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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Dahal P, Joshi SK, Swahnberg K. A qualitative study on gender inequality and gender-based violence in Nepal. BMC Public Health 2022; 22:2005. [PMID: 36320057 PMCID: PMC9628167 DOI: 10.1186/s12889-022-14389-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 10/19/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Gender inequality and violence are not mutually exclusive phenomena but complex loops affecting each other. Women in Nepal face several inequalities and violence. The causes are diverse, but most of these results are due to socially assigned lower positioning of women. The hierarchies based on power make women face subordination and violence in Nepal. The study aims to explore participants' understanding and experience to identify the status of inequality for women and how violence emerges as one of its consequences. Furthermore, it explores the causes of sex trafficking as an example of an outcome of inequality and violence. METHOD The study formulated separate male and female groups using a purposive sampling method. The study used a multistage focus group discussion, where the same groups met at different intervals. Six focus group discussions, three times each with male and female groups, were conducted in a year. Thirty-six individuals, including sixteen males and twenty females, were involved in the discussions. The study used constructivist grounded theory for the data analysis. RESULTS The study participants identify that a power play between men and women reinforce inequality and increases the likelihood of violence for women. The findings suggest that the subjugation of women occurs due to practices based on gender differences, constricted life opportunities, and internalization of constructed differences among women. The study identifies that interpersonal and socio-cultural violence can result due to established differences between men and women. Sex trafficking, as an example of the outcome of inequality and violence, occurs due to the disadvantageous position of women compounded by poverty and illiteracy. The study has developed a concept of power-play which is identified as a cause and consequence of women's subordination and violence. This power play is found operative at various levels with social approval for men to use violence and maintain/produce inequality. CONCLUSION The theoretical concept of power play shows that there are inequitable power relations between men and women. The male-centric socio-cultural norms and practices have endowed men with privilege, power, and an opportunity to exploit women. This lowers the status of women and the power-play help to produce and sustain inequality. The power-play exposes women to violence and manifests itself as one of the worst expressions used by men.
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Affiliation(s)
- Pranab Dahal
- grid.8148.50000 0001 2174 3522Department of Health and Caring Science, Linnaeus University, 391 82 Kalmar, Sweden
| | - Sunil Kumar Joshi
- grid.415089.10000 0004 0442 6252Department of Community Medicine, Kathmandu Medical College, 446 00 Kathmandu, Nepal
| | - Katarina Swahnberg
- grid.8148.50000 0001 2174 3522Department of Health and Caring Science, Linnaeus University, 391 82 Kalmar, Sweden
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Niraula SR, Manandhar N, Pandey S, Jha N. Stressors of Suicide Among the Residents of Ilam, Eastern Nepal: an Investigation Into a Neglected Burden. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-020-00480-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Colombini M, Mayhew SH, Hawkins B, Bista M, Joshi SK, Schei B, Watts C. Agenda setting and framing of gender-based violence in Nepal: how it became a health issue. Health Policy Plan 2016; 31:493-503. [PMID: 26412857 PMCID: PMC5007602 DOI: 10.1093/heapol/czv091] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2015] [Indexed: 11/13/2022] Open
Abstract
Gender-based violence (GBV) has been addressed as a policy issue in Nepal since the mid 1990s, yet it was only in 2010 that Nepal developed a legal and policy framework to combat GBV. This article draws on the concepts of agenda setting and framing to analyse the historical processes by which GBV became legitimized as a health policy issue in Nepal and explored factors that facilitated and constrained the opening and closing of windows of opportunity. The results presented are based on a document analysis of the policy and regulatory framework around GBV in Nepal. A content analysis was undertaken. Agenda setting for GBV policies in Nepal evolved over many years and was characterized by the interplay of political context factors, actors and multiple frames. The way the issue was depicted at different times and by different actors played a key role in the delay in bringing health onto the policy agenda. Women's groups and less powerful Ministries developed gender equity and development frames, but it was only when the more powerful human rights frame was promoted by the country's new Constitution and the Office of the Prime Minister that legislation on GBV was achieved and a domestic violence bill was adopted, followed by a National Plan of Action. This eventually enabled the health frame to converge around the development of implementation policies that incorporated health service responses. Our explicit incorporation of framing within the Kindgon model has illustrated how important it is for understanding the emergence of policy issues, and the subsequent debates about their resolution. The framing of a policy problem by certain policy actors, affects the development of each of the three policy streams, and may facilitate or constrain their convergence. The concept of framing therefore lends an additional depth of understanding to the Kindgon agenda setting model.
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Affiliation(s)
- Manuela Colombini
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK,
| | - Susannah H Mayhew
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Ben Hawkins
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Meera Bista
- Department of Community Medicine, Kathmandu Medical College and Teaching Hospital (KMC), Sinamangal, Kathmandu, Nepal and
| | - Sunil Kumar Joshi
- Department of Community Medicine, Kathmandu Medical College and Teaching Hospital (KMC), Sinamangal, Kathmandu, Nepal and
| | - Berit Schei
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Charlotte Watts
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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