Healthcare approach to domestic violence

WITH the Covid-19 crisis, we have seen a rise in domestic violence that has been referred to as a “pandemic within a pandemic”. Meanwhile, healthcare resources, especially in hospitals and emergency rooms, are being stretched to the limit to treat Covid-19 patients.

As we weather the pandemic, we must also look to the future and assess how we can strengthen our healthcare system both to withstand acute public health crises, like the one we are currently in, and to better address longer-term issues such as domestic violence.

One way to do this is to strengthen the response to domestic violence at primary healthcare clinics such as the government’s klinik kesihatan. This would not only ensure better support for survivors but also help alleviate the burden on hospitals.

Primary healthcare clinics are best placed to reach domestic violence survivors, as survivors frequently seek help from healthcare providers even before the police. And clinics are their first point of contact with the healthcare system.

According to a 2019 study, 22% of women who visited primary healthcare clinics in Kuala Lumpur had experienced domestic violence. Yet, there is currently no systematic response mechanism to address domestic violence at the primary healthcare level. As a result, healthcare providers who are already in contact with domestic violence survivors miss the opportunity to offer them support.

In its latest brief, “Strengthening the Primary Healthcare Response to Domestic Violence”, Women’s Aid Organisation (WAO) presented four recommendations based on World Health Organisation (WHO) guidelines to strengthen domestic violence response at primary healthcare clinics.

1. Healthcare providers should be trained to identify conditions associated with domestic violence and talk to patients about them.

Domestic violence can underlie or complicate various health conditions, particularly mental health (such as sleep disorders, which can result from stress and anxiety due to prolonged physical and psychological abuse) and sexual and reproductive health (unexplained symptoms like pelvic pain). To effectively manage these conditions, healthcare providers need to know whether their patients have been exposed to domestic violence. Research shows that domestic violence survivors are more willing to disclose their situation if healthcare providers initiate the conversation.

Special attention should be given to detecting domestic violence among patients at maternity clinics, as the health consequences of violence are graver during pregnancy. Pregnant women also visit maternity clinics multiple times throughout their pregnancy, giving healthcare providers more opportunities to detect signs of domestic violence and provide follow-up care.

2. Healthcare providers should be trained to recognise, respond to and refer cases of domestic violence. Training is crucial, as concerns about offending patients and not knowing how to ask the necessary questions are among the top barriers to asking for help, according to a Malaysian study involving primary care clinicians.

To train healthcare providers, we can draw on WHO’s training curriculum on violence against women for healthcare providers.

3. Primary healthcare clinics should display information on domestic violence in their waiting rooms and wash rooms. This would enable survivors to 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 signal that clinics are sensitive to the issue and may encourage survivors to seek help.

4. The government should establish a referral system for domestic violence at the primary healthcare level. This system could be integrated into the existing Guidelines for Handling 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 emergency care.


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