**4. Summary and recommendation**

Balinese women are born to carry out their duties and responsibilities to become obedient, loyal and devoted women to God, ancestors, in-laws, husbands, children and their parents. That is the full responsibility of Balinese women in the family, even though sacrifice has never been properly interpreted.

Violence against women is a serious violation of human rights, because it has a negative impact on the health and welfare of women. Violence against women undermines the dignity of women as human beings. The cause of domestic violence incidents is influenced by individual, family, community and societal factors. The ecological framework of the model can explain in detail the influence of these factors on the incidence of DV. Economic abuse and emotional/psychological abuse are the most common forms of DV experienced by pregnant women in Bali. The type of abuse experienced is more of multiple abuse.

There are various reasons why health services have a critical role in helping women victims of violence. Women victims of DV will use health facilities more often, and health workers are the professionals who first make contact with victims. The most common and the most severe form of violence against women, can occur in a variety of settings. The incidence of DV is taboo to tell, in fact women are often blamed for various incidents of sexual violence they have experienced.

The role of midwives is very strategic in preventing and early detection of incidents of violence against women, especially during pregnancy, because it has a negative impact on the health and well-being of pregnant women and their fetuses. Cooperation across sectors, programs and laws and regulations that clearly regulate efforts to eliminate incidents of violence against women is urgently needed. There must be synergy between policy makers, community or traditional leaders, health care institutions and midwifery education institutions in the effort to eliminate acts of violence against women.

### **Acknowledgements**

The author would like to thank: Head of the Health Research and Development Agency, Center for Humanities, Health Policy and Community Empowerment, Surabaya; Prof. Anom Umbara, from Udayana University as research consultant; and Prof. dr. M. Hakimi.
