‘They aren't really black fellas but they are easy to talk to’: Factors which influence Australian Aboriginal women's decision to disclose intimate partner violence during pregnancy Jo Spangaro, PhD, B Soc Stud (Hons) a,n , Sigrid Herring, B Ed, Adv Dip Aboriginal Specialist Trauma Counselling b , Jane Koziol-Mclain, PhD, FCNA (NZ), RN c , Alison Rutherford, BMed MA MPH FAFPHM FAChSHM d , Mary-Anne Frail, Adv Dip Aboriginal Specialist Trauma Counselling a , Anthony B. Zwi, MB, BCh, MSc, PhD a a School of Social Sciences, University of New South Wales, Sydney, NSW 2052, Australia b NSW Education Centre Against Violence, Locked Bag 7118, Parramatta BC, NSW 2150, Australia c Centre for Interdisciplinary Trauma Research, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand d School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia article info Article history: Received 24 March 2016 Received in revised form 4 August 2016 Accepted 5 August 2016 Keywords: Culture Cultural safety Disclosure Indigenous health services Intimate partner violence Midwifery abstract Objectives: intimate partner violence is a significant global health problem but remains largely hidden. Understanding decisions about whether or not to disclose violence in response to routine enquiry in health settings can inform safe and responsive systems. Elevated rates of violence and systematic dis- advantage found among Indigenous women globally, can impact on their decisions to disclose violence. This study aimed to test, among Indigenous women, a model for decisions on whether to disclose in- timate partner violence in the context of antenatal routine screening. Design: we employed Qualitative Configurative Analysis, a method developed for the social sciences to study complex phenomena with intermediate sample sizes. Data were drawn from single semi- struc- tured interviews with Indigenous women 28 þ weeks pregnant attending antenatal care. Interviews addressed decisions to disclose recent intimate partner violence in the context of routine enquiry during the antenatal care. Interview transcripts were binary coded for conditions identified a priori from the model being tested and also from themes identified within the current study and analysed using Qua- litative Configurative Analysis to determine causal conditions for the outcome of disclosure or non- disclosure of violence experienced. Settings: five Aboriginal and Maternal Infant Health Services (two urban and three regional), and one mainstream hospital, in New South Wales, Australia. Participants: indigenous women who had experienced partner violence in the previous year and who had been asked about this as part of an antenatal booking-in visit. Of the 12 participants six had elected to disclose their experience of violence to the midwife, and six had chosen not to do so. Findings: pathways to disclosure and non-disclosure were mapped using Qualitative Configurative Analysis. Conditions relevant to decisions to disclose were similar to the conditions for non-Aboriginal women found in our earlier study. Unique to Aboriginal women's decisions to disclose abuse was cultural safety. Cultural safety included elements we titled: Borrowed trust, Build the relationship first, Come at it slowly and People like me are here. The absence of cultural safety Its absence was also a factor in decisions not to disclose experiences of violence by this group of women. Key conclusions: cultural safety was central to Indigenous women's decision to disclose violence and processes for creating safety are identified. Other forms of safety which influenced disclosure included: safety from detection by the abuser; safety from shame; and safety from institutional control. Disclosure was promoted by direct asking by the midwife and a perception of care. Non-disclosure was associated Contents lists available at ScienceDirect journal homepage: www.elsevier.com/midw Midwifery http://dx.doi.org/10.1016/j.midw.2016.08.004 0266-6138/Crown Copyright & 2016 Published by Elsevier Ltd. All rights reserved. n Corresponding author. E-mail addresses: j.spangaro@unsw.edu.au (J. Spangaro), Sigrid.Herring@health.nsw.gov.au (S. Herring), jane.koziol-mclain@aut.ac.nz (J. Koziol-Mclain), a.rutherford@unsw.edu.au (A. Rutherford), m.frail@unsw.edu.au (M.-A. Frail), a.zwi@unsw.edu (A.B. Zwi). Midwifery 41 (2016) 79–88