**3.4 The history of physical, emotional, sexual, social and economical abuse**

The problem faced by pregnant women is that the history of domestic violence that is generally experienced is not only one type, but multiple or even a pregnant woman has experienced two or more types of violence by her husband [8, 10, 17, 19]. The results obtained are that there are 2 pregnant women with a history of experiencing physical and sexual violence at the same time, there is one pregnant woman who is a victim of physical, emotional and economic violence, one person experiences sexual and social violence. As many as two pregnant women who admitted to experiencing physical and sexual violence at the same time in their lifetime, two pregnant women experienced a history of sexual and emotional violence, and the most pregnant women experienced economic violence. Thus, women at most experience more than one form of violence in their lives, especially physical, sexual and emotional violence, in addition to economic violence [19]. Women experience the most economic violence when compared to other forms of violence, such as sexual, physical, social, and emotional or psychological violence. In the picture below, an overlapping illustration of violence experienced by pregnant women in the last 12 months is shown (**Figure 1**).

The results of the study in India found that the most common type of violence reported was physical violence. The most common cause of domestic violence reported

**Figure 1.** *Overlapping of domestic violence experience among pregnant women In Denpasar City and Karangasem Regency.*

in our study was financial problems followed by influence under alcohol [32]. As many as 60% of women who reported having been threatened with violence in Uganda, but few reported acts of violence that had been experienced. The previous year, and very few reported acts of violence [9]. Thus, DV events experienced by women are in the form of more than one form of violence or multiple acts. This condition certainly has a bad impact on the health and welfare of women.

Husbands who were perpetrators of violence, when asked the reasons for beatings or engaging in sexual coercion, said that women must be educated properly by their husbands. Women must not violate the restrictions given by their husbands, as well as actions taken by their husbands as normal things to do. The explanation of this behavior is based on the WHO's ecological model framework theory. There are four levels that trigger it, namely: the individual level, personal relationships, community and societal factors. From the individual characteristics in Bali that are related to abusive behavior, they are men with low education level, low income, have a habit of drinking alcohol, live in the periphery or rural areas. Community and societal factors that trigger violence by men are patriarchal culture, family upbringing, and the existence of values that view violence is commonly committed by men. There have been no clear sanctions for perpetrators of violence. In this case, results from in-depth interviews with traditional leaders in Bali, it is found that there needs to be customary rules or "Awig-awig" for perpetrators of violence. Despite the fact, it takes a lot of hard work and a lot of money to make customary rules.

#### **3.5 Impact of domestic violence experience to women and babies wellbeing**

Pregnant women in Bali experience several forms of physical violence by their husbands, for example: beatings on the stomach, breasts and genitals which have a direct negative impact on their pregnancy [19]. In other words, the act of DV especially physical violence against pregnant women, increases the negative risk during pregnancy by 2 times [3, 4, 8, 17, 19, 25, 32–36]. The main health or psychological problems faced by pregnant women especially poor appetite, easily tired/ feeling tired, frequent headaches, sleep disturbances and tired/tired all the time, had thought of committing suicide and thought of ending life [19]. That acute stress levels are related to the incidence of cardiovascular disease, hypertension, gastrointestinal disorders, chronic pain and diabetes. Stress during pregnancy is associated with the birth of low birth weight babies (LBW) as a result of increased cortisol levels which stimulate constriction of blood vessels that restrict blood flow to the uterus. Thus, the hypothalamic–pituitary-and adrenal response as a trigger or trigger of preterm labor and preterm birth, through the contraction of the smooth muscle tissue in the uterus [36]. Exposure of prenatal stress can have negative longlasting impacts on health and disease susceptibility [4, 6–8, 19, 23, 26, 27, 34–37]. Acts of violence or abuse by an intimate partner can cause physical trauma, psychological trauma, and fear of women who are victims [38–40]. Physical trauma is experienced from mild to severe, which affects the disability and death of women. Physical disorders or trauma affect the mental health conditions of victims/women in the form of post-traumatic stress disorder, anxiety, depression, eating disorders and suicidal thoughts [3]. Sub-ordination in Bali has an impact on decision making in choosing the place of delivery, who is the delivery assistant and other preparations when facing pathological conditions and/or emergencies during pregnancy and childbirth. Decision making is mostly determined by husbands and in-laws. The wife can only be the recipient of this decision. This has an impact on delays in referral efforts and acts to save mothers and their babies, so that the morbidity and mortality rates for mothers and babies are still high.

*Domestic Violence in Pregnant Women and Their Types. Case Study in Bali, Indonesia DOI: http://dx.doi.org/10.5772/intechopen.98669*

Domestic violence is a global issue that requires extraordinary efforts from various components to overcome it. DV problem solving starts from individual, family, group and community lines. Broad-scale research in the field of gender issues, especially domestic violence, is expected to be able to open up insights and commitments from policy holders related to gender. Women who have been physically or sexually abused by their partners report higher rates of a number of important health problems [3]. According to The Legal Aid Foundation of the Indonesian Women's Association for Justice in 2020, found that strong patriarchal norms and conservative religious values that put men above women. Including the patriarchal culture in Hindu society in Bali which indirectly perpetuates acts of violence against women both in the domestic and public sphere.

#### **3.6 Policies and roles of midwives to eliminate incidents of violence against women**

The Indonesian government issued a law related to the elimination of domestic violence in 2004, which was followed by a 2009 Minister of Health decree on Guidelines for the Management of Integrated Services for Victims of Violence against Women and Children in Hospitals. The personnel or officers who have responsibility and competence in providing services to victims of violence are: 1) a forensic specialist/psychiatrist/other specialist doctor; 2) trained general practitioners; 3) midwife/nurse; 4) psychologist; 5) social workers; and 6) other health workers in the form of administrative personnel and medical records.

Midwives have a strategic role in early detection and provide assistance to pregnant women victims of violence. Midwives are health professionals who are at the forefront of maternal and child health services. Since the last decade, the issue of violence against women has been rolled out and has become a national issue. The midwife has a strategic role because pregnant women are the first to be contacted by a pregnant woman in a health care facility. Midwives with the motto as friends of women will be able to dig up more data and early detection of these incidents of violence. Screening is the right step for health workers. Screening is carried out with adequate instruments and in accordance with the local socio-culture [41].

Midwives in Bali have been given training several times regarding early detection of incidents of violence against pregnant women and referral measures, as part of integrated services in basic health care facilities. The problem is that the training activities have not been evenly distributed to all midwives on duty, so that the problem of violence against women, especially pregnant women, has not been optimally resolved. The effort of midwifery education institutions is to include the topic of gender issues and violence against women in the midwifery education curriculum, especially reproductive health. Introducing midwife students is a strategic effort as a provision in providing services in their place of duty.

Researchers in the field of reproductive health and maternal and child health have attempted to carry out various studies related to gender issues, especially the incidence of violence against women and disseminate the results of the study widely. The main obstacle in accelerating the reduction in the incidence of violence against women, especially pregnant women, is that there is no clear and sustainable policy from policy makers regarding the elimination of incidents of violence against women.

In the case in Bali, women victims of domestic violence were given explanations and were guided in efforts to save themselves and seek help when they were in a situation that threatened their safety. An important and simple trick is the most appropriate step in addition to empowering community organizations in customary villages.
