Strengthening Health Systems’ Response to Violence Against Women in Three Tertiary Health Facilities of Maharashtra

• Published in: Journal of obstetrics and gynaecology of India 2021-12, Vol.71 (Suppl 2), p.90-95
• Main Authors: Gaddappa, Shrinivas, Deshpande, Sonali, Gaikwad, Nandkishor, Rokade, Jyoti, Prabhu, Priya, Arora, Sanjida, Rege, Sangeeta
• Format: Article
• Language: English
• Subjects: Gynecology; Medicine; Medicine & Public Health; Obstetrics/Perinatology/Midwifery; Original; Original Article
• ISSN: 0971-9202; 0975-6434
• DOI: 10.1007/s13224-021-01596-6

Background Domestic violence is known to have a significant impact on the health of women. Despite this, the health system in India is not equipped to respond to women facing violence. This can be attributed to limited information on how the evidence-based guidelines can be implemented in resource-constrained settings. To fill this gap, implementation research was carried out in three tertiary medical teaching hospitals in Maharashtra. Methods The project was implemented in the OBGY, Medicine and Emergency department of a medical college and a district hospital in the state of Maharashtra. The intervention included consultation with key providers of three departments and a 5 day training of trainers on VAW. The trainers conducted 2 day onsite training for the health care providers. System-level interventions included the development of SOPs, IEC material, documentation format and identifying places for a private consultation. The research involved a pre- and post-test to assess change in KAP of providers after training, analysis of documentation register and interviews with trained providers and survivors. Results Findings indicate a significant change in knowledge, attitude and practice of the providers. Documentation registers introduced in the facility departments showed 531 women facing violence were responded by providers in 9 months. In 59% of cases, the provider suspected violence based on presenting health complaints, indicating the success of the capacity building programmes in the development of skills to identify VAW signs and symptoms, as well as provide psychological support to women/girls. There was a high acceptability of intervention among providers. Survivors also recognised the usefulness of health care facility-based support services for violence. Conclusion A multi-component intervention comprising of building capacity of providers and facility readiness is feasible to implement in low- and middle-income countries (LMIC) and can strengthen health systems’ response to VAW.