Dilemmas and opportunities for an appropriate health-service response to violence against women

Women's health and rights in the twenty-first century

In the twenty-first century, the complex relationship between women's health and rights has been influenced by a range of interconnected challenges, including gender inequity, reproductive health disparities, maternal mortality and morbidity, and women's inability to access life-saving, high-quality healthcare services including family planning. Going forward, the world needs to find ways to implement the unfinished agenda of the International Conference on Population and Development (ICPD) 1994 and the Sustainable Development Goals (SDGs), thus prioritizing health and rights for women and girls as essential not only to their survival but also to their progress, agency and empowerment. It is also important to consider the interconnection between women's health and rights and climate change, with its disproportionate impact on the well-being of girls and women, and to address the impact and opportunities afforded by digital technologies. By embracing a holistic approach, societies might be able to advance the cause of women's health and rights in a more inclusive and sustainable manner.

The Role of Structural Factors in Support-Seeking Among Women Experiencing Intimate Partner Violence (IPV) in Mwanza, Tanzania: Findings From a Qualitative Study

In this qualitative study of women participating in an intimate partner violence (IPV) prevention trial, experiences of IPV and the context that shapes support-seeking were explored through in-depth interviews and focus groups discussions. Decisions to seek support were influenced by a range of factors including fear of further abuse, shame, acceptance of IPV as normal, belief that IPV is a private matter between the couple, economic dependence on male partners, and a poorly responsive legal and justice system. Gender empowerment programs need to intervene at the social, cultural, political, and economic levels that shape justification and meanings attached to IPV and women's decisions in seeking support.

The Effect of an Intimate Partner Violence Against Women Training Program Based on the Theory of Planned Behavior on the Approaches of Nurses and Midwives: A Randomized Controlled Study

The aim of this study was to analyze the effect of intimate partner violence against women training program based on the theory of planned behavior on nurses' and midwives' approaches of violence. A randomized controlled trial was performed at nurses and midwives in Turkey, between December 2016 and August 2017. The participants were separated into an intervention group (n = 50) and control group (n = 49). According to the result of study, training given to the intervention group was more effective in increasing the intimate partner violence attitudes, practices, and reporting compared to the control group. These results show that this training program effectively developed the nurses' and midwives' approaches about intimate partner violence against women.

Coping with intimate partner violence and the COVID-19 lockdown: The perspectives of service professionals in Spain

Socioeconomic crisis and humanitarian disasters can cause increased stress for women who experience inter-partner violence (IPV). This study analyzed the impact of the COVID-19 lockdown on this important issue, their related health and social services and working conditions from the perspectives of professionals in different sectors. Forty-three semi-structured interviews were carried out with 47 professionals (44 women and 3 men) from 40 different entities (September 2020-April 2021). This content analysis suggests that the pandemic and its associated prevention measures have had a negative impact on women exposed to IPV and their children, which affected their social wellbeing. Professionals described burnout, difficult and slow administrative processes, and problems with coordination and access to information. These negative impacts were mitigated, in part, by the work of professionals, but this suggests that a series of key strategies are needed to improve the response capacity of the service sector to IPV in situations of crisis. These improvements are related to the availability of human and material resources; an efficient coordination network between the professionals from different sectors; existence of informal support networks in the community; protocols/procedures and prior training for better implementation; and greater flexibility and accessibility of basic services that benefit women who experience IPV.

Addressing Intimate Partner Violence Using Gender-Transformative Approaches at a Community Level in Rural Tanzania: The UZIKWASA program

Intimate partner violence (IPV) is recognized as an important public health and social problem, with far-reaching consequences for women's physical and emotional health and social well-being, yet little is known about how behavior change campaigns (BCCs) affect this type of behavior and other related abuses in Tanzania and in other sub-Saharan African countries. UZIKWASA is a civil society organization based in Pangani District in coastal Tanzania and since 2009 has conducted BCCs focused on promoting gender justice and effective leadership. As with other complex programs there is a question about how such approaches affect norms and practice in relation to violence against women and girls. Drawing on longitudinal research utilizing more than 1000 community diary entries (hearsay ethnographies) and qualitative methods using 20 in-depth interviews and 16 focus group discussions with women and men, and adolescent girls and boys, this article explores the ways in which UZIKWASA's program effects change. The findings reveal personal and community narratives about gender-based and IPV as forms of retributive justice and assertion of authority by men. Drawing on gender performance as an explanation for violence, the research revealed changes in norms and practice in relation to violence against women and girls. Thus, we argue that UZIKWASA is gender-transformative by addressing gender norms and the critical awareness among leaders and the community of the social construction and reconstruction of gender that creates the context for real impact on changes in behavior.

Training healthcare providers to respond to intimate partner violence against women

BACKGROUND

Intimate partner violence (IPV) includes any violence (physical, sexual or psychological/emotional) by a current or former partner. This review reflects the current understanding of IPV as a profoundly gendered issue, perpetrated most often by men against women. IPV may result in substantial physical and mental health impacts for survivors. Women affected by IPV are more likely to have contact with healthcare providers (HCPs) (e.g. nurses, doctors, midwives), even though women often do not disclose the violence. Training HCPs on IPV, including how to respond to survivors of IPV, is an important intervention to improve HCPs' knowledge, attitudes and practice, and subsequently the care and health outcomes for IPV survivors.

OBJECTIVES

To assess the effectiveness of training programmes that seek to improve HCPs' identification of and response to IPV against women, compared to no intervention, wait-list, placebo or training as usual.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase and seven other databases up to June 2020. We also searched two clinical trials registries and relevant websites. In addition, we contacted primary authors of included studies to ask if they knew of any relevant studies not identified in the search. We evaluated the reference lists of all included studies and systematic reviews for inclusion. We applied no restrictions by search dates or language.

SELECTION CRITERIA

All randomised and quasi-randomised controlled trials comparing IPV training or educational programmes for HCPs compared with no training, wait-list, training as usual, placebo, or a sub-component of the intervention.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures outlined by Cochrane. Two review authors independently assessed studies for eligibility, undertook data extraction and assessed risks of bias. Where possible, we synthesised the effects of IPV training in a meta-analysis. Other analyses were synthesised in a narrative manner. We assessed evidence certainty using the GRADE approach.

MAIN RESULTS

We included 19 trials involving 1662 participants. Three-quarters of all studies were conducted in the USA, with single studies from Australia, Iran, Mexico, Turkey and the Netherlands. Twelve trials compared IPV training versus no training, and seven trials compared the effects of IPV training to training as usual or a sub-component of the intervention in the comparison group, or both. Study participants included 618 medical staff/students, 460 nurses/students, 348 dentists/students, 161 counsellors or psychologists/students, 70 midwives and 5 social workers. Studies were heterogeneous and varied across training content delivered, pedagogy and time to follow-up (immediately post training to 24 months). The risk of bias assessment highlighted unclear reporting across many areas of bias. The GRADE assessment of the studies found that the certainty of the evidence for the primary outcomes was low to very low, with studies often reporting on perceived or self-reported outcomes rather than actual HCPs' practices or outcomes for women. Eleven of the 19 included studies received some form of research grant funding to complete the research. Within 12 months post-intervention, the evidence suggests that compared to no intervention, wait-list or placebo, IPV training: · may improve HCPs' attitudes towards IPV survivors (standardised mean difference (SMD) 0.71, 95% CI 0.39 to 1.03; 8 studies, 641 participants; low-certainty evidence); · may have a large effect on HCPs' self-perceived readiness to respond to IPV survivors, although the evidence was uncertain (SMD 2.44, 95% CI 1.51 to 3.37; 6 studies, 487 participants; very low-certainty evidence); · may have a large effect on HCPs' knowledge of IPV, although the evidence was uncertain (SMD 6.56, 95% CI 2.49 to 10.63; 3 studies, 239 participants; very low-certainty evidence); · may make little to no difference to HCPs' referral practices of women to support agencies, although this is based on only one study (with 49 clinics) assessed to be very low certainty; · has an uncertain effect on HCPs' response behaviours (based on two studies of very low certainty), with one trial (with 27 participants) reporting that trained HCPs were more likely to successfully provide advice on safety planning during their interactions with standardised patients, and the other study (with 49 clinics) reporting no clear impact on safety planning practices; · may improve identification of IPV at six months post-training (RR 4.54, 95% CI 2.5 to 8.09) as in one study (with 54 participants), although three studies (with 48 participants) reported little to no effects of training on identification or documentation of IPV, or both. No studies assessed the impact of training HCPs on the mental health of women survivors of IPV compared to no intervention, wait-list or placebo. When IPV training was compared to training as usual or a sub-component of the intervention, or both, no clear effects were seen on HCPs' attitudes/beliefs, safety planning, and referral to services or mental health outcomes for women. Inconsistent results were seen for HCPs' readiness to respond (improvements in two out of three studies) and HCPs' IPV knowledge (improved in two out of four studies). One study found that IPV training improved HCPs' validation responses. No adverse IPV-related events were reported in any of the studies identified in this review.

AUTHORS' CONCLUSIONS

Overall, IPV training for HCPs may be effective for outcomes that are precursors to behaviour change. There is some, albeit weak evidence that IPV training may improve HCPs' attitudes towards IPV. Training may also improve IPV knowledge and HCPs' self-perceived readiness to respond to those affected by IPV, although we are not certain about this evidence. Although supportive evidence is weak and inconsistent, training may improve HCPs' actual responses, including the use of safety planning, identification and documentation of IPV in women's case histories. The sustained effect of training on these outcomes beyond 12 months is undetermined. Our confidence in these findings is reduced by the substantial level of heterogeneity across studies and the unclear risk of bias around randomisation and blinding of participants, as well as high risk of bias from attrition in many studies. Further research is needed that overcomes these limitations, as well as assesses the impacts of IPV training on HCPs' behavioral outcomes and the well-being of women survivors of IPV.

[Proposals for approaching violence against women in health care. A qualitative analysis]

OBJECTIVE

Identify improvement proposals for approaching violence against women through the evaluation of 2009s Protocol for approaching Violence Against Women in Health Care in Cataluña (PAVIM).

DESIGN

Qualitative ethnographic study, 2019.

SETTING

Public Health Care in Catalonia.

PARTICIPANTS

One hundred eighty one participants, of which: 104 health care professionals, 43 women's associations and/or experts in violence against women and 34 experts on health and violence against women.

METHOD

Intentional sampling. Eighteen focus groups and 34 semi-structured interviews. Evaluation with a gender and intersectional perspective.

RESULTS

Results are structured along PAVIM's phases.

PREVENTION

mandatory and institutionally recognized training for the whole professional team, with a gender and intersectional perspective. Detection: diagnostic code standardization for violence against women and improve coordination between primary care, emergency service, pediatrics and Assistance to Sexual and Reproductive Health. Care and recovery: territorial equity in the applied resources on cases of violence against women care (in the 9 sanitary regions of Catalonia) and improves communication between health and associative fields.

CONCLUSIONS

The improvement proposals identified are those that have generated a greater consensus among participants and are the most interesting to primary care. As limitations, stand out the temporality and heterogeneity of the Catalan territory.

Perception of Women with Lived Experience of Domestic Violence and Abuse on the Involvement of the Dental Team in Supporting Adult Patients with Lived Experience of Domestic Abuse in England: A Pilot Study

While there is existing evidence highlighting the important roles of health care professionals and the health care system in supporting patients with lived experience of domestic violence and abuse (DVA), there is a dearth of knowledge on the perception of dental patients on the involvement of the dental team, as health care professionals, in supporting adult patients experiencing domestic abuse. Data were collected from 24 women withs lived experience of domestic abuse using mixed methodological approaches and analysed using relevant analytic techniques. Results from this pilot study show that patients want to be asked about their experience of domestic abuse. Although there were barriers to disclosing to the dentist, evidence from this pilot study highlights that the dental practice is an avenue that can be used for appropriately signposting patients to relevant services. Evidence from this pilot study contributes to the existing knowledge on the need to raise awareness among the patient population with lived experience of DVA that the dental team can support them. In addition, there is a need for on-going training to enhance the capacity of the dental team for appropriately supporting their adult patients with lived experience of DVA.

Physical and mental health of women exposed to intimate partner violence in the 10 years after having their first child: an Australian prospective cohort study of first-time mothers

OBJECTIVE

To investigate mental and physical health of mothers exposed to recent and early postpartum intimate partner violence (IPV) in the 10 years after having their first child.

DESIGN

Prospective pregnancy cohort study.

SETTING

Women were recruited at six metropolitan public maternity hospitals in Melbourne, Australia and followed up at 1, 4 and 10 years post partum.

STUDY MEASURES

Exposure to physical and/or emotional IPV was measured using the Composite Abuse Scale at 1, 4 and 10 years. At 10-year follow-up, mothers reported on physical and mental health, and functional health status.

PARTICIPANTS

1507 first-time mothers enrolled at mean of 15 weeks' gestation.

RESULTS

One in three women experienced IPV during the 10 years after having their first child. Women experiencing recent IPV (19.1%) reported worse physical and mental health than women not reporting IPV. Compared with women not reporting IPV, women experiencing recent IPV had higher odds of poor functional health status (Adj OR=4.5, 95% CI 3.2 to 6.3), back pain (Adj OR=2.0, 95% CI 1.4 to 2.9), incontinence (Adj OR=1.8, 95% CI 1.2 to 2.6), depressive symptoms (Adj OR=4.9, 95% CI 3.2 to 7.5), anxiety (Adj OR=5.1, 95% CI 3.0 to 8.6) and post-traumatic stress symptoms (Adj OR=7.2, 95% CI 4.6 to 11.1) at 10 years. Women with past IPV at 1 and/or 4 years (15.7% of the cohort) also had higher odds of physical and mental health problems. There was evidence of a gradient in health outcomes by recency of exposure to IPV.

CONCLUSIONS

Both recent and past exposure to IPV are associated with poor maternal physical and mental health 10 years after a first birth. Health services and advocacy organisations providing support to women need to be aware of the consistent relationship between IPV and a range of physical and mental health conditions, which may persist even after IPV appears to have ceased.

Usability of two brief questions as a screening tool for domestic violence and effect of #MeToo on prevalence of self-reported violence

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Domestic violence is a major public health problem that violates human rights.

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In long-lasting and frequent violence, the victim is usually a woman.

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Being a victim of domestic violence is a highly intimate and stigmatising experience and thus difficult to screen.

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Even broad social media movements such as #MeToo do not necessarily facilitate screening.

Objective

Domestic violence is a hidden epidemic. We used a two-question screening tool to explore the prevalence of domestic violence among gynaecological outpatients. We also retrospectively assessed whether there was a change in the prevalence rate of self-reported violence after the launch of the #MeToo movement.

Study design

Over an 11-month period, all gynaecological first-time visitors to our outpatient clinic were asked two dichotomous questions that screened for domestic violence and examined whether the violence had an ongoing impact on the respondent’s everyday life. We used logistic regression models to assess whether the launch of #MeToo was associated with the answers to these two questions.

Results

Of the 6,957 screened women, 154 (2.2 %) tested positive for domestic violence. Among the screen-positive women, 87 (56.5 %) reported that the violence affected their health and well-being. Of these 87 women, 52.9 % wanted further support and 72.4 % had already contacted psychiatric care. Out of all of the patients, the proportion of screen-positive respondents was 2.3 % before and 2.2 % after #MeToo. We did not detect increased odds of self-reporting domestic violence (odds ratio 0.97, 95 % confidence interval 0.70–1.36) or its ongoing impact on the victim’s everyday life (odds ratio 1.05, 95 % confidence interval 0.53–2.07) after #MeToo.

Conclusions

Our two-question screening tool detected a lower prevalence of domestic violence among gynaecological outpatients than previous reports examining the general population. Our results illustrate the dire challenges in screening for domestic violence that persist even in the post-#MeToo era. Domestic violence remains a highly intimate, stigmatising, and underreported health issue, and systematic measures to screen for and prevent it should be advocated, both in gynaecological patients and the general population.

Intimate partner violence and maternal mental health ten years after a first birth: An Australian prospective cohort study of first-time mothers

BACKGROUND

We aimed to assess the relationship between intimate partner violence (IPV) and maternal mental health ten years after a first birth METHODS: 1507 first-time mothers completed questionnaires at 3, 6, 12 and 18 months postpartum and 4 and ten years post the index birth. Exposure to IPV was assessed using the Composite Abuse Scale at 1, 4 and ten years. Standardised measures of depressive (CES-D), anxiety (BAI) and post-traumatic stress symptoms (PCL-C) were completed at ten-year follow-up.

RESULTS

One in three (34%) women experienced IPV between the birth of their first child and their child turning 10. For the one in six women (18.6%) who experienced IPV in the year prior to ten-year follow-up, the prevalence of depressive symptoms was 38.9% compared with 14.2% for women who never reported IPV (adjusted odds ratio [AdjOR] 2.9, 95% confidence interval [CI] 1.9-4.5). Prevalence of anxiety symptoms was 28.1% compared with 8.5% (AdjOR 3.4, 95% CI 2.0-5.9); and prevalence of post-traumatic stress symptoms was 41.9% compared with 11.3% (AdjOR 4.9, 95% CI 3.0-7.9).

LIMITATIONS

Mental health symptoms and exposure to IPV were assessed by self-report and may be subject to misclassification bias as a result of non-disclosure.

CONCLUSIONS

The high prevalence of mental health symptoms among women exposed to IPV in the ten years after giving birth coupled with the extent of post-traumatic stress symptoms and co-morbid mental health symptoms reinforce the need to provide appropriate care and referral pathways to women in the decade after having a baby. Recognition of the context of IPV and nature of mental health concerns is needed in tailoring responses.

Using Digital Technology for Sexual and Reproductive Health: Are Programs Adequately Considering Risk?

Digital technologies provide opportunities for advancing sexual and reproductive health and services but also present potential risks. We propose 4 steps to reducing potential harms: (1) consider potential harms during intervention design, (2) mitigate or minimize potential harms during the design phase, (3) measure adverse outcomes during implementation, and (4) plan how to support those reporting adverse outcomes.

Screening for partner violence in the early postpartum period: are we missing families most at risk of experiencing violence?

OBJECTIVES

In Manitoba, government policy is for public health nurses to screen families with newborns within 1-week post-discharge for risk factors associated with poor child developmental health. The purpose of this study was to compare the characteristics of families who are screened for intimate partner violence (IPV) with families without a documented response to an IPV screen item. This information can be used to help identify and target families in need of support whose needs are not being met within the current system.

METHODS

Manitoban women giving birth to a live singleton in the province from January 1, 2003 to December 31, 2006 were included in the analyses (N = 52,710). Data were part of a larger research study following these families for several years to examine longer-term developmental outcomes. Administrative databases from the Manitoba Centre for Health Policy provided data for the study. Descriptive statistics and logistic regression were used to examine relationships between IPV screen status and socio-demographic covariates and birth outcomes.

RESULTS

In the study population, 66.7% of the sample were screened for IPV. Women less than 20 years of age, not in married or common-law unions, and living in lower income areas were less likely to have a documented response to the IPV screen item. A low number of prenatal care visits, prenatal mental health problems, and prenatal substance use, as well as premature and low birthweight delivery, were associated with a decreased likelihood of having a documented response to the IPV screen item.

CONCLUSION

Incorporating violence screening into routine prenatal and postnatal care, rather than only screening women after birth, may help to better identify families with unmet needs and ensure more timely referrals to positive strengths-based supports and services.

Healthcare Professionals' Perceptions and Concerns towards Domestic Violence during Pregnancy in Southern Italy

BACKGROUND

Literature on pregnancy highlighted a large number of women abused by their partners, especially among low-income teenagers attending hospital for pregnancy check-ups. Pregnancy represents a key moment for diagnosing domestic violence.

METHOD

This study explores health professionals' perceptions and concerns about domestic violence against women in services dealing with pregnant women. The twenty-four interviewees were from an Obstetrical-Gynecological walk-in Clinic in the south of Italy. The textual data has been complementarily analyzed by means of two different procedures: Symbolic-structural semiotic analysis and Thematic content analysis.

RESULTS

What emerges is that the interviewees of the clinic do not regard the issue of domestic violence as a matter of direct interest for the health service. The clinic is seen as a place for urgent contact, but one where there is not enough time to dedicate to this kind of patient, nor an adequate space to care for and listen to them. Obstetricians and health personnel expressed a negative attitude when it comes to including questions regarding violence and abuse in pre-natal reports. Training for health and social professionals and the empowering of institutional support and networking practices are needed to increase awareness of the phenomenon among the gynecological personnel.

A qualitative exploration of 'thrivership' among women who have experienced domestic violence and abuse: Development of a new model

BACKGROUND

Domestic violence and abuse (DVA) is a serious public health issue, threatening the health of individuals the world over. Whilst DVA can be experienced by both men and women, the majority is still experienced by women; around 30% of women worldwide who have been in a relationship report that they have experienced violence at the hands of their partner, and every week in England and Wales two women are killed by their current or ex-partner. The purpose of this study was to explore the concept of thrivership with women who have experienced DVA, to contribute to our understandings of what constitutes 'thriving' post-abuse, and how women affected can move from surviving to thriving.

METHODS

Thirty-seven women took part in this qualitative study which consisted of six focus groups and four in-depth interviews undertaken in one region of the UK in 2018. Data were analysed using a thematic analysis approach. Initial findings were reported back to a group of participants to invite respondent validation and ensure co-production of data.

RESULTS

The process of 'thrivership' - moving from surviving to thriving after DVA - is a fluid, non-linear journey of self-discovery featuring three 'stages' of victim, survivor, and thriver. Thriving after DVA is characterised by a positive outlook and looking to the future, improved health and well-being, a reclamation of the self, and a new social network. Crucial to ensuring 'thrivership' are three key components that we propose as the 'Thrivership Model', all of which are underpinned by education and awareness building at different levels: (1) Provision of Safety, (2) Sharing the Story, (3) Social Response.

CONCLUSIONS

The study findings provide a new view of thriving post-abuse by women who have lived through it. The proposed Thrivership Model has been developed to illustrate what is required from DVA-services and public health practitioners for the thrivership process to take place, so that more women may be supported towards 'thriving' after abuse.

A Self-Management Training Intervention: Perceptions and Practices of Community Health Workers in South Africa

Background. While community health workers (CHWs) are increasingly being used as a strategy for increasing health care access, particularly in rural communities, interventions are needed to improve their skill sets in inspiring health behavior change, both for themselves and among their community clients. Self-management (SM) education interventions have shown to improve health behaviors and well-being. Purpose. This article reports on systematic, in-depth interviews conducted with rural CHWs in South Africa to understand (1) their motivation for participating in SM training, (2) skills gained from training and (3) perceived impact of training on CHW health behavior, both personally and as health professionals. Method. Nineteen rural CHWs who completed an SM training participated in face-to-face semistructured interviews. Transcripts were independently coded by two researchers using the thematic framework approach. Findings. CHWs felt empowered to change their health behavior by skills such as goal setting and action planning, and by growth in self-awareness and confidence. They expressed that their desire to help others motivated them to participate in SM training. Conclusion. SM training programs that address practice skill gaps hold promise in producing health behavior changes for rural CHWs and their clients.

Intimate partner violence and abuse against Nigerian women resident in England, UK: a cross- sectional qualitative study

BACKGROUND

Intimate partner violence and abuse is a public health problem affecting more than one third of all women globally. It usually takes place between individuals in intimate relationships and/or within the family. In the United Kingdom (UK), while theoretical and policy interventions have led to an increase in intimate partner violence and abuse service provision for women, there is paucity of research on the disclosure and help-seeking practices of women from ethnic minority populations.

METHODS

A cross-sectional qualitative research design was utilised. This included individual, in-depth semi-structured interviews with Nigerian women (n = 16) resident in England with lived experience of intimate partner violence and abuse. The interviews were conducted between May 2012 and May 2013, and data were analysed using thematic analysis technique.

RESULTS

Three main themes were identified as factors influencing the disclosure and help-seeking practices of Nigerian (ethnic minority population) women in England, UK. These are socialisation from country of birth, immigration status, and acculturation in the country of immigration.

CONCLUSIONS

Nigerian (ethnic minority populations) women resident in England with lived experience of abuse are likely to seek help from leaders and members of their ethnic community groups and faith-based organisations. There is need for collaborative working with ethnic community groups and faith-based organisations to enhance access and facilitate the utilisation of existing intimate partner violence services.

Social support factors associated with psychological resilience among women survivors of intimate partner violence in Gauteng, South Africa

BACKGROUND

Women's experiences of intimate partner violence (IPV) increase their risk for mental ill health. However, some women exposed to IPV and adversity are psychologically resilient and function well despite these exposures.

OBJECTIVES

We conducted a study to investigate the factors that are associated with psychological resilience among abused women, using data collected in a household survey conducted in Gauteng province of South Africa.

METHODS

Data is from a cross-sectional study. A multi-stage random sampling approach was used to select a sample of 501 women. The World Health Organization (WHO) Multi-Country Study on Women's Health and Domestic Violence Questionnaire was used to measure lifetime experience of physical and sexual IPV. Only 189 women who had experienced lifetime IPV were included in this secondary analysis. Resilience was measured as scoring below the threshold for the Centre for Epidemiological Studies Depression Scale and the Harvard Trauma Questionnaire. Other explanatory factors measured included child sexual abuse, non-partner rape, other traumatic life events, social support indicators, binge drinking and socio-demographic variables. Multivariable regression analysis was used to test factors associated with resilience.

RESULTS

Forty two percent of women scored below the threshold for post-traumatic stress disorder (PTSD) or depressive symptoms at the time of the survey and so were categorized as resilient. Social support indicators were associated with increased resilience. Women who perceived that their communities were supportive and they would easily find money in an emergency were more likely to be resilient. Women who binge drank, experienced severe IPV in the past 12 months, received negative reactions to disclosure and utilized medical or psychosocial services were less likely to be resilient.

CONCLUSION

Social support indicators including social connectedness, stronger network ties and perceived supportive communities are key factors in fostering resilience among abused women. Interventions should aim to promote stronger and supportive social networks and increase women's utilization of formal support services.

Gender-based violence among people with disabilities is a neglected public health topic

This paper aims to provide an analytical insight on the current state of knowledge on gender-based violence among people with disabilities, a topic where the level of data is relatively low. We briefly discuss the current research on: (a) the prevalence, risk factors and the theoretical approaches for gender-based violence among people with disabilities. (b) Service provision among people with disabilities who experience gender-based violence. (c) We also highlight areas where further research is required, the applicable theoretical approaches and provide an example on how Sweden is attempting to bridge this knowledge gap through implementing the Disability and Intimate-partner violence project (DIS-IPV) project.

Physical violence by an intimate partner and the inappropriate use of prenatal care services among women in Northeastern Brazil

OBJECTIVE

To analyze the association between physical violence by an intimate partner (PVIP) and the inappropriate use of prenatal care services.

METHODS

A nested cross-sectional study was conducted with 1,026 women, based on data from a prospective cohort study designed to investigate intimate partner violence among pregnant women enrolled in the Family Health Program (PSF) in Recife, Northeastern Brazil. The use of prenatal care services was assessed with basis on the guidelines from the Program for Humanization of Prenatal Care and Childbirth (Brazilian Ministry of Health) and considered the time of the first prenatal care visit and the total number of visits during the pregnancy. Data were collected through two face-to-face interviews (one in the last pregnancy trimester and the other in the postpartum period), using standardized questionnaires and data on Pregnancy Card records. An unconditional logistic regression was performed to estimate the odds ratio (OR) and the 95% confidence intervals to measure the association between an PVIP and the inappropriate use of prenatal care services, using the stepwise method.

RESULTS

The prevalence of the inappropriate use of prenatal care services was 44.1% and of an PVIP, 25.6%. In the logistic regression analysis, an intimatePVIP was associated with inappropriate prenatal care (OR = 1.37; 95%CI 1.01 - 1.85; p = 0.04) after adjustment by variables confirmed as confounders (parity, alcohol use in pregnancy, and education level).

CONCLUSION

Women who are victims of an PVIP have more chance of receiving inappropriate prenatal care due to late onset of prenatal care, fewer prenatal care visits, or both.

Understanding the Effects of Forced Sex on Sexually Transmitted Disease Acquisition and Sexually Transmitted Disease Care: Findings From the National Survey of Family Growth (2011-2013)

BACKGROUND

Although there is evidence for heightened sexually transmitted disease (STD) acquisition among women who experienced sexual violence, little is known about their patterns of STD testing, STD diagnosis, and STD treatment.

METHODS

Data was drawn from cycle eight of the National Survey of Family Growth (2011-2013). Logistic regression analyses used SUDAAN to examine the link between forced sex and risky sexual behavior as well as forced sex and STD testing, diagnoses, treatment, and connection to care.

RESULTS

Women who experienced forced sex were more likely to have risky sex (adjusted odds ratio [AOR], 1.56; 95% confidence interval [CI], 1.08-2.24), risky partners (AOR, 1.90; 95% CI, 1.11-3.23), and report substance abuse (AOR, 1.80; 95% CI, 1.28-2.53) than women who never experienced forced sex. Women who reported forced sex were more likely to be tested for an STD (AOR, 1.67; 95% CI, 1.34-2.09), and be diagnosed with herpes (AOR, 1.94; 95% CI, 1.13-3.32), genital warts (AOR, 2.55; 95% CI, 1.90-3.41), and chlamydia (AOR, 1.83; 95% CI, 1.03-3.25) than those who have never had forced sex. Results indicated a direct relationship between particular STD diagnoses and treatment in the past 12 months (AOR, 6.81; 95% CI, 4.50-10.31). Further analyses indicate that forced sex moderated the link between STD diagnoses and STD treatment (AOR, 0.43; 95% CI, 0.19-0.98).

CONCLUSIONS

Results indicate that women who reported experiencing forced sex were more likely to be diagnosed with chlamydia, herpes, and genital warts than women who never had forced sex. There may be a need to pay particular attention to women who experienced forced sex and a history of STDs to ensure that they are retained in care.

Domestic violence against women: representations of health professionals

OBJECTIVE

to analyze the representations about domestic violence against women, among health professionals of Family Health Units.

METHOD

qualitative study based on the Theory of Social Representations. Data were collected by means of evocations and interviews, treating them in the Ensemble de Programmes Pemettant L'Analyse des Evocations software - EVOC and content analysis.

RESULTS

nurses, physicians, nursing technicians and community health agents participated. The evocations were answered by 201 professionals and, of these, 64 were interviewed. The central core of this representation, comprised by the terms "aggression", "physical-aggression", "cowardice" and "lack of respect", which have negative connotations and were cited by interviewees. In the contrast zone, comprised by the terms "abuse", "abuse-power", "pain", "humiliation", "impunity", "suffering", "sadness" and "violence", two subgroups were identified. The first periphery contains the terms "fear", evoked most often, followed by "revolt", "low self-esteem" and "submission", and in the second periphery "acceptance" and "professional support".

CONCLUSION

this is a structured representation since it contains conceptual, imagetic and attitudinal elements. The subgroups were comprised by professionals working in the rural area and by those who had completed their professional training course in or after 2004. These presented a representation of violence different from the representation of the general group, although all demonstrated a negative connotation of this phenomenon.

Sexual violence associated with poor mental health in women attending Australian general practices

OBJECTIVE

Sexual violence (SV) against adult women is prevalent and associated with a range of mental health issues. General practitioners could potentially have a role in responding, however, there is little information to help guide them. Data around prevalence of all forms of adult SV (not just rape) is inconsistent, particularly in clinical samples, and the links between other forms of SV and mental health issues are not well supported. This study aimed to address these gaps in the knowledge base.

METHODS

A descriptive, cross-sectional study was conducted in Australian general practice clinics. Two hundred and thirty adult women completed an anonymous iPad survey while waiting to see the doctor.

RESULTS

More than half the sample had experienced at least one incident of adult SV. Most commonly, women reported public harassment or flashing, unwanted groping and being coerced into sex. Women who had experienced adult SV were more likely to experience anxiety than women who had not, even after controlling for other factors. Women who had experienced adult SV were more likely to feel down, depressed or hopeless than women who had not; however, this association disappeared after controlling for childhood sexual abuse.

CONCLUSIONS

The findings support the association between SV and poor mental health, even when 'lesser' incidents have occurred. Implications for public health: General practitioners should consider an experience of SV as a possible factor in otherwise unexplained anxiety and depressive symptoms in female patients.

Elimination of violence against women and girls as a global action agenda

This article outlines the goals and targets of Sustainable Development Goals (SDGs) related to elimination of violence against women and girls (VAWG) and to explain the framework to target these goals. Prevention of VAWG has been identified as one of the key agents for sustainable development. SDGs gave enough importance and called for the elimination of "all forms of violence against all women and girls everywhere". It identified different social and political enablers of reducing violence which are targeted under different SDGs. This acknowledges tacitly that VAWG is preventable and it is set to prevent and eliminate it. Evidences show that preventing VAWG is possible through multi-sectorial programs. The United Nations committed to revitalized global partnership to mobilize resources for implementing the agenda. Hence, designing and implementing interventions and subsequently scaling-up and intensifying these interventions are required to end VAWG.

Intimate partner violence in women with disabilities: perception of healthcare and attitudes of health professionals

PURPOSE

Intimate partner violence (IPV) is a major social problem and public health issue, but we still have a relatively small amount of data about partner violence in women with disabilities. The main objective of this study was to understand the experiences of women with disabilities who are or have been abused by their partners and to explore the knowledge, views and training requirements of primary care professionals.

METHOD

Qualitative study using semi-structured interviews with women with disabilities who had experienced IPV (n = 14), and focus groups with healthcare professionals (n = 16).

RESULTS

Women with disabilities suffer specific forms of abuse. Because they depend on the people around them to take action, they are subordinate and this can prolong the abuse. The healthcare staff frequently mentioned that it is often difficult to notice that women with disabilities are being abused. Their lack of training about disabilities and gender-based violence makes them less sure of their ability to identify and deal with any possible cases of abuse.

CONCLUSIONS

The difficulties described by the women interviewed are broadly speaking the same as those described by the healthcare professionals consulted. A number of suggestions for improvements are provided based on the results found. Implications for Rehabilitation The rehabilitation of abused disabled women implies that women perceive the health system as a resource to resolve their situation. Healthcare professionals should be trained on how to detect, treat and communicate with disabled women who experience partner violence. Is needed to establish a comprehensive system of coordination between services involved in caring for abused women and with disabilities.

Prevalence of intimate partner violence and abuse and associated factors among women enrolled into a cluster randomised trial in northwestern Tanzania

BACKGROUND

Intimate partner violence (IPV) is recognised as an important public health and social problem, with far reaching consequences for women's physical and emotional health and social well-being. Furthermore, controlling behaviour by a partner has a similar impact on women's well-being, yet little is known about the prevalence of this type of behaviour and other related abuses in Tanzania and in other sub-Saharan African countries.

METHODS

We conducted a cross-sectional study to determine the lifetime and past 12-month prevalence of physical and sexual IPV, economic abuse, emotional abuse and controlling behaviour among ever-partnered women in Mwanza, Tanzania. Women (N = 1049) were enrolled in an ongoing trial (Maisha study) to assess the impact of microfinance combined with gender training on participants' experience IPV, and other related outcomes. Interviews were conducted by same sex interviewers to collect information about socio-demographic characteristics, experiences of specific acts of IPV and abuse, and symptoms of poor mental health status.

RESULTS

Overall, about 61% of women reported ever experiencing physical and/or sexual IPV (95% CI: 58-64%) and 27% (95% CI: 24-29%) experienced it in the past 12 months. Partner controlling behaviour was the most prevalent type of abuse with 82% experiencing it in their lifetime and 63% during the past 12 months. Other types of abuses were also common, with 34% of women reporting economic abuse and 39% reporting emotional abuse during the past 12 months. The prevalence of IPV and abuses varied by socio-demographic characteristics, showing much higher prevalence rates among younger women, women with young partners and less educated women. After we adjusted for age and socio-economic status, physical violence (OR = 1.8; 95% CI: 1.3-2.7) and sexual violence (OR = 2.8; 95% CI: 1.9-4.1) were associated with increased reporting of symptoms of poor mental health. Similarly, experience of abuse during the past 12 months was associated with increased reporting of symptoms of poor mental health.

CONCLUSIONS

The high prevalence of IPV and abuses and its strong links with symptoms of poor mental health underline the urgent need for developing and testing appropriate interventions in settings like Tanzania to tackle both violence and abusive behaviours among intimate partners.

TRIAL REGISTRATION

ClinicalTrials.gov - ID NCT02592252 , registered retrospectively on 13 August 2015.

'They just walk away' - women's perception of being silenced by antenatal health workers: a qualitative study on women survivors of domestic violence in Nepal

Background

Domestic violence during pregnancy has detrimental effects on the health of the mother and the newborn. Antenatal care provides a ‘window of opportunity’ to identify and assist victims of domestic violence during pregnancy. Little is known about the experience, needs, and expectations from the women's perspective in relation to domestic violence in Nepal.

Objective

Our study aims to explore how women who have experienced domestic violence evaluate their antenatal care and their expectations and needs from health centers.

Design

Twelve in-depth interviews were conducted among women who had experienced domestic violence during pregnancy and utilized antenatal care. The women were recruited from two different organizations in Nepal.

Results

Women in our study concealed their experience of domestic violence due to fear of being insulted, discriminated, and negative attitudes of the health care providers. The women wished that the health care providers were compassionate and asked them about their experience, ensured confidentiality and privacy, and referred them to services that is free of cost.

Conclusions

Findings from our study may help the health care providers to change their attitudes toward women survivors of domestic violence. Identifying and assisting these women through antenatal care could result in improved services for them and their newborns.

Intimate partner violence as a predictor of marital disruption in rural Rakai, Uganda: a longitudinal study

OBJECTIVES

We assessed the association between intimate partner violence (IPV) and union disruption (divorce or separation) in the rural Ugandan setting of Rakai District.

METHODS

We analyzed longitudinal data collected from April 1999 to June 2006, from 6834 women (15-49 years) living in 50 communities in Rakai. Participants were either officially married, traditionally married or in a consensual union during one or more surveys and completed at least one follow-up survey. The primary outcome was union disruption through divorce or separation from the primary sexual partner.

RESULTS

Past year IPV ranged from 6.49 % (severe physical abuse) to 31.99 % (emotional abuse). Severe physical IPV was significantly associated with divorce/separation, after adjusting for other covariates (aOR = 1.80, 95 % CI 1.01-3.22). Another predictor of union disruption was a woman having two or more sexual partners in the past year (aOR = 8.42, 95 % CI 5.97-11.89). Factors protecting against divorce/separation included an increasing number of co-resident biological children and longer duration of union.

CONCLUSIONS

IPV, particularly severe physical abuse, is an important risk factor for union disruption. Marital counseling, health education and interventions should address the role of IPV on the wellbeing of women and the stability of couples in Uganda.

Student nurses' knowledge and attitudes towards domestic violence: results of survey highlight need for continued attention to undergraduate curriculum

AIMS AND OBJECTIVES

To gain a comprehensive understanding of undergraduate nursing student attitudes and views towards domestic violence, and employ the findings to inform undergraduate curriculum development.

BACKGROUND

Nurses have an important role in identifying people who are victims of domestic violence through screening and facilitating their access to assistance and support. Undergraduate nursing education is key to shaping attitudes and facilitating the development of a comprehensive understanding of domestic violence. Little research has been undertaken exploring nursing students' attitudes towards domestic violence.

METHODS

A cross-sectional survey of undergraduate nursing students enrolled in a three-year Bachelor of Nursing programme across three campuses of a regional university in NSW, Australia. Students completed a pen and paper survey during class time and descriptive and comparative analysis was undertaken.

RESULTS

The majority of respondents were female, first year students females aged 17-26 years. Many students understood the nature and consequences of domestic violence, yet others across the course of the programme demonstrate attitudes that reflect a lack of understanding and misconceptions of domestic violence. Stereotypical and gendered attitudes that normalise violence within intimate partner relationships and sustain victim-blaming attitudes were evident across the cohort.

CONCLUSIONS

It is important for nurses to understand the relationship between exposure to violence and women's ill health, and be able to respond appropriately. Undergraduate programmes need to highlight the important role of nurses around domestic violence and address stereotypical conceptions about domestic violence.

RELEVANCE TO CLINICAL PRACTICE

Continued effort is required to address domestic violence in undergraduate nursing education so that nursing graduates understand the association between violence exposure and poor health and are able to assess exposure and respond appropriately in the clinical environment.

Perceived Impact of a Land and Property Rights Program on Violence Against Women in Rural Kenya: A Qualitative Investigation

The current study focuses on a community-led land and property rights program in two rural provinces in western Kenya. The program was designed to respond to women's property rights violations to reduce violence against women and HIV risks at the community level. Through in-depth interviews with 30 women, we examine the perceived impact that this community-level property rights program had on violence against women at the individual and community level. We also examine perceptions as to how reductions in violence were achieved. Finally, we consider how our findings may aid researchers in the design of structural violence-prevention strategies.

Abuse During Pregnancy in Industrialized and Developing Countries

Abuse during pregnancy has increasingly been identified as an important problem with significant consequences for maternal and infant health, particularly in North America. The authors review available evidence of the prevalence and consequences of abuse during pregnancy, including maternal mortality, outside of North America. The range of prevalence found in developing countries is much wider (3.8% to 31.7%) than that of industrialized countries (3.4% to 11%), which is much closer to findings from North America. There is a need for more studies using consistent definitions and methodologies to examine the patterns and forms of abuse related to pregnancy worldwide.

Differentiating perceptions of intimate partner violence in Nepal

Perception of domestic violence is a frequently used indicator of women's empowerment. It is, however, thought to be a binary variable, where women either justify wife beating or they do not. In the Nepal Demographic Health Survey, empowerment is 'high' if the woman answers no to one of five circumstances of wife beating. This study develops a Latent Class Analysis model to determine whether there are categories of women who endorsed some type of violence but not others. A more nuanced measure of perception of domestic violence would improve our understanding on women's empowerment.

Addressing violence against women: a call to action

Violence against women and girls is prevalent worldwide but historically has been overlooked and condoned. Growing international recognition of these violations creates opportunities for elimination, although solutions will not be quick or easy. Governments need to address the political, social, and economic structures that subordinate women, and implement national plans and make budget commitments to invest in actions by multiple sectors to prevent and respond to abuse. Emphasis on prevention is crucial. Community and group interventions involving women and men can shift discriminatory social norms to reduce the risk of violence. Education and empowerment of women are fundamental. Health workers should be trained to identify and support survivors and strategies to address violence should be integrated into services for child health, maternal, sexual, and reproductive health, mental health, HIV, and alcohol or substance abuse. Research to learn how to respond to violence must be strengthened. The elimination of violence against women and girls is central to equitable and sustainable social and economic development and must be prioritised in the agenda for development after 2015.

Trends in public health policies addressing violence against women

OBJECTIVE

To analyze the content of policies and action plans within the public healthcare system that addresses the issue of violence against women.

METHODS

A descriptive and comparative study was conducted on the health policies and plans in Catalonia and Costa Rica from 2005 to 2011. It uses a qualitative methodology with documentary analysis. It is classified by topics that describe and interpret the contents. We considered dimensions, such as principles, strategies, concepts concerning violence against women, health trends, and evaluations.

RESULTS

Thirteen public policy documents were analyzed. In both countries’ contexts, we have provided an overview of violence against women as a problem whose roots are in gender inequality. The strategies of gender policies that address violence against women are cultural exchange and institutional action within the public healthcare system. The actions of the healthcare sector are expanded into specific plans. The priorities and specificity of actions in healthcare plans were the distinguishing features between the two countries.

CONCLUSIONS

The common features of the healthcare plans in both the counties include violence against women, use of protocols, detection tasks, care and recovery for women, and professional self-care. Catalonia does not consider healthcare actions with aggressors. Costa Rica has a lower specificity in conceptualization and protocol patterns, as well as a lack of updates concerning health standards in Catalonia.

Synergistic vulnerabilities: antiretroviral treatment among women in Uganda

Despite being an early success story in the reduction of HIV infection rates, Uganda faces myriad challenges in the recent era of accelerated antiretroviral treatment (ARV) scale-up. For those able to access treatment, ongoing vulnerabilities of poverty and violence compound treatment-related costs and concerns. This paper explores experiences of one particularly vulnerable population - women on ARVs who have also experienced intimate partner violence (IPV). Data were collected over 12 months in Uganda. They include ethnographic interviews (n = 40) drawn from a larger sample of women on ARV and semi-structured interviews with policy-makers and service providers (n = 42), examining the intersection of experiences and responses to treatment from multiple perspectives. Women's narratives show that due to treatment, immediate health concerns take on secondary importance, while other forms of vulnerability, including IPV and poverty, can continue to shape treatment experiences and the decision to stay in violent relationships. Providers likewise face difficulties in overburdened clinics, though they recognise women's concerns and the importance of considering other forms of vulnerability in treatment. This analysis makes the case for integrating treatment with other types of social services and demonstrates the importance of understanding the ways in which synergistic and compounding vulnerabilities confound treatment scale-up efforts.

Social representation of domestic violence against women among Nursing Technicians and Community Agents

OBJECTIVE To analyze the social representations of the Nursing Technicians and Community Health Agents about domestic violence against women. METHOD A qualitative study carried out in the city of Rio Grande, RS, in which evocations and interviews were collected between July and November 2013. For the treatment of data were used the EVOC 2005 software and the context analysis. RESULT It is a structured representation, in which the central nucleus contains conceptual, imaging and attitudinal elements, namely: abuse, aggression, physical aggression, cowardice and lack of respect. Such terms were present in the context of the interviews. The professionals acknowledged that violence is not limited to physical aspects and were judgemental about the acts of the aggressor. CONCLUSION This knowledge may enable the problematization of the studied phenomenon with the team, and facilitate the search for prevention and intervention strategies for victims, offenders and managers of health services.

Health sector responses to intimate partner violence: a literature review

BACKGROUND

Intimate partner violence (IPV) is a common and serious public health concern, particularly in South Africa, but it is not well managed in primary care.

AIM

This review aims to summarise the current state of knowledge regarding health sector-based interventions for IPV, their integration into health systems and services and the perspectives of service users and healthcare workers on IPV care, focusing on the South African context.

METHOD

PubMed, CINAHL, PsycINFO and Google Scholar were searched between January 2012 and May 2014. All types of study design were included, critically appraised and summarised.

RESULTS

Exposure to IPV leads to wide-ranging and serious health effects. There is sufficient evidence that intervening in IPV in primary care can improve outcomes. Women who have experienced IPV have described an appropriate response by healthcare providers to be non-judgmental, understanding and empathetic. IPV interventions that are complex, comprehensive and utilise systems-wide approaches have been most effective, but system- and society-level barriers hamper implementation. Gender inequities should not be overlooked when responding to IPV.

CONCLUSION

Further evaluations of health sector responses to IPV are needed, in order to assist health services to determine the most appropriate models of care, how these can be integrated into current systems and how they can be supported in managing IPV. The need for this research should not prevent health services and healthcare providers from implementing IPV care, but rather should guide the development of rigorous contextually-appropriate evaluations.

Assessing the psychometric properties of the Turkish version of attitudes and practice of health care providers regarding intimate partner violence survey scale

This study was planned to assess the psychometric properties of the Turkish version of the "attitudes and practices of health care providers regarding intimate partner violence" (APHCPs-IPV) survey scale. The sample consisted of 355 primary health care providers. A Likert-type scale composed of eight subfactors, and 43 items were used. Means and standard deviations were calculated for interval-level data. Ap value of less than .05 was considered statistically significant. The Turkish version consisted of eight factor groups. The Cronbach's alpha of the general scale was .66, and the Cronbach's alpha of the factor groups ranged from .29 to .81. It was determined that the APHCPs-IPV scale was a valid and reliable scale to be used in Turkish society, on the condition that item number 33 be removed.

Measuring the effectiveness of an intensive IPV training program offered to Greek general practitioners and residents of general practice

BACKGROUND

The need for effective training of primary care physicians in the prevention, detection and handling of intimate partner violence (IPV) has been widely acknowledged, given its frequency in daily practice. The current intervention study aimed to measure changes in the actual IPV knowledge, perceived knowledge, perceived preparedness and detection ability of practicing general practitioners (GPs) and general practice residents, following an intensive IPV training program.

METHODS

A pre/post-test design with a control group was employed to compare changes in baseline measures of IPV at the post intervention stage and at 12 months. A total of 40 participants provided full data; 25 GPs (11 in the intervention and 14 in the control) and 15 residents (intervention only). Three scales of the PREMIS survey were used to draw information on the study outcomes.

RESULTS

The training program met high acceptance by both groups of participants and high practicality in clinical practice. The GPs in the intervention group performed better than the GPs in the control group on "Perceived preparedness" and "Perceived knowledge" in both the post-intervention (p= .012, r= .50 and p= .001, r= .68) and the 12-month follow-up (p= .024, r= .45 and p= .007, r= .54) as well as better than the residents in "Perceived preparedness" at post-intervention level (p= .037, r= .41). Residents on the other hand, performed better than the GPs in the intervention group on "Actual knowledge" at the 12-month follow-up (p= .012, r= .49). No significant improvements or between group differences were found in terms of the self-reported detection of IPV cases.

CONCLUSION

Further studies are needed to decide whether residency training could serve as an early intervention stage for IPV training.

The role of the healthcare sector in the prevention of sexual violence against sub-Saharan transmigrants in Morocco: a study of knowledge, attitudes and practices of healthcare workers

BACKGROUND

Sub-Saharan transmigrants in Morocco are extremely vulnerable to sexual violence. From a public health perspective, the healthcare system is globally considered an important partner in the prevention of sexual violence. The aim of this study is twofold. In a first phase, we aimed to identify the current role and position of the Moroccan healthcare sector in the prevention of sexual violence against sub-Saharan transmigrants. In a second phase, we wanted these results and available guidelines to be the topic of a participatory process with local stakeholders in order to formulate recommendations for a more desirable prevention of sexual violence against sub-Saharan transmigrants by the Moroccan healthcare sector.

METHODS

Knowledge, attitudes and practices of healthcare workers in Morocco concerning sexual violence against sub-Saharan transmigrants and its prevention were firstly explored in semi-structured interviews after which they were discussed in a participatory process resulting in the formulation of recommendations.

RESULTS

All participants (n=24) acknowledged the need for desirable prevention of sexual violence against transmigrants. Furthermore, important barriers in tertiary prevention practices, i.e. psychosocial and judicial referral and long-term follow-up, and in secondary prevention attitudes, i.e. active identification of victims were identified. Moreover, existing services for Moroccan victims of sexual violence currently do not address the sub-Saharan population. Thus, transmigrants are bound to rely on the aid of civil society.

CONCLUSIONS

This research demonstrates the low accessibility of existing Moroccan services for sub-Saharan migrants. In particular, there is an absence of prevention initiatives addressing sexual violence against the sub-Saharan transmigrant population. Although healthcare workers do wish to develop prevention initiatives, they are dealing with structural difficulties and a lack of expertise. Recommendations adapted to the context of sub-Saharan transmigrants in Morocco are suggested.