Primary healthcare clinics must help domestic violence survivors

A study reveals that survivors are more willing to disclose domestic violence if healthcare providers initiate the conversation. Photo: Pixabay

In light of the rise in domestic violence cases during the Covid-19 pandemic, the Women’s Aid Organisation (WAO) has released a brief entitled ‘Strengthening the Primary Healthcare Response to Domestic Violence’.

The brief, which is based on World Health Organisation (WHO) guidelines, presents four recommendations on how to strengthen the response of primary healthcare clinics such as Klinik Kesihatan to domestic violence cases. This will, they say, help alleviate existing healthcare resources such as hospitals and emergency rooms, that are being stretched to their limits treating Covid-19 patients during the pandemic.

Primary healthcare clinics are the best place to reach domestic violence survivors who often seek medical help even before going to the police, and hence, are the first point of contact for the survivors.

In a 2019 study entitled Exploring Intimate Partner Violence Among Women Attending Malaysian Primary Care Clinics, it was discovered that 22% of the women who visited primary healthcare clinics in Kuala Lumpur have experienced domestic violence.

But because there is currently no systematic response mechanism for domestic violence at the primary healthcare level, these clinics may not be able to offer them the full support, the brief stated.

Drawing on their experience working with victims of violence, WAO has recommended four steps to resolve this issue.

Healthcare providers can be trained to identify health conditions associated with domestic violence; ask patients about domestic violence.

Some health conditions, especially those related to mental health, such as sleep disorders resulting from stress and anxiety, or to sexual and reproductive health, such as unexplained reproductive symptoms like pelvic pain, may be related to (or complicated by) domestic abuse.

In order to effectively treat and manage these conditions, healthcare providers need to know whether their patients have experienced domestic violence. So they need to be trained to identify and proactively ask women about this.

A 2013 study entitled Victims’ Barriers to Discussing Domestic Violence in Clinical Consultations: A Qualitative Enquiry reveals that survivors are more willing to disclose domestic violence if healthcare providers initiate the conversation.

Special attention should be given to patients at maternity clinics because the health consequences of violence are more severe during pregnancy.

Healthcare providers must be trained to recognise, respond to, and refer cases of domestic violence.

Training (based on WHO’s training curriculum on Violence Against Women for Healthcare Providers) is crucial because some of the top barriers faced by primary care clinicians when asking their patients about domestic violence, are concerns about offending the patients and not knowing how to ask the right questions (Domestic Violence Management in Malaysia: A Survey on the Primary Healthcare Providers, 2018).

Primary healthcare clinics should display information on domestic violence in their waiting rooms and washrooms.

This lets survivors obtain information in a discreet manner, which could help ensure their safety, especially if they are accompanied by their abuser to the clinic.

Displaying information on domestic violence also sends the right signal that health clinics are sensitive to domestic violence, which may encourage survivors to seek help.

Government must establish a referral system for domestic violence at the primary healthcare level.

This referral system could be integrated into the existing Guidelines for Handling Domestic Violence Cases, which outline how government agencies are to respond to domestic violence cases.

By strengthening the primary healthcare response to domestic violence, more survivors will get the support they need and fewer will find themselves in a crisis where they are forced to seek treatment/care at a hospital or emergency room.

More info at: Women's Aid Organisation

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