Intimate Partner Violence: Barriers to Action and Opportunities for Intervention Among Health Care Providers in São Paulo, Brazil

Abstract

Health care providers (HCPs) who directly interact with women play a critical role in intimate partner violence (IPV) prevention and response. The aim of this study was to identify the structural and interpersonal barriers to IPV response among HCPs working in public health clinics in Santo André, Brazil. Eligible participants included all HCPs providing direct care to individuals at three public health clinics. Participants self-administered an adapted Knowledge, Attitudes, and Practices survey on IPV. Data were analyzed using Epi Info 7 and SAS 9.4. 114 HCPs completed surveys. Less than half of HCPs (41%, n = 34) reported ever having asked a woman about abuse in the past year. HCPs who perceived fewer barriers were more likely to report asking about IPV. The top three reported barriers to asking women about IPV included the following: few opportunities for one-on-one interaction (77%, n = 65), a lack of privacy (71%, n = 60), and fear of offending women (71%, n = 60). Fewer providers who perceived the barriers of lack of privacy asked about IPV (50.8%, n = 33 compared with 84.2%, n = 16; p < .05); less providers who perceived few opportunities for private patient interactions asked about IPV (48.3%, n = 29 compared with 75.0%, n = 18; p < .05). Our results support the need for a systems approach of institution-wide reforms altering the health care environment and avoiding missed opportunities in IPV screening and referring women to appropriate resources or care. Two of the most frequently reported barriers to asking IPV were structural in nature, pointing to the need for policies that protect privacy and confidentiality. Within the Brazilian context, our research highlights the role of HCPs in the design and implementation of IPV interventions that both strengthen health systems and enable providers to address IPV.

Intimate partner violence: a cross-sectional study in women treated in the Brazilian Public Health System

“…A possible explanation for this occurrence could be a conversion of factors such as the sum of different participants who had experienced different types of violence, cultural issues of submission of the feminine to the masculine, (3) and given the research site that were a Basic Health Unit that is part of Brazilian Public Health System. (10) The highest prevalent type of violence was psychological, which confirmed the initial hypothesis of this study. This type of violence was followed by physical and sexual, which are similar results of those reported in the literature.…”

“…Primary Health Care (PHC), the front door of the Brazilian Public Health System, provides the first care for violence victims, in addition, PHC is responsible to provide the necessary treatments for them to recover from the violence suffered. (10)…”

Social comorbidities? A qualitative study mapping syndemic theory onto gender-based violence and co-occurring social phenomena among Brazilian women

“…This analysis was part of a larger study examining individual experiences and community perceptions of GBV. Detailed information on the methods of the parent study are available in earlier publications [20,21]. The project was conducted in partnership with the SPM in Santo André, the Municipal Ministry of Health, and the ABC School of Medicine (Faculdade de Medicina do ABC).…”

“…Future research should seek to better understand the impact of disparity conditions on social comorbidities, particularly potential interventions that address these conditions. In the context of Brazil, violencespecific policies such as the Maria da Penha law have seen some limited success; however, the integration of these conceptual frameworks may lead one to examine broaderreaching policies that address social determinants that are linked to social comorbidities such as poverty and genderbased inequity [2,20,21].…”

"These Questions Have Everything That Happens to me": Analysis of a Femicide Risk Assessment Tool for Abused Women in Brazil

“…Seven HBW are currently in operation including our study site in Curitiba, Brazil (Curitiba, 2016). Despite the promise of these structures, impunity for perpetrators of violence (Evans et al, 2018), lack of trust in the health and legal sectors (Evans et al, 2020a(Evans et al, , 2020b, barriers to addressing IPV among health providers (Evans et al, 2019), and other factors impede the prevention of IPV and femicide. A recent study revealed that the Curitiba's Metropolitan area faces higher rates of femicide compared to the state average and the most common location of these crimes was in the home (35%) using firearms (44%) (Wanzinack et al, 2020).…”