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

Abstract

Objective To assess the effectiveness of a counselling intervention in antenatal care settings for pregnant women who report domestic violence.Design Pre-experimental study with pretest-posttest design.Settings Two public hospitals in Mumbai, India.Sample In all, 2778 pregnant women accessing antenatal care (ANC) in the hospitals from February to November 2016 were approached for study participation; 2515 women consented. These women were screened by trained counsellors for domestic violence during pregnancy (domestic violence during pregnancy). Domestic violence during pregnancy was reported by 16.2% (408) of women. Of these, 155 women sought counselling services. Postintervention analyses were carried out with 142 women at 6 weeks post-delivery; 13 women were not contactable.Methods The 442 women who reported domestic violence during pregnancy were provided a minimum of two counselling sessions by trained counsellors during their ANC visits. A counselling intake form was used to collect pre-and post-intervention data.Main outcome measures Prevalence of domestic violence during pregnancy, change in women's ability to cope, safety, and health.Results Prevalence of domestic violence during pregnancy (16.1%) was comparable to those of common obstetric complications routinely screened for during ANC. In all, 60-65% women reported cognitive changes such as recognising impact of violence and need to speak out against it. In all, 50.7% women took action at the individual level to address domestic violence during pregnancy. This change was not statistically significant (P-value 0.193). Of the women studied, 35.9% adopted at least one safety measure, and 84% of the women reported better health status post-intervention.Conclusions Routine enquiry and counselling for domestic violence during pregnancy are effective in improving women's ability to cope, safety, and health.

‘We don’t see because we don’t ask’: Qualitative exploration of service users’ and health professionals’ views regarding a psychosocial intervention targeting pregnant women experiencing domestic and family violence

“…In agreement with previous studies, competing demands, time constraints and lack of sufficient resources were mentioned as the hindering factors for delivering DFV interventions in healthcare settings [28,29]. System level changes such as training of HCPs, staff commitment, institutional support, onsite support services and effective collaboration with local stakeholders involved in providing support services are important for delivering continual and effective service to victims of DFV [40,43,44]. Considering the social stigma related to seeking help from DFV services and minimal funding in this area [8,10], integrating DFV program into routine ANC and/or PMTCT counselling services can be a potential cost-effective strategy to improve response mechanisms against DFV in resource-constrained settings like Nepal.…”

“…Due to the safety concerns, it was not possible to capture the reasons for discontinuation of the study by the participants (7 women at the first follow-up and 19 at the second follow-up were lost to follow-up). However, these drop-out rates are comparable with similar research [14,40] and the intervention appeared to be effective in addressing important needs of the victims. Furthermore, as this study included only women accessing one health facility for their antenatal check-up, it did not represent the overall expectations and attitudes of women visiting other health facilities.…”

“…Screening in the antenatal period would provide an opportunity in creating awareness regarding potential causes and effects of DFV, which is crucial to protect the survivors and hold perpetrators accountable. Although screening at an ANC clinic has been significantly linked to increased identification of victims of DFV [40,41], screening alone does not necessarily help victims to access services [16]. In the excerpts provided in the first domain in this study, it was evident that HCPs considered themselves unprepared to challenge the existing norms supporting violence and take action to help the victims of DFV.…”

“…Considering the time and resource constraints, and evidence from past studies demonstrating the significant effects of single session therapy (SST) in improving the mental health and safety behaviours of abused women [37,38], SST is considered a pragmatic and the best option. In addition, interventions requiring multiple interactions with women was pointed out as an important reason for high drop-out rates [39] and low attendance rates were seen in subsequent sessions [14,40].…”

Magnitude of domestic violence and its socio-demographic correlates among pregnant women in Delhi

“…This highlights the probable utility of individual counseling at primary care level and above, as a tool for prevention and minimizing the impact of domestic violence among women. [16] Studies have highlighted the critical role of the health system in India to address the domestic violence in relation to both immediate biomedical concerns, as well as her overall well-being. [17] Development of a system that provides more constructive and sustainable response to domestic violence in India, will definitely lead to a positive improvement in women's health and well-being.…”