but not all types 
of violence were reported at equal rate. Violence 
perpetrated by health care system was the least reported, 
in contrast to psychological violence, which was most 
frequently disclosed. Approximately half of respondents 
who reported every instance of violence most frequently 
reported violence experienced by health care system.
There are differences regarding which health worker they 
choose to disclose a specific type of violence. Table 3 
shows that while violence perpetrated by health workers 
is most often disclosed to the physician or the nurse at 
the primary level, other types of violence are more often 
reported to a psychologist, physician on a secondary or 
tertiary level, or a social worker, but not to a nurse. 
Table 4 shows that women speak about violence if 
asked about it by a physician. They more often report 
psychological violence, unlike about physical violence, 
which is rarely reported. 
The research shows differences in the extent of the 
severity of various types of violence (Table 5). Violence 
committed by health workers causes least consequences, 
and sexual violence caused severe consequences for more 
than half of women who experienced it. A significant 
proportion of women (32.5%) do not disclose sexual 
violence, but the suffering caused by it is severe. Some 
women who experienced violence did not ask for help: 
one tenth of those who experienced physical violence, 
one fifth of those who were psychologically abused, and 
one third of those who were sexually abused.
4 DISCUSSION
Disclosure is an essential step that enables various 
institutions to start with the procedures aimed at 
protecting victims against violence. However, many 
obstacles prevent victims from disclosing violence. 
Distrust, shame and fear affect women’s attitude towards 
various public services, and few women are willing to 
speak about violence. Women who have experienced 
violence seek health care due to physical injuries, 
but often they do not disclose the associated abuse or 
violence. ‘A health-care provider is likely to be the first 
professional contact for survivors of intimate partner 
violence or sexual assault. Statistics show that abused 
women use health-care services more than non-abused 
women do. […] Health professionals can provide assistance 
by facilitating disclosure; offering support and referral; 
providing the appropriate medical services and follow-
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224
up care; or gathering forensic evidence, particularly in 
cases of sexual violence’ (19). Research findings show 
the tendency to downplay violence as a problem issue. 
It has been shown that most victims presenting for social 
and health care are not asked about violence and do not 
receive attention or intervention (30).
Our research data show that approximately one third 
of women never disclose violence they experienced, 
while less than half of those who do report violence are 
willing to tell everything. 9.3% (counted together all ‘yes’ 
answers in Table 4), and 20.8% of respondents disclosed 
psychological, physical, or sexual violence in intimate 
relationships to health workers, while 44% disclosed 
violence perpetrated by health workers. Data points 
to a difference between IPV and institutional violence. 
Different research shows that women often tolerate 
violence in intimate partnership, fail to recognise it, find 
it difficult to resist, and even more difficult to leave such 
a relationship, because they frequently believe that the 
perpetrator loves them and that he will change (20). They 
seek reasons for violence in the problems of their partners, 
they tend to minimise the problem, and attribute it to 
their own behaviour (provoking the partner, refusing 
sex). Other reasons of staying in violent relationship 
include fear of retribution, a lack of alternative means 
of economic support, concern for the children, emotional 
dependence, a lack of support from family and friends, 
and an abiding hope that the partner will change (14). 
Reasons for disclosing the institutional violence differ from 
IPV. The primary common feature of each type of violence 
is a wish to gain power and control, regardless of whether 
it is committed in IPV or elsewhere. It is a means taken by 
the perpetrator to acquire power over other members of 
a society and subordinate them (21). It should be noted, 
Table 5.
Table 4.
Seeking help after experiencing violence.
Disclosing violence to a health worker.
No, since it did not cause 
much suffering
No, although I suffered a lot
Yes, I sought help
No
Yes, he already knew  
Yes, when he asked about it
Yes, I told it of my own will
44.7
30.3
25.0
80.4
3.9
9.8
5.9
83.8
11.5
4.7
56.0
8.3
10.7
25.0
55.6
24.0
20.4
79.2
2.8
7.3
10.7
70.7
18.4
10.9
90.7
2.3
2.9
4.1
% of seeking 
help
% of disclosure 
Sexual violence 
(N=76)
Sexual violence 
Violence by health care 
system (N=148)
Violence by health care 
system
Psychological violence 
(N=225)
Psychological violence
Physical violence 
(N=256)
Physical violence 
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225
however, that abuse in healthcare is defined by patients’ 
subjective experiences of encounters with the health care 
system, characterized by devoid of care, where patients 
suffer and feel they lose their value as human beings (22). 
Violence in health care is performed by men and women 
alike, and research shows that the most common forms 
of violence against women are neglect, verbal violence, 
including rough treatment, threats, scolding, shouting, 
and intentional humiliation, then physical violence, 
including denial of pain-relief when technically indicated, 
and sexual violence, which is similar to the forms of 
violence that occur in IPV (23). The main difference 
between IPV and institutional violence that leads to 
a higher percentage of reported violence perpetrated 
by medical staff in our survey is a lack of emotional 
attachment and, consequently, a lack of tolerance to such 
practices. The percentage of women in our survey that 
did not disclose violence committed by medical staff is 
the highest, which is a paradoxical situation that needs 
to be further examined, because it points to the specific 
relationship between a patient and a physician. Power 
relations and hierarchical structures are significant for 
medical institutions, not just between physicians and 
patients, but also between different medical professions. 
Patients often subordinate to physicians because of the 
awareness of hierarchal positions (24). Such patients 
internalize social hierarchy and subordinated positions, 
and develop fear of disclosure. Others do not have such 
fear; they understand mechanisms within power relations 
and are, accordingly, capable of resistance. They have 
trust in medical knowledge, expect professional attitude 
based on mutual respect, and respect for dignity even if 
the situation involves uneven power relations (23). They 
refuse to accept inappropriate institutional conduct 
regardless of their own position in the social hierarchy. 
They do not defy the social prestige associated with 
medical profession, but are convinced that prestige does 
not imply superiority over patients (24). 
Our research pointed to the difference between the 
disclosure of the IPV and of the violence within the health 
system, which is important when planning measures to 
prevent violence within health institutions. While physical 
and sexual violence in intimate partnerships is disclosed 
primarily to psychologists, physicians or social workers, 
violence perpetrated by medical staff is mainly disclosed 
to physicians and nurses. One of the reasons is that violence 
committed by health workers (excluding severe sexual or 
physical violence) does not cause as much suffering as 
violence in intimate partnership, so it is not reported to 
psychologists and social workers. Another reason is that 
in the case of violence perpetrated by health workers, 
the complaint procedure is better defined, which makes it 
easier for them to speak out. It is also important to stress 
that in our survey, physicians perpetrated the largest 
part of violence within the health system, so the victims 
speak about it to other health workers. This information 
is important in planning the ways to encourage disclosure 
of violence. Nonetheless, in the case of violence in health 
institutions, it is important to establish as independent as 
possible complaint procedures, and to ensure that IPV is 
reported in a personal contact with a physician. A nurse 
cannot pose questions about violence as part of routine 
inquiries before the patient encounters the physician. 
Much time and more visits are needed so that women 
can speak out, and in order to bring them to voice their 
problems, health workers’ attitude must be respectful, 
so that women are encouraged to disclose violence. They 
will not speak out unless they believe that it is safe to 
disclose violence. 
5 CONCLUSION 
Institutional violence undermines public good (25) that 
should provide every person with dignity and respect. 
Health care institutions (as much as educational, social, 
cultural and other) are responsible to treat people equally 
regardless of their personal circumstances, and to broaden 
their choices for dignified life. They should understand 
power relations that are incorporated in medical system 
as much as in the relationship between a patient and a 
physician. ‘However, addressing the problem of violence 
by health workers is necessary to support the efforts of 
dedicated staff who are committed to improving clinical 
practice’ (23). It is important to sensitize health care 
providers and encourage routine screening for abuse, as 
well as to draw up protocols for proper management of 
abuse (28, 29).
To maximize efficiency when identifying the victims of 
violence, health workers should persistently encourage 
women to speak about potential violence rather than 
asking about it only once. There are tools available to 
screen women for IPV during obstetric care (26) that can 
be adopted to Slovene situation. It is also important that 
such inquiries are made on different levels and not only in 
primary health institutions (27, 31). The WHO emphasises 
that it is the public health institutions that encounter 
almost all victims of violence, so their staff needs to 
be highly trained to recognize violence and effectively 
handle it. Accordingly, they should establish cooperation 
with other institutions trained to handle violence, 
which will enable them to avoid excessive burden that 
could reduce the likelihood of dealing suitably with the 
problem. It is important to sensitize health care providers 
and encourage routine screening for abuse, as well as 
to draw up protocols for proper management of abuse. 
Confronting deep-rooted beliefs and attitudes is also 
important. Research suggests that making procedural 
changes in patient care has the greatest effect on the 
behaviour of health care providers (14).
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226
CONFLICTS OF INTEREST
The authors declare that no conflicts of interest exist.
FUNDING
The research study did not receive funds. 
ETHICAL APPROVAL
Ethical approval was received by the National Medical 
Ethics Committee (no. 64/11/13). 
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