South Asia is considered to have a high prevalence of intimate partner violence (IPV) against women. Therefore the World Health Organisation has called for context-specific information about IPV from different regions. A scoping review of published and gray literature over the last 35 years was conducted using Arksey and O'Malley's framework. Reported prevalence of IPV in Sri Lanka ranged from 20-72%, with recent reports of rates ranging from 25- 35%. Most research about IPV has been conducted in a few provinces and is based on the experience of legally married women. Individual, family, and societal risk factors for IPV have been studied, but their complex relationships have not been comprehensively investigated. Health consequences of IPV have been reported, with particular attention to physical health, but women are likely to underreport sexual violence. Women seek support mainly from informal networks, with only a few visiting agencies to obtain help. Little research has focused on health sector responses to IPV and their effectiveness. More research is needed on how to challenge gendered perceptions about IPV. Researchers should capture the experience of women in dating/cohabiting relationships and women in vulnerable sectors (post-conflict areas and rural areas), and assess how to effectively provide services to them. A critical evaluation of existing services and programmes is also needed to advance evidence informed programme and policy changes in Sri Lanka.

BackgroundExposure to armed conflict and/or war have been linked to an increase in intimate partner violence (IPV) against women. A substantial body of work has focused on non-partner rape and sexual violence in war and post-war contexts, but research about IPV is limited, particularly in Asian settings. This paper presents the finding of a study conducted in the Eastern Province of Sri Lanka. The study explored women’s experiences of and responses to IPV as well as how health and social service providers perceive the problem. It also explored the IPV-related services and supports available after the end of a 30-year civil war.MethodWe conducted in-depth, qualitative interviews with 15 women who had experienced IPV and 15 service providers who were knowledgeable about IPV in the Eastern Province of Sri Lanka. Interviews were translated into English, coded and organized using NVivo8, and analyzed using inductive thematic analysis.ResultsParticipants described IPV as a widespread but hidden problem. Women had experienced various forms of abusive and controlling behaviours, some of which reflect the reality of living in the post-war context. The psychological effects of IPV were common, but were often attributed to war-related trauma. Some men used violence to control women and to reinstate power when their gender roles were reversed or challenged due to war and post-war changes in livelihoods. While some service providers perceived an increase in awareness about IPV and more services to address it, this was discordant with women’s fears, feelings of oppression, and perception of a lack of redress from IPV within a highly militarized and ethnically-polarized society. Most women did not consider leaving an abusive relationship to be an option, due to realistic fears about their vulnerability to community violence, the widespread social norms that would cast them as outsiders, and the limited availability of related services and supports.ImplicationsThese findings revealed the need for more research about IPV in post-war contexts. Women’s experiences in such contexts are influenced and may be masked by a complex set of factors that intersect to produce IPV and entrap women in violence. A more nuanced understanding of the context-specific issues that shape women’s experiences of IPV- and community responses to it—is needed to develop more comprehensive solutions that are relevant to the local context.

ObjectiveAccess to healthcare is an important part of the (re)settlement process for Syrian refugees in Canada. There is growing concern about the healthcare needs of the 54,560 Syrian refugees who were admitted to Canada by May 2018, 80% of whom are women and children. We explored the healthcare needs of newcomer Syrian women, their experiences in accessing and using health services, and the factors and conditions that shape whether and how they access and utilize health services in the Greater Toronto Area (GTA).MethodThis community-based qualitative descriptive interpretive study was informed by Yang & Hwang (2016) health service utilization framework. Focus group discussions were held with 58 Syrian newcomer women in the GTA. These discussions were conducted in Arabic, audio-recorded with participants’ consent, translated into English and transcribed, and analyzed using thematic analysis.ResultsParticipants’ health concerns included chronic, long-term conditions as well as new and emerging issues. Initial health insurance and coverage were enabling factors to access to services, while language and social disconnection were barriers. Other factors, such as beliefs about naturopathic medicine, settlement in suburban areas with limited public transportation, and lack of linguistically, culturally, and gender-appropriate services negatively affected access to and use of healthcare services.ConclusionResponding to the healthcare needs of Syrian newcomer women in a timely and comprehensive manner requires coordinated, multi-sector initiatives that can address the financial, social, and structural barriers to their access and use of services.

BackgroundMedical education research in general, and those focusing on clinical settings in particular, have been a low priority in South Asia. This explorative study from 3 medical schools in Sri Lanka, a South Asian country, describes undergraduate medical students’ experiences during their final year clinical training with the aim of understanding the teaching-learning experiences.MethodsUsing qualitative methods we conducted an exploratory study. Twenty eight graduates from 3 medical schools participated in individual interviews. Interview recordings were transcribed verbatim and analyzed using qualitative content analysis method.ResultsEmergent themes reveled 2 types of teaching-learning experiences, role modeling, and purposive teaching. In role modelling, students were expected to observe teachers while they conduct their clinical work, however, this method failed to create positive learning experiences. The clinical teachers who predominantly used this method appeared to be ‘figurative’ role models and were not perceived as modelling professional behaviors. In contrast, purposeful teaching allowed dedicated time for teacher-student interactions and teachers who created these learning experiences were more likely to be seen as ‘true’ role models. Students’ responses and reciprocations to these interactions were influenced by their perception of teachers’ behaviors, attitudes, and the type of teaching-learning situations created for them.ConclusionsMaking a distinction between role modeling and purposeful teaching is important for students in clinical training settings. Clinical teachers’ awareness of their own manifest professional characterizes, attitudes, and behaviors, could help create better teaching-learning experiences. Moreover, broader systemic reforms are needed to address the prevailing culture of teaching by humiliation and subordination.

Intimate partner violence (IPV) is a major health concern for women worldwide. Prevalence rates for IPV are high in the World Health Organization South-East Asia Region, but little is known about health-sector responses in this area. Health-care professionals can play an important role in supporting women who are seeking recourse from IPV. A comprehensive search was conducted to identify relevant published and grey literature over the last 35 years that focused on IPV, partner/ spousal violence, wife beating/abuse/battering, domestic violence, and Sri Lanka. Much of the information about current health-sector response to IPV in Sri Lanka was not reported in published and grey literature. Therefore, key personnel from the Ministry of Health, hospitals, universities and nongovernmental organizations were also interviewed to gain additional, accurate and timely information. It was found that the health-sector response to IPV in Sri Lanka is evolving, and consists of two models of service provision: (i) gender based violence desks, which integrate selective services at the provider/facility level; and (ii) Mithuru Piyasa (Friendly Abode) service points, which integrate comprehensive services at the provider/facility level and some at the system level. This paper presents each model's strengths and limitations in providing comprehensive and integrated health services for women who experience IPV in the Sri Lankan context.