The insight gained from this study may be useful for midwifery care practices. The philosophy of midwifery care embraces respect for human dignity, individuality, and diversity among women receiving care, proving complete and accurate information to assist women in making informed decisions and involvement of the women’s designated family members in all health-care experiences (American College of Nurse Midwives [ACNM], 2010). The model of care promotes a partnership with the woman, acknowledging her life experiences and knowledge.
Midwifery care begins with comprehensive assessments, which should also include the women’s lifetime abuse experiences as well as current relationship status and partner abuse. Such assessments could occur during all phases of the women’s healthcare and is important for building trust and the women’s feelings of safety in disclosing abuse status to midwives. Midwifery care that offers focused counseling to provide women with accurate information about HIV testing and treatment options is important. The findings from this study suggested that women with this knowledge opted to get tested. Women also indicated that once knowing their status, they were motivated to initiate treatment, which was perceived as beneficial to their babies. Counseling could provide strategies to enhance social networks and empower women to safely disclose their HIV status and initiate HIV care and treatment interventions early.
The positive social support that the women reported they received from family and friends could have increased their motivation to perform health-promoting behaviors, which is supported in the HBM. Also important is the need for midwives to integrate the women’s spiritual beliefs and faith in motivating them to perform health-promoting behaviors. As this study demonstrated, women relied on their faith for strength to deal with the challenges they faced, as demonstrated in other studies (Minnie, Klopper, & Walt, 2008).
Midwives can also be active advocates for the healthcare policies that make comprehensive reproductive care available for all women. In an economy that threatens cuts to entitlement programs and other women’s health services, midwives can continue to advocate universal screening for intimate partner violence, and HIV testing and counseling, as part of women’s healthcare, including follow-up care for appropriate treatment options. This is critical given the high percentage of women in this study that reported lifetime abuse and who may have been unknowingly exposed to HIV.