SeriesDilemmas and opportunities for an appropriate health-service response to violence against women
Section snippets
Ensuring safety for women
Some argue that asking women about partner violence in a sympathetic and non-judgmental manner can in itself be therapeutic (figure 2). This approach can signal that someone is interested, that the woman is not alone, and that there is a space in which she can talk about the problem if and when she wishes to do so. Many women, regardless of whether they had experienced intimate partner violence, would welcome health providers asking questions on abuse—even if they chose not to disclose
Interventions in health-care settings
Reviews of in-service training and screening programmes have shown the lack of formal assessment of such interventions and that there are few data on their effectiveness.15, 16 The few assessments that have been done focus on process measures, such as increases in identification rates, and lack well defined, long-term outcome measures.17, 18 Experiences have been documented almost exclusively in developed countries, particularly the USA. However, initiatives are now also underway in developing
Training in health-care settings
Many problems with implementation of appropriate interventions could arise from inadequate training. Although some efforts32, 33 have begun to integrate violence against women or family violence into undergraduate curricula of doctors and nurses, most health professionals will graduate without having heard about these issues. These issues should be given higher priority since education would provide the basis for later in-service training. A review of primary care, obstetrics and gynaecology,
Gender and power in the health system
The inequalities between women and men that are common in most societies are usually also reflected in the health sector. Warshaw40 has discussed extensively how the medical model and its institutions restrict the possibilities of responding to women experiencing violence. She emphasises the need for structural transformation as essential for development of an effective health-service response to women in abusive situations. This change is especially important in settings in which violence
Context specific models
The level of intervention that is appropriate will vary between settings depending on the availability of human and financial resources and of services to which health workers can refer women. Different levels of response are possible, ranging from posters or other messages highlighting the problem to more proactive interventions. Even within one health-care setting such as a hospital, there may be great variation between units in what is feasible. Protocols, training, and information should be
Assessment and outcome measures
Although asking questions about abuse is an intervention in its own right and might be effective, the experience of most clinicians is that an appropriate response is needed when women have been identified as being abused. However, screening might become an end in itself rather than a first step towards making available or providing access to a range of services and responses. In some cases, a list of telephone numbers or possible places for referral can be provided, and in others referral to a
Conclusions and recommendations
Health services are increasingly recognised as being able to play an important part in addressing the more common forms of violence against women, especially in secondary and tertiary prevention. A consensus is also growing on the need to assess and identify effective health-sector interventions to convince health providers and policy makers of the value of these interventions. Although research on interventions is methodologically difficult and can be expensive, without a concerted effort in
References (44)
Health consequences of intimate partner violence
Lancet
(2002)Intimate partner violence: causation and primary prevention
Lancet
(2002)- et al.
Improving detection of violence among pregnant adolescents
J Adolescent Health
(1997) - et al.
Identification and management of domestic violence: a randomized trial
Am J Prev Med
(2000) - et al.
Family violence issues in obstetrics and gynecology, primary care, and nursing texts
Obstet Gynecol
(1997) - et al.
“Women enjoy punishment”: attitudes and experiences of gender violence among primary health care nurses in rural South Africa
Soc Sci Med
(2002) - et al.
The prevalence of domestic violence among obstetric nurses
Women's Health Issues
(1998) - et al.
Womankind: an innovative model of health care response to domestic abuse
Women's Health Issues
(1995) The effects of woman abuse on health care utilization and health status: a literature review
Women's Health
(1992)Violence against women: relevance for medical practitioners
JAMA
(1992)
Domestic violence. ACOG Technical Bull number 209
Domestic violence: a health care issue
Domestic abuse in pregnancy: position paper number 19
Letting compassion open the door: battered women's disclosure to medical providers
Cambridge Q Healthcare Ethics
Women's opinions about domestic violence screening and mandatory reporting
Am J Preventive Med
Breaking the silence: battered women's perspectives on medical care
Arch Fam Med
A qualitative analysis of how physicians with expertise in domestic violence approach the identification of victims
Ann Intern Med
Ruta Critica que siguen las mujeres victimas de violencia intrafamiliar: análisis y resultados de la investigación Panama City, Panama 1998
Community health workers' response to violence against women
Aust NZ J Mental Health Nursing
Screening for intimate partner violence by health care providers: barriers and interventions
Am J Prev Med
Cited by (145)
Proposals for approaching violence against women in health care. A qualitative analysis
2021, Atencion PrimariaUsability of two brief questions as a screening tool for domestic violence and effect of #MeToo on prevalence of self-reported violence
2020, European Journal of Obstetrics and Gynecology and Reproductive BiologyIntimate partner violence and maternal mental health ten years after a first birth: An Australian prospective cohort study of first-time mothers
2020, Journal of Affective DisordersSexual violence associated with poor mental health in women attending Australian general practices
2017, Australian and New Zealand Journal of Public HealthAn insight on gender-based violence
2024, Health Science ReportsMandatory reporting obligations within the context of health research: Grappling with some of the ethical-legal complexities
2023, South African Journal of Bioethics and Law