Improving the primary health care response to violence against women in low and middle income countries

Violence against women is a violation of human rights and threatens the status, health and well-being of women. Overall, 35% of women worldwide have experienced either physical and/or sexual intimate partner violence or non-partner sexual violence, with a higher prevalence in most low and middle income countries (LMIC). Violence against women damages women's health. Women who have been have been physically and/or sexually abused by their partner are twice as likely to have an abortion, twice as likely to suffer from depression and in some regions 1.5 times more likely to acquire HIV compared to women who have not experienced such violence. They are also 16% more likely to deliver a low birth weight baby. In addition, children who are exposed to violence against their mothers are more likely to experience long term damage to their health and development. Therefore, prevention of violence against women and development of a health care response is a global priority.

This study aims to understand how primary healthcare systems in low and middle income countries can develop and evaluate interventions for violence against women that link with community services. The research will build on existing research collaborations with academics, health care providers and violence against women services in the Occupied Palestinian Territories and Brazil. The research aims to address the following:

1) Explore to what extent the primary health care system in Palestine and Brazil can identify women who are affected by violence and abuse and offer support and referrals to services that can help them.

2) Draw on a proven UK intervention and adapt it to the Palestinian and Brazilian context through discussions with local stakeholders.

3) Pilot test the agreed intervention.

The findings of the research will be of benefit to violence against women and health systems researchers worldwide. It will also be of benefit to health policy makers and health care practitioners who want to develop a health care response to violence against women.

Violence against women (VAW) is widely recognized as an obstacle to reaching the newly agreed Sustainable Development Goals (SDGs), particularly SDG 5 related to gender equality and empowerment of women. It is a violation of human rights and threatens the status, health and well-being of women. The proposed collaborative project aims to understand how primary healthcare systems in low and middle income (LMIC) countries can develop and evaluate interventions for violence against women (VAW) that link with community services, and ultimately ensure better health outcomes for women and their children. Building on existing research collaborations with academics, health care providers and VAW services in two LMIC (Occupied Palestinian Territories and Brazil) we will conduct multidisciplinary research to:

1) Evaluate the readiness of the primary care system in the Occupied Palestinian Territories and in Brazil to integrate identification of VAW, to care for survivors and to offer referral to VAW services. Formative research will include interviews with primary health care providers, women survivors of VAW and representatives of VAW services to understand their views and preferences for a primary health care response to VAW, and use of a health systems readiness tool and observations of the study facilities will be conducted to assess their readiness to link with or integrate VAW services.

2) Adapt a UK evidence-based intervention, through engagement with key stakeholders in each country using Theory of Change to gain consensus of the causal pathways within the intervention, identify areas of uncertainty and how these should be addressed.

3) Pilot test its feasibility in primary health care (PHC) centres in Palestine and Brazil using mixed methods.

In order to maximise uptake of the research findings, we will engage in a wide range of dissemination activities targeting academics, key policy makers, women's advocacy especially VAW groups, and primary health care practitioners at national and international levels. This will include:

1) Academics through peer review publications in high impact journals; key international conferences (e.g. Sexual Violence Research Initiative; Futures Without Violence); in-country conferences and seminars.

2) Health policy makers, donors, women's organisations (including violence against women groups) and health practitioners and health managers: through our local in-country steering committees which will consist of Ministry of Health representatives, NGOs including violence against women organisations, primary health care managers.

3) The general public through press releases and websites and with input from the external relations offices at all the Universities involved.