Healthcare system responses to intimate partner violence in low and middle-income countries: evidence is growing and the challenges become clearer

Abstract

The damage to health caused by intimate partner violence demands effective responses from healthcare providers and healthcare systems worldwide. To date, most evidence for the few existing, effective interventions in use comes from high-income countries. Gupta et al. provide rare evidence of a nurse-delivered intimate partner violence screening, supportive care and referral intervention from a large-scale randomised trial in Mexican public health clinics. No difference was found in the primary outcome of reduction in intimate partner violence. There were significant short-term benefits in safety planning and mental health (secondary outcomes) for women in the intervention arm, but these were not sustained.This important study highlights the challenges of primary outcome choices in such studies, and further challenges for the sustainability of healthcare systems and healthcare provider interventions. These challenges include the role of theory for sustainability and the risk that baseline measures of intimate partner violence can wash out intervention effects. We emphasise the importance of studying the processes of adaptation, integration and coordination in the context of the wider healthcare system.Please see related article: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0880-y

Effectiveness of a counselling intervention implemented in antenatal setting for pregnant women facing domestic violence: a pre‐experimental study

“…If HCPs are unable to respond to the woman, this can lead to re-victimisation and can accentuate feelings of self-blame, hopelessness, and stigmatisation. 49 This clearly specifies the responsibility of health systems to collaborate with various stakeholders involved in providing support services to women reporting violence.…”

Patterns of healthcare services utilization associated with intimate partner violence (IPV): Effects of IPV screening and receiving information on support services in a cohort of perinatal women

“…Despite these findings, other studies paint a more ambivalent picture of HCS utilization among women experiencing IPV [20]. Such studies suggest that many of these women face barriers limiting their ability to seek help via HCS, and that they might use these services less Patterns of healthcare services utilization associated with intimate partner violence PLOS ONE | https://doi.org/10.…”

“…Utilization of specialist services was higher among women aged 25-34, women with university education, women who were after birth during the interview, and mothers of children. ER visit rates were higher among mothers in the youngest age group [16][17][18][19][20][21][22][23][24], with lower education (less than high school), those who were pregnant during the interview, and those with no children. Hospitalization was higher among women with lower education (high school or less), pregnant women, and mothers with no children during the interview (S1a Appendix).…”

“…and its handling of VAW [26]. External societal factors surrounding women's status and the actions of perpetrators [20] can also affect women's help seeking behaviors and whether women disclose IPV to a HCP [27,28]. Meanwhile, a related gap remains understudied among minority women experiencing IPV, whose help seeking was even lower [29,30], as they face more social and economic barriers to HCS use than others [23,[31][32][33][34].…”

Protocol for a Matched-Pair Cluster Control Trial of ARCHES (Addressing Reproductive Coercion in Health Settings) among Women and Girls Seeking Contraceptive Services from Community-Based Clinics in Nairobi, Kenya

“…In 2013, based on the growing understanding of the negative effects of GBV on the health of women and girls, and the need to address GBV as a human rights abuse, the World Health Organization (WHO) issued global guidelines recommending the identification and support of IPV survivors within health services (18).This guidance was updated in 2019 to include the identification of RC(19). Despite this global call-to-action, to date, only one clinic-based GBV prevention interventionhas been shown via experimental or quasi-experimental design to reduce women's experience of IPV in an LMIC context (20)(21)(22) and none have addressed RC or increased female contraceptive control. Although an important advance, this model was limited to women in the third trimester of pregnancy, and required (4) two-hour sessions with a counselor not providing routine care (22), making it challenging to integrate this intervention into existing routine health services.…”