Responding to intimate partner and sexual violence against women

Abstract

On 20 June the World Health Organization published its first clinical and policy evidence based guidelines on responding to intimate partner violence and sexual violence against women. 1 These landmark guidelines draw from a WHO study of 24 097women in 10 countries. 2 This study showed widespread lifetime physical and sexual violence by an intimate partner (15-71% prevalence among ever partnered women) and associated effects on health. Health outcomes associated with such violence include substantially increased risk of suicide attempts, suicidal thoughts, pain, dizziness, and vaginal discharge. 3 The 2010 Global Burden of Disease Study ranked intimate partner violence fifth in terms of years lost owing to disability. 4 In a study of Australian women of reproductive age (15-44 years), intimate partner violence was the largest risk factor for poor health (greater than smoking, alcohol, obesity, hypercholesterolaemia, and hypertension). 5 Such violence is undoubtedly a major public health problem that requires a compassionate and effective health response.The WHO guidelines offer 37 recommendations about the clinical care of women who have experienced intimate partner violence or sexual violence (or both), the training of healthcare providers, and the formulation of healthcare policy and service provision. They meet a crucial need to raise awareness of such violence as a health matter-rather than just a criminal justice, social, or personal problem-among healthcare providers, trainers, and policy makers.The WHO report acknowledges that men also experience domestic and sexual assault, although its causes are different in men, as are the experiences and needs of men. The risks of adverse sequelae are higher when the perpetrator is male rather than female. Women generally experience more sexual violence, more severe physical violence, more abuse after separation, and more coercive control from male partners. 6Recognition that the global problems of intimate partner violence and sexual violence vary between the sexes enables more effective policy and service responses to be developed. A recent study of data from 70 countries (with varying religions, levels of income, and political systems), covering 85% of the world's population, found that the generation of public support and media attention through a strong autonomous feminist movement was the key catalyst for government action on violence against women. 7 This was more important than the wealth of a nation, the number of female politicians, or the positioning of parties on the left-right political spectrum. The current WHO guidelines may be used, alongside evidence based literature on the prevention of violence, 8 by civil society groups, health organisations, and others to push for national and local changes.Best clinical guidance for women who have been sexually assaulted includes recommendations on the use of emergency contraception and post-exposure prophylaxis for HIV and sexually transmitted diseases, along with the offer of safe legal abortion and psychologi...

Sexual relationship power and intimate partner violence among sex workers with non-commercial intimate partners in a Canadian setting

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The Case for Early Intervention to Reduce the Impact of Intimate Partner Abuse on Child Outcomes: Results of an Australian Cohort of First‐Time Mothers

“…This reinforces the importance of effective early intervention to support mothers and children exposed to IPA. Such strategies have the potential to improve outcomes across the life course and interrupt the intergenerational transmission of poor outcomes . The perinatal and early childbearing period is a unique time when women are in contact with a range of health professionals including obstetricians, midwives, maternal child health nurses, and general practitioners.…”

“…Attention to the broader context of women's lives—including the impact of partner abuse on women and their children—needs to have a more central place in health professionals' scope of practice. The refining and testing of interventions in perinatal settings to improve the identification and appropriate care and support pathways for families experiencing IPA and other types of social adversity is an urgent public health issue .…”

Improving the healthcare response to domestic violence and abuse in UK primary care: interrupted time series evaluation of a system-level training and support programme

“…In most settings, including high-income countries, healthcare is still not responding adequately to violence against women, which will most commonly be DVA [8]. This response's contribution to delivering better healthcare for all has not been realised [9]. Ten years following the completion of our cluster randomised controlled trial demonstrating the effectiveness of IRIS-Identification and Referral to Improve Safety of women affected by DVA-a complex, system-level, training, support and referral programme, designed to improve the primary healthcare response to DVA [10], we now report an analysis of a population-wide implementation evaluation of IRIS, over four years (2012 to 2017).…”