Facilitators and barriers to routine intimate partner violence screening in antenatal care settings in Uganda

Abstract

Background Uganda clinical guidelines recommend routine screening of pregnant women for intimate partner violence (IPV) during antenatal care (ANC). Healthcare providers play a critical role in identifying IPV during pregnancy in ANC clinics. This study explored facilitators and barriers for IPV screening during pregnancy (perinatal IPV screening) by ANC-based healthcare workers in Uganda. Methods We conducted qualitative in-depth interviews among twenty-eight purposively selected healthcare providers in one rural and an urban-based ANC health center in Eastern and Central Uganda respectively. Barriers and facilitators to IPV screening during ANC were identified iteratively using inductive-deductive thematic analysis. Results Participants had provided ANC services for a median (IQR) duration of 4.0 (0.1–19) years. Out of 28 healthcare providers, 11 routinely screened women attending ANC clinics for IPV and 10 had received IPV-related training. Barriers to routine IPV screening included limited staffing and space resources, lack of comprehensive gender-based violence (GBV) training and provider unawareness of the extent of IPV during pregnancy. Facilitators were availability of GBV protocols and providers who were aware of IPV (or GBV) tools tended to use them to routinely screen for IPV. Healthcare workers reported the need to establish patient trust and a safe ANC clinic environment for disclosure to occur. ANC clinicians suggested creation of opportunities for triage-level screening and modification of patients’ ANC cards used to document women’s medical history. Some providers expressed concerns of safety or retaliatory abuse if perpetrating partners were to see reported abuse. Conclusions Our findings can inform efforts to strengthen GBV interventions focused on increasing routine perinatal IPV screening by ANC-based clinicians. Implementation of initiatives to increase routine perinatal IPV screening should focus on task sharing, increasing comprehensive IPV training opportunities, including raising awareness of IPV severity, trauma-informed care and building trusting patient-physician relationships.

Healthcare provider experiences interacting with survivors of intimate partner violence: A qualitative study to inform survivor-centered approaches

“…Healthcare responses to survivor needs may be challenging. Prior research shows that facility-based clinicians, especially in rural settings, often do not routinely screen for IPV among healthcare seeking individuals (11). Women are already reluctant to report abuse because it violates gender norms of the ideal wife, or because they fear that their partners will become more violent or retaliate nancially.…”

“…Usually, the initial response to IPV reported to healthcare providers involves managing the immediate medical emergencies and safety related issues. Non-disclosure of IPV is compounded by barriers to routine IPV screening by healthcare workers such as inadequate sta ng levels, limited privacy, lack of provider IPV awareness and comprehensive GBV prevention and response training (11).…”

“…In order to adequately respond to survivor concerns and needs, it is important to improve healthcare workers' awareness of IPV and facility infrastructure to support IPV detection among survivors during patient-provider interaction. Prior research shows that providers who were aware about availability of GBV screening tools were more likely to have adequate capacity to suspect, and screen for IPV exposure (11). During patient-provider interaction, clinicians usually adopt patient-centered care models that focus mostly on the patients presenting symptoms, physical signs, and medical treatment.…”

Barriers to routine screening for intimate partner violence during pregnancy in Nigeria

“…In low-income countries, the rate of IPV screening is low when compared to the rates in high income countries. In Uganda, Kenya, and South Africa, health professionals do not always screen pregnant women for IPV [ [17] , [18] , [19] ]. Anguzu et al [ 18 ], found that 11 out of 28 health professionals screened pregnant women for IPV.…”

“…In Uganda, Kenya, and South Africa, health professionals do not always screen pregnant women for IPV [ [17] , [18] , [19] ]. Anguzu et al [ 18 ], found that 11 out of 28 health professionals screened pregnant women for IPV. The screening rate is moderately low when compared to the total health professionals that were interviewed.…”