Security from above and below: A critical ethnography of the health response to violence against women in Timor-Leste

Wild, Kayli; Gomes, Lidia; Fernandes, Angelina; Araujo, Guilhermina de; McDonald, Susan; Taft, Angela

doi:10.1016/j.socscimed.2020.113191

Cited by 3 publications

(5 citation statements)

References 16 publications

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“…Rather, health providers have a central role in facilitating both formal and informal support for women. This suggests that more needs to be done to enhance the continuum of options for women across these formal services and informal spaces, to support health providers to safely engage with families and communities, and to develop mechanisms to deal with complex social issues within local health systems (Wild et al, 2020a).…”

Section: Discussionmentioning

confidence: 99%

“…The woman could then decide whether she would want that intervention from her health provider by placing the card in the ‘yes’, ‘maybe’ or ‘no’ pile that was labelled in front of her. The list of 25 interventions was based on a similar study conducted by Chang and colleagues (2005), with additional interventions based on our previous research with midwives and community leaders (Wild et al, 2019, 2020a) and questions specific to the mandatory reporting context in the country. For example, we included several different questions about the circumstances where women would want health providers to report to the police.…”

Section: Methodsmentioning

confidence: 99%

“…The lowest-ranked interventions were around giving women advice on how to be patient and avoid arguments, talking to her husband to try and resolve the problem and giving them couple-counselling. All of these have been reported as common practices by midwives in a separate study in the same three municipalities of Timor-Leste (Wild et al, 2016(Wild et al, , 2020a. Reviews of health system barriers to providing care also showed that women often fear that the provider will violate confidentiality and confront the abuser (Hamberger & Phelan, 2006;Hegarty et al, 2008).…”

Section: Implications For Practicementioning

confidence: 97%

“…Only one third of women who received healthcare for a violence-related injury told the healthcare worker the real cause of their injury (The Asia Foundation, 2016). The need to create conditions in which women feel safe to disclose is hampered by health system barriers (Wild et al, 2019, 2020a). Mandatory reporting laws, in which health providers are obligated to provide information about known cases of domestic violence to the police, have been shown to be a barrier to disclosing in other settings (Hamberger & Phelan, 2006; Lippy et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

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Healthcare Responses to Gender-Based Violence in Timor-Leste: Women Want Empathy, Information and Safety From an Integrated Support System

Wild

Young

Araujo

et al. 2022

J Interpers Violence

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Healthcare providers are one of the first professionals women are likely to come into contact with after experiencing violence as they seek care for injuries and associated health problems or in routine care such as reproductive health services. Systematic reviews of women's experiences and expectations when disclosing abuse in health settings reveal a dearth of research with women in low-income countries and from rural areas. The aim of this study was to understand the information and interventions women who have experienced domestic violence or sexual assault want from their health providers in Timor-Leste, a country with a largely rural population and very high rates of violence against women. The mixed-methods study consisted of in-depth qualitative interviews with 28 women survivors of violence, followed by a ‘pile-sort’ activity in which they rated their preference for different types of interventions they wanted from their healthcare provider. The pile-sort activity showed the highest-ranked interventions centred around emotional support, information and safety, the middle-ranked interventions centred around empowering women and playing an advocacy role, and the lowestranked interventions were around intervening at the relationship level and mandatory reporting to the police. The qualitative interviews provided rich insights that affirmed women value empathy and kindness from service providers, they want to be supported to make their own decisions and the importance of formal as well as informal sources of support such as community leaders and family. There are significant implications for the content of existing training programmes on gender-based violence in Timor-Leste and similar contexts, particularly the need to build capacity on how to respond in an empathic and empowering way and how to balance mandatory reporting obligations, while also practising woman-centred care and providing the kind of support women value. Abstratu Tetun Fornesedór kuidadu saúde nuudar profisionál dahuluk ida neebé iha posibilidade atu halo kontaktu ho feto sira depoiz de hetan violénsia tanba sira buka tratamentu ba kanek no problema saúde neebe iha ligasaun ka iha kuidadu rutina sira hanesan servisu saúde reprodutiva nian. Estudu sistemátiku kona-ba feto sira nia esperiénsia no espetativa bainhira fósai abuzu iha kontestu saúde nian dehan katak ladun barak peskiza ho feto sira iha nasaun ho rendimentu kiik no husi área rurál sira. Estudu ida nee ezamina informasaun no intervensaun feto sira neebé hetan violénsia doméstika ka asaltu seksuál sira nia hakarak hosi fornesedor saúde iha Timor-Leste, nasaun ida neebé ho populasaun rurál barak no númeru neebe mak aas tebes hosi violénsia hasoru feto. Métodu estudu mistura ne'ebé kompostu hosi entrevista kualitativa profundu ho sobrevivente feto na'in 28 ne'ebé sofre violénsia, tuir fali ho atividade pile sort’ iha ne'ebé sira klasifika sira nia preferénsia ba tipu intervensaun ne'ebé diferente. Atividade pile sort hatudu intervensaun sira neebé hetan klasifikasaun boot liu mak iha apoiu emosionál, informasaun no seguransa, intervensaun ho klasifikasaun médiu foka liu ba empoderamentu feto no halao papél advokasia, no intervensaun ho klasifikasaun kik liu mak iha intervensaun iha nivel relasaun, no keixa obrigatóriu (mandatory reporting) ba iha polisia. Entrevista kualitativu fórnese persepsaun barak neebe feto sira koalia sai kona-ba sira nia valor empatia no laran-di'ak hosi prestadór servisu, sira hakarak atu hetan apoia atu halo desizaun rasik, no importánsia husi fonte formal no mos informál sira nia apoiu, hanesan lider komunitáriu no família. Iha implikasaun signifikativu ba konteúdu programa formasaun ne'ebé eziste kona-ba violénsia bazeia ba jéneru iha Timor-Leste no kontextu neebe mak hanesan, liu-liu presiza atu hasa'e kapasidade kona-ba oinsá atu responde ho maneira empatia no empodera feto sira no oinsa halo balansu obrigasaun relatóriu mandatóriu (mandatory reporting) enkuantu mós prátika kuidadu feto sira no fornese apoiu neebe mak iha valor ba feto sira. Disclaimer Readers should be aware that this article contains stories of trauma and abuse that some people may find difficult to read. If you experience any distress or something similar has happened or is happening to you, there are support services available in most countries. If you are in Timor-Leste, where this research was conducted, the following website has a list of services and contact details to get further assistance www.hamahon.tl . Nota: Le nain sira tenke hatene katak artigu ida ne'e kontein istória trauma no abuzu ne'ebé ema balun dalaruma sente defisil atu lee. Karik ita boot esperiensia difikuldade ruma ka iha esperiensia ruma neebé hanesan akontese ona ka akontese hela ba ita boot, iha servisu apoiu neebé mka disponivel iha nasaun barak. Karik ita boot hela iha Timor-Leste, iha nasaun ne'ebé halao peskiza ida nee, website tuir mai ne'e iha lista servisu no kontaktu detallu hodi hetan liu tan asisténsia www.hamahon.tl

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Implications For Practicementioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Healthcare Responses to Gender-Based Violence in Timor-Leste: Women Want Empathy, Information and Safety From an Integrated Support System

Wild

Young

Araujo

et al. 2022

J Interpers Violence

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“…However, in Timor-Leste it is common for health providers to blame women and to ask them what they did to cause the abuse. 35 , 57 Although there are national guidelines for health providers to assist survivors of IPV, 35 there is much to be done to improve communication, respect, and emotional support to vulnerable people given the magnitude of violence against women, children, and people with disabilities in Timor-Leste. 58…”

Section: Experience Of Care Standardsmentioning

confidence: 99%

Factors Affecting Quality of Care in Maternal and Child Health in Timor-Leste: A Scoping Review

Khorshed

Lindsay

McAuliffe

et al. 2022

Health�Serv�Insights

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Timor-Leste faces many challenges implementing quality maternal, newborn and child health (MNCH) services due to resource constraints and socio-cultural factors that disproportionately affect the health of women and children. A scoping review was conducted to map the quality of MNCH services against WHO quality standards on: 1. Provision of care, 2. Experiences of care, and 3. Cross-cutting standards. The literature search identified 1058 citations, from which 28 full-text articles met the inclusion criteria. The findings highlight health workers’ limited capacity to provide quality services and referrals. The major reasons for this are: a lack of essential supplies, poor infrastructure and transport, limited opportunities for ongoing learning, and gaps in health information systems. Provision of care standards and cross-cutting standards require attention at a broad systems level. Findings related to experiences of care highlight the importance of effective communication, respect, and emotional support, particularly for vulnerable women and children who have difficulty accessing services, and for those who have experienced violence. These experience-related standards could be addressed at an individual health worker and health service level, as well as at a systems level. This review provides direction to focus quality-improvement initiatives within local health facilities, as well as at municipal and national level.

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The COVID-19 pandemic and cases of domestic violence: perceptions of primary healthcare professionals in the context of social isolation

Bartos,

Da Silva,

Lucchesi

et al. 2024

Cad. Ibero Am. Direito Sanit.

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Objective: to analyze the perceptions of primary health care professionals in Paranaguá/PR about the relationship between the COVID-19 pandemic and cases of domestic violence in their assigned territories, identifying challenges in the approach, impacts on families and case management. Methodology: qualitative research was conducted using semi-structured interviews and focus groups with 36 professionals from two primary health care units in Paranaguá, on the Paraná coast. Results: Primary health care professionals unanimously reported an increase in the number of domestic violence cases in those communities, affecting women, children, and adolescents, with the closure of schools identified as an aggravating factor. The main challenges highlighted were the disruption of primary health care services during the peak of the pandemic due to the reallocation of professionals and resources; misinformation about referral processes for domestic violence cases within the intersectoral network; fear among professionals regarding the pandemic and reporting domestic violence cases; and high staff turnover. Conclusion: The period of social isolation caused by the pandemic intensified domestic violence cases, according to the perceptions of primary health care professionals in Paranaguá. The dismantling of the intersectoral network further compromised the care of individuals in situations of vulnerability and/or violence. The absence of national guidelines from the federal government left municipalities and primary health care professionals on their own to deal with the issue. Submission: 03/30/23| Review: 06/14/23| Approval: 10/04/23

show abstract

Security from above and below: A critical ethnography of the health response to violence against women in Timor-Leste

Cited by 3 publications

References 16 publications

Healthcare Responses to Gender-Based Violence in Timor-Leste: Women Want Empathy, Information and Safety From an Integrated Support System

Healthcare Responses to Gender-Based Violence in Timor-Leste: Women Want Empathy, Information and Safety From an Integrated Support System

Factors Affecting Quality of Care in Maternal and Child Health in Timor-Leste: A Scoping Review

The COVID-19 pandemic and cases of domestic violence: perceptions of primary healthcare professionals in the context of social isolation

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