Everyone knows about it, everyone knows how important it is, but the question is always: How?
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Department of Midwifery, fh gesundheit- health university of applied sciences tyrol, Innsbruck, Austria
Department of Public Health, UMIT Tirol, The Tyrolean Private University, Hall in Tirol, Austria
University of Klagenfurt, Klagenfurt, Austria
Medical University of Innsbruck, Innsbruck, Austria
UMIT Tirol. The Tyrolean Private University, Hall in Tirol, Austria
Publication date: 2023-10-24
Corresponding author
Martina König-Bachmann   

Department of Midwifery, fh gesundheit- health university of applied sciences tyrol, Innsbruck, Austria
Eur J Midwifery 2023;7(Supplement 1):A181
Good sexual and reproductive health implies a state of complete physical, mental and social well-being. It implies that individuals are able to lead satisfying and safe sexual lives by having the capacity to reproduce and the freedom to decide for themselves whether, when, and how often to reproduce1. Sex is a determinant factor of health2. Unequal power relations between men and women, social norms that reduce access to education and paid employment opportunities, an exclusive focus on women's reproductive role, and potential or actual experiences of physical, sexual, and emotional violence are sociocultural factors that prevent women and girls from accessing quality health services and thus achieving the best possible level of health3. One in three women between the ages of 18 and 74 in Austria has experienced physical or sexual violence within or outside of intimate partnerships during their adult lives4. In Austria, there is no statistical recording of abortions; it is assumed that a quarter to half of all women in Austria have an abortion performed once in their lives5. These issues are still taboo and stigmatised topics within society, which is reflected in particular in the healthcare system. The literature offers hardly any references or didactic forms and models that provide a methodological approach for integrating sensitive topics into general teaching in the course of healthcare professionals’ training. The goal is to build awareness and enable sensitivity in order to make taboo topics visible and manageable. Furthermore, the topics are to be understood as a mission within the framework of women’s health, in order to recognise and discuss them in a socio-political context. It is a major concern to help health professionals out of uncertainty and into security, in order to subsequently act adequately, mindfully with the respective affected persons* and to be able to offer rapid support services, if necessary. The health professionals’ own attitude to the topic and access to resources available to them also play a role. In the context of these considerations, the researchers have chosen the topics domestic violence and abortion for ‘social reasons’ from their own gender research. As part of this, backgrounds, contexts and needs on the part of women and healthcare professionals are made visible and models are developed from the results in each case, which are applicable to the healthcare professions and contribute to educational design in a broader sense. The focus is on the sensitivity of the two research topics, not on the fundamental comparability of the two. A similarity of approach is evident in the attitude. Everyone knows about it, everyone knows how important it is, but the question is always: How? How should the topic be addressed? How should and may this be implemented and reflected in the respective work? What networking possibilities are there despite the complexity that these vulnerable topics can entail? Healthcare workers are often helpless in the face of these different challenges, although professional help for the needs of women and families is expected from experts. “Efficient assistance requires a common knowledge base” according to Erdemgil Brandstätter. Common knowledge standards need to be implemented. In the best case, this can be achieved by including them in the curricula of healthcare training programmes and by implementing gender-sensitive teaching.

The primary goal was to identify the needs of women and healthcare professionals on the respective topics in order to establish possible algorithms of action/corresponding models of the two gender-guided topics as the secondary goal, helping to make these models more manageable for the women and the experts working in the healthcare sector. The tertiary concern is reflected in the establishment of the models a) in teaching at bachelor and master level on a disciplinary and interprofessional level and b) in the context of both face-to-face and online training events. This creates multipliers who live and pass on an open approach to the respective vulnerable topics.

Both research projects were based on qualitative data collection. The data collection on domestic violence took place from 2018–2022 in Tyrol/Austria. In order to determine the needs, wishes, best practices for networking and support of professionals working in women’s health, the data collection was divided into three phases. 1. At the start of the project, two focus groups (one group in an urban and one group in a rural area) with experts from violence protection institutions were conducted (n=10). The focus was to define common goals on domestic violence. Initial results were presented during a training on domestic violence planned by the research team. Subsequently, the experts from the focus groups volunteered to participate in a panel discussion in order to promote a dialogue and to minimise any fears or concerns healthcare professionals, in particular midwives, might have with regards to contacting violence protection experts. 2. In the next phase of the project, meet and greet events took place in five different districts in Tyrol (Innsbruck, Kufstein, Reutte, Lienz, Landeck). The group of participants consisted of midwives (n=20) and experts (n=24) from violence protection institutions, and the aim was to facilitate networking between midwives in practice and experts from specialised institutions in these districts in order to enable rapid and adequate mediation in practice when needed. The analyses were based on a thematic content analysis according to Mayring. After the meet and greet events, the research group developed guidelines based on theoretical knowledge, recent research on domestic violence and resilience, and the described needs, experiences from the meet and greet groups. 3. In a further step, another qualitative study design was implemented using semi-structured interviews (n=22) and a reflection on thematic analysis according to Braun and Clarke. The focus was on the one hand on the findings of the conducted meet and greet events, and on the other hand on the feedback on the brochure/guide “Let’s talk – guidelines for midwives on talking about violence”, which was developed in parallel to the project and made available to the participants. A qualitative cross-sectional study with semi-structured individual interviews with 26 women in German-speaking countries was conducted from March to November 2021 to investigate women’s motives for abortion and possible needs after abortion. This was preceded by a positive ethics vote from the Research Committee for Scientific Ethical Questions (RCSEQ 2815/20). The interviews were analysed using qualitative content analysis according to Mayring. Based on the results of the individual interviews, a model for dedicated care after abortion was developed. This was evaluated in January and February 2023 on the basis of expert interviews with midwives, gynecologists, social workers and psychotherapists. The expert interviews were evaluated using the qualitative content analysis according to Mayring. In both projects, all interviews were recorded and transcribed with the consent of the participants. MAXQDA software was used for data analysis.

The results of the survey on domestic violence showed that networking between professional groups in the context of pregnancy and violence is low. It was also found that midwives who received training on violence against women (VAW) were generally more perceptive of VAW. In order to enable midwives and other healthcare professionals to communicate about domestic violence with the women they care for and to reduce inhibitions such as apprehension and/or fear of raising this issue in practice, guidelines on talking about violence were developed using the findings. The guidelines are divided into four sections: preparation, questions, strengths and follow-up. Before asking questions about violence, enough time should be spent preparing. This includes attending a training on domestic violence, self-reflection on violence and self-care, and networking with violence prevention organisations in advance. To talk about domestic violence, consider conversation-opening questions in advance. When women report domestic violence, they should be empowered in what they can do and contacts with victim protection agencies should be facilitated. The follow-up is all about documenting the experiences and acceptance for the path that the woman subsequently takes for herself. The results on abortion for ‘social reasons’ show that the motives for which women decide to have an abortion are diverse, individually different and can be found in the After an abortion for ‘social reasons’, many women would like to be offered a voluntary, free and low-threshold follow-up consultation. They would like to be able to talk openly about this life event with empathetic and non-stigmatising professionals, as this does not seem possible for them in their private environment without experiencing stigma. The model of committed care after an abortion for ‘social reasons’ should contribute to the implementation of this follow-up consultation. The model for committed care after abortion consists of four pillars: attention, accountability, competence and resonance. In a state-organised healthcare system, responsibility for the legal and monetary design of care lies with the state (attention). Once a need for action is identified, implementation must be delegated to appropriate organisations (accountability). The caring activity itself, in the form of a psychosocial consultation service, is in the hands of trained professionals (competence). The model is a process defined by its interdependence. The fourth phase serves the evaluation, from which necessary changes in the implementation can result (resonance).

On the basis of the theoretical description and the results presented, a high need for preparation and pedagogical, didactic support for midwives and other healthcare professionals is evident in relation to sensitive, taboo and stigmatised topics. In connection with the presented topic areas, the question is how issues such as domestic violence and socially indicated abortion can be didactically mediated in order to replace uncertainty with security in healthcare services. Here in particular models and action algorithms are presented, which are to be integrated in the basic training of midwives, but also for advanced training and master programmes with an interprofessional approach circularly over the course of semesters and module units.

There are no conflicts of interests regarding the studies.
Part of the Study was funded by Tiroler Wissenschaftsförderung (TWF).
United Nations Population Fund. Sexual & reproductive Health. Published April 4, 2022. Accessed March 7, 2023.
Gaiswinkler S, Antony D, Delcou J, Pfabigan J, Pichler M, Wahl A. Frauengesundheitsbericht 2022. Bundesministerium für Soziales, Gesundheit, Pflege und Konsumentenschutz. 2023
World Health Organization. Women’s Health Published 2021. Accessed March 7, 2023.
Statistik Austria. Geschlechtsspezifische Gewalt gegen Frauen in Österreich: Prävalenzstudie beauftragt durch Eurostat und das Bundeskanzleramt. Published 2022. Accessed March 7, 2023.
Fiala C. Österreichischer Verhütungsreport 2012. 2012.
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