Barriers and Facilitators to Integrating Health Service Responses to Intimate Partner Violence in Low‐ and Middle‐Income Countries: A Comparative Health Systems and Service Analysis

Colombini, Manuela; Dockerty, Colleen; Mayhew, Susannah

doi:10.1111/sifp.12021

Cited by 58 publications

(84 citation statements)

References 34 publications

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“…Intuitively, persistent exposure to torturous and violent behavior by an intimate partner can force a woman to escape from home, resulting in homelessness, economic insecurity, and substance abuse [8][9][10][11], which themselves are strong risk factors for abduction, harassment, sexual assault, and socioeconomic marginalization. As such, IPV can have serious repercussions on women's livelihood and economic security, safety, health, and overall well-being [12][13][14][15]. Despite this, there is currently no research evidence on IPV in many countries in SSA, including Angola.…”

Section: Introductionmentioning

confidence: 99%

Alcohol Drinking by Husbands/Partners Is Associated with Higher Intimate Partner Violence against Women in Angola

Yaya

Bishwajit

2019

Safety

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Intimate partner violence (IPV), as the most prevalent form of violence against women, is a commonly encountered phenomenon across sub-Saharan African countries, including Angola. As a fast-growing economy, Angola is experiencing a booming alcohol industry and persistent IPV and women’s rights issues, along with weak prohibition and enforcement against this practice. However, so far, there is no systematic research investigating the predictors of IPV in Angola and whether spousal alcohol drinking has any relationship with women’s experience of IPV. Therefore, in this study, we aimed to assess the predictors of IPV (defined as physical, emotional, and sexual violence) among Angolan women with a special focus on their partners’ alcohol drinking habit. Cross-sectional data on 7669 women aged 15–49 years from the Angola Demographic and Health Survey were used for this study. Data were analyzed using descriptive and logistic regression methods. Results indicated that physical IPV (32.3%, 95% Confidence Interval = 30.3 to 34.5) was most prevalent, followed by emotional (27.3%, 95% CI = 25.3 to 29.4) and sexual IPV (7.4%, 95% CI = 6.6 to 8.4). In the multivariate analysis, higher education and household wealth status showed protective effects against certain forms of IPV. Alcohol drinking by husbands/partners was associated with significantly higher odds of experiencing physical [OR = 2.950; 95% CI = 2.632, 3.306], emotional [OR = 2.470; 95% CI = 2.187,2.789], and sexual IPV [OR = 2.729; 95% CI = 2.220, 3.354] among women. Women who reported experiencing physical IPV had increased odds of drinking alcohol [OR = 1.474; 95% CI = 1.290, 1.684] compared with those who did not. These findings reflect the widespread prevalence of IPV in sub-Saharan African countries. Special focus should be given to married men with alcohol drinking habits to reduce women’s vulnerability to IPV and dependence on alcohol use.

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Section: Introductionmentioning

confidence: 99%

Alcohol Drinking by Husbands/Partners Is Associated with Higher Intimate Partner Violence against Women in Angola

Yaya

Bishwajit

2019

Safety

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“…However, the lack of guidelines at care services locations can be linked not only to poor political leadership but also to the government's lack of prioritisation of this public health and judicial problem. These figures can probably impact on the lack of government investment compromising implementation, monitoring and evaluation of national strategies [28,29,32,33].…”

Section: Documents Alignment With National Policiesmentioning

confidence: 99%

“…Some of this material has been designed to target assistance or prevention activities, often undermining the multisectoral approach. Conversely, it makes the strategies of prevention and control of DV institutionalised, questioning the rationalisation of resource use [15,32,[36][37][38].…”

Section: Documents Alignment With National Policiesmentioning

confidence: 99%

Domestic Violence in Mozambique From policy to practice

Jethá¹,

Keygnaert

Martins³

et al. 2020

Preprint

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Background: To reduce the impact of domestic violence (DV), Mozambican governmental and non-governmental entities are making efforts to strengthen the legislative framework and improve the accessibility of care services for survivors of violence. Despite this remarkable commitment, the translation of policies and legislation into actions remains a huge challenge. Therefore, this paper aims to identify gaps in the implementation of existing national policies and laws for DV in the services providing care for survivors of DV. Methods: This study, using a qualitative approach had two components. The first was content analysis of guidelines and protocols for DV care provision. The second consisted of in-depth interviews with institutional gender focal points. The analysis of the document content was based on a framework developed according to key elements recommended by international agencies (PAHO and UN) for DV policies and strategies design. Data from the in-depth interviews, where analysed in accordance with study objectives. Results: Eleven (11) guidelines/protocols of care provision and innumerable brochures and pamphlets were identified and analysed. There is a standardised form which highlights the integrated approach incorporating fields for police and the health sector but excludes Civil Society Organizations. However, there is no national DV database. Although the focal points recognised the relevance of the reviewed documents, many identified gaps in implementation. This is related to the weaknesses of the offender’s penalisation and to the scarcity of care providers. And, many providers who do exist often lack appropriate training. They also recognised their performance is negatively influenced by socio-cultural factors. Conclusion : Within services providing care to survivors of DV, a scarcity of guidelines and protocols exist, compromising the quality and standardisation of care . Recognition of the relevance of care guidelines and protocols is a strength, there are challenges governmental and non-governmental entities must address in order to ensure DV prevention and control strategies have the desired results.

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“…There is currently insufficient evidence to show that screening increases referrals to DVA support agencies, reduces violence or improves health outcomes [35,36] . These mixed findings reflect multiple barriers in identifying and responding to IPV in healthcare settings [34,37] . Whilst healthcare professionals believe IPV to be a healthcare issue, they are often reluctant to ask about abuse [38][39][40] .…”

Section: Introductionmentioning

confidence: 99%

Cry for health: a quantitative evaluation of a hospital-based advocacy intervention for domestic violence and abuse

Halliwell

Dheensa

Fenu

et al. 2019

Preprint

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Background Domestic violence and abuse damages the health of survivors and increases use of healthcare services. We report findings from a multi-site evaluation of hospital-based advocacy services, designed to support survivors attending emergency departments and maternity services. Methods Independent Domestic Violence Advisors (IDVA) were co-located in five UK hospitals. Case-level data were collected at T1 (initial referral) and T2 (case closure) from survivors accessing hospital (T1 N = 692; T2 N = 476) and community IDVA services (T1 N = 3,544; T2 N = 2,780), used as a comparator. Measures included indicators of sociodemographic characteristics, experience of abuse, health service use, health and safety outcomes. Multivariate analyses tested for differences in changes in abuse, health and factors influencing safety outcomes. Health service use data in the six months pre-and post- intervention were compared to generate potential cost savings by hospital IDVA services. Results Hospital IDVAs worked with survivors less visible to community IDVA services and facilitated intervention at an earlier point. Hospital IDVAs received higher referrals from health services and enabled access to a greater number of health resources. Hospital survivors were more likely to report greater reductions in and cessation of abuse. No differences were observed in health outcomes for hospital survivors. The odds of safety increased two-fold if hospital survivors received over five contacts with an IDVA or accessed six or more resources / programmes over a longer period of time. Six months preceding IDVA intervention, hospital survivors cost on average £2,463 each in use of health services; community survivors cost £533 each. The cost savings observed among hospital survivors amounted to a total of £2,076 per patient per year. This offset the average cost of providing hospital IDVA services. Conclusions Hospital IDVAs can identify survivors not visible to other services and promote safety through intensive support and access to resources. The co-location of IDVAs within the hospital encouraged referrals to other health services and wider community agencies. Further research is required to establish the cost-effectiveness of hospital IDVA services, however our findings suggest these services could be an efficient use of health service resources.

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Barriers and Facilitators to Integrating Health Service Responses to Intimate Partner Violence in Low‐ and Middle‐Income Countries: A Comparative Health Systems and Service Analysis

Cited by 58 publications

References 34 publications

Alcohol Drinking by Husbands/Partners Is Associated with Higher Intimate Partner Violence against Women in Angola

Alcohol Drinking by Husbands/Partners Is Associated with Higher Intimate Partner Violence against Women in Angola

Domestic Violence in Mozambique From policy to practice

Cry for health: a quantitative evaluation of a hospital-based advocacy intervention for domestic violence and abuse

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