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Shrestha R, Sapkota D, Sarraf RR, Mehra D, Ekström AM, Deuba K. Perceptions on violence against women and its impacts on mental health and response mechanisms among community-based stakeholders: a qualitative study from Nepal. BMC Womens Health 2024; 24:258. [PMID: 38658963 PMCID: PMC11040903 DOI: 10.1186/s12905-024-03064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/29/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Violence against women (VAW) is a significant public health problem. With the emergence of the COVID-19 pandemic, the frequency and severity of VAW has escalated globally. Approximately one in four women in Nepal have been exposed to either physical, psychological, and/or sexual violence in their lifetime, with husbands or male partners being the perpetrators in most cases. VAW prevention has been under-researched in low- and middle-income countries, including Nepal. This study aims to explore the perspectives of local stakeholders, including healthcare providers and survivors of violence in Madhesh Province. The overarching goal is to provide insights for designing prevention and support programs that are acceptable to communities and cater to the needs of survivors. METHODS An explorative qualitative study was conducted in Madhesh Province, southern Nepal. A total of 21 interviews, including 15 in-depth interviews (IDIs) with health care providers, three IDIs with women seeking general or maternal and child health services at health care centres, three key informant interviews with the local stakeholders working in the field of VAW, and one focus group discussion with violence survivors, were conducted in Nepali by trained field interviewers. Interviews were recorded, transcribed, translated into English, and analysed using content analysis. RESULTS VAW, particularly physical violence, was a common experience in the study area. Sociocultural traditions such as dowry, child marriages and son preference were identifiable triggers for VAW, causing significant physical injuries and mental health problems, including suicide. Health care providers reported that violence survivors often hide their experiences of violence and do not seek any kind of help. Women feared that violence would increase in frequency and intensity if their perpetrators found out that they had disclosed their experiences of violence to health care providers. Local stakeholders emphasized the importance of engaging community leaders and garnering support from both women and men in interventions designed to reduce VAW and its impacts on mental health. CONCLUSIONS Participants reported that verbal and physical violence is often perceived as a normal part of women's lives. Women should be made aware of available support services and empowered and supported to increase access and uptake of these services. Additionally, more individual-based counselling sessions that encourage women to escape violence and its mental health consequences while maintaining privacy and confidentiality are recommended.
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Affiliation(s)
- Rachana Shrestha
- Public Health and Environment Research Centre (PERC), Lalitpur, Nepal
- Knowledge to Action (K2A), Lalitpur, Nepal
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Diksha Sapkota
- Public Health and Environment Research Centre (PERC), Lalitpur, Nepal
- Griffith Criminology Institute, Queensland, Australia
| | | | - Devika Mehra
- MAMTA Health Institute for Mother and Child, New Delhi, India
- Public Health Consultant, Medeon Science Park, Malmö, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, South General Hospital, Stockholm, Sweden
| | - Keshab Deuba
- Public Health and Environment Research Centre (PERC), Lalitpur, Nepal.
- Knowledge to Action (K2A), Lalitpur, Nepal.
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
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Deuba K, Shrestha R, Koju R, Jha VK, Lamichhane A, Mehra D, Ekström AM. Assessing the Nepalese health system's readiness to manage gender-based violence and deliver psychosocial counselling. Health Policy Plan 2024; 39:198-212. [PMID: 38300229 PMCID: PMC10883662 DOI: 10.1093/heapol/czae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 12/26/2023] [Accepted: 01/29/2024] [Indexed: 02/02/2024] Open
Abstract
Violence against women (VAW), particularly intimate partner violence (IPV) or domestic violence, is a major public health issue, garnering more attention globally post-coronavirus disease 2019 (COVID-19) lockdown. Health providers often represent the first point of contact for IPV victims. Thus, health systems and health providers must be equipped to address survivors' physical, sexual and mental health care needs. However, there is a notable lack of evidence regarding such readiness in Nepal. This study, utilizing a concurrent triangulation design, evaluated the readiness of public health facilities in Nepal's Madhesh Province in managing VAW, focusing on providers' motivation to offer psychosocial counselling to survivors. A cross-sectional study was conducted across 11 hospitals and 17 primary health care centres, where 46 health care providers were interviewed in February-April 2022. The study employed the World Health Organization's tools for policy readiness and the Physician Readiness to Manage IPV Survey for data collection. Quantitative and qualitative data were collected via face-to-face interviews and analysed using descriptive and content analysis, respectively. Only around 28% of health facilities had trained their staff in the management of VAW. Two out of 11 hospitals had a psychiatrist, and a psychosocial counsellor was available in four hospitals and two out of 17 primary health care centres. Two-thirds of all health facilities had designated rooms for physical examinations, but only a minority had separate rooms for counselling. Though a few health facilities had guidelines for violence management, the implementation of these guidelines and the referral networks were notably weak. Hospitals with one-stop crisis management centres demonstrated readiness in VAW management. Health providers acknowledged the burden of IPV or domestic violence and expressed motivation to deliver psychosocial counselling, but many had limited knowledge. This barrier can only be resolved through appropriate training and investment in violence management skills at all tiers of the health system.
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Affiliation(s)
- Keshab Deuba
- Department of Global Public Health, Karolinska Institutet, Stockholm, Widerströmska Huset Tomtebodavägen 18 A, Plan 3, Solna 17165, Sweden
- Public Health and Environment Research Centre (PERC), Sanepa-2, GPO Box 8975, EPC 450, Lalitpur, Bagmati, Nepal
- Knowledge to Action (K2A), Sanepa-2, Lalitpur, Bagmati 4700, Nepal
| | - Rachana Shrestha
- Department of Global Public Health, Karolinska Institutet, Stockholm, Widerströmska Huset Tomtebodavägen 18 A, Plan 3, Solna 17165, Sweden
- Public Health and Environment Research Centre (PERC), Sanepa-2, GPO Box 8975, EPC 450, Lalitpur, Bagmati, Nepal
- Knowledge to Action (K2A), Sanepa-2, Lalitpur, Bagmati 4700, Nepal
| | - Reena Koju
- Public Health and Environment Research Centre (PERC), Sanepa-2, GPO Box 8975, EPC 450, Lalitpur, Bagmati, Nepal
- Knowledge to Action (K2A), Sanepa-2, Lalitpur, Bagmati 4700, Nepal
| | - Vijay Kumar Jha
- Health Directorate, Ministry of Social Development, Sapahi, Dhanusha, Janakpur, Madhesh Province 45600, Nepal
| | - Achyut Lamichhane
- Public Health and Environment Research Centre (PERC), Sanepa-2, GPO Box 8975, EPC 450, Lalitpur, Bagmati, Nepal
- Knowledge to Action (K2A), Sanepa-2, Lalitpur, Bagmati 4700, Nepal
| | - Devika Mehra
- MAMTA Health Institute for Mother and Child, New Delhi 110048, India
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Box 117, Lund 221 00, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Widerströmska Huset Tomtebodavägen 18 A, Plan 3, Solna 17165, Sweden
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Chalise P, Manandhar P, Infanti JJ, Campbell J, Henriksen L, Joshi SK, Koju R, Pun KD, Rishal P, Simpson MR, Skovlund E, Swahnberg K, Schei B, Lukasse M. Addressing Domestic Violence in Antenatal Care Environments in Nepal (ADVANCE) - study protocol for a randomized controlled trial evaluating a video intervention on domestic violence among pregnant women. BMC Public Health 2023; 23:1794. [PMID: 37715147 PMCID: PMC10503096 DOI: 10.1186/s12889-023-16685-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/04/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Domestic violence (DV) prior to, and during pregnancy is associated with increased risks for morbidity and mortality. As pregnant women routinely attend antenatal care this environment can be used to offer support to women experiencing DV. We have developed a video intervention that focuses on the use of behavioral coping strategies, particularly regarding disclosure of DV experiences. The effectiveness of this intervention will be evaluated through a randomized controlled trial (RCT) and a concurrent process evaluation. METHODS All pregnant women between 12-22 weeks of gestation attending routine antenatal care at two tertiary level hospitals in Nepal are invited to participate. DV is measured using the Nepalese version of the Abuse Assessment Screen (N-AAS). Additionally, we measure participants' mental health, use of coping strategies, physical activity, and food security through a Color-coded Audio Computer Assisted Self Interview (C-ACASI). Irrespective of DV status, women are randomized into the intervention or control arm using a computer-generated randomization program. The intervention arm views a short video providing information on DV, safety improving actions women can take with an emphasis on disclosing the violence to a trusted person along with utilizing helplines available in Nepal. The control group watches a video on maintaining a healthy pregnancy and when to seek healthcare. The primary outcome is the proportion of women disclosing their DV status to someone. Secondary outcomes are symptoms of anxiety and depression, coping strategies, the use of safety measures and attitudes towards acceptance of abuse. Follow-up is conducted after 32 weeks of gestation, where both the intervention and control group participants view the intervention video after completing the follow-up questionnaire. Additionally, a mixed methods process evaluation of the intervention will be carried out to explore factors influencing the acceptability of the intervention and the disclosure of DV, including a review of project documents, individual interviews, and focus group discussions with members of the research team, healthcare providers, and participants. DISCUSSION This study will provide evidence on whether pregnant women attending regular antenatal visits can enhance their safety by disclosing their experiences of violence to a trusted person after receiving a video intervention. TRIAL REGISTRATION The study is registered in ClinicalTrial.gov with identifier NCT05199935.
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Affiliation(s)
- P Chalise
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
- Department of Nursing and Midwifery, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.
| | - P Manandhar
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | - J J Infanti
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - J Campbell
- Department of Community-Public Health, Johns Hopkins University School of Nursing, Baltimore, USA
| | - L Henriksen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - S K Joshi
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | - R Koju
- Department of Internal Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - K D Pun
- Department of Nursing and Midwifery, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - P Rishal
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - M R Simpson
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - E Skovlund
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - K Swahnberg
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linneaus University, Kalmar, Sweden
| | - B Schei
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway
| | - M Lukasse
- Center for Women's, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, P.O. Box 235, N-3603, Kongsberg, Norway
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Amel Barez M, Mirzaii Najmabadi K, Latifnejad Roudsari R, Mosavi Bazaz M, Babazadeh R. "Family and society empowerment": a content analysis of the needs of Iranian women who experience domestic violence during pregnancy: a qualitative study. BMC Womens Health 2023; 23:370. [PMID: 37438772 PMCID: PMC10339606 DOI: 10.1186/s12905-023-02525-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 07/03/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Domestic violence threatens maternal physical, psychological and emotional safety. Victim/survivor pregnant women required interventions based on their actual needs with the purpose of reducing domestic violence and its negative consequences. The present study aimed to explore the experiences of victimized Iranian pregnant women and identify their neglected needs. METHODS This qualitative descriptive study was performed from September 2019 to August 2021 in Mashhad, Iran. Semi-structured interviews with 14 women (8 pregnant and 6 after birth) who were the victims of domestic violence, and 11 key informants with various discipline specialties until the data saturation was achieved. Participants were selected through purposive sampling. Qualitative data were analyzed based on the conventional content analysis adopted by Graneheim & Lundman. FINDINGS The main theme emerging from the data analysis was "family and society empowerment" that implied the necessity of family, health system, legal, social and inter sectoral empowerment to reduce domestic violence during pregnancy. "Family and society empowerment" was comprised of three categories such as "need to empower couples to reduce domestic violence during pregnancy", "demand for improved health care services", and "need to strengthen inter-sectoral, legal and social supports". CONCLUSION Victim/survivor pregnant women experienced individual, interpersonal and inter sectoral needs. Family and society empowerment constituted the actual needs of victimized pregnant women. Awareness of policymakers and health system managers of these needs could be the basis for designing a supportive care program according to victim/survivor women's actual needs. In addition to the educational and skill empowerment of couples, it is essential that supportive organizations cooperate with each other to provide integrated and coordinated services to victim/survivor pregnant women and strengthen and facilitate their access to supportive resources.
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Affiliation(s)
- Malikeh Amel Barez
- Department of Midwifery, Faculty of Nursing and Midwifery, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran
| | | | | | - Mojtaba Mosavi Bazaz
- Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Raheleh Babazadeh
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
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Rajah V, Osborn M. Understanding the Body and Embodiment in the Context of Women's Resistance to Intimate Partner Violence: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2022; 23:1461-1477. [PMID: 33641497 DOI: 10.1177/1524838021995941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Scholars acknowledge that women oppose male intimate partner violence (IPV). Yet there is limited comprehensive knowledge regarding how women's bodies and embodiment, that is, their physical and emotional practices and the cultural and social systems that influence them, figure in this process. Our scoping review helps fill this gap by analyzing and synthesizing 74 research articles published in English-language scholarly journals between 1994 and 2017 to address three research questions: (1) How does existing IPV research conceptualize resistance? (2) To what extent do the body and embodiment appear in this research? and (3) What common themes emerge from investigation of the role of embodiment and the body in the context of IPV? The articles identify several subtypes of resistance strategies including avoidance, help-seeking, violent action, and leaving a violent relationship. The reviewed research also regularly describes women's physical and emotional states in the context of IPV. Only a small number of these texts, however, define or conceptualize embodiment. Our analysis of the manner in which the body figures in women's resistance to IPV yielded four themes: (1) the active body, (2) the injured/constrained body, (3) the interactive body, and (4) the transformative body. We conclude with a discussion of policy and practice implications, such as the need to increase awareness about how institutions enforce embodied norms among victims and use the body to assign blame and/or proffer assistance in the context of IPV.
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Affiliation(s)
- Valli Rajah
- John Jay College, The Graduate Center, City University of New York, NY, USA
| | - Max Osborn
- John Jay College, The Graduate Center, City University of New York, NY, USA
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Amel Barez M, Mirzaii Najmabadi K, Latifnejad Roudsari R, Mousavi Bazaz M, Babazadeh R. ‘It is a hard decision’: a qualitative study of perinatal intimate partner violence disclosure. Reprod Health 2022; 19:208. [PMID: 36376884 PMCID: PMC9664727 DOI: 10.1186/s12978-022-01514-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background Perinatal intimate partner violence is a hidden under reported and difficult to identify problem which has negative effects on mother and child. The present study aimed to explore barriers and facilitators of perinatal intimate partner violence disclosure.
Methods This qualitative study was carried out from October 2019 to January 2021 in Mashhad, Iran. Participants included 23 abused women (11 pregnant and 12 after birth) which were selected via purposive sampling. Semi-structured in-depth interviews and focus group discussion were conducted until the data saturation was achieved. The data analysis was performed based on conventional content analysis adopted by Graneheim & Lundman. Results The main themes “barriers to disclosure” and “facilitators of disclosure” were emerged as the result of data analysis. Barriers to disclosure included negative disclosure consequences and protection of family privacy. Facilitators of disclosure included maternal self-efficacy, threats to security, and formal and informal supportive networks. Conclusions Most abused women did not disclose violence despite routine screening for perinatal intimate partner violence in antenatal care. Recognizing the barriers to and facilitators of violence disclosure play an important role in eliminating barriers, strengthening facilitators, providing effective supportive services for abused women, and reducing perinatal violence. Focus on the barriers to and the facilitators of disclosure will be useful to policymakers, health program planners, and health care providers to identify and manage intimate partner violence, appropriately. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-022-01514-7. Disclosure of perinatal intimate partner violence is a difficult decision. Several barriers prevent abused pregnant women from disclosing violence. The present study explained barriers and facilitators of perinatal intimate partner violence disclosure. 23 women (11 pregnant and 12 after birth) who experienced perinatal intimate partner violence were interviewed in Mashhad, Iran. The results showed the barriers to disclosure include negative disclosure consequences and protection of family privacy and the facilitators of disclosure include maternal self-efficacy, threats to security, and formal and informal supportive networks. In conclusion eliminating barriers and strengthen facilitators play an important role in providing effective supportive services for abused women and reducing perinatal violence. The result will be useful to policymakers, health program planners, and health care providers for appropriate management of perinatal intimate partner violence.
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Silva T, Agampodi T, Evans M, Knipe D, Rathnayake A, Rajapakse T. Barriers to help-seeking from healthcare professionals amongst women who experience domestic violence - a qualitative study in Sri Lanka. BMC Public Health 2022; 22:721. [PMID: 35410170 PMCID: PMC9004164 DOI: 10.1186/s12889-022-13116-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/30/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Domestic violence (DV) is a major global public health problem which is associated with significant adverse consequences. Although Sri Lankan women who experience DV receive treatment from healthcare professionals (HCPs) for DV related physical and psychological problems, disclosure of DV within health services is quite low. This study explored barriers to disclosure of DV to HCPs among Sri Lankan women who experience DV. METHOD This qualitative study took place in the Central Province of Sri Lanka. Twenty women who had experienced DV were recruited from Gender Based Violence Centers (Mithuru Piyasa Centers) and a toxicology unit of the two selected hospitals. Participants were purposefully selected using maximum variation sampling technique. In-depth interviews were conducted until data saturation was reached. Interviews were recorded, and analyzed using thematic analysis. RESULTS Survivor related barriers to help seeking included women's lack of knowledge and perceptions about the role of HCPs, lack of confidence in HCPs, fear of repercussions, personal attitudes towards DV, and their love and loyalty towards the perpetrator. Women preferred it if HCPs initiated discussions about DV, and they valued it when HCPs could be confidential and protect their privacy, and give enough time for DV related issues during consultations. A perpetrator related barrier was the controlling behavior of the perpetrator. Social stigma and social and cultural norms about the role of women emerged as the socio-cultural constraints to disclosure. CONCLUSIONS Barriers to help seeking for DV from HCPs exist at individual, healthcare level, and societal level. Community programs are needed to increase women's access to healthcare services and interventions should be implemented to develop effective, preventive, and supportive strategies at the healthcare system level.
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Affiliation(s)
- Tharuka Silva
- grid.11139.3b0000 0000 9816 8637South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- grid.11139.3b0000 0000 9816 8637Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Thilini Agampodi
- grid.430357.60000 0004 0433 2651Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University, Anuradhapura, Sri Lanka
| | - Maggie Evans
- grid.5337.20000 0004 1936 7603Centre for Academic Primary Care, Population Health Science Institute, University of Bristol, Bristol, UK
| | - Duleeka Knipe
- grid.11139.3b0000 0000 9816 8637South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- grid.5337.20000 0004 1936 7603Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Abey Rathnayake
- grid.11139.3b0000 0000 9816 8637Department of Sociology, Faculty of Arts, University of Peradeniya, Peradeniya, Sri Lanka
| | - Thilini Rajapakse
- grid.11139.3b0000 0000 9816 8637South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- grid.11139.3b0000 0000 9816 8637Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Sapkota D, Baird K, Saito A, Rijal P, Anderson D. Antenatal-Based Pilot Psychosocial Intervention to Enhance Mental Health of Pregnant Women Experiencing Domestic and Family Violence in Nepal. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP3605-NP3627. [PMID: 32812489 DOI: 10.1177/0886260520948151] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Survivors of domestic and family violence (DFV) report poorer quality of life and worsening mental health. This study evaluated the effect of a counseling and education intervention on the mental health and help-seeking behaviors among pregnant women living with DFV. A parallel pilot randomized controlled trial was performed among 140 pregnant women attending an antenatal clinic of a tertiary hospital of Nepal. Using computer-generated random numbers, participants were randomized to the intervention group (a counseling session, an information booklet about DFV, and contact details of the counselor) or a control group (usual care plus a booklet containing contact details of local DFV support services). Outcome measures included mental health, quality of life (QOL), self-efficacy, social support, and safety planning behaviors. Analyses followed intention-to-treat, using the generalized estimating equation model. Intervention participants showed significant improvements in anxiety (β = -3.24, p < .001) and depression (β = -3.16, p < .001) at postintervention. Such improvements were also sustained at follow-up assessment (p < .001). Significant group and time interaction for QOL, social support, use of safety behaviors, and self-efficacy (p < .05) revealed a greater increase in these outcome measures among intervention participants at both follow-up assessments compared with the control group. This pilot integrated intervention showed promising outcomes in improving the mental health, social support, and the use of safety behaviors among women with DFV. This intervention could be incorporated into regular antenatal care as a strategy to identify and support victims of DFV. Larger controlled trials with longer follow-up are needed to support and expand on the current findings regarding the effectiveness of a psychosocial intervention targeting victims of DFV in resource-constrained settings.
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Affiliation(s)
- Diksha Sapkota
- Griffith University, Meadowbrook, Queensland, Australia
- Menzies Health Institute Queensland, Gold Coast, Australia
| | - Kathleen Baird
- Griffith University, Meadowbrook, Queensland, Australia
- University of Technology Sydney, New South Wales, Australia
| | - Amornrat Saito
- Griffith University, Meadowbrook, Queensland, Australia
- Menzies Health Institute Queensland, Gold Coast, Australia
| | - Pappu Rijal
- B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Debra Anderson
- Menzies Health Institute Queensland, Gold Coast, Australia
- University of Technology Sydney, New South Wales, Australia
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Heron RL, Eisma MC. Barriers and facilitators of disclosing domestic violence to the healthcare service: A systematic review of qualitative research. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:612-630. [PMID: 33440034 PMCID: PMC8248429 DOI: 10.1111/hsc.13282] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/18/2020] [Accepted: 12/08/2020] [Indexed: 05/25/2023]
Abstract
Domestic violence victims are in frequent contact with the healthcare service yet rarely disclose. Therefore, it is critical to understand victims' experiences and perceptions regarding disclosure in healthcare settings. The goal of this review is to provide an updated synthesis of qualitative research identifying barriers and facilitators, advice, and positive and negative outcomes of adult victims' disclosure of domestic violence to healthcare professionals (HCPs). A systematic search of PsychINFO, CINAHL and Web of Science was conducted in January 2018. Thirty-four eligible studies were identified, including 783 domestic violence victims (781 females). Formal quality assessment indicated variable study quality. Barriers of disclosure included negative HCPs attitudes, victims' perceptions of safety and concerns about the consequences of disclosing. Facilitators of disclosing included a positive relationship with the HCP, HCPs directly asking victims about abuse, and HCPs ensuring that the environment is safe and disclosure is confidential. Victims advised increased awareness of HCPs reactions to disclosure and avoiding mirroring their perpetrators minimization. HCPs were encouraged to engage in direct questioning and maintain a supportive and secure environment. Positive and negative outcomes of abuse were identified, such as being able to leave the abuser or, on the other hand, the victims' situation not changing. Our results indicate that barriers for disclosure of domestic violence in healthcare settings persist despite the widespread implementation of policies and guidelines to counter them. Based on these findings, we provide recommendations for clinical practice and future research to help improve disclosure in healthcare settings.
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Affiliation(s)
- Rebecca L. Heron
- Department of Arts and SciencesUniversity of Houston‐VictoriaVictoriaTXUSA
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenThe Netherlands
| | - Maarten C. Eisma
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenThe Netherlands
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Rezaee N, Mardani-Hamooleh M. A Qualitative Study of the Health-Related Perceptions of Married Iranian Women Who Have Experienced Domestic Violence. JOURNAL OF FORENSIC NURSING 2021; 17:34-42. [PMID: 33350665 DOI: 10.1097/jfn.0000000000000314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Violence against women occurs all over the world; it is a phenomenon that is considered an invasion of human rights. The most common form of this phenomenon is domestic violence (DV). AIM The purpose of this study was to explore the health-related perceptions of married women in Iran who have experienced DV. METHOD This qualitative study was carried out using conventional content analysis method. In total, a purposive sample of 27 women who had been subjected to violence by their spouses agreed to participate in this study. Individual, in-depth, and semistructured interviews were conducted. FINDINGS Three main categories emerged from the data: (a) perceptions related to physical health (including non-sex-organ injuries and sex organ injuries), (b) perceptions related to psychological health (including fear, concern, and the creation of challenges), and (c) perceptions related to sociocultural health (specifically social health and cultural health). CONCLUSION In Iran, DV threatens women's health and is influenced by personal, familial, social, and cultural factors. Nurses should consider various aspects of physical, psychological, and sociocultural health when caring for women who have experienced DV. Social and cultural-based interventions are needed to address negative attitudes, stigma, and false beliefs that sanction DV in Iran.
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Affiliation(s)
- Nasrin Rezaee
- Author Affiliations:Department of Psychiatric Nursing, Community Nursing Research Center, Zahedan University of Medical Sciences
| | - Marjan Mardani-Hamooleh
- Department of Psychiatric Nursing, Nursing Care Research Center, Iran University of Medical Sciences
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Infanti JJ, Zbikowski A, Wijewardene K, Swahnberg K. Feasibility of Participatory Theater Workshops to Increase Staff Awareness of and Readiness to Respond to Abuse in Health Care: A Qualitative Study of a Pilot Intervention Using Forum Play among Sri Lankan Health Care Providers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207698. [PMID: 33096886 PMCID: PMC7589055 DOI: 10.3390/ijerph17207698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 11/16/2022]
Abstract
Women globally experience mistreatment by health providers during childbirth. Researchers have identified strategies to counteract this type of abuse in health care, but few have been evaluated. We used a theater technique, Forum Play, in a brief training intervention to increase awareness of abuse in health care and promote taking action to reduce or prevent it. The intervention was implemented in four workshops with 50 participating physicians and nurses from three hospitals in Colombo, Sri Lanka. This article reports the views of 23 workshop participants who also took part in four focus group discussions on the acceptability and feasibility of the method. The participants reported that the intervention method stimulated dialogue and critical reflection and increased their awareness of the everyday nature of abuses experienced by patients. Participants appreciated the participatory format of Forum Play, which allowed them to re-enact scenarios they had experienced and rehearse realistic actions to improve patient care in these situations. Structural factors were reported as limitations to the effectiveness of the intervention, including under-developed systems for protecting patient rights and reporting health provider abuses. Nonetheless, the study indicates the acceptability and feasibility of a theater-based training intervention for reducing the mistreatment of patients by health care providers in Sri Lanka.
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Affiliation(s)
- Jennifer J. Infanti
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, N-7491 Trondheim, Norway
- Correspondence: ; Tel.: +47-94721964
| | - Anke Zbikowski
- Women’s Clinic, Ryhov County Hospital, SE-55185 Jönköping, Sweden;
| | - Kumudu Wijewardene
- Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda 10250, Sri Lanka;
| | - Katarina Swahnberg
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, SE-391 82 Kalmar, Sweden;
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Gashaw BT, Schei B, Solbraekke KN, Magnus JH. Ethiopian Health Care Workers' Insights into and Responses to Intimate Partner Violence in Pregnancy-A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103745. [PMID: 32466276 PMCID: PMC7277814 DOI: 10.3390/ijerph17103745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 12/24/2022]
Abstract
Violence against women is a global pandemic, with the potential to spread through generations. Intimate partner violence has impacts on women’s sexual, reproductive, and psycho-social health. It can occur during pregnancy and adversely affect the health of both mother and child. Health care workers involved in antenatal care can have a unique role in identifying intimate partner violence and in intervening, preventing, and mitigating its consequences. In this study, the objective was to explore Ethiopian health care workers’ insights of and responses to intimate partner violence in pregnancy. Using an exploratory design, this qualitative study includes ten semi-structured interviews of health care workers representing different antenatal care centers in Jimma, Ethiopia. The content analyses of translated interview notes were conducted with Atlas.ti7 software, (Atlas.ti Scientific Software Development Gmbh, Berlin). The health care workers shared their insights of the consequences of intimate partner violence during pregnancy in addition to their experience with and responses to the victims. There was a limited understanding of the extent of the adverse impacts of intimate partner violence on pregnancy outcomes, as well as the potential long-term health implications. The informants described how they only gave medical treatment for obstetric complications or visible trauma during pregnancy. There was no formal referral to or linkages with other resources. Women’s empowerment and systemic changes in the health care, including training and capacity building, clear guidelines addressing management of intimate partner violence in pregnancy, and inclusion of intimate partner violence screening tools in the Ethiopian antenatal care chart/card, were recommended by the informants. The adverse impacts of intimate partner violence on pregnancy outcomes were poorly understood by the Ethiopian health care workers in this study. They offered limited assistance to the victims and recommended changes in the routine antenatal care (ANC) and health care systems. They identified various policy initiatives focusing on women’s empowerment to reduce intimate partner violence and its complications especially during pregnancy.
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Affiliation(s)
- Bosena Tebeje Gashaw
- College of Health Sciences, Jimma University, 1355 Jimma, Ethiopia
- Faculty of Medicine, University of Oslo, 0316 Oslo, Norway;
- Correspondence:
| | - Berit Schei
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, University of Science and Technology, N-7489 Trondheim, Norway;
- Department of Obstetrics and Gynaecology, St. Olav’s Hospital, 7030 Trondheim University Hospital, N-7489 Trondheim, Norway
| | | | - Jeanette H. Magnus
- Faculty of Medicine, University of Oslo, 0316 Oslo, Norway;
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
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Rishal P, Devi Pun K, Schei B, Bhandari B, Kumar Joshi S, Swahnberg K, Infanti JJ, Lukasse M. Improving Safety Among Pregnant Women Reporting Domestic Violence in Nepal-A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2268. [PMID: 32230945 PMCID: PMC7177396 DOI: 10.3390/ijerph17072268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/16/2022]
Abstract
Introduction: Domestic violence (DV) during pregnancy is associated with poor health outcomes for both the mother and newborn, and sometimes death. In a low-income country like Nepal, women have few options to leave abusive situations. Therefore, there is a need for interventions to improve their safety. The aim of our study was to explore the use of safety measures before and after an educational intervention among women who have reported DV during pregnancy. Materials and methods: Of 1010 pregnant women screened consecutively for DV using the Abuse Assessment Screen (AAS) during routine antenatal care, 181 women reported domestic violence. All 1010 participating pregnant women were taught 15 safety measures using a locally developed flipchart. We obtained contact with 80 of the 181 eligible women postpartum, of whom 62 completed the follow-up assessment. We explored and described the use of safety measures at baseline and follow-up, using a standardized instrument called the Safety Behavior Checklist. Results: At follow-up, less than half of the women (n = 30, or 48.3%) reported any form of DV. Of the women who reported DV at follow-up, significantly more reported the experience of both violence and fear at baseline (21.9%, p = 0.01) compared with the women who did not report DV at follow-up (3.3%, p = 0.01). Women reporting DV at baseline and follow-up used more safety measures at baseline (56) and follow-up (80) compared with women reporting DV at baseline only (36 and 46). Women reporting DV at baseline and follow-up used more safety measures for the first time at follow-up, 57 new measures compared with the 28 new measures used by women reporting DV at baseline only. Conclusions: The use of a flipchart teaching session on safety measures within antenatal care may increase the number of safety measures women use to protect themselves during pregnancy and decrease the risks of adverse health effects of DV.
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Affiliation(s)
- Poonam Rishal
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Postbox 8905, 7491 Trondheim, Norway; (P.R.); (K.D.P.); (B.S.); (J.J.I.)
- Department of Community Medicine, Kathmandu Medical College and Teaching Hospital, PO Box 21266, Sinamangal, Kathmandu 44600, Nepal;
- Kathmandu University School of Medical Sciences, Kathmandu University and Dhulikhel Hospital, Dhulikhel 45200, Bagmati, Nepal
| | - Kunta Devi Pun
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Postbox 8905, 7491 Trondheim, Norway; (P.R.); (K.D.P.); (B.S.); (J.J.I.)
- Kathmandu University School of Medical Sciences, Kathmandu University and Dhulikhel Hospital, Dhulikhel 45200, Bagmati, Nepal
| | - Berit Schei
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Postbox 8905, 7491 Trondheim, Norway; (P.R.); (K.D.P.); (B.S.); (J.J.I.)
- Department of Obstetrics and Gynecology, St. Olavs University Hospital, Postbox 3250, Sluppen, 7006 Trondheim, Norway
| | - Buna Bhandari
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu 44600, Nepal;
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Sunil Kumar Joshi
- Department of Community Medicine, Kathmandu Medical College and Teaching Hospital, PO Box 21266, Sinamangal, Kathmandu 44600, Nepal;
| | - Katarina Swahnberg
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnæus University, 391 82 Kalmar, Sweden;
| | - Jennifer Jean Infanti
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Postbox 8905, 7491 Trondheim, Norway; (P.R.); (K.D.P.); (B.S.); (J.J.I.)
| | - Mirjam Lukasse
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Postbox 4, St. Olavs Plass, 0130 Oslo, Norway
- Department of Health and Social Sciences, University College of Southeast Norway, Postbox 235, 3603 Kongsberg, Campus Vestfold, 3184 Borre, Norway
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Sapkota D, Baird K, Saito A, Rijal P, Pokharel R, Anderson D. Counselling-based psychosocial intervention to improve the mental health of abused pregnant women: a protocol for randomised controlled feasibility trial in a tertiary hospital in eastern Nepal. BMJ Open 2019; 9:e027436. [PMID: 31015275 PMCID: PMC6500424 DOI: 10.1136/bmjopen-2018-027436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The strong correlation between domestic and family violence (DFV) and mental health has been well documented in studies. Pregnancy is a period when both DFV and mental distress tend to occur and/or accentuate. Although limited, available evidence from developed countries has shown continual support and education as psychological first aid that can reduce DFV and improve mental health. However, there is significantly less number of studies from resource-constrained countries; thus, there continues to be a substantial gap in knowledge and awareness regarding effective interventions for DFV. METHODS AND ANALYSIS A two-arm randomised trial with a nested qualitative study has been planned to assess feasibility and treatment effect estimates of a counselling-based psychosocial intervention among pregnant women with a history of abuse. A total of 140 pregnant women who meet the inclusion criteria will be recruited into the study. Block randomisation will be used to allocate women equally into two groups. The intervention group will receive a counselling session, an information booklet and continuous support by a researcher, while women in the control group will receive contact information of local support services. Feasibility measures, such as rates of recruitment, consent and retention, will be calculated. Qualitative interviews with participants and healthcare providers will explore the acceptability and usability of the intervention. Outcome measures, such as psychological distress, quality of life, social support and self-efficacy, will be measured at baseline, 4 weeks postintervention and 6 weeks postpartum. ETHICS AND DISSEMINATION This study has obtained ethical approval from the Griffith University Human Research Ethics Committee, the Nepal Health Research Council and the Institutional Review Board of a tertiary hospital in Dharan, Nepal. The findings will be disseminated via peer-reviewed publications and conference presentations and will be used to inform a future multicentre trial. TRIAL REGISTRATION NUMBER 12618000307202; Pre-results.
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Affiliation(s)
- Diksha Sapkota
- School of Nursing and Midwifery, Griffith University, Loganlea, Queensland, Australia
- Women's Wellness Research Program, Menzies Health Institute Queensland, Nathan, Queensland, Australia
- Department of Nursing, Kathmandu University School of Medical Sciences, Dhulikhel, Province 3, Nepal
| | - Kathleen Baird
- School of Nursing and Midwifery, Griffith University, Loganlea, Queensland, Australia
- Women, Newborn and Children's Services, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Amornrat Saito
- School of Nursing and Midwifery, Griffith University, Loganlea, Queensland, Australia
- Women's Wellness Research Program, Menzies Health Institute Queensland, Nathan, Queensland, Australia
| | - Pappu Rijal
- BP Koirala Institute of Health Sciences, Dharan, Kathmandu, Nepal
| | - Rita Pokharel
- BP Koirala Institute of Health Sciences, Dharan, Kathmandu, Nepal
| | - Debra Anderson
- School of Nursing and Midwifery, Griffith University, Loganlea, Queensland, Australia
- Women's Wellness Research Program, Menzies Health Institute Queensland, Nathan, Queensland, Australia
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Rishal P, Pun KD, Darj E, Joshi SK, Bjørngaard JH, Swahnberg K, Schei B, Lukasse M. Prevalence and associated factors of domestic violence among pregnant women attending routine antenatal care in Nepal. Scand J Public Health 2017; 46:785-793. [PMID: 29578383 DOI: 10.1177/1403494817723195] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS The primary aim of this study was to assess the prevalence of domestic violence (DV) and its associated factors among pregnant women in Nepal. The secondary aims were to investigate disclosure of DV by women to health-care personnel and to assess whether health-care personnel had asked women about their experience of DV. METHODS This cross-sectional study included 2004 pregnant women between 12 and 28 weeks of gestation attending routine antenatal care at two hospitals in Nepal from August 2014 to November 2015. In this study, DV was defined as fear of a family member and/or an experience of physical, emotional or sexual violence. Associated risk factors were analysed using logistic regression analyses. RESULTS Twenty-one per cent of the women had experienced DV; 12.5% experienced fear only, 3.6% violence only and 4.9% experienced both violence and fear. Less than 2% per cent reported physical violence during pregnancy. This study found that just 17.7% had ever been asked by health-care personnel about DV, and of the women who had reported DV, only 9.5% had disclosed their experience to health-care personnel. Women of young age and low socio-economic status were more likely to have experienced DV. Women who reported having their own income and the autonomy to use it were at significantly lower risk of DV compared to women with no income. CONCLUSIONS A substantial proportion of women reported having experienced DV. Victims had rarely disclosed their experience of DV to health-care personnel. This study underlines the importance of integrating systematic assessment of DV in antenatal care.
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Affiliation(s)
- Poonam Rishal
- 1 Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Norway.,5 Department of Community Medicine, Kathmandu Medical College Teaching Hospital, Nepal
| | - Kunta Devi Pun
- 1 Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Norway.,2 Kathmandu University School of Medical Sciences, Kathmandu University, Nepal
| | - Elisabeth Darj
- 1 Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Norway.,3 Department of Obstetrics and Gynaecology, St. Olav's Hospital, Norway.,4 Department of Women's and Children's Health, Uppsala University, Sweden
| | - Sunil Kumar Joshi
- 5 Department of Community Medicine, Kathmandu Medical College Teaching Hospital, Nepal
| | - Johan Håkon Bjørngaard
- 1 Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Norway.,6 Forensic Department and Research Centre Bröset, St. Olav's University Hospital, Norway
| | - Katarina Swahnberg
- 7 Department of Health and Caring Sciences, Faculty of Health and Life Science, Linnaeus University, Sweden
| | - Berit Schei
- 1 Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Norway.,8 Department of Obstetrics and Gynaecology, St. Olav's Hospital Trondheim University Hospital, Norway
| | - Mirjam Lukasse
- 9 Faculty of Health Sciences, Oslo and Akershus University College, Norway.,10 Department of Health and Social Sciences, University College of Southeast Norway, Norway
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